Because increasing numbers of physicians are being trained in specialized medicine, health professional shortage areas remain common in the United States, and the role of physician assistants (PAS) in health services provision is becoming increasingly important, especially in rural and underserved areas. By most accounts, there is a shortage of PAS in the United States, particularly in rural areas. A nationwide survey was conducted in 1994 to determine what attracted PAS to rural settings and what they found satisfying about their work and community. This study involved a random sample of 1,263 PAS who practiced in rural (nonmetropolitan) areas of the United States. A 15-item scale was developed to measure job satisfaction. A statistical model was tested for its ability to predict levels of job satisfaction using multiple regression analysis. Independent variables included demographics, practice, and community factors. Findings indicated that rural PAS were generally satisfied with their work. The most significant predictors of satisfaction included practice factors (e.g., importance of autonomy and a good relationship with the supervising physician), extent of practice responsibilities (e.g., regular and on-call hours and the percentage of PAS' patient load that was not discussed with the supervising physician), and community factors (e.g., community satisfaction).

Job Satisfaction Among Rural Physician Assistants

Currently, economic and social pressures have resulted in a dramatic restructuring of health care organizations. Hospitals under heavy pressure to contain prices are moving rapidly toward the deskilling of nursing duties as an immediate way to reduce their labor costs. This article discusses this movement and how, while at first glance it may appear acceptable, the change is nothing more than a movement from Taylorism to Fordism. Deskilling is a step backward for the industry and it has serious implications for patient care. The industry should instead be attempting to build on the flexibility that has always been inherent in nursing so as to create an adaptable workforce capable of going beyond Fordism. For this concept to come to fruition, however, nursing will need to be given more decision-making authority over its role in the health-care delivery system.

Nursing beyond fordism

Nurses report a decline in RN/patient and skill mix in the 1990s while quantitative studies fail to confirm this. This study examines aggregate hospital nursing staff in Pennsylvania from 1991-1997, focusing on changes in licensed nursing staff. It finds that licensed nursing staff declined while nursing assistants increased in this period. With adjustment for patient acuity, there was a slight decrease in RN/adjusted patient days of care (APDC), a 23% decrease in LPN/APDC, and a 4% decrease in licensed nurse/APDC. The RN/nurse ratio increased slightly, and licensed nurse/nurse fell slightly. Since RNs often operate in environments which make use of teams of licensed staff, nurses' perceptions of a decline in the RN/patient ratio is a result of the decline in licensed staff/APDC, and of an increase in patient acuity.

Katherine W. Carey

Papers

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