Objective: Changes to health care in Ontario over the latter part of the 1990’s have resulted in a number of new challenges for hospital nurse executives and health care leaders. In response to fiscal constraints and funding reductions, Ontario health care settings have restructured and downsized in an effort to reduce costs and improve the efficiency of services provided. Change has occurred at all levels within the organization, as settings re-configured their services and structures, redesigned patient care systems and processes, and introduced new staff mixes and models for providing patient care. These changes, coupled with an impending nursing shortage, have prompted concern in the nursing community regarding the quality of the work life environment for nurses. The objective of this study was to examine the relationships between different nursing staff mix models and outcomes experienced by the nurse in their work environment, as well as outcomes for the system of care delivery.
Methods: A descriptive, correlational study design was used to determine the association between four distinct nurse staffing models, nursing care delivery models, work environment variables and costs.
Sampling: A purposive sampling strategy was used to achieve the registered nurse sample for this study. Using a random sampling method, registered nurses from each of the 77 patient care units involved in the study were recruited, until the desired sample of 14 nurse subjects from each of the study units was obtained. These registered nurses then completed a survey questionnaire relating to the nurse outcomes of job stress, role tension, and job satisfaction. A total of 1116 registered nurses participated in the study.
Setting: Data were collected from nurses providing care to patients on units in 19 urban teaching hospitals in Ontario hospitals.
Names of Variables: The nurse outcome variables examined in this study include nursing job satisfaction, job stress, unit coordination, and role tension. Unit coordination of care were measured using Shortell et al. (1991) communication and coordination instrument. Job satisfaction was measured using the Job Descriptive Index (Ironson et al, 1989); job stress was measured using the Job Stress Index (Smith et al., 1992), and role tension with Lyons Tension Index (Lyons, 1971), all measures with demonstrated reliability and validity in previous studies as well as in this study.
Findings: This presentation will focus on the outcomes of the system changes as experienced by registered nurses. The quality of care provided by nurses on the unit was found to have a statistically significant positive influence on nurses perceptions of job satisfaction (t=.5.71; p=.0001), and a statistically significant negative influence on nurses perceptions of job pressure (t=.-3.78; p=.0008), and job threat (t=.-3.72; p=.0009). Programming approaches for the coordination of care had a statistically significant negative influence on nurses perceptions of job satisfaction (t=.-2.16; p=.04), and a statistically significant positive influence on nurses perceptions of job pressure (t=.2.40; p=.02). Finally, nursing leadership was found to have a statistically significant positive influence on nurses perceptions of job satisfaction (t=4.88; p=.0001), and a statistically significant negative influence on nurses perceptions of job pressure (t=-3.57; p=.004), job threat (t=-4.58; p<.001), and role tension (t=-7.16; p<.0001).
Conclusions: Thus, this research suggests that nursing job satisfaction is influenced by the environment in which nurses’ work. As well, mechanisms used for the coordination of patient care activities influences nurses’ job satisfaction and job stress. Finally, nursing leadership at the unit level is an important component in nurses work satisfaction.
Implications: The study results provide important information on the influence of organizational change strategies and nursing staff mix model on nurse outcomes. The implications of these findings for nurses and the nursing profession will be discussed and suggestions for policy changes will be presented.
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