Predictors of registered nurses' organizational commitment and intent to stay

BACKGROUND: Health care reform has significantly altered employment relations. Research findings suggest that the presence or absence of supportive work environments helps explain the differences observed in employee attitudes and turnover intentions. PURPOSES: The purposes of this study were to examine frontline registered nurses' (RNs') perceptions of organizational culture and attitudes and behaviors and test a model linking culture to outcome (organizational commitment and intent to stay). METHODOLOGY: A non-experimental predictive survey design was used to test the model in a sample (N = 343) of acute care RNs employed in one Canadian province. Data were collected with the following scales: Emotional Climate, Practice Issues, Collaborative Relations, Psychological Contract Violation, General Job Satisfaction, Organizational Commitment Questionnaire, and Intent to Stay. FINDINGS: The response rate was 29.4%. Most respondents were middle aged and diploma prepared, were in their current positions for 5 years or more, had 10 or more years of nursing experience, and worked full time. Despite moderate levels of job satisfaction, RNs held negative perceptions of culture (emotional climate, practice-related issues, and collaborative relations), trust, and commitment and were unlikely to stay with current employers. Structural equation modeling provided support for the impact of culture, trust, and satisfaction on commitment and partial support for intent to stay, explaining 45 and 31% of the variance, respectively. PRACTICE IMPLICATIONS: The development and implementation of policies and interventions aimed at creating more supportive work environments and greater trust in employers and job satisfaction have merit. The most obvious benefit from such strategic interventions is the potential for improving RNs' organizational commitment and reducing turnover intentions.     

Identifying and Prioritizing Workplace Climate Predictors of Burnout Among VA Primary Care Physicians

Burnout, or job-related stress, affects more than half of all US physicians and has been linked to increased medical errors, staff turnover, and reduced productivity. Primary care physicians (PCPs) experience among the highest burnout rates in medicine. Workplace climate, defined as shared worker attitudes and perceptions of their work environment, is a leading determinant of physician burnout. However, prior studies have not examined the relative importance of different elements of workplace climate (eg, leadership, support). Our study identifies and prioritizes workplace climate predictors of physician burnout among PCPs employed by Veterans Affairs (VA) nationwide. We conducted a cross-sectional analysis of data from the 2013-2017 VA All Employee Survey (AES), an annual organizational census that includes questions on burnout and workplace climate. Dependent variables addressed two dimensions of burnout from the Maslach Burnout Inventory (eg, emotional exhaustion and depersonalization); symptoms > once per week indicated burnout. Independent variables included 30 questions related to elements of workplace climate (ie, leadership, support, rewards, recognition, autonomy, satisfaction, tolerance, conflict, workload, growth opportunity, physical and psychological safety, communication, collaboration, risk-taking, and sense of belonging and purpose) scored on a 5-point agreement/satisfaction scale. We included PCP demographic covariates. Independent and dependent variables were measured from separate random samples to avoid method bias. Collapsing AES responses among PCPs on the medical-site level by reporting year, we used the semi-automated LASSO procedure to identify workplace climate predictors of burnout and assessed their relative importance using the Shapely value decomposition. PCPs employed at 157 VA medical sites nationwide. Among a sample of 305 facility-year observations, an average of 65.5% of PCPs screened positive for emotional exhaustion and 47.8% for depersonalization. We identified 7 workplace climate predictors of emotional exhaustion (pseudo R2 for full model = 0.667). The majority of explained variation in emotional exhaustion was attributable to perceptions of workload (32.6%), organization satisfaction (28.2%), and organization support (19.4%); other contributors included praise (7.8%), employee development (8.1%), psychological safety (1.9%), and innovation (2.0%). We identified 9 workplace climate predictors of depersonalization (pseudo R2 for full model = 0.590). The majority of explained variation in depersonalization was attributable to workload (25.3%), organization satisfaction (22.9%), and connection to VA mission (20.7%); other contributors included job control (11.4%), praise (9.6%), work/family balance (9.1%), quality of direct supervision (<1%), psychological safety (<1%), and innovation (<1%). Apart from innovation, higher agreement/satisfaction scores for workplace climate predictors were associated with a lower likelihood of PCP burnout. The most influential workplace climate predictors of burnout among PCPs included perceptions of workload, organization satisfaction, organization support, and connection to institutional mission. Praise, employee development, job control, and work/family balance were moderately influential. Identifying and understanding the relative importance of workplace climate factors are important for guiding optimal allocation of health organization resources to mitigate and prevent burnout within the PCP workforce. To address burnout, our research suggests organizations should prioritize practices and policies that reduce physician workload and create a supportive work environment that promotes employee satisfaction and sense of connection to institutional mission. Department of Veterans Affairs.     

Happy employees lead to loyal patients. Survey of nurses and patients shows a strong link between employee satisfaction and patient loyalty

A strong relationship exists between employee satisfaction and patients' perceptions of the quality of their care, measured in terms of their intent to return and to recommend the hospital to others. Employee dissatisfaction can negatively affect quality of care and have an adverse effect on patient loyalty and, thus hospital profitability. Therefore, health care marketers should regularly measure employee satisfaction as one way to monitor service quality. Health care marketers must work more closely with their human-resource departments to understand and influence employees' work environment and maintain a high level of job satisfaction. Marketers also should place an increased emphasis on both employee and patient perceptions of satisfaction when developing internal and external strategic marketing plans and formulating future research.     

Organizational culture: does it affect employee and organizational outcomes?

This study determined the type of organizational culture (bureaucratic, innovative, or supportive), and determined the relationships among organizational commitment, and behavioural outcomes (turnover, absenteeism, and productivity) in hospital foodservice departments. The sample included 423 foodservice employees from nine hospitals in eastern Canada and nine hospitals in East Tennessee. Two research instruments were used for data collection. The historical data instrument, completed by the department director, obtained data to calculate productivity, turnover, and absenteeism rates. The four-part employee instrument included the 24-item Organizational Culture Index, the 15-item Organizational Commitment Questionnaire, five questions to determine perceptions of job satisfaction, and demographic items. Multiple linear regression analysis tested relationships among variables. The predominant culture was bureaucratic (14.9 +/- 4.3 of a possible 24). Means were lower for innovative (13.2 +/- 4.3) and supportive (12.7 +/- 5.0) cultures. Supportive and innovative cultures had positive relationships with both job satisfaction and organizational commitment. Organizational culture was not related to turnover, absenteeism, or productivity. Mean productivity was 3.8 +/- 3.2 meals per labour hour, ranging from 0.8 to 15.1. Employees rated satisfaction with co-workers highest, and satisfaction with pay lowest. These findings will help hospital foodservice managers understand the relationship of culture to organizational and employee outcomes; changing culture may improve desired outcomes.     

Psychological morale and job satisfaction among homecare workers who care for persons with AIDS.

This paper reports the findings of a study of 103 home care workers who have cared for PWAs. It investigated degree of "exposure" to AIDS cases, perception of risk of occupational contagion, client/worker relationships, attitudes toward homosexuality and drug abuse and other work related factors for their relationship with psychological morale and job satisfaction. Multivariate analyses found sociodemographic characteristics and physical health to be the strongest predictors of morale. The quality of client/worker relationships and risk perception were the strongest predictors of job satisfaction. These findings, and that of the relative lack of importance of exposure to AIDS cases and attitudes toward the risk groups in accounting for job satisfaction, are discussed in terms of qualitative data collected from respondents during informal small group discussions.     

The relationship between job appreciation and absenteeism studied with the use of a simple questionnaire]

In the period February 1986-January 1988 a questionnaire study was carried out among 455 men aged 39-55 years working for the Netherlands Post Office to determine whether a correlation exists between job appreciation and absenteeism. Job appreciation was estimated by means of seven questions concerning: pleasure at work, fatigue after work, job satisfaction, mental stress due to the work, tension in contact with colleagues, tension in contacts with superiors and the physical exertion of working. Answers were scored on a 7-point scale. It was found that a particular score area exists that is correlated with significantly more absenteeism. The results apply to groups, not to individuals.     

工作场所暴力对商丘市医务人员工作能力、工作满意度和转岗打算影响的通径分析

目的以职业紧张理论为模式探讨工作场所暴力对医务人员工作能力、工作满意度、转岗打算的影响,为科学评价工作场所暴力的作用过程和不良后果提供理论依据。方法采用分层整群随机抽样的方法抽取河南省商丘市5家市级医院483名医务人员作为研究对象,运用自制调查表对其遭受工作场所暴力、暴力恐惧、暴力应对资源、工作能力、工作满意度、转岗打算等情况进行调查。采用有序结果变量回归和通径分析探讨各变量的关系。结果通径分析显示:(1)工作场所暴力既可直接影响工作能力和工作满意度,又可间接通过暴力恐惧影响工作能力和工作满意度。(2)工作场所暴力通过暴力恐惧、工作满意度间接影响转岗打算。结论遭受工作场所暴力可以通过直接或间接作用影响医务人员的工作能力、工作满意度、转岗打算。应采取措施,控制工作场所暴力的发生以降低其不良影响。     

Country of origin and racio-ethnicity: are there differences in perceived organizational cultural competency and job satisfaction among nursing assistants in long-term care?

BACKGROUND: Long-term care facilities nationwide are finding it difficult to train and retain sufficient numbers of nursing assistants, resulting in a dire staffing situation. Researchers, managers, and practitioners alike have been trying to determine the correlates of job satisfaction to address this increasingly untenable situation. One factor that has received little empirical attention in the long-term care literature is cultural competence. Cultural competence is defined as a set of skills, attitudes, behaviors, and policies that enable organizations and staff to work effectively in cross-cultural situations. PURPOSE: To examine organizational cultural competence as perceived by nursing assistants and determine if this was related to differences in job satisfaction across countries of origin and racio-ethnic groups. METHODS: Primary data collected from a cross-section of 135 nursing assistants at four New England nursing homes. Demographics, perceptions of organizational cultural competence, and ratings of job satisfaction were collected. A multivariate, generalized linear model was used to assess predictors of job satisfaction. A secondary analysis was then conducted to identify the most important components of organizational cultural competency. RESULTS: Perception of organizational cultural competence (p = .0005) and autonomy (p = .001) were the strongest predictors of job satisfaction among nursing assistants; as these increase, job satisfaction also increases. Neither country of origin nor racio-ethnicity was associated with job satisfaction, but racio-ethnicity was associated with perceived organizational cultural competence (p = .05). A comfortable work environment for employees of different races/cultures emerged as the strongest organizational cultural competency factor (p = .04). RECOMMENDATIONS: Developing and maintaining organizational cultural competency and employee autonomy are important managerial strategies for increasing job satisfaction and improving staff retention. Toward this end, creating a comfortable work environment for employees of different races/cultures is an integral part of the process. Managerial recommendations are discussed.     

Psychosocial working characteristics before retirement and depressive symptoms across the retirement transition: a longitudinal latent class analysis

Objectives:Retirement is a major life transition. However, previous evidence on its mental health effects has been inconclusive. Whether retirement is desirable or not may depend on pre-retirement work characteristics. We investigated trajectories of depressive symptoms across retirement and how a number of psychosocial working characteristics influenced these trajectories.Methods:We included 1735 respondents from the Swedish Longitudinal Occupational Survey of Health (SLOSH), retiring during 2008–2016 (mean retirement age 66 years). They had completed biennial questionnaires reporting job demands, decision authority, workplace social support, efforts, rewards, procedural justice and depressive symptoms. We applied group-based trajectory modelling to model trajectories of depressive symptoms across retirement. Multinomial logistic regression analyses estimated the associations between ­psychosocial working characteristics and depressive symptom trajectories.Results:We identified five depression trajectories. In four of them, depressive symptoms decreased slightly around retirement. In one, the symptom level was initially high, then decreased markedly across retirement. Perceptions of job demands, job strain, workplace social support, rewards, effort–reward imbalance and procedural justice were associated with the trajectories, while perceptions of decision authority and work efforts were only partly related to the trajectories.Conclusions:We observed a rather positive development of depressive symptoms across retirement in a sample of Swedish retirees. For a small group with poor psychosocial working characteristics, symptoms clearly decreased, which may indicate that a relief from poor working characteristics is associated with an improvement for some retirees. However, for other retirees poor working characteristics were associated with persistent symptoms, suggesting a long-term effect of these work stressors.     

Decision latitude and workload demand: implications for full and partial absenteeism

This research examined the relative importance of two components of job stress--decision latitude and workload demand--on employee absenteeism. The analysis was based on confidential self-reported data from employees at two worksites, which were collected in three independent cross-sections beginning in 1995. The negative binomial technique was used to estimate the effects of decision latitude and workload demand on employee attendance, while controlling for employee demographics and other workplace characteristics. Estimation results show that high decision latitude was negatively and significantly related to number of full days absent from work (full absenteeism) and number of days arriving late to work or leaving work early (partial absenteeism). Conversely, the coefficient estimates for low decision latitude were positive in every model and significantly related to partial absenteeism. Low workload demand was negatively and significantly related to partial absenteeism, but not full days absent. The interaction effects of decision latitude and workload demand on absenteeism were not statistically significant. Several recent studies have estimated a significant relationship between decision latitude, workload demand, and medical problems such as cardiovascular disease. The current findings suggest that decision latitude and workload demand are also related to workplace attendance. Employers and occupational hygienists should consider decision latitude and workload demand as a means to improve workplace productivity and employee health.     

Employee perceptions of workplace health and safety issues. Can a questionnaire contribute to health needs assessment?

A questionnaire survey was conducted to determine attitudesand perceptions of employees of a Scottish local authority ofthe role of occupational health services. Questions were includedcovering the following areas: influences on health, the effectof the workplace on health, satisfaction with work and workingconditions, the role of occupational health services, and personalhealth experience. Most of the survey respondents believed thatthe prime function of an occupational health service is to ensurea safe working environment. However, it was indicated that managementhas responsibility for employee welfare at work and that anapprorpiate management structure to address safety issues shouldbe accessible. In addition, employees would like the occupationalhealth service to provide some health promotional activities,particularly stress management courses and the opportunity forexercise.     

Hospital nurses' intentions to remain: exploring a northern context

Retaining nurses is of significant concern to all hospitals but even more of a concern to northern and rural hospital managers. This study provides insights into factors related to nurses' intentions to remain. A sample of 122 nurses from 13 northern hospitals in Western Canada participated in the study. The nurses completed questionnaires and participated in structured interviews. A model was proposed which suggested that work experiences (job and decision latitude, feedback, perceptions of how viewed and treated by others, fairness of policies, and safety of the job environment) would be related to job satisfaction and then affective commitment. Age and tenure, and ties to the community were proposed as predictors of continuance commitment. Both affective and continuance commitments were expected to be related to intention to remain in the hospital. The model was partially supported by regression analyses. Work experiences predicted job satisfaction and affective commitment. Affective commitment, continuance commitment, and ties to the community are related to nurses' intentions to remain. Supplemental analyses indicated that the strongest relationships were found for management's views and treatment of nurses, knowledge and ability utilization, safe environment, and fairness of organizational policies.     

Community Care Workers in Rural Southern Illinois

This study examined factors related to community care worker job satisfaction, as a method of assessing problems related to employee turnover, based on data collected from 393 community care workers who worked with elderly clients from the 13 southernmost rural counties in Illinois in 1987. Results suggested that the majority of workers were satisfied with their job; however, there was a difference in the mean scores of those employed for more than one year and those employed for less than one year (those employed for longer than one year had significantly lower satisfaction scores than those employed for less than one year). Although only 19 individuals indicated they were intending to quit within the year, 88 respondents answered "no opinion." Reasons given why new employees quit were: low wages, no benefits, no raises or promotions, cannot cope with the elderly, do not like the elderly, or not well-suited for this type of work. Also, many of the workers responded that people quit because the job was not what they expected, they did not give it a chance, they did not receive the proper training, and that the job was too stressful or frustrating. Recommendations made on the basis of these study data include the development of a new job hierarchy (which will increase the probability of being promoted) and more detailed pre-service training program which covers in detail what new employees can expect from the job. Health education training programs are recommended as a major tool for reducing the problem of employee turnover by helping the worker manage the high levels of stress experienced on the job.     

An analysis of relationships among transformational leadership,job satisfaction,organizational commitment and organizational trust in two Turkish hospitals

The purpose of this study was to investigate the relationships among employee organizational commitment, organizational trust, job satisfaction and employees' perceptions of their immediate supervisors' transformational leadership behaviors in Turkey. First, this study examined the relationships among organizational commitment, organizational trust, job satisfaction and transformational leadership in two Turkish public hospitals. Second, this investigation examined how job satisfaction, organizational trust and transformational leadership affect organizational commitment. Moreover, it was aimed to investigate how organizational commitment, job satisfaction and transformational leadership affect organizational trust. A quantitative, cross‐sectional method, self‐administered questionnaire was used for this study. Eight hundred four employees from two public hospitals in Turkey were recruited for collecting data. The overall response rate was 38.14%. The measurement instruments of survey were the Job Satisfaction Survey (developed by P. Spector), the Organizational Commitment Questionnaire (developed by J. Meyer and N. Allen), the Organizational Trust Inventory‐short form (developed by L. Cummings and P. Bromiley) and the Transformational Leadership Inventory (TLI) (developed by P. M. Podsakoff). Five‐point Likert scales were used in these measurement instruments. Correlation test (the Pearson's rank test) was used to examine relationships between variables. Also, multiple regression analysis was used to determine the regressors for organizational commitment and organizational trust. There were significant relationships among overall job satisfaction, overall transformational leadership and organizational trust. Regression analyses showed that organizational trust and two job satisfaction dimensions (contingent rewards and communication) were significant predictors for organizational commitment. It was found that one transformational leadership dimension (articulating a vision), two job satisfaction dimensions (pay and supervision) and two organizational commitment dimensions (affective commitment and normative commitment) were significant regressors for organizational trust. There is a lack of research in the health organizations regarding organizational commitment, organizational trust, job satisfaction and transformational leadership. The investigator of the proposed study intends to add to the literature and intends to prove that the proposed study would be important for healthcare organizations. A number of specific measures should be undertaken to reduce factors that negatively affect organizational commitment, organizational trust and job satisfaction of hospital personnel and to improve transformational leadership behaviors of hospital administrators. Copyright © 2012 John Wiley & Sons, Ltd.     

Exploring patient, co-worker, and management burnout in health care: an empirical study

Previous work in services marketing reveals that much is to be gained by considering distinct types of employee burnout. The current work extends these findings into the health care environment by examining the antecedents and effects of patient, co-worker, and management burnout. It is suggested that the distinction among the various types of burnout are especially important in the increasingly competitive and stressful health care setting. Several hypotheses are derived from burnout, social support, and exchange theory, and an empirical study from a hospital setting is discussed. The results indicate that of the three burnout types, management burnout has the strongest influence on employee service delivery, job satisfaction, organizational commitment, and intentions to leave the health care organization. Implications for managers and suggestions for future research are discussed.     

Disability at Work: A Look Back and Forward

Purpose This article presents new evidence on employment barriers and workplace disparities facing employees with disabilities, linking the disparities to employee attitudes. Methods Analyses use the 2006 General Social Survey to connect disability to workplace disparities and attitudes in a structural equation model. Results Compared to employees without disabilities, those with disabilities report: lower pay levels, job security, and flexibility; more negative treatment by management; and, lower job satisfaction but similar organizational commitment and turnover intention. The lower satisfaction is mediated by lower job security, less job flexibility, and more negative views of management and co-worker relations. Conclusion Prior research and the present findings show that people with disabilities experience employment disparities that limit their income, security, and overall quality of work life. Technology plays an increasingly important role in decreasing employment disparities. However, there also should be increased targeted efforts by government, employers, insurers, occupational rehabilitation providers, and disability groups to address workplace barriers faced by employees with disabilities, and by those with disabilities seeking to return to work.     

Risk factors for interpersonal conflicts at work

OBJECTIVES: The main goal of this study was to identify work-related risk factors for the onset of interpersonal conflicts at work. METHODS: Longitudinal data from the Maastricht Cohort Study on "fatigue at work" (N=9241) were used. After the respondents who reported an interpersonal conflict at baseline were excluded, logistic regression analyses were used to determine the role of several work-related risk factors at baseline in the onset of a conflict with coworkers or supervisors after 1 year of follow-up. RESULTS: Higher psychological job demands, higher levels of role ambiguity, the presence of physical demands, higher musculoskeletal demands, a poorer physical work environment, shift work, overtime, and higher levels of job insecurity significantly predicted the onset of both a coworker conflict and a supervisor conflict. Higher levels of coworker and supervisor social support, more autonomy concerning the terms of employment, good overall job satisfaction, monetary gratification, and esteem reward significantly protected against the onset of both a coworker conflict and a supervisor conflict. Higher levels of decision latitude and more career opportunities also significantly protected against the onset of a supervisor conflict. CONCLUSIONS: Several factors in the work environment were related to the onset of interpersonal conflicts at work. Given the rather serious consequences of interpersonal conflicts at work with respect to health and well-being, the observed risk factors can serve as a starting point for effective prevention and intervention strategies in the workplace.