The results indicated that all seven dimensions of satisfaction were relevant in the model. However, pay contributes least to the latent variable nurses’ job satisfaction. The impact of the organizational-structure variables was significant in the model. The large negative impact of centralization (coefficient of ? 0. 54) and the positive impact of formalization and specialization (coefficients of 0. 14 and 0. 21) were clear. These three structural variables were correlated.
Formalization and specialization were positively correlated and centralization and specialization were negatively correlated. The model indicated that centralized hospitals also had low specialization, two structural characteristics that result in low satisfaction. Goodness-of-fit statistics indicated whether the model was a good fit for our data. We looked at fit indices that were useful for large samples, such as the AGFI and CFI. The fit was moderate with an AGFI of 0. 923 and a CFI of 0. 874. The model explained 40% of the variance of nurses’ job satisfaction.
The residual covariances for pay were large for the covariances ‘pay and tasks’ and ‘pay and organizational policies’, indicating that these pairs of variables were related. In general, pay was different from the other dimensions of satisfaction. Excluding pay from the model would improve
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As the literature indicated, the relationships between the organizational structure and nurses’ job satisfaction differ according to the dimension of satisfaction studied. However, our data also indicated that the relationships found in previous studies were not general relationships because only two of the propositions could be confirmed and several of our findings contradict the literature. The literature suggests negative relationships between centralization and satisfaction for autonomy, interaction, organizational policies, and status, which were confirmed by our data.
Hence, Proposition 1 was accepted. Although centralization was not particularly high in the three hospitals (an average of 3. 5 on a scale with a maximum of 7), it was perceived as too high, limiting nurses’ autonomy. The literature suggests that decentralization in combination with clear procedures and standards is most appropriate in hospitals, allowing nurses sufficient autonomy (Kramer and Schmalenberg, 2003). Furthermore, horizontal communication structures among nurses and between nurses and doctors are crucial.
High centralization reduces interaction among nurses, as the lack of freedom to make decisions and to solve problems independently limits the horizontal interaction among nurses, resulting in less horizontal relationships. In addition, nurses were very dissatisfied with a hospital’s organizational policies when they considered their organization as too centralized. The high impact of management on decision-making due to the centralized structure was negatively perceived. In a centralized structure, nurses were also less satisfied with their task requirements. They perceived also too heavy a workload.
One explanation is that the centralized structure demands a lot of paperwork to meet the hierarchical control needs; another is that the lack of freedom for nurses to organize their own work results in a suboptimal task allocation and, hence, dissatisfaction with task requirements. Greater clarity in rules and procedures through formalization did not help to improve the perception on the relationship between nurses and doctors and did not lead to more satisfaction with autonomy. The latter finding was unexpected because formalization can allow more autonomy among nurses (Cumbey and Alexander, 1998).
Considerable freedom can be allowed when rules and boundaries are clear. The relationship between formalization and satisfaction with autonomy was positive but too weak to be significant. Hence, Proposition 3b was also rejected. We expected to find positive and negative relationships between specialization and satisfaction depending on the kind of dimensions of satisfaction considered. There was no evidence for the assumed negative relationship between specialization and satisfaction with organizational policies. Thus, Proposition 2a was rejected.
On the contrary, nurses who were able to specialize and to fully deploy their talents were satisfied with organizational policies. The proposed positive relationship between specialization and satisfaction with task requirements, status, interaction and pay was found in our data; however, the relationship between specialization and satisfaction with task requirement was not significant. Hence, Proposition 2b was partially accepted. Specialization also had an effect on satisfaction with autonomy, as more specialization resulted in more autonomy for nurses.
Thus, restructuring organizations to allow for more specialization among nurses will result in greater satisfaction. Nurses who are unable to develop themselves fully through specialization are dissatisfied and have the least opportunity for involvement in the decision-making process and to organize their own work. Hence, one possibility for increasing satisfaction is to involve nurses with a generic role in management processes, as well as doctors and specialized nurses. Participation in decision-making increases nurses’ job satisfaction (Campbell et al.
, 2004). Nurses with a more generic role are most likely also unable to devote enough time to their patients and important nursing tasks because they have too many side-tasks, which also lowers their status. Lack of autonomy further emphasizes their somewhat low-level status in the organization (Kramer and Schmalenberg, 2003). Hence, more attention to the work quality of this group of nurses is advisable. This group has a lower level of education, slightly longer tenure, rarely includes men, and includes many part-time workers.
They are discriminated against in both pay and work quality because of their low chances to specialize. Literature has emphasized the need to value nurses’ work sufficiently high enough to increase the attractiveness of the job and to maintain a highly motivated workforce (Campbell et al. , 2004). In America the demand often exceeds the supply of people interested in the nursing job. Job satisfaction is an important variable to prevent nurses form quitting their job and to keep them motivated (Campbell et al. , 2004, Kalliath and Morris, 2002, Price, 2001, Tzeng, 2002).