Background
Study aims
Literature review
Theoretical perspective on institutional differences
Underlying mediators of institutional differences | Associated theories and mechanisms | Derived hypotheses |
---|---|---|
Organisational size | Regulation hypothesis: Due to higher levels of standardisation, regulation and formalisation that is associated with larger organisations [67], we expect that nurses working in larger types of organisations (i.e. hospitals) are less likely to experience autonomous and participative work than nurses working in smaller organisations (e.g. nursing homes, home care services) [69], which might also increase level of work strain and lower job satisfaction and organisational commitment [70, 71]. Resource hypothesis: Through more resources, diversification and fixed policies, we expect that larger institutions can offer more formal benefits, salary (resulting in higher satisfaction with salary) and advancement [72]. | |
Activity type | Pricing-system hypothesis: Since in Switzerland, stationary acute care is priced through flat rates per case [Diagnosis Relate Groups (DRG)] while outpatient and long-term care are priced through time fees, we expect hospital nurses to experience more alienating WCS through less care quality and more work strain [15]. Long-term care hypothesis: We expect that nurses working in stationary long-term care face specific occupational stressors (e.g. challenging patient behaviour, specific conditions related to more intensive care), and therefore—since this is connected to negative emotions and less relatedness—report more stress [70, 75]. Furthermore, we expect stress to be even higher since socio-medical institutions are especially concerned with staff shortage [76]. Outpatient hypothesis: Since outpatient nurses often work in more rural or mobile settings, we expect that nurses in outpatient or home care experience a higher degree of autonomy and participation, more rewarding patient relationships, good team climate but lower levels of advancement opportunities [77]. | |
Ownership and goal system | For-profit hypothesis: Since private for-profit hospitals often focus on private patients and individual care [80] and are more likely to specialise on certain, profitable treatments [81], we expect that nurses working for private hospitals perceive more convenient environmental WCS than public hospitals, such as less stress and a better social atmosphere. Non-profit hypothesis: Since mission-oriented work, in contrast to profit- or policy-oriented work, is associated with a more self-determined work environment and less regulations [82], we expect non-profit organisations and home care services to experience more autonomy, participation as well as more organisational commitment. |
Methods
Data
Institutional categories
Type of institution | Activity type | Organisational size | Ownership and goal system |
---|---|---|---|
Public hospitals (PuHs) | Acute, stationary medical care | Large | Public; oriented towards public policy (policy-oriented) |
Private hospitals (PrHs) | Acute, stationary medical care | Medium to large | Private; profit-oriented |
Private medical offices (PrOs) | Outpatient medical care | Small | Private; profit-oriented |
Socio-medical institutions (SOMEDs) | Residential care, long-term care or day-care | Medium | Private, public or hybrid; policy-oriented, mission-oriented or hybrid |
Non-profit organisations (NPOs) | Miscellaneous | Small to large | Private; mission-oriented |
Home care services (HCs) | Home care, long-term care | Small | Private, public; profit-oriented or mission-oriented |
Sample
Sample of individuals captured in the analysis (n = 6 490) |
n
| Percent/years |
Women | 5 659 (male 831) | 87.2% (male 12.8%) |
Average age (ages ranging from 20 to 64 years) | 42.0 years | |
Highest diploma | ||
Basic nurse diploma | 3 765 | 58.0% |
Specialisation diploma (postgraduate studies, certificate of advanced studies) | 1 174 | 18.1% |
Higher professional education (HöFa 1 & 2, diploma of advanced studies) | 594 | 9.2% |
Bachelor, Master or PhD in nursing or other discipline | 957 | 14.7% |
Sample of reported work episodes captured in the analysis (n = 8 399) |
n
| Percent |
Public hospitals (PuHs) | 5 567 | 66.3 |
Socio-medical institutions (SOMEDs) | 1 219 | 14.5 |
Home care services (HCs) | 763 | 9.1 |
Private hospitals (PrHs) | 690 | 8.2 |
Non-profit organisations (NPOs) | 105 | 1.3 |
Private medical offices (PrOs) | 55 | 0.7 |
Measures of WCS
Statistical analysis
Results
Dependent variables | Independent variables | |||||
---|---|---|---|---|---|---|
Lowest marginal prediction | Highest marginal prediction | |||||
Autonomy | PrOsABC | PuHsA | PrHsAB | SOMEDsB | HCsBC | NPOsC |
Flexibility | PuHsA | SOMEDsA | PrHsAB | PrOsAB | HCsB | NPOsB |
Participation | PuHsA | PrHsA | PrOsABC | SOMEDsB | HCsC | NPOsBC |
Relationships | SOMEDsA | PrHsB | PuHsB | NPOsAB | HCsB | PrOsB |
Recognition | SOMEDsA | PrHsAB | PuHsAB | HCsC | NPOsBC | PrOsBC |
Absence of alienation | SOMEDs | PuHsC | PrHsB | HCsAB | NPOsABC | PrOsA |
Advancement | PrOsA | SOMEDsA | PrHsAB | HCsC | NPOsBC | PuHsC |
Organisational commitment | PrHsA | PuHsA | SOMEDsAB | HCsB | PrOsABC | NPOsC |
Professional identification | PrOsA | NPOsA | HCsA | PuHsA | PrHsA | PrHsA |
Satisfaction with salary | PrHsA | SOMEDsB | PuHsB | HCsB | PrOsAB | NPOsB |
Job satisfaction | SOMEDsA | PrHsAB | PuHsB | HCsB | PrOsABC | NPOsC |
No turnover intention* | PrHsB | NPOsAB | SOMEDsAB | PuHsAB | HCsA | PrOsAB |