Date of Award
2004
Degree Type
Dissertation
First Advisor
Hesook Suzie Kim
Abstract
The organizational context of hospital nursing practice has gained international attention as a growing body of research demonstrates its significance as a factor affecting the supply and performance of registered nurses and the quality of patient care. Studies of organizations designated by the American Nurses Credentialing Center (ANCC) as magnet hospitals demonstrate significant and positive relationships among organizational, nurse, and patient variables. However, knowledge about the nursing work environment as an influence on practice is limited by the absence of studies exploring the actual practice of staff nurses and the nursing unit as the more immediate context in which it occurs. The aim of this qualitative research investigation was to describe the influence of the nursing unit as the context for staff nurse practice. Kim's conceptualization of practice guided the design of the study, and addressed the following three research questions: (a) What is the nature of deliberations and enactments that constituted nursing practice on a medical inpatient unit? (b) how does the nursing unit as the context of practice influence the nurses' practice? and (c) what are the nurses' perceptions of the extent to which organizational changes associated with the ANCC Magnet model influenced practice? Using Schatzman and Strauss's three-phase fieldwork approach, the study obtained and analyzed data from participant observations and semi-structured interviews with five nurse key informants working in a medical inpatient unit in an ANCC Magnet designated acute-care hospital in Southern New England. Data analysis was an integrative and iterative creative process involving data reduction, thematic identification, cross-tabulation, conclusion drawing, and member checks. A new understanding of the complexity of nurses' work emerged that revealed a contextual orientation to nursing practice in the hospital setting. The nursing role was an integration of professional and organizational expectations, with nurses reconciling a philosophy of work with the philosophies of care and therapy described by Kim. Primary nursing from a shift orientation was functioning within a patient-centered care model. Two types of practice occurred on the medical unit: routine practice and practice in uncertainty that centered on knowing the patient. Nurses used a variety of strategies to deal with unit constraints. Organizational changes affected practice in widening spheres of influence, with changes altering the RN role as the most influential. Nurses reported that magnet designation validated their professional role, increased pride, and enhanced the image and stature of nursing in the organization, but had not influenced their daily practice with patients.
Recommended Citation
Stolzenberger, Kathleen M., "Nursing practice in a magnet hospital: A descriptive study" (2004). Open Access Dissertations. Paper 1965.
https://digitalcommons.uri.edu/oa_diss/1965
Terms of Use
All rights reserved under copyright.
