Health care restructuring in acute care settings : implications for registered nurses' attitudes

Baker, Norma G. L. (2002) Health care restructuring in acute care settings : implications for registered nurses' attitudes. Masters thesis, Memorial University of Newfoundland.

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Abstract

A descriptive correlational design was used to investigate acute care nurses' perceptions of the impact of health care reforms and their work-related attitudes and behavioral intentions following restructuring of acute care services in Newfoundland and Labrador. The interrelationships among the key study variables (i.e., personal characteristics and staffing issues, impact of reforms, work-related attitudes, and behavioral intentions) were also examined. The Conceptual Model of Behavioral Intentions (CMBI) was used as the framework for this study. -- The stratified random sample was comprised of 223 registered nurses working in acute care settings under the institutional/integrated boards responsible for health care services in the eight health districts of the province of Newfoundland and Labrador. A response rate of 34.1% was achieved. The majority of respondents were female (97.8%), had a diploma/certificate education level (86.1%), were employed on a full-time permanent basis (76.2%), had 10 or more years of nursing experience (74%), were in their current positions for less than 10 years (64.1%), and were employed in facilities outside of the St. John's region (58.8%). The mean age of the sample was 38.26 {SD ±8.07). Data were collected via a mail-out questionnaire (i.e., Employee Attitudes Survey) between November, 1999 and February, 2000. -- Study findings indicated that acute care nurses were generally negative about the overall impact of health care reforms five to six years post- implementation. Respondents were most negative about the emotional climate of the workplace and the quality of care, and most positive about the importance of reforms. As well, most respondents felt their employers had violated psychological contracts made upon hiring, were generally dissatisfied with their jobs, had slightly low levels of commitment to their organizations, and were uncertain about staying with current employers. -- Most of the reform impact variables (i.e., importance of reforms, emotional climate, practice-related issues, quality of care, safety concerns, and standards of care) depicted significant, positive relationships with intervening attitudes (i.e., psychological contract violation, restructuring satisfaction, job satisfaction, and organizational commitment) and behavioral intentions (i.e., intent to stay). As well, intervening attitudes depicted significant, positive relationships with each other and behavioral intentions. Several personal characteristics (i.e., employment status, work experience, current position tenure, and age) and most staffing issues variables exerted a minimal, but significant, influence on work- related attitudes and behavioral intentions. -- Study findings provided partial support for the major assumptions of the CMBI. Consistent with model predictions different combinations of reform impact variables exerted a direct effect on intermediate outcomes (i.e., psychological contract violation, restructuring satisfaction, job satisfaction, and organizational commitment) and behavioral intentions. As well, most intermediate outcomes were strong predictors of one another and behavioral intentions. As predicted, personal characteristics and staffing issues had limited influence on intermediate outcomes and behavioral intentions. Importantly, study findings did not always support the causal, linear process proposed by the CMBI (i.e., mediating influence of intervening attitudes for the reform impact variables and each other). -- Although study findings supported previous research, generalizability of the results to other acute care nurses is cautioned. There is an obvious need for further research to develop a greater understanding of those aspects of the job and work environment most affected by health care reforms in the acute care sector. Most importantly, the onus is on health care researchers to investigate the long-term impact of system changes on nurses' work-related attitudes and behavioral intentions.

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