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Hospital Restructuring: Impact On Nurses Mediated By Social Support And A Perception Of Challenge

Author: KATHLEEN A. MOORE
Published in JHHSA, Vol. 23 No. 4

Health care has not escaped the economic
rationalization experienced throughout the western world
during the 1990s. In Australian, the introduction of
Casemix and its accompanying budget cuts, has required
major restructuring in hospitals. Change can be stressful
yet a consultative style, beliefs that change is a challenge,
and good social support were proposed as mediators of the
negative effects of change for nurses. This paper presents
data from 201 nurses working in three Australian hospitals.
The results indicate that, despite restructuring changes
during the previous 12 months and their high impact upon
hospital and nurse conditions nurses maintained a strong
sense of professional efficacy. However, these changes and
their impact also predicted nurse burnout. Nurses felt
unable to challenge the actual restructuring changes (eg
closed units/beds) however, they saw working against the
impact of these changes (reduced time, resources) as a
challenge. Management’s communications about the
changes was proposed as a mediator against burnout, but
this hypothesis was not supported. Nurses considered
management to have adopted a top-down approach and
this non-consultative style of communication also predicted
nurse burnout. The restructuring changes, their impact,
and poor communication style, and burnout also predicted nurses’ intention to quit however, a sense of professional
mediated this intent. The implications of the findings are
discussed.

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