The impact of ethical climate types on nurses’ behaviors in Bosnia and Herzegovina

Abstract

Background:

The performance of nurses has become vital in hospitals. Some studies have suggested that nurses’ perceptions of the ethical climate in their hospitals are related to higher job satisfaction and organizational commitment and in turn lessen the issue of nursing shortage.

Hypothesis:

(1) The ethical climate types “caring,” “independent,” “law and code,” and “rules” have a significant positive impact on overall job satisfaction. (2) The ethical climate types and overall job satisfaction have significant positive influences on normative and affective and significant negative influences on continuance commitment.

Research design:

The study uses path analysis to understand which types of ethical climate impact overall job satisfaction. It also tries to find the effect of different types of ethical climate and overall job satisfaction on the components of organizational commitment. The relationships between variables were evaluated using factor analysis, reliability, descriptive statistics, correlations, and regression in this study.

Participants and research context:

A total of 171 useful questionnaires were collected from nurses working in public and private hospitals in Bosnia and Herzegovina.

Ethical considerations:

Formal research approval was obtained from the administration of each study hospital. Questionnaires with a cover letter were mailed to the hospitals that agreed to participate in the study. In the cover letter, the researchers explained the study purpose, encouraged nurses’ voluntary participation, and guaranteed the anonymity of participants.

Findings:

In the first path analyses, “rules” and “caring” climates significantly and positively affected overall job satisfaction. In the second one, while overall job satisfaction and “rules” climate significantly influenced normative commitment, “caring” climate and overall job satisfaction significantly affected affective commitment.

Discussion:

The findings of the study have been convenient with the literature.

Conclusion:

Public and private hospitals can enhance overall job satisfaction and organizational commitment by altering the ethical climate of organizations. Hospital administrations should nurture caring and rule types of ethical climate which influence overall satisfaction. By this way, they could reduce nursing shortage.

Keywords

Bosnia and Herzegovina ethical climate types hospitals organizational commitment components overall job satisfaction

Introduction

Nurses are the most significant human resource in medical services. Their performance is directly related to the performance of clinics and hospitals. Working in different shifts, direct contact with patients, and heavy workloads are some of the everyday difficulties which constitute their job. Due to these difficulties, nursing shortage and high turnover have become widespread issues in medical system recently. For example, Andrews and Dziegielewski,¹ using data from the Health Resources and Services Administration, showed that there is a critical shortage of registered nurses in the United States and they anticipated that the demand for nursing services is expected to exceed supply by almost 30% by 2020. In the case of countries of the Far East, Tsai and Huang² also emphasized high turnover and nursing shortage in public and private hospitals of Taiwan. In the case of Bosnia and Herzegovina (BiH) the situation is similar. According to data from the Department of Health Statistics for BiH, the annual increase rate of the number of nurses in medical services in 2014 is approximately 0.007%.³ A great number of nurses have also migrated to European countries, mostly Germany in recent years.ⁱ Thus, the low increase in the number of nurses every year contrasted with the high drain of nurses to other countries make nursing shortage an important issue in BiH. While there are a lot of factors that influence nurses’ shortage, job satisfaction (JS) is the most frequently cited one.^4,5 Meeusen et al.’s⁶ study found that work climate characteristics had important correlations to JS. Among different types of work climates, ethical climate (EC) plays a significant role in developing the context in which the employees operate.⁷ Several studies also indicated that one of the most important factors in enhancing employees’ JS is organizations’ EC.⁸ On the other hand, JS and organizational commitment (OC) are frequently examined together.² A number of studies showed that JS had a significant impact on OC.^9,10 However, some studies found that hospitals increase nurses’ JS and OC by affecting their organization’s EC.^2,11 While there is an abundance of studies which have investigated the relationship between employees’ JS, OC, and EC of organizations, literature focusing on the effects of EC types on JS and OC components is severely limited. What is also lacking are empirical studies which explore the relationship among EC types, JS, and OC components in developing countries.

BiH is a developing and transitional country situated in the heart of the Balkan Peninsula. The conflict which lasted from 1992 to 1995 devastated this small country. After signing the Dayton agreement in 1995, BiH has started recovering and its economy has been developing slowly with the help of developed countries. Demolished public organizations have been reconstructed and new private institutions have been built in this transitional country. Medical services are one of the greatest necessities of people in the post-conflict period. The quality of these services has also been improving. Public hospitals which were founded during the period of the former Socialist Federal Republic of Yugoslavia have been repaired. However, local and foreign entrepreneurs established new private clinics and hospitals and these modern medical institutions have become competitors to public hospitals and clinics. People with high levels of income have a tendency to utilize private medical services rather than public hospitals and clinics which provide very slow health services due to their heavy bureaucracy. In this competition between public and private medical services, nurses’ function and performance play a very important role. This study examines the factors which influence nurses’ performance in hospitals in BiH.

Overall, this investigation examines existing ethical climate types in public and private hospitals and the degree of job satisfaction and organizational commitment components of nurses in BiH. This study utilizes path analysis illustrated in the research model (Figure 1). The model requires two paths that consist of some regression analyses. The first path investigates the relationship between EC types and overall JS. The second path investigates the relationship between different types of EC, overall JS, and OC components. The purpose of this study is to explore whether organizations can foster several types of EC to enhance JS and OC of employees.

Figure 1.

Research model.

Theoretical background and hypotheses

Ethical Climate and Job Satisfaction

Ethical climate is a type of organizational work climate and it is defined as “prevailing perceptions of typical organizational practices and procedures that have ethical content” (p. 101).¹² It shapes ethical understanding and behavior of employees and thus serves as “a perceptual lens through which workers diagnose and assess situations” (p. 129).¹³ Victor and Cullen¹² classified EC into five types in their initial work: caring, independent, law and code, rules, and instrumental. The following brief descriptions are derived from Victor and Cullen:^12,14

Caring climate is a type which is based on the concern for others. In this climate type, employees have an interest in each other’s well-being within and outside the organization.

Independent climate is a type in which individuals act according to their own personal moral beliefs.

Law and code climate type is dependent on the perception that employees adhere to the codes and regulations of their profession or another authority. According to this climate type, employees should make decisions based on some external system such as law or professional codes of conduct.

Rules climate is related to the accepted rules of conduct determined by the organization.

Instrumental climate is basically dependent upon the maximization of self-interest. This climate type is the least preferred one.¹³

Job satisfaction is “a pleasurable or positive emotional state resulting from the appraisal of one’s job or job experiences” (p. 1304).¹⁵ It is the affective approach of employees toward their jobs. Several researches have shown that EC has a huge influence on employees’ job attitudes in the organizations. For example, some authors have found a relationship between EC and JS.^8,16,17 Some studies explored the relationships between EC types and JS.^8,18 Tsai and Huang² also investigated this relationship in hospitals of Taiwan and their findings recommend that caring, independence, and rules EC types have a significant positive impact on nurses’ JS. Based on this, the first path explores the relationship between EC types and overall JS with the following hypothesis:

Hypothesis 1. The EC types “caring,” “independent,” “law and code,” and “rules” have a significant positive impact on overall JS.

Ethical Climate, Job Satisfaction, and Organizational Commitment

Organizational commitment is very important for organizations because they desire to retain talented employees. Briefly defined it is the “recognition with and devotion to the concerned organization and its targets.”¹⁹ Employees who are committed to their companies tend to accept organizational goals and wish to stay in the organizations. According to Meyer and Allen,²⁰ there are three components of OC: affective commitment (AC; emotional attachment to the organization), continuance commitment (CC; attachment based on the accumulation of valued side bets such as loss of prestige or status), and normative commitment (NC; a feeling of obligation to continue employment). Several researchers reconceptualized OC dimensions and added calculative commitment which is “a commitment to an organization which is based on the employee’s receiving inducements to match contributions”²¹ to literature.

Various studies have investigated the antecedents and outcomes of organizational commitment. Job satisfaction is highly related to employees’ commitment to their organizations. However, while there are a plenty of studies that showed positive relationships between JS and OC,^22,23 the order of the causal relationship between two job attitudes has not been clearly established. The prevailing view in the literature assumes satisfaction causes commitment.²⁴ In other words, employees who are satisfied with their jobs feel the strongest commitment to their organizations. Strong evidence confirms this relationship.^23,25 But, few studies have examined the relationship between JS and the components of OC. In a meta-analysis, Meyer and associates found strong positive correlations between JS and AC and NC. Conversely, JS was correlated negatively by CC.²⁶

On the other hand, recent evidence has showed a positive relationship between ethical climate and organizational commitment.¹³ However, a limited number of studies have focused on the EC types and the components of OC. For example, Tsai and Huang² found a positive relationship between “caring” and “rules” types of climate in the hospitals of Taiwan and nurses’ AC and NC. Filipova²⁷ also found that the “caring” type of EC had a significantly positive impact on OC of nurses in Midwestern United States. In a nutshell, according to literature discussed above, “caring,” “law and code,” “rules,” and “independent” EC types have significant positive effects on overall JS. Additionally, while affective, normative, and calculative commitment has positive correlations with overall JS, CC is negatively related to overall JS. Therefore, the influence of EC types and overall JS on the components of OC can be hypothesized as follows:

Hypothesis 2. The EC types “caring,” “independent,” “law and code,” and “rules” and overall JS have significant negative influences on CC.

Hypothesis 3. The EC types “caring,” “independent,” “law and code,” and “rules” and overall JS have significant positive influences on NC.

Hypothesis 4. The EC types “caring,” “independent,” “law and code,” and “rules” and overall JS have significant positive influences on AC.

Research method

Sample and data collection

The BiH has 10 cantons, with different administrative and judiciary systems. Medical services are run according to the regulations of the ministry of health in that canton. Today, there are eight general hospitals (one of them is in Herzegovina) in BiH public health sector.²⁸ Medical services in private sector mainly include dentist offices, ambulants and policlinics providing specialist and primary level services, and private pharmacies.²⁹ In 2010, there were 1026 private health institutions in the BiH, out of which 111 were in Herzegovina canton. In order to enable greater generalization of the research results, the study targeted hospital nurses in the three biggest cantons in BiH: Sarajevo Canton, Tuzla Canton, and Herzegovina-Neretva Canton. One hospital was selected per each sampled canton, giving a total of four hospitals (one private and three public hospitals). Fifty questionnaires were distributed in each hospital, resulting in a total possible sample of 200 nurse assistants and nurse technicians (male nurse assistants). Even though there are around 13,338 nurses in BiH, only 8303 of them are nurse assistants.³⁰ This study distributed 200 questionnaires constituting about 1/40 of the nurse assistant population. However, in previous studies on EC or JS among nurses, such as Joseph and Deshpande¹⁸ and Ruggiero,³¹ the sample sizes are between 114 and 247. There are 171 validity questionnaires of this study, which should be representative of the effectiveness of the study.

The questionnaires with return envelopes were sent to the administration of each study hospital. Staff in each hospital administration distributed the questionnaire with return envelopes to nurses via representatives at unit or department levels. These questionnaires were distributed to nurses who agreed to participate in the study. The staff then collected the sealed questionnaires from the nurses after completion, again through representatives at the unit or department levels, and mailed them to the research team. A reminder notice was given to nurses in order to collect the completed surveys, approximately 1 week after the distribution of the questionnaires. The overall response rate (180 completed questionnaires of which 171 were useful) was 85%.

A summary of the sample characteristics is presented in Table 1. The majority of the respondents (59.6%) were female and 55.6% of these nurses were more than 31 years old. Predominant education of the nurses (91.08%) was high school and bachelor level. The majority (65.5%) was earning more than 570 USD. In total, 72% of the nurses’ total work experience was more than 5 years.

Table 1.

Sample characteristics.

Variable	Demographics	Number	Valid percent
Gender	Male	69	40.4
Gender	Female	102	59.6
Age	Under 20 years	9	5.3
	21–25 years	23	13.5
	26–30 years	44	25.7
	31–35 years	39	22.8
	36–40 years	29	17
	Over 41 years	27	15.8
Hospital type	Public	132	77.2
Hospital type	Private	39	22.8
Tenure in the hospital	Under 5 years	51	29.8
	5–10 years	53	31
	10–15 years	36	21.1
	Over 15 years	31	18.1
Total tenure	Under 5 years	48	28.1
	5–10 years	49	28.7
	10–15 years	38	22.2
	Over 15 years	36	21.1
Education level	High school	86	50.3
	Bachelor’s degree	71	41.5
	Master’s degree	14	8.2
Average wage	0–285 USD	7	4.1
	285–570 USD	52	30.4
	570–860 USD	83	48.5
	Over 860 USD	29	17

Instruments and measures

A three-page questionnaire with four sections was used to collect data. The first section of the questionnaire included questions about EC. The second section was about OC, and the third section consisted of questions about JS. Finally, the last section included demographic questions. Questions such as age group, gender, education, income, and duration of nurse’s employment in the hospitals were asked in this section.

The survey was prepared in English first and then translated into the Bosnian language. The back-translation method³² was adopted to translate the survey from English to Bosnian. The translation of the questionnaire was done by experts who know both languages and respective cultures. Retesting of the questionnaire was administered with 30 respondents chosen conveniently among nurses working in the hospitals. The purpose of retesting was to assess the validity of the survey. Ambiguous questions were evaluated again and finalized for data collection.

All of the questions were measured using a 5-point Likert scale, with scale anchors ranging from “1” (strongly disagree) to “5” (strongly agree).

Ethical Climate

Nurse respondents completed the 14-item ethical climate questionnaire (ECQ) developed by Huang et al.¹¹ They adapted this ECQ scale from Victor and Cullen.¹² They found five different dimensions of EC: “caring” climate, “independent” climate, “law and code” climate, “rules” climate, and “instrumental” climate. While all EC dimensions consisted of three items, the “rule” climate included two items. The coefficient alpha of EC types in their study ranged from 0.507 to 0.813. Sample items are “The most important concern is the good of all the people in the hospital as a whole” and “Successful people in this hospital go by the book.”

Organizational Commitment

Nurse respondents completed the 18-item organizational commitment scale developed by Meyer and Allen.³³ They found three OC components: AC, CC, and NC. The Cronbach’s alpha coefficients for the factors in their study ranged from 0.78 to 0.89. Sample items are “I owe a great deal to my hospital” and “This hospital deserves my loyalty.”

Job Satisfaction

Nurses completed the overall job satisfaction scale developed by Judge et al.³⁴ They adapted five-item version of the scale from Brayfield and Rothe’s³⁵ JS scale. The coefficient alpha of this scale in their study was 0.80. Sample items include “I feel fairly satisfied with my present job” and “Most days I am enthusiastic about my work.”

Data analysis

The collected data were analyzed using SPSS (v. 20) software packages. Exploratory factor analysis was used to analyze initial factor structure. Internal consistency reliability of the scales was measured using Cronbach’s alpha coefficients. General characteristics of participants were summarized using descriptive statistics. While Pearson’s correlations were used to show the relationships among EC types, overall JS, and the OC components, paired-samples t tests were utilized to examine differences in EC dimensions and OC components. Finally, in order to determine the effects of EC dimensions on overall JS and the components of OC, regression analyses were used. The results are presented in the next section.

Results

Initial analyses

The construct validity of three scales used in the analysis was checked using the exploratory factor analysis to analyze the initial factor structure.³⁶ The ethical climate scale was analyzed first. In the analysis, the principal component analysis was used as the factor extraction method, and the varimax method was used for the component rotations. After three runs, items 7, 12, and 13 in this scale were removed from further analysis. The items were removed as they were cross-loaded on two components. These items were “In this hospital, the law or ethical code of their profession is the major consideration,” “People are expected to do anything to further the hospital’s interests, regardless of the consequences,” and “There is no room for one’s own personal morals or ethics in this hospital.” At the fourth run, item 14 was extracted due to its lower loading than 0.4. This item was “In this hospital, people protect their own interests above all else.” Four meaningful factors were obtained. One indication of the reliability of the dimensions is that the Cronbach’s alpha value ranged from 0.61 to 0.81. The factors represented the four different dimensions of EC: (1) caring climate, (2) independent climate, (3) law and code climate, and (4) rules climate. The factor loadings and coefficient alpha of EC scale are presented in Table 2.

Table 2.

Factor loadings and coefficient alpha for ethical climate.

Ethical climate types	Factor loading	Cronbach’s alpha
1. Caring		0.61
The most important concern is the good of all the people in the hospital as a whole	0.756
What is best for everyone in the hospital is the major consideration here	0.645
Our major concern is always what is best for the other person	0.53
2. Independent		0.73
Each person in this hospital decides for themselves what is right and wrong	0.815
In this hospital, people are guided by their own personal ethics	0.762
In this hospital, people are expected to follow their own personal and moral beliefs	0.733
3. Law and code		0.81
People are expected to comply with the law and professional standards over and above other considerations	0.66
In this hospital, people are expected to strictly follow legal or professional standards	0.645
4. Rules		0.71
People in this hospital strictly obey hospital policies	0.879
Successful people in this hospital go by the book	0.795

Second, the overall job satisfaction scale was analyzed. After two runs, items 1 and 5 were removed since there was cross-load on the two components. These items were “I feel fairly satisfied with my present job” and “I consider my job to be rather unpleasant.” The Cronbach’s alpha value of this scale was 0.71. The factor loadings and coefficient alpha of the overall JS scale are presented in Table 3.

Table 3.

Factor loadings and coefficient alpha for overall job satisfaction.

Overall job satisfaction	Factor loading	Cronbach’s alpha
Most days I am enthusiastic about my work	0.898	0.71
I find real enjoyment in my work	0.870
Each day at work seems like it will never end^a	0.568

^aItems are reverse coded.

Finally, the organizational commitment scale was analyzed in order to reach a clear structure of dimensions and items. After three runs, item 1 was eliminated from further analysis as it was cross-loaded on two components. This item was “I would be very happy to spend the rest of my career in this hospital.” Items 3, 17, and 8 were also removed because their loadings were lower than 0.4. These items were “I do not feel any obligation to remain with my current employer,” “If I had not already put so much of myself into this hospital, I might consider working elsewhere,” and “Right now, staying with my hospital is a matter of necessity as much as desire.” In the final run, items 2, 4, and 13 were removed from further analysis due to their low Cronbach’s alpha coefficients.³⁷ Three meaningful factors were obtained. The Cronbach’s alpha coefficient ranged from 0.62 to 0.88. The three factors identified were (1) NC, (2) CC, and (3) AC. The factor loadings and coefficient alpha of the OC scale are presented in Table 4.

Table 4.

Factor loadings and coefficient alpha for organizational commitment.

Components of organizational commitment	Factor loading	Cronbach’s alpha
1. Normative		0.88
I would not leave my hospital right now because I have a sense of obligation to the people in it	0.856
I owe a great deal to my hospital	0.849
This hospital deserves my loyalty	0.808
I would feel guilty if I left my hospital now	0.785
Even if it were to my advantage, I do not feel it would be right to leave my hospital now	0.738
2. Continuance		0.73
One of the few negative consequences of leaving this hospital would be the lack of available alternatives	0.824
I believe that I have too few options to consider leaving this hospital	0.813
Too much of my life would be disrupted if I decided I wanted to leave my hospital right now	0.744
3. Affective		0.62
I do not feel like part of the family at my hospital^a	0.800
I do not feel emotionally attached to this hospital^a	0.779
I do not feel a strong sense of belonging to my hospital^a	0.618

^aItems are reverse coded.

Descriptive statistics, correlations, and paired-samples t tests for EC types, overall JS, and components of OC

Table 5 presents the means, standard deviations, and correlations for the variables used in the study. Relationships exist among the variables of the study. The respondents identified the presence of a “law and code” climate (mean = 4.12). It was followed by “caring” climate (mean = 3.79), “rules” climate (mean = 2.94), and “independent” climate (mean = 2.86). Paired-samples t tests for the means of EC types are presented in Table 6; all pairs had significant differences between means with the exception of “independent” climate versus “rules” climate.

Table 5.

Mean, standard deviations, and correlations.

Variables	Mean	SD	1	2	3	4	5	6	7	8
1. Caring	3.79	0.749	1
2. Independent	2.86	1.000	0.068	1
3. Law and code	4.12	0.764	0.313**	−0.162*	1
4. Rules	2.94	0.978	0.238**	0.345**	−0.201**	1
5. Normative	2.44	0.986	0.151*	0.289**	−0.205**	0.555**	1
6. Continuance	3.72	0.910	0.106	−0.108	0.381**	−0.320	−0.279**	1
7. Affective	3.12	0.868	0.253**	−0.180*	0.094	0.107	0.369**	−0.153*	1
8. Overall JS	2.49	0.907	0.140	0.154*	−0.281**	0.369**	0.531**	−0.249**	0.233**	1

SD: standard deviation; JS: job satisfaction.

*p < 0.05; **p < 0.01.

Table 6.

Paired-samples t tests for ethical climate types.

Paired		Paired differences
Paired		Mean	SD	df	t
Pair 1	Caring–independent	0.9220	1.2075	170	9.986***
Pair 2	Caring–law and code	−0.3343	0.8870	170	4.929***
Pair 3	Caring–rules	0.8470	1.0811	170	10.245***
Pair 4	Independent–law and code	−1.2563	1.3532	170	−12.141***
Pair 5	Independent–rules	−0.0750	1.1317	170	−0.867
Pair 6	Law and code–rules	1.1813	1.3566	170	11.386***

SD: standard deviation.

***p < 0.001 (two-tailed).

Across the components of OC the highest mean score was for CC (mean = 3.72), followed by AC (mean = 3.12), and finally NC (mean = 2.44). Paired-samples t tests for the means of the components of OC are presented in Table 7; all pairs had significant differences between means. Finally, the mean score of overall JS was 2.49.

Table 7.

Paired-samples t tests for the components of organizational commitment.

Paired		Paired differences
Paired		Mean	SD	df	t
Pair 1	Normative–continuance	−1.2815	1.5168	170	−11.048***
Pair 2	Normative–affective	−0.6772	1.0462	170	−8.465***
Pair 3	Continuance–affective	0.6043	1.3504	170	5.852***

SD: standard deviation.

***p < 0.001 (two-tailed).

Path analysis of the relationship among EC types, overall JS, and components of OC

To test Hypothesis 1, Table 8 shows that “rules” climate significantly and positively affected overall JS. A “rules” climate means that nurses strictly obey hospital rules, policies, and procedures. The results of the study indicate that hospital administrators can positively influence nurses’ overall JS by fostering a “rules” climate.

Table 8.

Path analysis of the relationship among ethical climate types, overall job satisfaction, and three components of OC.

Ethical climate types	Overall job satisfaction	Organizational commitment
Ethical climate types	Overall job satisfaction	NC	CC	AC
Caring	0.195*	0.007	0.111	0.228*
Independent	0.003	0.097	0.033	−0.211**
Law and code	−0.327***	−0.012	0.333**	0.084
Rules	0.254**	0.383***	−0.246**	0.063
Overall JS		0.404***	−0.091	0.227**

NC: normative commitment; CC: continuance commitment; AC: affective commitment; JS: job satisfaction.

*p < 0.05; **p < 0.01; ***p < 0.001.

According to the study, “caring” EC type significantly and positively influenced overall JS. The respondents who believed that their hospitals had a caring climate were more satisfied with their job overall. Thus, hospital administrations can enhance a caring atmosphere and ensure that they are concerned with the well-being of all people in the hospital.

“Law and code” climate significantly but negatively influenced overall JS. “Law and code” climate implies that nurses should obey regulations of external system such as law or professional codes of conduct. But, in this study, nurses in hospitals which are governed by external rules were not satisfied with their job overall. “Independent” type EC did not significantly impact overall JS in this study. Therefore, Hypothesis 1 is partially supported.

In regard to Hypothesis 2, Table 8 shows that “rules” climate significantly and negatively impacted CC. According to Meyer and Allen,³³ employees with strong CC feel that they are “trapped” in a “no choice” situation. Nurses who are in “rules” environment are less likely to develop CC. In the study, “law and code” climate significantly and positively affected CC. On the other hand, “caring” and “independent” climate types and overall JS did not have any influence on CC. Therefore, Hypothesis 2 is not supported.

To test Hypothesis 3, Table 8 shows that “rules” climate significantly and positively influenced NC. NC may develop based on experiences of social norms provided by the family, culture, and employing organization. A “rules” climate in the hospital may encourage an organization to develop an appropriate culture.² Additionally, results of this study indicate that respondents who were satisfied with their job may develop NC. In other words, if nurses are satisfied with their job, they could feel that the hospital deserves their loyalty. But, “caring,” “independent,” and “law and code” EC types did not affect NC significantly. Therefore, Hypothesis 3 is partially supported.

Finally, in regard to Hypothesis 4, Table 8 shows that “independent” climate significantly and negatively affected AC. When people are treated well by an organization, they tend to develop AC.³⁸ The nurses who believed that their hospitals had a caring climate felt emotional commitment to their hospital and also felt like a part of the family. In addition, the respondents who are satisfied with their job felt a strong sense of belonging to their hospital. On the other hand, an “independent” climate can be available in an organization where each nurse makes decisions for himself or herself in regard to what is right and wrong. If nurses who decide for himself or herself what is right and wrong receive good feedback by their hospitals, there is a greater tendency for their AC to decrease in this study. However, “law and code” and “rules” climates did not have any significant impact on AC. Therefore, Hypothesis 4 is partially supported.

Conclusion and limitations

In this study, “law and code” was the most highly rated type among the four different EC types in hospitals in BiH. This is consistent with Deshpande’s⁸ findings which indicated that “law and professional code” referred to as “professionalism” was the most rated EC type in an organization. “Caring” climate which was employees’ most preferred work climate in some studies¹³ was also rated as the second most rated EC type. Conversely, “independent” was the least rated EC type. Nurses strictly obey regulations of their profession and laws instead of their own personal moral principles in hospitals. On the other hand, the respondents were not satisfied with their job overall. This result can be related to the bad economic situation in BiH. The nurses have to keep their current job despite their dissatisfaction. This research suggests that hospital administrators can nurture JS by reminding nurses of the importance of their job, establishing working teams, giving nurses control over their jobs, and even involving them in institutional problem solving.² The respondents rated commitment with CC highest and NC lowest among three components of OC. AC was another least rated OC component. According to Meyer et al.,³⁹ employees who have a strong AC remain with the organization because they want to, those who have a strong CC because they need to, and those having a strong NC remain because they feel they ought to do so. Various studies indicated a high and negative correlation between turnover intention and AC, a relatively low but significant negative correlation between turnover intention and CC, and a moderate negative correlation between turnover intention and NC.⁴⁰ Thus, this study suggests that hospital administrators should increase nurses’ AC in order to retain them in their hospital. The significant implication of this research is that nurses in BiH identify a moderate OC which requires fostering overall JS to reduce their intention to migrate to European countries.

One of the conclusions of this research is that a hospital can improve nurses’ JS and OC by affecting its EC. A “rules” climate significantly and positively influences nurses’ overall JS and NC, but significantly and negatively influences CC. A rules climate guarantees that nurses strictly obey hospital rules and procedures. Nurses in this climate feel obliged to keep their employment due to mainly high unemployment rate which is 44.86% in BiH. (Unemployment of BiH can be found from the website http://www.tradingeconomics.com/bosnia-and-herzegovina/unemployment-rate). Similarly, the research result regarding “independent” climate which has only negative impact on AC may also be explained by this high unemployment rate. That is to say, priority of nurses in hospitals is to keep their job even if they are not satisfied with it in the hospitals. One important conclusion of this study is that “caring” climate which was one of the most highly rated EC types positively and significantly affects nurses’ overall JS and their AC to hospital. This is consistent with findings of Fu and Deshpande⁴¹ whose results showed that “caring” climate had a bigger impact on OC of Chinese employees working in a private construction company. Tsai and Huang’s² findings also indicated a significant positive effect of “caring” climate on overall JS. In a “caring” atmosphere, nurses perceived that major consideration of hospital is what is best for everyone and ethical concern exists for others in hospital. Nurses who are satisfied with their job in this atmosphere feel a strong sense of belonging to their hospitals. Similar to “caring” climate, “law and code” was the most highly rated climate but it did not influence overall JS positively. In fact, this climate type had significant and positive influence only on CC. This result is consistent with similar studies.² According to these studies, the effect of “law and code” climate on JS is uncertain. Martin and Cullen⁴² showed that rules from external systems such as professional codes, when perceived to be internalized within the organization, can produce positive relationships with organizational outcomes. The results of this study imply that the law and professional rules established by the hospital administrations in BiH were not internalized by the nurses, thus a “law and code” climate do not impact JS and OC. However, people in BiH distrust the central government with a rotating, tripartite presidency divided between predominantly Serb, Croatian, and Bosnian political parties and its heavy bureaucracy. This prejudice may be a reason for the negative relationship between “law and code” climate and overall JS. According to this investigation, an “instrumental” climate was not identified by the respondents. The instrumental climate, which is the least preferred in various studies,¹³ is available in the organizations in which employees protect their own interests above all other things. The fact that employees whose priorities are their own benefits are not preferred by organizations in especially developing countries may be an explanation of this result. Based on these results, this research recommends that hospital administrators should develop “caring” and “rules” climate in their hospitals. They should further foster these EC types by including the following: codes of ethics, whistle-blowing systems, ethical training, and top management role modeling as topics of conversations with nurses.

Finally, the research implies that overall JS among other independent variables is the factor that most significantly affected NC and AC. The results of this study suggest that hospital administrators can positively influence nurses’ satisfaction with job. In order to do that, they can encourage participation, fully empower staff, increase educational training, and promote the growth of nurses.²

There are some limitations in this study. First, the results found in this research come from a limited sample. Surveys with higher sample sizes may yield different results. Second, self-reported issue may be another constraint of this study. Furthermore, future researches should prefer more convenient instruments for BiH context. Final limitation of this research is the insufficient literature. Further study should add JS facets in EC types and OC components relationship. Future studies should also examine the influences of EC on nurses’ work behaviors such as JS, OC, and organizational citizenship behavior in BiH.

Footnotes

Note

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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