The Impact of Supervisor-Nurse Relationships, Patient Role Clarity, and Autonomy upon Job Satisfaction: Public and Private Sector Nurses

Article excerpt

Abstract: In the Australian healthcare sector, many changes in the public sector have affected nurse management and thereby, nurses. Yet it is unclear whether such efficiency measures, based on private sector business models, have impacted private sector nurses in similar ways. This paper examines four important issues for nurses: supervisor-subordinate relationships; perceptions of autonomy; role clarity in relation to patients; and job satisfaction. The paper uses an embedded mixed methods research design to examine the four issues and then compares similarities and differences between public and private sector nurses. The findings suggest supervisor-subordinate relationships, patient role clarity and autonomy significantly predict job satisfaction. The private sector nurses reported more satisfaction than public sector nurses with their supervisor-subordinate relationships, plus higher perceptions of patient role clarity and autonomy, and hence, higher levels of job satisfaction. The findings raise questions about whether present management practices (especially public sector) optimise service delivery productivity.

Keywords: nursing, healthcare administration, nurse supervisors, job satisfaction, role clarity, autonomy, Australia

Nursing shortages continue to plague many countries, and the quality of nurses' working experiences is implicated in the attrition rates in nursing. This is an important issue because Australia is similar to other OECD countries in facing a shortage of skilled nurses (Kingma, 2001; OECD, 2005), relying on growing numbers of nurse migrants (Hawthorne, 2001), with potential consequent transitional safety issues (Tregunno, Peters, Campbell, & Gordon, 2009).

Notably, an effective supervisor-subordinate relationship has been identified as the factor most likely to improve retention outcomes (Cohen, 2006). Supervisors are also important because nurses reporting dissatisfaction with management policies and practices have a 65% higher probability of leaving than nurses reporting satisfaction (Secombe & Smith, 1997). However, the relative impacts that nurse supervisors have upon the job satisfaction of nurses in these different sectors remains under-researched. This is imperative because we know that job satisfaction is a predictor of nurse turnover (Cowin, 2002); hence this paper explores the impact of nurse management practices upon job satisfaction, plus the similarities and differences across the public and private hospital sectors.

One significant change in public sector hospitals is the recent implementation of management reforms. These reforms focused on replacing the public sector management model - relying on the power and professionalism of its professionals (nurses, doctors) to ration the distribution of public goods and services - with a private sector model focused on achieving outcomes (Ackroyd, Kirkpatrick, & Walker, 2007). The changes that occurred were numerous, including the need for nurses to learn new skills and attitudes (Winch, Creedy, & Chaboyer, 2002), and supervisors were given increased managerial autonomy, simultaneously reducing the power of their staff. According to Currie and Procter (2002), public sector managers have greater managerial power than their private sector counterparts. Nevertheless, they have not been given the training or resources to manage more effectively - hence subordinates tend not be motivated by their management practices (Butterfield, Edwards, & Woodall, 2005; Hoque, Davis, & Humphries, 2004). Further, Ferlie, Pettigrew, Ashburner, and Fitzgerald (1996) argue that the autonomy of public sector employees has been curtailed, but not uniformly. Instead, the extent to which public sector nurses have experienced reduced autonomy appears to be dependent upon the ability of supervisors to 'mediat[e] the excesses of NPM [new public management]' (Ackroyd et al., 2007, p. 21). The supervisor- subordinate relationship therefore seems an important ingredient affecting how much autonomy public sector nurses have in addressing patients' needs. …