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2009Andersonocr.Pdf (1.794Mb) A COMPARISON OF NURSES' PERCEPTIONS OF THE CULTURE OF NURSING IN SUBURBAN COMMUNITY AND URBAN ACADEMIC HOSPITALS A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN THE GRADUATE SCHOOL OF THE TEXAS WOMAN'S UNIVERSITY COLLEGE OF NURSING BY JACQUELINE J. ANDERSON, B.A., M.S.N DENTON, TEXAS MAY 2009 TEXAS WOMAN'S UNIVERSITY LIBRARY TEXAS WOMAN'S UNIVERSITY DENTON,TEXAS April 14, 2009 To the Dean of the Graduate School: I am submitting herewith a dissertation written by Jacqueline J. Anderson entitled "A Comparison of Nurses' Perceptions of the Culture of Nursing in Suburban Community and Urban Academic Hospitals." I have examined this dissertation for form and content and recommend that it be accepted in partial fulfillment of the requirements for the degree of Doctor of Philosophy with a major in Nursing Science. Associate Dean, College of Accepted: ~~ Dean of the Graduate School Copyright© Jacqueline J. Anderson, 2009 All rights reserved. 111 ACKNOWLEDGMENTS The author wishes to thank my parents, Ted and Joan, family, and friends who supported me during this adventure. A special thanks to Rod, Carrie, Chris and Claire who gave up a lot to send wife and mom to school. Thank you also to the Houston Organization of Nurse Executives for providing funds for this study. IV ABSTRACT JACQUELINE J. ANDERSON A COMPARISON OF NURSES' PERCEPTIONS OF THE CULTURE OF NURSING IN SUBURBAN COMMUNITY AND URBAN ACADEMIC HOSPITALS MAY 2009 The purpose of this research was to explore the differences in the perceptions of the culture of nursing of nurses in suburban community hospitals when compared to nurses in urban academic hospitals. A secondary goal was to identify potential demographic variables of the nurses or the hospitals that could influence the culture of nursing, regardless of the setting. This descriptive exploratory study used an across-methods triangulation design to compare the culture of nursing in suburban academic hospitals and urban academic hospitals. The theoretical framework used for this study was Leininger's Culture Care Diversity and Universality Theory and the Sunrise Model. The quantitative data were collected using a demographic questionnaire and the Organizational Culture Assessment Instrument (OCAI). The qualitative data were collected using open-ended questions. A convenience sample of 164 nurses from the 4 suburban community hospitals and 187 nurses from the 2 urban academic hospitals completed the instruments. V The suburban community nurses had the following mean scores: (a) 28.83 for the clan culture, (b) 25.57 for the adhocracy culture, (c) 26.68 for the hierarchy culture, and (d) 26.33 for the market culture. The urban academic nurses had the following mean scores: (a) 28.03 for the clan culture, (b) 26.54 for the adhocracy culture, (c) 26.98 for the hierarchy culture, and (d) 27 .10 for the market culture. The ANOVA substantiated this finding with no statistically significant difference in the mean scores of the four culture types. Regression analysis was used to identify potential demographic variables of the nurses and the hospitals that may influence the culture type scores on the OCAI, regardless of the setting. Two variables, ethnic origin of the nurses and highest degree held in nursing were identified as factors influencing the culture scores, but the results were not strong enough to suggest a relationship. The qualitative analysis of the written answers to the open-ended questions revealed three themes: (a) relationships, (b) professionalism and empowerment of nursing, and (c) commitment to quality and patient safety. The themes and specific comments shared supported the ranking of the mean scores in each setting. VI TABLE OF CONTENTS Page COPYRIGHT PAGE ...................................................................................... iii ACKNOWLEDGMENTS ................................................................................. iv ABSTRACT .................................................................................................... V TABLE OF CONTENTS ................................................................................ vii LIST OF TABLES ........................................................................................... X LIST OF FIGURES ......................................................................................... xi Chapter I. INTRODUCTION ................................................................................. 1 Problem of Study ................................................................................. 2 Rationale for the Study ........................................................................ 3 Theoretical Framework ........................................................................ 5 Assumptions ...................................................................................... 12 Research Questions .......................................................................... 12 Definitions .......................................................................................... 13 Limitations ......................................................................................... 14 Summary ........................................................................................... 15 II. REVIEW OF THE LITERATURE ....................................................... 16 Corporate Culture .............................................................................. 16 Cultural Assessment. ......................................................................... 24 Nursing Culture .................................................................................. 25 Job Satisfaction ............................................................................ 26 Nurse Retention ............................................................................ 29 Patient Outcomes ......................................................................... 29 Nursing Unit Culture ..................................................................... 30 Culture vs. Climate ....................................................................... 30 Magnet Culture .................................................................................. 31 Urban vs. Community ........................................................................ 36 Vll Summary .......................................................................................... 37 Ill. PROCEDURE FOR THE COLLECTION AND TREATMENT OF DATA ........................................................................................... 38 Setting ............................................................................................... 39 Population and Sample ..................................................................... 40 Protection of Human Subjects ........................................................... 40 Instruments ........................................................................................ 41 RN Demographic Data Questionnaire ........................................... 41 Hospital Demographic Data Questionnaire ................................... 42 Organizational Culture Assessment Instrument. ............................ 42 Open-Ended Questions ................................................................. 48 Data Collection .................................................................................. 48 Treatment of Data .............................................................................. 54 Summary ........................................................................................... 59 IV. ANALYSISOFDATA ........................................................................ 60 Findings of the Quantitative Analysis ................................................. 65 Research Question 1 ..................................................................... 65 Research Question 2 ..................................................................... 71 Findings of the Qualitative Analysis ................................................... 78 Research Question 3 ..................................................................... 78 Relevant Themes .......................................................................... 78 Study Findings Across Methods ........................................................ 84 Clan Culture ................................................................................... 85 Market Culture ............................................................................... 87 Hierarchy Culture ........................................................................... 88 Adhocracy Culture ......................................................................... 89 Summary of Findings ......................................................................... 91 V. SUMMARY OF THE STUDY ............................................................. 93 Summary ........................................................................................... 94 Discussion of the Findings ................................................................. 97 Conclusions ..................................................................................... 105 Implications ..................................................................................... 105 Recommendations for Further Study ............................................... 106 Summary ........................................................................................
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