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  1. Sharp, Nancy D. PhD
  2. Greiner, Gwendolyn T. MPH, MSW
  3. Li, Yu-Fang PhD, RN
  4. Mitchell, Pamela H. PhD, RN, FAAN
  5. Sochalski, Julie A. PhD, RN, FAAN
  6. Cournoyer, Paulette R. DNSc, RN
  7. Sales, Anne E. PhD, RN


Objective: To examine nurse executive perceptions of effects of service line reorganization on nurse executive roles, nursing staff and patient care, and compare nurse executive responses to staff nurse reports of job satisfaction and quality of care in the same types of Veterans Health Administration facilities.


Background: Although a growing body of research focuses on the association between nurse staffing structures, nurse satisfaction, and patient outcomes, relatively little attention has been paid to the effects of hospital restructuring on nursing management and nursing staff.


Methods: Data on hospital and nursing service organization and nurse executive perceptions were collected through structured interviews with 125 nurse executives conducted from December 2002 through May 2003. Staff nurse data were derived from a survey of Veterans Health Administration nursing staff conducted from February through June 2003 at the same facilities.


Results: Nurse executives in Veterans Health Administration described significant changes in the nurse executive role, and new challenges for managing nursing practice and achieving consistent quality of nursing care. Although nursing management perceived differences in the overall effects of restructuring on nursing staff depending on the type of reorganization, staff nurses reported significant differences in perceived quality of patient care across organization types.