The relationships among nursing unit structure, autonomy, professional job satisfaction, and nurse-patient interaction in ambulatory care clinics

Abstract

In. this study the relationships among· nursing unit structure, autonomy, professional job satisfaction, and nurse-patient interaction in ambulatory care clinics were investigated. A conceptual framework was derived from the Structure Interaction Model of Client Health Behavior, a model developed by the researcher that COIJlbined and synthesized concepts from quality of care, organization theory, and client-centered care. The hypothesized relationships were investigated using LISREL VI analysis. A sample of 134 registered nurses and 375 patients from 5 ambulatory care settings was used in this study. Nurses' perceptions of nursing unit structure, autono~y, and professional job satisfaction and patients' perceptions of the nurse-patient interaction were measured using five instruments. Testing of the proposed causal.model resulted in beginning support for the causal chain between the theo+etical constructs of nursing unit structure, autonomy, professional job satisfaction; and nurse-patient interaction. These relationships pointe~ to the impact of structural factor on professional factors and professional factors on the process of care, namely the nurse-patient interaction .. The findings · were . that positive· perceptions of unit nursing struGture had a direct positive effect on perceptions of nursing autonomy ·. and indirectly affected perceptions of professional satisfaction when mediated by autonomy; positive perceptions of autonomy by the nurses · had . a di-rect positive effect on nurses perceptions of professional job satisfaction; and finally, positive perceptions of professional job satisfaction had a direct positive effect on patient perceptions of the nurse-patient interaction.