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Organizational stress in the

hospital: Development of a
model for diagnosis and
prediction

Article in Health Services Research · March 1985

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Organizational Stress in
the Hospital: Development of a
Model for Diagnosis and Prediction
Pamela A. Gray- Toft and James G. Anderson

A model of organizational stress in the hospital was developed and tested. The
model utilized measures of organizational climate, supervisory practices, and work
group relations as predictors of the amount of role conflict and ambiguity that
nurses perceived in providing patient care. Role conflict and ambiguity were treated
as variables that intervene between organizational variables and the level of stress
that the nursing staff experienced. Nursing stress was viewed as a direct cause of
job dissatisfaction and as an indirect cause of absenteeism among the nursing staff.
Data from 158 registered nurses, licensed practical nurses, and nursing assistants
on seven nursing units in a 1,160-bed private teaching hospital were used to
estimate the parameters of a structural equation model. The model was used to
predict the results of a survey feedback project designed to change the supervisory
style used on the units. Pre- andposttest data from four surgical units were used to
validate the model. The findings suggest that, as predicted, supervisory practices
that led to more open expression of views and joint problem solving resulted in
reduced role conflict, ambiguity, and stress; increasedjob satisfaction; and lower
levels of absenteeism among the nursing staff.

INTRODUCTION
Results from an earlier study of the causes and effects of nursing stress
suggest that factors inherent in the nursing role that result in role
conflict and ambiguity are important determinants of stress [1]. This
article extends the earlier model of stress to explicitly include role

Pamela A. Gray-Toft is Vice President, Division of Human Resources and Organiza-

tion Development, Methodist Hospital of Indiana, Inc., 1604 North Capitol Avenue,
Indianapolis, IN 46202. James G. Anderson, Ph.D. is Professor of Sociology, Depart-
ment of Sociology and Anthropology, Purdue University, and is affiliated with the
Division of Academic Affairs, Methodist Hospital of Indiana, Inc. Address correspon-
dence and requests for reprints to Dr. Gray-Toft.
754 Health Services Research 19:6 (February 1985, Part I)

conflict and ambiguity and their organizational determinants -

organizational climate, supervisory style, and work group relations
[2-4].
Role perceptions, specifically, role conflict and ambiguity, are
introduced as variables that intervene between organizational variables
and the level of stress that the nursing staff experiences in providing
patient care [5-7]. Nursing stress is viewed as a direct cause of job
dissatisfaction and as an indirect cause of absenteeism among the nurs-
ing staff [8]. This expanded model is depicted in Figure 1. Theory and
research that support the hypothesized causal relations among the vari-
ables are discussed in the next section.
A structural equation model was constructed from questionnaire
data obtained from the nursing staff as part of an organizational devel-
opment program in a large private community teaching hospital.
Computer simulation experiments were performed with this model to
predict the probable outcome of feedback sessions on three experimen-
tal units. This program was designed to change the supervisory style
used on the units. The actual model and the empirical results of the
simulation experiments are presented in the results section. Finally,
pre- and posttest data from three experimental and one control hospital
unit are used to validate the model.

A HYPOTHETICAL MODEL OF
ORGANIZATIONAL STRESS
Research based largely on Likert's model of human organizations [9]
suggests several important social-psychological factors that character-
ize the influence process in multilevel institutions such as hospitals-
namely, organizational climate, supervisory style, and work group
relations. Empirical studies based on longitudinal data support the
causal sequence shown among these variables in Figure 1 [3-4].

ORGANIZATIONAL CLIMATE

Organizational climate refers to conditions created for work groups by

others higher up in the organizational hierarchy. These conditions
provide the environment in which work groups operate. Organiza-
tional climate determines to a substantial degree the leadership behav-
ior of work group supervisors [3-4]. For example, an organizational
climate characterized by a deemphasis on hierarchy, conflict resolution
 0.

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756 Health Services Research 19:6 (February 1985, Part I)
through direct confrontation, joint problem solving, and open commu-
nication results in an open supervisory style [10].
The organizational climate also directly affects staff role percep-
tions and job satisfaction 111]. For example, a number of studies have
indicated that when nursing staff perceive conflicts between the two
lines of authority that make up the organizational structure of the
hospital, they experience role conflict and ambiguity [12-151 as well as
job dissatisfaction [16].
SUPERVISORY STYLE
Research suggests that the behavior of supervisors has important
effects on work group relations as well as on subordinate motivation,
satisfaction, and performance. Bowers and Seashore's study [17] found
that the best predictor of peer support, goal emphasis, and work facili-
tation was the corresponding behavior of the group's supervisor. Oak-
lander and Fleishman [18] came to a similar conclusion regarding the
effects of supervision on work group relations in a study of 1 18 supervi-
sors in three hospitals. They found significantly less interpersonal con-
flict and hostility and fewer noncooperative relationships among nurs-
ing personnel in groups where the supervisor allowed subordinates
greater participation in decision making and encouraged two-way
communication.
Further, evidence from a number of studies indicates that supervi-
sory behavior, such as assigning tasks, specifying procedures, and clar-
ifying expectations, creates a structure for subordinates that results in a
reduction in role ambiguity and an increase in job satisfaction among
high occupational level employees [6, 19, 20]. At the same time,
behavior that creates a supportive work environment has been found to
be associated consistently with high levels of subordinate satisfaction
and performance [7, 21]. Such an environment involves support,
openness, trust, friendliness, and advance notice of organizational
changes that affect subordinates.
WORK GROUP RELATIONS
Most of the actual tasks performed by the nursing staff in providing
patient care are part of a team effort. In part, this reflects increased
technological sophistication and specialization [15, 22]; in part, it rep-
resents institutionalized defenses against the stress and anxiety result-
ing from frequent staff exposure to life-threatening situations requiring
fast, appropriate decisions [1, 23]. Consequently, the model hypothe-
sizes that nursing staff who perceive their work group as open, support-
 Stress Diagnosis/Prediction 757

ive, cohesive, and able to resolve conflict satisfactorily, will experience

less role conflict and ambiguity and will be more satisfied with their
work.
ROLE PERCEPTIONS
Role conflict arises from different expectations regarding an individ-
ual's behavior, whereas role ambiguity occurs when an individual is
unclear about what is expected of him/her and unsure of the responses
to his/her behavior. Role theory predicts (and studies in many types of
complex organizations confirm) that role conflict and ambiguity result
in stress, job dissatisfaction, and decreased levels of performance
[1, 5, 6, 7, 24]. Consequently, the model hypothesizes that role con-
flict and role ambiguity affect job satisfaction directly as well as indi-
rectly by resulting in increased stress among the nursing staff [25, 26].
NURSING STRESS
The model predicts that staff who frequently experience stressful situa-
tions in the performance of their nursing duties will be the most dissat-
isfied with their work. This relationship has been demonstrated with
data from a national survey of large scale organizations [5] as well as
from the results of a study of nursing units in a large private teaching
hospital [1, 27].
JOB SATISFACTION
AND ABSENTEEISM
Virtually all major reviews of the literature have found a consistent,
significant relationship between job dissatisfaction and absenteeism
[8]. Consequently, the model postulates that absenteeism will result
when high levels of job dissatisfaction exist among the staff.
BACKGROUND CHARACTERISTICS
A number of characteristics of individuals have been found to be
related to stress. A study by Gray-Toft and Anderson [1] found that
registered nurses experience significantly more stress than licensed
practical nurses and nursing assistants due to differences in the roles
that they perform. Consequently, the model postulates that RNs will
experience the most role conflict, ambiguity, and stress - NAs the
least.
Personality characteristics have also been found to account for
differences among the individuals in the amount of role conflict, role
758 Health Services Research 19:6 (February 1985, Part I)
ambiguity, and stress they experience in organizations [1, 51. Conse-
quently, the model hypothesizes that staff members with high levels of
trait anxiety will experience more role conflict, ambiguity, and stress in
performing their duties.

METHODOLOGY
DATA COLLECTION
Several instruments were developed to measure the variables that com-
prise the model. These are described below.

Organizational Questionnaire
An organizational questionnaire modeled after the Michigan Organi-
zational Assessment Questionnaire [28] was developed to measure staff
perceptions of organizational climate, supervisory style, work group
relations, role conflict and ambiguity, job satisfaction, and background
characteristics. The majority of the items were based on information
obtained through interviews with vice-presidents, clinical directors of
nursing, supervisors, and staff on seven nursing units, although some
items from the Michigan instrument were used as well. The question-
naire was modular and scales were derived from separate factor analy-
ses of sets of items designed to measure each of the constructs included
in the model. The number of items that make up each scale, sample
items, and reliability coefficients are shown in Table 1.
Job Description Index
An additional measure of job satisfaction was used to validate the
model's predictions. The Job Description Index [29] provides five sub-
scales that measure satisfaction with different aspects of the work envi-
ronment. The satisfaction with supervision subscale was used for this
study.
Nursing Stress Scak
An expanded version of the Nursing Stress Scale developed by Gray-
Toft and Anderson [30] was used to measure stress. The scale consisted
of 46 nursing situations that commonly occur in hospital units. Staff
were asked to indicate on a four-point scale how frequently they found
each situation stressful. Factor analysis was used to create eight sub-
scales as well as a total stress score which was used in this analysis.
 Stress Diagnosis/Prediction 759

Table 1: Scales with Sample Items and Reliability

Coefficients
Number
of Reliability
Scak Items Coefficient*
Organizational Climate-Hospital Administration 7 .78
Indicate the extent to which you feel the following state-
ments are true of the hospital as a place to work:
613 Differences and disagreement between units or
departments are accepted and worked through
619 Hospital Administration has clear-cut goals and
objectives
Organizational Climate-Communication 6 .78
617 When decisions are being made, the persons
affected are asked for their ideas
618 I am able to challenge a decision of my immedi-
ate supervisor
Supervisory Styk 3 .91
Indicate whether you agree or disagree with each of the
statements as a description of your direct supervisor.
412 Is willing to listen and consider my ideas
416 Makes sure subordinates have clear goals to
achieve
417 Is available when I need him/her
433 Maintains high standards of performance
Work Group Relations 10 .89
How much do you agree or disagree with each statement
about your work group? In general ...
312 Conflicts are brought out into the open in my
work group
313 I can find support in my work group when I am
under stress
317 If we have a decision to make, everyone is
involved in making it
Rok Conflict 4 .71
How much do you agree or disagree with each statement
as a description of your job?
115 On my job I can't satisfy everybody at the same
time
123 I have so much work that I can't do everything
well
Rok Ambiguity 5 .64
119 I seldom know whether I'm doing my job well or
poorly
120 On my job I do not know exactly what is
expected of me
Continued
760 Health Services Research 19:6 (Februa?y 1985, Part I)

Table 1: Continued
Number
of Reliability
Scak Items Coefficient*
Nursing Stress Scak 46 .92
Indicate how often each situation is stressful for you:
10 The death of a patient, including suicide
11 Conflict with a physician
27 Feeling inadequately prepared to help with the
emotional needs of a patient

Job Satisfaction -Extrinsic Satisfaction 3 .71

Indicate how satisfied you are with each of the following
aspects of your job:
224 The fringe benefits you receive
231 The amount of pay you get

Job Satisfaction -Intrinsic Satisfaction 7 .83

225 The friendliness and supportiveness of the people
you work with
230 The opportunity you have to help people
232 The opportunity you have to take part in making
decisions

Job Satisfaction -Supervision 18 .67

Place a "Y" beside an item if the item describes your job;
an "N" if it does not; a "?" if you cannot decide. My
supervisor:
- Asks my advice
- Hard to please
- Tells me where I stand

Absenteeism 1
The number of times a staff member was absent from
work during a 9-month period divided by 9

Training I
This variable was coded as follows:
3 - Nursing Assistant
4 - Licensed Practical Nurse
5 - Registered Nurse

IPAT Anxiety Scale 40 .92

Total Raw Score
*Coefficient Alpha.
 Stress Diagnosis/Prediction 761
Sample items as well as a reliability coefficient for the total scale are
shown in Table 1.
Institute for Personality and Ability Testing (IPAT)
Anxiety Scale
The IPAT Anxiety Scale was used to measure trait anxiety [31]. This
instrument consists of 40 questionnaire items.
Absenteeism
Absenteeism was obtained from nursing administration records. Since
the records do not include detailed reasons for an absence, the mea-
sures used to test the model include all absences from work for any
reason, including sickness, personal reasons, and unexcused absences.
SAMPLE
These instruments were administered to the two clinical directors of
nursing and to all supervisors and full-time nursing staff on four surgi-
cal units and three psychiatric units in a 1,160-bed private teaching
hospital in the Midwest. Clinical directors and unit supervisors were
excluded from this analysis so that the model could include a measure
of staff perceptions of supervisory behavior. Unit secretaries, too, were
excluded, because this group of employees is not responsible for direct
patient care and many of the items on the Nursing Stress Scale were
thus inappropriate. The final sample used to estimate the parameters
of the model shown in Figure 1 consisted of 159 registered nurses,
licensed practical nurses, and nursing assistants.
MULTIVARIATE ANALYSIS
A structural equation model was constructed to examine the hypothe-
ses concerning the causes and effects of organizational stress [32].
Hypothesized relationships are represented by arrows linking groups of
variables in Figure 1. The organizational climate variables and back-
ground characteristics at the left of the diagram are considered to be
exogenous since they are relatively enduring characteristics of the orga-
nization and of individual staff members, even though they may
change over longer periods of time. Anxiety is considered to be largely
a trait measure and, thus, exogenous. All of the other variables in the
model are considered to be endogenous, jointly dependent upon one
another and on the exogenous variables, and subject to short-term
change.
762 Health Services Research 19:6 (February 1985, Part I)

Table 2: Intercorrelations, Means, and Standard Deviations

(N = 158)
Anxiety Supervisory
Administration Communication Training Scoe Styk
Hospital
administration 0.63 -0.23 -0.07 0.21
Communication -0.03 0.05 0.33
Training -0.05 -0.01
Anxiety score -0.03
Supervisory
style
Workgroup
relations
Role conflict
Role ambiguity
Nursing stress
Extrinsic
satisfaction
Intrinsic
satisfaction
Mean 2.80 2.53 5.13 27.79 3.51
Standard
deviation 0.57 0.64 0.85 11.86 0.56

The model is recursive; consequently, the regression coefficients

of the structural equations were estimated by ordinary least squares.
The intercorrelation matrix for the variables induded in the model is
shown in Table 2. Standardized partial regression and multiple correla-
tion coefficients are presented in Table 3. All coefficients were signifi-
cant at the .05 level or above. The effects of model variables are
decomposed into their direct and indirect components in Table 4 [33].
A number of computer simulation experiments were performed
with the model [34]. These experiments were used to predict the out-
come of survey feedback sessions [35] with the nursing staff of three
surgical units. These sessions were designed to change the behavior of
nursing supervisors in order to permit greater staff participation in
decision making.
 Stress Diagnosis/Prediction 763

Table 2: Continued
Workgroup Rok Rok Nursing Extrinsic Intrinsic
Relations Conflict Ambiguity Stress Satisfaction Satisfaction Absenteeism

0.14 -0.25 -0.24 -0.19 0.21 0.31 0.07

0.28 -0.16 -0.26 -0.13 0.26 0.51 -0.03
-0.13 0.23 0.20 0.38 0.18 0.12 -0.15
-0.02 0.20 0.15 0.32 -0.12 -0.13 0.04

0.64 -0.09 -0.36 -0.15 0.22 0.52 -0.13

-0.14 -0.39 -0.13 0.12 0.49 -0.18

0.34 0.34 -0.19 -0.26 0.04
0.36 -0.06 -0.40 0.03
-0.15 -0.26 0.03

0.50 -0.09

-0.09
3.13 3.03 2.50 0.96 3.31 3.42 4.19

0.65 0.68 0.57 0.33 0.74 0.63 4.24

VALIDATION OF THE MODEL

To validate the model's predictions, three surgical units were selected
as experimental units and one unit as a control. Nursing supervisors on
the experimental units were provided with comparisons of their self-
ratings and staff ratings concerning their style of supervision. Feedback
sessions were also held with the supervisor and staff of each shift to
discuss the survey findings and problems that they wished to address.
At the conclusion of these sessions, several of the instruments used
to measure work group relations, role conflict and ambiguity, nursing
stress, and satisfaction with supervision were readministered to staff on
the experimental and control units. In addition, nursing administra-
tion records were used to compute individual absentee rates for 9
months previous to the project and for 9 months after the feedback
sessions had been discontinued.
 764 Health Services Research 19:6 (February 1985, Part I)

Table 3: Structural Equations for the Model of Organiza-

tional Stress Standardized Regression and Multiple Correlation
Coefficients
Predetermined Variabls
Organizational Climate Background Characteristics
Dependent
Variabk Administration Communication Training Anxiety Score
Supervisory
style 0.335
Workgroup
relations -0.125
Role
conflict -0.194 0.194 0.194
Role
ambiguity -0.151 0.176 0.158
Nursing
stress 0.320 0.274
Extrinsic
satisfaction 0.216 0.291
Intrinsic
satisfaction 0.329 0.277
Absenteeism

FINDINGS
Results of this study confirm the findings of other studies that suggest
that role conflict, role ambiguity, and stress are inherent in the nursing
role [1, 12, 36, 37]. Table 4 indicates that level of training, and conse-
quent responsibility for patient care, is a significant determinant of
each of these variables which directly affect job satisfaction and indi-
rectly affect absenteeism. At the same time, the findings suggest that
one of the major psychological functions that organizational practices,
supervision, and work groups perform in hospitals is the reduction of
role conflict, role ambiguity, and stress.
The model indicates that administrative efforts to establish goals,
to plan and coordinate, and to resolve interdepartmental conflicts
result in increased job satisfaction and reduced absenteeism primarily
by reducing the level of role conflict that staff experience. The Hospital
Administration variable has a direct, negative effect on role conflict in
 Stress Diagnosis/Prediction 765

Table 3: Continued
Endogenous Variables
Role Perceptions Job Satisfaction Multipk
Supervisory Workgroup Nursing Correlation
Style Relations Conflict Ambiguity Stress Extrinsic Intrinsic Coefficient

0.335

0.636 0.649

0.363

-0.163 -0.218 0.492

0.146 0.206 0.577

-0.162 -0.181 0.409

0.199 0.260 -0.138 -0.214 0.724

-0.054 -0.067 0.105

Table 4. House and Rizzo [7] found that similar practices in a manu-
facturing company led to a reduction in role ambiguity. These different
results suggest that the effect of organizational practices may be some-
what dependent upon the nature of the work and the type of employee.
In organizations where much of the work is carried out by professionals
and is of a nonroutine nature, traditional management functions such
as goal setting, planning, and coordinating may lead to a reduction in
conflict by clarifying jurisdictions and overall goals, but may have little
effect on the ambiguous nature of the tasks and roles performed by
professional employees.
In contrast, efforts to involve staff in decision making reduce the
amount of role ambiguity that staff experience, and thus lead to
increased job satisfaction and reduced absenteeism. Table 4 indicates
that representation, consultation, and involvement of staff in decision
making (communication) directly and indirectly led to a significant
reduction in role ambiguity among the nursing staff. In addition to
their direct effects, these organizational practices result in a more
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 768 Health Services Research 19:6 (February 1985, Part I)

open, supportive style of supervision and more supportive work group

relations that further attenuate role ambiguity.
A second important finding is the relationship between supervi-
sion and role ambiguity. Supportive supervision leads to a reduction in
role ambiguity. In contrast, House and Rizzo [7] found that a reduc-
tion in role conflict among employees of a manufacturing company
resulted from similar supervisory practices. This may indicate that,
like organizational climate, the effects of supervisory practices may
depend somewhat on the type of employee and the nature of his/her
work. In health service organizations such as hospitals, where employ-
ees must exercise judgment and make critical decisions - in some
instances under life-threatening circumstances, one of the major func-
tions of a supervisor may be the reduction of role ambiguity for staff.
Another important finding is the effect of the supervisor's behav-
ior on work group relations. The model indicates that supportive
supervisory behavior results in more open, supportive relations among
co-workers. Such work group relations in turn lead to a significant
reduction in role ambiguity among nurses. Menzies [23] has also noted
the importance of group defense mechanisms in alleviating stress
among nurses in a teaching hospital.
As predicted by role theory [5], the level of stress that nurses
experience in performing their duties is largely determined by the
amount of role conflict and role ambiguity they perceive. Table 4
indicates significant direct effects of these two variables on stress. In
addition, higher levels of training and trait anxiety, in part, result in
more stress for nurses by exposing them to more role conflict and
ambiguity.
The results indicate that job satisfaction is significantly reduced
when staff experience high levels of role conflict, ambiguity, and stress
in carrying out nursing tasks. This confirms the findings of a national
study of employees which found that a lack of clarification of the scope
and responsibilities of their jobs led to increased tension and anxiety,
and decreased job satisfaction and productivity among 35 percent of
the sample [5].
The model also confirms a finding of the earlier study of nursing
stress [1]. When stress and other factors affecting job satisfaction are
controlled, RNs are the most satisfied with their work. The direct
effects of training on Extrinsic and Intrinsic Job Satisfaction (Table 4)
are both positive. The indirect effects, however, are negative, indica-
ting that the higher levels of role conflict, ambiguity, and stress that
RNs experience significantly reduce their satisfaction with their work.
Satisfaction with both the extrinsic and intrinsic aspects of nursing
 Stress Diagnosis/Prediction 769

is enhanced significantly by the direct involvement of staff in decision

making. The direct effects of the communication variable on both
measures of job satisfaction are large and positive. In addition, Table 4
indicates that open, supportive supervision and work group relations
have significant positive effects on satisfaction with the intrinsic nature
of the nurse's hospital role.
As predicted, absenteeism is largely a function ofjob satisfaction.
As satisfaction increases, absenteeism declines, a finding that has been
confirmed by a series of studies [8]. The indirect effects in Table 4
indicate that role conflict and stress result in higher rates of absentee-
ism primarily through their negative effects on job satisfaction. Con-
versely, organizational efforts that lead to greater participation in deci-
sion making, and more supportive supervision and work group
relations result in a decrease in absenteeism by improving job satis-
faction.

SOME EXPLORATORY ANALYSES WITH

THE ORGANIZATIONAL STRESS MODEL
Further insights into the dynamics of the model of organizational stress
can be obtained from computer simulation experiments with the struc-
tural equation model shown in Table 3 [34]. Such experiments permit
predictions of the effects of organizational practices designed to create a
more open, supportive, participative work environment. Table 5 shows
the results of three computer simulation experiments.
The first policy that was simulated had to do with changes by the
hospital administration involving goal setting, planning, coordinating,
and adoption of innovative techniques. The first three columns indi-
cate the predicted effects of these changes. The effects appear to be
quite small. A decrease in role conflict was predicted as well as a very
small increase in job satisfaction. The model predicted that little or no
change in absenteeism would result from these organizational changes.
The model was also used to predict the effects of policies or proce-
dures that would result in greater representation and participation by
nursing staff in decision making. It was predicted that one unit
increase on the communication variable would result in more open,
supportive supervision and work group relations. A decrease in the
amount of role ambiguity and stress that staff experience in providing
patient care was also predicted. The analysis indicates that, as a result,
job satisfaction would increase and absentee rates would decrease.
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 Stress Diagnosis/Prediction 771

Finally, the effects of a change in supervisory behavior were ana-

lyzed. It was predicted that more openness and supportiveness among
supervisors would have a significant positive effect on work group
relations. The model predicts that a significant reduction in role ambi-
guity would occur as well as in stress. At the same time, there would be
a significant increase in job satisfaction resulting in decreased absen-
teeism among the nursing staff.

VALIDATION OF THE MODEL

OF ORGANIZATIONAL STRESS
Pre- and posttest data from a survey feedback project [35] on four
surgical units were used to validate the model's predictions. After the
pretest data were collected, feedback sessions were held with nursing
supervisors and with staff on the three experimental units. These ses-
sions were designed to encourage a more open, supportive, participa-
tory style of supervision on these units. After the project was com-
pleted, posttest data were collected from the three experimental units
and one control unit. The results are shown in Table 6.
As predicted by the model, role conflict, role ambiguity, and nurs-
ing stress significantly declined on the experimental units. Satisfaction
with supervision increased significantly. The absentee rate on the
experimental units declined while absenteeism on the control unit
increased, although neither difference was statistically significant.

DISCUSSION
The model that was developed in this study provides important insights
into the nature of organizational stress in hospitals. The results clearly
indicate that role conflict and ambiguity are important intervening
variables that mediate the effects of organizational variables on stress,
job satisfaction, and absenteeism among the hospital nursing staff. In
general, the findings suggest that staff are more satisfied and perform
more effectively when administrative and supervisory practices result
in an environment that permits an open expression of views and joint
problem solving. Such an organizational environment leads to more
open and supportive relations among co-workers, which in turn
reduces role ambiguity affecting stress, job satisfaction, and absen-
teeism.
The findings of this study extend the results of earlier studies
 772 Health Services Research 19:6 (February 1985, Part I)
Table 6: Effects of Survey Feedback to Change Supervisory
Style on Hospital Surgical Units
Experimental Units Control Unit
Aspects of the N 84
-
N = 30
Organization Pretest Posttest t- Pretest Posttest t-
Affected Mean Mean Value Mean Mean Value
Workgroup
relations 3.15 3.06 0.90 2.80 2.71 0.45
Role
conflict 3.22 3.00 3.29* 3.08 2.75 3.02t
Role
ambiguity 2.60 2.46 2.20t 2.55 2.35 1.35
Nursing
stress 0.98 0.79 4.40* 0.85 0.73 1.44
Job
satisfaction
supervision 2.03 2.23 -2.20$ 1.86 2.06 -1.61
Absenteeism 0.54 0.46 0.94 0.45 0.59 -1.54
*p < .001.
tP < .01.
tp < .05.

concerning the effects of organizational climate and supervision

[10, 38]. Other studies have noted that supportive supervisory prac-
tices affect subordinate job satisfaction and performance by reducing
role ambiguity [7, 19, 20]. The effect of such practices on work group
relations and the latter's subsequent effect on satisfaction have not been
demonstrated before, however.
What is more, this study suggests a number of dynamic relation-
ships among organizational characteristics of the hospital and nursing
role perceptions that have not been noted before. An important finding
is that organizational practices and supervisory behavior can be used to
reduce role conflict and role ambiguity among the nursing staff, two
major causes of stress, job dissatisfaction, and absenteeism.
While the elements included in the model represent many impor-
tant aspects of the hospital's organizational structure, many variables
are missing, as indicated by the moderate magnitude of the multiple
correlation coefficients associated with the structural equations. Nota-
bly lacking are variables that describe the nature of nursing tasks and
individual and group differences in values and skills. In general, the
factors included in the model represent aggregations of many aspects of
the organization. Such aggregation, however, makes it possible to per-
 Stress Diagnosis/Prediction 773

form analyses and make predictions concerning organizational

changes -as has been done in this study. The expansion of this model
to include a wider variety of variables holds promise for a significant
increase in our understanding of how the hospital's organizational
structure affects the ability of its staff to perform their functions.

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