Purpose
This study aimed to investigate the influence of role conflict, head nurses’ super leadership and nursing organizational culture on organizational commitment among male nurses.
Methods: This cross-sectional study included 221 male nurses who had worked for more than six months in university hospitals, general hospitals, and clinics. Data were collected using structured, self-administered questionnaires on role conflict, head nurse super leadership, nursing organizational culture, and organizational commitment. The data obtained were analyzed using descriptive analysis, independent t-test, analysis of variance, Scheffé test, Pearson’s correlation coefficients, and regression analysis.
Results: Organizational commitment had a significant positive correlation with head nurse super leadership, innovation-oriented culture, and relation-oriented culture; however, it had a significant negative correlation with role conflict and task-oriented culture. Among the general characteristics, the significant factors influencing organizational commitment among male nurses were number of beds and departments. Furthermore, among the main variables, innovation-oriented culture, task-oriented culture, role conflict, and head nurse super leadership influenced organizational commitment.
Conclusion: To increase male nurses’ organizational commitment, it is necessary to create an innovative organizational culture, reduce role conflicts, and improve head nurse super leadership.
,1
and Yujeong Kim2
This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-
This study aimed to investigate the influence of role conflict, head nurses’ super leadership and nursing organizational culture on organizational commitment among male nurses.
This cross-sectional study included 221 male nurses who had worked for more than six months in university hospitals, general hospitals, and clinics. Data were collected using structured, self-administered questionnaires on role conflict, head nurse super leadership, nursing organizational culture, and organizational commitment. The data obtained were analyzed using descriptive analysis, independent t-test, analysis of variance, Scheffé test, Pearson’s correlation coefficients, and regression analysis.
Organizational commitment had a significant positive correlation with head nurse super leadership, innovation-oriented culture, and relation-oriented culture; however, it had a significant negative correlation with role conflict and task-oriented culture. Among the general characteristics, the significant factors influencing organizational commitment among male nurses were number of beds and departments. Furthermore, among the main variables, innovation-oriented culture, task-oriented culture, role conflict, and head nurse super leadership influenced organizational commitment.
To increase male nurses’ organizational commitment, it is necessary to create an innovative organizational culture, reduce role conflicts, and improve head nurse super leadership.
The number of men choosing to become nurses is increasing on account of improved awareness of nursing as a profession, changes in job stereotyping, and preference for stable jobs owing to a rise in the unemployment rate [1]. The number of male nurses in Korea increased from 829 in 2004 to 24,546 in 2021 [2]. However, male nurses were rejected by patients and often had to take up non-nursing tasks that required physical strength, causing them to be disappointed with their jobs and resulting in decreased organizational commitment [3].
Organizational commitment refers to employees’ identification with the organization and the fulfillment of their obligations and commitment to organizational performance [4]. Low organizational commitment increases job stress, leading to a negative attitude toward work and burnout, which makes employees consider moving to another organization [5]. According to a previous study, organizational commitment is likely to be lower among male nurses than female nurses [6]. In addition, the turnover rate of male nurses was 27.1%, which was higher than the average nurse turnover rate of 12.6% in 2016 [7]. Therefore, it is necessary to devise interventions to examine the factors that influence and enhance organizational commitment among male nurses. Glisson and Durick [8] divided the factors influencing organizational commitment into personal, job-related, and organizational factors. This study used the same classification of factors that influence organizational commitment among male nurses.
Personal factors need to be further validated as researchers have reported contradictory findings regarding the influence of age, marital status, position, salary satisfaction, and hospital type on male nurses’ organizational commitment [6, 9]. Role conflict, as a job-related factor, refers to the incompatibility of requirements and expectations from a role [10]. Male nurses also experience rejection from patients [5]. In Korea, male nurses often work as assistants to physicians and surgeons; however, their authority and obligations are not clearly defined, leading to role conflicts [3]. Thus, it is necessary to explore role conflict perceived by male nurses and its influence on organizational commitment.
Super leadership and organizational culture affect organizational commitment [11]. Super leadership is defined as leadership that leads all members of an organization to do their best at work with a master spirit [11]. According to Manz and Sims [12], super leadership is necessary to improve organizational commitment because a leader helps members recognize their goals clearly and motivates them by stimulating and encouraging self-leadership. A previous study reported that head nurse super leadership promotes nurses’ self-leadership and maximizes their potential, ensuring a high level of thinking and action strategies as well as acceptance of and trust in the organization’s values and goals [13]. However, studies on the relationship between super leadership and organizational commitment among male nurses are lacking.
Organizational culture has also been reported to increase participation and commitment among nurses to improve organizational performance by enhancing productivity and strengthening bonds and unity among members [14]. A relationship exists between the behavior of organizational members and organizational culture [4], and a nursing organizational culture that motivates members and enables them to exert their maximum abilities has a significant correlation with nurses’ job satisfaction and organizational commitment [15]. Moreover, only a few studies have examined male nurses perception of the culture of nursing organizations and how this perception influences their organizational commitment.
Therefore, this study aimed to explore the factors influencing organizational commitment among male nurses, including their general characteristics, role conflict, head nurse super leadership, and nursing organizational culture.
This cross-sectional study explored the factors that affect the organizational commitment of male nurses.
The participants were recruited through convenience sampling. They voluntarily agreed to participate in this study after completely understanding its purpose and methods. We excluded novice nurses with less than six months of work experience and nurse managers: novice nurses because they may lack an understanding of the organization, and nurse managers because their job characteristics may work as an exogenous variable in measuring organizational commitment.
We applied the G*Power 3.1.9.7 program for multiple regression analysis, with an effect size of .10, power of .80, significance level of .05, and number of predictors up to 12, and calculated that 190 participants were required for this study. Considering the dropout rate, a survey was administered to 232 participants.
Role conflict was measured using the instrument developed by Kim and Park [10], which comprises 37 questions, including 15 on role ambiguity, 11 on lack of competence, 6 on environmental obstacles, and 5 on lack of cooperation. Each item is rated on a 5-point Likert scale, ranging from 1 strongly disagree to 5 strongly agree; a higher score indicates a higher level of role conflict. The Cronbach’s α of Kim and Park’s [10] study was .94, and that of this study was .95.
Head nurse super leadership was measured using the supervisor’s super leadership instrument modified by Kim et al. [16] based on Manz and Sims’ instruments [12]. This instrument comprises 14 items: 2 items each for “encourages self-observation”, “encourages self-goal setting”, “encourages self-expectation”, “encourages self-criticism”, “encourages rehearsal”, “encourages self-reward”, and “encourages constructive thinking”. Each item is rated on a 5-point Likert scale, ranging from 1 strongly disagree to 5 strongly agree; a higher score indicates a higher level of head nurse super leadership as perceived by nurses. The Cronbach’s α of Kim et al.’s [16] study was .84, whereas for this study, it was .96.
Nursing organizational culture was measured using an instrument developed by Han [15] for clinical nurses. This tool comprises 20 items, including five for relation-oriented culture, 6 for innovation-oriented culture, 5 for hierarchy-oriented culture, and 4 for task-oriented culture. This tool calculates each subdomain without adding up or averaging the subdomains. Each item is rated on a 5-point Likert scale, ranging from 1 strongly disagree to 5 strongly agree; a higher score indicates a higher level of recognition of the culture. At the time of development and in this study, Cronbach’s α for each subdomain of the tool was.82 and .83 for innovation-oriented culture, respectively;.84 and .93 for relation-oriented culture, respectively; .66 and .72 for hierarchy-oriented culture, respectively; and.63 and .42 for task-oriented culture, respectively.
This study used the instrument revised by Kim [17] for nurses based on the three dimensions of organizational commitment suggested by Allen and Meyer [4]: affective, continuance, and normative commitment. This instrument comprises 15 items, including 6 items on affective commitment, 5 on continuance commitment, and 4 on normative commitment. Each item is rated on a 5-point Likert scale, ranging from 1=strongly disagree to 5=strongly agree. All three types of commitment were positive factors, and negative items (e.g., “I do not feel an affection for this organization,” and “I do not have a strong feeling of belonging to this organization”) were calculated by inverse transformation. The Cronbach’s α of Kim’s [17] study as well as this study was .81.
To collect data, research instructions and recruitment notices were sent to the Busan Male Nurses Association, nurses’ social network service (SNS), and nursing departments of two general hospitals in Busan and one general hospital in Daegu. After approval by the administrator of each institution and SNS, the research instructions and recruitment notices were posted on online bulletin boards. After interested participants accessed the online link and read the explanation, they confirmed their participation in this study by clicking the consent button. The data were collected from December 7~30, 2020, and it took approximately 15 minutes for a participant to complete the questionnaires. Responses with obvious errors or missing information were excluded from the analysis.
Data from two participants with insincere responses and nine who met the exclusion criteria were excluded. Finally, 221 responses were analyzed. Data were analyzed using IBM SPSS 25. Participants’ general characteristics were analyzed using descriptive statistics. The levels of role conflict, head nurse super leadership, nursing organizational culture, and organizational commitment were analyzed using mean, standard deviation, and minimum and maximum values. Differences in organizational commitment according to the participants’ general characteristics were analyzed using an independent t-test, one-way analysis of variance, and Scheffé test. Correlations between variables were analyzed using Pearson’s correlation coefficients, and the factors affecting organizational commitment were evaluated using hierarchical multiple regression.
Data collection was initiated after receiving approval from the institutional review board of the university (No. KNU-2020-0132). Participants were informed of guaranteed anonymity; that they could withdraw their participation at any time during the survey, without penalty; and that the results of the study would be used only for research purposes. The researcher organized the data to maintain confidentiality. Participants who completed the questionnaire were given a gift.
The average age of the participants was 29.3±4.3 years, with 66.1% in their 20s and 33.9% in their 30s or older. Regarding educational attainment, marital status, and monthly average income, most participants had a bachelor’s degree (81.5%), were single (76.0%), and had a monthly average income of less than 3 million won (55.2%), respectively. The average working experience was 4.42±4.00 years, and those with less than 1~3 years’ experience accounted for the majority (40.3%). The average working experience at the current hospital was 4.14±3.95 years, with 38.5% of those having 1~3 years of experience. Regarding occupational position, general nurses accounted for 88.7% of the participants; moreover, operating room nurses accounted for the largest proportion of participants (25.8%), followed by intensive care unit nurses (24.0%), general ward nurses (19.0%), emergency room nurses (16.3%), and outpatient department nurses (14.9%). The number of beds in the organization in which participants worked was 300~499 beds for 27.6% of the participants, 1,000 or more beds for 27.1% of the participants, 300 or fewer beds for 24.0% of the participants, and 500~999 beds for 21.3% of the participants (Table 1).
Table 1
Differences in Organizational Commitment according to Characteristics (N=221)
Table 2 shows the level of role conflict, head nurse super leadership, nursing organizational culture, and organizational commitment. Skewness and kurtosis were evaluated to determine whether the normality of the data assumption was satisfied to detect skewness of less than ±2 and kurtosis of less than ±7. Because the data satisfied the assumption of normality, no problems were identified in the distribution of data to proceed with the parametric statistical analysis.
Table 2
The Level of Study Variables (N=221)
The average score was 2.64±0.63 for role conflict and 3.07±0.89 for head nurse super leadership. For nursing organizational culture, the average score was 3.02±0.78 for innovation-oriented culture, 3.34±0.98 for relation-oriented culture, 3.47±0.66 for hierarchy-oriented culture, and 2.12±0.99 for task-oriented culture. The average score for organizational commitment was 3.23±0.61 (Table 2).
Among the general characteristics, the variables with significant differences in organizational commitment were age (t=-3.38, p=.001), average monthly income (t=-3.34, p=.001), career (F=6.22, p<. 001), current hospital experience (F=7.47, p<.001), position (t=-4.01, p<.001), department (F=4.38, p=.002), and the number of beds in the organization for which participants worked (F=19.34, p<.001).
The level of organizational commitment was higher for those in their 30s than for those in their 20s and for those with an average monthly income of 3 million won or more than for those with less than 3 million won. In terms of years of experience, the level of organizational commitment was higher for those with 3~5 years or more of experience than in those with experience of 1~3 years or less. Regarding occupational position, higher organizational commitment was found among nurse managers than among general nurses, as well as in those working in emergency rooms or intensive care units than in those working in general wards. As for the number of beds, organizational commitment was significantly higher for individuals working in hospitals with 300 beds or more than for those working in hospitals with less than 300 beds (Table 1).
Table 3 shows the correlations identified between role conflict, nursing organizational culture, head nurse super leadership, and organizational commitment. Organizational commitment was negatively correlated with role conflict (r=-.17, p=.012) and positively correlated with head nurse super leadership (r=.47, p<.001). Among the subdomains of nursing organizational culture, organizational commitment showed a significant positive correlation with innovation-oriented culture (r=.44, p<.001) and relation-oriented culture (r=.36, p<.001) but a significant negative correlation with task-oriented culture (r=-.22, p=.001). We found no significant correlation between organizational commitment and hierarchical culture (Table 3).
Table 3
Correlations among Variables
Hierarchical multiple regression was used to confirm the factors influencing organizational commitment (Table 4). In Step 1, the general characteristic variables that were significant for organizational commitment were input. In Step 2, the subdomain variables that were significantly correlated with organizational commitment were input, including role conflict, head nurse super leadership, and nursing organizational culture. Verifying the basic assumption of the regression analysis showed that the Durbin-Watson statistic was 2.18, which was close to 2, satisfying the assumption of independence of the residuals [18]. Total years of experience were highly correlated with age and experience in the current hospital, and thus were excluded as a problem of multicollinearity. The variance inflation factor ranged from 1.05~1.39, less than 10, excluding multicollinearity [18].
Table 4
Factors Affecting Organizational Commitment (N=221)
In Step 1, position, operating room, general ward among departments, and hospital size had statistically significant effects on organizational commitment. Organizational commitment was higher for nurse managers than for general nurses (β=.25, p=.001), lower for those working in a general ward than in the emergency room (β=-.20, p=.017) and for those working in the operating room (β=-.24, p=.006), and higher for hospitals with 300~499 beds (β=.34, p<.001), 500~999 beds (β=.38, p<.001), and more than 1,000 beds (β=.53, p<.001) than for those with 300 beds. These variables explained 27% of the variance in organizational commitment.
In Step 2, for variables with a statistically significant influence on organizational commitment, organizational commitment was lower when the department was an operating room (β=-.17, p=.025) than an emergency room and higher for hospitals with 300~499 beds (β=.22, p=.003), 500~999 beds (β=.22, p=.004), and more than 1000 beds (β=.30, p<.001) than for those with less than 300 beds. In addition, organizational commitment was higher when role conflict was lower (β=-.21, p<.001), as well as when head nurse super leadership (β=.21, p=.001) and innovation-oriented culture was higher (β=.32, p<.001). In contrast, it was lower when the level of task-oriented culture was higher (β=-.22, p<.001). Relation-oriented culture had no significant influence on organizational commitment. Among these factors, innovation-oriented culture (β=.32, p<.001) had the greatest influence on organizational commitment. The entry of three factors explained an additional 21%p of organizational commitment. All variables of Step 2 explained the 48% of the variance in organizational commitment1 (Table 4).
This study aimed to investigate the factors that influence organizational commitment among male nurses. The level of organizational commitment among the participants was 3.23, which was slightly higher than the 3.08 in the study on general hospital nurses using the same tools by Kim [17]. As the previous study was conducted mostly with female nurses, the finding contradicts the result that male nurses tend to have lower organizational commitment in nursing organizations with a higher proportion of women [6]. It is necessary to assess the trend of change through future research, to investigate whether the changes can be attributed to the overall improvement of the nursing environment and work system or the change in the profession of male nurses.
Significant differences were observed in organizational commitment according to age, average monthly income, total career duration, current hospital experience, position, department, and number of beds among personal factors. The reason for this may be that as nurses get older, gain more years of experience, and attain a higher position, they are likely to understand their jobs better, show increased productivity, display an increased need for job stability, have greater satisfaction with the organization owing to improved welfare benefits, and express a greater desire to stay with the organization [9]. Magnet hospitals generally implement a strategy to improve nurses' organizational commitment through salaries, and since the results of this study also indicated a relationship between income and organizational commitment, support from hospitals and national policies is needed [19].
The number of beds and working departments were significant factors that influenced male nurses’ organizational commitment. In a study targeting male nurses [20], hospital type and working department were significantly associated with organizational commitment. Moreover, nurses in small- and medium-sized hospitals have low organizational commitment and high turnover rates owing to a lack of wages, promotion opportunities, and opportunities for self-development, and increased working hours and workload [21]. To solve this problem, the Philippine nursing community is attempting to improve the working environment through appropriate manpower placement, providing career opportunities to male nurses, and establishing a fair compensation system [6]. In future research, it is also necessary to confirm the impact of organizational commitment, including hospital welfare, flexible working patterns, educational programs, nursing workload, positive managerial leadership, and organizational culture.
Male nurses working in operating rooms had lower organizational commitment than those working in other departments. This was similar to the results of a study on male nurses in which organizational commitment was low among those working in an anesthesiology unit [6]. Male nurses tend to be more proud when working themselves instead of being instructed on what to do, and their organizational commitment is likely to increase when they are satisfied with performing professional tasks [22]. Several male nurses work as physician assistants in operating rooms and anesthesia departments and may consequently have low organizational commitment owing to performing auxiliary and cooperative work with doctors [21]. Further studies are required to identify the nursing experience of male nurses working as physician assistants or in operating rooms.
The level of role conflict in this study was 2.64, which is an important job-related factor influencing organizational commitment, similar to the results of previous studies [23]. Many male nurses experience role conflict because they are expected to perform work that they find undesirable, such as working in special departments, or performing doctor-dependent tasks and non-nursing tasks [7]. When providing care for female patients, physical contact may be misunderstood as inappropriate or they may experience rejection for being male, regardless of their nursing ability [24]. For these tasks, the boundaries of authority and responsibility are not clearly defined; thus, organizational commitment is reduced [22]. In 2016, the turnover rate of male nurses was 27.1%, which was higher than the average nurse turnover rate of 12.6%[7]. Therefore, it is necessary to resolve role conflicts that arise among male nurses and improve their job satisfaction and organizational commitment.
In this study, head nurse super leadership, as an organizational factor, had a significant influence on organizational commitment. This result is consistent with those of a previous study [25] that reported that nurse managers’ leadership affects nurses’ organizational commitment. Head nurse super leadership helps individual nurses increase their job competence and motivation to control their work and perform better as self-leaders, thereby increasing their organizational commitment [26]. A previous study [27] reported that the core competencies of managers’ super leadership are coaching and communicative support, and through this, super leadership buffers the negative influence of the organization and enhances employees’ enjoyment and immersion in the work. Therefore, it is necessary to enhance head nurse super leadership by including coaching and communication competency-building content in education and training programs for head nurses.
In this study, innovation-oriented culture had the largest influence on organizational commitment, perhaps because male nurses actively engaged in organizational change to emphasize their merits in a nursing organization with a conservative culture, accepting these changes flexibly and immersing themselves in the nursing organization [5]. In contrast, previous studies found task-oriented culture to be a significant factor that lowered the job satisfaction of male nurses [28]. “The Innovation Road Map: A Guide for Nurse Leaders,” a guidebook on nursing innovation published in the US, recommends that nurse leaders embrace the following characteristics to promote an innovation-oriented culture: divergent thinking, risk-taking behavior, willingness to learn from failure, and agility and flexibility in designing solutions [29]. As nursing leaders establish and implement guidelines and roadmaps for innovation, the nursing organizational culture will be more innovative and can influence organizational members.
However, relation-oriented culture did not have a significant influence on organizational commitment in this study. In female-dominant occupations, it was reported that male nurses experienced feelings of isolation, enmity from female colleagues, and underestimation of masculinity [30]. Therefore, a relation-oriented culture in a nursing organization dominated by women may not significantly influence male nurses' organizational commitment. Future studies on how nurses' perceptions of nursing organizational culture differ according to gender and their effects are also needed.
This study found that organizational culture, head nurse super leadership, role conflict, department, and number of beds influenced male nurses' organizational commitment. Nevertheless, this study’s limitations must be considered. First, it included only male nurses; therefore, comparisons with female nurses could not be drawn. Future studies must consider undertaking a comparative study of both male and female nurses’ organizational commitment. Second, the study did not separately assess male nurses who assisted physicians. This group may not perform holistic care for patients, and head nurses may have been surveyed as managers. Therefore, it is necessary to identify physician-assistant male nurses separately in future studies. Third, male nurses were conveniently selected through online recruitment for this study, which may affect the generalization of the results. It is necessary to expand the research by applying stratified sampling according to hospital type, region, and age. Fourth, the reported level of organizational commitment may differ from the actual level. In addition, the reliability of the nursing organizational culture tool used in this study was low. Therefore, it is necessary to explore more objective measurement tools and other tools that reflect the work situation and organizational culture characteristics of nurses in Korea.
This study indicated that innovation-oriented culture and head nurse super leadership are the main factors that positively influence male nurses' organizational commitment. In addition, task-oriented culture and role conflict decreased male nurses' organizational commitment. Therefore, based on these results, it is necessary to build an innovation-oriented culture in nursing organizations and facilitate head nurse super leadership competency. Furthermore, we propose a qualitative study that analyzes the causes of male nurses' role conflict in depth and a study that implements interventions.
This article is a condensed form of the first author's master's thesis from Kyungpook National University.
