Hospital restructuring and downsizing: Effects on nursing staff well-being and perceived hospital functioning


  • Ronald J. Burke
  • Eddy W. S. Ng
  • Jacob Wolpin


The health care system, and hospitals, underwent considerable restructuring and downsizing in the early to mid-1900s in several countries as governments cut costs to reduce their budget deficits. Studies of the effects of these efforts on nursing staff and hospital functioning in various countries generally reported negative impacts. Health care restructuring and hospital downsizing was again being implemented in North America in 2009/2010 as governments struggled to once again reduce deficits at a time of worldwide economic recession. This study examines the relationship of downsizing and restructuring efforts with work and well-being outcomes. Data were collected from over 289 nursing staff working in California hospitals in 2009/2010. This research considers the relationship of number of hospital restructuring initiatives reported by nursing staff with indicators of their work satisfaction and psychological well-being and their perceptions of the impact of these initiatives on aspects of hospital performance. Nurses reported a relatively large number of restructuring and downsizing initiatives during the preceding year. Consistent with findings reported over 15 years ago, nursing staff reporting a greater number of restructuring and downsizing initiatives indicated less favorable work and well-being outcomes and more negative effects on hospital functioning. Some suggestions for more successful approaches to cost reductions are offered.