Background
Study aim
Theoretical perspective on workplace differences between healthcare employers
Underlying mediators of institutional differences | Description | Associated theories |
---|---|---|
Organisational size | Organisational size is a pivotal variable in classic organisational theory and considered a key mediator of differences in organisational structures, WCS and behaviour. According to the Formal Theory of Differentiation in Organisations and the Evolutionary Model of Organisation, size leads to the distinct characteristics of work, for example, by promoting functional specialisation, divided responsibility, wider control spans, standardisation, formalisation and less centralisation [9‐11]. More recent economic theories have described the effects of organisational size on WCS, particularly the positive effect on compensation, training, promotion opportunities, job security and the negative effect on participation, meaningful work, worker’s confidence, autonomy and job satisfaction [12‐21] | |
Activity type | Activity type refers to the type of treatment, patients and locations a healthcare provider is associated with, which, according to the self-determination theory and the job characteristics theory, can impact work motivation, exhaustion and overall job satisfaction by offering various levels of personal-identity-fit, perceived impact on others, meaning and interestingness, as well as autonomy and feedback [24‐24]. Moreover, with regard to the effect of patient types, social interaction theories suggest that the quality of nurse–patient relationships affects nurses’ well-being and work strain by positive and negative regulation of emotions [25, 26]. Finally, context variables indirectly impact WCS by being linked to activity type. For example, in Switzerland, different billing systems for various treatments affect nurses’ WCS by promoting cost-savings [27, 28] | |
Ownership and goal system | Ownership and goal systems refer to institutions being in either private or public ownership and following for-profit or non-profit objectives. As for-profit, non-profit and public organisations typically act consistent with different macroeconomic roles [29], they promote different workplace characteristics and therefore offer different intrinsic and extrinsic stimuli for workers’ motivation. From the self-determination theory perspective, promoting autonomy, relatedness and competence increases workers’ intrinsic motivation [22] and job satisfaction [30, 31]. NPOs offer more autonomy because of the relative absence of competitive or legislative/regulatory pressure, compared with for-profit or public organisations, while both public organisations and NPOs can offer more relatedness at work than their for-profit counterparts because of public service motivation [32, 33] |
Nurses’ WCS and turnover across different types of organisations
Methods
Data
Sample
Reasons to quit
Statistical analysis
Principal component analysis
Latent construct name | Item name (binary scale: 0 = no; 1 = yes) | Statement |
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Non-nursing tasks avoidance | Non-nursing tasks avoidance (RQ1) | I had to do too many non-nursing tasks (for example, picking up the food plateaus) |
Work hours | Work hours (RQ2) | My working hours were too inconvenient |
Care quality | Care quality (RQ3) | I had the impression that the quality of the care and/or the patient safety were insufficient |
Exhaustion (KR-20 = .70) | Stress (RQ4) | The work was too stressful, too much physical and/or mental stress |
Professional exhaustion (RQ24) | I was in a state of professional exhaustion | |
Health problems (RQ25) | I had a health problem | |
Violence | Violence (RQ5) | There was increased verbal or physical violence from patients/relatives to nurses |
Wish for change (KR-20 = .50) | Interest in other profession (RQ6) | I was interested in another profession |
Professional development wish (RQ7) | I wanted to professionally develop | |
Education wish (RQ27) | I wanted to do an education / a training | |
Skill-use opportunity | Skill-use opportunity (RQ8) | I was not able to use my nursing education and specific skills |
Self-actualisation (KR-20 = .67) | Autonomy (RQ9) | I could hardly work independently |
Participation (RQ10) | I had very little opportunity to decide (about the patient care, the department, the company) | |
Mobbing | Mobbing (RQ11) | I was bullied at the workplace |
Interesting job offer | Interesting job offer (RQ12) | I got an interesting job offer |
Advancement (KR-20 = .64) | Training opportunities (RQ13) | I could hardly benefit from further training opportunities |
Career opportunities (RQ14) | I did not have enough career opportunities | |
Team (KR-20 = .79) | Team mood (RQ15) | The team mood was bad |
Team cooperation (RQ16) | The cooperation in the team was unsatisfying | |
Superiors (KR-20 = .78) | Superiors' support (RQ17) | I did not get enough support from my superiors |
Recognition (RQ18) | My work has not been sufficiently recognised | |
Organisational commitment | Organisational commitment (RQ19) | At that time, I had no sense of belonging to this organisation |
Professional identification | Professional identification (RQ20) | At that time, I was only slightly identified with the nursing profession |
Work–life balance (KR-20 = .67) | Work–life balance (RQ21) | I wanted more time for my private life (for example family, travel …) |
Taking care of children (RQ22) | I wanted to look after my children | |
Moving to a new house | Moving to a new house (RQ23) | I moved houses |
Salary | Salary (RQ26) | The compensation and/or social benefits were unsatisfying |
Regression analysis
Results
Employer strengths | Employer weaknesses | Paradox (strong pull argument; strong push argument) | Irrelevance (weak pull argument; weak push argument) | |||||
---|---|---|---|---|---|---|---|---|
Prevalence (strong pull argument; weak push argument) | Unfounded attraction (strong pull argument; average push argument) | Chance (average pull argument; weak push argument) | Inability (strong push argument; weak pull argument) | Threat (strong push argument; average pull argument) | Unfounded repulsion (average push argument; weak pull argument) | |||
Public hospitals | Advancement Skill-use opportunity Wish for change Pay Non-nursing tasks avoidance | Organisational commitment Professional identification | Exhaustion Work–life balance | Care quality Aggression | Work hours Harassment | Moving to a new house | ||
Private hospitals | Aggression Non-nursing tasks avoidance | Pay | Exhaustion Work hours Skill-use opportunity | Self-actualisation | Professional identification Work–life balance | |||
Private medical offices | Work hours | Work–life balance | Exhaustion Care quality | Wish for change | Skill-use opportunity Advancement Pay Self-actualisation Non-nursing tasks avoidance Professional identification | Aggression Moving to a new house | ||
Socio-medical institutions (SOMEDs) | Harassment Moving to a new house | Interesting job offer Advancement | Team Self-actualisation Work hours Skill-use opportunity Non-nursing tasks avoidance Organisational commitment | Wish for change Pay | Exhaustion Aggression Care quality Superiors | |||
Non-profit organisations (NPOs) | Wish for change | Harassment | Interesting job offer Self-actualisation | Work hours Skill-use opportunities | Advancement Pay Care quality | |||
Home-care services | Self-actualisation Care quality | Exhaustion Team | Wish for change | Work hours |