Background Hospital care mostly involves complex processes that are continuously adjusted to match individual client needs. As most patients cannot evaluate the technology used, they focus on personal interactions with care providers when making judgements about the care received. Nurses are the care team members that primarily provide ongoing care.

Aims This study aims to further understand factors that influence the way nursing staff relate to their patients. A model is presented of the contextual and self-perceptual factors that influence the level of customer/client orientation of nursing services in an Australian hospital setting along with details of a quantitative study.

Methods Nurses completed an anonymous questionnaire, which was then mailed directly to the researchers. Analysis of the data included factor analysis, regression and path analysis.

Findings The results show that contextual elements such as management commitment to service quality and self-perceptual factors such as role stress impact on the nurses’ client service orientation. However, the variables being studied commonly have both direct and indirect effects with feelings about commitment to the organization having a notable mediating influence. The scales adapted from use in other industries are able to measure the perceptual and outcome variables in a health institutional setting.

Conclusions The managerial implications are that both a comprehensive programme of organizational culture and individual staff member development is needed if an enhanced customer orientation and the consequent improvement in client satisfaction with nursing care is to occur.