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By Linda H. Aiken, PhD, RN, FRCN, FAAN, Donna S. Havens, PhD, RN, and Douglas M. Sloane, PhD - page 5 / 10

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Organizational Characteristics of the Two Groups of Hospitals

Average scale score from the NWI-R

3.01

2.86

2.95

2.65

    • 3.03

      ANCC magnet hospitals

    • 2.98

      Original magnet hospitals

Nurses’

Nurses’ control

Nurse relations

autonomy

over the practice

with physicians

setting

T-tests for mean differences were 6.2 (p < 0.001), 12.3 (p < 0.001), and 1.6 (p = 0.10) for nurses’ autonomy, control over the practice setting, and relations with physicians, respectively. Standard errors associated with the estimated means are approximately 0.02 points.

NWI-R to measure the extent of nurse autonomy, nurses’ control over their practice environment, and the quality of nurses’ relations with physicians.18 Our previous research showed that nurses’ clinical work context in the original magnet hospitals was characterized by significantly greater autonomy, more control over the practice setting, and better relations with physicians when compared with nurses’ practice environment in nonmagnet hospi- tals.9, 12 In the current study, however, high levels of nurse autonomy and nurse control over the practice setting were more characteristic of ANCC magnet hospitals than of the original magnet hospitals, and these differences were statistically significant (see Organizational Characteristics of the Two Groups of Hospitals, above). By control over the practice setting, we mean that nurses had sufficient intraor- ganizational status to influence others and to deploy resources when necessary for good patient care. Nurses’ relationships with physicians were similar in the two groups of magnet hospitals.

The positive conditions for nursing practice in ANCC magnet hospitals were further apparent when we considered a few of the items from the NWI-R. Nurses’ Perceptions of the Practice Envi- ronment in the Two Groups of Hospitals (page 31) shows the percentage of nurses agreeing that certain positive characteristics listed in our survey exist in their institutions (for example, having a powerful chief nursing executive). Nurses in ANCC magnet hospitals were substantially and significantly more likely than nurses in the original magnet hospitals to report that their units have adequate support services and enough RNs to provide high-quality care. They also reported having adequate time to discuss patient problems with other nurses. These findings are con-

sistent with the higher reported nurse-to-patient ratios in ANCC magnet hospitals. Nurses in ANCC magnet hospitals also reported (in greater relative numbers) that they control their own practice, par- ticipate in policy decisions, have a powerful chief nursing executive, and that the contributions they make are greatly appreciated. In responding to these survey items and a majority of the full set of items on the NWI-R, the nurses in ANCC magnet hospitals rated their practice environments more highly than did nurses in the original magnet hospitals. Here again, we note that our previous research docu- mented that nurses in the original magnet hospitals rated their practice environments significantly more favorably than did nurses in nonmagnet hospitals.

Burnout and job satisfaction. Differences in staffing and practice environments were associated with differences in nurse outcomes in the two groups. Nurses in ANCC magnet hospitals were significantly less likely than nurses in the original magnet hospitals to report feeling burned out, emo- tionally drained, or frustrated by their work (see Nurse Burnout in the Two Groups of Hospitals, page 31). Moreover, when nurses were asked how satisfied they were with their present job, those in ANCC magnet hospitals answered decidedly differ- ently from those in the original magnet hospitals. Although half the nurses in both settings reported being moderately satisfied, nurses in the ANCC magnet hospitals were considerably less likely than those in original magnet hospitals to report being dissatisfied (16% vs. 28%, respectively) and were more likely to report being very satisfied (33 % vs. 22%, respectively) (see Nurses’ Job Satisfaction in the Two Groups of Hospitals, page 32).

Quality of care. In previous research, we docu-

JONA • Vol. 39, No. 7/8 • July/August Supplement 2009

S9

Copyright @ 2009 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

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