The qualitative component of the study

Semi-structured, in-depth interviews were used in an effort to capture rich, detailed descriptions of factors in the work environment that impact upon nurses’ quality of working life and on their decisions to stay or leave their chosen profession. The qualitative data comprised the transcribed tape-recorded interviews, and responses to two open survey questions that asked for participants to provide reasons for either planning to continue, or discontinue, a career in nursing. While the two sets of data were analysed separately, they were both analysed using the process of qualitative content analysis (Palmquist, 2004).

4.6.1 The interviewees

In order to obtain personal stories about the factors that impact the quality of working life, face-to-face interviews were conducted with a purposeful sample of ten hospital-based RNs working in the designated hospital settings, and an extreme sample of five RNs who had left the nursing profession to follow a new career path. Patton (1990) describes an extreme case sample as one whose experiences or outcomes have been extreme, and who therefore have the potential to provide a researcher with especially enlightening information. Choosing to leave one’s profession is an extreme outcome (Cheung, 2004). The inclusion of this extreme case sample offered the opportunity to gain rich information about why nurses make the extreme decision to leave a career for which they are qualified and have worked hard to enter. Indirectly, the inclusion of this extreme case sample also provided the

opportunity to gain understanding of what adjustments needed to occur in the workplace in order for them to have continued working in the profession.

The inclusion and exclusion criteria was identical to that for the quantitative component of the research, other than that the RNs who had abandoned the profession were required to have left nursing within twelve months prior to their interviews. It was considered that events and feelings experienced in the prior 12 months were more likely to be recalled with accuracy than after a more extended period of time.

Participants working as RNs were recruited via promotional brochures that thanked those who completed the survey and invited them to participate further through an interview with the researcher. Brochures and information packages were left in the main lunch rooms of the participating hospitals. The packages included a participant information letter (Appendix D) and a consent form (Appendix E). Participants willing to be interviewed were asked to place a completed consent form in a sealed box that was left in each lunch room. The researcher collected the sealed boxes one week after placing them. The first ten employed RNs who agreed to participate were interviewed. The concept of theoretical saturation was used to determine the sample size for this cohort (Strauss & Corbin, 1998). A preliminary data analysis revealed that no new information was gained after the 8th interview.

Snowball (chain) sampling was used to recruit the five participants who formed the extreme sample of nurses who had left the profession. The interviewees who were

working as RNs were asked to give information packages to any colleagues they knew who had left the nursing profession within the previous twelve months. They were requested to ask those colleagues to contact the researcher if willing to be interviewed. This resulted in interviews with two RNs who had left the profession. They were then asked to follow the same process, giving information packages to any of their prior work colleagues who met the criteria for this cohort. This resulted in another three interviews. This extreme case sample was self limiting in size due to the effect of this sampling process. However, “there are no rules for sample size in qualitative inquiry” and “in-depth information from a small number of people can be very valuable, especially if the cases are information-rich” (Patton, 1990, p. 184).

4.6.2 The qualitative procedures

The interviews, which were approximately 60-90 minutes in length, took place at times and locations convenient to the participants and in an atmosphere that ensured privacy and confidentiality. An aide-memoire style interview guide was used as a discreet prompt (David & Sutton, 2004). An informal, conversational mode of interviewing was used because, as May (1997) explains, it is a mode that encourages disclosure and provides a forum within which participants are most likely to reveal deeply held values, opinions and feelings. This was important because nurses are often reluctant to speak out about difficult and sometimes hidden aspects of their work (Buresh & Gordon, 2006; Gordon, 2005; Sherson, 2005). The interviews focussed on gathering information to complement the quantitative data and also to indirectly elicit information, not necessarily in the participants’ conscious awareness, about what they valued and needed from their work in order to experience an

acceptable quality of working life. While the aide-memoire style interview guide was used to ensure no planned areas of exploration were neglected, additional points of concern or interest that were raised, and appeared to be of particular importance to the participants, were also pursued. A range of recommended interview techniques, including verbal and non-verbal cues and focussed and probing questions (Stein- Parbury, 2005) were employed to ensure the topics relevant to nurses’ quality of working life were fully explored, while also ensuring that every participant had the opportunity to reveal any uniquely personal experiences (Britten, 1995; Patton, 1990; Smith & Osborn, 2003).

While personal work values were central to the way this study was conceptualised, information about what the interviewees valued and needed from their work was not sought through a direct approach. Rather, the aim was for this information to emerge indirectly through questions focused on the experience of being a nurse, opinions about various aspects of the work environment, and reasons for staying or leaving the nursing profession. This indirect approach to eliciting information about personal work values was taken because, according to Sharf (2002), it is unusual for individuals to have consciously formulated their work values or to have considered them in relation to their workplace and the organisational practices inherent in their particular work environment. In an effort to ascertain what it was that the participants most valued and needed from their work the researcher asked a range of questions. These included, but were not limited to the following:

Tell me about what happens during an average day at work for you. What are the best things about your job?

What are the most difficult things you have to deal with at work? What helps you to cope when life at work gets difficult?

If you could change anything about your job what would you change? What are the good things about the management in your hospital? What improvements would you like to see in the way your unit is run? Tell me about your relationships with the people you work with.

In order to elicit information about decisions to stay or leave nursing, the interviews concluded with the questions: How do you feel now about nursing as your career choice?” and “Where do you see yourself in two years time?

4.6.3 Data management

The tape-recorded interview data was transcribed verbatim. The transcripts were divided into two sets, reflecting the two cohorts of participants; employed RNs (cohort 1) and RNs who had left the profession (cohort 2). For ease of tracking, a different coloured font was used for transcribing the data from each cohort. To ensure confidentiality of participants, each was allocated a pseudonym. The transcripts were coded with the cohort number and the allocated pseudonym; for example C1: Julie. To provide an audit trail, every page of each transcript was numbered, and each line of every page was also numbered. Use of these tracking mechanisms is illustrated in the following segment of text:

Things were all over the place, messy, you couldn’t find anything you wanted. If it’s a pleasing environment you want to stay there, if not you don’t. C1: Julie: Pg6:Ln291-293

Polit and Beck (2006) suggest that when combined, these strategies create a system of identification and tracking that provide an effective audit trail. In this study they make it possible to locate the page and quote from any transcript, therefore providing others with a means to verify the evidence upon which the researcher’s assertions and findings are based.