Excellence and success in small rural hospitals : the interrelationships of power, participation in decision-making and organizational commitment in rural nurses

Abstract

The purpose of this study was to explore power, participation in decision making, and organizational commitment among nurses in small rural hospitals. Quality of care and length of stay cost efficiency were viewed as outcome variables. All of these relationships are embedded in a changing health care environment. Fifty rural hospitals of 100 beds or fewer from eight rural states agreed to be in the study. From the 50 hospitals, 319 RNs participated. The study had three research hypotheses: Hypothesis 1: Changes· related tq the health care organization, patient care, and nursing d~partments are being experienced by RNs working in small rural hospitals. A high degree of change was evident in the responses, though the pattern of change differed from the changes in other studies. · Hypothesis 2: There are positive relationships among power as knowing participation in change, participation in decision-making, and organizational commitment among nurses working in rural hospitals. Pearson's r correlations among the variables were low-moderate. Hypothesis 3: Power, participation in decision-making, and organizational commitment have a positive effect on quality patient care and cost effectiveness in small rural hospitals. In staff nurses, organizational commitment was significant for both quality and length of stay cost efficiency, and decision-making was significant for quality accounting for 35% of the variance. The highest variance was with top-line manageme·nt nurses. Sixty percent of the variance in quality was accounted for by power and organizational commitment.