Professional Commitment and Its Associated Factors Among Nurses in Public Hospitals of East Gojjam Zone,Northwest Ethiopia: A Cross-Sectional Study

Abstract

Introduction

The commitment of nurses to their profession involves belief in professional values, commitment to its goals, willingness to exert effort, commitment to stay in the profession and handle its challenges. Lack of commitment hinders goal achievement and fosters indifference, leading to poor performance, turnover, and dissatisfaction. However, evidence on professional commitment and its associated factors among nurses in Ethiopia, especially in the study area, is limited.

Objective

The first objective was to determine the level of professional commitment, and the second was to identify its determinants among nurses in East Gojjam Zone, Northwest Ethiopia.

Method

A facility-based cross-sectional study was conducted in 391 nurses using a simple random sample technique from November 1 to November 30, 2024. Data were collected using a self-administered structured questionnaire. After verifying its completeness, the data were entered and cleaned using EpiData version 4.2, and then exported to Statistical Package for Social Science version 27 for statistical analysis. Simple and multivariable linear regression analyses were conducted using a 95% confidence interval (CI) to identify predictors. A p-value < .05 was considered statistically significant.

Results

In this study, a total of 381 individuals returned and completed the questionnaire, yielding a response rate of 97.4%. The mean score of professional commitment of nurses was 33.47 ± 6.10 (95% CI [32.86, 34.08]). Perceived promotional opportunity (β = 0.655; [0.213–1.097]), affective organizational commitment (β = 0.299; [0.208–0.389]), work–life balance (β = 0.125; [0.049–0.201]), and normative organizational commitment (β = 0.359; [0.186–0.532]) were significant predictors of professional commitment.

Conclusion

This study revealed that the level of professional commitment of nurses was medium. Perceived promotional opportunity, affective organizational commitment, work–life balance, and normative organizational commitment were significant predictors of professional commitment. Therefore, providing better promotion opportunities, enhancing normative commitment, and enhancing work–life balance could increase nurses’ commitment.

Keywords

professional commitment nurses East Gojjam Zone public hospital Ethiopia

Introduction

Professional commitment is defined as allegiance, a desire to stay in a profession, and a sense of responsibility for the particular problems and difficulties faced by those in the profession (Zhao et al., 2022). It explains having faith in and acceptance of the profession's goals and values, being prepared to put in a significant amount of effort on the profession's behalf, and having an intense drive to continue as a member of the profession(Mlambo et al., 2021).

The nursing profession demands a high level of professionalism and commitment, and nurses who are committed will shape the future of nursing (Duran et al., 2021). However, for nursing managers, enhancing nurses’ professional commitment has emerged as a major problem in today's world (Sarman et al., 2023). The global scarcities of nurses, employee turnover, and nursing professionals’ decisions to quit have consequences that include stress, a lack of autonomy, and an excessive workload. Therefore, assessing the factors that affect nursing professional commitment is increasingly important (Nabi Foodani et al., 2024).

Review of Literature

The levels of professional commitment among nurses vary across the world. Studies done in China, Iran, and Nigeria revealed that 75.07 ± 14.715, 71.42%, and 73% of nurses demonstrated professional commitment, respectively (Ndubuisi Sunday & Makata Ngozi, 2022; Parnikh et al., 2022; Zhang et al., 2023). In a study carried out in Ethiopia regarding the professional commitment of nurses, it was found that 36.3% displayed a low level of commitment, 27.8% had a moderate level, and only 36% showed a high level of commitment to their profession (Gizaw et al., 2016).

Nurses with lower professional commitment often perform poorly, arrive late to work, are disinterested in continuing with the organization, and lack motivation (Kelly et al., 2021; Ystaas et al., 2023). The likelihood of repeated hospital admissions, increased medical errors, more hospital stays, high medical expenses, and lower patient satisfaction with the services received is high when there are less committed nurses (Pappa et al., 2022). It also decrease the efficacy and efficiency of the health care organization, and it ultimately results in poor healthcare quality (England, 2023).

The World Health Organization's framework for the health system lists human resources for health as one of its essential components (Nwankwo et al., 2024). Different studies have shown that factors associated with professional commitment of nurses were coworker interaction, profession choice, managerial position, sufficient income level, gender, nursing work experience, monthly salary, opportunity for promotion, high pay, organizational commitment role status, perceived leadership, degree of control over work, level of exposure to ongoing training, work–life balance, autonomy, motivation, and job satisfaction (Bell & Sheridan, 2020; Gassas & Salem, 2023).

The Federal Ministry of Health in Ethiopia is working to enhance the professional commitment of nurses by implementing compassionate and respectful care, which has been shown to enhance professional commitment and improve patient outcomes (Health, 2021). Despite these efforts, studies indicated that poor professional commitment remains significantly higher in Ethiopia (Ayehu, 2023). Analyzing professional commitment and associated factors among nurses is critical for health institutions’ management strategy to improve the healthcare system's performance and find opportunities for improvement.

In Ethiopia, there are limited published studies concerning professional commitment and associated factors among nurses; no published studies have been conducted in the study area that specifically addresses this issue. Furthermore, this study aimed to explore new variables that have not been thoroughly examined in previous research, such as having children, work–life balance, and willingly choosing the profession. These factors are critical to understanding the determinants of professional commitment and can offer important insights to improve nurses’ commitment and enhance health institutions’ quality of care. Therefore, the first objective of this study was to determine the level of professional commitment and the second objective was to identify factors affecting professional commitment among nurses working in public hospitals in East Gojjam Zone, Northwest Ethiopia.

Method

Study Area and Period

The study was conducted in the East Gojjam Zone, Northwest Ethiopia, from November 1 to November 30, 2024. East Gojjam Zone is bordered to the south by the Oromia Region, on the north by South Gondar, on the east by South Wollo, and on the west by West Gojjam. East Gojjam Zone has a total of 21 woredas, one comprehensive specialized hospital, one general hospital, and nine primary hospitals, with a total number of 753 nurses working in public hospitals.

Design

A facility-based cross-sectional study was conducted. All nurses working in selected public hospitals of East Gojjam Zone, Northwest Ethiopia, who meet the eligibility criteria and were available at the time of data collection were included.

Eligibility

Inclusion Criteria

All nurses who were working for at least six months at randomly selected public hospitals were included in this study.

Exclusion Criteria

Nurses who are on sick or maternity leave, providing voluntary services, or temporarily employed were excluded from this study.

Sample

The sample size was calculated by using the single population proportion formula with a 95% confidence level, a 5% margin of error, and a proportion of professional commitment among nurses in Jimma was 36.3%.

n = \frac{{(Z α / 2)}^{2} p (1 - p)}{d^{2}}

where n = sample size

Zα/2 ₌ value corresponding to a 95% level of significance = 1.96

P = proportion of nurses’ professional commitment in the previous study = 36.3% = 0.363

q = (1 − p) = (1–0.363) = 0.637

d = Margin of error (5%).

Therefore, based on using the above single population proportion formula, the sample size is calculated as:

n = (1.96)2 0.363(1–0.363)

(0.05)2

n = 355.3

By considering a 10% nonresponse rate, the sample size was 391.

Sampling Technique and Procedure

Simple random sampling was employed to select the study participants. First, six hospitals were chosen by lottery method from a total of 11 hospitals in the East Gojjam Zone. The study participants were proportionally allocated for eachted hospitals and then multiplying by the total sample size. After that, we obtained the proportionate sample hospital by dividing the number of nurses in a specific hospital by the total number of nurses in the selecsize from each hospital. Finally, using the hospital's payroll registration as a sampling frame, nurses were selected from each hospital through simple random sampling using the lottery method (Figure 1).

Figure 1.

Sampling Techniques of Professional Commitment and Associated Factors Among Nurses Working in East Gojjam Zone Public Hospitals, Northwest Ethiopia, 2025.

Study Variable

Dependent Variable

Nurses’ Professional commitment was the study's outcome variable.

Independent Variables

Sociodemographic variables (age, gender, marital status, educational level, working unit, working hospital, work experience, and having children), organizational commitment-related factors (affective commitment, continuance commitment, and normative commitment), job satisfaction-related factors (perceived staff interaction and working environment, perceived remuneration, perceived promotion opportunity, autonomy, perceived recognition, and professional training), and work–life balance were the study's independent variables.

Operational Definitions

Nurse Professional Commitment: refers to the relative strength of an individual's connection to the respective profession. It explains having faith in and acceptance of the profession's goals and values, and being prepared to put in a significant amount of effort on the profession's behalf and having an intense drive to continue as a member of the profession. This was assessed using 10 items on a 5-point Likert scale, with a score ranging from 10 to 50. As the sum of scores increases from 10 to 50, professional commitment also increases; as the sum of scores decreases from 50 to 10, professional commitment decreases. The mean score was converted to a standardized percentage mean score (%SM) calculated as follows (Nima et al., 2017; Siraneh et al., 2018).

Percentages mean score of professional commitment =

\frac{a c t u a l m e a n s c o r e - m i n i m u m p o t e n t i a l s c o r e}{m a x i m u m p o t e n t i a l s c o r e - m i n i m u m p o t e n t i a l s c o r e} \times 100

Work–Life Balance: deals with balanced participation in paid work and other aspects of life. The score ranges from a minimum of 8 to a maximum of 40. The higher the sum of the score reflects the higher the work–life balances (Clark, 2001).

Job Satisfaction: refers to the desire or positive feelings that nurses have toward their jobs. The higher the sum of the scores reflects the higher the job satisfaction. Such as perceived promotion opportunity (it denotes both career development and educational upgrading opportunities in one organization), perceived professional training (it represents the way the organizations treat the health professionals and the existence of on-job or off-job training programs for the health professionals). Perceived remuneration (includes wages, benefits, incentives, or other payments in the organization) and perceived staff interaction and work setting (is the formal/informal relationship that is warm or bad that is practiced between anyone in the organization, and the situation in which the professionals work and the presence of adequate supplies and time for each client). Perceived recognition: The nurses’ feelings toward the praise they get for doing a good job (Cheng & Stockdale, 2003; Lu et al., 2007).

Organizational Commitment: The relative strength of an individual's connection and identification with the respective organization. This was measured using three components of preassumed scales (affective/affection for the organization, continuance/fear of leaving, and normative commitment/sense of obligation to stay; Haileamlak, 2018).

Data Collection Tool and Procedure

The data were collected using a self-administered structured questionnaire that was adapted from different literature based on the study objectives (Anshebo et al., 2021; Gizaw et al., 2016; Israel et al., 2017; Siraneh et al., 2018; Tourangeau et al., 2006) and was pretested and translated into Amharic and then back into English to check consistency. The data collection tool has five parts and has a total of 77 items. Part 1 focuses on sociodemographic and economic data, consisting of 12 items. Part two comprises 23 items to measure job satisfaction with five subcomponents. Part 3, work–life balance, comprises eight items of a 5-point Likert scale to measure. Part 4 contains 10 items that measure professional commitment. Part five has 24 items of a 5-point Likert scale to measure organizational commitment, with three components of commitment, each containing eight items. Professional commitment, organizational commitment scale, and work–life balance were addressed on a 5-point Likert scale with response options ranging from 1 (very disagree) to 5 (very agree). A tool related to the job satisfaction scale was also addressed by a 5-point Likert scale ranging from 1 (very dissatisfied) to 5 (very satisfied). Six Bachelor of Science (BSc) degree nurses who had experience in data collection were selected for data collection, and three BSc degree nurses were assigned as supervisors.

After selecting participants using the lottery method, trained data collectors visited them in person at their respective hospital units, provided study information, obtained written consent, and administered the self-completed paper questionnaire on site.

Data Quality Control

The questionnaire was pretested on 5% (20) of the nurses in the actual sample size at Finote Selam General Hospital, which is located outside the study area, before the actual data collection period in order to ensure that the questionnaires are consistent. One full day of training was given to orient the data collectors and supervisors on the procedure, technique, and ways of collecting the data, and follow-up and supervision were conducted by supervisors during data collection. The collected data was reviewed and checked by the principal investigator each day. Once the data was recorded from nurses, it was coded to avoid duplication. Cronbach's alpha was used to assess the internal consistency of each dimension of the questionnaire. The outcome variable has a Cronbach's alpha of .87, whereas the Cronbach's alpha for each dimension is greater than .7. To assure the validity of the study tool, all measuring tools were adapted from previous studies. Face validity: advisers and instructors evaluated the tools to make sure they appeared to measure the appropriate things. The questionnaire was administered in Amharic, the local working language, after translation and back-translation for consistency.

Statistical Analysis

Before analysis, the consistency and completeness of the data were verified. Then, cleaning, editing, and coding of the data were performed. Data was entered into EpiData Version 4.2, and following data entry, it was exported to the Statistical Package for Social Science version 27 software for further cleaning and analysis. The data was recoded and cleaned. Before progressing to the analysis, assumptions of multiple linear regressions were checked. Initially, the normality of the data was tested using a histogram, and Kolmogorov–Smirnov value = 0.150 and it was normally distributed. The linearity of the data was assessed by creating a scatter plot, and all of the points in the plot fell along a straight line. The multicollinearity of data was assessed using the variance inflation factor (VIF) and tolerance, and all the VIF values were below 5 and tolerance values above 0.1. Homoscedasticity of the error was checked by generating a plot of the standard residual against the standard predicted values of the dependent variable created using regression models; this study showed the distribution of data points that are consistent across different values of independent variables. Autocorrelation or independence of residuals was tested using a Durbin–Watson statistic. The study's findings showed that 1.97, there was no autocorrelation. The percentage, mean, standard deviation, and frequency were calculated. Simple linear regression was carried out, and significant variables at p-value < .25 were taken as candidates for multiple linear regression. Factors predicting professional commitment were identified using multiple linear regression analysis with a significance level of p-value < .05 with a 95% confidence interval (CI). Lastly, the results were presented using texts, tables, and figures.

Results

Sociodemographic Characteristics

Among 391 eligible participants, 385 (98.4%) returned the questionnaires. Out of the returned questionnaires, four were discarded due to incompleteness. Considering these, the response rate was 381/391 (97.4%). The mean age and work experience in years were 33.3 ± 4.74 and 9.62 ± 4.15, respectively. More than half, 202 (53%), of respondents were females. The majority of the study participants were married, 280 (73.5%). Among the study participants, 268 (70.3%) of nurses were bachelor's degree holders (Table 1).

Table 1.

Sociodemographic Characteristics in the Study of Professional Commitment and Associated Factors Among Nurses Working in East Gojjam Zone Public Hospitals, Northwest Ethiopia, 2025 (n = 381).

Variables		Frequency (n)	Percent
Sex	Male	179	47
Sex	Female	202	53
Educational qualification	Diploma	39	10.3
	Degree	268	70.3
	Master	74	19.4
Working hospital	Primary	123	32.3
	Compherensive specialized	199	52.2
	General	59	15.5
Age category	<24	11	2.9
	25–29	99	26.0
	30–34	111	29.1
	35–39	122	32
	>40	38	10
Work experience	0.5–5 years	64	16.8
	6–10 years	173	45.4
	11–15 years	112	29.4
	>15years	32	8.4
Working unit	Inpatient	256	67.2
Working unit	Outpatient	125	32.8
Income level	<6,193	22	5.8
	6,194–7,071	124	32.5
	7,072–8,017	129	33.9
	8,018–9,056	92	24.1
	9,057–10,150	14	3.7
Religeous status	Orthodox	342	89.8
	Muslim	36	9.4
	Protestant	3	0.8
Marital status	Single	94	24.7
	Married	280	73.5
	Divorced	6	1.6
	Widowed	1	0.2
Willingly chosen profession	Yes	329	86.4
Willingly chosen profession	No	52	13.6
Position	Staff nurse	339	89.0
Position	Staff manager	42	11.0
Having children	Yes	305	80.1
Having children	No	76	19.9

Level of Professional Commitment

The total mean of professional commitment score of nurses was 33.47 ± 6.10 (95% CI [32.86, 34.08]). The standardized percentage mean score was 58.65%. Out of 381 study participants, about 48.8% and 15.2% of respondents agreed and strongly agreed that they would accept almost any type of job that related to their profession to keep working beyond what was expected of them, respectively. Moreover, about 45.4% and 23.1% of study participants agree and strongly agree with the statement that proud to belong to their profession (Table 2).

Table 2.

Frequency Distribution of 5-Point Likert Scale Responses of Participants for Professional Commitment Measuring Items, Northwest Ethiopia, 2025 (n = 381).

Items measuring professional commitment (number of items = 10, score range = 1–5)	M + SD
I am willing to put in a great deal of effort to develop my profession beyond expectations	3.7 ± 1.22
I am a person who identifies strongly with my profession	3.65 ± 1.186
I would accept almost any type of job that is related to my profession to keep working beyond expected of me	3.45 ± 1.175
I am a person who feels a strong tie with other members of my profession	3.66 ± 1.133
I am a person who is proud to belong to my profession	3.65 ± 1.147
My profession really inspires the very best in me in the way of job performance	3.50 ± 1.204
I am extremely glad that I chose this profession to work for the rest of my career.	3.54 ± 1.164
I am a person who criticizes my profession	2.42 ± 1.241
I am a person who considers my profession to be important	3.46 ± 1.381
I am a person who tries to hide belonging to my profession	2.44 ± 1.239
Total mean	33.47 ± 6.10

Job Satisfaction-Related Factors

Regarding remuneration, the mean score was 11.05 ± 1.72 on a scale of 5 to 15. About 56.7% of the participants were satisfied with your income reflecting the work you do. From the promotion opportunity, the mean score was 10.52 ± 1.87 on a scale of 5 to 15. About 48% of the participants were satisfied with the support for personal growth and development through education and training they received. Likewise, from recognition, the mean score was 10.12 ± 2.32 on a scale of 5 to 15. About 42.5% of participants were satisfied with adequate consideration given to their personal needs. Similarly, regarding training, the mean score was 9.27 ± 3.35 on a scale of 5 to 15. About 37.5% of the participants were satisfied with the statement that their organization gives training and orientation to new staff well. Regarding autonomy, the mean score was 10.93 ± 2.43 on a scale of 5 to 15. About 51.2% of participants were satisfied with the support given to be fully accountable for their decisions. Once more, regarding interaction and working environment, the mean score was 27.13 ± 6.50 on a scale of 8 to 40. About 45.7% of participants were satisfied with the atmosphere of cooperation between staff and managers (Table 3).

Table 3.

Perceived Job Satisfaction of Nurses Who Work in Selected Public Hospitals in the East Gojjam Zone.

Job satisfaction variable domains	Number of items	Score range	M + SD
Remuneration/payment	3	3–15	11.05 ± 1.72
Promotion opportunity	3	3–15	10.52 ± 1.87
Recognition (leadership style)	3	3–15	10.12 ± 2.32
Professional training	3	3–15	9.27 ± 3.35
Autonomy (leadership style)	3	3–15	10.93 ± 2.43
Interaction and working environment	8	8–40	27.13 ± 6.50

Organizational Commitment-Related Factors

Regarding affective organizational commitment, the mean score was 30.20 ± 5.62 on a scale of 8 to 40. About 49.6% of the participants agreed that they feel as if their organization's problems are their own. For continuance organizational commitment, the mean score was 24.30 ± 7.05 on a scale of 8 to 40. About 36.2% of the participants agreed it would be very hard for them to leave their organization right now, even if they wanted to. Likewise, from normative organizational commitment, the mean score was 29.21 ± 4.97 on a scale of 8 to 40. About 52% of participants who agreed with moving from organization to organization seem at all unethical to them (Table 4).

Table 4.

Organizational Commitment of Nurses Who Work in East Gojjam Zone Selected Public Hospitals.

Organizational commitment domains	Number of items	Score range	M + SD
Affective commitment	8	8–40	30.20 ± 5.62
Continuance commitment	8	8–40	24.30 ± 7.05
Normative commitment	8	8–40	29.21 ± 4.97

Work–Life Balance

Regarding work–life balance, the mean score was 26.05 ± 6.55 on a scale of 8 to 40. About 39.1% of the participants agreed that the facility provides good healthcare services to their families. The top-rated item among the work–life balance questions is that they work under less stressful situations, with a mean score of 3.41 ± 1.20 (Table 5).

Table 5.

Work–Life Balance of Nurses in East Gojjam Zone Selected Public Hospitals.

Work–life balance items	Score range	M + SD
I have sufficient time to undertake both my job and family-related issues	1–5	3.03 ± 1.306
I have reasonable leisure time	1–5	3.15 ± 1.227
The facility provides good healthcare services to my family	1–5	3.28 ± 1.173
The working environment doesn’t affect my personal health conditions	1–5	3.32 ± 1.230
I work under less stressful situations	1–5	3.41 ± 1.20
I have a friendly relationship with my colleagues	1–5	3.29 ± 1.287
My workload does not affect my personal life	1–5	3.19 ± 1.336
My job permits me to undertake my social obligations	1–5	3.39 ± 1.251
Total mean	8–40	26.05 ± 6.55

Model Fitness and Assumptions

Assumptions of multiple linear regressions were checked and fitted. Normality was tested using a histogram and the Kolmogorov–Smirnov test, and it was normally distributed. Then the linearity of the data was assessed by generating a scatter plot, and all of the points in the plot fell along a straight line. VIF and tolerance were used to check for multicollinearity; all VIF values were less than 5, and tolerance values were greater than 0.1. Homoscedasticity of the error was assessed by generating a plot of the standard residual against the standard predicted values of the dependent variable, which was created using regression models; this study showed the distribution of data points that are consistent across different values of independent variables. Autocorrelation or independence of residuals was tested using a Durbin–Watson statistic. The study's findings showed that 1.97, there was no autocorrelation.

Factors Associated With Professional Commitment

A simple linear regression analysis was performed for all independent variables to see their association with the level of professional commitment. Accordingly, having children, perceived promotion opportunity, perceived training, interaction, and environmental factors, continuance organizational commitment, affective organizational commitment, recognition, autonomy, work–life balance, and normative organizational commitment variables were identified as having less than a 0.25 significance level in the bivariable simple linear regression. These variables were further entered into the final multivariable linear regression model to identify factors associated with professional commitment after adjusting. The study's regression model demonstrated statistical significance, as indicated by a p-value of less than .05. A multiple linear regression analysis resulted in a significant F-test equation, F (10,380) = 44.807, p-value = .000, with an adjusted R² = 0.535. This means that combinations of variables significantly predicted professional commitment.

Perceived promotion opportunity had a significant association with professional commitment. A unit increment in perceived promotion opportunity score was associated with a 0.655 unit (95% CI [0.213, 1.097]; p = .004) increase in professional commitment. Affective organizational commitment and normative organizational commitment were significant factors associated with professional commitment. A unit increase in normative organizational commitment was associated with a 0.359 ([0.186, 0.532]; p = .000) increase in professional commitment, and a unit increase in affective organizational commitment was associated with a 0.299 ([0.208, 0.389]; p = .000) increase in professional commitment. Besides, a unit increase in work–life balance was associated with a 0.125 ([0.49, 0.201]; p = .001) increase in professional commitment score (Table 6).

Table 6.

Multivariable Linear Regression Analysis Results in the Study of the Level of Professional Commitment and Associated Factors Among Nurses Working in East Gojjam Zone Public Hospitals, 2025.

Variables	β [95% CI]	Standard error	t	p
Perceived recognition	0.171 [−0.26, 0.367]	0.100	1.710	.088
Perceived promotion opportunity	0.655 [0.213, 1.097]	0.225	2.916	.004*
Perceived training	0.116 [−0.026, 0.257]	0.72	1.612	.108
Perceived autonomy	0.012 [−0.187, 0.210]	0.101	0.115	.908
Perceived interaction and working environment	0.003 [−0.072, 0.078]	0.038	0.088	.930
Work–life balance	0.125 [0.049, 0.201]	0.038	3.255	.001*
Affective organizational commitment	0.299 [0.208, 0.389]	0.046	6.488	.000*
Continuance organizational commitment	−0.019 [−0.081, 0.043]	0.032	−0.608	.544
Normative organizational commitment	0.359 [0.186, 0.532]	0.088	4.085	.000*
Having children	0.358 [−0.703, 1.420]	0.540	0.664	.507

Note. B = unstandardized beta coefficient; CI = confidence interval; SE = standard error.

*statistically significant at 95% CI.

Discussion

The current study pointed out that the total mean score of professional commitment of nurses was 33.47 ± 6.10, and the percentage mean score of professional commitment of nurses was 58.65%. The mean score in this study was lower than the study conducted in Turkey, 71.20 ± 11.94 (Duran et al., 2021); Shiraz University, Iran, 71.42 ± 11.62 (Parnikh et al., 2022). The discrepancy observed in Turkey may be attributed to the difference in socioeconomic status and advanced health care institutions. In the case of Shiraz University of Iran, the discrepancy might be that the study population only includes operating room nurses (Parnikh et al., 2022).

Additionally, the percentage mean score of the current study was lower than studies conducted in Ghana 68% (Honyenuga et al., 2012), Egypt was 70.5% (El Said Ahmad et al., 2020). A possible explanation for the disparity in the Ghana study might be a difference in sample size. The difference in Egypt may arise from the disparity in the study population, which consisted solely of nurses working in inpatient units.

On the other hand, the percentage mean score of the current study was higher than studies conducted in Nigeria, which was 37.5% (Ndubuisi Sunday & Makata Ngozi, 2022), and Ethiopia, where the level of professional commitment of nurses was 36.3% (Gizaw et al., 2016). The discrepancy with the Nigerian study might be inclusion criteria differences (Ndubuisi Sunday & Makata Ngozi, 2022). In Ethiopia, the differences might be attributed to variations in the study area and period, as well as a larger sample size in the present study and geographical diversity.

This study showed that perceived promotional opportunity is a significant predictor of professional commitment. This finding is supported by nurses who perceived promotional opportunities; they are more likely to be committed to their profession (Bell & Sheridan, 2020; Hazanov et al., 2021). In addition, according to the theory of Herzberg's two-factor explains that professional advancement increases the professional commitment of workers. This might be addressed, as professional promotion can result in a nursing workforce that is more committed, engaged, and satisfied (Peramatzis & Galanakis, 2022). This would imply that there is a need to establish transparent career ladders and professional development opportunities to increase perceived opportunities for promotion.

The findings from this study indicated that professional commitment was predicted by perceived work–life balance. Previous research has also shown that nurses who have a better work–life balance are more committed to their profession than those who have work–life conflict because they are satisfied with a supportive work environment, flexible schedules, and manageable workloads that enhance commitment (Hazanov et al., 2021; Kinman et al., 2020). This implies that, to promote work–life balance, nurse-to-patient ratios should be kept at optimal levels to prevent overwork, allowing nurses to disconnect during off hours and lowering burnout.

In this study, affective organizational commitment (emotional attachment to the job) was significantly associated with professional commitment. This finding is in agreement with the study conducted in Iran (Paparisabet et al., 2024). This can be the fact that nurses with strong affective organizational commitment, have a positive emotional bond with their organization, and are deeply involved in their jobs, which encourages internal drive and enhances professional commitment (Meyer & Allen, 1991). This would suggest encouraging inclusivity and acknowledgment in the workplace by providing frequent feedback and rewarding excellence to boost affective organizational commitment.

Another organizational commitment-related predictor of professional commitment is normative organizational commitment. Related researchers supported this finding by defining a sense of duty or obligation to stay in their organizations (Deniz, 2024; Gulzar, 2021). This feeling of obligation may arise from several factors. They might think that they should remain with the organization since it has invested in several ways and become professionally committed (Herrera & De Las Heras-Rosas, 2021). The retention motivations, such as awards for lengthy service, additionally use mission-driven communication to highlight the moral obligations of nursing could encourage normative commitment in the organizations.

Strength and Limitations

A key strength of this study is its comprehensive assessment of multiple predictors of professional commitment among nurses in the Ethiopian context using a relatively large and geographically diverse sample. The use of standardized, reliable measurement tools further enhances the validity of the findings. However, because this study used a cross-sectional design, it demonstrates only temporal associations between variables, making it impossible to infer causality. In addition, the result of this study could not be generalized to a broader nurse population in the country, as it was done in a specified region. Furthermore, as the study relied on self-reported measures, responses may have been subject to social desirability and recall bias, potentially affecting accuracy.

Implications for Practice

This study highlights actionable strategies to strengthen nurses’ professional commitment. Enhancing perceived promotional opportunities through transparent career ladders, clear advancement criteria, and continuous professional development can foster engagement and retention. Promoting work–life balance by maintaining optimal nurse-to-patient ratios, ensuring manageable workloads, and offering flexible scheduling may reduce burnout and improve job satisfaction. Strengthening affective organizational commitment through recognition, constructive feedback, and inclusive workplace cultures, alongside reinforcing normative commitment via long-service recognition, training investments, and mission-driven communication, can further deepen loyalty and dedication. Collectively, these measures can improve workforce stability and contribute to higher quality patient care.

Conclusion

The level of professional commitment of nurses working in East Gojjam Zone public hospitals was medium. Perceived promotional opportunity, work–life balance, affective organizational commitment, and normative organizational commitment were significantly associated with the professional commitment of nurses. Federal ministers of health and hospital managers should focus on enhancing nurses’ work–life balance, as they play major role in the health sector. This will help create a more committed nursing workforce and improve the quality of service delivery. Nurses should also be provided with better promotion opportunities, and normative commitment (moral obligations) should be enhanced through mission-driven communication. Furthermore, future researchers are encouraged to conduct qualitative research to explore the underlying meanings behind this result.

Supplemental Material

sj-docx-1-son-10.1177_23779608251397445 - Supplemental material for Professional Commitment and Its Associated Factors Among Nurses in Public Hospitals of East Gojjam Zone, Northwest Ethiopia: A Cross-Sectional Study

Supplemental material, sj-docx-1-son-10.1177_23779608251397445 for Professional Commitment and Its Associated Factors Among Nurses in Public Hospitals of East Gojjam Zone, Northwest Ethiopia: A Cross-Sectional Study by Ayenew Amlaku, Temesgen Ayenew, Addisu Getie, Haile Amha and Girma Alem in SAGE Open Nursing

Footnotes

Acknowledgments

Debre Markos University is acknowledged for providing the opportunity to conduct this study, whereas study participants are acknowledged for their unreserved support and cooperation. Our gratitude also extends to the Ethical review committee and the Research and Community Service director of Debre Markos University, College of Medicine and Health Sciences, for issuing ethical clearance and support letters, respectively.

ORCID iDs

Temesgen Ayenew

Haile Amha

Ethical Considerations

This study was approved by Debre Markos University's College of Medicine and Health Science Ethical Review Committee with Ethical clearance number: DMU/CMHS/ERC/043/2025. All hospitals accepted the same approval without requiring separate institutional approval letters. Data collectors explained the purpose of the investigation, its benefits, and its procedures to each potential respondent, and any respondent seeking further clarification was assisted. The written informed consent to participate was then obtained from all of the participants before the start of the study. Any person unwilling to participate was not forced to do so, and any person wishing to withdraw at any time during the study was free to do so. Confidentiality and privacy were strictly maintained. Only the principal investigator and research assistants accessed the data. In general, the study was carried out in accordance with the Declaration of Helsinki of the World Medical Association.

Contributions

A.A., T.A, and M A.G. conceptualized the study, conducted statistical analysis, and wrote the main manuscript; T.A and M A.G. supervised the data collection and data analysis; H.A. and G.A. reviewed the manuscript. All authors have seen and approved the final manuscript for publication.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

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

Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Supplemental Material

Supplemental material for this article is available online.

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Supplementary Material

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