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The effect of clinical nurses’ job-esteem on work
engagement: Identifying mediating and moderating
effects of positive nursing organizational culture
Ji-Eun Cha
Nurse, Deajeon Eulji Medical Center
Eun-Hi Choi ( choieh@eulji.ac )
Eulji University, Eulji University
Research Article
Keywords: Clinical Nurses, Job esteem, work engagement, organizational culture, Descriptive Correlation
Design
Posted Date: August 4th, 2023
DOI: https://doi.org/10.21203/rs.3.rs-3206437/v1
License: This work is licensed under a Creative Commons Attribution 4.0 International License.
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Abstract
Background
Nursing services play an important role in providing quality healthcare. However, the association of
positive nursing organizational culture with job esteem and work engagement of clinical nurses is not
well established. In this study, we assessed the mediating and moderating effects of positive nursing
organizational culture and job esteem on work engagement among clinical nurses.
Methods
The study adopted a descriptive correlational design. A total of 200 nurses with more than six months’
experience at two university hospitals in Korea participated in the study. Data were collected using a
questionnaire which comprised questions on general characteristics of the participants, positive nursing
organizational culture, the Job-Esteem Scale for Korean Nurses, and the Utrecht Work Engagement Scale.
Results
The results revealed that the direct effect of job esteem on work engagement, indirect effect via positive
nursing organizational culture, and total effect were statistically signicant. The moderating effect of
positive nursing organizational culture on job esteem was not statistically signicant.
Conclusion
The results highlight the need for a development plan to increase job esteem and create a positive
nursing organizational culture to improve the work engagement of clinical nurses. Nursing colleges also
need to implement measures to improve job esteem and develop step-by-step education programs,
interventions, and policy support considering clinical experience. Moreover, establishment of fair
procedures and appropriate compensation may boost nurses’ morale leading to increased work
engagement.
Background
Medical institutions are advancing and becoming more specialized in a rapidly changing medical
environment; therefore, consumers expectations of quality medical services are increasing (1).
Accordingly, medical institutions are striving for high-quality medical services by providing patient-centred
services, improving patient care (2) and emphasising the importance of respecting patients' rights (3).
Nursing teams have the most manpower in medical institutions, and nurses spend signicant time
providing patient care. Nursing services greatly affect the quality of medical services and excellent nurses
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with expertise play an important role in providing quality care. Therefore, the interest in improving the
motivation and enthusiasm of nurses has increased, resulting in the emergence of the concept of work
engagement (WE) (4, 5). WE is dened as a fullling, positive attitude toward work and a state of being
completely immersed in one’s job with passion (6). Nurses with high WE have a high level of energy and
improve their focus on patient-centred nursing, thus, becoming the foundation of quality nursing (7).
Furthermore, WE improves focus on patient care even with a heavy workload (8), resulting in improved
patient satisfaction with nursing services and performance (9). Therefore, to improve the quality of
nursing care and provide patient-centred nursing care, factors affecting WE need to be identied.
Job esteem (JE) refers to the level of respect and authority that an individual has towards their job, and
beliefs and values related to the job (10). The term JE was rst used by Miller (10) in 1999, rst
conceptualized by Choi and Jung (11) in 2019, and instrumentalized in 2020 (12). Organization-based
self-esteem, an early concept of JE, affects the intrinsic motivation of organizational members to strive to
do their job well (13). Moreover, high JE leads to value recognition and self-esteem improvement, and
affects the attitude of maintaining a job with rewards and attachment to one’s job. This helps with job
satisfaction and adaptation to provide quality nursing care to patients (11, 14). Thus, JE may be a factor
that positively affects WE.
Organizational culture refers to the basic assumptions or beliefs that are shared by members of an
organization and are unconsciously implemented in the organization and its environment (15).
Organizational culture affects the performance of nursing staff (16). A positive nursing organizational
culture (PNOC) has a positive effect on individual professional growth and organizational development
by providing an environment in which members of the organization can strengthen solidarity and work
with attachment. It is also an important factor for improving the quality of nursing care and the
competitiveness of hospitals, and developing the nursing profession (17, 18). Thus, the assessment of
the effect of PNOC on WE is important.
Thus far, studies on WE have focused on grit and positive psychological capital (19), emotional labour
strategy (20), and the mediating effects of nursing service quality and performance (5, 21). In contrast,
information available on JE and PNOC is limited. Therefore, this study aimed to evaluate the effect of JE
and PNOC on WE among clinical nurses and develop measures to increase nurses’ motivation and job
satisfaction.
Methods
Research Design
This descriptive correlational study identies the mediating and moderating effects of PNOC on JE and
WE among clinical nurses in D and U cities Eulji university hospitals in South Korea.
Participants and Data Collection
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This study included clinical nurses working in domestic medical institutions after obtaining a nursing
license, working at university hospitals with more than 500 beds in
D
and
U
cities, and with more than six
months of clinical experience. As the questionnaire also included a section on managers’ leadership, the
managers of each department were excluded from the study. Using the G*power 3.1.9.4 program, based
on previous studies (18), considering the median effect size of 0.15, signicance level of 0.05, power of
0.95, and predictor variable 14, the minimum samples required for a regression analysis was 194.
Considering a dropout rate of 10%, the questionnaire was distributed to 219 people, and the response rate
was 100%. A total of 200 questionnaires were analysed, excluding 19 questionnaires with missing data.
After the study purpose was explained to the nursing departments of two university hospitals and
consent was obtained, data was collected only from participants who voluntarily agreed to the survey
according to the hospital’s guidelines. The questionnaires were placed in envelopes and distributed to the
nursing departments. The head of the nursing department of the hospital distributed the questionnaires
to each department. The completed questionnaire was sealed by the participant and deposited in a box.
Seven days after the questionnaire was distributed, the researcher contacted the nursing department of
the hospital and collected the questionnaires directly. The questionnaire was self-administered and 15–
20 minutes were needed to complete it. The data collection period for this study was from July 25 to
August 10, 2022.
Ethical Considerations
In this study, data were collected after obtaining approval (EU22-31-01) from the Institutional Review
Board (IRB) of E University in U City. Participants were informed that they could discontinue at any time
and that their participation would be kept anonymous. Only the participants who agreed to participate in
the study were surveyed. The completed questionnaires were placed in individual envelopes, sealed by
the participants, and then collected by the researcher. A small gift was provided to the questionnaire
participants.
Measurement Variables
Job Esteem
This study used the Job-Esteem Scale for Korean Nurses [JES-KN] developed by Choi and Jung (12). This
scale has seven sub-domains on vocational self-awareness, ve on vocational competences, four on
roles, professionalism, and caring, four questions on social trust and respect, four questions on respect
and recognition from the organization, and four questions on professional authority and future value,
comprising a total of 28 items. Items were measured on a 5-point Likert scale ranging from 1 point for
‘not at all’ to 5 points for ‘very much so’, and the higher the score, the higher the JE of Korean nurses.
In Choi and Jung’s study (12), Cronbach's α was 0.94, and in this study, Cronbach's α was 0.93. Reliability
by sub-domain was classied as an occupational self-awareness factor of 0.86, occupational
competence factor of 0.85, caring role and professionalism factor of 0.83, social trust and respect factor
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of 0.80, organizational respect and recognition factor of 0.87, and occupational authority and future
value factor of 0.80.
Positive Nursing Organizational Culture
In this study, the PNOC measurement questionnaire developed by Kim and Kim (18) was used. This
questionnaire comprises 26 questions, including seven questions on the active leadership of nursing
managers, seven questions on the pursuit of common values, eight questions on trust-based
organizational relationship formation, and four subdomains of four questions for the fair management
system. It was measured on a 5-point Likert scale ranging from 1 for ‘strongly disagree’ to 5 points for
‘very much agree’.
Cronbach's α was 0.95 in Kim and Kim’s (18) study, and Cronbach’s α was 0.95 in this study. Reliability by
subdomain was active leadership of nursing managers (0.95), pursuit of common values (0.85), trust-
based organizational relationship formation (0.89), and fair management system (0.84).
Work Engagement
In this study, the Utrecht Work Engagement Scale (UWES), developed by Schaufeli et al. (22), was used
with the Utrecht Work Engagement Scale-Korean Version (UWES-K), adapted by Kim et al. (23). This tool
comprises nine items in three subdomains: vitality with three items, immersion with three items, and
commitment with three items. It was measured on a 7-point Likert scale, ranging from 0 points for ‘never’
to 6 points for ‘always felt’, with higher scores indicating higher zeal for jobs of nurses.
In the study by Schaufeli et al. (22), Cronbach's α was 0.93; in the study by Kim et al. (23), Cronbach's α
was 0.91, and in this study, Cronbach’s α was 0.92. Reliability by subdomain was 0.85 for vitality, 0.82 for
commitment, and 0.88 for immersion.
Data Analysis
The collected data were analysed using SPSS WIN 28.0 (IBM corp., NY, USA). The general characteristics
of the participants were presented using descriptive statistics. JE, PNOC, and WE were presented using
mean and standard deviation. The differences in WE according to the general characteristics of the
participants were analysed using the
t
-test and analysis of variance (ANOVA), and the post-hoc test was
analysed using the Scheffé test. The relationships between JE, PNOC, and WE were analysed using
Pearson's correlation coecient.
The SPSS PROCESS macro model 14 proposed by Hayes (24) was used to test the mediating and
modulating effects of PNOC on the effect of JE on WE. To verify the signicance of the mediating and
moderating effects, a signicance test was conducted using the condence interval (CI) in the
bootstrapping method. In this study, a 95% CI was determined by extracting 5,000 bootstrap samples. All
variables were as they were for analysis. In the moderating effect analysis, mean centring of the variables
was used to reduce the problem of multi-coordinates and improve the ease of interpretation. Moreover,
the measured variables were standardized to identify standardized coecients in the moderating effect
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analysis. In the case of moderated variables, the graphs were presented at the high, medium, and low
percentile values of 16, 50, and 84 provided by PROCESS.
Results
Participant Characteristics and Variables
A total of 200 participants were included in the study with 12.5% males and 87.5% females, and an
average age of 28.36 ± 4.64 years. Regarding marital status, 83.5% were unmarried and 90.5% had no
children. Overall, 67.0% of the participants reported that they followed no religion. In this study, average
JE was calculated to be 3.79 ± 0.45 points out of 5 points, average PNOC was calculated to be 3.54 ± 0.56
points out of 5 points, and average WE was calculated to be 2.94 ± 0.93 points out of 6 points (Table1).
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Table 1
Participant’s General Characteristics and Measurement Variables (N = 200)
Characteristics Categories N (%) M ± SD
Gender
Male 25 (12.5)
Female 175 (87.5)
Age (yrs.)
≤ 25 74 (37.0) 28.36 ± 4.64
26–29 61 (30.5)
30–34 45 (22.5)
≥ 35 20 (10.0)
Marital status
Married 33 (16.5)
Single 167 (83.5)
Child
Yes 19 (9.5)
No 181 (90.5)
Religion
Yes 66 (33.0)
No 134 (67.0)
Job position
Staff nurse 177 (88.5)
Charge nurse 14 (7.0)
PA nurse 9 (4.5)
Clinical experience (yrs.)
< 5 106 (53.0) 5.54 ± 4.40
5–10 58 (29.0)
*Special unit: Emergency room, intensive care unit, and operating room.
**Wards: General wards, Comprehensive nursing care service wards
†Others: Ambulatory care, physician assist, hemodialysis unit, delivery room
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Characteristics Categories N (%) M ± SD
≥ 10 36 (18.0)
Work unit
Special unit*108 (54.0)
Wards** 72 (36.0)
Others†20 (10.0)
Shift pattern
Day shift only 30 (15.0)
Shift work 170 (85.0)
Average night shift days (per month)
≤ 3 36 (18.0) 5.62 ± 2.32
4–6 55 (27.5)
≥ 7 109 (54.5)
Heath Status
Healthy 35 (17.5)
Neutral, unknown 139 (69.5)
Not healthy 26 (13.0)
Job-Esteem (JE) 3.79 ± 0.45
Professional self-awareness 3.91 ± 0.51
Professional competence 3.84 ± 0.54
Role and expertise of care 4.17 ± 0.56
Social trust and respect 3.95 ± 0.59
Respect and recognition of the organization 3.26 ± 0.72
Positive Nursing Organizational Culture (PNOC) 3.54 ± 0.70
Professional authority and future value 3.54 ± 0.56
*Special unit: Emergency room, intensive care unit, and operating room.
**Wards: General wards, Comprehensive nursing care service wards
†Others: Ambulatory care, physician assist, hemodialysis unit, delivery room
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Characteristics Categories N (%) M ± SD
Positive leadership of nursing unit manager 3.45 ± 0.78
Pursuit of common values 3.57 ± 0.56
Form organizational relationship based on trust 3.72 ± 0.58
Fair management system 3.30 ± 0.72
Work Engagement (WE) 2.94 ± 0.93
Vigor 2.44 ± 0.97
Dedication 3.31 ± 1.00
Absorption 3.07 ± 1.14
*Special unit: Emergency room, intensive care unit, and operating room.
**Wards: General wards, Comprehensive nursing care service wards
†Others: Ambulatory care, physician assist, hemodialysis unit, delivery room
[Table1 about here]
Differences in WE Based on General Characteristics of
Participants
A signicant difference was observed in WE based on age (F = 3.476,
p
= 0.017). A post-hoc analysis
revealed that WE was signicantly higher in the ≥ 35 years or older age group than that in the ≤ 25 and
the 26–29 age groups. WE according to marital status was signicantly higher in married nurses with
children than in single nurses with children (
t
= 2.332,
p
= 0.023), and signicantly higher than in those
without children (
t
= 3.100,
p
= 0.005).
A signicant difference was also observed in WE based on clinical experience. A post-hoc analysis
revealed that the group with > 10 years of experience had a higher WE than the group with < 5 years of
experience (
F
= 3.911,
p
= 0.022). Based on health status, the ‘healthy’ group had a signicantly higher WE
than the ‘unhealthy’ group (
F
= 5.658,
p
= 0.004) (Table2).[Table2 about here]
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Table 2
Differences in Work Engagement according to the General Characteristics of Participants (N =
200)
Characteristics Categories N M ± SD t/F
p
(Scheffe)
Gender Male 25 25.48 ± 8.64 -0.627 0.535
Female 175 26.63 ± 8.40
Age ≤ 25a 74 25.06 ± 6.75 3.476 0.017
(yrs.) 26–29b 61 26.96 ± 8.93 (a, b < d)
30–34c 45 25.88 ± 9.76
≥ 35d 20 31.65 ± 7.51
Marital status Married 33 29.09 ± 6.63 2.332 0.023
Single 167 25.97 ± 8.65
Child Yes 19 31.05 ± 6.53 3.100 0.005
No 181 26.01 ± 8.46
Religion Yes 66 27.15 ± 8.01 0.635 0.426
No 134 16.16 ± 8.62
Job position Staff nurse 177 26.05 ± 8043 2.221 0.111
Charge nurse 14 30.50 ± 7.56
PA nurse 9 28.88 ± 8.00
Clinical experience < 5a 106 25.26 ± 7.48 3.911 0.022
(yrs.) 5–10b 58 26.72 ± 9.97 (a < c)
≥ 10c 36 29.72 ± 7.59
Work unit Special unit*108 26.55 ± 8.84 0.007 0.993
Wards** 72 26.41 ± 7.71
Others†20 26.40 ± 8.92
*Special unit: Emergency room, intensive care unit, and operating room.
**Wards: General wards, Comprehensive nursing care service wards
†Others: Ambulatory care, physician assist, hemodialysis unit, delivery room
Values with superscript letters a, b, and c are signicantly different across rows (
p
< 0.05)
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Characteristics Categories N M ± SD t/F
p
(Scheffe)
Shift pattern Day shift only 30 26.53 ± 7.23 0.035 0.973
Shift work 170 26.48 ± 8.62
Average night shift days ≤ 3 36 27.88 ± 8.14 1.191 0.306
(per month) 4–6 55 27.18 ± 8.74
≥ 7 109 25.67 ± 8.32
Health status Healthy a35 29.34 ± 10.77 5.658 0.004
Neutral, unknown b139 26.57 ± 7.58 (a > c)
Not healthy c26 22.19 ± 7.61
*Special unit: Emergency room, intensive care unit, and operating room.
**Wards: General wards, Comprehensive nursing care service wards
†Others: Ambulatory care, physician assist, hemodialysis unit, delivery room
Values with superscript letters a, b, and c are signicantly different across rows (
p
< 0.05)
Correlation of Measured Variables
JE was signicantly and positively correlated with WE (
r
= 0.598,
p
< 0.001) and positively correlated with
PNOC (
r
= 0.441,
p
< 0.001). The PNOC had a signicant positive correlation with WE (
r
= 0.447,
p
< 0.001)
(Table3).
Table 3
Correlation of Measured Variables (N = 200)
Variable 1 2
1. JE 1
2. PNOC 0.441(< 0.001) 1
3. WE 0.598(< 0.001) 0.447(< 0.001)
JE: Job Esteem; PNOC: Positive Nursing Organizational Culture; WE: Work Engagement
Mediating and Moderating Effects of PNOC on WE by JE
To determine the mediating effect of PNOC on JE and WE, PNOC was used as a parameter and age,
marital status, children, clinical experience, and health status were used as control variables. The direct
effect of JE on WE (B = 0.905, 95% CI = 0.631–1.179), indirect effect via PNOC (B = 0.269, 95% CI = 0.109–
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0.453), and total effect (B = 1.174, 95% CI = 0.924–1.424) was statistically signicant (0 was not included
in the interval) (Table4).
Table 4
Mediating and moderating effects of PNOC on WE by JE (N = 200)
Categories Variable B SE β95% CI
LLCI ULCI
Mediate JE → WE (Direct effect) 0.905 0.139 0.269 0.631 1.179
Effect JE → PNOC → WE (Indirect effect) 0.269 0.087 0.130 0.109 0.453
Total 1.174 0.127 0.567 0.924 1.424
R20.372
F 19.115
p
< 0.001
Moderate JE 0.894 0.141 0.404 0.617 1.171
Effect PNOC 0.421 0.105 0.239 0.214 0.629
JE × PNOC 0.099 0.182 0.025 -0.260 0.457
R20.423
F 17.519
p
< 0.001
Control variable: Age, Marital status, Child, Clinical experience, health status
β: standardized coecient
5,000 samples were re-extracted for bootstrap; CI: condential interval; LLCI: lower limit of B in 95%
condence interval; ULCI: upper limit of B in 95% condence interval. JE: Job Esteem; PNOC: Positive
nursing organizational culture; WE: Work engagement
The results were controlled for age, marital status, children, clinical experience, and health status to
determine the moderating effect of PNOC on JE and WE. JE and PNOC were mean-centring, and JE and
PNOC variables were standardized when standardization coecients were obtained. The moderating
effect of PNOC on JE was not statistically signicant (B = 0.099, 95% CI = -0.260∼0.457) (Table4, Fig.1).
Discussion
This study aimed to identify the effects of JE in clinical nurses and that of PNOC on WE. Moreover, the
study aimed to provide basic data to develop measures to improve WE in clinical nurses.
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In this study, the average WE was 2.94 points out of 6 points, which was less than half the maximum
possible score. In a study of general hospital nurses in Korea (25) that used the same scale, the score
was 3.08. Additionally, it was 4.60 in a study with Spanish nurses (26), and 4.40 in a study with Egyptian
nurses (27). Although a direct comparison is dicult, Korean nurses were observed to have a relatively
low WE compared to nurses in other countries. WE increased with age and clinical experience, similar to
the results of previous studies (19). In WE, higher age and clinical experience is associated with higher
knowledge and experience of nursing, resulting in higher skill levels. As these experienced nurses can
exibly cope with various situations in the hospital, they may nd pleasure in the work itself and become
immersed in it (28). Therefore, the policies and systems for career development should be reorganized so
that nurses can inspire WE to create a working environment to induce long-term employment. Moreover,
higher health levels were associated with higher WE. Lower health levels may result in greater physical
and mental burden of patient care (29). Therefore, it is necessary to create an autonomous working
environment and provide healthcare support to nurses.
In this study, the average score for JE was 3.79 out of ve points. However, the scale used for JE was
relatively new and was only developed in 2020 for nurses. Therefore, few studies have used the scale,
and therefore making comparisons is dicult. In the subdomains of JE, the average score of the role and
professionalism of caring was the highest, and the average score of respect and recognition of the
organization were the lowest. Thus, there is a gap between nurses who have a high value for their work
and expertise but a low level of feeling that they are respected by the hospital organization. Nurses
working in clinics experience diculties communicating with various departments and confusion about
their roles and identities during periods of excessive work, and therefore, they do not feel valued at their
jobs which results in negative sentiments of the value and expertise of their work (30). Nurses feel
rewarded and proud when they are provided an environment where they can demonstrate their abilities
and expand their skills while applying their professional knowledge to various situations. Hospitals
should identify factors that hinder nurses’ JE and develop interventions for them. Moreover, the study
highlights the need for measures to promote JE in nurse education.
JE had a direct impact on WE, and WE was observed to increase when nurses themselves considered
rewards and self-worth important in their jobs and evaluated them highly. These results are similar to the
that of a study that reported higher intrinsic value of evaluating one’s work as unique and altruistic was
associated with higher WE (31). Saks (32) reported that nurses worked enthusiastically when their work
was considered necessary in the organization and recognized by others. Praise and acknowledgement for
their abilities in the organization affected their immersion and satisfaction in the organization (33).
Therefore, conrming the positive evaluation or expectation level of nurses for their jobs is important (11,
14).
In this study, PNOC had a mediating role on the effect of JE on WE. Thus, higher JE was associated with
higher WE. Additionally, WE was reported to further improve as nurses’ JE was weighted by PNOC. Direct
comparison with previous studies is dicult, as there are no similar studies. However, a previous study
reported that perceived organizational support has a positive effect on self-esteem and professional
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benet (34). Furthermore, PNOC was observed to inuence WE (35) by understanding and predicting each
other’s behaviour through active mutual exchanges among members. However, another study with a
different order of variables (36) reported that self-esteem mediates perceived organizational support and
affects the intention to remain.
In this study, PNOC had a positive moderating effect of JE on WE, however, this was not statistically
signicant. As shown in Fig.1, as JE increases, WE increases, and the slope is the same. Furthermore, Yu
et al. (37) reported a positive moderating effect on subjective well-being between self-esteem and
perceived organizational support, and that people with high self-esteem had a larger slope toward
subjective well-being. Kim et al. (38) reported that organizational justice had a positive moderating effect
on self-ecacy and nursing performance. In the case of high organizational justice and self-ecacy,
nursing performance increased rapidly compared to the group with low self-ecacy, consistent with the
ndings of this study. However, there was a difference in the results of Kim et al.’s study and this study
which may be due to the different components of the concepts of JE and self-esteem. Self-esteem
includes feeling the value assigned to oneself, self-acceptance, including one’s mistakes, and ability to
cope with situations (39), and is the result of a subjective self-evaluation (40). Since the social structure
is associated with self-esteem (41), self-esteem is based on one’s expectations to take certain actions
within a family or organization and feedback from the other person about oneself. Therefore, a person
with high self-esteem desires to be recognized by others, resulting in an interaction effect with PNOC. JE
is based on social trust and respect, and the social image of the job, social reliability of the job, and
extrinsic values all together become the driving force for maintaining the job (11). Thus, the value of an
individual's ability can interact with PNOC, however, JE, which includes the social perception of the job
that an individual feels, does not have an interaction effect with PNOC. Thus, this study revealed that
PNOC had a mediating effect on JE, but no moderating effect. Therefore, an individual's self-assessed
beliefs and values about their job improve WE through organizational leadership and trust-based
organizational relationships. However, it does not change the social image of the job, social trust, or
extrinsic value.
In this study, the average PNOC score was 3.54 points out of 5 points. Moreover, trust-based
organizational relationships had the highest score at 3.72 points compared to other areas. In previous
studies, relation-oriented culture (42), a sub-domain of nursing organizational culture, had a similar result
with 3.68 points out of 5 points. Understanding and empathic relationships based on trust act as positive
factors that can exibly solve problems, even during conict (18). A fair management system had the
lowest PNOC score with 3.30 points. Unfairness in an organization affects trust, and the consequent
damage to trust leads to negative behaviour in the organization (43). Thus, fair distribution and
procedures result in a perception of being rewarded for one’s efforts, inuencing the behaviour of
members and the organization’s behaviour. Therefore, to improve nurses' perception of fair treatment,
nursing managers need to provide general nurses with opportunities to participate in decision-making
and provide their opinions through proper communication to be actively reected on. In addition, hospital
organizations need to establish a fair and consistent evaluation system for determining compensation,
personnel evaluation, and promotion.
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This study has several limitations. First, since the participants were limited to nurses from two hospitals
in the same region, the results of the study could vary depending on the size and specialty of the hospital,
which limits generalization. Second, nurses in management positions were excluded. Therefore, the
average clinical experience was 5.54 years, which is a low level of experience, making it dicult to
represent all nurses. Third, the research period was more than two years after the start of the COVID-19
pandemic in 2020, and many nurses were exhausted; therefore, it is dicult to generalize the results to
other periods. Despite these limitations, nurses fullled their duties despite the threat of COVID-19
infection, which was motivated by JE (44). Moreover, studies on JE are almost non-existent. Therefore, it
is important to study the relationship between JE, PNOC, and WE.
Based on this study, we suggest the following: First, since JE inuences WE, a plan to promote JE is
needed. JE is based on choosing a job and learning. Therefore, it is necessary to develop education
programs that recognize the importance and necessity of JE, starting with student education. In
hospitals, identifying the factors that hinder JE and managing their mediating factors, is important.
Second, as PNOC had a mediating effect between JE and WE, providing a positive nurses’ organizational
culture is important. Nurses can easily burn out in a negative organizational culture during shift work and
heavy workloads. Therefore, it is necessary to facilitate development of trust between colleagues, provide
positive leadership, and strive to provide fair compensation. Third, PNOC did not have a moderating
effect on JE and WE, however, a policy that can increase social trust and extrinsic value of JE nurses is
needed.
Conclusion
This descriptive correlational study identies the mediating and moderating effects of PNOC on JE and
WE in clinical nurses. Moreover, we attempted to provide basic data to provide quality nursing care by
increasing WE.
This study suggests that a plan to enhance JE and create PNOC is needed to improve WE of clinical
nurses. Furthermore, support should be provided at an organizational level. Nursing colleges also need to
try to improve JE and develop step-by-step education programs, interventions, and policy support in
consideration of clinical experience. In addition, if a fair procedure and an appropriate compensation
system are established to boost nurses’ morale, the impact of WE can be enhanced.
Abbreviations
JE
job esteem
PNOC
positive nursing organizational culture
WE
work engagement
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Declarations
Ethics approval and consent to participate
This study was approved by the Institutional Review Board of Eulji University (EU22-31-01) before data
collection. The participants were provided with an information sheet and consent form specifying the
anonymous nature of the survey and their freedom to withdraw from the study at any time. In this study,
informed consent was obtained from all participants and all methods were carried out in accordance with
relevant guidelines and regulations.
Consent for publication
Not applicable
Availability of data and materials
Data available upon request by email to the corresponding author.
Competing interests
Not applicable
Funding
This research received no specic grant from any funding agency in the public, commercial, or not-for-
prot sectors. The authors declare that there are no conicts of interest.
Authors’ Contributions
Study conception and design: JE, & EH, Data collection: JE, Data analysis and interpretation: JE, Drafting
of the article: JE, & EH, Critical revision of the article: EH, Final approval of the version to be published: EH.
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Figures
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Figure 1
Interaction effect between JE and PNOC
