The Impact of Organizational Culture on Nurses’ Performance in Hospitals

Purpose of the study

This study explores organizational culture's impact on nurses' Performance in Jordanian

hospitals. It aims to understand how cultural factors affect the Nurses’ performance. This

knowledge is crucial for hospital management to create a conducive work environment,

enhancing nurse performance and improving patient care outcomes.

1.5 Research Questions

The study answered the following questions:

1) What is the current status of organizational culture in Jordanian hospitals, and what are

its key components?

2) What is the level of nurses' performance in Jordanian hospitals?

3) Is there a significant relationship between organizational culture and nurses' performance

in Jordanian hospitals?

4) Are there significant differences in nurses' performance based on sociodemographic

characteristics (such as age, gender, education, marital status, experience, and hospital

status)?

5) Are there significant differences in the status of organizational culture based on

sociodemographic characteristics (such as age, gender, education, marital status,

experience, and hospital status)?

6) Nursing Work Index (PES-NWI) :

7) The organizational culture ( work envrionemnt), was measured using the Nursing Work

Index (PES-NWI), developed by Lake, (2024). The scale comprise 31 items with 5

subscales; nurse participation in hospital affairs subscale (9 items), nursing foundations

 for quality-of-care subscale (10 items), nurse manager ability, leadership and support of

nurses’ subscale (5 items), staffing and resource adequacy subscale (4items) and collegial

nurse-physician relationships subscale (3 items). The items on the scale are scored on a 4-

point Likert scale (4= strongly agree, to 1= strongly disagree). The scores of each

subscale is computed as mean of each items. Overall score is obtained as the mean of the

five subscales. A cut score of 2.5 is used to distinguish between positive and negative

environment, with scores above 2.5 showing positive work environment. The tools has

good psychometric properties. Its construct validity was determined using factor

analysis, which confirmed the five-factor structure. Reliability was established through

internal consistency with Cronbach's alpha values ranging from 0.80 to 0.90 across

subscales (Lake, 2024). The Six-Dimension scale of Nursing performance scale:

8) The scale was developed by Schwirian (1978). It measures nurse performance using 52

items and six dimensions; leadership (5 items), critical care 7 (items), teaching/

collaboration (11 items), planning/ evaluation (7 items), interpersonal relations/

communications (12 items), and professional development (10 items). It is divided into

two columns. Column A measures the frequency of performance; and the items in the

scale are scored on a four point likert scale; (1- Not expected in this job to 4- Frequently).

Column B measures the quality of performance and the items are scored on a four point

likert scale (1- Not very well, 2- Satisfactorily 3- Well, 4- Very Well). High score reflecs

high performance. The instrument is valid and reliable, with reliability Cronbach's alphas

of subscales ranging from 0.84 to 0.97 (Schwirian 1978).

 Appendix B

Appendix B.1: Subscales And Component Items

The Practice Environment Scale of the Nursing Work Index

Subscale Component items

Nurse Participation in Hospital Affairs 5, 6, 11, 15, 17, 21, 23, 27, 28

Nursing Foundations for Quality of Care 4, 14, 18, 19, 22, 25, 26, 29, 30, 31

Nurse Manager Ability, Leadership, and Support of Nurses 3, 7, 10, 13, 20

Staffing and Resource Adequacy 1, 8, 9, 12

Collegial Nurse-Physician Relations 2, 16, 24

SCORING DIRECTIONS

Score each item so that higher numbers indicate greater agreement. Calculate nurse-

specific subscale scores as the mean of the items in the subscale. The mean permits easy

comparison across subscales. For hospital-level scores, calculate the item-level means at the

hospital level. Then proceed with the standard computation for subscale scores. This approach

permits all nurse responses, including responses of nurses who did not answer all items, to be

included in the hospital score.

Calculate an overall PES-NWI “composite” score as the mean of the five subscale scores.

This approach gives equal weight to the subscales, rather than to the items.
 Appendix B.2: The Practice Environment Scale of the Nursing Work

Index

The Practice Environment Scale of the Nursing Work Index

For each item, please indicate the extent to which you agree that the item is PRESENT IN YOUR

CURRENT JOB. Indicate your degree of agreement by circling the appropriate number.

Strongly Disagree Agree Strongly

Disagree Agree

1 Adequate support services allow me to spend time with my patients. 1 2 3 4

2 Physicians and nurses have good working relationships 1 2 3 4

3 A supervisory staff that is supportive of the nurses. 1 2 3 4

4 Active staff development or continuing education programs for nurses. 1 2 3 4

5 Career development/clinical ladder opportunity. 1 2 3 4

6 Opportunity for staff nurses to participate in policy decisions. 1 2 3 4

7 Supervisors use mistakes as learning opportunities, not criticism. 1 2 3 4

8 Enough time and opportunity to discuss patient care problems with other 1 2 3 4

nurses

9 Enough registered nurses to provide quality patient care. 1 2 3 4

10 A nurse manager who is a good manager and leader. 1 2 3 4

11 A chief nursing officer who is highly visible and accessible to staff 1 2 3 4

12 Enough staff to get the work done 1 2 3 4

13 Praise and recognition for a job well done. 1 2 3 4

14 High standards of nursing care are expected by the administration 1 2 3 4

15 A chief nursing officer equal in power and authority to other top-level 1 2 3 4

hospital executives
 16 A lot of team work between nurses and physicians. 1 2 3 4

17 Opportunities for advancement. 1 2 3 4

18 A clear philosophy of nursing that pervades the patient care environment. 1 2 3 4

19 Working with nurses who are clinically competent. 1 2 3 4

20 A nurse manager who backs up the nursing staff in decision making, 1 2 3 4

even if the conflict is with a physician.

21 Administration that listens and responds to employee concerns. 1 2 3 4

22 An active quality assurance program. 1 2 3 4

23 Staff nurses are involved in the internal governance of the hospital (e.g., 1 2 3 4

practice and policy committees).

24 Collaboration (joint practice) between nurses and physicians. 1 2 3 4

25 A preceptor program for newly hired RNs 1 2 3 4

26 Nursing care is based on a nursing, rather than a medical, model. 1 2 3 4

27 Staff nurses have the opportunity to serve on hospital and nursing 1 2 3 4

committees.

28 Nursing administrators consult with staff on daily problems and 1 2 3 4

procedures

29 Written, up-to-date nursing care plans for all patients. 1 2 3 4

30 Patient care assignments that foster continuity of care, i.e., the same 1 2 3 4

nurse cares for the patient from one day to the next.

31 Use of nursing diagnoses. 1 2 3 4

Source: Eileen T. Lake. “Development of the Practice Environment Scale of the

Nursing Work Index.” Research in Nursing & Health, May/June 2002; 25(3): 176-188.
 Appendix C: Six Dimension Scale Of Nursing Performance

Patricia M. Schwirian, Ph.D., R.N.

The Ohio State University College of Nursing
1585 Neil Avenue - Columbus, OH 43210

Instructions: The following is a list of activities in which nurses engage with

varying degrees of frequency and skill.

1. IN COLUMN A: please enter the number that best describes how often the nurse
performs the activities in the performance of his/her current job.

2. IN COLUMN B: for those activities that the nurse does perform please enter the
number that best describes how well he/she performs them.

PLEASE USE THE KEY AT THE TOP OF EACH COLUMN

COLUMN A COLUMN B
How often does this nurse perform How well does this nurse perform
these activities in his/her current job? these activities in his/her current job?
1- Not expected in this job 1- Not very well
2- Never or seldom 2- Satisfactorily
3- Occasionally 3- Well
4- Frequently 4- Very Well

Column A Column B
1. Teach a patient's family members about the patient's needs.

2. Coordinate the plan of nursing care with the medical plan

of care.
3. Give praise and recognition for achievement to those under
his/her direction
4. Teach preventive health measure to patients and their
families.
5. Identity and use community resources in developing a plan
of care for a patient and his/her family.

Column A Column B
6. Identify and include in nursing care plans anticipated
changes in patient's conditions.
7. Evaluate results of nursing care.

8. Promote the inclusion of patient's decision and desires

concerning his/her care.
9. Develop a plan of nursing care for a patient.

10. Initiate planning and evaluation of nursing care with

others.
11. Perform technical procedures: e.g. oral suctioning,
tracheostomy care, IV therapy, catheter care, dressing
changes.
12. Adapt teaching methods and materials to the
understanding of the particular audience: e.g., age of
patient, educational background and sensory deprivation.
13. Identify and include immediate patient needs in the plan
of nursing care.
14. Develop innovative methods and materials for teaching
patients.
15. Communicate a feeling of acceptance of each patient and
a concern for the patient's welfare.
16. Seek assistance when necessary.

17. Help a patient communicate with others.

18. Use mechanical devices: e.g., suction machine, Gomco,

cardiac monitor, respirator
19. Give emotional support to family of dying patient.

20. Verbally communicate facts, ideas, and feelings to other

health care team members.
21. Promote the patients' rights to privacy.

22. Contribute to an atmosphere of mutual trust, acceptance,

and respect among other health team members.
23. Delegate responsibility for care based on assessment of
priorities of nursing care needs and the abilities and
limitations of available health care personnel.
24. Explain nursing procedures to a patient prior to
performing them.

Column A Column B
25. Guide other health team members in planning for
nursing care.
 26. Accept responsibility for the level of care under his/her
direction.
27. Perform appropriate measures in emergency situations.

28. Promote the use of interdisciplinary resource persons.

29. Use teaching aids and resource materials in teaching

patients and their families.
30. Perform nursing care required by critically ill patients.

31. Encourage the family to participant in the care of the

patient.
32. Identify and use resources within the health care agency
in developing a plan of care for a patient and his/her
family.
33. Use nursing procedures as opportunities for interaction
with patients.
34. Contribute to productive working relationships with
other health team members.
35. Help a patient meet his/her emotional needs.

36. Contribute to the plan of nursing care for a patient.

37. Recognize and meet the emotional needs of a dying

patient.
38. Communicate facts, ideas, and professional opinions in
writing to patients and their families.
39. Plan for the integration of patient needs with family
needs.
40. Function calmly and competently in emergency
situations.
41. Remain open to the suggestions of those under his/her
direction and use them when appropriate.
42. Use opportunities for patient teaching when they arise.

The following PROFESSIONAL DEVELOPMENT behaviors should be evaluated

in terms of quality only--i.e. COLUMN B.

Column A Column B

43. Use learning opportunities for ongoing personal and

professional growth.

44. Display self-direction.

 45. Accept responsibility for own actions.

46. Assume new responsibilities within the limits of

capabilities.

47. Maintain high standards of performance.

48. Demonstrate self-confidence.

49. Display a generally positive attitude.

50. Demonstrate a knowledge of the legal boundaries of

nursing.

51. Demonstrate knowledge in the ethics of nursing.

52. Accept and use constructive criticism.

Further information regarding the development, use and scoring of the Six
Dimension Scale of Nursing Performance can be found in: Schwirian, P.M. (1978).
Evaluating the performance of nurses: A multi-dimensional approach. Nursing Research,
27, 347-351.