The impact of health care reforms on community health nurses' attitudes

Morgan, Natalie D. G. (2002) The impact of health care reforms on community health nurses' attitudes. Masters thesis, Memorial University of Newfoundland.

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Abstract

A descriptive correlational design was used to investigate community health nurses' perceptions of the impact of health care reforms and their work-related attitudes and behavioral intentions following a period of regionalization of community health services in Newfoundland and Labrador. The relationships between and among the key study variables (i.e., personal characteristics and staffing issues, perceived 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 sample consisted of 170 community health nurses (i.e., 151 staff nurses and 19 managers) working with regional health and community services boards. A response rate of 52.8% was achieved. The majority of respondents were female (98.2%) and ranged in age from 25 to 57 years, (M¹ = 40.66, SD ± 7.78). Data collection occurred from October to December, 2000 using a mailed- out questionnaire (i.e., Employee Attitudes Survey). -- Study findings indicated that community health nurses were neither totally negative nor positive about the overall impact of health care reforms. Respondents were most negative about the quality of care, emotional climate of the workplace, and safety concerns, and were most positive about the importance of reforms, standards of care, and practice-related issues. Respondents were divided on whether or not they believed that employers had violated psychological contracts, were neither completely satisfied nor dissatisfied with managerial support and interdisciplinary relations since restructuring, were slightly satisfied with their jobs, were slightly committed to their organizations, and were uncertain about whether or not they would stay with current employers. Study findings also demonstrated that community health nurses in management positions were significantly more positive about practice- related issues and standards of care, less likely to perceive psychological contract violations, and more committed to their organizations than staff nurses. -- Study findings provided partial support for the major assumptions of the CMBI. All of the reform impact 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 violations, restructuring satisfaction, job satisfaction, and organizational commitment) and behavioral intentions (i.e., intent to stay). As well, all of the intervening attitudes depicted moderate to strong, positive correlations with each other and with behavioral intentions. With the exception of job level (i.e., managers vs. staff nurses), most personal characteristics and staffing issues variables did not influence the intervening attitudes. However, employment status and age were found to influence behavioral intentions. -- Contrary to the causal, linear process proposed by the CMBI, study findings failed to confirm organizational commitment as a key predictor of behavioral intentions. During regression analysis, emotional climate surfaced as the key predictor of behavioral intentions. Also, personal characteristics (i.e., age and employment status) emerged as better predictors of behavioral intentions than some intervening attitudes (i.e., restructuring satisfaction and organizational commitment). More specifically, emotional climate of the workplace, job satisfaction, psychological contract violation, age, and employment status combined to explain 53.4% of the variance in behavioral intentions. Similarly, emotional climate surfaced as the best predictor for all intermediate outcomes (i.e., intervening attitudes), with the exception of restructuring satisfaction. -- The results of this study support some of the findings from previous research and suggest that health care reforms can have both negative and positive consequences for community health nurses, and their work-related attitudes and behavioral intentions. However, due to study limitations, generalizability of the findings to other community health nurse populations is cautioned. There is a need for further investigation in order to develop a greater insight into other factors possibly influencing community health nurses' work- related attitudes and behavioral intentions.

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