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An Examination of Telenursing: Description of the Professional Role and Predictors of Role

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An Examination of Telenursing: Description of the Professional Role and Predictors of Role An examination of telenursing: Description of the professional role and predictors of role stress, role ambiguity and role conflict. By Loretta M. Schlachta-Fairchild Submitted to the Faculty of the School of Graduate Studies of the Medical College of Georgia in partial fulfillment of the Requirements for the Degree of Doctor of Philosophy Date: November 7, 2000 An examination oftelenursing: Description of the professional role and predictors of role · stress, role ambiguity and role conflict. This dissertation is subn:iitted by Loretta. Schlachta~Fair_child ~cl has been examined and approved by an appo~nted co~~ittee of the faculty of the School of. Graduate Studies of the Medical College of Georgia... -- . The signatures which app~ar below vetify the·fact that all required changes have been incorporated and that the dissertation has received final appro·val with .reference to . ' content, form and accuracy 9f pres~ntatfon. ' This dissertation is therefore in partial ful_fillment of the requirements for the degree of Doctor of Philosophy. .. Date 3 CHAPTER 3: METHOD .................................................p. 37 · I. Researchhypotheses ............· ............ ; ....................... p. 38 II. Setting and Sample ................................... ·.............. p. 41 III. Design ............................................ ; . p. 45 IV. Measurement.". .....................................................p. 47 a. Procedures ...... ~ ..........................................p. 48 b. Instrumentation ........................................· ... p. 50 V. Analysis ............................................................ p 58 a. Methods ........................ :.; ......· ................... p. 58 b. Limitations .............. ·.................................. p. 61 VI.Human Subjects Protection ........................................ p. 62 CHAPTER 4: FINDINGS. ................................................ p. 64 I. Individual Characteris,tics .................................... p. 65 II. Professional Role ..............................................p. 68 III. Work Satisfaction ............................................. p. 75 IV. Role Strain/Role Stress ....................................... p. 80 CHAPTER 5: DISCUSSION AND RECOMMENDATIONS ...... _.p. 90 I. Limitations of Study .......................................... p. 91 II. Directions for Future Research .............................. p. 112 III. Conclusion ...................................................... p. 113 REFERENCES .............................................................. p. 115 APPENDICES Copyright© 2000 by Loretta Schlachta-Fairchild. All rights reserved ii ACKNOWLEDGEMENTS It is with the deepest gratitude that I thank, first and foremost, my loving husband, Hank and sons Joseph and Henry for all the hours, days and milestones that they provided their love and support to me. I missed many a ball game and many a romp on the lawn with them to complete this goal, and they always supported me unconditionally. To my Committee Chair, Dr Suzanne Pursley-Crotteau, I owe a great debt of gratitude for her mentorship, kindness and wisdom during this journey. Without her knowledge and support I would not have completed this goal. Dt. Peggy Parks has given of her time, support, mentorship and consultation during this past year. Her guiding li~ht has shown the path when many times the path was too dark for me to see. To my dissertation committee members, my nurse colleagues, my neighbors and friends who have provided insight, wisdom, humor and in~piration, I thank you from the bottom of my heart. A special thanks goes to Jo Ann Klein for her web authorship of the Internet-based Telenursing Role Survey and for her unending encouragement. And, last, but never least, to my dear friend Beth Buckley for her inspiration to me. as a special friend, a nurse colleague, a fellow student_ and a cancer survivor. Her will and constitution served to inspire me to continue on this journey, as she has continued on her journey, even when at times the path seemed impassable. Loretta Schlachta-Fairchild ', November 2000 iii ABSTRACT An examination of telenursing: Description of the professional role and predictors of role stress, role ambiguity and role conflict. Telenursing is the use of telehealth technology to deliver nursing care and conduct nursing practice (Schlachta & Sparks, 1999). In response to the rapid adoption of telemedicine technology in he'1:lthcare organizations, telenursing is emerging as a new role, prompting discussion of licensure, malpractice, and credentialing issues within nursing. Role stress associated with new nursing roles such as telenursing impacts individual patients and the larger healthcare organization, causing turnover, burnout, loss of continuity of care and loss of operational expertise. As with many emerging technologies, nurses assume increasingly complex roles and responsibilities. As telemedicine proliferates, the role of nurses in participating in and improving the telemedicine process will take on more pr.ominence. It is important to identify issues related to use and integration of telemedicine into nurses' roles to minimize role stress, encourage telenursing participation and position nursing practice to take advantage of telemedicine technologi~s. Using the portion of Role Theory, that relates to the impact of Role Set upon Role· Strain, as a framework this was a descriptive ·research study that identified a current population of 796 telenurses in the U.S., representi!lg 40 states. From this population, 196 telenurses participated in a telephonic or an online, web-based survey during Summer 2000. The purposes were to 1) Describe a) telenurses' professional role(s) and characteristics and b) U.S. strategies for nursing competence and patient safety iv 2) Measure telenurses' work satisfaction_ and its components, and role stress and its components 3) Predict the relationship between the components of work satisfaction, individual and professional role characteristics, and role stress, role ambiguity and role conflict. Findings of the Telenursing Role Study indicated that the typical Y2K telenurse is 46 years old, has worked 21 years in nursing and >6 months in her telenursing position. She has a 27% chance of being an advanced practice nurse, and has at least a baccalaureate degree, and likely a graduate degree. The typical telenurse is white, female, married, and has children .. She works full-time in teleriursing and makes just over $49,000 per year. Telenurse.s work in over 29 practice settings, including web portals, private companies and for telemedicine equipment vendors. They have a host of unique, new titles such as Bioengineering Clinical Nurse Specialist, Telehealth Project Director and Consumer Information Nurse. Telenurses experience less than average role stress, role ambiguity and role conflict. They also have the same work satisfaction as other hospital-based nurses. The most important factor contributing to telenurses' work satisfaction is autonomy. Findings of regression analysis were that education level and level of work satisfaction both predict role stress and role ambiguity in telenurses. Higher education levels of telenurses are associated with higher role stress and role ambiguity. Higher levels of work satisfaction of telenurses are associated with lower role stress and role ambiguity. Role ambiguity, level of education and work satisfaction are significant predictors of role conflict in telenurses. V LIST OF TABLES Table 1: Summary of Literature Related to Telenursing .... ·..................... Appendix F Table 2: Summary of Literature Related to \1/ork Satisfaction ..................Appendix G Table 3: Summary of Literature Related to Role Stress ..........................Appendix H Table 4: Summary of Literature Related to Role Conflict , and Role Ambiguity ..........................................................Appendix I Table 5: Research Hypotheses ............................................................. p. 38 Table 6: Components ofTelenursinp Role Survey ...................................... p. 46 Table 7: Telenursing Role Survey Sections and Content.. .............................. p. 50 Table 8: Age of Telenurses ................................................................. p. 66 Table 9: Telenurses with Advanced Practice Preparation .... , ......_ ................... p. 67 Table 10: Employment Status and Salaries of Telenurses ............ ." ................. p. 68 Table 11: Work Settings of Telenurses .................................................... p. 68 Table 12: Role Functions of Telenurses and Percentage of Time Spent in each Role Function ........................................................................... p. 71 Table 13: Types ofTelenursing Role Functions ....................... .' .................. p. 72 Table 14: Telenursing Position Titles ..................................................... p. 73 Table 15: Types ofTelemedicine Patients seen by Telenurses ........................ p. 75 Table 16: Individual Work Satisfaction Scores of Telenurses ............_ ........ : ..... p. 77 Table 17: Telenurses Total Work Satisfaction Scores by Quartile ..................... p. 78 Table 18: Overall Index of Work Satisfaction for Telenurses as a Group ............ p. 79 Table 19: Role Stress, Role Ambiguity and Role Conflict Scores of Telenurses .... p. 80 vi Table 20: Pearson Correlations of Study Variables ......................................
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