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with staff satisfaction. Greater staff participation in resident treatment affected the outcome only indirectly through staff satisfaction. The total effect of staff satisfaction, using path analysis, was .55 (.38 direct and .17 indirect).
A 1985 publication by Weisman and Nathanson (1985) reported on a study of teenage clients who attended 1 of 77 family planning clinics. Although this research does not involve the acute care setting, findings may still be pertinent. The 77 clinics involved in the research represented data from 344 nurses and 2,900 clients. Outcomes investigated were client satisfaction and rate of compliance with contraceptive prescriptions. Using path analysis, a significant direct effect (.32) of job satisfaction on client satisfaction was discovered. There was no direct effect of this variable on compliance rates. However, there was a significant indirect effect (.08) of job satisfaction on compliance through client satisfaction. Hays and White (1987) reanalyzed the Weisman and Nathanson (1985) data using structural equation modeling with LISREL. They supported the model proposed in the original study and proposed an alternative model that also fits the data. Both models supported the significant relationship between job satisfaction and client outcomes.
Of the four studies at the invitational conference that were also looking at the relationship between staff satisfaction and outcomes, none reported significant direct or indirect relationships. However, final data analyses were not completed for all of the studies.
Summary: Linkages And Gaps
Although some of the findings from investigations are limited by the number of studies supporting the relationship, small sample sizes, or both, some tentative conclusions can be drawn from the research presented. Research, either previously published or reported through the invitational conference, has supported the following linkages:
There is a relationship between a professional practice environment and perceptions of control over practice and autonomy.
There is a relationship between a professional practice environment and job satisfaction.
A professional practice environment and job satisfaction improve retention of staff.
The implementation of a professional practice model is cost neutral.
The proportion of RNs on a nursing staff has positive influence on severity-adjusted Medicare mortality rates.
A professional practice environment has a positive influence on severity-adjusted Medicare mortality rates, over and above the influence of staffing mix.
There is inconsistent evidence of the effect of nursing-staff-related