The Organizational Trust and its Relation to Staff Nurse Retention in their job

Abstract

Background: Higher organizational performance and competitiveness are linked to trust in the workplace. Also, it improves patient care and institutional operations. It improves nurses' job satisfaction, organizational commitment, and productivity, encourages cooperation, effective communication, and compensates for their inadequate skills. Aim: assessing the organizational trust and its relation to staff nurse retention in their job. Research design: A descriptive correlational research design was used. Setting: The study was conducted at the Health Insurance Hospital in Minia city, Egypt. Subjects: The sample included all staff nurses working at Health Insurance Hospitals. Their total numbers were 222 nurses. Tools: two self-administrated tools: Tool (I): Organizational Trust Scale: included two parts: Part 1: Socio-demographic data &Part 2: Organizational Trust Scale and Tool (II): Staff Nurse Retention Scale: Intent to Stay. Results: half of the nursing staff had high level of organization trust, and more than half had moderate level. On the other hand more than two third had moderate level of intension to stay. Conclusion:   There were positive correlation between organization trust of nursing with their intension to stay and it’s domains. Recommendation: to keep staff nurses in the hospital, job involvement needs to be more included, decrease workload, promote support and, quality & safety, and increase job satisfaction.

Keywords:  Organizational Trust, Staff Nurse Retention

Introduction

Nurses are vital members of the healthcare team, with primary roles including responding to evolving healthcare demands and achieving organizational priorities and goals. Organizational trust, on the other hand, is a crucial component of a healthy workplace and is recognized as one of the most important entraining factors for organizational success. Improved nurse faith in their organization, as well as their ability to work there in the long run, should be a top priority for health care executives (Gustafsson, Gillespie, Searle, Hope Hailey, & Dietz, 2021).

Organizational trust is one of the important components in the organizational success and has a great advantage for organizations. It is defined as a psychological state by providing a feedback on how nurses perceive the problems in the situations in which the organization is endangered. Organizational trust is a psychological condition that offers guidance on how workers view challenges in circumstances where the organization's survival is in jeopardy (Gustafsson et al., 2021).

The organizational trust in the work environment has been associated with higher levels of organizational performance and competitiveness. Also, it is known to have positive effects on patient care and on institutions. The personnel who experience high levels of organizational trust are accountable, more creative, and performing behaviors for the organization. Additionally, it enhances the job satisfaction, organizational commitment, and productivity of nurses, promotes cooperation, centralization of issues, effective communication, and information sharing and can compensate for the limited capabilities of nurses (Yu, Mai, Tsai, & Dai, 2018).

Organization must retain their staff nurses so that they can realize their organizational targets and therefore increase efficiency, which are of vital importance for continuing their existence. The intent to stay at an institution is the intent of the nurses to stay with their current employers and to sustain the current work relationship in the long term (Al-dalahmeh, Khalaf, & Obeidat, 2018).

It is indicated in the research carried out that the trust in the organization decreases the turnover intention, that organizational trust has a positive relation with decrease in the turnover intention trust in manager or leader positively affects the term of employment of the nurses. In the event that the employee perceives the leadership style as positive, their turnover intention decreases accordingly, and this relationship may enhance even further by the effect of trust in the leader. In addition, the presence of organizational trust and trust in the leaders is associated with the intention of staying at work along with the turnover intention (Archimi, Reynaud, Yasin, & Bhatti, 2018).

There is a high tendency for an open and participatory environment and responsibilities to be exhibited by nurses. Managers must promote organizational trust to improve the levels of compliance and commitment to organizational goals, and willingness to demonstrate extra-role behaviors by nurses. Failure to build the required level of trust in organizations is likely to result in the neglect of opportunities to build cooperative relationships. This will consequently result in a substantial loss of value-enhancing opportunities that comes along with high organizational trust (Loes & Tobin, 2020).

Significance of the study:

In today's dramatically restructured healthcare work environments, organizational trust is an increasingly important element in determining employee performance and commitment to the organization.  Moreover, organizations involve individuals with diverse backgrounds, skills and experience; they work together as a supportive entity to attain definite goals and objectives. The major responsibility of healthcare owners is to generate and sustain a positive organizational culture and organizational trust (Elewa & El Banan, 2019).

The shortage of nurses has been a persistent problem in the history in the nursing profession. The problem has become worse in recent years. Recognizing that this shortage is an increasingly grave problem, healthcare researchers are attempting to identify how to ameliorate its effects on practicing nurses. Studies indicate that many factors may contribute to the shortage, but one of the major factors is high turnover. Organizational trust has been extensively researched as an important factor in employee retention and motivation. There has been considerable interest in this construct due to its reported relationship with organizational efficiency and effectiveness (Saad Elzohairy et al., 2019).

Also, through my work in the Health Insurance Hospital. It was observed that shortage of nurses by 15.9% percent and some of staff nurses leaving the profession due to highly dissatisfaction toward their job arising from current working condition that are characterized by heavy workloads, poor of communication between of them, lack of development opportunities, lack of salary, poor support and poor advocate from the superiors to subordinate, lack of continuing education, and lack of equipment and supplies etc. all These issues affect negatively on staff nurses.

Aim of the study

The aim of the current study is to assess the organizational trust and its relation to staff nurse retention in their job

Research questions

1. What is the degree of the organizational trust among nursing staff?
2. What is the degree of staff nurse retention in their job?
3. What is the relation between the organizational trust and staff nurse retention in their job?

Subjects and Methods

Research design

A descriptive correlational research design was used to achieve the aim of the current study.

Setting

The study was conducted at the Health Insurance Hospital in Minia city, Egypt.

Subjects

The sample included all staff nurses working at Health Insurance Hospital. Their total numbers were 222 nurses and are classified as follows:

Data collection tools

             Data were collected using two self-administrated tools and include the following.

Tool (I): Organizational Trust Scale

It was included two parts:

Part 1: Socio-demographic data: It was used to collect data about nursing staff and encompass items such as age, sex, marital status, qualification, department, years of experience in the nursing field, and residence.

Part 2: Organizational Trust Scale

This tool was developed by Dirks & Ferrin (2002) to assess organizational trust. It consists of 27 items divided into three subscales, nine unique items for each subscale as follows: Trust in the Supervisors (9 items); trust in co-workers (9 items); and trust in the organization management (9items). Each item was measured by a 5 Likert scale ranging as: (Strongly agree=5, Agree= 4, Neutral =3, Disagree =2, and strongly disagree =1). So, the scoring system was ranged from 27 to 135 in the centralized decision and from 27 to 135 and is divided into three levels as follows:

• Low organizational trust ranged from 27 to 63.
• Moderate organizational trust ranged from 64 to 99.
• High organizational trust ranged from 100 to 135.

Tool (II): Staff Nurse Retention Scale: Intent to Stay

The staff nurse retention scale developed by Hoar (2011), which included 50 items, was measured by 5 Likert scales ranging as: (Strongly agree=5, Agree= 4, Neutral =3, Disagree =2, and strongly disagree =1). So, the scoring system was ranged from 50 to 250 and is divided into three levels as follows:

• Low staff nurse retention ranged from 50 to 116.
• Moderate staff nurse retention ranged from 117 to 183.
• High staff nurse retention ranged from 184 to 250.

Validity of Tools:

The tool was tested for content validity by a jury of 5 experts in the field of Nursing Administration, and no modification was done. The jury was composed of one assistant professor from the Faculty of Nursing, Minia University, and four professors from the Faculty of Nursing, Assuit University. Each expert panel was asked to examine the instruments for content coverage, clarity, wording, length, format, and overall appearance.

Reliability of Tools:

                The tool was tested for internal reliability by using Cronbach's alpha test evidenced strong reliable tools were used which finding was as follow:

Pilot Study:

                Before starting data collection, a pilot study was carried out on 10% of staff nurses (21 nurses and one head nurse) from the Health Insurance Hospital. This pilot study aims to test the clarity, comprehensiveness, accessibility, and applicability of the tools and estimate the appropriate time required to fill the questionnaire. The sample of the pilot study was included in the main study sample.

Data collection procedure

An official letter was granted from the Dean of the faculty of nursing. This letter included a brief explanation of the objectives of the study. Staff nurses were interviewed on a group basis to explain the nature and purpose of the study. The time required to fill out the questionnaires was estimated after making the pilot study. Written approval was obtained from the director of the Health Insurance Hospital.

The tools were distributed to all the participants after explaining the purpose and process of data collection. Tools were directly administered and supervised by the researcher with the assistance of the head nurse for each department. The researcher distributed the study self-administered tools to the participants during the morning and evening shifts during the working days. Participants were given from 20 minutes to 30 minutes to answer the tools. They were allowed to discuss any item that needed more clarification with the researcher. The data collection was performed from staff nurses of the Hospital at Minia during the period of 6 months from the beginning of December 2021 to June 2021

Ethical Consideration:

• An official letter was granted from the research ethics committee of the Faculty of Nursing, Minia University.
• Approval to conduct the study was obtained from the Dean of the Faculty of Nursing, Minia University.
• Permission and consent were obtained from the director of the hospital and nursing directors.
• Permission and consent were obtained from the head of the department and the head nurse.
• Before the conduction of the pilot study and the actual study, oral consent was obtained from the participants who were willing to participate in the study after explaining the nature and purpose of the study. The study subject has the right to refuse to participate or withdraw from the study without any rationale at any time. Study subject privacy was considered during the collection of data. Participants were assured that all their data were highly confidential; anonymity was also assured by assigning a number for each nurse instead of names to protect their privacy..

Data statistical analysis

Upon completion of data collection, the data were scored, tabulated, and analyzed through data entry and analysis by computer using the "Statistical Package for Social Science" (SPSS) (IBM 28).

 Data were presented using descriptive statistics in percentages, frequency mean, and standard deviation. Inferential statistical tests of significance such as the Fisher exact test and Pearson correlation were used to identify group differences and the relations among the study variables.

Correlation is used to test the nature and strength of the relation between personal data of the nursing staff, organizational trust, and their intention to stay. The sign of the coefficient indicates the nature of relation (positive/negative) while the value indicates the strength of relation as follows: no correlation for rho value less than 0.19, a weak correlation for rho of value between 0.20 - 0.29, a moderate correlation for rho of value between 0.30-0.39, a strong correlation for rho of value between 0.4-0.69, and very strong correlation for values between 0.7-0.99.

Results

Table (1): Distribution of the studied nursing staff according to their personal data (n= 222).

Table (1): Presents that more than three-quarters (77.5%) of the studied nursing staff  their  age are ranging 20 - < 30 with mean age 25.0 ± 3.2 years. Most of the studied nursing staff is female and working as a nurse (92.0% & 90.8%, respectively). Nearly two-thirds of the studied nursing staff married (65.5%) and the majority (86.2% & 80.5% respectively) of them graduated from the nursing technician, and their years of experience in the current department ranged between 1- < 6 years with mean experience 4.0 ± 3.5 years in the nursing field.

Figure (1): Distribution of the nursing staff according to their gender (n = 222).

Figure (1): illustrates that majority (86.5%) of the nursing staff are female, and a minority (13.5%) of them are male.

                                                          Figure (2): Distribution of the nursing staff according to their residence                                                         

 (n = 222).

Figure (2): Illustrates that nearly two-thirds (60.4%) of the nursing staff live in rural area, and a more than one-third (39.6%) of them are lives in the urban area.

Figure (3) Distribution of Nursing Staff Level of organizational trust and its domains (n= 222).

Figure (3): Present that nearly half (46.8%) of the nursing staff have a high level of organizational trust; nearly half of them (48.6%) have a high level of trust in the supervisors, more than half (58.1%) have a high level of trust in the co-workers and nearly half (31.1%) have a high level of trust in the organizational management.

Figure (4) Distribution of Nursing Staff Level of intention to stay and its domains (n= 222).

Figure (4): Present that nearly two-thirds (64.0%) of the nursing staff have a high level of quality and safety; majority of them (88.3%) have a moderate level of acceptable workload, more than two-thirds (70.3% & 67.6% respectively) have a moderate level of job involvement and intension to stay.

Table (2): Correlations between organizational trust of nursing staff and their intension to stay (n = 222).

*Correlation is significant at the 0.05 level          **Correlation is significant at the 0.01 level

Table (2):  Presents that there were positive correlations between organizational trust of nursing staff with their intension to stay and support domain (r= 0.699, P – value < 0.001). Also, positive correlation between trust in the supervisors with their intension to stay and support domain (r= 0.631, P – value < 0.001).

Discussion

Healthcare environments were increasingly demanding environments consider nurses a vulnerable group experiencing a high degree of stress due not only through exposure to high patient acuity. Organizational trust requires a positive emotional exchange between an organization and its employees. Often there was a problematic relationship between the person and the work environment. Therefore, organizational trust had become a major issue in the nursing and essential for an effective organization (Hall, 2022).

Regarding the personal data of the studied nurses the present study showed that that more than three-quarters (77.5%) of the studied nursing staff  their  age are ranging 20 - < 30 with mean age 25.0 ± 3.2 years and 68.9 of them were married. Also less than three quarter of them (74.3%) had Nursing technician and more than three quarter of them 77.5% had 1 - <11 years of experience.

This result come in the line with (Labrague et al., 2018) who studied ''Organizational commitment and turnover intention among rural nurses in the Philippines: Implications for nursing management'' and reported that 67.4% of the studied sample were in between age of 20:29 years. But the current study differ with the same author in reporting that 95.8% of them had bachelor degree and 67.5% of them had 1-5 years of experience.

But this result come inconsistent with (Özgür & Tektaş, 2018) who studied ''An examination of the correlation between nurses' organizational trust and burnout levels'' and stated that 37.4% of the studied sample were in between 20:29 years and less than one third of them 30.3% had 5 years of experience. But the current study come in the line with the same author in reporting that 68.4% of the studied sample were married.

In addition this result differ with (Chen et al., 2015) who studied ''Organizational justice, trust, and identification and their effects on organizational commitment in hospital nursing staff'' and stated that  almost half (45.3 %) of the participants were aged 31–40 years. Most (85.0 %) participants had a bachelor degree. Regarding seniority, most (41.7 %) had 10 or more years of nursing experience, and most (37.6 %) were currently assigned to the surgical department.

As regarding the gender of the studied nurses the current study showed that the majority (86.5%) of the nursing staff was female, and the minorities (13.5%) of them were male.  This result come in accordance with (Labrague et al., 2018) who stated that 78.9% of the studied sample were female. This result come in the line with (Elewa & El Banan, 2019) who studied ''organizational culture, organizational trust and workplace bullying among staff nurses at public and private hospitals'' and stated that the majority (72.2%) of the staff nurses were female. Also this result supported by (Ahmed, Abdelwahab, & Elguindy, 2017) who studied ''Staff nurses’ intention to leave nursing profession and their organizational commitment in selected hospitals at Beni-Sueif city'' and reported The majority (99%) of nurses were female

Concerning the studied nurses total organizational trust, the present study illustrated that nearly half (46.8%) of the nursing staff had a high level of organizational trust; nearly half of them (48.6%) had a high level of trust in the supervisors, more than half (58.1%) had a high level of trust in the co-workers and nearly half (31.1%) had a high level of trust in the organizational management. This finding might due to head nurse at work has skills that performance a good job, their competence and knowledge of the minutiae of matters in head nurse work make trust him, and they provides assistance and support to others, away from the motive of financial and moral gain.  Also, head nurse support the personal principles of all employees that they believe in and strives to get along with nurses without favoring his self-interest.

This result was confirmed by (Altuntas & Baykal, 2010) who studied ''relationship between nurses’ organizational trust levels and their organizational citizenship behaviors'' and stated that  nurses had a higher than average level of trust in their managers and coworkers and they trusted more in their managers and coworkers than their institutions. 

Also this result come in the line with  (Safari, Haghighi, Rastegar, & Jamshidi, 2011) who studied ''The relationship between psychological empowerment and organizational trust of nurses: an examination of the mediating role of organizational learning'' and reported that high level of organizational trust status among the nursing staff . Also this result differ with (Basit & Duygulu, 2018) who studied ''Nurses’ organizational trust and intention to continue working at hospitals in Turkey'' and stated that nurses’ trust in their current institution was low and their trust in their colleagues was high.

In addition this result was supported by (Ali et al., 2021) who studied '' Spiritual Leadership and its Relation to Organizational Trust among Nurses at Menoufia University Hospitals'' and mentioned that the staff nurses’ levels of organizational trust dimensions were high of colleagues' trust (73.5%) while they had low level of nursing managers' trust (54.77%) and organization's trust (73.25%).

Concerning the total intension to stay, the present that nearly two-thirds (64.0%) of the nursing staff had a high level of quality and safety; majority of them (88.3%) had a moderate level of acceptable workload, more than two-thirds (70.3% & 67.6% respectively) had a moderate level of job involvement and intension to stay. This result could to be related to the employees’ expectation that managers would have a constructive, well-intentioned approach to problems related to them and would not see them as tools for achieving institutional targets. This could be explained with the managing nurses being accessible, having positive leadership skills, and possessing the knowledge to check the work being performed and providing feedback regarding its quality to the employees.

This result contraindicated with (Kassem & Ahmed, 2021) who studied ''Effect of Work Values and Quality of Work Life on Intention to Stay among Head Nurses working at Oncology Center'' and reported that more than two thirds of them showed high level of intention to stay at their work.

Also this result come in consistent with (Basit & Duygulu, 2018) who studied '' Nurses’ organizational trust and intention to continue working at hospitals in Turkey'' and reported that about half of the nurses working in these hospitals may leave at the first chance. In addition this result come inconsistent with (Sasso et al., 2019) who studied '' Push and pull factors of nurses' intention to leave'' and reported that More than one third of the nurses in this study intended to leave their job at the hospital within the next year.

Moreover this result contraindicated with Saad Elzohairy, Elsayed, & Ghandour, (2019) who studied ''Relationship between Organizational Commitment and Intention to Leave among Professional Nurses at Damanhur National Medical Institute '' and stated that above half of professional nurses (52.5%) had moderate level of intention to leave, followed by nearly one third (30.7%) of them had low level of intension to leave, while only 16.8% of them had high level of intention to leave.

Regarding the correlations between organizational trust of nursing staff and their intension to stay, the present study illustrated that there were positive correlations between organizational trust of nursing staff with their intension to stay and support domain (r= 0.699, P – value < 0.001). Also, positive correlation between trust in the supervisors with their intension to stay and support domain (r= 0.631, P – value < 0.001). From the researcher point view this result  might due to open and participatory environment and responsibilities to be exhibited by nurses. Headnurse promote organizational trust to improve the levels of compliance and commitment to organizational goals, and willingness to demonstrate extra-role behaviors by nurses.

This result come in the line with (Basit & Duygulu, 2018) who reported that the trust levels of nurses who were satisfied with their current institution and who intended to continue there was high.

This result come in line with (Dahmardeh & Nastiezaie, 2019) who studied '' The impact of organizational trust on organizational commitment through the mediating variable of organizational participation'' and reported that organizational trust has a positive and significant effect on organizational commitment and participation. Also this result was confirmed by (Atalla & Abdelaal, 2019) who reported that there is a strong positive high significant correlation between overall organizational trust and overall organizational citizenship behaviors as perceived by staff nurses.

Conclusion

Based on the present study findings, it is concluded that:

Half of the nursing staff had a high level of organizational trust and more than half had moderate level. On the other hand, more than two-thirds had a moderate level of intension to stay. In addition, there were positive correlations between organizational trust of nursing staff with their intension to stay and support domain. Also, positive correlation between trust in the supervisors with their intension to stay and support domain.

Recommendations

Based on the results of the present study, the researcher came up with the following recommendations:

1. Increase trust between staff nurses and supervisors to ensure that effective & safe care is provided and enhance the work effectiveness and minimize errors and dissatisfactions.
2. Enhance trust between staff nurses and co-workers lead to improve dignity and honoring the presence of each other, including feelings, thoughts and expertise
3. Continuous educational training for new nurses to improve nurses' supervisor trust.
4. Promote job involvement, job satisfaction, quality and safety and acceptable workload to positively influence nurse retention
5. Increase the number of nursing staff per shift to reduce workload.