Abstract
Background
Workplace bullying experienced by clinical nurses is a critical and pervasive issue that not only detrimentally impacts nurses but also poses a significant threat to the overall quality of nursing services and patient care. This study aimed to determine the mediating role of organizational commitment in the relationship between workplace bullying and turnover intention among clinical nurses in China.
Methods
Participants were recruited from 40 hospitals in various provinces of China from December 2, 2021 to February 25, 2023, using convenience sampling. After obtaining hospital ethical approval and participants’ informed consent, clinical nurses (n = 585) from different nursing departments in different hospitals completed the questionnaire. The Socio-demographic Questionnaire, Negative Acts Qestionnaire, Chinese Workers’ Organizational Commitment Scale and Turnover Intention Questionnaire were used to collect general demographic data of nurses and assess workplace bullying they experienced, their level of organizational commitment and turnover intention. Descriptive statistics, Pearson correlation analyses and structural equation model were adopted to analyze the data.
Results
Pearson’s correlation analysis showed that that workplace bullying was significantly negatively correlated with organizational commitment (r = − 0.512, P<0.01) and significantly positively correlated with turnover intention (r = 0.558, P<0.01), organizational commitment was significantly negatively correlated with turnover intention (r = − 0.539, P<0.01). Mediation analysis indicated organizational commitment partially mediated the association between workplace bullying and turnover intention. The total effect (β = 0.69) of workplace bullying on turnover intention consisted of its direct effect (β = 0.41) and the indirect effect mediated through organizational commitment (β = 0.280), with the mediating effect accounting for 40.58% of the total effect.
Conclusion
Organizational commitment mediated the associations of workplace bullying and turnover intention. Therefore, healthcare organizations and nursing managers should develop appropriate strategies to enhance nurses’ organizational commitment in order to reduce their turnover intention.
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Introduction
Workplace bullying
Workplace bullying is a serious social issue [1], which has a great impact on the development of nursing and nurses. Workplace bullying has been defined as “a situation where employees are consistently subjected to negative and aggressive words or behavior at work” [2]. Academics have reported on bullying in different research settings around the world and studies has shown that workplace bullying is more common and severe in nursing than in other professions [3, 4]. De Cieri et al. found that 42% of healthcare professionals, including nurses, had experienced bullying at work in the previous 12 months [5]. According to a cross-sectional study among clinical nurses in China, 68% of nurses had experienced workplace bullying in the previous 12 months [Prevalence of workplace bullying among chinese clinical nurse As a source of work–family conflict, workplace bullying is common among nurses and has a non-negligible impact on nurses’ work and life [45,46,47]. Our research showed that the prevalence of workplace violence among nurses (54.6%) is relatively lower than the findings of Zhang (68.31%) [66]. This suggests that managers should step up efforts to publicize the harm of workplace bullying, strengthen nurses’ awareness of workplace bullying, and set a model of appropriate behavior for employees after being properly trained, such as violence prevention skills training, so that nurses can recognize and resist workplace bullying in time [67]. Besides, in order to reduce workplace bullying among nurses, hospital managers should improve the relationship-oriented organizational culture and mitigate the hierarchy-oriented culture [68], and enacting relevant institutional regulations, such as emphasizing in the “Code of Ethics for Nurses” that nurses should maintain a collaborative and respectful relationship with colleagues, and oppose lateral violence in the workplace. It was found that having a system for reporting all bullying incidents leads to significantly lower levels of bullying [69], so leadership can require specific anti-bullying language in organizational policies and establish a credible set of policies and procedures and multiple channels to support those accused of bullying (e.g., confidential multi-assessment 360° assessments) [70]. Secondly, it is necessary to improve the level of nurses’ organizational commitment to reduce the impact of work bullying on turnover intention. The pay-return imbalance model discusses the mechanism of work stress from the perspective of social exchange theory. The theory is that the time and energy people put into their jobs needs to be compensated by money, respect, and opportunities for professional development. Once the organization fails to give corresponding rewards to the employees, the employees will change their original work status, such as late arrival and early departure, absenteeism, decreased satisfaction, job burnout, and reduced organizational commitment [71]. The results of this study indicate that nurses exhibited relatively lower levels of commitment in the dimensions of economic and opportunity commitment among the five dimensions of organizational commitment. Therefore, we recommend that nursing managers prioritize these two dimensions and take targeted measures to improve their levels of organizational commitment. On the one hand, it is necessary to improve the organizational culture and environment of the system to solve the root problem of workplace bullying, managers should establish a fair performance management system and a reasonable incentive system [72, 73], practical strategies could include offering competitive employee benefits, establishing employee-employer relationships, involving them in their own performance appraisal process, etc. [74]. These measures can help nurses recognize that their efforts can be rewarded accordingly, thereby contributing to an improvement in their levels of economic commitment. On the other hand, it is important to establish a fair and well-defined promotion mechanism that offers nurses a transparent and viable career development path with ample opportunities for growth. Besides, offering additional learning opportunities can contribute to enhancing nurses’ levels of opportunity commitment. Albooghobeish’s research suggests that professional ethics education based on a multi-method approach can increase nurses’ organizational commitment [75]. By creating an environment that promotes continuous learning and development, nurses are more likely to perceive a promising career trajectory and remain dedicated to the organization. Furthermore, hospital administrators can enhance nurses’ overall organizational commitment by employing long-term commitment strategies to retain experienced employees, constructing an empowering work environment, implementing flexible work systems, fostering a positive organizational culture, and strengthening the development of a magnetic hospital [76,77,78]. By implementing these measures, administrators can foster a sense of loyalty and attachment among nurses towards the organization, consequently enhancing their organizational commitment. This study has several limitations. First of all, convenience sampling was adopted in this study due to practical reasons such as resource constraints, convenience sampling is a non-probability sampling method that relies on individuals who are easily accessible or readily available to participate in the study, which may lead to selection bias. Future studies should consider using more representative sampling methods to increase the generality of the findings. Second, the participants in this study were mainly recruited from hospitals in central and southern China through convenience sampling, and the proportion of nurses with less than 5 years of experience was close to average, which may generate selection bias and limit the generality of the findings. Future studies should consider expanding the geographical range of the sample and balancing the selection of participants from different regions and different working years. Third, despite the researchers’ diligent efforts to interpret the questionnaire prior to collection, our data relied solely on self-reported responses and may lead to information bias. Therefore, data from care administrators, physicians, and patients can be collected in the future to further complement and enhance our research. Fourth, although SEM is generally referred to demonstrate the direct and indirect associations of variables, the lack of use of longitudinal data prevents the interpretation form reflecting true causality. Therefore, further longitudinal studies should be conducted to better explore the long-term and dynamic effects of workplace bullying on turnover intention of nurses. Workplace bullying should be addressed at both organizational and unit levels. By recognizing workplace bullying is a key factor influencing nurses’ intention to leave, healthcare organizations can be motivated to develop and implement comprehensive anti-bullying policies and procedures. In addition, healthcare organizations should invest in educational programs and training initiatives to raise awareness among healthcare workers about the detrimental effects of workplace bullying and promote a culture of respect and collegiality in order to create a supportive and respectful work environment. Our findings also highlight the importance of organizational commitment, which suggests that nursing managers should pay attention to enhancing the nurses’ organizational commitment, encouraging and supporting nurses to work adequately, and improving their sense of identification with the organization in order to achieve stability in the nursing workforce.Limitations
Practical implications of the study
Conclusion
Our findings demonstrated that organizational commitment served as a mediator between workplace bullying and turnover intention. Healthcare organizations and nursing managers should develop appropriate strategies and actively carry out relevant continuous education and training to enhance nurses’ organizational commitment in order to reduce their turnover intention and stabilize the nursing workforce.
Data Availability
All methods were carried out in accordance with academic standard and declaration of Helsinki. All relevant data are within the manuscript and its Additional files.
Change history
20 November 2023
A Correction to this paper has been published: https://doi.org/10.1186/s12912-023-01591-4
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Acknowledgements
The authors wish to thank all participants and those who helped recruit the participants in the survey.
Funding
This work was supported by Shenzhen Bao’an District Medical health research project (No. 2022JD042) and Clinical Nursing and Management Personnel Research Start-up Foundation of the ** Chen & Zhengxia Lei
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Zhengxia Lei and Yi** Chen was the primary investigator of the study. Guili **a and Yi Zhang did a statistical analysis and wrote this paper. Ling Dong and Fengtao Huang helped conduct the study and revised the manuscript; Yao Pu and Jiang Luo helped supervised the survey and checked the data. All authors contributed to and approved the final manuscript.
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**a, G., Zhang, Y., Dong, L. et al. The mediating role of organizational commitment between workplace bullying and turnover intention among clinical nurses in China: a cross-sectional study. BMC Nurs 22, 360 (2023). https://doi.org/10.1186/s12912-023-01547-8
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DOI: https://doi.org/10.1186/s12912-023-01547-8