title: Organizational configuration of hospitals succeeding in attracting and retaining nurses.
abstract: OBJECTIVE
  This paper contrasts structural and managerial characteristics of low- and high-turnover hospitals, and describes the organizational configuration of attractive hospitals.
  
  
  BACKGROUND
  In countries facing nurse shortages and turnover, some hospitals succeed in recruiting and retaining nurses. In Magnet Hospitals, managerial practices and environmental characteristics increase nurses' job satisfaction and their commitment to the organization, which in turn decreases nurse turnover. Such an approach suggests that organizations are best understood as clusters of interconnected structures and practices, i.e. organizational configurations rather than entities whose components can be understood in isolation.
  
  
  METHODS
  From a sample of 12 hospitals whose nurse turnover was studied for 1 year, structural and organizational features of hospitals in the first and fourth quartiles, i.e. attractive (turnover <3.1%) vs. conventional (turnover >11.8%) were contrasted. A questionnaire, including perceptions of health-related factors, job demands, stressors, work schedules, organizational climate, and work adjustments antecedent to turnover, was received from 401 nurses working in attractive hospitals (response rate = 53.8%) and 774 nurses in conventional hospitals (response rate = 54.5%).
  
  
  RESULTS
  Structural characteristics did not differentiate attractive and conventional hospitals, but employee perceptions towards the organization differed strikingly. Differences were observed for risk exposure, emotional demands, role ambiguity and conflicts, work-family conflicts, effort-reward imbalance and the meaning of work, all in favour of attractive hospitals (P < 0.001). Relationships with nursing management, work ability and satisfaction with working time, handover shifts and schedules were also better in attractive hospitals (P < 0.001). Job satisfaction and commitment were higher in attractive hospitals, whereas burnout and intention to leave were lower (P < 0.001).
  
  
  CONCLUSIONS
  Organizational characteristics are key factors in nurse attraction and retention. Nurses face difficulties in their work situations, but some hospitals are perceived as healthy organizations. The concept of attractive institutions could serve as a catalyst for improvement in nurses' work environments in Europe.
authors.affiliation: Unite d'Epidemiologie, de Biostatistique et de Methodes Operationnelles en Sante, Publique, Brussels, Belgium. stordeur@epid.ucl.ac.be
authors.forename: Sabine
authors.initials: S
authors.lastname: Stordeur
authors.forename: William
authors.initials: W
authors.lastname: D'Hoore
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006761:Hospitals; D006801:Humans; D007400:Interprofessional Relations; D007588:Job Satisfaction; D008297:Male; D009741:Nursing Staff, Hospital / Q000523:psychology / Q000600:supply & distribution*; D015279:Organizational Culture; D010561:Personnel Staffing and Scheduling / Q000592:standards; D010563:Personnel Turnover; D011795:Surveys and Questionnaires; D000078329:Workforce