The nursing workforce in transition: a qualitative study on the structure of the nursing work environment and level of commitment

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Aim and research questions: to provide a diagnosis of the structural characteristics of the nursing work environment in a Dutch hospital. Three research questions: (1) What is the perceived level of commitment among nurses? (2) What are the actual values of the structural parameters of the nursing departments in the selected hospital? (3) To what extent do the actual structures of the nursing departments enable high commitment among nurses? Background: The nursing work environment is an important element in nursing care delivery and appears to be a strong predictor of both patient and nurse outcomes. However, knowledge about how the quality of the nursing work environment is related to characteristics in the organizational structure and employee commitment seems scarce. Socio-technical design principles developed by De Sitter enable analysis and diagnosis of organizational structures to eventually improve the level of employee commitment. Design and methods: This qualitative practice-oriented research consisted of 15 semi-structured interviews with nurses and managers. Data were collected from July to September 2020 and convenience sampling was used for the selection of the interviewees. A deductive type of reasoning is used and template analysis was conducted to analyze the organizational structure and level of commitment. Results: On both the production and control structure the parameter values were high, but the values are somewhat higher on the control structures. Due to the high values, nurses have to work in complex network with a high variability of tasks with many dependencies from other disciplines and departments. In addition, nurses were not involved in strategic design processes and in many departments support processes were allocated outside the teams. The perceived level of commitment was generally high and nurses were happy with their employer. However, there was a need for more transparency and involvement from the higher management. Conclusions and implications: Flexibility of the organization is under pressure and the high parameter values suggest that the organization is less able to attenuate disturbances. Nurses were happy with their employer and were motivated to be involved in regulatory processes. However, lack of shared decision-making and recognition for nursing work sometimes made this impossible which jeopardizes the level of commitment. These findings can be used for further (re)design of a healthy nursing work environment.
Faculteit der Managementwetenschappen