In OECD countries, the public healthcare environment has been affected by management reforms, such as the New Public Management (NPM) reform, empowering public sector managers with increased managerial control, increasing... [ view full abstract ]
In OECD countries, the public healthcare environment has been affected by management reforms, such as the New Public Management (NPM) reform, empowering public sector managers with increased managerial control, increasing standardization of service delivery and providing greater accountability of public service professionals in the delivery of services (Byrkjeflot, 2011). Such reforms have affected the organizational culture of a number of professions, including nursing, and some of the resultant problematic outcomes include increased workloads (Friedson, 2001) and more bureaucratic “red tape” (see Brewer and Walker, 2010). These changes are likely to have a negative impact on well-being (Lindorff et al., 2011) and to reduce levels of organisational commitment, especially for nursing professionals (Nelson, 2012). Because most of the research on the impact of management reforms on the healthcare environment has been done in developed countries (Christensen and Lægreid, 2011), little is known about the impact of management reforms on healthcare environments in Brazil.
Bullying has been identified as a serious problem in the healthcare sector in Brazil (Cahu et al., 2012), and may be associated with the implementation of NPM reforms. Poor LMX, coupled with workplace bullying and stressful employment patterns (Dick, 2010), such as contract employment and multi-jobbing for a high proportion of nursing staff (e.g. Brazil), are conditions that clearly affect nursing professionals’ well-being and in turn, their commitment to the organisation. Social exchange theory (SET) is used as the framework (Graen and Uhl-Bien, 1995) to examine the consequences of the organisational change in Brazilian public hospitals brought about by NPM reforms. In particular, we argue that good management of change and positive relationships between supervisors-employees are likely to reduce the levels of bullying, enhance well-being and increase levels of organisational commitment. The study focuses on public nursing professionals in the Northeast of Brazil. The primary research question is:
RQ1 What are the linkages between supervisor-employee relationships, bullying, well-being and organisational commitment for Northeast Brazilian nursing professionals?
Using a cross-sectional, survey-based design, data was obtained from 685 nursing professionals in six public hospitals in the Northeast of Brazil. Path analysis using an ordinary least squares (OLS) approach was used to test the ‘goodness of fit’ of the proposed model (Ahn, 2002). The findings suggest that LMX, bullying and well-being together explained 22.8% of the variance of affective commitment and all three variables were significant, except bullying. The findings also suggest that LMX has a significant impact on wellbeing (R2 =10.1%), and commitment (R2 = 9.9%) and also on bullying (R2 1.9%). These low levels of LMX suggest that poor supervisor support does not minimise the impact of bullying, which may in fact emanate from over stressed supervisors seeking to meet bureaucratic demands of NPM. This is a concern for Brazilian nursing professionals or management, especially as it relates to nurse well-being. Healthcare managers need to take initiatives to address the negative consequences of NPM approaches to nurse management and to strengthen supervisor-nurse relationships, minimize bullying and to strengthen/enhance nursing professionals’ well-being and organisational commitment.
