N U R SI N G W O R K F O R C E I S S U E S

Organisational climate, organisational commitment and intention to

leave amongst hospital nurses in Taiwan
Shwu-Ru Liou and Ching-Yu Cheng

Aims and objectives. To examine: (1) Taiwanese nurses perceptions of organisational climate, levels of organisational
commitment and intention to leave, as well as relationships between these three variables; (2) demographic differences in the
levels of these variables; and (3) mediating effects of organisational commitment on the relationship between organisational
climate and intention to leave.
Background. Organisational climate is related to organisational commitment and affects nurses performances and attitudes
towards an organisation.
Design. A cross-sectional, descriptive design.
Method. Registered nurses working in eight hospitals in southern Taiwan for more than six months were recruited. Data were
collected using the Litwin and Stringers Organisational Climate Questionnaire, Organizational Commitment Questionnaire
and a five-item scale measuring intention to leave. Questionnaires were distributed to 612 potential participants; 486 valid
returned questionnaires were analysed.
Results. The studys participants were generally satisfied with their hospitals climate and yet claimed low commitment to their
organisation and, nevertheless, reported low intention to leave their job. Single nurses were more satisfied with their hospitals
climate and were more committed to their hospital and had a lower intention to leave their job compared to married nurses.
Nurses working in district hospitals perceived a better hospital climate and had a lower intention to leave than nurses working
in teaching or regional hospitals. Staff nurses perceived a better organisational climate than did nurse managers. Organisational
climate, organisational commitment and intention to leave were intercorrelated. Organisational climate had almost 60%
indirect effect on organisational commitment related to intention to leave.
Conclusions. Creating a good organisational climate may increase nurses organisational commitment and, in turn, decrease
their intention to leave.
Relevance to clinical practice. To motivate nurses positive organisational behaviours and to address their diverse needs,
hospital administrators are encouraged to understand nurses work-climate perceptions and to address nurses varied demo-
graphic factors.

Key words: intention to leave, nurses, nursing, organisational climate, organisational commitment, Taiwan

Accepted for publication: 30 June 2009

of Taiwan is 22,958,360 in 2007 (Directorate-General of

Introduction
Budget, 2009). Taiwans populace is served by 530 hospitals,
Hospitals in Taiwan are accredited as teaching (medical 68,449 registered nurses and 12,825 licensed practical
centre), regional and/or district hospital. The total population nurses. In southern Taiwan, where the reported study was

Authors: Shwu-Ru Liou, PhD, RN, Assistant Professor, Chang Gung Correspondence: Ching-Yu Cheng, Assistant Professor, Taipei
Institute of Technology, Chiayi; Ching-Yu Cheng, PhD, Assistant Medical University, 250 Wu-Hsing Street, Taipei City, Taiwan
Professor, Taipei Medical University, Taipei City, Taiwan 110. Telephone: 886 2 27361661 ext. 6334.
E-mail: chingyuus@gmail.com

2010 Blackwell Publishing Ltd, Journal of Clinical Nursing, 19, 16351644 1635
doi: 10.1111/j.1365-2702.2009.03080.x
S-R Liou and C-Y Cheng
conducted, there are 187 hospitals, 19,532 registered nurses
and 3886 licensed practical nurses (Department of Health,
2008). Most hospitals offer a three-shift working schedule
with eight working hours per shift. Nurses may choose to
work on a fixed shift schedule (i.e. day, evening, or night
shift) or rotate in a three-shift schedule. To be classified as a
full-time employee, nurses must work 40 hours per week.
Regardless of the level of hospitals, from 20042008,
Taiwanese nurses who left their jobs within one year ranged
from 8130% (International Council of Nurses, 2009).
Following the 1995 implementation of the Taiwan
National Health Insurance program and related policies,
the Taiwan Bureau of National Health Insurance became the
only payer of health insurance fees to healthcare facilities. To
deal with this supersized provider and accommodate nego-
tiated healthcare costs, Taiwanese hospital administrators
have sought to implement various strategies for reducing
personnel and administrative costs: restructuring the hospital
healthcare system, modifying working procedures and
increasing healthcare providers roles and responsibilities.
Unfortunately, these changes may negatively influence hos-
pital employees perceptions of their organisation and, as a
result, adversely affect their attitudes and behaviours towards
the organisation, such as job performance, organisational
commitment (OCo) and intention to stay in their current job
(Sims & Lafollette 1975, Kozlowski & Hults 1987, Neher
1996, Jackson-Malik 2005). Nurses represent the largest
proportion of healthcare providers in a healthcare facility and
provide the frontline health services before physicians arrive,
therefore, they are the first to endure the impact of any
organisational changes. Thus, how nurses perceive their
organisational climate (OCl) is an important factor affecting
their attitudes towards the organisation and their intention to
remain in the organisation. However, few studies have
investigated Taiwanese hospital nurses perceptions of their
organisations and the influence of their perceptions.
The purposes of the present study, therefore, were to
examine the characteristics of OCl as perceived by hospital
nurses in southern Taiwan and to explore the relationship of
OCl with OCo and intention to leave (ITL). Research
questions included: (1) what are the degrees of perception
of OCl, OCo and ITL? (2) Do the degrees of OCl, OCo and
ITL differ by demographics? (3) What are relationships
between OCl, OCo and ITL? (4) Does OCo mediate the
relationship between OCl and ITL?
Background
OCl refers to the psychological climate of an organisation,
which is a consequence of the interaction between individuals
1636 2010 Blackwell Publishing Ltd, Journal of Clinical Nursing, 19, 16351644
and their external environment in an organisation (Pritchard
& Karasick 1973). Litwin and Stringer (1968) defined OCl as
a set of measurable properties of the work environment,
perceived directly or indirectly by the people who live and
work in this environment and assume to influence motivation
and behaviour (p. 1). Researchers have proposed that a
perceived well-ordered OCl can arouse individuals motiva-
tion and, consequently, cause emergent behaviours such as
commitment, job performance and satisfaction and retention
(Kozlowski & Hults 1987, Neher 1996, Jackson-Malik
2005).
Commitment is a strong psychological and social attach-
ment to something in a social endeavour (Alexander & Tyree
1996). Mowday et al. (1979) defined OCo in three related
dimensions: a strong belief in and acceptance of the
organisations goals and values, a willingness to exert
considerable effort on behalf of the organisation and a strong
desire to maintain membership in the organisation (p. 226),
and the most influential aspects of commitment are attitudi-
nal commitments (Morrow 1993, Brown 1996, Slocombe &
Dougherty 1998, Yousef 2003). One of the important
outcomes of OCo is that, once it exists, it empowers
individuals and stabilises their behaviour as circumstances
change (Mowday et al. 1979).
The concept of ITL differs from turnover. Turnover refers
to the act of individuals actually leaving an organisation
whereas ITL is individuals perceptions towards leaving. Yet,
ITL is related to and is an immediate predictor of turnover
behaviour (Price & Mueller 1981, Randall 1990, Somers
1995). Findings from studies of hospital employees demon-
strate moderate to strong correlations between the measures
for thinking of quitting, ITL and turnover (Mobley et al.
1978, Cavanagh 1990).
Commitment is often a consequence of events, actions and
policies by which the organisation creates positive emotional
connections with members of the work group (Meyer &
Allen 1997), therefore, OCl can be an event that triggers
individuals to commit to their organisation. In addition,
committed employees are more willing to exert considerable
effort on behalf of the organisation and have a stronger desire
to maintain membership in the organisation, which means
remaining in the organisation (Mowday et al. 1979). Find-
ings from studies involving hospital nurses in the USA
revealed that nurses working in an attractive climate, such as
Magnet hospitals, have a lower level of burnout and OCl is a
significant predictor of nurses ITL (Jackson-Malik 2005,
Stone et al. 2006, Stordeur et al. 2007). OCl has also been
found to be associated with or to be a significant predictor of
individuals commitment to their organisation (ODriscoll
et al. 2006, Fiorito et al. 2007, Stordeur et al. 2007).
Nursing workforce issues
Amongst nurses, OCo not only significantly correlates with,
but also predicts ITL (Fang 2001, Ingersoll et al. 2002, Lynn
& Redman 2005). Nursing studies have also found a
mediating effect of OCo on the relationships between other
predicting factors and ITL (Lum et al. 1998).
Methods
Design, sample and settings
The study used a correlational and descriptive design with
convenience sampling from eight hospitals (including three
district, two regional and three teaching hospitals) located in
southern Taiwan. After the proposal of the research, which
included cover letter and questionnaire, was completed, the
primary author discussed the proposal with the Directors of
Nursing Department of all sampled hospitals. Permissions to
conduct the study were obtained from those hospitals before
data collection. All registered nurses working in the sampled
hospitals for more than six months, which is considered a
suitable period of time for employees to become familiar with
their hospitals system, were invited to participate. Complet-
ing and returning the questionnaires indicated the subjects
consent to participate.
Study participants received data collection packets. Each
packet contained (1) a cover letter that explained the study
purpose and procedure and outlined participants rights and
confidentiality; (2) a set of self-administered questionnaires;
and (3) an envelope that would be returned to a secure data
collection box placed in the participating nursing units. There
was no identifying information on any of the data collection
forms, including the return envelopes. The trained project
assistants collected each data collection box on a regular
basis.
For the present study, there was a response rate of 855%,
in that, 612 questionnaires were distributed and 523 of them
were returned. However, seven participants had a missing
rate of over 14% on one of the studys instruments.
Therefore, 486 participants data were analysed, representing
a valid response rate of 794%. A post hoc statistical power
was calculated using results of multiple regression (alpha =
005, two predictors, R2 = 028 and n = 486); the power of
the study was 100 (Elashoff 2005). Of the 486 participating
nurses, 983% were females, 758% were younger than
36 years old, 446% were married, 759% had a nursing
associate degree, 278% had been working at their hospital
for 410 years and 239% for more than 10 years, 43% of
participants were working in regional hospitals whilst 319%
were from district hospitals and 134% were employed as a
nurse manager at their hospital.
2010 Blackwell Publishing Ltd, Journal of Clinical Nursing, 19, 16351644
Taiwanese nurses intention to leave
Instruments
Organisational climate
OCl was measured with the Litwin and Stringers (1968)
organizational climate questionnaire (LSOCQ). The LSOCQ
is a 50-item, four-point Likert scale (ranging from 14) that
includes nine subscales (stated later). Higher scores indicate
that individuals perceive a better OCl. Cronbachs alphas for
the subscales of the LSOCQ ranged from 045092 in Litwin
and Stringers study. In 1972, Hsu translated the LSOCQ into
Chinese (C-LSOCQ) and tested it amongst industrial
employees in Taiwan (Hsu 1972). The validity of the
C-LSOCQ was evidenced by a principal component analysis,
which revealed 11 components that explained 592% of the
variance of OCl. In the current study, the Cronbachs alpha
for the C-LSOCQ was 074.
Nine factors underlie the construct of OCl includes
structure, responsibility, reward, risk, warmth, support,
standards, conflict and identity (Litwin & Stringer 1968).
Structure refers to the feeling that employees have about the
formal organisational chart, line of communication and
constraints in the system. Responsibility relates to the
employees feeling of autonomy to perform their job without
simply following orders. Reward identifies a feeling of being
rewarded for a job well performed, emphasising positive
rewards rather than blame and perceiving the organisations
fairness of wage and promotion policies. Risk refers to a
sense of riskiness and challenge in the job and the organisa-
tion. Warmth relates to a feeling of good fellowship and a
caring atmosphere that prevails in the organisation. Support
identifies employees feeling of being accepted and supported
by superiors and colleagues. Standards indicate that individ-
uals perceive the importance of explicit and implicit goals and
clearly defined performance standards for achieving those
goals. Conflict identifies the feeling that different opinions are
allowed in the organisation and problems are dealt with
openly instead of being ignored or skimmed over. Identity
refers to a sense of belonging to an organisation as a valuable
member.
Organisational commitment
For the present study, the 15-item organizational commit-
ment questionnaire (OCQ) developed by Mowday et al.
(1979) was translated to Chinese to measure nurses OCo. A
higher score indicates higher commitment to the organisa-
tion. In the original scale-development study, the Cronbachs
alpha was 090 whilst the validity was evidenced with con-
struct, discriminant and predictive validity (Mowday et al.
1979). In the current study, the OCQs seven-point Likert
scale was modified to a four-point Likert scale to be
1637
S-R Liou and C-Y Cheng

consistent with other scales used in this study. The Cron-

Results
bachs alpha for the scale was 088.

Descriptive results of measured variables

Intention to leave
For the purpose of the present study, a five-item, four-point
Likert scale tool was created to measure participants ITL.
The items included the following statements: I cannot wait to
go home after work, It is obviously a mistake that I decided
to work in this hospital, I have no sense of achievement by
working in this hospital, I dont think it will do me any good
to work in this hospital for long and I will resign the position
if I cannot agree with the hospitals policies. The Cronbachs
alpha was 073; one component, which explained 3619% of
ITL, was revealed by principal component analysis.
The descriptive results for all measured variables were
presented using item mean score, where an items mean
score higher than 25 indicated an agreement with the
measured concept. Overall, participants were satisfied with
their hospitals climate, however, scored low on subscales of
risk, warmth, support, standards, conflict and identity of the
C-LSOCQ. The participants claimed low commitment to
their hospitals and, nevertheless, reported low intention to
leave their job (see Table 1).

Comparisons of measured variables

Statistical analysis
Data were managed and analysed with SPSS 14.0 (SPSS Inc.,
Chicago, IL, USA). Descriptive analyses were used to
examine demographic information and level of measured
variables (i.e. OCl, OCo and ITL). To compare differences of
measured variables amongst various demographical groups,
one-way ANOVA was used if there were more than two groups
(i.e. age, years of working and type of hospitals); t-test was
used if there were two groups (i.e. marriage); MannWhitney
U test (i.e. educational level and position at hospital) was
used when difference in sample size amongst groups was
large. Pearson correlation was used to examine correlation
between measured variables. Multiple linear regression and
Sobel test were used to test mediating effects of OCo
(Preacher & Hayes 2004). Statistical significance was deter-
mined with an alpha level of 005.
Diverse demographic factors revealed differences in the
participants levels of OCl, OCo and ITL (see Table 2).
Compared to married nurses, single nurses perceived a better
OCl, were more committed to their hospital and reported a
lower ITL. Nurses working in district hospitals perceived a
better OCl and had a lower ITL than nurses working in
regional or teaching hospitals. Nurses who were older than
35 years and nurses who worked longer than 10 years at
their current hospital had the lowest scores on commitment
and the highest scores on ITL than other groups; whereas,
nurses who were younger than 25 years and nurses who had
worked less than one year at their current hospital had less
ITL. Staff nurses perceived a better OCl and had a lower ITL
than nurse managers.
Scores from the subscales of the C-LSOCQ and the OCQ
were compared, by the type of hospital where the nurses

Table 1 Descriptive results for instruments

Possible scale Study scale Scale Item

Concept and instruments range range mean SD mean SD

Organisational climate (C-LSOCQ) 50200 81176 13006 1383 260 028

Structure 832 1130 2094 322 262 040
Responsibility 728 1028 1911 273 273 039
Reward 624 1024 1727 277 288 046
Risk 520 620 1209 227 242 045
Warmth 520 520 1217 226 243 045
Support 520 519 1235 183 247 037
Standards 624 921 1484 197 247 033
Conflict 416 416 1147 204 287 051
Identity 416 416 983 213 246 053
Organisational commitment (OCQ) 1560 1560 3459 700 231 047
Organisational identification 936 936 1941 429 216 048
Willingness to exert effort 624 624 1518 336 253 056
Intention to leave 520 420 1211 272 242 054

LSOCQ, Litwin and Stringers organizational climate questionnaire; OCQ, organizational commitment questionnaire.

1638 2010 Blackwell Publishing Ltd, Journal of Clinical Nursing, 19, 16351644
 Table 2 Comparisons of organisational climate (OCl), organisational commitment (OCo) and intention to leave (ITL) by demographics

OCl OCo ITL

2 2
Variable n Mean SD F/t/Z p Eta /d Mean SD F/t/Z p Eta /d Mean SD F/t/Z p Eta2/d
Nursing workforce issues

Age 175 016 001 1390 <0001* 008 814 <0001 005
<25 123 263 027 241 050 226 061
2630 143 261 024 240 039 239 052
3135 97 260 024 232 044 244 043
>35 116 256 034 208 047 261 053
Education 092 036 123 022 074 046
Associate and lower 398 259 027 230 046 243 055
Higher than associate 75 264 029 235 051 238 052
Marriage 258 001 023 558 <0001 052 402 <0001 038
Married 212 257 027 219 044 253 052
Single 246 263 027 242 045 233 054
Years of working 175 016 001 540 0001 003 675 <0001** 005
6 months1 year 97 263 028 239 055 223 065
14 years 127 262 024 235 040 242 051
410 years 129 261 026 234 045 244 048
>10 years 111 254 033 216 048 258 048

2010 Blackwell Publishing Ltd, Journal of Clinical Nursing, 19, 16351644

Type of hospitals 828 <0001 003 644 0002 003 1365 <0001 006
Teaching hospital 122 259 027 240 051 242 054
Regional 209 256 029 222 042 255 046
District 155 267 025 234 048 225 061
Position 239 002 178 008 302 0003
Nurse manager 64 253 034 222 059 259 052
Staff nurse 415 261 028 232 045 239 054

*Post hoc tests showed that nurses older than 35 years had higher commitment than nurses at other age groups.

Post hoc tests showed that nurses older than 35 years had higher intention to leave their current job than nurses younger than 30 years old.

MannWhitney U test was used because of the large difference on sample size between groups.

Post hoc tests showed that nurses working at current hospital longer than 10 years had lower commitment than nurses who worked for <10 years groups.

Welch test was used for the analysis because the assumption of equal variance was violated.
**Post hoc tests showed that nurses who worked less than one year at current hospital had lower intention to leave their current job than nurses working longer than one year.

Post hoc tests showed that nurses working in district hospitals had statistical higher score than nurses working in teaching hospitals or regional hospitals.

Post hoc tests showed that nurses working in teaching hospitals had higher commitment than nurses working in regional hospitals.

Post hoc tests showed that nurses working in district hospitals had lower intention to leave their current job than nurses working in teaching hospitals or regional hospitals.
Taiwanese nurses intention to leave

1639
S-R Liou and C-Y Cheng
worked and by the nurses position. Results showed that
nurses working in district hospitals had higher scores on the
C-LSOCQs subscales of structure, reward, risk and identity
and on the OCQs subscale of organisational identification
than nurses working in regional hospitals. Nurses working in
district hospitals also had higher scores on the C-LSOCQs
subscales of structure and reward than nurses working in
teaching hospitals. Nurses working in teaching hospitals had
higher scores on the C-LSOCQs subscale of identity and the
OCQs subscale of organisational identification than nurses
working in regional hospitals (see Table 3). When comparing
scores of the C-LSOCQ and OCQ by nurse position, staff
nurses had significantly higher scores on the C-LSOCQs
subscales of structure, support and identity and on the OCQs
subscale of organisational identification than nurse managers
(Table 4).
Relationships between measured variables
OCl was statistically and positively correlated with OCo
(r = 057); whereas, OCl was negatively associated with
ITL (r = 040). Likewise, OCo was negatively related to ITL
(r = 051).
Mediating effects of organisational commitment
A mediator is a variable that accounts for the relation
between a predictor and a dependent variable. The Sobel
test, which has a higher statistical power than the method
proposed by Baron and Kenny (1986), was developed by
Sobel to test the indirect effect of an independent variable
on a dependent variable through a mediator (Preacher &
Hayes 2004). Before applying the Sobel test, assumptions of
the mediator model were tested using three regression
analyses to reveal the direct effect of a predictor on a
mediator (Path A), the direct effect of a mediator on
a dependent variable (Path B) and the direct effect of a
predictor on a dependent variable (Path C). To show the
mediating effects, Path A, Path B and Path C must first exist
(Baron & Kenny 1986).
For the current study, the predictor in this analysis was
OCl, the mediator was OCo and the dependent variable was
ITL. First, the results of these three regression analyses
indicated that OCl showed effects on OCo (R2 = 032, B =
029, t = 1518, p < 0001, Path A) and on ITL (R2 = 026,
B = 010, t = 1296, p < 0001, Path C). OCo showed
effects on ITL (R2 = 016, B = 015, t = 947, p < 0001,
Path B). Second, the results from the Sobel test showed
significant mediating effects of OCo (Sobel = 328,
p = 0001) on the relationship of OCl and ITL. The OCo
1640 2010 Blackwell Publishing Ltd, Journal of Clinical Nursing, 19, 16351644
mediated 1771% of the effects between OCl and ITL;
however, the effect was not strong.
Because the mediating effect of OCo on the relationship of
OCl and ITL was not strong and because participants had
mid-high scores on the C-LSOCQ and low scores on the
OCQ and ITL, another analysis was performed to determine
whether OCl was a mediator of OCo and ITL. The Sobel test
showed strong mediating effects of OCl (Sobel = 766,
p < 0001). The OCl mediated 5998% of the effects of OCo
on ITL.
Discussion
Study results reveal that, in general, hospital nurses in Taiwan
perceived their hospitals provided a good working environ-
ment. Nurses who agreed with their hospitals structure
reported feeling they had autonomy to perform their job,
feeling a sense of being rewarded and feeling different
opinions were allowed in their hospital. However, they did
not agree that their working environment was enriched with a
caring atmosphere or full of challenges and they did not have
strong identification with their hospital. Although the nurses
might not have had a high level of commitment to their
hospital, they did not have a strong intention to leave their job.
From the standpoint of OCo, the current studys results are
consistent with the attributes of collectivism (Triandis 1995)
and traditional Chinese cultural values (Chen & Francesco
2000). According to cultural studies (Hofstede 1980,
Triandis 1995), the population in Taiwan is a collectivist
society where individuals highly regard relationships, value
loyalty and tend to give priority to the goals of the in-group
(Triandis 1995). Additionally, an individuals main loyalty is
to ones immediate boss (Chen & Francesco 2000). There-
fore, although nurses in the present study did not have a
strong commitment to their organisation, they worked for the
benefit of their hospital, likely because of their culturally
based loyalty to individual relationships with colleagues or to
their immediate boss.
Findings from this study also suggested that Taiwanese
nurses working in district hospitals perceived a better OCl
than nurses working in regional or teaching hospitals. Nurses
who worked in district hospitals felt they understood the
hospitals formal organisational chart, perceived fair policies
in payment and promotion, felt their job included challenges,
felt valuable as a member in their hospital and were willing to
exert efforts on behalf of their organisation. The reason for
these findings may be that district hospitals have fewer levels
of organisational structure than regional and teaching hos-
pitals. Consequently, as Pierce et al. (2001) noted, employees
in smaller organisation have a greater knowledge of their job
Nursing workforce issues Taiwanese nurses intention to leave

Table 3 Comparisons of subscales of the C-LSOCQ and OCQ by type of hospitals*

Variable Mean SD F p Post hoc test

Organisational climate
Structure 1770 <0001 District hospital > teaching hospital and regional hospital
Teaching hospital 254 038
Regional 255 040
District 277 038
Responsibility 361 003 District hospital > regional hospital
Teaching hospital 269 041
Regional 270 038
District 280 038
Reward 784 <0001 District hospital > teaching hospital and regional hospital
Teaching hospital 281 048
Regional 284 048
District 299 030
Risk 475 001 District hospital > regional hospital
Teaching hospital 246 048
Regional 235 043
District 248 046
Warmth 247 009
Teaching hospital 247 045
Regional 238 044
District 248 047
Support 235 010
Teaching hospital 251 039
Regional 243 034
District 249 038
Standards 140 025
Teaching hospital 243 034
Regional 248 033
District 250 032
Conflict 087 042
Teaching hospital 282 058
Regional 287 049
District 290 048
Identity 744 0001 Teaching hospital and district hospital > regional hospital
Teaching hospital 255 053
Regional 235 051
District 253 054
Organisational commitment
Organisational identification 788 <0001 Teaching hospital > regional and district hospital
Teaching hospital 230 053
Regional 203 042
District 214 048
Willingness to exert effort 577 0004 District hospital > regional hospital
Teaching hospital 255 057
Regional 244 051
District 264 060

LSOCQ, Litwin and Stringers organizational climate questionnaire; OCQ, organizational commitment questionnaire.
*The n for nurses in teaching hospital, regional hospital and district hospital were 122, 209 and 155, respectively.

The p-value for the post hoc comparison was 005 and 95% CI ranged from 0000101978. The result may not be considered significant.

Welch test was used for the analysis because the assumption of equal variance was violated for the one-way ANOVA .

and organisation, feel more comfortable communicating environment than employees in larger organisations. These
with their superiors and have more of a sense of freedom individuals, therefore, are more willing to involve themselves
to exercise personal control over their job and work deeply into their job and organisation (Pierce et al. 2001).

2010 Blackwell Publishing Ltd, Journal of Clinical Nursing, 19, 16351644 1641
S-R Liou and C-Y Cheng

Table 4 Comparisons of subscales of the C-LSOCQ and OCQ by managers are expected to play numerous roles such as
position planner, implementer, coordinator, supporter and trouble-
Variable Mean SD Z p shooter; however, their excellent job performance is often
taken for granted, and they rarely receive proportionate
Structure 265 001
rewards. Therefore, nurse managers may not perceive an
Nurse manager 249 049
Staff nurse 264 038 optimal OCl.
Responsibility 164 010 In the current study, single nurses scored higher on OCl
Nurse manager 266 041 than married nurses. Few nursing studies have focused on
Staff nurse 274 038 marital status to help explain this finding. Gray (1989) noted
Reward 153 013
that, compared to single career women, married career
Nurse manager 282 053
Staff nurse 289 045
women are understandably more likely to suffer from role
Risk 167 010 overload or role stress because of employment demands and
Nurse manager 233 051 domestic tasks. In Taiwan, these duties are especially
Staff nurse 243 044 challenging for married nurses. Most Taiwanese families
Warmth 122 022 include three generations of family members. Also, most
Nurse manager 238 055
Taiwanese married women are expected to be at home some
Staff nurse 244 044
Support 276 001 time during the day, especially in the evening, to tend to
Nurse manager 236 043 domestic tasks such as making meals and taking care of other
Staff nurse 249 035 family members. However, nursing jobs in Taiwan offer little
Standards 044 066 flexibility for work schedules, and nurses are expected to
Nurse manager 246 032
rotate three shifts that include evening hours. Such demanding
Staff nurse 248 033
Conflict 048 063
schedules may not meet married nurses needs and, conse-
Nurse manager 288 045 quently, may negatively affect their perceptions of their OCl.
Staff nurse 286 051 The current study found that OCl was positively correlated
Identity 210 004 with OCo but negatively related to ITL. These findings
Nurse manager 233 059 support several researchers theory that OCl serves as a
Staff nurse 248 052
function to arouse employees motivation and, furthermore,
Organisational commitment
Organisational identification 226 003 influence their organisational behaviours such as OCo, job
Nurse manager 217 046 satisfaction, job performance and retention (Barling et al.
Staff nurse 207 060 1990, Neher 1996, Jackson-Malik 2005, Stone et al. 2006,
Willingness to exert effort 152 013 Fiorito et al. 2007). In addition, participants with a high level
Nurse manager 245 068
of commitment to their hospital reported a low intention to
Staff nurse 255 054
leave their current job, which was similar to findings from
LSOCQ, Litwin and Stringers organizational climate questionnaire; other research (Cohen 1998, Fang 2001, Ingersoll et al. 2002,
OCQ, organizational commitment questionnaire. Lynn & Redman 2005). This finding also supports Mowday
The n for nurse manager and staff nurse were 64 and 415, respec-
et al.s (1979) description of the characteristics of OCo,
tively. MannWhitney U test was used because of the big difference
on sample size between groups. where committed individuals have a stronger desire to
maintain membership in their organisation.
Data analyses for the current study indicated OCo signif-
The current study also revealed that staff nurses perceived icantly but not strongly (1771% of indirect effects)
a better OCl especially hospital structure, support and mediated the relationship between OCl and ITL. In contrast,
identity than nurse managers. Despite limited studies that results from an extra analysis of the Sobel test revealed OCl
focus on comparing the perceptions of OCl between stuff mediated almost 60% of the effects of the OCo on ITL, which
nurses and nurse managers, the present investigations finding was stronger than the mediation effects of OCo on OCl and
is congruent with findings in Mok and Au-Yeungs (2002) ITL. These findings suggest that Taiwanese nurses who do not
study amongst hospital nurses in Hong Kong. These highly commit to their hospitals are, however, willing to exert
researchers found that frontline nurses had a more positive efforts for and stay in their hospital if they perceive a good
view towards OCl than middle and top nurse managers. The working atmosphere. In other words, a positive working
logical reason may be that nurse managers are under multi- environment may encourage Taiwanese nurses to identify
layers of pressure. As Mok and Au-Yeung noted, nurse with, commit to and extend extra efforts on behalf of their

1642 2010 Blackwell Publishing Ltd, Journal of Clinical Nursing, 19, 16351644
Nursing workforce issues
organisation, which in turn may assure their retention in the
hospital. It is interesting to note that these particular findings
do not correspond with results (OCo functions as a buffer
between predictors and ITL) from previous studies conducted
with nurses in the Western culture (Gregson 1992, DeConinck
& Bachmann 1994, Lum et al. 1998). However, because the
researchers in the previous studies did not test the indirect
effects of OCo on ITL, they did not report the amount of
mediation of OCo on OCl and ITL. Therefore, a direct
comparison of the results from the current study and from
previous studies may not be appropriate.
Limitations
Findings from the current study offer an initial step to
exploring OCl, OCo and ITL, especially amongst nurses in
Taiwanese hospital settings. However, generalisability of the
studys findings is limited because of the sampling method,
which was based on responses from nurses working in
hospitals located in southern Taiwan. To increase the power
of generalisability of results, it is recommended that future
investigations include nurses working in other areas of
Taiwan. Additional limitation in this study was the use of a
cross-sectional design. A one-time measure does not permit
testing causal effects of OCl and OCo on ITL. Researchers
are encouraged to conduct longitudinal studies to explore the
possibility of mutual determination and to establish the
causal relationships of OCl, OCo and ITL.
Conclusions
The current studys findings indicate that although hospital
nurses in Taiwan generally perceive a good OCl, they have a
low commitment to their organisation and yet have a low ITL
their current job. The study participants low ITL, despite their
low commitment to their organisation, likely reflects Taiwans
collectivist culture, where individuals highly regard relation-
ships, value loyalty and tend to give priority to the goals of the
in-group (Triandis 1995). Results from the current study also
reveal that additional, varied demographic factors such as
differences in job positions, type of hospitals where they work
and marital status affect nurses perceptions of their OCl.
These findings suggest that nurses have diverse needs and
cultural backgrounds that deserve special attention to motivate
nurses positive behaviours on behalf of their organisation.
Relevance to clinical practice
Data from the present study shed more light on the
relationships between OCl, OCo and ITL. This study reveals
2010 Blackwell Publishing Ltd, Journal of Clinical Nursing, 19, 16351644
Taiwanese nurses intention to leave
that OCl not only is associated with, but also mediates OCo
and ITL amongst hospital nurses in Taiwan. Based on this
finding, it is important for administrators of healthcare
organisations facing high nursing turnover rates to identify
typical factors that influence nurses perception of OCl and
intention to leave their job. Such predictors, when recognised
early, provide information that allows administrators to
adopt measures that may alleviate nurses ITL and encourage
them to remain with the organisation.
Contributions
Study design: SRL, CYC; data collection and analysis: CYC
and manuscript preparation: SRL, CYC.
Conflict of interest
The authors declare no conflict of interest in the study.
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