Background
The psychological contract (PC), as an exchange relationship, involves the mutual responsibilities that employers and their employees have toward each other [1, 2]. Some parties’ obligations are formally outlined in employment contracts, while some unofficial expectations, such as promotion and career advancement, are not explicitly defined. These subjective expectations define the employee’s psychological contract with the organization [3, 4]. Psychological contracts in nursing refer to the mutual responsibilities between nurses and employers.
A psychological contract breach occurs when an employee feels that the organization has not fulfilled one or more of its obligations [5]. Psychological contract breach negatively affects employees’ organizational attitudes and behaviors, which also adversely impacts productivity, job performance, job satisfaction, trust, organizational commitment and increases absenteeism [6]. Psychological contract breach affects important organizational outcomes such as job satisfaction and intention to leave [7]. However, employees may decide to remain with their employer and attempt to remedy the breach of contract by restructuring or revising their psychological contract to adapt to the new circumstances [8]. According to unofficial statistics from the Iranian Nursing System Organization, the number of nurses migrating has tripled since the COVID–19 pandemic, with approximately 100 nurses leaving the country each month [9]. Saleh et al. (2023) also showed that the incentive for migration among Iranian nurses was high, with 99.2% of nurses experiencing high mental burdens and 88.8% of nurses finding the work environment inappropriate for their health [10].
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Investigating the extent and antecedents of unmet expectations and psychological contract breach among nurses can assist managers and policymakers in the healthcare system in reducing the turnover rate [11].
Previous research has shown that the extent and manner of employee response to contract breach can be related to the cognitive assessment of individuals within the organization’s context. Part of this assessment is influenced by employees’ perception of organizational justice [12]. Understanding organizational justice is especially crucial in nursing, given that nurses operate in highly demanding, stressful, and challenging environments. Organizational justice can serve as a safeguard against undesired and negative emotions and behaviors [13]. The perception of injustice among nurses can lead to increased stress, mental health disorders, and absenteeism, while also diminishing the quality of patient care [14, 15]. Additionally, previous researches indicate a direct correlation between nurses’ perceived organizational justice and job satisfaction, organizational commitment, and trust within the organization [16‐18].
The perception of fairness within an organization makes individuals feel valued as group members. This, in turn, enhances their commitment to the organization and creates a sense of obligation for individuals to reciprocate this fair treatment. A person’s positive experiences in the workplace, such as fairness and support, can result in positive responses and feelings [19]. Perceived organizational justice among nurses is a key factor that influences their sense of social responsibility and duty [20]. Organizational justice, as described in most sources, encompasses three dimensions: distributive justice, procedural justice, and interactional justice [21‐25].
Distributive justice refers to how outcomes and resources are shared within an organization [21], and how nurses are distributed in terms of resources, benefits, and workloads [23]. Procedural justice involves experiencing fairness in the decision-making process, including the motives, methods, mechanisms, and processes used to determine outcomes [21]. Interactional justice refers to employees’ perception of fairness in interpersonal behaviors that are influenced by decision-making processes [21], This pertains to the humanitarian aspect of organizational performance.
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Interpretation of a psychological contract breach is strongly influenced by perceived mutual fairness or employees’ beliefs about interpersonal behavior, such as honesty, respect, and adequate explanation. As a result of unfair interpersonal behavior, the employee feels angry and betrayed by the organization or manager [26].
Given the significance of the psychological contract breach concept and its association with important organizational factors such as intention to leave, it is imperative to identify the determinants influencing this phenomenon in nursing. Although many studies have been conducted on the consequences of psychological contract breach, few studies have addressed the antecedents of this concept in nursing [27]. Also, considering that these concepts are context-dependent [3, 28, 29], therefore, we implemented a cross-sectional study with the primary objective of assessing the level of perceived organizational justice and the psychological contract breach among Iranian nurses. Our second objective was to evaluate the correlation between the various dimensions of organizational justice (distributive, procedural, interactional justice) and psychological contract breach among clinical nursing staff.
The present study does not aim to offer a solution or panacea for psychological contract breach among nurses. This study aimed to provide a theoretical framework for a better understanding of the relationship between the different dimensions of organizational justice and the psychological contract breach among clinical nurses.
Research objectives and questions
The present study aimed to investigate the relationship between various dimensions of organizational justice and psychological contract breach among clinical nurses.
Research design and setting
This cross-sectional, descriptive-correlational study was conducted at six general teaching hospitals affiliated with one of the medical sciences universities in Tehran, Iran. This study was reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.
Participants
A sample size of 370 nurses at confidence level of 95% with the assumption of r = 0.2, \(\:\alpha\:=0.05,\:{\upbeta\:}=0.10\:\)and an attrition rate of 10%, was determined.
$$n \geqslant {\left[ {\frac{{\left( {{z_{1 - \alpha /2}} + {z_{1 - \beta }}} \right)}}{{0.5 \times \ln \left[ {\left( {1 + r} \right)/\left( {1 - r} \right)} \right]}}} \right]^2} + 3$$
In total, 370 questionnaires were distributed, and 350 were returned. In addition, 22 participants were excluded due to incomplete answers, leaving 328 questionnaires for the final analysis (effective response rate 88%). Before the participants completed the questionnaire, the research objectives were explained. The participants were also assured that their responses would be kept confidential and used exclusively for research. The questionnaires were distributed anonymously to the nurses to ensure compliance with ethical standards. The criteria for entering the study were: frontline nurses with a minimum one year of work experience in clinical nursing (without a managerial position) and having a bachelor’s degree or higher in the field of nursing.
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Data collection
Multistage random sampling was conducted. Six hospitals (Ayatollah Taleghani, shahid modarres, Mhdiyeh, Emam Hosein, Shohadaye Tajrish, Loghman Hakim hospitals) were randomly selected from 12 educational hospitals affiliated with one of the medical sciences universities in Tehran, Iran, from June 28 - August 10, 2022. A quota was allocated to each hospital and its departments based on the total number of nurses and samples. The number of nurses recruited from each hospital was determined by multiplying the total number of nurses by the study sample size and dividing the result by the total number of nurses in all six hospitals, i.e., 2560. Then, according to the quota of each ward, nurses were selected through convenience sampling. Questionnaires were delivered to the nurses of each ward at the beginning of their work shift. Each nurse put the questionnaire into an envelope and gave the envelope to the secretary of their department at the end of work shift.
Measures
The data were collected using a demographic questionnaire, the Niehoff and Moorman Organizational Justice Questionnaire, and the Robinson and Morrison (2000) psychological contract breach questionnaire.
The demographic questionnaire included information on age, sex, level of education, clinical experience, and marital status.
The Niehoff and Morman questionnaire (1993) measures organizational justice across three dimensions: distributive justice (five questions), procedural justice (six questions), and interactional justice (nine questions) [30]. These dimensions were scored using a five-point Likert scale ranging from “strongly disagree” (1) to “completely agree” (5). Higher scores indicate greater perceptions of organizational justice among nurses [27, 28]. The validity of this questionnaire was evaluated by Niehoff and Moorman (1993) using factor analysis, which confirmed the questionnaire’s construct validity [28]. In a study conducted on Iranian nurses, Manochehri et al. reported a content validity index above 0.80, and the Cronbach’s alpha coefficient was reported to be 0.93 [31]. In the current research, the reliability of this questionnaire was determined by Cronbach’s alpha coefficient (α = 0.917).
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The Morrison and Robinson (1993) questionnaire was utilized to evaluate psychological contract breach. This questionnaire comprised five questions scored on a five-point Likert scale. A higher score on this questionnaire indicates a greater level of psychological contract breach [26]. In Iran, Sepahvand et al.(2020) reported that the reliability of the questionnaire was 0.784 [32]. In current study the reliability of the scale was confirmed at the Cronbach’s alpha coefficient of 0.72.
Data analysis
The data were analyzed in SPSS version 21.0 (SPSS; IBM, New York, NY). The t-test, ANOVA, and Tukey post hoc test analyzed the differences on organizational justice and psychological contract breach according to the general characteristics of the study participants. Pearson’s correlation coefficient (r) was used to assess the correlations between the study variables. Multiple linear regression analysis (stepwise) was used to evaluate the predictive power of the independent variables for the dependent variables. All the statistical analysis were performed using two-tailed tests with an alpha error of 0.05, and a P-value less than 0.05 was considered to indicate statistical significance. The data are expressed as the means and standard deviations for continuous variables and as numbers (%) for categorical variables.
Ethical considerations
The study protocol was approved by the Ethics Committee of the Faculty of Nursing and Midwifery at Shahid Beheshti University of Medical Sciences (IR.SBMU.PHARMACY.REC.219). Before collecting the data, the research objectives were thoroughly explained to the nurses. It was emphasized that their participation in the study was entirely voluntary, the questionnaires were anonymous, and the results were used solely for research purposes. Informed consent to participate was obtained from all of the study participants.
Results
According to the results, Majority of participant (83.5%, n = 274) were female. Majority of them (68.6%, n = 225) were marriedand most of them (42.1%, n = 138) belonged to 31–40 year age group (Table 1). According to Table 2, all dimensions of organizational justice scored below the average. The lowest average score was found for the dimension of distributive justice (M = 1.89, SD = 0.66). The perceived psychological contract breach among nurses also scored above average and was unfavorable (M = 3.74, SD: 0.71). The results of the t-test,
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ANOVA, and Tukey post hoc tests showed no meaningful statistical differences on organizational justice and psychological contract breach according to the general characteristics of the study participants (Table 1).
Table 1
Demographic characteristics of the participants and the distributions of the organizational justice and psychological contract breach in categorical items (N = 328)
Variable Categories | n (%) | Organizational justice Mean (SD) | Psychological contract breach Mean (SD) | |
|---|---|---|---|---|
Gender | P = 0.16 | P = 0.79 | ||
Male | 54 (16.5) | 2.18 (0.75) | 3.72 (0.82) | |
Female | 274 (83.5) | 2.04 (0.69) | 3.75 (0.7) | |
Age (y) | P = 0.057 | P = 0.15 | ||
20–30 | 92 (28) | 2.15 (0.69) | 3.63 (0.75) | |
31–40 | 138 (42.1) | 1.94 (0.70) | 3.84 (0.68) | |
41–50 | 91(27.7) | 2.16 (0.68) | 3.71 (0.72) | |
51–60 | 7 (2.1) | 2.12 (0.71) | 3.65 (0.62) | |
Marital status | P = 0.12 | P = 0.14 | ||
Single | 96 (29.3) | 1.9557 | 3.84 | |
Married | 225 (68.6) | 2.1071 | 3.7 | |
Other status (divorced, widow) | 7 (2.1) | 2.3286 | 4.05 | |
Work experience (y) | P = 056 | P = 0.1 | ||
≤ 5 | 72 (22) | 2.21 (0.70) | 3.57 (0.75) | |
5–10 | 73 (22.3) | 1.99 (0.69) | 3.80 (0.65) | |
11–15 | 70 (21.3) | 1.98 (0.74) | 3.83(0.76) | |
16–20 | 57 (17.4) | 1.90 (0.61) | 3.86 (0.71) | |
≤20 | 56 (17.1) | 2.23 (0.68) | 3.66 (0.67) | |
Type of work shifts | P = 0.18 | P = 0.28 | ||
Morning | 89 (27.1) | 2.16 (0.67) | 3.68 (0.63) | |
Evening | 3 (0.9) | 2.63 (1.06) | 3.06 (0.41) | |
Night | 26 (7.9) | 1.90 (0.66) | 3.83 (0.66) | |
Rotation | 210 (64) | 2.03 (0.70) | 3.76 (0.75) | |
The Pearson correlation test was utilized to assess the relationship between organizational justice and its dimensions and psychological contract breach in participants. The results indicated a significant correlation between the overall score of organizational justice and all of its dimensions and the degree of psychological contract breach in nurses (Table 2).
Table 2
Mean, standard deviation and correlations of organizational justice and its dimensions with psychological contract breach
Variables | Range | Mean | SD | 1 | 2 | 3 | 4 | 5 |
|---|---|---|---|---|---|---|---|---|
1- Organizational justice | 1–5 | 2.06 | 0.7 | 1 | ||||
2- Distributive justice | 1–5 | 1.89 | 0.66 | 0.74 ** | 1 | |||
3- Procedural justice | 1–5 | 1.97 | 0.76 | 0.90 ** | 0.39 ** | 1 | ||
4- Interactional justice | 1–5 | 2.22 | 0.86 | 0.94 ** | 0.39 ** | 0.39 ** | 1 | |
5- Psychological contract breach | 1–5 | 3.74 | 0.71 | -0.64** | -0.43** | -0.57** | -0.63** | 1 |
In the next stage, stepwise regression analysis was employed to determine the predictive power of the variables that were significant predictors of psychological contract breach in participants. According to the Pearson correlation results, distributive justice, procedural justice and interactional justice were significantly related to psychological contract breach; therefore, all three dimensions of organizational justice were included in the regression model to predict psychological contract breach in paticipants. The results of the regression analysis indicated that, between the dimensions of organizational justice, the variables of interactional justice and procedural justice were included in the regression model and significantly predicted psychological contract breach (F = 115.310, P = 0.001). These dimensions explained 41% of the variance in psychological contract breach among participants (Table 3).
Table 3
The results of stepwise multiple regression
Model | Sum of Squares | df | Mean Square | F | R | R2 | Adj R2 | P | |
|---|---|---|---|---|---|---|---|---|---|
1 | Regression | 67.221 | 1 | 67.221 | 216.000 | 0.63 | 0.399 | 0.397 | 0.001 |
Residual | 101.453 | 326 | 0.311 | ||||||
Total | 168.674 | 327 | |||||||
2 | Regression | 70.011 | 2 | 35.006 | 115.310 | 0.644 | 0.415 | 0.411 | 0.001 |
Residual | 98.663 | 325 | 0.304 | ||||||
Total | 168.674 | 327 |
As shown in Table 4, the regression coefficients analaysis indicate that a one standard deviation change in interactional justice is associated with a -0.47 standard deviation change in psychological contract breach and a one standard deviation change in procedural justice is associated with a -0.20 standard deviation change in the psychological contract breach of paticipants. The regression coefficients also show that interactional justice and procedural justice have a significant and inverse effect on the psychological contract breach of participants. In other words, greater interactional and procedural justice are associated with less psychological contract breach (Table 4).
Table 4
Regression analysis for variables predicting psychological contract breach among participants
Independent variables | Unstandardized Coefficients | Standardized Coefficients | t | P | ||
|---|---|---|---|---|---|---|
B | Std. Error | Beta | ||||
Constant | 4.992 | 0.088 | 56.564 | 0.0001 | ||
Interactional Justice | − 0.388 | 0.057 | -0.47 | -6.854 | 0.0001 | |
Procedural Justice | − 0.193 | 0.064 | -0.20 | -3.032 | 0.003 | |
Discussion
This study aimed to evaluate the relationship between clinical nurses’ perceived organizational justice and its dimensions and perceived psychological contract breach.
The results indicated that only two dimensions, interactional justice, and procedural justice, can explain 41% of the variance of the perceived psychological contract breach among nurses. The regression coefficients suggested that interactional justice is more than twice as effective as procedural justice in explaining the variance of perceived psychological contract breach in nurses. Cassar et al. (2015) also indicated that high procedural and interactional justice levels are associated with reduced psychological contract breach and improved employee emotional well-being [33]. Similarly, the results of Rodwell and Johnson (2022) revealed that the level of psychological contract breach among Australian nurses was below average. There was a significant correlation between all dimensions of organizational justice and the reported level of psychological contract breach [34]. Kickul et al. (2002) reported a significant negative correlation between the procedural and interactional justice dimensions and psychological contract breach [12].
Dinani (2016) indicated that distributive and interactional justice dimensions can explain the psychological contract breach among Iranian teachers. When employees perceive justice within the organization, they believe it upholds psychological contracts, fostering a positive sentiment towards the organization [35].
The results of a qualitative study by Söderberg et al. (2023) on nurses revealed inequality within the same occupational group or between different occupational groups, especially nurses and doctors. Inequality in salary or behaviors such as bullying, backtalk, and cliques can serve as antecedents of psychological contract breach [36].
Given that many determinants of distributive justice, such as salary, income, and working hours, are objectively outlined in initial employee contracts, and considering that the psychological contract pertains to the employee’s subjective expectations of the organization and managers, this dimension did not strongly correlate with the level of perceived psychological contract breach among Iranians nurses. Interactional justice emerged as the most significant dimension in explaining psychological contract breaches among nurses. This finding aligns with the principles of the group-value model. As a result, the quality of treatment shapes individuals’ self-concept by providing social information concerning their position in a valued group [37]. Conversely, interactional justice engenders a sense of value and involvement among individuals in the group, while formal procedures are characterized by their static and objective nature. Moreover, interactional justice also provides individuals with insights into their status within the group through social interactions. For example, An individual who is treated respectfully and considered within the group represents a high status; on the other hand, a person who is disrespected is regarded as a low-status [38]. Given the collaborative nature of nursing teamwork, it appears that nurses prioritize interactional justice to ascertain their elevated position within their group and workplace [37].
Previous studies have shown that interactional justice can explain many behaviors and organizational attitudes in nurses. According to Zahednezhad et al. (2021), interactional justice was the most significant dimension for explaining job satisfaction among nurses. Currently, hospitals hire young, educated nurses with high career development needs, value their independence, and prioritize their quality of life at work. Respect and recognition for their excellent performance are expected in the hospital environment [39].
The average scores for organizational justice and psychological contract breach showed that Iranian nurses experienced high psychological contract breach and injustice. The perception of organizational justice among nurses was below average across all dimensions. In previous studies conducted on Iranian nurses, similar findings were reported. Iranian nurses reported the highest level of injustice in distributive justice and the strongest level of interactional justice. However, contrary to previous findings in the present study, nurses perceived injustice in all dimensions [22, 39]. This finding necessitates further research involving a larger sample size and a more diverse group of Iranian nurses.
Practical implications
The results of the current study revealed that procedural and interactional justice can explain psychological contract breach among clinical nurses. In light of this issue, managers can play a key role in reducing psychological contract breach among nurses. Establishing clear and fair procedures or making greater efforts to ensure that all nurses are treated with respect and dignity can decrease nurses’ psychological contract breach. Nursing managers can increase nurses perception of procedural and interactional justice by providing employees with opportunities to challenge or appeal employment decisions, listening to their concerns, establishing open communication channels to inform them about decision-making processes and the fulfillment of promises [28]. This, in turn, can help reduce psychological contract breach among nurses. Some organizational changes and pressures may prevent organizations from fulfilling their promises, resulting in psychological contract breach. Explaining reasons for unmet promises by nursing managers can contribute to reducing breach in psychological contract.
It is recommended that training workshops be conducted for managers of healthcare organizations regarding the various dimensions of organizational justice and providing effective strategies to promote interactional and procedural justice among nurses which can be lead to mitigating the psychological contract breach. The literature indicates that teaching the principles of ethical leadership to nursing managers may be associated with an increased perception of organizational justice among clinical nurses [40]. Periodical assessment of nurses’ perception of these concepts and evaluating the effectiveness of interventions within the organization is also essential. Healthcare workers expect fairness in allocating organizational resources and opportunities, wages, decision-making processes, interpersonal behaviors, and information in their workplace.
The findings suggested several future research directions. First, this study found a positive relationship between perceived organizational justice and psychological contract breach among frontline nurses. However, the relationship might differ among nursing managers (e.g., head nurses and nurse supervisors) and have different antecedents and consequences.
In addition, the findings showed that procedural and interactional justice can explain psychological contract breach among nurses, which can be evaluated in an experimental study.
Limitations of the study
This article has several limitations. First, the data collection occurred during the COVID-19 outbreak, which made it challenging for researchers to access nurses. Strict health protocols were enforced for entry into the inpatient departments of hospitals, further complicating access to nursing staff. Second, the increased workload of nurses, the rising death rates among patients and healthcare workers, and the prevalence of psychological complications among healthcare staff during the COVID-19 outbreak also posed significant challenges [41]. It is possible that the perceived organizational justice among nurses was influenced by these issues. Therefore, the findings should be cautiously generalized to other settings. Third, our study adopted a cross-sectional design. As a result, we cannot establish causal relationships among the findings.
Conclusion
This study presented a comprehensive framework that offers theoretical and practical insights into predicting psychological contract breach among nurses. The framework is based on the various dimensions of organizational justice. The findings indicated that interactional justice and procedural justice play a significant role in explaining the occurrence of psychological contract breach among nurses. Consequently, it is recommended that nursing managers prioritize enhancing fair decision-making processes and the quality of treatment and interactions with nurses.
Acknowledgements
Hereby, we extend our gratitude to the nurses of Shahid Beheshti University Medical Sciences Hospital for their participation in this research project.
Declarations
Ethical approval and consent to Participate
The protocol of this study was approved by the Ethics Committee of the Faculty of Nursing and Midwifery at Shahid Beheshti University of Medical Sciences (IR.SBMU.PHARMACY.REC.219). Participation in the study was voluntary, and the respondents were informed of the research objectives, voluntary participation, anonymous responses, and confidentiality terms. Informed consent to participate was obtained from all of the participants in the study.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
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