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Executive Summary
The amount and frequency of change affecting the health care industry makes management of a work environment particularly challenging for nursing leaders
Numerous studies are discussed that explore the influence of organization behavior and issues of staff perception on measurable outcomes such as nurse retention and patient satisfaction.
The authors surveyed staff nurses using instruments that assess their perceptions of (a) autonomy, control, and physician relationships; (b) faith and confidence in peers and managers; (c) emotional exhaustion; (d) job satisfaction; and (e) the quality of patient care.
The findings suggest that perceived autonomy, control, and physician relationships influence the trust, job satisfaction, and perceived quality of patient care.
Professional practice models may provide a means to achieve positive staff perceptions of autonomy and control while managing the realities of flattening organizational structures.
ORGANIZATIONAL CHANGE has been the one enduring phenomenon in health care settings over the past 10 years. As organizations restructured to create more efficient patient care delivery systems, downsizing of programs and staff layoffs were common. The resulting uncertainty in health care work environments has shaken employees' confidence and trust in management. Survivors of organizational downsizing are uncertain about the future direction of the organization and their place within it. Organizational trust is the extent to which employees are willing to ascribe good intentions to, and have confidence in the words and actions of other people (Cook & Wall, 1980). Mistrust results when information is withheld, resources are allocated inconsistently, and when employees have limited support from management. Research has shown that intra-organizational communication is often problematic in downsizing situations. For instance, Cole (1993) found that cross-unit information sharing decreased as a result of decreased interpersonal communication among employees and managers. Others report that downsizing results in increased interpersonal conflict, increased centralization of decision making, and decreases in employee morale and loyalty (Cameron, Freeman, & Mishra, 1993). It is ironic that, at a time when trust is most needed for successful organizational transformation, the changes resulting from restructuring have diminished trust within the work setting.
As the largest group of health care providers in hospitals, nurses have been particularly hard hit by recent downsizing. With the continued threat of layoffs, it is not surprising that nurses' trust in management...