Predictors of career commitment and job performance of Jordanian nurses

Transcription

1 Journal of Nursing Management, 2008, 16, Predictors of career commitment and job performance of Jordanian nurses MAJD T. MRAYYAN PhD, RN 1 and IBRAHIM AL-FAOURI PhD, RN 2 1 Dean, Associate Professor, Faculty of Nursing, The Hashemite University and 2 Assistant Professor, Faculty of Nursing, The Hashemite University, Zarqa, Jordan Correspondence Majd T. Mrayyan Faculty of Nursing The Hashemite University PO Box Zarqa Jordan mmrayyan@hu.edu.jo MRAYYAN M. T. & AL-FAOURI I. (2008) Journal of Nursing Management 16, Predictors of career commitment and job performance of Jordanian nurses Background and aims Few studies focused on nursesõ career commitment and nursesõ job performance. This research aimed at studying variables of nursesõ career commitment and job performance, and assessing the relationship between the two concepts as well as their predictors. Methods A survey was used to collect data from a convenient sample of 640 Registered Nurses employed in 24 hospitals. Results Nurses ÔagreedÕ to be committed to their careers and they were performing their jobs ÔwellÕ. As a part of career commitment, nurses were willing to be involved, in their own time, in projects that would benefit patient care. The highest and lowest means of nursesõ job performance were reported for the following aspects: leadership, critical care, teaching/collaboration, planning/evaluation, interpersonal relations/communications and professional development. Correlating of total scores of nursesõ career commitment and job performance revealed the presence of a significant and positive relationship between the two concepts. Stepwise regression models revealed that the explained variance in nursesõ career commitment was 23.9% and that in nursesõ job performance was 29.9%. Implications for nursing management Nurse managers should promote nursing as a career and they should develop and implement various strategies to increase nursesõ career commitment and nursesõ job performance. These strategies should focus on nurse retention, staff development and quality of care. Conclusions NursesÕ career commitment and job performance are inter-related complex concepts that require further studies to understand, promote and maintain these positive factors in work environments. Keywords: career commitment, job performance, Jordan, nurse, predictors Accepted for publication: 11 April 2007 What the article adds to current knowledge While few studies focused on nursesõ job performance, career commitment was used a psychology-related concept. This is the first Jordanian nursing research that focuses on nursesõ career commitment and job performance. Prior studies have not adequately investigated the commitment performance relation, including the inclusion of sampleõs characteristics as predictors. In this study, a significant and positive relationship between nursesõ job performance and career commitment is reported, and there was 23.9% DOI: /j x 246 ª 2008 Blackwell Publishing Ltd

2 Career commitment and job performance explained variance in nursesõ career commitment and 29.9% in nursesõ job performance. In general, nurses ÔagreedÕ to be committed to their careers and they were performing their jobs ÔwellÕ. NursesÕ career commitment and job performance in this study are better than those reported in previous studies. Introduction Interest in organizational commitment involves its presumed relation with organizational outcomes as job performance and turnover (Cohen 1992, 1993, Shore et al. 1995). Some studies yielded inconsistent results about career commitment and its related outcomes (Mathieu & Zajac 1990, Cohen 1991), which could be related to the complex and indirect relations between commitment and its outcomes, and the presence of some moderated variables between the two concepts such as tenureship (Mathieu & Zajac 1990, Wright & Bonett 2002). NursesÕ job performance and career commitment have not been studied thoroughly in the literature (McCloskey & McCain 1988, Gardner 1992, Somers 2000). NursesÕ career commitment is a complex concept that varied with time. Low nursesõ career commitment could result in high intention to leave the profession and organization (Gardner 1992, Cohen 1998, Somers 2000). There are some inconsistencies in using the concepts of nursesõ career commitment and job performance as dependent and independent variables. For example, Gardner (1992) reported that career commitment influenced job performance, while the opposite was reported by McCloskey and McCain (1988). Organizational commitment is a presumed antecedent of performance (Ingersoll et al. 2000, Wright & Bonett 2002). In this study, the researchers used nursesõ career commitment as the independent variable, while nursesõ job performance as the dependent variable. The main purpose of this study was to answer the following research questions: (1) what variables do influence nursesõ career commitments? (2) what variables do influence nursesõ job performances? (3) what is the relationship between nursesõ career commitment and nursesõ job performance? (4) what are the predictors of nursesõ career commitment? and (5) what are the predictors of nursesõ job performance? Significance of the study Since the 1980s, few studies focused on nursesõ job performance. Originally, career commitment was studied in the ÔpsychologyÕ literature. Moreover, few nursing studies linked career commitment to job performance (McCloskey & McCain 1988, Somers 2000, Wright & Bonett 2002). This is the first Jordanian nursing research that focuses on nursesõ career commitment and job performance. At the level of policy making, the outcomes of this research are the basic milestones in designing protocols to promote nursesõ career commitment, and in turn to improve nursesõ job performance. Literature review Career commitment and job performance Career commitment is linked to job performance (McCloskey & McCain 1988, Somers 2000, Wright & Bonett 2002). Career commitment of RNs is linked to their turnover and job performance (Gardner 1992). Various conceptualizations and measurements of the ÔcommitmentÕ construct abound (Morrow 1983, Charles W. Mueller, University of Hawaii, Manoa, Honolulu, USA; Jean E. Wallace, University of Calgary, Calgary, Canada; and James L. Price, Washington University School of Medicine, St Louis, MO, USA, unpublished paper, Gardner 1992, Zangaro 2001, Wright & Bonett 2002). However, the most frequently studied concept has been the Ôattitudinal commitmentõ (Mowday et al. 1979). This concept is defined as the strength of employeesõ emotional attachment to the organizations and acceptance of their goals and values (Cooper-Hakim & Viswesvaran 2005). Employees who have high levels of attitudinal commitment remain in the organization because they like their jobs (Meyer et al. 1993, Meyer & Allen 1997). NursesÕ job performance is defined as how well nurses perform their jobs in relation to standards (Schwirian 1978, McConnell 2003). Many variables influence career commitment; these include age (Leiter & Maslach 1988, Wright & Bonett 1997, 2002), education (Sikorska-Simmons 2005), gender (Scandura & Lankau 1998, Karrasch 2003), and heavy workload and burnout (McNeese-Smith 2001). Area of work influences career commitment; nurses in critical care units (ICUs) and medical-surgical speciality areas had the lowest levels of career commitment (Ingersoll et al. 2002). Any variable could have positive or negative consequences on commitment. For example, experienced employees with low job performance may attempt to compensate for their low performance by contributing to the organization by increased expressions of loyalty (Sikorska-Simmons 2005). ª 2008 Blackwell Publishing Ltd, Journal of Nursing Management, 16,

3 M. T. Mrayyan and I. Al-Faouri Many variables influence nursesõ job performance; these include: leadership and management skills (McConnell 2003), career competencies (Tzeng 2004), balanced workload (Reid & Dawson 2001, Josten et al. 2003), recognition of achievement (Cronin & Becherer 1999, Fort & Voltero 2004), work satisfaction (Scandura & Lankau 1998), employeeõs education and skills (Mansoer & Oei 1999, McConnell 2003, Tzeng 2004), age (Reid & Dawson 2001), social support (AbuAlRub 2004), supportive communication and feedback (Fort & Voltero 2004) and holistic management (Meretoja & Leino-Kilpi 2003, Meretoja et al. 2004). As a result, nursesõ career commitment and nursesõ job performance are multifaceted and complex phenomena. The relationship between the two concepts Previous studies have not adequately investigated the commitment performance relationship (Mathieu & Zajac 1990). The failure of previous research to address the relationship between the two concepts resulted in potentially misleading conclusions regarding the stability of this relationship over time (Cohen 1993). Such failure was also accompanied with several methodological issues. Research studies have consistently concluded that the least encouraging finding in the commitment outcome research literature involves the highly discordant results found between commitment and performance (Riketta 2002). Concerning the positive relation between the two concepts, Mowday et al. (1979) suggested that individuals who have job commitment enter an organization with higher initial career commitment, and subsequently engage in performance-enhancing behaviours on the job. Moreover, continued employment is presumed to have a strong influence on the development of commitment. Mowday et al. (1979) proposed that the length of service increases the likelihood that employees will receive more challenging job assignments, greater autonomy and discretion at work, and receive higher levels of extrinsic rewards, which is also supported by a recent research study (Wright & Bonett 2002). On the other hand, some studies were not supportive of the positive relationship between commitment and performance. For example, stated that there was a negative relationship between attitudinal commitment and performance (Wright & Bonett 1997). Consequences of career commitment are tremendous. For example, committed employees behave in ways that facilitate attainment of organizational goals. Yet, such high commitment requires knowledge and experience. That is, knowledgeable and experienced employees will perform better according to SuperÕs (1957) career development theory. Other positive outcomes of career commitment include decreased incidence of job tardiness or absenteeism from work (Dahlke 1996, Corser 1998), job satisfaction (Siu 2002) and positive perceptions of organizational culture (Shore & Wayne 1993, Brooks & Swailes 2002); the latent two variables were strong predictors of career commitment (Sikorska- Simmons 2005). Research design Sample and procedures Nurses and hospitals were selected using convenience sampling technique. In this study, 640 Jordanian RNs were recruited. Covering the middle, northern and southern parts of Jordan, this study was conducted in 24 hospitals, two teaching hospitals, 11 governmental hospitals and 11 private hospitals. Ethical approval Before collection of data, approvals were obtained from hospitalsõ administrators and nurses. Data were collected during summer Nurses were asked to participate voluntarily in the study. Anonymity and confidentiality of information were assured; all questionnaires were numerically coded, and only the overall statistical results were shared with nursing administrators. Instruments: reliability and validity A demographic form was used to collect data on gender, marital status, shift worked, time commitment for work, level of education, age, experience, area of work, average daily census, organizational structure, model of nursing care and decision-making style. A 10-item scale was used to measure nursesõ career commitment (Gardner 1986) with 1 = strongly disagree, 2 = disagree, 3 = undecided, 4 = agree and 5 = strongly agree. Any mean higher than three was considered as a positive variable that influences nursesõ career commitment. The scale has internal consistency as determined by CronbachÕs alpha ranged from 0.80 to 0.82 (Gardner 1986). In this study, the reliability coefficient was A 52-item scale of ÔSix Dimension (6D) Scale of Nursing PerformanceÕ was used to measure nursesõ job performance (Schwirian 1978). This scale consists of six subscales: Leadership (five items), Critical Care (seven 248 ª 2008 Blackwell Publishing Ltd, Journal of Nursing Management, 16,

4 Career commitment and job performance items), Teaching/Collaboration (11 items), Planning/ Evaluation (seven items), Interpersonal Relations/ Communication (11 items) and Professional Development (10 items) with 0 = not at all, 1 = not very well, 2 = satisfactory, 3 = well and 4 = very well. The Professional Development subscale is as follows: 0 = never, 1 = seldom, 2 = occasionally, 3 = frequently and 4 = consistently. Any mean higher than three was considered as a positive variable that influences nursesõ job performance. The original scale has internal consistency as determined by CronbachÕs alpha ranged from 0.84 to In this study, the reliability coefficients of the subscales were Leadership = 0.72, Critical Care = 0.70, Teaching/Collaboration = 0.83, Planning/Evaluation = 0.75, Interpersonal Relations/Communication = 0.84 and Professional Development = Moreover, the reliability coefficient of the overall scale of nursesõ job performance was Data analyses At a significance level of 0.05, SPSS was used to analyse the data (SPSS Base 2001). Descriptive and inferential statistics were used to describe the studied variables including means, standard deviations, frequencies and correlations. Stepwise regression analyses were used to identify predictors of nursesõ career commitment and job performance (Polit & Beck 2004). In this study, a stepwise regression model was performed twice with: (1) the dependent variable of nursesõ career commitment and the independent variables of total scale of nursesõ job performance and nursesõ demographics and organizational characteristics; (2) the dependent variable of nursesõ job performance and the independent variables of total score of nursesõ career commitment scale and nursesõ demographics and organizational characteristics. In each stepwise regression model, all variables were entered at the same time to assess which variables carried more weight in explaining the variance in the dependent variable (Polit & Beck 2004). Results SampleÕs profile Six hindered and forty nurses completed the questionnaire with a response rate of 58.1%. Nurses were recruited from teaching hospitals (65.0%), governmental hospitals (19.4%) and private hospitals (15.6%). In the present sample, there were male nurses (58.7%), single (63.0%), young (less than 34 years old) (88.5%), worked rotating shifts (62.1%) in critical care units (69.3%), on a full-time basis (76.7%), held baccalaureate degree (77.7%) and had 4 years or less of experience in nursing (71.4%). Nurses perceived that they dealt with 20 patients and more a day (42.2%), worked in a unit or ward that had vertical organizational structure (34.0%), used mixed decision-making style (41.9%) and used team nursing as a nursing care delivery model (45.0%) (see Table 1). Based on total scores, the mean of nursesõ career commitment in the whole sample was 3.53, which indicated that nurses ÔagreedÕ to be committed to their careers. Based on total scores also, the mean of nursesõ job performance in the whole sample was 2.75, indicating that the nurses were performing their jobs ÔwellÕ. NursesÕ career commitment Answering the first research question revealed that the highest mean of nursesõ career commitment indicated that nurses were willing to be involved, on their own time, in projects that would benefit patient care (X = 3.70), while the lowest reported mean indicated that nurses will not encourage their children to pursue a career in nursing (X = 2.66) (Table 2). NursesÕ job performance Answering the second research question revealed that the following highest and lowest means for each subscale of nursesõ job performance: leadership: nursing leader should remain open to their employeesõ suggestions and use these suggestions when appropriate (X = 2.75) when compared with nursing leader should praise and recognize the achievement of nurses (X = 2.40); critical care: nurses perform technical procedures (X = 2.97) when compared with nurses function calmly and competently in emergency situations (X = 2.78); teaching/collaboration: nurses teach families about their patientsõ needs (X = 2.81) when compared with nurses use teaching aids and resource materials in teaching patients and their families (X = 2.45); planning/evaluation: nurses develop plans of nursing care for patients (X = 2.83) when compared with nurses initiate planning and evaluation of nursing care with others (X = 2.61); interpersonal relations/communication: nurses promote patientsõ right to privacy (X = 3.10) when compared with nurses promote the inclusion of the patientsõ decisions and desires concerning their care (X = 2.64); and professional development: nurses demonstrate self-confidence (X = 3.08) when compared with nurses use learning opportunities for on-going personal growth (X = 2.51) (Table 3). ª 2008 Blackwell Publishing Ltd, Journal of Nursing Management, 16,

5 M. T. Mrayyan and I. Al-Faouri Table 1 SampleÕs demographics (n = 640*) Variables n* % Gender Male Female Marital status Single Married Separated/divorced and widowed Shift worked Day Evening Night Rotating Time commitment Full-time Part-time Level of education Diploma Baccalaureate Master and above Age Less than 25 years years years years and above Experience Less than 1 year years years years years or more Area of work Critical care units Wards Type of hospitals Governmental Teaching Private UnitÕs average daily census 1 5 patients patients patients patients More than 20 patients Units or wardsõ organizational structure Vertical Horizontal Matrix Unclear Model of nursing care provision Primary Team Functional Unclear Decision making style Authoritative Participative Mixed Unclear *The total for some categories does not equal 640 and in turn 100% due to missing data. The relationship between nursesõ job performance and career commitment Answer to the third research question indicated the presence of a significant and positive relationship between nursesõ job performance and career commitment (r = 0.457). Predictors of nursesõ career commitment Answer to the fourth research question revealed the following predictors of nursesõ career commitment: contributing to patient care (r 2 change = 0.106), maintaining high standards of self-performance (r 2 change = 0.050), using nursing procedures as opportunities for interaction with patients (r 2 change = 0.027), performing appropriate measures in emergency situations (r 2 change = 0.020), gender (r 2 change = 0.016), initiating planning and evaluation of nursing care with others (r 2 change = 0.011) and using learning opportunities for on-going personal growth (r 2 change = 0.008) (Table 4). Previous variables explained 23.9% of the variance in nursesõ career commitment. Predictors of nursesõ job performance Answer to the fifth research question revealed that job assignment was closely related to career interests and goals (r 2 change = 0.197), being active in the nursing career (r 2 change = 0.036), having long-range career goals (r 2 change = 0.017), marital status (r 2 change = 0.015), years of experience in nursing (r 2 change = 0.018), time commitment (r 2 change = 0.009) and nursesõ willingness to participate in projects that would benefit nurses and nursing (r 2 change = 0.007) (Table 5). Previous variables explained 29.9% of the variance in nursesõ job performance. Discussion Nurses ÔagreedÕ to be committed to their careers and they were performing their jobs ÔwellÕ. Career commitment of nurses in this study is higher than that reported in previous studies (Gardner 1992). Jordanian nursesõ job performance was also higher than job performance of nurses in McCloskey and McCainÕs (1988) study. In this research, as a part of nursesõ career commitment, nurses were willing to be involved in projects that would benefit patient care. Such an attitude should be encouraged and maintained using various incentives such as career advancement opportunities and providing essential resources to enhance patient care. Career commitment influences job performance (McCloskey & 250 ª 2008 Blackwell Publishing Ltd, Journal of Nursing Management, 16,

6 Career commitment and job performance Table 2 Means, standard deviations and frequencies of variables of nursesõ career commitment (n = 640) Variables of nursesõ career commitment X SD Nurses would be willing to be involved on their own time in a project which would benefit patient care Advancement opportunities in nursing are important to nurses Nurses would be willing to be involved on their own time in a project which would benefit nurses and nursing Nurses have long-range career goals Nurses plan to be continuously active in a nursing career throughout their lives Providing care to patients/clients is the reason that nurses chose nursing as a career NursesÕ present work assignment is closely related to their career interests and goals Nursing career is a central interest in nursesõ lives Working in nursing is important to nurses Nurses would encourage my child to pursue a career in nursing McCain 1988, Somers 2000, Wright & Bonett 2002) and in turn the two concepts together may influence positively the quality of care (Tzeng 2004). However, nursesõ career commitment in Jordan is mandatory rather than optional. That is, Jordanian nurses are burdened by the financial responsibilities that they must handle; these heavy burdens force them to stick to their jobs, which is interpreted as career commitment. In nursesõ job performance, nursing leaders were open to suggestions of those under their direction and used them when appropriate; nurses performed technical procedures, they taught families about their patientsõ needs to be able to develop accurate plans of care and they promoted patientsõ right to privacy. All these findings were supported by studies in the literature. That is, leadership styles that support participative decision making, mutual communication and continuous feedback are needed to support nursesõ commitment to their careers, which may result in enhanced job performance (Pincus 1986, McCloskey & McCain 1988, Cronin & Becherer 1999, McConnell 2003, Fort & Voltero 2004). In critical care where more acute cases are usually treated, nurses perform more critical care skills and fewer teaching skills (McCloskey & McCain 1988), which may influence the time that nurses devote for planning and evaluation such as the time taken to develop plans of nursing care. Not to be compromised under any situation, patientsõ privacy is an essential component of patientsõ bill of rights as well as nursesõ code of ethics. For their professional development, nurses should always demonstrate self-confidence (Flagler et al. 1988, Rafferty 2000). Autonomy, job satisfaction, job performance, retention and career commitment will not happen all of a sudden; self-confidence is a pre-requisite to these concepts. Professional development should be given particular attention; this will not happen unless there is a reasonable workload, adequate staff and self-motivation of nurses themselves (Smith 1998, Claudio 2004). As indicated in the stepwise regression model and supported by the literature, planning and evaluation skills and professional development opportunities explained 17.5% of the variance in nursesõ career commitment (Caffarella & Zinn 1999). Interpersonal and communication skills and skills to handle emergency situations and gender (Igbaria & Baroudi 1995) explained 23.9% of the variance in nursesõ career commitment. However, it is important to mention that men are usually over-representative in technical departments; thus the influence of gender on nursesõ job performance is difficult to explain. As indicated in the stepwise regression model, job assignment, being active in nursing career, having longrange career goals, willingness to be involved in projects that would benefit nurses and nursing, marital status and time commitment (Lum et al. 1998), and years of experience in nursing explained 29.9% of the variance in nursesõ job performance. Clear job assignments that are linked to nursesõ career goals may increase nursesõ job satisfaction (AbuAlRub 2004), and in turn may influence nursesõ job performance and nursesõ career activities. In this study, the majority of nurses were single; thus the influence of marital status on nursesõ career commitment is difficult to interpret. However, single nurses may have less social and family responsibilities; thus they may have more commitment to their career. It is expected that nurses who work on full-time basis will be more committed to their career because they have more career continuity (Chang 1999). The influence of number of years of experience in nursing is obvious on nursesõ job performance (McCloskey & McCain 1988, Wright & Bonett 2002), which may also apply to nursesõ career commitment. Career competencies are important for high career commitment and ª 2008 Blackwell Publishing Ltd, Journal of Nursing Management, 16,

7 M. T. Mrayyan and I. Al-Faouri Table 3 Means, standard deviations and frequencies of variables of nursesõ job performance for the whole sample (n = 640) Variables of nursesõ job performance X SD The leadership Remains open to the suggestions of those under your direction and uses them when appropriate Guides other health team members in planning for nursing care Delegates responsibility for care based on assessment of priorities of nursing care needs and the abilities and limitations of available health care personnel Accepts responsibility for the level of care provided by those under your direction Gives praise and recognition for achievement to those under your direction Critical care Performs technical procedures: e.g. oral suctioning, tracheotomy care, intravenous therapy, catheter care dressing changes, etc. Performs nursing care required by critically ill patients Uses mechanical devices: e.g. suction machines, cardiac monitor, respirator, etc Performs appropriate measures in emergency situations Gives emotional support to family of dying patient Recognizes and meets the emotional needs of a dying patient Functions calmly and competently in emergency situations Teaching/collaboration Teaches a patientõs family members about the patientõs needs Encourages the family to participate in the care of the patient Teaches preventive health measures to patients and their families Identifies and uses resources within your health care agency in developing a plan of care for a patient and his/her family Adapts teaching methods and materials to the understanding of the particular audience: e.g. age of patient, educational background and sensory deprivations Identifies and uses community resources in developing a plan of care for a patient and a family Communicates facts, ideas and professional opinions in writing to patients and their families Plans for the integration of patient needs with family needs Promotes the use of interdisciplinary persons Develops innovative methods and materials for teaching patients Uses teaching aids and resource materials in teaching patients and their families Planning/evaluation Develops a plan of nursing care for a patient Coordinates the plan of nursing care with the medical plan of care Evaluates results of nursing care Identifies and includes immediate patientõs needs in the plan of nursing care Identifies and includes in nursing care plans anticipated changes in patientõs condition Contributes to the nursing care for the patient Initiates planning and evaluation of nursing care with others Interpersonal relations/communication Promotes the patientõs right to privacy Contributes to productive working relationships with other health team members Contributes to an atmosphere of mutual trust, acceptance, and respect among other health team members Verbally communicates facts, ideas and feelings to other health team members Explains nursing procedures to a patient prior to performing them Helps a patient meet his/her emotional needs Seeks assistance when necessary Uses nursing procedures as opportunities for interaction with patients Helps a patient communicate with others Uses opportunities for patient teaching when they arise Communicates a feeling of acceptance of each patient and a concern for the patientõs welfare Promotes the inclusion of the patientõs decisions and desires concerning his/her care Professional development Demonstrates self-confidence Demonstrates knowledge of legal boundaries of nursing Maintains high standards of self-performance Displays a generally positive attitude Accepts responsibility for own actions ª 2008 Blackwell Publishing Ltd, Journal of Nursing Management, 16,

8 Career commitment and job performance Table 3 (Continued) Variables of nursesõ job performance X SD Demonstrates knowledge of the ethics of nursing Assumes new responsibilities within limits of capabilities Accepts and uses constructive criticism Displays self-direction Uses learning opportunities for on-going personal growth Table 4 Stepwise regression analysis of nursesõ career commitment (n = 640) Subscale Step Predictor r r 2 r 2 change b F value Significance Planning/Evaluation 1 Contribute to the nursing care <0.001 for the patient Professional Development 2 Maintain high standards of <0.001 self-performance Interpersonal Relations/ 3 Use nursing procedures as <0.001 Communication opportunities for interaction with patients Critical Care 4 Perform appropriate measures <0.001 in emergency situations NursesÕ Demographics 5 Gender <0.001 Planning/Evaluation 6 Initiate planning and evaluation <0.001 of nursing care with others Professional Development 7 Use learning opportunities for on-going personal growth <0.001 Table 5 Stepwise regression analysis of nursesõ job performance (n = 640) Step Predictor r r 2 r 2 change b F value Significance 1 Job assignment is closely related to career interests and goals < Nurses plan to be continuously active in nursing career through <0.001 their lives 3 Nurses have long-range career goals < Marital status ) < Years of experience in nursing < Time commitment ) < Nurses are willing to be involved on their own time in projects that would benefit nurses and nursing <0.001 better job performance (McNeese-Smith 2000, Wright & Bonett 2002, Tzeng 2004). In developing countries, nursing as a profession is not fully accepted; thus promoting nursing as a career is a key strategy for nursesõ career commitment (Gardner 1992). Implications Regarding nursing practice as a profession in Jordan, when compared with other professions such as medicine and engineering, it is still not fully accepted; thus nurses may not recommend a career in nursing for their children. Students enrolled in schools of nursing mainly because they would have immediate jobs and not because they had internal motivation and interests; the unemployment rate of nursing career is still very low in Jordan. Nurses have to change their attitudes toward nursing as a profession before they can encourage their children or relatives to pursue a career in nursing. To promote nursing as a career, nurses have to consider nursing as a central interest in their lives; changing such image should start by changing our lenses. ª 2008 Blackwell Publishing Ltd, Journal of Nursing Management, 16,

9 M. T. Mrayyan and I. Al-Faouri Hospitals, nursing administrators and decision makers have to consider developing and implementing various strategies to promote life-long commitment to nursing career and high levels of nursesõ job performance. These strategies should include, but should not be limited to, retention, workforce planning and staff developments which are aimed at obtaining positive patients, nursing and organizational outcomes such as nurses and patients satisfaction and high-quality care. Developing national workforce planning strategies will help in meeting patients and nursesõ needs and service demands, which will help in achieving positive outcomes. Positive practice environments through effective human resources management, professional practice investment, adequate staffing and organizational support are warranted. As a part of workforce planning, it is important to address the challenges of recruitment and retention among nurses to ensure a more stable workforce in future, emphasizing team work, reducing turnover and supporting high-quality nursing care (International Center on Nurse Migration 2006). Nursing leaders must praise their nurses and recognize their achievement. Nurses must work competently in critical situations, use teaching aids and resource materials in teaching patients and their families, initiate planning and evaluation of nursing care with others, promote the inclusion of patientsõ decisions and desires concerning their care (this is an essential part of interpersonal relations) and use learning opportunities for on-going personal growth (this would promote nursesõ professional development) (Caffarella & Zinn 1999). All previous interventions could be used as strategies for nurse retention, staff development and quality of care. Regarding nursing research, nursesõ career commitment and job performance are complex phenomena; thus the two concepts should be studied through longitudinal studies while measuring a wide variety of variables such as organizational factors including the decision-making style, leadership styles, recognition, models of nursing care, professional opportunities, career competencies and career ladders. A random sampling technique should be used for a better generalization of results. A qualitative research design could be used to understand better why nurses may not recommend a career in nursing for their children, and why nurses may not consider nursing as a prestigious career. Other studies are needed to understand how dealing with death and dying issues and dealing with advanced technology may influence nursesõ job performance in critical care units and while handling critical conditions. Other areas to be investigated are how team and interdisciplinary work and initiating planning and evaluation activities with others would influence nursesõ job performance. One of the interesting findings in this study is that nurses used nursing procedures as opportunities to communicate with their patients; it will be beneficial to explore how such interaction influences the progress of patientsõ diseases, patientsõ recovery and patientsõ compliance to treatment regimens. Also, taking into account that some patients may recover from their critical conditions and may regain consciousness, it will be a unique contribution to nursing knowledge if we understand the influence of nursesõ communication with critical and unconscious patients on their recovery; some of these patients were able to tell their stories. Summary Nurses ÔagreedÕ to be committed to their careers and they were performing their jobs ÔwellÕ. Nurses were willing to be involved, on their own time, in projects that would benefit patient care; this is an indication of career commitment. However, some nurses reported that they will not encourage their children to pursue a career in nursing. Nurse leaders were open to suggestions of those under their direction and used them when appropriate. Nurses performed technical procedures ÔwellÕ. In critical care, nurses performed more critical care skills and fewer teaching skills. To reflect their professional development, nurses demonstrated self-confidence. A significant and positive relationship was found between nursesõ career commitment and nursesõ job performance. Stepwise regression models revealed that the explained variance in nursesõ career commitment was 23.9% which was related to contributing to patient care, maintaining high standards of self-performance, using nursing procedures as opportunities for interaction with patients, performing appropriate measures in emergency situations, gender, initiating planning and evaluation of nursing care with others, and using learning opportunities for on-going personal growth. Stepwise regression models revealed that the explained variance in nursesõ job performance was 29.9% which was related to clear job assignment, being active in the nursing career, having long-range career goals, marital status, years of experience in nursing, time commitment and nursesõ willingness to participate in projects that would benefit nurses and nursing. Career commitment and job performance in nursing are complex phenomena that require further research. 254 ª 2008 Blackwell Publishing Ltd, Journal of Nursing Management, 16,

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