Redesigning the jobs of nurses working in six nursing specialities.

Abstract

Job design (redesign) is a management tool to develop and revise the job content of employees in order to improve both their operational efficiency and in turn influence their self-motivation and job satisfaction. One of the most extensively studied theories of job design is the Job Characteristics Model. Developed by Hackman and Oldham (1976, 1980), this theory postulates that the presence of five job characteristics, namely skill variety, task identity, task significance, autonomy and feedback from the job, will influence the psychological states of the employee which in turn will result in a number of behavioural and affective outcomes. Numerous studies have applied this theory in the context of nurses in order to identify the most effective job redesign strategies within their setting. Likewise the aim of this study was to apply the Job Characteristics Model to redesign the jobs of nurses working in six nursing specialities. The targeted population consisted of nurses working in medical, surgical, orthopaedic, paediatric, critical care units and the operating theatres at Saint' Luke's Hospital. A questionnaire based on the Job Diagnostic Survey as devised Hackman and Oldham (1980) was distributed to a convenience sample of nurses working in these wards/units. Moreover, interviews were held with the Departmental Nursing Managers responsible for each speciality in order to validate the results obtained from the survey and to identify practical guidelines for redesigning the nurses' job. Out ofa total of218 questionnaires distributed, 115 (or 53% response rate) were sent by mail. The majority of the respondents were females (67.8%), staff nurses (71.7%) and fall within the 20-29 years of age (43.5%). Out of the individual characteristics, increase in age was positively related with general satisfaction and internal work motivation whilst females seem to have significant higher mean internal work motivation score and mean growth satisfaction score than males. With regards to the question related to the type of organisation of care that they practice, out of those who responded (N=94), the majority of the respondents (70%) described the type of organisation of care that they practise in their wards as patient-allocation. There was a significant difference in the responses obtained between nurses working in different specialities. This may indicate that the type of organisation of care varies between specialities; with the majority of orthopaedic, paediatric and critical care nurses in the sample perceive to practise patient allocation, whilst the majority of the respondents working in medical, surgical and the theatres, feel that their work is more a task-allocated. Moreover, respondents who felt that their organisation of care is patient allocated felt to have a job that was higher in motivating potential than respondents who said that their care is organised around tasks. The applicability of the Job Characteristics Model was tested for the respondents of the study. A positive correlation was found between the job characteristics and the mean psychological states and between the experienced psychological states and almost all mean affective outcomes. With respect to the "moderators" constructs, the only predictor of all experienced psychological scores and all affective outcomes was social satisfaction. Based on the results obtained from the questionnaire and the responses given by the Departmental Nursing Managers a number of recommendations were proposed. Redesigning the job of nurses, especially in medical and surgical wards, by shifting from task allocation to patient allocation was highlighted. However, in order for this change to take place a number of implications were identified including; increasing the nurse to patient ratio, increasing support staff and increasing commitment for change. Other job design strategies proposed consisted of job enlargement especially through job expansion, job rotation and team building. These changes have been proposed in the light of the major reforms that are happening in the public health care service especially due the migration to Mater Dei Hospital, the increasing professionalisation of nurses and the search for a more sustainable and effective service.