title: The effects of health care reforms on job satisfaction and voluntary turnover among hospital-based nurses.
abstract: OBJECTIVE
  Among the consequences of downsizing and cost containment in hospitals are major changes in the work life of nurses. As hospitals become smaller, patient acuity rises, and the job of nursing becomes more technical and difficult. This article examines the effects of changes in the hospital environment on nurses' job satisfaction and voluntary turnover between 1993 and 1994.
  
  
  METHODS
  Data were collected in a longitudinal survey of 736 hospital nurses in one hospital to examine correlates of change in aspects of job satisfaction and predictors of leaving among nurses who terminated in that period.
  
  
  RESULTS
  Unadjusted results showed decline in most aspects of satisfaction as measured by Hinshaw and Atwood's and Price and Mueller's scales. Multivariate analysis indicated that the most important determinants of low satisfaction were poor instrumental communication within the organization and too great a workload. Intent to leave was predicted by the perception of little promotional opportunity, high routinization, low decision latitude, and poor communication. Predictors of turnover were fewer years on the job, expressed intent to leave, and not enough time to do the job well.
  
  
  CONCLUSIONS
  The authors conclude that although many aspects of job satisfaction are diminished, some factors predicting low satisfaction and turnover may be amenable to change by hospital administrators.
authors.affiliation: Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA.
authors.forename: H
authors.initials: H
authors.lastname: Davidson
authors.forename: P H
authors.initials: PH
authors.lastname: Folcarelli
authors.forename: S
authors.initials: S
authors.lastname: Crawford
authors.forename: L J
authors.initials: LJ
authors.lastname: Duprat
authors.forename: J C
authors.initials: JC
authors.lastname: Clifford
mesh_terms: D000328:Adult; D003142:Communication; D003363:Cost Control / Q000379:methods; D004651:Employment; D006754:Hospital Restructuring; D006801:Humans; D007588:Job Satisfaction; D008137:Longitudinal Studies; D015999:Multivariate Analysis; D015401:Nursing Administration Research; D009741:Nursing Staff, Hospital / Q000523:psychology* / Q000600:supply & distribution*; D009936:Organizational Innovation; D010563:Personnel Turnover; D000078329:Workforce; D016526:Workload