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Research Article
Open Access Peer-reviewed

Study of the Relationship between Organizational Climate and Nurses' Performance: A University Hospital Case

Hind Abdullah Mohamed, Samia Gaballah
American Journal of Nursing Research. 2018, 6(4), 191-197. DOI: 10.12691/ajnr-6-4-7
Published online: May 21, 2018

Abstract

Background: Competent nurses' performance and typical work climate are targets that challenge hospital administrators to achieve likely results for success. A positive work climate leads to and sustains nurses' motivation and high performance. Aim: This study aimed to explore the relationship between organizational climate and nurses' performance. Material and methods: A quantitative descriptive correlational research design was utilized. A sample of 110 nurses was recruited from all inpatients' department of the Main Mansoura University Hospital. Tools of data collection: Personal and job characteristics of the participants, organizational climate questionnaire and nurses’ performance evaluation. Results: The study findings highlighted that 51% of the nurses had positive work climate with a higher mean score (12.15±2.39) for customer service while the lowest mean score (5.65±3.1) for compensation. And 30.9 % of nurses had competent performance level with a higher mean score for hospital behavioral expectations domain (75.51±10.41), while the lowest mean score was for education domain (6.91±1.42). A significant relationship was found only between nurses’ performance and age (8.44) and educational level (8.42). Conclusion: The study concluded that a statistically significant positive association was also identified between nurses’ perception of work climate and job performance (.049). So, hospital administrators must push nurses’ performance forward to a high level of competency through creating an exemplary work climate which values nurses, and allows them to share ideas, team spirit and creativity.

1. Introduction

In competitive global health care settings, there is recognition of the importance of the health workforce to health systems development, and the need to establish a positive work climate is increasingly critical to nurses' satisfaction, productivity, and performance 1. A positive organizational climate can increase nurses’ commitment to their job and reduce their intention to leave 2. Therefore, creating and examining a positive work climate that directly influences staff nurses' moral, behavior and attitude is a main concern for health care providers 3.

Organizational climate is defined as the recurring patterns of behavior, attitudes and feelings that characterize life in the organization that is more related to atmosphere and values 4, 5. Farooqui 6 claimed that organizational climate is a set of characteristics that describe an organization and that distinguish the organization from others. Organizational climate is defined as a group of measurable characteristics that employees could perceive directly or indirectly in the work place 7.

Nurses want a more proper work climate that gives them a sense of worth when they do beneficial and competent work. Martine 8 mentioned several factors that contribute to a favorable climate and affect staff nurses’ performance including: work facilitation, concern for people, team building, decision making, participation, communications, customer service, quality, staff/physician relationship and compensation 9.

Unhealthy work environments are an important determinant of several work-related outcomes, including burnout and job dissatisfaction 10. Conversely, nurses who perceive their work environments as being supportive and friendly are more likely to exhibit positive behaviors and good performance 11. Furthermore, Ghasemi and Keshavarzi 12 added that a suitable organizational climate leads to innovation and inspiration in the organization and has a positive role in reaching organizational objectives.

Organizational work climate is linked with diverse types of organizational performance especially nursing performance. Within the hospital setting, the nurses' performance is recognized as an integral component in the provision of quality health care and it plays as a key role in personnel decisions such as promotion and retention 13. Performance is the process of evaluating how well employees perform their jobs when compared to a set of standards, and then delivering that information to those employees 14.

Nurses’ performance is defined as how well the job is done in accordance to established standards. It represents the prospective likelihood to carry out particular actions in order to successfully achieve set goals within the given time frame and constraints of the stakeholders and the situation, and also, it is the actual results achieved compared to the desired results 15. Nursing performance refers to how effectively a nurse carries out job roles and responsibilities 16.

Nurse's performance is essential in accomplishing the goals and objectives of an organization as the patient care is at the core of nurses' performance in the hospital. Patients want to be treated well, to know their nurse is knowledgeable, skilled, and competent, to have high quality every time and want nurses to have a caring and human attitude, making them feel safe and comfortable and enabling them to be treated as a human being not a case with compassion, respect and empathy 17.

The nurse’s competence can be improved by analysis of nurses' performance and identification of training needs for further improvement 18. Also, frequent measurement of nurses' performance creates a health care system that provides efficient, effective and high quality of care 17. In this respect Necochea and Fort 19 stated that to enhance nurse's performance, the hospital administrators must create an environment which values nurses, empowers them in a way that latent potential can be realized, and can strengthen or change positively the organization's culture.

Consequently, a study conducted by Alves and Guirardello 20 investigated the relation between nursing work environment, patient safety and quality of care in a pediatric hospital. The study concluded that the professional practice environment in health institutions impact the quality and safety of the care provided to patients. Also, another study done in Egypt aimed to examine the relationship between organizational climate and nurses' job outcomes, and found that organizational climate was correlated to nurses' job outcome 21. In Accordance with the literature, organizational climate is correlated with work effectiveness, nurses’ job outcome and organizational performance that is considered as an important parameter in the nursing profession 22. So, this study aims to explore the relation between organizational climate and nurses' job performance.

1.1. Aim

The current study aimed to explore the relationship between organizational climate and nurses' performance.

1.2. Research Objectives

1. Identify nurses' perception related to organizational climate.

2. Assess the nurses' job performance.

3. Detect the relationship between organizational climate and nurses' job performance regarding personal and job characteristics.

4. Find out the relationship between organizational climate perception and job performance of nurses.

2. Methods

2.1. Research Design

A quantitative descriptive correlational research design was utilized to explore the relation between organizational climate and nurses' job performance.

2.2. Setting

The present study was conducted at all medical and surgical units of the Main Mansoura University Hospital in El Dakahlia Governorate, Egypt. This hospital provides a wide spectrum of health care services at Delta region.

2.3. Participants

A convenient sample of 110 nurses who were working in the previous setting.

2.4. Instruments

The instruments that were used in the current study were divided into three sections; which are Personal and Job Characteristics of the participants, Organizational Climate Questionnaire and Nurses’ Performance Evaluation.

Section (1): Personal and job characteristics for the participants:

This part consisted of personal and job characteristics of the study sample such as age, gender, marital status, educational level, and years of experience.

Section (2): Organizational Climate Questionnaire:

The instrument was developed by Martine 8, and aimed to measure perception of organizational climate characteristics among nurses. The instrument consists of 30 items grouped into ten domains as the following; work facilitation, concern for nurses, team building, decision making, participation, communications, customer service, hospital reputation, staff/physician relationships and compensation. Every domain had three items.

Organizational Climate Questionnaire is a five-point Likert scale ranging from never (1) to always (5). The score obtained ranges from 30-150, level of perceived organizational climate is high if the percentage score is 60% or more, and low if less than 60%, based on cut of points.

Section (3): Nurses’ Performance Evaluation:

The researcher used an observation checklist that was created by Cobb 23 and aimed to measure nurses’ job performance. It included 60 items that were classified into four domains; expected hospital behavior (25 items), nursing process (18 items), quality of care (13 items), and education (four items).

Nurses’ Performance Evaluation is a five-point Likert scale ranging from unacceptable (1) to outstanding (5). The points that can be scored on the scale fluctuate between 60 and 300. The subject is considered practice with competent performance level if the percentage score is 68% or more and practice with incompetent level if less than 68% 24.

In the two instruments, for each domain, the scores of the items were summed-up and the total was divided by the number of the items, giving a mean score for each part.

2.5. Tools Validity and Reliability

The two tools were translated into Arabic language by the researcher. Translation-back translation was conducted by a bilingual professional person. Tools were submitted to a panel of seven experts in the field of the study to confirm face and content validity.

The Cronbach Alpha reliability for the organizational climate questionnaire and nurses’ performance evaluation was done before and was found (0.91, 0.95) respectively. Meanwhile, the Cronbach's alpha for the translated organizational climate questionnaire and nurses’ performance evaluation were (0.93, 0.89) respectively.

2.6. Data Collection

The study was conducted at the Main Mansoura University Hospital, which affiliated to Mansoura University Hospitals, in Egypt. Data was collected 5 days/week over three shifts and the time of the data collection lasted for five months from January to May 2016. Organizational Climate Questionnaire took around 15 minutes to be filled by each participant. Nurses’ Performance Evaluation was fulfilled using observational techniques for 3 different times to assure and verify the nurses' performance level by calculating the average score of each item in the observational checklist.

2.7. Pilot Study

A pilot study was carried out on 10% of the studied sample with a total number of eleven nurses who were selected randomly before starting data collection, to ascertain the clarity and applicability of the tools, also to estimate the needed time to fill it. Those who took part in the pilot study were included in the study.

3. Ethical Considerations

A written approval to conduct the study was obtained from Dean of the Faculty of Nursing. Another ethical approval was obtained from the medical and nursing directors of the setting where data was collected, and a verbal consent was obtained from the participants. Research aim and approach to completing the instruments were clearly explained for all participants. Anonymity and voluntary participation in the study was assured to all participants without coercion or pressure. Confidentiality was declared to all participants and the researcher confirmed that information will be used for the research purpose only.

4. Statistical Analysis

Data was analyzed with SPSS version 22.0. The normality of data was first tested with one-sample Kolmogorov–Smirnov test. Qualitative data was described using number and percentage. Continuous variables were presented as mean ± SD (standard deviation) for parametric data. Two un-matched groups were compared using independent sample ‘T’ test. Analysis of Variance (one-way ANOVA test) was used for comparison of means of more than two groups, and Pearson correlation coefficient was used. Statistical significance was considered at the 0.05 level.

5. Results

That majority of nurses were females (95.5%) and have a mean score of age (27.35± 7.43), married (83.6%), have less than 10years of experience (43.6%), and have nursing diploma as educational level (44.5%).

Table 1 showed the work climate as perceived by nurses. The table highlighted that more than half of the nurses had high perception of positive work climate with mean score (93.1±17.26), with a higher mean score (12.15±2.39) for customer service followed by hospital reputation (10.02±3.03), while the lowest mean score (5.65±3.1) for compensation.

Table 2 illustrated the nurses' performance as observed among nurses. It is noted that less than one third of nurses had high level of competent performance (179.67±21.11), with a higher mean score for hospital behavioral expectations domain (75.51±10.41), while the lowest mean score was for education domain (6.91±1.42).

Table 3 indicated the relation between nurses’ mean score of work climate and their personal and job characteristics. The table reflected that the higher mean scores of work climate were detected among elder male nurses who had experience more than 30 years with educational level of technical institute and single (97.00, 105.8, 101.7, 94.05and 96.57 respectively). Nonetheless of these relations are statistically significant.

Table 4 portrays the relation between staff-nurses’ level of performance and their personal and job characteristics. It was noticed that there was a significant relationship at level (0.01) between nurses’ level of performance and: age (8.44) for a higher level of competency for who had 30-<40 years, and educational level (8.42) for a higher level of competency for faculty graduated nurses. Nonetheless of other the characteristics had significant relations.

Table 5 displays a correlation between staff nurses’ work climate and job performance. The table concluded that, there was a positive statistically significant relationship between staff nurses’ perception of work climate and job performance (P=<.049).

6. Discussion

Organizational climate reflected staff behavior and feelings toward their work place 25. And the creation of positive work climate is a key to organization successes and progress and is essential to achieve the best work results of nurses 26. Accordingly, the present study examined the relationship between nurses' perception of work climate and their performance.

Indeed, the research findings illustrated that nurses perceived customer service, hospital reputation and work facilitation positively, but they perceived decision making, team building and compensation negatively that are characteristics of their work climate. Also, the findings revealed that more than half of the nurses perceived a high level of organizational climate. In this context, Jianwei Zhang 7 claimed that institutional climate consists of measurable attributes that employees perceive in their work environment. This is in the same vein of Abd El-Megeed and Ahmed 27 who concluded that the good spirits and relationships, and human treatment between nurses are indicators of open and positive climate. Also, previous researchers found that organizational support, cooperative work environments and fair rewarding were indicators of organizational climate perception 28, 29, 30.

As results indicated before, nurses had the highest mean score for customer service that revealed patients were respected and provided with fast and efficient services. These results are in congruence with Wu and Norman 31; Abd El-shafy 32 who claimed that nurses have good interaction with patients and others. Conversely, the lowest mean score was found for compensation. This indicates that most nurses reported they did not have enough privileges compared with other hospitals, and there is no fair strategy in increasing salaries. This finding agreed with those of Kassem and Gaber 26 in their study of organizational climate and its impact on nurses’ job empowerment, and concluded that the majority of staff nurses reported that they were not rewarded in proportion to their excellence and they do not have enough privileges.

The study result is consistent with Aiken et al., 33 who were studying the work environment of nurses in 12 European countries and found that the highest percentage of nurses had positive perception toward work climate. Besides, the study results were parallel to Kassem and Gaber 26 who found that nurses perceived their organizational climate positively. This finding is congruent with Giacomo 34; Mryyan’s 35 point of view. Unlike to this perspective, Van Bogaert et al., 36 indicated that nurses are dissatisfied with their work environment. Meanwhile, El-Salam et al., 37 claimed that the majority of staff nurses in different units perceived moderate organizational climate.

The current study also highlighted that less than one third of nurses had high level of performance competency, meanwhile, the majority of them had incompetent level of performance which is somehow in accordance with Shehata 38 who examined the relationship between the disposition of staff nurses toward critical thinking and quality of their performance at Mansoura university hospital. Concerning performance domains, the research finding displayed that the four domains of performance were ranked as hospital behavioral expectations, nursing process, quality of care and education from highest to the lowest mean score.

The low level of competency may be attributed to the fact that those nurses had many performance areas that were in need for enhancement as assessment, diagnoses, formulating a nursing care plan, appropriate interventions for risky patients, following universal precaution during care provided and documentation. This poor performance level was interpreted by the current research finding that revealed most nurses are in need for educational training program to upgrade their practice and attitude that reflect high patient care quality. This point of view is upheld and supported by Ibrahim et al., 39 who studied head nurses' leadership styles and staff nurses' job performance in Egypt. The same finding was reported by Fathi 40 who reported that the quality of nurse's performance is/was affected by lack of training and guidance in carrying out their tasks. On a similar line, Ali 41 illuminated that training and development as well as supportive work environment is are urgent demands to improve nursing personnel performance.

Conversely, the study results contradicted with Mohamed 42 who specified that the highest percentage of nurses at Alexandria Hospital valued dimensions of their performance as well performed in their units which might be related to the fact that nurses' performance self-appraisal rated their performance higher than reality or than supervisors' appraisal. On the other hand, Saleh 43 reported a moderate level of nurses' performance and there is a need for nurses to be proactive in identifying opportunities for improving care, documenting that care and recommending, implementing and evaluating actions to bring about improvements in their performance.

The present study noted that elder single nurses who have experience and advanced educational level had more competent performance than other nurses with a statistically significant difference. Those nurses stay in hospital for long term time so; they may have sufficient knowledge and skills that enhance their performance. These results are in congruence with Rabeel 44 who found that nurses with more years of nursing experience become more expert and knowledgeable. This was in the same line with Refaat 45 who found a statistical significant correlation between performance level and nursing qualification which mean that nurses with higher qualification had generally higher scores of total performance compared to the nursing school graduates, as they transmit their educational knowledge to clinical practice.

Additionally, this finding was in accordance with Serra 46 who proved that there was a positive statistical significant relationship between nurses' age and their performance. Also, Shehata, 47 found that older nurses at Mansoura University Hospital had more experience in providing nursing care to take challenging tasks. In addition, they had more confidence to pursue a standard of excellence and emphasize quality over quantity. On the other hand, none of the personal and job characteristics had a statistically significant relations with nurses’ work climate. This is in agreement with other studies of El-Salam et al, 37; Abd El-shafy 32. Also, Zayan et al., 21 concluded that there was no significant relation between nurses’ experience and organizational climate dimensions.

Furthermore, it is obvious from the study result that there was a statistically significant positive association between nurses’ perception of work climate and their performance at work place. This finding goes in the same line with Nojehdehi et al., 2 who compared organizational climate and nurses’ intention to leave among different hospitals, and reported that organizational climate is a critical issue in increasing the quality of performance and achieving the hospitals goals. Also, Galer et al., 48 stated that a positive work climate motivates staff and pushes them to use their capabilities to perform extra effort, consequently, job performance becomes more competent.

This can be clarified by Suliman and Isles 49 who claimed that the organization that had positive work climate and aimed to enhance the effectiveness of their employees by assisting and supporting them consequently, managed to make its employees more satisfied and committed to their organization. This is the same view point of Bahramia et al., 25. Also, Chahal1 et al., 50 stated that a good work climate denotes the staff loyalty and their work efficiency towards their organization. In particular studies, researchers have found links between organizational climate and employee performance 51. On the other hand, Wilmer et al., 52 found that unhealthy work environments are detrimental to nurses’ ability to provide quality patient care. Finally, Meyer and Allen 53; Vanaki and Vagharseyyedin 54 assured that favorable organizational climate that supports, assists staff and provides them with good working condition leads to job satisfaction and consequently, they can achieve a high level of performance.

7. Conclusion

The current research concluded that there is a statistically significant positive association between nurses’ perception of work climate and job performance. According to many scholars, the quality of the job is an indicating factor which influences performance 33, 55. Consequently, the hospital administrators must push nurses’ performance forward to a high level of competency through provision of an exemplary work climate that allows nurses to share ideas, team spirit and creativity.

8. Recommendations

In accordance with the foregoing research, the following points are suggested:

- All levels of health managers from the executive director to the team leader must strive to create a typical work environment which values nurses and empowers them.

- Using efficacious and infallible leadership styles that pays- attention for nurses' recognition, encouragement, appreciation and professional development - they have proved satisfactory impact on improving work climate.

-Clarity, support and challenge should be taken into consideration as a crucial motivational behavior in fostering nurses' performance.

-The nurse's competence can be improved by frequent measurement of nurses' performance and the identification of training needs to improve poor areas of performance.

- Reward and sanction system in hospitals should be applied as a main component of nurse motivation.

- Further research must be carried out by the scholars in this scope from other points of view considering the impact of any other overlapping variables.

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[50]  Chahal. R., Dua.S., Singh. N. and Mahey. S. (2012). Study of Organizational climatic factor for employee effectiveness: A Study of Jalandhar Leather factories, International Journal of Management & Information Technology, Vol. (1), No. (2), P.p 21-30.
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[52]  Wilmer, A., Louie, K., Dodek, P., Wong, H. and Ayas, N. (2010). Incidence of medication errors and adverse drug events in the ICU: A systematic review. Quality and Safety in Health Care, Vol. (19), Pp. 1-9.
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[53]  Meyer, J.P. and Allen, N.J. (1993). Commitment to organization and occupations: Extension of a three-component model, J Appl Psychol, Vol. (78), No.(4), Pp. 538-551.
In article      View Article
 
[54]  Vanaki, Z. and Vagharseyyedin, S.A. (2009). Organizational commitment, work environment conditions, and life satisfaction among Iranian nurses, Nurs Health Sci, Vol. (11), No.(4), Pp. 404-409.
In article      View Article
 
[55]  Almalki, M., J., FitzGerald, G. and Clark M. (2012). The relationship between quality of work life and turnover intention of primary health care nurses in Saudi Arabia, BMC Health Services Research, Vol. (2), Pp. 12-314.
In article      View Article
 

Published with license by Science and Education Publishing, Copyright © 2018 Hind Abdullah Mohamed and Samia Gaballah

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Hind Abdullah Mohamed, Samia Gaballah. Study of the Relationship between Organizational Climate and Nurses' Performance: A University Hospital Case. American Journal of Nursing Research. Vol. 6, No. 4, 2018, pp 191-197. http://pubs.sciepub.com/ajnr/6/4/7
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Mohamed, Hind Abdullah, and Samia Gaballah. "Study of the Relationship between Organizational Climate and Nurses' Performance: A University Hospital Case." American Journal of Nursing Research 6.4 (2018): 191-197.
APA Style
Mohamed, H. A. , & Gaballah, S. (2018). Study of the Relationship between Organizational Climate and Nurses' Performance: A University Hospital Case. American Journal of Nursing Research, 6(4), 191-197.
Chicago Style
Mohamed, Hind Abdullah, and Samia Gaballah. "Study of the Relationship between Organizational Climate and Nurses' Performance: A University Hospital Case." American Journal of Nursing Research 6, no. 4 (2018): 191-197.
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  • Table 3. Relation between nurses’ mean score of work climate and their personal and job characteristics
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In article      View Article
 
[50]  Chahal. R., Dua.S., Singh. N. and Mahey. S. (2012). Study of Organizational climatic factor for employee effectiveness: A Study of Jalandhar Leather factories, International Journal of Management & Information Technology, Vol. (1), No. (2), P.p 21-30.
In article      
 
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In article      View Article
 
[52]  Wilmer, A., Louie, K., Dodek, P., Wong, H. and Ayas, N. (2010). Incidence of medication errors and adverse drug events in the ICU: A systematic review. Quality and Safety in Health Care, Vol. (19), Pp. 1-9.
In article      View Article
 
[53]  Meyer, J.P. and Allen, N.J. (1993). Commitment to organization and occupations: Extension of a three-component model, J Appl Psychol, Vol. (78), No.(4), Pp. 538-551.
In article      View Article
 
[54]  Vanaki, Z. and Vagharseyyedin, S.A. (2009). Organizational commitment, work environment conditions, and life satisfaction among Iranian nurses, Nurs Health Sci, Vol. (11), No.(4), Pp. 404-409.
In article      View Article
 
[55]  Almalki, M., J., FitzGerald, G. and Clark M. (2012). The relationship between quality of work life and turnover intention of primary health care nurses in Saudi Arabia, BMC Health Services Research, Vol. (2), Pp. 12-314.
In article      View Article