Applied Nursing Research xxx (2014) xxx–xxx
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The effect of structural empowerment and organizational commitment on Chinese nurses' job satisfaction Jinhua Yang, MSN, RN a,⁎, Yanhui Liu, PhD b, Yan Chen, PhD c, Xiaoyan Pan, MSN c a b c
School of Nursing, Hunan University of Chinese Medicine, Hanpu science park, Changsha, Hunan, China, 410208 School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China, 300193 School of Nursing, Hunan University of Chinese Medicine, Hunan, China
a r t i c l e
i n f o
Article history: Received 8 February 2013 Revised 4 December 2013 Accepted 14 December 2013 Available online xxxx Keywords: China Empowerment Job satisfaction Nurses Nursing
a b s t r a c t Purposes: The purposes of this study were (1) to examine the level of structural empowerment, organizational commitment and job satisfaction in Chinese nurses; and (2) to investigate the relationships among the three variables. Background: A high turnover rate was identified in Chinese staff nurses, and it was highly correlated with lower job satisfaction. Structural empowerment and organizational commitment have been positively related to job satisfaction in western countries. Methods: A cross-sectional survey design was employed. Data analysis included descriptive statistics and multiple step-wise regression to test the hypothesized model. Results: Moderate levels of the three variables were found in this study. Both empowerment and commitment were found to be significantly associated with job satisfaction (r = 0.722, r = 0.693, p b 0.01, respectively). The variables of work objectives, resources, support and informal power, normative and ideal commitment were significant predictors of job satisfaction. Conclusions: Support for an expanded model of Kanter's structural empowerment was achieved in this study. © 2013 Elsevier Inc. All rights reserved.
1. Introduction A serious shortage and a high turnover of nurses have become global issues (Baernholdt & Mark, 2009), and studies have found that nurse turnover was highly linked with job satisfaction (Sullivan, 2009). As a result, the exploration of nurses' job satisfaction and its underpinning variables are of growing importance for the international nursing community to explore. According to Vinita, Ken, and Ann (2009), lower job satisfaction resulted in professional burnout and increased sick leave and absenteeism. In addition, lower job satisfaction has been linked to reduced patient care quality and lower patient satisfaction (Szecsenyi, Goetz, Campbell, et al., 2011). Organizational administrators have the responsibility for helping to increase nurses' job satisfaction. The Ministry of Health (2012) estimated that the nursing workforce in China was 2,244,000 persons—a ratio of 1.66 nurses per 1,000 people. The causes of nurse shortage vary across different countries. For China, three main reasons exist. Firstly, with the increase of both the population and elder people, more and more nurses are needed in China. The number of graduates from all programs each year is not sufficient to meet the needs of the country. Secondly, nurses' poor working conditions are related to the shortage. Conditions include the poor position, hard work, and relative lower ⁎ Corresponding author. Tel.: +86 0731 88458317. E-mail address: [email protected] (J. Yang).
pay that causes work stress and strain, which have caused a high degree of dissatisfaction among nurses as a whole. As a consequence, nurses are seeking employment in other fields, which exacerbates the nursing shortage even more (Cao, Shi, Chen, et al., 2013). Thirdly, more and more international RNs migrate to western countries where opportunities and salaries are better over the last 20 years, such as North America and Europe. The migration fills the gaps of western countries' healthcare needs, but this migration makes the shortage more severe for the exporting nations, such as China. According to Kanter (1977), empowerment was highly related with organizational effectiveness. Therefore, understanding how organizations create structural empowering workplaces to bring about positive nurse outcomes is significant. Many independent variables, including personal, organizational and contextual characteristics, have been proven to have positive effects on nurses' job satisfaction in western countries. Some Chinese nurse administrators have become more aware of the significance of empowering working settings and the relationships among the three study variables. However, scant studies are available on this issue in China. The purpose of this study was to explore the relationships among work empowerment, organizational commitment and job satisfaction among nurses in China. 1.1. Review of the literature Power is defined as the ability to get things done, to mobilize resources, to get and use whatever it is that a person needs for the
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Please cite this article as: Yang, J., et al., The effect of structural empowerment and organizational commitment on Chinese nurses' job satisfaction, Applied Nursing Research (2014), http://dx.doi.org/10.1016/j.apnr.2013.12.001
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J. Yang et al. / Applied Nursing Research xxx (2014) xxx–xxx
goals he or she is attempting to meet (Kanter, 1993). The concept of structural empowerment originated from Kanter's Theory of Structural Power in Organizations, which describes the conditions of the work environment. Kanter's theory (1977) states that in an empowered work environment, the work activity of empowered employees would be enhanced. Empowered employees have less work pressure and job burn-out, and therefore, are more likely to accomplish their work successfully and be satisfied with their jobs. Lautizi, Laschinger, and Ravazzolo (2009) argued that structural empowerment was the core of the work environment and included organizational strategies for individuals to work in an empowered environment and enable these individuals to accomplish the work effectively. Kanter' organizational empowerment structures stems from four sources: access to information, receiving support, the ability to mobilize resources, and the structure of opportunity. Access to information means that employees have the chance to learn the organizational decisions, policies, data, as well as goals. At the same time, employees should also have technical knowledge and expertise for achieving their work effectively in the work place. When employees get feedback and leadership from superiors, peers and subordinates, it means that they have received the support. Access to resources relates to one's ability to acquire money, materials, time, and equipment to finish work and organizational aims. Access to opportunity refers to job conditions, which provide more learning, challenges, knowledge, and skills for employees to advance and develop. According to Kanter's (1993) model of structural empowerment, the four structural factors within the work environment have a greater impact on employees' work attitudes and behaviors than personal predispositions or socialization experiences. Structural empowerment comes from both the formal and informal systems in the workplace. A growing number of studies have supported Kanter's empowerment theory in the nursing staff members and have linked empowerment to various organizational outcomes. The outcomes included organizational commitment (Laschinger, Finegan, & Wilk, 2009), job satisfaction (Laschinger, Leiter, Day, & Gilin, 2009; Sun, He, & Wang, 2009), lower levels of burnout, and job strain (Manojlovich, 2003). A convenience sample of 416 nurses was tested in Korea (Han, Ja, & Kyoung, 2009). The results showed structural empowerment was related to job satisfaction and organizational commitment. Similar results were found in Taiwan (Kuo, Yin, & Li, 2008) and Italy (Lautizi et al., 2009). Organizational commitment, as the relative strength of an individual's involvement in and identification with a particular organization, is a crucial issue in current restructured health care settings. Organizational commitment is a multidimensional work attitude, determined to include affective, continuance, and normative commitment. Allen and Meyer (1990) have demonstrated that organizational commitment positively associated with job satisfaction, job retention as well as job performance. In this study, organizational commitment is defined by Lin, Zhang, and Fang (2001) as the strong desire of an employee to maintain membership of an organization. He described five components of organizational commitment: affective, normative, ideal, economic, and opportunity commitment. Affective commitment refers to an employee's emotional attachment to and identification with the organization. The employee is willing to consecrate to the survival and development of the organization, even without any kind of reward, and never consider job-hopping in any temptation. Normative commitment refers to an employee's desire to stay with the organization based on a sense of duty, social norms, or ethical standards. Ideal commitment refers to an employee's attention paid to personal growth and the pursuit of realization of the ideal. The employee concerns about whether the individual expertise can be exerted in the organization. Economic commitment refers to an employee's fear of suffering economic loss
after leaving the organization. Opportunity commitment refers to an employee's fundamental reason to stay in the organization in that no more satisfying job could be found or no opportunity is found to look for another job due to the employees' low level of technology skills. Employees who were highly committed to the organization might increase their willingness to be involved in the organization's activities to stay with the employing organization (Felfe, Schmook, Schyns, & Six, 2008). Thus, the nurse manager must assess the nurses' commitment levels to better understand what motivates nurses. The mediating role of organizational commitment has been proven in the perceptions of the practice environment–intention to leave relationship (Lious & Grobe, 2008). Job satisfaction represents the degree to which employees' needs and wants are satisfied within the workplace (Utriainen & Kyngs, 2009). Namely, job satisfaction is related to the extent to which individuals love or enjoy their jobs. Job satisfaction comprised of three components: intrinsic, extrinsic, and general job satisfaction. Intrinsic job satisfaction refers to individuals' value in the light of their creativity, future development and stability, opportunities for resource mobilization derived from their work. Extrinsic job satisfaction includes factors related to job performance within the workplace, which refers to salary, promotion and the management. General job satisfaction refers to the work environment and relationship between the employees. Many independent variables influenced nurses' job satisfaction. Studies have found that autonomy was the strongest predictor of nurses' job satisfaction, which was subsequently related to nurse retention (George & Meg, 2009). Laschinger (2008) indicated that a statistically significant positive relationship existed between structural empowerment and perceived control over nursing practice, which in turn reflected positively on job satisfaction. A convenient sample of 416 nurses was tested in Korea (Han et al., 2009), and the results showed that structural empowerment was related to job satisfaction. In conclusion, structural empowerment can increase nurses' job satisfaction by optimizing use of professional expertise and nursing skills. Structural empowerment and organizational commitment are linked. Because job dissatisfaction is a primary cause of turnover in the nursing population, previous findings have important implications in the current shortage of nursing staff in China as in other countries. In this study, the relationships among structural empowerment, organizational commitment, and job satisfaction of RNs working in China are tested. Kanter's organizational empowerment theory provides the theoretical framework for this study. 1.2. Hypotheses It is significant to investigate whether or not support for an expanded model of Kanter's organizational empowerment theory was achieved in Chinese nurses. Thus, we tested two hypotheses in a sample of Chinese nurses: • Staff nurses' structural empowerment is statistically related to their organizational commitment and job satisfaction. • Staff nurses with high levels of empowerment and organizational commitment are more satisfied with their jobs. 2. Methods 2.1. Design and sample A cross-sectional survey design was used in the present study. A convenience sample of 600 full-time qualified nurses employed by five tertiary first-class hospitals in Tianjin was surveyed. The five teaching hospitals are in the highest Chinese health-care system ranking by the Ministry of Health. Of 600 questionnaires, 574
Please cite this article as: Yang, J., et al., The effect of structural empowerment and organizational commitment on Chinese nurses' job satisfaction, Applied Nursing Research (2014), http://dx.doi.org/10.1016/j.apnr.2013.12.001
J. Yang et al. / Applied Nursing Research xxx (2014) xxx–xxx
questionnaires were completed and returned. Our actual final sample consisted of 524 usable questionnaires with a response rate of 87%. Data were collected in March 2012. 2.2. Procedure Ethical approval was gained from the Tianjin University of Traditional Chinese Medicine's Research Ethics Committee. Before the distribution of the questionnaires, a nominated survey coordinator contacted the nursing department of the five hospitals and obtained consent from the nursing administrators, who provided us with a meeting schedule. Around 20 questionnaires were distributed to nurses in 5–8 key departments in each of the 5 hospitals for a total of 600 questionnaires. All the departments had similar organizational structures. A trained researcher explained the purposes of this study to the potential participants. Informed consent was obtained from all participants, and all participants were assured of their right to withdraw from the study at any time with no negative ramifications. Anonymity and confidentiality were assured. The four questionnaires were placed in an envelope and nurses who consented to participate completed the questionnaires immediately upon receipt and placed the questionnaires back into the envelope. All completed questionnaires were collected after the meeting, and a small gift was given to the participants. Only the researchers could examine the completed questionnaires on which code numbers were placed after collection.
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strongly satisfied (5), with high scores representing high levels of job satisfaction. In this study, the alpha reliability coefficients were 0.94 for the total scale. To measure demographic data, we designed six items to collect information on characteristics such as age, education level, specialty area and work objective. 2.4. Data analysis The data analysis was conducted by SPSS (version 11.5, SPSS Inc., Chicago, IL, USA), using descriptive statistics, correlation analysis and multiple stepwise regression analysis. 3. Results 3.1. Demographic characteristics Demographic characteristics are presented in Table 1. The respondents all worked full-time, and most were women (97.7%). The age of the respondents ranged from 18–54 years old with a mean age of 30.2 years (SD = 5.76, median = 27). In terms of marital status, 34.3% were single, and 65.7% were married. Nearly half of respondents had been in their current workplace for 1 to 5 years. Majority of the samples were primary nurses (57.6%), had an associate degree (48.5%) and worked for survival needs (76.0%).
2.3. Instruments 3.2. Structural empowerment of the nurses Participants were asked to complete four questionnaires. Structural empowerment was measured with the 19-item Conditions for Work Effectiveness Questionnaire–II (CWEQ-II) (Laschinger, Finegan, Shamian, & Casier, 2000). With three items for each of the five subscales (opportunity, resource, information, support, and formal empowerment) and four items for the subscale of informal empowerment, CWEQ-II demonstrated adequate confirmatory factor analytic structure across Chinese nurse samples (X 2 = 300, df = 136, Comparative Fit Index [CFI] = 0.94, Tucker Lewis index (TLI) = 0.93, Root Mean Square Error of Approximation [RMSEA] = 0.07) and had strong internal reliability (alpha = 0.936) (Huang & Liu, 2011). Items are rated on a 5-point scale. To get a composite empowerment score (score range: 6–30), all items for each of the six subscales are summed and averaged to provide a subscale composite average. In this study, the alpha reliability of the total scale was 0.94 and for each subscale was between 0.76–0.91. The two-item global empowerment scale was significantly related to the CWEQ-II (r = 0.704, p b 0.01), which demonstrated reasonable construct validity of the translated instrument. Organizational commitment was operationalized using Professor Lin Wenquan's (2001) multidimensional concept (OCQ for Chinese, COCQ) which included five dimensions of commitment: affective, normative, ideal, economic, and opportunity. Each dimension has 5 questions, with a total of 25 questions. All measures are selfassessments and use a 5-point Likert scale. All five responses for each of the five dimensions are summed and averaged to obtain a dimension mean score, with higher scores representing higher levels of perceived affective, normative, ideal, economic and opportunity commitment. An overall organizational commitment score is obtained by summing the means of the 5 scales. The alpha reliability of the total scale in the current study was 0.85 and for each subscale was between 0.67–0.78. Job satisfaction was measured with the 20-item Minnesota Satisfaction Questionnaire (MSQ) developed by Weiss and Davis (1967). MSQ has been used in previous studies of Chinese nurses' job satisfaction. The items form 3 subscales: intrinsic, extrinsic and general satisfaction, with twelve, six and two items, respectively. The subscales use a 5-point Likert score from strongly dissatisfied (1) to
Structural empowerment scores are shown in Table 2. The respondents did not consider their workplace to be highly empowering (mean = 13.36, SD = 3.54), slightly lower than Lautizi et al. (2009) hospital-based study in America but much lower than American nurse practitioners in Stewart, McNulty S., Quinn Griffin, et al.'s (2010) study. Within the six dimensions of structural empowerment, support (mean = 2.40, SD = 0.77) and opportunity (mean = 2.39, SD = 0.70) were the two highest scored dimensions. The formal power was the lowest dimension (mean = 1.92, SD = 0.76). This pattern is similar to those in Young-Ritchie and Laschinger's (2009) study, although the ratings of each subscale were considerably lower in the current study. Table 1 Demographic characteristics of nurses (n = 524). Variables Gender Female Male Age (years), M ± SD(range) Year(s) working b1 1–5 6–10 N11 Marital status Married Single Educational level Bachelor's degree Associate degree Secondary technical certificate Professional title Senior nurse Junior nurse Primary nurse Work objective Love nursing Satisfy parents' expectation Survival need
n (%) 512 (97.7) 12 (2.3) 30.2 ± 5.76 (18–54) 78 252 90 104
(14.9) (48.1) (17.1) (19.9)
344 (65.7) 180 (34.3) 209 (39.9) 254 (48.5) 61 (11.7) 58 (11.1) 164 (31.3) 302 (57.6) 85 (16.2) 41 (7.8) 398 (76.0)
Please cite this article as: Yang, J., et al., The effect of structural empowerment and organizational commitment on Chinese nurses' job satisfaction, Applied Nursing Research (2014), http://dx.doi.org/10.1016/j.apnr.2013.12.001
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Table 2 Item, range, means (M), and standard deviations (SD) among variables (n = 524). Variable
Item
Range
M
SD
1. Total empowerment Support Opportunity Resource Information Informal power Formal power 2. Total commitment Normative Economic Affective Opportunity Ideal 3. Total JS Intrinsic JS Extrinsic JS General JS
19 3 3 3 3 4 3 25 5 5 5 5 5 20 12 6 2
6–30 1–5 1–5 1–5 1–5 1–5 1–5 5–25 1–5 1–5 1–5 1–5 1–5 1–5 1–5 1–5 1–5
13.36 2.40 2.39 2.33 2.04 2.28 1.92 14.38 3.17 2.92 2.82 2.75 2.72 2.95 3.09 2.95 2.51
3.54 0.77 0.70 0.77 0.78 0.66 0.76 3.07 0.73 0.70 0.82 0.68 0.79 0.75 0.67 0.80 0.98
3.3. Organizational commitment of the nurses Organizational commitment scores are shown in Table 2. The overall mean score of organizational commitment was 14.38 ± 3.07 (mean ± SD), indicating a moderate level of organizational commitment. These findings are consistent with numerous studies of staff nurses in various clinical settings (Laschinger et al., 2000; YoungRitchie & Laschinger, 2009). Within the different dimensions of organizational commitment, normative (mean = 3.17, SD = 0.73) and economic (mean = 2.92, SD = 0.70) were the two highest scored dimensions. 3.4. Job satisfaction of the nurses Job satisfaction scores are shown in Table 2. The respondents had a medium-high level of job satisfaction, with an average degree of 2.95 ± 0.75, lower than the level of nursing assistants in Taiwan (Kuo et al., 2008). Within the three dimensions, the highest dimension of job satisfaction was the intrinsic satisfaction (mean = 3.09, SD = 0.67). 3.5. Job satisfaction related factors The correlations between the variables of the current study are presented in Table 3. Structural empowerment was significantly and positively related to organizational commitment (r = 0.63, p b 0.01). Both structural empowerment and organizational commitment were significantly and positively related to job satisfaction (r = 0.72, r =
0.69, p b 0.01, respectively). All dimensions in both structural empowerment and organizational commitment had statistically significant association with job satisfaction. Similar results have been found in other countries, such as North America (Laschinger, Leiter, Day, & Gilin, 2009), England and Malaysia (Ahmad & Oranye, 2010). We used the method of multiple stepwise regression analysis to understand which of the variables predicted the nurses' job satisfaction, and the results are shown in Table 4. In the regression analysis, job satisfaction was used as a dependent variable. The demographic variables, all significant variables of structural empowerment (containing the total six dimensions) and all significant variables of organizational commitment (containing the total five dimensions) were used as independent variables. The variables of work objectives in demographic factors (standardized B = − 0.379, t = − 2.641), support, resources and informal power in structural empowerment (standardized B = 3.774, t = 3.910; standardized B = 3.497, t = 3.919; standardized B = 2.828, t = 2.787; respectively) and normative, ideal in organizational commitment (standardized B = 3.970, t = 3.542; standardized B = 4.301, t = 4.014; respectively) were significant independent predictors of job satisfaction, explaining 67.0% of the variance (adjusted R 2 = 0.670, F = 35.915, p b 0.001). This finding is consistent with those of Laschinger's study (2009b) in America and Kuo's study (2008) in Taiwan.
4. Discussion The paper examines the levels of job satisfaction, structural empowerment and organizational commitment and investigates the relationships among the three variables in Chinese nurses. All in all, the respondents have a moderate level of job satisfaction, and many factors appeared to contribute to their job satisfaction. The results highlight the importance of empowerment to positive employee outcomes. The findings of the study revealed that the participants had moderate levels of structural empowerment and organizational commitment. And similar level has been demonstrated in previous studies in China (Cai & Zhou, 2009). Concerning organizational commitment, normative and economic commitments got the top two high scores. Concerning structural empowerment, support and opportunity got the top two high scores. Nurses rated their access to information and formal power lowest. Nurses perceived themselves to be highly empowered when they collaborated with other professionals and had autonomy to any problems within the organization. Recent research supports our results (Chen & Lin, 2002). In China, the lack of access to information and resources may account for the moderate level of empowerment.
Table 3 Correlations among structural empowerment, organizational commitment and job satisfaction among nurses (n = 524).
1.Total empowerment 2.Opportunity 3.Information 4.Support 5.Resources 6.Formal power 7.Informal power 8.Total commitment 9.Affective 10.Normative 11.Ideal 12.Economic 13.Opportunity 14. Job satisfaction
1
2
3
4
5
6
7
8
9
10
11
12
13
— .76 .80 .85 .81 .85 .78 .63 .55 .51 .58 .33 .36 .72
— .51 .60 .53 .54 .52 .45 .40 .37 .41 .29 .26 .54
— .70 .54 .63 .50 .52 .40 .38 .49 .27 .33 .49
— .65 .66 .53 .50 .49 .42 .47 .27 .30 .59
— .64 .58 .57 .51 .45 .52 .26 .36 .67
— .61 .50 .44 .41 .50 .24 .33 .57
— .47 .46 .43 .43 .37 .27 .61
— .79 .78 .81 .70 .72 .69
— .67 .61 .57 .48 .69
— .55 .49 .47 .61
— .52 .51 .69
— .69 .38
— .45
All correlations significant at p b 0.01 (two-tailed test).
Please cite this article as: Yang, J., et al., The effect of structural empowerment and organizational commitment on Chinese nurses' job satisfaction, Applied Nursing Research (2014), http://dx.doi.org/10.1016/j.apnr.2013.12.001
J. Yang et al. / Applied Nursing Research xxx (2014) xxx–xxx Table 4 Stepwise regression analysis of job satisfaction (n = 524). Variable
B
Beta
t
p
Work objectives Support Resources Informal power Normative Ideal
−0.379 3.774 3.497 2.828 3.970 4.301
−0.274 0.216 0.199 0.138 0.206 0.252
−2.641 3.910 3.919 2.787 3.542 4.014
0.009 0.000 0.000 0.006 0.000 0.000
R2 = 0.689, adjusted R2 = 0.670, F = 35.915, p b 0.001.
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of pride. Meanwhile, these nurses would have a sense of obligation for a return to hospital. This inner satisfaction can produce a more lasting impact, so the nurses would regard work as their own responsibilities and obligations, and devote more effort to the organization. According to the attitude–behavior consistency principle and the theory of attitude determines behavior, nurse managers should start with the molding of attitudes and try to create the conditions for the professional development of nurses, thereby increasing job satisfaction.
5. Implications for practice In the correlation analysis, nurses' overall perceptions of structural empowerment were significantly and positively correlated with job satisfaction, which supported previous research (Lautizi et al., 2009). When nurses perceive they that cannot be fully empowered, they experience lower job satisfaction. Because nurses who are satisfied with their jobs are less likely to experience burnout (Laschinger, Leiter, Day, & Gilin, 2009), our results suggest that organizational administrators should assure that working situations are helpful to improve nurses' satisfaction with their jobs. Moreover, we found that organizational commitment was statistically significant and positively related to job satisfaction, consistent with those of previous studies (Ahmad & Oranye, 2010). In order to improve the ardently love of nursing staff for their work, nurse managers could address the organizational commitment, with particular emphasis on the recognition for the young nurses on organizational values, culture, social norms to help them develop practical career planning, which are essential for the formation of organizational commitment. In the multiple regression analysis, work objective was the only demographic variable that significantly predicted job satisfaction. The result is consistent with Sun & Wang (2009) finding. Nurses who loved the nursing profession perceived higher job satisfaction. However, only 16.2% respondents in this study loved the nursing profession, most respondents worked to survive. Therefore, to improve job satisfaction, nurse managers should focus on the education of nursing professionals and improve the level of professionals' acceptance of nurses. The three significant predictors of job satisfaction in structural empowerment were resources, support, as well as informal power. Loretta (2011) reported that middle managers authorized to obtain more resources would be seen as more effective leadership to frontline nurses, which lead to the nurses also getting more resources, thereby enhancing the quality of care. Respondents who perceived themselves gaining support from managers showed increased job satisfaction. According to Manojlovich (2003), support from their organization can ensure nurses with creative solutions to care issues, and enable them to demonstrate higher performance. In order to improve nurses' work satisfaction, managers should support the work of nurses, concern about their clinical work, and provide effective advice and recommendations to help them to maximize their performance. In this study, informal power had an impact on each dimensions of job satisfaction. However, respondents felt less informal power than the nurses in other studies (Laschinger, Wong, & Greco, 2006). To a large extent, the reason is that front-line nurses in Chinese nursing environment do not participate in decision-making and have less autonomy. Furthermore, frontline nurses in China have little chance to build relationships with other professionals because collaborations with healthcare professionals are often the nurse manger's responsibility. The two significant predictors of job satisfaction in organizational commitment were normative and ideal. Lu (2008) reported that commitment to the organization was a significant independent predictor of job satisfaction explaining 46.7% of the total variance. Our results suggest that the hospital should pay attention to improve nurses' satisfaction, which can enhance these nurses' sense
Results of these studies suggest that nurse managers can increase nurses' job satisfaction in terms of empowering them and improving the staff nurses' commitment to the organization by means of manipulating workplace structures. An understanding of current perceptions of empowerment and its relationships to organizational commitment and job satisfaction in the nursing workforce may be instructive in removing barriers to access of power sources, facilitating acceptance of change, increasing organizational commitment, and providing high quality patient care. Thus, nurse managers should encourage and support interdependence among health care providers; enable these providers to accomplish the work effectively; and create a supportive environment for nurses to build effective relationships with peers, superiors and subordinates within and outside the organization. Furthermore, the nurses need to formulate individualized professional development plans and be encouraged to participate in the management of the organization.
6. Limitations Concerning the cross-sectional nature of the data, we do not know whether there are causal relationships among structural empowerment, organizational commitment and job satisfaction. Future research should test the causal model using a longitudinal design. Limitations of this study are the use of a convenience sample, and the data were collected from nurses in only one city in China, which both limit the generalization of these findings. Additional unmeasured variables may have also affected our results, such as psychological empowerment, job strain, and leadership, which could have direct effects on job satisfaction.
7. Conclusions Further support was obtained from this study for Kanter's theory, which could be used with Chinese nurses. The most compelling finding from this study is that structural empowerment and organizational commitment contribute to higher job satisfaction in the Chinese work environment. Since the links between these variables were quite powerful, surely efforts to enhance work empowerment and organizational commitment could be justified. In China, nurse managers should focus on the above factors and actively take measures to improve the organizational empowering work conditions. These findings would be beneficial to the stability of nursing personnel in China and Chinese nursing profession.
Acknowledgments Financial support for this research was received from the National Ministry of Education (11YJCZH112). The authors also gratefully acknowledge the supervisors and 600 nurses who participated in this study for their assistance as well as all the experts and members of our group who participated in the research for their help and advice.
Please cite this article as: Yang, J., et al., The effect of structural empowerment and organizational commitment on Chinese nurses' job satisfaction, Applied Nursing Research (2014), http://dx.doi.org/10.1016/j.apnr.2013.12.001
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Please cite this article as: Yang, J., et al., The effect of structural empowerment and organizational commitment on Chinese nurses' job satisfaction, Applied Nursing Research (2014), http://dx.doi.org/10.1016/j.apnr.2013.12.001
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Applied Nursing Research journal homepage: www.elsevier.com/locate/apnr
The effect of structural empowerment and organizational commitment on Chinese nurses' job satisfaction Jinhua Yang, MSN, RN a,⁎, Yanhui Liu, PhD b, Yan Chen, PhD c, Xiaoyan Pan, MSN c a b c
School of Nursing, Hunan University of Chinese Medicine, Hanpu science park, Changsha, Hunan, China, 410208 School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China, 300193 School of Nursing, Hunan University of Chinese Medicine, Hunan, China
a r t i c l e
i n f o
Article history: Received 8 February 2013 Revised 4 December 2013 Accepted 14 December 2013 Available online xxxx Keywords: China Empowerment Job satisfaction Nurses Nursing
a b s t r a c t Purposes: The purposes of this study were (1) to examine the level of structural empowerment, organizational commitment and job satisfaction in Chinese nurses; and (2) to investigate the relationships among the three variables. Background: A high turnover rate was identified in Chinese staff nurses, and it was highly correlated with lower job satisfaction. Structural empowerment and organizational commitment have been positively related to job satisfaction in western countries. Methods: A cross-sectional survey design was employed. Data analysis included descriptive statistics and multiple step-wise regression to test the hypothesized model. Results: Moderate levels of the three variables were found in this study. Both empowerment and commitment were found to be significantly associated with job satisfaction (r = 0.722, r = 0.693, p b 0.01, respectively). The variables of work objectives, resources, support and informal power, normative and ideal commitment were significant predictors of job satisfaction. Conclusions: Support for an expanded model of Kanter's structural empowerment was achieved in this study. © 2013 Elsevier Inc. All rights reserved.
1. Introduction A serious shortage and a high turnover of nurses have become global issues (Baernholdt & Mark, 2009), and studies have found that nurse turnover was highly linked with job satisfaction (Sullivan, 2009). As a result, the exploration of nurses' job satisfaction and its underpinning variables are of growing importance for the international nursing community to explore. According to Vinita, Ken, and Ann (2009), lower job satisfaction resulted in professional burnout and increased sick leave and absenteeism. In addition, lower job satisfaction has been linked to reduced patient care quality and lower patient satisfaction (Szecsenyi, Goetz, Campbell, et al., 2011). Organizational administrators have the responsibility for helping to increase nurses' job satisfaction. The Ministry of Health (2012) estimated that the nursing workforce in China was 2,244,000 persons—a ratio of 1.66 nurses per 1,000 people. The causes of nurse shortage vary across different countries. For China, three main reasons exist. Firstly, with the increase of both the population and elder people, more and more nurses are needed in China. The number of graduates from all programs each year is not sufficient to meet the needs of the country. Secondly, nurses' poor working conditions are related to the shortage. Conditions include the poor position, hard work, and relative lower ⁎ Corresponding author. Tel.: +86 0731 88458317. E-mail address: [email protected] (J. Yang).
pay that causes work stress and strain, which have caused a high degree of dissatisfaction among nurses as a whole. As a consequence, nurses are seeking employment in other fields, which exacerbates the nursing shortage even more (Cao, Shi, Chen, et al., 2013). Thirdly, more and more international RNs migrate to western countries where opportunities and salaries are better over the last 20 years, such as North America and Europe. The migration fills the gaps of western countries' healthcare needs, but this migration makes the shortage more severe for the exporting nations, such as China. According to Kanter (1977), empowerment was highly related with organizational effectiveness. Therefore, understanding how organizations create structural empowering workplaces to bring about positive nurse outcomes is significant. Many independent variables, including personal, organizational and contextual characteristics, have been proven to have positive effects on nurses' job satisfaction in western countries. Some Chinese nurse administrators have become more aware of the significance of empowering working settings and the relationships among the three study variables. However, scant studies are available on this issue in China. The purpose of this study was to explore the relationships among work empowerment, organizational commitment and job satisfaction among nurses in China. 1.1. Review of the literature Power is defined as the ability to get things done, to mobilize resources, to get and use whatever it is that a person needs for the
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Please cite this article as: Yang, J., et al., The effect of structural empowerment and organizational commitment on Chinese nurses' job satisfaction, Applied Nursing Research (2014), http://dx.doi.org/10.1016/j.apnr.2013.12.001
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J. Yang et al. / Applied Nursing Research xxx (2014) xxx–xxx
goals he or she is attempting to meet (Kanter, 1993). The concept of structural empowerment originated from Kanter's Theory of Structural Power in Organizations, which describes the conditions of the work environment. Kanter's theory (1977) states that in an empowered work environment, the work activity of empowered employees would be enhanced. Empowered employees have less work pressure and job burn-out, and therefore, are more likely to accomplish their work successfully and be satisfied with their jobs. Lautizi, Laschinger, and Ravazzolo (2009) argued that structural empowerment was the core of the work environment and included organizational strategies for individuals to work in an empowered environment and enable these individuals to accomplish the work effectively. Kanter' organizational empowerment structures stems from four sources: access to information, receiving support, the ability to mobilize resources, and the structure of opportunity. Access to information means that employees have the chance to learn the organizational decisions, policies, data, as well as goals. At the same time, employees should also have technical knowledge and expertise for achieving their work effectively in the work place. When employees get feedback and leadership from superiors, peers and subordinates, it means that they have received the support. Access to resources relates to one's ability to acquire money, materials, time, and equipment to finish work and organizational aims. Access to opportunity refers to job conditions, which provide more learning, challenges, knowledge, and skills for employees to advance and develop. According to Kanter's (1993) model of structural empowerment, the four structural factors within the work environment have a greater impact on employees' work attitudes and behaviors than personal predispositions or socialization experiences. Structural empowerment comes from both the formal and informal systems in the workplace. A growing number of studies have supported Kanter's empowerment theory in the nursing staff members and have linked empowerment to various organizational outcomes. The outcomes included organizational commitment (Laschinger, Finegan, & Wilk, 2009), job satisfaction (Laschinger, Leiter, Day, & Gilin, 2009; Sun, He, & Wang, 2009), lower levels of burnout, and job strain (Manojlovich, 2003). A convenience sample of 416 nurses was tested in Korea (Han, Ja, & Kyoung, 2009). The results showed structural empowerment was related to job satisfaction and organizational commitment. Similar results were found in Taiwan (Kuo, Yin, & Li, 2008) and Italy (Lautizi et al., 2009). Organizational commitment, as the relative strength of an individual's involvement in and identification with a particular organization, is a crucial issue in current restructured health care settings. Organizational commitment is a multidimensional work attitude, determined to include affective, continuance, and normative commitment. Allen and Meyer (1990) have demonstrated that organizational commitment positively associated with job satisfaction, job retention as well as job performance. In this study, organizational commitment is defined by Lin, Zhang, and Fang (2001) as the strong desire of an employee to maintain membership of an organization. He described five components of organizational commitment: affective, normative, ideal, economic, and opportunity commitment. Affective commitment refers to an employee's emotional attachment to and identification with the organization. The employee is willing to consecrate to the survival and development of the organization, even without any kind of reward, and never consider job-hopping in any temptation. Normative commitment refers to an employee's desire to stay with the organization based on a sense of duty, social norms, or ethical standards. Ideal commitment refers to an employee's attention paid to personal growth and the pursuit of realization of the ideal. The employee concerns about whether the individual expertise can be exerted in the organization. Economic commitment refers to an employee's fear of suffering economic loss
after leaving the organization. Opportunity commitment refers to an employee's fundamental reason to stay in the organization in that no more satisfying job could be found or no opportunity is found to look for another job due to the employees' low level of technology skills. Employees who were highly committed to the organization might increase their willingness to be involved in the organization's activities to stay with the employing organization (Felfe, Schmook, Schyns, & Six, 2008). Thus, the nurse manager must assess the nurses' commitment levels to better understand what motivates nurses. The mediating role of organizational commitment has been proven in the perceptions of the practice environment–intention to leave relationship (Lious & Grobe, 2008). Job satisfaction represents the degree to which employees' needs and wants are satisfied within the workplace (Utriainen & Kyngs, 2009). Namely, job satisfaction is related to the extent to which individuals love or enjoy their jobs. Job satisfaction comprised of three components: intrinsic, extrinsic, and general job satisfaction. Intrinsic job satisfaction refers to individuals' value in the light of their creativity, future development and stability, opportunities for resource mobilization derived from their work. Extrinsic job satisfaction includes factors related to job performance within the workplace, which refers to salary, promotion and the management. General job satisfaction refers to the work environment and relationship between the employees. Many independent variables influenced nurses' job satisfaction. Studies have found that autonomy was the strongest predictor of nurses' job satisfaction, which was subsequently related to nurse retention (George & Meg, 2009). Laschinger (2008) indicated that a statistically significant positive relationship existed between structural empowerment and perceived control over nursing practice, which in turn reflected positively on job satisfaction. A convenient sample of 416 nurses was tested in Korea (Han et al., 2009), and the results showed that structural empowerment was related to job satisfaction. In conclusion, structural empowerment can increase nurses' job satisfaction by optimizing use of professional expertise and nursing skills. Structural empowerment and organizational commitment are linked. Because job dissatisfaction is a primary cause of turnover in the nursing population, previous findings have important implications in the current shortage of nursing staff in China as in other countries. In this study, the relationships among structural empowerment, organizational commitment, and job satisfaction of RNs working in China are tested. Kanter's organizational empowerment theory provides the theoretical framework for this study. 1.2. Hypotheses It is significant to investigate whether or not support for an expanded model of Kanter's organizational empowerment theory was achieved in Chinese nurses. Thus, we tested two hypotheses in a sample of Chinese nurses: • Staff nurses' structural empowerment is statistically related to their organizational commitment and job satisfaction. • Staff nurses with high levels of empowerment and organizational commitment are more satisfied with their jobs. 2. Methods 2.1. Design and sample A cross-sectional survey design was used in the present study. A convenience sample of 600 full-time qualified nurses employed by five tertiary first-class hospitals in Tianjin was surveyed. The five teaching hospitals are in the highest Chinese health-care system ranking by the Ministry of Health. Of 600 questionnaires, 574
Please cite this article as: Yang, J., et al., The effect of structural empowerment and organizational commitment on Chinese nurses' job satisfaction, Applied Nursing Research (2014), http://dx.doi.org/10.1016/j.apnr.2013.12.001
J. Yang et al. / Applied Nursing Research xxx (2014) xxx–xxx
questionnaires were completed and returned. Our actual final sample consisted of 524 usable questionnaires with a response rate of 87%. Data were collected in March 2012. 2.2. Procedure Ethical approval was gained from the Tianjin University of Traditional Chinese Medicine's Research Ethics Committee. Before the distribution of the questionnaires, a nominated survey coordinator contacted the nursing department of the five hospitals and obtained consent from the nursing administrators, who provided us with a meeting schedule. Around 20 questionnaires were distributed to nurses in 5–8 key departments in each of the 5 hospitals for a total of 600 questionnaires. All the departments had similar organizational structures. A trained researcher explained the purposes of this study to the potential participants. Informed consent was obtained from all participants, and all participants were assured of their right to withdraw from the study at any time with no negative ramifications. Anonymity and confidentiality were assured. The four questionnaires were placed in an envelope and nurses who consented to participate completed the questionnaires immediately upon receipt and placed the questionnaires back into the envelope. All completed questionnaires were collected after the meeting, and a small gift was given to the participants. Only the researchers could examine the completed questionnaires on which code numbers were placed after collection.
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strongly satisfied (5), with high scores representing high levels of job satisfaction. In this study, the alpha reliability coefficients were 0.94 for the total scale. To measure demographic data, we designed six items to collect information on characteristics such as age, education level, specialty area and work objective. 2.4. Data analysis The data analysis was conducted by SPSS (version 11.5, SPSS Inc., Chicago, IL, USA), using descriptive statistics, correlation analysis and multiple stepwise regression analysis. 3. Results 3.1. Demographic characteristics Demographic characteristics are presented in Table 1. The respondents all worked full-time, and most were women (97.7%). The age of the respondents ranged from 18–54 years old with a mean age of 30.2 years (SD = 5.76, median = 27). In terms of marital status, 34.3% were single, and 65.7% were married. Nearly half of respondents had been in their current workplace for 1 to 5 years. Majority of the samples were primary nurses (57.6%), had an associate degree (48.5%) and worked for survival needs (76.0%).
2.3. Instruments 3.2. Structural empowerment of the nurses Participants were asked to complete four questionnaires. Structural empowerment was measured with the 19-item Conditions for Work Effectiveness Questionnaire–II (CWEQ-II) (Laschinger, Finegan, Shamian, & Casier, 2000). With three items for each of the five subscales (opportunity, resource, information, support, and formal empowerment) and four items for the subscale of informal empowerment, CWEQ-II demonstrated adequate confirmatory factor analytic structure across Chinese nurse samples (X 2 = 300, df = 136, Comparative Fit Index [CFI] = 0.94, Tucker Lewis index (TLI) = 0.93, Root Mean Square Error of Approximation [RMSEA] = 0.07) and had strong internal reliability (alpha = 0.936) (Huang & Liu, 2011). Items are rated on a 5-point scale. To get a composite empowerment score (score range: 6–30), all items for each of the six subscales are summed and averaged to provide a subscale composite average. In this study, the alpha reliability of the total scale was 0.94 and for each subscale was between 0.76–0.91. The two-item global empowerment scale was significantly related to the CWEQ-II (r = 0.704, p b 0.01), which demonstrated reasonable construct validity of the translated instrument. Organizational commitment was operationalized using Professor Lin Wenquan's (2001) multidimensional concept (OCQ for Chinese, COCQ) which included five dimensions of commitment: affective, normative, ideal, economic, and opportunity. Each dimension has 5 questions, with a total of 25 questions. All measures are selfassessments and use a 5-point Likert scale. All five responses for each of the five dimensions are summed and averaged to obtain a dimension mean score, with higher scores representing higher levels of perceived affective, normative, ideal, economic and opportunity commitment. An overall organizational commitment score is obtained by summing the means of the 5 scales. The alpha reliability of the total scale in the current study was 0.85 and for each subscale was between 0.67–0.78. Job satisfaction was measured with the 20-item Minnesota Satisfaction Questionnaire (MSQ) developed by Weiss and Davis (1967). MSQ has been used in previous studies of Chinese nurses' job satisfaction. The items form 3 subscales: intrinsic, extrinsic and general satisfaction, with twelve, six and two items, respectively. The subscales use a 5-point Likert score from strongly dissatisfied (1) to
Structural empowerment scores are shown in Table 2. The respondents did not consider their workplace to be highly empowering (mean = 13.36, SD = 3.54), slightly lower than Lautizi et al. (2009) hospital-based study in America but much lower than American nurse practitioners in Stewart, McNulty S., Quinn Griffin, et al.'s (2010) study. Within the six dimensions of structural empowerment, support (mean = 2.40, SD = 0.77) and opportunity (mean = 2.39, SD = 0.70) were the two highest scored dimensions. The formal power was the lowest dimension (mean = 1.92, SD = 0.76). This pattern is similar to those in Young-Ritchie and Laschinger's (2009) study, although the ratings of each subscale were considerably lower in the current study. Table 1 Demographic characteristics of nurses (n = 524). Variables Gender Female Male Age (years), M ± SD(range) Year(s) working b1 1–5 6–10 N11 Marital status Married Single Educational level Bachelor's degree Associate degree Secondary technical certificate Professional title Senior nurse Junior nurse Primary nurse Work objective Love nursing Satisfy parents' expectation Survival need
n (%) 512 (97.7) 12 (2.3) 30.2 ± 5.76 (18–54) 78 252 90 104
(14.9) (48.1) (17.1) (19.9)
344 (65.7) 180 (34.3) 209 (39.9) 254 (48.5) 61 (11.7) 58 (11.1) 164 (31.3) 302 (57.6) 85 (16.2) 41 (7.8) 398 (76.0)
Please cite this article as: Yang, J., et al., The effect of structural empowerment and organizational commitment on Chinese nurses' job satisfaction, Applied Nursing Research (2014), http://dx.doi.org/10.1016/j.apnr.2013.12.001
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Table 2 Item, range, means (M), and standard deviations (SD) among variables (n = 524). Variable
Item
Range
M
SD
1. Total empowerment Support Opportunity Resource Information Informal power Formal power 2. Total commitment Normative Economic Affective Opportunity Ideal 3. Total JS Intrinsic JS Extrinsic JS General JS
19 3 3 3 3 4 3 25 5 5 5 5 5 20 12 6 2
6–30 1–5 1–5 1–5 1–5 1–5 1–5 5–25 1–5 1–5 1–5 1–5 1–5 1–5 1–5 1–5 1–5
13.36 2.40 2.39 2.33 2.04 2.28 1.92 14.38 3.17 2.92 2.82 2.75 2.72 2.95 3.09 2.95 2.51
3.54 0.77 0.70 0.77 0.78 0.66 0.76 3.07 0.73 0.70 0.82 0.68 0.79 0.75 0.67 0.80 0.98
3.3. Organizational commitment of the nurses Organizational commitment scores are shown in Table 2. The overall mean score of organizational commitment was 14.38 ± 3.07 (mean ± SD), indicating a moderate level of organizational commitment. These findings are consistent with numerous studies of staff nurses in various clinical settings (Laschinger et al., 2000; YoungRitchie & Laschinger, 2009). Within the different dimensions of organizational commitment, normative (mean = 3.17, SD = 0.73) and economic (mean = 2.92, SD = 0.70) were the two highest scored dimensions. 3.4. Job satisfaction of the nurses Job satisfaction scores are shown in Table 2. The respondents had a medium-high level of job satisfaction, with an average degree of 2.95 ± 0.75, lower than the level of nursing assistants in Taiwan (Kuo et al., 2008). Within the three dimensions, the highest dimension of job satisfaction was the intrinsic satisfaction (mean = 3.09, SD = 0.67). 3.5. Job satisfaction related factors The correlations between the variables of the current study are presented in Table 3. Structural empowerment was significantly and positively related to organizational commitment (r = 0.63, p b 0.01). Both structural empowerment and organizational commitment were significantly and positively related to job satisfaction (r = 0.72, r =
0.69, p b 0.01, respectively). All dimensions in both structural empowerment and organizational commitment had statistically significant association with job satisfaction. Similar results have been found in other countries, such as North America (Laschinger, Leiter, Day, & Gilin, 2009), England and Malaysia (Ahmad & Oranye, 2010). We used the method of multiple stepwise regression analysis to understand which of the variables predicted the nurses' job satisfaction, and the results are shown in Table 4. In the regression analysis, job satisfaction was used as a dependent variable. The demographic variables, all significant variables of structural empowerment (containing the total six dimensions) and all significant variables of organizational commitment (containing the total five dimensions) were used as independent variables. The variables of work objectives in demographic factors (standardized B = − 0.379, t = − 2.641), support, resources and informal power in structural empowerment (standardized B = 3.774, t = 3.910; standardized B = 3.497, t = 3.919; standardized B = 2.828, t = 2.787; respectively) and normative, ideal in organizational commitment (standardized B = 3.970, t = 3.542; standardized B = 4.301, t = 4.014; respectively) were significant independent predictors of job satisfaction, explaining 67.0% of the variance (adjusted R 2 = 0.670, F = 35.915, p b 0.001). This finding is consistent with those of Laschinger's study (2009b) in America and Kuo's study (2008) in Taiwan.
4. Discussion The paper examines the levels of job satisfaction, structural empowerment and organizational commitment and investigates the relationships among the three variables in Chinese nurses. All in all, the respondents have a moderate level of job satisfaction, and many factors appeared to contribute to their job satisfaction. The results highlight the importance of empowerment to positive employee outcomes. The findings of the study revealed that the participants had moderate levels of structural empowerment and organizational commitment. And similar level has been demonstrated in previous studies in China (Cai & Zhou, 2009). Concerning organizational commitment, normative and economic commitments got the top two high scores. Concerning structural empowerment, support and opportunity got the top two high scores. Nurses rated their access to information and formal power lowest. Nurses perceived themselves to be highly empowered when they collaborated with other professionals and had autonomy to any problems within the organization. Recent research supports our results (Chen & Lin, 2002). In China, the lack of access to information and resources may account for the moderate level of empowerment.
Table 3 Correlations among structural empowerment, organizational commitment and job satisfaction among nurses (n = 524).
1.Total empowerment 2.Opportunity 3.Information 4.Support 5.Resources 6.Formal power 7.Informal power 8.Total commitment 9.Affective 10.Normative 11.Ideal 12.Economic 13.Opportunity 14. Job satisfaction
1
2
3
4
5
6
7
8
9
10
11
12
13
— .76 .80 .85 .81 .85 .78 .63 .55 .51 .58 .33 .36 .72
— .51 .60 .53 .54 .52 .45 .40 .37 .41 .29 .26 .54
— .70 .54 .63 .50 .52 .40 .38 .49 .27 .33 .49
— .65 .66 .53 .50 .49 .42 .47 .27 .30 .59
— .64 .58 .57 .51 .45 .52 .26 .36 .67
— .61 .50 .44 .41 .50 .24 .33 .57
— .47 .46 .43 .43 .37 .27 .61
— .79 .78 .81 .70 .72 .69
— .67 .61 .57 .48 .69
— .55 .49 .47 .61
— .52 .51 .69
— .69 .38
— .45
All correlations significant at p b 0.01 (two-tailed test).
Please cite this article as: Yang, J., et al., The effect of structural empowerment and organizational commitment on Chinese nurses' job satisfaction, Applied Nursing Research (2014), http://dx.doi.org/10.1016/j.apnr.2013.12.001
J. Yang et al. / Applied Nursing Research xxx (2014) xxx–xxx Table 4 Stepwise regression analysis of job satisfaction (n = 524). Variable
B
Beta
t
p
Work objectives Support Resources Informal power Normative Ideal
−0.379 3.774 3.497 2.828 3.970 4.301
−0.274 0.216 0.199 0.138 0.206 0.252
−2.641 3.910 3.919 2.787 3.542 4.014
0.009 0.000 0.000 0.006 0.000 0.000
R2 = 0.689, adjusted R2 = 0.670, F = 35.915, p b 0.001.
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of pride. Meanwhile, these nurses would have a sense of obligation for a return to hospital. This inner satisfaction can produce a more lasting impact, so the nurses would regard work as their own responsibilities and obligations, and devote more effort to the organization. According to the attitude–behavior consistency principle and the theory of attitude determines behavior, nurse managers should start with the molding of attitudes and try to create the conditions for the professional development of nurses, thereby increasing job satisfaction.
5. Implications for practice In the correlation analysis, nurses' overall perceptions of structural empowerment were significantly and positively correlated with job satisfaction, which supported previous research (Lautizi et al., 2009). When nurses perceive they that cannot be fully empowered, they experience lower job satisfaction. Because nurses who are satisfied with their jobs are less likely to experience burnout (Laschinger, Leiter, Day, & Gilin, 2009), our results suggest that organizational administrators should assure that working situations are helpful to improve nurses' satisfaction with their jobs. Moreover, we found that organizational commitment was statistically significant and positively related to job satisfaction, consistent with those of previous studies (Ahmad & Oranye, 2010). In order to improve the ardently love of nursing staff for their work, nurse managers could address the organizational commitment, with particular emphasis on the recognition for the young nurses on organizational values, culture, social norms to help them develop practical career planning, which are essential for the formation of organizational commitment. In the multiple regression analysis, work objective was the only demographic variable that significantly predicted job satisfaction. The result is consistent with Sun & Wang (2009) finding. Nurses who loved the nursing profession perceived higher job satisfaction. However, only 16.2% respondents in this study loved the nursing profession, most respondents worked to survive. Therefore, to improve job satisfaction, nurse managers should focus on the education of nursing professionals and improve the level of professionals' acceptance of nurses. The three significant predictors of job satisfaction in structural empowerment were resources, support, as well as informal power. Loretta (2011) reported that middle managers authorized to obtain more resources would be seen as more effective leadership to frontline nurses, which lead to the nurses also getting more resources, thereby enhancing the quality of care. Respondents who perceived themselves gaining support from managers showed increased job satisfaction. According to Manojlovich (2003), support from their organization can ensure nurses with creative solutions to care issues, and enable them to demonstrate higher performance. In order to improve nurses' work satisfaction, managers should support the work of nurses, concern about their clinical work, and provide effective advice and recommendations to help them to maximize their performance. In this study, informal power had an impact on each dimensions of job satisfaction. However, respondents felt less informal power than the nurses in other studies (Laschinger, Wong, & Greco, 2006). To a large extent, the reason is that front-line nurses in Chinese nursing environment do not participate in decision-making and have less autonomy. Furthermore, frontline nurses in China have little chance to build relationships with other professionals because collaborations with healthcare professionals are often the nurse manger's responsibility. The two significant predictors of job satisfaction in organizational commitment were normative and ideal. Lu (2008) reported that commitment to the organization was a significant independent predictor of job satisfaction explaining 46.7% of the total variance. Our results suggest that the hospital should pay attention to improve nurses' satisfaction, which can enhance these nurses' sense
Results of these studies suggest that nurse managers can increase nurses' job satisfaction in terms of empowering them and improving the staff nurses' commitment to the organization by means of manipulating workplace structures. An understanding of current perceptions of empowerment and its relationships to organizational commitment and job satisfaction in the nursing workforce may be instructive in removing barriers to access of power sources, facilitating acceptance of change, increasing organizational commitment, and providing high quality patient care. Thus, nurse managers should encourage and support interdependence among health care providers; enable these providers to accomplish the work effectively; and create a supportive environment for nurses to build effective relationships with peers, superiors and subordinates within and outside the organization. Furthermore, the nurses need to formulate individualized professional development plans and be encouraged to participate in the management of the organization.
6. Limitations Concerning the cross-sectional nature of the data, we do not know whether there are causal relationships among structural empowerment, organizational commitment and job satisfaction. Future research should test the causal model using a longitudinal design. Limitations of this study are the use of a convenience sample, and the data were collected from nurses in only one city in China, which both limit the generalization of these findings. Additional unmeasured variables may have also affected our results, such as psychological empowerment, job strain, and leadership, which could have direct effects on job satisfaction.
7. Conclusions Further support was obtained from this study for Kanter's theory, which could be used with Chinese nurses. The most compelling finding from this study is that structural empowerment and organizational commitment contribute to higher job satisfaction in the Chinese work environment. Since the links between these variables were quite powerful, surely efforts to enhance work empowerment and organizational commitment could be justified. In China, nurse managers should focus on the above factors and actively take measures to improve the organizational empowering work conditions. These findings would be beneficial to the stability of nursing personnel in China and Chinese nursing profession.
Acknowledgments Financial support for this research was received from the National Ministry of Education (11YJCZH112). The authors also gratefully acknowledge the supervisors and 600 nurses who participated in this study for their assistance as well as all the experts and members of our group who participated in the research for their help and advice.
Please cite this article as: Yang, J., et al., The effect of structural empowerment and organizational commitment on Chinese nurses' job satisfaction, Applied Nursing Research (2014), http://dx.doi.org/10.1016/j.apnr.2013.12.001
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