An Integrated Review of the Research Literature R
Iran J Nurs Midwifery Res. 2016 Mar-April; 21(2): 107–117.
An integrative review of literature on determinants of nurses' organizational commitment
Seyyed Abolfazl Vagharseyyedin
iNursing and Midwifery College, Birjand University of Medical Sciences, Ayatollah Ghaffari Avenue, Birjand, Iran
Received 2014 May 17; Accustomed 2015 Aug nineteen.
Abstract
Groundwork:
This integrative review was aimed to examine in literature and integrate the determinants of nurses' organizational commitment in hospital settings.
Materials and Methods:
In this study, an integrative review of the literature was used. The search strategy began with six electronic databases (due east.g. CINAHL and Medline). Because the inclusion criteria, published studies that examined the factors influencing nurses' organizational commitment in the timeframe of 2000 through 2013 were called. Data extraction and assay were completed on all included studies. The last sample for this integrative review comprised 33 studies.
Results:
Based on common meanings and central issues, 63 different factors contributing to nurses' organizational commitment were integrated and grouped into four main categories: Personal characteristics and traits of nurses, leadership and management style and beliefs, perception of organizational context, and characteristics of job and piece of work surround.
Conclusions:
In general, categories emerged in this study could exist useful for formulating initiatives to stimulate nurses' OC. However, footling is known about the relative significance of each identified cistron among nurses working in different countries. Qualitative research is recommended for narrowing this gap. Future research should be directed to examine the psychometric backdrop of the organizational scales for nurses in different cultures.
Keywords: Integrative review, nurses, organizational commitment
INTRODUCTION
It is widely agreed that organizational delivery (OC) is an important determinant of nurse turnover.[i,2] Previous research has suggested a significant positive association between piece of work outcomes such as functioning and productivity, and OC.[3,iv]
In general, OC is variously divers and conceptualized in the literature; nonetheless, at that place are two perspectives on this concept in general: Attitudinal and behavioral.[5] The attitudinal perspective focuses on employee's identifying with the organization and his/her desire to maintain the relationship with the organization,[6] whereas OC, from a behavioral perspective, describes a person'south preoccupation with the organization every bit evidenced by personal time devoted to organizational activities.[7]
Co-ordinate to Zangaro, the about widely accepted definition of OC is that suggested by Mowday et al.[5] They define it every bit "the relative force of an individual's linkage to the organization"; this is further characterized past three factors which are strong belief in and credence of the organization's goals and values, willingness to exert considerable effort on behalf of the organisation, and stiff desire to maintain membership in the organization.[eight]
It tin exist assumed that factors influencing OC may alter over fourth dimension. That is because nurses continue to feel changes in role and office in the workplace. Carver and Candela emphasize on each generation's unique perspective of OC.[ix] It is extremely important for nurse managers to understand the influencing factors on the OC of the electric current nursing workforce. Thus, the current review was aimed to appraise in literature and integrate the determinants of nurses' OC in hospital settings.
MATERIALS AND ThousandETHODS
Study design
In this integrative review, the methodology proposed by Whittemore and Knafl was followed. Since the integrative review method has been critiqued for lack of rigor and its potential for bias, Whittemore and Knafl have provided a five-step procedure to enhance the rigor of this method in nursing. According to them, the process of an integrative review includes joint of the trouble to exist studied, completion of a well-defined literature search, evaluation of the quality of data, analysis of the information, and presentation of conclusions. The commencement footstep is a clear identification of the problem that the review is addressing and the purpose of the review. Literature search should conspicuously address issues such as search terms, the databases used, additional search strategies, and the inclusion and exclusion criteria for determining relevant main sources. For evaluating and interpreting the quality of included studies, no gold standard exists.[x] The American Association of Disquisitional Care Nurses' (AACN) Testify-Leveling Hierarchy[11] has been effectively used for grading in the integrative review method, where various primary sources (such equally quantitative and qualitative studies) are included.[12,xiii] In the data analysis process, data from primary sources are ordered, coded, categorized, and summarized into a unified and integrated decision. Finally, conclusions of reviews tin can be reported in a table or diagram.[10]
A systematic search was conducted using vi online databases: CINAHL, Medline, ERIC, PROQUEST, and 2 Iranian databases: Iran Medex, and Scientific Information Database. Keywords used for this review were "organisational delivery" or "organizational commitment" with limitation to studies conducted in nursing. The inclusion criteria were: (a) Works written in English or Western farsi in the timeframe of 2000 through March 2013, (b) the inclusion of the search term in the title or the keywords, (c) scholarly works published in a peer-reviewed journals, and (d) studies including nurses who worked only in hospitals. Studies that used a mixed sample of nurses along with other healthcare workers were included if only the studies consistently analyzed and reported nurses' information separately from other participants. The studies that were excluded included those described in ane-folio reviews, letters, and those published in other than the selected languages. Furthermore, boosted papers from reference lists of the studies reviewed were identified. The purpose of this study was to identify the determinants of nurses' OC; therefore, those studies that applied experimental design were excluded with the goal of improved understanding of factors influencing OC in the absence of variable manipulation. The search was completed in Apr 2013.
The initial search resulted in a sample of 594 articles (464 English and 130 Western farsi articles). In light of the inclusion and exclusion criteria, 33 studies remained in our review [Table 1].
Table 1
A summary of reviewed studies
Measures
In the current review, studies were evaluated for quality using the AACN revised evidence-leveling system. The new AACN structure consists of 6 rating levels. Meta-analyses and meta-syntheses are placed as the highest levels of show (Level A). Level B includes both randomized and non-randomized well-designed controlled studies. Level C encompasses qualitative studies, descriptive or correlational studies, integrative reviews, systematic reviews, or randomized controlled trials with inconsistent results. Level D indicates peer-reviewed professional organizational standards. Level Eastward signifies theory-based evidence from multiple-case reports and expert opinion, and Level M is used to place manufacturer recommendations.[11] In the current review, 32 out of the 33 included studies (96.9%) used a quantitative cantankerous-sectional blueprint. McNeese-Smith used a qualitative method, withal.[40] Therefore, as presented in Tabular array 1, almost all the included studies were descriptive in nature with most receiving a level C rating.
Analytic strategy
The data were analyzed with consideration of purpose, methods, and findings of the reviewed studies. Taking into consideration the primary findings, descriptions of determinants of OC were starting time extracted and the fashion these factors afflicted OC was identified and summarized. Then, based on common meanings and central issues of these findings, they were organized and integrated equally categories and themes. A summary of four main categories and their themes was emerged and are presented in Tabular array 2.
Table two
Summary of determinants of nurses' OC
RESULTS
Measurement of OC and methodological aspects of the studies reviewed
The three scales developed past Allen and Meyer (1990), Meyer et al. (1993), and Meyer and Allen (1997) were used in 17 out of 33 included studies.[xiv,16,17,18,22,23,24,25,29,31,32,33,34,35,41,42,44] According to Meyer and Allen, OC contains the post-obit three dimensions: (one) Affective commitment that refers to the members of an organization who are emotionally attached to, identify themselves with, and feel devoted to an organization; (2) continuance delivery that describes the employees who are committed because they believe the costs associated with leaving the system are besides high and, hence, they remain; and (3) normative delivery that refers to the group of employees who experience like they should stay with the organisation across a sense of obligation.[47] Information technology is noteworthy that 11 studies used the affective OC subscale of each of the above scales.[eighteen,22,23,24,25,26,27,28,29,thirty,31,32,33,34,35,41,42,44,46]
The xv-item scale by Mowday et al. (1979) was used to measure OC in 7 of the 33 included studies.[15,26,27,37,38,39,43,45] Yang and Chang (2008) used the calibration developed by Mowday et al. (1982) which contained three dimensions: (1) A stiff belief in, and acceptance of, the organization'southward goals and values (value commitment); (two) a willingness to exert a considerable effort on behalf of the organization (effort delivery); and (3) a strong intent or want to remain with the arrangement (memory delivery).[45] Chang and Chang[19] and Ho et al.[28] evaluated OC through a researcher-fabricated questionnaire. Leach[36] assessed OC using a xv-particular delivery scale developed by Penley and Gould (1988). This scale contains three subscales: Moral commitment (a normative, internalized identification with organisation), calculative commitment (a remunerative or compliance involvement in organization), and alienative commitment (a negative resistance).[36]
The fifteen-item OC scale developed by Porter et al. (1974) was used in Chiok Foong Loke's study.[21] Jalonen et al. used a single question to inquire about OC.[30] Finally, in the study of Chang et al.,[xx] OC was measured by Blauetal's (1993) tool, which comprised half-dozen items.
In the majority of studies reviewed, nurses' OC was measured using like tools. Thus, it should be said that the authors had a similar view of the empirical referents of OC. On the one mitt, it can be considered as a potential force because the results of such studies enable researchers to make international comparisons.
In light of the statistical assay, all the reviewed studies except three[24,27,36] used multiple regression assay. Moreover, a considerable number of researchers used the Structural Equation Modeling (SEM).[17,22,26,28,35,43,45] It is obvious that applying such statistical technique can be helpful to examination the proposed models of OC in nursing field and, consequently, to develop the body of knowledge in nursing. Some included studies were guided by a theoretical framework[22,32,35,36,41,45] which enhances the validity of the studies.
Determinants of nurses' OC
Personal characteristics and traits of nurses
The category of personal characteristics and traits of nurses encompasses two themes including a) biopsychosocial parameters and b) personal and family unit life.
Regarding the biopsychosocial parameters theme, age was positively correlated with OC in iii studies.[20,30,36] Also, age was found to be negatively associated with calculative commitment in one study.[36] In Tsai and Wu's report, OC was not related to age.[43] These findings indicate a demand for more than exploration of impact of historic period on OC.
Four studies reported that as task tenure increased, OC increased also.[fifteen,20,29,36] However, in Liou and Cheng'south (2010) study, job tenure was negatively related to OC.[37] Personality trait of extroversion, as a third psychological factor in this theme, positively influenced OC.[15] Furthermore, mental health, emotional intelligence,[16] and well-being[17] were establish to be associated with increased levels of OC. The other factors included psychological distress,[xxx] individual levels of negative affectivity,[18] and exhaustion[22,35] that were found to negatively bear on OC. Negative affectivity was considered as the extent to which certain negative emotions were experienced by nurses. As opposed to these latter factors, psychological empowerment (the psychological state that employees must experience for managerial empowerment interventions to be successful) positively influenced OC in two studies.[34,41] Within this theme, factors such as employee engagement,[17] job satisfaction,[14,19,21,26,28,29,38] social rewards,[42] and professional commitment[39] were as well identified as positive determinants of nurses' OC. In improver, McNeese-Smith showed that preferring stability to change positively afflicted OC.[40] The final factor in this theme was "surface acting" which negatively impacted OC. In surface acting, persons change and control their emotional expressions. Inauthentic surface acting may result over time in a feeling of detachment from one's true feelings.[45]
Five factors formed the theme of personal and family life. Life satisfaction was found to be positively correlated with OC.[44] The remaining four factors included coming together the family'due south needs, creating a better life for self and family unit, and having a plan to retire from the organization, all of which were reported as positive determinants of OC.[twoscore]
Leadership and management style and behavior
Both nature of relationships and leadership style were themes of influence within the leadership and management style and behavior category. Nature of relationships included factors such as psychological rewards from the head nurse and supervisor incivility which were effective in shaping the interpersonal relationships betwixt managers and nurses. Starting time, perception of nurses of managers' practice was cited equally an important determinant of OC. For example, in English and Chalon's written report, fairness perception of alter management was associated with college levels of affective commitment.[25] As well, a positive correlation was reported between OC and relational justice. Relational justice refers to the extent to which employees perceive the supervisor as treating them with politeness and consideration.[30] Finally, the researchers found that both psychological rewards received from the head nurse[23] and trust in management[33] were positive predictors of OC. In contrast to the four factors described, the remaining two factors within nature of relationships theme, i.e., supervisor in civility[35,41] and employee cynicism, were negatively related to OC.[25] According to English and Chalon who studied the relationship between employee cynicism and OC, employee pessimism is targeted toward senior management and stems from perceptions of unfair direction practices.[25]
Organizational context
Two themes were identified inside this category: Organization'south norms and functioning and organizational policies and procedures.
Organization'south norms and performance theme focused on findings well-nigh the perception held past nurses concerning organizational climate and practice. As presented in Table 2, this theme included eight factors. Outset, positive perceptions of the fairness of personnel practices (procedural justice and interactional justice) were positively related to OC.[25] Conversely, lack of fairness from organization was related to lack of OC in the written report of McNeese-Smith.[40] As the side by side factor, favorable perception of internal marketing was noted as a positive predictor of OC.[43] The concept of internal marketing argues that enterprises should value and respect their employees by treating them as internal customers. Another gene identified was perceived organizational back up, which was found to be associated with increased levels of OC.[17] In one study, perception of organizational civilisation (emotional climate, practice issues, and collaborative relations) was a potent positive predictor of nurses' OC.[26] Inside this theme, organizational trust was also a positive predictor of commitment amongst nurses.[31] The relationship between OC and psychological contracts, as another factor, was found to be positive in the report of Kafashpour et al.[31] These authors defined psychological contract as the individual'southward idea about mutual obligations in the context of the relationship betwixt the employer and the employee. Finally, factors related to organizational climate such as warmth, conflicts, and standards were shown to be positively correlated with higher levels of OC.[37]
The organizational policies and procedures theme encompasses ii factors: Permanent job status/job security and budgetary benefits. Change from temporary job status to a permanent one predicted sustained OC of the staff nurses in ii studies.[27,thirty] Consequent with this finding, chore security was 1 of the emerged factors in the study conducted by McNeese-Smith.[40] Too, in the to a higher place-mentioned study, nurses cited monetary benefits as one of the factors shaping loftier-level commitment.
Characteristics of task and work environment
This category included iii themes: Growth and evolution, content and organization of tasks, and common respect.
Growth and development theme consisted of seven studies that examined the influence of appropriate role performance and career development on OC. Chang et al.[20] found that the gap between career needs and career development programs made negative contributions to OC. In five studies, having access to conditions that enabled optimal role performance of the nurses (structural empowerment) positively influenced affective OC.[22,33,34,35,36,37,38,39,41] A negative correlation betwixt dubiety of patients' treatment and affective OC was also reported.[18] Finally, being in a learning surround, modern applied science, the opportunity for acquiring new skills, and continuing instruction were found to be associated with higher levels of OC.[xl]
Several factors related to the nature of nurses' tasks and work surround conditions were integrated into the content and organization of tasks theme. A favorable perception of piece of work environment conditions, such equally interpersonal relationships, managerial support, and regular routines, was found to be positively associated with higher levels of affective commitment in 2 studies.[42,44] Job control[xxx] and chore rotation[28] were cited as significant determinants of OC. In two of the included studies, the perception of office conflict and ambivalence were negatively related to nurses' OC.[18,39] As well, significant positive relationships between OC, professional privilege,[42] workplace spirituality,[32] and clinical challenges[42] were reported. In McNeese-Smith's report,[40] hard or repetitive patient care negatively influenced OC. In addition, time pressure,[xviii] task stress,[39,35] and overload[40] were found to exist negative determinants of OC.
Focus of mutual respect theme covered interpersonal relationships existing in the work environment. One of the factors within this theme was participative safety,[42] which was constitute to be a positive determinant of nurses' OC. By and large, participative safety was conceptualized as the extent to which the interpersonal atmosphere was non-threatening in the report of Jalonen et al.[30] Workplace violence,[18,24] bullying, and internal emotional abuse[24] were identified as negative determinants of OC. According to Demir and Rodwell,[24] internal emotional abuse points out to types of workplace violence exerted past coworkers or supervisors. Consequent with these findings, McNeese-Smith[xl] reported that having good relations with coworkers was associated with higher levels of OC. Finally, nurses' satisfaction with psychological rewards received from physicians was identified to positively bear upon their melancholia OC.[23]
DISCUSSION
The purpose of this integrative review was to examine in literature and integrate the determinants of nurses' OC in hospital settings. Unlike factors from 33 included studies were integrated into nine themes. Afterward, based on the mutual meanings and the relationships between the themes, this rather large number of themes was combined into four principal categories. The categories included: Personal characteristics and traits of nurses, leadership and management manner and behavior, perception of organizational context, and characteristics of job and work surroundings. Factors within each theme were constitute to positively or negatively influence the OC of nurses working in hospitals. The electric current review also showed that research was inconsistent with respect to the correlation between some personal factors such as age and OC. A possible statement is that these findings may exist context-specific and should be taken into business relationship when managers want to design initiatives to stimulate nurses' OC. In other words, problems important for a specific age grouping of nurses in i country may non exist every bit much important for nurses of the aforementioned historic period group in another country.
A review of literature indicates that many factors influencing OC identified in this study tin be improved by specific interventions designed to this end. Job stress, coworker incivility, exhaustion, work environs weather condition, empowerment, and management style are among these factors.[48,49,l,51,52,53]
In improver, as noted previously, researchers believed that different generations of nurses accept unique perspectives of OC. Employees born into a generational cohort of peers accept similar life experiences. These experiences have strong effects on their work values and needs also as their expectations of employers, which in plow touch the influential parameters of employees' OC. Every bit an example, Carver and Candela[9] believed that nurses born during 1961-1981 prefer working independently, while younger ones enjoy working in groups.[ix] So, it tin be expected the integrated findings in the current review provide a foundation for comparison of factors that contribute to OC of different generations of nurses. Further, these findings have potential for developing the trunk of cognition related to OC in nursing context and clarifying theoretical basis of this concept.
As another finding in this written report, it became evident that all the tools applied for measuring nurses' OC were developed in western countries. It has been suggested that the concept of OC is culturally specific.[v] Since work culture varies in unlike countries, the conceptual framework and operationalization of commitment may be understood differently across various countries.[54] It is not meant that tools adult in western countries are not valid in other countries such equally Islamic republic of iran; information technology simply means that these tools need to be tested more in other cultures before their validity can be fully established. On the other hand, healthcare organizations in different countries face different challenges, which in turn impact the OC of employees. Qualitative research has the potential to offering some insights into nurses' experiences of OC in different countries and cultures and, hence, to provide valuable context-based data.
Most of the included studies used a cross-sectional design, and hence, the potential reciprocal relationships between revealed determinants and nurses' OC cannot be fully interpreted causally. Therefore, as far as possible, future enquiry could be conducted using longitudinal designs to further consider the impact of the specific determinants of OC.
Also, only three studies addressed anonymity of respondents.[23,32,43] This limitation may take influenced the responses to some extent if nurses felt worried about loss of their job position in infirmary. Too, all the studies reviewed relied upon self-study of OC levels when assessing determinants. In the future studies, researchers may need to examine the OC among nurses using data triangulation that refers to the use of multiple methods of data sources to validate conclusions. For example, the nurses' performance and questions regarding their performance appraisal should be included in the assessment of OC. In add-on, measurement of the level of OC, along with the related outcomes such as nurse turnover,[55] may contribute to a broader agreement of nurses' feelings toward their organizations. Moreover, positive results bias should not be ignored when interpreting the results of the current review. Positive results bias means that the researchers who obtain positive findings are more probable to submit their papers to a journal. Nevertheless, the included studies had considerable strengths. Notably, all but four studies drew their samples from more than 1 site, which in plough might have increased the generalizability of studies included.[21,24,31,45]
We acknowledge that this review has some limitations. In the present review, only those studies published in English language and Farsi were included. This may take resulted in the omission of several valuable studies. Besides, it is evident that OC is an important construct in turnover research. Considering the selected inclusion criteria in this review, nosotros may have possibly missed research studies that take looked at the antecedents and consequences of OC in the context of turnover.
CONCLUSION
Nurses' OC is influenced by diverse factors related to personal characteristics, leadership and management, organizational context, and characteristics of task and work environment. Given the different work cultures beyond the world, notwithstanding, petty is known about the relative significance of each factor amid nurses working in different countries. These issues should be taken into business relationship in planning the evidence-based strategies to ameliorate nurses' OC. For this end, qualitative research will be an invaluable tool. These studies will capture the existent perception of nurses nearly OC and specific factors impacting it. The findings of the present study could be useful for formulating initiatives to stimulate nurses' OC. In hereafter researches, reviewing this construct, specifically in the context of turnover, can be considered. As the next footstep, researchers are recommended to programme research studies that will reveal the causes of high OC on which organizations can influence directly. Future research tin can as well be designed to compare the influential factors on OC in different generations of nurses in countries such as Iran with its specific social and economical context. Finally, regarding the used scales for measuring the OC, future research can be directed to examination the psychometric properties of the OC scales for nurses in the different societies or cultures.
Footnotes
Source of Support: Nix
Conflict of Interest: None declared.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4815364/
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