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HSR&D 2004 National Meeting Abstracts


1021. Effects of Organizational Change on Nursing Services in VHA Hospitals
Nancy D Sharp, PhD, HSR&D Northwest Center for Outcomes Research in Older Adults, VA Puget Sound Health Care System and University of Washington, GT Greiner, HSR&D Northwest Center for Outcomes Research in Older Adults, VA Puget Sound Health Care System and University of Washington, Y Li, HSR&D Northwest Center for Outcomes Research in Older Adults, VA Puget Sound Health Care System and University of Washington, AE Sales, HSR&D Northwest Center for Outcomes Research in Older Adults, VA Puget Sound Health Care System and University of Washington

Objectives: Many VHA facilities have reorganized patient care services in the past decade. We examined Nurse Executive perceptions of the effect of organizational changes on nursing management and patient care.

Methods: Data were obtained through structured telephone interviews from December 2002 to May 2003 with 125 Nurse Executives at VHA hospitals. Interviews included Nurse Executive ratings and open-ended responses regarding the effects of reorganization on aspects of patient care in general, nursing care, and nursing staff.

Results: 89% of Nurse Executives described facility-level organizational changes that affected nursing services over the past 5-7 years. Although overall management responsibilities increased for many Nurse Executives, 88% of those in hospitals with service lines stated that service line reorganization had a mixed or negative effect on integration of patient care, degree of patient-centered care, delivery of nursing care, or nurse workloads. Nine hospitals had recentralized all or part of the nursing service from a service line organization, and 5 other hospitals were planning to do so at the time of the interviews. All of the Nurse Executives at these facilities believed that reintegration of nursing services produced positive changes in patient care processes and nurse satisfaction.

Conclusions: Nurse Executives described significant impacts on nursing staff and patient care due to changes in facility organization. Fragmentation of nursing services created new challenges to nursing supervision and implementation of nursing practice changes.

Impact: Understanding the local impact of organizational change is essential for improving nursing staff recruitment and retention and nurse-sensitive patient outcomes.