Role of job satisfaction and work environment on the organizational commitment of nurses: a cross-sectional study

The relationship between exercise commitment and college students' exercise adherence: The chained mediating role of exercise atmosphere and exercise self-efficacy

OBJECTIVE

This study aims to explore the mechanisms underlying exercise commitment, exercise atmosphere, exercise self-efficacy, and exercise adherence among college students, as well as the impact of gender differences on these mechanisms.

METHODS

Using a stratified cluster sampling method, 984 college students (aged 19.74 ± 1.25 years) from six universities in Anhui, Shandong, and Shaanxi provinces were randomly selected, with 403 male students and 581 female students. They had completed the Exercise Commitment Scale (ECC), Physical Exercise Atmosphere Scale (PEAS), Exercise Self-Efficacy Scale (ESES), and Exercise Adherence Scale (EPS). The study variables were analyzed in sequence for reliability and validity, correlation analysis, regression analysis, structural equation model testing, and bias-corrected percentile Bootstrap testing using SPSS 23.0 software and Hayes' (2013) Process plug-in.

RESULTS

Exercise commitment significantly positively predicted exercise adherence (β = 0.796, p < 0.01), exercise commitment significantly positively predicted exercise environment and exercise self-efficacy (β = 0.645, p < 0.01, β = 0.356, p < 0.01), exercise environment significantly positively predicted exercise self-efficacy and exercise adherence (β = 0.344, p < 0.01, β = 0.144, p < 0.01), and exercise self-efficacy significantly positively predicted exercise adherence (β = 0.934, p < 0.01). The mediating role of exercise environment in the relationship between exercise commitment and exercise adherence does not exist in male college students, while it exists in female college students.

CONCLUSIONS

Exercise atmosphere and exercise self-efficacy play a mediating role between exercise commitment and exercise adherence, with a total mediating effect value of 0.796. This study indicates that exercise commitment not only directly predicts exercise adherence, but also indirectly predicts exercise adherence through the chained mediating effects of exercise atmosphere and exercise self-efficacy. The above-mentioned mediating effect exists in female college students, while some mediating effects do not exist in male college students, thus gender has a significant impact on this mediating effect.

Depression, professional self-efficacy, and job performance as predictors of life satisfaction: the mediating role of work engagement in nurses

Background

The life satisfaction and job performance of nursing professionals are affected by a multitude of factors, including work engagement, self-efficacy, and depression. The Job Demands-Resources (JD-R) model provides a theoretical framework to explore these relationships.

Objective

Our study aimed to analyze the primary goal of this research, which is to examine the mediating role of work engagement in the relationship between depression, professional self-efficacy, job performance, and their impact on life satisfaction in nurses, using the JD-R theory as a guide.

Methods

This cross-sectional study involved 579 participants aged between 21 to 57 years (M = 39, SD = 9.95). Mediation analysis was used to examine the influence of depression, self-efficacy, and job performance on work engagement, and in turn, its effect on life satisfaction.

Results

Findings indicated that work engagement plays a crucial mediating role between depression, self-efficacy, job performance, and life satisfaction. Interventions to increase work engagement could assist nurses in better managing depression and improving their performance and life satisfaction.

Conclusions

Our study highlights the need for workplace policies and strategies that foster work engagement and self-efficacy among nurses while effectively managing job demands to prevent depression. Moreover, these findings underscore the importance of the JD-R theory to understand and improve nurses' job satisfaction and performance, and suggest areas for future research, including exploring other potential factors and applying these findings across different contexts and cultures.

Nurses' Risk Perception of Adverse Events and Its Influencing Factors: A Cross-Sectional Study

To investigate clinical nurses' perception of adverse event risk and to analyze its influencing factors. A proportional stratified random sampling method was applied to recruit nurses from a hospital in Shiyan City, Hubei Province, China. The Nursing Adverse Event Risk Perception Scale, Organizational Support Questionnaire, Nurse Manager Leadership Behavior Questionnaire, Nursing Safety Behavior Questionnaire, and Burnout scale was used to investigate 1084 nurses. Univariate analysis, Pearson correlation analysis, and multiple linear regression analysis were used to analyze the influencing factors. The scores of the Nurses' Risk Perception of Adverse Nursing Event Scale, Organizational Support Questionnaire, Nurse Manager Leadership Behavior Questionnaire, Nursing Safety Behavior Questionnaire, and Burnout Scale were 14.98 ± 5.39, 52.57 ± 10.00, 88.98 ± 21.08, 56.42 ± 5.03, 30.90 ± 21.49, respectively. According to the correlation analysis, nurses' perception of adverse nursing events was positively correlated with the sense of organizational support (r = .457, P < .01), head nurses' leadership behavior (r = .348, P < .01), and nurse safety behavior (r = .457, P < .01), and negatively correlated with the level of burnout (r = -.384, P < .01). According to the Regression analysis, nurses' departments (β = .226, P < .001), daily working hours (β = 1.122, P < .001), adverse events experience (β = -1.505, P < .001), organizational support (β = .105, P < .001), head nurses' leadership behavior (β = .072, P < .001), and burnout (β = -.052, P < .001) held an influence on nurses' risk perception of adverse nursing event. These factors explained 42.5% of the total variation. Nurses' risk perception of adverse nursing events needs to be improved. Nursing managers need to strengthen organizational support for nurses, change the leadership behavior of nurse managers, reduce nurses' burnout, improve nurses' risk perception of adverse nursing events, prevent adverse events, and ensure patient safety.

Fostering the Job Performance of Nurses: A Responsibility of an Ethical Hospital

Introduction

Corporate social responsibility (CSR) practices refer to the deliberate actions and strategies implemented by a company or organization to generate positive outcomes for its stakeholders beyond the sole objective of profit maximization. Internal CSR is a significant management and investment concept within enterprises, such as hospitals, that enhances organizational performance excellence.

Objectives

The article aims to trace how hospitals thrive in nurses' job performance by leveraging internal CSR practices.

Methods

Cross-sectional design quantitative research through structured questionnaire interviews on 215 nurses in Vietnam. Data collection was conducted from May 2023 to August 2023. Partial least squares structural equation modeling was applied to test the hypotheses.

Results

The study has proven that a hospital's internal CSR practices impact nurses' job performance. Income and benefits, human resource training and development, and work-related quality of life directly and significantly impact three dimensions of a nurse's job performance (competence to practice patient care, attitude to performance work, and management and professional development capacity). Connection and trust in the workplace and health and safety at work significantly affect two dimensions of a nurse's job performance (namely, competence to practice patient care and attitude to performance work). Diversity in the workplace impacts nurses' competence in practicing patient care and their management and professional development capacity. Demographic variables did not correlate statistically significantly with dimensions of internal CSR and nurses' job performance.

Conclusion

The study presents significant findings on the influence of internal CSR on nurses' job performance within the hospital management theory of an emerging market. The results of the present study contribute to a better understanding of the benefits of hospitals' socially responsible actions and contribute further to resource management in hospitals, especially nursing. If the nursing staff positively perceives the hospital's internal CSR practices, they will be more able to perform their job, impacting the hospital's overall performance. This study has certain limitations regarding the representative nature of the sample, the use of the self-report survey instrument, and the use of cross-sectional data.

Workplace discrimination and its relationship with organizational commitment among the surgical technologist: A national cross-sectional study in Iran

Background

Discrimination in healthcare centers can reduce care quality and job satisfaction, weaken the morale of the personnel and increase the cost of health care and finally lead to turnover intention. Discrimination in hospitals can affect the work outcomes and performance indicators of nurses such as their organizational commitment. Due to the vital role of surgical technologists in surgery and justice as the basis of effective performance, as well as the role of organizational commitment in care quality, the present study was conducted aimed to determine the level of workplace discrimination from viewpoint of the surgical technologists and its relationship with the organizational commitment.

Methods

This cross-sectional study was conducted on 615 surgical technologists in 8 metropolises of Iran in 2022. The sampling method in this study was multi-stage. The data collection tools included three questionnaires (demographic information, workplace discrimination, and Allen and Meyer's organizational commitment). Data were collected within 2 months and analyzed by SPSS version 22. Descriptive and inferential analyzes including independent t-test and analysis of variance were used for data analysis. p-value ≥ 0.05 was considered significant.

Results

The average age of the participants in the study were 29.90 ± 5.83 years with the participation of 464 women. The results of the data analysis showed an inverse and significant correlation between workplace discrimination and organizational commitment (r = -0.149, p-value < 0.001). The mean and standard deviation for workplace discrimination was 108.20 ± 11.53, which is average. Also, the mean and standard deviation for total organizational commitment was 100.56 ± 19.14, which is higher than the average.

Conclusion

According to the results of this study, managers need to pay attention to reduce discrimination in the operating room and establish organizational justice, to improve the motivation of surgical technologists and the quality of their performance. It is also suggested that operating room managers and supervisors, by creating a safe, confidential, and fearless environment to encourage the personnel to express what they understand about discriminatory conditions.

The relationship between work practice environment and work engagement among nurses: The multiple mediation of basic psychological needs and organizational commitment a cross-sectional survey

Background

Previous researchers have demonstrated that the work practice environment influences nurses' engagement; however, few studies have explored the mechanisms that explain the links between them.

Objectives

To examine whether basic psychological needs and organizational commitment mediate the relationship between the work practice environment and work engagement.

Methods

A cross-sectional survey was conducted with a sample of 893 nurses from 14 cities in Sichuan Province of China between November 2021 and December 2021. Data were collected online using the Chinese version of the Practice Environment Scale of the Nursing Work Index, Basic Needs Satisfaction in General Scale, Organizational Commitment Scale, and Utrecht Work Engagement Scale. The Pearson correlation analysis and multiple mediation model were used to analyze the data.

Results

The Pearson correlation analysis showed that work practice environment, basic psychological needs, and organizational commitment were positively associated with work engagement. The positive relationship between work practice environment and work engagement was mediated by basic psychological needs and organizational commitment [B = 0.505, SE = 0.032, 95% CI (0.442, 0.566)].

Conclusions

The study substantially contributes to the existing knowledge by revealing the mechanisms of fostering work engagement among nurses and explaining why the work practice environment influences work engagement.

Organizational commitment of emergency physician and its related factors: A national cross-sectional survey in China

Background

Organizational commitment is important for job performance and employee retention. However, studies on the level of organizational commitment and its related factors among emergency physicians in China are scarce. Therefore, this study aimed to identify the factors associated with organizational commitment among emergency physicians in China.

Methods

A national cross-sectional study was conducted in 2018 among emergency physicians in China. Data were collected from 10,457 emergency physicians using a standard structured anonymous questionnaire, including demographic characteristics, organizational structure factors and work environment factors. A generalized linear model was used to explore the correlation between the independent variables and organizational commitment.

Results

In this study, 55.3% of emergency physicians reported a moderate level of organizational commitment. The physicians who were male, younger than 40 years old, had a mid-level title and had a lower average monthly income were more likely to show lower organizational commitment levels. Conversely, the organizational commitment was higher among physicians who perceived that promotion is easy and the number of emergency physicians meet their daily work or had not experienced workplace violence in the last year.

Conclusions

The study showed that organizational commitment among Chinese emergency physicians was moderate and related to gender, age, monthly income, frequency of daily visits, departmental promotion mechanism and workplace violent. Targeted interventions are needed to improve the organizational commitment of emergency physicians in a comprehensive way.

Predictors of organizational commitment among Chinese nurses during the COVID-19 pandemic

AIM

To investigate organizational commitment among Chinese nurses and analyze factors influencing organizational commitment during COVID-19.

BACKGROUND

Organizational commitment is the most important link between nurses and the organization because it is effective in work retention and the motivation of nurses, especially when addressing the COVID-19 crisis. However, there has been no empirical study conducted to predict organizational commitment in the field of nursing by combining work values with professional practice environments.

METHODS

A cross-sectional predictive study was done with 362 nurses recruited from two tertiary hospitals in China. The Organizational Commitment Questionnaire, the Work Values Scale, and the Practice Environment Scale of the Nursing Work Index were used to collect data. Two factors related to the organizational commitment of nurses were investigated by using binary logistic regression analyses.

RESULTS

Increased work values and a professional practice environment were associated with an increased likelihood of higher organizational commitment.

DISCUSSION

The COVID-19 crisis became the utmost challenge to global healthcare systems and professional organizational commitment. Nurses' organizational commitment was directly influenced by the professional practice environment and work values, especially intrinsic work values, in which the spirit of collectivism was consequential. CONCLUSION AND IMPLICATIONS FOR THE FIELD OF NURSING AND HEALTH POLICY: Study results provide information for global hospital administrators to promote these organizational commitment predictive factors, including work values and a professional practice environment in nursing practice. This helped foster a stronger organizational commitment among nurses to reduce nurse resource flow during COVID-19.

Servant Leadership and Job Satisfaction and Organizational Commitment: Empirical Evidence from Surabaya Health Care Sector

Background: The concept of Servant Leadership has grown as a distinct management style with numerous applications in management research since its inception. It is likely one of the most successful styles for earnest management and for having a good attitude and concern for those around social organizations' well-being and quality of life. Quality human resources are essential to high commitment and satisfaction at work. Satisfy human resources who are committed will take care of the interests of the organization. Because of the practical nature of the problem among in the organization (Klinik Utama Usada Buana), Surabaya personnel, this research is expected to be conducted as an analytic study with a cross-sectional design. Methods: Therefore, data were collected using simple random sampling and then analyzed and interpreted to test the model. Result :The findings demonstrate that servant leadership styles can help people become more committed to their jobs and feel more satisfied. This model's practical and theoretical aspects have been discussed in the relevant sections of this article.

Burnout, Professional Self-Efficacy, and Life Satisfaction as Predictors of Job Performance in Health Care Workers: The Mediating Role of Work Engagement

Background:

It is essential to identify the factors that influence the work performance of health professionals working in health care facilities, especially in the context of the COVID-19 pandemic, since these factors have an impact on the quality of medical care provided to the population.

Objective:

This study aimed to analyze the mediating role of work engagement in the relationship between job burnout, professional self-efficacy, life satisfaction, and job performance in Peruvian health care workers.

Methods:

Cross-sectional explanatory study, with the voluntary participation of 508 health professionals (physicians and nurses) of both sexes (70.7% women, 29.3% men), and from different health facilities in the city of Lima. All participants were administered the Single Burnout Item questionnaire, the Professional Self-Efficacy Scale (AU-10), the Satisfaction with Life Scale (SWL), the Individual Work Performance Questionnaire (IWPQ), and the Utrecht Work Engagement Scale (UWES-9). Structural Equation Modeling (SEM) was used for data analysis.

Results:

In the SEM analysis, it was found that for the mediation model the incremental goodness-of-fit indices were significant (χ² = 2292.313, gl = 659, P < .001, χ²/gl = 2.788). Career self-efficacy (β = .557, P < .001) and life satisfaction (β = .289, P < .001) were positive predictors of work engagement. While burnout was a negative predictor (β = .878, P < .001). The consistent mediation of work engagement of professional self-efficacy, life satisfaction, and burnout had a positive predictor effect on job performance (β = .878, P < .001).

Conclusion:

Research provides evidence that professional self-efficacy, life satisfaction, and burnout could influence job performance through work engagement.

Relationships between perceived support types and the job satisfaction levels of nurses

PURPOSE

To identify the relationships between nurses' perceived support and their job satisfaction levels.

DESIGN AND METHODS

The sample of this descriptive and correlational study comprised 655 nurses working at a medical faculty hospital in Istanbul.

FINDINGS

A statistically significant positive relationship was detected between the total score means of nurses' job satisfaction and perceived administrative support (r = 0.275; p = .001; p < .01), perceived coworker support (r = 250; p = .001; p < .01) and perceived organizational support levels (r = 0.262; p = .001; p < .01). The linear regression model was found to be statistically significant (F = 24.625; p = .001; p < .01).

PRACTICE IMPLICATIONS

Training and corporate regulations (e.g., performance system involving promotion, reward, wages) for increasing nurses' perceptions for organizational support should be planned. Activities that increase nurses' perception of social support could also increase their job satisfaction.

Model of Organizational Commitment Applied to Health Management Systems

In this paper, we try to build on the problems surrounding the management of human resources in health care organizations worldwide. After the analysis of the reviewed literature, we detected that the scientific community considers several recurring themes that need attention: stress, burnout, and turnover intention. Based on this, we developed a model of organizational commitment that aims to achieve performance and health quality, its main result the establishment of the appropriate management policies in order to avoid the abandonment of the organization through the search for commitment and job satisfaction. Amongst our main conclusions, we highlight the need to implement a human resources model for hospital administrators based on the relationships with "patients" not "clients" through the maintenance of a positive and strong atmosphere of staff participation. It is important to develop innovative practices related to clear job design that eliminate reasons for ambiguity and stress in executing the tasks of the healthcare system. Finally, we urge training programs in transformational leadership to promote the well-being and organizational commitment of employees.

Exploring factors influencing the retention of nurses in a religious hospital in Taiwan: a cross-sectional quantitative study

Background

Long-term deficits in the nursing labor force and high turnover rates are common in the Taiwanese medical industry. Little research has investigated the psychological factors associated with the retention of nursing staff. However, in practice, religious hospitals often provide nursing staff with education in medicine or the medical humanities to enhance their psychological satisfaction. The objective of this study was to explore factors influencing nursing staff retention in their work in relation to different levels of needs. A further objective was to investigate whether medical humanities education was associated with the retention of nursing staff.

Methods

This study used self-administrated questionnaires to survey nurses working in northern areas of Taiwan. The questionnaire design was based on the six levels of Maslow’s hierarchy of needs. Participation was voluntary, and the participants signed informed consent documents. Self-administrated questionnaires were distributed to a total of 759 participants, and 729 questionnaires were returned (response rate 96.04%). Logistic regression analysis was used to estimate the impact of seniority on nurses’ reported intention to stay after adjustment for nurse characteristics (gender and age).

Results

In the Pearson correlation analysis, nurses’ willingness to stay was moderately correlated with “physical needs”, “safety needs”, “love and belonging needs”, and “esteem needs” (r = 0.559, P < 0.001; r = 0.533, P < 0.001; r = 0.393, P < 0.001; and r = 0.476, P < 0.001, respectively). Furthermore, nurses’ willingness to stay was highly correlated with “self-actualization needs”, “beyond self-actualization needs” and “medical humanities education-relevant needs” (r = 0.707, P < 0.001; r = 0.728, P < 0.001; and r = 0.678, P < 0.001, respectively). We found that the odds ratios (ORs) of retention of nursing staff with less than 1 year (OR = 4.511, P = 0.002) or 1–3 years (OR = 3.248, P = 0.003) of work experience were significantly higher than that of those with 5–10 years of work experience.

Conclusions

With regard to medical humanities education, we recommend adjusting training, as the compulsory activities included in the official programs are inadequate, and adjusting the number of required hours of medical humanities education. Tailoring different educational programs to different groups (especially nurses who have worked 3–5 years or 5–10 years in the case study hospital) might improve acceptance by nursing staff.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00558-7.

Self-realisation-What does this mean for school nurses to remain in nursing practice?

AIMS AND OBJECTIVES

To describe and interpret what it means for school nurses to realise themselves so that they remain in nursing practice.

BACKGROUND

Self-realisation seems to influence on nurses remaining in nursing practice. School nurses report aspects (i.e. autonomy and professional development) which can be linked to self-realisation as important for themselves, but few studies describe what it means for school nurses to realise themselves so that they remain in practice.

DESIGN AND METHOD

This study used a qualitative design, conducting two individual in-depth interviews with 15 school nurses. The interviews were analysed with a phenomenological hermeneutic method. The COREQ checklist has been used in reporting this study.

RESULTS

The following themes were emerged: (a) being attentive to yourself, (b) acting true to yourself and (c) making independent choices.

CONCLUSION

This study offers insight into what it means for school nurses to realise themselves so that they remain in nursing practice, that is to practise their originality and take a stand for what they consider important. Self-realisation was embedded within nursing practice and consequently seems to impact on nurses remaining in practice.

RELEVANCE TO CLINICAL PRACTICE

Nurses who practise their originality and take a stand for what they identify as important realise self. This implies being themselves and practising nursing in a way they find relevant. Nursing leaders who encourage nurses to articulate what this entails facilitate their self-realisation. A clinical practice where nurses can be attentive and act true to themselves, and have opportunities to make independent choices, will be a practice where nurses can realise self. We suggest that clinical practice which emphasises opportunities for nurses' self-realisation may facilitate their remaining in practice.

The organisational context of nursing practice in hospitals in China and its relationship with quality of care, and patient and nurse outcomes: A mixed-methods review

BACKGROUND

Achieving high-quality care and retention of nurses are major concerns for nurse leaders in hospitals. The organisational context is theorised to influence the quality of care and patient and nurse outcomes. This review focuses on China where the healthcare system is different from most Western countries in terms of government healthcare expenditure, public health insurance and healthcare delivery system.

OBJECTIVES

To explore the organisational context of nursing practice in hospitals in China and its relationship with quality of care, patient outcomes (patient adverse events, safety and satisfaction) and nurse outcomes (burnout, job satisfaction and intention to leave).

DESIGN

A mixed-methods review.

DATA SOURCES

The electronic databases PubMed, EMBASE, CINAHL, PsycINFO and China Academic Journals Database were used.

METHODS

This review was conducted using the SALSA (Search, Appraisal, Synthesis and Analysis) framework. Quality assessment was conducted using the Joanna Briggs Institute (JBI) critical appraisal checklists for cross-sectional studies and qualitative research. A narrative synthesis was conducted and was supported by tabulation of study data. The PRISMA guidelines were used for this review.

RESULTS

Twenty-three articles met the inclusion criteria and were retrieved, analysed and synthesised. This review supports the link between organisational context, quality of care, and patient and nurse outcomes in the Chinese healthcare system. Aspects of organisational context warrant attention including nurse staffing levels, the shortage of nurses, a lack of nurse participation in hospital affairs and support for the professional development of nurses.

CONCLUSIONS

The findings suggest that tailored interventions are needed to improve the organisational context of nursing practice in Chinese hospitals and, in particular, to address the nurse workforce issues and organisational leadership and support. The unique policy context of the Chinese healthcare system should be considered when developing these interventions.

RELEVANCE TO CLINICAL PRACTICE

Recognising the importance of the organisational context, it is imperative that nurse leaders make every effort to legislate for safe nurse staffing and to establish a caring culture to improve quality of care and nurse and patient outcomes.

Continuing medical education and work commitment among rural healthcare workers: a cross-sectional study in 11 western provinces in China

OBJECTIVES

Continuing medical education (CME) and work commitment are important for rural healthcare workers (RHWs) and rural medical work. The significant association between continuing education and work commitment has been reported in many studies from several different industries. However, very few studies have analysed the association of CME with work commitment among healthcare workers, let alone among RHWs. This study aimed to identify the significance of CME for the work commitment of RHWs (doctors and nurses) in China.

DESIGN AND SETTING

The cross-sectional study interviewed RHWs from 11 western provinces in China.

PARTICIPANTS

In total, 4118 RHWs, consisting of 2490 doctors and 1628 nurses who were working clinically, were included in the study.

PRIMARY OUTCOME MEASURES

Work commitment (ie, the relative importance of work to one's sense of self) focussing on the affective component was the dependent variable, and it included four subdomains: pride, concern, and dedication, extracted by exploratory factor analysis of a 5-point Likert scale, and turnover intent, measured by a dichotomous question. CME (ie, a variety of educational and training activities to maintain, develop or increase knowledge, skills and professional performance and relationships) was the independent variable, including three subdomains: opportunity, participation and expectation, measured by three dichotomous questions.

RESULTS

Of the 4118 respondents, 91.2% reported insufficient opportunities for CME, 21.3% had never participated in CME and 83.3% had a high expectation of CME. The mean scores of pride in, concern for and dedication to work were 3.54, 3.81 and 3.61 (out of a maximum of 5), respectively, and 30.6% presented turnover intent. After adjusting for gender, age, marriage, education, technical title, income and type of rural healthcare organisation, the multivariate analyses suggested that there was a significant positive association between CME and work commitment among RHWs. RHWs who had a significant high-level work commitment were those who reported a sufficient opportunity for CME (β and 95% CI for pride in, concern for and dedication to work: 0.33, 0.23 to 0.43; 0.19, 0.09 to 0.28; and 0.25, 0.15 to 0.35), had participated in CME (β and 95% CI for pride in, concern for and dedication to work: 0.11, 0.04 to 0.19; 0.09, 0.02 to 0.15; and 0.10, 0.03 to 0.17) and had a high expectation of CME (β and 95% CI for pride in, concern for and dedication to work: 0.22, 0.15 to 0.30; 0.21, 0.13 to 0.28; and 0.28, 0.20 to 0.36), and having sufficient opportunities for CME significantly increased the odds of having no turnover intent (OR and 95% CI: 1.70, 1.26 to 2.28). Age, marriage, education, technical title, income and type of rural healthcare organisation were significantly associated with the work commitment of RHWs. Differences were observed between rural doctors and nurses in the association of CME with work commitment.

CONCLUSIONS

CME has a significant positive association with the work commitment of RHWs in China. RHWs' work commitment should be further improved in future rural health workforce management. In addition, governments, healthcare organisations and professional associations should establish a professional and complete CME system in China to provide sufficient opportunities for CME for RHWs, encourage them to participate and meet their expectations.