ACSPRI Conferences, ACSPRI Social Science Methodology Conference 2010

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Managing organisations in health: A mixed methods study of relationships between nursing practice environment, job satisfaction and quality of nursing care

Nazlee Siddiqui, Anneke Fitzgerald

Building: Holme Building
Room: Holme Room
Date: 2010-12-03 11:00 AM – 12:30 PM
Last modified: 2010-11-23


Relationship between the three concepts of nursing practice environment, nurses' job satisfaction and quality of nursing care have frequently been studied for a way forward to superior healthcare delivery. For example, it has been explained within the Donabedian's (1969) structure-process-outcome paradigm, how a nursing practice environment (NPE) should have the right structure and processes to lead to outcomes of nurses' job satisfaction (JS) and quality of nursing care (QNC) (Kramer and Schmalenberg, 2004; Schmalenberg & Kramer 2008). One of the gaps is that the existing literature is skewed towards reporting research that analyses the relationship of the three concepts in one directional sequence that initiates at NPE to lead to the outcomes of JS and/or QNC. Accordingly, hospital managers can become more focused to intervene in nursing practice environment (NPE) rather than having a side by side plan to intervene in nurses' job satisfaction (JS) and/or quality of nursing care (QNC) for betterment of functionality of hospitals.   

 This paper contributes to the literature by discussing an alternative approach to investigating the relationships between nursing practice environment (NPE), nurses' job satisfaction (JS) and quality of nursing care (QNC). Here the reciprocity of relationships between the three concepts are analysed, with the aim to make recommendation to hospital managers to include a managerial focus on improving nurses' job satisfaction and/or quality of care to combat current crisis in functionality of hospitals in NSW, Australia. 

 A mixed method of questionnaire survey and one to one semi-structured interviews were applied here. The survey provided a snapshot of nurses' perception of whether NPE can be a mediator in between the reciprocal relationship of JS and QNC. The mediator analysis of nursing practice environment followed the three steps of Baron and Kenny (1986) and accordingly three (3) regressions were undertaken. One of the limitations was that the survey had a low response rate of 7.6%. Consequently, it is not claimed that this study represent a generalized picture of relationships between NPE, JS and QNC in NSW hospitals.    

 The interviews complemented the surveys by revealing rationales behind the reciprocal relationship of NPE, JS and QNC from the lived experiences of practicing nurses. Each interview was organised in QSR NVivo 8 to identify patterns regarding the relationship of the three concepts. Initial brush coding was undertaken to identity broad themes. Then axial coding was done to seek for patterns of behaviour. The research data are contextually bound to NSW hospitals between February 2009 and February 2010.

 The mixed methods of statistical analysis of a validated survey questionnaire combined with interview data that reflect real live experiences of those in the field do provide an example of building methodological robustness in research. The research findings also give valuable contribution to the literature by disclosing that nurses feel the relationship of the three concepts can be initiated at concepts of JS and/or QNC and be mediated by NPE.