Employee response to major organizational redesign

Registered nurses' experiences of organizational change in acute care settings: a systematic review protocol

REVIEW OBJECTIVE

The objective of this review is to explore how registered nurses working in acute care settings experience organizational change.

Nurses' experiences of working in organizations undergoing restructuring: A metasynthesis of qualitative research studies

BACKGROUND

Health care organizations worldwide undergo continual reconfiguration and structural changes in order to optimize the use of resources, reduce costs, and improve the quality of treatment.

OBJECTIVE

The objective of this study was to synthesize qualitative studies of how nurses experience working in organizations undergoing structural changes.

DESIGN

The review is designed as a metasynthesis and follows the guidelines put forth by Sandelowski and Barroso for synthesizing qualitative research.

DATA SOURCES

From January to April 2015, literature searches were conducted in the CINAHL, PubMed, ProQuest, and Web of Science databases for the period from 1994 to 2014.

REVIEW METHODS

A total of 762 articles were found and screened, 12 of which were included in the review after being appraised using a specially designed reading guide. The inclusion criteria were qualitative studies in English, German, Norwegian, Swedish, or Danish on nurses' experiences with being employed in organizations undergoing structural changes. The data were then analyzed in a metasummary and metasynthesis.

RESULTS

Four overall categories that illustrate how nurses experience working in organizations undergoing structural changes were identified: nursing management, emotional responses, nursing work, and colleagues. Generally, nurses seemed to describe their experiences working in organizations undergoing structural changes in a negative way, as all of the included articles reported that nurses experience an increased workload due to restructuring. However, some of the articles reported that nurses also experience a certain joy associated with the nursing work despite the negative consequences of the structural changes.

CONCLUSIONS

The findings can be seen as a paradox because former research has shown that an increased workload reduces the pleasure in working. Further research on this topic is needed to ensure a better working environment for nurses.

Teaching and Community Hospital Work Environments

The Institute of Medicine report suggests that nursing work environments experience threats to patient safety related to organizational management and workforce deployment practices, work design, and organizational culture. Organizational factors contribute to nursing and potentially patient outcomes, yet few studies have examined the differences in practices perceived by nurses employed in different settings. Nurses from 16 medical and surgical units in eight randomly selected acute care hospitals representing teaching and community organizations participated in this project. Nurses working in teaching hospitals reported lower levels of role tension, yet their perceptions of the quality of work, the work environment, nursing unit leadership, quality of care, and levels of job stress and job satisfaction were higher than their colleagues in the community sites. This study highlights some important differences between teaching and community hospitals that can inform nurse executives and policy makers of the unique work–life issues for different groups of nurses.

Understanding the barriers to physician error reporting and disclosure: a systemic approach to a systemic problem

INTRODUCTION

The issues of medical errors and medical malpractice have stimulated significant interest in establishing transparency in health care, in other words, ensuring that medical professionals formally report medical errors and disclose related outcomes to patients and families. However, research has amply shown that transparency is not a universal practice among physicians.

METHODS

A review of the literature was carried out using the search terms "transparency," "patient safety," "disclosure," "medical error," "error reporting," "medical malpractice," "doctor-patient relationship," and "physician" to find articles describing physician barriers to transparency.

RESULTS

The current literature underscores that a complex Web of factors influence physician reluctance to engage in transparency. Specifically, 4 domains of barriers emerged from this analysis: intrapersonal, interpersonal, institutional, and societal.

CONCLUSION

Transparency initiatives will require vigorous, interdisciplinary efforts to address the systemic and pervasive nature of the problem. Several ethical and social-psychological barriers suggest that medical schools and hospitals should collaborate to establish continuity in education and ensure that knowledge acquired in early education is transferred into long-term learning. At the institutional level, practical and cultural barriers suggest the creation of supportive learning environments and private discussion forums where physicians can seek moral support in the aftermath of an error. To overcome resistance to culture transformation, incremental change should be considered, for example, replacing arcane transparency policies and complex reporting mechanisms with clear, user-friendly guidelines.

Clients' initiatives and caregivers' responses in the organizational dynamics of care delivery

Our aim with this article is to develop a typology for the analysis of client-caregiver encounters in health care. We first observed client-caregiver interactions in the homes of home care clients and during the care processes of surgical patients. We then conducted a data-driven analysis to identify the clients' initiatives and the degree of engagement in the responses they received. The clients shaped their care by commenting on, questioning, ensuring, and enriching their care. The responses from the caregivers consisted of neutral acceptance, disregard, and shared expansive development of the clients' initiatives. The typology developed from these will be a tool to widen our understanding of the complex interactions in care delivery and of the different conceptualizations of care that actors hold. In future studies this typology will help in the analysis of the organizational dynamics of health care delivery.

"We inform the experience of health": perspectives on professionalism in nursing self-employment

Nursing work has evolved tremendously over the last century, raising ongoing questions about nursing's professional status. Through various strategies, professionalization in nursing has to some extent been accomplished, although autonomy over nursing practice has been elusive. This is especially so in the contemporary health care system, in which managerial control is emphasized and physician dominance continues. In response to professional constraints in traditional work settings, nursing self-employment is growing. In this study I used focused ethnography to explore the professional experiences of Canadian self-employed nurses and to reconsider nursing knowledge, ethics, and professionalism in this unique context. Despite the barriers they faced, these nurses offered a perspective on nursing professionalism that transcends classic professional traits, showing how the concept of professionalism can be invoked not as a way to "prove" status but as a way to describe a sense of commitment and the contribution to societal well-being.

Occupational musculoskeletal and mental health: Significance of rationalization and opportunities to create sustainable production systems - A systematic review

This literature review aims to identify occupational musculoskeletal and mental health effects of production system rationalization as well as organizational-level measures that may improve health outcome ("modifiers" in this review). A short review of the effect of ergonomic interventions is included as background and rationalization is discussed as a theoretical concept. Indicator variables for occupational musculoskeletal and mental health and related risk factors are presented. Variables with a generalized format were allowed in the literature searches (e.g., job satisfaction and absenteeism were accepted as risk factor and health indicator, respectively), suitable for the research fields of work sociology, organization science, human resource management (HRM) and economics research. One hundred and sixty-two studies of rationalization effects on health and risk factors and 72 organization-level modifier results were accepted into the final database. Entries were sorted by rationalization strategy and work life sector, and trends in outcome (positive, mixed, no effect, or negative effect on health and risk factors) were determined. Rationalizations have a dominant negative effect on health and risk factors (57% negative, 19% positive); the most negative effects were found for downsizing and restructuring rationalizations in general (71 studies negative, 13 positive) and for the health care sector in particular (36 studies negative, 2 positive). The rationalization strategy High Performance Work System (HPWS) was associated with the highest fraction positive outcome studies (6 of 10 studies). Other rationalization strategies (lean practices, parallel vs. serial production and mechanization level) reported intermediate results, in part dependent on work life sector, but also on the year when studies were carried out. Worker participation, resonant management style, information, support, group autonomy and procedural justice were modifiers with favourable influence on outcome. It is concluded that production system rationalization represents a pervasive work life intervention without a primary occupational health focus. It has considerable and mostly negative influence on worker health, but this can be reduced by attention to modifiers. The results create a basis for new priorities in ergonomic intervention research.

Influence of workplace demands on nurses' perception of patient safety

Patient safety is an ongoing challenge in the design and delivery of health-care services. As registered nurses play an integral role in patient safety, further examination of the link between nursing work and patient safety is warranted. The present study examines the relationship between nurses' perceptions of job demands and nurses' perceptions of patient safety. Structural equation modeling is used to analyze the data collected from a survey of 430 registered nurses at two community hospitals in the USA. As hypothesized, nurses' perception of patient safety decreases as the job demands increase. The level of personal control over practice directly affects nurses' perception of the ability to assure patient well-being. Nurses who work full-time and are highly educated have a decreased perception of patient safety, as well. The significant relationship between job demands and patient safety confirms that nurses make a connection between their working conditions and the ability to deliver safe care.

Voluntary turnover among nurses working in Kuwaiti hospitals

BACKGROUND

Voluntary turnover rates are high among staff nurses working in Kuwaiti hospitals. It is a major problem, costly and it is presumed to impact on the quality of nursing care delivered.

AIMS

The two aims of this study were to (1) find out if nurses' resignations in Kuwaiti hospitals could be ascribed to failure in the recruitment process and (2) examine the feelings of nurses who resigned.

METHODS

Two sets of exit interviews with 60 nurses who had resigned were conducted.

RESULTS

No evidence emerged that any false information or misleading information was provided except for the salary adjustments. The real insight lay in what might not have been said in the recruitment interviews. While feelings of discontent emerged in the interviews relating to the loss of income, the greatest source of complaint related to the failure of managers to solve the evident problems.

CONCLUSIONS

High rates of voluntary turnover require more attention from administrators and policy makers because of its potential consequences in terms of the quality of nursing care delivered. Implications for nursing management This paper identifies many causes of nurses' voluntary turnover. It also shows the need for nursing managers to explore these causes and suggests successful strategies for recruitment and retention practices and policies.

Relationship of RN Role Responsibilities to Job Satisfaction

This study tested a delivery of care model that maximizes the role of the registered nurse in rehabilitation by providing care based on the scope of practice exclusive to the registered nurse and supplementing that practice with licensed and non-licensed support personnel. The model of care was developed as a response to the nursing shortage. The model attempts to best utilize the limited resource of registered nurse staffing. The nursing shortage is a national and global public health problem that is expected to intensify as the nursing population ages. The hypothesis was that when the rehabilitation registered nurse is allowed to function in areas for which they are exclusively trained, job satisfaction will significantly improve as long as there is sufficient support staff to provide for non-essential functions. The conceptual model for the study is based on Donabedian's model which demonstrates the relationship between satisfaction and patient outcomes. Results indicated that after an initial stage of discomfort resulting from a change in role expectations nurse satisfaction improved when registered nurses functioned within their exclusive scope of practice.

Using Lewin's force field analysis in implementing a nursing information system

Change is a regular occurrence in the healthcare environment. The computerization of nursing systems is one aspect of the changes taking place in the information revolution. As a result, nurses have widely varying attitudes toward computers and change in the workplace. To transition the nursing team effectively from one system to another, the nurse informaticist must be aware of the factors that encourage and those that impede the change. Strategies must be developed to assist nurses in moving forward with the transition. This article presents a theoretical discussion of how Lewin's Force Field Analysis Model could be applied in the practice setting to implement a nursing information system successfully.

Clinical nurses' response to an environment of health care reform and organizational restructuring

BACKGROUND

Clinical nurses at the crux of health care service delivery experienced radical organizational restructuring during the 1990s in Australia. Despite the implications organizational restructuring has for patient care delivery, clinical nurses continue to lack presence in policy decision-making processes.

AIMS

The aim of this paper is to provide an explanation for clinicians' undisputed acceptance of change. This will be performed by examining the process of organizational restructuring across three analytical levels -- the macro, meso and micro; identifying the consequences of restructuring for clinical nurses' performance; and evaluating organizational restructuring using a micro-political theoretical framework.

FINDINGS

Utilizing Hoyle's (1988) micro-political theory, it would appear that clinical nurses are functioning within a paradigm of maintenance. In order to provide quality patient care, effective resource use and preservation of the status quo are prioritized.

CONCLUSION

Successful change outcomes are dependent on clinical nurses' performance. Whether nurses are politically inactive as a result of poor communication, as a consequence of the structural change environment or because their energy is devoted to achieving a balance between organizational imperatives and their personal commitment to patient care requires further investigation.

Trends in adverse events in hospitalized patients

The Institute of Medicine reported unacceptably high rates of medical error but did not identify whether this is a growing or a stabilized problem. This study used longitudinal data from all acute care hospitals in Pennsylvania to track rates of acuity-adjusted iatrogenic atelectasis, cardiac complications, complications in general, decubitus ulcers, gangrenous ulcers, falls, hemorrhage, mortality, penumonia, post-procedural infections, treatment complications, and urinary tract infections, from 1994 to 1997. More than one-half of these adverse events increased during this time. It is important to identify the causes and correct trends in hospital systems that may produce an increase in preventable adverse events.