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

Hind Abdullah Mohamed, Samia Gaballah*

Lecturer of Medical Surgical Nursing, Faculty of Nursing, Suez Canal University, Egypt

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

Keywords: Nurses' performance, organizational climate, relationship, university hospital

Citation: Hind Abdullah Mohamed, Samia Gaballah, Study of the Relationship between Organizational Climate and Nurses' Performance: A University Hospital Case. American Journal of Nursing Research, 6 (4). 191-197. January 2018. doi:10.12691/ajnr-6-4-7

1. Introduction

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

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

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

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

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

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

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

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

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

1.1. Aim

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

1.2. Research Objectives

1. Identify nurses' perception related to organizational climate.

2. Assess the nurses' job performance.

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

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

2. Methods

2.1. Research Design

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

2.2. Setting

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

2.3. Participants

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

2.4. Instruments

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

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

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

Section (2): Organizational Climate Questionnaire:

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

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

Section (3): Nurses’ Performance Evaluation:

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

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

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

2.5. Tools Validity and Reliability

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

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

2.6. Data Collection

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

2.7. Pilot Study

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

3. Ethical Considerations

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

4. Statistical Analysis

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

5. Results

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

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

Table 1. Work climate as perceived by nurses (110)

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

Table 2. Nurses' performance as observed among nurses (110)

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

Table 3. Relation between nurses’ mean score of work climate and their personal and job characteristics

Table 4. Relation between nurses’ level of performance and their personal and job characteristics

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

Table 5. Correlation between staff nurses work climate perception and job performance

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

6. Discussion

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

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

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

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

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

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

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

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

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

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

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

7. Conclusion

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

8. Recommendations

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

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

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

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

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

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

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

References

[1]   | Munyewende, P.O., Rispel, L.C. and Chirwa, T. (2014). Positive practice environments influence job satisfaction of primary health care clinic nursing managers in two South African provinces. Human Resources for Health, 12 (2014), p. 27.
[2]   | Nojehdehi, M.M., Farahani, M.A., Rafii, F. and Bahrani, N. (2015). A Comparison of Organizational Climate and Nurses’ Intention to Leave Among Excellence Awarded Hospitals and Other Hospitals. Iran Red Crescent Med J, May; Vol (17), No (5): e19000.
[3]   | Choi, S., Cheung, K., and Pang, S. (2012). Attributes of nursing work environment as predictors of registered nurses’ job satisfaction and intention to leave. Journal of Nursing Management, Vol (21), No (3), Pp. 1-11.
[4]   | Aiswarya, B. and Ramasundaram, G. (2012). A Study on Interference of Work–Life Conflict between Organizational Climate and Job Satisfaction of Women Employees in the Information Technology Sector, Asia-Pacific Journal of Management Research and Innovation, Vol. (8), No. (3), Pp. 351-360.
[5]   | Moghimi, S. and Subramaniam, I.D. (2013). Employees’ Creative Behavior: The Role of Organizational Climate in Malaysian SMEs, International Journal of Business and Management, Vol. (8), No.( 5 ), Pp. 1-13.
[6]   | Farooqui, M.R. (2012). Measuring Organizational Citizenship Behavior (OCB) as a Consequence of Organizational Climate (OC), Asian Journal of Business Management, Vol. (4), No. (3), Pp. 294-302.
[7]   | Jianwei Zhang. (2010). Organizational Climate and its Effects on Organizational Variables: An Empirical Study. Published by Canadian Center of Science and Education. International, Journal of Psychological Studies, Vol. (2), No. (2).
[8]   | Martine, P. (2006). Organizational climate survey. Available at: http://www.mhei.org/consult/ocs.
[9]   | Awad, N. (2008). The relationship between nurses' perception of organizational work climate and their job empowerment, Unpublished Master thesis, Faculty of Nursing, University of Alexandria.
[10]   | Aiken, L.H., Sloane, D.M., Clarke, S., Poghosyan, L., Cho, E., Yu, L. and Aungsuroch, Y. (2011). Importance of work environments on hospital outcomes in nine countries, International Journal of Quality in Health Care, Vol.(23), Pp. 356-364.
[11]   | Wolf, D.A.P., Dulmus, C.N. and Maguin, E. (2012). Organizational Culture and Climate, Res Soc Work Pract, Vol. (22), No.( 6 ), Pp. 665-671.
[12]   | Ghasemi, B. and Keshavarzi R. (2014). The relationship between organizational climate, organizational commitment and organizational citizenship behavior in a hospital environment, Reef Resour Assess Manag Tech Pap, Vol. (40), No.(2), Pp. 759-73.
[13]   | Luo, Z., Shi, K., Li, W. and Mia, D. (2008): Construct of Job performance: Evidence from Chinese’s Military Soldiers, Asian Journal of psychology, Vol. (11), No. (3), Pp. 222-223.
[14]   | Mathis, R.L. and Jackson, J.H. (2000): Human resource management. 9th ed. Cincinnati, Ohio: South Western College Publishing.
[15]   | Yu, M., Hamid, S., Ijab, M. and Soo, H. (2009). The balanced score card (E-BSC) for measuring Academic staff performance Excellence. High education: 57: 813-828.
[16]   | Nabirye, R. (2010). Occupational stress, job satisfaction and job performance among hospital nurses in Kampala Uganda, Published Doctoral Thesis of philosophy, Makerere University, Pp: 29. Retrieved at March, 23, 2011, from: ProQuest Dissertation & Thesis.
[17]   | Griffiths, M., Wood, V. and Maben, D. (2008). High quality nursing care- what is it and how can we best ensure its delivery? National Nursing Research Unit. London. King's college. Retrieved at March, 23, 2011, from: nnru@kcl.ac.uk
[18]   | Rao, V. (2011). Human resource management. Text and cases, 3rd ed., New Delhi, Excel books, Pp: 788-789.
[19]   | Necochea, E. and Fort, A. (2003). Measurement and evaluation of performance in international reproductive health, Performance Improvement, Vol.(42 ), No.(8), Pp. 9-13.
[20]   | Alves, D. F. and Guirardello, E.B. (2016). Nursing work environment, patient safety and quality of care in pediatric hospital, Rev. Gaúcha Enferm, Vol. (37), No.(2).
[21]   | Zayan, N.M., Reizian, A.E. and Hamouda, G. M. (2013). Relationship between Organizational Climate and Nurses’ Outcomes, J Am Sci, Vol. (9), No.(5), Pp. 184-192.
[22]   | Becton, J. (2012). Using biodata as a predictor of errors, tardiness, policy violations, overall job performance, and turnover among nurses, Journal of Management and Organization, Vol. (18), No.(5 ), Pp. 714-727.
[23]   | Cobb, J. R. (2008). Registered Nurse-Performance Evaluation. Retrieved from http/www.halogen software.com.
[24]   | El-Ghabor, G.M. (2014). The effect of work stress management training for head nurses on their job performance, Unpublished Doctorate Thesis. Faculty of Nursing, Port Said University, Egypt.
[25]   | Bahrami, M.A, Barati, O, Ghoroghchian, M., Montazer-alfaraj, R. and Ezzatabadi, M.R. (2016). Role of Organizational Climate in Organizational Commitment: The Case of Teaching Hospitals, Osong Public Health Res Perspect, Vol. (7), No. (2), Pp. 96-100.
[26]   | Kassem, A.H. and Gaber, H. (2015). Organizational climate and its impact on nurse's job empowerment at Main Mansoura University Hospital and Urology and Nephrology Center, IOSR Journal of Nursing and Health Science (IOSR-JNHS), Volume (4), No. (2), Pp. 40-48.
[27]   | Abd El-Megeed,M.and Ahmed, B. (1996). Relationship of organizational climate to quality of care among critical care nurses, Egyptian journal of international medicine, Vol. (5), No. (1), Pp. 97-112.
[28]   | Mok, E. and Au-Yeung, B. (2002). Relationship between the organizational climate and empowerment of nurses in Hong Kong, Journal of Nursing Management, Vol. (10), Pp. 129-137.
[29]   | Ying, L., Kunaviktikul, W. and Tonmukayakal, O. (2007). Nursing competency and organizational climate as perceived by staff nurses in a Chinese university hospital, Nursing and Health Sciences, Vol.(9), Pp. 221-227.
[30]   | Virasombat, N., Sudto, M. and Laohapoonrangsri, B. (2007). Organizational Climate and Organizational Commitment Assessment of Health Care Personnel in Sung Noen Hospital, Changwat Nakhon Ratchasima, Journal of Health Science, Vol.(17), Pp. 273-280.
[31]   | Wu, L. and Norman, I. (2006). An investigation of job satisfaction, organizational commitment and role conflict and ambiguity in a sample of Chinese undergraduate nursing students, Nursing education today, Vol. (26), No. (4), P.p 304-314.
[32]   | Abd El-shafy, EL. (2013). Relation between organizational climate and staff nurses job outcome, Unpublished Master thesis, Faculty of Nursing, Port Said University.
[33]   | Aiken, L.H., Sloane, D.M., Bruyneel, L., Van Den Heede, K. and Sermeus, W. (2013). Nurses’ reports of working conditions and hospital quality of care in 12 countries in Europe, International Journal of Nursing Studies, Vol.(50), Pp. 143-153.
[34]   | Giacomo, R.C. (2011). An Analysis of the Relationship between Select Organizational Climate Factors and Job Satisfaction Factors, published Ph-D Dissertation, University of Florida.
[35]   | Mrayyan, M.I. (2009). Differences of hospitals‟ organizational climate and Nurses intent to stay: Nurses‟ perspectives, Journal of Research in Nursing, 14-465-477, SAGE
[36]   | Van Bogaert, P., Clarke, S., Roelant, E., Meulemans, H. and Van de Heyning, P. (2013): Impacts of unit-level nurse practice environment and burnout on nurse-reported outcomes: A multilevel modelling approach, Journal of Clinical Nursing, Vol. (19), Pp. 1664-1674.
[37]   | El-Salam, G.A., Ibrahim, M.M., Mohsen, M.M.and Hassanein, S.E. (2008). Relationship between Organizational Climate and Empowerment of Nurses in Menoufiya Hospitals Egypt , Eastern Mediterranean Health Journal, Vol. (4), Pp. 1173-1184.
[38]   | Shehata, R. (2010). Relationship between the Disposition of Staff Nurses toward Critical Thinking and Quality of Their Performance at Mansoura University Hospital. Unpublished PhD Thesis, Faculty of Nursing, University of Mansoura.
[39]   | Ibrahim, S.A., El Sayed, R. I., Attala,M.M. and Elmezin, N. K. (2016). Relationship between Head Nurses' Leadership Styles and Staff Nurses' Job Performance, IOSR Journal of Nursing and Science, Vol. (5), No.(1), Pp. 66-74.
[40]   | Fathi, W. (2011). The Effect of Job Conscientiousness on Job Performance, Nature and Science, Vol.(9), No.(12), Pp. 173-179.
[41]   | Ali, S. A. (2006). The relationship between head nurses commitment and their performance, Unpublished Master Thesis, Faculty of Nursing, University of Alexandria.
[42]   | Mohamed, R. (2006). Relationship between nurses intra group conflict and their performance at Alexandria Main University hospital, Unpublished Master Thesis, Faculty of Nursing, Alexandria University, Pp: 59-62.
[43]   | Saleh, H. (2000). Relationship of patient' satisfaction and quality of care, Unpublished Master Thesis, Faculty of nursing, Ain Shams University, Pp: 85.
[44]   | Rabeel, A. (2004). Developing a tool for assessing nurse professional identity, Unpublished Doctorate Thesis, Faculty of nursing, Cairo university, pp: 98.
[45]   | Refaat, A. (2010). Developing and validating a model for nurses' professional identity and quality of nursing care, Unpublished Doctoral degree, faculty of nursing, Ain Shams University pp: 130, 132.
[46]   | Serra, M. (2008). learning to be a nurse: Professional identity in nursing students, Journal of Educational Science, Vol. (3), No.(5), Pp. 65-76. Retrieved at March, 23, 2011 from: www.sisifofpce.ul.
[47]   | Shehata, R. (2008). Organizational culture versus occupational stress among staff nurses at Mansoura University Hospital, Unpublished Master Thesis, Faculty of Nursing, Mansoura University, p 106-107.
[48]   | Galer, J.B., Vriesendorp,S., and Ellis, A. (2005). Managers Who Lead: A Handbook For Improving Health Services. Boston Management Science For Health.
[49]   | Suliman, A. M. and Isles, P.A. (2000). The multi-dimensional nature of organizational commitment in a non-Western context, J Manag Dev, Vol. (19), No.(1), Pp. 71-82.
[50]   | Chahal. R., Dua.S., Singh. N. and Mahey. S. (2012). Study of Organizational climatic factor for employee effectiveness: A Study of Jalandhar Leather factories, International Journal of Management & Information Technology, Vol. (1), No. (2), P.p 21-30.
[51]   | Heyart, B. (2011). The Role of Organizational Climate and Culture in Service Encounters, Published Doctoral Thesis, Wayne State University.
[52]   | Wilmer, A., Louie, K., Dodek, P., Wong, H. and Ayas, N. (2010). Incidence of medication errors and adverse drug events in the ICU: A systematic review. Quality and Safety in Health Care, Vol. (19), Pp. 1-9.
[53]   | Meyer, J.P. and Allen, N.J. (1993). Commitment to organization and occupations: Extension of a three-component model, J Appl Psychol, Vol. (78), No.(4), Pp. 538-551.
[54]   | Vanaki, Z. and Vagharseyyedin, S.A. (2009). Organizational commitment, work environment conditions, and life satisfaction among Iranian nurses, Nurs Health Sci, Vol. (11), No.(4), Pp. 404-409.
[55]   | Almalki, M., J., FitzGerald, G. and Clark M. (2012). The relationship between quality of work life and turnover intention of primary health care nurses in Saudi Arabia, BMC Health Services Research, Vol. (2), Pp. 12-314.