RELATIONSHIP BETWEEN OCCUPATIONAL STRESS AND CAREER GROWTH

WITH ORGANIZATIONAL COMMITMENT AMONG NURSES OF A MEDICAL

COLLEGE HOSPITAL, BANGLADESH

AKRAMUL HAQUE

A THESIS SUBMITTED IN A PERTIAL FULFILMENT OF THE REQUIREMENTS

FOR THE MASTER DEGREE OF NURSING SCIENCE

(INTERNATIONAL PROGRAM)

FACULTY OF NURSING

BURAPHA UNIVERSITY

JULY 2014

COPYRIGHT OF BURAPHA UNIVERSITY

ACKNOWLEDGEMENT

My stay at Burapha University as an international graduate student in the

faculty of nursing was very meaningful one. It could not be successful in all aspects

without the help and support that I received from many people. I am sincerely thankful to

my thesis advisor Asst. Prof. Dr. Areerut khumyu, whose encouragement, guidance and

support from the initial to the final level enabled me to develop and understand the

subject. I extend my most sincere appreciations to her.

I am equally thankful to my co-advisor Assoc. Prof. Dr. Puangrat Boonyanurak

and the thesis committee members whose input and guidance enabled me to accomplish

my goal. I would be definitely say ‘thanks’ to all teachers of the faculty of nursing for

their unconditional love, care, and support.

I would like to extend my deepest gratitude to the director of nursing service

and ministry of health for making pace for higher study of the nurses of Bangladesh. I

would like to express appreciation and gratitude to the director of Rangpur medical

college hospital, Bangladesh for giving support and allowed me to come abroad for

study. I am highly indebted to world health organization (WHO) for providing financial

support otherwise it would not possible for me to accomplish the degree. My sincere

appreciation is extended to all the research participants who have equally important

contributions.

Gratitude remains in my heart for my parents, brother and sisters who have

always supported, encouraged and believed in me in all my endeavors, and who so

lovingly and selflessly cared for my wife and my only son when they went through in

difficult times in my absence. Appreciation is especially extended to my wife and son for

their patience and understanding for the time I could not be there for them when it was

most needed.

seitia t a yM, study and research in Burapha University were memorable years

that brought me great satisfaction in my professional and personal life in which I learnt

about new words. iI aitiM ia yMyieyteMiMiteyeityiM aiyiBie eia aiotaaia ie Mtaa aaia yi

ayeM aMio ieyi ytyei aity. In many ways, there has never been a better time than to be

a graduate student in Burapha University.

Finally thanks to Burapha and sincere thanks to them who should have been

mentioned but I could not and special thanks to Thailnad.

se.euett iimtr yi

iv

55910276: MAJOR: NURSING SCIENCE; M.N.S.

KEYWORDS: ORGANIZATIONAL COMMITMENT/ OCCUPATIONAL STRESS/

CAREER GROWTH/ NURSE

AKRAMUL HAQUE: RELATIONSHIP BETWEEN OCCUPATIONAL

STRESS AND CAREER GROWTH WITH ORGANIZATIONAL COMMITMENT

AMONG NURSES OF A MEDICAL COLLEGE HOSPITAL, BANGLADESH

ADVISORY COMMITTEE: AREERUT KHUMYU, D.S.N. PUANGRAT

BOONYANURAK, Ed.D. 78 P. 2014.

This descriptive correlational study was aimed to explore the relationship

between occupational stress and career growth with organizational commitment. The

sample was 176 nurses in a medical college hospital in Bangladesh who met the criteria

and was selected by using simple random sampling. A self administered questionnaire

was used to collect data including demographic questionnaire, organizational

commitment, occupational stress, and career growth questionnaire. Content validity index

and the chornbach’s alpha coefficient of organizational commitment questionnaire,

occupational stress questionnaire and career growth questionnaire were .82, .80 and .89

and .90, .80 and .89, respectively. Data were analyzed using descriptive statistics and

Pearson’s correlation coefficient.

The results revealed that nurses had high level of organizational commitment

(M =2.59, SD = .32) and had moderate level of occupational stress (M= 2.73, SD =.37)

and career growth (M =3.05, SD = .53). The results of the study illustrated that there was

a significant negative and low relationship between occupational stress and

organizational commitment (r = -.22, p < .01). This study also found a significant

positive and moderate relationship between career growth and organizational

commitment (r = .32, p < .01).

Nursing practice could be improved by using the results of the research findings

by setting strategies to reduce occupational stress since the study revealed moderate level

of occupational stress. The study results can be applied by developing guideline for

nurses to increase organizational commitment in relation to occupational stress and career

growth.

CONTENTS

Page

ABSTRACT………………………………………………………………………... iv

CONTENTS .............................................................................................................. v

LIST OF TABLES .................................................................................................... vii

LIST OF FIGURES ................................................................................................... viii

CHAPTER

1 INTRODUCTION ............................................................................................ 1

Background and significance .................................................................. 1

Research objectives ................................................................................ 4

Hypotheses and rationales ....................................................................... 5

Scope of study ......................................................................................... 5

Conceptual framework ............................................................................ 5

Definition of terms .................................................................................. 7

2 LITERATURE REVIEWS .............................................................................. 8

Organizational commitment .................................................................... 8

Definition and concepts ........................................................................... 8

Measurement of organizational commitment .......................................... 10

Organizational commitment in health care ............................................. 11

Factors related to organizational commitment ........................................ 12

Occupational stress .................................................................................. 13

Definition and concepts ........................................................................... 13

Occupational stress in health care organization ...................................... 15

Occupational stress and organizational commitment .............................. 16

Career growth .......................................................................................... 17

Definition and concepts ........................................................................... 17

Nursing career growth ............................................................................. 19

Career growth and organizational commitment ...................................... 20

3 RESEARCH METHODOLOGY ..................................................................... 23

Setting ...................................................................................................... 23

Population and sample ............................................................................ 23

vi

CONTENTS (Cont.)

CHAPTER Page

Research instrument ................................................................................ 24

Validity and reliability ............................................................................ 26

Protection of human subjects .................................................................. 27

Data collection ......................................................................................... 28

Data analysis………………………….. ................................................. 29

4 RESULTS ........................................................................................................ 30

Demographic characteristics of sample ……………………………….. 31

Level of org. commitment, occ. stress and career growth……………... 32

Relationship …........................................................................................ 33

5 DISCUSSION .................................................................................................. 34

Summary of the findings ……………………………………………..... . 34

Discussion of the study findings ………………………………………. 35

Implications for administration and practice ………………………….. 41

Recommendation for future research ...................................................... 42

REFERENCES .......................................................................................................... 43

APPENDICES ........................................................................................................... 57

APPENDIX 1 ......................................................................................................... 58

APPENDIX 2 ......................................................................................................... 60

APPENDIX 3 ......................................................................................................... 63

APPENDIX 4 ......................................................................................................... 65

APPENDIX 5 ......................................................................................................... 68

APPENDIX 7 ......................................................................................................... 75

BIOGRAPHY ............................................................................................................ 78

vi

LIST OF TABLES

Tables Page

1 Number of population and sample in-patients departments .......................... 24

2 Demographic characteristics of sample ......................................................... 31

3 Mean, standard deviation and level of organizational commitment, occupational

stress and career growth .............................................................................. 32

4 Pearson’s correlation coefficient between occupational stress and career growth

and their sub domains with organizational commitment............................... 33

vi

LIST OF FIGURE

Figure Page

1 Conceptual framework .................................................................................. 6

CHAPTER 1

INTRODUCTION

Background and significance of the problem

Nurses’ commitment towards job is important for administrators in healthcare

organizations. Organizational commitment has been found as an important factor of

employee retention and motivation (Krishna, 2008). It is important in showing how the

manager has to work hard in order to keep their staff or employees committed to the

organization. Organizational commitment in recent years has become an important

concept in organizational research to understand employees' behavior in the workplace.

Organizational commitment has been shown as a reliable predictor of employee

behaviors such as turnover and absenteeism (Dorgham, 2012). Therefore, moving an

employee towards commitment to the organization is challenge to a manager.

Commitment is very important in nursing career. Nurses who have high

organizational commitment are adhered to influence hospital productivity and the

performance; where as non committed nurses experience turnover and absenteeism (Butt,

Khan, Rasli, & Iqbal, 2012). Today’s nurses have options to work in many areas both in

the health care field and outside of health care areas. Improving the productivity,

performance and quality of work life has become the main goals of the organizations

(Birjandi & Ataei, 2013). Success of organization on efficient managing of human

resources is to have organizational commitment of employees. Mowday, Steers and

Porter (1979) identified organizational commitment based on three factors. First is an

employee's acceptance of the organization's goals and values. Second is the employee's

willingness to help the organization to achieve its goals. Third is the desire the employee

has to remain with the organization. The employee's commitment is shown through their

involvement within the organization. It may be how an employee identifies him/herself

with the organization through its goals and values.

Occupational stress in the nursing profession has been a global problem.

Nursing is generally perceived as a demanding profession both physically and

psychologically. Over the past several years, occupational stress has been increasing

among nurses. A study (Noura, Sanaa, Harisa, & Hoda, 2010) found that, more than half

of nurses (56.5%) had high level of occupational stress. The issue of occupational stress

causes a great deal of employees stress. If stress becomes excessive, nurses will lose

2

beneficial effect of stress and becomes harmful (Moustaka & Theodoros, 2010). The

working environment of nurses is in shift rotation. A study conducted in Bangladesh

found that nurses with rotating schedule have less mental health problem than nurses with

fixed schedule (Haq & Uddin, 2001). In the medical college hospital nurses work in

rotating schedule in in-patients department and fixed schedule in out-patients department.

Nurses who work in in-patients departments face many unwanted events and became

exhausted such as not having enough security, more visitors with patient, non nursing

activities, mal distribution of nursing man power, unequal time in each shift, long hour’s

night shift, and frequent night duty.

Occupational stress can be organizational symptoms such as displeasure and

poor morale among staff, performance losses, poor interpersonal relationships with

clients, and other stakeholders, damage to the institutional image and reputation, missed

opportunities, high staff turnover, poor internal communications and increased internal

conflicts (Sudhaker, 2010). Occupational stress has been linked to organizational

commitment and health care costs and illness (Yahaya, Yahaya, Maalip, & Ramli, 2012).

The less the nurses have occupational stress, the more the nurses are committed with their

organization is developed (Noura et al., 2010).

Previous research showed relationship between occupational stress and

organizational commitment. Lee (2007) Lambert and Paoline (2009) Omolara (2008)

Boyas and Wind (2009) found a negative relationship between occupational stress and

organizational commitment. Wells, Minor, Anger, Matz, & Amato (2009) showed a

positive relationship between occupational stress and organizational commitment.

Somers (2009) also found a significant relationship between job stress and affective

commitment and normative commitment continuance commitment. Moreover, some

studies showed a strong relationship between occupational stress and organizational

commitment (Lee & Henderson, 1996; Kobasa & Antrosrusky, 1998). A recent study

found associations between occupational stress and organizational commitment among

nurses in Jordanian hospitals (Al-Hawajreh, 2011).

Career growth is also a factor related to organizational commitment. Career

growth has received considerable research attention (Maurer & Lippstreu, 2006). Career

growth has positive effect on desired employee attitudes such as organizational

commitment (De Vos, Dewettinck, & Buyens, 2007). From an organizational

perspective, the management and structuring of employees career enable the manager to

take care of, and develop the growth of employees (Ronn, 2010). Career growth has been

3

an important determinant of commitment (Zhou, 2009). A well functioning career growth

system ensures both an organized working environment and human basic needs including

self-actualization and personal progression (Weng, James, & McElroy, 2012).

A researcher found positive relationship between career growth and

organizational commitment (Weng, James, Paula, & Rongjhi, 2010). Organizations that

fail to provide career growth opportunities make the prospects of employment elsewhere

more attractive. Widyanti,Thoyib, Setiawan, & Solimun (2012) found that career growth

affect organizational commitment. Weng et al (2010) stated that the individuals who get

the opportunity for career growth have a higher level organizational commitment.

Career growth is very fragmented and old job classes continued in Bangladesh.

A nurse could have growth to be staff nurse; ward manager and matron. However, there

are few posts and promotions are based on seniority and about 95% of general nurses

stop at staff nurse position (Luoma, Jobayda, Chowdhury, & Wang, 2009). In Bangladesh

nurses has dissatisfaction about career growth. Less opportunity is available to upgrade

individual career in government hospitals. Majority of the nursing staffs reach their

retirement age remaining in the same position. In a study, 23 out of 28 respondent nurses

said that it was very difficult to pursue a nursing career in Bangladesh. There are limited

opportunities for career growth. Because of this situation, nurses are interested to migrate

in abroad which have an impact to organizational commitment (Aminuzamman, 2007).

There are many different types of nurses, and several different ways to obtain

nursing careers. According to the regulations, there are three educational paths to

becoming a nurse. A diploma from an accredited nursing school, an associate’s degree in

nursing for one year or a bachelor’s degree (Bachelor of Science in Nursing). Diploma

tracks have become less popular over the years, as most candidates opt for associate’s

degrees or directly bachelor’s degrees, due to their availability and versatility. Finally,

before becoming licensed and practicing as a nurse, one must pass the National Council

Licensure Examination for Registered Nurses or comprehensive nursing.

In Bangladesh, Health care delivery system is a daunting challenge area. The

most critical challenge faced by the health systems in Bangladesh is in the arena of

nursing resources for health care (Mahmood, 2012). Bangladesh is still running a

staggering shortage of almost 140,000 nurses. Absenteeism of key health human

resources often make matters much worse. The international standard for nurse-patient

ratio is 1:4 for general care and 1:1 for intensive care. In the case of Bangladesh, the

general nurse-patient ratio is 1: 13. (Aminuzamman, 2007). Nurses need to perform

4

overloaded service. Patients from many area of Bangladesh come to take special service

from big hospitals which have not available in another general public hospital in Rangpur

city. Moreover, medical college hospitals were study hospitals. Many students from

medical college and from nursing college come to perform clinical practice. The staff

nurses who work here need to supervise nursing students’ performance. These surplus

activities shorten nurse time during providing care to the patient. In respect of time

limitation and lots of work demands, nurses feel stress in work.

Therefore, nurses in Bangladesh face a problem of workload. Bangladesh needs

more 45,649 nurses from the existing number (Aminuzamman, 2007). Lee and Wang

(2002) investigated perceived occupational stress and related factors among public health

nurses. They reported that personal responsibility and workloads were the major sources

of occupational stress. Excessive work load was also included as a major contributor to

stress among hospital based Brazilian nurses (Stacciarini & Troccoli, 2004).

Nurses’ with low commitment is being a problematic in many countries. Many

researchers have cautioned that the health care workforce faces the serious risk of losing

one in five registered nurses for reasons other than retirement. The role of organizational

commitment is crucial both in shaping reactions to career growth and in serving as a key

indicator of the impact of such practices. In most cross-sectional research on career

growth and organizational commitment found that there is a relationship between

occupational stress and organizational commitment. Many studies found that there is a

relationship between career growth and organizational commitment in many

organizations but not in health care organizations. However, few research studies have

been done to examine the relationship between occupational stress and career growth

with organizational commitment among nurses. Therefore, the researcher wanted to study

organizational commitment among nurses in Rangpur medical college hospital in

Bangladesh and selected factors related to organizational commitment including

occupational stress and career growth.

Research Objectives

1. To examine the level of organizational commitment, occupational stress and

career growth of nurses in a medical college hospital in Bangladesh.

2. To examine the relationship between occupational stress and career growth

with organizational commitment of nurses in a medical college hospital in Bangladesh.

5

Hypotheses and rationales

H1: Occupational stress has relationship with organizational commitment.

Rationales: According to literature review, Lee and Henderson (1996) found

negative relationship between occupational stress and organizational commitment. A

study also found a significant correlation between occupational stress and organizational

commitment (r = 0.085, p = 0.002) (Yaghoubi, Yarmohammadian, & Afshar, 2009).

Another researcher showed occupational stress has significantly negative relationship

with organizational commitment (Al-Hawajreh, 2011). Researchers found negative

relationship between occupational stress and organizational commitment (Chang, 1999).

H2: Career growth has relationship with organizational commitment.

Rationales: Some research revealed that employee career growth is positively

related to organizational effectiveness and that career planning activities can lead more

committed work force to the organization (Hall, 1976). A substantial amount of research

has investigated the relationship between career growth activities and organizational

commitment. Chang (1999) said that career growth opportunities provided by the

organization can affect employees’ psychological states. Weng et al., (2012) found that

career growth is positively related to organizational commitment (r=.10). By giving

career growth opportunities, individuals feel that the organization is interested in

developing their skills and abilities, and in return they become more attached to the

company.

Scope of study

This study was aimed to examine the level of organizational commitment,

occupational stress and career growth and to explore the relationship between

occupational stress and career growth with organizational commitment of nurses in a

medical college hospital in Bangladesh. The study population of this study was 398

nurses who had been working in the hospital for at least two years. The independent

variables of this study were occupational stress and career growth and the dependent

variable was organizational commitment.

Conceptual framework

Conceptual framework of this study comes from Luthans and previous

researches. Luthans (2002 a) identified the fundamental dimensions of psychological

6

capital which promote employee well-being and functionality, it is important to position

these concepts prior to critiquing its impact on the practical workplace for high

organizational commitment. However, in this study, occupational stress and career

growth are selected as organizational variables related to organizational commitment.

Therefore, Research framework of this study comes from Luthans (2002 a & 2002 b) and

following previous researches. Luthans (2002 a) highlighted the determinants of

organizational commitment as personal, organizational and non-organizational variables.

Previous studies have shown that organizational commitment of employees can be

influenced by occupational stress and career growth. Tett and Meyer (1993) reported that,

there is a strong relationship between occupational stress and organizational commitment.

Moreover, Al-Hawajreh (2011) also found relationship between occupational stress and

organizational commitment. Widyanti et al., (2012) have found positive relationship

between career growth and organizational commitment. Therefore, occupational stress

and career growth are factors related to organization commitment. The research

framework of this study is shown in figure 1.

Figure 1 Conceptual framework

Occupational

stress

1. Source of work

stress

2. Physical health

Organizational

Commitment

Career growth

1. Organizational

career growth

2. Individual career

growth

7

Definitions of Terms

Organizational commitment: Organizational commitment is nurses’

perception on the relative strength of involvement, willingness to work hard and desire to

maintain membership in a particular organization. It was measured by the organizational

commitment questionnaire.

Occupational stress: Occupational stress is nurses’ perception on the degree of

their responses to pressure situation in the workplace where the demands of the job

exceed capabilities and resources. Occupational stress was measured by occupational

stress questionnaire. Occupational stress consists of two components including sources of

stress at work and physical health.

Career Growth: Career growth is nurses’ perception on concerted efforts

directed towards assessing a workers’ potentials identifying likely career paths for that

employee and designing and implementing various forms of training and experience to

prepare that person for more advanced job. Career growth was measured by career

growth questionnaire. Career growth consists of two components including

organizational career growth and individual career growth.

Nurse: Nurse refers to the staff nurses holding diploma in nursing or bachelor

of science in nursing or master degree and working as a nurse in the medical college

hospital in Bangladesh.

CHAPTER 2

LITERATURE REVIEWS

This chapter provides a review of existing literature and researches related to

occupational stress, career growth and organizational commitment. The review of

organizational commitment is presented first and factors related to organizational

commitment including occupational stress and career growth are followed. The contents

in this chapter are following.

1. Organizational commitment

1.1 Definition and concept of organizational commitment

1.2 Measurement of organizational commitment

1.3 Organizational commitment in health care

1.4 Factors related to organizational commitment

2. Occupational stress

2.1 Definition and concept of occupational stress

2.2 Occupational stress in health care organization

2.3 Occupational stress and organizational commitment

3. Career growth

3.1 Definition and concept of career growth

3.2 Nursing career growth

3.3 Career growth and organizational commitment

Organizational commitment

Definition and concept of organizational commitment

Organizational commitment refers to a psychological state that binds the

individual to the organization (Meyer & Allen, 1990). Organizational commitment has

been defined by different authors and researchers. In general terms, organizational

commitment has described as the level of attachment felt towards the organization in

which one is employed.

Mowday, Porter, & Steers (1982) define organizational commitment as the

relative strength of an individual’s identification with and involvement in a particular

organization. They stated that organizational commitment has three characteristics

including 1) strong belief in an acceptance of the organization’s goals and values, 2) a

9

willingness to exert considerable effort on behalf of the organization; and 3) a strong

desire to maintain membership in the organization.

Organizational commitment has been extensively researched as an important

factor in employee retention and motivation (Krishna, 2008). The definition suggests that

organizational commitment is an affective or emotional attachment of employee to the

employing organization. Commitment involves an active relationship with the

organization, and it represents something beyond mere passive loyalty to an organization.

Meyer and Allen (1991) define organizational commitment as a psychological

state that characterizes the employee’s relationship with the organization and has

implications for the decision to continue or discontinue membership in the organization.

The most commonly used definition of organization commitment belongs to Allen and

Meyer (1990).

According to Meyer and Allen (1991) there are three different types of

organizational commitment including 1) affective, 2) normative, and 3) continuance

commitment (Meyer and Allen,1991). Affective commitment is the employee’s

emotional attachment to, identification with, and involvement in the organization.

Normative commitment is defined as a feeling of obligation to continue employment. In a

study, (Mowday et al., 1982) organizational commitment is defined as “the relative

strength of an individual’s identification with and involvement in a particular

organization”.

Finally, continuance commitment is a result of awareness of the costs associated

with leaving the organization. Each dimension is thought to contribute to an employee’s

relationship with the organization, has implications for his/her continuing membership,

and may be affected by different antecedents or may have different consequences.

Research on organizational commitment is important to healthcare agencies that

strive for a competitive advantage. Nurses’ work long hours and experience frequent shift

changes as well as other unique stressors (Barber, Bland, Langdon, & Michael, 2000).

Organizational commitment is a major challenge for American healthcare systems

(Karsh, Booske, & Sainfort, 2005; Wilke, 2008).

The main perspectives of organizational commitment are attitude and behavior.

The attitudinal perspective focused on outlining the factors that have contributed to the

development of commitment. The behavioral approach focused on identifying the

conditions where behaviors tend to be repeated and how these behaviors affect attitude

change (Meyer and Allen, 1991). Mowday et al., (1982) further emphasize differences

10

between two approaches. Attitudinal commitment focuses on the process by which

people come to think about their relationship with the organization. In many ways, it can

be thought of as a mind set in which individuals consider the extent to which their career

growth is congruent with those of the organization.

Commitment, on the other hand, relates to the process by which individuals

become locked into a certain organization and how they deal with this problem.

Indications of organizational commitment are concerned with feelings of attachment to

the goals and values of the organization, one’s role in relation to this, and attachment to

the organization for its own sake rather than for strictly instrumental values (Salleh,

2012). Steers (1977) investigated the outcomes of commitment and found that

commitment was related to an increase in employees‟ intention to remain with an

organization (r = .31; p < .001) (Barbara, 2003).

The assumption here is that organizational commitment is a determinant of job

performance or vice versa. In other words, performance and commitment are reciprocally

related. Increased performance caused increased commitment and, in turn, increase

commitment caused further increase in performance (Reichers, 1985).

Workers’ commitment to organization is also a function of their perception of the

organization’s commitment to them. Healthcare organizational stability rests on

organizational commitment (Mary & Carman, 2011). Organizational commitment has

been viewed by Chen and Francesco (2003) as a dimension of organizational

effectiveness, which contributes to increased nurses’ effectiveness through work

performance and reducing turnover.

Few experimental designs have been employed to study organizational

commitment among nurses (Wagner, 2007). Numerous contemporary causal models and

multivariate designs have produced consistent evidence-based information regarding key

antecedents and outcomes associated with organizational commitment among nurses and

mixed staff nurse samples (Fang, 2001).

However, in this study organizational commitment is nurses’ perception on their

strong belief and acceptance of goals and values of the organization, willingness to work

hard for the organization, and desire to maintain membership in the organization.

Measurement of organizational commitment

Organizational commitment can be conceived of as having several dimensions

(Meyer & Allen, 1997).The body of research on organizational commitment is well

established, and tools to measure organizational commitment are characterized by sound

11

psychometric properties (Allen & Meyer,1996). Commitment is not something that can

be directly seen. The employees should have commitment with their organization focus

on characteristics and personal sacrifices (Yahaya et al., 2012). Meyer and Allen (1997)

developed a tool to measure affective, continuance, and normative commitment to the

organization. Their continuance scale has been used in numerous organizational

commitment studies, but there are growing concerns related to the psychometrics of the

tool. Meyer and Allen (1991) have identified three types of organizational commitment.

Affective commitment describes individual emotional attachment, identification with,

and involvement in a particular organization. Furthermore, continuance commitment

reflects employee awareness of the costs of leaving an organization. Finally, normative

commitment reflects individual sense of obligation to remain in an organization.

Mowday et al., (1982) viewed organizational commitment as a measurement of

an individual’s dedication and loyalty to an organization. Most researchers agree that

organizational commitment describes a psychological state that characterizes the

relationship of an employee with the organization for which they work and that has

implications for their decision to remain with the organization (Allen, 2001).

Organizational commitment comprises employee attachment to their organization

(Mowday et al., 1979). The organizational commitment scale was to determine the extent

or the level of organizational commitment among nurses. Elements of the questionnaire

were determined and based on Mowday, Steers, and Porter’s (2002) scale and Brewer

and Look’s (1995) scale. It was consisted of 14 items dealing with other opportunities for

work, mismatching with policies and procedures, and incentives for staying in job. The

possible response for each item was on a three-point Likert-type scale with choices of

"agree", “uncertain”, or “disagree."

Organizational commitment in health care

Commitment in nursing has always been of great interest in the health care

sector, largely because of the enormous costs involved in staff turnover. Interest in issues

related to organizational commitment in nursing began to appear in the nursing literature

over three decades ago (Zangaro, 2001). Most early nursing organizational commitment

studies of the 1970s focused on correlations between organizational commitment and

related concepts such as staff nurse turnover and from 1980s it is continued to focus on

describing key antecedents and consequences of organizational commitment among staff

nurses.

12

The other primary focus of the early studies consisted of describing antecedents

and consequences of organizational commitment among staff nurses (Mary & Carman,

2011). Research has shown that increased commitment improves work performance and

reduces absenteeism and turnover (Al-Hussami, 2008). Organizational commitment

research among staff nurses grew in sophistication from 1990 to the present. Because of

the difficulty of exploring organizational commitment through experimental designs,

multivariate designs were increasingly employed in this era to explore structural causal

models and mediating variables in the link between organizational commitments among

staff nurses (Daly, 2005). Study found that the nurses’ low commitment is being a

problematic in many countries. Aiken et al. (2001) have cautioned that the health care

workforce faces the serious risk of losing one in five registered nurses for reasons other

than retirement. The nurses' perception to commitment recorded score range of (9.72-

81.94), (54.98±10.49) and most of them respond neutrally to commitment domains.

Moreover, un-ignorable number of nurses did not respond to some of the reflective

statement of continuance commitment. Moreover, several personal and occupational

characteristics of the nurses were affecting their perception of emotional attachment,

loyalty and obligation to the organization (Aseeri, 2012).

Factors related to organizational commitment

Studies have shown that organizational commitment of employees could be

influenced by a number of variables. These variables have been described as either

determinants or antecedents of organizational commitment in the literature. For instance,

Luthans (2002 a) highlighted the determinants of organizational commitment as personal,

organizational, and non-organizational variables. Personal variables include age,

workload, absenteeism and turnover such as positive or negative affectivity or internal or

external attribution. Organizational variables include job design, values, and working

environment. Non-organizational variables refer to the availability of alternatives after

making the initial choice to join an organization (Igbeneghu & Popoola, 2011). Mowday

(1999) concluded that the nurses’ perceptions of the workplace and their fit between the

organization and their environment should have a more direct effect on commitment than

the hospital.

Researchers have identified a range of variables that affect organizational

commitment, including personal characteristics (age and level of education), job

characteristics (autonomy, feedback, teamwork, work environment, and work pressure),

and organizational characteristics (size, leadership style, career prospects, human

13

resource policies, possibilities for future education and participation in decision making).

Organizational commitment is considered to be one of the foremost important and crucial

outcomes of the human resource strategies. And the employee commitment is seen as the

key factor in achieving competitive performance (Sahnawaz & Juyal, 2006).There are

different dimensions of organizational commitment. The most commonly measured

dimension is affective or attitudinal, that is, an emotional attachment to and involvement

and identification with the organization. The second dimension labeled continuance

commitment refers to the perceived cost associated with leaving the organization, such as

giving up pension plans and profit sharing (Becker, 1980). Although organizational

commitment has been studied among all these groups, it has yet to be studied in a large,

strictly nurse sample.

Occupational stress

Definition and concept of occupational stress

Quick, Quick, Nelson, & Hurrell (1997) defined stress as an individual’s

adaptive response to a situation that is perceived as challenging or threatening to the

person’s well-being (Yahaya et al., 2012). Occupational stress is a result of imbalance

between psychological demands and how much control one has over his/her work, which

can harm the health of workers. Many studies have sought associations between high

strain jobs according to the Demand-Control Model and health disorders. Hypertension,

minor psychological disorders and musculoskeletal pain are among the main studied

disorders; many of these studies have found positive association between such disorders

and high strain.

This literature review will examine two components of occupational stress

including the sources of occupational stress and physical health. Sources of work stress

for nurses can be divided into four areas: workload, organizational pressures,

interpersonal interactions, and professionalism. In reality it is rare that only one source of

stress is present. Sources of stress are frequently interrelated and synergistic effects are

observed due to a variety of sources of stress. For example, interpersonal conflicts may

be due to organizational and management issues. Research has demonstrated that sources

of occupational stress among nurses vary between regions, countries, organizations,

departments, nursing specialties and individuals. This has been attributed to the different

health systems, their culture, availability of resources, nature of work, different

14

educational levels, age, employment contract, work experience and personality traits

(Lindholm, 2006).

Physical health is another component of occupational stress. Individual effort-

reward imbalance has been associated with burnout, which results from prolonged intense

stress. In a study of burnout among nurses in Germany, the nurses who experienced effort

reward imbalance reported higher levels on two of the three core dimensions of burnout

(Bakker, Killmer, Siegrist, & Schaufeli, 2000). Bakker et al., (2000) found that the nurses

who identified a negative imbalance between efforts spent on their job and the reward

they felt from the job reported feeling more emotionally drained than those who did not.

The feelings of personal accomplishment were lowest among nurses who had a mismatch

between demands and rewards, and who had high intrinsic effort in their jobs. Emotional

exhaustion and burnout have been recognized as occupational hazards for people-oriented

professions such as nursing. Brown and colleagues examined demanding work schedules

and mental health in nursing assistants working in nursing homes, and reported that

working two or more double shifts per month was associated with an increased risk for

all negative mental health indicators (Brown, Zijlstra & Lyons, 2006).

Even though studies addressing health disorders in nursing workers have

considerably developed in recent years, the relationship of such disorders with stressing

factors in the workplace still requires greater clarification. In this context, identifying the

profile of nursing professionals working in emergency hospital services in relation to

their perceptions concerning psychological demands and control over their jobs can

support the planning and implementation of actions toward a better quality of life and

quality of life at work, both on the part of nursing workers and managers of health

facilities (Urbanetto et al., 2011).

The literature indicates that there is a relationship between age, gender, marital

status, educational level, position, length of service and working experience with

occupational stress (Landa, Esther, Martos, & Carmen, 2008). Occupational stress has

been a long-standing concern of the health care industry. Studies indicate that health care

workers have higher rates of substance abuse and suicide than other professions and

elevated rates of depression and anxiety linked to job stress.

In addition to psychological distress, other outcomes of job stress include

burnout, absenteeism, employee intent to leave, reduced patient satisfaction, and

diagnosis and treatment errors (Department of health and human services, 2008). Stress

first coined in the 1930s, has in more recent decades become a commonplace of popular

15

parlance. Stress could be defined simply as the rate of wear and tear on the body systems

caused by life. It occurs when a person has difficulty dealing with life situations,

problems and goals. Stress has physical, emotional, and cognitive effects. Although

everybody has the capacity to adapt to stress, not everyone responds to similar stressors

exactly the same.

Nursing involves activities and interpersonal relationships that are often

stressful. Caring for clients who are experiencing high levels of anxiety can be stress

provoking for nurses. Thus, the actual reaction to an environmental event may be as

important as the event itself. A stressor can be social, physiological or environmental

origin (Marjan & Nasrin, 2010). Occupational Stress among health workers has been a

matter of much scientific inquiry in literature over the past decades. High level of stress

at work is a major threatening factor to both physical and psychological health of

individuals (Verhaeghe, Vlerick, Backer, Van Maele, & Gemmel, 2008). Workplace

stress has been extensively studied in recent years from different perspectives aiming to

identify its importance in the etiology of workers’ health disorders. Stress and the

negative outcomes of stress have been recognized as financially costly to any health care

organization.

Negative outcomes of job stress among nurses include illness, decline in overall

quality of care, job dissatisfaction, external environment, and staff turnover (Schwab,

1996). There are, of course, numerous definitions of stress, just as there are numerous

theories of stress. A fine line exists between theory and definitions. Definitions are more

likely to be products of theories, and they express the evolving nature of our knowledge

and the direction that research. While each theory adopts its own particular focus, all are

generally structured around a common set of components that are basically linked

together in a relationship that is process-oriented.

The idea of process is, more often than not, expressed through the ideas of “fit

or balance” and is, now, more likely to be transactional rather than interactional in nature

(Cooper-Hakim & Viswesvaran, 2000). Far from questioning the theoretical rigor and

empirical significance of Lazarus’ transactional theory, with its emphasis on the appraisal

process, most critics observe that there are, in the work stress agenda, opportunities for

all aspects of the stress process to be studied (Frese & Zapf, 1999).

16

Occupational stress in health care organization

Numerous recent studies have explored occupational stress among health care

personnel in many countries. Occupational stress in nurses affects their health and

increases absenteeism, and turnover (Shirey, 2006 ). Investigators have assessed work

stress among medical technicians, radiation therapists, social workers, occupational

therapists, physicians, and collections of health care staff across disciplines and the study

indicated as much as 50% of overall stress could be reduced (Shreedevi, 2013 ). Stress in

nurses is an endemic problem and contributes to health problems in nurses and decreases

their efficiency. Majority of nurses 73% experienced headache and fatigue are the most

physically type of stress experienced among them 44% accepted that lack of

concentration (Onasoga, Ogbebor, & Ojo, 2013). Another study showed that 26.2% of

the nurse had high stress and 73.8% had low stress (Aoki, 2011).

However, health care professionals are more susceptible to occupational stress

because of intense daily activity. With the global increase in the aged population, the

intensity of health care problems, the incidence of chronic illnesses and advanced

technology, nurses are faced with a variety of work-related stressors. The researchers

found that reveals that for age, 30% of them were between 31 and 40 years, also 30% are

between 51 and 60 years of age, while 11% of the respondents were between age 21-30

years (Onasoga et al., 2013).

Occupational stress and organizational commitment

Many researchers point to a negative relationship between job stress and job

satisfaction (Ahsan, Abdullah, Fie, & Alam, 2009) and a positive relationship between

organizational commitment and job satisfaction (Garland, Mccarty, & Zhao, 2009).

Therefore, a negative relationship between job stress and organizational commitment

seems reasonable. However, conflicting results in previous researches have obtained.

Lambert & Hogan (2009) found a negative relationship between job stress and

organizational commitment. In another study Wells et al., (2009) found a positive

relationship between job stress and organizational commitment. Research revealed that

60% of employees had medium job stress and 32% high job stress (Khatibi, Asadi &

Hamidi, 2009). Somers (2009) showed a significant relationship between job stress and

affective commitment and normative commitment but no significant relationship between

job stress and continuance commitment (Somers, 2009). One study conducted among

nurses indicated that total stress scores were statistically significantly and positively

correlated with sources of work stress (r=0.61, p<0.001) (Al-Hawajreh, 2011).

17

Career growth

Definition and concept of career growth

Career growth is a process by which individuals develop, implement, and

monitor career goals and strategies (Greenhaus & Callanan, 1994). In more detail career

growth is define as the process by which individuals develop insight into themselves and

their environment, formulate career goals and strategies, and acquire feedback regarding

career progress (Eby, 2009). Grobler, Warnich, Carell, Elbert, & Hatfield (2006) defined

in Human resource management book (Third edition) as career growth is the process of

designing and implementing goals, plans and strategies that enable human resource

professionals and managers to satisfy workforce needs and allow individuals to achieve

their career objectives (Grobler et al, 2006).

A number of similarities can be found in the above mentioned definitions, e.g.,

the emphasis placed on the developmental perspective of an individual, and the fact that

it is a process taking place over a period of time. However, the definitions express

differences in the importance they place on organizational versus individual

responsibility taken for this development. Career growth is an umbrella used to describe

one's commitment to a number of work related targets; namely, to one's career, one's

profession and one's occupation (Cooper-Hakim & Viswesvaran, 2005).

However, career growth had two components including organizational career

growth and individual career growth. The finding that the dimensions of organizational

career growth explained significant amounts of variation in affective occupational

commitment suggests that what goes on within one's organization affects the degree to

which an individual identifies with their chosen line of work (Weng et al., 2012). The

organizational perspective on careers is important because of its effects on the

achievement of an organization’s objectives. Insight into organizational career growth

demonstrates how organizations must consider both internal and external pressures and

adjust their career systems simultaneously as the organization changes. By investigating

the organizational perspective of career growth, one gains insight into how the careers of

individuals are affected by organizational activities and transformations (Campbell &

Moses, 1986), and how the organization continuously utilizes specific practices to

develop and improve human resources that will benefit both the individual and the

organization (Byars & Rue, 1997). Moreover, Greenhaus & Callanan (1994) argue that

the ongoing nature of career growth makes possible for individuals and organizations to

18

have a more informal approach to the career growth, and that this approach may be

considered the most effective one. Much of the research by vocational psychologists and

organizational scholars on the effects of career growth focuses on objective and

subjective measures of one's career success (Eby, Sorensen, & Feldman, 2005) over one's

work life or career stage, and across organizations, in contrast to viewing career growth

experiences from the perspective of one's experiences within their current organization.

For individual career growth, there are specific individual characteristics and activities

that are of importance for effective career progression. These include a realistic view of

one’s current position, a personal idea of what is regarded as career success, and the

planning and implementation of actions performed with the aim of moving oneself from

the current position to the desired position. This kind of necessary information can be

obtained either individually through the study of workbooks, personal conversations with

supervisors or external counselors, or with the help from colleagues or other participants

through a number of group or organizational based activities, such as assessment centers,

workshops, and business simulations (London & Stumpf, 1982). Organizations may

benefit from encouraging their employees to perform the individual career growth

activities described above. However, to better understand employee related behaviors,

such as turnover and willingness to adjust to organizational changes, the individual

perspective should be supplemented with an understanding of how organizational

characteristics and activities influence the nature of careers (Campbell & Moses, 1986).

Weng (2010) proposed that employee organizational career growth could be

captured by four factors including 1) career goal progress, or the degree to which one's

present job is relevant to and provides opportunities for one to realize their career goals,

2) professional ability development, or the extent to which one's present job enables them

to acquire new skills and knowledge, 3) promotion speed, an employee's perceptions of

the rate and probability of being promoted, and 4) remuneration growth, or employee

perceptions of the speed, amount, and likelihood of increases in compensation.

This multi-dimensional conceptualization implies that organizational career

growth is both a function of the employees' own efforts in making progress toward their

personal career goals and acquiring professional skills within the organization and the

organization's efforts in rewarding such efforts, through promotions and salary increases

(Rousseau, 2004).

Workers in contemporary society are expressing a strong desire to pursue more

than just a job. They are looking for employment opportunities that promise an extension

19

of their interests, personality and abilities. Then want a variety of things from their jobs

besides a pay cheque and a few fringe benefits, and their loyalty to the organization

depends upon the degree to which their employer satisfies these wants (Agba, 2004).

Study suggested that the modern world of work, to a larger extent than before, requires

individuals to be proactive in their career growth activities (Schreuder & Coetzee, 2006).

Meyer, Becker, & Vandenberghe, (2004) proposed that on the one hand, employees with

a promotion focus view their behavior as more internally driven, experiencing intrinsic,

identified and integrated regulation. However, Career growth involves concerted efforts

directed towards assessing a workers’ potentials identifying likely career paths for that

employee and designing and implementing various forms of training and experience to

prepare that person for more advanced job. Career development has both personal and

organizational dimensions. In organizational level, it is a planned program designed to

match individual and organizational needs (Peterson & Tracy, 1979).

Researchers stated that the individuals who get the opportunity for career

growth have a level higher organizational commitment (Weng et al., 2010). In the

organization, individuals can be more satisfied with their jobs and committed to his job if

understand what the basis of his career (Cichy, Cha, & Kim, 2009).

Nursing career growth

Career growth is essential in modern day nursing and it is not restricted simply

to lifelong learning. However, in practice disciplines, such as nursing, learning can be

maximized through experience located in the clinical setting. Feedback and “moving to

the next step” are essential in this process and experiences in 'real-life' settings need to be

effectively facilitated to obtain the desired outcomes (Henderson, 2006).

A nursing discipline, learning can be maximized through experience located in

the clinical setting. Theoretical knowledge or knowledge that has previously been 'distal'

to practice could be integrated into immediate practice via mutual collaboration of

nursing team members (Howarth, 2006). Nursing career growth is as a life-long process

of active participation by nurses in learning activities that assist in developing and

maintaining their continuing competence, enhancing their professional practice, and

supporting achievement of their career goals. It is important for enhancing service

provision, maintaining safety for patients and themselves, and increasing career and

personal opportunities (Gould, Drey, & Berridge, 2007).

Continuing professional development of nurses is increasingly necessary due to

rapid change of advancements in knowledge and technology of health care service

20

(Berings, Poell , Simons, and Veldhoven, 2007). A study in Ireland, McCarth, Tyrrell,

and Croni (2002)

found half of the respondents (53%) reported experiencing some form

of career growth, typically in the form of in service education (25%) and study

days/seminars (28%), with few respondents report having access to study leave (12%)

and financial support (10%). The authors conclude that large numbers of nursing staff do

not have access to professional growth (Fantis, 2010).

According to one study results of the research, the majority of the participants

were working in emergency department, secondly came the surgery clinic, then the

Intensive care ward and finally the Pathology and the Cardiology clinics. Trying to

interpret these results, one can assume that these clinics need good management and

high-speed services. These needs require that the nursing staff are highly educated, have

the appropriate experience, are able to identify their learning needs and finally plan their

work effectively, in accordance with career growth objectives (Gould, Kelly, Goldstone,

& Maidwell, 2001).

Career growth and organizational commitment

Employee career effectiveness is directly related to organizational effectiveness

and that career planning activities can lead to a more committed work force (Hall, 1976).

Similarly, Stevens, Janice, & Trice (1978) stated that too much time in one position may

be perceived as career stagnation and have an adverse effect on commitment (Agba,

Festus, & Ushie 2010). Research suggested that different types of organizational career

growth can benefit both the organization and the individual employee by creating a social

exchange relationship that provokes the reciprocation of increased organizational

commitment. It can also be the case that by receiving career growth help from the

organization, employees simply feel more valued and appreciated and consequently more

satisfied with their job. Hence, affective organizational commitment is expected to

increase (Ronn, 2010).

A study also indicated significant associations between affective commitment

and career growth activities (Sturges, David, Conway, & Davey, 2002). Other

investigation has also supported the proposition that there is a relationship between career

growth and propensity to remain, which is an aspect of organizational commitment (Agba

et al., 2010). However, in accordance with the study findings, some researcher also

suggested that greater organizational career growth would be associated with more

internally oriented self career growth activities (Sturges et al., 2002). Career growth has a

greater impact to occupational stress and organizational commitment. Additionally,

21

finding supports that the successful career growth should be the result of some kind of

career growth activities between the individual and the organization (Orpen, 1994). It

also suggests that there may have the potential for nurses to create a circle of

organizational and individual career growth activities which facilitate career development

and make them committed to the organization. High levels of organizational commitment

would lead to more externally oriented career growth activity.

Summary

The review of related literature on organizational commitment, occupational

stress and career growth has helped the researcher to identify the gap and has provided an

insight to the direction of current study. The problem of stress is inevitable and

unavoidable in the healthcare sector. A majority of nurses face severe stress- related

ailments and a lot of psychological problems. Work related stress is a feature which most

individuals suffer at times and to different extents. The negative effects of occupational

stress are reduced efficiency, decreased capacity to perform, dampened initiative and

reduced interest in work, increased rigidity of thought, and lack of concern for the

organization and colleagues and a loss of responsibility. An effective organization always

promotes a sense of commitment and satisfaction among its employees. The significance

and importance of the concept of organizational commitment in terms of leading to

beneficial organizational and desirable outcomes such as increased productivity, reducing

absenteeism and turnover. The development of organizational commitment in nurses in

acute care environments has important ramifications. Organizational commitment has

been shown to be a consequence of the perceptions of nurses. Therefore, additional

research was required to enable nursing leaders to appreciate the process of

organizational commitment and the impact of leader behaviors on staff nurse

commitment and the achievement of organizational goals. Career growth requires that a

number of individual aspects are taken into consideration if one is to establish a well

functioning career growth system. These aspects include the individual’s skills and

achievements, knowledge and learning style, and values and interests. However,

researcher used the concept from Luthans (2002 b) to examine the relationship between

occupational stress and career growth with organizational commitment. Luthans stated

that the positive organizational behavior that is organizational commitment approach

incorporates overlooked state-like positive psychological strengths and capacities such as

hope, optimism, and resiliency. These positive states, which in aggregate are referred to

as a core factor of psychological capital may have important implications for employee

22

work motivation and authentic leadership. With the review of literature, it becomes

evident that though a lot of studies are conducted separately on organizational

commitment, occupational stress and career growth but only a few studies are there on

health care sector linking these three variables together. So it was crucial to conduct a

study on organizational commitment, occupational stress and career growth in hospital

organization and also to identify the relationship among these factors.

CHAPTER 3

RESEARCH METHODOLOGY

This descriptive correlational study was conducted to examine the relationship

between occupational stress and career growth with organizational commitment of nurses

in a medical college hospital in Bangladesh. The setting, population and sample, research

instruments, protection of human subjects, data collection procedure and data analysis are

as follows:

Setting

This study was carried out at a medical college hospital, in Bangladesh

affiliated to The Ministry of Health. This hospital consists of 1000 beds with a total

number of 398 nurses.

Population and sample

Population

Population of this study was 398 nurses who were working as staff nurses in a

medical college hospital in Bangladesh.

Sample

Sample was 176 nurses who were working as staff nurse in in-patients

departments in a medical college hospital in Bangladesh. Inclusion criteria were working

experience for at least two years and were willing to participate in this study.

Sample size

The sample size was calculated based on formula from Yamane (1973), with

95% certainty. The sample size in this study was 176 nurses.

N

n =

1+N(e)2

(n = Sample size

; N = Population size; e = Level of precision)

398

n =

1+ 398 (0.05)2

n = 176

24

Sampling method

The researcher used simple random sampling technique to collect data from

subjects who met the selection criteria in a medical college hospital. The researcher

assigned a numerical label to every subject from the list of the nurses. Then, the

researcher wrote the numerical labels on slip of paper; place them in a box and mixed

well. After that, the researcher drew out one at a time until the desired sample size

reached in each department. The sample size in each department was calculated

proportionally as shown in table 1.

Table 1: The number of population and sample in-patients departments

Departments Population Sample

Medicine 60 26

Surgery 170 76

Intensive care 33 15

Operation theater 60 26

Psychiatry and pediatrics 75 33

Total 398 176

Research instrument

A self-administered questionnaire was used for collecting data of this study. The

questionnaire had four parts including the questionnaire of demographic, organizational

commitment, occupational stress and career growth.

Part 1: Demographic questionnaire: Researcher developed the demographic

questionnaire concerned with nurse's socio-demographic data such as age, gender, marital

status, education, current position, and years of working experience.

Part 2: Organizational commitment: Organizational commitment was

measured by organizational commitment questionnaire. The researcher modified the

organizational commitment questionnaire is to determine the extent of organizational

commitment among nurses. An element of the original questionnaire of organizational

commitment was developed by Al-Hawajreh (2011). The original questionnaire was

developed to measure organizational commitment in general as total. In this study, the

organizational questionnaire consists of 14 items. Researcher modified by changing

25

words in some items and changed 3 negative items to the positive items for make it easily

understandable for the samples. The possible response for each item is on a three-point

Likert-type scale with choices of "agree", “uncertain”, or “disagree." There were given

scores of 3, 2, and 1, respectively, for positive items. The higher score indicates high

commitment level of the participants’ to the organization. The internal consistency of the

organizational commitment questionnaire was reported as Cronbatch’s alpha of .88 (Al-

Hawajreh, 2011).

Score transformation: The level of organizational commitment was interpreted

as follows (Polit & Hunglers, 1999).

1.00 – 1.66 the level of organizational commitment is low

1.67 – 2.33 the level of organizational commitment is moderate

2.34 – 3.00 the level of organizational commitment is high

Part 3: Occupational stress questionnaire: Researcher modified the

occupational stress scale of Al-Hawajreh (2011) to make consistent with different setting

and culture of Bangladesh. The internal consistency of the questionnaire was reported in

a previous study as .85 (Al-Hawajreh, 2011). In this study, occupational stress

questionnaire consisted of 36 items within two domains including sources of stress at

work (26 items) and physical health (10 items). In the source of work stress there were 24

positive items and 2 negative items. Researcher recoded two negative items during data

analysis. For positive items, five possible responses of each item were never, rarely,

sometimes, often, and always. The score was 1, 2, 3, 4, and 5 respectively but for

negative items score was 5, 4, 3, 2 and 1 respectively (Al-Hawajreh, 2011).

Score transformation: Responses summed and divided by 5 to provide a mean

score. The highest mean score was 5.00 and the lowest mean score was 1.00. Dividing

the highest mean score minus the lowest mean score by 3 was an interval of 1.33. Hence,

the level of occupational stress was interpreted by mean score as follows (Polit &

Hunglers, 1999).

1.00 – 2.33 the level of occupational stress is low

2.34 – 4.49 the level of occupational stress is moderate

4.50 – 5.00 the level of occupational stress is high

Part 4: Career growth questionnaire: Researcher assessed career growth by

modifying career growth questionnaire developed by Sturges et al., (2002). The internal

consistency of the questionnaire was reported in a previous study as .79. Researcher

modified wording in some items for the new setting and culture. Career growth

26

questionnaire consisted of 26 items and measured two different components of

organizational career growth (10 items) and individual career growth (16 items). It was in

the 5-point Likert scale. The participants were asked to give their responses on a

frequency scale, indicating how often they had been given the opportunity to participate

in different organizational career growth activities, ranging from very seldom to very

often. The score was 1, 2, 3, 4, and 5 respectively. In the career growth questionnaire,

there was no negative item.

Score transformation: The highest mean score was 5.00 and the lowest mean

score was 1.00. The level of career growth was interpreted by mean score as follows

(Polit & Hunglers, 1999).

1.00 – 2.33 the level of career growth is low

2.34 – 4.49 the level of career growth is moderate

4.50 – 5.00 the level of career growth is high

Validity and Reliability

Validity

The researcher modified the instrument considering the culture of new setting.

Therefore, content validity of organizational commitment, occupational stress and career

growth questionnaires were reviewed and approved by five experts. The expert rated

independently the relevance of each item to the objective using four point rating scale: (1)

not relevant, (2) somewhat relevant, (3) quite relevant, and (4) very relevant. The content

validity index (CVI) was defined as proportion of items given a rating of quite/very

relevant by five raters. The content validity index (CVI) was acceptably relevant when

the score was at least 0.80 (Waltz, Strickland, & Lenz, 2005). However, the content

validity index of the modified organizational commitment questionnaire was .82. Content

validity index of modified occupational stress questionnaire was .80 and the content

validity index of modified career growth questionnaire was .89.

In the context of Bangladesh, the education system from elementary level,

students were to learn English as compulsory subjects. Learning English language is

common part as the curriculum of general education. Moreover, for nurses the medium of

learning was English and they must complete all course works in English language from

the diploma level. Curriculum of Bangladesh Nursing Council (BNC) was written in

English language. Nurses of Bangladesh could read and write and understand English

27

language since they need to perform their duty considering English as an official

language. Therefore, considering the understanding level of staff nurse, researcher did not

translate all three questionnaires into Bengali (Bangla) language.

Reliability

The reliability of the instrument was assessed through measurement of its

internal consistency using chronbach alpha coefficient analysis. The try out study was

conducted in 30 nurses from out patients department in Rangpur medical college hospital

to measure reliability using internal consistency before conducting the actual study

survey. For internal consistency of the reliability the acceptable values of alpha, was 0.70

(Tavakol & Dennick, 2011). The Cronbach’s alpha coefficient of organizational

commitment questionnaire, the occupational stress questionnaire and the career growth

questionnaire were .90, .80 and .89, respectively.

Protection of human subjects

A written approval letter for data collection was obtained from the Institutional

Review Board (IRB), faculty of nursing Burapha University, Thailand. Permission for

conducting the study was granted from the director and nursing superintendant of a

medical college hospital, Bangladesh. After completion of these formalities, eligible

subjects of the study would be informed about the purpose and the methods of the study

by providing a letter of explanation and invitation.

To ensure anonymity and confidentiality of responses, the questionnaires were

coded so that they could not be identified. The participants were informed that they are

purely voluntary and no remuneration would be given. The participants were told that the

information would be kept confidentially and would only be used for the purposes

intended and the subject to all the legal requirements regarding data collection.

The participants were also be assured that only the overall result would be

shared with ministry, health centers and the nursing administration for the purpose of

designing needed managerial interventions. During data collection if any subject wanted

to withdraw from the study, the researcher would respect their decisions and assured

anonymity and confidentiality and needed no penalty for withdrawal or termination from

the study.

28

Data collection

The procedure of data collection was carried out as following:

1. The proposal was granted ethical approval from ethical review board of

faculty of nursing. After obtaining the permission to collect the data, a letter from the

dean of faculty of nursing, Burapha University sent to the director of health department

of Rangpur medical college hospital, Bangladesh.

2. The researcher was obtained the permission from the director of a medical

college hospital, Rangpur, Bangladesh to collect the data by submitting approval

document and the introducing letter to conduct the research.

3. The researcher was also been obtained the permission from the director of

the hospital as well as from nursing administrator to collect the data.

4. The researcher obtained the list of potential respondents from the director

office of Rangpur medical college hospital. Before selecting participants by using random

sampling method from the list, the researcher divided all in-patients departments under

five major categories such as medicine, surgery, intensive care, operation theatre, and

psychiatry and pediatrics department.

5. The researcher met the charge nurse of the wards of the hospital for an

orientation of the study and informed the objectives of the study and for the support to

establish the relationship with the participants.

6. The researcher made contact with the participants, explained the objectives

of the study, invited them to participate in the study and asked for their voluntary

participation. Then took consent form to each participant who was willing to participate.

The cover letter would explain the nature of the study, invitation for participation in the

study, and provided assurances of the anonymity, voluntary, and confidential nature of

responses, methods for insuring confidentiality and assured that participation was

voluntary.

7. After receiving the written consent forms, questionnaires were delivered

hand to hand to the participants by the researcher in the study hospital in the morning

shift. The participants were asked to mark the section by using paper and pencil and

return them directly to the researcher or to the incharge nurse.

8. The charge nurse took the responsibility to collect the questionnaires and did

it very cordially.

29

9. The researcher went everyday of the week except Friday to collect previous

questionnaires and went another department to give questionnaires to the participants in

the same way.

10. Researcher allowed one to three days to fill the questionnaire and submit it

to the concern charge nurse for that ward. Researcher met the charge nurse and collected

the questionnaires before the morning shift was over.

11. All participants sincerely filled the questionnaire and submitted to the in-

charge nurse within the mentioned time. Then researcher checked all items of the

questionnaire and collected them for analysis.

12. The researcher reviewed all the data and prepared data for analysis.

13. The researcher collected data from 10th

April to 30th

April, 2014 and the

respond rate in this study was hundred percent.

Data analysis

Data entry and analysis was done using computers statistical program. Data

were analyzed as following.

1. Data was presented using descriptive statistics in the form frequencies and

percentages means and standard deviations.

2. Pearson Product Moment correlation coefficient analysis was used for

assessment of the inter relationships between occupational stress and career growth with

organizational commitment. The level of relationship was interpreted as follows (Diane,

1997).

r Level

0 to .25 Low

.25 to .75 Moderate

.75 to 1 High

CHAPTER 4

RESULTS

The aim of this study was to explore the relationship between occupational

stress and career growth with organizational commitment among nurses in a medical

college hospital and examine the level of organizational commitment, occupational

stress and career growth of nurses. This chapter includes findings from data analysis

which are as follows:

1. Demographic characteristics of sample

2. Level of organizational commitment, occupational stress and career

growth.

3. Relationship between occupational stress and career growth with

organizational commitment.

31

Demographic characteristics of sample

This section presents the demographic data of 176 sample of in-patients

department of a medical college hospital, Bangladesh.

Table 2 Frequency, percentage, mean, standard deviation of nursing staffs by age,

gender, education, marital status, current position and working experience of

nurses (n=176).

Nurses’ characteristics frequencies (%) Mean SD Min-Max

Age (Years) 41.74 5.69 30-57

30-39 65 36.9

40-49 89 50.6

50-60 22 12.5

Gender

Male 27 15.3

Female 149 84.7

Education

Diploma in nursing 160 90.9

Bachelor in nursing 13 7.4

Master in nursing 3 1.7

Marital status

Married 173 98.3

Single 3 1.7

Working experience (Years) 16.3 7.31 3-32

3-10 30 17.1

11-20 109 61.9

21-32 37 21

As evident from the table 2, the majority of nurses was in the age of 40 to 49

(50.6%) and with average age of 41.74 years. The majority of the participants was

female (84.7%) and married (98.3%). Most of the participants’ have diploma in

nursing (90.9%). Their total working experience was ranging from 3 to 32 years, with

32

an average of 16.3 years. Most of them have working experience from 11 to 20 years

(61.9%).

Level of organizational commitment, occupational stress and career

growth

Table 3 Mean, standard deviation and level of organizational commitment,

occupational stress and career growth

Variables M SD Level

Organizational commitment 2.59 0.32 High

Occupational stress

Source of occupational stress

Physical health

2.73

2.79

2.57

0.37

0.38

0.46

Moderate

Moderate

Moderate

Career growth

Organizational career growth

Individual career growth

3.05

2.33

3.50

0.53

0.55

0.69

Moderate

Low

Moderate

Results from table 3 showed that there were high level of organizational

commitment (M = 2.59, SD =.32), moderate level of occupational stress (M= 2.73, SD

=.37) and career growth (M = 3.05, SD =.53) among nurses of the study hospital.

Nurses reported moderate level of source of occupational stress (M = 2.79, SD =0.38)

and physical health (M = 2.57, SD =0.46). Nurses reported low level of organizational

career growth (M = 2.33, SD = 0.55).

33

Relationship between occupational stress and career growth with

organizational commitment

Table 4 Pearson’s correlation coefficient between occupational stress and career

growth and their sub domains with organizational commitment

Organizational commitment

Occupational stress

Source of occupational stress

Physical health

-.226**

-.243**

-.134

Career growth

Organizational career growth

Individual career growth

.327**

.034

.389**

**P ˂.01

The findings in table 4 indicated that occupational stress has a significant

negative and low relationship with organizational commitment (r = -.226**

, p ˂.01).

Career growth has a significant positive and moderate relationship with organizational

commitment (r = .327**

, p ˂.01).

CHAPTER 5

CONCLUSION AND DISCUSSION

This chapter includes a summary of the study and findings in relation to those

previously reported in the literature. Subsequently, the implications for nursing,

recommendation for future research are presented.

Summary of the study

The aim of the descriptive correlational study was to examine the level of

occupational stress, career growth and level of organizational commitment and to

assess the relationships between occupational stress and career growth with

organizational commitment among nurses of a medical college hospital, Rangpur in

Bangladesh.

The population of this study was 398 nurses who were working in a medical

college hospital. The simple random sampling method was used to select sample. Self

reported questionnaires were used to collect data including demographic,

organizational commitment, occupational stress and career growth questionnaire.

Content validity of organizational commitment, occupational stress and career growth

questionnaires were reviewed and approved by five experts. The content validity of

organizational commitment questionnaire was .82, occupational stress questionnaire

was .80 and career growth questionnaire was .89. The internal consistency for

occupational stress questionnaire was 0.89, career growth questionnaire was 0.88 and

the organizational commitment questionnaire was 0.81. Data were analyzed using

descriptive statistics and Pearson’s correlation coefficient. The results of the study

were as follows.

1. Demographic characteristics:

Nurses of a medical college hospital reported that, the majority of nurses was

in the age of 40 to 49 (50.6%) and with average age of 41.74 years. The majority of the

participants was female (84.7%) and married (98.3%). Most of the participants’ have

diploma in nursing (90.9%). Their total working experience was ranging from 3 to 32

years, with an average of 16.3 years. Most of them have working experience from 11

to 20 years (61.9%).

35

2. Level of organizational commitment, occupational stress and career

growth:

Finding of the study showed that nurses have high level of organizational

commitment (M = 2.59, SD =.32). Moderate level of occupational stress (M= 2.73, SD

=.37) and moderate level of career growth (M = 3.05, SD =.53) among nurses of the

study hospital. However, for both sub scales of occupational stress indicate moderate

level. Source of occupational stress (M = 2.79, SD =0.38), physical health (M = 2.57,

SD =0.46), and for sub scales of career growth including individual career growth

showed moderate level (M = 3.50, SD = 0.69) and organizational career growth of

nurses showed low level (M = 2.33, SD = 0.55).

3. Pearson’s product-moment coefficient correlations:

The findings of the study indicate that occupational stress has a significant

negative and low relationship with organizational commitment (r = -.226**

, p ˂.01).

Career growth has a significant positive and moderate relationship with organizational

commitment (r = .327**

, p ˂.01).

Discussion of the study findings

The findings of this study are discussed in relation to research objectives are

as follows.

1. Level of organizational commitment

The result of the present study showed that the nurses of the study hospital

had high level of organizational commitment. A similar finding was attained by

Benson, Finegold, & Mohrman, (2004) who found that organizational commitment

level was high among employees. One study conducted in Jordanian nurse. They found

statistically significantly higher organizational commitment among male nurses, than

female nurses (Al-Hawajreh, 2011). The study showed that physical environment,

organizational factors, job design, career development and social stressors would have

an impact on the level of occupational stress and organizational commitment. The

above authors have explained this by the fact that when nurses gain more experience,

they may be reluctant to give-up their seniority and reputation of being experts on

particular units, and thus become increasingly committed to the organization.

However, another study found moderate level of organizational commitment

36

(Fernandez, 2014). The reverse finding has found in Jordanian hospital nurses. They

reported that two-fifth of the nurses had organizational commitment. Moreover, Diab

(2003) has reported that the level of commitment among nurses was high with more

total years of experience. The discrepancy with this study finding might be related to

the generally high level of organizational commitment among nurses, as revealed in

the results. This may be because of productive age of the samples since; the descriptive

statistics showed that most of the nurses were in the middle age ranged from 30-49

years (87.5%). Usually, in this age employee becomes more productive and remains

loyal to the organization and conscious about their professional career.

2. Level of occupational stress

Findings of this study revealed occupational stress in nurses in general was in

moderate level. A study conducted in Iranian nurses found that nurses of surgical and

internal wards showed significantly higher level of occupational stress in most scales

of occupational stress, except relationship, compared with nurses working in

psychiatric wards (Sahraian, Davidi, Bazrafshan, & Javadpour, 2013). The components

of occupational stress, source of occupational stress and physical health also showed

moderate level among samples of the study hospital. Moreover, the statistically

significant and higher level of occupational stress was reported among nurse in

Jordanian hospital (Al-Hawajreh, 2011). They found low level of organizational

commitment and high level of occupational stress. This variation of the result with

other study findings may found because of different culture and nature of job. The

higher level of stress in health service has been attributed to the nature of the work of

nurses and hospital administrators are involved in providing help to people

experiencing life crises (Tyson & Pongruengphant, 2004). Nursing has been shown to

be a strenuous profession, with more exposed to stress-provoking factors than other

healthcare workers. According to Evans (2002), a survey commissioned by the Sunday

Times in 1997 reported that nursing was the sixth most stressful profession. The level

explains the degree of certainty, which means that occupational stress increases with

decreasing level of organizational commitment. Physical environment, organizational

factors, job design, career development and social stressors would be associated with

level of occupational stress. However, the reason may be the study setting was a

government tertiary level academic hospital. Nurses were eager to work in this

37

organization as it was situated in a city. Moreover, from demographic characteristics it

is revealed that majority of samples (82.9%) were working in the same hospital for

more than ten years. Most of the nurses of the study hospital live with their family and

got familial support from their individual family. For this reason, they might be more

loyal to their organization despite of having moderate level of occupational stress.

3. Level of career growth

Findings of the research result indicated that the career growth among nurses

of the study hospital was in moderate level. For the two components of career growth,

individual career growth showed moderate level and organizational career growth of

nurses showed low level. In a survey report found that nurses between the ages of 35

and 49 years express low level of career growth than those ages 50 years and over.

Compared with responses to a 2002 survey conducted by the Oregon area health

education centers program, respondents to the 2008, registered nurse survey report was

significantly higher level of overall career growth (Kristine, 2010). The survey report

was done on registered nurse and they found that Nurse faculty expresses a lower level

of satisfaction with income and the number of hours they work than the general nurse

population. Result of the current study may be different because of the age of samples.

However, the similar finding has been shown in a study conducted among nurses in a

large academic hospital in Netherlands (Pool, Poell, Olle, & Cate, 2013). They found

that the eagerness of some young nurses for further career growth opportunities gave

them the impression that these young colleagues did not find their work appealing.

Range of age nurses of that study hospital was 35-49 years. This finding was consistent

with the result of present study since the younger nurses may seem on becoming a

better nurse. The study findings illustrated that the high level of organizational

commitment can help nurses to improve nursing performance by offering from

moderate to high if the career growth opportunities.

4. Relationship between occupational stress and organizational

commitment

Findings of this research indicated that occupational stress was statistical

significant negative and low relationship with organizational commitment. The result

of this study supports the hypothesis one of this study. This result was also consistent

with the findings of Michael, Deborah, & Pnina, (2009) study. Michael et al., (2009)

38

found that occupational stress negatively related to organizational commitment. Result

of this study strongly supports the finding of well Brown and Peterson (1993), as they

found that there was a strong inverse relationship between organizational commitment

and intent to leave. The domains of occupational stress were statistically significantly

inter-correlated. Domains of occupational stress reported significant relationship with

organizational commitment. Source of occupational stress was statistically

significantly correlated with organizational commitment. However, other studies have

reported contradictory results regarding the relation between organizational

commitment and occupational stress. Thus, Srinivas (2005) could not find any

statistically significant relationship between organizational commitments and stress.

This inconsistent finding may because of different culture and characteristics of

samples. In another study that examined the impact of stress on individuals with

varying degrees of commitment, it was found that individuals who have a high degree

of commitment to their organizations experience greater amounts of occupational

stress than those who are less committed. Wells et al., (2009) claimed a positive

relationship between occupational stress and organizational commitment. Another

research revealed that 60% of employees had medium job stress and 32% high job

stress (Khatibi et al., 2009). Similarly, Somers (2009) showed a significant relationship

between occupational stress and organizational commitment. It revealed the correlation

between two dimensions of occupational stress and organizational commitment among

studied subjects.

Additionally, the results indicated similarities with others studies since they

found the employees' job stress increases, their commitment to organization decreases

and vice versa. The results of this research is consistent with the research results of Lee

(2007), Lambert and Paoline (2008) Omolara (2008) Boyas and Wind (2009) but

inconsistent with the research results of Wells et al. (2009) and Yaghoubi et al. (2009).

Furthermore, Chen (2002) has reported that occupational stress has a statistically

significant negative effect on organizational commitment. However, Yaghoubi et al.

(2009) claimed this finding. He announced that there is not a significant relationship

between organizational commitment and occupational stress. This finding does not

support the finding of the present study since, there was a significant negative and low

relationship found between occupational stress and organizational commitment. In

39

addition, the negative relationships have been found between source of work stress and

organizational commitment and physical health. Moreover, Lambert and Hogan (2009)

found a negative relationship between job stress and organizational commitment which

supports hypothesis one of the present study, as they revealed the negative relationship

between occupational stress and organizational commitment. The finding of the

present study may be due to some specific demographic characteristics such as age,

gender and years of experience because most of the nurses were middle aged. The

large numbers of participants were female. Most of the nurses working experience

were eleven to twenty years. Moreover, in the study hospital almost all of the nurses

were married. They stayed near the organization with their family and they got familial

support. These may be the reason for what nurses had high organizational commitment

though there was a negative relationship between occupational stress and

organizational commitment.

5. Relationship between career growth and organizational commitment

The result revealed that there was a positive relationship between

organizational commitment and career growth. The result of the present study supports

the hypothesis two. Study finding was also similar to Michael et al. (2009) who found

that organizational commitment tends to increase when employees realize that there is

career growth opportunity in the organization. This was not supported by some other

study findings as well. This finding contradicts with Morrow (1993) and Lee et al.

(2000); who were believed that organizational commitment is negatively related to

career growth.

However, Pearson’s correlation coefficient between career growth and

organizational commitment analysis of present study revealed that there was a

statistically significant and moderate relationship. This finding of the study was the

agreement with Luthans (2002 a). He highlighted the determinants of organizational

commitment as personal, organizational, and non-organizational variables. Personal

variables include age, workload, absenteeism and turnover such as positive or negative

affectivity or internal or external attribution. All these things affect subsequent

organizational commitment. Organizational variables include job design, values, and

working environment. Non-organizational variables refer to the availability of

alternatives after making the initial choice to join an organization (Igbeneghu and

40

Popoola, 2011). Moreover, concerning the domains of career growth of this study

revealed that individual career growth has positive significant relationship with

organizational commitment. Results indicated moderate relationship between career

growth and organizational commitment as more or less they feel emotionally attached

to their hospital, or their hospital did not deserved their loyalty because of low

facilities from organizational career growth. This may be due to their negative

perceptions regarding career growth activities as reported in the study.

Research findings of the present study also consistent with the finding of

Vianen and Van (2000) who concluded that person’s values and organization’s values

are associated with behavioral and affective outcomes such as organizational

commitment. Moreover, concerning for the components of career growth, this study

findings indicated that organizational career growth has no relationship with

organizational commitment. However, the individual career growth has moderate

relationship with organizational commitment. It indicates that the samples were eager

to avail career growth opportunities. It may due to their age since majority (79%) of

the samples was in the range of 3-20 years of age. As in practice disciplines, such as

nursing, learning can be maximized through experience located in the clinical setting.

Feedback and “moving to the next step” has impact in this process and experiences in

'real-life' settings need to be effectively facilitated to obtain the desired outcomes

(Henderson, 2006).

Research study supported that organizational commitment and career growth

of both genders have core contribution to increase performance of the employees

within the organization. This finding is consistent with the study of Sturges et al

(2002), they found that there was a significant positive relationship between career

growth and organizational commitment of both genders. Another study finding also

congruent with result of this study. They found a relationship between career growth

and propensity to remain which is an aspect of organizational commitment (Agba et

al., 2010). However, these results would benefit to human resources’ managers during

the selection process of new job applicants as well as supervisors and managers when

trying to control the effect of work related stress on the organizational commitment

level of employees to reduce turnover and develop career growth opportunity.

41

Implications for administration and practice

1. Nursing administration: The results of the current study have implications

for nursing administrators. Most obviously, job redesign is needed and should include

a reward system that supports and appreciates appropriate employee efforts. Nurse

Administrator can apply study results for developing guideline for nurses to increase

organizational commitment in relation to occupational stress and career growth. It

might be helpful for nurse administrator to bring positive work attitude among the

nurses. Managers’ at all level and particularly nursing superintendent and chief nurses

can work together with their hospital administrators and nurses to reduce occupational

stress for improving quality of care. Nurse administrator can use these findings to take

necessary steps to increase organizational commitment in future. Nurses have the

opportunity to acquire new skills related to their career, and that the organization will

reward those efforts to increase of retaining those employees and building their sense

of organizational commitment.

2. Nursing practice: Nursing practice could be improved by using the results

of the research findings by setting strategies to reduce occupational stress since the

study revealed moderate level of occupational stress. Taking this into account, nurses

should improve their commitment by increasing their peer interaction, working on

their communication skills and making an effort to support their peers and make them

feel appreciated. If the entire hospital would try this, there should be cyclic effects

which could continue to increase the nurses’ organizational commitment.

3. Nursing education: The results of this study can contribute to nursing

education. Nurse educator can provide students with new information regarding the

level of organizational commitment among nurses in a hospital and the relationship

between occupational stress and career growth with organizational commitment.

Moreover, nurse educators can use the findings of career growth, occupational stress,

and organizational commitment for teaching students in nursing management.

42

Recommendation for further research

1. The study result can be helpful to provide primary information for further

study to develop nurses’ organizational commitment model. Further studies should be

conducted in a large scale to identify and clarify the specific strategies used by nurses,

and to increase understanding factors of organizational commitment.

2. This study revealed that there is a relationship between occupational stress

and career growth with organizational commitment. Therefore, further study should be

conducted to examine the causal relationship among organizational commitment,

occupational stress and career growth.

3. Researchers should conduct an in-depth study in hospitals by using focus

group to gain valuable information contribute to organizational commitment. A further

study should add nurse managers or hospital administrators in a sample to understand

organizational commitment of nurses in Bangladeshi context.

4. It is also recommended to investigate whether the improvement of career

growth can really promote nurse’s organizational commitment.

REFERENCES

Agba, A. M., Festus, N., & Ushie, E. M. (2010). Career development and employee

commitment in industrial organisations in Calabar, Nigeria. American

Journal of Scientific and Industrial Research, 1(2), 105-114.

Agba, A. M. (2004). Teachers’ perception of the impact of motivation on their job

performance. Unpublished post graduate diploma thesis of the University of

Calabar, Nigeria.

Ahsan, N., Abdullah, Z., Fie, D. Y. G. & Alam, S. S. (2009). A study of job stress on

job satisfaction among university staff in Malaysia: Empirical Study.

European Journal of Social Sciences, 8, 121-131.

Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J. A., Busse, R., Clarke, H.,

Giovannetti, P., Hunt, J., Rafferty, A. M., & Shamian, J. (2001).

Nurses'reports on hospital care in five countries. Health Affairs, 20, 43-53.

Al-Hawajreh, K. (2011). Exploring the relationship between occupational stress and

organizational commitment among nurses in selected jordanian hospitals.

An - Najah University Journal of Research (Humanities), 25(7), 1931-1975.

Al-Hussami, M. (2008). Predictors of nurses’ commitment to health care organisations.

Australian Journal of Advanced Nursing , 26 (4), 36-48.

Allen, N. J. (2001). Employee commitment to the organization and customer reactions

mapping The linkages. Human Resource Management Review, 11,209-236.

Allen, N. J. (2003). Organizational commitment in the military: A discussion of

theory and practice. Military Psychology , 15(3), 237-253.

Allen, N. J., & Meyer, J. P. (1990). The measurement and antecedents of affective,

continuance and normative commitment to the organization. Journal of

Occupational Psychology, 63, 1-18.

Allen, N. J. & Meyer, J. P. (1996), Affective, continuance, and normative commitment

to the organization: an examination of construct validity. Journal of

Vocational Behaviour, 49(3), 252-76.

44

Aminuzamman. (2007). Migration of skilled nurses from bangladesh: An exploratory

study. Development research centre on migration, globalisation and

poverty. Retrived from http://www.migrationdrc.org/publications/research_

reports/Migration_of_Skilled_Nurses_from_Bangladesh.pdf

Aoki, K. (2011). Job stress among nurses in public hospitals in Ratchaburi province,

Thailand. Journal of Public Health and Development, 9(1), 19-27.

Aseeri., M. A. (2012). Perception of organizational commitment among nurses in

different governmental health sectors at riyadh city. American Academic &

Scholarly Research Journal, 4(5), 1- 4. Retrived from http://http:// naturals

publishing.com/files/published/d7z9921pn9j1s4.pdf

Bakker, A. B., Killmer, C. H., Siegrist, J., & Schaufeli, W. B. (2000). Effort-reward

imbalance and burnout among nurses. Journal of Advanced Nursing, 31(4),

884.

Barbara, B. B. (2003). Employees’ organizational commitment and their perception of

supervisors’ relations-oriented and task-oriented leadershipbehaviors.

Unpublished Ph.D. Thesis.Virginia Polytechnic Institute and State

University, Virginia.

Barber, J. L., Bland, C., Langdon, M. B., & Michael, S. (2000). LPN role

advancement: From blueprints to ribbon cutting. Journal for Nurses in Staff

Development, 16(3), 112-117.

Becker, H. S. (1980). Notes on the concept of commitment. American Journal of

Sociology, 66, 32- 42.

Benson, G., Finegold, D., & Mohrman, S. (2004). You paid for the skills, now keep

them: Tuition reimbursement and voluntary turnover. Academy of

Management Journal, 47(3), 315-331.

Berings, M. G. M. C., Poell, R. F., Simons, P. R. J., & Veldhoven, M. J. P. M. (2007).

The development and validation of the On-the-job learning styles.

Questionnaire for the nursing profession. Journal of Advanced Nursing

58(5), 480–492.

45

Birjandi, M., & Ataei, M. (2013). The relationship between the quality of work life and

organizational commitment of the employees of Darab cement company:

Case study in Iran. International Journal of Economics, Business and

Finance, 1(7), 154-164.

Boyas, J., & Wind, L. H. (2009). Employment-based social capital, job stress and

employee burnout: A public child welfare employee structural model.

Children and Youth Services Review Journal, 32(3), 380-8.

Brewer, A., & Look, P. (1995). Management strategy & nursing commitment in

Australian hospital. Journal of nursing administration, 5(21), 780-799.

Brown, H., Zijlstra, F., & Lyons, E. (2006). The psychological effects of

organizational restructuring on nurses. Journal of Advanced Nursing, 53(3),

344-357.

Brown, S. P., & Peterson, R. A. (1993). Antecedents and consequences of salesperson

job satisfaction: meta-analysis and assessment of causal effects. Journal of

Market Research, 30(1), 63 – 77.

Butt, H. S., Khan, F., Rasli, A. B. M., & Iqbal, M. J. (2012). Impact of work and

physical environment on the hospital nurses commitment. International

Journal of Economoc Research, 3 (3), 33-43.

Byars, L. L., & Rue, L. W. (1997). Human resource management. (5th

ed.). New

York: McGraw-Hill.

Campbell, R. J., & Moses, J. L. (1986). Organizational career development systems:

The state of the practice. In D. T. Hall (Ed.). Career development in

organizations (pp. 236-273). San Francisco: Jossey-Bass.

Chang, E. (1999). Career commitment as a complex moderator of organizational

commitment and turnover intention. Human Relations, 52(10), 1257-1278.

Chen, H. M. (2002). A study of role stress, social support and organizational

commitment of clinical nursing faculty, Unpublished Thesis. Master Thesis.

Chinese.

Chen, Z. X., & Francesco, A. M. (2003). The relationship between the three

components of commitment and employee performance in China. Journal of

Vocational Behaviour, 62(3), 490‑510.

46

Cichy, R. F., Cha, J., & Kim, S. (2009). The relationship between organizational

commitment and contextual performance among private club leaders. Journal

of Hospitality Management, 28, 53-62.

Cooper, C. L. (Ed.). (2000). Theories of organizational stress. Oxford: Oxford

University Press.

Cooper-Hakim, A., & Viswesvaran, C. (2005). The construct of work commitment: An

integrative framework . Psychological Bulletin, 131, 241–259.

Daly, J. (2005). Professional nursing: Concepts, issues, and challenges. New York:

Springer.

Department of health and human services. (2008). Exposure to stress, occupational

hazards in hospitals. Retrieved from http://www.cdc.gov/niosh/docs/2008-

136/pdfs/2008-136.pdf

De Vos, A., Dewettinck, K., & Buyens, D. (2008). To move or not to move? The

relationship between career management and preferred career moves.

Employee Relations, 30(2), 156-175.

Diab, G. M. (2003). The influence of leaderships on job satisfaction and commitment

at university hospital in menoufyia. Master thesis, Faculty of nursing,

Menoufyia University.

Diane, S. (1997). Degree of correlation. Retrieved from http://pinkmonkey.com

Dorgham, S. R. (2012). Relationship between organization work climate & staff nurses

organizational commitment. Nature and Science, 10(5), 80-91

Eby, A. T. (2009). A cross-level investigation of the relationship between career

management practices and career-related attitudes. Grout & Organization

Management, 30(6), 565-596.

Eby, L. T., Sorensen, K. L., & Feldman, D. C. (2005). Predictors of objective and

subjective career success: A meta-analysis. Personnel Psychology, 58(2),

367–408.

Evans, L. (2002). An exploration of distict nurses' perception of occupational stress.

British Journal of Nursing, 11(8), 576-585.

Fang, Y. (2001). Turnover propensity and its causes among Singapore nurses: An

empirical study. The International Journal of Human Resource Management,

12(5), 859-871.

47

Fantis, I. T. (2010). Nurses’ attitudes regarding continuing professional development

in a district hospital of greece. Health Science Journal, 4(3),193-200.

Fernandez, R. (2014). A descriptive study to assess occupational stress and job

satisfaction among it workers in a selected company at bangalore, Master

thesis of Faculty of nursing, Rajiv Gandhi University of health sciences,

Karnataka, Bangalore.

Frese, M., & Zapf, D. (1999). On the importance of the objective environment in stress

and attribution theory: Counterpoint to Perrewe and Zellars. Journal of

Organizational Behavior, 20, 761–765.

Garland, B. E., Mccarty, W. P., & Zhao, R. (2009). Job Satisfaction and organizational

commitment in prisons, an examination of psychological staff, teachers and

unit management staff. Criminal Justice and Behavior, 36(2), 163-183.

Gould, D., Drey, N., & Berridge, E. J.(2007). Nurses’ experiences of continuing

professional development. Nurse Education Today, 27 (6), 602–609.

Gould, D., Kelly, D., Goldstone, L., & Maidwell, A. (2001). The changing training

needs of clinical nurse managers: Exploring issues for continuing

professional development. Journal of Advance Nursing , 34(1), 7-17.

Greenhaus, J. H., & Callanan, G. A. (1994). Career management (2nd

Ed.). Fort

Worth, TX: The Dryden Press.

Grobler, P.,Warnich, S., Carell, M., Elbert, N., & Hatfield, R. (2006). Human resource

management in south africa (3rd

ed.). London: Thomson.

Hall, D. T. (1976). Careers in Organizations. Santa Monica. Good year publication.

Retrieved from http://books.google.co.th/books/ about/Careers_in_

organizations. html?id=Qeovaqaamaaj&redir_esc=y

Haq, M., & Uddin, K. M. (2001). Occupational stress, job involvement and mental

health of doctors and nurses working under fixed and rotating schedule in

private and public hospitals and clinics. Retrived from http://www.

psychologybd.com/ BPA %20&%20SAAP%20Abstract22.html

Henderson, W. S. (2006). Progress: A conceptual model for continuous clinical

education. Nurse Education Today , 26(2), 104-9.

Howarth, M, H. K. (2006). Education needs for integrated care: A literature review.

Journal of Advance Nursing, 56(2), 144-56.

48

Igbeneghu, B. I., & Popoola, S. O. (2011). Influence of locus of control and job

satisfaction on organizational commitment: A study of medical records

personnel in University teaching hospitals in nigeria. Retrived from

http://digitalcommons.unl.edu/cgi/viewcontent.cgi? article=1606& context=

libphilprac

Ilies, R. S., & Judge, T. A. (2006). The interactive effects of personal traits and

experienced states on intraindividual patterns of citizenship behavior.

Academy of Management Journal, 49(3), 561-575.

Karsh, B., Booske, B., & Sainfort, F. (2005). Job and organizational determinants of

nursing home employee commitment, job satisfaction and intent to turnover.

Ergonomics, 48(10), 1260-1281.

Khatibi, A., Asadi, H., & Hamidi, M. (2009). The relationship between job stress and

organizational commitment in national olympic and paralympic academy.

World Journal of Sport Sciences, 2(4), 272-278.

Kobasa, S. C., & Antrosrusky. (1998). Commitment and coping strategies in stress

resistance among lawyers. Journal of Personality and Social Psychology. 42,

707-717.

Krishna, V. (2008). Exploring organizational commitment from an organizational

perspective:organizational learning as a determinant of affective

commitment in indian software firms. Doctoral Dissertation, George

Washington University Washington, DC, USA.

Kristine, K. C. (2010). Career satisfaction among Oregon’s registered nurses, A

report from the Oregon center for nursing. Retrived from http://http://www.

oregoncenter fornursing.org/documents/CareerSatisfaction.pdf

Landa, J. M. A., Esther, L. Z., Martos, M., & Carmen, A. L. (2008). The relationship

between emotional intelligence. Occupational stress and health nurses: A

questionnaire survey. International Journal of Nursing Studies, 45(6), 888-

901.

Lambert, E., & Hogan, N. (2009). The importance of job satisfaction and

organizational commitment in shaping turnover intent: A test of a causal

model. Criminal Justice Review, 34(1), 96-118.

49

Lambert, E., & Paoline, E. A. (2008). The influence of individual, job and

organizational characteristics on correctional staff job stress, job satisfaction

and organizational commitment. Criminal Justice Review, 33(4), 541-564.

Lee, J. A. (2007). Organizational justice: A mediated model from individual well-being

and social exchange theory perspectives. Doctoral dissertation, TOURO

University International.

Lee, K., Carswell, J. J., & Allen, N. J. (2000). A meta-analytic review of occupational

commitment: Relationships with person- and work-related variables. Journal

of Applied Psychology, 85(5), 799-811.

Lee, I., & Wang, H. (2002). Perceived occupational stress and related factors in

public health nurses. Journal of Nursing Research, 10(4), 253-259.

Lee, V., & Henderson, M. C. (1996). Occupational stress and organizational

commitment in nurse administrators. Journal of Nursing Administration,

26(5), 21-28.

Lindholm, M. (2006). Working conditions, psychosocial resources and work stress in

nurses and physicians in chief managers positions. Journal of Nursing

Management, 14(4), 300-309.

London, M., & Stumpf, S. A. (1982). Managing careers. Reading: Addison-Wesley.

Luoma, M., Jobayda, F., Chowdhury, J. H., & Wang, H. (2009). Incentives to improve

retention and performance of public sector doctors and nurses in

Bangladesh. Retrived from http://hpnconsortium.org/.../report_-

_incentives_to_ improve_reten

Luthans, F. (2002 a). Organizational behavior (9th

ed). New York: McGraw-Hill.

Luthans, F. (2002 b). The need for and meaning of positive organizational behaviour.

Journal of Organizational Behaviour, 23(6), 695-706.

Mahmood, S. A. (2012). Health systems in Bangladesh, health systems and policy

research. Internet Medical Publishing Journals, 1(1), 1- 4.

Malikeh, B., & Rahele, N. (2013). Role of occupational stress in organizations.

Interdisciplinary Journal of Contemporary Research in Business, 4( 9), 648-

657.

50

Marjan, L., & Nasrin, A. (2010). Nursing and coping with stress. International Journal

of Collaborative Research on Internal Medicine & Public Health, 2(5), 168-

181.

Mary, B., & Carman, T. (2011). Organizational commitment among licensed practical

nurses: exploring associations with empowerment,conflict and trust. Retrived

from http://ir.uiowa.edu/etd/2678

Maurer, T. J., & Lippstreu, M. (2006). Who will be committed to an organization that

provides support for employee development?. Journal of Management

Development, 27(3), 328-347.

McCarthy, G., Tyrrell, M. P., & Cronin, C. (2002). National study of turnover in

nursing and midwifery report. Dublin: Department of nursing studies,

University college, National University of Ireland.

Meyer, J. P., & Allen, N. J. (1991). A three component conceptualization of

organizational commitment. Human Resource Management Review, 1, 61-89.

Meyer, J. P., & Allen, N. J. (1997). Commitment in the workplace: theory, research,

and application. Thousand Oaks, CA: Sage Publications.

Meyer, J. P., Becker, T. E., & Vandenberghe, C. (2004). Employee commitment and

motivation: A conceptual analysis and integrative model. Journal of

Applied Psychology, 89(6), 991-1007.

Meyer, J. P., Paunonen, S. V., Gellatly, I. R., Goffin, R. D., & Jackson, D. N. (1989).

Organizational commitment and job performance: It’s the nature of the

commitment that counts. Journal of Applied Psychology, 74, 152-156.

Michael, O., Deborah, C., & Pnina, P. (2009). Job stress and organizational

commitment mentoring coordinators. International Journal of Educational

Managemnet, 23(3), 266-288.

Mitus, J. S. (2006). Organizational socialization from a content perspective and its

effect on the affective commitment of newly hired rehabilitation counselors.

Journal of Rehabilitation , 72(2), 12-20.

Morrow, P. C. (1993). The theory and measurement of work commitment. Greenwich,

CT: Jai Press.

Moustaka, E., & Theodoros, C. (2010). Sources and effects of work-related stress in

nursing. Health Science Journal, 4(4), 210-216.

51

Mowday, R. (1999). Reflections on the study and relevance of organizational

commitment. Human Resources Management Journal, 8(4), 387-401.

Mowday, R., Porter, L., & Steers, R. (1982). Organizational linkages: The psychology

of commitment, absenteeism, and turnover. San Diego, CA: Academic Press.

Mowday, R., Steers, R., & Porter, L. (1979). The measurement of organizational

commitment. Journal of Vocational Behavior,14, 224-247.

Mowday, R. Steers, R. & Porter, L. (2002). The measurement of organizational

commitment. Journal of Vocational Behavior. 14(2), 224-247.

Noura, G. M., Sanaa, A. I., Harisa, M.S., & Hoda, W. G. (2010). Relationship between

occupational stress and organizational commitment among nurses in port-said

city hospitals. Zagazig Nursing Journal, 6(11), 1-14.

Omolara, B. E. (2008). Influence of work related stress on organizational commitment

at olabisi onabanjo university ago iwoye ogun state nigeria. Retrived from

https://www.google.co.th/?gws_rd=cr,ssl&ei=TqrXU4KnL

YKIuATPooHoAw#q=Influence+of+work+related+stress+on+organizational

+commitment+%09at+olabisi+onabanjo+university+ago+iwoye+ogun+state

+nigeria%2C+

Onasoga, O. A., Ogbebor, S. O., & Ojo. A. A. (2013). Occupational stress

management among nurses in selected hospital in Benin city, Edo state,

Nigeria. European Journal of Experimental Biology, 3(1), 473-481.

Orpen, C. (1994). The effects of organizational and individual career management on

career success. International Journal of Manpower, 15 (1), 27-37.

Oulton, J., & Hickey, B. (2009). Review of the nursing crisis in Bangladesh, India,

Nepal and Pakistan. Retrived from http://www.unfpa.org/.../R155_Oulton

Hickey_ 2009_SouthAsiaReview_Nursin

Peterson, R. B., & Tracy, L. (1979). Systematic management of human resources.

Addison; Wesley publishing company.

Polit, D. F., & Hungler, B. P. (1999). Nursing research: Principles and methods (6th

ed.). Philladelphia: Lippincott.

Pool, I.A. Poell, R. B. Olle, T., & Cate, C. (2013). Nurses’ and managers’ perceptions

of continuing professional development for older and younger nurses: A

focus group study. International Journal of Nursing Studies 50, 34–43.

52

Popoola. (2006). Personal factors affecting organizational commitment of records

management personnel in Nigerian state universities. Ife Psychologia: an

International Journal of Psychology in Africa, 14 (1),183-197.

Quick, J. C., Quick, J. D., Nelson, D. L., & Hurrell, J.J. (1997). Preventive stress

management in organizations. Retrieved from http://wweb.uta.edu/

management/Dr.Quick/publications.htm

Reichers, A. E. (1985). A review and reconceptualization of organizational

commitment. Academy of Management Review, 10, 465-476.

Ronn, M. (2010). The relationship between career management and organisational

commitment: The moderating effect of openness to experience. Masters

thesis, Department of industrial psychology, University of Stellenbosch.

Rousseau, D. (2004). Psychological contracts in the workplace: Understanding the ties

that motivate . The Academy of Management Executive , 18(1), 120–127.

Sahnawaz, M. G., & Juyal, R. C. (2006). Human resources management practices and

organizational commitment in different organizations. Journal of the

Indian Academy of Applied Psychology, 32, 171-178.

Sahraian, A., Davidi, F., Bazrafshan, A., & Javadpour, A. (2013) Occupational stress

among hospital nurses: Comparison of internal, surgical, and psychiatric

wards. International Journal of Community Based Nursing and Midwifery,

1(4),182-190.

Salleh, M. S. (2012). Job satisfaction, organizational commitment, and turnover

intention: A case study on employees of a retail company in Malaysia.

World academy of science, Engineering and Technology. International

Journal of Social, Management, Economics and Business Engineering, 6(12),

702-709.

Schreuder. A. M. G., & Coetzee, M. (2006). Careers: An organisational perspective.

(3rd

ed.). Landsdowne: Juta.

Schwab, L. (1996). Individual hardiness and staff satisfaction. Nursing Economics,

14(3), 171-173.

Shakeel Ahmed. (2012). Health systems in Bangladesh. Helath Systems and Policy

Research, 1(1), 1.

53

Shirey, M. (2006 ). Stress and coping in nurse managers: Two decades of research.

Nurse Economics, 24, 203-11.

Shreedevi, D. (2013 ). Stress management among health care professionals, Its not

stress that kills us, It is our reaction to it-Hans selye. International

Journal of Research in Business Management, 1(3), 37-48.

Sikorska-Simmons, E. (2008). Predictors of staff-supportive organizational culture in

assisted living. Journal of Gerontological Nursing, 34(3), 15-25.

Somers, M. J. (2009). The combined influence of affective, continuance, and

normative commitment on employee withdrawal. Journal of Vocational

Behavior, 74, 75–81.

Srinivas, N. (2005). Contrasting visions of global civil society for organization and

policy. Public Administration Review 65(6), 743-47.

Stacciarini, J. M. R., & Troccoli, B. T. (2004). Occupational stress and constructive

thinking: Health and job satisfaction. Journal of Advanced Nursing , 46(5),

480-487.

Steers, R. M. (1977). Antecedents and outcomes of organizational commitment.

Administrative Science Quarterly, 22(1), 46-56.

Stevens, J. M., Janice, M., & Trice, J. (1978). Assessing personal, role and

organizational predictors of managerial commitment. Academy of

Management Journal, 21, 380- 395.

Sturges, J., David, G., Conway, N., & Davey, K. M. (2002). A longitudinal study of

the relationship between career management and organizational commitment

among graduates in the first ten years at work. Journal of Organizational

Behavior, 23, 731–748.

Sturges, J. C. (2005). Managing the career deal: The psychological contract as a

framework for understanding career management, organizational

commitment and work behavior. Journal of Organizational Behavior, 26,

821-838.

Sudhaker, L. A. (2010). Job stress, coping strategies and the job quality index of

nurses working inselected multispeciality hospitals–towards human

resources development. Journal of the Academy of Hospital Administration.

22(1&2), 10-14.

54

Tavakol, M., & Dennick, R. (2011). Making sense of cronbach’s alpha. International

Journal of Medical Education, 2, 53-55.

Tett, R. P., & Meyer, J. P. (1993). Job satisfaction, organizational commitment,

turnover intention, and turnover: Path analyses based on meta-analytic

findings. Personnel Psychology, 46, 259-293.

Tyson, P. D., & Pongruengphant, R. (2004). Five-year follow-up study of stress among

nurses in public and privet hospital in Thailand. International Journal of

Nursing Studies, 41(3), 247-254.

Urbanetto, S. J., Silva, P. C., Hoffmeister, E., Negri, B. S., Costa, B. E. P., &

Figueiredo, C. E. P. (2011). Workplace stress in nursing workers from an

emergency hospital: Job Stress scale analysis. Rev. Latino-Am.

Enfermagem, 19(5), 1122-31.

Verhaeghe, R., Vlerick, P., Backer, G., Van Maele, G., & Gemmel, P. (2008).

Recurrent changes in the work environment. Job resources and distress

among nurses: a comparative cross-sectional survey. International Journal of

Nursing Studies , 45(3), 382-92.

Vianen, E. M., & Van. (2000). Person- organization fit: the match between new

comers’ and recruiters’ preferences for organizational cultures. Personnel

Psychology, 53(1), 113- 150.

Wagner, C. M. (2007). Organizational commitment as a predictor variable in nursing

turnover research: Literature review. Journal of Advanced Nursing, 60(3),

235-247.

Waltz, C. F., Strickland, O. L., & Lenz, E. (2005). Measurement in nursing and health

research (3rd

ed.). New York: Springer publishing.

Wells, J. B., Minor, E., Anger, A., Matz, & Amato, N. (2009). Predictors of job

stress among staff in juvenile correctional facilities. Criminal Justice and

Behavior, 36(3), 245-258.

Weng, Q., James, C., & McElroy. (2012). Organizational career growth, affective

occupational commitment and turnover intentions. Journal of Vocational

Behavior, 80, 256–265.

55

Weng, Q., James, C., Paula, C., & Rongjhi, L. (2010). The relationship between career

growth and organizational commitment. Journal of Vocational Behavior , 77,

391- 400.

Weng, Q. X. ( 2010). Career growth study: Scale development and validity test.

Management Review Journal, 22(10), 22–31.

Widyanti, R., Thoyib, A., Setiawan, A., & Solimun. (2012). The perception of

individual and organizational careers in increasing the organizational

commitment. Journal of Economics, Business, and Accountancy Ventura,

15(2), 231 – 244.

Wilke, C. L. (2008). Intent to quit perceptions of nursing assistants working in

Oklahoma State veterans administration-owned and administered nursing

homes. Dissertation Abstracts International Section A: Humanities and

Social Sciences, 68(11), 4781-4781.

Xianyu, Y., & Lambert, V. A. (2006). Investigation of the relationships among

workplace stressors. ways of coping and the mental health of Chinese head

nurses. Nursing and Health Sciences, 8, 147-155.

Yaghoubi, M. (2007). Relationship between organizational commitment and job stress

among hospital administrators, Isfahan University of medical sciences.

[Research Project]. Isfahan: Health Management and Economics Research

Center, (Persian).

Yaghoubi, M., Yarmohammadian, M. H., & Afshar, M. (2009). A survey on

relationship between job stress and three dimensions of organization

commitment among nursing managers in educational hospitals of Isfahan

University of medical sciences. International Journal of Nursing

Management Reasearch , 14(3), 131-135.

Yahaya, A., Yahaya, N., Maalip, H., & Ramli, J. (2012). The relationship between the

occupational stress, organizational commitment, and job satisfaction with

organizational citizenship behavior. Archives Des Sciences, 65(3), 55-73.

Yamane, T. (1973). Statistics: An introductory analysis (3rd

ed.). New York: Harper &

Row.

Zangaro, G. A. (2001). Organizational commitment: A concept analysis. Nursing

Forum, 36(2), 14.

56

Zhou, H. L. ( 2009). What is the most important predictor of employees' turnover

intention in Chinese call centre: Job satisfaction, organizational commitment

or career commitment?. International Journal of Services, Technology and

Management, 12(2), 129–145.

APPENDICES

APPENDIX 1

Permission letter to use instruments

Kamel Hawajreh

To Me

Feb 8

Dear Sir,

Thank you for your viewing pleasure on our study, I do not mind the use of the

questionnaire attached in the study, With reference to the need to study in our name

and it's a tool back to us

Thank you for your perusal

Professor Kamel Al-Hawajreh

Middle East University

Me

To Kamel Hawajreh

hawajreh2055@yahoo.com

Feb 7

Dear Sir,

I beg most respectfully to state that I am a second year masters student of faculty of

nursing in Burapha University,Thailand. I have come from Bangladesh.My discipline

is nursing administration. I am preparing my thesis proposal. Main variables of my

thesis are occupational stress,career growth and organizational commitment. I studied

your uploaded article in the internet and I found it very effective for me to increase

my knowledge regarding research in this field. I would be happy enough to

get permission from you to use your questionnaire of occupational stress and

organizational commitment for my thesis to serve an academic purpose only.

Therefore, I pray and hope that you would be kind enough to give permission to use

your questionnaire of occupational stress and organizational commitment to complete

my research study to serve only academic purpose.

Md. Akramul Haque

MNS (International Program)

BUU, Thailand.

Phone: 0876142376

APPENDIX 2

Approval letter of study from the faculty of nursing, Burapha University

61

APPENDIX 3

Ethical clearance for study from the director of Rangpur medical college hospital,

Bangladesh

APPENDIX 4

Participants consent form

PARTICIPANT’S INFORMATION SHEET

Dear …………………………………..

I am Md. Akramul Haque, working as a staff nurse at Rangpur Medical

College Hospital. I am now studying Master of Nursing Science under

Burapha University, Thailand. As per course requirements I am going to conduct a research on

“Relationship between occupational stress and career growth with organizational commitment

among nurses of a medical college hospital, Rangpur, Bangladesh”.

The intention of the study is to examine the level of organizational commitment,

occupational stress and career growth of nurses in Rangpur medical college hospital in

Bangladesh and to examine the relationship between occupational stress, career growth and

organizational commitment of nurses in Rangpur medical college hospital in Bangladesh.

The samples are 176 staff nurses who are working in in-patients department at

Rangpur medical college hospital in Bangladesh.

This study will be a descriptive correlational study. Your participation in this study is

completely voluntary. Whether you participate in this study or not depends on your sole

decision. In this regard, your decision will be respected and you have the right to stop or

withdraw from the study at any time without needing any reason. If you agree to participate in

the study then I will give you a questionnaire including demographic data, organizational

commitment, occupational stress and career growth. This will take approximately 30 minutes to

fill up the all items. All the information you provide will be kept in strictly confidential. Your

anonymity will be guaranteed and your identity will not be reflected in any part of the

document. The raw data will be permanently discarded once data analysis is finished and a

report is published.

The outcomes of this study will contribute to nursing education, nursing practice,

nursing administration, and future nursing research in Bangladesh.

The research will be conducted by Md. Akramul haque under supervision of my

major-advisor, Asst. Prof. Dr. Areerut Khumyu. If you have any questions, please contact me at

# telephone: 0876142376 (Thai:), 01716223832 (Bang:) or by email: akramulni@yahoo.com

and my advisor’s e-mail address: areerutk@yahoo.com , Your cooperation is greatly

appreciated. You will be given a copy of this consent form to keep.

Md. Akramul Haque

66

INFORMED CONSENT

Title: “Relationship between occupational stress and career growth with

organizational commitment among nurses of a medical college hospital, Rangpur,

Bangladesh”

IRB approval number:…………………………..

Date of collection data ……………Month ………….Years………………

Before I give signature in below, I already be informed and explained from Mr.

Md. Akramul haque about purposes, method, procedures, and benefits of this study,

and I understood all of that explanation. I agree to be as a participant of this study.

I am Mr.Md.Akramul haque as a researcher had explained all of explanation

about purposes, method, procedures, and benefits of this study to the participant with

honesty; then, all of data/information of the participants will only be used for purpose

of this research s

............................................................ ...................................

Name and Signature of the Participant Date

..................................................... ..................................................

Name and Signature of witness Name and Signature of the researcher

APPENDIX 5

Questionnaires

Subject code...............

Research title: “RELATIONSHIP BETWEEN OCCUPATIONAL STRESS AND

CAREER GROWTH WITH ORGANIZATIONAL COMMITMENT AMONG

NURSES OF A MEDICAL COLLEGE HOSPITAL, RANGPUR, BANGLADESH”

QUESTIONNAIRE

Introduction:

Please read the following before you complete the questionnaire. Your name

is not required. Do not write your name anywhere on this document. All of your

replies will be treated confidentially by the University Research Team.

This questionnaire is designed to measure sources of stress, to identify groups

of people that feel stress more often than others, and to identify how they cope. This

survey is completely anonymous and confidential. Your participation is voluntary and

return of the questionnaire will be considered as consent to participate in the survey.

This questionnaire has five sections:

Part 1: Demographic questionnaire

Part 2: Organizational commitment questionnaire

Part 3: Occupational stress questionnaire

Part 4: Career growth questionnaire

69

Part 1: Demographic questionnaire

Please indicate your answer

1. Age……………….years

2.Gender

� Female

� Male

3.Highest education

� Diploma in nursing

� Bachelor in nursing

� Master in nursing

� Other please specify ……………………………….

4.Marital status

� Married

� Single

� Other please specify ……………………………….

5.Current position

� Staff nurse

� Senior staff nurse

6. Total working experience in this hospital…………….years

70

Part 2: Organizational commitment questionnaire

Direction: Please mark √ in the column under the number that most closely indicates

how you feel about statement in each item. Please respond to each item as:

1 = Disagree 2 = Uncertain 3 = Agree

Items 3 2 1

Agre

e

Uncertai

n

Disagre

e

1. I commit to push all my efforts to support the

success of this hospital.

2. I tell my friends that my hospital is great and

fantastic.

3. I feel emotional attachment to the hospital.

4. I accept any assignment related to my job here.

5. My value and value of this hospital are very

similar.

6. I am proud to be part of this hospital.

7. I prefer to work and perform the same job here.

8. This hospital gives me the best so that I can

perform my duties well.

9. If a very small change occurs, I will not quit

the job.

10. I am satisfied with my choice to work for this

hospital.

11. There are many things that make this hospital

better than other similar hospitals.

12. I agree with the policy of the hospital in the

care for nursing staffs.

13. I am concerned about the hospital’s image.

14. I am happy to work all these years for this

hospital.

71

Part 3: Occupational stress questionnaire

Direction: Almost anything can be a source of stress at a given time, and individuals

perceive potential sources of pressure differently. The statements below are all

potential sources of pressure. Please rate the degree of stress you perceive in each

items/statements by writing a number indicates your response to pressure situation in

your workplace. Please answer each item below as:

1 = Never 2 = Rarely 3 = Sometimes

4 = Often 5 = Always

Statements Answer

Source of stress at work

1. Too much work to do.

2. Not having enough power and influence to work well.

3. Working beyond level of ability.

4. Not having enough work to do.

5. Managing or supervising the work of other people.

6. Cannot cope with working policies.

7. Have to take work to do at home.

8. Low rate of payment.

9. Have conflict between personal beliefs and organization beliefs.

10. Inadequate guidance and back up form superiors.

11. Lack of consultation and communication.

12. Dealing with advance technology in the job.

13. Job role ambiguity.

14. Inadequate or poor quality of training.

15. Lack of social support by people at work.

16. Positive attitude of family towards my job and career.

17. Work very long hours.

18. Less in interesting tasks.

19. Lack of encouragement from superiors.

20. Being undervalued from colleagues.

21. High risks at work.

72

Statements Answer

Source of stress at work

22. Working with people who have opposite culture.

23. Lack of emotional support from others.

24. Lack of direct control in doing everything in the job.

25. Personality clashes with others.

26. Pursuing a career at the expense of home life

Direction: Below are a number of statements relating to your physical health. Please

indicate how often you feel the following occur by writing beside each item a number

from the scale below:

1 = Never 2 = Rarely 3 = Sometimes

4 = Often 5 = Always

Statements Answer

Physical health

27. Inability to get to sleep or stay asleep.

28. Headaches.

29. Indigestion or sickness.

30. Feeling unaccountably fatigued or exhausted.

31. Tendency to eat and/ or drink more than usual.

32. Tendency to tea/smoke more than usual.

33. Tendency to eat and/ or drink less than usual, that is, a

decrease in appetite.

34. Muscles trembling, for example, eye twitch.

35. Feeling as though you don’t want to get up in the morning.

36. Tendency to sweat or a feeling of your heart beating hard.

73

Part 4: Career growth questionnaire

Direction: Please indicate on the scale below how often you have experienced the

outlined activities ranging from 1(very seldom) to 5 (very often). Please read each

item and circle the number that most represent your experience in this hospital.

Items

Very seldom Very often

Organizational career growth

1. I have been trained to develop my career. 1 2 3 4 5

2. My departmental officer has made sure I get

the training I need for my career.

1 2 3 4 5

3. I have been taught things I need to know in

this organization.

1 2 3 4 5

4. I have been given a personal development

plan.

1 2 3 4 5

5. I have been given work which has

developed my skills for the future.

1 2 3 4 5

6. My departmental officer has given me clear

feedback on my working performance.

1 2 3 4 5

7. I have been given impartial career advice

when I need it.

1 2 3 4 5

8. I have been introduced to people at work to

help me develop knowledge and skills.

1 2 3 4 5

9. I have been given a mentor to help my

nursing career development.

1 2 3 4 5

10. My departmental officer gives me

knowledge and skills necessary for nursing

career growth.

1 2 3 4 5

74

Items

Very seldom Very often

Individual career growth

11. I introduce myself to people who can

influence my career.

1 2 3 4 5

12. I talk to seniors at social gatherings. 1 2 3 4 5

13. I have built contacts with people in areas

where I would like to work within the hospital.

1 2 3 4 5

14. I push myself to involve in high profile

projects.

1 2 3 4 5

15. I ask for career advice from people even

when it has not been offered.

1 2 3 4 5

16. I ask for feedback to improve my

performance.

1 2 3 4 5

17. I accept a new role because it would help

me develop new skills.

1 2 3 4 5

18. I make plan to improve my skills and

experience for working.

1 2 3 4 5

19. I look forward for reward from my career

work.

1 2 3 4 5

20. I keep my career path plan up to date. 1 2 3 4 5

21. I monitor job progression available outside. 1 2 3 4 5

22. I read work-related journals and books in

my spare time.

1 2 3 4 5

23. I search for career related training or

qualifications.

1 2 3 4 5

24. I take extra activities to gain good

experiences.

1 2 3 4 5

25. I make sure to get credit for the work I do. 1 2 3 4 5

26. I make my departmental officer aware of

my accomplishments.

1 2 3 4 5

APPENDIX 7

Item analysis

Frequency and percentages of rating on each questions of organizational commitment

questionnaire (N = 176)

Organizational commitment Rating of organizational commitment

3 2 1

n

%

n

%

n %

1. I commit to push all my efforts to

support the success of this hospital.

167 94.9 9 5.1 -

2. I tell my friends that my hospital is

great and fantastic.

149 84.7 18 10.2 9 5.1

3. I feel emotional attachment to the

hospital.

129 73.3 38 21.6 9 5.1

4. I accept any assignment related to my

job here.

91 51.7 63 35.8 22 12.5

5. My value and value of this hospital are

very similar.

38 21.6 85 48.3 53 30.1

6. I am proud to be part of this hospital. 153 86.9 6 3.4 17 9.7

7. I prefer to work and perform the same

job here.

124 70.5 28 15.9 24 13.6

8. This hospital gives me the best so that

I can perform my duties well.

116 65.9 41 23.3 19 10.8

9. If a very small change occurs, I will

not quit the job.

113 64.2 55 31.2 8 4.9

10. I am satisfied with my choice to

work for this hospital.

151 85.8 21 11.9 4 2.3

11. There are many things that make this

hospital better than other similar

hospitals.

98 55.7 57 32.4 21 11.9

12. I agree with the policy of the

hospital in the care for nursing staffs.

61 34.7 71 40.3 44 25.0

77

Organizational commitment

Rating of organizational commitment

3 2 1

n

%

n

%

n %

13. I am concerned about the hospital’s

image.

154 87.5 20 11.4 2 1.1

14. I am happy to work all these years

for this hospital.

160 90.9 8 4.5 8 4.5

78

BIOGRAPHY

Name Md.Akramul Haque

Date of birth November 11, 1975

Place of birth Rangpur shadar, Rangpur, Bangladesh

Present address Dhap hazy para, Road no-10/1, House no-43,

Post office-Rangpur, Police station-Kotwali,

District-Rangpur, Bangladesh

Position held

1999 – Present Senior staff nurse, Rangpur medical

college hospital, Rangpur, Bangladesh.

Education

2003-2005 Bachelor of nursing science, Gazipur,

Dhaka, Bangladesh

2012-2013 Master of nursing science

(International program),

Faculty of nursing, Burapha University, Chon

buri, Thailand

E-mail akramulni@yhaoo.com