The effects of job characteristics, organizational justice and work engagement on nursing care quality in China: A mediated effects analysis

Assessing the mediating role of organizational justice between the responsible leadership and employee turnover intention in health-care sector

PURPOSE

The aim of this study is to investigate the extent to which organizational justice (OJ) mediates between responsible leadership (RL) and employee turnover intention (TI).

DESIGN/METHODOLOGY/APPROACH

Both online and offline questionnaire was used to collect the data from 387 Indian health-care employees, and the data were analyzed using partial least squares structural equation modeling (PLS-SEM) with the help of SmartPLS 4.

FINDINGS

The study's findings demonstrated a significant positive association between RL and OJ and a negative association between OJ and employee TI. Furthermore, results also confirmed the mediating role of OJ between RI and TI.

RESEARCH LIMITATIONS/IMPLICATIONS

The generalizability of the study's data collection is limited because it is based on the responses of Indian health-care sector employees to an online and offline survey. The authors propose that the health-care sector uses RL as an approach that takes a broad view of the parties with a stake and focuses on creating fairness in acts and justice at the workplace to address the major issue of employee turnover.

ORIGINALITY/VALUE

This study expanded on previous research by demonstrating that the influence of responsible leadership on employee TI is mediated by OJ in the context of India's health-care sector. It also contributes to the literature regarding RI, OJ and TI. The study also enriched the body of knowledge about using the PLS-SEM approach to predict employee TI.

Updating Factors Influencing Nurse Work Engagement in the Hospital Settings: A Systematic Review

Background

Understanding the factors influencing work engagement among nurses is crucial for ensuring high-quality care and positive patient outcomes. Despite numerous factors associated with nurse work engagement, many were explored before the pandemic, potentially overlooking aspects relevant to the current context.

Aim

To explore and update factors related to nurse work engagement in the new normal era.

Design

Systematic review.

Data Sources

The search was restricted to articles published from 2019 to 2024 in CINAHL, PubMed, Scopus, ScienceDirect, Web of Science, and ProQuest, with full English text. The search was conducted from September 13th to 15th, 2023. Quantitative research articles that examined factors related to work engagement were included.

Review Methods

Data extraction, quality appraisal, and data analysis were performed in all included studies. Manual content analysis method was used to classify and group the factors.

Results

Sixty-one research articles were included in the final review. Five key groups of factors were generated from content analysis, including 1) individual-related factors, 2) organizational-related factors, 3) job and role-related factors, 4) work-life balance, and 5) work environment.

Conclusion

Understanding and addressing these multifaceted factors holistically is essential to develop strategies to sustain optimal engagement levels among nursing staff and improve overall patient care outcomes. Further studies are needed to confirm the findings.

The Effect of Holistic Nursing Competence on Work Engagement, Self-Reflection and Insight in Nurses

This study aimed to examine the effects of holistic nursing competence on work engagement, self-reflection and insight in nurses. This descriptive and cross-sectional study was conducted with 309 nurses working in Turkey. Data were collected using the "Descriptive Information Form", "Holistic Nursing Competence Scale (HNCS)", "Utrecht Work Engagement Scale (UWES)", and "Self-Reflection and Insight Scale (SRIS)". Pearson correlation analysis and multiple linear regression analysis were used to analyze the data. We found that the HNCS had a moderate positive relationship (r = 0.411, p < 0.05) with the UWES, and a weak positive relationship (r = 0.324, p < 0.05) with the SRIS. In the model established by multiple regression analysis, the effect of the HNCS, age, marital status, position, and performing the profession willingly on work engagement explained 33.7% of the variance. In another established model, the effect of the HNCS, gender, and having children on self-reflection and insight explained 11.5% of the variance. Our findings revealed the effect of holistic competence on nurses' positive attitudes about their work engagement and self-reflection in practice. We recommended developing awareness-based programs for nurses to increase their holistic nursing competence.

Associations among leadership, resources, and nurses' work engagement: findings from the fifth korean Working Conditions Survey

BACKGROUND

Nurses' work engagement has received extensive attention due to its positive impacts on individual and organizational outcomes, including patient safety and quality care in healthcare organizations. Although nurse managers' leadership and a variety of resources have been identified as important factors of nurses' work engagement, these relationships have not been well understood in Korean nursing contexts. The purpose of this study was to examine the associations among nurse managers' leadership, resources, and work engagement among Korean nurses after controlling for nurses' demographic and work-related characteristics.

METHODS

This is a cross-sectional study using data from the fifth Korean Working Conditions Survey. Using a sample of 477 registered nurses, we employed hierarchical linear regression analyses. Nurse managers' leadership, job resources (organizational justice and support from peers), professional resources (employee involvement), and personal resources (meaning of work) were examined as potential predictors of nurses' work engagement.

RESULTS

We found that nurse managers' leadership (β = 0.26, 95% confidence interval [CI] = 0.17-0.41) was the strongest predictor of nurses' work engagement, followed by meaning of work (β = 0.20, 95% CI = 0.07-0.18), organizational justice (β = 0.19, 95% CI = 0.10-0.32), and support from peers (β = 0.14, 95% CI = 0.04-0.23). Employee involvement was not a statistically significant predictor of nurses' work engagement (β = -0.07, 95% CI = -0.11-0.01).

CONCLUSIONS

Our findings suggest that comprehensive approaches are required to promote nurses' work engagement. Considering that nurse managers' leadership was the strongest predictor of nurses' work engagement, nurse managers should demonstrate supportive leadership behaviors such as acknowledging and praising their unit nurses' work performance. Furthermore, both individual- and organizational-level strategies are necessary for nurses to be engaged at work.

The impact of organizational justice on psychological distress among Chinese public hospitals nurses: A cross-sectional study

Few studies have explored the association between organizational justice and mental health, particularly in collectivist countries. Hence, the aim of the present study was to evaluate the impact of organizational justice on psychological distress and to discuss the findings in collectivist culture. A cross-sectional survey was conducted among nurses from public hospitals in western of China, July 2022, which followed the STROBE guidelines. This study used Chinese versions of the Organizational Justice Scale and Kesseler Psychological Distress Scale to assess the perceptions of organizational justice and mental health levels, respectively. A total of 663 nurses completed the questionnaires. The psychological distress of university-educated and low-income nurses was poor. There was a moderately positive relationship between organizational justice and psychological distress (R = 0.508, P < .01), indicating that the greater level of organizational injustice, the poorer mental health. Hierarchical regression analysis showed that organizational justice was an strong predictor of psychological distress, accounting for approximately 20.5% of the psychological distress. The findings of this study highlight the importance of interpersonal injustice and distributive injustice on psychological distress specific in Chinese culture, suggesting that nursing management or leaders should notice that the most being taken seriously by nurses is their recognition and respect for subordinate, meanwhile, alerting nurses, in some sense, a negative relationship with leaders as a kind of workplace bullying could harm their mental health. The promulgation of organizational justice policy to protect employees from the government and the real role of employee labor union organizations are urgently needed.

Nurses' work engagement: The influences of ambidextrous leadership, clinical nurse leadership and workload

AIM

To test the relationships among staff nurses' work engagement, nurse managers' ambidextrous leadership and staff nurses' clinical leadership and workload.

DESIGN

A multicentre cross-sectional survey design was used.

METHODS

The study was conducted in eight medical centres from six representative provinces of China in October 2019. The participants completed electronic questionnaires that measured ambidextrous leadership, clinical nurse leadership, workload and work engagement. We used structural equation modelling to test a hypothetical model.

RESULTS

The hypothetical model had a good fit to the actual data. Ambidextrous leadership was positively associated with clinical nurse leadership and work engagement, and clinical nurse leadership had a significant positive relationship with work engagement, which partially mediated the path from ambidextrous leadership to work engagement. In addition, workload moderated the relationship between ambidextrous leadership and clinical nurse leadership.

CONCLUSION

This study makes a timely contribution to the nursing literature by demonstrating that nurse managers' ambidextrous leadership and clinical nurse leadership are important determinants of work engagement. Improving the level of ambidextrous leadership and clinical nurse leadership helps to enhance work engagement.

IMPACT

This study provides a new strategy to increase nurses' work engagement from a new perspective of nursing leadership. Enhancing nurse managers' ambidextrous leadership and clinical nurse leadership can increase work engagement. Nurse managers should value the role of ambidextrous leadership and clinical nurse leadership in promoting work engagement, especially when nurses perceive they have a low workload.

Personal and Job-Related Factors Influencing the Work Engagement of Hospital Nurses: A Cross-Sectional Study from Saudi Arabia

This study explored the levels of work engagement and identified whether personal and job-related factors influenced the work engagement dimensions of vigor, dedication, and absorption of nurses working in a Saudi hospital. A descriptive, cross-sectional correlational survey of nurses in inpatient wards (general medical, surgical, and specialized wards) and critical care units in a tertiary hospital in Saudi Arabia, using The Utrecht Work Engagement Scale. Using a self-report questionnaire, 426 staff nurses and 34 first-line nurse managers were surveyed. Data collected consisted of selected personal and professional factors, including gender, age, education, current work setting, years of experience, nationality, and participation in committees, and/or work teams alongside the 17-item version of the UWES. The study participants showed high levels of work engagement. Age, years of experience, and participation in committees were significantly associated with work engagement. Nurses who were older, possessed more experience, and participated in committees showed higher levels of engagement. Healthcare organizations and their leaders, policymakers, and strategic planners should create a conducive work environment that supports the work engagement of nurses by considering the influencing antecedents. The nursing profession, patients' safety issues, and vital economic problems are the fundamental issues facilitated by the creation of practice environments that entirely engage nurses in their work.

Antecedents and Outcomes of Work Engagement among Psychiatric Nurses in Japan

While previous studies have examined antecedents and outcomes of work engagement among general nurses, studies among psychiatric nurses remain limited. This study aimed to explore the antecedents (i.e., job crafting and nursing practice environment) and outcomes (i.e., strength-oriented care attitudes, mental health, and turnover intention) of work engagement among psychiatric nurses in Japan. This cross-sectional study included 309 nurses from three psychiatric hospitals in Japan (valid response rate: 60.4%). Data collection using the self-administered questionnaire took place from July to August 2021. We performed Structural Equation Modeling to examine the directional relationships among variables. Job crafting (β = 0.57, p < 0.01) and nursing practice environment (β = 0.23, p = 0.01) exhibited positive effects on work engagement. Work engagement had positive effects on strength-oriented care attitudes (β = 0.15, p = 0.04) and mental health (β = 0.37, p < 0.01) as well as negative effects on intention to resign from their profession as a nurse (β = -0.17, p = 0.01). Job crafting and a healthier nursing practice environment could help enhance work engagement. Higher work engagement could contribute to improving strength-oriented care attitudes, mental health, and intention to resign from their profession as a nurse.

The relationships between organizational culture and thriving at work among nurses: The mediating role of affective commitment and work engagement

AIM

Guided by the social embeddedness model of thriving at work, this paper explores how nursing organizational culture, work engagement and affective commitment affect nurses' thriving at work.

BACKGROUND

Thriving at work has implications for better employee and organization outcomes. The antecedents of thriving at work among the nursing population needs to be expanded by analysing the cross-level impact of organizational and individual characteristics.

METHODS

A cross-sectional design was used to collect data from 1437 frontline nurses in a tertiary teaching hospital in China between April and May 2020 through an online survey about perceived nursing culture, work engagement, affective commitment and thriving at work. Data were analysed using SPSS, and a structural equation model was established using the PROCESS macro.

RESULTS

Our results showed that work engagement and affective commitment mediated the relationship between nurses' perceived nursing culture and their thriving at work. Among nurses, work engagement was positively correlated to affective commitment.

CONCLUSION

Our study confirmed the social embeddedness model of thriving at work by showing that both contextual and dispositional factors can influence nurses' thriving at work. Nurse leaders can foster nursing staff's thriving at work by building an inclusive work environment and by providing adequate resources to staff. Future research is needed to elaborate on employee and organizational outcomes associated with thriving at work.

IMPACT

Nurse leaders should be the advocate for nurses to improve their organizational identification, fostering their thriving at work. Individual nurses can also take an active role in developing work-related resources to sustain their thriving through self-adaption processes. Collective thriving in the nursing workforce is needed to overcome adversity and hardship in the ever-changing and increasingly demanding health care industry and to further contribute to the vitality of the broader social and public environments.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. This study did not involve patients, service users, caregivers or members of the public.

Working Conditions Among Chinese Nurses Employed in Japan: A Cross-Sectional Survey-Based Study

Introduction

Although the number of Chinese nurses employed in Japan is increasing, the situation regarding their work conditions has not been clarified. It is necessary to understand such conditions to consider support for Chinese nurses in Japan.

Objective

This study examined the professional nursing practice environment, occupational career, and work engagement of Chinese nurses in Japan.

Methods

Using a cross-sectional study design, 640 paper questionnaires were mailed to 58 Japanese hospitals that employed Chinese nurses and included a QR code for online responses. A survey request form and URL were sent to the Wechat app, where Chinese nurses in Japan communicate. The contents include attribute-related questions, the Practice Environment Scale of the Nursing Work Index (PES-NWI), Occupational Career Scale, and Utrecht Work Engagement Scale. Either Wilcoxon's rank-sum or the Kruskal-Wallis test was performed to compare scores of the study variables between subgroups.

Results

A total of 199 valid responses were obtained, of which 92.5% were female, and 69.3% had a university degree or higher. The PES-NWI score was 2.74, and the work engagement score was 3.10. The group with a university degree or higher had significantly lower scores on PES-NWI and work engagement than those with diplomas. Regarding the subscale of occupational career, scores of forming and coordinating interpersonal relationships, self-development, and accumulating a variety of experience were 3.80, 2.58, and 2.71, respectively. The scores were significantly higher with more than 6 years of nursing experience in Japan than those with 0-3 years or 3-6 years.

Conclusion

Most participants had university degrees or higher, and their scores of PES-NWI and work engagement tended to be lower than those with diploma degrees. Participants showed low self-ratings in self-development and lacked a variety of experience. Understanding Chinese nurses' work conditions in Japan enables hospital administrators to develop measures for continuing education and support.

The Impact of Quality of Work Organization on Distress and Absenteeism among Healthcare Workers

The quality of work organization may be responsible not only for reduced productivity but also for an increased risk of mental and physical disorders. This study was aimed at testing this hypothesis. Workers of a local health unit in Italy were asked to fill out the Work Organization Assessment Questionnaire (WOAQ) during their periodic medical examinations in the second half of 2018. On the same occasion, they also completed the Demand/Control/Support (DCS) measure of job strain, the Effort/Reward Imbalance (ERI) questionnaire, and the General Health Questionnaire (GHQ12) to assess psychological health. A total of 345 workers (85.8%) completed the survey. Linear regression analysis showed that the quality of work organization was inversely proportional to psychological health problems (p < 0.001). Occupational stress, measured both by job strain and ERI, was a moderating factor in this relationship. The relationship between the WOAQ and psychological health, moderated by job strain or ERI, remained highly significant even after adjustment for sex, age, social support, and overcommitment. Regression models explained over 40% of the shared variance of the association between quality of work organization and psychological health. The quality of work organization significantly predicted the risk of sickness absence for musculoskeletal disorders (OR = 0.984, CI95% 0.972-0.996) and for other health problems (OR = 0.977, CI95% 0.967-0.988). A continuous improvement of work organization must consider not only the clients' or production needs but also the well-being of workers.

Exploring the Impact of Employee Engagement and Patient Safety

Background

Health service administrators are continually investigating new ways to improve the safety and quality of health services. A positive and powerful relationship between employee engagement and patient safety has been suggested in the research literature, and steps can be taken by employers to enhance engagement to improve the safety of health services, particularly considering the coronavirus disease 2019 (COVID-19) pandemic.

Objective

The aim of this review was to explore the current literature on the impact of employee engagement on patient safety.

Methods

A review of peer-reviewed literature relating to the impact of employee engagement on patient safety within health services between January 2015 and May 2021 was conducted using Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline Complete, Scopus, Health Business Elite and Business Source Ultimate databases. A search of grey literature using the Bielefeld Academic Search Engine database was also completed.

Results

Of relevant articles, 3693 were identified, of which 15 studies were included in this review. Ten articles measured employee engagement using existing, validated tools, whereas patient safety was most frequently assessed through surveys seeking staff member’s perceptions of safety or the quality of care they provide. Overall, there appeared to be a positive correlation between employee engagement and patient safety, but the strength of the relationship varied.

Conclusion

Anecdotal accounts of improving employee engagement and improving patient safety abound, and the evidence reviewed appears in agreement. However, research into the impact of employee engagement on patient safety is in its early stages. As health service managers consider the best use of funding to support safe and high-quality care, evidence to support the positive impact employee engagement has on patient safety may be useful in managing the fallout from the COVID-19 pandemic.

Work Engagement and Patient Quality of Care: A Meta-Analysis and Systematic Review

Past research has demonstrated that work engagement among health care professionals influences patient quality of care. There is, however, no estimate of the strength of this relationship, and existing reviews have not always explained conflicting findings. We conduct a meta-analysis and review of 25 articles, and find a small to medium mean effect size (r = .26, p < .01) for the positive association between engagement and quality of care. Moderator analyses on five factors (type, data source, level of analysis of the quality of care measure, profession, and work engagement measure) indicate that only data source is significant, providing preliminary evidence that the relationship is stronger if quality of care is measured via self-assessments. Although a more consistent conceptualization of quality of care is needed to better determine its association with work engagement, our findings suggest that work engagement is as important as burnout in predicting quality of care.

Insecure Employment Contracts during the COVID-19 Pandemic and the Need for Participation in Policy Making

Job security influences the ability of nurses to provide high-quality nursing care. The Iranian health system has always faced nursing shortages, and the COVID-19 pandemic has worsened this situation. Although nurses have been labelled 'heroes' across the globe, many of them have been hired using insecure employment contracts. This commentary aims to describe issues surrounding job contracts for Iranian nurses during the COVID-19 pandemic and discusses how the current situation can be improved. Iranian nurses are at the frontline of the fight against COVID-19 and need to receive better support in terms of job security and dignity. They should participate more in policymaking activities to improve their job condition and prevent the development and implementation of the short-term and insecure job contracts that lead to job insecurity.

Mediating effect of work engagement between job characteristics and nursing performance among general hospital nurses

Objective

This study aimed to determine the effects of job characteristics and work engagement on the nursing performance of nurses working in general hospitals.

Methods

Data were collected from 169 nurses who are working in a general hospital in South Korea by using a cross-sectional descriptive survey design.

Results

Nurses’ job characteristics and work engagement showed positive effects on nursing performance. This effect was magnified when work engagement was used as a mediating variable.

Conclusions

The findings elucidate the factors influencing job performance and provide managers with important information for developing programs to improve the job skills and work engagement of nurses.

Impact of Job Engagement on the Quality of Nursing Services: The Effect of Person-Centered Nursing in South Korean Nurses

Nurses' job engagement could help improve the quality of nursing services, and person-centered nursing is expected to play an important role in this relationship. However, little is known about the role of person-centered nursing in the association between job engagement and quality of nursing services. This study examines the moderating and mediating effects of person-centered nursing on the relationship between the job engagement and the quality of nursing services in Korean nurses. In October 2020, 200 hospital nurses were surveyed at three university hospitals. The moderating and mediating effects of person-centered nursing were determined using hierarchical regression analysis. There was a significant positive correlation between job engagement, person-centered nursing, and quality of nursing services. Person-centered nursing was found to have a mediating and moderating role in the relationship between job engagement and quality of nursing service. In conclusion, in the impact of job engagement on the quality of nursing service, it plays a buffering role, and the job engagement of nurses improves the quality of nursing services through improvement of person-centered nursing. Therefore, this study recommends the development and implementation of an educational program to foster person-centered nursing in order to improve the quality of nursing services.

Explaining Organizational Citizenship Behavior Among Chinese Nurses Combating COVID-19

Background

Little is known about the associated factors with organizational citizenship behavior among Chinese nurses combating COVID-19. The aim of the present study was to investigate the relationships between autonomy, optimism, role conflict, work engagement, and organizational citizenship behavior based on moderated mediation models among Chinese nurses combating COVID-19.

Methods

This cross-sectional study was performed on a sample of 368 nurses supporting the COVID-19 epidemic in Wuhan Leishenshan Hospital, China. According to the Job Demands-Resources model, two moderated mediation models were tested, in which autonomy/optimism was associated with organizational citizenship behavior through work engagement, when role conflict served as a moderator.

Results

This current study found the mediating effect of work engagement and the moderating effect of role conflict on the relationship between autonomy/optimism and organizational citizenship behavior among nurses. Of note, nurses working in the COVID-19 epidemic viewed role conflict as challenge job demands rather than hindrance job demands.

Conclusion

Based on the findings, organizational citizenship behavior can be affected by work engagement and role conflict. Nursing management is suggested to put emphasis on work engagement and role conflict among nurses supporting the COVID-19 epidemic.

Effects of self-rated workload and nurse staffing on work engagement among nurses: A cross-sectional survey

AIM

To analyse net effects of self-rated workload and nurse staffing (nurse-to-patient ratio and staff skill mix) on work engagement among clinical nurses.

BACKGROUND

Improving nurses' engagement is necessary to enhance patient outcomes, so factors that influence engagement should be explored.

METHODS

A cross-sectional study was conducted in 1,428 registered nurses from 145 units of 11 hospitals. A hierarchical linear model was used to analyse the data.

RESULTS

Self-rated workload had a negative effect on engagement (β = -0.353, p < .001, effect size (f² ) = 14.20%), while only one index of skill mix (percentage of nurses with ≤ 5 work years) had a significant effect on engagement, which was positive (β = 0.258, p < .05, f²  = 8.50%). These two variables explained 22.7% of the variance of engagement at the unit level (R² _between  = 22.7%, p < .05). No significant effect of staffing on self-rated workload was found.

CONCLUSIONS

Self-rated workload had more effect on engagement than did staffing, and factors that influence self-rated workload need to be explored.

IMPLICATIONS FOR NURSING MANAGEMENT

Balancing the mix of experience levels in nursing teams may improve work engagement. Managers should pay attention to multiple strategies to motivate nurses to engage in work in clinical practice.

The relationship between autonomy, optimism, work engagement and organisational citizenship behaviour among nurses fighting COVID-19 in Wuhan: a serial multiple mediation

OBJECTIVES

High levels of organisational citizenship behaviour can enable nurses to cooperate with coworkers effectively to provide a high quality of nursing care during the outbreak of COVID-19. However, the association between autonomy, optimism, work engagement and organisational citizenship behaviour remains largely unexplored. This study aimed to test if the effect of autonomy on organisational citizenship behaviour through the mediating effects of optimism and work engagement.

STUDY DESIGN

This was a cross-sectional study.

SETTING

The study was conducted in the Wuhan Jinyintan Hospital in China.

PARTICIPANTS

In total, 242 nurses who came from multiple areas of China to work at the Wuhan Jinyintan hospital during the COVID-19 epidemic participated in this study.

METHODS

A serial mediation model (model 6) of the PROCESS macro in SPSS was adopted to test the hypotheses, and a 95% CI for the indirect effects was constructed by using Bootstrapping.

RESULTS

The autonomy-organisational citizenship behaviour relationship was mediated by optimism and work engagement, respectively. In addition, optimism and work engagement mediated this relationship serially.

CONCLUSION

The findings of this study may have implications for improving organisational citizenship behaviour. The effects of optimism and work engagement suggest a potential mechanism of action for the autonomy-organisational citizenship behaviour linkage. A multifaceted intervention targeting organisational citizenship behaviour through optimism and work engagement may help improve the quality of nursing care among nurses supporting patients with COVID-19.