Abstract
An effective workforce performing within the context of a positive cultural environment is central to a healthcare organization’s ability to achieve quality outcomes. The Nursing Culture Assessment Tool (NCAT) provides nurses with a valid and reliable tool that captures the general aspects of nursing culture. This study extends earlier work confirming the tool’s construct validity and dimensionality by standardizing the scoring approach and establishing norm-referenced scoring. Scoring standardization provides a reliable point of comparison for NCAT users. NCAT assessments support nursing’s ability to evaluate nursing culture, use results to shape the culture into one that supports change, and advance nursing’s best practices and care outcomes. Registered nurses, licensed practical nurses, and certified nursing assistants from 54 long-term care facilities in Kentucky, Nevada, North Carolina, and Oregon were surveyed. Confirmatory factor analysis yielded six first order factors forming the NCAT’s subscales (Expectations, Behaviors, Teamwork, Communication, Satisfaction, Commitment) (Comparative Fit Index 0.93) and a second order factor—The Total Culture Score. Aggregated facility level comparisons of observed group variance with expected random variance using rwg(J) statistics is presented. Normative scores and cumulative rank percentages and how the NCAT can be used in implementing planned change are provided.
Highlights
Organizational culture is believed to affect workplace safety, efficiency, and effectiveness; in long-term care (LTC) settings the high rate of staff turnover further complicates instability of the occupational subculture of nursing [1]
The nursing’s occupational subculture, includes licensed nurses, as well as certified nursing assistants (CNAs), all of whom must function as a nursing team
In LTC settings, turnover rates are as high as 80%–85% for CNAs and typically occur in the first 90 days of employment
Summary
Organizational culture is believed to affect workplace safety, efficiency, and effectiveness; in long-term care (LTC) settings the high rate of staff turnover further complicates instability of the occupational subculture of nursing (the primary oversight of resident safety and health) [1]. Turnover affects staffing decisions and adds to organizational costs associated with reduced worker efficiency and productivity because of the instability in the workforce that results, especially when high performing staff leave and must be replaced [5,6,7]. High turnover rates for licensed and non-licensed nursing staff can be found in all types of healthcare settings. In LTC settings, turnover rates are as high as 80%–85% for CNAs and typically occur in the first 90 days of employment. Relationships among nursing staff are derived from the workplace cultural environment, which emerges from the values, attitudes, and beliefs held by staff, and make a critical contribution to the organization’s ability to achieve quality care outcomes
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