Winning nurses’ commitment in the Indian healthcare system

Motivation, morale and retention of nurses have emerged as issues of significant concern for healthcare providers and policymakers in recent time. Day-to-day nursing tasks are physically and emotionally demanding and depend not so much on standardized rules but on situational requirements. The nature of the work in the service-intensive healthcare organizations entails nurses to be deeply engaged in their work roles and willingly go beyond the call of their duty. Defined as a ‘psychic kick of immersion, striving, absorption, focus and involvement’, engagement is characterized by dedication, vigour and absorption. Organization citizenship behaviour is defined as ‘individual behaviour that is discretionary, not directly or explicitly recognized by the formal reward system and in the aggregate promotes the efficient and effective functioning of the organization’. Nurses’ engagement and citizenship behaviours have been recognized as critical skills for enhancing quality of patient care and well-being.

Recently, we undertook a study to test the impact of ‘perceived organizational support’ on nurses’ work engagement and organizational citizenship behaviour. The study examined the process as well as the workplace conditions under which above mentioned effects may or may not hold true. Given that nursing constitutes the largest share of healthcare workforce, we believe that a study of this kind is timely and much needed.

The study results supported the idea that commitment is a direct response to perceived organizational support (POS) and an explanatory mechanism for the effects of POS on work engagement and organizational citizenship behaviour. Enjoying support from their organizations is likely to foster nurses’ emotional bonding and identification with the organization. Nurses’ positive job experiences can promote their emotional and attitudinal responses that then result in their positive work behaviours, a sequence of influence that is corroborated by the commonly assumed job experience–attitude–behaviour sequence of relationship.

The results of this study demonstrated the potential of perceived quality of relationship, measured through perceived contract breach, in influencing the effects of POS and commitment.

Employee attitudes and behaviours are not shaped by the availability of organizational resources in isolation. Along with available resources, evaluation of organizational fairness in terms of fulfilment of promissory expectations may define the magnitude of effects of resources on employee outcomes. Psychological contract is an employee’s cognitive evaluation about the extent of fulfilment of the promised obligations implicitly agreed on in the employment relationship. Psychological contract breach occurs when an employee believes that her organization has failed to fulfil one or more promises in the psychological contract, thereby causing an undesired change in the social exchange relationship. Nurses evaluate failure of their organization to not fulfil their promises and maintain the desired level of social exchange as unfair. This feeling of unfairness may induce stress and initiate a process of resource drain. The stress associated with perception of contract breach is likely to diminish the positive effects of perceived support from organization and by reducing the emotional bonding of employees with their organization.

Our research showed that in a state of perceived contract breach, nurses may weaken the psychological bonds they share with their organizations, perhaps as an important self-protective mechanism that prevents their future frustration. The stress caused as a result of perceived contract breach undermines the belief nurses have in the organization that it can take care and support them, thereby, assuaging the indirect positive effects of POS on work outcomes through commitment. Our finding of a moderating influence of perceived contract breach offers a new insight into the relationship between perceived organizational support and affective commitment. Social exchange at the workplace may be more complex than originally believed and shows that reciprocity does not operate in a straightforward fashion.

In an increasingly competitive healthcare environment, characterized with increasing work demands and limited resources, providing a working environment that generates positive work attitudes and behaviours is critical for organizations. Building a supportive work environment is an effective way of increasing nurses’ psychological bonding and enhancing positive work-related outcomes that may, in turn, enhance organizational performance. Organizations may inadvertently fail to meet the expectations of their employees concerning the employment relationship, resulting in a sense of insecurity and poor confidence in organizational intention. Breach of expectations can induce a perception of organizational injustice that may harm the quality of employment relationship and damage organizational performance. Absence of clear expectations over contract elements conveyed to employees may lead to perceived contract breach. As a policy implication, caution needs to be exercised in conveying promises to applicants in the recruitment process. Organizations should make realistic job previews an essential part of their recruitment strategy. Realistic job previews accurately depict the behaviours expected for the successful completion of the job, lower grandiose expectations and thus improve the fit between individual’s expectations and organization’s ability to fulfil them. Moreover, organizations should focus nurses’ attention on the most important terms of the job contract and promote a shared understanding of the job demands. Doing so would enable applicants to make an informed choice about whether or not to accept the offer of employment, thereby reducing the probability of unmet promises.

(Vishal Gupta is an Associate Professor in Organizational Behaviour Area at IIM Ahmedabad. Upasna A Agarwal is an Associate Professor in Human Resources Management Area at NITIE Mumbai.)

This article presents the authors’ personal views and should not be construed to represent the institute’s position on the subject.

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