Relationship between Psychological Empowerment ...

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perceived by ICU nurses working in Saudi governmental hospitals. ..... (64.58±10.25) as compared to those working in the military hospital (67.07±11.01).
Relationship between Psychological Empowerment and Organizational Commitment as Perceived by ICU Nurses at Governmental Saudi Hospitals. Mona A. Al-Aseeri, M.S.N, B.Sc.N.*and, Hanan A. Ezzat, Ph.D., M.S.N., B. Sc. N.*

Abstract: Nurses' commitment is influenced greatly by their perceived empowerment in form of professional socialization, which culminate greatly in the integration of their internal motives "psychological empowerment". Thus this study aimed to address the relationship between psychological empowerment and organizational commitment as perceived by ICU nurses working in Saudi governmental hospitals. A convenient sample of 340 nurses working in Intensive Care Units in three Governmental Hospitals in Riyadh city were surveyed. A questionnaire was developed from two validated scales, and used in collecting data pertaining to the study. Namely the scales are: "Psychological Empowerment Instrument" and "Three Components Model Employee Commitment Survey". The main findings of the study were that nurses' perception for psychological empowerment was highly recorded at whole subjects, while their perception for commitment was minimal, with no significant difference among the three hospitals. A negative association was detected between nurses' perception for commitment and their professional status (clinical ladder and education). Moreover, empowerment and commitment were negatively associated among nurses with (30>40) years old, as well as nurses who have experience in the current unit ranged between (5>10) years. In contrast, psychological empowerment and commitment were positively associated among female nurses, specialized areas, and nurses whose career experience exceeds fifteen years.

Key words: Psychological Empowerment, Organizational Commitment, ICUs, Nurses. Introduction: Working within a climate of uncertainty and disempowerment along with high organizational demands put nurses under considerable stress (1,2). This condition threatens both physical and emotional wellbeing of the nurses, and the profession itself(2). Moreover, it may result in nurses' low commitment, which in turn may contribute to disengagement or withdrawal of nurses from their organizations (3,4). Consequently, threaten organizational functioning and quality of care as well (5). Many countries (6-10), and the Kingdom of Saudi Arabia (11) is of no exception, are suffering from nursing low commitment, which is evidenced by registered nurses' high turnover rate and resignation. However, national studies and articles highlighted that governmental sectors in Riyadh city, KSA, is suffering for many years from high turnover rate of nurses, which reached 70% , and resulted in an observable phenomenon of nurses' shortage (12,13). Many studies and public media discussions as well as nursing publications revealed nurses' shortage and poor nurse's performance to many factors such as non-supportive work conditions, salary, nursing disempowerment and uncertainty, which in turn lead nurses to be uncommitted to their organizations.(14,15)

Operational definitions: For the purpose of this study, the following terms were managed and utilized with the hereafter meanings:  Empowerment: is an interpersonal process by which the superior enables or enhances his/her subordinate's self efficacy. 



Psychological empowerment: internal motives that allow nurses to successfully do what they want to do rather than getting them to do what the managers want them to do. It consists of FOUR dimensions: -

Meaning: is the value of the work goals or purposes for the nurse. It involves a fit between his/her values, believes and behaviors and their work goals.

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Impact: is the degree to which nurses can influence the outcomes of the organization.

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Competence: is a reflection of nurse's self efficacy or believes in his/her capability of performing work tasks.

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Self determination: believes that nurses have choice in initiating actions in the work place.

Organizational commitment: the strength of nurses' attachment, loyalty and identification with their organization. It consists of THREE dimensions: -

Affective commitment: is the nurse's emotional attachment to, identification with and involvement in a particular organization (i.e., they stay because they want to stay).

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Continuance commitment: is the nurse's awareness of the benefit/cost associated with leaving the organization (i.e., they stay because they ought to stay.).

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Normative commitment: is the nurse's sense of obligation for remaining in the organization (i.e., they stay because they have to do so.).

Literature Review: Several studies of nurse managers and staff nurses found that empowerment has been significantly associated with lower levels of emotional exhaustion, job stress, and voluntary turnover (16-18). In contrast, many nursing literature suggest that at low levels of job satisfaction and organizational commitment, retention of nursing staff is low and absenteeism increases (19). Despite high valuation and persistent challenges of nurses and hospital administrators to maintain healthy work environment in the form of psychological empowerment which targeted at employee level, nursing research related to this subject was of global skepticism (20).

Many studies show that autonomy is an integral part of empowerment while job satisfaction, commitment to the job, level of professional activity were correlate strongly with nurse empowerment, also findings of these studies revealed that empowerment has a significant positive effect on affective commitment and trust in management (21). However, Spreitzer (2005)(22) viewed psychological empowerment as the affective state that employees must experience for interventions to be successful. Hence, defined it as "a motivational construct that consisted of four dimensions, namely are meaning, competence, self-determination and impact" Together, these four dimensions reflect an active orientation to the work role as well as lowered job stress and increase job satisfaction. Spreitzer(23) argued that empowered employees usually experience positive feelings about their work and feel more committed to the organization as well as they are likely to be seen as effective because they proactively execute their job responsibilities and see themselves as competent and able to influence their jobs and work environment in a meaningful way(23). Adding to these arguments, empowered employees usually experience positive feelings about their work, feel more committed to the organization (24), and feel that the requirements of the job and their own beliefs and values are congruent, resulted in giving their job greater meaning and contributes more to organizational effectiveness (25) . Supportively, overall reviewed literature shows that psychological empowerment has direct effect on both job strain and job satisfaction (26), while higher levels of psychological empowerment motivates employees to experience positive feelings about their work and being more productive and effective in meeting organizational goals (27). Such response results from confidence in their abilities to perform the job, as well as their feeling that they have control over their work and feel that they have an impact on important organizational outcomes (28). Organizational commitment, on the other hand, has been and continues to be of great interest to researchers of organizational behavior and management practitioners, since it was associated with such desirable work behaviors as increased productivity, personnel stability, lower absenteeism rate, job satisfaction and organizational citizenship (15). Scholl(29) and McDermott (30) viewed organizational commitment as a dimension of organizational effectiveness which contributes to increased effectiveness through improving work performance and reducing turnover. Moreover, Obeng and Ugboro(31) argued that commitment shields or protects employees from the adverse effects of stress such as those caused by organizational hardship (layoffs), since it enables them to attach directions and meaning to their work. Additionally, Steers (32) concluded that increased commitment improves work performance and reduces absenteeism and turnover, which are costly to organizations. Meyer and Allen (33) developed a Three Components Model of Organizational Commitment (TCM), and provide a comprehensive meaning for each of its components, namely these components are affective commitment; continuance commitment and normative commitment. Moreover, Schwartz and Tessler(34) identified personal norms as the responsible factor for what Wiener referred to as

an internalized normative pressure, that makes organizational commitment a moral obligation because the individual feels that he/she ought to do so. Thus, there may be some overlap between affective and normative commitment, both were relatively independent of continuance commitment.(23) Affective commitment has many positive consequences for the organization. Employees with strong affective commitment tend to contribute more to the accomplishment of organizational goals, and they are more likely to rise to the challenges imposed by restructuring, as well as being less likely to leave the organization (35). On the other hand, employees with high continuance commitment are also less likely to leave the organization, and as a result, lower turnover (23,35). This claim was corroborated by McCloskey and McCain (36) who found that nurses who stayed in their positions because of job scarcity reported higher levels of absenteeism and were increasingly more likely to demonstrate poor work performance. Hence, it is easy to recognize that the professionals' commitment and empowerment , especially that of nurses, will have repercussions in the interaction with the other members of the team, patients and community. This is expected to improve organizational effectiveness and efficacy, and exerting its influence in the organizational development itself (35). Locally, reviewed literature for studies conducted in Saudi Arabia revealed that none has been focused on issues concerning psychological empowerment, organizational commitment, and/or nurses' perception for both or any of them. On the other hand, several studies and articles (11,37,38) highlighted that the current nurses' work condition in Saudi health care system is considered harmful as evidenced by nurses' perception of uncertainty and high turnover that caused nurses shortage and cost increment in Saudi health care sector. Thus, it is wise for the health care administrators to pay a critical attention to plan, implement and maintain strategies for retaining currently working nurses and recruiting new candidates who are committed to their organizations. Research Questions: To fulfill the study purpose, the following research questions were targeted: 1. What is the nurses' perception of psychological empowerment? 2. What is the nurses' perception of organizational commitment? 3. Is there significant relationship between psychological empowerment and organizational commitment from one side, and a selected personal and/or occupational characteristics of the subjects from the other side? 4. What is the relationship between nurses' perception of psychological empowerment and organizational commitment? Materials and Methods: Design: A descriptive correlational design was selected for this study.

Setting: The study was conducted in all general and specialized, adults and pediatrics/neonatal Intensive Care Units (ICUs) (n = 17) in three major governmental hospitals representing the military sector (3 units), university sector (6 units), and ministry of health sector (8 units). Additional specialized ICU was included in the study settings for the purpose of conducting pilot study. Subjects: A convenient sample of nurses working in the selected settings, meeting the inclusion criteria and available at the time of data collection were involved in the study (n = 340). Inclusion criteria included a minimum of one year experience in the current unit and did not assume a managerial position Tool: A structured questionnaire was derived from two validated instruments, namely: Psychological Empowerment Scale (39) , and Three Components Model-Employee Commitment Scale (40). Spreitzer G. (22), and Laschinger et al (41) assured the scales' validity and reliability (Cronbach alpha = 0.79 to 0.85, and 0.87 to 0.92 respectively). Prior utilization, an internal consistency for the questionnaire was assured. The questionnaire comprised of two main parts. The first part geared toward eliciting information related to selective personal and occupational characteristics. Personal characteristics included age, gender, nationality and educational level, while occupational characteristics included career experience, current unit experience, current clinical ladder and specialty area. The second part included 30 statements directed toward eliciting nurses' perception to psychological empowerment (12 statements), and their perception to commitment (18 statements). A 5-point Likert scale was used to rate each statement. It ranged from (5) denoting "Strongly Agree", down to (1) denoting "Strongly Disagree". The scoring of negative statements was reversed. Data Analysis: The statistical Package for Social Science (SPSS 12), and the Expanded Program for Immunization (EPI INFO 3.2 - 2006)were used to analyze study data. Various parametric and non-parametric tests were used. Common statistical classification for Correlation Coefficient (r-Value) was used to obtain relationship between study variables. A cutoff point was decided for the study based on reviewed literature (42) as follow: Strong if r-Value (≥75), Moderate if r-Value (75≥50), and Weak if r-Value is (40 c. 40>50 d. 50+ Significance X2 (P) 2. Gender: a. Male b. Female Significance Z – test (P) 3. Nationality: a. Indian b. Philippine c. Others‡ Significance X2 (P) 4. Education: a. Diploma b. Baccalaureate c. postgraduate Significance X2 (P)  



X ± SD

Impact X ± SD

Total Psychological empowerment

72.74±13.86 75.00±14.23 79.22±13.19 79.17±16.48 10.79* (0.013)

55.47±19.34 52.61±18.22 57.42±21.72 57.99±25.24 5.55 (0.136)

55.64±16.11 53.40±16.17 59.02±13.01 56.25±22.42 4.80 (0.187)

65.76±9.13 65.38±9.52 69.72±9.79 68.32±15.84 8.27* (0.041)

72.69±16.62 81.11±12.59

71.76±15.69 75.78±14.15

53.70±27.00 52.31±18.03 54.89±19.74 55.62±16.02

62.62±13.97 66.85±9.87

1.97 (0.049)

0.83 (0.408)

0.13 (0.896)

0.85 (0.396)

1.01 (0.311)

79.80±12.49 80.73±13.41 82.94±12.34

74.20±13.15 76.59±15.23 75.40±13.01

47.53±21.22 59.39±16.46 57.74±22.65

55.53±17.03 54.00±15.79 61.11±13.61

64.27±9.56 67.68±10.72 69.30±8.01

2.20 (0.333)

1.32 (0.516)

20.25* (40 c. 40>50 d. 50+ Significance X2 (P) 2. Gender: a. Male b. Female Significance Z – test (P) 3. Nationality: a. Indian b. Philippine c. Others‡ Significance X2 (P) 4. Education: a. Diploma b. Baccalaureate c. postgraduate Significance X2 (P)  



Affective X ± SD

Continuance

X ± SD

Normative X ± SD

56.64±15.44 54.62±12.42 59.59±13.88 58.33±20.34

54.77±10.58 53.06±12.86 56.45±13.50 59.55±16.55

53.34±12.85 51.79±12.93 57.08±12.16 56.42±19.77

8.22* (0.042)

5.90 (0.116)

8.30* (0.040)

44.68±22.72 57.18±13.49

49.07±16.01 55.05±12.53

46.99±20.70 54.06±12.87

2.06* (0.040)

1.56 (0.119)

1.22 (0.222)

58.00±13.69 55.71±13.75 55.46±18.25

55.87±10.85 54.07±13.88 54.07±13.41

52.50±12.84 54.79±13.22 52.68±15.88

2.80 (0.247)

1.12 (0.572)

2.03 (0.363)

58.07±15.01 55.96±12.77 38.75±15.22

56.42±11.70 53.38±13.82 47.08±8.11

53.37±13.83 54.83±12.88 41.25±9.31

16.64* (0.002)

8.87* (0.012)

11.34* (0.003)

Total Organizational Commitment 54.92±9.87 53.16±10.16 57.71±10.57 58.10±12.63

11.17* (0.011) 46.91±17.34 55.43±9.82

2.06* (0.040) 55.46±8.64 54.86±11.10 54.07±12.84

0.15 (0.928) 55.95±10.49 54.72±10.17 42.36±7.24

18.64* (0.0001)

Others included Saudi, Jordanians, Yemenis, Egyptians, Australians, Bangladesh, Pakistani, Malaysians, Indonesian, and Slovak. *Significant : P-Value ( ≤ 0.05)

Table 5: Nurses' perception for organizational commitment as distributed by their occupational characteristics. Organizational Commitment Domains Occupational Characteristics 1. Hospital a. University b. Military c. Ministry of Health. Significance X2 (P) 2. Career Experience: a. 1>5 b. 5>10 c. 10>15 d. 15+ Significance X2 (P) 3. Current Unit Experience: a. 1>5 b. 5>10 c. 10>15 d. 15>20 e. 20+ Significance X2 (P) 4. Current Position (Ladder): a. Staff Nurse I (SN I) b. Staff Nurse II (SN II) Significance Z-test (P) 5. Specialty Area: a. Adult G. ICU b. Adult Spec. ICU‡ c. Pediatric G. ICU d. Pediatric Spec. ICU‡‡ Significance X2 (P) ‡

Affective X ± SD

Continuance

58.44±15.96 52.68±14.54 58.52±11.49 13.25* (0.001)

55.97±13.21 50.83±13.83 57.48±10.07 14.86* (0.0006)

53.32±14.52 55.91±11.23 51.52±14.33 51.68±11.78 56.29±10.80 57.43±6.91 7.57* 15.97* (0.023) (0.0003)

56.76±13.27 55.54±14.11 53.49±13.02 60.57±15.65

55.28±9.33 54.89±10.25 52.24±14.78 56.77±14.42

51.48±12.31 53.33±12.11 51.34±13.12 57.53±15.05

16.01* (0.001)

5.56 (0.135)

10.57* (0.014)

57.02±13.66 54.07±13.55 54.84±15.26 60.73±15.66 60.73±21.92

55.84±11.17 51.94±12.15 51.61±20.06 59.22±12.00 54.55±14.25

53.44±12.06 53.03±14.07 54.84±17.38 54.17±14.28 58.33±15.92

10.52* (0.033)

11.13* (0.025)

2.94 (0.568)

52.04±15.00 58.09±13.81

51.04±13.76 56.02±12.19

3.36* (0.0008)

2.85* (0.004)

0.97 (0.331)

55.28±16.28 62.42±15.75 55.10±11.59 64.06±8.31

55.48±13.70 56.29 ±11.10 53.43±12.55 57.29±12.15

52.56±13.35 57.63±12.76 52.63±13.46 65.63±10.15

16.07* (0.001)

 included Burn, Maternity, and coronary care ICUs. ‡‡  included Respiratory, and Surgical ICUs.  *Significant : P-Value ( ≤ 0.05)

X ± SD

2.54 (0.468)

Normative X ± SD

Total Organizational Commitment

54.51±8.29 54.59±9.62 52.36±10.96 58.29±11.20

15.49* (0.001) 55.43±9.22 53.01±10.48 53.76±15.86 58.04±9.16 57.70±13.12

8.78 (0.067)

52.84±14.26 51.97±12.17 53.98±13.17 56.03±9.64

15.27* (0.002)

2.83* (0.005) 54.44±10.98 58.78±10.22 53.72±9.86 62.33±8.64

15.11* (0.002)

Table 6: Correlation between psychological empowerment and organizational commitment as perceived by nurses

Domains

Meaning

Competence

0.5190 ‡ (