Background
Nursing professional autonomy is the freedom and responsibility to make independent decisions based on knowledge, expertise, and evidence-based practice [1, 2]. Research has shown that professional autonomy increases nurses’ job satisfaction and improves patient outcomes [2,3]. It also boosts nurses’ motivation, organizational commitment, and job performance [4, 5].
Nurses’ job performance includes the activities and behaviors that enhance patient well-being and meet patient needs [6], ensuring quality of care, safety, and satisfaction [7‐9]. Any organization’s efficiency, productivity, and success depends on its employees’ job performance [10]. Numerous factors influence nurses’ job performance, with organizational commitment being one of the most important. A study by Loan (2020) demonstrated a significant positive relationship between organizational commitment and job performance [11].
Anzeige
Organizational commitment is an attitude that reflects employees’ interest, attachment, and loyalty to the organization as well as their desire to remain within it [12]. Due to their demanding nature, employees in certain organizations, such as hospitals—particularly nurses—require a high organizational commitment to avoid quitting their jobs. Nursing challenges and difficulties arise from various factors, including constant contact with patients’ pain and suffering, staff shortages, multiple responsibilities, high workloads, task complexity, and rotating shifts. In recent years, concerns about nurse turnover have become a significant challenge for healthcare system managers [13, 14]. Organizational commitment prevents job turnover and results in more motivated and enthusiastic job performance. It also improves communications with patients and their companions, enhances patient safety, and increases job satisfaction [15‐17].
Job satisfaction is crucial for nurses’ job performance [18]. It involves their positive feelings and attitudes towards their jobs [19], which are not determined by the nature of the profession but rather by their expectations from the job [20]. Nurses’ job satisfaction has extensive and comprehensive effects. It can impact their quality of life, improve the quality of care, and enhance patient satisfaction [21].
The nursing profession plays a crucial role in enhancing patient safety and maintaining community health. Nurses’ job performance is a key indicator for evaluating hospitals, and its improvement positively impacts patients, nurses, hospitals, and society. Therefore, it is highly significant to consider nurses’ professional autonomy and its potential connection with organizational commitments, job satisfaction, and job performance. These variables significantly impact patients and nurses, especially in the ICU.
Given the critical nature of patients hospitalized in the ICU, prompt and timely interventions are essential. Therefore, nurses in the ICU need professional autonomy that allows them to take swift actions during times of crisis. These nurses face numerous challenges, including caring for critically ill patients, managing heavy workloads, and enduring high levels of physical, mental, and psychological stress in their work environment, all of which can affect their job satisfaction [22].
Anzeige
Although previous studies [4, 5] have confirmed the connection between professional autonomy and nurses’ job performance, there is still a significant gap in research regarding the mediating roles of job satisfaction and organizational commitment in this relationship. Addressing this gap is crucial for enhancing our understanding and improving outcomes in nursing practice. Therefore, this study aimed to determine the effect of professional autonomy on job performance through the mediating effect of job satisfaction and organizational commitment among nurses working in ICUs.
Conceptual framework and hypothesis development
Professional autonomy and job performance
Studies have shown that increased professional autonomy improves job performance among nurses [3‐5]. Labrague et al. (2019) also reported a significant positive relationship between professional autonomy and job performance [23]. However, the findings of a study by Faizy et al. (2017) are inconsistent with those of the previous studies. Faizy et al. (2017) demonstrated that job autonomy cannot directly predict nurses’ job performance. They examined the relationship between professional autonomy and job performance among a small group of nurses in different departments [24]. The current research will specifically focus on ICU nurses, utilizing a larger sample size, as autonomy is particularly important for this group. Consequently, the research team hypothesized:
H1
Professional autonomy has a positive relationship with nurses’ job performance.
The mediating effect of job satisfaction
Previous studies have demonstrated a significant positive relationship between professional autonomy and job satisfaction [23, 25]. Kim et al. (2022) revealed that higher professional autonomy increases nurse job satisfaction [26]. Liu et al. (2016) showed that job satisfaction is a crucial aspect of employment and enhances the quality of nursing care and job performance in particular [27]. Platis et al. (2015) reported a strong positive relationship between job satisfaction and job performance [28]. Based on two previous theoretical studies [29, 30], other hypotheses were presented as follows:
H2
Professional autonomy has a positive relationship with nurses’ job satisfaction.
H3
Job satisfaction has a positive relationship with nurses’ job performance.
The main hypothesis
Job satisfaction mediates the relationship between professional autonomy and nurses’ job performance.
The mediating effect of organizational commitment
The results of studies by Labrague et al. (2019), Kim and Kim (2018), and Hwang and Lee (2017) [23, 31, 32] demonstrated that increased professional autonomy enhances organizational commitment among nurses [31, 32]. It has also been shown that organizational commitment can enhance positive organizational behaviors by positively impacting motivations and creating an emotional attachment to the organization. This, in turn, can improve nurses’ job performance and lead to the advancement of their clinical competence [33, 34]. Therefore, the research team proposed the following hypotheses:
H4
Professional autonomy has a positive relationship with nurses’ organizational commitment.
H5
Organizational commitment has a positive relationship with nurses’ job performance.
The main hypothesis
Organizational commitment mediates the relationship between professional autonomy and nurses’ job performance.
Fig. 1
Study sampling flow diagram
×
![]()
All the hypothesis is presented in conceptual framework (Fig. 2).
Fig. 2
Conceptual framework
×
![]()
Methods
Research design and sampling
The present study is a descriptive-correlational study in which structural equation modeling was used to investigate the mediating effect of various factors. The study was conducted on ICU nurses from July 2022 to July 2023. The research population consisted of nurses working in ICUs of the teaching hospitals affiliated with Urmia University of Medical Sciences, Urmia, northwestern Iran (Motahari, Imam Khomeini, Seyed al-Shohada, and Taleghani Hospitals).
Anzeige
The following formula was used to calculate the minimum required sample size. A minimum correlation coefficient of 0.15 between the research variables was assumed to determine the larger sample size with a confidence level of 95% and a test power of 80% [35]. The calculation required a minimum sample size of n = 350. Considering a potential 20% sample attrition rate, 420 eligible nurses were recruited for the study.
After determining the sample size, nurses were selected using a proportional quota sampling method based on the number of nurses in each ICU. Initially, the total population of ICU nurses (n = 503) was identified, and then the desired sample number (n = 420) was divided by this total.
$$\:\frac{\text{n}}{\text{N}}=\:\frac{420}{503}=0.835$$
The resulting fraction (0.835) was then multiplied by the number of nurses in each category to determine how many from each category should be selected. For example, to determine the sample size for Imam Khomeini Hospital, the sample size was calculated to be n = 184 (220 × 0.835), considering the number of ICU nurses there (n = 220). The sample sizes for other hospitals were calculated using a similar method (Fig. 1). The sampling process lasted eight months, from October 2022 to June 2023.
Anzeige
$$w = \frac{1}{2}\ln \,\frac{{1 + r}}{{1 - r}}$$
$$\:n=\frac{{\left({Z}_{1-\frac{\alpha\:}{2}}+{Z}_{1-\beta\:}\right)}^{2}}{{W}^{2}}+3\:\Rightarrow\:\:n=\frac{{\left(1.96+0.84\right)}^{2}}{({0.15)}^{2}}+3\:\Rightarrow\:n=350$$
Eligibility criteria
The inclusion criteria were as follows: full-time nurses employed in intensive care units, holding at least a bachelor’s degree, having a minimum of 6 months of work experience, willing to participate in the study, and not being on long-term medical or unpaid leave during the sampling period. Nurses who submitted incomplete questionnaires were excluded from the study.
Data Collection Tools
Data were gathered using a demographic questionnaire, the Varjus Professional Autonomy Scale (V-PAS), the Porter Organizational Commitment Questionnaire (P-OCQ), the Minnesota Satisfaction Questionnaire (MSQ), and the Paterson Job Performance Questionnaire (P-JPQ).
Anzeige
I.
The demographic questionnaire covered personal details such as marital status, age, gender, employment status, work experience, educational level, department type, and hospital.
II.
Varjus Professional Autonomy Scale (V-PAS).
This scale consists of 18 items categorized into three bases: knowledge, action, and value. Responses are measured using a 6-point Likert scale, ranging from “strongly disagree = 1” to “strongly agree = 6.” The total score can range from 18 to 108, which indicates three levels of professional autonomy: low (18-47.99), moderate (48-77.99), and high (78–108). This scale has been used in Finland by Varjus et al. (2003) to assess the autonomy of ICU nurses and has been validated with Cronbach’s alpha of 0.56 for knowledge, 0.62 for action, and 0.76 for values [36]. In Iran, this scale was applied in a study by Yeganeh et al. (2019), validated by faculty members, and confirmed reliable with a Cronbach’s alpha of 0.99. A preliminary study was conducted on 30 participants using a test-retest method over two weeks, confirming its reliability with an alpha of 0.8 [37].
III.
Porter Organizational Commitment Questionnaire (P-OCQ).
This questionnaire consists of 15 items developed by Mowday, Steers, and Porter. It utilizes a 7-point Likert scale, ranging from “strongly disagree = 1” to “strongly agree = 7.” The questionnaire includes three subscales: willingness to exert effort, desire to maintain membership in the organization and acceptance of organizational values. Total scores indicate levels of organizational commitment: high commitment (70–105), moderate commitment (35–69), and low commitment (below 35). Questions 3, 7, 9, 11, 12, and 15 require reverse scoring. The validity of this questionnaire for the general organizational commitment, emotional commitment, continuous commitment, and excitement commitment, respectively, is 0.88, 0.77, 0.61, and 0.79. Its reliability through Cronbach’s alpha is 0.91 [38]. Another study in Australia reported a Cronbach’s alpha of 0.89 for this questionnaire [39]. Seyyedmoharrami et al. (2019) confirmed its validity and reliability in Iran, with a Cronbach’s alpha of 0.80 [40]. In recent research conducted in Iran, Ebrahimi et al. reported that all coefficient alphas were above 0.70. The Cronbach’s alpha coefficient for organizational commitment was 0.858 [41].
IV.
Minnesota Satisfaction Questionnaire (MSQ).
The MSQ has been developed to assess job satisfaction levels. This questionnaire comprises 19 items and is divided into six subscales, including compensation system (3 items), job type (4 items), advancement opportunities (3 items), organizational climate (2 items), leadership style (4 items), and physical conditions (3 items). Each item is rated on a 5-point Likert scale ranging from “strongly disagree = 1” to “strongly agree = 5”. The total score for each respondent can range from 0 to 45. Total scores indicate levels of job satisfaction: high job satisfaction (above 57), moderate job satisfaction (39–57), and low job satisfaction (19–38) [42]. A study validated the reliability of the MSQ, showing a Cronbach’s alpha of 0.89 [43]. The reliability of the MSQ in an African context has been confirmed, with Cronbach’s alpha values of 0.79 for the intrinsic subscale, 0.82 for the extrinsic subscale, and 0.86 for the overall scale, indicating strong internal consistency [44]. Heydari et al. confirmed the validity of this questionnaire and obtained its reliability to be 0.86 in the Iranian population [45]. Otaghi et al. reported an internal consistency reliability measured with a Cronbach’s alpha of 0.87 [46].
V.
Paterson Job Performance Questionnaire (P-JPQ).
The P-JPQ is a 15-item questionnaire developed by Paterson to assess employees’ job performance. This questionnaire utilizes a 4-point Likert scale with points assigned as follows: “rarely = 0”, “sometimes = 1”, “often = 2”, and “always = 3”. The total score for each respondent can range from 0 to 45. Total scores indicate levels of job performance: strong job performance (above 22), moderate job performance (15–22), and poor job performance (0–15) [47]. The reliability of this questionnaire was evaluated by Shokrkon et al. (2008), who found a Cronbach’s alpha of 0.85 and confirmed its validity through a significant correlation with a self-assessment job performance questionnaire (p < 0.05) [48]. Alinejad et al. (2011) reported a Cronbach’s alpha of 0.80 in a pilot study [49]. Additionally, ten faculty members validated all the questionnaires, and their reliability was confirmed through a split-half test conducted with 60 participants in a pilot study, resulting in an alpha coefficient greater than 0.88.
Procedure
The researcher first obtained approval from the Research Council of Urmia University of Medical Sciences and then received ethical clearance from the Regional Ethics Committee. Subsequently, the researcher introduced himself to the relevant units. The leading researcher obtained lists of nurses from nursing offices and hospital administrators to identify eligible participants. The questionnaires were distributed to participants anonymously, ensuring that ethical considerations were respected. Visits were made to hospitals throughout the week, covering morning, afternoon, and night shifts to ensure accessibility for all nurses. The study’s objectives were explained to potential participants individually, and they then provided written informed consent. Questionnaires were given to eligible nurses, with flexible completion times to accommodate their workload and response speed. The nurses completed the questionnaires independently and collected the completed forms. To ensure consistency, the questionnaires were administered in person, with the researcher present to assist the nurses as they completed them and to answer any questions. Nurses were encouraged to complete the questionnaires at their own pace and anonymously in a relaxed setting to boost response rates. They were also given extra time to finish the questionnaires. The researcher followed up with the participants to ensure the nurses completed the questionnaires. We assured the confidentiality and anonymity of the data provided by the participants.
Data analysis
Data analysis was conducted using SPSS version 23 and SmartPLS version 3. Quantitative variables were reported as means ± standard deviations, and qualitative variables were presented as counts (percentages) in structured tables and charts. The discriminant validity of the model was evaluated using the Fornell-Larcker criterion, while internal consistency was verified using Cronbach’s alpha. Path coefficients (β) and t-values were employed to assess the conceptual model. Furthermore, the bootstrap macro method was utilized to explore the mediating effects of variables. A p-value of less than 0.05 was deemed statistically significant.
Results
Out of 420 distributed questionnaires, 400 were fully completed, yielding a response rate of 95%. The mean (± standard deviation) age of the 400 participating nurses was 38.39 ± 7.2 years. The participants’ total and ICU work experience mean scores were 13.53 ± 6.8 and 7.72 ± 5.19, respectively. Regarding marital status, 32.5% (130 nurses) were single, and 67.5% (270 nurses) were married. Regarding gender distribution, 56.8% (227 nurses) were female and 43.3% (173 nurses) were male. Regarding educational attainment, 74.5% (298 nurses) held a bachelor’s degree, and 25.5% (102 nurses) had a master’s degree. The distribution of shifts among the nurses was 45.8% (183 nurses) on fixed day shifts, 5% (20 nurses) on fixed day and evening shifts, and 49.3% (197 nurses) on rotating shifts. Employment status was divided as follows: 19.8% (79 nurses) were on contract, 27.5% (110 nurses) were in a temporary-to permanent employee positions, and 52.8% (211 nurses) held permanent employee positions. Within specialty areas of work, the results showed that 36.3% (145 nurses) worked in general ICU, 18% (72 nurses) in cardiac ICU, 4.3% (17 nurses) in trauma ICU, and 41.5% (166 nurses) in other departments (Table 1).
Table 1
Frequency distribution of demographic variables
Variables | Frequency | Percent | |
|---|---|---|---|
Gender | Female | 227 | 56.8 |
Male | 173 | 43.3 | |
Marital Status | Single | 130 | 32.5 |
Married | 270 | 67.5 | |
Educational Status | Bachelor’s degree | 298 | 74.5 |
Master’s degree | 102 | 25.5 | |
Employment Status | Contractual Employee | 79 | 19.8 |
Temporary-to permanent Employee | 110 | 27.5 | |
Permanent Employee | 211 | 52.8 | |
Employment Settings | Imam Khomeini Hospital | 162 | 42.1 |
Taleghani Hospital | 98 | 25.5 | |
Seyedalshohada Hospital | 69 | 17.9 | |
Motahari Hospital | 56 | 14.5 | |
Employment wards | General ICU | 145 | 36.3 |
Cardiac ICU | 72 | 18.0 | |
Trauma ICU | 16 | 4.2 | |
Others | 166 | 41.5 | |
Shift schaldule | Day shifts | 183 | 45.8 |
Day & Evening shifts | 20 | 5.0 | |
Rotating shifts | 197 | 49.3 | |
Variables | Mean | SD | |
Ages (years) | 38.39 | 7.22 | |
Work Experience (years) | 13.53 | 6.8 | |
Work Experience in ICU (years) | 7.72 | 5.19 | |
The mean scores for professional autonomy, job satisfaction, job performance, and organizational commitment were 64.27 ± 16.8, 56.9 ± 11.68, 28.1 ± 8.26, and 61.65 ± 12.42, respectively.
The results indicated that Cronbach’s alpha values for all variables were above 0.7, suggesting that the model possesses good internal reliability (Table 2). According to the Fornell-Larcker criterion, the model displayed acceptable discriminant validity1 (Table 3).
Table 2
Internal consistency reliability coefficients (Cronbach’s alpha)
Variables | Cronbach’s alpha coefficients |
|---|---|
Professional autonomy | 0.959 |
Job satisfaction | 0.901 |
Job performance | 0.905 |
Organizational commitment | 0.875 |
Table 3
Fornell and Larker method (discriminant validity)
Variables | Organizational commitment | Professional autonomy | Job performance | Job satisfaction |
|---|---|---|---|---|
Organizational commitment | 1 | |||
Professional autonomy | 0.823 | 1 | ||
Job performance | 0.459 | 0.506 | 1 | |
Job satisfaction | 0.533 | 0.485 | 0.286 | 1 |
General conceptual model
The results are presented in two sections: path coefficients2 (β) and t-values3. These results are displayed in Fig. 2; Table 4.
Table 4
Results of structural equation analysis for the general conceptual model
Path | β | t | Sig. | Result |
|---|---|---|---|---|
H1: Professional autonomy → Job performance | 0.708 | 9.867 | < 0.001 | Confirmed |
H2: Professional autonomy → Job satisfaction | 0.854 | 39.736 | < 0.001 | Confirmed |
H3: Job satisfaction → Job performance | 0.321 | 3.660 | < 0.001 | Confirmed |
H4: Professional autonomy → Organizational commitment | 0.199 | 2.256 | = 0.000 | Confirmed |
H5: Organizational commitment → Job performance | 0.406 | 4.419 | < 0.001 | Confirmed |
Professional autonomy has a strong and positive effect on job performance (β = 0.708) and job satisfaction (β= 0.854). Job satisfaction also has a moderate and positive effect on job performance (β = 0.321), while the effect of professional autonomy on organizational commitment is weak but positive (β = 0.199). Organizational commitment has a moderate and positive effect on job performance (β = 0.406) (Table 4) (Fig. 3).
Fig. 3
The direct Model (N = 400)
×
![]()
The effect size was calculated in the study paths, which was interpreted as follows: The effect of professional autonomy on job performance was large (0.968), professional autonomy on job satisfaction was large (0.940), job satisfaction on performance was moderate (0.743), professional autonomy on organizational commitment was small (0.330), and organizational commitment on job performance was moderate (0.690) [50].
The t-values for the relationships between variables exceed the critical value of 1.96, indicating with at least a 95% confidence interval that these connections are statistically significant (Fig. 3).
This study examined indirect relationships between variables using the bootstrap macro method. The upper and lower bounds of the indirect relationship of professional autonomy to job performance through job satisfaction and organizational commitment do not include zero, indicating that these indirect pathways are statistically significant across the entire sample (mediating roles confirmed) (Table 5).
Table 5
Indirect effects and Bootstrapping results with all paths (multiple mediation analysis)
Path | Indirect effect | Bootstrap standard errors | 95% Bootstrapped Confidence Interval | |
|---|---|---|---|---|
Lower | Upper | |||
Professional autonomy to Job performance through Job satisfaction | 0.4016 | 0.0378 | 0.3280 | 0.4736 |
Professional autonomy to Job performance through Organizational commitment | 0.7582 | 0.075 | 0.6088 | 0.9086 |
Model appropriateness
The RMSEA index was utilized to validate the structural model’s appropriateness. A RMSEA value of 0.093 indicates the model's overall suitability, supported by the following criteria values.
X2 = 121951.05, RMSEA = 0.093, NFI = 0.97, NNFI = 0.99, PNFI = 0.94, CFI = 0.99, IFI = 0.99, RFI = 0.97, SRMR = 0.068, RMS Theta = 0.11.
Reverse model
The reverse model did not confirm a relationship between job performance, professional autonomy, and job satisfaction (p > 0.05) (Fig. 4; Table 6). The mediating role of job satisfaction was not confirmed, but the mediating role of organizational commitment was confirmed (Table 7).
Fig. 4
The indirect Model (N = 400)
×
![]()
Table 6
Results of structural equation analysis for the general conceptual reverse model
Path | β | t | Sig. | Result |
|---|---|---|---|---|
H1: Job performance → Professional autonomy | 0.327 | 1.023 | = 0.307 | Rejected |
H2: Job performance → Job satisfaction | 0.079 | 1.092 | = 0.217 | Rejected |
H3: Job satisfaction → Professional autonomy | 0.467 | 7.481 | = 0.001 | Confirmed |
H4: Job performance → Organizational commitment | 0.105 | 2.231 | = 0.000 | Confirmed |
H5: Organizational commitment → Professional autonomy | 0.185 | 3.235 | < 0.001 | Confirmed |
Table 7
Indirect effects and Bootstrapping results with all paths for reverse model (multiple mediation analysis)
Path | Indirect effect | Bootstrap standard errors | 95% Bootstrapped Confidence Interval | |
|---|---|---|---|---|
Lower | Upper | |||
Job performance to Professional autonomy through Job satisfaction | 0.0297 | 0.0335 | − 0.0355 | 0.0983 |
Job performance to Professional autonomy through Organizational commitment | 0.4052 | 0.0447 | 0.3196 | 0.4955 |
Discussion
This study aimed to investigate the impact of professional autonomy on job performance, focusing on the mediating effects of organizational commitment and job satisfaction among ICU nurses.
The results indicated that professional autonomy positively affects ICU nurses’ job performance. A review of similar studies in Iran demonstrated that professional autonomy leads to improved health and enhanced job performance by reducing job stress [51]. Mirzaei et al. (2021) demonstrated that nurses in intensive care units had greater professional autonomy compared to nurses in other departments, and this autonomy was directly linked to their performance [52]. The findings of studies conducted outside of Iran have also aligned with our findings. Labrague et al. (2019) reported a significant positive relationship between professional autonomy and job performance [23]. The results of a study in Iraq also corroborate our research findings [53]. Studies have shown that decent levels of professional autonomy lead to higher job performance among nurses [4, 5].
However, the results of the present study are inconsistent with those of some other studies. Faizy et al. (2017) showed that job autonomy cannot directly predict nurses’ job performance [24]. Possible reasons for the discrepancy may be the limited sample size and the use of different autonomy scales in the two studies. In this study, the sample size consisted of 400 participants, and the Varjus Professional Autonomy Scale was utilized. In contrast, Faizy et al.‘s study involved 213 nurses, and they used the Gunster Job Autonomy Scale. Professional autonomy enhances employees’ innovative behaviors through increased motivation, job engagement, and decision-making ability. When individuals have freedom in decision-making in work-related situations, they will feel a sense of accomplishment. In organizational settings where individuals have sufficient autonomy in performing their tasks, employees’ creativity and initiative in adopting new approaches to their work are stimulated. This enhances their occupational learning, increases their sense of accomplishment, and consequently improves job performance and service quality. Managers and organizational leaders can foster motivation and encourage employees to learn new skills and specialties and improve individual and organizational performance by granting them independence and freedom of action to think freely, express their ideas and opinions, create new procedures, schedule their tasks, exert maximum effort in performing their duties with higher quality, and utilize their full potential to achieve organizational goals [54, 55]. Higher job satisfaction enhances the impact of professional autonomy on job performance, leading to improved job performance. This will be important for nurses working in ICUs because their level of dissatisfaction is high [22]. The findings are consistent with those of Khan et al. (2012), who concluded that increased professional autonomy leads to improved job performance through enhanced job satisfaction [56]. Various studies have confirmed the positive role of nurses’ job satisfaction on their job performance [34, 57, 58]. High job satisfaction first reduces stress and job burnout among nurses and then leads to increased motivation and organizational commitment among them [59, 60]. All of the above effects ultimately enhance nurses’ job performance.
Furthermore, the results also indicated that organizational commitment enhances the impact of professional autonomy on job performance, leading to improved job performance among nurses. Therefore, organizational commitment plays a mediating role in the relationship between professional autonomy and job performance. The linkage between professional autonomy and organizational commitment has been shown in previous studies [23, 61]. Additionally, literature reviews have indicated a positive and direct relationship between organizational commitment and job performance among nurses [12, 34]. Nurses with high organizational commitment exhibit greater job motivation and superior performance [62]. ICU nurses who are deeply engaged in their work can experience varying stress levels. If their efforts don’t lead to the recognition and rewards, they deserve, they may feel a heightened sense of burnout [63]. Additionally, low organizational commitment can negatively impact their job performance. This indicates that organizational commitment can foster a stronger organizational identity among ICU nurses and enhance the moderating effect on the relationship between professional autonomy and job performance.
Study strengths & limitations
This study is the first to investigate how professional autonomy affects job performance in Iran and globally, focusing on the mediating roles of job satisfaction and occupational commitment. This study has several limitations. Its findings apply specifically to ICU nurses, which may limit their generalizability to other nursing units. Additionally, the large number of questions in the four data collection tools may have discouraged participation due to the demanding nature of nurses’ work schedules. To reduce non-response and social desirability biases, nurses were encouraged to complete the questionnaires at their own pace and anonymously in a calm environment.Careful management of quotas was implemented to address selection bias, complexity, and potential errors associated with quota sampling. Distributing the questionnaire during the COVID-19 crisis also presented challenges, particularly when interacting with nurses caring for infected patients. Researchers aimed to address this by asking nurses to complete the questionnaires at convenient times. Conducting similar studies in other units during a non-pandemic period and comparing the results with this study can help interpret its findings.
Conclusion
Our findings indicate that professional autonomy positively affects job performance among Iranian ICU nurses. In this context, job satisfaction and organizational commitment serve as mediators, further enhancing the relationship between professional autonomy and job performance. This suggests that job satisfaction and organizational commitment are crucial factors in improving the performance of Iranian nurses who work in ICUs.
Healthcare managers are essential in promoting ICU nurses’ autonomy, job satisfaction, and organizational commitment, which enhances their job performance. Nursing managers support these nurses in patient care decisions and encourage independence in critical situations.
The research team suggests that nursing managers take significant measures to enhance ICU nurses’ knowledge by organizing educational classes that improve their scientific competence and decision-making skills. Expanding ICU nurses’ roles, developing professional associations, ensuring proper documentation, and establishing clear definitions can enhance their professional autonomy. Key strategies also include forming interprofessional teams, gaining support from administrators, expanding community nursing services, and implementing interprofessional education.
Hospitals should adopt practical strategies, create nurse staffing policies, and implement improvement programs to increase nurses’ job satisfaction and organizational commitment. Healthcare managers can offer competitive salaries, streamline the promotion process, and improve working conditions. Additionally, they should provide stress reduction classes, manage workloads, address nursing shortages, reduce working hours, and offer support to staff. Nurses who are satisfied with their work are more likely to stay committed and excel in their roles within the hospital, especially in the ICUs. This study was conducted in Iranian culture, where cultural factors could impact job satisfaction and organizational commitment. Thus, it is recommended that similar research be conducted in various countries, cultures, and contexts to compare and evaluate the findings.
Acknowledgements
This study is derived from a nursing project (record No. 11913). The authors would like to thank the Research Deputy of the Nursing School at Urmia University of Medical Sciences for their support and express their appreciation for the sincere cooperation of the participants.
Declarations
Ethics approval and consent to participate
This research was conducted following the guidelines of the Declaration of Helsinki. Approval was obtained from the Research Review Board of Urmia University of Medical Sciences (Date: 03/08/2023/ No: IR.UMSU.REC.1401.418). All the participants signed written informed consent. We used codes or pseudonyms instead of names in our research records to protect participant anonymity. All records were securely stored and locked.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
