Implications of acute care restructuring for managerial personnel

A descriptive correlation design was used to investigate acute care managers' attitudes 4 to 5 years following extensive restructuring of the health care system in the province of Newfoundland and Labrador. The relationships among personal characteristics, perceived impact of health care reforms, restructuring initiatives, intervening attitudes, and behavioral intentions were also examined. The modified Conceptual Model of Behavioral Intentions (CMBI), based on the integrated causal model of nurse turnover behaviors (Price & Mueller, 1986) and consequences of psychological contract violations (Turnley & Feldman, 1998, 1999), provided the framework for this study. -- The sample was comprised of 197 acute care managers (i.e., senior to first-line) employed in three regions with differing degrees of restructuring. Respondents ranged in age from 24 to 58 years (M = 44.28, SD ± 6.87). The majority of respondents were female (64%), had 20 or more years of work experience (60.2%), were in their current position for 5 years or less (61.5%), had a baccalaureate or higher level of education (56.9%), had non-nursing professional backgrounds (55.3%), and worked in the St. John's region (75.6%). A substantial number were primarily responsible for clinical services (47.2%). Data were collected between April and June, 2000 with the Employee Attitude Survey. -- Study findings indicated that managers were generally more positive than negative about the overall impact of health care reforms. Respondents were most positive about the importance of reforms and the adequacy of safety measures, and most negative about the emotional climate of the workplace and the quality of care. Respondents believed that there was movement toward meeting the objectives of regionalization of health services and program management Respondents were divided on whether or not employers had violated psychological contracts, were more satisfied than dissatisfied with their jobs, were slightly committed to their organizations, and were uncertain about whether or not they would stay with current employers. -- Most of the reform impact and restructuring initiative variables were significantly and positively related to intervening attitudes (i.e., psychological contract violations, job satisfaction, organizational commitment) and behavioral intentions (i.e., intent to stay). As well, intervening attitudes depicted moderate to strong, positive correlations with each other and with behavioral intentions. The personal characteristics most likely to influence intervening attitudes and behavioral intentions included managerial position, current position tenure, primary area of responsibility, gender, and region of employment Study findings provided partial support for the CMBI. During regression analysis, the reform impact variables exerted the greatest influence on contract violations, with diminishing effects on each successive variable. Emotional climate emerged as the most important predictor. As well, each intervening attitude was found to be most predictive of the attitude or behavioural intention variable that immediately followed it. Specifically, psychological contract violations accounted for 39.1% of the variance in job satisfaction; job satisfaction accounted for 64.5% of the variance in commitment; and organizational commitment accounted for 36.5% of the variance in intent to stay. -- Although the current study's results support some of the findings from previous research, they have limited generalizability beyond the study sites. The results of this study suggest that future research efforts should focus on evaluating the long-term impact of health care reforms on acute care managers' work-related attitudes and behavioral intentions. There is an obvious need for more research to investigate the effects of similar and different job-related and work environment factors