Evaluation of On-Job Training in a Ward: Nurses Job Satisfaction and Professional Commitment

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1 Evaluation of On-Job Training in a Ward: Nurses Job Satisfaction and Professional Commitment LI-SE YANG, YA-WEN CHOU Department of Nursing En Chu Kong Hospital No.399, Fuxing Rd., Sanxia District, New Taipei City 237, Taiwan, R.O.C @km.eck.org.tw, 11716@km.eck.org.tw PEI-LIN HSU Department of Elderly Care Oriental Institute of Technology No. 58, Sec. 2, Szechwan Rd., Banciao District, New Taipei City 220, Taiwan, R.O.C. peiling@mail.oit.edu.tw HSIEH-HUA YANG Department of Health Care Administration, Oriental Institute of Technology No. 58, Sec. 2, Szechwan Rd., Banciao District, New Taipei City 220, Taiwan, R.O.C. yansnow@gmail.com Abstract: - The aim of this study is to evaluate the effect of on-job training on job satisfaction and professional commitment. A quasi-experimental design was used in which one pre-intervention survey and one postintervention survey was used to collect data from the 20 nurses in a ward. The result showed that the score of job satisfaction in the domain of human relationship and professional commitment were significantly improved. The other 4 domains of job satisfaction had not been changed. The advice network centralization was decreased after intervention, but not friendship network. The symmetric dyad of advice network was no longer affected by position after intervention. It is concluded that the effects of intervention are significant on professional commitment and advice network. The effect on job satisfaction is limited. Key-Words: - Friendship, Social networks, empowerment, intervention, professional commitment 1 Introduction In the present context of visible resource constraints, a hospital s management is crucially dependent upon the positive professional commitment of staff. To believe much of the related literature, mobilizing the necessary input is a relatively straightforward matter of internal team dynamics. Certainly the only way to deliver a responsive service is empowering staff to reinforce professional commitment and team coordination. Since 1995, the implementation of national health insurance system has leaded to the rapid growth of the overall demand for medical services, and the health care organizations expansion. In order to curb rising medical costs, global budget, then case payment system had been implemented successively. Hospitals are beginning to feel pressure from the internal dynamics of decentralization as well as from external forces of hospital accreditation. Hospitals have to adopt organizational change through on-job training. In order to mitigate the impact of the change, the on-job training plan is initiated in a volunteer ward. The aim of this study is to describe the training effect in a single ward. 2 Literature Review 2.1 On-job training The key element of on-job training is empowerment in this study. Notions of empowerment are derived from theories of participative management and employee involvement [1]. The original impetus for research on empowerment was performance oriented. Herein, organizational scholars emphasize cascading power, information, rewards, and training to the lowest level possible in the organizational ISBN:

2 hierarchy to increase worker discretion [2], and advocate that managers share decision making power with employees to enhance performance and work satisfaction [3-5]. However, recent conceptualizations of empowerment are extended by joining psychological state and focusing on the individual experience. Empowerment is viewed as a state of power and control within the individual that is enabling and facilitative of a state of intrinsic task motivation for the individual [6]. The internal nature of empowerment is motivational and consistent with the expectations of the individual. Empowerment as a psychological conceptualization is an internal, subjective experience. Commitment may be viewed as a control structure that allows for the empowerment of individuals. Empowered people choose their own course and are committed to it because they play a part in determining it. The concept of empowerment, which was developed in studies of western organizations, is often discussed from organizational and psychological perspectives. Organizational empowerment is the perceived presence or absence of empowering conditions in the workplace [7], and psychological empowerment is the psychological perception or attitudes of employees about their work and their organizational roles [8]. Nurses who are psychologically empowered felt they had access to strategic information and perceived support from managers in the organization. Frans [9] suggested that empowerment is composed of five components: a self-concept which describes self-validation and self-esteem; a critical awareness of one s place in larger systems such as family, agency, or society; possession of knowledge and abilities to influence one s self or others; a propensity to act which describes the ability to initiate effective action for one s self or others and ; a sense of collective identity which describes sharing goals, resources, and aspirations of an identified social systems. 2.2 Professional commitment Professional commitment is a person s involvement, pledge, promise or resolution towards his/her profession [10]. The importance of professional commitment has been widely advocated [11-14]. A review of the literature shows that three aspects of commitment have been applied to many domains. They are willingness to exert effort on its behalf, a desire to remain in the profession, and identifying with the profession by acceptance of its goals and values [15]. There is broad consensus that future careers will be less organizationally focused and more directed toward occupational or professional commitment. And it is proposed that the empowerment intervention will improve professional commitment. 2.3 Social networks Employees who have friends at work are more likely to be engaged in their jobs. A review or research suggests that workplace friendship is positively related to employees' job satisfaction, performance, team cohesion, and organizational commitment; it is negatively associated with employees' turnover intentions and negative emotions [16-18]. The cohesiveness of the ward nursing team was mentioned as a strong predictor of job satisfaction [19]. The basic element of cohesive team is friendship network. Literature documents that individuals will have benefits through their social networks. Takase, Oba, and Yamashita [20] found the issues in interpersonal relationships were frequently cited causes that made nurses consider leaving their jobs. Bjorvell and Brodin s [21] found social support might reduce personnel turnover in hospitals. Greater social support and pay can reduce turnover by their positive impact on job satisfaction [22]. In Taiwan, Chang, Lin, Kuo, Teng, and Lee [23] showed that interpersonal relationship was the highest factor of job satisfaction. And, the research [24] in a Norwegian population of nurses found that interaction, followed by pay and autonomy were the most important job factors. In organizational settings, Hodson [25] convincingly argued, the social relations of the workplace may make a key contribution to employees job satisfaction, productivity, and well-being. It was reported that change was positively influenced by health workers having a sense of belonging, as well as mutual respect between supervisors and health workers [26]. And it is proposed that the process of empowerment intervention will improve social network. The aim of this study was to describe the empowerment effect on professional commitment and social networks. 3 Method 3.1 Setting and participants The 13th ward is a surgical ward of En Chu Kong Hospital. The total bed number is 44 with 80% ISBN:

3 occupancy rate. All of the 20 nurses working in the 13 th ward were voluntary to participate in this study. 3.2 Intervention Theoretical based intervention program was applied from May to October in First a needs assessment was carried out. Then, key persons were interviewed and group discussions were held. Subsequently, the results were translated into specific objectives and used in intervention development for the 13 th ward s staff. Strengthening professional commitment and harmonic interaction was defined as objectives. And 16-hour training sessions were designed. The training sessions included courses, conferences and workshops. According to Frans [9] themes, the content of sessions included facilitation skills, standards of service, developing self-esteem and assertiveness, realize your potential, discovering the secrets of self confidence, smart thinking and smarter working, effective communication, and essentials of personal development. 3.3 Study design A quasi-experimental design was used in which one pre-intervention survey and one post-intervention survey was used to collect data from the participants. The empowerment intervention was followed up through a combination of surveys of professional commitment and social networks. In the January 2011, prior to the start of the intervention, a first survey was made through a questionnaire to measure the job satisfaction, professional commitment, and social network. The second survey was implemented after the intervention had been going on for 10months. The most important parameters of the overall data collection were the change in the job satisfaction, professional commitment, and social networks. The collected data was analyzed in both individual and organizational levels. 3.4 Questionnaires for intervention evaluation Social network nomination was applied to derive the participants friendship networks. The participants were asked to nominate up to 18 colleagues using two questions: When you encounter difficulty in your job, from whom you ask for help?, and Whom you talk your private affairs with in daily chat?. The advice network will construct from the first question, and friendship network from the second question. Professional commitment scale is a 6-point Likert type scale (1 = strongly disagree, 6 = strongly agree) with 3 items. These 3 items are Being a professional nurse is great helpful to my self-image, I am proud of being a professional nurse, and I am enthusiastic about nursing care. The Cronbach s alpha was The NJSS was adopted from Lin, Wang, Li, & Huang [27]. It was applied to measure job satisfaction in 5 domains of job environment, human relationship, feedback, benefit and promotion, and work load. The questions were scored on a 6-point Likert scale ranging from 1 point (very dissatisfied) to 6 points (very satisfied). The measurement has strong internal consistency with all multiple-item constructs achieving Cronbach s alpha ranged between 0.89 and 0.98, exceeding the 0.7 threshold commonly suggested for exploratory research [28]. Excel was applied to data coding and processing. UCINET 6 for window [29] was used to calculate the social network variables. The nomination number is defined as outdegree and the number of nominated as indegree. Efficiency is effective size divided by observed size [30]. 4 Result All of the participants are females. Within these 20 participants, one is charge nurse, 16 nurses and 3 nurse aides. Eight of them are married. The average age is years old with range. Most of them have graduated from college or university. 4.1 The effect on job satisfaction and professional commitment Comparing the professional commitment and 5 domains of job satisfaction between time 1 and time 2, t-test was implemented. The result is shown as table 1. The score of human relationship and professional commitment are significantly improved. The other 4 domains of job satisfaction had not been changed. 4.2 The effect on social networks In the individual level analysis, the constraint of advice network was decreased and the indegree of friendship network was increased (table 2). For the whole network analysis, the advice network centralization was decreased after intervention for both outdegree and indegree. The friendship network centralization was increased for outdegree, and decreased for indegree. At time 1, one nurse has only one linkage in the advice network. She has connection with two other nurses at time 2. And ISBN:

4 after intervention, these 2 isolated nurses had linkage with others in friendship network. Table 1 Effect on job satisfaction and professional commitment T1 Variables T2 job satisfaction Job environment Human relationship Feed back Benefit and promotion Work load Professional commitment Table 2 Comparison of social network variables between time 1 and time 2 T1 T2 t p Advice network outdegree indegree effective size efficiency constraint hierarchy Friendship network outdegree indegree effective size efficiency constraint hierarchy t p Further analysis was applied on dyads of advice network at time 1 and time 2. Domination forms a dyad. If two persons dominate each other, the dyad is symmetric. In advice network, there were 114 dyads at time 1 and 121 at time 2. The dyads were increased after intervention. Logistic regression model was applied to identify the factor of symmetric dyads. Dyads were included as dependent variable, and education, marriage, tenure, and position were independent variables. If the education, marriage, tenure, and position were the same for each dyad, it was coded as 1. Otherwise, it was 0. The results are shown as table 3. Obviously, the symmetric advice dyads were more often formed between two nurses with the same position at time 1. However, after intervention the effect of position diminished. Table 3 Factors of symmetric advice relation Variables Time 1 B SE p Time 2 B SE p Age Education (same/diff) Marriage (same/diff) Tenure Position (same/diff) Constant Log likelihood ISBN:

5 5 Discussion and Conclusion The empowerment intervention has achieved its objectives. The professional commitment can be improved and the advice interaction can be modified, but not for all the domains of job satisfaction. Since professional commitment was tested to be related to job satisfaction [10], and the cohesiveness of the ward nursing team was mentioned as a strong predictor of job satisfaction [19], it is expected that the long-term effect will appear in the next stage. The design of intervention is based on empowerment theory after needs assessment. Empowerment theory has been used to assist the nursing profession in coping with the unequal power base that is common in healthcare settings [31-33]. The significant effects will assists nurses coping with recurring healthcare crises. Homophily is a major characteristic of friendship: individuals tend to become and remain friends with others that are similar to them [34-36]. The homophilous effect is also found in this study. The symmetric relations exist between 2 persons of the same tenure and positions before intervention. It means that the different positions will hinder interaction. It is not good for cooperation. Fortunately, the homophilous effect of position disappeared after intervention. Further, empowerment in Asian cultures relates much more to the individual and his/her merits, in contrast to organizationally-driven empowerment in Western countries [37]. The management should not ignore the interpersonal network. The experiment showed limited suggestions of changes of job satisfaction. The organization s complexity and the traditional hierarchy of hospitals do not stimulate change easily, but the nurses involvement is critical to the result of the staff s work. Work place interventions are complicated and complex and influenced by many factors. Ten months is a very short time for an intervention. The importance of the experience of the staff of an improved work environment is however not to be diminished. References: [1] G. M. Spreitzer, M. A. Kizilos, S. W. Nason, A dimensional analysis of the relationship between psychological empowerment and effectiveness, satisfaction, and strain, Journal of Management, Vol.23, No.5, 1997, pp [2] D. E. Bowen, E. E. Lawler III, The empowerment of service workers: what, why, how and when, MIT Sloan Management Review, Vol.33, No.3, 1992, pp [3] J. L. Cotton, D. A. Vollrath, K. L.,Froggatt, M. L. Lengnick-Hall, K. R. Jennings, Employee participation: Diverse forms and different outcomes, Academy of Management Review, Vol.73, 1988, pp [4] K. I. Miller, P. R. Monge, Participation, satisfaction, and productivity: A meta-analytic review, Academy of Management Journal, Vol.29, 1986, pp [5] J. A. Wagner III, Participation s effects on performance and satisfaction: A reconsideration of research evidence, Academy of Management Review, Vol.19, 1994, pp [6] K. Thomas, B. Velthouse, Cognitive elements of empowerment: An interpretive model of intrinsic task motivation, Academy of Management Review, Vol.15, 1990, pp [7] R. M. Kanter, Men and Women of the Corporation, Basic Books, New York, [8] G. M. Spreitzer, Psychological empowerment in the workplace: Dimensions, measurement, and validity, Academy of Management Journal, Vol.38, No.5, 1995, pp [9] D. Frans, A scale for measuring social work empowerment, Research on Social Work Practice, Vol.3, No.3, 1993, pp [10] Y. Fang, Turnover propensity and its causes among Singapore nurses: an empirical study, International Journal of Human Resource Management, Vol.12, No.5, 2001, pp [11] S. Aryee, K. Tan, Antecedents and outcomes of career commitment, Journal of Vocational Behavior, Vol.40, 1992, pp [12] A. G. Bedeian, E. R. Kemery, Career commitment and expected utility of present job as predictors of turnover intention and turnover behavior, Journal of Vocational Behavior, Vol.39, 1991, pp [13] G. Blau, M. Lunz, Testing the incremental effect of professional commitment on intent to leave one's profession beyond the effects of external, personal, and work-related variables, Journal of Vocational Behavior, Vol.52, 1998, pp [14] E. Chang, Career commitment as a complex moderator of organizational commitment as a complex moderator of organizational commitment and turnover intention, Human Relations, Vol.52, 1999, pp [15] S. Aryee, T. Wyatt, M. K. Min, Antecedents of organizational commitment and turnover intentions among professional accountants in different employment settings in Singapore, Journal of Social Psychology, Vol.131, 1991, pp ISBN:

6 [16] E. M. Berman, J. P. West, M. N. Richter, Workplace relations: Friendship patterns and consequences (according to managers). Public Administration Reviews, Vol.62, No.2, 2002, pp [17] R. Morrison, Information relationships in the workplace: Association with job satisfaction, organizational commitment and turnover intentions, New Zealand Journal of Psychology, Vol.33, 2004, pp [18] B. A. Winstead, V. J. Derlega, M. J. Montgomery, C. Pilkington, The quality of friendships at work and job satisfaction, Journal of Social and Personal Relationships, Vol.12, 1995, pp [19] H. Lu, A. E. While, K. L. Barriball, Job satisfaction among nurses: a literature review, International Journal of Nursing Studies, Vol.42, 2005, pp [20] M. Takase, K. Oba, N. Yamashita, Generational differences in factors influencing job turnover among Japanese nurses: An exploratory comparative design, International Journal of Nursing Studies, Vol.46, 2009, pp [21] H. Bjorvell, B. Brodin, Hospital staff members are satisfied with their jobs, Scandinavia Journal of Caring Sciences, Vol.6, No.1, 1992, pp [22] J. L. Price, Reflections on the determinants of voluntary turnover, International Journal of Manpower, Vol.22, No.7, 2001, pp [23] F. M. Chang, C. J. Lin, H. W. Kuo, Y. K. Teng, J. N. Lee, Appraisal and satisfaction among staff nurses in the health stations of Taiwan province, China Journal of Public Health, Vol.14, 1995, pp [24] I. T. Bjork, G. B. Samdal, B. S. Hansen, S. Torstad, G. A. Hamilton, Job satisfaction in a Norwegian population of nurses: A questionnaire survey, International Journal of Nursing Studies, Vol.44, 2007, pp [25] R. Hodson, Group relations at work: Solidarity, conflict and relations with management, Work and Occupations, Vol.24, 1997, pp [26] P. Sennun, N. Suwannapong, N. Howteerakul, O. Pacheun, Participatory supervision model: building health promotion capacity among health officers and the community, Rural Remote Health, Vol.6, No.2, 2006, pp [27] C. J. Lin, H. C. Wang, T. C. Li, L. C. Huang, Reliability and validity of nurses job satisfaction scale and nurses professional commitment, Mid-Taiwan Journal of Medicine, Vol.12, 2007, pp [28] J. C. Nunnally, Psychometric Theory, New York, McGraw-Hill, [29] S. P. Borgatti, M. G. Everett, L. C. Freeman, UCINET 6 for Windows: Software for Social Network Analysis, Harvard, MA, Analytic Technologies, [30] R. S. Burt, Structural Holes: The Structure of Competition, MA, Harvard University Press, [31] D. J. Manson, B. A. Backer, C. A. Georges, Toward a feminist model for the political empowerment of nurses, Image: Journal of Nursing Scholarship, Vol.23, 1991, pp [32] J. A. Sabaston, H. K. Spence-Lashinger, Staffnurse work empowerment and perceived autonomy, Journal of Nursing Administration, Vol.25, No.9, 1995, pp [33] B. Wilson, H. K. S. Laschinger, Staff-nurse perception of job empowerment and organizational commitment: a test of kanter's theory of structural power in organizations, Journal of Nursing Administration, Vol.24, No.4, 1994, pp [34] J. Cohen, Sources of peer group homogeneity, Sociological Education, Vol.50, 1997, pp [35] D. B. Kandel, Homophily, selection, and socialization in a adolescent friendships, American Journal of Sociology, Vol.84, 1978, pp [36] M. McPherson, L. Smith-Lovin, J. M. Cook, Birds of a feather: homophily in social networks, Annual Review of Sociology, Vol.27, 2001, pp [37] C. Cheung, T. Baum, A. Wong, Relocating empowerment as a management concept for Asia, Journal of Business Research, Vol.65, 2012, pp ISBN:

Perceived Organizational Culture, Professional Commitment, Advice Network and Job Satisfaction of Novice Nurses

Perceived Organizational Culture, Professional Commitment, Advice Network and Job Satisfaction of Novice Nurses HSIEH-HUA YANG, FEN FEN HUANG Department of Health Care Administration Oriental Institute