Hospital restructuring: impact on nurses mediated by social support and a perception of challenge

Health care has not escaped the economic rationalization experienced throughout the western world during the 1990s. In Australia, the introduction of Casemix and its accompanying budget cuts has required major restructuring in hospitals. Change can be stressful yet a consultative style, beliefs that change in challenging, and good support were proposed as mediators of the negative effects of change for nurses. This article presents data from 201 nurses working in three Australian hospitals. The results indicate that, despite restructuring changes during the previous 12 months and their high impact upon hospital and nurse conditions, nurses maintained a strong sense of professional efficacy. However, these changes and their impact also predicted nurse burnout. Nurses felt unable to challenge the actual restructuring changes (closed units/beds) however and saw working against the impact of these changes (reduced time, resources) as a challenge. Management's communications about the changes was proposed as a mediator against burnout but this hypothesis was not supported. Nurses considered management to have adopted a top-down approach and this non-consultative style of communication also predicted nurse burnout. The restructuring changes, their impact, and poor communication style, and burnout also predicted nurses' intentions to quit; however, a sense of professionalism mediated this intent. The implications of the findings are discussed.