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Workplace empowerment and organizational commitment among nurses working at the Main University Hospital, Alexandria, Egypt

Ibrahem, Samaa Z.a; Elhoseeny, Taghareeda; Mahmoud, Rasha A.b

The Journal Of The Egyptian Public Health Association: August 2013 - Volume 88 - Issue 2 - p 90–96
doi: 10.1097/01.EPX.0000430957.52814.8a
Original articles
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Background High-quality patient care depends on a nursing workforce that is empowered to provide care according to professional nursing standards. Numerous studies have established positive relationships between empowerment and important nursing outcomes such as work effectiveness, job satisfaction, and organizational commitment.

Participants and methods A cross-sectional study design was used to assess the relationships between structural and psychological empowerment and their effects on hospital nurses’ organizational commitment at the Main University Hospital in Alexandria governorate. The total number of nurses who participated in the study was 150 nurses, and four interview questionnaires were used to measure the study variables.

Results The mean score percentage was higher for overall psychological empowerment (68.75%) than for overall structural empowerment (46.25%). There was a significant direct intermediate correlation between nurses’ perceptions of overall structural and psychological work empowerment and their overall organizational commitment. There was no significant relationship between structural and psychological empowerment, organizational commitment and sociodemographic characteristics of nurses except for the overall organizational commitment with age (r=0.260), overall structural empowerment in the working department (P=0.031), and overall organizational commitment with nursing experience (significance=0.025).

Conclusion and recommendations Overall psychological empowerment achieved a higher mean score percentage compared with overall structural empowerment. Changing workplace structures is within the mandate of nurses’ managers in their roles as advocates for and facilitators of high-quality care. The most significant opportunity for improvement is in the area of formal power, including flexibility, adaptability, creativity associated with discretionary decision-making, visibility, and centrality to organizational purpose and goals.

aDepartment of Health Administration and Behavioural Sciences, High Institute of Public Health

bFaculty of Nursing, Alexandria, Egypt

Correspondence to Samaa Z. Ibrahem, Department of Health Administration and Behavioural Sciences, High Institute of Public Health, 165 Al-Horreya Road, Al-Hadara, Alexandria 2156, Egypt Tel: +20 342 85575/+20 111 411 3455; fax: +20 349 07535; e-mail: samaa752002@yahoo.com

Received April 30, 2013

Accepted April 30, 2013

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Introduction

The importance of high-quality nursing work environments to patient safety has been emphasized 1, and several studies have linked the quality of nursing work environments to patient mortality 2–4. Employee empowerment as a strategy for increasing job satisfaction and performance has received considerable attention in the general management literature and, to a lesser extent, in nursing 5–8. Moreover, empowerment has been viewed as having potential to play a key role in professional development, resulting in better care to patients, and includes a sense of meaning, self-determination, competence, and impact 9. Therefore, it is required that managers with appropriate interventions in the field of healthcare environments prepare the grounds to facilitate appropriate conditions for nurses to be empowered 10.

Numerous studies have established positive relationships between structural empowerment and important nursing outcomes such as work effectiveness 11,12, job satisfaction 13,14, organizational commitment 14,15, organizational trust and respect 16,17, and interactional justice 17. The ameliorating effects of structural empowerment on outcomes such as job tension 12 and burnout 18 have also been established in the nursing literature.

Empowerment is a multidimensional social process that helps people gain control over their own lives. It is a process that fosters power in people – for the betterment of their own lives, of their communities, and in their society – by acting on issues that people define as important 19. Moreover, empowerment has been defined as the ability of an individual to independently make decisions and utilize available resources to accomplish the necessary goals 20. Measuring worker empowerment in the workplace can help mangers identify and remove conditions in the organization that foster powerlessness and provide structural processes that foster empowerment 21.

There are two concepts of empowerment stated in the management and organizational literature. First, according to Kanter’s theory of structural empowerment, employees are empowered when they are given access to empowerment structures to accomplish their work, including opportunity, information, support, resources, formal power, and informal power. Both types of power are associated with autonomy and mastery, instead of domination and control 20. The components of structural empowerment lead to psychological empowerment, which in turn leads to positive work behaviors and attitudes, including low job stress, low burnout, increased job commitment, and increased job satisfaction 22.

Second, another concept of empowerment is from a psychological perspective. In this approach, psychological empowerment is achieved by promoting workers’ beliefs about the meaning of their work, their capability to succeed in their job, their sense of self-determination, and their autonomy in influencing the outcomes of their work 23.

Psychological empowerment can be viewed as a way to stimulate an individual’s commitment to the organization, as it leads to a fit between work roles and personal value systems, confidence in an individual’s capability to do work well (which in turn encourages him or her to put more effort on the organization’s behalf), more extensive participation in decision-making, and contribution to shaping organizational systems through a greater level of impact 24.

There are three forms of organizational commitment: affective, continuance, and normative. Affective commitment means how an employee feels about the organization. Continuance commitment means how an employee thinks about changing the organization. Normative commitment means how an employee responds to the organization. Common to all of the three types of commitment is the view that commitment is a psychological state that characterizes the employee’s relationship with the organization and has implication for the decision to continue or discontinue membership in the organization 25.

Organizational commitment is of particular importance to healthcare organizations. Employees in turbulent environments struggle to maintain high-quality patient care with fewer resources 26. In addition, organizational commitment has received substantial attention in the past research because of its significant impact on work attitudes such as job satisfaction and performance 27. A study carried out in Canada revealed that nurses reported moderate levels of empowerment, respect, and organizational commitment. Moreover, structural empowerment, psychological empowerment, and respect explained 48% of the variance in affective commitment 28. The aim of this study was to measure structural empowerment, psychological empowerment, and organizational commitment and to assess the relationship between nurses’ empowerment and organizational commitment among nurses at the Main University Hospital in Alexandria, Egypt.

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Participants and methods

Study setting and design

A cross-sectional descriptive design was used for this study. The study was carried out at the Main University Hospital in Alexandria, Egypt, which is a multispecialty 2000-bed hospital.

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Study population

The study included nurses working in the surgical and medical departments within the study hospital. The total number of nurses working in the hospital was 611; of whom, 383 nurses were working in the surgical departments (45 were professional nurses, 14 were technical nurses, and 324 were practical nurses) and 228 nurses were working in the medical departments (15 were professional nurses, seven were technical nurses, and 206 were practical nurses).

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Sample size

A random sample of nurses was chosen by proportional allocation according to the categories of nurses. Using MedCalc 13 (MedCalc Software, Acacialaan, Ostend, Belgium) and based on a previous study on the effect of structural and psychological empowerment on the perceived respect in acute care nurses 29 as well as assuming a mean total empowerment score of 17.8, SD of 3.3, an accepted error of 1, an α of 0.05, and power 95%, a minimum sample size required was calculated to be 142, which was raised to 150 for better accuracy in classification 30.

A total number of 150 nurses, working in the hospital under the study, who accepted to participate, were involved in the study, of whom, 94 nurses were working in the surgical departments, whereas 56 nurses were working in the medical departments.

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Data collection

Four interview questionnaires were used to measure the study variables. They were translated into Arabic to be accepted and understood by nurses. A specially designed structured interview questionnaire was used to obtain demographic and personal data including age, educational level, work status, years of experience, and department.

The Conditions of Work Effectiveness Questionnaire-II (CWEQ-II) was used to measure structural empowerment 20,31. It contains 19 items that measure nurses’ perceptions of access to the six elements of structural empowerment, namely access to information, support, resources, learning opportunities, formal power, and informal power. The items are rated on a five-point Likert scale ranging from strongly disagree to strongly agree. A total score is created by averaging the six subscales.

The Psychological Empowerment Questionnaire (PEQ) was used to measure psychological empowerment 23. It contains 12 items that measure the four subconstructs of psychological empowerment, namely autonomy, competence, meaning, and impact. The items are rated on a five-point Likert scale ranging from strongly disagree to strongly agree. A total score is calculated by averaging the four subscales.

The commitment to the organizations instrument was used to measure organizational commitment 25. It contains 18 items consisting of the three factors of organizational commitment – affective, continuance, and normative. Each component is measured by six items on a seven-point Likert scale (1=strongly disagree, 7=strongly agree). Four items are negatively worded. The scales of these items were reversed before analysis in this study.

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Statistical analysis

SPSS for Windows, version 13 (SPSS Inc., Chicago, Illinois, USA) was used for inputting, processing, and analyzing the data used in the study. The reliability of the instruments used in the study was examined using Cronbach’s α. The subscale scores for the three constructs were calculated by the average scores of each of the three components. The relationships between structural empowerment, psychological empowerment, and organizational commitment were assessed using a Pearson correlation analysis [weak correlation (r<0.25), intermediate correlation (r=25 to <0.75), strong correlation (r>0.75)]. Relationships between some work-related factors and the major study variables were tested using the independent sample t-test (computed using the analysis of variance test when there are mean values of more than two groups).

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Ethical considerations

The study was approved by the Ethical Review Committee of High Institute of Public Health. Before being interviewed, the researcher informed the respondents about the purpose of the study and their right to refuse participation or to withdraw at any time, and assured anonymity and confidentiality of information.

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Results

Sample characteristics

With regard to the demographic characteristics of the participating nurses, the mean age was 37.54±10.39 years, with the highest percentage of nurses (32.7%) aged between 30 and 40 years. As regards the educational level, 86.7% held a diploma of secondary technical nursing school. More than 50% of nurses had ‘15 and more’ years of experience, with a mean years of experience of 18.39±10.85 years.

Table 1 shows nurses’ perceptions of structural empowerment, psychological empowerment, and organizational commitment. Overall psychological empowerment achieved a higher mean score percentage (68.75%) compared with overall structural empowerment (46.25%), whereas organizational commitment achieved an overall mean score percentage of 59.17%. With regard to structural empowerment, formal power achieved the lowest mean score (mean=2.31, SD=1.074), whereas opportunity achieved the highest mean score (mean=3.36, SD=1.198). For psychological empowerment, impact achieved the lowest mean score (mean=3.21, SD=1.016), whereas competence achieved the highest mean score (mean=4.24, SD=0.8536). In relation to organizational commitment, the continuance and normative dimensions of commitment achieved the highest scores, with nearly equal mean scores (mean=4.5, SD=1.79 and mean=4.3, SD=1.88, respectively).

Table 1

Table 1

Data from Table 2 illustrates the correlation between nurses’ perception of empowerment items and organizational commitment. There was a significant direct intermediate correlation between overall structural empowerment and overall organizational commitment (r=0.281, P=0.000), as well as between each of the empowerment structures, expect for formal power (r=0.026, P=0.757) and information (r=0.154, P=0.060). Support was most strongly related to structural commitment (r=0.343, P=0.000). Similarly, for psychological empowerment, there was a significant direct intermediate correlation between overall psychological empowerment and overall organizational commitment (r=0.570, P=0.000). Each of the four subconstructs was positively correlated to commitment, with self-determination and impact being the most strongly related (r=0.483, P=0.000 and r=0.482, P=0.000, respectively), whereas meaning was the least strongly related (r=0.302, P=0.000). These patterns were repeated for the three components of organizational commitment, except for the affective component of organizational commitment, in which competence was least strongly related with it (r=0.234, P=0.004).

Table 2

Table 2

Table 3 shows the relationship between structural empowerment, psychological empowerment, organizational commitment and the working department of nurses. The mean score was significantly (P=0.031) higher in medical departments (2.96) compared with surgical departments (2.78) with respect to overall structural empowerment only. In contrast, the mean score was insignificantly lower in medical departments (3.69 and 4.47, respectively) compared with surgical departments (3.79 and 4.60, respectively) for both overall psychological empowerment and overall organizational commitment (P=0.319 and 0.400, respectively).

Table 3

Table 3

The relationship between structural empowerment, psychological empowerment, and organizational commitment and nursing experience is shown in Table 4. There was no significant difference between the mean scores of overall structural empowerment and psychological empowerment and nursing experience (P=0.166 and 0.148, respectively). In contrast, there was a significant difference between the mean values for organizational commitment (P=0.025), with the mean score being the highest for nurses with a nursing experience of 15 years and above.

Table 4

Table 4

Data from Table 5 show the relationship between structural empowerment, psychological empowerment, organizational commitment, and the work status of nurses. There was no significant difference between overall structural empowerment, psychological empowerment, organizational commitment and the work status (P=0.895, 0.803, and 0.888, respectively). The mean score was the highest for technical nurses with regard to overall psychological empowerment and overall organizational commitment (3.87 and 4.59, respectively), whereas it was the highest for both professional and practical nurses for overall structural empowerment, with nearly equal values (2.86 and 2.85, respectively).

Table 5

Table 5

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Discussion

According to the workplace empowerment theory presented by Kanter 20 and expanded upon by DeCicco et al. 28, the way a job is structured can significantly affect the ability of the individual to be effective in the job and is connected to improved job satisfaction. Managers for nurses need a work environment that is structured to provide them with tools to effectively carry out this important role. Moreover, psychological empowerment is achieved by promoting workers’ beliefs on the meaning of their work, their capability to succeed in their job, their sense of self-determination, and their autonomy in influencing the outcomes of their work 23.

The results of the present study demonstrated that there was a significant direct relationship between structural empowerment, psychological empowerment and organizational commitment. This result suggests that employees who have access to empowering structures in the workplace have more positive attitudes toward their work.

Consistent with the present study, a study carried out on Filipino and American registered nurses working in the USA found that structural empowerment, psychological empowerment, affective commitment, and normative commitment were positively correlated to each other in both groups of nurses. Indeed, the more they perceive a high level of structural empowerment and/or psychological empowerment, the more they want to stay in the organizations 32. These relationships are similar to those reported by previous studies on with nurses in Canada 28,33.

According to both Kanter’s structural empowerment and Spreitzer’s psychological empowerment theories, employees who work in an environment that provides good opportunities, ample resources, useful information, and great support will have the capacity to achieve their goals. Moreover, they will feel empowered if they are able to manage their jobs 32. The present study revealed that nurses reported opportunity as the most empowering structure (mean=3.36, SD=1.198) but felt they had minimal access to formal power (mean=2.31, SD=1.074). Nurses reported competencies as the most empowering psychological empowerment item (mean=4.24, SD=0.8536) but felt that they had less ability to make a significant impact in the organization (mean=3.21, SD=1.016). Similarly, a study carried out in Canada to examine the relationships between structural and psychological empowerment and their effects on hospital nurses’ perceptions of respect demonstrated that nurses reported opportunity as the most empowering structure (mean=4.0, SD=0.79) but felt they had minimal access to formal power (mean=2.4, SD=0.86). Nurses reported a sense of meaning in their work (mean=4.2, SD=0.76) but did not feel they were able to make a significant impact in the organization (mean=2.5, SD=0.97) 29.

The present study reported that psychological empowerment attained a higher mean score percentage (68.75%) compared with structural empowerment (46.25%). This means that having access to empowering structures within nurses’ work setting that enables them to practice according to professional standards (structural empowerment) is less fundamental to nurses compared with these aspects of psychological empowerment.

The results of the present study revealed that although each empowerment structure was positively correlated with organizational commitment, except for formal power and information, yet support and informal power were the most strongly related to nurses’ feeling of being committed to their organization. This supports Kanter’s contention that informal power through networking and effective collaborative relationships and support from managers, colleagues, and other health professionals are important to nurses’ perceptions of respect 28,29.

Inconsistent with the results of the present study, a study carried out in North Carolina revealed a significant negative correlation between competence and affective commitment, indicating that highly competent survivors have a high propensity to leave an organization subsequent to restructuring and downsizing 34.

According to the finding of the present study, no significant relationships were found between structural, psychological empowerment, and commitment and work status, working department, and nursing experience, and the only significant relationships were found between overall structural empowerment and working department (P=0.031) and for overall organizational commitment with nursing experience (P=0.025). These findings comply with the results of a study carried out on 500 randomly selected hospital staff nurses working in an acute care facility in Canada, which revealed insignificant relationships between the demographic variables and the major study variables 29. This study found that the working unit was a predictor for affective and normative commitments. Nurses who worked in noncritical care areas would stay longer in their organizations compared with those who worked in critical care units. However, age was not a predictor for the three components of commitment.

On the basis of the findings of the present study, the most significant opportunity for improvement is in the area of formal power in relation to structural empowerment, as it had the lowest mean score (mean=2.31, SD=1.074).

The other significant opportunity for improvement identified through the conditions of the work effectiveness questionnaire in the present study was in the area of impact in relation to psychological empowerment (mean=3.21, SD=1.016).

The findings of this study must be viewed with caution, given the cross-sectional design and our inability to make a strong causality assessment between the social structural factors and empowerment. There may be other important variables that could be added to provide a more comprehensive explanation and understanding of the effects of professional practice environments on nurses and patient outcomes. This should be addressed in further research.

Application of Kanter’s theory of organizational empowerment could be an effective recruitment and retention strategy in present healthcare work settings experiencing shortages of these essential personnel. The most significant opportunity for improvement is in the area of formal power, including flexibility, adaptability, creativity associated with discretionary decision-making, and visibility and centrality to organizational purpose and goals. Using activities such as applying tools for facilitating organizational communications, creating flexibility in the organization’s practices, reducing formalization, assigning the enforcement of laws to the employees, investing individuals with authority to control activities within their work scope, and decentralizing the organizational structure to enable their participation in decisions and organizational planning is very critical to facilitate the movement toward a more organized atmosphere and to establish better staff empowerment.

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Acknowledgements

The authors acknowledge the assistance of all the nurses, nursing directors, and head nurses who participated in this research.

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Conflicts of interest

There are no conflicts of interest.

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Keywords:

job satisfaction; nurses’ empowerment; organizational commitment

© 2013 Egyptian Public Health Association