Assessing organizational social context in surgical domains: perspectives of nursing staff and first-line nurse managers and their associations with nurse-focused outcomes

Nurse shortages underscore the need to understand how organizational culture and climate affect nurse-focused outcomes in surgical care. This study analyzed how nursing staff and first-line nurse managers perceive organizational culture and climate in surgical domains and explored the differences in their perceptions. Furthermore, it analyzed how these perceptions and discrepancies correlate with nurse-focused outcomes, such as nursing staff sickness absences and gross turnover. Additionally, the study investigated how unit sizes and care settings influence the relationship between the organizational social context and nurse-focused outcomes. A cross-sectional survey was conducted from November 2020 to February 2021 across 52 surgical units in seven Finnish public healthcare organizations. The Organizational Social Context (OSC) measure was used to assess organizational culture and climate. Nurse-focused outcomes, sickness absences and gross turnover were obtained from HR records. Gross turnover was based on all recorded entries into and exits from the unit among employed nursing staff. Statistical methods suitable for group-level investigation were used. Statistical analyses, including Spearman correlations and regression analyses, were used to evaluate relationships between perceptions of the organizational social context and nurse-focused outcomes. Interaction effects of unit size and care settings were analyzed. Participating nursing staff from 52 surgical groups (n = 627) and first-line nurse managers from 7 groups (n = 61) showed within-group consistency in their perceptions of organizational culture and climate based on rWG indices. Nursing staff and first-line nurse managers had significantly different perceptions of organizational culture and climate across most dimensions, with first-line nurse managers providing more positive assessments. Nursing staff’s assessments of functionality negatively correlated with nursing staff gross turnover. For first-line nurse managers, higher resistance, rigidity and stress correlated negatively and engagement positively with nursing staff gross turnover. Additionally, the analysis found statistically significant interaction effects of the care setting, showing that certain relationships between organizational social context dimensions assessed by first-line nurse managers and nursing staff gross turnover varied across different surgical care settings. The findings highlight the importance of fostering a well-functioning work environment and aligning first-line nurse manager and nursing staff perceptions to improve staff retention. First-line nurse managers’ perspectives appear relevant to nursing staff gross turnover, with variation across surgical settings, highlighting the need for tailored approaches.