Gail L. Ingersoll

Relationship of organizational culture and readiness for change to employee commitment to the organization.

OBJECTIVES A study was undertaken to determine the relationships among organizational culture, organizational commitment, and organizational readiness in a sample of employees participating in a hospital-wide redesign process. METHODS Employees of an organization undergoing patient-focused redesign were surveyed after a 6-month period of preparation and before the initiation of the new care delivery model. RESULTS Organizational readiness, a variable rarely described in organizational change literature, was the strongest predictor of employee commitment to the organization. Constructive culture also was predictive, but less so than readiness for change. CONCLUSIONS Additional research is needed to clarify how an organizations history and culture of change contribute to employee willingness to work for the goals of the organization. Findings suggest that when change is seen as a positive characteristic of the environment, employees are more likely to commit to the work of the institution.

Using organizational mission, vision, and values to guide professional practice model development and measurement of nurse performance

An organizations mission, vision, and values statements are the guiding forces behind the institutions administrative strategic planning and performance assessment activities. Linking nursing professional practice model components and performance evaluation criteria with each of these foundational documents assures that their values, beliefs, and intentions are evident in daily work life.

A time comparison study of the New York State Safety Belt Use Law utilizing hospital admission and police accident report information

New York state enacted the first safety belt use law in the United States in 1984. We evaluated the effects of the law by reviewing all hospital admissions from motor vehicle crashes in Monroe County, New York. We compared admissions for the 18 months prior to the effective date of the law with those for the 18 months after the law became effective. Police accident reports and hospital records were coupled and intensively reviewed. Motorcyclists, pedestrians, and bicyclists (bicycle collisions with motor vehicles) became controls for the study. Seat belt usage was determined from police and hospital record information. Analysis of the data revealed that safety belt use among patients hospitalized because of motor vehicle accidents increased from 11.2% before the law became effective to 53% after the law became effective. Hospital admissions decreased 11.9% among motor vehicle occupants and increased 2.6% among controls. The ISS decreased from 16.01 to 14.55 for motor vehicle occupants and increased from 14.77 to 15.11 among controls. Among subjects all injuries decreased except injuries of the spine and abdomen, which increased in the postlaw period.

Managed-care research, Part 1: Defining the domain.

New research opportunities are arising in response to the changes associated with care delivery provided in managed-care environments. A review of the managed-care literature suggests five characteristics that are associated with the care delivery models currently in place. Each of these components needs investigation to determine which of them contribute to cost reductions and care delivery outcomes seen.

Nursing job satisfaction, certification and healthcare-associated infections in critical care

OBJECTIVE The purpose of this study was to examine the relationship between nursing job satisfaction and healthcare-associated infections (HAIs) in adult critical care. METHODS Multilevel modelling was used to examine the relationship between nursing job satisfaction and two HAIs, ventilator-associated pneumonia (VAP) and central-line associated bloodstream infections (CLABSI). RESULTS Units with nurses that reported satisfaction with organisational policies were associated with a 6.08 decrease in VAP (p=0.013) and units with nurses reporting favourable perception of task requirements were associated with a 7.02 decrease in VAP (.014). Positive perception of organisational policies was associated with lower rates of CLABSI (p=0.002). Unexpected findings include a positive relationship between perception of pay and autonomy and CLABSI as well as perception of interactions and VAP. Units with a higher proportion of Critical Care Registered Nurse (CCRN) certified nurses were associated with lower rates of both CLABSI (p<0.001) and VAP (p=0.037). CONCLUSION This study provides preliminary evidence to support the relationship between nursing job satisfaction and HAIs in critical care, although some relationships were counterintuitive. A secondary finding included significant relationships between CCRN certified nurses and HAIs.

Transforming the organizational culture of a school of nursing through innovative program development.

This article illustrates how a grant designed to promote new program development provided a vehicle for organizational transformation. The collaboration surrounding this initiative created a common focus within the school that more effectively channeled its resources and resulted in an unprecedented level of scholarly achievement and recognition. Faculty leveraged the success of this initial grant to procure additional funding for related projects. The importance of partnerships and teamwork were two valuable lessons learned. We believe that our experience is replicable in other schools of nursing interested in organizational transformation. Gibson and Barsades model of managed change guided the projects implementation and evaluation processes. Recommendations for engaging faculty, gaining support, and developing a collaborative network are discussed in the article, with findings from a stakeholder-focused evaluation demonstrating new program goal achievement as well as the transformative changes that occurred in the organizational culture. A focused, theory-derived program plan, with comprehensive process and outcome evaluation components resulted in a major transformation of one school of nursing. Unanticipated outcomes included renewed synergy among faculty; the development of a preferred vision for the future; scholarly collaboration around a central theme that effectively channeled limited resources and dramatically increased productivity; increased regional and national recognition; and the creation of regional, national, and international partnerships.

Implementation of a professional practice model for nursing in a rural hospital.

Growing concern about rural hospitals and the health of rural citizens highlight the need for high quality, progressive nursing care. To address this concern, several program changes to improve patient and organizational outcomes were made in one rural hospital; implementation success varied. Hospital culture and changes occurring within the health care environment affected the change process.

Managed-care research, Part 2: Researching the domain.

A review of research pertaining to managed care suggests that little information is known about the impact of the components of managed care on care delivery outcomes. Characteristics of managed-care systems rarely are considered, resulting in uncertainty and confusion about which of the domain components of managed care have contributed to the outcomes seen. In part 1 (JONA November 1999) of this two-part series, we described how the shift to managed care has affected healthcare organizations and healthcare providers. We also identified several research questions relevant to the five domain components of managed care. In this article, we review the research literature concerning managed care and identify where research deficiencies exist within the domain.

Recruiting Retaining, and Advancing Careers for Employees From Underrepresented Groups

In response to the need to increase the number of persons from underrepresented groups working in acute care settings, 2 hospitals in upstate New York implemented a multidimensional workforce development project targeting existing and new employees meeting federally defined poverty levels. The authors describe the project and its outcomes, which surpassed original expectations.