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NURSING WORKFORCE ISSUES
Organisational climate, organisational commitment and intention to
leave amongst hospital nurses in Taiwan
Shwu-Ru Liou and Ching-Yu Cheng
Aims and objectives. To examine: (1) Taiwanese nurses’ perceptions of organisational climate, levels of organisational
commitment and intention to leave, as well as relationships between these three variables; (2) demographic differences in the
levels of these variables; and (3) mediating effects of organisational commitment on the relationship between organisational
climate and intention to leave.
Background. Organisational climate is related to organisational commitment and affects nurses’ performances and attitudes
towards an organisation.
Design. A cross-sectional, descriptive design.
Method. Registered nurses working in eight hospitals in southern Taiwan for more than six months were recruited. Data were
collected using the Litwin and Stringer’s Organisational Climate Questionnaire, Organizational Commitment Questionnaire
and a five-item scale measuring intention to leave. Questionnaires were distributed to 612 potential participants; 486 valid
returned questionnaires were analysed.
Results. The study’s participants were generally satisfied with their hospital’s climate and yet claimed low commitment to their
organisation and, nevertheless, reported low intention to leave their job. Single nurses were more satisfied with their hospital’s
climate and were more committed to their hospital and had a lower intention to leave their job compared to married nurses.
Nurses working in district hospitals perceived a better hospital climate and had a lower intention to leave than nurses working
in teaching or regional hospitals. Staff nurses perceived a better organisational climate than did nurse managers. Organisational
climate, organisational commitment and intention to leave were intercorrelated. Organisational climate had almost 60%
indirect effect on organisational commitment related to intention to leave.
Conclusions. Creating a good organisational climate may increase nurses’ organisational commitment and, in turn, decrease
their intention to leave.
Relevance to clinical practice. To motivate nurses’ positive organisational behaviours and to address their diverse needs,
hospital administrators are encouraged to understand nurses’ work-climate perceptions and to address nurses’ varied demo-
graphic factors.
Key words: intention to leave, nurses, nursing, organisational climate, organisational commitment, Taiwan
Accepted for publication: 30 June 2009
Introduction
Hospitals in Taiwan are accredited as teaching (medical
centre), regional and/or district hospital. The total population
of Taiwan is 22,958,360 in 2007 (Directorate-General of
Budget, 2009). Taiwan’s populace is served by 530 hospitals,
68,449 registered nurses and 12,825 licensed practical
nurses. In southern Taiwan, where the reported study was
Authors: Shwu-Ru Liou, PhD, RN, Assistant Professor, Chang Gung
Institute of Technology, Chiayi; Ching-Yu Cheng, PhD, Assistant
Professor, Taipei Medical University, Taipei City, Taiwan
Correspondence: Ching-Yu Cheng, Assistant Professor, Taipei
Medical University, 250 Wu-Hsing Street, Taipei City, Taiwan
110. Telephone: 886 2 27361661 ext. 6334.
E-mail: chingyuus@gmail.com
Ó2010 Blackwell Publishing Ltd, Journal of Clinical Nursing,19, 1635–1644 1635
doi: 10.1111/j.1365-2702.2009.03080.x
conducted, there are 187 hospitals, 19,532 registered nurses
and 3886 licensed practical nurses (Department of Health,
2008). Most hospitals offer a three-shift working schedule
with eight working hours per shift. Nurses may choose to
work on a fixed shift schedule (i.e. day, evening, or night
shift) or rotate in a three-shift schedule. To be classified as a
full-time employee, nurses must work 40 hours per week.
Regardless of the level of hospitals, from 2004–2008,
Taiwanese nurses who left their jobs within one year ranged
from 8Æ1–30% (International Council of Nurses, 2009).
Following the 1995 implementation of the Taiwan
National Health Insurance program and related policies,
the Taiwan Bureau of National Health Insurance became the
only payer of health insurance fees to healthcare facilities. To
deal with this supersized provider and accommodate nego-
tiated healthcare costs, Taiwanese hospital administrators
have sought to implement various strategies for reducing
personnel and administrative costs: restructuring the hospital
healthcare system, modifying working procedures and
increasing healthcare providers’ roles and responsibilities.
Unfortunately, these changes may negatively influence hos-
pital employees’ perceptions of their organisation and, as a
result, adversely affect their attitudes and behaviours towards
the organisation, such as job performance, organisational
commitment (OCo) and intention to stay in their current job
(Sims & Lafollette 1975, Kozlowski & Hults 1987, Neher
1996, Jackson-Malik 2005). Nurses represent the largest
proportion of healthcare providers in a healthcare facility and
provide the frontline health services before physicians arrive,
therefore, they are the first to endure the impact of any
organisational changes. Thus, how nurses perceive their
organisational climate (OCl) is an important factor affecting
their attitudes towards the organisation and their intention to
remain in the organisation. However, few studies have
investigated Taiwanese hospital nurses’ perceptions of their
organisations and the influence of their perceptions.
The purposes of the present study, therefore, were to
examine the characteristics of OCl as perceived by hospital
nurses in southern Taiwan and to explore the relationship of
OCl with OCo and intention to leave (ITL). Research
questions included: (1) what are the degrees of perception
of OCl, OCo and ITL? (2) Do the degrees of OCl, OCo and
ITL differ by demographics? (3) What are relationships
between OCl, OCo and ITL? (4) Does OCo mediate the
relationship between OCl and ITL?
Background
OCl refers to the psychological climate of an organisation,
which is a consequence of the interaction between individuals
and their external environment in an organisation (Pritchard
& Karasick 1973). Litwin and Stringer (1968) defined OCl as
‘a set of measurable properties of the work environment,
perceived directly or indirectly by the people who live and
work in this environment and assume to influence motivation
and behaviour’ (p. 1). Researchers have proposed that a
perceived well-ordered OCl can arouse individuals’ motiva-
tion and, consequently, cause emergent behaviours such as
commitment, job performance and satisfaction and retention
(Kozlowski & Hults 1987, Neher 1996, Jackson-Malik
2005).
Commitment is a strong psychological and social attach-
ment to something in a social endeavour (Alexander & Tyree
1996). Mowday et al. (1979) defined OCo in three related
dimensions: ‘a strong belief in and acceptance of the
organisation’s goals and values, a willingness to exert
considerable effort on behalf of the organisation and a strong
desire to maintain membership in the organisation’ (p. 226),
and the most influential aspects of commitment are attitudi-
nal commitments (Morrow 1993, Brown 1996, Slocombe &
Dougherty 1998, Yousef 2003). One of the important
outcomes of OCo is that, once it exists, it empowers
individuals and stabilises their behaviour as circumstances
change (Mowday et al. 1979).
The concept of ITL differs from turnover. Turnover refers
to the act of individuals actually leaving an organisation
whereas ITL is individuals’ perceptions towards leaving. Yet,
ITL is related to and is an immediate predictor of turnover
behaviour (Price & Mueller 1981, Randall 1990, Somers
1995). Findings from studies of hospital employees demon-
strate moderate to strong correlations between the measures
for thinking of quitting, ITL and turnover (Mobley et al.
1978, Cavanagh 1990).
Commitment is often a consequence of events, actions and
policies by which the organisation creates positive emotional
connections with members of the work group (Meyer &
Allen 1997), therefore, OCl can be an event that triggers
individuals to commit to their organisation. In addition,
committed employees are more willing to exert considerable
effort on behalf of the organisation and have a stronger desire
to maintain membership in the organisation, which means
remaining in the organisation (Mowday et al. 1979). Find-
ings from studies involving hospital nurses in the USA
revealed that nurses working in an attractive climate, such as
Magnet hospitals, have a lower level of burnout and OCl is a
significant predictor of nurses’ ITL (Jackson-Malik 2005,
Stone et al. 2006, Stordeur et al. 2007). OCl has also been
found to be associated with or to be a significant predictor of
individuals’ commitment to their organisation (O’Driscoll
et al. 2006, Fiorito et al. 2007, Stordeur et al. 2007).
S-R Liou and C-Y Cheng
1636 Ó2010 Blackwell Publishing Ltd, Journal of Clinical Nursing,19, 1635–1644
13652702, 2010, 11-12, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2702.2009.03080.x by Chang Gung University of Science and Technology, Wiley Online Library on [24/05/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Amongst nurses, OCo not only significantly correlates with,
but also predicts ITL (Fang 2001, Ingersoll et al. 2002, Lynn
& Redman 2005). Nursing studies have also found a
mediating effect of OCo on the relationships between other
predicting factors and ITL (Lum et al. 1998).
Methods
Design, sample and settings
The study used a correlational and descriptive design with
convenience sampling from eight hospitals (including three
district, two regional and three teaching hospitals) located in
southern Taiwan. After the proposal of the research, which
included cover letter and questionnaire, was completed, the
primary author discussed the proposal with the Directors of
Nursing Department of all sampled hospitals. Permissions to
conduct the study were obtained from those hospitals before
data collection. All registered nurses working in the sampled
hospitals for more than six months, which is considered a
suitable period of time for employees to become familiar with
their hospital’s system, were invited to participate. Complet-
ing and returning the questionnaires indicated the subjects’
consent to participate.
Study participants received data collection packets. Each
packet contained (1) a cover letter that explained the study
purpose and procedure and outlined participants’ rights and
confidentiality; (2) a set of self-administered questionnaires;
and (3) an envelope that would be returned to a secure data
collection box placed in the participating nursing units. There
was no identifying information on any of the data collection
forms, including the return envelopes. The trained project
assistants collected each data collection box on a regular
basis.
For the present study, there was a response rate of 85Æ5%,
in that, 612 questionnaires were distributed and 523 of them
were returned. However, seven participants had a missing
rate of over 14% on one of the study’s instruments.
Therefore, 486 participants’ data were analysed, representing
a valid response rate of 79Æ4%. A post hoc statistical power
was calculated using results of multiple regression (alpha =
0Æ05, two predictors, R
2
=0Æ28 and n= 486); the power of
the study was 1Æ00 (Elashoff 2005). Of the 486 participating
nurses, 98Æ3% were females, 75Æ8% were younger than
36 years old, 44Æ6% were married, 75Æ9% had a nursing
associate degree, 27Æ8% had been working at their hospital
for 4–10 years and 23Æ9% for more than 10 years, 43% of
participants were working in regional hospitals whilst 31Æ9%
were from district hospitals and 13Æ4% were employed as a
nurse manager at their hospital.
Instruments
Organisational climate
OCl was measured with the Litwin and Stringer’s (1968)
organizational climate questionnaire (LSOCQ). The LSOCQ
is a 50-item, four-point Likert scale (ranging from 1–4) that
includes nine subscales (stated later). Higher scores indicate
that individuals perceive a better OCl. Cronbach’s alphas for
the subscales of the LSOCQ ranged from 0Æ45–0Æ92 in Litwin
and Stringer’s study. In 1972, Hsu translated the LSOCQ into
Chinese (C-LSOCQ) and tested it amongst industrial
employees in Taiwan (Hsu 1972). The validity of the
C-LSOCQ was evidenced by a principal component analysis,
which revealed 11 components that explained 59Æ2% of the
variance of OCl. In the current study, the Cronbach’s alpha
for the C-LSOCQ was 0Æ74.
Nine factors underlie the construct of OCl includes
structure, responsibility, reward, risk, warmth, support,
standards, conflict and identity (Litwin & Stringer 1968).
Structure refers to the feeling that employees have about the
formal organisational chart, line of communication and
constraints in the system. Responsibility relates to the
employees’ feeling of autonomy to perform their job without
simply following orders. Reward identifies a feeling of being
rewarded for a job well performed, emphasising positive
rewards rather than blame and perceiving the organisation’s
fairness of wage and promotion policies. Risk refers to a
sense of riskiness and challenge in the job and the organisa-
tion. Warmth relates to a feeling of good fellowship and a
caring atmosphere that prevails in the organisation. Support
identifies employees’ feeling of being accepted and supported
by superiors and colleagues. Standards indicate that individ-
uals perceive the importance of explicit and implicit goals and
clearly defined performance standards for achieving those
goals. Conflict identifies the feeling that different opinions are
allowed in the organisation and problems are dealt with
openly instead of being ignored or skimmed over. Identity
refers to a sense of belonging to an organisation as a valuable
member.
Organisational commitment
For the present study, the 15-item organizational commit-
ment questionnaire (OCQ) developed by Mowday et al.
(1979) was translated to Chinese to measure nurses’ OCo. A
higher score indicates higher commitment to the organisa-
tion. In the original scale-development study, the Cronbach’s
alpha was 0Æ90 whilst the validity was evidenced with con-
struct, discriminant and predictive validity (Mowday et al.
1979). In the current study, the OCQ’s seven-point Likert
scale was modified to a four-point Likert scale to be
Nursing workforce issues Taiwanese nurses’ intention to leave
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consistent with other scales used in this study. The Cron-
bach’s alpha for the scale was 0Æ88.
Intention to leave
For the purpose of the present study, a five-item, four-point
Likert scale tool was created to measure participants’ ITL.
The items included the following statements: ‘I cannot wait to
go home after work,’ ‘It is obviously a mistake that I decided
to work in this hospital,’ ‘I have no sense of achievement by
working in this hospital,’ ‘I don’t think it will do me any good
to work in this hospital for long’ and ‘I will resign the position
if I cannot agree with the hospital’s policies.’ The Cronbach’s
alpha was 0Æ73; one component, which explained 36Æ19% of
ITL, was revealed by principal component analysis.
Statistical analysis
Data were managed and analysed with
SPSSSPSS
14.0 (SPSS Inc.,
Chicago, IL, USA). Descriptive analyses were used to
examine demographic information and level of measured
variables (i.e. OCl, OCo and ITL). To compare differences of
measured variables amongst various demographical groups,
one-way
ANOVAANOVA
was used if there were more than two groups
(i.e. age, years of working and type of hospitals); t-test was
used if there were two groups (i.e. marriage); Mann–Whitney
Utest (i.e. educational level and position at hospital) was
used when difference in sample size amongst groups was
large. Pearson correlation was used to examine correlation
between measured variables. Multiple linear regression and
Sobel test were used to test mediating effects of OCo
(Preacher & Hayes 2004). Statistical significance was deter-
mined with an alpha level of 0Æ05.
Results
Descriptive results of measured variables
The descriptive results for all measured variables were
presented using item mean score, where an item’s mean
score higher than 2Æ5 indicated an agreement with the
measured concept. Overall, participants were satisfied with
their hospitals’ climate, however, scored low on subscales of
risk, warmth, support, standards, conflict and identity of the
C-LSOCQ. The participants claimed low commitment to
their hospitals and, nevertheless, reported low intention to
leave their job (see Table 1).
Comparisons of measured variables
Diverse demographic factors revealed differences in the
participants’ levels of OCl, OCo and ITL (see Table 2).
Compared to married nurses, single nurses perceived a better
OCl, were more committed to their hospital and reported a
lower ITL. Nurses working in district hospitals perceived a
better OCl and had a lower ITL than nurses working in
regional or teaching hospitals. Nurses who were older than
35 years and nurses who worked longer than 10 years at
their current hospital had the lowest scores on commitment
and the highest scores on ITL than other groups; whereas,
nurses who were younger than 25 years and nurses who had
worked less than one year at their current hospital had less
ITL. Staff nurses perceived a better OCl and had a lower ITL
than nurse managers.
Scores from the subscales of the C-LSOCQ and the OCQ
were compared, by the type of hospital where the nurses
Table 1 Descriptive results for instruments
Concept and instruments
Possible scale
range
Study scale
range
Scale
mean ±SD
Item
mean ±SD
Organisational climate (C-LSOCQ) 50–200 81–176 130Æ06 ±13Æ83 2Æ60 ±0Æ28
Structure 8–32 11–30 20Æ94 ±3Æ22 2Æ62 ±0Æ40
Responsibility 7–28 10–28 19Æ11 ±2Æ73 2Æ73 ±0Æ39
Reward 6–24 10–24 17Æ27 ±2Æ77 2Æ88 ±0Æ46
Risk 5–20 6–20 12Æ09 ±2Æ27 2Æ42 ±0Æ45
Warmth 5–20 5–20 12Æ17 ±2Æ26 2Æ43 ±0Æ45
Support 5–20 5–19 12Æ35 ±1Æ83 2Æ47 ±0Æ37
Standards 6–24 9–21 14Æ84 ±1Æ97 2Æ47 ±0Æ33
Conflict 4–16 4–16 11Æ47 ±2Æ04 2Æ87 ±0Æ51
Identity 4–16 4–16 9Æ83 ±2Æ13 2Æ46 ±0Æ53
Organisational commitment (OCQ) 15–60 15–60 34Æ59 ±7Æ00 2Æ31 ±0Æ47
Organisational identification 9–36 9–36 19Æ41 ±4Æ29 2Æ16 ±0Æ48
Willingness to exert effort 6–24 6–24 15Æ18 ±3Æ36 2Æ53 ±0Æ56
Intention to leave 5–20 4–20 12Æ11 ±2Æ72 2Æ42 ±0Æ54
LSOCQ, Litwin and Stringer’s organizational climate questionnaire; OCQ, organizational commitment questionnaire.
S-R Liou and C-Y Cheng
1638 Ó2010 Blackwell Publishing Ltd, Journal of Clinical Nursing,19, 1635–1644
13652702, 2010, 11-12, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2702.2009.03080.x by Chang Gung University of Science and Technology, Wiley Online Library on [24/05/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Table 2 Comparisons of organisational climate (OCl), organisational commitment (OCo) and intention to leave (ITL) by demographics
Variable n
OCl OCo ITL
Mean ±SD F/t/Z p Eta
2
/dMean ±SD F/t/Z p Eta
2
/dMean ±SD F/t/Z p Eta
2
/d
Age 1Æ75 0Æ16 0Æ01 13Æ90 <0Æ001* 0Æ08 8Æ14 <0Æ001
0Æ05
<25 123 2Æ63 ±0Æ27 2Æ41 ±0Æ50 2Æ26 ±0Æ61
26–30 143 2Æ61 ±0Æ24 2Æ40 ±0Æ39 2Æ39 ±0Æ52
31–35 97 2Æ60 ±0Æ24 2Æ32 ±0Æ44 2Æ44 ±0Æ43
>35 116 2Æ56 ±0Æ34 2Æ08 ±0Æ47 2Æ61 ±0Æ53
Education
0Æ92 0Æ36 – 1Æ23 0Æ22 – 0Æ74 0Æ46 –
Associate and lower 398 2Æ59 ±0Æ27 2Æ30 ±0Æ46 2Æ43 ±0Æ55
Higher than associate 75 2Æ64 ±0Æ29 2Æ35 ±0Æ51 2Æ38 ±0Æ52
Marriage 2Æ58 0Æ01 0Æ23 5Æ58 <0Æ001 0Æ52 4Æ02 <0Æ001 0Æ38
Married 212 2Æ57 ±0Æ27 2Æ19 ±0Æ44 2Æ53 ±0Æ52
Single 246 2Æ63 ±0Æ27 2Æ42 ±0Æ45 2Æ33 ±0Æ54
Years of working 1Æ75 0Æ16 0Æ01 5Æ40 0Æ001
§
0Æ03 6Æ75
–
<0Æ001** 0Æ05
6 months–1 year 97 2Æ63 ±0Æ28 2Æ39 ±0Æ55 2Æ23 ±0Æ65
1–4 years 127 2Æ62 ±0Æ24 2Æ35 ±0Æ40 2Æ42 ±0Æ51
4–10 years 129 2Æ61 ±0Æ26 2Æ34 ±0Æ45 2Æ44 ±0Æ48
>10 years 111 2Æ54 ±0Æ33 2Æ16 ±0Æ48 2Æ58 ±0Æ48
Type of hospitals 8Æ28 <0Æ001
0Æ03 6Æ44 0Æ002
0Æ03 13Æ65
–
<0Æ001
§§
0Æ06
Teaching hospital 122 2Æ59 ±0Æ27 2Æ40 ±0Æ51 2Æ42 ±0Æ54
Regional 209 2Æ56 ±0Æ29 2Æ22 ±0Æ42 2Æ55 ±0Æ46
District 155 2Æ67 ±0Æ25 2Æ34 ±0Æ48 2Æ25 ±0Æ61
Position
2Æ39 0Æ02 – 1Æ78 0Æ08 – 3Æ02 0Æ003 –
Nurse manager 64 2Æ53 ±0Æ34 2Æ22 ±0Æ59 2Æ59 ±0Æ52
Staff nurse 415 2Æ61 ±0Æ28 2Æ32 ±0Æ45 2Æ39 ±0Æ54
*Post hoc tests showed that nurses older than 35 years had higher commitment than nurses at other age groups.
Post hoc tests showed that nurses older than 35 years had higher intention to leave their current job than nurses younger than 30 years old.
Mann–Whitney Utest was used because of the large difference on sample size between groups.
§
Post hoc tests showed that nurses working at current hospital longer than 10 years had lower commitment than nurses who worked for <10 years groups.
–
Welch test was used for the analysis because the assumption of equal variance was violated.
**Post hoc tests showed that nurses who worked less than one year at current hospital had lower intention to leave their current job than nurses working longer than one year.
Post hoc tests showed that nurses working in district hospitals had statistical higher score than nurses working in teaching hospitals or regional hospitals.
Post hoc tests showed that nurses working in teaching hospitals had higher commitment than nurses working in regional hospitals.
§§
Post hoc tests showed that nurses working in district hospitals had lower intention to leave their current job than nurses working in teaching hospitals or regional hospitals.
Nursing workforce issues Taiwanese nurses’ intention to leave
Ó2010 Blackwell Publishing Ltd, Journal of Clinical Nursing,19, 1635–1644 1639
13652702, 2010, 11-12, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2702.2009.03080.x by Chang Gung University of Science and Technology, Wiley Online Library on [24/05/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
worked and by the nurses’ position. Results showed that
nurses working in district hospitals had higher scores on the
C-LSOCQ’s subscales of structure, reward, risk and identity
and on the OCQ’s subscale of organisational identification
than nurses working in regional hospitals. Nurses working in
district hospitals also had higher scores on the C-LSOCQ’s
subscales of structure and reward than nurses working in
teaching hospitals. Nurses working in teaching hospitals had
higher scores on the C-LSOCQ’s subscale of identity and the
OCQ’s subscale of organisational identification than nurses
working in regional hospitals (see Table 3). When comparing
scores of the C-LSOCQ and OCQ by nurse position, staff
nurses had significantly higher scores on the C-LSOCQ’s
subscales of structure, support and identity and on the OCQ’s
subscale of organisational identification than nurse managers
(Table 4).
Relationships between measured variables
OCl was statistically and positively correlated with OCo
(r=0Æ57); whereas, OCl was negatively associated with
ITL (r=0Æ40). Likewise, OCo was negatively related to ITL
(r=0Æ51).
Mediating effects of organisational commitment
A mediator is a variable that accounts for the relation
between a predictor and a dependent variable. The Sobel
test, which has a higher statistical power than the method
proposed by Baron and Kenny (1986), was developed by
Sobel to test the indirect effect of an independent variable
on a dependent variable through a mediator (Preacher &
Hayes 2004). Before applying the Sobel test, assumptions of
the mediator model were tested using three regression
analyses to reveal the direct effect of a predictor on a
mediator (Path A), the direct effect of a mediator on
a dependent variable (Path B) and the direct effect of a
predictor on a dependent variable (Path C). To show the
mediating effects, Path A, Path B and Path C must first exist
(Baron & Kenny 1986).
For the current study, the predictor in this analysis was
OCl, the mediator was OCo and the dependent variable was
ITL. First, the results of these three regression analyses
indicated that OCl showed effects on OCo (R
2
=0Æ32, B=
0Æ29, t=15Æ18, p<0Æ001, Path A) and on ITL (R
2
=0Æ26,
B=0Æ10, t=12Æ96, p<0Æ001, Path C). OCo showed
effects on ITL (R
2
=0Æ16, B=0Æ15, t=9Æ47, p<0Æ001,
Path B). Second, the results from the Sobel test showed
significant mediating effects of OCo (Sobel = 3Æ28,
p=0Æ001) on the relationship of OCl and ITL. The OCo
mediated 17Æ71% of the effects between OCl and ITL;
however, the effect was not strong.
Because the mediating effect of OCo on the relationship of
OCl and ITL was not strong and because participants had
mid-high scores on the C-LSOCQ and low scores on the
OCQ and ITL, another analysis was performed to determine
whether OCl was a mediator of OCo and ITL. The Sobel test
showed strong mediating effects of OCl (Sobel = 7Æ66,
p<0Æ001). The OCl mediated 59Æ98% of the effects of OCo
on ITL.
Discussion
Study results reveal that, in general, hospital nurses in Taiwan
perceived their hospitals provided a good working environ-
ment. Nurses who agreed with their hospital’s structure
reported feeling they had autonomy to perform their job,
feeling a sense of being rewarded and feeling different
opinions were allowed in their hospital. However, they did
not agree that their working environment was enriched with a
caring atmosphere or full of challenges and they did not have
strong identification with their hospital. Although the nurses
might not have had a high level of commitment to their
hospital, they did not have a strong intention to leave their job.
From the standpoint of OCo, the current study’s results are
consistent with the attributes of collectivism (Triandis 1995)
and traditional Chinese cultural values (Chen & Francesco
2000). According to cultural studies (Hofstede 1980,
Triandis 1995), the population in Taiwan is a collectivist
society where individuals highly regard relationships, value
loyalty and tend to give priority to the goals of the in-group
(Triandis 1995). Additionally, an individual’s main loyalty is
to one’s immediate boss (Chen & Francesco 2000). There-
fore, although nurses in the present study did not have a
strong commitment to their organisation, they worked for the
benefit of their hospital, likely because of their culturally
based loyalty to individual relationships with colleagues or to
their immediate boss.
Findings from this study also suggested that Taiwanese
nurses working in district hospitals perceived a better OCl
than nurses working in regional or teaching hospitals. Nurses
who worked in district hospitals felt they understood the
hospital’s formal organisational chart, perceived fair policies
in payment and promotion, felt their job included challenges,
felt valuable as a member in their hospital and were willing to
exert efforts on behalf of their organisation. The reason for
these findings may be that district hospitals have fewer levels
of organisational structure than regional and teaching hos-
pitals. Consequently, as Pierce et al. (2001) noted, employees
in smaller organisation have a greater knowledge of their job
S-R Liou and C-Y Cheng
1640 Ó2010 Blackwell Publishing Ltd, Journal of Clinical Nursing,19, 1635–1644
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and organisation, feel more comfortable communicating
with their superiors and have more of a sense of freedom
to exercise personal control over their job and work
environment than employees in larger organisations. These
individuals, therefore, are more willing to involve themselves
deeply into their job and organisation (Pierce et al. 2001).
Table 3 Comparisons of subscales of the C-LSOCQ and OCQ by type of hospitals*
Variable Mean ±SD F p Post hoc test
Organisational climate
Structure 17Æ70 <0Æ001 District hospital >teaching hospital and regional hospital
Teaching hospital 2Æ54 ±0Æ38
Regional 2Æ55 ±0Æ40
District 2Æ77 ±0Æ38
Responsibility 3Æ61 0Æ03 District hospital >regional hospital
Teaching hospital 2Æ69 ±0Æ41
Regional 2Æ70 ±0Æ38
District 2Æ80 ±0Æ38
Reward
7Æ84 <0Æ001 District hospital >teaching hospital and regional hospital
Teaching hospital 2Æ81 ±0Æ48
Regional 2Æ84 ±0Æ48
District 2Æ99 ±0Æ30
Risk 4Æ75 0Æ01 District hospital >regional hospital
Teaching hospital 2Æ46 ±0Æ48
Regional 2Æ35 ±0Æ43
District 2Æ48 ±0Æ46
Warmth 2Æ47 0Æ09 –
Teaching hospital 2Æ47 ±0Æ45
Regional 2Æ38 ±0Æ44
District 2Æ48 ±0Æ47
Support 2Æ35 0Æ10 –
Teaching hospital 2Æ51 ±0Æ39
Regional 2Æ43 ±0Æ34
District 2Æ49 ±0Æ38
Standards 1Æ40 0Æ25 –
Teaching hospital 2Æ43 ±0Æ34
Regional 2Æ48 ±0Æ33
District 2Æ50 ±0Æ32
Conflict
0Æ87 0Æ42 –
Teaching hospital 2Æ82 ±0Æ58
Regional 2Æ87 ±0Æ49
District 2Æ90 ±0Æ48
Identity 7Æ44 0Æ001 Teaching hospital and district hospital >regional hospital
Teaching hospital 2Æ55 ±0Æ53
Regional 2Æ35 ±0Æ51
District 2Æ53 ±0Æ54
Organisational commitment
Organisational identification
7Æ88 <0Æ001 Teaching hospital >regional and district hospital
Teaching hospital 2Æ30 ±0Æ53
Regional 2Æ03 ±0Æ42
District 2Æ14 ±0Æ48
Willingness to exert effort
5Æ77 0Æ004 District hospital >regional hospital
Teaching hospital 2Æ55 ±0Æ57
Regional 2Æ44 ±0Æ51
District 2Æ64 ±0Æ60
LSOCQ, Litwin and Stringer’s organizational climate questionnaire; OCQ, organizational commitment questionnaire.
*The nfor nurses in teaching hospital, regional hospital and district hospital were 122, 209 and 155, respectively.
The p-value for the post hoc comparison was 0Æ05 and 95% CI ranged from 0Æ0001–0Æ1978. The result may not be considered significant.
Welch test was used for the analysis because the assumption of equal variance was violated for the one-way
ANOVAANOVA
.
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The current study also revealed that staff nurses perceived
a better OCl – especially hospital structure, support and
identity – than nurse managers. Despite limited studies that
focus on comparing the perceptions of OCl between stuff
nurses and nurse managers, the present investigation’s finding
is congruent with findings in Mok and Au-Yeung’s (2002)
study amongst hospital nurses in Hong Kong. These
researchers found that frontline nurses had a more positive
view towards OCl than middle and top nurse managers. The
logical reason may be that nurse managers are under multi-
layers of pressure. As Mok and Au-Yeung noted, nurse
managers are expected to play numerous roles such as
planner, implementer, coordinator, supporter and trouble-
shooter; however, their excellent job performance is often
taken for granted, and they rarely receive proportionate
rewards. Therefore, nurse managers may not perceive an
optimal OCl.
In the current study, single nurses scored higher on OCl
than married nurses. Few nursing studies have focused on
marital status to help explain this finding. Gray (1989) noted
that, compared to single career women, married career
women are understandably more likely to suffer from role
overload or role stress because of employment demands and
domestic tasks. In Taiwan, these duties are especially
challenging for married nurses. Most Taiwanese families
include three generations of family members. Also, most
Taiwanese married women are expected to be at home some
time during the day, especially in the evening, to tend to
domestic tasks such as making meals and taking care of other
family members. However, nursing jobs in Taiwan offer little
flexibility for work schedules, and nurses are expected to
rotate three shifts that include evening hours. Such demanding
schedules may not meet married nurses’ needs and, conse-
quently, may negatively affect their perceptions of their OCl.
The current study found that OCl was positively correlated
with OCo but negatively related to ITL. These findings
support several researchers’ theory that OCl serves as a
function to arouse employees’ motivation and, furthermore,
influence their organisational behaviours such as OCo, job
satisfaction, job performance and retention (Barling et al.
1990, Neher 1996, Jackson-Malik 2005, Stone et al. 2006,
Fiorito et al. 2007). In addition, participants with a high level
of commitment to their hospital reported a low intention to
leave their current job, which was similar to findings from
other research (Cohen 1998, Fang 2001, Ingersoll et al. 2002,
Lynn & Redman 2005). This finding also supports Mowday
et al.’s (1979) description of the characteristics of OCo,
where committed individuals have a stronger desire to
maintain membership in their organisation.
Data analyses for the current study indicated OCo signif-
icantly – but not strongly (17Æ71% of indirect effects) –
mediated the relationship between OCl and ITL. In contrast,
results from an extra analysis of the Sobel test revealed OCl
mediated almost 60% of the effects of the OCo on ITL, which
was stronger than the mediation effects of OCo on OCl and
ITL. These findings suggest that Taiwanese nurses who do not
highly commit to their hospitals are, however, willing to exert
efforts for and stay in their hospital if they perceive a good
working atmosphere. In other words, a positive working
environment may encourage Taiwanese nurses to identify
with, commit to and extend extra efforts on behalf of their
Table 4 Comparisons of subscales of the C-LSOCQ and OCQ by
position
Variable Mean ±SD Zp
Structure 2Æ65 0Æ01
Nurse manager 2Æ49 ±0Æ49
Staff nurse 2Æ64 ±0Æ38
Responsibility 1Æ64 0Æ10
Nurse manager 2Æ66 ±0Æ41
Staff nurse 2Æ74 ±0Æ38
Reward 1Æ53 0Æ13
Nurse manager 2Æ82 ±0Æ53
Staff nurse 2Æ89 ±0Æ45
Risk 1Æ67 0Æ10
Nurse manager 2Æ33 ±0Æ51
Staff nurse 2Æ43 ±0Æ44
Warmth 1Æ22 0Æ22
Nurse manager 2Æ38 ±0Æ55
Staff nurse 2Æ44 ±0Æ44
Support 2Æ76 0Æ01
Nurse manager 2Æ36 ±0Æ43
Staff nurse 2Æ49 ±0Æ35
Standards 0Æ44 0Æ66
Nurse manager 2Æ46 ±0Æ32
Staff nurse 2Æ48 ±0Æ33
Conflict 0Æ48 0Æ63
Nurse manager 2Æ88 ±0Æ45
Staff nurse 2Æ86 ±0Æ51
Identity 2Æ10 0Æ04
Nurse manager 2Æ33 ±0Æ59
Staff nurse 2Æ48 ±0Æ52
Organisational commitment
Organisational identification 2Æ26 0Æ03
Nurse manager 2Æ17 ±0Æ46
Staff nurse 2Æ07 ±0Æ60
Willingness to exert effort 1Æ52 0Æ13
Nurse manager 2Æ45 ±0Æ68
Staff nurse 2Æ55 ±0Æ54
LSOCQ, Litwin and Stringer’s organizational climate questionnaire;
OCQ, organizational commitment questionnaire.
The nfor nurse manager and staff nurse were 64 and 415, respec-
tively. Mann–Whitney Utest was used because of the big difference
on sample size between groups.
S-R Liou and C-Y Cheng
1642 Ó2010 Blackwell Publishing Ltd, Journal of Clinical Nursing,19, 1635–1644
13652702, 2010, 11-12, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2702.2009.03080.x by Chang Gung University of Science and Technology, Wiley Online Library on [24/05/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
organisation, which in turn may assure their retention in the
hospital. It is interesting to note that these particular findings
do not correspond with results (OCo functions as a buffer
between predictors and ITL) from previous studies conducted
with nurses in the Western culture (Gregson 1992, DeConinck
& Bachmann 1994, Lum et al. 1998). However, because the
researchers in the previous studies did not test the indirect
effects of OCo on ITL, they did not report the amount of
mediation of OCo on OCl and ITL. Therefore, a direct
comparison of the results from the current study and from
previous studies may not be appropriate.
Limitations
Findings from the current study offer an initial step to
exploring OCl, OCo and ITL, especially amongst nurses in
Taiwanese hospital settings. However, generalisability of the
study’s findings is limited because of the sampling method,
which was based on responses from nurses working in
hospitals located in southern Taiwan. To increase the power
of generalisability of results, it is recommended that future
investigations include nurses working in other areas of
Taiwan. Additional limitation in this study was the use of a
cross-sectional design. A one-time measure does not permit
testing causal effects of OCl and OCo on ITL. Researchers
are encouraged to conduct longitudinal studies to explore the
possibility of mutual determination and to establish the
causal relationships of OCl, OCo and ITL.
Conclusions
The current study’s findings indicate that although hospital
nurses in Taiwan generally perceive a good OCl, they have a
low commitment to their organisation and yet have a low ITL
their current job. The study participants’ low ITL, despite their
low commitment to their organisation, likely reflects Taiwan’s
collectivist culture, where individuals highly regard relation-
ships, value loyalty and tend to give priority to the goals of the
in-group (Triandis 1995). Results from the current study also
reveal that additional, varied demographic factors – such as
differences in job positions, type of hospitals where they work
and marital status – affect nurses’ perceptions of their OCl.
These findings suggest that nurses have diverse needs and
cultural backgrounds that deserve special attention to motivate
nurses’ positive behaviours on behalf of their organisation.
Relevance to clinical practice
Data from the present study shed more light on the
relationships between OCl, OCo and ITL. This study reveals
that OCl not only is associated with, but also mediates OCo
and ITL amongst hospital nurses in Taiwan. Based on this
finding, it is important for administrators of healthcare
organisations facing high nursing turnover rates to identify
typical factors that influence nurses’ perception of OCl and
intention to leave their job. Such predictors, when recognised
early, provide information that allows administrators to
adopt measures that may alleviate nurses’ ITL and encourage
them to remain with the organisation.
Contributions
Study design: SRL, CYC; data collection and analysis: CYC
and manuscript preparation: SRL, CYC.
Conflict of interest
The authors declare no conflict of interest in the study.
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