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Impact of Relational Coordination on Nurse Job Satisfaction, Work Engagement and Burnout

Achieving the Quadruple Aim

Havens, Donna Sullivan PhD, RN, FAAN; Gittell, Jody Hoffer PhD; Vasey, Joseph PhD

JONA: The Journal of Nursing Administration: March 2018 - Volume 48 - Issue 3 - p 132–140
doi: 10.1097/NNA.0000000000000587

AIM To explore how relational coordination, known to enhance quality and efficiency outcomes for patients and hospitals, impacts direct care nurse outcomes such as burnout, work engagement, and job satisfaction, addressing the “Quadruple Aim,” to improve the experience of providing care.

BACKGROUND Hospitals are complex organizations in which multiple providers work interdependently, under conditions of uncertainty and time constraints, to deliver safe quality care despite differences in specialization, training, and status. Relational coordination—communicating and relating for the purpose of task integration—is known to improve quality, safety, and efficiency under these conditions, but less is known about its impact on the well-being of direct care providers themselves.

METHODS Surveys measuring relational coordination among nurses and other types of providers as well as job-related outcomes in 5 acute care community hospitals were completed by direct care RNs.

RESULTS Relational coordination was significantly related to increased job satisfaction, increased work engagement, and reduced burnout.

CONCLUSIONS Relational coordination contributes to the well-being of direct care nurses, addressing the Quadruple Aim by improving the experience of providing care.

Author Affiliations: Professor (Dr Havens), School of Nursing, The University of North Carolina at Chapel Hill; Professor (Dr Gittell), Heller School for Social Policy & Management, Brandeis University, Waltham, Massachusetts; Principal (Dr Vasey), Tosti-Vasey & Vasey, Bellefonte, Pennsylvania.

A core concept in this article,—relational coordination,—was measured using a survey developed by Dr Gittell as part of her PhD dissertation. It is now available commercially from a company she cofounded along with Brandeis University, called Relational Coordination Analytics. Dr Gittell serves as the chief scientific officer and as a stockholder in the company, in partnership with Brandeis University.

This study was funded by the US Department of Health & Human Services (HRSA grant D11HP0975 to D.S.H., principal investigator).

The authors declare no conflicts of interest.

Corresponding author: Dr Havens, School of Nursing, The University of North Carolina at Chapel Hill, Carrington Hall, CB #7460, Chapel Hill, NC 27599 (

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