hospital nurses’ job satisfaction, individual and organizational characteristics

Hospital nurses' job satisfaction, individualand organizational characteristics

Ann Adams PhD MSc BA Hons RGN

Research Fellow, European Institute of Health and Medical Sciences,

University of Surrey, Guildford

and Senga Bond PhD FRCN RGN

Professor of Nursing Research, Centre for Health Services Research,

The University, Newcastle upon Tyne, England

Accepted for publication 21 February 2000

ADAMSADAMS AA. && BONDBOND SS. (2000)(2000) Journal of Advanced Nursing 32(3), 536±543

Hospital nurses' job satisfaction, individual and organizational characteristics

Using the Ward Organizational Features Scales (WOFS), relationships between

aspects of the organization of acute hospital wards, nurses' personal charac-

teristics and nurses' job satisfaction are examined among a nationally repre-

sentative sample of 834 nurses in England. The analysis contributes to a

growing body of evidence demonstrating the importance of interpersonal

relationships to nurses' job satisfaction. In particular, the positive contribution

of the cohesiveness of ward nursing staff is highlighted, but the potential for

many current NHS staf®ng strategies and work environments to undermine the

development of cohesive working relationships is also noted. Other in¯uential

factors are nurses' relationships with medical staff, perceptions of their

workload and their evaluation of the appropriateness of the system of nursing

being practised. The importance of measuring nurses' subjective assessments of

their work environment is emphasized. A weak association was found between

grade and job satisfaction. Individual nurse characteristics were found not to be

associated with job satisfaction.

Keywords: job satisfaction, ward organization, working relationships, clinical

grade, nurse characteristics, work environment, British NHS, human resource

management, retention, commitment

INTRODUCTION

It has long been recognized in Britain that there is a

consistent relationship between aspects of the organiza-

tion and management of hospitals, staff responses to these

processes and clinical outcomes of care. The number of

quali®ed nurses available to provide care in the National

Health Service (NHS) is associated with the effectiveness

and ef®ciency of nursing services (Ministry of Health

1948), while Revans (1964) pointed to the association

between staff morale and length of patient stay. More

recently, other aspects of the organization of hospitals and

individual wards have been associated with the effective-

ness of hospital care as measured by patient outcomes.

These include the organization of nursing care and ways

in which hospital restructuring rede®nes the context for

provider±patient relations and clinical decision making

(Aiken et al. 1994, 1997). In a study of intensive care units

in the United States of America (USA), Knaus et al. (1986)

found that the pattern of communication between nurses

Correspondence: Ann Adams, European Institute of Health and Medical

Sciences, Edward Duke of Kent Building, University of Surrey, Guildford

GU2 5TE, England. E-mail: [email protected]

Journal of Advanced Nursing, 2000, 32(3), 536±543 Nursing and health care management issues

536 Ó 2000 Blackwell Science Ltd

and physicians was the most important factor associated

with variation in mortality. This ®nding may be speci®c to

a culture where many physicians have patients in a single

ward and to a highly acute care setting where patients

require prompt treatment decisions. At a common-sense

level, however, where organizational environments facili-

tate good communication between staff, then patients are

likely to bene®t.

While, arguably, patient outcomes are the best measure

of the effectiveness of hospital care, also important are the

effects of hospitals on the staff they employ. Intractable

and negative staff outcomes associated with working in

hospitals are high levels of stress which undermine

performance and lead to high staff turnover (Packard &

Motowidlo 19871 , Cavanagh & Cof®n 1992, Wheeler &

Riding 1994, Janssen et al. 1999). Recent nurse recruit-

ment and retention problems in Britain have brought this

issue to the forefront of politicians' and health service

managers' minds (Buchan et al. 1998). The United

Kingdom (UK) government's White Paper Working

Together (Department of Health 1999a) is the ®rst national

policy document to lay down speci®c requirements for the

development of a range of human resource management

(HRM) policies within the NHS. This is to ensure that the

workforce is properly equipped to prosecute the govern-

ment's health improvement programme to meet national

targets (Deparment of Health 1998b), and to enhance

management and retention of the human resource. This

aim is also re¯ected in the government's Human Resource

Management Research Initiative (Department of Health

1998c) which seeks to develop an evidence base to

underpin effective staff deployment and management

within the NHS.

This paper focuses on nurses' job satisfaction, an import-

ant facet of HRM. It is treated here as an intervening variable

between ward organization on the one hand, and job

performance and staff turnover on the other, and attends

to some of the antecedents of nurses' job satisfaction.

The importance of ward level analysis

Acute sector organizations are amenable to analysis at

different levels. It is possible to characterize the larger unit

of the hospital as a distinct entity embracing categories

such as urban, rural or teaching/non-teaching and char-

acterized by variables such as size and range of clinical

services provided. However, hospitals can also be charac-

terized according to management arrangements such as

degree of centralization or devolution and these are

known to have an impact on nurses' work experiences.

Weissman et al. (19802 ) found that predictors of nurses' job

satisfaction differed between hospitals, and Tovey &

Adams (1999) found differences in staff morale associated

with variation in management styles and HRM practice.

Findings derived from the important series of studies of

Magnet hospitals in the USA also pointed to the import-

ance of hospital level differences. Those hospitals deemed

to have high quality nursing which both `magnetically'

attracted and retained staff, were characterized by a ¯at

organizational structure and having a nurse director with a

strong position in the management executive (McClure

et al. 1982).

While hospital level variables are in¯uential, the ward

as a physical and social organizational unit probably

remains the most signi®cant unit of analysis when exam-

ining determinants of nurses' feelings about their work

and patient outcomes. The smaller clinical units within

the Magnet hospitals had organizational attributes recog-

nized in other studies as being positively associated with

reduced mortality, namely: decentralized decision

making, standardization of nursing procedures, a high

ratio of quali®ed nurses and good relationships with

medical staff (Aiken et al. 1994).

The importance of the ward as an organizational unit

has also been demonstrated. Ward culture was found to

have a pervasive in¯uence over patterns of nurses' beha-

viour and their views of the work environment (Thomas

1992). These patterns are consistent between staff grades

within wards, and are related to the way in which patient

care is provided (Anderson & Choi 1980, Thomas 1992).

Moreover, wards within the same hospital have been

shown to vary on a number of organizational characteris-

tics (Adams et al. 1995). While there are occasions when it

is appropriate to consider the relationship between

hospital as the organizational unit and nurses' job satis-

faction, there is also compelling evidence that aggregating

wards to provide a hospital-level analysis masks impor-

tant between-ward variation.

Job satisfaction

As well as being associated with reduced mortality,

Magnet hospitals are acknowledged as good places for

nurses to work, as evidenced by low turnover rates.

Consistent features of USA Magnet hospitals associated

with job satisfaction were greater professional autonomy,

greater control over the practice environment and the use

of nursing systems that promote accountability and conti-

nuity of care. Conversely, in other settings, higher turn-

over rates and propensity to leave have been associated

with job dissatisfaction (Cavanagh 1990, Irvine & Evans

1995) and stress (Cavanagh & Cof®n 1992). There is a need

to understand more about the relationship between

nurses' job satisfaction and aspects of ward organization.

Different groups of job satisfaction theories can be

described as: (i) discrepancy theories, which examine

the extent to which employee needs or wants are satis®ed

within the workplace; (ii) equity theories, which highlight

social comparisons in the evaluation of job rewards; and

(iii) expectancy theories, which focus on employee moti-

Nursing and health care management issues Job satisfaction

Ó 2000 Blackwell Science Ltd, Journal of Advanced Nursing, 32(3), 536±543 537

vation. Job satisfaction is also conceived as an overall

rating or as the sum of several discrete dimensions of job

characteristics (Stamps & Peidmont 1986, Mueller &

McCloskey 1990, Traynor & Wade 1993). Despite these

differences there is consensus that job satisfaction may be

de®ned as the degree of positive affect towards a job or its

components. This is determined by characteristics both of

the individual and of the job, and particularly how work is

organized within the corporate work environment.

Job satisfaction and ward organization

Associations have been found between a number of

organizational features and job satisfaction. Blegen's

(1993) meta-analysis of North American studies shows a

strong relationship between stress and job satisfaction.

The importance of stress in human service work is being

increasingly recognized (Williams et al. 1998). In this

context, the way in which nurses perceive work attributes,

or their evaluations of them, may be more important than

objective measures. In this regard the recent high and

increasing levels of reported stress and work intensi®ca-

tion among UK nurses (Harvey 1995, McNeese-Smith

1999) is likely to have a bearing on job satisfaction. Stress

is particularly associated with increasing workloads, but

also with methods of work organization which reduce

variability among patients' care needs within speci®c

settings, so that nurses caring for highly dependent

patients experience little respite in their pace of work.

Skill-mix strategies which transfer new clinical tasks and

areas of responsibility from other health care professionals

onto already busy nurses, while simultaneously replacing

professional nursing colleagues with larger numbers of

health care assistants, are also perceived to give rise to

increased stress and isolation (Adams et al. 1998).

Commitment to the organization, associated with staying,

has a strong relationship with job satisfaction (Blegen

1993). However, rather than being antecedent, commit-

ment is often placed causally after job satisfaction.

Job autonomy, cited as a cause of job satisfaction is

found to be moderately related across a number of

occupational groups, including nurses (Loher et al.

1985). So too is recognition for performance, while rout-

inization of work shows a moderate negative correlation

with job satisfaction. Interpersonal factors comprising

communication with supervisor and with peers are also

moderately correlated (Blegen 1993). Thus while having

autonomy in performing their work impacts on nurses' job

satisfaction, they also require the support of good inter-

personal relationships both with manager and colleagues.

Nurses do not work in isolation and, as well as relation-

ships with nursing peers, their relationships with medical

colleagues are important features of the work environ-

ment. The quality and quantity of interaction with

medical staff is particularly in¯uential in how nurses

regard their work (Mackay 1991, Shortell et al. 1994,

Walby et al. 1994). So too are changes to job boundaries

between nurses and doctors, with extensions to nurses'

work having the effect of increasing job satisfaction for

some, while reducing it for others (Adams et al. 1998),

particularly if such work is regarded as inappropriate (Last

et al. 1992), or occurring in the absence of professional

recognition and career development (Furlong & Glover

1998).

Individual nurse characteristics

Individual characteristics such as age, years of experience

and education are found to have lower order, but stable

correlations across studies. They have been shown to

contribute far less to the understanding of nurses' job

satisfaction than perceptions of the ward, quality of

working relationships and content and standards achieved

in work (Blegen 1993). The current study provides an

opportunity to re-examine the relative importance of

individual nurse characteristics and organizational

features Ð arguably individual perceptions of the organ-

ization and job are more potent than objective indicators

as predictors of job satisfaction. Consequently relation-

ships between nurses' perceptions of organizational and

structural aspects of the ward which they identi®ed as

important, nurses' personal characteristics and nurses' job

satisfaction are examined.

METHODS

The Ward Organizational Features Scales (WOFS) were

developed to enable comparisons of the views of nurses

working in acute hospitals of ward structure and organ-

ization, care processes and job satisfaction. WOFS include

six sets of measures comprising 14 sub-scales (Table 1)

presented as Likert-type four-point scales.

Full details of the samples, methods of scale develop-

ment and the statistical properties of scales are reported in

Adams et al. (1995). Brie¯y, data were collected by means

of a postal survey in 1994 using a self-completion ques-

tionnaire sent to a sample of 1499 day nurses of clinical

grade C and above, listed as permanently allocated to 119

acute adult wards randomly selected from 17 hospitals

strati®ed to include all English health regions. Excluded

were wards in maternity and psychiatric specialities as

well as those treating highly dependent patients such as

intensive and coronary care. With one reminder question-

naire, an overall response rate of 57% was obtained,

providing a ®nal sample of 834 nurses. The ®nal sample

was biased towards the south of England (54% vs. 46%),

with a higher response rate (66% vs. 47%). We have no

reason to believe that the high level of non-response

biased the sample in ways that in¯uenced the results

obtained.

A. Adams and S. Bond

538 Ó 2000 Blackwell Science Ltd, Journal of Advanced Nursing, 32(3), 536±543

Data analysis occurred in three stages. The ®rst stage

explored relationships between individual nurse charac-

teristics, job satisfaction and other WOFS scores using

analysis of variance. The second stage examined relation-

ships between nurses' job satisfaction and their percep-

tions of other aspects of the ward organizational

environment by correlating scale scores using the Pearson

correlation coef®cient. Finally, in order to asses the

cumulative effects of ward organizational features on

nurses' job satisfaction, multiple regression analysis was

carried out using a stepwise procedure. Job satisfaction

was treated as the dependent variable, and sub-scales of

WOFS the independent variables.

FINDINGS

Job satisfaction and individual nursecharacteristics

Mean item scores according to clinical grade are shown in

Table 2. These demonstrate variations in how positively

nurses rated the different organizational features of their

ward. Most positively rated are aspects of ward services

which include facilities and layout, while the sample as a

whole perceived that they had little control over aspects of

ward management, including when events took place or

in¯uence over human resources.

Between grade comparisons, using analysis of variance,

show that there are no differences between grades in the

scales measuring perceptions of ward facilities, layout or

services, but differences are obtained on all of the other

sub-scales. Differences are in the direction of more posi-

tive views of ward organization and job satisfaction the

higher the grade. The trend to lower scores in the

hierarchical practice scale is because there is an inverse

relationship between scores on this scale and the level of

development of professional practice achieved within

wards.

With regard to job satisfaction, no differences were

found between scale scores according to nurses' age, level

of education or length of ward service, while there was a

signi®cant difference between nurses of different clinical

grades (P < 0á001). However, despite systematic grade

differences in score, these were not large, and little

variance is explained by clinical grade (r2� 0á03). On the

strength of this ®nding, data used in all subsequent

analyses relate only to nurses of grades C to F. Separate

analysis for ward managers is not presented because a full

set of data is not available, i.e. the team building skills of

ward leaders was not collected from this group. Individual

nurse characteristics were not included in any subsequent

analyses.

Job satisfaction and ward organizational features

Pearson correlation coef®cients of job satisfaction scores

and other WOFS scores are presented in Table 3. The

Table 1 Summary of scales

and their statistical

properties Name of scale

No. of

items

Cronbach's

alpha

Test-retest Pearson

correlation coef®cient

I. Physical environment of the ward

Ward facilities 5 0á79 0á80

Staff organization 5 0á80 0á71

Ward layout 6 0á81 0á75

Quality of ward services 4 0á68 0á71

II. Professional nursing practice

Professional practice 13 0á83 0á77

Hierarchical practice 6 0á66 0á74

III. Ward leadership

Team-building skills of ward leader 9 0á92 0á90

IV. Professional working relationships

Collaboration with medical staff 9 0á86 0á83

Collaboration with other health

care professionals 7 0á84 0á70

Cohesion amongst nurses 10 0á91 0á84

V. Nurses' in¯uence over:

Ward management 10 0á90 0á80

Timing of ward and patient events 9 0á85 0á71

Financial and human resources 5 0á81 0á78

VI. Job satisfaction

Job satisfaction 7 0á77 0á77



highest correlations found are between job satisfaction

and cohesion of the ward nursing team (0á51), staff

organization (0á46) (which includes items about the rela-

tionship between staf®ng and workload), the level of

professional practice achieved within the ward (0á46) and

collaboration with medical staff (0á41).

Table 4 shows the results of including nurses' WOFS

scale scores in a multiple regression analysis using a

stepwise procedure incorporating elements of both

forwards and backwards selection of variables to identify

the most important predictors of job satisfaction.

This analysis (Table 4) shows a similar pattern in results

to those presented in Table 3, that the most important

Table 2 Mean scale item scores by clinical grade

Clinical grade

Name of scale

C

(n = 32)

D

(n = 313)

E

(n = 285)

F

(n = 91)

G and above

(n = 113)

ANOVAANOVA

P value

R2

value

Ward facilities 3á2 3á2 3á2 3á2 3á4 ± ±

Staff organization 2á6 2á6 2á8 2á8 3á2 <0á001 0á03

Ward layout 3á5 3á3 3á3 3á2 3á4 ± ±

Quality of ward services 3á5 3á8 3á8 3á8 3á8 ± ±

Professional practice 3á1 3á2 3á2 3á2 3á5 <0á001 0á05

Hierarchical practice 2á8 2á7 2á5 2á3 2á0 <0á001 0á11

Team-building skills of ward leader 2á9 2á9 2á93 3á3 ± <0á001 0á04

Collaboration with medical staff 2á4 2á7 2á6 2á6 2á8 <0á001 0á02

Collaboration with other health

care professionals

3á0 3á0 3á1 3á1 3á3 <0á001 0á02

Cohesion amongst nurses 2á7 2á7 2á9 3á0 3á3 <0á001 0á05

In¯uence over ward management 1á3 1á7 2á1 2á8 3á5 <0á001 0á58

In¯uence over the timing of ward

and patient events

1á7 1á9 2á1 2á2 2á6 <0á001 0á14

In¯uence over human and ®nancial resources 1á0 1á2 1á2 1á8 3á3 <0á001 0á62

Job satisfaction 2á9 2á9 3á0 3á0 3á3 <0á001 0á03

Name of scale

Correlation

coef®cient

Signi®cance

level

Ward facilities 0á31 P < 0á001

Staff organization 0á46 P < 0á001

Ward layout 0á28 P < 0á001

Quality of ward services 0á18 P < 0á001

Professional practice 0á46 P < 0á001

Hierarchical practice )0á35 P < 0á001

Team-building skills of ward leader 0á33 P < 0á001

Collaboration with medical staff 0á41 P < 0á001

Collaboration with other health care professionals 0á26 P < 0á001

Cohesion amongst nurses 0á51 P < 0á001

In¯uence over ward management 0á25 P < 0á001

In¯uence over the timing of ward and patient events 0á23 P < 0á001

In¯uence over human and ®nancial resources 0á20 P < 0á001

Table 3 Correlations

between job satisfaction and

scores for other WOFS scales

Table 4 Results of step-wise regression analysis

Name of scale

Standardized

regression coef®cient

Cohesion amongst nurses 0á26

Staff organization 0á20

Collaboration with medical staff 0á20

Hierarchical practice )0á11

Professional practice 0á11

Ward facilities 0á08

Team-building skills of ward leader 0á06

R2 = 0á42.



contributors to nurses' job satisfaction are the degree of

cohesion existing among ward nurses, the degree of

collaboration with medical staff and perceptions of staff

organization, respectively, i.e. the system of nursing

organization used and the perceived appropriateness of

staf®ng levels to cope with the ward workload. Percep-

tions of professional practice and the perceived team

building skills of the ward manager remain important, but

have less bearing on job satisfaction.

DISCUSSION

This study has considered the effects of both nurses'

individual characteristics and their perceptions of organ-

izational aspects of the wards in which they work,

including perceptions of their practice and relationships

with nurses and other staff, and how these elements relate

to job satisfaction.

Most salient to nurses were their social and professional

relationships with nursing and other professional coll-

eagues. It is fashionable to talk about multidisciplinary

teamwork and the ward team while much of the literature

is anecdotal and exhortatory (Opie 1997). WOFS do not

assess the extent of team functioning. They address

nurses' views of their relationships with nursing, medical

and other professional colleagues. The scales measuring

nurses' views of cohesion with their ward nursing

colleagues and collaboration with medical staff were

found to be the best predictors of job satisfaction.

However, the scale measuring relationships with therapy

staff was not found to contribute to nurses' job satisfaction

Ð perhaps re¯ecting their lesser signi®cance to many

nurses' work in general wards.

Ward facilities, services provided by hospital depart-

ments which have a bearing on nurses' work and aspects

of the physical environment considered to in¯uence

patient care, are often omitted from studies of nurses'

job satisfaction. We included these and examined the

effects of nurses' views of staff, the appropriateness of

grade mix and rostering practice for providing patient

care. These elements of ward nursing practice were all

associated with nurses' job satisfaction in a positive

direction, i.e. where they considered suf®cient numbers

of skilled staff were rostered and organized appropriately,

nurses' satisfaction was greater.

The quality of the professional service nurses consider

they provide is also predictive of job satisfaction.

Certainly lack of pride in the quality of service and

perceived inability to provide a service at appropriate

standards are reported elsewhere as reasons for job

dissatisfaction, stress and leaving nursing (Mackay

1989). The professional practice scale included a number

of items related to nurses' own professional development

as well as to the involvement of patients and families in

care decisions. These ideas are regarded as `progressive' in

nursing literature and recent policy documents (Ersser &

Tutton 1991, NHS Executive 1996, Department of Health

1999a), and evidence of their importance to nurses was

found in views expressed in the qualitative phase of scale

development. The other side of the coin, as shown by its

negative correlation with job satisfaction, is hierarchical

practice. This scale re¯ects a staff that feels they and their

work are devalued by nursing superiors and medical staff.

The team building skills of the ward manager also contrib-

uted to staff nurses' job satisfaction, as reported in other

studies (McNeese-Smith 1993, Boumans & Landeweerd

19933 , Hart & Rotem 1995, Morrison et al. 1997). While this

variable is related to professional practice in how staff are

treated regarding professional development, it also

includes aspects of managing relationships and the atmo-

sphere that prevails in the wards.

Thus from the range of the ward features that nurses

identi®ed as being important to the provision of patient

care, the elements that predict their job satisfaction are the

quality of working relationships, having suf®cient staff

with the right mix of skills to cope with their workload,

and to a lesser extent, achieving professional standards of

practice and personal development. Absent from this list

are the extents to which nurses have control over a range

of features of the ward. However, participation in the

aspects of ward management included in the scale was

generally at a very low level among this staff nurse sample.

This points to the need to include items in scales that have

a high degree of salience for the staff grades concerned.

We found signi®cantly higher scores on this scale among

ward managers. While a correlation with job satisfaction

was found, control over ward events did not predict it.

Individual nurse characteristics, with the exception of

clinical grade, were not found to be associated with job

satisfaction. However, the explanatory relationship

between grade and job satisfaction was weak. These

®ndings are broadly in line with those of previous

research, where nurses' experience, tenure and position

in the hierarchy have been found to be signi®cantly

associated with job satisfaction (Hinshaw & Attwood

1984). However, recent qualitative work (Tovey & Adams

1999) highlighted the increasingly different work experi-

ences of ward managers (G grade) compared with nurses of

lower clinical grades, suggesting that grade differences

may become more marked in future. Ward managers are

frequently dissatis®ed because they feel under pressure to

take on additional work roles for themselves and their

staff, both managerial responsibilities and expanded clin-

ical roles, which causes them to experience role con¯ict.

On the other hand, managers derive greater satisfaction

from team working with other disciplines. Nurses of lower

clinical grades are dissatis®ed with low staf®ng and

perceived falling standards of care provision, as well as

with local Trust management practice and service-wide

changes in the NHS (Robinson et al. 1999).



Our qualitative work that preceded scale construction

led to the conclusion that nurses are an increasingly

heterogeneous group with regard to job satisfaction and

given the increasing diversi®cation and extension of

nurses' work roles (Adams et al. 1998, Department of

Health 1999b), this trend looks set to continue. While the

®ndings presented in this paper demonstrate that clinical

grade explained little variance in nurses' experiences of

job satisfaction in the mid-1990s, it may be that data

collected at the present time would reveal a stronger

relationship between these two variables. The increasing

heterogeneity evident in nurses' work roles needs to be

re¯ected in future empirical work.

CONCLUSION

This paper has highlighted the importance of organiza-

tional features of acute hospital wards as predictors of

nurses' job satisfaction, over and above the importance

of individual nurse characteristics. It also points to the

importance of exploring subjective perceptions of ele-

ments of the physical work environment, work processes

and job design, rather than relying purely on objective

measures. By using scales grounded in nurses' views of

their work, they were able to alert us to the importance

of several new factors likely to impinge on providing

good quality patient care and which affect their job

satisfaction, and which seldom appear in traditional

studies or measures of their work experience. These

include the quality of ward facilities and of services

provided to the ward by other departments, which affect

nurses' ability to do their work. Most importantly,

nurses highlighted their perceptions of the appropriate-

ness of the balance between number of available staff,

skill mix, care organization and rostering practice and

the ward's workload as a major in¯uence on their job

satisfaction.

Overall, relatively high levels of job satisfaction were

found among staff, at a time of immense change in the

health care system in the UK. In particular, the study

reinforces the importance of the quality of nurses' working

relationships in enhancing job satisfaction. Even in times

of turbulence and objectively high workloads, similar

factors impact on job satisfaction. Our research demon-

strates that the cohesiveness of the ward nursing staff is

the most important working relationship for nurses, with

the most signi®cant impact on their job satisfaction. Yet its

development requires staff stability and a suf®cient core of

permanent staff. These conditions are threatened by

recruitment and retention dif®culties and reliance on

transient staff because of the HRM policies emphasizing

¯exibility. Recent proposals for continuing to expand

nurses' work roles to make better use of their knowledge

and skills (Department of Health 1999b) are likely to

exacerbate these conditions.

In order to break the negative cycle of job dissatisfaction

leading to reduced commitment and turnover, and to solve

recruitment and retention problems, our ®ndings suggest

that NHS managers need to focus attention on creating

conditions that facilitate intra-professional teamwork

amongst nurses and inter-professional teamwork with

medical colleagues. This requires long-term commitment

to resourcing, workforce planning and achieving strategic

aims such as those set out in Working Together (Depart-

ment of Health 1999a). Cohesive ward nursing teams

developed with the capacity to support each other while

coping with heavy workloads are needed to yield the

health improvements cherished by our political masters.

Acknowledgements

We would like to thank all the nurses and managers who so

generously gave their time to assisting us in this study, and

research staff at the Universities of Surrey and Newcastle

who assisted with data collection. The study was supported

by a grant from the Department of Health. The views

expressed are those of the authors and not the funding body.

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