Survey Instruments

Labor accounts for most of the operating costs in hospitals. The shortages in supply of registered nurses have been a leading driver of increases in hospital costs. Shortages in nursing staff are linked with poorer quality of care and negative patient outcomes. In a study conducted by Alexander et al (2007) assessed patient satisfaction using a survey questionnaire instrument that had 49 standard questions in ten different areas which mirrored the experience the patients had from admission until discharge.

The various sections had between 3 to 5 questions that were representative of valid and reliable measures for the aspect of care being measured. Every question had a balanced Likert-type 5-point response scale (1=very poor, 2=poor, 3=fair, 4=good and 5 = very good). Each section then had its mean score calculated. The nursing section had six questions which measured the patients’ perception of the quality of nursing care.

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These included courtesy/friendliness of the nurses, promptness in responding to the call button, the attitude of the nurses’ to patients’ requests, the amount of attention that was paid to the personal or special needs of the patients, how well the nurses kept the patient informed and the skill of the nurses (Alexander et al, 2007). The mean of the six questions represented the composite score in the nursing section. The instrument underwent rigorous psychometric tests to meet the necessary standards for validity and reliability (Alexander et al, 2007).

The questionnaires were sent to the patient within a week of discharge so that the patients could easily recall and evaluate their experience. The data collected on patient satisfaction was aggregated by facility. The time frame for the sample was selected so that it could match the supply data for Registered Nurses (Alexander et al, 2007). The respondents from each facility were a minimum of 30. The state scores were determined by averaging the facility scores. Each state had a minimum of ten facilities. This was helpful in ensuring confidentiality and also in maintaining the representativeness of the data (Alexander et al, 2007).

The variables compared were RN employment data and patient satisfaction with RN employment being the independent variable. The ratio of working RNs with population were compared to the domains of care in the questionnaires and the strongest correlation was found to be between Registered Nurse supply and patient satisfaction with nursing care (Alexander et al, 2007). A study conducted to find out the healthcare attributes which contributed to increased patient satisfaction. The study found that out of six attributes, nursing care had the largest estimate for patient satisfaction.

The study done by Barney Steven collected data using a questionnaire that was mailed to patients within ten to fourteen days of being discharged from hospital. The participants were recruited from the discharge record of BJC Health System. The independent variable was the patient reaction to each health attribute while the dependent variable was the patient satisfaction level and behavioral intentions. The instrument was developed and tested for high validity and reliability. The six attributes of the instrument were confirmed using a confirmatory factor analysis.

The attributes considered were nursing care, the admission process, physician care, compassion to friends/family, the discharge process and pleasantness of surroundings (Barney, 2004). The control variables were individual characteristics of the patient (such as predisposing, need characteristics and enabling characteristics) and factors within the organization. The predisposing or sociodemographic characteristics included gender, race, age and marital status. The need characteristics included perceived health status of the patient and length of stay. The organizational factor considered was department type (Barney, 2004).

The enabling characteristics were distance from the health facility and the status of health insurance. Analysis in the study consisted of two parts, first an examination of the effect of six attribute reactions on the satisfaction of patients their behavioral intentions and secondly an evaluation of the relationship between every one of the six attributes and patient satisfaction (Barney, 2004). The results of the study showed all the attributes to be positively related with the overall satisfaction model. Parameter estimates made it possible to rank order the healthcare attributes; nursing care had the largest parameter estimate.