THE EFFECTS OF HEALTH-CARE REFORMS ON JOB-SATISFACTION AND VOLUNTARY TURNOVER AMONG HOSPITAL-BASED NURSES

OBJECTIVES. Among the consequences of downsizing and cost containment in hospitals are major changes in the work life of nurses. As hospital s become smaller, patient acuity rises, and the job of nursing becomes more technical and difficult. This article examines the effects of ch anges in the hospital environment on nurses' job satisfaction and volu ntary turnover between 1993 and 1994. METHODS. Data were collected in a longitudinal survey of 736 hospital nurses in one hospital to examin e correlates of change in aspects of job satisfaction and predictors o f leaving among nurses who terminated in that period. RESULTS. Unadjus ted results showed decline in most aspects of satisfaction as measured by Hinshaw and Atwood's(14) and Price and Mueller's(10) scales. Multi variate analysis indicated that the most important determinants of low satisfaction were poor instrumental communication within the organiza tion and too great a workload. Intent to leave was predicted by the pe rception of little promotional opportunity high routinization, low dec ision latitude, and poor communication. Predictors of turnover were fe wer years on the job, expressed intent to leave, and not enough time t o do the job well. CONCLUSIONS. The authors conclude that although man y aspects of job satisfaction are diminished, some factors predicting low satisfaction and turnover may be amenable to change by hospital ad ministrators.