Research Objectives: Job satisfaction, professional commitment to career ideals, and intent to turnover are important variables during hospital mergers, acquisitions and restructuring. This study is among the first to investigate differing organizational levels of these constructs in relation to professional nursing during a merger process.
Design: A quasi-experimental, correlational, descriptive study was designed to assess the impact of a multi-hospital merger and restructuring on RNs employed on general medical-surgical nursing units.
Population, Sample, Setting, Years: All full time and part time registered nurses who provided direct patient care from three hospitals (Hospitals A, B and C) involved in a merger process. Hospital A is the acquired hospital while Hospitals B and C are considered the acquiring hospitals of the newly formed Healthcare System. The sample included 98 registered nurses, primarily female, with six months to twenty-six years of tenure. Data collection occurred during year four of the merger process and took three months to complete.
Concept or Variables Studied Together: Job satisfaction, professional or career commitment and intent to turnover.
Methods: All registered nurses employed on general nursing units at three hospitals involved in a merger process completed the Organizational Job Satisfaction Scale, a Professional Commitment Scale, and an Intent to Turnover Scale adapted from the Michigan Organizational Assessment Questionnaire. Semi-structured interviews were also conducted.
Findings: Overall job satisfaction was found to be consistently moderate at all three hospitals. Greater satisfaction with pay was found for the nurses at the unionized hospital (Hospital A) than the non-unionized hospitals (Hospitals B & C), which prompted nurses at those hospitals to seek unionization. Time constraints in performing nursing duties and staffing ratios were voiced as major areas of discontent at Hospital A. Nurses at Hospitals B and C voiced concern primarily over professional practice issues. Professional commitment was moderate at each hospital with a significant number of nurses expressing disillusionment with the nursing profession by scoring low on questionnaire items related to enthusiasm for nursing and dissatisfaction with the profession. Qualitative data indicated that nurses felt the general public and physicians had a poor image of professional nursing. Nurses at all three hospitals had no strong feelings about either staying or leaving their present position although the interviews demonstrated that nurses with greater tenure wanted to stay within the newly formed umbrella Healthcare System organization because of benefits and seniority concerns. Significant positive relationships were found for job satisfaction and professional commitment while a significant inverse relationship was demonstrated between these same variables and intent to turnover.
Conclusions: Differences in job satisfaction were more notable within the subscales of the instrument showing that nurses are satisfied with selected aspects of their job. However, the dissatisfiers tended to evoke a more emotional response, which was also reflected in the level of professional commitment to the nursing profession.
Implications: Job satisfaction, professional commitment, and intent to turnover are important to being supportive of the values, beliefs, and goals of the newly formed Healthcare System. Low levels of job satisfaction and professional commitment have been shown to precipitate nursing turnover. As mergers of health care organizations become more commonplace, RNs have been left anxious regarding job security and frustrated over delivering quality patient care in the new and emerging corporate culture in which they find themselves employed. Nurses leaving the profession over dissatisfaction in work-related issues may beget a further shortage of RNs in those facilities in which patient care acuity is high thus jeopardizing the safety of patients and reducing the quality of patient care related to poor staffing ratios.
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