School nursing: A study of the relationships of professional characteristics, professional orientation, the environment, and organizational structure to professional practice and satisfaction

In response to reports of structural constraints on school nursing practice and literature implying nurses' responsibility to effect change, a model of relationships affecting Professional Practice and Professional Satisfaction, drawing on theories of professions and of organizations, was proposed. Concepts included were: Professional Satisfaction, Professional Practice, Professional Orientation, Professional Characteristics, Internal Work Environment, Bureaucratic Characteristics, and External Community Environment.;A stratified, disproportional sample of New York State school nurses, employed by health departments and boards of education, was surveyed in Fall, 1990. Dillman's (1978) method was used. Instruments included: a revision of Hall's (1963) Organizational Inventory; Snizek's (1972) revision of Hall's (1968) Occupational Inventory; White's (1985) Rochester School Nurse Activities Questionnaire; and Price and Mueller's (1986) Job Satisfaction scale. The final section included items concerning: Professional Satisfaction; Professional Characteristics; Internal Work Environment; External Community Environment; and demographics, of which two were from public records.;The response rate was 80.9% (n = 514). Psychometric analysis indicated acceptable reliability for all indices. Ten of 13 study questions, focused on examining relationships suggested by the literature, were supported by significant correlation coefficients. Both Satisfaction and Practice were related to measures of professionalism (Professional Characteristics and Professional Orientation); relationships with Bureaucratic Characteristics and Internal Work Environment wore not supported.;The LISREL 7.13 program was used for structural equation modeling. The initial model was rejected. An alternative model including substantive changes was accepted. Direct relationships, suggested in the original model, between Bureaucratic Characteristics to Professional Practice and Satisfaction and from Internal Work Environment to Professional Practice were excluded. New relationships included: External Community Environment and Bureaucratic Characteristics to Professional Orientation; Professional Characteristics to Internal Work Environment; and External Community Environment to Satisfaction and Internal Work Environment.;The findings supported propositions about professionalism and the open systems theory of organizations. Measures of professionalism and External Community Environment directly influenced Professional Practice and/or Satisfaction. Constructs representing natural and rational systems theory did not influence outcomes. It was concluded that an isolated focus on professionalism is ineffective for change in school nursing practice and that forces outside the control of the nurse strongly influence school nursing practice.