Environmental turbulence and innovation durability in selected patient care units

Abstract

A previously unexamined issue, innovation durability relative to perceived environmental uncertainty and nursing unit culture among staff nurses (N = 48), was investigated. The Differentiated Group Professional Practice (DGPP) in Nursing project was selected for this five-year follow-up study. Verran, Milton, Murdaugh, and Gerber developed the DGPP model in two urban hospitals and one rural hospital in Arizona in 1988. Model implementation and evaluation was completed in 1992. The theoretical model incorporated elements of contingency and learning organization theories. A descriptive correlation research design was used to explore the relationships among environmental uncertainty, nursing unit culture, innovation durability and two innovation outcomes: control over nursing practice and work satisfaction. Data were collected in October 1997 at three selected patient care units in one rural hospital. The hospital was selected because the implementation of the DGPP model was successful, and no other redesign activity was implemented between 1992 and 1997. Structured self-report scales were used to measure each of the concepts within this study. RNs' perceptions of the current nursing practices suggested that the DGPP model was in existence on the three patient care units at the time data were collected. Nursing unit culture (β = .53) was the best predictor of the DGPP model durability (R² = .28) and its subcomponents of group governance (R² = .24) and shared values (R² = .49). Group governance and innovation related behaviors showed significant individual and combined effects on RNs' perceived control over nursing practice (R² = .55). Decision making, innovation related behaviors, and group governance accounted for the variance in RNs' overall work satisfaction (R² = .50). Although perceived control over nursing practice remained unchanged over a period of 5 years, decreases were found in overall work satisfaction and satisfaction with organizational policies. The findings provided support for the conceptual model as expected with one exception, the positive correlation between DGPP model durability and perceived uncertainty in the internal environment. In summary, the findings suggested the inclusion of environmental uncertainty and nursing unit culture in studies of innovation durability and innovation outcomes.