| This study examines the effects of a hospital merger and restructuring on nurses at the Beth Israel Deaconess Medical Center in Boston, Massachusetts. BIDMC, like hospitals across the country, underwent restructuring in response to an increasingly competitive and cost-restrictive medical marketplace. Like nurses across the country, nurses at this distinguished Harvard teaching hospital complained about decreasing job satisfaction, increasing burnout, and heightened concerns about the quality of patient care at their institution. This study evaluates nurses' claims in light of the changes at BIDMC. I examine the experiences of survivors of organizational restructuring and change using a multi-method (surveys, focus groups, participant observation, interviews, and archival data) embedded case study design of six inpatient units in the hospital. This research focuses on changes in institutional-, unit-, and individual-level organizational arrangements important to nurses—status, autonomy, access to resources, doctor-nurse relations, job demands, and control over work. I examine the interplay of these factors and nurses' power and control in the hospital. I conclude that nurses' claims reflect actual changes in organizational arrangements that affect nurses' well-being and ability to perform their work. Their complaints are not merely indicative of resistance to and resentment of change in general or to changes that decrease their professional influence. The BIDMC case points to the potential crisis in hospitals today as they restructure to meet the challenges of a changing marketplace without careful consideration of the effects on front-line staff. Such changes may threaten the competence of institutions to provide high quality care by compromising patient safety and driving skilled, educated, and committed caregivers away from the bedside. |
