What are the keys to keeping nurses happy?

What are the keys to keeping nurses happy?

Article Review

Nurses in Intensive Care Units are confronted with a difficult working environment, with a high level of responsibility and stress, and are confronted on a daily basis with pain, suffering and death. These aspects of their work can negatively affect job satisfaction, inducing a high staff turnover and indirectly, affect productivity and efficacy. Nevertheless, other features can increase interest in work and self-esteem, making nurses feel attached to their unit and preventing them to leave; they promote affective commitment, defined as the psychological attachment of staff towards their team or unit. 

In the recent article “Nurses well-being in intensive care units: study of factors promoting team commitment”, the authors aimed to examine how organisational factors could affect the experience of identification and commitment among ICU staff. 

The study consisted of a cross-sectional survey with a self-reported questionnaire administered to confirmed nurses of 12 ICUs in four Italian urban hospitals, based on validated scales derived from psycho-social literature. Nurses were given three weeks to complete the questionnaire, on a voluntary and anonymous basis. The questionnaires were constructed around six variables: nurse-physician collaboration, job autonomy, perceived quality of nursing practice, perceived supervisor support, job satisfaction and team affective commitment. Organisational tenure was introduced as a control variable. 

A total of 323 questionnaires were provided and 222 returned entirely completed (response rate of 68.1%). Despite the fact that the study was conducted only on a convenience sample, a response rate over 68% can be considered as fairly representative. 

Consistent with previous studies, the answers showed that three variables were directly related to team commitment: job autonomy considered as freedom and discretion in scheduling tasks, making decisions and choosing procedures; nurse-physician collaboration and communication; and perceived quality of practice, which affects identification with the team and its objectives. Organisational tenure was not a significant factor in this study. Furthermore, the positive relationship between these variables and team commitment were mediated by job satisfaction and perceived supervisor support, crucial to develop a good climate for clinical practice.

“nurses need to know when they are doing a good job and that they are valued for it; the role of supervisors support is essential to develop job satisfaction…”

One of the most important messages of this study is the fact that, as important as the feeling of working in an efficient team, nurses need to know when they are doing a good job and that they are valued for it; the role of supervisors support is essential to develop job satisfaction and thus affective team identification. Translating these findings in new management strategies could represent a breakthrough in ICU organisation: supervisors should not only increase autonomy, but consider individual’s needs as well as the unit’s needs, caring about the well-being of healthcare professionals and developing the interpersonal relationships within the unit. Such strategies could increase team collaboration and commitment, with preservation of a well-qualified, efficient and motivated workforce, ready to face the challenges of working in the ICU and improving indirectly the health of patients. 

Article review prepared and submitted by Silvia Calviño Günther, member of the N&AHP Committee of ESICM.


Galletta M, Portoghese I, Coppola RC, Finco G, Campagna M. Nurses well-being in intensive care units: study of factors promoting team commitment. British Association of Critical Care Nurses (2014); doi: 10.1111/nicc.12083.

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