Workload demand: a significant factor in the overall well-being of directors of associate degree nursing programs

Article Outline

• Abstract
• 1. Review of literature
  • 1.1. Directors of ADN programs
  • 1.2. Directors and deans of schools of nursing within universities
  • 1.3. Nursing faculty and administrative responsibilities
• 2. Theoretical framework
• 3. The study
  • 3.1. Design
  • 3.2. Sample
  • 3.3. Instrument
• 4. Results
• 5. Discussion
• 6. Conclusion
• Acknowledgments
• References
• Copyright

Abstract 

This descriptive study of workload in relation to the overall well-being of academic program directors was conducted among 242 associate degree nursing program directors in the United States. The Copenhagen Psychosocial Questionnaire II from researchers in Denmark was the instrument used. Participants reported high levels of quantitative and emotional work demands that correlated with high levels of stress, burnout, sleep problems, and decreasing overall physical health. These results support international research findings that have analyzed similar variables in other employment positions. As we face a growing international shortage of nurses, the need for nurse faculty and nurse program directors continues to grow. However, given the state of the nurse program director position, it is not surprising that few qualified faculty prospective applicants are expressing interest in an administrative role. Results are discussed in relation to other recent workload studies, and recommendations follow.

Keywords: Academic program directors, Workload, Personal well-being

Nursing administrators in the academic setting play a vital role in ensuring that quality programs are in place to generate sufficient numbers of nurse graduates to meet future health care demands. Studies and anecdotal evidence support the assumption that the associate degree nursing (ADN) directors are demonstrating limited retention due in part to high job demands and stress, decreased resources, and questionable emotional support (Mintz-Binder, 2008). A newly published qualitative study of an ADN faculty in Florida confirmed their lack of interest in pursuing an administrative position in a college (Lane, Esser, Holte, & McCusker, 2010). Similar findings were reported by Adams (2007) in her quantitative study that revealed 63% of nursing educators would not consider taking on a higher level administrative position. The chief reasons given were excessive workload and conflict-related concerns. Issues such as work overload and conflict in the workplace can generate occupational stress, which, as shown in past occupational psychology research from Denmark and the Netherlands, can lead to burnout, physical health concerns, and/or increased use of sick time (Clausen, 2009, Clausen et al., 2010, Rugulies et al., 2010, Schaufeli and Bakker, 2004). Researchers from Canada, the United Kingdom, and Australia, assessing stress levels of faculty and staff at colleges and universities worldwide, have noted increased stress in academia with increased workloads, low salaries, and increased pressure to publish and acquire grant funding (Catano et al., 2010, Kinman and Jones, 2008, Winefield et al., 2008).

If the workload has increased for faculty internationally, it would not be surprising that workload and stress have correspondingly increased for the program directors or department chairpersons, who not only assign duties and workload to faculty but also need to recruit and hire new faculty, process and admit students, attend numerous administrative meetings, address student, clinical sites and college-wide concerns, and manage departmental budgets that fluctuate with the financial health of each state. As discussed in the 1980s and the 1990s, efficient and strong department chairpersons are critical to the positive administrative functioning of a community college (Murray and Murray, 1998, Whetten and Whetten, 1985). Turnover at the faculty level can be difficult and stressful; however, turnover of an experienced strong program administrator or department chair can cost up to 25 times the monthly salary of an employee (Glick, 1992).

Not only is the loss of a director problematic, but a lack of willing and qualified future directors to administer nursing programs does not bode well for maintaining or creating quality nursing programs. Traditionally, deans of nursing and department chairs rise up from the ranks of nursing faculty. Less than 10% of faculty in the ADN programs has greater than a master's degree, and increasingly, nursing programs are relying more heavily on part-time nursing educators to fill growing numbers of vacancies (Nurse Faculty Support Continues to Fall Short, 2006). Left unaddressed, poor leadership succession can have a detrimental effect on the future of nursing academia. Despite the concerning outlook in meeting future demands for nursing faculty administrators and directors, there is a surprising lack of research on the effects of workload and well-being associated with this position in the field of nursing. This study addresses the relationship of workload and personal well-being specific to current ADN program directors across the United States.

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1. Review of literature 

A pronounced gap in literature exists regarding research on directors of ADN programs. Few published studies on ADN directors' workload and occupational stress could be found. It became necessary to broaden the review of literature to include groups that shared some of the similar work or position characteristics as those found with ADN program directors. As a result, the most relevant research studies on nursing faculty, deans and directors of baccalaureate, and higher nursing programs are presented.

1.1. Directors of ADN programs 

ADN directors in California were the focus of a correlational study on the relationship between social support and job satisfaction (Mintz-Binder & Fitzpatrick, 2009). Using a convenience sampling of directors at the 2006 California Organization of Associate Degree Nursing Directors in Rancho Mirage, CA, 61 attendees completed a survey that used the Job Satisfaction Survey(Spector, 2006) and the Personal Resource Questionnaire 2000 (Weinert, 2003). A significant positive correlation was found between social support and job satisfaction. Several noteworthy trends also emerged in this study; almost one fourth of the directors surveyed were in a nonpermanent status. Also reported through rating scales, directors' levels of daily stress (M = 8.03) and personal sacrifice (M = 8.38) were considered to be high.

As part of her dissertation, Reese (2004) conducted research on directors and faculty of Associate Degree Registered Nurse (ADRN) programs based out of public community colleges in North Carolina, surveying leadership practices and empowering strategies and their impact on job satisfaction and productivity. The group, consisting of 23 directors and 113 nursing faculty, reported having a high degree of job satisfaction, with directors reporting 85.71% satisfaction and faculty at 90.27%. Although no instrument specifically measured job stress, numerous negative comments were elicited under the demographic section from directors and faculty centering on work overload. In general, directors felt it was unrealistic to expect them to not only administer their nursing programs but also maintain a teaching load. Common complaints offered by the teaching faculty indicated that to adequately meet course demands, often work had to be taken home to complete, thus intruding on their personal lives. Despite the overall high job satisfaction of faculty and directors, Reese (2004) voiced concern regarding job stress caused by work overload and its possible negative effect on program quality and high staff turnover.

1.2. Directors and deans of schools of nursing within universities 

The goal of Adams' (2007) study of nursing academic administrators and faculty was to identify factors that positively or negatively influenced nursing faculty to enter into the career of nursing academic administrator. Surveys were sent out to a cross section of full-time nursing faculty and administrators of accredited private colleges and universities. An 87% response rate was achieved, and both administrators and faculty completed leadership-based instruments. The top three factors listed for the pursuit of administrative positions by directors were the following: additional challenges, opportunity to influence or change the organization, and personal growth and development. For faculty, the opportunity to influence/change the organization was listed first, followed by personal growth and development, and third was additional challenge. The top three factors discouraging administrators from pursing administrative responsibilities were workload, budgetary constraints, and anticipated conflict with faculty. More than one third of all administrators and nearly one half of all faculty identified workload as being the single biggest negative factor affecting their decision to pursue another administrative position or a position without further administrative responsibilities. Further reinforcing the apparently negative view held with respect toward an administrative role, 63% of the faculty surveyed indicated that they would not consider taking on additional administrative responsibilities.

Horton, Gerbasi, and Lovell (2008) conducted a descriptive study on a group of 25 certified registered nurse anesthetist program directors who were also program faculty, using interviews for data collection. Open-ended questions focusing on six themes (i.e., motivation for becoming an educator, positive and negative aspects of the director/educator role, job evolution, reasons for longevity as a director, and advice for the future educator/director) were posed to the participants. Overall, the high job satisfaction and longevity of this group of long-time program directors were attributed to the variety of work, presence of effective support system, and finding the work personally rewarding. The chief negative aspects of being a director/educator were multiple demands on time, workload, and politics. The authors explained the inconsistency of variety of work being a positive and multiple demands on time being a negative as a balance tilting too much to one side. Variety of work in the form of additional duties can be appreciated until it reaches the point of overwhelming, at which time it becomes work overload. The authors concluded that if retention and longevity of an administrative position are important elements, studies that evaluate work environment, including workload, social support, and schedule flexibility, should be undertaken.

1.3. Nursing faculty and administrative responsibilities 

The National League of Nursing (NLN) in partnership with the Carnegie Foundation endeavored to conduct a massive survey of the estimated 32,000 nurse educators nationwide of accredited schools of nursing in the United States via e-mails and postcards (Kaufman, 2007). Through their efforts, 8,498 nurse educators participated in the survey for a response rate of 25%. An in-depth demographic survey of nurse educators was conducted, including race, age, gender, education, employment characteristics, anticipated retirement, workloads, and job satisfaction. Significant findings for this literature review were that the average nurse educator worked more than 56 hours per week, and an additional 2 hours if the faculty member held an administrative position. Two thirds reported their workload exceeded their expectations at the onset of their employment, having a detrimental effect on job satisfaction. It was found that 44% reported being dissatisfied with their current workload. Twenty-five percent of the nurses reported intentions of leaving, citing the need for a decreased workload as the chief motivating factor.

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2. Theoretical framework 

The Job Demands and Resources Model (JD-R) was the primary model used for this aspect of the study. The JD-R explores how work demands, such as work overload and personal conflicts, combined with the absence of positive resources, such as social support and decision making involvement, can predict burnout that has been demonstrated to lead to physical illness and position turnover (Bakker and Demerouti, 2007, Maslach et al., 1996). This model has been applied to a variety of occupational positions where studies have looked at imbalances in work demands, burnout, stress, strain, and physical health. Work demand and personal well-being are the primary two variables discussed below.

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3. The study 

This extensive study was designed with the purpose of examining work demands in relation to job satisfaction in association with multiple work variables in the ADN's program director's work environment. Because of the quantity of data collected, only that which is relevant to work demands and personal well-being in this group of ADRN program directors will be presented.

3.1. Design 

As part of a 2008 NLN research funded study with institutional review board approval from University of Texas at Arlington, a nationwide work environment study using an exploratory, descriptive correlational design was conducted using a convenience sample that included all National League of Nursing Accrediting Commission-accredited ADN academic administrators having principal responsibility for administering their college's ADN program. The Copenhagen Psychosocial Questionnaire II (COPSOQII; Kristensen et al., 2005, Pejtersen et al., 2010) survey was successfully sent to 580 NLN-approved associate degree program directors across all 50 states and Washington, DC, with valid e-mail addresses in December 2008 through Survey Monkey. Of the directors with active and available e-mails, the survey response rate was 44.3% (n = 257). The respondents represented employment in 42 states plus Washington, DC. Directors from 8 states did not return surveys, and 42 director e-mails were returned and could not be forwarded due to college firewalls, program elimination, or invalid e-mail addresses. Of the 257, 12 (4.7%) were eliminated from the data run due to lack of survey completion, giving a final response count of 242. Data were imported into SPSS 16.0 for all statistical calculations reported.

3.2. Sample 

A final total of 242 directors returned completed and useable surveys; participants ranged from 42 states, plus Washington, DC, with the largest number being from New York (n = 21), Texas (n = 17), and California (n = 13).

3.3. Instrument 

The COPSOQII was the principal instrument used for this study. The COPSOQII medium-length questionnaire (Pejtersen et al., 2010) is an 87-item multipoint Likert scale that measures 28 subscales of the psychosocial work environment. These 28 subscales were further grouped into 7 primary scales that include work demands, work organization and content, social relationships and leadership, job satisfaction, workplace values, health/well-being, and exposure to violence. Since its inception in 1997, solid reliability and validity measurements have been consistently reported by Scandinavian and German researchers. The revised COPSOQII has strong reliability and validity as reported from a study of 8,000 Danish civil working adults.

Operational definitions for the two variables of interest from the instrument authors (Pejtersen et al., 2010) included the following: The work demand scale was designed to include measures of quantitative demands (tasks and amount of time needed), work pace (expected time to complete a task), and emotional demands (intensity of work), and the health well-being scale was designed to include measures of one's general overall physical functioning, physical and emotional exhaustion, level of tension and irritability, and assessment of sleep related to their position.

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4. Results 

The return rate of 242 complete surveys out of the 587 represented 41.2% of the total number of ADRN program directors with viable e-mail addresses in the United States. Most of the respondents (97.9%) were female, Caucasian (92.1%), and older than 51 years (82.3%). The number of programs that each director oversaw ranged from 1 to 12, with those having administrative titles such as dean with higher numbers of nonnursing programs under management. In terms of supportive assistance, 49.8% reported with one secretary or clerical assistant. Of those directors (n = 162) who had an assistant director of nursing, the highest number reported that no release time for administrative duties was granted to that person (25.9%, n = 42).

It was determined that Spearman's rho, a nonparametric data analysis technique, would be the best statistical test due to fluctuating Likert scale answer options (3–5) and the inconsistent range of scale and subscale questions inherent in the COPSOQII. Relationships were analyzed between two of seven primary scales: demands of work and health/well-being. The median of demands of work was the highest of all scales and calculated to 63.6, indicating that directors viewed their work demands as very high. The health/well-being scale was calculated to 47.9 and was the second highest, indicating that directors rated these areas as medium high. Table 1 presents the medians and positive statistically significant correlation between these two scales (see Table 1).

Table 1. Medians and Spearman's rho analysis of two COPSOQII primary scales: Demands of work and health/well-being

These two primary scales were further broken down into their corresponding seven subscales, demands of work included the three subscales of quantitative work demands, emotional work demands, and work pace, and health/well-being included the four subscales of self-rated health, burnout, stress, and sleep troubles. A statistically significant correlational relationship was demonstrated between all of the subscales except between work pace and self-rated health (see Table 2). The correlation for most of the subscales was highly significant to the .01 level (two tailed).

Table 2. Spearman's rho analysis of subscales related to work demands and health/well-being

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5. Discussion 

Demographics did not appear to have a notable effect on variation among the study's participants in areas of health/well-being, and demands of work.

Using the Spearman's rho (two tailed), the primary scales showed a strong correlation between the two primary scales (work demands and health/well-being with a Spearman's ρ = .52, p < .01). This result supports a 2010 study from Denmark on the relationship between work demands (emotional specifically) and the potential for extended sick time (Rugulies et al., 2010). The Danish study focused on residents of Denmark who were listed on a Centralized Civil Register and were current wage earners. These researchers found that with high quantitative and emotional work demands along with reported role conflicts, their subjects demonstrated a higher risk for sickness absence.

The primary subscales also demonstrated the same strong relationships across the categories. Using Spearman's rho (two-tailed) analysis, each of the subscales, the exception being between work pace and self-rated health, showed a significant correlation between each category. Quantitatively, emotional work demands and work pace (subscales for demands of work) showed significant correlations ranging from .15 to .54, P < .05, in relation to self-rated health, burnout, stress, and sleep problems (subscales of health/well-being). The strongest correlations were noted to be between emotional work demands and stress (ρ = .54) and also between emotional work demands and burnout (ρ = .52). These results follow the used JD-R theoretical framework that suggests work overload and other work-related demands can predict burnout and ultimately future physical illness and position turnover (Maslach et al., 1996). In addition, these results support Netherlands' researcher's findings that burnout is predicted by excessive work demands and is related to health concerns and position turnover (Schaufeli & Bakker, 2004).

Not surprisingly, the subscales of stress and burnout correlated extremely high (ρ = .83), demonstrating how closely those two subscales are correlated. The presence of sleep-related difficulties and its strong correlation to stress and burnout are to be noted. To a lesser extent, but still statistically significant, there is evidence of a correlation between sleep-related difficulties and emotional work demands, as well as self-rated health. These results support the data emerging in studies with hospital nurse managers. Shirey, Ebright, and McDaniel (2008) presented qualitative data of nurse manager interviews that spoke on sleep pattern disturbances, both emotional and physical exhaustion, and the demands of a never-ending workload. The same scenario of an expanding role, greater expectations, and fewer resources appears to be simultaneously occurring in the ADN nursing education departments.

This study illustrates the strong relationship between workload (quantitative, work demands, emotional work demands, and work pace) and health/well-being factors (self-rated health, burnout, stress, and sleep problems). With two thirds of all U.S. nursing faculty between the ages of 45 and 60 years, the prospect of retirement within the next 5 to 15 years is a realistic proposition (Nurse Faculty Support Continues to Fall Short, 2006). Faced with the current reluctance of faculty to take on the role of administrator as these roles currently exist (Adams, 2007, Lane et al., 2010, McCall et al., 1997), nursing programs may be leaderless for extended periods. Although a higher degree of job stress and work responsibility can be satisfying and viewed as a challenge or growth experience (Hurley, 2002), after a certain point, sustained elevated levels of job stress and overwork can tilt the balance in the other direction, leading to health problems, burnout, and dissatisfaction (Horton et al., 2008, Rugulies et al., 2010, Schaufeli and Bakker, 2004). The point at which job stress becomes too much appears to vary from individual to individual.

Much of the literature supported the correlation between workload and occupational stress in academic nursing (Hood, 1997, Mirvis et al., 2006, Spurlock, 2008) and within the faculty representing universities internationally (Catano, 2010, Catano et al., 2010, Kinman and Jones, 2008). Increases in both psychological distress and presence of physical health symptoms within university faculty were reported in Canadian universities (Catano, et al., 2010). Women faculty have been noted to have significantly higher scores as compared with men in a variety of international studies as well (Catano et al., 2010, Winefield et al., 2008).

The exodus of nursing administrators may be better explained by the prevalence of work overload in the director's role and its effects on their overall health and well-being. Working an average of 56 hours per week, plus an additional 2 hours if in administration (Kaufman, 2007), work responsibilities impinge on personal life (Mintz-Binder and Fitzpatrick, 2009, Reese, 2004). It is not surprising why so few qualified and capable faculty express interest in pursuing academic administrative positions (Adams, 2007, Lane et al., 2010, Mintz-Binder, 2008). Unless the ADN director job descriptions in the United States specifically are curtailed, allowing for an appropriate and manageable level of work demands, the future looks especially grim for nursing academic administration.

For ADN program directors who are currently experiencing work overload, the following suggestions are offered: (a) Always remember to take time to relax every work day by taking a walk, closing your door and participating in a relaxation exercise, and/or taking a 30-minute nonwork lunch break. (b) It is very easy to choose sugar (candy, soft drinks, desserts) as a means to handle stress. Sugar only perpetuates changes to our biochemistry, which increases our stress, and withdrawing from sugar can cause us to feel irritable and impatient (Challem, 2009). Rather, make good food choices and select protein, fruits, crackers, and nonsugar alternatives. (c) Protect your work–family life balance and make that time meaningful. Time away from work is critical, for replenishing yourself, for enjoying hobbies and friends, and for adding a wonderful dimension to your life. (d) Lastly, easier said than done, but know that it is okay to say no. Know what you can and what you cannot do, and if additional work is requested of you, negotiate what you need to take that on. If administrators are unwilling to give you additional assistance, then politely and confidently say no to the additional project.

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6. Conclusion 

Given that ADN programs account for 58% of the current U.S. nursing programs and 60% of the new graduates (Kaufman, 2009), it is surprising that only two published studies could be found specifically on ADN program directors. The focus of two studies was job satisfaction (Mintz-Binder and Fitzpatrick, 2009, Reese, 2004), with neither of them specifically targeting job stress or workload as primary variables. This study shows a clear relationship between components of workload and health/well-being. These findings were reflected in the literature review, with overwhelming time demands being mentioned repeatedly by subjects in almost all of the studies as a source of dissatisfaction and job stress.

This study's findings are clearly in line with results from previous studies in the literature that follow the JD-R, which suggests that workload is related to high burnout and ultimately a physical toll on the worker (Maslach et al., 1996). Aspects of work demands, such as work pace and both quantitative and emotional work demands, appear to impact the ADN director's perception of stress levels and health/well-being. The current shortage of ADN directors may be compounded if the exodus from the field continues as a result of increased workload. Because workload appears to have far-reaching implications on health and well-being as well as a host of other variables in current literature, such as workplace commitment, work/family conflict, and turnover, future studies specifically focused on workload in the ADN administrator's role would clearly be beneficial. Such studies could prove useful in addressing issues of retention and recruitment in the current environment of nursing faculty and administration shortages.

The results of the study underscore the crucial problems encountered in the director's role that could ultimately affect recruitment of future directors. As previous studies are reporting, few qualified faculty are interested in administrative positions. Without strong, experienced academic administrators in place, ADN programs could be in jeopardy. It is essential that these programs remain strong and show patterns of high numbers of graduates concomitant with high NCLEX-RN pass rates. With the current push once again for bachelor of science in nursing (BSN) graduates, ADN programs and their leadership must be willing to prove their worthiness and engage in BSN transition discussions. Containing the current director workload so that these political efforts can be addressed is just one of many tasks facing those committed to ADN education. The time is now to begin strategizing on position containment and workload management so ADN programs can continue to grow and thrive in this time of political uncertainty.

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Acknowledgments 

Dr. Mintz-Binder would like to express gratitude to the NLN Foundation for their generous 2008–2009 Research Award that funded this study. In addition, the authors wish to thank Dr. Mary Lou Bond, Dr. Carolyn Cason, and the Center for Scholarship and Technology, University of Texas at Arlington for their guidance and support for this study.

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