The objective of the research is to assess the degree of adoption of high-involvement nursing work practices in long-term care organizations. It seeks to determine the organizational and workplace factors that are associated with the uptake/adoption of ten selected human resource high-involvement employee work practices.
A survey questionnaire was sent to 300 long-term care organizations (nursing homes) in western Canada. Results from 125 nursing home establishments (43 percent response rate) are reported herein.
Of the ten high-involvement nursing work practices examined, employee suggestion and recognition systems are the most widely adopted by homes in the sample, while shared governance and incentive/merit-base pay are used by a small minority of establishments.
The uptake of high-involvement nursing work practices is not adopted in a haphazard fashion. Their uptake is variously associated with a number of establishment and workplace factors, including the presence of a supportive and enabling workplace culture.
The objective of this research is to examine the extent and degree of adoption of high involvement work practices in a sample of long-term care establishments operating in the four provinces of western Canada.
Chronic diseases remain among the major causes of death and disability in Canada as well as in other western industrialized nations. The episodic, punctuated, acute care model of health service delivery that describes the organization and orientation of care delivery is ill prepared to meet the needs of society burdened by chronic illness. The chronic care model (CCM) has been advanced as a way by which primary care practices can be transformed to meet the challenge of chronic illness. The objective of this research is to examine how well primary care physician practices, including walk-in clinics, solo family practices, group family practices, community health centres and physicians practicing in primary care networks, are succeeding at implementing the components of the CCM. Results suggest that physician primary care practices have considerable way to go in implementing the model, with walk-in clinics and solo family practices showing the least progress in inculcating its components.
To investigate the impact that increasing human capital through staff training makes on the voluntary turnover of registered nurses.
Healthcare organizations in Canada, the United Kingdom, the United States, and Australia are experiencing turbulent nursing labour markets characterized by extreme staff shortages and high levels of turnover. Organizations that invest in the development of their nursing human resources may be able to mitigate high turnover through the creation of conditions that more effectively develop and utilize their existing human capital.
A questionnaire was sent to the chief nursing officers of 2208 hospitals and long-term care facilities in every province and territory of Canada yielding a response rate of 32.3%. The analysis featured a three-step hierarchical regression with two sets of control variables.
After controlling for establishment demographics and local labour market conditions, perceptions of nursing human capital and the level of staff training provided were modestly associated with lower levels of establishment turnover.
and implications for Nursing Management The results suggest that healthcare organizations that have made greater investments in their nursing human capital are more likely to demonstrate lower levels of turnover of their registered nursing personnel.
Emergency departments in most developed countries have been experiencing significant overcrowding under a regime of severe resource constraints. Physicians in emergency departments increasingly find themselves toiling in workplaces that are characterized by diminished availability of, limited access to, and decreased stability of critical resources. Severe resource constraints have the potential to greatly weaken the overall job satisfaction of emergency physicians. This article examines the impact of hospital resource constraints on the job satisfaction of a large sample of emergency physicians in Canada. After controlling for workflow and patient characteristics and for various institutional and physician characteristics, institutional resource constraints are found to be major contributors to emergency physician job dissatisfaction. Resource factors that have the greatest impact on job satisfaction include availability of emergency room physicians, access to hospital technology and emergency beds, and stability of financial (investment) resources.
The purpose of this paper is to report on gender differences in emergency physicians with respect to their attitudes, knowledge, and practices concerning health promotion and disease prevention.
A mail survey of 325 male and 97 female Canadian emergency physicians.
Results suggest female emergency physicians report having greater knowledge of health promotion topics, spend more time with each of their patients in the emergency setting, and engage in more health promotion counseling in the emergency setting than do their male counterparts.
The paper argues that in the future, educating and socializing emergency physicians, both male and female, in the practice of health promotion will enhance the potential of the emergency department to be a more effective resource for their community.
Many health care workplaces are adopting more cooperative labour-management relations, spurred in part by sweeping changes in the economic environment that have occurred over the last decade. Labour-management cooperation is seen as essential if health care organizations are to achieve their valued performance objectives. Joint labour-management committees (LMCs) have been adopted in many health care workplaces as a means of achieving better industrial relations. Using data from a sample of Canadian union leaders in the health care sector, this paper examines the impact of labour-management forums and labour climate on employee and organizational outcomes. Research results suggest that labour climate is less important in predicting workplace performance (and change in workplace performance) than is the number of LMCs in operation. However, labour climate is found to be at least as important in predicting union member satisfaction (and change in member satisfaction) as is the wide adoption of LMCs in operation. These findings are consistent with the notion that the greater use of LMCs is associated with augmented workplace performance (and a positive change in workplace performance), notwithstanding the contribution of the labour climate in the workplace.
Over the past few years many nations have undertaken activities aimed at restructuring and reengineering their health system as a means of achieving greater cost effectiveness and consumer responsiveness. Most efforts at reforming healthcare delivery have been accompanied by the downsizing of healthcare organizations. Organizations that are undergoing decline or significant workforce contractions are widely believed to experience a number of negative or dysfunctional attributes as a consequence of reductions in, or redeployments of, their labor force. For organizations undergoing planned workforce reductions, much speculation has been made in an attempt to identify a set of "best practices" that have the potential to mitigate the dysfunctional consequences associated with large permanent reductions in the workforce. This article explores the relationships among workforce-reduction practices and perceptions of organizational dysfunction in a large sample of Canadian hospitals. Results of the analysis suggest that the application of certain "progressive" workforce-reduction practices preceding, during, and subsequent to the downsizing process may play an important role in mitigating some of these dysfunctional organizational consequences. This research provides some evidence to suggest that how a workforce reduction is carried out may have a greater effect on organizational effectiveness than either the magnitude or severity of the overall workforce reduction.
This study examines the association of high involvement nursing work practices with employer-of-choice (magnet) status in a sample of Canadian nursing homes.
In response to a severe shortage of registered nursing personnel, it is imperative for health care organizations to more effectively recruit and retain nursing personnel. Some long-term care organizations are developing employee-centred cultures that allow them to effectively enhance nurse and resident satisfaction. At the same time, many nursing homes have adopted progressive nursing workplace practices (high involvement work practices) that emphasize greater employee empowerment, participation and commitment.
A mail survey was sent to the director of nursing in 300 nursing homes in western Canada. In total, 125 useable questionnaires were returned and constituted the data set for this study. Separate ordinary least squares regressions are performed with magnet strength, nurse satisfaction and resident satisfaction used as dependent variables.
Nursing homes that demonstrate strong magnet (employer-of-choice) characteristics are more likely to have higher levels of nurse and patient satisfaction, even after controlling for a number of significant factors at the establishment level. Magnet nursing homes are more likely to have progressive participatory decision-making cultures and much more likely to spend considerable resources on job-related training for their nursing staff. The presence of high involvement work practices is not found to be a significant predictor in magnet strength, nurse or resident satisfaction.
Merely adopting more high involvement nursing work practices may be insufficient for nursing homes, which desire to become 'employers-of-choice' in their marketplaces, especially if these practices are adopted without a concomitant investment in nurse training or an enhanced commitment to establishing a more democratic and participatory decision-making style involving all nursing staff.
Turnover of nursing staff is a significant issue affecting health care cost, quality, and access. In recent years, a worldwide shortage of skilled nurses has resulted in sharply higher vacancy rates for registered nurses in many health care organizations. Much research has focused on the individual, group, and organizational determinants of turnover. Labor market factors have also been suggested as important contributors to turnover and vacancy rates but have received limited attention by scholars.
This study proposes and tests a conceptual model showing the relationships of organization-market fit and three local labor market factors with organizational turnover and vacancy rates.
The model is tested using ordinary least squares regression with data collected from 713 Canadian hospitals and nursing homes.
Results suggest that, although modest in their impact, labor market and the organization-market fit factors do make significant yet differential contributions to turnover and vacancy rates for registered nurses.
Knowledge of labor market factors can substantially shape an effective campaign to recruit and retain nurses. This is particularly true for employers who are perceived to be "employers-of-choice."
