Assessing the impact of reengineering on nursing

This study assessed the impact of organizational re-engineering on nursing in a large community teaching hospital in the Midwest, using an observational repeated measures design. Time, clinical unit, and nurse characteristics were incorporated as covariates. A second objective was to compare two sampling approaches for robustness and efficiency.

Economic and technological changes are having an enormous impact on acute care hospitals, which often attempt to adapt by re-engineering or restructuring their systems. Despite the difficulty of conducting research in a constantly changing setting, it is imperative that nursing evaluate its reactions and contributions to new delivery models.

During a hospital-wide reorganization, mail surveys were conducted to assess nurses' perceptions of their authority and autonomy in a new nursing model, commitment to a new philosophy (patient-focused care), and satisfaction with their ability to deliver care. To validate the findings, patient satisfaction was evaluated through a survey of 227 hospitalized patients. Over a 1-year period, two sampling approaches were used: three independent samples of nurses were surveyed at three dates, and a panel of nurses were surveyed repeatedly over the same three dates. Response rates were approximately 45% across the independent samples and 67% for the panel.

Comparison of nursing units that underwent re-engineering and units in which re-engineering was delayed showed no obvious effects. Data also showed that the estimates of effects of re-engineering were not subject to confounding from nursing unit, date, or nurses' experience, although there was evidence that the measures were sensitive to these covariates. No biases were found due to the two sampling schemes, yet the panel data was three to five times more efficient--that is, they produced more information--than the data from the independent samples.

This study reinforces the need to build evaluation research into organizational activities such as re-engineering. It also argues for the commitment of resources to organizational research so that information valuable to nursing and the healthcare system is not lost.