Attitudes and perceptions of registered nurses during and shortly after acute care restructuring in Newfoundland and Labrador

Challenges and factors likely to promote coping as anticipated by nurses preparing for a merger of intensive and intermediate care units

OBJECTIVE

To describe challenges and factors that support coping as anticipated by nursing staff preparing for a merger of intensive and intermediate care units.

RESEARCH METHODOLOGY

The method of empathy-based stories was employed to collect data from staff. The stories (n=20) were analysed using inductive content analysis.

SETTING

Nursing staff from the cardiac observation and evaluation, intensive care and surgical observation units in a central hospital in Finland.

FINDINGS

Participants anticipated challenges related to personal factors that affect coping at work, challenges in co-operation among nursing staff and problems associated with the new work context. Participants expected to need informational, concrete and social support from colleagues in future clinical nursing situations.

CONCLUSION

Fostering peer support and team spirit is important to ensure staff co-operation and smooth care processes following restructuring.

Health care quality from the perspective of health care providers and patients during and shortly after acute care restructuring in Newfoundland and Labrador

Objectives

To monitor changes in providers' perceptions of health care quality and the importance of health reform, and in patients' satisfaction with services during and two years after restructuring, comparing the region of the province that was restructured (StJohn's) with those regions in which hospitals were not aggregated.

Methods

The Employee Attitude Survey questionnaire was sent to acute care providers (n=5353) to assess personal characteristics and perceptions of the impact of reform on workplace conditions, work-related attitudes and turnover intentions. The response rate for 2000 and 2002 was 42% (n=1222 and1034, respectively). Only respondents in both surveys (n=589) were used in the analysis because study results were the same for both the repeat sample and total samples. A Patient Satisfaction Survey questionnaire was administered to patients discharged from acute care facilities in 2000 (n=1741) and 2002 (n=704). Response rates were 82.5% and 90.2%, respectively.

Results

Most providers felt, at both time periods, that restructuring of the health care system was a positive step, but felt that health care quality was low. In the StJohn's region, perceptions of quality and standards of care improved over time. Patients were extremely satisfied with the admission process and hospital stay at both time periods in StJohn's. However, satisfaction declined in 2002 in regions outside StJohn's.

Conclusions

Aggregation of acute care hospitals is possible without adverse effects on providers' perceptions of health care quality or on patient satisfaction.

Effects of Hospital Restructuring and Downsizing on Nursing Staff

The healthcare system underwent considerable restructuring and downsizing in the early to mid-1990s as governments cut costs to reduce their budget deficits. Studies of the effects of these efforts on nursing staff and hospital functioning generally reported negative impacts. Healthcare restructuring and hospital downsizing was again being implemented as governments struggled to once again reduce deficits. The present study examines the relationship of union support during hospital restructuring initiatives with a range of individual and unit/hospital outcomes in a sample of nursing staff working in healthcare settings (hospitals) undergoing significant restructuring and downsizing. Data were collected from 289 nursing staff in California hospitals. Nurses reported a relatively large number of restructuring and downsizing initiatives during the preceding year. Levels of union support had a significant relationship with hospital functioning, but not with nursing staff work and well-being outcomes. Although union support has not shown many benefits for nursing staff during hospital restructuring and downsizing given their focus on adherence to collective agreements, nursing unions can play a larger role here. The present study adds to our understanding of the potential benefits of union support during the current hospital restructuring and downsizing, and highlights the role of union leadership and management.

Changes in patient safety culture after restructuring of intensive care units: Two cross-sectional studies

OBJECTIVES

Compare changes in registered nurses' perception of the patient safety culture in restructured and not restructured intensive care units during a four-year period.

METHODOLOGY/DESIGN

Two cross-sectional surveys were performed, in 2008/2009 (time 1) and 2012/2013 (time 2). During a period of 0-3 years after time 1, three of six hospitals merged their general and medical intensive care units (restructured). The other hospitals maintained their structure of the intensive care units (not restructured).

SETTING

Intensive care units in hospitals at one Norwegian hospital trust.

OUTCOME MEASURE

The safety culture was measured with Hospital Survey on Patient Safety Culture.

RESULTS

At times 1 and 2, 217/302 (72%) and 145/289 (50%) registered nurses participated. Restructuring was negatively associated with change in the safety culture, in particular, the dimensions of the safety culture within the unit level. The dimensions most vulnerable for restructuring were manager expectations and actions promoting safety, teamwork within hospital units and staffing.

CONCLUSION

In this study, the restructuring of intensive care units was associated with a negative impact on the safety culture. When restructuring, the management should be particularly aware of changes in the safety culture dimensions manager expectations and actions promoting safety, teamwork within hospital units and staffing.

Restructuring a rehabilitation program for older adults: effects on patient outcomes and staff perspectives

The purpose of this mixed-methods research study was to examine the impact of organizational change on patient outcomes and staff experiences in a rehabilitation program for older adults. Program restructuring focused on reducing patient length of stay and increasing admissions to the rehabilitation program. Study findings revealed that patients admitted after restructuring, as compared to the time period just prior, experienced shorter lengths of stay yet made similar progress towards rehabilitation goals. The average discharge Functional Independence Measure (FIM) scores between the two time periods were not significantly different. Yet FIM efficiency scores improved after the restructuring. With this reorganization, rehabilitation staff reported working harder to help patients achieve satisfactory outcomes, although initially staff reported lower morale. Findings extend the current literature and have practical implications for health care professionals interested in facilitating successful organizational change.

Predictors of registered nurses' organizational commitment and intent to stay

BACKGROUND

Health care reform has significantly altered employment relations. Research findings suggest that the presence or absence of supportive work environments helps explain the differences observed in employee attitudes and turnover intentions.

PURPOSES

The purposes of this study were to examine frontline registered nurses' (RNs') perceptions of organizational culture and attitudes and behaviors and test a model linking culture to outcome (organizational commitment and intent to stay).

METHODOLOGY

A non-experimental predictive survey design was used to test the model in a sample (N = 343) of acute care RNs employed in one Canadian province. Data were collected with the following scales: Emotional Climate, Practice Issues, Collaborative Relations, Psychological Contract Violation, General Job Satisfaction, Organizational Commitment Questionnaire, and Intent to Stay.

FINDINGS

The response rate was 29.4%. Most respondents were middle aged and diploma prepared, were in their current positions for 5 years or more, had 10 or more years of nursing experience, and worked full time. Despite moderate levels of job satisfaction, RNs held negative perceptions of culture (emotional climate, practice-related issues, and collaborative relations), trust, and commitment and were unlikely to stay with current employers. Structural equation modeling provided support for the impact of culture, trust, and satisfaction on commitment and partial support for intent to stay, explaining 45 and 31% of the variance, respectively.

PRACTICE IMPLICATIONS

The development and implementation of policies and interventions aimed at creating more supportive work environments and greater trust in employers and job satisfaction have merit. The most obvious benefit from such strategic interventions is the potential for improving RNs' organizational commitment and reducing turnover intentions.