title: Service quality in hospital wards with different nursing organization: nurses' ratings.
abstract: OBJECTIVE
  This paper is a report of a study to assess: (1) the relations between nursing organization models in hospital wards and nurses' perception of the quality of patient care and dimensions of the practice environment, and (2) if these relations were modified by variations in local conditions at the ward level.
  
  
  BACKGROUND
  Previous literature is inconclusive concerning what model of nursing organization maximizes the quality of nursing services.
  
  
  METHODS
  A cross-sectional survey was carried out in a representative sample of Norwegian hospital wards in 2005. Intra-ward organization models were classified as: (1) Team leader (n = 30), characterized by extensive responsibilities for team leaders, (2) Primary nurse (n = 18), with extensive responsibilities for named nurses, and (3) Hybrid (n = 37), (1) and (2) combined. We prepared multilevel regression models using scales describing quality of patient care, learning climate, job satisfaction, and relationships with physicians as dependent variables. As independent variables, we used variables representing local ward conditions.
  
  
  RESULTS
  Eighty-seven wards and 1137 nurses (55% response rate) provided complete data. The ward level proportion of variance ranged from 0.10 (job satisfaction) to 0.22 (relationships with physicians). The univariate effect of organization models on quality ratings was not statistically significant. Introducing local ward conditions led to a statistically significant effect of primary nurse organization on relationships with physicians, and to a substantial proportional reduction in ward level variance, ranging from 32% (quality of patient care) to 24% (learning climate).
  
  
  CONCLUSIONS
  Caution is needed about using service quality arguments when considering the possible benefits and drawbacks of different organizational models.
authors.affiliation: Norwegian Knowledge Centre for the Health Services, Oslo, Norway Institute of Nursing and Health Sciences, University of Oslo, Norway. ingeborg.sjetne@nokc.no
authors.forename: Ingeborg S
authors.initials: IS
authors.lastname: Sjetne
authors.forename: Marijke
authors.initials: M
authors.lastname: Veenstra
authors.forename: Bodil
authors.initials: B
authors.lastname: Ellefsen
authors.forename: Knut
authors.initials: K
authors.lastname: Stavem
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards*; D005260:Female; D006272:Health Facility Environment / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D016294:Models, Nursing; D009664:Norway; D009741:Nursing Staff, Hospital / Q000193:education / Q000458:organization & administration; D010348:Patient Care Team; D019555:Physician-Nurse Relations; D011787:Quality of Health Care / Q000458:organization & administration / Q000592:standards*; D055815:Young Adult