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The world health care sector, as the industrialized organizations, has undergone dramatic restructuring and downsizing during the past decades, which incurred serious changes of conditions in which nurses deliver healthcare. As human resources management strategies seemed to have had a positive effect on the similar problems beard by other industries, it appears that the public healthcare sector as failed to endeavor in the same way and is still struggling to design and implement effective schemes. This issue is becoming more and more urgent. Indeed, as governments focus on improving quality and cost effectiveness of patient care, the public healthcare sector has fallen into a vicious circle caused by: "overall workforce shortage, increasingly high and complex workloads, difficult working conditions, a feeling of continuous change and a feeling that the profession is less valued. " (Review Body 1999; NHS, 1999, DoH, 1998 b; 1999). This paper will resume the major impacts restructuring brought out on nurses working conditions, and thus on quality of care. We will then look at the solutions to take up in order to maintain and improve quality of service.
There are two degrees of consequences resulting from the restructuring of hospitals, one leading to the other. As Reeves (1997) says, nursing personnel consist of the largest workforce and the most costly of the NHS, which explains why this group has been most affected by downsizing and reduction of costs leading to a first degree of staff-shortage and mistrust towards the system. This engendered many other problems thrusting the NHS in a vicious circle. Indeed, the staffing shortage increased the workload of nurses and the hiring of unlicensed assistive personnel. This demanded that nurses have a wider range of skills such as supervising the workers and multiplied the amount of paper work. As a result, nurses were faced with heavier responsibilities.
In addition, as hospitals tried to increase workforce flexibility, nurses are not as specialized as they were and, thus, are more and more rotated to other unfamiliar areas. Moreover, nurses have less and less time to take care of their patient, which, according to the study led by McNeely (1996), leaves nurses with a feeling of guilt and anxiety having the impression that "they have let their patients down." The changes mentioned above have been proved by the Corey-Lisle et al. (1999) study to be factors of lower job satisfaction and higher stress level. These results confirm those of an earlier study carried out by Davidson et al. (1997) which revealed that downsizing and job restructuring had a negative impact on most aspects of nurses' job satisfaction. At the same time, the mistrust resulting from the changes led to other problems in the organization. Cook and Wall define organizational trust as the extent to which one is willing to ascribe good intentions to and have confidence in the words and actions of other people.
This definition shows that the diminished level of trust and what it engendered, may be one of the reasons that the organization transformation was not very successful. As Spence Laschinger et al. (2001) point out, researches have proven that "decreased level of trust are associated with decreased communication and increased conflict. " and that mistrust is due to information not being shared, resources being attributed unevenly, and managers not supporting their employees. Likewise, Johns (1996) concluded that trust affected organizational factors such as job satisfaction, organizational effectiveness, commitment, organizational citizenship behavior, extent and efficiency of communication. Additionally, high absenteeism, limited learning, low accountability, reactionary thinking and low creativity are very common in low trust organizations.
With knowledge of all the above issues, it is understandable that nurses hesitate less to leave the public hospitals, as it is easier to find jobs elsewhere with the increased competition within the health care sector. Furthermore, it has been verified that in the United Kingdom, 10 % of the newly trained nurses leave the NHS within a year of qualification (Review Body for Nursing Staff, Midwives and Health Visitors, 1999) and a third of the trained nurses in age of working have abandoned the profession (DoH 1999 b; Audit Commission, 1997), taking us back to the first link of the viscous circle. These findings reflect the uneasiness of the National Health System. All of the problems that follow from nurse shortage and the mistrust of employees in the organization must certainly have an effect on quality of care given to patients.
Verily, communication for example, whether within teams or across departments, is vital to nurses and other medical staffs, and last but not least the patient. Clear and complete communication is necessary so that patients needs are not "lost in the maze" Flynn et Rica (2001, p. 49). Experience and expertise must be shared in order to facilitate diagnoses, problem solving, and decide of the suitable intervention for the patient. More and more nurses cannot take as much time as they think is needed to give psychological support to patient or their families, even though it is an integral part of patient care, which affects patient satisfaction and well being.
As Newman et al. (2001) mention, service quality and human resource management as well as marketing literature have emphasized the fact that there is an existing relation between staff satisfaction and customer satisfaction. In a service sector, for example the hotel industry, it is well known that the workforce plays an important role in customer satisfaction as it is them who deliver the service and this same workforce depends on its working environment. If the latter is not pleasant and easy, employees are not satisfied and there is a good chance for it to portray itself on the quality of service. Even though these notions are taken from private sector service industries, Newman et al. (2001, p. 61) declare "we see no reason why they should not be applicable in a public sector service context." Finally it is important to mention that industries seem more and more aware that employees can take active participation in the improvement of an organization.
Indeed many leading international companies have and continue to pay utmost attention to the available human resources strategies in order to implicate their employees in all aspects of organizational excellence. The reason being that by doing so, they were able to obtain a higher productivity and stay competitive on a market that is more and more fears. It appears that the NHS is in a critical situation caused by many factors and is still struggling to remedy it. Where it is even more surprising is that many studies have been undertaken since the early 1980 's revealing the same apprehensive situation existing today. In addition it seems incomprehensible that governments look to improve quality and cost-effectiveness without considering the role that employees can play in doing so like it has been proven through many studies.
In the following part of this paper will look at the various human resources strategies that could enable the NHS to see the end of this crisis and verify their applicability. As we have discussed above, many issues have arisen from the restructuring of the NHS. We could imagine that there would be one solution to each problem evoked and that it would be one of the reasons the NHS is still fighting. But it appears that a few big changes could help improve all the negative aspects of the organization. Lets recall the fact that if nurses leave their job it is mostly due to organizational factors since initially, the act of integrating a hospital service evokes a personal attribute whereby nurses retrieve satisfaction and pleasure by caring for others. The two major strategies, which are strongly linked, we will discuss of, are empowerment and organizational culture.
According to Johns (1996) "empowering employees involves understanding the needs and capabilities of employees, trusting them, and helping them to maximize their fulfillment while pursuing corporate goals. " In the study conducted by Spence Laschinger et al. (2001), a strong relationship between trust and share of the information was found. Indeed, it is the managers who control the flow of information. When information is not being shared, employees will automatically speculate as to why, resulting in a loss of trust towards management. Moreover, it is important that information, such as budgetary, goals of managed care, is provided to nurses, as they would better understand how the organization functions and could even contribute to its improvement and evolution. Additionally, it would intensify the feeling of being part of a group. If a trustful relation could be integrated, then nurses would not feel betrayed when actions or changes were to be implemented which would facilitate transformation such as the ones undergone in the past.
Understanding the needs and capabilities of employees implies supporting them. In the previous literatures examining nurses work conditions, lack of support from management was brought up several times. A very simple example taken from McNeelys's tudy (1996), is that there was so little recognition of the stress carried by staff that some admitted not turning to professional help because of fear of repercussion for their career. A bigger issue is that of management having failed to support nurses taking career breaks and reward good work. As a result many nurses felt that they had no choice but leave the NHS if they wanted to move forward in their career. Managers can support nurses by providing useful feedback and guidance whilst allowing them to use their own judgment to make decisions especially on patient care issues.
By taking part in the decisions making affecting themselves and their departments, nurses will feel fulfilled a...
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Research essay sample on Impact Of On Nurses Working Conditions
