The floating of nurses is traced back to about four decades ago. In most cases, the floating of nurses occurs in the event of a sudden change in the hospital staffing requirements within a healthcare facility. According to Estryn-Behar et al. (2010) the situations that disrupt the normal staffing operations in the hospital includes an unanticipated worsening of a patient’s conditions that bring about the need for one-to-one care or when the nursing staff members experience familial or personal emergencies thus cannot fully work as per the assigned schedule.
Initially, the floating of nurses was a decision made by individual nurses. However, as time went by, the floating of nurses was a mandatory undertaking and the commands were carried out by the manager. However, there is a huge gap in relation to the lived experiences in relation to the floating experience and this is what warrants for more research. According to Roach, Tremblay, and Carter (2011), the floating of nurses first occurs in specific units within the facility which is later followed by a hospital-wide engagement. As of 2015, a colossal number of hospitals are still practicing the floating of nurses and this is mainly driven by the budgetary constraints among other reimbursement hurdles. Currently, the Centre for Medicare and Medicaid has eliminated the fees-for-service reimbursements and this has played a huge role towards the involuntary allocation of nurses to areas in need by most managers (CMS.gov, 2018; CMS.gov, 2013). However, this forceful floating of nurses as a result of monetary issues and staffing fluctuations has had negative impacts that the managers do not take into consideration.
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According to a study conducted by Heuer et al. (1996), a study conducted on nurses found out that 35% of them cited floating as being the most stressful element. A similar study in 1990 conducted by Foxall et al. from three diverse nursing specialties (Medical-surgical nursing, critical care nursing, and hospice nursing) identified floating as being the most stressful even across the three specialties. A similar study conducted by Banks et al. (1993) also highlighted that 73% of the nurses disapproved the floating requirements. Nonetheless, the choice to use a qualitative study, interpretive phenomenology is ideal to address the gap of literature on the lived experiences of floating nurses. According to Giorgi (2011), an individual will have an ability to describe an encounter with a phenomenon accurately, as lived. More importantly, a variety of conceptual models exists in relation to the nurses’ lived experiences in Float Pools. The theoretical framework will, therefore, provide one with a set of concepts that will function as the research’s blueprint in understanding the phenomenon. The most suitable theory for this study was the Karasek Job Demand model.
Proposed Theory Description
Philosophical Underpinnings
Robert Karasek was a USA sociologist and in 1979, he presented an assessment of the stress factors and stress within a working environment and promotion of health at the workplace with his Job Demand-Control Model ( JDC ) . This model was highly renown after its inception and it was based on two vital facets in relation to work-related stress and workload; decision latitude (control) and height of strains (demand) (Karasek, 1979) . According to the height of strains, it comprises the various requirements that set-in any workplace ranging from the difficulties, effort, pressure, time, availability, and work rate. In most instances, these activities represent the various stressors related to one’s psychological well-being . The decision latitude revolves around the freedom that an employee has in relation to organizing and controlling his/her individual work (Karasek, 1979). Every employee would like to have some certain control over how they perform various duties, and how they would want to tackle any tasks assigned. This facet comprises of the decision making and competence authority of an employee.
Basing on Karasek's JDC model, the management capabilities and job requirements can either be high or low. Nonetheless, the JDC aims at showing that what leads to high incidents of psychological stress is not only the strain but rather the amalgamation of decision latitude and strain that a specific job offers. In case the employee latitude to manage individual work as per one’s ideas is restricted, the likelihood of stress development is high. Nevertheless, in case an employee is given an opportunity to regulate himself, the employee will likely have an ability to adequately handle any workload and also become more motivated at the same time. Therefore, the aim of the JDC model developed to bring balance between the employee autonomy and job requirements. Employees who have more demanding jobs will mostly suffer from high levels of stress in case they are restricted. However, in case some element of control is not present or less, and the job demands are still high, an employee will not be stressed a lot.
Karasek put the JDC model on a diagram with the job demands placed on the horizontal axis being either high or low and the job decision latitude on the vertical axis being either low or high. From this model, one can get four situations; low strain jobs, high strain jobs, passive jobs and active jobs (Karasek, 1979). The low-strain jobs comprise those that have little demands and provide the employee with the freedom to organize their individual work schedule. However, these jobs have little motivational indices for they are mostly routine jobs for employee do not have a platform to encounter new challenges thus they quickly get bored. The high-strain jobs have minimal control through a higher demand and are complex. An employee has no freedom and must follow what he/she is told thus it lacks a decision latitude. These jobs have higher stress levels. Passive jobs have little to no decision latitude and mostly made up of production and repetitive tasks. The jobs have the lowest stress levels though the employee has petite initiative levels. Active jobs are classified as being highly demanding and employees can decide what they would want to engage in. This high decision latitude capability makes such jobs less stressful despite it having a huge toll on their psychological well-being . Karasek believed that such jobs allow employees to gain intrinsic motivation and they have a platform for encountering challenges thus promotes their professional and personal development and growth (Karasek, 1979).
Theory Propositions
The JDC’s prominence results from its nature of being flexible. According to the theory, its first proposition is that the job demands and job resources can be used in modeling all job characteristics or working environments (Bakker, 2011). This indicates that any working environment can benefit from this theory and this can perfectly be modeled to fit within any occupational needs. The job demands comprise of the organizational, social, psychological and physical job aspects that necessitate unrelenting psychological and or physical determinations and are thus allied with certain psychological and or physiological expenses (Bakker, 2011). The job resources comprise the organizational, social, psychological and physical job facets that; encourage personal development, learning or growth, lessen job demands and any related psychological and physiological expenses and purposeful in attaining work objectives. It is therefore evident that for one to fully deal with job demands, resources are a vital necessity.
The second proposition is that job demands and job resources are activators of two equitably independent processes; motivational and health impairment (Bakker et al., 2010) . Through job demands, one can witness outcomes such as strain injuries, psychosomatic health complaints, exhaustion among others while on the other hand, job resources are predictors of work engagement, motivation, satisfaction and enjoyment (Bakker et al., 2010). This results from the fact that energetic resources and effort are the costs of job demands while psychological needs such a competence, relatedness, and autonomy are fulfilled by job resources.
Major Theory Concepts
According to Karasek ( 1979), the core concepts of his Job Demand-Control model is the impacts of strain and stress on employees. The model is made up of three different paradigms (control, work overload and effective strain) . According to Tucker et al., (2008), the effective strain will form foundations for the development of short-term reasoning dysfunction. The other vital concept of the model is the work overload. This results from incidents whereby, a normal nurse might work in units with a nurse to the patient ration of 1:3 and when floated, it increases to 1:5. Additionally, the ability of an individual to complete any assigned duty is based on the amount of freedom he/she has in making decisions. A change in any of these three paradigms that form the core concepts of the JDC model will form a foundation for disequilibrium thus affecting the employees overall work performance.
Theory Evaluation
Significance
The significance of Karasek’s theory on job demand lies in his concern with the third nursing metaparadigm that focus on the environment and more specifically its impacts on the nurses’ job satisfaction and engagement levels. Additionally, the theory’s predictive power is relatively higher in that, in case the job demands and job control paradigm are present, one will most likely have an opportunity to witness an improved and vice versa. It is an indication that the positive changes of implementing or not implementing the two paradigms can be predicted with certainty from the nurses’ behavior. Furthermore, the theory’s explanatory power is of quality for it allows one in having a deeper understanding of what is going on in a physical system thus allowing for other scholars to develop further theories. This is supported by Kain and Jex (2010) who state that the Karasek’s theory is one of the most influential theories in terms of trying to explain occupational stress and health. The conceptual model used in forming the theory is based on two factors; control and demand. Karasek has effectively explained how they impact the emergence of occupational stress and being a sociologist, this gives the right awareness to explain these human behavior factors.
Internal Consistency
The core concepts used by Karasek in this theory are based on the impact of stress, work overload and effective strain on an employee. Karasek has fully provided an analysis of all his concepts for they play a central role in his theory. The outcome concepts are discussed in a detailed manner which results from the three paradigms. Karasek uses the definitions of his concepts throughout and this will make it easier for a reader to follow the theory and its concepts. There is also an accurate diagrammatic representation of his theory. Nonetheless, according to Cox & Griffin (2003), they found inconsistencies in Karasek’s theory for it does not explain the process that occurs during an employee interaction with his/her environment. From this, the authors, therefore, tend to believe that it, therefore, makes it hard for one to fully link his concepts to the theory. Therefore, they state that this divergence makes Karasek’s philosophical underpinnings vague. Despite this, the structural consistency of his theory does not have any flaws.
Parsimony
Karasek’s JDC theory was further developed and this has made it have parsimony. This saw the theory having consistent terminology, a more disciplined writing and additional diagrams on the theoretical models. All these factors have played a vital role in making it more concise and clear.
Testability
Karasek’s theory is testable within human science paradigm which he proposes for his work. Likewise, Karasek has employed a variety of transcendental phenomenology in his works in trying to explain the various concepts about the theory. Furthermore, Karasek and his peers have undertaken numerous studies on his theory since its development in 1979. Nonetheless, most of the researches have been focused on cardiovascular diseases whereby Karasek and his peers studied the impacts of latitude and psychological strain on the worker's overall health and wellbeing.
Empirical Adequacy
According to Fawcett (2005), a theory meets the empirical adequacy criteria if empirical data from other studies can conform to its assertion in an adequate and reasonable manner. According to a study conducted by Hausser et al. (2010), they conducted a systemic review of 83 studies from 1998-2007 to determine whether the concepts outlined by the theory are true. The researchers found out that the impacts in high demand/low control jobs, the theory was a perfect predictor of psychological strain at a rate of 60-68 percent. This was based on a study of various occupations ranging from correctional officers, health care employees, medical practice staff, and education among others. Additionally, De Witte et al., (2007) carried out a study on a sample of 2,212 first time employees to test Karasek’s hypothesis. The results indicated that his theoretical framework presented a valid means of analyzing the impacts of psychological strain and high demand/low control at the workplace . These two studies made an adequate use of Karasek’s theory.
Pragmatic Adequacy
Before applying the theory, the nursing managers must first undergo some form of training that will equip them with the best knowledge on how to ensure they do not implement policies that affect the nurses’ ability to work. The theory has massively been employed in various academic literature and job redesigns. As stated by Kain & Jex (2010), the theory is one of the most influential theories in terms of trying to explain occupational stress and health in the workplace. Additionally, the theory’s nursing actions will play a vital role in improving patient outcomes. They will have an optimum health to carry out their duties without any psychological stressors. Additionally, it is much easier for one to check the outcomes of implementing the theory and once it is not implemented by determining the nurses’ job satisfaction and performance levels.
Theory Application
Theory Relation to Topic
In most cases, different individuals will provide a diverse explanation of phenomena basing on its occurrence. In this case, the topic is to determine the lived experiences of float pool nurses within a healthcare facility. A common phenomenon that affects nurses is work and caring for patients found in unfamiliar units. As a result of this, they at times tend to suffer from increased rates of job dissatisfaction and psychological disorders such as anxiety, nervousness, and stress. However, in order to determine this, there is a need for one to come up with a model that will outline the impacts of increased demands on nurse, strain, and control. Therefore, the best model, in this case, is the JDC model as provided by Karasek. This model will enable one to come up with an assessment of the stress factors and stress within a working environment and promotion of health at the workplace.
Theory and Study
A theory is used in providing a researcher with concepts that will be used as blueprints for conducting research (Fawcett, 2005). The theory will allow one in coming up with a perfect background on the study. The theory revolves around three paradigms, control, work overload, and strain. It is therefore vital for the background of the study to focus on these three factors in relation to the floating of nurses. The background will provide information related to other studies that have focused on the three paradigms and what their impacts were on float pool nurses. Additionally, at the purpose section of the study, the theory will allow one in exploring the impact of three paradigms as part of the lived experiences of float pool nurses. It will ensure that one does not stray into other matters that are irrelevant to the study. With the theory being focused on the strain , work overload, and control, it will enable one to pick participants who will have a direct impact on the research hypothesis. Without the theory in place, one might end up picking participants who have no relation to the study thus making its invalid. The theory similarly permits the researcher in formulating questions that are related to the study. Using its concepts, one and came up with the right data gathering methodologies and ensure that it matches the study’s topic.
Conclusion
The floating of nurses has been a major staffing strategy employed by a variety of healthcare facilities. Nonetheless , what the management does not consider is that this strategy has negative impacts on the nurses’ ability to carry out their duties. As seen from Karasek’s JDC model, floating is bound to bring about various psychological disorders such as stress. This is based on three concepts work overload, control, and effective stress. According to the theoretical evaluation of Karasek’s theory using Fawcett’s criteria, it meets all the facets in relation to its significance, internal consistency, parsimony, testability, empirical adequacy, and pragmatic adequacy. This makes it the best theory to use in the study for it forms the right blueprints for carrying out a successful study.
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