Nurse Satisfaction with Patient Flow Redesign: A Qualitative Descriptive Embedded Case Study

Nurse Satisfaction with Patient Flow Redesign: A Qualitative Descriptive Embedded Case Study

Author: 
Mary A. Ditri
Program of study: 
D.H.A.
Abstract: 
Efforts to understand what influences nurse satisfaction in health care organizations have improved since the 1980s; however, understanding nurses' expectations and opinions of satisfaction in a setting that has undergone a major patient flow redesign may remain unclear. The purpose of this qualitative descriptive embedded case study was to describe the influence of a patient flow redesign on acute care perioperative nurse satisfaction in a nonprofit regional tertiary teaching hospital in the Northeast United States. The basis of the study was the self-reported opinions of nurse satisfaction for the 60-month period covering the implementation and post-completion period of the redesign. Data triangulation occurred using nurse satisfaction, turnover rates, and patient flow assessment data sets. A description of opinions of satisfaction emerged by adopting Locke’s range of affect theory. Prevailing findings across all data suggest four factors influenced satisfaction in the current case: (a) co-worker relationships, (b) management support, (c) workload predictability, and (d) ability to provide good patient care. Participants cited work environment, leadership support, and relationships as motivating sources of satisfaction. Although participants cited challenges in the work environment, the underlying commitment to patient care and colleague relationships were the foundation for satisfaction and wish to remain employed. Leaders may translate findings into sustainable improvements by understanding the aspects of workflow, management support, and co-worker relationships that influence satisfaction in an environment where a patient flow redesign has occurred.
Dedication: 
Thank you to my husband Michael, who waited patiently while “one more paragraph” was written or “one last edit” was made. His love, support, and endless encouragement made this possible. His golf game has been perfected during the long lonely weekends of writing! Thank you to my children Nicholas and Sheana who made me smile when I wanted to cry, walking beside me throughout this journey, and pouring only the best wines to celebrate small successes. Their lives have changed drastically since I began – now parents to my granddaughter Bella Jack who they will guide through life. I can only hope that they will recognize the importance of pursuing your dreams, even when others think you are crazy. Thank you to Cookie and Jim, who cheered me on with endless pride through every small step I took. To my mother-in-law, the “other Mary Ditri” – thank you to her for understanding when visits were not as often as we would have liked because of classwork deadlines. She waited patiently to brag to her friends. Many thanks to Carol, Bill, Jennifer, and Elliot, and dearest friends Beth, Robin, Bill, and Linda, Goddaughters Emily and Lily, and all those who stood behind me calling me “Dr. D.” far too soon, practicing for the day it would all come true! To all, it will be returned tenfold! And finally, with love to two special angels who left us far too soon. To my Dad who reminded me daily to do my homework … he faced his own challenges through these years but always took that second to ask about my classwork … I just wish he were here in the end to see his “daughter the doctor.” And to my Mom who has watched over me and those I love throughout these years, giving me the strength I needed each time I thought I could not see this through to the end.
Acknowledgements: 
An effort such as this cannot be entered into without faith that those around you will support and encourage you along the way. To my colleagues who encouraged me to take my first step – thank you Betsy and Aline for supporting my time and attention to school. To Eugene, Sandeep, Meng, and the team at IHO whose expertise in operations management made this all look so easy – what was I thinking? Thank you to Pat, Joe, and their colleagues who welcomed me into their hospital home to conduct this study. To my fellow doctoral learners with special recognition to Teresa and Ed and my residency buddies who helped me survive many a meltdown. A special thanks to Dr. Ken Sherman who spent many months working with me to create a strong foundation for research. Thank you to my Chair, Dr. Keri L. Heitner, who took me on without hesitation when unforeseen changes turned my life upside down. When my head was spinning she took me off the ledge. Thank you as well to Dr. Patricia D’Urso who graciously came on board and gave me incredible support and guidance; and to Dr. Louise Underdahl who believed in me before anyone else. Without these three women this would never have been possible.