Nurses' perceptions of the impact of health care reforms, psychological contract violation, restructuring and general job satisfaction, organization commitment, and intent to stay

Chubbs, Dawn O. (2002) Nurses' perceptions of the impact of health care reforms, psychological contract violation, restructuring and general job satisfaction, organization commitment, and intent to stay. Masters thesis, Memorial University of Newfoundland.

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Abstract

A descriptive, correlational design was used to explore nurses1 perceptions of the impact of health care reforms and work-related attitudes and behavioural intentions four years following the implementation of major restructuring initiatives in the province of Newfoundland and Labrador. The relationships between and among key study variables (i.e., personal characteristics, perceived impact of health care reforms, work-related attitudes, and behavioural intentions) were also examined. A modified version of the integrated causal model. The Conceptual Model of Behavioural Intentions (CMBI), constituted the basic framework for this research study. -- The study sample consisted of 181 registered nurses employed in direct care, administration, and/or education from all health care regions of the province of Newfoundland and Labrador from 1995 to 1999. Data were collected over a five-week period, from June to July 1999, using a mailed-out questionnaire. -- Study findings indicated that nurses were generally more negative than positive about the impact of health care reforms. In comparison to baseline data collected prior to managerial restructuring and downsizing (i.e., in 1995), there was a significant worsening of nurses' attitudes toward the impact of reforms. Respondents were most negative about quality of care, emotional climate, and standards of care. Study findings also demonstrated that respondents were neither totally satisfied nor dissatisfied with most aspects of restructuring, had a slightly low or neutral level of commitment to their organizations, felt that implied psychological contracts with the organization had been violated, and were uncertain about whether they would stay with their current employer. -- Partial support for the major assumptions of the CMBI was provided through the study findings. All of the reform variables (i.e., importance of reforms, emotional climate, practice-related issues, quality of care, safety concerns, and standards of care) were significantly and positively related to the intervening attitudes (i.e., psychological contract violation, restructuring satisfaction, job satisfaction, and organizational commitment) and behavioural intentions (i.e., intent to stay). As well, all of the intervening attitudes depicted moderate to strong, positive correlations with each other and with behavioural intentions. While none of the personal characteristics influenced the intervening attitudes, geographic region of workplace and level of education were found to influence behavioural intentions. -- Study findings failed to support the causal, linear process proposed by the CMBI, where organizational commitment is represented as a key predictor of behavioural intentions. Regression analysis supported general job satisfaction as the key predictor of behavioural intentions. Further, the work-related variable of standards of care emerged as a better predictor of behavioural intentions than intervening variables (i.e., restructuring satisfaction and organizational commitment). These two variables combined to explain 28% of the variance in behavioural intentions (i.e., intent to stay). -- The findings of this study suggest that nurses working within the Newfoundland and Labrador health care system four years after the implementation of major health care reforms are experiencing high levels of dissatisfaction and frustration with conditions in their work environment. While these findings support the work of previous researchers, the generaiizability of results to other nursing populations is limited. Further research is needed to explore how other factors in the changing work environment are impacting nurses' work-related attitudes and behavioural intentions.

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