title: Nurse executive and staff nurse perceptions of the effects of reorganization in Veterans Health Administration hospitals.
abstract: OBJECTIVE
  To examine nurse executive perceptions of effects of service line reorganization on nurse executive roles, nursing staff and patient care, and compare nurse executive responses to staff nurse reports of job satisfaction and quality of care in the same types of Veterans Health Administration facilities.
  
  
  BACKGROUND
  Although a growing body of research focuses on the association between nurse staffing structures, nurse satisfaction, and patient outcomes, relatively little attention has been paid to the effects of hospital restructuring on nursing management and nursing staff.
  
  
  METHODS
  Data on hospital and nursing service organization and nurse executive perceptions were collected through structured interviews with 125 nurse executives conducted from December 2002 through May 2003. Staff nurse data were derived from a survey of Veterans Health Administration nursing staff conducted from February through June 2003 at the same facilities.
  
  
  RESULTS
  Nurse executives in Veterans Health Administration described significant changes in the nurse executive role, and new challenges for managing nursing practice and achieving consistent quality of nursing care. Although nursing management perceived differences in the overall effects of restructuring on nursing staff depending on the type of reorganization, staff nurses reported significant differences in perceived quality of patient care across organization types.
authors.affiliation: VA Puget Sound Health Care System, Seattle, and Department of Health Services, University of Washington, Seattle, WA 98101, USA. nancy.sharp@med.va.gov
authors.forename: Nancy D
authors.initials: ND
authors.lastname: Sharp
authors.forename: Gwendolyn T
authors.initials: GT
authors.lastname: Greiner
authors.forename: Yu-Fang
authors.initials: YF
authors.lastname: Li
authors.forename: Pamela H
authors.initials: PH
authors.lastname: Mitchell
authors.forename: Julie A
authors.initials: JA
authors.lastname: Sochalski
authors.forename: Paulette R
authors.initials: PR
authors.lastname: Cournoyer
authors.forename: Anne E
authors.initials: AE
authors.lastname: Sales
mesh_terms: D001291:Attitude of Health Personnel; D006787:Hospitals, Veterans / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D007588:Job Satisfaction; D009718:Nurse Administrators / Q000523:psychology*; D009732:Nursing Care / Q000639:trends*; D009741:Nursing Staff, Hospital / Q000458:organization & administration / Q000523:psychology*; D011787:Quality of Health Care; D014481:United States