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Longitudinal evaluation of professional nursing practice redesign.
1Department of Patient Services, University of Colorado Hospital, USA. mary.krugman@uhcolorado.edu
The Journal of Nursing Administration
|May 20, 1999
Summary
Organizational redesign at a teaching hospital did not improve nurse job satisfaction but increased autonomy in Phase I. However, autonomy declined and patient satisfaction decreased in Phase II.
Area of Science:
- Healthcare Management
- Nursing Administration
- Organizational Psychology
Background:
- A western university teaching hospital transitioned from public to private status, necessitating a strategic shift in professional nursing practice.
- The initiative aimed to enhance nurse autonomy and job satisfaction while improving patient care quality.
- Systematic evaluation of organizational redesign provided longitudinal data to inform nursing executive decisions.
Purpose of the Study:
- To evaluate the impact of organizational redesign on nurse job satisfaction, autonomy, and patient satisfaction over a 5-year period.
- To analyze longitudinal trends in key outcome variables following a significant institutional change.
- To provide data-driven insights for nurse executives in a dynamic healthcare landscape.
Main Methods:
- A quasi-experimental design was employed, comparing intervention units with control units from 1992 to 1995 (Phase I).
- Key outcome variables measured included nursing job satisfaction (McCloskey Mueller Satisfaction Scale), autonomy (Schutzenhofer's Scale), and patient satisfaction (Picker Institute survey).
- Data were trended longitudinally across units and departments over five years, with continued evaluation into Phase II.
Main Results:
- Phase I showed no significant difference in aggregate nurse job satisfaction but a significant improvement in nurse autonomy.
- Control units demonstrated higher nursing documentation scores than experimental units in Phase I.
- Phase II revealed no change in aggregate nurse job satisfaction, a decline in autonomy, and decreased patient satisfaction, with significant variations across units and departments.
Conclusions:
- Longitudinal evaluation offers valuable data for nurse executives navigating healthcare uncertainties.
- The study observed a lack of congruence between nurse job satisfaction and autonomy scores, suggesting greater independence between these variables than previously understood.
- Findings highlight the complex and variable effects of organizational redesign on nursing outcomes.