The mediating effects of nurses’ professional values on the relationship between work environment and organizational commitment among long-term care hospital nurses

Elderly populations are rapidly increasing throughout the world [1]. Such a rapid increase has placed intense demands on long-term care (LTC) services, increasing the number of LTC hospitals in South Korea grew from 690 in 2008 to 1,382 in 2024 [2].

Nurses comprise the largest proportion of the LTC workforce. They are responsible for many medical and nursing duties in areas of personal care, social services, and medical/rehabilitative care while also being tasked with integrated services, including those aimed at daily life performance for patients [3]. These heavy workloads may create burnout, which reduces care quality and negatively affects patient outcomes [4]; meanwhile, poor work life increases turnover intention [5]. In Korea, reports show a 20.4% turnover rate among LTC hospital nurses, which is substantially higher than the 11.6% found at tertiary general hospitals [6]. This further increases workloads and stress levels among the remaining nurses while negatively impacting the quality of patient care and overall organizational effectiveness [4].

The nursing literature clearly shows that organizational commitment can reduce burnout and turnover intention [7, 8]. It is a useful concept for predicting the behaviors of organizational members, and has been found to encourage vigorous and devoted work in the nursing environment, with significant impacts on work performance, organizational productivity, and efficiency [9, 10]. Therefore, increasing the organizational commitment of LTC hospital nurses is an important aspect of efficient human resource management and organizational performance, so it is important to assess their organizational commitment and identify related factors.

Medical organizations should establish nursing work environments that help nurses provide patients with quality professional care; this includes the physical environment, colleague interactions, and organizational/policy aspects [11]. A good nursing work environment increases organizational commitment by enhancing job satisfaction and supporting the best nursing work [12]. By contrast, poor work environments and associated stresses have been found to reduce job satisfaction for hospital nurses, thereby diminishing organizational commitment [12]. This is further affected by the trust relationship between nurses and head nurses, which is a subfactor of the nursing work environment [10, 13]. As LTC hospitals have fewer personnel and less material support than general hospitals [14], it is especially important to understand and improve the relationship between organizational commitment among LTC nurses and their nursing work environment.

While the nursing work environment may directly impact organizational commitment, this can partially be adjusted through personal factors (e.g., resilience) [12]. In other words, there may be a limited range of improvement potentials depending on the institutional characteristics. This highlights the need to identify personal factors that buffer the effects of the nursing work environment on organizational commitment. In addition to working efficiently, confidently, and with pride, nurses with strong nursing professional values improve job involution via positive attitudes and satisfaction [15]. Research has shown that higher nursing professional values can positively affect organizational commitment [16]. Meanwhile, nursing professional values are facilitated through good nursing work environments, which entail positive professional relations, professional autonomy, and opportunities for professional advancement [17]. As both the nursing work environment and nursing professional values can affect organizational commitment, it can reasonably be predicted that nursing professional values directly and indirectly buffers the impacts of the nursing work environment on organizational commitment.

Studies on nursing work environment, nursing professional values, and nurses’ organizational commitment have focused primarily on general hospital nurses [5, 9, 16, 18]. In addition, studies of LTC hospital nurses have focused on the fragmentary relationships among these variables [12]. Many studies have confirmed the effectiveness of organizational commitment at predicting turnover intention [5, 7], and to only investigate direct and indirect factors affecting organizational commitment among LTC hospital nurses is insufficient [8]. Therefore, this study is intended to identify the mediating effects of nursing professional values on the relationship between the nursing work environment and organizational commitment among LTC hospital nurses. Investigating both the direct and indirect factors influencing organizational commitment among LTC hospital nurses can provide important managerial implications for establishing interventional strategies to promote their organizational commitment.

This study’s results constitute basic data for improving organizational commitment among nurses working in LTC hospitals. In particular, nursing professional values was found to partially mediate the relationship between the nursing work environment and organizational commitment. In this study, participants rated the nursing work environment as 2.46 out of 4, which is similar to the 2.50 that Hwang and Cho [26] found among LTC nurses using same measurement tool. Both numbers are lower than the 2.62 found among nurses working at general hospitals [12] and the 3.10 found among hospital nurses in the United States [27]. Regarding care quality, research has shown that LTC facilities with better nursing work environments report fewer pressure ulcers and hospitalizations [14]. Meanwhile, nurses in facilities with positive work environments are significantly less likely to exhibit burnout and job dissatisfaction. In other words, a proper nursing work environment is critical for improving care quality and retaining nurses in LTC facilities [14]. As such, LTC hospital managers must actively target this factor.

This study returned a nursing professional values score of 3.40 out of 5, which is similar to the 3.48 reported by a previous study among LTC nurses [28]. However, a study in Iran reported a score of 3.95 using the same tool among university hospital nurses [29]. This difference is understandable, as nursing professional values may differ depending on the institutional type and/or national culture [30].

This study returned an organizational commitment score of 3.12 out of 5. In Turkey, a study among clinical nurses found a substantially higher score of 3.91 [31]. In previous study, nurses had the lowest level of organizational commitment compared to other healthcare workers [32]. Given that a committed nursing workforce fosters work engagement, job satisfaction, and quality of care [9, 31], nursing managers in LTC hospital need to be interested in the organizational commitment of nurses and actively strive to improve it.

Participants with full-time work had higher organizational commitment than those with three-shift work. Akgerman and Sönmez [33] also found that full-time workers had higher organizational commitment than shift workers. Shift work exacerbates fatigue and may result in chronic sleep problems, which makes it difficult to concentrate on nursing tasks. These factors may induce negative organizational perceptions, thereby decreasing organizational commitment [34]. Meanwhile, full-time nurses tend to have more experience and higher positions [18] while playing key organizational roles and do not want to leave the organization with a strong sense of responsibility and actively participate in work, which positively influences organizational commitment [35]. This highlights the need for strategies aimed at maintaining positive organizational commitment by identifying attitudes toward the nursing organization.

This study confirmed that nursing professional values partially mediated the relationship between the nursing work environment and organizational commitment. Notably, nursing professional values can buffer the effects of the nursing working environment on organizational commitment. LTC hospital nursing managers need to actively target these factors and strive to improve them. This is consistent with previous studies among nurses in which organizational commitment increased with increasingly positive perceptions of the nursing work environment and nursing professional values [8]. White et al. [14] found that only 22% of LTC nurses perceived good nursing work environments. This underscores the need to actively improve the nursing work environment for LTC hospital nurses. In other words, LTC hospital nursing managers need to create a good nursing work environment by providing nurses with opportunities to participate in decision-making related to hospital operations and offering various rewards in respect of their opinions. For example, idea contests can help solicit information to improve hospital operations while offering nurses a way to participate in decisions related to hospital problems and operations [36]. In addition, institutional and administrative efforts of LTC hospital nursing managers such as securing appropriate nurse manpower, establishing work-related incentives, and holding workshops to improve communication skills among professionals will be necessary to improve the nursing work environment [36]. Furthermore, in order to firmly establish nursing professional values among LTC hospital nurses, it is necessary to redesign jobs that can reduce the ambiguity of work divisions and roles and promote nurses’ responsibility and autonomy, and to offer systematic practical education and training on this basis [37].

Across both Eastern and Western contexts, the issue of nurse turnover in long-term care hospitals is a critical concern [6, 37, 38]. This study holds practical significance in nursing practice as it identifies key factors influencing organizational commitment, which is a crucial determinant of nurse turnover. By providing empirical evidence to enhance nurses’ organizational commitment, this research ultimately contributes to turnover prevention. A previous study conducted on LTC hospital nurses in the United States highlighted the significance of the nursing work environment in increasing their intent to stay [38]. Similarly, a study focusing on LTC hospital nurses in China emphasized the importance of recognizing and developing nurses’ professional competencies [37]. In this context, sustained attention to the nursing work environment and nursing professional values of LTC hospital nurses is essential.

Synthetically, this study confirmed that nursing professional values can buffer the effects of the nursing work environment on organizational commitment among LTC hospital nurses. Therefore, LTC hospital managers should strive to enhance the nursing work environment and foster professional nursing values to strengthen nurses’ organizational commitment.

This study confirmed that nursing professional values can buffer the effects of the nursing work environment on organizational commitment among LTC hospital nurses. Uniquely, it identified personal factors that can help these nurses immerse themselves in their organizations despite poor nursing work environments while also highlighting the importance of strengthening nursing professional values. Efforts to improve the nursing work environment while strengthening nursing professional values may constitute an effective strategy for increasing organizational commitment among LTC hospital nurses.