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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

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UMI Number: 9634320

Copyright 1996 by
Beckwortn, Cherry Kay Bruce
AH rights reserved.

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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

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

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Copyright by Cherry Kay Bruce Beckworth 1996


All Rights Reserved

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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

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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

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ABSTRACT

A STUDY OF THE RELATIONSHIP BETWEEN ORGANIZATIONAL CHANGE,


JOB STRESS, JOB SATISFACTION, AND ORGANIZATIONAL
COMMITMENT OF SOCIAL WORKERS
AND REGISTERED NURSES

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

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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.

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TABLE OF CONTENTS

ACKNOWLEDGMENTS ..........................................................................................

ABSTRACT ................................................................................................................ vi
LIST OF ILLUSTRATIONS ..................................................................................... xi
LIST OF TABLES ..................................................................................................... xii
Chapter
I.

INTRODUCTION ..........................................................................................

Purpose of the study ...........................................................................


Significance of the stu d y .....................................................................
Theoretical Framework .......................................................................
Statement of the Problem ...................................................................
Hypotheses ..........................................................................................
Definition of Terms .............................................................................
Assumptions .......................................................................................
Limitations ..........................................................................................

2
2
3
17
19
20
26
26

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


Organizational Factors ........................................................................
Job Stress ...........................................................................................
Job Satisfaction ...................................................................................
Organizational Commitment ...............................................................
Turnover .............................................................................................
Summary .............................................................................................

27
35
45
54
60
67

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

68

Research D esign..................................................................................
Sampling Procedures ..........................................................................
Description of Instruments ..................................................................
Reliability of Instruments ...................................................................
Procedure ...........................................................................................

68
69
71
77
79

viii

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Protection of Human Subjects............................................................


Data A nalysis.....................................................................................

79
79

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

91

Demographic Profile.......................................................................... 91
Analysis of Variance Between Groups ............................................. 99
Findings from Structural Equation Modeling .................................... 106
Hypothesis Testing ............................................................................ 116
Tenability of Theories ....................................................................... 120
V. IMPLICATIONS, RECOMMENDATIONS FOR FUTURE STUDIES,
AND CONCLUSIONS ..............................................

125

Implications for Social Work ............................................................ 125


Recommendations for Future Studies ............................................... 130
Conclusions ....................................................................................... 132
VI. SUMMARY ..................................................................................................... 134
Theoretical Framework .....................................................................
Method of S tudy ................................................................................
Findings .............................................................................................
Implications and Conclusions ............................................................

134
136
139
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 S cale............................................................................. 150

ix

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


H. Permission to Use Intention to Turn Over Scale .............................................. 155
REFERENCES ........................................................................................................... 157

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LIST OF ILLUSTRATIONS

Figure

Page

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

2. P -E F itT h eo ry .........................................................................................................

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 tu d y .........................................................................................

82

7. Job Stressors o f 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

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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 o f 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

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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 clearto 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.

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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

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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 o f 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).

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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

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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

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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.

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Eo: Objective Job Demands

Ex: Subjective Job Demands


HI

Work Load
Job Complexity

Work Load
Job Complexity

Strains

Objective Supplies
for Motives

Subjective Supplies
for Motives

Participation
Self-Utilization

Participation
Self-Utilization

H 8^

H3

Job Dissatisfaction
Boredom
Anxiety
Depression

Subjective Social Support


Coping Behaviors

somatic
Complaints
Cholesterol

Defense Mechanisms
Smoking
Drinking Coffee
Po: Objective Abilities Re:
Work Load
Job Complexity
Objective Motives
& Goals Re:
Participation
Self-Utilization

Ps: Subjective Abilities Re:


A
A2
----->

Work Load
Job Complexity

Morbidity and
Mortality

Subjective Motives
& Goals Re:
Participation
Self-Utilization

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).

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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

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9
High

Excess Supply
Environment
or
Person
(Underload)

(Overload)

Low

+1

+2

P-EFit
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

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10

Matteson (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).

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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.

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12
Table l.--The Dynamics of Hygiene and Motivation (Herzberg, 1976)

The Dynamics o f Hygiene

The Dynamics o f 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
environment
Hygiene improvements have short-term
effects

There are limited sources of motivator


satisfaction
Motivator improvements have long-term
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.

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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

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14
Table 2.Definitions of Variables of the Causal Model o f Turnover (Price, & Mueller,
1986)

Variable

Definition

1. Opportunity

Availability of alternative jobs in the organization's


environment

2. Routinization

Degree to which jobs in an organization are


repetitive

3. Centralization

Degree to which power is concentrated in an


organization

4. Instrumental Communication Degree to which information about the job is


formally transmitted by an organization to its
members
5. Integration

Degree to which the members of an organization


have close friends in their immediate work units

6. Pay

Money and its equivalents which individuals


receive for their services to the organization

7. Distributive Justice

Degree to which rewards and punishments are


related to performance inputs into the organization

8. Promotional Opportunity

Degree of potential vertical occupational mobility


within an organization

9. Role Overload

Extent to which demands of the job are extensive

10. Professionalism

Degree of dedication to occupational standards of


performance

11. General Training

Degree to which the occupational socialization of an


individual results in the ability to increase the
productivity of different organizations

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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).

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O pportunity
Routinization
C entralization
Instrum ental Communication
Integration
Pay
D istribuative Justice

Satisfaction

Prom otional O pportunity

^ Com m itm ent

^ Intent To

^ T u rn o v e r

Leave

Role Overload
Professionalism
G eneral T raining
Kinship Responsibility
Size

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

OS

17
Statement o f 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 o f the work environment are organizational
commitment and job satifaction. Job satisfiers are measured by MICRO job stressors. The

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Organizational
Commitment

Restructuring

Reengineering

Turnover

Job Redesign
Job
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.

2.

Organizational restructuring has a significant positive direct effect on


organizational reengineering.

3.

Organizational restructuring has a significant positive direct effect on job


redesign.

4.

Organizational reengineering has a significant positive direct effect on


MACRO organizational stress of human service workers.

5.

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.

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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


social workers and registered nurses.

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,

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21
the design of physical facilities for increased efficiency, and the design o f
simplified paperwork methods.
Reengineering is operationalized by items 2 ,5 ,8 ,1 1 , and 13 on the Organ
izational Change Questionnaire (Appendix B).
3.

Job redesign - The process of changing the duties and responsibilities o f a


specific job and the characteristics o f 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.

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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
Diagnostic Survey, Form A.

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
Diagnostic Survey, Form A.

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.

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


Stress Diagnostic Survey, Form A.
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
Stress Diagnostic Survey, Form A.

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
Diagnostic Survey, Form A.

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.

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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
Stress Diagnostic Survey, Form A.

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
Stress Diagnostic Survey, Form A.

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.

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25
Job Scope is operationalized through items 36,44,52, and 60 of the Stress
Diagnostic Survey, Form A.
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).

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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.

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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

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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.

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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

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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

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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 o f the social worker's generalized body of
knowledge and professional skills. Deskilling resulted from the division o f 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 o f 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

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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

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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.

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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.

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

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36
which a job requires making decisions, constant monitoring of equipment, repeated exchange
o f 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 o f 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

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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.

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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

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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

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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).

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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
advance- ment, 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

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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

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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.

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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 o f 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

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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 o f the var
iance. The study showed that job stress has the negative effect o f 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

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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 o f 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).

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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.

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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 Motivation-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,

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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) conclued 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 o f teamwork and communication.
In a study evaluating job satisfaction o f 188 psychiatric social workers, there was
positive overall job satisfaction (Marriott, Sexton, & Staley, 1994). The highest areas o f 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

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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

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51

routine 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

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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 visioninvolving others in ideas, interests, and a vision of the possible; enabling others to a c tempowering and building teamwork and trust; modeling the waybeing 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

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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

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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 o f 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.

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55
General Studies of Organizational Commitment
Because of studies that presented various meanings to the construct o f 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 o f 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 o f an individual's organ
izational commitment and the occurrence of organizational departure. It was felt that

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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

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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 o f perceived emphasis on flexibility and adaptation, rules and regulations, hierrarchy 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

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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

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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).

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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

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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.

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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

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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

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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).

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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 o f 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

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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).

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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.

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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 o f 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

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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

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70

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

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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

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72
Table 3.Selection Process of RNs From Public Health Regions of Texas

County:

Public Health Total Number of Total Number Staff Number of


Region
Registered Nurses Nurses in Acute
Subjects
Hospital Settings
Selected

Hale

132

41

Potter

2,135

639

64

Dallas

9,090

3,753

375

Anderson

327

73

Gregg

921

271

27

Rusk

187

Harris

22,370

6,439

644

Hill

165

17

McLennan

1,436

298

30

Travis

5,128

1,024

102

Bexar

10,578

2,818

282

Midland

776

222

22

El Paso

10

3,377

952

95

Cameron

11

1,218

349

35

Webb

11

517

152

15

58,357

17,056

1,720

Totals:

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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 o f 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

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74
perceptions o f job stress. The instrument contained sixty items to assess fifteen different
aspects o f job stress. These were divided into MACRO and MICRO job stressors.
The MACRO job stressors consisted o f 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 o f 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

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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

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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 o f 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).

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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

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

Subscales

Cronbach's Alpha

Politics

Jl

Human Resource Development

.80

Rewards

.90

Participation

.84

Underutilization

.76

Supervisory Style

.89

Organization Structure

.74

Role Ambiguity

.81

Role Conflict

.80

Overload Quantitative

.74

Overload Qualitative

.71

Career Progress

.79

Responsibility for People

.76

Time Pressure

.88

Job Scope

.69

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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

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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

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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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Reduce MM

E14

E15

E16

Politics

HRD

Rewards

E17

E18

Participation

EI9

Underutilize

Supervisor

E20
Structure

Downsizing

E2

Restructuring
D ept Chng
4^

E30

MACRO

Reorg MM

E31
Commitment

E 5 - * Processes

D6

D2

Look

Computers

E6

p Philosophy

Turnover

Reengineer

Fft ^ Efficiency

Think

Case Mana
JoB------Satisfaction

DS

Float
D3

Duties

MICRO

Job Redesign
Cross Train
E13

Job Descrip'

A m b ig u ity

Conflict

Quantitative Q u a lita tiv e

C a re e r

Figure 6. Statistical Model o f Study.

R e sp o n s

T im e

Scope

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;

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17.

V17 = + *F4 +E17;

18.

V18 = + *F4 +E18;

19.

V 19= + *F4 +E19;

20.

V20= + *F4 +E20;

21.

V21 = +1.0F5 +E21;

22.

V22= + *F5 +E22;

23.

V23 = + *F5 +E23;

24.

V 24= + *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

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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

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86
Table 5.--Means, skewness and kurtosis of variables in study

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

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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

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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

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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.

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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.

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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

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92
Table 6.~Personal Demographic Data of Total Subjects

Frequency

Adjusted
Percentage

327

77.5

95

22.5

Profession
Registered Nurse
Social Worker

(N = 422)
Sex
Males
Females

49

11.7

370

88.3

(N = 419)
Marital Status
268

66.8

Single

88

21.9

Divorced

38

9.5

Widowed

1.5

Gay Union

0.3

Married

(N = 401)
Age In Years
(N = 399)

Mean

SD

Range

39.9

8.3

25 - 68

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Social Workers

Registered Nurses

Frequency

Adjusted
Percentage

Male

20

21.5

29

8.9

Female

73

78.5

297

91.1

Adjusted
Percentage

Frequency

Sex

(N = 93)

(N = 326)

Marital.Status
Married

60

64.5

208

67.5

Single

25

26.9

63

20.4

Divorced

7.5

31

10.1

Widowed

0.0

2.0

Gay Union

1.1

(N = 93)
Age In Years

0.0

II
U> o
o
00
W

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Table 7.Demographic Data o f Social Workers and Registered Nurses in Study

Mean

SD

Range

Mean

SD

Range

91

43.2

10.5

2 5 -6 8

308

39.0

7.2

2 7 -5 4

94
Table 8.-Educational Comparison of Social Workers and Registered Nurses

Social Workers

Frequency

Adjusted
Percentage

Registered Nurses

Frequency

Adjusted
Percentage

Highest Educational Level


Diploma

0.0

37

11.3

Associate Degree

0.0

134

41.0

Bachelor's

6.3

147

45.0

88

92.6

2.4

1.1

0.3

Master's
Doctorate

Subjects Practice Area


The number of years worked in the field and the number o f 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.

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95
Table 9.--Demographics of Practice Areas

Social Workers

Registered
Nurses

Total
Subjects

Mean

13.4

11.0

11.5

Standard Deviation

9.9

7.2

7.9

Number o f Years in Field

2 -5 7

1 -3 2

1 -5 7

90

325

415

Mean

6.4

5.7

5.9

Standard Deviation

7.5

4.5

5.3

1-21

1 -4 9

313

406

Range
N
Number of Years in Present
Position

Range
N

1-4 9
93

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

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96
Table lO.-Area of Specialization for Social Workers and Registered Nurses

Social Workers

Registered Nurses

Adjusted
Adjusted
Frequency Percentage Frequency Percentage

Generalist Practice

35

36.8

12

3.7

Medical - Surgical

28

29.5

61

18.7

Critical Care

7.4

87

26.6

Surgical Service

2.1

40

12.2

Emergency Care

1.1

32

9.8

Maternal-Child, Women's Health

9.4

54

16.5

Psychiatry

6.3

24

7.3

Long Term Care

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

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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 o f registered nurses as their area o f special
ization. Psychiatry was reported to be the main area o f practice for 6.3 percent o f 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

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98
Table 11.Characteristics of Employing Hospitals

Social Workers

Frequency

Registered Nurses

Adjusted
Percentage Frequency

Adjusted
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 = 325

N = 91

Type of Hospital
NonProfit: Church

19

20.4

105

32.4

NonProfit: Other

19

20.4

73

22.5

Hospital District

9.7

26

8.0

For Profit

25

26.9

79

24.4

Government

21

22.6

41

12.7

N = 93

N = 324

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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 o f Subjects by Public Health Region

Total Subjects

Social Workers

Registered Nurses

Frequency

Adjusted
Percentage

Frequency

Adjusted
Percentage

Frequency

Adjusted
Percentage

26

6.2

2.1

24

7.3

Region 2 - 3

107

25.4

31

32.6

76

23.2

Region 4 - 5

11

2.6

3.1

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

3.2

14

4.3

Region 11

2.1

3.2

1.8

Region 1

N = 422

N = 95

N = 327

o
o

101
Table 13.ANOVA Between Social Workers and Registered Nurses

Variable

1.

2.

3.

4.

5.

6.

7.

8.

9.

SOCW

RN

Significance o f F

Politics
Mean
S.D.

3.57
1.40

3.96
1.33

6.20

.013

HRD
Mean
S.D.

3.53
1.33

4.13
1.32

15.61

.001 *

Rewards
Mean
S.D.

3.68
1.50

4.51
1.51

22.24

.000 *

Participation
Mean
S.D.

3.78
1.41

4.31
1.33

11.42

.001 *

Underutilization
Mean
S.D.

3.28
1.24

3.46
1.17

1.85

Supervisory Style
Mean
S.D.

3.37
1.39

3.95
1.52

11.13

Organization Structure
Mean
S.D.

3.11
1.22

3.44
1.19

5.59

.019

Role Ambiguity
Mean
S.D.

2.63
1.25

2.83
1.21

1.87

.173

Role Conflict
Mean
S.D.

2.94
1.35

3.19
1.27

2.79

.095

.174

.001 *

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102
Table 13.Continued

Variable

SOCW

10. Overload Quantitative


Mean
S.D.

3.42
1.42

11. Overload Qualitative


Mean
S.D.

Significance of F

3.02
1.23

7.35

.007 *

2.19
0.86

2.57
1.05

10.68

.001 *

12. Career Progress


Mean
S.D.

3.21
1.15

3.17
1.30

0.06

.802

13. Responsibility for People


Mean
S.D.

3.10
1.23

3.55
1.36

8.64

.004 *

14. Time Pressure


Mean
S.D.

4.04
1.52

3.87
1.59

0.84

.361

15. Job Scope


Mean
S.D.

2.93
1.27

3.12
1.12

1.93

.165

16. Job Satisfaction


Mean
S.D.

64.48
11.70

63.86
11.19

0.23

.634

17. Organizational Commitment


Mean
4.65
S.D.
1.24

4.35
1.14

4.90

.027

18. Turnover
Mean
S.D.

7.20
4.13

0.87

.353

6.76
3.97

RN

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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.

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104
Low Stress
Region

Moderate
Stress Region

High Stress
Region

4.0

6.0

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

1.0

2.0

3.0

5.0

7.0

Mean Category Values


Figure 7. Job Stressors for Social Workers in Study.

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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

1.0

2.0

3.0

4.0

5.0

6.0

7.0

Mean Category Values


Figure 8. Job Stressors for Registered Nurses in Study.

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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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1.91 -

Reduce MM

2 .92 -

Downsizing

3 .82 -

D ept Chng

4 80 _

Reorg MM

E14

E15

E16

E17

E18

E19

.58

.50

.50

.44

.59

.53

underutilize

Supervisor

4
Rewards

Politics

i
Participation

E20
i
.62

4
Structure

estructunng

.86

MACRO

Commitment

Look
6 - .9 4 .

Computers

7 - .94 -

Philosophy

8 9 0 .

Efficiency

9 - . 85

Case Mana

0-

Turnover

Reengineer

Think
59 Satisfaction

.78

1 - .6 9 .

Duties

MICRO

4g5( Job Redesign

2 .88 .

Cross Train te

3 .79 -

Job Descnp

.61

A m b ig u ity

1
1
E21

Conflict

.51
1
1
E22

Quantitative Q u a lita tiv e

1
1
E23

.73
I
1
E24

C a re e r

.69
I
1
E25

R e sp o n s

.61
I
1
E26

Figure 9. Path Coefficients o f Confirmatory Model.

T im e

S co p e

.77
I

.58

E27

E27

108

forjudging 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

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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 14Correlation Matrix o f Final Model


1

10

11

12

13

14

1. Reduce middle mana.

1.36

2. Downsizing

0.22

1.14

3. Departmental change

0.35

0.32

4. Reorganize middle mana.

0.36 0.19 0.29 0.73

3. Floating to other areas

0.33

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

8. Job descriptions

0.31

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

1.06

1.06

1.17

1.15 0.97

15

16

1.08

0.33 0.38 0.34

1.42

1.44

0.22 0.32 0.34 0.35 0.45 0.33

1.02

0.39 0.35 0.38 0.21

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

18. Look for new job

0.10 0.55 0.44 0.30 0.51

19. Think about quitting

0.18

0.41

0.16 0.25 0.97

0.65 0.45 0.33 0.65 0.60 0.22 0.26

1.17

8.02

1.05

1.09

1.14 0.83

1.24 0.77 -12.26

1.22

1.37

1.38

1.55 0.94 -14.35

1.06

17

18

19

Ill
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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E14

E15

E16

E17

E18

E19

E20

0.'S8

o.ta

0.'48

0.44

o.do

O.fo

0.&

Under
Utilization

Supervisory
Style

Politics

Rewards

HRD

0.82
0.91,

0.87

X 0.88

Participation

0.90

0.80

z '0.85

t
Structure

0.78

Reduce MM
E30
M acro

0.43
E2-0.90

Downsizing

E3.0.81

D epartm ent

0 .4 4\

__________

0.44'

'^ 0 . 4 5

O.g^^R cstructuring

0.73
Comm itm ent
D5

0.58

0.19
0.64

E4_ 0.81 _ > M ana. Chng


0.90

T urnover

0.47
E l 0 - 0 . 7 5 Floating
-0.30

0.78

0.89

Duties

C ross-train 4r
Jo b
Descriptions

0.49

Job
Redesign

-0.25

Job
Satisfaction

0.43

Look

Think

0.62

0.46

D3

Figure 10. Final Parsimonious Model o f Study.


to

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Table 15.~Measurment Equations o f Final Model with Standard Errors and Test Statistics'*

Variable

Variable
VI

Reduce MM
Standard Error
z Test Statistic
Robust S.E.
Robust z
V7 Dept Chng
Standard Error
z Test Statistic
Robust S.E.
Robust z
V10 ReorgMM
Standard Error
z Test Statistic
Robust S.E.
Robust z
V I 1 Duties
Standard Error
z Test Statistic
Robust S.E.
Robust z
V12 Cross Train
Standard Error
z Test Statistic
Robust S.E.
Robust z
V12 Job Decrip
Standard Error
z Test Statistic
Robust S.E.
Robust z

1.06*Restruc
.18
6.02
.19
5.63
1.3I*Restruc
.18
7.16
.19
6.93
1.07*Restruc
.15
7.12
.18
6.00
.96*ReJob
.08
11.98
.07
13.10
.74*ReJob
.09
8.49
.09
8.37
.71*ReJob
.08
9.45
.09
8.30

1.00 E l

1.00 E3

1.00 E4

1.00 E ll

+ 1.00 E12

+ 1.00 E13

V14 Politics
Standard Error
z Test Statistic
Robust S.E.
Robust z
V15HRD
Standard Error
z Test Statistic
Robust S.E.
Robust z
V16 Reward
Standard Error
z Test Statistic
Robust S.E.
Robust z
V17 Participation
Standard Error
z Test Statistic
Robust S.E.
Robust z
V18 Underutilization
Standard Error
z Test Statistic
Robust S.E.
Robust z
V19 Supervisory Style
Standard Error
z Test Statistic
Robust S.E.
Robust z

1.18+MACRO
.06
18.47
.06
18.82
1.25*MACRO
.06
20.09
.07
19.36
1.45*MACRO
.07
20.39
.08
19.48
1.31*MACRO
.06
20.88
.06
20.62
1.02*MACRO
.06
17.97
.06
18.17
1.37*MACRO
.07
19.42
.07
18.65

+ 1.00 E14

+ 1.00 E15

+ 1.00 E16

+ 1.00 E17

+ 1.00 E18

1.00 E19

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Table 15.Continued*

Variable
V29 Job Satisfaction
Standard Error
z Test Statistic
Robust S.E.
Robust z

-3.55*ReJob
.79
-4.49
.75
-4.75

V30 Commitment
Standard Error
z Test Statistic
Robust S.E.
Robust z

.05*JobSat
.00
13.12
.00
12.73

V I 07 Think about quitting


Standard Error
z Test Statistic
Robust S.E.
Robust z

1.102*Tumover
16.61
.06
19.69

-.54*MACRO +
.05
-11.10
.05
-10.98

,07*MACRO +

*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

115
Table 16.--Construct Equations of Final Model

Variable
F3 Job Redesign
Standard Error
z Test Statistic
Robust S.E.
Robust z

1.51 Restruc + 1.00 D3


.22
7.05
.23
6.67

F4

MACRO Job Stress = .88*Restruc +


Standard Error
.15
z Test Statistic
5.89
Robust S.E.
.16
Robust z
5.59

F5

Turnover
Standard Error
z Test Statistic
Robust S.E.
Robust z

1.00 D4

-.05*JobSat +
.76*Commit + ,69*Restruc+ 1.00 D5
.01
.08
.19
-6.42
-9.80
3.64
.01
.07
.18
-6.79
-10.44
3.88

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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
1.

Organizational restructuring has a significant positive direct effect on


MACRO organizational stress of human service workers.

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.

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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.
4.

Organizational reengineering has a significant positive direct effect on


MACRO organizational stress of human service workers.

Organizational reengineering was omitted from the final model and therefore did not
have a significant effect on MACRO organizational stress of human service workers.
5.

Organizational reengineering has a significant positive direct effect on


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.

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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.

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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


social workers and registered nurses.

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


social workers and registered nurses.

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

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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 responibility for people. Both groups perceived the least amount of stress in the area o f 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-

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Table 17.--Summary o f Hypotheses Testing

Test Statistic

Path Coefficient

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

Hypotheses Related to Model

1. Organizational restructuring has a significant positive direct effect on MACRO organizational


stress o f human service workers.

4. Organizational reengineering has a significant positive direct effect on MACRO organizational


stress o f human service workers.

Deleted from final model

5. Organizational reengineering has a significant positive direct effect on MICRO organizational


stress o f human service workers.

Deleted from final model

6. Organizational job redesign has a significant positive direct effect on MICRO organizational
stress o f human service workers.
7. MACRO organizational stress has a signficant negative direct effect on organizational
commitment o f human service workers.
8. MICRO organizational stress has a significant negative direct effect on job satisfaction for
human service workers.

-1.42
(In initial model)

-75.22

.25

11.10

-.45

5.56
(In initial model)
Deleted from final model

-.42
(In initial model)

to

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Table 17.~Continued

Test Statistic

Path Coefficient

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

Test Statistic F

Means

Hypotheses Related to Model

9.

Hypotheses Related to Differences Between Groups

11. There is no signficant difference in MACRO organizational stressors between social workers
and registered nurses.

12.68
Sig = .00

Social Workers:
3.49
Registered Nurses: 3.97

12. There is no signficant difference in MICRO organizational stressors between social workers
and registered nurses.

.93
Sig = .34

Social Workers:
3.06
Registered Nurses: 3.17

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

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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 o f 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.

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CHAPTER V
IMPLICATIONS, RECOMMENDATIONS FOR FUTURE
STUDIES, AND CONCLUSIONS
This chapter discusses the significance o f 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 PersonEnvironment 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

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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.

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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 o f 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 o f 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

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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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129
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 o f 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

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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 o f 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

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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 o f 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 o f a minimal number of
clients to the acute hospital setting with responsibility for a larger group of clients. Nursing

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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

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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 o f 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

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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 o n clu sio n s

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

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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.

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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 PersonEnvironment 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 ad136

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137
vancement, recognition, responsibility, growth and the job itself (Herzberg, 1966). Dissatisfiers 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 routinization, 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

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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 o f 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

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139
questionnaire explained the study and informed subjects of their right to refuse to participate.
O f 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 o f 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

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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 o f .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.

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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

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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.

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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. O f the subscales o f
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 o f 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.

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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.

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APPENDIX A
COVER LETTER OF SURVEY

145

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146

The
University of Texas
at
Arlington

School of Social Work


Box 19129
800 S. Cooper
Arlington, 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 e m b e r l f 1995. Thank you very much for your participation.
Sincerely,

Cherry K. Beckworth, B.S.N., M.S.

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APPENDIX B
ORGANIZATIONAL CHANGE QUESTIONNAIRE

147

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148
Department:

Nursing Service_

Social Service_

Job Title:___

Full-time:____

_Part-time:_

Sex:_______

Marital Status:

_ Age:____

Number o f years in current field:______


Highest Educational Level:

Diploma.

Associate Degree.

_ Number o f years in present position:_____


Bachelor's Degree__________ Doctorate_
Master's Degree___________

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

. Medical/Surgical.
.Emergency Services:..

. Psychiatry_
100-499 beds:

Long Term Care: _


More than 500 beds:

.Non-profit (Other).

. Hospital District.

Government_____

DIRECTIONS: Many changes are taking place in


hospitals across the nation. Please read each item
and circle the response th a t relfects changes in your
job or hospital over the PAST 1-2 YEARS.

1. This hospital has structurally reorganized to reduce middle


management positions.
2. The process and work methods by which patient care is delivered has
changed within the past 1-2 years.
3. I am expected to function in areas different from which I was hired at
times.
4. Within the acute care areas of the hospital, there has been a
downsizing o f staff.
5. There has been an increase in the use o f information processing
systems and computerization.
6. The tasks and duties I am expected to perform in my job have
changed over the past 1-2 years.
7. There has been a change in the total number o f departments and how
they relate to each other.
8. The philosophy and values of this organization have changed to
emphasize the importance o f customers and teamwork.
9. I have been trained to do the job o f other workers within this hospital,
if necessary.
10. There has been a reorganization o f management positions (not the
people, but position) and duties within those positions.
11. There have been changes made to increase the efficiency in the
process o f delivering services.
12. There have been changes in job descriptions in the past 1-2 years.
13. Case management is being utilized more extensively.

$
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iv>

/
1

1
1

2
2

3
3

4
4

5
5

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APPENDIX C
STRESS DIAGNOSTIC SURVEY - FORM A

149

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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 o f 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.

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151

People tend to take credit for someone else's work


achievements.
2. As job openings occurs, available candidates from
within the organization are not properly trained to fill them.
3. Promotions are not based on performance.
4. People working here do not have the opportunity to
participate in making significant decisions.
5. Employees are not able to use their full skills and
abilities while doing the job.
6. Supervisors do not go to bat for their subordinates with
their supervisors.
7. The formal policies employees are expected to follow
are too restrictive.
8. There is a tendency to exchange favors with people of
higher rank in the organization.
9. The organization has no sound program to attract needed
and capable people.
10. There does not seem to be a clear relationship between job
performance and rewards.
11. Opinions of employees about the job are not listened to by
management.
12. Job assignments are not challenging.
1.

1
1

2
2

3
3

4
4

5
5

6
6

7
7

17.

Supervisors are not concerned about the personal welfare of


their subordinates.
The chain o f command around here is not clearly
understood.
There is a lot of game playing on the part o f employees
trying to obtain power and authority.
Our organization makes no real attempt to keep good
people.
People are not rewarded on the basis of solid performance.

18.

Employees have no influence over how to do jobs.

19.

Job assignments in this organization do not make use of the


talents o f the employee.
Supervisors show a lack o f trust in their subordinates.

13.
14.
15.
16.

20.

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29.

The w ay m y w ork unit fits in w ith others in the overall


plan is confusing.
O ne w ay to get ahead around here is to know the right
person.
T he organization does not m ake an effort to develop
people to handle m ore authority and responsibility.
The rew ards for w orking here are not handed out
fairly.
Em ployees are only asked to participate in making
trivial decisions.
Em ployees feel like they are not as involved in their
w ork as they should be.
Supervisors do not show enough respect for
subordinates.
T he w ay this organization is set up (organized) is too
im personal.
T he goals and objectives for m y jo b are not clear.

30.

I am asked to do a lot o f unnecessary projects.

31.

I have to take w ork hom e to stay caught up.

32.

The w ork quality standards here are unrealistic.

33.

There are insufficient opportunities for advancem ent


in this organization.
I am held accountable for the w ork o f m y co-workers.

36.

T he tim e deadlines for com pleting work assignments


are too unreasonable.
T he jo b s I am assigned too are ju s t not important.

37.

It is not clear to m et w hat m y jo b responsibilities are.

38.

I seem to receive conflicting requests from different


people, (e.g., co-w orkers, bosses).
I spend too much tim e in unim portant m eetings which
take m e aw ay from m y work.
M y assigned tasks are too difficult for m e to d o .

21.
22.
23.
24.
25.
26.
27.
28.

34.
35.

39.
40.

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153

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-S V

I do things on the job that are accepted by one person


and rejected by another person.
I am responsible for too many different activities.

49.

I am asked to do things that I have not been trained to


do.
I am hurting my career progress by staying in my job.

50.

I am too responsible for providing needed information.

51.

There is just not enough time to do my work.

52.

My job lacks any variety - it is the same old thing over


and over.
1 am not certain of how much authority I have.

56.

I can't seem to do my job because I am asked to do too


many conflicting things.
I have too much work to do to be able to complete it all
in a timely fashion.
I can't do a good job with my present skill and abilities.

57.

1 am not learning new skills in my job.

58.

59.

1 am too responsible for keeping my work group one


big happy family.
1 am constantly against the pressure of time.

60.

1 am not given enough freedom to do my job as I see fit.

41.
42.
43.
44.
45.
46.
47.
48.

53.
54.
55.

I do not have the opportunity to develop myself for the


future.
I am expected to be a source o f help for too many
people.
I have to rush in order to complete my job.
I do not receive enough feedback on how well I am
doing my work.
1 am not sure exactly what is expected o f me.

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APPENDIX D
INDEX OF JOB SATISFACTION

154

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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.

2.

My job is usually interesting enough to keep me from


getting bored.
3. It seems that my friends are more interested in their
jobs.
4. I consider my job rather unpleasant.

S.

I enjoy my work more than my leisure time.

6.

I am often bored with my job.

7.

I feel fairly well satisfied with my job.

8.

Most o f the time I have to force myself to go to work.

9.

I am satisfied with my job for the time being.

10. I feel that my job is no more interesting than other I


could get.
11. I definitely dislike my work.

12. I feel that I am happier in my work than most other


people.
13. Most days I am enthusiastic about my work.

14. Each day of work seems like it will never end.

IS. I like my job better than the average person.

16. My job is pretty uninteresting.

17. I fmd real enjoyment in my work.

18. I am disappointed that I ever took this job.

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APPENDIX E
ORGANIZATIONAL COMMITMENT QUESTIONNAIRE

156

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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.

3 4

2. I talk up this organization to my friends as a great organization


for which to work.

3 4

3. I feel very little loyalty to this organization.

3 4

4. I would accept almost any type of job assignment in order to


keep working for this organization.

3 4

5. I find that my values and the organization's values are very


similar.

3 4

6. I am proud to tell others that I am a part of this organization.

3 4

7. I would just as well be working for a different organization as


long as die type o f work was similar.

3 4

8. This organization really inspires the very best in me in the way of


job performance.

3 4

9. It would take very little change in my present circumstances to


cause me to leave this organization.

3 4

10. 1 am extremely glad that I chose this organization to work for


over others I was considering.

3 4

11. There is not too much to be gained by sticking to this


organization indefinitely.

3 4

12. Often, I find it difficult to agree with this organization's policies


policies on important matters relating to its employees.

3 4

13.1 really care about the fate o f this organization.

3 4

14. For me, this is the best of all possible organizations for which to
work.

3 4

IS. Deciding to work for this organization was definitely a mistake


on my part.

3 4

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APPENDIX F
INTENT TO TURNOVER SCALE

158

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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.

2. I often think about quitting.

3. How likely is it that you could find a job with


another employer with about the same pay and
benefits you now have?

Thank you for participating in this study.

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APPENDIX G
PERMISSION TO USE ORGANIZATIONAL
COMMITMENT QUESTIONNAIRE

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161

7/24/95

RECEIVED
AUG 0 3 1995

Cheny K. Beckworth
14051 Shadow Grove Circle
Waco, TX 76712
(817)772-1537

p erm issio n s d e p a rtm e n t

Director of Copyrights
Journal of Vocational Behavior
Academic Press
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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 of
organizational 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

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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
are n givingxJ^rmissibn for separate sale of your article.

w e ly
Permissions Departnu
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August 7, 1995

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APPENDIX H
PERMISSION TO USE INTENTION TO
TURN OVER SCALE

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164

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