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A STUDY OF THE RELATIONSHIP BETWEEN ORGANIZATIONAL CHANGE,

JOB STRESS, JOB SATISFACTION, AND ORGANIZATIONAL

COMMITMENT OF SOCIAL WORKERS

AND REGISTERED NURSES

by

CHERRY KAY BRUCE BECKWORTH

Presented to the Faculty of the Graduate School of

The University of Texas at Arlington in Partial Fulfillment

of the Requirements

for the Degree of

DOCTOR OF PHILOSOPHY

THE UNIVERSITY OF TEXAS AT ARLINGTON

May 1996


UMI Number: 9634320

Copyright 1996 by Beckwortn, Cherry Kay BruceAH rights reserved.

UMI Microform 9634320 Copyright 1996, by UMI Company. All rights reserved.

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UMI300 North Zeeb Road Ann Arbor, M I 48103






The members of the Committee approve the doctoral dissertation of Cherry Kay Bruce Beckworth

Charles H. Mindel Supervising Professor

James W. Callicutt

Richard A. Hoefer

James C. Quick

M. Coleen Shannon

Dean of the Graduate School

•7


Copyright © by Cherry Kay Bruce Beckworth 1996 All Rights Reserved


DEDICATION

This dissertation is dedicated to the memory of my parents, Mr. & Mrs. Gordon Bruce. They

taught me to love learning and to value education. The love and guidance they gave me

throughout their lives helped me to achieve my goals and to live to my fullest potential


ACKNOWLEDGMENTS

I wish to thank my chairperson, Dr. Charles Mindel for his kindness and expert

guidance throughout the dissertation process. His expertise in the use of EQS and assistance

in the statistical analysis is greatly appreciated. In addition, I wish to thank the committee

members, Dr. James Callicutt, Dr. Richard Hoefer, Dr. Coleen Shannon, and Dr. James

Quick for their input that has enhanced this study.

I wish to acknowledge my husband, Ed Beckworth, my daughter and son-in-law,

Laurel and David Isaak, and my sister and brother-in-law, Jill and Fred Quick, whose love,

patience, and understanding helped me throughout my course of study. All the things my

family did for me is sincerely appreciated.

April 11,1996


ABSTRACT





Publication No.______

Cherry Kay Bruce Beckworth, Ph.D.

The University of Texas at Arlington, 1996

Supervising Professor: Charles H. Mindel

The major purpose of this study was to determine the relationship between

organizational changes and job stressors, job satisfaction, organizational commitment and

turnover of human service workers.

The sample consisted of 98 social workers and 324 registered nurses employed in

acute hospital settings. Respondents represented different hospital types, sizes and the 11

public health regions in Texas. The survey mailed to subjects included the Stress Diagnostic

Survey - Form A, the Organizational Commitment Questionnaire, the Intention to Turn Over

scale, and a questionnaire developed for this study to measure organizational change.

vi


Structural equation modeling using EQS was employed in testing the model. The

initial model proposed that organizational changes of restructuring, reengineering, and job

redesign led to increased MICRO and MACRO organizational job stress. The initial model

also proposed that job stress led to decreased organizational commitment and decreased job

satisfaction, which in turn led to turnover. The initial model required respecification which

dropped reengineering and MICRO organizational job stress. One significant finding was

that restructuring was initially thought to have indirect affects on turnover, but in the final

model it was found to have both direct and indirect affects. The final model fit indices were

a BBNFI of .92, a BBNNFI of .94, and a CFI of .95. For the prediction of turnover r2 = .59.

An ANOVA indicated that registered nurses experienced significantly greater stress

in the areas of human resource development, the reward system, participation in decision

making, the style of supervision, responsibility for people, and qualitative work overload.

Social workers experienced significantly greater stress in the area of quantitative work

overload.

The study had implications for social workers, registered nurses, and hospital

administrators. As organizational changes occur, preventive stress management efforts

should be employed and evaluated in order to counteract the negative affects of the changes

on job satisfaction, organizational commitment and turnover.


TABLE OF CONTENTS

ACKNOWLEDGMENTS .......................................................................................... v

ABSTRACT ................................................................................................................ vi

LIST OF ILLUSTRATIONS ..................................................................................... xi

LIST OF TABLES ..................................................................................................... xii

Chapter

I. INTRODUCTION .......................................................................................... 1

Purpose of the study ........................................................................... 2Significance of the study..................................................................... 2Theoretical Framework ....................................................................... 3Statement of the Problem ................................................................... 17Hypotheses .......................................................................................... 19Definition of Terms ............................................................................. 20Assumptions ....................................................................................... 26Limitations .......................................................................................... 26

II. REVIEW OF LITERATURE ............................................................................ 27

Organizational Factors ........................................................................ 27Job Stress ........................................................................................... 35Job Satisfaction ................................................................................... 45Organizational Commitment ............................................................... 54Turnover ............................................................................................. 60Summary ............................................................................................. 67

III. METHOD OF STUDY .................................................................................. 68

Research Design.................................................................................. 68Sampling Procedures .......................................................................... 69Description of Instruments .................................................................. 71Reliability of Instruments ................................................................... 77Procedure ........................................................................................... 79

viii


Protection of Human Subjects............................................................ 79Data Analysis..................................................................................... 79

IV. DATA ANALYSIS AND INTERPRETATION ............................................. 91

Demographic Profile.......................................................................... 91Analysis of Variance Between Groups ............................................. 99Findings from Structural Equation Modeling .................................... 106Hypothesis Testing ............................................................................ 116Tenability of Theories ....................................................................... 120

V. IMPLICATIONS, RECOMMENDATIONS FOR FUTURE STUDIES,AND CONCLUSIONS .............................................. 125

Implications for Social Work ............................................................ 125Recommendations for Future Studies ............................................... 130Conclusions ....................................................................................... 132

VI. SUMMARY ..................................................................................................... 134

Theoretical Framework ..................................................................... 134Method of S tudy................................................................................ 136Findings ............................................................................................. 139Implications and Conclusions ............................................................ 141

APPENDIX

A. Cover Letter ..................................................................................................... 137

B. Organizational Change Questionnaire ............................................................. 139

C. Stress Diagnostic Survey - Form A .................................................................. 141

D. Index of Job Satisfaction .................................................................................. 146

E. Organizational Commitment Questionnaire ..................................................... 148

F. Intention to Turn Over Scale............................................................................. 150

ix


G. Permission to Use Organizational Commitment Questionnaire ....................... 152

H. Permission to Use Intention to Turn Over Scale .............................................. 155

REFERENCES ........................................................................................................... 157

x


LIST OF ILLUSTRATIONS

Figure Page

1. P - E Fit Model Showing Effects of Stressful Job Environments ............................ 7

2. P-E FitTheory ......................................................................................................... 9

3. Causal Model of Turnover of Price and Mueller ..................................................... 16

4. Conceptual Model of Study ...................................................................................... 18

5. Public Health Regions for the State of Texas .......................................................... 70

6. Statistical Model of S tudy......................................................................................... 82

7. Job Stressors of Social Workers in Study ................................................................. 104

8. Job Stressors of Registered Nurses in Study ............................................................ 105

9. Path Coefficients of Confirmatory M odel................................................................. 107

10. Final Parsimonious Model of Study ....................................................................... 112

xi


LIST OF TABLES

Table Page

1. The Dynamics of Hygiene and Motivation ............................................................. 12

2. Definitions ofVariables of Causal Model ofTurnover ........................................... 14

3. Selection Process ofRNs from Public Health Regions in Texas ............................. 72

4. Reliabilities for the Subscales of the Stress Diagnostic Survey - Form A ............... 78

5. Means, skewness, and kurtosis of variables ............................................................. 86

6. Demographic Data o f Total Subjects ...................................................................... 92

7. Demographic Data for Social Workers and Registered Nurses in Study ................ 93

8. Educational Comparison of Social Workers and Registered Nurses in Study ........ 94

9. Demographic Data of Practice Areas .................... 95

10. Areas of Specialization for Social Workers and Registered Nurses ........................ 96

11. Characteristics of Employing Hospitals........................................................ 98

12. Residence of Subjects by Public Health Region....................................................... 100

13. ANOVA Between Social Workers and Registered Nurses ..................................... 101

14. Covariance Matrix of Final Model .......................................................................... 110

15. Measurement Equations of Final Model with Standard Errors and Test Statistics . .113

16. Construct Equations of Final Model with Standard Errors and Test Statistics........ 115

17. Summary of Hypotheses Testing ............................................................................. 121

xii


CHAPTER I

INTRODUCTION

The healthcare system is undergoing major transformation in view of increased

demands for access, quality and cost containment from the consumers of health care services.

Changes in the system are necessary and inevitable. The purpose of the transformation of the

healthcare system in the United States is clear—to reduce healthcare costs while improving

quality and access to that care. The healthcare environment is in turmoil. Changes in

legislation, funding, technology, and available resources are hard to predict and scanning the

environment is difficult for administrators. Additionally, environmental uncertainty poses

difficult planning and decision making problems for healthcare administrators. Restructuring

of organizations, reengineering of service processes, and job redesign measures are being

implemented by many healthcare organizations. These changes are potential organizational

stressors.

As these changes have been occurring rapidly, little research has been done on the

effects of these changes on health team members. Many studies link various job factors to

stress, but virtually no study has been done that links rapid organizational change to stress,

job satisfaction, organizational commitment, and turnover. Therefore, this study intends to

evaluate effects of organizational changes on job stress, job satisfaction, organizational

commitment and turnover of hospital social workers and registered nurses in acute hospital

settings.

1


2

Purpose of the Study

The purposes of this study are as follows:

(1) To determine the relationship between organizational changes on job stressors,

job satisfaction, organizational commitment and turnover of human service workers.

(2) To contrast effects of organizational changes on social workers and registered

nurses in acute hospital settings.

Significance of the Study

Changes in the United States healthcare system lead to changes in all the subsystems,

such as hospitals. It is necessary to plan delivery services responsive to limited resources,

organize service to increase productivity and maximize patient benefit, and educate members

of the health team about reasons for delivery changes. With the changes also comes potential

for increased job stress. It is well documented that job stress leads to burnout, increased

employee turnover, and lost productivity from illness and absenteeism. While the cost

containment measures of restructuring, reengineering, and job redesign can save financial

resources, the costs of orienting and maintaining a healthy workforce can offset the money

saved.

A study that evaluates the effects of organizational changes on job stressors, job

satisfaction, organizational commitment, and turnover is beneficial to planning human

services in healthcare settings. Environmental turbulence and organizational change are

likely to continue into the twenty-first century as healthcare reform and balancing the federal

budget necessitate streamlining hospital budgets. When organizational stressors can not be


controlled or minimized, initiatives planning preventive stress management programs are

indicated. If organizational change increases organizational stressors, distress of health team

members can be better controlled or minimized through preventive stress management. The

hospital social worker is one of the best resources that the organization can use to implement

such programs.

Along with planning and implementing such programs, employees must be motivated

to be more flexible, accept new responsibility, and to participate in the transformation

process. This study could point to the need of organizational behavior needs within

healthcare settings. Social work is well positioned to assume this vital role in healthcare

organizations because of knowledge and skills already available.

Motivating employees to be more flexible, accept new responsibility, and to

participate in the transformation process requires strong leadership throughout an

organization. Social work can provide this leadership as well as provide the resources for

other health team members to reduce stress. If the goal of restructuring is to control costs,

but causes increased job stress and burnout resulting in job dissatisfaction and turnover, then

the process could lead to increased costs rather than controls. Social work should position

itself to meet the challenges faced as the changes are implemented.

Theoretical Framework

The Person-Environment Fit theory is used to describe and explain job stress that is

incurred in the acute hospital setting among social workers and registered nurses (French,

Rodgers, & Cobb, 1974).


4

The Motivation - Hygiene theory of Herzberg (1966) is used to describe factors that

lead to job satisfaction or job dissatisfaction that is incurred in the acute hospital setting

among social workers and registered nurses.

The Causal Model of Turnover by Price and Mueller (1986) is used to describe

factors that lead to turnover of social workers and registered nurses in acute hospital settings.

Person-Environment Fit Theory

The Person-Environment (P-E) Fit theory of French, Rodgers, and Cobb (1974) is

derived from Lewin's theory (1935) which proposes that performance and emotional well -

being is a function of person and environment. This assertion is symbolized by the notation:

B = f(P,E), where behavior is a function of person and environment. The P-E theory is

intended to explain and quantify the goodness of "fit" between the characteristics o f the

person and the environment. This theory is based on the assumption that people vary in their

needs and abilities. French et al., (1974) suggest that job stress develops when there is

incongruence between a person's characteristics, skills, and abilities and the demands of the

job. Job stress also develops when there is incongruence between a person's needs and the

needs supplied by the job environment. Strain is the degree of physiological, psychological,

and/or behavioral deviation from normal functioning resulting from stress (Quick, & Quick,

1984).

The person environment fit theory emphasizes the causal relationship between misfit

of the person and his environment and psychological strain. This theory hypothesizes five

factors that determine strain in response to poor P-E fit. These are (1) motives which are not


5

being met, (2) a person's abilities to meet demands of the job, (3) the genetic and social

background of the individual, (4) defense and coping predisposition of the individual, and (5)

situational constraints on particular responses (French, Caplan, & Harrison, 1982).

The Person-Environment Fit theory utilizes the following symbolic notations:

P0 = the objective persons or actual person;

Ps = the subjective person or self-concept;

E0 = the objective environment independent of the persons' perception;

Es = the subjective environment as perceived and reported by the person;

F0 = the objective fit; and

Fs = the subjective fit.

This notation is used in the derivation of the following formulas:

(1) F0 = P0 - E„ = the objective P-E fit is the difference between the

environmental supply and the person's need for it;

(2) Fs = Ps - Es = the subjective P-E fit that is utilized in the derivation of the

formulas 3 and 4;

(3) R = E0 - Es = reality of the subjective report of the environmental supply, also

called contact with reality;

(4) A = P0 - Ps = the subjective report of the amount of supply necessary to

satisfy this person, also referred to as the accuracy of self-assessment.

Each of the equations describes some parameter of mental health. A negative value of

Fs indicates a lack of adjustment and is associated with psychological strain and the


6

probability of various coping or defensive behaviors. Figure 1 is the model of P-E fit theory

showing the effects of stressful job environments on subjective stresses. The arrows

represent direct causal relationships. The broken lines represent the four dimensions of

mental health. The first dimension is objective person-environment fit (F0). The second is

subjective person-environment fit (Fs). The next are accessibility of the self (A) and contact

with reality (R).

The hypotheses corresponding to the model are as follows:

Hypothesis 1 (HI): Objective job demands and supplies for needs tend to produce

corresponding perceived demands and supplies.

Assumption 2 (A2): Objective abilities and goals will produce corresponding

subjective abilities and goals.

Hypotheses 3 (H3): High demands or low supplies in the subjective environment

cause strains such as job dissatisfaction and anxiety, smoking, and

hypertension.

Hypothesis 4 (H4): The greater the subjective misfit between the person's

subjective abilities and goals and the corresponding subjective job demands and

supplies, the greater the psychological, physiological and behavioral strain.

Assumption 5: Coping activities will reduce objective misfit between the person

and environment.

Assumption 6: Defense mechanisms reduce subjective misfit by distorting the

perception of the environmental stress.


7

Eo: Objective Job Demands Ex: Subjective Job Demands

Work Load HIWork Load

Job ComplexityJob ComplexityR

Objective Supplies for Motives

Subjective Supplies for Motives

ParticipationSelf-Utilization

H 8 ^

ParticipationSelf-Utilization

H3

Subjective Social Support

Coping Behaviors

Defense Mechanisms

Po: Objective Abilities Re: Ps: Subjective Abilities Re:

Work Load A Work LoadJob Complexity

A2Job Complexity

Objective Motives -----> Subjective Motives& Goals Re: & Goals Re:

Participation ParticipationSelf-Utilization Self-Utilization

Strains

Job Dissatisfaction Boredom

AnxietyDepression

somaticComplaints

Cholesterol

SmokingDrinking Coffee

Morbidity andMortality

Figure 1. The P-E Fit Model Showing Effects of Stressful Job Environments. Reprinted, by permission, from J. R. P. French, R. D. Caplan, & R. V. Harrison, The Mechanisms of Job Stress and Strain (John Wiley & Sons, Inc., 1982).


8

Hypothesis 7: Defense mechanisms will reduce strain.

Hypothesis 8: Subjective social support will reduce stresses in the subjective

environment.

Hypothesis 9: The greater the subjective social support, the lower the strain.

Assumption 10: To the extent that there is high subjective social support,

subjective stresses will not produce the usual strain.

Hypothesis 11: There are various direct and indirect causal relations among

strains (French, Caplan, & Harrison, 1982).

A person's needs are demands that must be met by the environment. French et al.,

(1974) considered a person's needs as being demands that must be supplied by the

environment. On the other hand, environmental demands, i.e., role requirements of the job,

must be supplied by the person's abilities. The purpose of determining P-E fit is to identify

the discrepancies between these various supplies and demands. Therefore, if Fs = Ps - Es or

Fo = Po - Eo yielded a negative value, then the person is considered to be under stress,

experiencing strain, and is probably using defensive coping techniques. French et al., (1974)

indicate job stress could result from two problems defined as overload and underload.

Overload could be described as an increased environmental demand for an ability to

meet the demand. Underload is the opposite; there is a decrease in environmental demand for

an ability or the person has more ability than the environment demands. Both forms of job

stress fit the U shaped curve where the least amount of stress occurs is at the zero point as

shown in figure 2 (French, Rodgers, and Cobb, 1974). The horizontal axis represents a scale


9

High

Excess Supply

Environment

or

Person

(Underload) (Overload)

Low

1 0 +1 +2

P - E F i t

Figure 2. Person - Environment Fit.

of the person-environment fit, and zero at the center of the scale represents the point of

perfect fit where the person score and environment score are equal. Negative scores to the

left indicate a deficiency where the person wants to interact more than the environment will

allow. Positive scores to the right indicate the individual must interact more than desired.

The vertical axis represents strain resulting from the misfit of the person with the

environment, such as job dissatisfaction.

French et al., (1974) agree there is difficulty in measuring objective P-E fit and that

subjective P-E fit is considered to be a reliable measurement method. Ivancevich and


10Matteson (1982) considered subjective P-E fit when they developed the Stress Diagnostic

Survey (SDS).

Motivation - Hygiene Theory of Job Satisfaction

Job satisfaction is a condition where perceived benefits of the job exceed the per

ceived negative aspects. Following an extensive review of literature of job attitudes of over

two thousand articles spanning a fifty year time period, Frederick Herzberg noted that the

primary difference in studies depended on whether investigators were looking at factors

workers liked about their jobs or factors they disliked about their jobs (Herzberg, Mausner,

Peterson, & Capwell, 1957). From this review, Herzberg (1959) conducted a study to

investigate whether different kinds of factors brought about job satisfaction and job dissat

isfaction. The premise on which the work is based is that human beings have two sets of

needs: the need to avoid pain and the need to grow psychologically. When people are happy

with their jobs, they most frequently report factors related to their tasks, to events that

indicate to them that they are successful in the performance of their work, and have the

possibility of professional growth. These factors satisfy the person's need for self-actual

ization and thus create positive attitudes about their job. These factors are intrinsic to the job.

Conversely, when feelings of unhappiness are reported, they are associated with conditions

that surround doing the job. These conditions suggest to the person that the environment in

which work is done is unfair and represents an unhealthy psychological work environment.

The pain avoidance behaviors are stimulated by the job environment. The Motivation -

Hygiene theory is formulated from this work (Herzberg, 1959).


In the Motivation-Hygiene theory the factors involved in job satisfaction are

advancement, recognition, responsibility, growth and the job itself (Herzberg, 1966). These

factors are termed satisfiers or motivators. According to this theory, if satisfiers are

optimized, they improve performance, reduce turnover, and create more positive attitudes of

workers toward the organization and management. Herzberg termed the factors that act in a

negative direction dissatisfiers or hygiene factors. Dissatisfiers were identified as working

conditions and amenities, administrative policies, relationship with supervisors, technical

competence of supervisors, pay, job security and relationships with peers. Dissatisfiers

essentially describe the environment and serve primarily to prevent job dissatisfaction. These

factors do not in themselves influence positive job attitudes. For these reasons,

Herzberg (1966) termed them hygiene factors. The dynamics of hygiene factors and

motivation factors are identified in table 1 (Herzberg, 1976).

The theory distinguishes between frequency and importance of factors leading to job

satisfaction. Herzberg identifies achievement as the most frequently reported motivator and

personal growth is the least frequently reported motivator (Herzberg, 1976). He sees the

most important motivators occurring with the least frequency. The significance is that the

most frequently identified motivators lead to growth. The most common dissatisfier is

organizational policy and administration. Herzberg identifies the dissatisfiers as being of

equal importance because of the subjective nature of dissatisfaction. He notes that the degree

of dissatisfaction caused by work factors varies between individuals.


Table l.--The Dynamics of Hygiene and Motivation (Herzberg, 1976)

12

The Dynamics of Hygiene The Dynamics of Motivation

The psychological basis of hygiene needs is The psychological basis of motivation is the

the avoidance of pain from the need for personal growth

environment

There are infinite sources of pain in the There are limited sources of motivator

environment satisfaction

Hygiene improvements have short-term Motivator improvements have long-term

effects effects

Hygiene needs are cyclical in nature Motivators are additive in nature

Hygiene needs have an escalating zero Motivator needs have a nonescalating zero

point point

There is no final answer to hygiene needs There are answers to motivator needs

The contribution of Motivation-Hygiene Theory is that it views job satisfaction as

bidimensional rather than as one overall feeling state. The two factors account for two

qualitatively different feeling states rather than for overall job satisfaction.

The Stress Diagnostic Survey utilized in this study measures stressors that include

both motivators and hygiene factors. The MICRO organizational stressors are potential

motivators and the MACRO organizational stressors are potential hygiene factors.


Causal Model of Turnover

The causal model of turnover of Price and Mueller (1986) predicts turnover of

employees. Turnover is movement across the membership boundaries of a work

organization (Price, 1977). In the causal model, turnover describes the specific aspect of

voluntarily leaving the organization. Price and Mueller's review of the literature indicates

that turnover has negative effects on the productivity and efficiency of an organization.

Turnover is costly to organizations because employees who leave an organization must be

replaced, which requires recruiting expenses and orientation expenses for the newly hired.

Turnover also increases burdens on the other employees and supervisors who must assume

the duties of that person until the person is replaced.

The causal model of Price and Mueller (1986) is appropriate for this study since it

was done with hospital employees in two hospitals of less than one hundred beds and three

hospitals with between one hundred and five hundred beds. All employees were utilized in

the study that yielded a sample size of 2,192. Five months were spent in the hospitals with

preliminary field work to gain cooperation. Path analysis was the method employed to test

the causal model.

The causal model contains sixteen variables. These are defined in table 2. Of these

variables, opportunity, routinization, centralization, instrumental communication, integration,

pay, distributive justice, promotional opportunity, role overload, professionalism, general

training, and kinship responsibility are similar concepts to the job stressors that are utilized in

this study. The model is shown in figure 3. The model predicts that job satisfaction is


14

Table 2.—Definitions of Variables of the Causal Model of Turnover (Price, & Mueller,1986)

Variable Definition

1. Opportunity

2. Routinization

3. Centralization

Availability of alternative jobs in the organization's environment

Degree to which jobs in an organization are repetitive

Degree to which power is concentrated in an organization

4. Instrumental Communication Degree to which information about the job isformally transmitted by an organization to its members

5. Integration

6. Pay

7. Distributive Justice

8. Promotional Opportunity

9. Role Overload

10. Professionalism

11. General Training

Degree to which the members of an organization have close friends in their immediate work units

Money and its equivalents which individuals receive for their services to the organization

Degree to which rewards and punishments are related to performance inputs into the organization

Degree of potential vertical occupational mobility within an organization

Extent to which demands of the job are extensive

Degree of dedication to occupational standards of performance

Degree to which the occupational socialization of an individual results in the ability to increase the productivity of different organizations


15

Table 2.--Continued

Variable Definition

12. Kinship Responsibility Involvement in kinship groups in the community

13. Size Scale of operations

14. Satisfaction Degree to which individuals like their jobs

15. Commitment Loyalty to the organization

16. Intent to Leave An individual's perception of the likelihood of continued membership in an organization

predicted by routinization, centralization, instrumental communication, integration, pay,

distributive justice, promotional opportunity, and role overload. Commitment is predicted by

job satisfaction, professionalism, general training, and kinship responsibility. Intent to leave

is predicted by commitment, professionalism, general training and kinship responsibility.

Turnover is predicted by intent to leave and opportunity.

The results of the study done on the model were similar to other studies done on

turnover. When individuals are the unit of analysis, 12 percent of the variance is explained

by the model. When work units are the unit of analysis, 15 percent of the variance is

explained. The recommendation for future research agendas is to drop the professionalism

variable. This does not seem to be an important determinant in turnover. The model operates

the same in a variety of situations, thus basically rejecting the contingency point of view

(Price, & Mueller, 1986).


Reproduced

with perm

ission of the

copyright ow

ner. Further

reproduction prohibited

without

permission.

Opportunity

Routinization

Centralization

Instrum ental Communication

Integration

Pay

Distribuative Justice

Promotional Opportunity

Role Overload

Professionalism

General Training

Kinship Responsibility

Size

Satisfaction ^ Commitment ^ Intent To Leave

^ T u rn o v e r

Figure 3. Causal Model of Turnover of Price and Mueller (1986).

OS

17Statement of the Problem

Does organizational restructuring, reengineering, and job redesign lead to increased

job stress for human service workers in acute hospital settings?

Does job stress lead to decreased organizational commitment for human service

workers in acute hospital settings?

Does job stress lead to decreased job satisfaction for human service workers in acute

hospital settings?

Does decreased organizational commitment lead to turnover of human service

workers in acute hospital settings?

Does decreased job satisfaction lead to turnover of human service workers in acute

hospital settings?

Are there differences in job stressors of social workers and registered nurses in acute

hospital settings?

These are reflected in the conceptual model of the study shown in figure 4. In the

model, organizational restructuring and reengineering are predictors of MACRO organi

zational stress. Reengineering and job redesign are predictors of MICRO organizational

stress. MACRO organizational stress predicts organizational commitment and MICRO

organizational stress predicts job satisfaction. Organizational commitment and job satisfac

tion are predictors of turnover. Measures of the person in the P-E fit theory are MICRO and

MACRO organizational stressors. Measures of the work environment are organizational

commitment and job satifaction. Job satisfiers are measured by MICRO job stressors. The


Reproduced

with perm

ission of the

copyright ow

ner. Further


without

permission.

OrganizationalCommitmentRestructuring

Reengineering Turnover

Job RedesignJob

Satisfaction

MICRO Job Stress

Figure 4. Conceptual Model o f Study.

19

causal model of turnover is used as a general framework in development of the model of the

study.

Hypotheses

1. Organizational restructuring has a significant positive direct effect on

MACRO organizational stress of human service workers.


organizational reengineering.

3. Organizational restructuring has a significant positive direct effect on job

redesign.

4. Organizational reengineering has a significant positive direct effect on



MICRO organizational stress of human service workers.

6. Organizational job redesign has a significant positive direct effect on MICRO

organizational stress of human service workers.

7. MACRO organizational stress has a significant negative direct effect on

organizational commitment of human service workers.

8. MICRO organizational stress has a significant negative direct effect on job

satisfaction for human service workers.


20

9. Organizational commitment has a significant negative direct effect on turn

over of human service workers.

10. Job satisfaction has a significant negative direct effect on turnover o f human

service workers.

11. There is no significant difference in MACRO organizational stressors between

social workers and registered nurses.

12. There is no significant difference in MICRO organizational stressors between


Definition of Terms

1. Restructuring - The process of changing the way an organization is formed, its

channels of authority, span of control, and lines of communication. This is

depicted by a change in the organizational chart. Restructuring is operational

ized by items 1,4,7, and 10 on the Organizational Change Questionnaire

developed by the researcher (Appendix B).

2. Reengineering - The process of changing the formulation and deployment

of resources that support the strategic plan of the organization, utilization of

resources, information flow, personnel utilization, and the degree to which

performance objectives are being met, including the process by which services

are delivered, analysis and design of work methods and work systems, deter

mining personnel utilization, development of employee motivation plans,


21

the design of physical facilities for increased efficiency, and the design of

simplified paperwork methods.

Reengineering is operationalized by items 2 ,5 ,8 ,11 , and 13 on the Organ

izational Change Questionnaire (Appendix B).

3. Job redesign - The process of changing the duties and responsibilities of a

specific job and the characteristics of the individual needed to perform it

successfully.

Job redesign is operationalized by items 3,6 ,9 , and 12 on the Organizational

Change Questionnaire (Appendix B).

4. Job stressor - A physiological, psychological, or sociological demand

placed on an individual in his employment setting.

Job stressors are operationalized by the Stress Diagnostic Survey - Form A

and include politics of the organization, human resource development, reward

systems, participation in decision making, underutilization, supervisory style,

organizational structure, role ambiguity, role conflict, quantitative overload,

qualitative overload, career progress, responsibility for people, time pressure,

and job scope (Appendix C).

5. Politics - A source of job stress that results from the formal and informal

power structures and their processes within an organization.

Politics is operationalized through items 1,8,15, and 22 of the Stress

Diagnostic Survey, Form A.


6. Human Resource Development - A source of job stress that results from an

organization's plan to train and educate workers to perform their jobs and

learn new skills to help them advance within the organization.

Human Resource Development is operationalized through items 2,9,16,

and 23 of the Stress Diagnostic Survey, Form A.

7. Rewards - A source of job stress that results from the incentive structure of

an organization and the way in which they are distributed.

Rewards is operationalized through items 3,10,17, and 24 of the Stress


8. Participation - A source of job stress that results when workers do not have

the opportunity or feel they have insufficient input into the decisions made

within an organization.

Participation is operationalized through items 4,11,18, and 25 of the Stress


9. Underutilization - A source of job stress that results when a worker has more

knowledge, skills, and abilities than is required by the job.

Underutilization is operationalized through items 5,12,19, and 26 of the

Stress Diagnostic Survey, Form A.

10. Supervisory Style - A source of job stress for a worker that results from the

interpersonal style of leadership of supervisors.


Supervisory Style is operationalized through items 6,13,20, and 27 of the


11. Organization Structure - A source of job stress for a worker that results from

the way an organization is formed, its channels of authority, span of control,

and lines of communication.

Organization Structure is operationalized through items 7,14,21, and 28

of the Stress Diagnostic Survey, Form A.

12. Role Ambiguity - A source of job stress that occurs when a worker does not

know or understand what management expects him to accomplish.

Role Ambiguity is operationalized through items 29,37,45, and 53 of the


13. Role Conflict - A source of job stress caused by difficulty or inability to meet

various sets of expectations placed on a worker by others.

Role Conflict is operationalized through items 30,38,46, and 54 of the Stress


14. Overload Quantitative - The physical demands of a job exceed the worker's

capacity, for instance, when a worker has more work than he can do in a given

amount of time.

Overload Quantitative is operationalized through items 31,39,47, and 55 of

the Stress Diagnostic Survey, Form A.


24

15. Overload Qualitative - The form of work overload that occurs when a worker

feels he does not possess the required knowledge, skills, and abilities to

perform a job.

Overload Qualitative is operationalized through items 32,40,48, and 56 of

the Stress Diagnostic Survey, Form A.

16. Career Progress - A source of job stress that results when a worker has lack of

stimulation and growth opportunities in his career.

Career Progress is operationalized through items 33,41,49, and 57 of the


17. Responsibility for People - A source of job stress that results from having to

supervise or oversee the work of others, providing information to others, or

being accountable for the work of others.

Responsibility for People is operationalized through items 34,42, 50, and 58

of the Stress Diagnostic Survey, Form A.

18. Time Pressure - A source of job stress that results from having insufficient

time to complete tasks.

Time Pressure is operationalized through items 35,43,51, and 59 of the


19. Job Scope - A source of job stress that results from having too few responsi

bilities, lack of challenge, or feeling a job is insignificant.


25

Job Scope is operationalized through items 36,44,52, and 60 of the Stress


20. Macro Job Stress - Organizational specific factors that contribute to job stress.

Macro Job Stress is operationalized through the subscales of Politics, Human

Resource Development, Rewards, Participation, Underutilization, Supervisory

Style, and Organization Structure on the Stress Diagnostic Survey Form A.

21. Micro Job Stress - The job specific factors that contribute to job stress.

Micro Job Stress is operationalized through the subscales of Role Ambiguity,

Role Conflict, Overload Quantitative, Career Progress, Responsibility for

People, Time Pressure, and Job Scope on the Stress Diagnostic Survey Form

A.

22. Job satisfaction - the combination of psychological, physiological, and envi

ronmental circumstances that cause a person to feel contentment in the

activities surrounding his job.

Job Satisfaction is operationalized by the Index of Job Satisfaction by

Brayfield and Rothe (1951) (Appendix D).

23. Organizational commitment - A state in which an individual identifies with an

organization and its goals and values and has a strong desire to maintain

involvement with the organization.

Organizational commitment is operationalized by the Organizational

Commitment Questionnaire by Mowday and Steers (1979) (Appendix E).


26

24. Turnover - An individual's desire not to continue to be an organization

member.

Intent to turnover is operationalized by the Intention to Turn Over Scale from

the Michigan Organization Assessment Questionnaire (Appendix F).

Assumptions

It is assumed that social workers and registered nurses employed in acute hospital

settings for at least one year:

1. Experience some form of job stress;

2. Perceive stress to be a personal concept that differs from one person to

another;

3. Candidly complete the questionnaires.

Limitations

1. Age, educational level, and work experience of social workers and registered

nurses might be covariates that would alter job stress, job satisfaction, and

organizational commitment.

2. The sample of hospital social workers obtained from membership lists provided by

the National Association of Social Workers might not be representative of all

hospital social workers.


CHAPTER II

REVIEW OF LITERATURE

The review of literature consists of findings of studies that pertained to organizational

factors of structure, reengineering, and job redesign; job stress viewed from macro and micro

perspectives; job satisfaction; organizational commitment; and turnover.

Organizational Factors

Organizations are complex social entities composed of people that are goal-directed,

deliberately structured activity systems with an identifiable boundary (Daft, 1992). This

definition also establishes that organizations exist for a purpose which is related to work

activities. The work is subdivided into departments for efficiency. This is the structure of

the organization. The processes involved in doing the work are engineering tasks. Job

design is how the work is done. The literature will be reviewed as to the elements of

structure, engineering, and job design.

Organizational Structure

Organizational structure designates the formal reporting relationships within an

organization and identifies the departments within the total organization, and is depicted by

the organizational chart. Two British management scholars, Bums and Stalker (1961), found

that when environmental uncertainty is high, the organizational structure must adapt for

maximum effectiveness of the organization. They identified two types of organizational

27


28

structures employed based on stability of the environment. With stable environments, they

found that mechanistic structures that utilized hierarchical reporting relationships and reli

ance on policies and procedures similar to a bureaucracy worked best. They called this

organizational structure "mechanistic." The type they found most suited to unstable environ

ments was the organic structure that was flexible, flatter with fewer reporting relationships,

and where workers relied more on judgment than on rules.

Lawrence and Lorsch (1969) analyzed the manufacturing, research, and sales depart

ments in 10 corporations. They found that when the external environment is complex and

rapidly changing, organizational departments become highly specialized to handle the un

certainty. This was identified as organizational differentiation. Integration was identified as

collaboration between departments that became necessary as differentiation increased.

Integration between departments was accomplished with people in boundary spanning roles

who worked between different departments. The research of Lawrence and Lorsch (1972)

concluded that organizations perform best when the levels of differentiation and integration

match the levels of uncertainty in the environment.

Oliver (1991) found that in environments with high uncertainty, organizations tend to

imitate other organizations in the same task environment or industry. This was identified as

the institutional perspective. Managers assumed that other organizations faced similar uncer

tainty, and they tended to copy other strategies. Organizations did not wish to be criticized

for being too different; therefore, they followed the lead of other organizations.


29

In healthcare settings, the trend has been to have fewer levels in the administrative

hierarchy and greater integration of departments. Differentiation of services and departments

has been found traditionally in healthcare organizations as they increase in size. The current

trend is for patient-centered delivery of services that places several services in one area under

one manager to provide service to particular patient groups, such as surgical or oncology

patients. This has increased the amount of integration of services, but not necessarily has

differentiation increased.

In looking at the relationship between job satisfaction and organizational structure,

one study demonstrated that in smaller organizations, job satisfaction was greater in flatter

organizations (Porter & Lawler, 1965). Carpenter (1971) noted that teacher satisfaction was

greater in flat organizational structures. Ivancevich and Donelly (1975) found that salesmen

in flat organizations have higher job satisfaction, less anxiety, and perform more efficiently

than those in tall organizations.

In a qualitative case study of a non-profit, Catholic hospital, it was noted that organ

izational structural changes initiated because of the unstable healthcare environment were

made to help ensure the institutional survival of the hospital (Dwyer, 1989). The data for the

study came from interviews with thirty-nine governing board members, administrators, and

physicians, and a thorough review of organizational documents. Increased budgetary con

straints due to decreased reimbursement and increasing competition was a major problem

identified for the hospital. This created the problem of a lack of adequate funding for indi

gent care, a long-standing mission of the hospital. The findings indicated that administrators


30

have gained increasing organizational authority while physicians perceived decreased power.

There was also the perception that power had shifted to physicians who had many admis

sions, creating high revenue for the hospital. Decision making became more centralized with

administrators making more managerial and institutional decisions. This was counter to the

national trend to decentralize decision making. This study was of interest because this

hospital became more centralized while the current emphasis is on decentralization and

development of more organic structures.

With restructuring, many middle management positions have been eliminated. At

Vanderbilt University Hospital, an estimated 7.5 percent savings in cost per patient day was

estimated to result from eliminating middle management and administrative positions

(Anderson, 1993). In a study of 281 general acute care hospitals, a strong relationship

between mortality in Medicare patients and downsizing was found (Murphy, 1993).

Hospitals that made across the board staffing cuts of 7.5 percent or more or who were at an

average staffing level of 3.35 full-time equivalents per adjusted occupied bed or below were

more likely to experience an increase in mortality and morbidity (Murphy, 1993).

In a study of organizational structure, burnout, and job satisfaction, the organizational

structure was shown to influence the overall job satisfaction of social workers (Arches,

1991). A study conducted in Massachusetts o f600 randomly selected social workers listed

with the Massachusetts Registry of Social Workers in 1988 identified the perception of

autonomy, the degree of bureaucratization, and organizational supports and social supports of

the social workers in the study. Of the questionnaires returned, 275 were used in the


31

analysis. The review of literature indicated that bureaucratization lead to feelings of isola

tion, fragmentation, and deskilling. Isolation resulted from limited peer consultation and

informal interactions. Fragmentation resulted from compartmentalization into narrowly

defined tasks that prevent social workers from holistically approaching their task. Deskilling

was defined as the breakdown and destruction of the social worker's generalized body of

knowledge and professional skills. Deskilling resulted from the division of labor, specializa

tion of labor and reliance on technology inherent in a bureaucracy. Hierarchical multiple

regression was performed. The variables of sociodemographic data, organizational data,

autonomy, bureaucracy, organizational supports and social supports accounted for 38 percent

of the total explained variance in job satisfaction. The only significant variables were percep

tion of autonomy and bureaucratization. The study indicated that social workers are most

satisfied in their jobs when they have autonomy, are not limited by demands of funding

resources and are not stifled by bureaucracy (Arches, 1991).

Reengineering

Hammer and Champy (1993) defined reengineering as "the fundamental rethinking

and radical redesign of business processes to achieve dramatic improvements in critical,

contemporary measures of performance, such as cost, quality, service and speed." Three

major driving forces have been identified that necessitate reengineering: customers, compe

tition, and change (Blancett, & Flarey, 1995). The healthcare environment is customer

driven and must be responsive to customer needs. Competition between healthcare organi

zations has greatly increased, which has changed the way services are delivered. Change is


32

rapidly occurring and unpredictable in the healthcare environment currently. The literature

was reviewed to determine what effects reengineering processes has had on both the organi

zation and its employees. Studies found were evaluations that demonstrated financial savings

due to reengineering, but effects on workers were not reported.

One reengineering process that began in 1988 in Lake Land Regional Medical Center

was based on the premise that downsizing strategies were only temporary solutions to the

problems facing healthcare institutions. The analysis from the consulting firm of Booz-Allen

& Hamilton, Incorporated identified that only sixteen percent of the hospital's structure was

spent delivering medical, technical, or clinical care and that documenting, scheduling, and

coordinating were the primary operating functions of the hospital. The conclusions were that

the primary costs and performance measures were controlled by the organization's structure,

management processes, and deployment strategies (Manion, & Watson, 1995). Based on

these findings, the hospital was separated into five operating centers, each managed as unique

entity. Rather than utilizing separate departments to provide services, a patient-centered

approach was implemented that put teams together to work on patient units to provide

service. Jobs were redesigned to increase the quality of work life and job satisfaction for

health care workers and support staff. The methods utilized in the job redesign process to

increase job satisfaction were not described. A decision was made to cross train workers to

work in areas outside their usual areas of functioning. An organizational culture change was

implemented to foster teamwork. The conclusion of the study was that the quality of care

had been improved, but no measures were given to support the conclusion. The study also


33

concluded that job satisfaction increased, but no data was given to support the conclusion

(Manion, & Watson, 1995).

A northeastern hospital underwent reengineering to address philosophy, values, the

environment, structure, work activities, and the organizational culture in order to enhance

organizational effectiveness (Farrell, Bourgeois, & Sroczynski, 1994). The process began

with meetings conducted with employees to gather ideas, develop a new mission statement,

and establish operational guidelines. The evaluation of the project demonstrated cost effec

tiveness and decreased length of stay by patients. An average of a half-day decrease in

length of stay saved fifteen dollars per patient per day. Savings were noted in operating room

expenses of $26,360 per year and in the emergency department of $39,420 per year (Farrell,

Bourgeois, & Sroczynski, 1994). Patient satisfaction, employee satisfaction, and other

effects of the changes were either not studied or were not reported.

Changing the corporate culture has been considered part of reengineering. In evalua

ting the effects of corporate culture on stress, the most stressful companies in the United

States were identified (Smith, 1975). One company that has been examined was ITT because

of terminating one hundred executives. This created stress throughout the company because

of lack of job security. Another company examined was the Gallo Winery because of their

demand for perfection and the low tolerance of their chief executive for failure. Both of these

situations can be likened to healthcare. With downsizing and emphasis on quality, healthcare

workers face potentially similar stresses.


34

Job Design

Turner and Lawrence (1965) hypothesized a set of requisite task attributes that

influence employees' responses to their jobs. The six attributes they identified were variety,

autonomy, required interaction, optional interaction, knowledge and skill, and responsibility.

Using these attributes, they created a job attitude survey to measure job satisfaction. In a

survey o f470 employees, they found that the attributes were related to job satisfaction and

attendance.

Building on the work of Turner and Lawrence, and considering the work of Frederick

Herzberg with his Motivation-Hygiene theory, Hackman and Oldham (1975) proposed a

more complete model of job design. They proposed that a well designed job leads to high

motivation, high quality performance, increased job satisfaction, and low absenteeism and

turnover. They identified three psychological states in employees that lead to these

outcomes: (1) they feel their work is meaningful and important to others; (2) they feel

personally responsible for their work; and (3) they receive feedback about how well they did

their jobs. Hackman and Oldham (1975) identified enriched jobs as having skill variety, task

identity, task significance, autonomy, and feedback.

In review of the literature, no studies identified how healthcare is designing jobs with

the intent of job enrichment or the effects of such designed jobs. The current focus from the

literature was on restructuring and reengineering.


35

Joh Stress

With efforts to reform our current healthcare system, components of the system are

going through a revolutionary period. Transition periods in individuals and organizations

give rise to strain and stress (Kimberly, Miles, & Associates, 1980). Strain is the degree of

physiological, psychological, and/or behavioral deviation from an individual's normal

functioning resulting from a stressful event or series of events (Quick, & Quick, 1984).

Direct and indirect consequences of organizational stress have been identified. Direct

consequences that adversely effect an organization include absenteeism, tardiness, turnover,

decreased productivity, decreased quality performance, and waste of supplies and resources.

Indirect consequences have been identified as low morale, low motivation, job dissatis

faction, communication breakdowns, poor work relations and faulty decision making (Quick,

& Quick, 1984). Many sources of organizational stress have been identified, including the

organizational structure, the politics of the organization, supervisoiy style, time pressure,

human resource development, career potential, rewards, participation, role ambiguity, role

conflict, quantitative overload, qualitative overload, and responsibility for people (Matteson,

& Ivancevich, 1987).

Being responsible for people in their jobs, their career development, and general

well-being has been shown to be a greater source of stress than responsibility for equipment

(Matteson & Ivancevich, 1982). In service professions such as social work, nursing, and

other health occupations there is increased responsibility for employees because of the

managerial nature of the work. There is a greater degree o f work stress based on the extent to


36

which a job requires making decisions, constant monitoring of equipment, repeated exchange

of information with others, performing unstructured tasks, and working in unpleasant phys

ical conditions, such as working weekends, nights, or holidays (Greenberg, & Baron, 1993).

These characteristics are inherent in jobs of healthcare workers. The literature was reviewed

from the perspective of the Person - Environment fit theory, job stress and the Stress Diag

nostic Survey, a social work perspective, and a nursing perspective.

Job Stress and P-E Fit Theory

French, Rodgers and Cobb (1974) applied the P-E fit theory to data gathered from

two previous studies to further validate the theory. The theory was tested with data gathered

by Bachman et al., (1967) with high school boys. This was not reviewed since it did not

relate to job stress. The data from a study by Caplan (1971) on engineers, administrators, and

scientists was then used to test the theory. The data was obtained from 189 men working at

the National Aeronautical Space Administration (NASA) for the purpose of determining the

effects of a variety of job stressors on various risk factors of coronary heart disease. The men

were surveyed with a sixty-seven item questionnaire that measured factors related to the

subjective job and the subjective job environment, i.e., work overload, time pressures, and

interpersonal relationships. They were also surveyed about job satisfaction and job related

threat, i.e., prospects for meeting one's own needs, for good health, and for feelings of

self-worth. The P-E fit score was obtained by subtracting the person score from the environ

ment score. Twenty oneway analysis of variance tests were performed between the P-E fit

score and job satisfaction and job threat. Significant values were found in thirteen variables


37

and six showed U shaped relationships. French et al., (1974) indicated these findings pro

vided preliminary support for the P-E fit theory.

In a follow up study of NASA employees at the Kennedy Space Center and the

Goddard Space Center, French (1974) further tested the P-E fit theory. The sample included

165 managers, engineers, and scientists at the Kennedy Space Center and 206 employees in

the same positions from the Goddard Space Center. The purpose of the study was to deter

mine if P-E fit accounted for more variance in mental health than by the linear effects of job

stress and personality variables. The employees from Goddard completed a questionnaire

regarding job satisfaction, including role ambiguity, relations with subordinates, quantitative

and qualitative work overload, responsibility for people and participation in decision making.

They were also surveyed with the items that measured job stress and job threat as in the

Caplan (1971) study. Data analysis revealed that the Goddard employees wanted less role

ambiguity, better relations with subordinates, more responsibility for others, more use of their

abilities, and more participation in decision making. It was concluded that job satisfaction,

job stress, and job threat formed curvilinear relationships with P-E fit scores as predicted by

P-E fit theory. The men from Kennedy Space Center were surveyed with the same instru

ments as in the Caplan (1971) study. Analysis of the data indicated the men wanted less role

ambiguity and more participation in decision making. Job stress, job satisfaction, and job

threat formed curvilinear relationships with P-E fit scores as predicted by the P-E fit theory.

In both the Kennedy and Goddard studies, congruence between the person and the job was

determined when the fit assumed the zero point on the U shaped curve.


38

Role theory proposes that organizations have expectations of what people are expec

ted to do in their jobs and how they will do their jobs. Because the expectations are defined

by others and then communicated to the worker, they are key ingredients to job stress (Beehr,

1985). Kahn et al., (1964) proposed that two types of role stressors occur in organizations:

role conflict and role ambiguity. Role conflict has been defined as the simultaneous occur

rence of two or more sets of pressures such that compliance with one would make compli

ance with the other more difficult (Kahn, Wolfe, Quinn, & Snoek, 1964). Role conflict

occurs when two or more role messages are contradictory. Four types of role conflict were

identified:

1. Intra-sender conflict - incompatible expectations within a person.

2. Inter-sender conflict - expectations from one role sender are in opposition to

expectations from other role senders.

3. Inter-role conflict - expectations for behaviors in two roles held by one person that

are incompatible.

4. Person-role conflict - needs and values of a person conflict with his role.

Role ambiguity occurs when clear and consistent information is not communicated to

a person about his role. According to role theory, it has been postulated that ambiguity

increases the probability that a person will be dissatisfied with his role, will experience psy

chological and physical stress, will seek opportunities for improving clarity and satisfaction,

and will generally show a lack of job interest. In a study to examine the effects of role ambi

guity on employees, three different occupational groups were surveyed. The groups included


39

salesmen, first-line supervisors, and operating employees. The review of literature noted that

studies of nurses, hospital administrators, diagnostic personnel, and managers suggest that

the need for clarity is a general need of various occupational groups. This study found statis

tically significant associations between role clarity and general job interest, job tension, and

propensity to leave the organization in all three occupational categories. The most substantial

association for the salesmen group was between role clarity and satisfaction with autonomy

(r = .61). For supervisors, the strongest association was between role clarity and physical

stress (r = .71). For the operating employees, the strongest association was between role

clarity and job tension (r = .78). It was concluded that the need for job clarity may be influ

enced by a person's job level (Ivancevich, & Donnelly, 1974).

Job Stress and the Stress Diagnostic Survey

The Stress Diagnostic Survey (SDS) has been utilized in numerous studies with a

variety of occupational groups (Ivancevich, Matteson, & Dorin, 1990). In contrast to other

measures of job stress that gave an overall index of job stress, the SDS measured fifteen

different job stressors. The stressors were divided into MACRO and MICRO aspects to

determine organizational environment specific factors and job specific factors. Since this

study proposed to evaluate the effects of organizational changes on job stressors, job satis

faction, organizational commitment and turnover, the SDS was deemed appropriate.

In a study by Lau ( Ivancevich, Matteson, & Dorin, 1990) done in a surgical depart

ment of a medium sized hospital, the SDS was used as an assessment test to determine

perceived sources of stress in the work environment. The sources of stress identified were


40

the basis of planning a stress management program. Employees were taught coping skills,

relaxation techniques, problem solving skills, and cognitive skills to reduce stress. Following

the stress reduction program, the SDS was used to evaluate the effectiveness of the program.

Results indicated that stress was significantly reduced. In addition, hospital savings occurred

due to an absenteeism decrease of thirty-three percent. There was also a decrease in patient

complaints by eighty-eight percent (Ivancevich, Matteson, & Dorin, 1990).

In a nationwide random sample of critical care nurses, the SDS was used for the

measure of job stress to examine the relationship between hardiness, job stress, and illness

(Summers, 1985). The study was framed on the Person-Environment Fit theory French,

Rodgers, & Cobb, 1974), the Hardiness theory (Kobasa, 1979), and the Stress-Illness theory

(Selye, 1976). Psychometric ambiguity was found in the hardiness scale. The study found a

reliability coefficient of .96 for the MACRO organizational scale and .93 coefficient alpha for

the MICRO organizational stress scale. Literature reviewed indicated that the average critical

care nurse was young, inexperienced, highly stressed, with frequent illnesses. This study

contradicted the literature. The average nurse in this study was thirty-three years old, married

and had worked in critical care for more than five years. The nurses in this study were mod

erately stressed and had few illnesses. Using path analysis, the hypotheses of the study were

rejected that proposed that job stress leads to illness and that hardiness factors are stress

mediators (Summers, 1985).


41

Job Stress of Social Workers

Hospital social workers perceive a higher degree of stress than social workers in other

settings (Sze, & Ivker, 1986). A survey that included 686 respondents (20% return) from

4,100 names selected from the National Association of Social Workers membership roster,

found that social workers had experienced increased stress and more stress related symptoms.

Factors that were identified as being the least stressful were the ability to make their own

decisions, role clarity, ability to try new methods, comfort with role, and working well with

non-social work colleagues. The areas identified as the greatest stressors were lack of

opportunity for advancement, decreased social exchange with colleagues, lack of career

advancement, inadequate salary, and low morale of fellow workers. The desire to change

employment agencies in a limited job market and the perception of lack of opportunity for

advancement appeared to be major factors in job dissatisfaction and stress. In comparing six

types of employing agencies, hospital social workers had more stress related symptoms. The

lowest number of stress related symptoms were found among public agency workers. Public

agency administrators had the highest number of stress related symptoms in the administrator

category, and university administrators indicated the lowest number of stress related symp

toms. The combined worker and administrator data indicated that hospital settings created

the greatest amount of stress related symptoms. Negative assessments of agency conditions

were correlated with increased strain (Sze, & Ivker, 1986).

Role ambiguity results whenever there is unclear or confusing information about the

expected role behaviors or when there is confusion about consequences of role behavior. In


42

an extensive review of the literature, findings showed that role ambiguity leads to low per

formance, low job satisfaction, high anxiety, and employee turnover (Van Sell, Brief, &

Schuler, 1981). The roles and functions of social workers and nurses can overlap at times

which leads to role ambiguity. In a study of social workers and nurses in a hospice setting, of

the fifteen activities and interventions for hospice care identified by the National Association

of Social Workers, hospice directors found social workers and nurses equally competent to

perform eleven functions, nurses more competent in two functions, and social workers more

competent in two functions (Kulys, & Davis, 1987). The social workers and nurses identified

that the provision of social services was a responsibility of both professions. Role conflict

and role ambiguity are significant predictors of depersonalization and burnout among health

care social workers (Siefert, Jayaratne, & Chess, 1991).

In a national survey of social workers who belonged to the National Association of

Social Workers, Jayaratne and Chess (1984) found that social workers in community mental

health, child welfare, and family services had different levels of stress. Child welfare work

ers reported a significantly higher stress level that community mental health workers or

family service workers. The family service workers reported the highest scores related to

work environment on seven of ten indexes: depersonalization, role ambiguity, value conflict,

work load, comfort, challenge, and role conflict. In contrast, the child welfare workers

scored lowest on six of these indicators. Regression analysis was done according to each

group. The best predictor of job satisfaction for all three groups was promotional oppor

tunities. The other significant factors differed between each group. The study found that


43

younger social workers with less experience were more likely to be employed in child wel

fare. These two factors were also predictive of job satisfaction for the child welfare workers.

Value conflict, challenge, and financial reward were other predictors for the community

mental health workers. In addition to promotional opportunities, comfort was a predictor of

job satisfaction for family service workers. The study pointed out the importance of under

standing the particular social work group under study in order to develop stress reduction

techniques and to increase job satisfaction (Jayaratne, & Chess, 1984).

In a study by Keller (1975), role ambiguity and role conflict were associated with low

levels of satisfaction with work. Eighty-eight professional employees of an applied science

department in a large government research and development organization were surveyed

using scales on role conflict and ambiguity, the Job Description Index, and the Study of

Values test. A correlational analysis showed that role conflict was significantly related to

low levels of satisfaction with supervision (r = -.28), pay (r = -.30), and opportunities for

promotion (r = -.39). Role ambiguity was significantly correlated to a low level of satisfac

tion with the work itself (r = -.54). It was concluded that role conflict was related to extrinsic

factors of job satisfaction. Role ambiguity was related to intrinsic factors of job satisfaction.

One study was conducted to identify the areas of potential role conflict and ambigu

ity for hospital social workers (Cowles, & Lefcowitz, 1992). Forty social workers, 273

nurses, and 174 physicians were surveyed as to whose job it was to perform 28 tasks. Op

tions were physician, nurse, social workers, and other. Social workers believed that tasks

dealing with the social environmental problems of patients were in the social work domain.


44

Physicians and nurses tended to agree. Physicians and nurses clearly identified social envir

onmental problems of families as being the role of social work. More than half of the social

workers expected their unique role to include assessment and treatment of social-environ

mental problems of patients and emotional problems of families. In contrast, physicians and

nurses expected social workers to share these tasks equally with other professions. The only

task that the majority of physicians and nurses thought was outside the domain o f social work

was assessment of the emotional problems of patients. Physicians and nurses generally did

not disagree with what the medical social workers were to do in their roles. Disagreement

came over what was the exclusive role of the medical social worker. The findings indicated

the importance of collaborative practice.

fob Stress-oLNurses

In a survey of 3,500 registered nurses in Texas, elements of job dissatisfaction were

studied (Wandelt, Pierce, & Widdowson, 1981). In analyzing factors that lead to dissatis

faction, it was concluded that dissatisfaction for registered nurses comes from the work

setting rather than from nursing practice. Another finding was that nurses are concerned

about the quality of care that they provide. When quality was compromised because of the

work environment, dissatisfaction occurred.

Using a prospective descriptive design, a study was conducted to develop a path

model to explain the effects of situational stress, job stress, job satisfaction and job moti

vation on burnout in a group of critical care nurses (Stechmiller, & Yarandi, 1993). The

sample included three hundred critical care nurses employed in nine hospitals in Florida. To


45

be included in the study, the nurses must have been employed for three months full-time.

The results demonstrated a causal progression of situational stress, job stress, job satisfaction

and emotional exhaustion. Commitment to career, health difficulties, psychologic hardiness,

work load satisfaction, dealing with others at work, job security, and job satisfaction had a

significant effect on emotional exhaustion. These variables explained 34 percent of the var

iance. The study showed that job stress has the negative effect of leading to burnout, which

leads to decreased productivity, increased absenteeism, and potential turnover (Stechmiller,

& Yarandi, 1993).

In a review of over one thousand articles dealing with job stress, Cohen and Mans

field (1989) found that job stress occurs on several levels. Job stress can occur at the org

anizational level, the unit level, the patient-care level, and the personal level. Factors that

contributed to job stress lead to job dissatisfaction. Job stressors included work overload,

interpersonal conflicts with co-workers and supervisors, and feelings of being unable to give

quality care. Nurses liked their jobs when they were able to give quality care and had pos

itive interpersonal relationships with co-workers. Work overload was directly related to

staffing levels; therefore, staffing was found to relate to job stress (Cohen, & Mansfield,

1989).

Job Satisfaction

Locke (1983) defined job satisfaction as "a pleasurable or positive emotional state

resulting from the appraisal of one's job or job experience." In reviewing the literature on job

satisfaction, many contradictions are found. Job satisfaction deals with complex human


46

emotions that can account for the variations from study to study. The literature was reviewed

from a general perspective, including the Brayfield-Rothe Index of job satisfaction, job

satisfaction among social workers, and job satisfaction among registered nurses.

General Perspective of Job Satisfaction

Evidence exists to support the contention that there is a causal relationship between

job satisfaction, absenteeism, and turnover (Price, & Mueller, 1981; Argyris, 1964; Vroom,

1964; & Porter, & Steers, 1973). Using a path analytic model, Michaels and Spector (1982)

found that the strongest immediate predictors of turnover were job satisfaction and organ

izational commitment. This study demonstrated the importance of studying job satisfaction.

Without job satisfaction, employees are more likely to leave their organization.

In the development of the Index of Job Satisfaction, Brayfield and Rothe (1951)

identified several attributes of an attitude scale to measure job satisfaction. They believed it

should give an overall index of job satisfaction rather than to specific aspects of a job. They

felt it should be applicable to a wide variety of jobs and sensitive to variations in attitude.

The scale had to yield a reliable and valid index that could be easily scored. Seventy-seven

men in a psychology class submitted 1000 items and an additional 75 were submitted by the

researchers. These were edited into 246 items. The items were submitted to a panel of

judges who sorted the items by the Thurstone method. These were sorted into 18 items. The

scale was then administered to 10 workers. A rank order correlation was computed. Two

items were revised. The scores on the revised scale were highly correlated with scores on the

Hoppock blank (Brayfield, & Rothe, 1951).


47

Job Satisfaction Among Social Workers

Two surveys of health care social workers done in 1979 and 1989 indicated that the

organizational environment has changed for health care social work (Siefert, Jayaratne, &

Chess, 1991). Significant increases were found in the proportion of social workers employed

in private agencies, in quantitative workload and in the perceptions of the challenges pre

sented by their jobs. The sample for both studies was obtained from members of the National

Association of Social Workers who identified themselves as working in health care. In the

1979 survey, 853 surveys were returned and in the 1989 study, 882 were returned. Very

similar findings were noted between both the 1979 and the 1989 studies as to job satisfaction.

In 1979,32.5 percent of the respondents identified that they were very satisfied and 53.2

percent reported that they were somewhat satisfied with their jobs. In 1989, 31.9 percent

indicated that they were very satisfied and 51.4 percent described themselves as somewhat

satisfied with their jobs. In 1979, high challenge and high perceived opportunity for promo

tion were significant predictors of job satisfaction. Emotional exhaustion was predicted by

not being married. Low role conflict was a predictor of a sense of personal accomplishment.

In the 1989 survey, high challenge, satisfaction with financial rewards, and low conflict with

professional values were significant predicators of job satisfaction. Emotional exhaustion

was predicted by role conflict, role ambiguity, and lack of comfort. Depersonalization was

predicted by high role conflict, low challenge, and low satisfaction with financial rewards.

One significant finding was the increase in feelings of effectiveness between 1979 and 1989.


48

Siefert, Jayaratne, and Chess (1991) concluded that there should be greater attention on

conflict resolution and ethical decision making in social work practice in health settings.

In a study of eighty social workers employed in thirty-six not-for-profit acute care

hospitals in Cook County, Illinois, job satisfaction was measured in relation to the discharge

planning role (Kadushin, & Kulys, 1995). This study was framed on Herzberg's Motiva-

tion-Hygiene theory. The review of literature in this study indicated that discharge planning

is stressful in that it involves the low-level skill of providing concrete resources, frequently

requires work with elderly people that can be difficult, and frustrates workers when they are

confronted with lack of resources and inadequate solutions to discharge plans. In this study,

the most frequently mentioned reason for satisfaction focused on helping patients and

families achieve desirable discharge plans, arranging concrete resources, and meeting the

challenge of the job. This finding contradicted the findings in the literature that depicted the

role of discharge planning as being unsatisfying because of the nature of the work. By

obtaining concrete resources for patients, this study indicated that this function was a major

source of satisfaction. Reasons for dissatisfaction focused on the context of work and

difficulties encountered while working in the institution. Pressure to discharge patients

quickly and lack of time to provide counseling or emotional support tied as the main reasons

for dissatisfaction. Lack of cooperation from hospital staff rated next as a source of dissat

isfaction. The primary group mentioned as refusing to cooperate were physicians. Addi

tional sources of dissatisfaction were related to lack of community resources, lack of under

standing of the social work role, low salaries, large caseloads, and uncooperative staff,


49

patients, and families. The number of reasons mentioned for either satisfaction or dissatis

faction did nor correlate with overall satisfaction. These findings were consistent with

Herzberg's theory of job satisfiers and hygiene factors. Kadushin and Kulys (1995) conclu-

ed there were 2 essential components of social work education for medical social workers

that should be stressed: the importance of understanding that hospitals struggle for economic

survival and have no control over requirements and regulations by external agencies, and the

importance of teamwork and communication.

In a study evaluating job satisfaction of 188 psychiatric social workers, there was

positive overall job satisfaction (Marriott, Sexton, & Staley, 1994). The highest areas of job

satisfaction were nontask aspects of work. Variety in work, autonomy, and opportunities for

social interaction were found to lead to job satisfaction. Money for continuing education was

a consistent source of dissatisfaction. Overall job satisfaction was determined to be deter

mined by position satisfaction, which connotated both tasks and status. The major correlate

of position satisfaction was the professional respect received from other disciplines and not

the specific tasks performed. These findings were interpreted as reflecting the effect of the

health care team interactions on job satisfaction. Significant correlations were found for

professional respect from psychologists (r = .36), psychiatrists (r = .34), nurses (r = .29), and

occupational therapists (r = .26). In the setting studied social workers were often dependent

on the quality of the team interactions to derive the variety, autonomy, and value in their

work. Because of this, it was difficult for them to keep subjectively clear the actual level of

satisfaction with the work itself. The capacity to utilize special skills was a predictor of


50

overall job satisfaction. Use of expertise on the job, encouragement to develop programs,

and implementing new service ideas were significant correlations with job satisfaction. A

second factor that emerged as a correlate of job satisfaction was educational opportunities.

Since satisfaction was obtained from use of special skills, having time and money to attend

continuing education to enhance skills was important to overall job satisfaction. Demo

graphics, work activities, except for planning, and teaching activities did not contribute to job

satisfaction. The study suggested that directors of hospital social work departments should

focus on developing a stronger sense of practice excellence and facilitating a subjective

separation between task-derived achievement and interpersonal enjoyment (Marriott, Sexton,

& Staley, 1994).

Job Satisfaction of Registered Nurses

A study of 221 female nurses in Los Angeles identified factors that predict job sat

isfaction of nurses (Cavanaugh, 1992). Using a structural equation model and EQS, positive

relationships were found between benefits, communication, integration, justice, participation,

promotion and salary and job satisfaction. Negative relationships were found between edu

cation, opportunity, and routine. The goodness of fit chi-squared analysis produced from the

obtained model a chi-square of 19433.59 with 55 degrees of freedom and a probability of

0.376. The non significant chi-squared statistic was interpreted as a good fit between the data

and the model. The Bentler-Bonett fit index was 0.981. Staff benefits had the largest effect

on job satisfaction, while salary was only weakly associated. Participation in decision mak

ing was the second strongest association. A finding contrary to previous findings was that


51routine led to job satisfaction rather than dissatisfaction. Nurses with higher levels of educa

tion were more dissatisfied. It was postulated that higher education and qualifications may

lead to different expectations of job roles.

In a meta-analytic study of job satisfaction of nurses, job satisfaction was found to be

indirectly related to turnover because of the mediating role of creating behavioral intentions

(Irvine, & Evans, 1995). Following a computer search of nursing, medical, allied health,

social science, and management literature, a meta-analysis was done based on the average

weighted correlation coefficient. Job satisfaction was found to be related to three variables:

economic factors, sociological and structural variables, and psychological variables. In the

economic category, pay and alternative employment opportunities contributed minimally to

job satisfaction. In the sociological and structural category, job content and work environ

ment factors were analyzed. Characteristics of the job, such as routinization, autonomy, and

feedback, or how the work role is designed, such as role conflict and role ambiguity, had

moderately strong relationships with nursing job satisfaction.

In an extensive review of literature, Hinshaw and Atwood (1983) identified nineteen

factors considered important in predicting job satisfaction. Demographic factors included

age, sex, intelligence, education, experience as a nurse, tenure, and position in the organiza

tional hierarchy. Environmental factors they found important were the clinical service, type

of work, nursing care delivery model, degree of professionalization, organizational climate,

supervision, and interpersonal relationships. The job characteristics they identified included


52

status, autonomy, repetition of duties, the nature of tasks to be performed, job outcomes, and

pay.

Two separate research studies conducted in 1991 in Seattle and in 1993 in Los

Angeles identified the association of different leader behaviors on job satisfaction, organ

izational commitment, and productivity (McNeese-Smith, 1995). The leadership behaviors

in the studies were derived from Kouzes and Posner's model. These included: challenging

the process--risk taking, being innovative and change-oriented; inspiring a shared vision-

involving others in ideas, interests, and a vision of the possible; enabling others to act-

empowering and building teamwork and trust; modeling the way—being role models, setting

examples of high standards; and engaging the heart-being supportive, caring, and encour

aging while recognizing accomplishments. Multiple regression by simultaneous entry was

utilized to assess the associations of the variables. In the Seattle study, enabling others to act

was a predictor of job satisfaction with a R2 of 0.11. Productivity was predicted by modeling

the way (R2 = 0.09). Challenging the process, enabling others to act and inspiring a shared

vision predicted organizational commitment (R2 = 0.16). In the Los Angeles study, job

satisfaction was predicted by inspiring a shared vision and enabling others to act (R2 = 0.27).

Encouraging the heart was a negative predictor of productivity and inspiring a shared vision

was positively correlated (R2 = 0.15). Organizational commitment was predicted by inspiring

a shared vision (R2 = 0.29). Since the findings were similar in the two studies, greater cred

ibility can be attributed to the findings. The findings indicated that the leadership behaviors


53

of managers in hospital organizations can influence job satisfaction, productivity, and organ

izational commitment of registered nurses (McNeese-Smith, 1995).

In a study describing the magnitude of the relationships between nurses' job satisfac

tion and variables most frequently associated with it, a meta-analysis study was conducted

from 48 studies with a total of 15,048 subjects (Blegen, 1993). To be included in this anal

ysis, studies had to be quantitative analyses of empirical data of registered nurses engaged in

patient care, bivariate correlations between job satisfaction and other variables had to be

reported, and job satisfaction had to be measured by an overall job satisfaction measure.

Stress (-.609) and organizational commitment (.526) were most strongly associated with job

satisfaction. Variables with a moderate correlation to job satisfaction were communication

with supervisor (.446), autonomy (.419), recognition (.415), routinization (-.412), and com

munication with peers (.358). Variables with small to moderate correlations with job satis

faction were fairness (.295), locus of control (-.283), age (.133), years of experience (.086),

education (-.070), and professionalism (.06). Analysis of the demographic variables indica

ted that nurses who were older were more satisfied and those with more education were less

satisfied with their work. No relationship between years of service and satisfaction was

found. Results of this analysis indicated that reducing job stress appears to be the most

important factor in enhancing job satisfaction (Blegen, 1993).

In a study comparing nurses to other professions to determine if nurses were less

satisfied, Wright et al., (1990) found that in comparison to teachers and accountants, many

aspects of job satisfaction were similar. In twelve of twenty factors, there were no significant


54

differences between the three groups. In comparison to the teachers and accountants, nurses

did not have significantly higher or lower means on any of the twenty factors. Teachers were

significantly lower in the areas of control over hours of work, professional status, and having

adequate supplies and help. Accountants had significantly higher means than nurses or

teachers in general satisfaction, satisfaction with salary, and chance for administrative parti

cipation. All three groups ranked opportunity to help others as the most important factor

contributing to job satisfaction. The factor that contributed to the greatest amount of dissat

isfaction was having too much busy work. Factors that also contributed to dissatisfaction for

nurses was less chance for administrative participation and lack of opportunity for advance

ment (Wright, McGill, & Collins, 1990).

Organizational Commitment

Organizational commitment is the strength of an individual's identification and in

volvement with an organization. Organizational commitment has important implications to

both the individual and the organization. A widely supported view is that strong organiza

tional commitment that includes feelings of affiliation, attachment, and citizenship behavior,

tends to improve organizational efficiency and effectiveness (Williams, & Anderson, 1991).

The literature was reviewed from a general perspective, and the perspectives of social work

and registered nursing.


r

55

General Studies of Organizational Commitment

Because of studies that presented various meanings to the construct of organizational

commitment, a study was conducted using the Organizational Commitment Questionnaire

(OCQ) to determine if it measured a global attitude of an employee to the organization

(McCaul, Hinsz, & McCaul, 1995). A sample of 356 employees from two manufacturing

and one service company were administered the Organizational Commitment Questionnaire,

a four-item scale measuring global attitude toward the organization, a five-item scale measur

ing the employees' willingness to work hard for the organization, a three-item scale measur

ing intent to leave, and a five-item scale measuring the employees' overall acceptance of the

goals and philosophy of their organization. The findings of the study indicated the OCQ can

be conceptualized as a measure of an employee's global attitude toward the organization.

Using two separate time intervals, correlations with the OCQ and the global attitude toward

the organization were .82 and .84. Correlations between the OCQ and the other variables

were also significant. The significance of the study was that organizational commitment can

be viewed as an attitude. The researcher concluded that attitudes can be changed or modi

fied, so in viewing the construct of organizational commitment as an attitude opens new

research avenues (McCaul, Hinsz, & McCaul, 1995).

Based on quantitative studies that demonstrated relatively small correlations between

organizational commitment and turnover, Cohen (1993) conducted a meta-analysis to exam

ine the moderating effect of the interval between the measurement of an individual's organ

izational commitment and the occurrence of organizational departure. It was felt that


56

controlling the commitment-tumover relationship by the time variable might show a stronger

relationship than had previously been found and might show organizational commitment as a

predictor of turnover. Studies included in the analysis were conducted between 1967 and

1991. To be included in the analysis, studies had to show correlational data between organ

izational commitment and turnover. Thirty-four studies were included that represented 36

samples. Results showed that the commitment-tumover relationship is stronger when there is

a short time interval between the measurement and organizational commitment. There was a

significantly stronger relationship when the interval was less than 6 months. There was a

significantly stronger relationship between the two variables when the person was at the early

career stage as opposed to later career stage. There was no significant difference between

organizational commitment and turnover when tenure was an indicator. Results also showed

a stronger relationship between organizational commitment and turnover when the full 15

item Organizational Commitment Questionnaire was used instead of a shortened version.

The main conclusion drawn from the study was that both methodological and theoretical

moderators strongly affect the organizational commitment and turnover relationship (Cohen,

1993).

Curry, Wakefield, Price and Mueller (1986) conducted a longitudinal design study on

the causal ordering of job satisfaction and organizational commitment. The sample included

508 employees from five voluntary acute care general hospitals in a western state. Data was

collected in two waves nine months apart. Data were analyzed using LISREL. There were

no causal effects in either direction between satisfaction and commitment over time. At time


57

1, the zero-order correlation between satisfaction and commitment was .499. When the

exogenous variables were held constant, the partial (maximum likelihood) correlation was

.106 which was not statistically significant. For the time 2 measures, the zero-order correl

ation was .534, and the partial (maximum likelihood) correlation was .190 which was also

nonsignificant. The indicators of organizational structure that had the strongest effects were

routinization and distributive justice. High levels of repetitive work were associated with

low commitment and high levels of fairness of rewards were associated with high commit

ment. The findings also indicated that role overload is strongly associated with satisfaction,

but not with commitment. The primary finding of this study was that there was no support

for causal linkages between job satisfaction and organizational commitment. The commonly

held position was that satisfaction is a determinant of commitment was not found in the

study. The results supported the finding that commitment is causally antecedent to satisfac

tion (Curry, Wakefield, Price, & Mueller, 1986).

A study of 1,428 employees from both public and private sector organizations exam

ined the differences in perceived management style and organizational commitment (Zeffane,

1994). Employees rated there organizations on an organic-mechanistic scale that included

the factors of perceived emphasis on flexibility and adaptation, rules and regulations, hier-

rarchy and role specialization, and work-group change. The analysis of variance done

between the public and private sector employees showed that public sector employees were

less committed to the goals and values of their organizations than private sector employees.

Results of regression analysis showed that management style accounted for a substantial


58

amount of the variance on commitment. Rigid control mechanisms and limited autonomy of

employees lead to decreased feelings of loyalty and attachment to the organization. For both

public and private sector employees, perceived emphasis on flexibility and adaptation was

the most predominant predictor of commitment. The study concluded that organizational

commitment is more likely to be found among employees who believe that they are being

treated as resources to be developed rather than as commodities to buy and sell (Zeffane,

1994). Another conclusion was that managers should not only provide motivators, but

should remove demotivators such as management style with the goal of being more flexible

and adaptable.

A negative effect of decreased organizational commitment was demonstrated from an

accounting perspective in a study by Nouri (1994). This study defined budgetary slack as the

amount by which excessive requirements for resources were built into the budget or know

ingly understating productive capability. This study was done with 203 supervisors and

managers in a large multinational oil and chemical organization. Using a multiple regression

analysis, the hypothesis that there was a relationship between budgetary slack and organiza

tional commitment was supported. Managers with high organizational commitment had a

decreased propensity to create budgetary slack. Managers with low organizational commit

ment had an increased propensity to create budgetary slack (Nouri, 1994). While this study

was done with supervisors and managers, it was of interest because in healthcare organiza

tions, social workers and registered nurses involved in direct patient care are involved in

budgetary concerns. Because of the sample, the results may not be generalizable to social


59

workers and nurses, but it was of interest because of the potential need of further research in

this area.

Organizational Commitment of Social Workers

In a quantitative descriptive study of 105 clinical social workers in a residential

treatment center, the social workers' degree of autonomy was correlated to organizational

alienation (Rabinowitz, 1984). Organizational alienation was defined as feelings of detach

ment or separation from the workplace. This concept was seen as being similar to organiza

tional commitment. In general, the social workers felt satisfied with their overall degree of

professional autonomy and felt that their organizations allowed them adequate autonomy.

There was a high degree of organizational commitment or attachment to their organizations.

The younger, less experienced social workers reported a higher degree of burnout. The more

experienced social workers reported a higher degree of organizational alienation, inconsistent

with other studies linking tenure to organizational commitment. Significant relationships

were found between perceptions of professional autonomy and organizational alienation and

perceptions of professional autonomy and burnout. Significant relationships were also found

between the conflict associated with professional autonomy and organizational alienation.

The study concluded that professional autonomy is central to the social worker's degree of

organizational commitment (Rabinowitz, 1984).


60

Organizational Commitment of Registered Nurses

A study of 61 staff nurses in an acute care teaching hospital in a large metropolitan

area was done to explore the relationship between the power and opportunity perceptions of

staff nurses and their commitment to the organization (Wilson, & Laschinger, 1994). The

study was based on Kanter's theory of organizational structure and its effect on employee

attitudes and behaviors within the organization. Kanter suggested that the structure of the

work environment is an important determinant of employee attitudes and behaviors and that

changing these structures results in increased job empowerment. The Conditions for Work

Effectiveness Questionnaire (CWEQ), the Organizational Description Questionnaire, and the

Organizational Commitment Questionnaire were used in the study. Consistent with theor

etical expectations, all variables measured by the CWEQ were positively correlated with

organizational commitment. Nurses overall feelings of empowerment were associated most

strongly with organizational commitment. In analyzing the power and opportunity structure,

perceived access to information had the strongest relationship with organizational commit

ment. The study implied that administrators can manipulate the work environment to em

power employees and increase organizational commitment and quality of care (Wilson, &

Laschinger, 1994).

Turnover

Turnover was been commonly defined as voluntary cessation of membership in an

organization by an individual who receives monetary compensation for participating in that

organization (Mobley, 1982). While turnover can have some potentially positive benefits, it


61

has the negative consequence of increased personnel costs. Dysfunctional turnover is said to

exist when "good performers leave or if poor performers stay" (Dalton, Todor, & Krackhardt,

1982). The significance of studying turnover is to try to prevent dysfunctional turnover and

keep good workers in an organization. Evidence supports that a relationship exists between

job satisfaction and employee turnover. Porter and Steers (1973) examined 15 studies and

found a positive relationship between the level of job satisfaction and turnover in all studies

except one. Turnover was reviewed from a general perspective, a social work perspective,

and a registered nurse perspective.

Turnover from a General Perspective

Turnover in general has been felt to have negative effects on organizations. Negative

consequences of turnover fall into three major categories: financial costs, decreased quality

of care and disrupted personnel relations (Stryker, 1981). Financial loss has been shown to

include costs of recruitment, selection, interviewing, training and orientation of new employ

ees, and overtime costs of other employees who must do the required work until the new

person is hired and trained. One hospital estimated the cost of each new employee to be

between three hundred and one thousand dollars (Strilaeff, 1976). Turnover has been shown

to correlate to longer lengths of stay for patients (Stryker, 1981). Standards of care are lower

when there is excessive turnover. Price (1977) noted that morale of other employees is

associated with turnover. Lower morale has been associated with increased stress and de

creased job satisfaction.


62

An analysis of a review of literature on turnover identified the major correlates of

turnover that had been researched (Hinrichs, 1980). Demographic factors, personality fac

tors, job attitudes, and organizational commitment were identified as being major research

areas. Reviews on turnover concluded that there was a significant and consistent relationship

between age and turnover. There was a greater likelihood that younger employees will leave

an organization more readily than older employees. In addition, it was found that tenure was

correlated with turnover. The longer employees had been with a company, the less likely

they were to leave. In the area of personality, it was concluded that the research was incon

clusive as to correlates with turnover. One exception in the area of personality was in self

perception of ability. The greater employees perceive their ability to be, the greater the

probability they will remain on the job. A consistent finding was that low job satisfaction is

highly correlated with turnover. Studies correlating organizational commitment to turnover

found that high levels of organizational commitment correlated to less turnover.

In a meta-analytic study of turnover, studies that gave sample sizes and reliability

estimates were used to correlate turnover with its antecedents (Horn, & Griffeth, 1995). The

study found that older employees with longer tenure quit less often than younger employees

with shorter tenure. The findings supported the idea that tenured employees have greater

long-term job investment. Consistent with most theoretical perspectives, job dissatisfaction

was correlated to turnover (r = -.19). Met expectations also predicted turnover (r = -.13).

Very little support was found to support that dissatisfaction with salary leads to turnover.

Supervision, especially communication with supervisors and participative leadership, were


63

found to be possible deterrents to turnover. Job stress was noted to have been neglected in

many studies of turnover, but in the studies where it was implicated as antecedent to turn

over, correlations were moderate to predicting turnover (r = .19). Role clarity lowered

turnover, while role overload and role conflict increased it. Opportunities for advancement

moderately affected turnover (r = -.15). The study found that work behaviors associated with

turnover included lateness, absenteeism, and decreased performance (Horn, & Griffeth,

1995).

In a study predicting turnover of part-time and full-time employees, five antecedents

of turnover were correlated with turnover (Peters, Jackofsky, & Salter, 1981). These in

cluded the degree of job satisfaction, intention to quit, thoughts of quitting, expectations of

finding alternative jobs, and job search behavior. Of the seventy-one participants selected,

thirty-one were employed full-time and forty were employed on a part-time basis. For full

time employees, thoughts of quitting and job satisfaction correlated significantly at the 0.05

level with turnover. Job search behavior, expectation of finding alternate employment and

intention to quit correlated at a 0.10 level of significance. For part-time employees, none of

the five variables significantly correlated with turnover. The study concluded that people

employed on a part-time basis do not make turnover decisions on the same basis as people

employed full-time. This leant support to part-time workers having a different psychology of

work (Peters, Jackofsky, & Salter, 1981).

A study of 212 managerial trainees in a large manufacturing company was done using

a fifteen month longitudinal design (Porter, Crampton, & Smith, 1976). Organizational


64

commitment was measured by the Organizational Commitment Questionnaire. Attitude data

was collected from the employees from the first day of employment to the end of the fifteen

months or until they left the organization. Results indicated that employees who left the

organization during the initial fifteen month employment period had begun to show a definite

decline in commitment. Early leavers tended to show an early decline and later leavers a

later decline.

Turnover of Social Workers

Recruiting and retaining social workers for hospital settings was a major concern

identified in a study examining job satisfaction and turnover among hospital social workers

(Chachkes, 1995). Turnover in medical social work was felt to be influenced by professional

expectations concerning the quality and significance of hospital social work and the ability to

meet these expectations. A critical premise of this study was that there have been organi

zational changes in hospitals that have created a work climate which has increased conflict

for professional social workers. The climate identified was one of a corporate focus with

emphasis on the bottom line rather than traditional bureaucratic features. The study analyzed

the influences of eleven independent variables on job satisfaction and turnover. Job chal

lenge, role conflict, work significance, co-worker support and perceived shifts in organiza

tional priorities were strongly associated with job satisfaction. Job satisfaction was found to

be strongly associated with turnover. If work is not considered significant, hospital social

workers were also more likely to turnover (Chachkes, 1995).


65

Social workers in nursing homes in Texas were surveyed to determine predictors of

job satisfaction and intention to turnover (Gleason-Wynn, 1994). Questionnaires were sent to

1,114 nursing homes across the state of Texas. Responses were returned from 326 (29.3%).

Multiple regression was utilized in determining the effects of seven organizational variables,

two client variables, and five personal variables on job satisfaction and intention to turnover.

Five variables were found to be predictors of job satisfaction and four variables were predic

tors of intention to turnover. The predictors of job satisfaction included the social worker's

level of satisfaction with the client (p = .316), autonomy (P = .210), job clarity (P = .183),

age of respondent (P = .163), and satisfaction with compensation (P = .136). The predictors

of intention to turnover were found to be job satisfaction (P = .439), job stress (p = .162),

support from co-workers (P = .143), and satisfaction with compensation (P = .136). The

study concluded that organizational policies have an impact on a social worker's degree of

job satisfaction and intention to leave an organization. It was further concluded that salary

and compensation packages and staffing ratios need to be examined (Gleason-Wynn, 1994).

In a study of sixty social workers and counselors in a private psychiatric hospital, it

was hypothesized that the degree of employees' trust in management was related to job

satisfaction, organizational commitment and intention to turnover. Multiple regression

analysis was done to indicate associations of the variables. The results indicated a significant

association between the social workers' trust in management, job satisfaction, organizational

commitment, and turnover at the .05 level of significance. When tenure was controlled, it did

not make a difference in the relationships. A strong positive relationship was found between


trust in management and organizational commitment (r = .74). It was concluded that one

method for an organization to develop a productive and committed workforce would be to

increase the employees' level of trust in management. It was also felt that social workers

were in a unique position to assist management in developing and implementing such stra

tegies (Matthai, 1989).

Turnover of Registered Nurses

In a study of nursing turnover, Hinshaw and Atwood (1983) found evidence for

predicting turnover due to job stress, and inhibiting turnover by job satisfaction. In a rep

lication of the Hinshaw and Atwood (1983) study, 385 full-time RNs in four southeastern

urban hospitals were surveyed (Lucas, Atwood, & Hagaman, 1993). Causal modeling was

used to test the theoretical model predicting job satisfaction, anticipated turnover, and actual

turnover. Having less experience, working on a medical-surgical unit, and shift work were

predictors of job stress. Job satisfaction was promoted by group cohesion, and inhibited by

job stress. Job satisfaction buffered the effects of job stress on both anticipated and actual

turnover. Group cohesion and job satisfaction inhibited the anticipated turnover. The find

ings of the study indicated the need to assess the aspects of medical-surgical nursing that

cause job stress. The study suggested that job satisfaction strategies should be targeted to

specific clinical types of practice. From an administrators view, the study showed how actual

turnover can be avoided if retention strategies are implemented to increase group cohesion

and job satisfaction (Lucas, Atwood, & Hagaman, 1993).


67

In a study of 188 registered nurses in six hospitals in southern California, the effects

of collaborative behavior, organizational climate, and job stress on job satisfaction and

anticipated turnover was done (Stichler, 1990). A path analytic model of anticipated turnover

was temporally ordered with all exogenous variables proposed to directly affect job satis

faction and anticipated turnover and indirectly affect anticipated turnover through job

satisfaction. Job stress and organizational climate were the strongest predictors of job stress.

Forty-one percent of the variance in job satisfaction was explained by job stress, organiza

tional climate, and collaborative behavior between nurses and physicians. Job satisfaction

was the strongest predictor of anticipated turnover. Post hoc analysis of variance revealed

several significant group differences in the study variables. Overall job satisfaction scores

between evening and night nurses differed significantly (p < .02) with night nurses reporting

higher mean scores than evening nurses. Night nurses also reported the lowest mean scores

for anticipated turnover (Stichler, 1990).

Summary

From the review of literature, there are indications that job stress leads to decreased

job satisfaction and decreased organizational commitment. There is evidence to support that

decreased job satisfaction and decreased organizational commitment are antecedent to turn

over. Studies were lacking that pointed to the effects of rapid organizational change in

healthcare settings on these variables. The intent of this study was to identify such effects.


CHAPTER III

METHODOLOGY

This chapter presents a discussion of the research design, sampling procedures,

instruments utilized in the study, procedures, protection of human subjects, and techniques

for data analysis.

Research Design

The study was an explanatory nonexperimental design employing structural equation

modeling (SEM). Structural equation modeling required the explicit declaration of the

theory of the model and its causal hypotheses. The strength of this design was the causal

ordering of the variables to test the proposed theoretical formulation. SEM has been shown

to more accurately estimate the causal effects among constructs by controlling random and

systematic measurement errors (Dwyer, 1983).

The study was designed to assess the effects of organizational restructuring, reeng

ineering, and job redesign on social workers and nurses in acute care hospital settings. The

terminology of Bentler (1995) was utilized identifying variables as independent or dependent.

With this terminology, independent variables are not explained and dependent variables are

influenced by other variables. In model diagrams, the independent variables have arrows

pointing to other variables and dependent variables have arrows pointing to them. Indepen

dent variables in the study were restructuring, reengineering, and job redesign. Dependent

68


69

variables in the study were organizational structure, organizational politics, supervisory style,

human resource development opportunities, career progress, job rewards, time pressure, par

ticipation in decision making, role ambiguity, role conflict, quantitative workload, qualitative

tive workload, responsibility for people, macro organizational job stress, micro organization

al job stress, job satisfaction, organizational commitment, and turnover.

Sampling Procedures

The sample selected for this study consisted of social workers and registered nurses

employed in acute care hospitals in the state of Texas. Social workers were selected from the

membership roster of the National Association of Social Workers who identified their area of

practice as medical or health care and the setting as inpatient health. Social workers from the

state of Texas were selected. This provided 355 possible subjects. All 355 subjects were

surveyed.

For the registered nurse sample, a proportionate allocation, stratified sampling proce

dure was done. Registered nurses were selected from the Board of Nurse Examiners for the

state of Texas roster based on identification as staff nurses working in hospital settings. The

eight areas over which the Texas Department of Health regional directors had jurisdiction

were identified as geographic regions from which to further select the sample. By this

method, of the eleven public health regions, regions two and three, four and five, and nine

and ten were combined. Figure 5 shows the public health regions. Counties without acute

care hospitals were omitted. From the remaining counties in each region, ten percent were


70

Figure 5. Public Health Regions for the State of Texas.


71

selected. The county with the major city within the region was selected. To achieve the

remaining ten percent of the counties for each region, a random selection process was used.

The counties selected are identified in table 3 along with the total number of registered nurses

per county, the number working in acute care hospitals, and the number selected per county.

This method yielded 17,056 registered nurses. Ten percent of the labels were randomly sel

ected from each county. This yielded a representative sample of 1,720.

Of the 355 social workers surveyed, 106 were returned for a response rate of 30.0

percent. Of the 1,720 registered nurses surveyed, 359 were returned for a response rate of

20.9 percent. If subjects failed to answer more than 15% (16) of the survey items, they were

not included in the analysis. Of the social workers, 95 were complete and included in the

analysis for a response rate of 26.8 percent. Of the registered nurses, 327 were complete and

included in the analysis for a response rate of 19 percent.

Description of Instruments

Five instruments were used in the study. These included the Organizational Change

Questionnaire, the Stress Diagnostic Survey - Form A, the Index of Job Satisfaction, the

Organizational Commitment Questionnaire, and the Intention to Turnover scale.

Organizational Change Questionnaire

The Organizational Change Questionnaire (Appendix B) was an instrument develop

ed to measure healthcare workers' perceptions as to the extent of restructuring, reengineering,

and job redesign within their organization. This instrument was developed by the researcher


72

Table 3.—Selection Process of RNs From Public Health Regions of Texas

Public Health Total Number of Total Number Staff Number of Region Registered Nurses Nurses in Acute Subjects

County: Hospital Settings Selected

Hale 1 132 41 4

Potter 1 2,135 639 64

Dallas 3 9,090 3,753 375

Anderson 4 327 73 7

Gregg 4 921 271 27

Rusk 4 187 8 1

Harris 6 22,370 6,439 644

Hill 7 165 17 2

McLennan 7 1,436 298 30

Travis 7 5,128 1,024 102

Bexar 8 10,578 2,818 282

Midland 9 776 222 22

El Paso 10 3,377 952 95

Cameron 11 1,218 349 35

Webb 11 517 152 15

Totals: 58,357 17,056 1,720


73

for use in this study. Statements were derived from indicators of change in organizational

structure, engineering processes, and job design obtained from a review of literature. A panel

consisting of a hospital social worker, a registered nurse, two hospital educators, and a bus

iness communication specialist were given definitions of restructuring, reengineering, and job

redesign and asked to identify organizational elements that would indicate these processes.

Five statements for each measure were then presented to the panel for evaluation. Sugges

tions made by the panel were incorporated into the statements. Permission was obtained to

pretest the instrument from the vice president of a 146 bed acute care hospital in central

Texas. Thirty questionnaires were distributed and twenty-two were returned. Factor analysis

revealed that the questionnaire contained three factors. Reliability analysis was done on the

three scales for restructuring, reengineering, and job redesign. One item was omitted from

the restructuring and job redesign scales to leave four items. The restructuring scale had a

Cronbach's Alpha of .65, a Spearman-Brown coefficient of .70, and a Guttman split-half

reliability of .70. The reengineering scale had a Cronbach's Alpha of .72, a Spearman-Brown

coefficient of .65, and a Guttman split-half reliability of .66. The job redesign scale had a

Cronbach's Alpha of .73, a Spearman-Brown coefficient of .82, and a Guttman split-half

reliability of .82.

Stress Diagnostic Survey

The Stress Diagnostic Survey - Form A (Appendix C) by John M. Ivancevich and

Michael T. Matteson was employed to measure the organizational stress variables (Ivance

vich, & Matteson, 1980). The instrument was developed in 1976 to measure employees


74

perceptions of job stress. The instrument contained sixty items to assess fifteen different

aspects of job stress. These were divided into MACRO and MICRO job stressors.

The MACRO job stressors consisted of thirty items to identify the organizational

sources of stress. These items factored into seven subscales: politics, human resource

development, rewards, participation, underutilization, supervisory style, and organizational

structure. The MICRO job stressors consisted of thirty items to identify the job specific

sources of stress. These factored into eight subscales: role ambiguity, role conflict, quanti

tative overload, qualitative overload, career progress, responsibility for people, time pressure,

and job scope.

The items were rated on a seven point Likert scale; one indicated a low incidence of

stress, and seven indicated a high incidence of stress. Items for each subscale were averaged.

The average reliability for the Stress Diagnostic Survey scales was .69. The average two

week test-retest was .71 (Ivancevich, Matteson, & Dorin, 1990). Construct validity of the

Stress Diagnostic Survey is based on factor analysis from data obtained from health care

personnel, managerial personnel, technicians, and graduate students over several years of

research. Permission to use the instrument in the study was granted per telephone

conversation from Fred Dorin of FD Associates.

Index-of Io.bJSatisfagiion

The Brayfield and Rothe Index of Job Satisfaction (Appendix D) was an overall index

of job satisfaction designed to be applicable to a wide variety of jobs (Brayfield, & Rothe,

1951). The construction of the scale was done at the University of Minnesota. The scale


75

had a Spearman-Brown reliability coefficient of .87. The method of construction and the

nature of the items provided face validity and construct validity. The scale was developed by

having seventy-seven men in occupations ranging from unskilled laborer to professional rate

each item as to whether or not it expressed job satisfaction or dissatisfaction. Each item

selected had agreement of each man. The product moment correlation between the Index of

Job Satisfaction by Brayfield and Rothe and the Hoppock Job Satisfaction scale was .92

(Brayfield, & Rothe, 1951).

The instrument consisted of eighteen items on a five point Likert scale. One indicated

job dissatisfaction and five indicated job satisfaction. Nine of the items were negatively

phrased and reverse scored. The instrument was in public domain and permission did not

need to be obtained for its use.

Organizational Commitment Questionnaire

The Mowday and Steers (1979) Organizational Commitment Questionnaire (Appen

dix E) used in this study was a questionnaire developed over a nine year period based on

responses from 2,563 employees from nine widely divergent work organizations. Organiza

tional commitment was characterized by three factors. These included a strong belief in and

acceptance of the organization's goals and values; a willingness to exert considerable effort

on behalf of the organization; and a strong desire to maintain membership in the organization

(Mowday & Steers, 1979). The scale contains fifteen items to capture the three factors.

The Organizational Commitment Questionnaire items were on a seven point Likert

scale with one indicating a low level of organizational commitment and seven indicating a


76

high level of organizational commitment. Six items were negatively phrased and reverse

coded. The items were summed and divided by fifteen. Convergent validity ranged from 0.6

to 0.7 when compared to other measures across six diverse samples. Cronbach's alpha

reliability scores range from 0.82 to 0.93 with a median of 0.90 (Mowday, & Steers, 1979).

Permission to use the scale was obtained from Academic Press, Incorporated, publishers of

the Journal of Vocational Behavior (Appendix G).

Intention to Turn Over Scale

The Intention to Turn Over scale (Appendix F) from the Michigan Organization

Assessment Questionnaire is a three item scale that measures an individual's desire not to

continue to be an organizational member (Cammann, Fichman, Jenkins, and Klesh, 1983).

Eleven organizational sites and 3,381 employees were used in the development of this scale.

The items were correlated with other measures indicative of leaving an organization. The

factor loadings for the three items were 0.79,0.41, and 0.75 respectively. Cronbach's alpha

reliability score for the intention to turn over index was 0.83 (Cammann, Fichman, Jenkins,

& Klesh, 1983).

The items were rated on a seven point Likert scale with a value of one indicating the

subject was unlikely to leave and a value of seven indicating a strong likelihood of leaving.

The three items on the scale were summed for a single score. Permission to use the scale was

obtained from John Wiley & Sons, Incorporated (Appendix H).


77

Reliability of Instruments

Instrument reliability determines the degree of consistency that an instrument mea

sures its intended concepts. Using the EQS subprogram RELIABILITY, the instruments

used in the study were analyzed to establish instrument reliability for this sample.

The Organizational Change Questionnaire measured the degree of restructuring,

reengineering, and job redesign. Coefficient alpha for the restructuring section was .61.

Coefficient alpha for the reengineering section was .60. Coefficient alpha for the job rede

sign section was .71.

The Stress Diagnostic Survey reliablities were done for the MACRO and MICRO

sections and their respective subsections. The coefficient alpha for the MACRO section was

.96. The coefficient alpha for the MICRO section was .95. Table 4 presents the Cronbach's

Alpha reliabilities for the subscales of the Stress Diagnostic Survey - Form A. Reliabilites

for the subscales ranged from .69 for Job Scope to .90 for Rewards.

The Index of Job Satisfaction consisted of eighteen interval level items that measured

the degree of job satisfaction. Coefficient alpha for the job satisfaction scale was .91

The Organizational Commitment Questionnaire consisted of fifteen interval items that

measured the degree of organizational commitment. Coefficient alpha for this scale was .91.

The Intent to Turnover scale consisted of three items that measured an individual's

desire to leave an organization. Coefficient alpha for the scale was .62. Since this departed

from previously identified reliability estimates by a substantial margin, factor analysis was

done on this scale. The orthosim solution in EQS was done, which is equivalent to the


78

Table 4.--Reliabilities for the Subscales of the Stress Diagnostic Survey - Form A

Subscales

Politics

Human Resource Development

Rewards

Participation

Underutilization

Supervisory Style

Organization Structure

Role Ambiguity

Role Conflict

Overload Quantitative

Overload Qualitative

Career Progress

Responsibility for People

Time Pressure

Job Scope

Cronbach's Alpha

Jl

.80

.90

.84

.76

.89

.74

.81

.80 •

.74

.71

.79

.76

.88

.69


79

varimax solution. Factor loadings for the three items was as follows: Item 1 = 0.74, Item 2 =

0.72, and Item 3 = 0.32. This indicated two factors rather than one. Based on this analysis,

item three, "How likely is it that you could find a job with another employer with about the

same pay and benefits you now have?" was omitted. Coefficient alpha on the two items

remaining was .83.

Procedure

The demographic data and all instruments were incorporated into a single question

naire. The questionnaire, a cover letter, and a business reply envelope were mailed to the

selected sample. The cover letter requested the completion and return of the questionnaire

within three weeks of the letter date (Appendix A). Subject's were informed that all respon

ses would be confidential.

Protection of Human Subjects

A cover letter informed the respondents of confidentiality and anonymity accompan

ied the questionnaire (Appendix A). Questionnaires were returned without identification

other than demographic data. Confidentiality and anonymity were maintained by numeric

coding of the questionnaire. Respondents exercised their right not to participate in the study

when they failed to complete or return the questionnaire.

Data Analysis

Data analysis determined the demographic profile of all subjects, the social workers

and registered nurses. Demographic information included the personal data of subjects and


80

the practice data of subjects. The personal data described the age, sex, marital status, and

educational level of the subjects. The practice data described the area of specialization,

hospital size, type of hospital and the county of residence for the subjects. The demographic

data were analyzed using EQS for Windows subprogram FREQUENCY TABLES with

descriptive statistics displayed.

The design of this study aggregates data across service areas of social work and

nursing, practice area, geographical region, and hospital size and type. In order to test the

assumption that data could be aggregated, a series of one-way analyses of variance

(ANOVA) were done. ANOVA using the Statistical Package for the Social Sciences (SPSS)

was done to test for differences between social workers and registered nurses on eighteen

variables. ANOVA was done between means of variables of subjects based on practice

areas, regions of Texas, and type and size of employing hospital.

Structural equation modeling (SEM) utilizing EQS for Windows was employed for

testing causal relationships among the stated variables. The EQS program utilized the

mathematical model of Bentler and Weeks (Byrne, 1995). This classifies all variables in the

model as either dependent or independent. Any variable that has an arrow pointing to it is a

dependent variable. The dependent variables are explained in terms of the other variables in

the model. Any variable that does not have an arrow pointing at it is an independent

variable. The independent variables are explanatory or causal variables. The dependent

variables are collected into the vector T|. The independent variables are collected in the


81

vector £. The Bentler-Weeks model is expressed as:

T]= Ptl+yS

where \ is the vector of the independent variables, rj is the vector of the dependent varia

bles, and the coefficient matrices (3 and y contain the unknown path coefficients represented

by one way arrows in the path diagram of the model (Hoyle, 1995).

The variables in the input data are measured variables. The hypothetical constructs in

the model that are not measured are latent variables. Structural equation modeling was

employed in the prediction of job stress resulting from organizational stressors created from

the independent variables of restructuring, reengineering, and job redesign. The effects of

organizational stressors on job satisfaction, organizational commitment and turnover were

incorporated into the model. The statistical model is shown in figure 6. Measured variables

are represented by rectangular symbols and latent variables are represented by ovals. In the

model, organizational restructuring and reengineering are predictors of MACRO organiza

tional stress. Reengineering and job redesign are predictors of MICRO organizational stress.

MACRO organizational stress predicts organizational commitment and MICRO organiza

tional stress predicts job satisfaction. Organizational commitment and job satisfaction are

predictors of turnover. The model is presented in a simplified form without the residual

errors in prediction of the latent factors and measurement errors associated with the measured

variables. In measuring Person-Environment fit, measures from previous studies had found

problems due to multicollinearity. Matteson and Ivancevich (1982) refined the theory so that

MACRO and MICRO stressors were used to measure the work environment. Organizational


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E15 E16 E18 EI9E14 E17 E20

HRD Rewards Participation Underutilize SupervisorPolitics StructureReduce MM

DownsizingE2Restructuring

D ept ChngE30MACRO4—̂ Reorg MM

E31

CommitmentE 5 - * ProcessesD6 LookD2

ComputersE6

Turnover—p Philosophy Reengineer

Fft ^ Efficiency

ThinkCase Mana

JoB-------SatisfactionDS

FloatD3

Duties MICROJob Redesign

Cross Train

Job Descrip'E13 A m biguity Conflict Quantitative Q u alita tiv e C areer R esp o n s T im e S cope

Figure 6. Statistical Model o f Study.

commitment measured the person. MICRO organizational stressors were also used as a

measure of motivators or satisfiers from the Motivation-Hygiene theory and MACRO

organization stressors were measures of hygiene factors (Herzberg, 1964). The model was

based on a similar flow as the Causal Model of Turnover (Price, & Mueller, 1986). The

equations for the model were:

1. VI = + 1.0F1 +E1;

2. V2 = + *F1 +E2;

3. V3 = + *F1 +E3;

4. V4 = + *F1 +E4;

5. V5 = + 1.0F2 +E5;

6. V6 = + *F2 +E6;

7. V7 = + *F2 +E7;

8. V8 = + *F2 +E8;

9. V9 = + *F2 +E9;

10. V10 == +1.0F3 +E10;

11. V ll == + *F3 + El 1;

12. V12 = + *F3 +E12;

13. V13 = + *F3 +E13;

14. V14 = +1.0F4 +E14;

15. V15 = + *F4 +E15;

16. V16 = + *F4 +E16;


17. V17 = + *F4 +E17;

18. V18 = + *F4 +E18;

19. V19= + *F4 +E19;

20. V20= + *F4 +E20;

21. V21 = +1.0F5 +E21;

22. V22= + *F5 +E22;

23. V23 = + *F5 +E23;

24. V24= + *F5 +E24;

25. V25 = + *F5 +E25;

26. V26 = + *F5 +E26;

27. V27 = + *F5 +E27;

28. V28 = + *F5 +E28;

29. V29 = + *F5 + E29;

30. V30= + *F4 +E30;

31. V31 = +1.0F6 +E31;

32. V32 = + *F6 + E32;

33. F3 = + *F1 +D3;

34. F4 = + *F1 + *F2 + D4;

35. F5 = + *F2 + *F3 +D5.

Each variable's mean and coefficients of skewness and kurtosis were analyzed to

determine if the distribution of variables was normal. The variable means and coefficients of


85

univariate skewness and kurtosis are presented in table 5. Univariate skewness ranged from

-1.3 for item 2 on the Organizational Change Questionnaire, "The processes and work

methods by which patient care is delivered has changed within the past 1-2 years," to 1.01 for

the role ambiguity subscale of the Stress Diagnostic Survey. Univariate kurtosis ranged from

-1.44 for item 10 on the Organizational Change Questionnaire, "There has been a reorgan

ization of management positions,: to 1.47 for item 2 on the Intention to Turnover Scale, "I

often think of quitting." While this provided an initial check of normality, an evaluation of

multivariate kurtosis was analyzed next. Mardia's coefficient was 32.36 and the normalized

coefficient was 11.76. Since this value exceeded the standard two or three, the scaled x2

statistic was chosen to correct the referenced %2 distribution.

The method of estimation employed was the maximum likelihood (ML), robust

method. By using this method, the standard test statistics as well as the robust test statistics

were provided. This method also provided the Satorra-Bentler x2 scaled test statistic. This

statistic has been shown to more closely approximate x2 than the usual test statistic. A

growing body of research has shown that ML performs reasonably well under a variety of

analytic conditions such as excessive kurtosis, but the Satorra-Bentler adjustment will cor

rectly adjust for any violations of normality. Also, it has been shown to perform better than

the asymptotic distribution-free methods generally recommended for nonnormal multivariate

data (Satorra, & Bentler, 1994). This method was recommended by Hoyle (1995) over use of

asymptotic distribution-free estimation. Using the robust method, Chou, Bentler, and Satorra

(1991) found that the correct standard errors as well as the asymptotic


Table 5.--Means, skewness and kurtosis of variables in study

86

Mean Skewness Kurtosis

VI - Reduce middle management 3.72 -0.73 -0.47

V4 - Downsizing 3.97 -0.95 0.02

V7 - Change in departments 3.66 -0.57 -0.45

V I0 - Management reorganization 4.03 -1.05 1.47

V2 - Process changes 4.18 -1.30 1.18

V5 - Computerization 4.15 -1.21 1.19

V8 - Organizational philosophy 3.74 -0.66 -0.59

V I1 - Efficiency 3.65 -0.68 -0.42

V I3 - Case management 3.89 -0.75 -0.00

V3 - Floating to other areas 3.79 -0.83 -0.35

V6 - Change in duties 3.95 -0.90 0.34

V9 - Cross-training 3.31 -0.22 -1.08

V12 - Job descriptions 3.88 -0.84 0.22

Politics 3.87 0.29 -0.67

Human Resource Development 4.00 0.30 -0.81

Rewards 4.32 -0.05 -0.96

Participation 4.19 -0.05 -0.74

Underutilization 3.42 0.34 -0.45

Supervisory style 3.82 0.29 -0.87


87

Table 5.-Continued

Mean Skewness Kurtosis

Organization structure 3.37 0.61 -0.14

Role ambiguity 2.78 1.01 0.87

Role conflict 3.14 0.73 0.08

Overload Quantitative 3.11 0.69 0.02

Overload Qualitative 2.49 0.99 1.05

Career Progress 3.18 0.61 -0.16

Responsibility for people 3.45 0.35 -0.67

Time pressure 3.91 0.18 -0.98

Job scope 3.08 0.61 -0.02

Job satisfaction 64.0 -0.76 0.77

Organizational commitment 4.42 -0.25 -0.26

Look for new job 3.38 0.33 -1.38

Think of quitting 3.72 0.10 -1.44


distribution free standard errors yielded more appropriate estimates of sampling variability

than maximum likelihood standard errors under conditions of nonnormality.

The conventional test of overall fit of the model was based on the chi square distribu

tion and the test statistic T = (N - l)Fmin. The statistical theory of T is asymptotic. The theory

holds with large sample sizes, but in small sample sizes, T may not be x2 distributed and

may not be correct for model evaluation (Hoyle, 1995). Taking this into consideration, the

evaluation of the model was determined by the following fit indexes: the Bentler-Bonett

Normed Fit Index (NFI), the Bentler-Bonett Nonnormed Fit Index (NNFI), the Comparative

Fit Index (CFI), the Robust Comparative Fit Index, the Bollen Incremental Fit Index (IFI),

the McDonald Fit Index (MFI), the Lisrel Goodness of Fit Index, and the Lisrel Adjusted

Goodness of Fit Index. Because of the number of indices of fit and lack of consensus as to

what constitutes "good fit", all indices were reported in keeping with recommendations of

Tanaka (1993).

The Normed Fit Index is not a good indicator of model fit when sample size is small.

The mean of the sampling distribution of NFI is positively associated with sample size and

NFI substantially underestimates its asymptotic value at small samples sizes of less than

1000 (Hoyle, 1995). This poses the problem of possibly rejecting the fit of a model when it

is true. Since the sample size in this study was 422, this would not be the best indicator of

overall model fit. Values of greater than 0.9 are desirable.

The Nonnormed Fit Index estimates the relative improvement per degree of freedom

of the target model over the baseline model. This fit index is also subject to limitations by


89

sample sizes of less than 500 (Hoyle, 1995). This index was reported, but was not the best

indicator due to sample size variation.

The Comparative Fit Index measures the relative reduction in lack of fit as estimated

by the noncentral x2 of a target model versus a baseline model. It has been shown to have the

advantage of the previous indices of fit by not being biased when the sample size is small.

The Robust Comparative Fit Index is similar to the CFI, but better fits data that may be non

normal. Indication of a good fit of a model is a value of 0.90 or higher.

The next group of fit indices are based on the size of weighted residuals compared to

the size of the weighted input data. These indices use arbitrary distribution theory for comp

utation. The Bollen Incremental Fit Index is less variable with small sample sizes than the

NNFI and is more consistent across estimation methods. It has been shown to perform well

when the maximum likelihood method is used, but to be downwardly biased when the gen

eralized least squares method is used.

The McDonald Fit Index is used when there are violations of normal theory. The

LISREL Goodness of Fit and Adjusted Goodness of Fit indices are indexes of the relative

amount of the observed variances and covariances accounted for by a model. These are

analogous to R2 utilized to summarize multiple regression analyses.

An additional test of model fit included analysis of the root mean squared residual.

The Wald test, a multivariate test of significance, was done to determine if any of the model

parameters could be dropped without reducing model fit.


90

Relationships and alternative causal paths hypothesized were assessed using a series

of structural models. Following the initial assessment of the proposed model based on the

standardized parameter estimates, the Wald test, and the LaGrange Multiplier test, modifica

tions were made to determine the optimal model.


CHAPTER IV

PRESENTATION AND ANALYSIS OF DATA

This chapter discusses the presentation and analysis of the data in four parts: (1) the

subjects' demographic profile, (2) the analysis of variance, (3) the findings derived from

structural equation modeling, and (4) the tenability of the theories that guided this study.

Demographic Profile

The demographic profile of the subjects are presented in two parts: (1) the subjects

personal profile, (2) the subjects' practice profile, (3) characteristics of employing hospitals,

and (4) the residence by public health regions of subjects.

Personal Profile

The subjects personal profile consisted of profession, sex, marital status, age, and

education. The demographics for the total number of subjects are presented in table 6. The

average subject is a 39 year old married female who holds a bachelor's degree. The demo

graphics comparing the social workers and registered nurses in the study are presented in

table 7. The average social worker is a married 43 year old female. The average registered

nurse is a married 39 year old female. Table 8 presents a comparison of the highest educa

tional levels for social workers and registered nurses. The average social worker has attained

a master's degree, while the average nurse has attained a bachelor's degree.

91


Table 6.~Personal Demographic Data of Total Subjects

92

Profession

Registered Nurse

Social Worker

Sex

Males

Females

Marital Status

Married

Single

Divorced

Widowed

Gay Union

Age In Years

(N = 399)

AdjustedFrequency Percentage

327 77.5

95 22.5

(N = 422)

49 11.7

370 88.3

(N = 419)

268 66.8

88 21.9

38 9.5

6 1.5

1 0.3

(N = 401)

Mean SD Range

39.9 8.3 25 - 68


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Table 7.—Demographic Data of Social Workers and Registered Nurses in Study

Social Workers Registered Nurses

FrequencyAdjusted

Percentage FrequencyAdjusted

Percentage

Sex

Male 20 21.5 29 8.9

Female 73

(N = 93)

78.5 297

(N = 326)

91.1

Marital.Status

Married 60 64.5 208 67.5

Single 25 26.9 63 20.4

Divorced 7 7.5 31 10.1

Widowed 0 0.0 6 2.0

Gay Union 1

(N = 93)

1.1

II U> o

o

00

W

0.0

Age In Years N Mean SD Range N Mean SD Range

91 43.2 10.5 25-68 308 39.0 7.2 27-54

Table 8.-Educational Comparison of Social Workers and Registered Nurses94


Frequency AdjustedPercentage

Frequency AdjustedPercentage

Highest Educational Level

Diploma 0 0.0 37 11.3

Associate Degree 0 0.0 134 41.0

Bachelor's 6 6.3 147 45.0

Master's 88 92.6 8 2.4

Doctorate 1 1.1 1 0.3

Subjects Practice Area

The number of years worked in the field and the number of years in the present

position were examined for both social workers and registered nurses. This data is presented

in table 9. The average social worker had been in social work for 13.4 years and in the

present position for 6.4 years. The average registered nurse had been in nursing for 11 years

and in the present position for 5.7 years.

The subjects represented diverse areas of specialization. Specialization areas for

social workers and registered nurses are presented in table 10. The area of generalist practice

was identified by 36.8 percent of social workers as their main area of specialization.


95

Table 9.--Demographics of Practice Areas

Social Workers RegisteredNurses

TotalSubjects

Number of Years in Field

Mean 13.4 11.0 11.5

Standard Deviation 9.9 7.2 7.9

Range 2 -5 7 1-32 1-57

N 90 325 415

Number of Years in Present Position

Mean 6.4 5.7 5.9

Standard Deviation 7.5 4.5 5.3

Range 1-49 1-21 1-49

N 93 313 406

Since 53.1 percent of social workers were employed in small to medium sized hospitals, this

finding was not unusual. Smaller hospitals have smaller social work departments that

necessitate working with a wider range of clients. In contrast, 3.7 percent of registered

nurses reported working in generalist specialization. The most frequently identified area of

specialization for social workers was medical - surgical practice. The area of medical -

surgical practice was identified by 18.7 percent registered nurses as their specialty. The area


Table lO.-Area of Specialization for Social Workers and Registered Nurses

96


FrequencyAdjusted


Percentage

Generalist Practice 35 36.8 12 3.7

Medical - Surgical 28 29.5 61 18.7

Critical Care 7 7.4 87 26.6

Surgical Service 2 2.1 40 12.2

Emergency Care 1 1.1 32 9.8

Maternal-Child, Women's Health 9 9.4 54 16.5

Psychiatry 6 6.3 24 7.3

Long Term Care 7 7.4 17 5.2

N = 95 N = 327

of critical care was identified by 7.4 percent of social workers and 26.6 percent of registered

nurses as their main area of practice. This was the most frequently reported practice area for

registered nurses. This is not unusual because the acuity of patients is getting higher which

necessitates more critical care services. Surgical service was reported as the main practice

area for 2.1 percent of social workers and 12.2 percent of registered nurses. Emergency

services were reported by 1.1 percent of social workers and 9.8 percent of registered nurses


97

as their main practice area. Maternal - child health and women's services were reported by

9.4 percent of social workers and 16.5 percent of registered nurses as their area of special

ization. Psychiatry was reported to be the main area of practice for 6.3 percent of social

workers and 7.3 percent of registered nurses. Long term care was reported to be the main

practice area for 7.4 percent of social workers and 5.2 percent of registered nurses.

Characteristics of Employing Hospitals

Hospitals were categorized by size and type. Table 11 presents the frequency and

adjusted percentage of social workers and registered nurses from the different hospital

categories. In hospitals with less than 100 beds, 17 (18.7%) social workers and 37 (11.4%)

registered nurses responded to the survey. In hospitals with between 100 and 499 beds, 35

(18.4%) social workers and 186 (57.2%) registered nurses responded to the survey. In

hospitals with over 500 beds, 39 (42.9%) social workers and 102 (31.4%) registered nurses

responded. Types of hospitals were classified on the basis of categories described by the

American Hospital Association (1995). Non-profit hospitals were the type of hospital most

represented. Non-profit hospitals with a church affiliation were represented by 19 (20.4%)

social workers and 105 (32.4%) registered nurses who responded to the survey. Non-profit

hospitals that were non church affiliated were represented by 19 (20.4%) of social workers

and 73 (22.5%) registered nurses who responded to the survey. Hospital districts were

represented by 9 (9.7%) social workers and 26 (8.0%) registered nurses who responded to the

survey. For profit hospitals were represented by 25 (26.9%) social workers and 79 (24.4%)

registered nurses who responded to the survey. Government owned hospitals that included


Table 11.—Characteristics of Employing Hospitals

98


Adjusted AdjustedFrequency Percentage Frequency Percentage

Hospital Size

Less than 100 Beds 17 18.7 37 11.4

100-499 Beds 35 38.4 186 57.2

More than 500 Beds 39 42.9 102 31.4

N = 91 N = 325

Type of Hospital

NonProfit: Church 19 20.4 105 32.4

NonProfit: Other 19 20.4 73 22.5

Hospital District 9 9.7 26 8.0

For Profit 25 26.9 79 24.4

Government 21 22.6 41 12.7

N = 93 N = 324


99

both military and Veterans' Administration hospitals were represented by 21 (22.6%) social

workers and 41 (12.7%) registered nurses. These responses were representative of the sizes

and types of hospitals in the state of Texas.

The public health regions represented by the sample are presented in table 12.

Regions 2 and 3 which included the Dallas-Fort Worth Metroplex had the largest percentage

(32.6) of social workers responding. Region 1 which included the Texas Panhandle had the

smallest percentage (2.1) of social workers responding to the survey. Region 7 which in

cluded the Austin/Central Texas area had the largest percentage (24.8) of registered nurses

responding. Region 11 which included the El Paso/West Texas area had the smallest per

centage (1.8) of registered nurses responding to the survey.

Analysis Of Variance Between Groups

The design of this study aggregated data across service lines, practice areas, geo

graphical regions, and hospital sizes and types. In order to test the assumption that data

could be aggregated, a series of one-way analyses of variance (ANOVA) were performed to

determine similarities and differences between social workers, registered nurses, area of

specialization, region of Texas, type and size of hospital. These analyses are presented in the

following section.

ANOVA Between Social Workers and Registered Nurses

Table 13 presents the ANOVA between social workers and registered nurses in the

study. Of the seven MACRO organizational stressors, significant differences were found


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Table 12.—Residence of Subjects by Public Health Region

Total Subjects Social Workers Registered Nurses

FrequencyAdjusted



Percentage

Region 1 26 6.2 2 2.1 24 7.3

Region 2 - 3 107 25.4 31 32.6 76 23.2

Region 4 - 5 11 2.6 3 3.1 8 2.5

Region 6 106 25.1 30 31.6 76 23.3

Region 7 92 21.8 11 11.6 81 24.8

Region 8 54 12.8 12 12.6 42 12.8

Region 9 -1 0 17 4.0 3 3.2 14 4.3

Region 11 9 2.1 3 3.2 6 1.8

N = 422 N = 95 N = 327

oo

Table 13.—ANOVA Between Social Workers and Registered Nurses

101

Variable SOCW RN F Significance of F

1. PoliticsMean 3.57 3.96S.D. 1.40 1.33 6.20 .013

2. HRDMean 3.53 4.13S.D. 1.33 1.32 15.61 .001 *

3. RewardsMean 3.68 4.51S.D. 1.50 1.51 22.24 .000 *

4. ParticipationMean 3.78 4.31S.D. 1.41 1.33 11.42 .001 *

5. UnderutilizationMean 3.28 3.46S.D. 1.24 1.17 1.85 .174

6. Supervisory StyleMean 3.37 3.95S.D. 1.39 1.52 11.13 .001 *

7. Organization StructureMean 3.11 3.44S.D. 1.22 1.19 5.59 .019

8. Role AmbiguityMean 2.63 2.83S.D. 1.25 1.21 1.87 .173

9. Role ConflictMean 2.94 3.19S.D. 1.35 1.27 2.79 .095


102

Table 13.—Continued

Variable SOCW RN F Significance of F

10. Overload QuantitativeMean 3.42 3.02S.D. 1.42 1.23 7.35 .007 *

11. Overload QualitativeMean 2.19 2.57S.D. 0.86 1.05 10.68 .001 *

12. Career ProgressMean 3.21 3.17S.D. 1.15 1.30 0.06 .802

13. Responsibility for PeopleMean 3.10 3.55S.D. 1.23 1.36 8.64 .004 *

14. Time PressureMean 4.04 3.87S.D. 1.52 1.59 0.84 .361

15. Job ScopeMean 2.93 3.12S.D. 1.27 1.12 1.93 .165

16. Job SatisfactionMean 64.48 63.86S.D. 11.70 11.19 0.23 .634

17. Organizational CommitmentMean 4.65 4.35S.D. 1.24 1.14 4.90 .027

18. TurnoverMean 6.76 7.20S.D. 3.97 4.13 0.87 .353


103

among four stressors between social workers and registered nurses: human resource

development, rewards, participation, and supervisory style. Registered nurses perceived

significantly greater amounts of stress in these four categories than did social workers. Of

the MICRO organizational stressors, significant differences were found in three areas:

quantitative overload, qualitative overload, and responsibility for people. In the quantitative

overload category, social workers perceived a greater amount of stress, while registered

nurses perceived greater amounts of stress due to responsibility for people and qualitative

work overload. There were no significant differences in job satisfaction, organizational

commitment, or turnover. Figures 7 and 8 show the relative degrees of job stressors for

social workers and registered nurses. The greatest stressor that social workers perceived was

time pressure. The greatest stressor that registered nurses perceived was participation in

decision making. Both groups perceived the least amount of stress in the area of qualitative

work overload. This would indicate relative comfort with both groups in perceived ability to

do their jobs.

ANOVA of Specialization. Region, and Hospital Size and Type

One-way ANOVA was performed on the total group and for service groups of social

workers and registered nurses for the demographic data of area of specialization, region,

hospital size and type. No significant differences were found between any of these group

ings. This supported findings of some studies (Summers, 1985) and contradicted others

(Selye, 1976) that indicated workers experience greater amounts of stress due to the specific

area of practice.


104

Low Stress Region

Moderate Stress Region

High Stress Region

A. Politics

B. Human Resource Development

C. Rewards

D. Participation

E. Underutilization

F. Supervisory Style

G. Organization Structure

H. Role Ambiguity

I. Role Conflict

J. Overload Quantitative

K. Overload Qualitative

L. Career Progress

M. Responsibility for People

N. Time Pressure

0 . Job Scope

2.01.0 3.0 4.0 5.0 6.0 7.0

Mean Category Values

Figure 7. Job Stressors for Social Workers in Study.


105

Low Stress Region

Moderate Stress Region

High Stress Region

A. Politics

B. Human Resource Development

C. Rewards

D. Participation

E. Underutilization

F. Supervisory Style

G. Organization Structure

H. Role Ambiguity

I. Role Conflict

J. Overload Quantitative

K. Overload Qualitative

L. Career Progress

M. Responsibility for People

N. Time Pressure

0. Job Scope

3.0 6.0 7.02.0 4.0 5.01.0

Mean Category Values

Figure 8. Job Stressors for Registered Nurses in Study.


106

The differences found in this analysis provide evidence necessary for doing correl

ational studies. Since this study intended to analyze effects of organizational change on

human service workers, the aggregate data provide organizational level information.

Findings from Structural Equation Modeling

This study proposed a model to predict turnover of social workers and registered

nurses in acute healthcare settings. The model tested had latent and manifest variables that

represented restructuring, reengineering, job redesign, MACRO and MICRO organizational

stressors, job satisfaction, organizational commitment and turnover.

EQS for Windows, a program designed to test latent variable models, was used to

assess the proposed relationships of the variables in the study. The estimation of the struc

tural model was based on the covariance matrix.

Confirmatory Analysis

The hypothesized model was tested to demonstrate the predictive value of restruc

turing, reengineering, job redesign, MACRO and MICRO organizational stressors, job sat

isfaction and organizational commitment on turnover. The path coefficients are presented in

figure 9.

The chi square value for the confirmatory model was highly significant indicating a

poor fit of the model to the data, %2 (df = 457) = 1733.83 (Satorra-Bentler = 1591.41), p <

.000. The goodness of fit indices did not indicate a well defined model for this data. Criteria


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E14 E15 E16 E17 E18 E19 E20.58

I.50

4.50

4.44

i.59 .53

4i.62

41 —.91 -

2 —.92 -

3 — .82 -

4 — 80 _

5 _ .86 -

6 - .9 4 .

7 - .94 -

8 —90.

9 - . 85

0 - .78

1 - .6 9 .

2 —.88 .

3 — .79 -

Politics Rewards Participation underutilize Supervisor StructureReduce MM

Downsizingestructunng

D ept Chng

MACROReorg MM

CommitmentLook

Computers

TurnoverPhilosophy Reengineer

Efficiency

ThinkCase Mana

59 Satisfaction

Duties MICRO4g5( Job Redesign

te.61

Cross Train

Job Descnp A m biguity Conflict Quantitative Q u alita tiv e C a re e r R esp o n s T im e Scope

11

t.51

11

1

t.73

I

t.69

I

t.61

I

t.77

I

t.58

1E21

1E22

1E23

1E24

1E25

1E26 E27 E27

Figure 9. Path Coefficients of Confirmatory Model.

108forjudging goodness of fit were indices greater than .90. In this model, the value for the fit

indices were:

Bentler-Bonett Normed Fit Index = 0.79

Bentler-Bonett Nonnormed Fit Index = 0.82

Comparative Fit Index = 0.84

Robust Comparative Fit Index = 0.84

Bollen Incremental Fit Index = 0.84

McDonald Fit Index = 0.22

LISREL GFI Fit Index = 0.78

LISREL AGFI Fit Index = 0.74

This indicated an inadequate fit between the model and the data. At this point, model

modification was done based on analysis of residuals, parameter test statistics, Wald tests,

and LaGrange Multiplier tests.

Exploratory Analysis

After performing a confirmatory test on the hypothesized model, an exploratory phase

was conducted to establish a model that more closely fit the data. This phase was required,

since the proposed model, while producing significant path parameters, did not adequately fit

the data. The correlations of parameter estimates were examined and all were within ±1.0 of

zero indicating adequate model specification. The exploratory process then centered on a

sequence of operations that removed residual variance from the model. The covariance


109

matrix of variables in the final model is presented in table 14, upon which was based the

estimation of the structural model.

The first step involved analyzing the effects of reengineering. The error variance

associated with the measured variables was large (Figure 9). In evaluating the standardized

residuals, the parameters associated with variables 5, 7 , and 8, measures of reengineering,

accounted for a major portion. The Wald test also indicated that the parameters should be

dropped. Following this, the model was retested. While some improvement in model fit

occurred, the indices of fit ranged from .79 to .85, still indicating inadequate fit of the data to

the model.

The parameters associating MICRO job stressors to job satisfaction and turnover were

then analyzed. Of the eight MICRO organizational stressors, the two most significant

predictors of job satisfaction were career progress and quantitative work overload. A mod

ified model was created that included just the MICRO organizational stress variables, job

satisfaction, organizational commitment and turnover. This modified model had fit indices

of .30 to .86, indicating poor fit of the model to the data. The model was trimmed to exclude

the MICRO organizational stressors and the EQS program was run again.

Based on LaGrange Multiplier tests, two new parameters were added. One was

directly from restructuring to turnover. This indicated that restructuring not only effected

turnover indirectly by increasing job stress, it had a direct effect leading to turnover. Another

parameter that was added was from job satisfaction to organizational commitment. This


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Table 14—Correlation Matrix of Final Model

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

1. Reduce middle mana. 1.36

2. Downsizing 0.22 1.14

3. Departmental change 0.35 0.32 1.08

4. Reorganize middle mana. 0.36 0.19 0.29 0.73

3. Floating to other areas 0.33 0.33 0.38 0.34 1.42

6. Change in duties 0.27 0.29 0.44 0.32 0.62 0.96

7. Cross-training 0.20 0.20 0.30 0.34 0.57 0.41 1.44

8. Job descriptions 0.31 0.22 0.32 0.34 0.35 0.45 0.33 1.02

9. Politics 0.14 0.36 0.33 0.14 0.42 0.37 0.20 0.21 1.83

10. HRD 0.16 0.37 0.26 0.15 0.44 0.36 0.24 0.19 1.34 1.80

11. Rewards 0.14 0.41 0.35 0.23 0.56 0.47 0.35 0.27 1.56 1.67 2.38

12. Participation 0.16 0.42 0.26 0.19 0.42 0.36 0.23 0.14 1.25 1.41 1.66 1.86

13. Underutilization 0.20 0.30 0.25 0.09 0.28 0.27 0.15 0.10 1.05 1.08 1.20 1.22 1.41

14. Supervisory style 0.10 0.44 0.38 0.14 0.50 0.40 0.28 0.14 1.41 1.42 1.74 1.60 1.23 2.29

15. Organization structure 0.19 0.35 0.28 0.21 0.39 0.35 0.38 0.21 1.06 1.06 1.17 1.15 0.97 1.23 1.44

16. Job satisfaction -0.87 -2.82 -1.91 -1.19 -2.06 -1.91 -0.84 -0.56 -4.60 -4.89 -5.25 -5.49 -4.93 -6.35 -4.18 127.55

17. Commitment -0.08 -0.32 -0.22 -0.12 -0.29 -0.20 -0.14 -0.06 -0.73 -0.82 -0.90 -0.91 -0.64 -0.98 -0.67 8.02

18. Look for new job 0.10 0.55 0.44 0.30 0.51 0.41 0.16 0.25 0.97 1.05 1.09 1.14 0.83 1.24 0.77 -12.26

19. Think about quitting 0.18 0.65 0.45 0.33 0.65 0.60 0.22 0.26 1.17 1.22 1.37 1.38 1.06 1.55 0.94 -14.35

I l l

finding was in keeping with some of the literature that indicated organizational commitment

was effected by job satisfaction.

The final model had a chi square of 365.96 (df = 146), p < .001. The Satorra-Bentler

scaled chi-square = 333.61 (df = 146), p < .000. This was not significant, but because of

sample size, the indices of fit were evaluated to determine the goodness of fit of the data to

the model. The indices were:

Bentler-Bonett Normed Fit Index ss 0.92

Bentler-Bonett Nonnormed Fit Index = 0.94

Comparative Fit Index = 0.95

Robust Comparative Fit Index = 0.95

Bollen Incremental Fit Index = 0.95

McDonald Fit Index = 0.77

LISREL GFI Fit Index = 0.91

LISREL AGFI Fit Index = 0.89

This indicated a good fit between the data and the model. Another indication of good

fit was the root mean squared residual of .79. The standardized root mean residual was 0.04,

indicating good fit. The final parsimonious model is presented in figure 10. The path

coefficients are indicated on the diagram. All path coefficients were significant. Table 15

presents the measurement equations and table 16 presents the construct equations of the final

model with standard errors, test statistics, robust standard errors and robust test statistics. A


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E140.'S8♦

Politics

E15

o.ta

HRD

E16

0.'48

E170.44

♦Rewards Participation

E18

o.do

UnderUtilization

E19

O.fo

SupervisoryStyle

E200.&t

Structure

X t z '0.82 0.87 0.88 0.90 0.80 0.85 0.78

Reduce MM0.91,E30

'^ 0 . 4 5 0.73

Commitment

M acro0.43DownsizingE2-0.90 0.44'0 .44\ __________

O.g^^RcstructuringE3.0.81 Department

D50.58 0.19

0.64Mana. ChngE4_ 0.81 _>

0.90Turnover0.47

E l 0 - 0 . 7 5 Floating

0.78 0.89-0.30Duties

JobRedesign

JobSatisfaction

L o o k Think-0.250.49Cross-train 4r

0.62 0.460.43Job

Descriptions D3

Figure 10. Final Parsimonious Model o f Study.to

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Table 15.~Measurment Equations of Final Model with Standard Errors and Test Statistics'*

Variable Variable

VI Reduce MM = 1.06*Restruc + 1.00 El V14 Politics = 1.18+MACRO + 1.00 E14Standard Error .18 Standard Error .06z Test Statistic 6.02 z Test Statistic 18.47Robust S.E. .19 Robust S.E. .06Robust z 5.63 Robust z 18.82

V7 Dept Chng 1.3I*Restruc + 1.00 E3 V15HRD = 1.25*MACRO + 1.00 E15Standard Error .18 Standard Error .06z Test Statistic 7.16 z Test Statistic 20.09Robust S.E. .19 Robust S.E. .07Robust z 6.93 Robust z 19.36

V10 ReorgMM = 1.07*Restruc + 1.00 E4 V16 Reward = 1.45*MACRO + 1.00 E16Standard Error .15 Standard Error .07z Test Statistic 7.12 z Test Statistic 20.39Robust S.E. .18 Robust S.E. .08Robust z 6.00 Robust z 19.48

V I1 Duties .96*ReJob + 1.00 E ll V17 Participation = 1.31*MACRO + 1.00 E17Standard Error .08 Standard Error .06

z Test Statistic 11.98 z Test Statistic 20.88Robust S.E. .07 Robust S.E. .06Robust z 13.10 Robust z 20.62

V12 Cross Train .74*ReJob + 1.00 E12 V18 Underutilization = 1.02*MACRO + 1.00 E18Standard Error .09 Standard Error .06

z Test Statistic 8.49 z Test Statistic 17.97Robust S.E. .09 Robust S.E. .06Robust z 8.37 Robust z 18.17

V12 Job Decrip .71*ReJob + 1.00 E13 V19 Supervisory Style = 1.37*MACRO + 1.00 E19Standard Error .08 Standard Error .07z Test Statistic 9.45 z Test Statistic 19.42Robust S.E. .09 Robust S.E. .07Robust z 8.30 Robust z 18.65

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Table 15.—Continued*

Variable

V29 Job Satisfaction = -3.55*ReJob +Standard Error .79z Test Statistic -4.49Robust S.E. .75Robust z -4.75

V30 Commitment = .05*JobSat + -.54*MACRO +Standard Error .00 .05z Test Statistic 13.12 -11.10Robust S.E. .00 .05Robust z 12.73 -10.98

VI07 Think about quitting 1.102*Tumover + ,07*MACRO +Standard Error 16.61z Test Statistic .06Robust S.E. 19.69Robust z

* Equations with fixed parameters are not shown.

bz Test Significant if > ± 1.96. All tests significant.

1.00 E29

1.00 E30

1.00 E32

Table 16.--Construct Equations of Final Model

115

Variable

F3 Job Redesign = 1.51 Restruc + 1.00 D3Standard Error .22z Test Statistic 7.05Robust S.E. .23Robust z 6.67

F4 MACRO Job Stress = .88*Restruc + 1.00 D4Standard Error .15z Test Statistic 5.89Robust S.E. .16Robust z 5.59

F5 Turnover = -.05*JobSat + .76*Commit + ,69*Restruc+ 1.00 D5Standard Error .01 .08 .19z Test Statistic -6.42 -9.80 3.64Robust S.E. .01 .07 .18Robust z -6.79 -10.44 3.88


116

test statistic greater than +1.96 rejected the null hypotheses that the effect is zero in the

population. All paths in the final model were significant.

The standardized residual variance in an equation can be obtained as the square of the

coefficient associated with the residual variable, which when subtracted from one yields the

squared multiple coefficient associated with the equation (Bentler, 1995). For the equation

associated with turnover in this model, R2 = 1 - .642 = .59, or 59% of the variance was ex

plained by the model.

Hypotheses Testing



Organizational restructuring was found to have a significant direct effect on MACRO

organizational stress of human service workers. The path coefficient for this parameter was

.44. A test statistic greater than ± 1.96 rejected the null hypothesis that the effect is zero in

the population. The test statistic was 7.05, which rejected the null hypothesis indicating that

the effect was not zero in the population and that organizational restructuring has a signifi

cant effect on MACRO organizational stress for human service workers.

2. Organizational restructuring has a significant positive direct effect on organ

izational reengineering.

This area was problematic. Organizational restructuring had a path coefficient of .89

with reengineering, this area dropped out of the final model when the model was respecified.

This is an area that would need further study to determine its effects in the model.


117

3. Organizational restructuring has a significant positive direct effect on job re

design.

The path coefficient between restructuring and job redesign was .90, and had a test

statistic of 6.93. This indicates that organizational restructuring leads to job redesign.



Organizational reengineering was omitted from the final model and therefore did not

have a significant effect on MACRO organizational stress of human service workers.


MICRO organizational stress of human service workers.

Again, reengineering was problematic. In the initial model, the path coefficient was

-1.42 and the test statistic was -20.00. This latent variable was omitted from the final model.

This area required further refinement in measurement.

6. Organizational job redesign has a significant positive direct effect on MICRO

organizational stress of human service workers.

The path coefficient from organizational job redesign to MICRO organizational stress

was .25 and had a test statistic of -75.22. This indicated that job redesign leads to MICRO

organizational stress.


118

7. MACRO organizational stress has a significant negative direct effect on

organizational commitment of human service workers.

The path coefficient between MACRO job stress and organizational commitment was

-.45. The test statistic was -11.10. This indicated the MACRO job stress leads to decreased

organizational commitment.

8. MICRO organizational stress has a significant negative direct effect on job

satisfaction for human service workers.

The area of MICRO organizational stress was another problematic area. In the initial

model, the path coefficient between MICRO organizational stress and job satisfaction was

-.42 and the test statistic was 5.56. This would indicate that MICRO organizational stress

leads to decreased job satisfaction. In the final model, the MICRO organizational stress

latent variable was dropped in order to improve model fit to the data. The measured

variables in this area had less variance than the in MACRO organizational stress area which

contributed to problems of statistical inference. This is an area that needs further refinement

and investigation.

9. Organizational commitment has a significant negative direct effect on turn

over of human service workers.

The path coefficient between organizational commitment and turnover was -.49 and

had a test statistic of -9.80. This indicated that low organizational commitment is associated

with turnover. This supports previous research studies.


119

10. Job satisfaction has a significant negative direct effect on turnover of human

service workers.

The path coefficient between job satisfaction and turnover was -.30 and the test

statistic was -6.42. This was a significant relationship that indicated that job satisfaction

prevents turnover and job dissatisfaction leads to turnover.

11. There is no significant difference in MACRO organizational stressors between


ANOVA between social workers and registered nurses on MACRO organizational

stress revealed that significant differences existed. Social workers had a mean MACRO

stress score of 3.49 and registered nurses had a mean of 3.97. The test statistic, F, was 12.68

which had a significance of .000. This indicated that registered nurses perceive greater

amounts of MACRO organizational stress than social workers in acute hospital settings. Of

the seven subscales of MACRO organizational stressors, significant differences were found

in the areas of human resource development, rewards, participation, and supervisory style.

Registered nurses perceived significantly greater amounts of stress in these four categories

than did social workers.

12. There is no significant difference in MICRO organizational stressors between


ANOVA between social workers and registered nurses on MICRO organizational

stress revealed that significant differences did not exist. Social workers had a mean MICRO

stress score of 3.06 and registered nurses had a mean of 3.17. The test statistic, F, was .9254


120

which had a significance level of .337. Of the subscales of MICRO organizational stressors,

significant differences were found in three areas: quantitative overload, qualitative overload,

and responsibility for people. In the overload categories, social workers perceived greater

amounts of stress, while registered nurses perceived greater amounts of stress due to respon-

ibility for people. Both groups perceived the least amount of stress in the area of qualitative

work overload. This would indicate relative comfort with both groups in perceived ability to

do their jobs.

Table 17 summarizes the hypotheses, test statistics, and path coefficients from the

model testing. Table 17 also summarizes the results from the ANOVA of MACRO and

MICRO organizational stressors between social workers and registered nurses.

Tenability-Qf.TheQiigs

The major support of the Person-Environment fit theory was the path coefficient

between MACRO organizational stress and organizational commitment. MACRO organiza

tional stress measured the person and organizational commitment measured the environment.

The path coefficient of -.45 indicated that as MACRO stress increased, organizational com

mitment decreased. This indicated a poor fit of the person and environment. The second

measure of Person-Environment fit, MICRO organizational stress measured the person and

job satisfaction measured the environment. In the initial analysis, the path coefficient was

-.42 between MICRO organizational stress and job satisfaction. This indicated as MICRO

organizational stress increased, job satisfaction decreased. This supported the Person-


Reproduced

with perm

ission of the

copyright ow

ner. Further


without

permission.

Table 17.--Summary o f Hypotheses Testing

Hypotheses Related to Model Test Statistic Path Coefficient

1. Organizational restructuring has a significant positive direct effect on MACRO organizational stress o f human service workers.

7.05 .44

2. Organizational resturcturing has a significant positive direct effect on organizational reengineering.

Deleted from final model .89(In initial model)

3. Organizational restructuring has a significant positive direct effect on job redesign. 6.95 .90

4. Organizational reengineering has a significant positive direct effect on MACRO organizational Deleted from final model stress o f human service workers.

5. Organizational reengineering has a significant positive direct effect on MICRO organizational Deleted from final model -1.42stress of human service workers. (In initial model)

6. Organizational job redesign has a significant positive direct effect on MICRO organizational stress o f human service workers.

-75.22 .25

7. MACRO organizational stress has a signficant negative direct effect on organizational commitment of human service workers.

- 11.10 -.45

8. MICRO organizational stress has a significant negative direct effect on job satisfaction for human service workers.

5.56 (In initial model)

Deleted from final model

-.42(In initial model)

to

Reproduced

with perm

ission of the

copyright ow

ner. Further


without

permission.

Table 17.~Continued

Hypotheses Related to Model Test Statistic Path Coefficient

9. Organizational commitment has a signficant negative direct effect on turnover o f human service workers.

-9.80 -.49

10. Job satisfaction has a signficant negative direct effect on turnover o f human service workers. -6.42 -.30

Hypotheses Related to Differences Between Groups Test Statistic F Means

11. There is no signficant difference in MACRO organizational stressors between social workers and registered nurses.

12.68 Sig = .00

Social Workers: Registered Nurses:

3.493.97

12. There is no signficant difference in MICRO organizational stressors between social workers and registered nurses.

.93Sig = .34

Social Workers: Registered Nurses:

3.063.17

123

Environment fit theory; however, this path was removed from the final model. This is an

area that would need further study.

Herzberg's Two Factor theory was unsupported by the data and the model. In the

exploratory phase of model respecification the factors that lead to job satisfaction or

dissatisfaction were analyzed. The satisfiers were considered to be measured by the MICRO

organizational stressors and the dissatisfiers were measured by the MACRO organizational

job stressors. The factors most closely correlated with job dissatisfaction were career

progress and quantitative work overload.

The Price and Mueller (1986) Causal Model of Turnover was used a general

framework for this study. In this model, commitment was predicted by job satisfaction,

professionalism, general training, and kinship responsibility. In this study, commitment was

found to be predicted by the MACRO organizational job stressors of the politics of the

organization, human resource development, the reward system, participation in decision

making, style of supervision, and the organizational structure. Organizational restructuring

had an indirect effect on organizational commitment. The Price and Mueller (1986) model

proposed that job satisfaction is predicted by routinization, centralization, instrumental

communication, integration, pay, distributive justice, promotional opportunity, and role

overload. In this study, this area was problematic. Job redesign predicted job dissatisfaction

and restructuring had an indirect effect. Intent to leave was predicted by commitment,

professionalism, general training and kinship responsibility, and indirectly by job satisfaction

in the Price and Mueller model. In this study, intent to leave was predicted directly by


124

organizational commitment, job satisfaction and organizational restructuring, and indirectly

by MACRO organizational job stressors. The model in this study explained 59% of the

variance, in contrast to the Price and Mueller model that explained twelve to fifteen percent

of the variance. This study utilized structural equation modeling that uses latent variables to

predict paths. By this method, error variance of individual variables is not included as in

path analysis; however, the assumption that reliability of measures is perfect is not necessary

in this method as it is in path analysis. This would explain some increase in R2. Some

increase would be attributable to a factor not previously investigated. That factor was organ

izational change and specifically restructuring and job redesign.


CHAPTER V

IMPLICATIONS, RECOMMENDATIONS FOR FUTURE

STUDIES, AND CONCLUSIONS

This chapter discusses the significance of the study's findings for social work and

nursing. The findings are presented in three parts: 1) implications for social work, 2)

implications for nursing, 3) recommendations for future studies, and 4) conclusions.

Implications for Social Work

The interaction between a person and the work environment is a determinant of

behavior. According to Walsh (1973), environments select and shape the behavior of

people who inhabit them. This view believes that people behave similarly in specific envir

onments regardless of their individual differences. This view is inherent in the Person-

Environment fit theory. This implies that healthcare workers employed in acute hospital

settings would behave in a similar fashion because of the stressors within the environment.

This study indicated that this view holds for social workers and registered nurses. The

pattern of MACRO and MICRO organizational stressors of the two groups was similar. The

fifteen stressors correspondingly increased or decreased with both groups (figures 7 and 8 in

chapter 4).

125


126

The major support of the Person-Environment fit theory was found between MACRO

organizational stress and organizational commitment. MACRO organizational stressors

related to the stressors specific to the organization. MACRO organizational stress measured

the person and organizational commitment measured the environment. This study indicated

that as MACRO stress increased, organizational commitment decreased. This indicated a

poor fit of the person and environment. This implies that as a person begins to feel that the

environment makes too great of demands on personal resources, strain develops. Attaining

healthful work environments is accomplished through one or both of the following: creating

a work environment conducive to health or helping people adapt to changes in the environ

ment. Psychosocial and physical stressors in the work environment should be identified and

controlled. Efforts should be employed in the work environment to help people change in

order to accommodate the environmental demands. These efforts can be accomplished

through preventive stress management programs.

Environmental turbulence and organizational change are likely to continue. It is

apparent from this study that job stress in human service workers in acute hospital settings is

related to the restructuring changes in Texas hospitals. In order to control or minimize job

stress, preventive stress management programs are indicated. If organizational change in

creases organizational stressors, distress of health team members can lead to decreased job

satisfaction, decreased organizational commitment and turnover. The hospital social worker

is one of the best resources to which the organization can turn to implement such programs.


127

Social workers can assume this vital role in healthcare organizations because of their know

ledge base and skills.

Social workers are well positioned to implement preventive stress management pro

grams in acute healthcare settings. One important consideration, however, is that the social

workers in this study perceived greater amounts of quantitative work overload. It would be

imperative that administrators while recognizing the importance of the development of pre

ventive stress management programs, also recognize that current caseloads would necessitate

increasing the number of social workers to conduct such programs in addition to routine

activities.

The findings of this study indicate that organizational changes in acute hospital set

tings, specifically organizational restructuring, are leading to decreased organizational com

mitment, decreased job satisfaction and turnover. It has been demonstrated that turnover

leads to both direct and indirect costs to an organization (Mowday, Porter, & Steers, 1982;

Stryker, 1981). Therefore, it is important to try to control excessive turnover. Since the

model in this study identified how restructuring leads to increased job stress, preventive

stress management programs that would control negative effects of stress and better prepare

employees for the current healthcare environment should be implemented and evaluated.

Herzberg's Motivation - Hygiene theory was unsupported by the data and the model

of this study. The factors most closely correlated with job dissatisfaction in this study were

career progress and quantitative work overload. Hospital social work directors should be

sensitive to these factors. Career development plans should be established, if not already in


128

place. These plans help social workers assess career paths within the organization and can

improve morale. Social work directors should evaluate caseloads. If they are increasing

significantly within their hospitals, justification for increasing the number of social workers

should be made. Job satisfaction is a complex issue that should be monitored by social work

directors.

The Price and Mueller (1986) Causal Model of Turnover was used a general frame

work for this study. In this model, commitment was predicted by job satisfaction, profession

alism, general training, and kinship responsibility. In this study, commitment was found to

be predicted by the MACRO organizational job stressors of the politics of the organization,

human resource development, the reward system, participation in decision making, style of

supervision, and the organizational structure. Organizational restructuring influenced organ

izational commitment indirectly. Organizational commitment is an active association be

tween individuals and organizations. Committed employees are willing to give of them

selves in order to contribute to the organization's well being. Directors of hospital social

work departments should evaluate the degree of organizational commitment present within

their departments. Organizational commitment comes from both personal and job related

characteristics. Understanding the dynamics of the process of commitment can help social

work department directors foster organizational commitment in their staff. Decreased organ

izational commitment leads to withdrawal behaviors, such as turnover. Organizational

effectiveness is facilitated by increasing commitment. Social work directors should examine


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the organizational stressors this study identified that decrease organizational commitment and

analyze methods of mediating negative affects of stress on staff.

Planning healthcare delivery services that are responsive to limited resources must

occur. What this study has demonstrated is the affect of organizational change on the health

care worker. With future planning, there must be consideration given to educating members

of the health team about reasons for changes and preventing the job stress that comes with the

changes. It is important to increase productivity and control costs, while improving quality

of healthcare. Unfortunately, without regard to the affects of changes on health team mem

bers, the savings from restructuring may be offset due to new costs related to turnover and

decreased quality of healthcare related to inexperienced health team members or employees

suffering from burnout.

Social work provides an important service to patients and the other members of the

healthcare team. With restructuring occurring, it is imperative that social work departments

be maintained and managed by social workers. The ability to communicate with peers

increases job satisfaction, which decreases turnover. When patient-centered approaches are

initiated that place different services together to provide care to particular patient groups,

social workers should seek opportunities to communicate with one another. They should also

become strong advocates of collaborative practice with this type design.

Social work education must help students accept the changes that are occurring in

healthcare. Medical social workers must be flexible and able to assume new responsibilities,

and to participate in the transformation process. Collaborative practice is likely to continue


130

as greater demands are placed on all health team members to reduce costs and reduce length

of hospitalizations. Collaboration is important not only for social work education, but also

for nursing education and medical education.

Social work can provide the leadership necessary to facilitate the transformation of

the healthcare system. Social work should position itself to meet the challenges faced as the

changes are implemented. Administrators should be sensitive to the feelings of overload

identified in this study. Planning and budgeting for increased staff to meet the new burdens

placed on social service departments is essential.

Implications for Nursing

Nursing service administrators should be sensitive to the results of this study. As the

acuity of patients increases, experience is vital for leadership on nursing units. If nurses

begin to leave hospital nursing for other areas of practice, there will become a shortage of

experienced nurses in acute care. This has been a periodic problem faced by nursing admin

istration through the years. A response to shortages of nursing personnel in the past has been

increasing salaries. At a time when cost containment is paramount, it would not be in the

best interest of hospital organizations to create situations in attempts to contain costs that lead

to dysfunctional turnover, and then respond by increasing salaries to attract more nursing

personnel.

In response to increased turnover problems, many organizations respond by develop

ing control or evaluation programs or adopting a plan in use at other organizations (Rowland,

& Rowland, 1992). Because factors related to turnover at one institution may be different


131

from other institutions, plans borrowed from other organizations often fail to achieve the

desired goals. Careful assessment of turnover problems should precede plans for correcting

the problem. Monitoring affects of restructuring is indicated from this study. The costs of

turnover should be assessed for each healthcare institution, including both quantitative costs

such as hiring, orienting, and potential overtime costs until nurses are replaced, as well as

qualitative costs such as decreased patient satisfaction and lowered morale of employees.

Nursing service administrators should be sensitive to the impact of the job stressors

identified in this study. Measures should be employed that would help reduce the organiza

tional job stressors in order to retain qualified nursing staff. Career development plans, such

as career ladders that allow nurses to advance in a clinical path rather than an administrative

path, should be initiated to decrease job stress and increase job satisfaction. Offering nurses

opportunities for growth, such as transferring from one clinical area to another would also be

indicated. Organizational development techniques designed to educate nurses about the

rationales for changing healthcare environments could deter feelings of lack of participation

in decision making.

Nursing education should prepare nurses for the demands placed on acute hospital

organizations by the healthcare environment. By knowing and understanding the problems

faced by healthcare organizations today, there would be less transition shock moving from

the more sheltered academic environment, focused on total care of a minimal number of

clients to the acute hospital setting with responsibility for a larger group of clients. Nursing


132

education should facilitate the transition by teaching students how to care for larger numbers

of clients.

Recommendations for Future Studies

Since changes in the healthcare system are affected by national standards, federal

laws, and regulatory agencies, this study should be replicated on a national level to determine

if the model in this study would be supported. Healthcare reform is likely to remain on the

national agenda until changes occur in the system to control costs, improve quality, and

increase access.

This study should be expanded to include all types of healthcare workers. Since

changes in healthcare organizations are affecting all members of the healthcare team, the

extent of effects would be important because of the differences in costs of recruiting, select

ing, and training the different types of healthcare workers.

A comparative study should be done that compares different types of restructuring

processes and what leads to positive outcomes for workers and what leads to negative out

comes for workers. The degree of participation in decision making by employees related to

organizational change may buffer the negative affects of restructuring. This would be an area

of potential benefit for administrators to study.

Because of the strong association of job stress to decreased organizational commit

ment and turnover, efforts should be employed to reduce employee job stress. Preventive

stress management programs should be implemented and followed with evaluation studies to


133

determine if the affects of restructuring, job stress, organizational commitment, and job sat

isfaction can be mediated.

The medical social workers in this study were found to experience significantly great

er quantitative work overload than the registered nurses. Since patients have higher acuity

and shorter length of hospital stays, it is possible that the social workers are getting increased

referrals from nurses and physicians to solve rather difficult home care and psychosocial

problems. This could account for the perceived work overload. A study that determines the

nature and number of consults requested of social service departments and how they com

pare to previous years could provide evidence of the need to increase the size of social

service departments.

A natural progression of this study would be to determine what effects are occurring

due to restructuring in relation to patient satisfaction. The direct and indirect results of staff

turnover can have negative consequences for hospitals, but a more important consequence is

related to the primary customer of healthcare settings: the patient. If patient's are not satis

fied, they will not return to a particular hospital. This is the start of lowering the reputation

of hospitals and ultimately to decreasing the average daily census.

In light of the current healthcare environment, studies that have been done on expec

tations of the medical social worker (Cowles, & Lefcowitz, 1992; Kulys, & Davis, 1987)

should be repeated to see if the role of the medical social worker is being more clearly delin

eated within the healthcare team. Since this study found that social workers experience

greater quantitative work overload, it is possible that other healthteam members such as


134

physicians and nurses are relying more on the social worker to handle psychosocial problems

and home care concerns. Greater role clarity and collaborative practice are potential sources

of job satisfaction for social workers.

Further studies refining and predicting job satisfaction are indicated. Job satisfaction

is a complex entity that may need longitudinal analyses to determine affects of time and

situational variables.

C onclusions

The model of this study added an element that had not been done in previous turnover

studies. The element included in the turnover model of this study was organizational change.

It is likely that organizational changes will continue until spiraling healthcare costs are con

trolled. What this study indicates is that not only should healthcare administrators focus on

controlling the costs of delivering services, but they also must focus on the people who are

delivering those services. If the pressures of working in a stressful environment cause em

ployees to leave, then ultimately there will be a lack of qualified people to provide services.

Controlling healthcare costs is essential for the good of all Americans and the gen

erations that will follow. Many areas of life impact health, such as housing, education, and

economic opportunity. As long as healthcare consumes such a large percentage of the gross

national product, there will continue to be lack of funds for these other important areas.

Problems of access to healthcare services must also be addressed. From the review of lit

erature, it appeared that the major focus of organizational change in healthcare organizations


135

was cost containment. Administrators should have a holistic view that evaluates cost, quality

and access.

From this study, it can be concluded that having job satisfaction and being committed

to an organization are factors that keep employees from leaving their employers. Adminis

trators should identify what factors are important to their employees to create satisfaction

with work. They should also identify strategies that create an affiliation to the organization.

This would help to increase employees hardiness, characteristics that make people more

stress-resistant.

It is also concluded that restructuring efforts should be done with sensitivity to the

impact on employees. Employees are the heart of an organization and a resource that should

be effectively managed. Organizational development interventions are indicated in today's

turbulent healthcare environment to maintain an efficient and motivated work force.

Restructuring an organization involves changing the methods used to coordinate

work. Restructuring may also affect the degree of authority delegated and the span of control

of managers. Changes are met with different reactions, including acceptance, acquiescence,

resistance or by leaving an organization. Leaving the organization is an extreme reaction to

change. This study demonstrated how restructuring is leading to turnover. While some turn

over may be functional and rid the organization of ineffective employees, excessive turnover

can be dysfunctional. Hospitals should monitor the affects restructuring efforts have on em

ployees and intervene to prevent dysfunctional turnover.


CHAPTER VI

SUMMARY

The purposes of this study were to determine the relationship between organizational

changes on MACRO and MICRO job stressors, job satisfaction, organizational commitment

and turnover of human service workers, and to contrast affects of organizational changes on

social workers and registered nurses in acute hospital settings. The summary includes 1) the

theoretical framework that guided the study, 2) the method of the study, 3) the findings, and

4) implications and conclusions.

IhsjjteticaLFjameaark

The three theories that guided this study were the Person-Environment fit theory

(French, Rodgers, & Cobb, 1974), the Motivation-Hygiene theory of job satisfaction

(Herzberg, 1959), and the Causal Model of Turnover (Price, & Mueller, 1985). The Person-

Environment fit theory (French, Rodgers, & Cobb, 1974) was based on the concepts of

overload and underload of stress. The Person-Environment fit theory was refined by

Ivancevich and Matteson (1982) after studies identified multicollinearity in the methods of

measuring person and environment. Organizational commitment was used to measure the

person and MACRO and MICRO organizational stressors were used to measure the work

environment.

The Motivation-Hygiene theory (Herzberg, 1966) identified factors that lead to job

satisfaction or dissatisfaction. The factors involved in job satisfaction, satisfiers, are ad-

136


137

vancement, recognition, responsibility, growth and the job itself (Herzberg, 1966). Dissat-

isfiers were identified as working conditions and amenities, administrative policies, relation

ships with supervisors, relationships with peers, technical competence of supervisors, pay,

and job security. According to this theory, if satisfiers are optimized, they improve perfor

mance, reduce turnover, and create more positive attitudes of workers toward the organiza

tion and management. Conversely, when feelings of unhappiness are reported, they are

associated with conditions that surround doing the job. Satisfiers were seen in this study as

MICRO organizational factors and dissatisfiers were seen as MACRO organizational factors.

The Causal Model of turnover predicted that job satisfaction was predicted by routin-

ization, centralization, instrumental communication, integration, pay, distributive justice,

promotional opportunity, and role overload (Price, & Mueller, 1986). Commitment was

predicted by job satisfaction, professionalism, general training, and kinship responsibility.

Intent to leave is predicted by commitment, professionalism, general training and kinship

responsibility. Turnover is predicted by intent to leave and opportunity. In this study,

turnover was predicted by similar measures.

Hypotheses

The hypotheses of the study were derived from the conceptual model. In the model,

organizational restructuring and reengineering were predictors of MACRO organizational

stress. Reengineering and job redesign were predictors of MICRO organizational stress.

MACRO organizational stress predicted organizational commitment and MICRO organiza


138

tional stress predicted job satisfaction. Organizational commitment and job satisfaction were

predictors of turnover.

Method of Study

The method of study section consisted of four parts. Those parts are summarized as

follows: 1) research design, 2) sample, 3) instruments and reliabilities, and 4) data analysis.

Research Design

The study was an explanatory nonexperimental design employing structural equation

modeling (SEM). Structural equation modeling required the explicit declaration of the

theory of the model and its causal hypotheses. The hypotheses sought to determine the direct

and indirect effects of the concepts of restructuring, organizational reengineering, job re

design, MACRO and MICRO job stress, job satisfaction, and organizational commitment on

turnover of social workers and registered nurses in acute hospital settings. A strength of this

design was that it allowed for the causal ordering of variables that tested the theories that

guided this study.

Sample

Questionnaires were sent to 355 social workers in Texas from the membership roster

of the National Association of Social Workers who identified themselves as working in

healthcare settings, and 1,720 registered nurses in Texas who were selected from a propor

tionate allocation, stratified sampling procedure. The cover letter that accompanied the


139

questionnaire explained the study and informed subjects of their right to refuse to participate.

Of the questionnaires mailed to social workers, 106 (30.0%) were returned and 95 (26.8%)

were complete and included in the analysis. Of the questionnaires mailed to registered

nurses, 359 (20.9%) were returned and 327 (19%) were complete and included in the anal

ysis. All areas of Texas were represented by social workers and registered nurses, and all

types of hospital organizations and sizes were represented.

Instruments and Reliabilities

The five instruments and demographic profile were combined into a single question

naire. Demographic items pertained to practice areas and to hospital organization character

istics. The Organizational Change Questionnaire, developed for this study, measured

restructuring, reengineering, and job redesign. Definitions of constructs were given to a

panel who identified items that indicated each construct. They were then asked to rate items.

Items were revised based on the panels suggestions. The items were then pretested with a

group of twenty-two nurses from a central Texas hospital. Coefficient alpha for the three

scales were .65, .72, and .73. For the subjects in this study, coefficient alphas were .61, .60,

and .71.

Job stress was operationalized by the Stress Diagnostic Survey - Form A that used a

Likert type scale to measure stress from one to seven, where one indicated low job stress and

seven indicated high job stress. Seven subscales comprised the MACRO organizational

stress scale. The MACRO stress scale had a reported coefficient alpha of .77 (Matteson, &

Ivancevich, 1982). For the subjects in this study, coefficient alpha for the MACRO stress


subscale was .96. Eight subscales comprised the MICRO organizational stress scale. The

MICRO stress scale had a reported coefficient alpha of .79 (Matteson, & Ivancevich, 1982)

For the subjects in this study, coefficient alpha was .95.

Job satisfaction was operationalized by the Index of Job Satisfaction (Brayfield, &

Rothe, 1964). This consisted of eighteen items scored on a five point Likert scale, with one

indicating dissatisfaction and five indicating satisfaction. Nine items were reverse scored.

The scale had a Spearman-Brown reliability coefficient of .77 (Brayfield, & Rothe, 1964).

For the subjects in this study, the scale had a coefficient alpha of .91.

Organizational commitment was operationalized by the Organizational Commitment

Questionnaire (Mowday, & Steers, 1979). This was a fifteen item scale scored on a seven

point Likert scale, with one indicating low affiliation to the organization and seven indicating

high commitment. Six items were reverse scored. The instrument had a reliability coeffi

cient of .90 (Mowday, & Steers, 1979). For the subjects in this study, the coefficient alpha

was .91.

Turnover was operationalized by the Intention to Turnover scale from the Michigan

Organization Assessment Questionnaire (Cammann, Fichman, Jenkins, & Klesh, 1983). This

consisted of three items that had a reported coefficient alpha of .83. For the subjects in this

study, coefficient alpha was .62. Factor analysis was done which indicated factor loadings of

.74, .72 and .32. Item three was dropped from the scale and the resulting coefficient alpha

was .83.


141

Data Analysis

The data were analyzed using EQS for Windows. The subprogram for descriptive

statistics was used to derive the descriptive statistics to analyze demographic data. The EQS

subprogram was used to derive the structural equations and indices of model fit. The Statis

tical Package for the Social Sciences was used to perform one-way analyses of variance

between social workers and registered nurses for the variables in the study. One-way anal

yses of variance were also done based on groups of specialties, hospital size and type, and

region of Texas for the total subjects, and for the separate groups of social workers and reg

istered nurses.

Findings

The parsimonious model of the study had a Bentler-Bonnett Normed Fit Index of .92,

a Bentler-Bonnett Nonnormed Fit Index of .94, and a Comparative Fit Index of .95. This

indicated a good fit of the model to the data. The amount of variance explained by the model

was 59% (r2 = .59).

Organizational restructuring was found to have a significant direct effect on MACRO

organizational stress of human service workers. The path coefficient for this parameter was

.44. Organizational restructuring was found to affect job redesign. The path coefficient

between MACRO job stress and organizational commitment was -.45. This indicated that

MACRO job stress leads to decreased organizational commitment. Job satisfaction had a

path coefficient of .47 to organizational commitment, indicating that as satisfaction either

increases or decreases, so does organizational commitment. Restructuring indirectly affected


142

organizational commitment. The path coefficient between organizational commitment and

turnover was -.49 and the path coefficient between job satisfaction and turnover was -.30.

This indicated that low organizational commitment and low job satisfaction are associated

with turnover. This was a significant relationship that indicated that job satisfaction prevents

turnover and job dissatisfaction leads to turnover.

It had been postulated that restructuring had indirect effects on turnover; however,

this study found that restructuring was also directly associated with turnover. This was

significant in that the affects of restructuring were stronger than had been anticipated.

The affects of reengineering were omitted from the final model. Another problematic

area was related to MICRO organizational job stressors. While in general they seemed to be

associated with job satisfaction, they did not provide a good fit of the model to the data. The

measured variables in this area had less variance than the MACRO organizational stressors

which contributed to problems of statistical inference. The MICRO organizational job stres

sors were also omitted from the final model.

ANOVA between social workers and registered nurses on MACRO organizational

stress revealed that significant differences existed. Social workers had a mean MACRO

stress score of 3.49 and registered nurses had a mean of 3.97. This was significant at the .000

level, indicating that registered nurses perceived greater amounts of MACRO organizational

stress than social workers in acute hospital settings. Of the seven subscales of MACRO

organizational stressors, registered nurses had significantly higher perceived stress in the

areas of human resource development, rewards, participation, and supervisory style.


143

Social workers had a mean MICRO stress score of 3.06 and registered nurses had a

mean of 3.17, which indicated no statistically significant difference. Of the subscales of

MICRO organizational stressors, significant differences were found in three areas: quanti

tative overload, qualitative overload, and responsibility for people. Social workers perceived

greater amounts of stress in the area of quantitative work overload. Registered nurses per

ceived greater amounts of stress due to responsibility for people and qualitative work over

load. The lowest perceived stressor for both groups was qualitative work overload. This

would indicate relative comfort with both groups in perceived ability to do their jobs.

Implications and Conclusions

Healthcare organizations are under going many changes. This study demonstrated

how these changes are impacting social workers and registered nurses in acute hospital

settings. Restructuring increases organizational stressors which in turn leads to decreased

organizational commitment, decreased job satisfaction, and increased turnover. While turn

over may be useful if ineffective employees leave an organization, dysfunctional turnover can

result if too many workers leave which would necessitate increased costs for hiring and

orienting. The turnover process can also lead to decreased quality of care if inexperienced

staff take the place of experienced workers.

This study indicates that healthcare administrators should not only focus on the costs

of delivery systems, but also focus on the people delivering those services. Administrators

should adopt a more holistic approach to evaluating cost, quality, and access to service.


144

Organizational development interventions are necessary in today's healthcare environment in

order to maintain an efficient, well trained, and motivated work force.

Hospital organizations should identify how their restructuring processes impact em

ployees. If negative effects are occurring, then preventive stress management programs are

indicated. Administrators should identify factors that create satisfaction with work and

factors that create an affiliation to the organization. Social workers suffer from stress, as do

other healthcare providers. Stressors should be identified and controlled. While social

workers are in a position to implement preventive stress management programs, current

caseloads would necessitate increasing the number of social workers. Career development

plans would offer social workers a means of advancement in hospital settings and improve

morale. Social work directors should examine the stressors identified in this study that

decrease organizational commitment and find methods to mediate negative affects of stress

on the staff.


APPENDIX A

COVER LETTER OF SURVEY

145


146

TheUniversity of Texas atArlington

School of Social Work Box 19129 800 S. CooperArlington, Texas 76019-9966

October 10,1995

Dear Social Worker or Registered Nurse:

I am a doctoral candidate in social work administration at the University of Texas at Arlington. Changes are occurring rapidly in the healthcare system today. The purpose of my dissertation is to study the effects of organizational changes within the acute hospital setting.

It is essential for administrators to know how organizational changes affect healthcare workers. Healthcare reform is likely to necessitate changes within acute care hospitals. Administrators need to know about possible effects of organizational change as they make planning decisions within their hospital setting. This study could have potential benefits on your future career.

You were selected as a possible participant because of employment in a hospital setting based on records obtained from the National Association of Social Workers and the Board of Nurse Examiners for the State of Texas.

Your participation is voluntary. If you have any questions, please feel free to contact me. I may be reached at the address above.

Confidentiality is assured and in no way will you be identified in the study. No individual responses will be disclosed. The questionnaire you complete and return will be taken as your consent to participate in the study and for me to use the information in reporting group data.

Please complete the questionnaire and return it in the enclosed envelope by N o v em b er l f 1995. Thank you very much for your participation.

Sincerely,

Cherry K. Beckworth, B.S.N., M.S.


APPENDIX B

ORGANIZATIONAL CHANGE QUESTIONNAIRE

147


148Department:

Job Title:___

Sex:_______

Nursing Service_ Social Service_

Full-time:____

Marital Status:

_Part-time:_

_ Age:____

Number o f years in current field:______

Highest Educational Level: Diploma.

Associate Degree.

_ Number of years in present position:_____

Bachelor's Degree__________ Doctorate_

Master's Degree___________

. Psychiatry_

Area of specialization (Select only one): Generalist Practice:.

Critical Care:_____________ Surgical Services:___

Matemal/Child/Women's Health.

Hospital Size: Less than 99 beds:_______

Hospital Type: Non-profit (Church)_____

For Profit

100-499 beds:

.Non-profit (Other).

Government_____

DIRECTIONS: Many changes are taking place in hospitals across the nation. Please read each item and circle the response that relfects changes in your job or hospital over the PAST 1-2 YEARS.

. Medical/Surgical.

.Emergency Services:..

Long Term Care: _

More than 500 beds:

. Hospital District.

iv>

/

£$

&

1. This hospital has structurally reorganized to reduce middle management positions.

1 2 3 4 5

2. The process and work methods by which patient care is delivered has changed within the past 1-2 years.

1 2 3 4 5

3. I am expected to function in areas different from which I was hired at times.

1 2 3 4 5

4. Within the acute care areas of the hospital, there has been a downsizing of staff.

1 2 3 4 5

5. There has been an increase in the use of information processing systems and computerization.

1 2 3 4 5

6. The tasks and duties I am expected to perform in my job have changed over the past 1-2 years.

1 2 3 4 5

7. There has been a change in the total number of departments and how they relate to each other.

1 2 3 4 5

8. The philosophy and values of this organization have changed to emphasize the importance of customers and teamwork.

1 2 3 4 5

9. I have been trained to do the job of other workers within this hospital, if necessary.

1 2 3 4 5

10. There has been a reorganization of management positions (not the people, but position) and duties within those positions.

1 2 3 4 5

11. There have been changes made to increase the efficiency in the process of delivering services.

1 2 3 4 5

12. There have been changes in job descriptions in the past 1-2 years. 1 2 3 4 513. Case management is being utilized more extensively. 1 2 3 4 5


APPENDIX C

STRESS DIAGNOSTIC SURVEY - FORM A

149


150

As individuals we differ in the way we respond to various situations and conditions. This questionnaire is designed to measure the way you respond to aspects of your job. There are no "right" or "wrong" answers to the survey. The best answer to each item is the one that most nearly describes the way you really feel or respond.

FOR PURPOSES OF THIS SURVEY STRESS IS DEFINED AS EXISTING WHENEVER YOU EXPERIENCE FEELINGS OF PRESSURE. STRAIN. OR EMOTIONAL UPSET AT WORK.

INSTRUCTIONS: For each item in the survey you are asked to indicate the frequency with which the condition the item describes is a source of stress to you. Some items may describe conditions which are never a source of stress; others will describe conditions which are the source of varying amounts of stress. Simply circle the appropriate number (1-7) for each item which best describes how frequently each item is a source of workplace stress:

Circle 1 if the condition described is never a source of stress;

Circle 2 if it is rarely a source of stress;

Circle 2 if it is occasionally a source of stress;

Circle 4 if it is sometimes a source of stress;

Circle 2 if it is often a source of stress;

Circle £ if it is usually a source of stress;

Circle 1 if it is always a source of stress.


151

1. People tend to take credit for someone else's work achievements.

1 2 3 4 5 6 7

2. As job openings occurs, available candidates from within the organization are not properly trained to fill them.

1 2 3 4 5 6 7

3. Promotions are not based on performance. 1 2 3 4 5 6 74. People working here do not have the opportunity to

participate in making significant decisions.1 2 3 4 5 6 7

5. Employees are not able to use their full skills and abilities while doing the job.

1 2 3 4 5 6 7

6. Supervisors do not go to bat for their subordinates with their supervisors.

1 2 3 4 5 6 7

7. The formal policies employees are expected to follow are too restrictive.

1 2 3 4 5 6 7

8. There is a tendency to exchange favors with people of higher rank in the organization.

1 2 3 4 5 6 7

9. The organization has no sound program to attract needed and capable people.

1 2 3 4 5 6 7

10. There does not seem to be a clear relationship between job performance and rewards.

1 2 3 4 5 6 7

11. Opinions of employees about the job are not listened to by management.

1 2 3 4 5 6 7

12. Job assignments are not challenging. 1 2 3 5 6 7

13. Supervisors are not concerned about the personal welfare of their subordinates.

1 2 3 4 5 6 7

14. The chain o f command around here is not clearly understood.

1 2 3 4 5 6 7

15. There is a lot of game playing on the part of employees trying to obtain power and authority.

1 2 3 4 5 6 7

16. Our organization makes no real attempt to keep good people.

1 2 3 4 5 6 7

17. People are not rewarded on the basis of solid performance. 1 2 3 4 5 6 7

18. Employees have no influence over how to do jobs. 1 2 3 4 5 6 7

19. Job assignments in this organization do not make use of the talents o f the employee.

1 2 3 4 5 6 7

20. Supervisors show a lack of trust in their subordinates. 1 2 3 4 5 6 7


21. The way my work unit fits in w ith others in the overall plan is confusing.

1 2 3 4 5 6 7

22. One w ay to get ahead around here is to know the right person.

1 2 3 4 5 6 7

23. The organization does not make an effort to develop people to handle more authority and responsibility.

1 2 3 4 5 6 7

24. The rewards for working here are not handed out fairly.

1 2 3 4 5 6 7

25. Employees are only asked to participate in making trivial decisions.

1 2 3 4 5 6 7

26. Employees feel like they are not as involved in their work as they should be.

1 2 3 4 5 6 7

27. Supervisors do not show enough respect for subordinates.

1 2 3 4 5 6 7

28. The way this organization is set up (organized) is too impersonal.

1 2 3 4 5 6 7

29. The goals and objectives for m y job are not clear. 1 2 3 4 5 6 7

30. I am asked to do a lot o f unnecessary projects. 1 2 3 4 5 6 7

31. I have to take work home to stay caught up. 1 2 3 4 5 6 7

32. The work quality standards here are unrealistic. 1 2 3 4 5 6 7

33. There are insufficient opportunities for advancement in this organization.

1 2 3 4 5 6 7

34. I am held accountable for the work o f my co-workers. 1 2 3 4 5 6 7

35. The tim e deadlines for completing work assignments are too unreasonable.

1 2 3 4 5 6 7

36. The jobs I am assigned too are ju st not important. 1 2 3 4 5 6 7

37. It is not clear to m et what m y job responsibilities are. 1 2 3 4 5 6 7

38. I seem to receive conflicting requests from different people, (e.g., co-workers, bosses).

1 2 3 4 5 6 7

39. I spend too much tim e in unimportant meetings which take me away from m y work.

1 2 3 4 5 6 7

40. M y assigned tasks are too difficult for me to d o . 1 2 3 4 5 6 7


153

at <£?* / / /& eg O -S’ V

41. I do not have the opportunity to develop myself for the future.

1 2 3 4 5 6 7

42. I am expected to be a source o f help for too many people.

1 2 3 4 5 6 7

43. I have to rush in order to complete my job. 1 2 3 4 5 6 7

44. I do not receive enough feedback on how well I am doing my work.

1 2 3 4 5 6 7

45. 1 am not sure exactly what is expected of me. 1 2 3 4 5 6 7

46. I do things on the job that are accepted by one person and rejected by another person.

1 2 3 4 5 6 7

47. I am responsible for too many different activities. 1 2 3 4 5 6 7

48. I am asked to do things that I have not been trained to do.

1 2 3 4 5 6 7

49. I am hurting my career progress by staying in my job. 2 3 4 5 6 7

50. I am too responsible for providing needed information. 1 2 3 4 5 6 7

51. There is just not enough time to do my work. 1 2 3 4 5 6 7

52. My job lacks any variety - it is the same old thing over and over.

1 2 3 4 5 6 7

53. 1 am not certain of how much authority I have. 1 2 3 4 5 6 7

54. I can't seem to do my job because I am asked to do too many conflicting things.

1 2 3 4 5 6 7

55. I have too much work to do to be able to complete it all in a timely fashion.

1 2 3 4 5 6 7

56. I can't do a good job with my present skill and abilities. 1 2 3 4 5 6 7

57. 1 am not learning new skills in my job. 1 2 3 4 5 6 7

58. 1 am too responsible for keeping my work group one big happy family.

1 2 3 4 5 6 7

59. 1 am constantly against the pressure of time. 1 2 3 4 5 6 7

60. 1 am not given enough freedom to do my job as I see fit. 1 2 3 4 5 6 7


APPENDIX D

INDEX OF JOB SATISFACTION

154


155

Some jobs are more interesting than others. Circle the number beside each statement that best describes how you feel about your present job. There are no wrong or right answers. Please be honest with your opinion on each statement.

1. My job is like a hobby to me. 1 2 3 4 5

2. My job is usually interesting enough to keep me from 1 2 3 4 5getting bored.

3. It seems that my friends are more interested in their 1 2 3 4 5jobs.

4. I consider my job rather unpleasant. 1 2 3 4 5

S. I enjoy my work more than my leisure time. 1 2 3 4 5

6. I am often bored with my job. 1 2 3 4 5

7. I feel fairly well satisfied with my job. 1 2 3 4 5

8. Most of the time I have to force myself to go to work. 1 2 3 4 5

9. I am satisfied with my job for the time being. 1 2 3 4 5

10. I feel that my job is no more interesting than other I 1 2 3 4 5could get.

11. I definitely dislike my work. 1 2 3 4 5

12. I feel that I am happier in my work than most other 1 2 3 4 5people.

13. Most days I am enthusiastic about my work. 1 2 3 4 5

14. Each day of work seems like it will never end. 1 2 3 4 5

IS. I like my job better than the average person. 1 2 3 4 5

16. My job is pretty uninteresting. 1 2 3 4 5

17. I fmd real enjoyment in my work. 1 2 3 4 5

18. I am disappointed that I ever took this job. 1 2 3 4 5


APPENDIX E

ORGANIZATIONAL COMMITMENT QUESTIONNAIRE

156


157

Listed below are a series of statements that represent possible feelings which individuals might have about the organization for which they work. With respect to your feelings about the hospital in which you work, please indicate the degree of your agreement or disagreement with each statement by circling one of the seven alternatives:

1. I am willing to put in a great deal of effort beyond that normally expected in order to help this organization be successful.

1 2 3 4 5 6 7

2. I talk up this organization to my friends as a great organization for which to work.

1 2 3 4 5 6 7

3. I feel very little loyalty to this organization. 1 2 3 4 5 6 7

4. I would accept almost any type of job assignment in order to keep working for this organization.

1 2 3 4 5 6 7

5. I find that my values and the organization's values are very similar.

1 2 3 4 5 6 7

6. I am proud to tell others that I am a part of this organization. 1 2 3 4 5 6 7

7. I would just as well be working for a different organization as long as die type of work was similar.

1 2 3 4 5 6 7

8. This organization really inspires the very best in me in the way of job performance.

1 2 3 4 5 6 7

9. It would take very little change in my present circumstances to cause me to leave this organization.

1 2 3 4 5 6 7

10. 1 am extremely glad that I chose this organization to work for over others I was considering.

1 2 3 4 5 6 7

11. There is not too much to be gained by sticking to this organization indefinitely.

1 2 3 4 5 6 7

12. Often, I find it difficult to agree with this organization's policies policies on important matters relating to its employees.

1 2 3 4 5 6 7

13.1 really care about the fate of this organization. 1 2 3 4 5 6 7

14. For me, this is the best of all possible organizations for which to work.

1 2 3 4 5 6 7

IS. Deciding to work for this organization was definitely a mistake on my part.

1 2 3 4 5 6 7


APPENDIX F

INTENT TO TURNOVER SCALE

158


159

Here are some statements about you and your job. How much do you agree or disagree with each?

1. I will probably look for a new job in the next year. 1 2 3 4 5 6 7

2. I often think about quitting. 1 2 3 4 5 6 7

3. How likely is it that you could find a job with another employer with about the same pay and 1 2 3 4 5 6 7benefits you now have?

Thank you for participating in this study.


APPENDIX G

PERMISSION TO USE ORGANIZATIONAL

COMMITMENT QUESTIONNAIRE


161

7/24/95 RECEIVED

Cheny K. Beckworth

AUG 0 3 1995

perm issions d e p a rtm e n t14051 Shadow Grove Circle Waco, TX 76712 (817)772-1537

Director of Copyrights Journal of Vocational Behavior Academic Press 6277 Sea Harbor Drive Orlando, FL 32887-4900

Dear Director:

I am a doctoral candidate at the University of Texas at Arlington and planning to conduct a study on the effects of changes in acute hospital settings on the stress levels o f nurses and social workers and how that is impacting organizational commitment. I would like permission to utilize the Organizational Commitment Questionnaire that was presented in the article:

Mowday, R. T., Steers, R. M., & Porter, L. W. (1979). The measurement oforganizational commitment. Journal of Vocational Behavior 14.224-247.

The copyright number identified on the article is: 0001-8791/79/020224-24.

Your assistance in tins matter is greatly appreciated.

Sincerely,

Cherry K. Beckworth


162

PERMISSION GRANTED, provided chat 1) complete credit is given to the source, including the Academic Press copyright notice; 2) the material to be used has appeared in our publication without credit or acknowledgement to another source and 3) if commercial publication should result, you must contact Academic Press again.

We realize that University Microfilms must have permission to sell copies of your thesis, and we agree to this. However, we must point out that we

sale of your article.

Orlando, FL. 32887 August 7, 1995

are n « givingxJ^rmissibn for separate

w e l yPermissions Departnu


APPENDIX H

PERMISSION TO USE INTENTION TO

TURN OVER SCALE


164

John Wiley & Sons, Inc.

60S Third A venu e N 'wJ° 'k .N Y 10158 0012 212-8S0.6000 FAX 212.850.6088 Telex 12.7063■ U .f V O O

Ceble IONWILE

Publishers Since 1807

September 15,1995

Cherry K. Beckworth 14051 Shadow Grove Circle Waco. TX 76712

Dear Ms. Beckworth:

Re: Your request of August 9, 1995 for permission to reuse a portion of table 4.2/jp.S4 fromSeashore/ASSESSING ORGANIZATIONAL CHANGE, a work published by John Wiley & Sons, Inc.

1. Permission is granted for this use, except that you must obtain authorization from the original source to use any material that appears in our work with credit to another source.

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rs915.5


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