Good literature review on work place dynamics: implications for nursing care in health care settings

Introduction

Industrial/Organizational psychology is an applied science dealing with psychology of ‘ people at work’. (Kalat 2002). The workplace dynamics comprise of both tangible and non-tangible elements, both of which impact on employee satisfaction. Satisfied employees tend to be more committed and enthusiastic about their work. Moreover, employee satisfaction and dedication is contingent on a number of closely related variables such as, employee engagement, empowerment, the perceived (organizational) support structures as well as the organization’s commitment to employee welfare. Employees feel empowered when they have more opportunities for interacting with colleagues, a certain level of decision making authority and are accorded a fair treatment by the employers.

Work place dynamics in health care settings

As against phenomenon like motivation and satisfaction in the work place, employee engagement and empowerment connote an element of dynamism in the employer-employee relationship. (Kalat; 2002) Medical care is a complex undertaking requiring inter-disciplinary collaboration. In large medical institutional settings, the functioning of nursing staff is critical for effective delivery of care besides affecting patient’s perception of the quality of care. Due to the inherent complexities and stressful nature of the job, maintaining an optimal nursing care environment is challenge for health administrators. (Clancy, 2011)
This work provides a brief overview of the range of factors affecting nursing staff performance in medical settings. Purposeful sampling of three recent peer reviewed studies was done with the objective to demonstrate that a wide gamut of diverse yet closely interrelated factors affect nursing performance. Two of the selected studies were conducted in Europe (one representing hospital settings in Belgium and 1 covering a large sample of nursing homes in Finland). The third study was conducted in a University hospital in Iran. The focus of the review is to illustrate the myriad ways in which human resource management can affect outcomes in institutional health care settings.

Influences on nursing performance

A cross sectional survey covering 120 nurses across six Belgian hospitals was conducted by Bogaert et al. (2014) Specifically, the study investigated the effect of workplace dynamics like management practices, inter-personnel relationships and a perceived feeling of empowerment (among nurses) on health care outcomes. Translated version of the Revised Nursing Work Index (NWI-R), was used to elucidate clinical setting variables. Further, instruments like Utrecht Work Engagement Scale (UWES) and 4 point Likert scale was used to document respondent responses. Aspects like ‘ decision latitude’ and ‘ social capital’ were adjusted by using modeling techniques. Face validity of the data and complex analyses was ascertained by various fit measures by comparing study population with earlier studies.
Despite the limitations of the study (self reported data, the study design allowed for measurement of association rather than causative linkages), it underscores the value of institutionalizing staff support mechanisms with optimal engagement of administrative, managerial and medical staff. Moreover it reveals robust linkages between appropriately delegated decision-making authority vested in nursing staff and their job satisfaction and retention.
A descriptive analytical study conducted in an Iranian hospital further reinforced the value of collaborative working environment for improving employee productivity and job satisfaction. (Gorji et al. 2014) The study population comprised of a total of one hundred and twenty three emergency nurses in General Hospitals of Qom, Iran. Study instrument was the ‘ Perceived Organizational Support and Job Involvement Questionnaire’. SPSS was used to calculate descriptive statistics and conduct correlation tests. The authors reported average levels of mean scores for perceived organizational support and job involvement (146/12 and 35/38, respectively). More importantly, the data suggested strong correlation between perceived organizational support and duration of service tenure. Similarly, strong relation was demonstrated between ‘ job involvement and perceived organizational support’. The study throws clear pointers that strong organizational support, mutual respect and opportunities for career advancement are keys to nurse performance in hospital settings.
The third study selected goes further to show how good work place dynamics go much beyond employee satisfaction and actually translate into positive consumer experience. A recently published study by Kvist T et al. in Finland reveals new facets of workplace dynamics. (2014) Investigators in this study involving 1047 female staff in 179 nursing homes, sought to explore the interplay between management style, organizational commitment, and job satisfaction. The data suggests that a perceived sense of justice in the organization may as well compensate for the lack of overt organization commitment to staff welfare.
In this large cross-sectional study female health staff was administered a questionnaire to assess their perceived sense of organizational justice. Other variables evaluating job satisfaction and the commitment of employers were also assessed. For-profit sheltered homes were generally associated with poor job satisfaction and organizational commitment to staff welfare.
After accounting for differences in age and case characteristics, analysis of covariance showed that organizational commitment and job satisfaction levels tended to be low in for-profit sheltered homes when justice levels were perceived to be low. However, when justice levels were high, for-profit sheltered homes did not differ from other ownership types. Similarly, organizational justice acted to counterbalance the negative effect of low commitment resulting from low staffing levels.

Conclusion

This review supports the case for better human resource practices and management in complex workplaces like hospitals and nursing homes. The selection of the studies took into account the depth and range of issues in relation to nursing staff in both developed and developing country health care settings. In depth manifestation of the variables of interest like employee engagement, employee empowerment and workplace dynamics was given precedence over representativeness of the studies. There were some methodological weaknesses that did not permit causal attributions in the three studies. However, the selected studies have face validity and effectively convey the critical importance of employee satisfaction and collaborative working environment in modern health care settings. Being a critical link in delivering inpatient services institutional mechanisms should promote fair treatment of nurses by managers. Better engagement and empowerment of nurses can go a long way in promoting a positive working environment in health care facilities.

References

Clancy, C. M. (2011). Patient Engagement in Health Care. Health Services Research, 46(2), 389–393. doi: 10. 1111/j. 1475-6773. 2011. 01254. x
Kalat, J. W. (2002). Social Psychology. In Introduction to psychology (6th Ed., pp. 533-543). Pacific Grove, CA: Wadsworth-Thomson Learning.
Kvist T, Voutilainen A,  Mäntynen R,  Vehviläinen-Julkunen K (2014). The relationship between patients’ perceptions of care quality and three factors: nursing staff job satisfaction, organizational  characteristics and patient age. BMC Health Serv Res. 2014 Oct 18; 14: 466. doi: 10. 1186/1472-6963-14-466.
Van Bogaert, P., van Heusden, D., Timmermans, O., & Franck, E. (2014). Nurse work engagement impacts job outcome and nurse-assessed quality of care: Model testing with nurse practice environment and nurse work characteristics as predictors. Frontiers in Psychology, 5, 1261. doi: 10. 3389/fpsyg. 2014. 01261
Hassan Abolghasem Gorji, Manal Etemadi, and Fatemeh Hosein (2014). Perceived organizational support and job involvement in the Iranian health care system: A case study of emergency room nurses in general hospitals. J Educ Health Promot. 2014; 3: 58. Published online Jun 23, 2014. doi: 10. 4103/2277-9531. 134760.