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Original Articles

Organizational Trust, Psychological Empowerment, and Organizational Commitment Among Licensed Practical Nurses

Loes, Chad N. PhD; Tobin, Mary B. PhD, RN

Author Information
Nursing Administration Quarterly: April/June 2020 - Volume 44 - Issue 2 - p 179-187
doi: 10.1097/NAQ.0000000000000414
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Abstract

DESPITE SOME STABILIZATION in nursing personnel shortages over the last decade as a result of the 2008-2009 economic recession, researchers predict that the issue of maintaining adequate staffing levels in the profession will worsen in a number of states.1–3 These shortages, termed an “epidemic” by some scholars, are expected not only among registered nurses (RNs) but also within another often overlooked, yet critically important, sector of today's nursing workforce—licensed practical nurses (LPNs).1–3

A number of factors exacerbate the shortage in the supply of LPNs. For example, many health care facilities currently experience staffing difficulties as baby boomer nurses retire. Parallel to the wave of nurse retirees is a substantial increase in the number of Americans older than 65 years who are placing additional demands on the health care system.3,4 Moreover, in certain health care settings, such as nursing homes, LPNs often represent the largest constituency of direct care workers. An astounding annual LPN turnover rate of 51% nationally burdens nursing home administrators, who already face an array of complex challenges.5–7 Turnover within the nursing profession is a particularly critical issue that affects not only the quality of patient care but also the morale of the nurses who remain in the workforce. Taken together, personnel shortages within the nursing profession in general, and among LPNs in particular, place a profound strain on the efficacy of health care delivery in the United States.3,8

Accordingly, administrators in all health care settings seek ways to retain employees in the nursing professions. Using Spreitzer's psychological empowerment theoretical framework, a number of studies explore antecedents of organizational commitment in a variety of work settings.9–14 Spreitzer's concept of psychological empowerment consists of 4 components. First, “meaning” refers to the alignment between an employee's beliefs and values on the one hand and the job requirements on the other hand. “Competence” is the amount of confidence one has in his or her job, “self-determination” is the perception of control over one's work, and, finally, “impact” is one's perception of being able to influence certain outcomes within an agency.9

Although some studies evaluate each of these 4 psychological empowerment components separately, Spreitzer9 finds the 4 dimensions form an overall gestalt of psychological empowerment. Accordingly, many studies examine the 4 psychological empowerment subscales together as a composite measure of overall psychological empowerment. Scholars posit that psychological empowerment occurs as a process in which the work environment interacts with personality to shape the 4 dimensions of empowerment and ultimately influence an individual's behavior within an organization.15–17

Researchers link employees' perceptions of organizational trust to enhanced psychological empowerment, as well as to organizational commitment.10,18,19 Furthermore, Bhatnagar20 finds that psychological empowerment is an antecedent to organizational commitment. Accordingly, researchers—guided by Spreitzer's psychological empowerment theoretical framework—examine the relationships among trust, psychological empowerment, and organizational commitment.9,21,22

As it pertains specifically to nursing, some research, typically grounded in a version of Kanter's theory of workplace performance, finds that psychological empowerment mediates the relationship between structural empowerment and job strain, job satisfaction, as well as innovative behavior among RNs.23–25 Expanding Kanter's theory of workplace performance, Laschinger and her colleagues23 find that structural empowerment leads to increased levels of psychological empowerment, which, in turn, reduces job strain and increases work satisfaction. This is an especially intriguing finding, as it points to the potential import of viewing psychological empowerment as a mechanism through which certain workplace experiences influence nurse outcomes.

Despite the substantial number of investigations on psychological empowerment in nursing research, no studies to date explore the potential mediating influence of psychological empowerment on the relationship between organizational trust and organizational commitment among LPNs. This is an especially curious lacuna in the literature considering the increasing demand/profound shortage in the supply of LPNs noted earlier, as well as documented differences in turnover rates and psychological empowerment levels between LPNs and RNs.2,5,26–28

Given the theory and research reviewed here, we offer the following hypotheses: First, net of a range of potential confounding influences, we predict that organizational trust will have a statistically significant, positive influence on organizational commitment. Second, consistent with prior research and the theoretical and conceptual models advanced by Spritzer and Laschinger et al, we predict that the effect of organizational trust on organizational commitment will be mediated by, or transmitted through, employees' psychological empowerment.9,23–25,29

METHODS

Sample

Our target population consists of registered LPNs in a Midwestern state. To obtain our sample, we contacted the State Board of Nursing, which provided us with a list of all LPNs in the state. During our data collection, there were 5486 active, full-time LPNs registered with the state. Accordingly, we sent our survey instrument to the entire population of 5486 eligible LPNs. A total of 1165 LPNs returned their surveys for a response rate of 21%. Unit missingness (ie, nonresponse) was not a major concern, given that those who responded did not differ substantially from those in the population as a whole. To determine whether item missingness was potentially biasing our estimates, we conducted a missing data analysis. Missing values for a given variable ranged from less than 1% to 4.4%, and listwise deletion would lead to a loss of nearly 12% of the sample. Accordingly, we used multiple imputation to create 10 imputed data sets. Thus, our final analytic sample consisted of 1165 respondents.

Variables

Dependent variable

The outcome of interest in this study is organizational commitment. Organizational commitment, the focus of legions of empirical investigations, is an antecedent of actual turnover.30 This measure was originally developed by Porter et al30 and later refined and validated by Mowday and colleagues.31 This scale is grounded in the proposition advanced by Porter et al that organizational commitment is characterized by at least 3 factors: “(a) a strong belief in, and acceptance of, the organization's goals and values; (b) a willingness to exert considerable effort on behalf of the organization; and (c) a definite desire to maintain organizational membership.”30(p604) Similar to other studies, our organizational commitment measure is highly reliable (α, internal reliability consistency = .92).

Independent variable

The primary independent variable in this study is organizational trust. This 7-item scale (validated by Moye32 in her investigation on organizational trust) assesses the degree to which respondents feel confident in relying on the systems in the organization. Similar to the other measures used in this study, the trust measure is highly reliable (α, internal reliability consistency = .92).

Mediating variable

The mediating variable in this study is psychological empowerment. To assess empowerment, we used a 12-item scale that considers the extent to which respondents felt their workplace provided meaning, competence, self-determination, and impact. This measure, validated in previous research, has a high degree of reliability in the current investigation (α, internal reliability consistency = .88).9

Control variables

Control variables included in all prediction equations consist of the following: age (coded as younger than 45 years = 1; 45 years or older = 0); gender (coded as female = 1; male = 0); marital status (coded as married = 1; unmarried = 0); number of years worked as an LPN (continuous); whether respondent has dependent children (1 = yes; 0 = no); and whether the respondent works in a long-term care setting (1 = yes; 0 = no). The operational definitions, means, and standard deviations of our primary variables of interest are shown in Table 1. (Descriptive statistics for control variables are available from the first author upon request.)

Table 1. - Definitions for Primary Variables of Interest
Variables Description
Dependent variable
Organizational commitment (α = .92) A 15-item scale (mean = 3.65, SD = 0.71) that asks the participants to respond to the following questions using a Likert-type scale ranging from 1 (strongly disagree) to 5 (strongly agree):
  1. I am willing to put in a great deal of effort beyond that normally expected in order to help my organization of employment be successful.

  2. I talk up this organization to my friends as a great organization to work for.

  3. I feel very little loyalty to this organization.

  4. I would accept almost any type of job assignment in order to keep working for this organization.

  5. I find that my values and the organization's values are very similar.

  6. I am proud to tell others that I am part of this organization.

  7. I could just as well be working for a different organization as long as the types of work were similar.

  8. This organization really inspires the very best in me in the way of job performance.

  9. It would take very little change in my present circumstances to cause me to leave this organization.

  10. I am extremely glad that I chose this organization to work for over others that I was considering at the time I joined.

  11. There's not too much to be gained by sticking with this organization indefinitely.

  12. Often I find it difficult to agree with this organization's policies on important matters relating to its employees.

  13. I really care about the fate of this organization.

  14. For me this is the best of all organizations for which to work.

  15. Deciding to work for this organization was a definite mistake on my part.

Mediating variable
Psychological empowerment (α = .88) A 12-item scale (mean = 4.15, SD = 0.55) that asks the participants to respond to the following questions using a Likert-type scale ranging from 1 (strongly disagree) to 5 (strongly agree):
  1. The work I do is very important to me.

  2. My job activities are personally meaningful to me.

  3. The work I do is meaningful to me.

  4. I am confident about my ability to do my job.

  5. I am self-assured about my capabilities to preform my work activities.

  6. I have mastered the skills necessary for my job.

  7. I have significant autonomy in how I do my job.

  8. I can decide on my own how to go about doing my work.

  9. I have considerable opportunity or independence and freedom in how Ido my job.

  10. My impact on what happens in my organization is large.

  11. I have a great deal of control over what happens in my department.

  12. I have significant influence over what happens in my organization.

Independent variable
Organizational trust (α = .92) A 7-item scale (mean = 3.39, SD = 0.42) that asks the participants to respond to the following questions using a Likert-type scale ranging from 1 (strongly disagree) to 5 (strongly agree):
  1. I believe that the organization I am employed in as an LPN has programs that meet LPN employee needs.

  2. Since I am personally unable to monitor all of the organizational activities, I would be willing to trust the systems of the organization to get the job done right.

  3. In general, I do not have confidence in the systems of the organization I am employed in.

  4. I believe the organization I am employed in is a credible organization.

  5. I feel that I can rely on the systems in the organization I am employed in.

  6. I have confidence in the systems of the organization I am employed in.

  7. Sometimes I feel like I cannot rely on the systems of the organization I am employed in.

Abbreviation: LPN, licensed practical nurse.

Figure.
Figure.:
Total-, direct-, and indirect-effects model (c = total effect, c' = direct effect, a × b = indirect effect). All estimates include controls for age, sex, marital status, years worked as a licensed practical nurse, whether the respondent has dependent children, and whether the respondent works in a long-term care setting.

Analysis

The first stage of our data analysis involved estimating the total effect of empowerment on organizational commitment through the use of reduced-form regression procedures.33,34 To do this, we used ordinary least squares regression to estimate the influence of organizational trust on organizational commitment while controlling for a wide range of potential cofounding influences. In the second stage of the analysis, we estimated the direct and indirect (ie, mediated) effects of organizational trust on organizational commitment (see Yarcheski et al35 for an excellent example of this approach in nursing research). To accomplish this task, we simply added the psychological empowerment scale to the reduced-form (total-effects) model. We hypothesized that the psychological empowerment scale would significantly influence the outcome measure of organizational commitment. We also predicted that the inclusion of the psychological empowerment scale to the model would reduce the influence of organizational trust on organizational commitment to nonsignificance.33,34 If this occurred, it would suggest that psychological empowerment completely mediates the influence of organizational trust on organizational commitment (Figure). Finally, we conducted a variance inflation (VIF) test to check for potential issues of multicollinearity. Our VIF ranged from 1.02 to 1.83, which is well within the acceptable levels recommended to ensure collinearity is not biasing our estimates.34

RESULTS

Column 1 of Table 2 illustrates the regression coefficients from the total-effects analysis, and column 3 of Table 2 depicts the results of the direct-effects analysis. When psychological empowerment was added to the total-effects equation, the influence of organizational trust on organizational commitment changed from 0.57 in the total-effects model to 0.45 in the direct-effects model, which is a drop of approximately 21%. Despite this drop, the organizational trust measure remained statistically significant, thus suggesting a partial mediation effect. This suggests that more than a fifth of the effect of organizational trust on organizational commitment is mediated by, or transmitted through, psychological empowerment. Finally, the indirect effect of organizational trust through psychological empowerment (see column 5 of Table 2) was 0.12 and statistically significant (z = 9.58, P < .001).36,37

Table 2. - Total, Direct, and Indirect Effects of Organizational Trust on Organizational Commitmenta
Predictor Total Effects Direct Effects Indirect Effects
(1)
Regression Coefficient
(2)
Standard Error
(3)
Regression Coefficient
(4)
Standard Error
(5)
Regression Coefficient
(6)
Standard Error
Younger than 45 y −0.12 0.07 −0.12 0.06
Female 0.03 0.15 −0.06 0.14
Married 0.14b 0.05 0.10b 0.05
Years as LPN 0.00 0.00 0.00 0.00
Has dependent children −0.02 0.06 −0.07 0.05
Long-term care workplace −0.21c 0.05 00.22c 0.05
Organizational trust 0.57c 0.02 0.45c 0.02
Psychological empowerment 0.33c 0.02 0.12c 0.02
R2 0.36 0.46
Abbreviation: LPN, licensed practical nurse.
aThe following variables are standardized: organizational trust, psychological empowerment, and organizational commitment. Sample size is 1165.
bP < .05.
cP < .001.

CONCLUSION AND DISCUSSION

This study explored data from LPNs throughout a Midwestern state in an attempt to determine whether employees' organizational trust influences commitment to their respective organizations. Even in the presence of a wide range of potentially confounding influences such as age, gender, marital status, number of years worked as an LPN, whether the respondent has dependent children, and whether the respondent works in a long-term care setting, organizational trust exerted a positive and statistically significant influence on organizational commitment, thus supporting our first hypothesis. Our second hypothesis was partially supported. Specifically, we found that more than one-fifth of the relationship between organizational trust and organizational commitment occurs indirectly through psychological empowerment. That is, organizational trust, at least partially, enhances psychological empowerment, which, in turn, increases one's level of commitment to the organization.

Our findings provide support for the theoretical and conceptual frameworks advanced by Petter et al29 and Spreitzer,9 which suggest workers' perceptions of their environments and their subsequent levels of empowerment influence organizational outcomes—in this case, their levels of commitment to their respective organizations. More specifically, our results suggest that organizational trust among workers increases their overall commitment to their respective organizations and that this relationship is partially transmitted through enhanced psychological empowerment.

The results of our investigation are especially timely. Specifically, considering the profound LPN shortages in a number of states, baby boomer retirements, and the aging US population, nurse administrators are at a critical juncture; there is a greater demand for LPNs, but an adequate supply of these important direct care workers does not exist in many states.1–3 These shortages not only affect nurse administrators who continually struggle to fill vacancies within the ranks of LPNs, but they also create the potential to negatively impact patient care and employee morale.8,38,39

Although not a primary focus of this study, it is important to note that LPNs working in long-term care facilities reported significantly less organizational commitment than their counterparts not working in such settings. This finding is congruent with other research suggesting that those working in long-term care facilities face unique challenges in terms of employee satisfaction and commitment to their respective organizations.40–42 Given the increasing elderly population in the United States and attendant long-term care demands, this is an especially pressing issue in the nursing workforce. To retain employees who are increasingly called upon to provide direct care (especially in long-term care settings), administrators of organizations should focus on work conditions that are empirically linked to enhancing commitment to the organization, such as organizational trust and psychological empowerment.23,43,44

Given the substantial influence of organizational trust on organizational commitment among LPNs in our study, it is important for administrators to consider the conditions that might foster trust within organizations. As many administrators know, trust within an organization is difficult to build and it can disappear quickly. Accordingly, it is important to be cognizant of the antecedents of trust in organizations. Research links 4 primary factors to enhanced trust in organizations: (a) open communication; (b) increasing employees' decision-making opportunities; (c) sharing important organizational information with employees; and (d) open dialogues, whereby employees have the opportunity to share their perceptions of the workplace.44 Purposefully focusing on these factors has the potential to enhance trust in organizations and thus increase organizational commitment.

In order for employees to feel more empowered in the workplace, it is important for administrators to foster conditions that enhance the 4 primary factors associated with enhancing empowerment, to wit, meaningfulness, competence, choice, and impact.9 Spreitzer describes meaningfulness as one's understanding of the value of the work in relation to the individual's beliefs, attitudes, and values. The key for managers is to help employees understand how the employees' values align with the work they do and to adjust accordingly when needed. Competence essentially refers to the belief in one's ability to perform the tasks required of the job. Regular feedback by managers can help employees get a better sense of their perceptions of competence in the workplace. If employees are not evaluated on this measure, it may be difficult for them to assess whether they have the ability to complete the tasks required of them. Choice (also known as autonomy) refers to one's sense of freedom in completing a given task. Although LPNs often have somewhat restricted levels of autonomy in the workplace, supervisors and managers can be intentional in allowing them to have more freedom in certain tasks they complete, especially if increasing empowerment is a goal of the organization. Finally, impact is the perception that one is producing the intended effects through control of the process. Including employees on the lower levels of the organizational tree, such as LPNs, in organization-level decisions and perhaps policies also enhances the potential for these employees to feel their work influences the outcomes of the organization.

Considering the profound issues facing nurse administrators regarding the shortage, attrition, and associated costs of LPN turnover, it is especially critical, now, that they focus on factors that are empirically shown to enhance the organizational commitment of LPNs in the nursing field. The results of this investigation suggest that by purposefully enhancing LPNs' perceptions of organizational trust, and subsequently their psychological empowerment, administrators can potentially ameliorate the issues of LPNs leaving their job. Intentionally focusing on this profound issue at this particularly critical juncture will likely yield benefits to patients and nurses alike.

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Keywords:

licensed practical nurse; organizational commitment; organizational trust; psychological empowerment; turnover

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