دانلود رایگان مقاله انگلیسی تاثیر دیفرانسیلی عوامل فردی و سازمانی بر تعهد سازمانی پزشکان و پرستاران - اشپرینگر 2018

Abstract

Background: Physician and nursing shortages in acute and critical care settings require research on factors which might drive their commitment, an important predictor of absenteeism and turnover. However, the degree to which the commitment of a physician or a nurse is driven by individual or organizational characteristics in hospitals remains unclear. In addition, there is a need for a greater understanding of how antecedent-commitment relationships differ between both occupational groups. Based on recent findings in the literature and the results of a pilot study, we investigate the degree to which selected individual and organizational characteristics might enhance an employee’s affective commitment working in the field of neonatal intensive care. Moreover, our aim is to examine the different antecedent-commitment relationships across the occupational groups of nurses and physicians. Methods: Information about individual factors affecting organizational commitment was derived from selfadministered staff questionnaires, while additional information about organizational structures was taken from hospital quality reports and a self-administered survey completed by hospital department heads. Overall, 1486 nurses and 540 physicians from 66 Neonatal Intensive Care Units participated in the study. We used multilevel modeling to account for different levels of analysis. Results: Although organizational characteristics can explain differences in an employee’s commitment, the differences can be largely explained by his or her individual characteristics and work experiences. Regarding occupational differences, individual support by leaders and colleagues was shown to influence organizational commitment more strongly in the physicians’ group. In contrast, the degree of autonomy in the units and perceived quality of care had a larger impact on the nurses’ organizational commitment. Conclusions: With the growing number of hospitals facing an acute shortage of highly-skilled labor, effective strategies on the individual and organizational levels have to be considered to enhance an employee’s commitment to his or her organization. Regarding occupational differences in antecedent-commitment relationships, more specific management actions should be undertaken to correspond to different needs and aspirations of nurses and physicians.

Conclusions

In accordance with findings of previous investigations [28], our study emphasizes the importance of examining factors driving an individual’s commitment, not only at the individual level, but also at unit level. Future studies should acknowledge the need to investigate drivers of commitment on different levels of analysis. In our study, however, we did not consider whether different factors might be associated with different aspects of affective commitment. The latest results of a study among nurses [57] emphasized the need to consider affective commitment in a more nuanced view. Hence, future studies might use, e.g., the Workplace Affective Commitment Multidimensional Questionnaire (WACMQ) [58], to investigate which targets of affective commitment might be influenced. In addition, this study extends our understanding of factors associated with organizational commitment with regard to the underlying occupational group. Our findings reveal that factors significantly associated with an individual’s organizational commitment differ between physicians and nurses. We recognize the urgent need to link the literature on the sociology of professions or the more focused literature on occupational differences in antecedent-commitment relationships to health care settings. In our study, we explicitly refrained from hypothesizing which factors might be more important for which occupational group, due to the lack of theoretical foundations. Further research is required to connect our conceptual model more closely to theoretical development.

In conclusion, our results indicate that more specific management actions corresponding to the different needs of physicians and nurses could be undertaken in order to improve employee commitment and, in the long run, reduce turnover intentions and improve patient safety [16]. This is particularly important in intensive healthcare settings with critically ill patients and highly specialized professionals, who are difficult – and often costly – to replace.