title: Clinical nurses' response to an environment of health care reform and organizational restructuring.
abstract: BACKGROUND
  Clinical nurses at the crux of health care service delivery experienced radical organizational restructuring during the 1990s in Australia. Despite the implications organizational restructuring has for patient care delivery, clinical nurses continue to lack presence in policy decision-making processes.
  
  
  OBJECTIVE
  The aim of this paper is to provide an explanation for clinicians' undisputed acceptance of change. This will be performed by examining the process of organizational restructuring across three analytical levels -- the macro, meso and micro; identifying the consequences of restructuring for clinical nurses' performance; and evaluating organizational restructuring using a micro-political theoretical framework.
  
  
  RESULTS
  Utilizing Hoyle's (1988) micro-political theory, it would appear that clinical nurses are functioning within a paradigm of maintenance. In order to provide quality patient care, effective resource use and preservation of the status quo are prioritized.
  
  
  CONCLUSIONS
  Successful change outcomes are dependent on clinical nurses' performance. Whether nurses are politically inactive as a result of poor communication, as a consequence of the structural change environment or because their energy is devoted to achieving a balance between organizational imperatives and their personal commitment to patient care requires further investigation.
authors.affiliation: School of Nursing, Deakin University, Burwood, Victoria, Australia. rwynne@deakin.edu.au
authors.forename: Rochelle
authors.initials: R
authors.lastname: Wynne
mesh_terms: D001291:Attitude of Health Personnel; D001315:Australia; D002983:Clinical Competence / Q000592:standards*; D003142:Communication; D003659:Decision Making, Organizational; D004650:Employee Performance Appraisal; D018166:Health Care Reform / Q000458:organization & administration*; D006754:Hospital Restructuring / Q000458:organization & administration*; D006801:Humans; D007400:Interprofessional Relations; D009740:Nursing Staff / Q000193:education / Q000523:psychology*; D009936:Organizational Innovation; D011057:Politics; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D017132:Workplace / Q000458:organization & administration / Q000523:psychology