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Communication satisfaction of professional nurses working in public

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DOI: 10.1111/jonm.12243

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 Journal of Nursing Management, 2014

Communication satisfaction of professional nurses working in

public hospitals
1 2 3
J.-D. WAGNER MA , M.C. BEZUIDENHOUT DLitt et Phil and J.H. ROOS DLitt et Phil

1
Student, 2Emeritus Professor and 3Professor, Department of Health Studies, Unisa, Pretoria, South Africa

Correspondence WAGNER J.-D., BEZUIDENHOUT M.C. & ROOS J.H.

(2014) Journal of Nursing Manage-
J.H. Roos ment
Department of Health Studies Communication satisfaction of professional nurses working in public hospitals
PO Box 392
Unisa 0003 Aim This study aimed to establish and describe the level of communication
Pretoria satisfaction that professional nurses experience in selected public hospitals in the
South Africa City of Johannesburg, South Africa.
E-mail: roosjh@unisa.ac.za Background The success of any organisation depends on the effectiveness of its
communication systems and the interaction between staff members.
Method Data were collected by means of questionnaires, based on the
Communication Satisfaction Questionnaire (CSQ), from a sample of 265
professional nurses from different categories, chosen using a disproportionate
random stratified sampling method.
Results The results indicated poor personal feedback between nurse managers
(operational managers) and professional nurses, as well as dissatisfaction among
nurse managers and professional nurses with regard to informal communication
channels. A lack of information pertaining to policies, change, financial standing
and achievements of hospitals was identified.
Conclusion Nurse managers should play a leadership role in bringing staff of
different departments together by creating interactive communication forums for
the sharing of ideas.
Implications for nursing management The results emphasise the need for nurse
managers to improve communication satisfaction at all levels of the hospital
services in order to enhance staff satisfaction and create a positive working
environment for staff members.
Keywords: communication satisfaction, nurse manager, operational manager,
personal feedback, professional nurses

Accepted for publication: 14 April 2014

to change existing communication structures. This

Introduction
Communication is an essential element in the success
of any organisation. For an organisation to perceive
itself as effective, it must have a thorough understand-
ing and in-depth knowledge of its communication sys-
tem (Muller et al. 2006, Trenholm 2011). Hospitals
function as organisations and therefore need to assess
their communication systems from time to time in
order to assess the effectiveness of these systems and
could be done by means of communication audits.
According to figures released by the South African
Nursing Council (SANC) in 2012 for 2011, profes-
sional nurses (PNs) and registered midwives numbered
30 770 in Gauteng. Of these, the largest number is
employed by hospitals in the public health sector
(South African Nursing Council 2012). Poor communi-
cation by professional nurses was noted as one of the
reasons for their intention to leave their organisations

DOI: 10.1111/jonm.12243
ª 2014 The Authors. Journal of Nursing Management Published by John wiley & Sons Ltd. 1
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and
distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
J.-D. Wagner et al.

(Mokoka et al. 2011). Professional nurses spend, on After analysing the data on management and com-
average, approximately 40 hours per week at work, munication contained in the audit, Landman et al.
where they are required to communicate effectively on (2001) are of the opinion that an organisation will be
an on-going basis. These nurses want to experience a unsuccessful if it does not value participation and con-
high level of communication satisfaction, which could sultation in decision making, if the views of ordinary
enhance their job satisfaction. staff members do not matter and if opportunities for
constructive communication are limited or non-exis-
tent.
Related research
A follow-up study at the Chris Hani Baragwanath
A study conducted by Kekana et al. (2007) on job sat- Hospital, conducted by Von Holdt and Maseramule
isfaction at a community hospital in Limpopo, indi- (2005), reported that this hospital still had no internal
cated poor interpersonal relationships between communication capacity, implying that it did not
supervisors and employees as a reason for job dissatis- make provision for either formal or informal commu-
faction. The respondents in this study indicated their nication channels. This constituted one of the hospi-
dissatisfaction with the amount of guidance provided tal’s many managerial problems, creating justifiable
by their supervisors and the lack of performance frustration and disempowerment among staff (Von
appraisals. However, they were satisfied with the Holdt & Maseramule 2005).
opportunity to get to know other people at work
and the chance to socialise and communicate with
Theoretical framework
colleagues.
Communication is identified as one of the most The theoretical framework that served as the basis for
important problems in the National Department of this study, was the Downs and Hazen Communication
Health (NDOH). This lack of communication efficacy Satisfaction Model (Downs & Hazen 1977), as shown
seems to have an impact on a wide spectrum within in Figure 1. This multidimensional model postulates
health care delivery institutions. ‘There is no effective that communication satisfaction depends on three sat-
communication on interdepartmental level and com- isfaction contexts, namely the interpersonal, group
munication is only one-directional’ (Enslin 2005). and organisational communication contexts.
An example of a negative practice environment is Each context is subdivided into dimensions. Interper-
evident from an ethics audit, completed by the Ethics sonal communication includes personal feedback, as well
Institute of South Africa in 2001, in one of the largest as communication between supervisor and subordinate.
health care facilities in the City of Johannesburg, Group communication entails horizontal communica-
namely the Chris Hani Baragwanath Hospital (Land- tion and organisational integration, while organisational
man et al. 2001). This audit included communication communication encompasses corporate information, the
as one of its major ethical pillars. communication climate and media quality dimensions.

COMMUNICATION SATISFACTION

Interpersonal Communication Group Communication Organisational

Context Context Communication Context

• Personal Feedback • Horizontal (Co-worker) • Corporate Information

Dimension Communication Dimension
Dimension
- Job performance - Organisational change
- Recognition of efforts - Profits/ financial standing
- Accuracy of co-worker - Achievements/failures
• Supervisory communication
Communication Dimension - Activeness of grapevine • Communication Climate
Dimension
- Openness
- Attention • Organisational - Motivation in the organisation
- Trust Integration Dimension - Identification with organisation
- Guidance - Attitude towards communication
- Departmental policies
• Subordinate and goals
Communication Dimension - Job requirements Figure 1
- Personnel news • Media Quality Dimension
Based on the Downs and Hazen
- Responsiveness to
- Meetings Communication Satisfaction Frame-
downward communication
- Written directives
- Initiating upward
- Amount of information work. Adapted by Downs and Adrian
communication
(2004) from the Downs and Hazen
(1977) model.

ª 2014 The Authors. Journal of Nursing Management Published by John wiley & Sons Ltd.
2 Journal of Nursing Management

For this study the dimensions of this theory were used
to design the data collection instrument and to analyse
and discuss the results of the study.
Aim
The purpose of this study was to establish and
describe the extent of communication satisfaction
among professional nurses, including the nurse manag-
ers and operational managers, in selected public hospi-
tals in the City of Johannesburg.
Methods
Study design
A quantitative and descriptive survey study was under-
taken, whereby structured questionnaires were used to
collect data in three public hospitals in the City of
Johannesburg, South Africa, during March 2012. The
hospitals were general hospitals comprising medical,
surgical, intensive care and casualty units. The bed
occupancy of the three hospitals was 500–800 patients.
Data collection instrument
A questionnaire, adapted from the Communication
Satisfaction Questionnaire (CSQ), comprising 40
closed-ended Likert scale questions (ranging from 1,
‘very dissatisfied’, to 5, ‘very satisfied’) was used
(Downs & Adrian 2004). All responses were coded,
analysed and interpreted accordingly. The response
alternatives of ‘very satisfied’ and ‘satisfied’ were
grouped together as ‘satisfied’, while the response
alternatives of ‘very dissatisfied’ and ‘dissatisfied’ were
grouped together as ‘dissatisfied’; the indifferent
responses stayed as supplied.
Cronbach’s alpha internal consistency analysis
Item analysis was done to assess the reliability of the
different dimensions or constructs in the questionnaire
via Cronbach’s alpha values. A Cronbach’s alpha
value above 0.8 indicates good reliability, a value
between 0.6 and 0.8 indicates acceptable reliability
and a value below 0.6 indicates unacceptable reliabil-
ity. The results of this internal reliability coefficient of
the communication satisfaction dimensions are dis-
played in Table 1. From the findings it is evident that
all of the constructs were measured with good reliabil-
ity. Therefore, it can be accepted that the reliability of
the data collection instrument is also good.
ª 2014 The Authors. Journal of Nursing Management Published by John wiley & Sons Ltd.
Journal of Nursing Management
Communication satisfaction
Table 1
Reliability coefficient of the communication satisfaction dimensions
(n = 130)
Factor/Dimension Cronbach’s alpha
Subordinate communication 0.9020
Supervisor communication 0.8758
Communication climate 0.8523
Media quality 0.8274
Personal feedback 0.8177
Corporate information 0.8071
Horizontal communication 0.7996
Organisational integration 0.7467
Sampling and sampling method
A disproportionate stratified random sample of 265
PNs was drawn from a total of 1001 PNs working in
various wards/departments in three selected public
hospitals. A simple formula was initially used to deter-
mine the sample size. A sampling proportion of 25%
was taken from the total population of each of the
three strata, which delivered a sample ratio of
5 : 75 : 170 for the three categories of professional
nurses, giving a rounded total of 250 respondents in
the sample. The three strata were, however, greatly
unequal in size. The nurse manager stratum was very
small in this study and therefore the sampling propor-
tion of this group was altered to include 100% of the
nurse managers. Twenty respondents were NMs, inter
alia, deputy directors (DDs) and assistant directors
(ADs) in nursing, 75 were operational managers
(OMs) in a chief professional nurse (CPN) capacity
and 170 were operational PNs.
Data analysis
The data analysis of this study was done with the assis-
tance of a statistician, utilising the Statistical Analysis
System (SAS JMP version 10.0; SAS Institute, Cary,
NC, USA) statistical software. Descriptive analysis was
done and a Cronbach alpha test was performed to
determine the internal reliability of the questionnaire.
A one-way analysis of variance (ANOVA) test was per-
formed to determine statistically significant differences
between the three strata.
Results
Respondents’ background
The results displayed in Table 2 indicate that of the
three respondent strata, 80 (88.9%) of the profes-
sional nurses were aged between 21 years and
3
J.-D. Wagner et al.
Table 2
Age distribution of respondents (n = 130)
NM (n = 18)
Age in years f %
21–29 0 0.0
30–39 2 11.2
40–49 6 33.3
50–59 6 33.3
60+ 4 22.2
Total 18 100
NM, nursing manager; OM, operational manager; PN, professional nurse.
49 years, falling into the younger age groups, whereas
21 (95.4%) of the operational managers ranged
between 40 years and 59 years of age, and 16
(88.8%) of the nurse managers were aged between
40 years and 60 years or more.
The gender mix of the respondents indicated that
119 (91.5%) of the respondents were female and 11
(8.5%) were male. All of the male respondents were
professional nurses, thus indicating that none of the
male respondents held a managerial position.
Results regarding communication satisfaction
The study revealed that the PNs and OMs experienced
personal feedback and the flow of communication
between managers and PNs was inadequate. The oper-
ational manager stratum, in particular, experienced
dissatisfaction with this dimension. Thirteen (59.1%)
of the OMs expressed dissatisfaction with the extent
to which problems in their jobs were being handled.
In contrast to the low number of NMs (n = 4; 22.2%)
who indicated their dissatisfaction with the recogni-
tion of their efforts, 13 (59.1%) OMs and 41 (45.5%)
PNs were dissatisfied with the lack of acknowledg-
ment they received for their work efforts (see the Sup-
porting Information, Table S1.)
The supervisor communication dimension pertains
to the way in which PNs perceive communication
from their supervisors. Seventy-six (58.4%) of all the
respondents were satisfied with the trust placed in
them by their supervisors and 77 (58.2%) were satis-
fied with the amount of supervision they received. The
professional nurse stratum, in particular, indicated
their satisfaction with their supervisors’ openness to
ideas (n = 51; 56.7%), although transparency was
indicated as posing a challenge to hospitals (see the
Supporting Information, Table S2). The findings indi-
cate that 11 (61.1%) NMs were dissatisfied with the
extent to which their supervisors (managerial commit-
4 Journal of Nursing Management
Number of responses
OM (n = 22) PN (n = 90) Total (n = 130)
f % F % F %
0 0.0 19 21.1 19 14.6
1 4.6 35 38.9 38 29.3
14 63.6 26 28.9 46 35.4
7 31.8 9 10.0 22 16.9
0 0.0 1 1.1 5 3.8
22 100 90 100 130 100
tees and the central office) listened and paid attention
to them. In contrast, 50 (55.5%) of PNs and nine
(40.9%) of OMs, indicated their satisfaction with the
extent to which their supervisors (NMs) listened and
paid attention to them. Respondents in the OM group
found themselves in two minds about the extent to
which their supervisors offered guidance with a view
to solving job-related problems as nine (40.9%) of the
OMs were dissatisfied, four (18.2%) were indifferent
and nine (40.9%) were satisfied. A large percentage
(n = 13; 72.2%) of NMs were satisfied with the
amount of supervision they received.
For obvious reasons, in the subordinate communica-
tion dimension section, only the PNs and OMs were
required to answer questions. The findings revealed a
positive tendency towards organisational effectiveness
in terms of communication, as it seems that communi-
cation does travel from one level to the next. How-
ever, there are also strong indications that information
is not travelling through the hierarchical structure cor-
rectly, especially when the OM is not present in the
ward/unit. This was also evident in the number of all
NMs (n = 17; 42.5%) who indicated indifference
towards the degree to which they can avoid communi-
cation overload. Managers often become overloaded
with unnecessary information and precious time is
consumed sifting through irrelevant information. The
NMs and OMs were positive with regard to subordi-
nates’ responsiveness to evaluations, suggestions and
criticism (n = 22; 55.0%). The NMs (n = 10; 55.6%)
were more satisfied with the extent to which subordi-
nates feel responsible for initiating accurate upward
communication than were the OMs (n = 7; 31.8%).
This could possibly be attributed to the direct feed-
back they receive from OMs (see the supporting infor-
mation, Table S3.)
Horizontal communication satisfaction includes all
informal communication aspects in an organisation
such as informal communication networks (‘grape-
ª 2014 The Authors. Journal of Nursing Management Published by John wiley & Sons Ltd.

vine’), communication with same-level employees,
adaptability of communication practices in emergen-
cies, compatibility of work groups and accuracy levels
of informal communication. The findings indicate that
respondents perceive the ‘grapevine’ as not being suffi-
ciently active and not meeting their information needs,
as the total satisfaction level in this regard was 23.8%
(n = 31). The NMs experienced a low level of satisfac-
tion (n = 7; 38.9%) with the extent to which their
working group members were compatible in compari-
son with the PNs, who indicated a higher level of sat-
isfaction (n = 53; 58.9%) with the same item. The
OMs (n = 11; 50%) and PNs (n = 50; 55.6%)
appeared to be more satisfied with their communica-
tion with other employees at the same level than were
the NMs (n = 7; 38.9%). The majority of operational
nurses (n = 12; 54.6%) and PNs (n = 49; 54.4%)
were satisfied with the adaptability of communication
with regard to emergencies in their hospitals (see the
Supporting Information, Table S4.)
In the organisational integration dimension, the pro-
fessional nurse stratum indicated a lower level of satis-
faction (n = 44; 48.9%) with the information they
received on progress in their jobs, compared with both
NMs and OMs. Although most of the NMs (n = 16;
88.9%) were satisfied with the news they receive
regarding staff matters, the OMs (n = 5; 22.7%) and
PNs (n = 32; 35.6%) were less satisfied. Eighty-five
(65.4%) respondents were satisfied with the informa-
tion they received regarding their job requirements,
but 62 (47.7%) indicated dissatisfaction with informa-
tion on their benefits and pay (see the Supporting
Information, Table S5.)
Regarding corporate information, the study revealed
that the majority of those reflected in the three respon-
dent strata (n = 84; 64.4%) were satisfied with the
information they received on hospital policies and
goals, but 78 (60.0%) were dissatisfied with the infor-
mation they received on their hospitals’ finances.
Compared with the NMs, who indicated satisfaction
(n = 16; 88.9%) with the information on governing
regulations affecting hospitals, PNs indicated dissatis-
faction with information on change in the hospitals
(n = 11; 61.1%), as well as on the achievements/fail-
ures of hospitals (n = 9; 50.0%) (see the Supporting
Information, Table S6).
Pertaining to the communication climate, only 42
(32.3%) of all respondents were satisfied with the
extent to which the communication at their hospitals
motivates them to meet its goals. Forty-seven (36.2%)
of all respondents indicated their indifference towards
the extent to which hospital employees (nurses) have
ª 2014 The Authors. Journal of Nursing Management Published by John wiley & Sons Ltd.
Journal of Nursing Management
Communication satisfaction
communication skills, while 53 (40.8%) indicated
indifference towards the extent to which communica-
tion in the hospital motivates them to identify with
the hospital, or make them feel as though they were a
vital part of the hospital. Only 51 (39.2%) of all
respondents indicated satisfaction with the extent to
which conflict was handled appropriately, using com-
munication channels (see the Supporting Information,
Table S7). However, a more positive aspect seems to
be the fact that 73 (56.1%) out of all the respondents
indicated their satisfaction with the extent to which
they receive information in good time to enable them
to do their job.
Media quality refers to important communication
methods, formats and channels, such as meetings and
directives. Seventy-five (57.7%) respondents from all
three strata indicated satisfaction with the extent to
which written directives and reports are clear and con-
cise. Overall, the three strata indicated their dissatis-
faction (n = 54; 41.5%) with just how helpful and
interesting the hospital’s communication was, as well
as their dissatisfaction with the staff’s attitude towards
communication (n = 53; 40.8%) (see the Supporting
Information, Table S8).
One-way ANOVA
A one-way ANOVA test was performed to identify statis-
tically significant differences between the communica-
tion satisfaction dimension mean scores of the three
strata of respondents at a level of P < 0.05 (Burns &
Grove 2009). The analysis of variance in statistics refers
to a collection of statistical models and their associated
procedures whereby the observed variances are parti-
tioned into components according to variables. Thus
ANOVA refers to a parametric statistical technique that
assists with inferring whether there are real differences
between the means of three or more groups responses
to one or more factors (Plichta & Garzon 2009:408).
The results revealed statistically significant differ-
ences between the different strata of NMs and OMs
in two of the communication satisfaction dimensions
tested namely the organisational integration and cor-
porate information dimensions. These differences are
displayed in Tables 3 and 4, respectively:
The P-value of 0.0079 (F2,129  5.03), which is
smaller than 0.05, indicates that there is a significant
difference between the mean organisational integration
scores of the different management levels in the hospi-
tals at a 95% level of confidence.
The P-value of 0.0129 (F2,129  4.50), which is
smaller than 0.05, indicates that there is a significant
5
J.-D. Wagner et al.

Table 3 felt that their efforts were not suitably recognised. The
One-way analysis of variance (ANOVA) test for the organisational
PNs felt that NMs did not seem to understand the
integration communication satisfaction dimension
job-related problems of subordinates and appeared to
Organisational Sum of Mean lack effective problem-solving skills.
integration df squares squares F-ratio F
Supervisory communication refers to both upward
Between the 2 4.914076 2.45704 5.0341 0.0079 and downward communication that subordinates
NM and OM
categories
experience with their supervisors. Nurses view their
Error 127 61.985616 0.48808 relationship with their managers as an important fac-
Total 129 66.899692 tor in their overall sense of job satisfaction and their
intention to remain in their hospitals (Dhlamini
NM, nursing manager; OM, operational manager.
2012). The PNs indicated satisfaction with the open-
ness of supervisors to their ideas and the extent to
Table 4 which their supervisors listened to them and paid
One-way analysis of variance (ANOVA) test for the corporate infor-
attention to them. Only the NM strata indicated dis-
mation communication satisfaction dimension
satisfaction with the latter aspect. According to Muller
Corporate Sum of Mean et al. (2006), open communication is the sharing of
information df squares squares F-ratio F
all types of information throughout the organisation,
Between the 2 4.792963 2.39608 5.0341 0.0129 across functional and hierarchical levels. In other
NM and OM
categories
words, in a situation of mutual trust and open com-
Error 127 67.611960 0.53238 munication, the supervisor can confidently be suscepti-
Total 129 72.404923 ble to new ideas coming from colleagues and
subordinates. The PNs were satisfied with the guid-
NM, nursing manager; OM, operational manager.
ance that their direct supervisors (OMs) offered with
regard to solving job-related problems and the extent
difference between the mean corporate information to which their direct supervisors trusted them. Jooste
scores of the different management levels in the hospi- (2009) stated that managers who supply their subordi-
tals at a 95% level of confidence. nates with appropriate information that will simplify
The NMs reported a higher level of satisfaction with their work and which is readily available, reflect an
both the organisational integration (average mean open climate of trust in nurses to make their own
score of 3.66) and corporate information (average decisions.
mean score of 3.39) dimensions than the OMs in both Regarding subordinate communication, OMs indi-
dimensions (see the Supporting Information, Table cated satisfaction with the extent to which their staff
S9). This phenomenon could result from the high level members were responsive to downwardly directed
of exposure the NMs enjoy and their direct contact communication, but felt that PNs’ initiating of com-
with these dimensions due to their post status in the munication with NMs was lacking. The NMs and
health service. There were no other significant differ- OMs remarked that staff members were not all that
ences between the strata of respondents. receptive to evaluation, suggestions and criticism,
while OMs indicated information overload as a prob-
lem. Communication overload could also indicate a
Discussion
communication chain that functions too slowly (Van
This study was undertaken to establish the extent of Staden et al. 2002): i.e. communication is not dealt
communication satisfaction among PNs in selected with in an efficient and timely manner.
hospitals in the City of Johannesburg. Horizontal communication refers to employees’ level
Both NMs and OMs experienced personal feedback of comfort with regard to using informal communica-
from PNs as being unsatisfactory, indicating that the tion channels (the ‘grapevine’) to discuss issues with
feedback received from PNs was incomplete or inaccu- co-workers and pertains to the accuracy and active-
rate. Muller et al. (2006) regard feedback as the com- ness thereof (Muller et al. 2006). The NMs and the
pletion of the communication cycle and in cases of PNs were dissatisfied with the extent to which the
problems sufficient feedback is essential to improve ‘grapevine’ and informal communication channels and
productivity and performance. Information regarding processes were active in their hospitals. The OMs
performance management received by the professional experienced dissatisfaction with the level of activity
nurse stratum was insufficient, while OMs and PNs and accuracy of these informal communication

ª 2014 The Authors. Journal of Nursing Management Published by John wiley & Sons Ltd.
6 Journal of Nursing Management

networks in their hospitals – if they were actually
functioning at all. The NMs indicated their dissatisfac-
tion with the extent to which their working group
members were compatible.
Regarding organisational integration, both NMs
and PNs were satisfied with the information received
on departmental policies and goals, as well as on the
requirements of their jobs, but only the NMs were
satisfied with the information received on progress in
their jobs. According to Meyer et al. (2009), policies
and procedures are guidelines for enhancing the stan-
dard of nursing care in the nursing unit, while
departmental goals are broad statements, used to for-
mulate departmental objectives that need to be
achieved by members of the health care team (Jooste
2010).
In relation to corporate information, PNs were dis-
satisfied with the amount, availability and accuracy of
the information on governing regulations affecting the
hospitals where they were employed. In addition, PNs
also indicated their dissatisfaction with the amount
and quality of information on change, profits and
financial standing, as well as the achievements and
failures of their hospitals. Jooste (2009) stated that
effective communication is essential if effective change
is to take place in the organisation. Employees must
be informed about the reasons for change, but circu-
lating this information only by e-mail is not good
enough. It will require a lot of face-to-face communi-
cation to get employees involved in the change
process.
Elements inherent in an ideal communication cli-
mate include supportiveness, participative decision-
making, trust, confidence and credibility, openness
and high performance goals (Meintjes & Steyn 2006).
The NMs reported apparent poor communication
ability among PNs in the communication climate. The
majority of the respondents indicated their dissatisfac-
tion with the extent to which conflict was handled
appropriately via the hospital’s proper communication
channels.
Media quality is also an area of concern, as most of
the respondents in all three strata indicated their dis-
satisfaction with the extent to which the hospital’s
communication was interesting and helpful, the atti-
tude of staff regarding communication and the
amount of information they received in their hospitals.
Most of the respondents in all three strata indicated
satisfaction with the organisation of meetings and
with the extent to which written directives and reports
were clear and concise. The value and importance of
meetings are supported by Jooste (2010), who stated
ª 2014 The Authors. Journal of Nursing Management Published by John wiley & Sons Ltd.
Journal of Nursing Management
Communication satisfaction
that meetings are ‘one of the most effective communi-
cation tools of the work environment’ where ideas can
be stimulated, plans of action generated, teamwork
encouraged, guidance provided, employees empowered
and productivity improved. She elaborated on this
statement by mentioning that ‘effective meetings
also ensure the continuous flow of information to all
levels and between all health care professionals’ in the
organisation (Jooste 2009).
Limitations
When analysing the results, some limiting aspects
should be taken into account. First, the questionnaire
was only available in English as the official language
medium, while the majority of respondents did not
use English as their first language.
Using ‘indifferent’ as a response alternative appears
to have been an unsuitable term in the questionnaire,
affecting the response by respondents, as well as the
interpretation of data. The term, ‘uncertain’ could
have facilitated a better understanding of what was
required and would therefore have provided data that
would be more valid in this sense.
Conclusion
This study was conducted to determine what consti-
tutes effective organisational communication and to
establish the extent of communication satisfaction
among PNs in selected public hospitals in the City of
Johannesburg. From the analysis of the findings, it
was established that PNs are experiencing dissatisfac-
tion with a number of communication factors, and
that the most noteworthy indicator of communication
satisfaction is the organisational integration abilities
of NMs and OMs. Recommendations were formu-
lated to address the communication dimensions that
had been rated as unsatisfactory.
Implications for nursing management
In view of the findings of this study, it is recom-
mended that NMs and OMs should schedule and
adhere to fixed performance management reviews for
their staff members during the year, and acknowledge
nurses who deliver quality work and excellent work
input not only by means of material rewards but also
by means of personal feedback in the form of verbal
and/or written recognition.
The PNs have to be guided by managers in work-
related problem-solving by means of encouragement,
7
J.-D. Wagner et al.
providing direction and mentorship. It is recommended
that, should problems persist, managers take a con-
structive leadership role in bringing all the relevant par-
ties together, using techniques such as brainstorming as
well as the nominal group technique to find possible
solutions. Thereafter, they should be instrumental in
applying/implementing the most feasible solution and
in monitoring progress.
Supervisory communication requires NMs and OMs
to observe and listen to staff members and pay atten-
tion to staff needs and ideas. This could be enhanced
by creating staff forums for sharing ideas and infor-
mation between different categories of staff.
It is suggested that NMs avoid downwardly directed
subordinate communication by utilising formal com-
munication structures to allow interactive communica-
tion (i.e. meetings or forums). Furthermore, they can
maintain an open climate that is conducive to the ini-
tiation of upward communication by using face-to-
face communication, presenting the manager to staff
as a person who understands their needs and the chal-
lenges they face.
The NMs could keep OMs informed about relevant
matters and the latter should then prioritise informa-
tion and assignments into high, medium and low pri-
ority categories in order to effectively manage the
demands facing them. By providing feedback in a tact-
ful, supportive and one-on-one manner that is focused
on developmental needs, NMs could reduce staff
members’ sensitivity with regard to evaluation, sugges-
tions and criticism.
Managers and all staff members who deal with the
distribution of information in the hospital, should
preferably provide staff with accurate information,
especially on issues that might cause anxiety and
result in discontent, such as change, major problems
and work security, in order to avoid the distortion of
information by hearsay and gossip.
Relating to organisational integration, managers are
required to update individual staff members on their
job progress (how well they are developing in their
jobs), by providing them with feedback and guidance
on career planning. All managers who develop and
distribute policies to staff members should ensure that
such policies are written in a simple, clear and concise
way, thereby enabling easy comprehension. All new
and key concepts should be defined and explained and
a list of abbreviations should be included.
The NMs need to update nurses on corporate infor-
mation, such as policies affecting the hospital and
nursing practice per se, and make regulations accessi-
ble to staff members by maintaining a file for such
ª 2014 The Authors. Journal of Nursing Management Published by John wiley & Sons Ltd.
8 Journal of Nursing Management
documents in the offices of OMs. Top management
should implement a corporate communication channel
that would inform all employees, via the electronic
media, about impending change, financial standing
and achievements/failures by the hospital. For exam-
ple, start a newsletter, highlighting events in the hospi-
tal, by allocating the task to creative staff members
who are interested in compiling such newsletter and
include this responsibility in their Key Performance
Areas (KPAs).
Regarding the communication climate, managers
could establish a team of different role-players, both
from inside the hospital and from the community, to
encourage organisational identification, which should
be evident in the conduct and behaviour of all staff
members. They could involve staff members in activi-
ties to improve the hospital’s professional image and
probe staff members by means of a needs analysis sur-
vey on possible improvements. Following a needs
analysis, and based on the outcomes of such need
analysis, NMs could schedule workshops on commu-
nication skills to address the needs of staff at different
levels of proficiency, in order to enhance their commu-
nication skills.
Media quality is important and top management,
NMs and OMs should distribute important informa-
tion in a formal, written format (i.e. memorandums,
policy statements and procedures) and follow up ver-
bal messages with written messages for verification
purposes. Messages could also be distributed via the
electronic media (i.e. via e-mail or as text messages).
Space should be provided on relevant documents
where staff can sign after reading the information, to
ensure that they have received the information.
Acknowledgement
The authors wish to thank Dr CW Downs for permis-
sion to use and adapt the ComSat (CSQ) for this
study. J.-D.W. gratefully acknowledges a bursary
received from Unisa in his final study year.
Source of funding
The authors did not receive any funding for this
paper.
Ethical approval
Before conducting the study, permission was obtained
from the Higher Degrees Committee of the Depart-
ment of Health Studies at Unisa (HSHDC57/2011),
 Communication satisfaction

from the Gauteng Department of Health and Social Trenholm S. (2011) Thinking Through Communication: An
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Van Staden E., Marx S. & Erasmus-Kritzinger L. (2002) Corpo-
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Supporting information
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