Longitudinal Evaluation of Professional Nursing Practice Redesign

Abstract

The authors describe a 5-year study at a western university teaching hospital that evaluated the effect of organizational redesign on nurse job satisfaction, autonomy, and patient satisfaction. Change in institutional status from public to private authority stimulated this hospital to map a new direction for professional nursing practice, to strengthen autonomy and job satisfaction while improving quality care outcomes. Evaluating redesign changes systematically provided significant longitudinal trended data to guide nurse executive actions. Phase I evaluation, from 1992 to 1995, was a quasiexperimental design comparing pre- and poststudy outcomes of facilitator-led activities on units receiving interventions compared with control units. Of 12 outcome variables measured, 3 were sustained longitudinally into Phase II: nursing job satisfaction using the McCloskey Mueller Satisfaction Scale (MMSS), autonomy using Schutzenhofer's Scale, and patient satisfaction using the Picker Institute survey. Data were trended across units and departments over a 5-year period. Phase I results reported that control units held higher nursing documentation scores than the experimental units. There were no significant differences in aggregate nurse job satisfaction scores. Nurse autonomy scores significantly improved. Other results are reported descriptively. Phase II continued the evaluation, reporting no differences in nurse job satisfaction aggregate scores, a decline in autonomy, and decreased patient satisfaction scores. There were significant differences by units and across departments. Longitudinal evaluation provides significant data to guide nurse executives in an uncertain healthcare environment. Of theoretical interest is the absence of congruence in nurse job satisfaction and autonomy scores, suggesting more independence between these variables than previously reported.