Research Article Open Access
Level of Professional Commitment and Associated Factors among Nurses Working In Jimma Zone Public Hospitals; Jimma South West Ethiopia, 2018
Admasu Belay Gizaw1*, Dagmawit Birhanu Kebede1, Lolemo Kelbiso Hanfore2 and Yeshitila Belay Belachew1
1Jimma University School of Nursing and Midwifery,
2Department of Nursing, Wolaita Sodo University, Wolaita Sodo, Ethiopia
*Corresponding author: Admasu Belay Gizaw, Jimma University School of Nursing and Midwifery, P.O. Box: 378, Ethiopia. Tel: 251471111458/60, 251925270512; Fax: 0471-11-14-50; E-mail: @
Received: July 09, 2018; Accepted: August 23, 2018; Published: August 30, 2018
Citation: Admasu BG, Dagmawit Birhanu K, Belay Belachew Y, Lolemo Kelbiso H (2018) Level of Professional Commitment and Associated Factors among Nurses Working In Jimma Zone Public Hospitals; Jimma South West Ethiopia, 2018. Palliat Med Care 5(3): 1-9. DOI: 10.15226/2374-8362/5/4/00164
SummaryTop
Background: Nursing profession is a highly stressful profession and nurses are susceptible to the development of burnout; mainly because of the nature and the emotional demands of their profession. Commitment to one’s profession has not been studied as extensively as organizational commitment and it has been comparatively neglected. Effective human resources are the major factor of continuity, success, and realization of the goals of health care organizations. However, the extent of level of professional commitment and associated factors among nurses is not well known in Ethiopia in general; particularly in Jimma zone. Therefore, this study was aimed to assess level of professional commitment and associated factors among nurses working at Hospitals in Jimma zone.

Objective: The main aim of this study was to assess level of professional commitment and associated factors among nurses working in Jimma Zone public Hospitals from March 10-April 10, 2014.

Methods: Institution based cross-sectional study was conducted on 317 nurses. Structured self-administered questionnaires were used to collect data. Data was entered and cleaned by using Epi-data version 3.1 and then it was exported to IBM SPSS version 20 for analysis. Descriptive statistics, Independent sample t-test, one-way ANOVA and linear regression were done to describe, to see mean difference and association of study variables. P-value of less than 0.05 was taken to declare statistical significance.

Result: This study showed, 115 (36.3%) of nurses have low level of professional commitment, 88 (27.8%) have moderate level of commitment and only one third 114 (36%) of them have high level of commitment to their profession. Position, organizational commitment and, job satisfaction were identified as factors associated with level of professional commitment among the study participants.

Conclusion: Only one third of nurses have better level of professional commitment. So, improving this level of commitment needs collaborative intervention on related factors which is a big homework for managers, nursing service managers of Jimma zone public Hospitals.

Keywords: Commitment; Professional commitment; Jimma Zone.
Background
Professional commitment is a person’s involvement, pledge, promise or resolution towards his/her profession and intention to continue working as a nurse. It describes individual attitudes toward their career, recognized as a form of work commitment that individuals have on a career facet and received a great deal of interest worldwide [1, 2]. It involves a group of characteristics which are different from one career to another and include a particular career staffs’ identification, autonomy, and receptivity of the professional values and goals [3, 4]. Professional commitment as a predictor for intention to leave the profession and higher the commitment that the nurses had, lower intention to leave their profession [5, 6]. People demonstrating high levels of professional commitment usually stay in their work for a long time and professional commitment has implications for employees’ decision to continue or discontinue membership of their profession [7-9].

The nursing profession is a highly stressful profession and nurses are susceptible to the development of burnout; mainly because of the nature and the emotional demands of their profession [10].

Commitment to one’s profession has not been studied as extensively as organizational commitment and it has been comparatively neglected. Effective human resources are the major factor of continuity, success, and realization of the goals of health care organizations [11].

A study conducted Mohammad Montazeri Hospital, City of Najafabad showed, nurses’ professional commitment positively influences their job performance and promotes positive client care outcome [12, 13]. Educational status, training, experience, autonomy, motivation and job satisfaction have been identified as the factors related to nurses’ clinical competence and professional commitment [4-17]. Lack of commitment and a high level of possibility that the employee would leave the health institution and professional reflected disloyalty to health institution [18].

Now days the main concern of each public health facilities is to provide quality care for their clients. But the main issues here on how to achieve and improve this quality patient care and improved patient outcome [19].

A study conducted in Dera Ismail Khan Show that nurses’ commitment towards their profession is important for healthcare organizations, policy makers and nurses. The finding also identified working experience as factors that affect level of commitment among nurses (20).

Successful nursing care requires high organizational commitment and nurses’ professional commitment [21]. Nursing work force in every corner of the world, in each health institutions and in any health care settings play a pivotal role to bring quality patient outcome and this all will be influenced by their job satisfaction and level of professional commitment [22]. Study revealed that age, gender, educational level, work experience and marital status; job features such as position, role conflict, role ambiguity, organizational structural characteristics such as the ratio, power centralization and employees work experience have impact on level of employees’ commitment. Commitment causes & increases trust towards the organization and is important factor in motivating people’s participation in the organization and job [23].

A study conducted in Jordanian hospitals among nurses showed significant relationship between professional commitment and gender or female nurses are more willing to work various nursing activities and more committed than the male nurses. A negative relationship was found with years of experience and level of education [24].

A study done in Imam teaching hospital in northern Iran revealed that total the level of professional commitment was high among nurses. The study also confirmed significant relationship between work related stress, job satisfaction and professional commitment [25].

A facility based cross sectional study conducted in government health facilities of Gurage Zone, South Ethiopia showed positive relationship between perceived leadership style and training opportunity and organizational commitment score [26].

However, the extent of level of professional commitment and associated factors among nurses is not well known in Ethiopia in general; particularly in Jimma zone. Therefore, this study was aimed to assess level of professional commitment and associated factors among nurses working at Hospitals in Jimma zone.
Methods and Materials
Study Area and Period
The study was conducted in three public hospitals found in Jimma Zone, Oromia Regional state from March 10-April 10 2014. Jimma is one of the 18 zones of the Oromia Regional State found at 352 kms from Addis Ababa, the capital city of Ethiopia, in the South western part. Based on the 2007 conducted Census by the CSA, this Zone has a total population of 2,486,155, of thus 1,250,527 are male and 1,235,628 female; with an area of 15,568.58 square kilometers[27, 28]. In this zone there are three public hospitals namely, Jimma University specialized hospital (JUSH), Shenen Gibe and Limu Genet hospital. The first two are situated in Jimma town where as the later one is at Limu town which is 72kms far from Jimma town. Except JUSH both are district level. JUSH plays a pivotal role in this zone and it is the only teaching and referral hospital in the southwestern part of the country, and provides specialized clinical services to about 15 million people South West part including those clients referred from Southern parts of Ethiopia [29].
Study Design
Institution based cross sectional study was conducted.
Sample Size Determination
The total populations of nurses in the three hospitals were 433. From these 73 of them have work experience of less than 6 months. Census was conducted on the rest study populations that fulfill the inclusion criteria.
Data Collection Procedures and Quality Control
Data Collection Instrument
The questionnaire for this study consisted of Sociodemographic characteristics, professional and Organizational Commitment Scale, Job satisfaction scales, Nurse Physician communication scale, and Job related stress Scale. Professional Commitment Scale adapted from Blau (2003), Organizational Commitment Scale adapted from instrument developed by Meyer and Allen (1988, 1990) which consists of affective, continuance and normative organizational commitment subscale respectively. Job satisfaction scale from McCloskey/Mueller satisfaction scale, Nurse Physician Communication was adapted from a study conducted in Iran and finally Job Related Stress was adapted from expanded nursing stress scale which was developed by Gray-Toft and Anderson and Revised by Susan E. French, Rhonda Lenton.

Five percent of the questionnaire was pre- tested at Woliso Referral Hospital to assess clarity, sequence, consistency, understandability and for total time it takes before the actual data collection. The result of reliability test showed that crombatch’s alpha for, job satisfaction scale, professional commitment scale, organizational commitment scale Nurse Physician communication scale and job related stress scale are 0.84, 0.83, 0.8, 0.86, 0.804 and 0.81 respectively on pre-test.
Data Collection Personnel
A total of five Diploma Nurses were recruited to distribute, facilitate and to collect data. They have been trained and oriented for one day on the questionnaire and the way of data collection.
Data Entry and Analysis Procedures
The data was edited, entered into Epi-Data version 3.1 for cleaning and to check completeness and missing values and then exported to IBM SPSS version 22 for analysis. Percentage, Frequency, mean and standard deviation were calculated. For professional commitment subscale, the participant’s responses on each item scored, summed: professional commitment score ranging from a minimum score of 07 and maximum score of 28. The higher the score the more professional commitment nurses had to their profession. Professional commitment scores were compared with socio-demographic characteristics using an independent sample t-test and one-way ANOVA. For the purpose of analysis dummy variables were created: Working hospitals into Referral vs. District, Marital status into Single vs. ever married, Working unit into inpatient and outpatient and Title/ position into clinical staff nurse and clinical nurse staff managers. Finally multivariable linear regression was done to see the association between the outcome variable and the independent variables. P-value of less than 0.05 was taken to declare statistical significance.
Ethical Consideration
Ethical clearance and approval letter to conduct study was obtained from Jimma University Institutional Review Board to communicate with Hospitals administrative body in Jimma zone. Permission letter was obtained from administrative body of each hospital. Prior to administering the questionnaires, the aims of the study were explained to the participants, also told that participation is voluntarily, confidential and anonymity ensured throughout the execution of the study as participants were not required to disclose personal information on the questionnaire. Finally verbal consent was assured from the study subjects.
Results
Among 341 study population to whom questionnaire were distributed, 321 respondents returned their questionnaires. From the total returned questionnaires 04 questionnaires have missing information, incomplete answer and place of work and some socio-demographic information were not complete so 317 questionnaire were used in this study which makes 92.96% response rate.

Among the total study participants majority of them 272(85.8%) were working at JUSH and the rest 45(14.2%) were working at District Hospitals (Limu and Shenen Gibe). Concerning gender distribution, half of study participants were female 159(50.2%) & the rest were male. Regarding their marital status, majority of nurses who participate in this study were single which account 171(53.9%) and the rest 138(43.5%), 7(2.2%) & 1(0.3%) were married, divorced and widowed respectively. Concerning Working Unit/department, the top four unit in which majority of nurses working include: Surgical ward, OPD, Medical ward and Pediatrics which account 66 (20.8%), 63 (19.9%). 53(16.7%) and 45 (14.2%) respectively while the rest were working at Gyn/Obs, Chronic Illness, major Operation room, Ophthalmic unit, ICU and Psychiatry as shown on the (Table 1). Coming to the educational qualification of nurses participating in this study, majority of them 196(61.8%) were clinical nurses whereas the rest 121 (38.2%) were Bsc nurses (Figure 1).
Table 1: Socio-demographic Characteristics in the study of level of professional commitment and associated factors among Nurses Working in Jimma Zone Public Hospitals, May, 2014 (n=317)

Socio-demographic Characteristics

 

N

%

Working Hospital

JUH

272

85.8

Shenen Gibe

20

6.3

 

Limu Genet

25

7.9

Gender

Male

158

49.8

Female

159

50.2

Marital status

Married

138

43.5

Single

171

53.9

Divorced

7

2.3

Widowed

1

0.3

Working Unit/department

Medical ward

53

16.7

Surgical ward

66

20.8

Intensive Care Unit (ICU)

10

3.2

Major Operation room

19

6

Psychiatry

7

2.2

Pediatrics

45

14.2

Obstetrics & Gynaecology

22

6.9

Ophthalmology

12

3.8

Chronic Illness Follow Up Clinic

20

6.3

OPD

63

19.9

Age

<24

107

33.8

25-29

149

47

30-34

20

6.3

35-39

14

4.4

>40

27

8.5

Work Experience in Nursing

0.5 -5 years

244

77.5

6-10 years

38

12.1

11-15 years

9

2.9

>15 years

24

7.6

Figure 1: Educational qualification of study participants in the study of level of professional commitment and associated factors among Nurses Working in Jimma Zone Public Hospitals, May, 2014.
Regarding study participants position, most of the respondents were staff nurses 282 (89%) who give direct patient care and a few of them were head nurses, shift supervisors and Matron (Table 1).

The mean age of the study participant is 27.83±6.8 with minimum age of 21 and maximum age of 58 years. The minimum monthly salary is 1233, and the maximum monthly salary 4820 Ethiopian birr with means salary of 1860.90 ± 496.26. The average service years of study population are 5.14 ± 6.27 years having minimum service of 8 months and maximum years of 39.

Regarding general working unit, majority of nurses 234 (73.8%) were working at inpatient unit while the rest 83 (26.2%) were working at outpatient department (Figure 2).
Figure 2: Percentage distribution of study participants’ position in the study of intention to stay in nursing profession and its predictors among nurses working at Jimma Zone Public hospitals May 15, 2014.
Descriptive Statistics of Study Variables and Level of Professional Commitment
Descriptive statistics was used to compute the overall mean and professional commitment and percentage mean score. The minimum score is 7 and the maximum score is 28, for questions about professional commitment. The overall mean professional commitment score of the study participants in this study was (15.73 ± 4.34).

The calculated mean score was changed to percentage mean score to identify percentage of nurses who have better level of commitment to their profession and calculated by using:

Percentage mean score of professional commitment = Actual mean score Maximum potential score * 100% =(15.73/28)*100%= 56.17%) MathType@MTEF@5@5@+= feaagGart1ev2aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr 4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq=Jc9 vqaqpepm0xbba9pwe9Q8fs0=yqaqpepae9pg0FirpepeKkFr0xfr=x fr=xb9adbaqaaeGaciGaaiaabeqaamaabaabaaGcbaWaaSaaaeaaca qGbbGaae4yaiaabshacaqG1bGaaeyyaiaabYgacaqGGaGaaeyBaiaa bwgacaqGHbGaaeOBaiaabccacaqGZbGaae4yaiaab+gacaqGYbGaae yzaaqaaiaab2eacaqGHbGaaeiEaiaabMgacaqGTbGaaeyDaiaab2ga caqGGaGaaeiCaiaab+gacaqG0bGaaeyzaiaab6gacaqG0bGaaeyAai aabggacaqGSbGaaeiiaiaabohacaqGJbGaae4BaiaabkhacaqGLbaa aiaabQcacaqGGaGaaeymaiaabcdacaqGWaGaaeyjaiaabccacaqG9a GaaeikaiaabgdacaqG1aGaaeOlaiaabEdacaqGZaGaae4laiaabkda caqG4aGaaeykaiaabQcacaqGXaGaaeimaiaabcdacaqGLaGaaeypai aabccacaqG1aGaaeOnaiaab6cacaqGXaGaae4naiaabwcacaqGPaaa aa@700F@ (Table 2)
Table 2: Descriptive Statistics of the study variables in the study of level of professional commitment and associated factors among Nurses Working in Jimma Zone Public Hospitals, May, 2014.

Study variables

Mini

Max

Mean

S. D

Professional Commitment

7

28

15.73

4.34

Job Satisfaction

15

55

35.19

7.62

Organizational Commitment

16

58

35.04

8.79

Job Related Stress

15

52

29.26

6.63

Nurse Physician Communication

12

60

39.28

4.02

Overall Level of Professional Commitment
Professional Commitment was computed as having mean score of=15.73±4.34 with maximum score=28 then percentage mean score= 56.17%. To determine the overall level of professional commitment, textile classification was done. Accordingly, 115 (36.3%) of nurses have low level of commitment, 88 (27.8%) have moderate level of commitment and only one third 114 (36%) of them have high level of commitment to their profession (Figure 3).

Independent Samples Test Were done to compare if there is mean difference between groups for variables that are categorized in to two (Table 3). Accordingly, mean difference was seen only in working unit. Nurses working in outpatient department have higher level of professional commitment compared to nurses working in inpatient department having t (315) =2.034, p=0.043with a mean value of (7.39 ±2.56).
Figure 3: Levels of professional commitment among nurses in the study of level of professional commitment and associated factors among Nurses Working in Jimma Zone Public Hospitals, May, 2014.
Table 3: Mean difference between professional commitment and selected socio-demographic characteristics in the study of level of professional commitment and associated factors among Nurses Working in Jimma Zone Public Hospitals, May, 2014.

Categorized Variables list

Outcome variable

Category

M

SD

t

P

Working Unit

Professional commitment

In Patient

6.76

2.36

-2

0.04*

Out Patient

7.39

2.56

-1.9

Position

Professional commitment

Clinical Staff nurse

6.9

2.38

-0.61

0.54

Clinical staff managers

7.17

2.83

-0.54

 Sex

Professional commitment

Male

6.75

2.38

-1.3

0.2

Female

7.11

2.47

-1.3

Educational qualification

Professional commitment

Diploma

6.97

2.42

0.38

0.7

BscN

6.87

2.45

0.38

Working Hospital

Professional commitment

Referal/ teaching

6.94

2.39

0.2

0.84

District

6.86

2.69

0.18

Marital Status

Professional commitment

single

6.79

2.38

-1.1

0.27

Ever married

7.09

2.48

-1.1

One-way Analysis of Variance (ANOVA) was done to see if there is a mean difference for professional commitment in Age, Length of Service and Monthly salary, but there is no significant association among these groups (Table 4).
Table 4: Mean difference between professional commitment and Length of Service, Monthly Salary category and age Category in the study of level of professional commitment and associated factors among Nurses Working in Jimma Zone Public Hospitals, May, 2014.

         Length of Service category

 

Sum of Squares

Df

Mean Square

F

p

Between Groups

21.719

2

10.86

1.849

0.159

Within Groups

1843.89

314

5.87

 

 

           Monthly Salary category

Between Groups

14.19

3

4.73

0.8

0.495

Within Groups

1851.41

313

5.92

 

 

Age Category

Between Groups

19.96

4

4.99

0.844

0.498

Within Groups

1845.65

312

5.92

 

 

Factors Associated with Professional Commitment
Position is identified as positively associated with professional commitment (β =0.862, p=0.048). Results from t-test also showed that, nurses working in outpatient department have higher level of professional commitment compared to nurses working in inpatient department. This indicated that being assigned at outpatient department increases their level of professional commitment 0.862 times.

Organizational Commitment was strongly and significantly associated with professional commitment (β =.276, p< .001). As commitment score to once Organization increases by one unit, his/her level of professional commitment also increases 0.276 times keeping the other variables constant.

Job satisfaction was significantly associated with professional commitment (β =.089, p< .001). As job satisfaction score increases by one unit, the level of professional commitment also increases 0.089 times. This means those nurses satisfied with their job may have better level of commitment to their profession compared to non- satisfied nurses (Table 5).

There was a positive relationship between nurses’ position (β =0.862, p=0.048), organizational commitment (β =.276, p< .001), job satisfaction (β =.089, p< .001) and professional commitment.
Table 5: Multi-variable Linear Regression Analysis results in the study of level of professional commitment and associated factors among Nurses Working in Jimma Zone Public Hospitals, May, 2014.

Model

Unstandardized Coefficients

t

p

95% CI    β

    β

Std. E

LB

UB

(Constant)

3.569

2.504

1.425

0.155

-0.36

8.497

Sex

-0.012

0.383

-0.033

0.974

-0.77

0.742

Age

-0.025

0.058

-0.437

0.663

-0.14

0.088

Marital status?

-0.417

0.369

-1.131

0.259

-0.14

0.309

Working experience

0.003

0.006

0.467

0.641

-0.01

0.013

Educational qualification

-0.573

0.84

-0.682

0.496

-0.22

1.081

Working unit

-0.018

0.023

-0.75

0.454

-0.06

0.029

Position

0.862

0.434

1.987

.048*

0.01

1.716

Salary

0

0.001

-0.582

0.561

-0.01

0.001

Working hospital

0.178

0.342

0.522

0.602

-0.49

0.851

Organizational Commitment

0.276

0.024

11.414

<.001*

0.23

0.323

Nurse-Physician Communication

0.006

0.022

0.262

0.793

-0.04

0.049

Job related stress

0.041

0.048

0.846

0.398

-54

0.135

Job Satisfaction

0.089

0.027

3.326

<.001*

0.036

0.141

Discussion
Overall level of Professional Commitment
The overall level of professional commitment in this study showed, 115 (36.3%) of nurses have low level of commitment, 88 (27.8%) have moderate level of commitment and only one third 114 (36%) of them have high level of commitment to their profession. This finding is relatively in line with study done in Taiwan [30] in which 32% of nurses reported as they are committed to their profession. The similarity might be related with similarity of nursing care activities and ethical principles in nursing profession in which majority of nurses all over the worlds are responsible to do and accountable for it. Different studies from different parts of the world witnessed as professional commitment can enhance patient safety and promote health care quality [31- 33]. The result of overall level of professional commitment in this study showed only 114 (36%) of nurses have high level of commitment which is not consistent with study done in northern Iran which revealed that high level of professional commitment. The difference might be related with differences related level of job satisfaction, benefits, professional autonomy, motivation and supervisor subordinate relationship among nurses in Iran and Ethiopia. So, studies at different parts of the world highly recommended to work on improving the level of professional commitment and organizational commitment to bring effective, efficient and successful nursing care quality [21, 33, 34].
Factors Associated with Professional Commitment
From socio-demographic characteristic variables only position was found to have significant association with professional commitment (β =0.862, p=0.048). Being assigned at outpatient department will increase the level of professional commitment in this study. This finding is consistent with study done in Iran [23] and not similar with study done in Jourdan, Taiwan and Dera Ismail Khan [20, 35]. The similarity might be due to similarities of socio-demographic variables of nurses in Ethiopia and Iran, but the difference might be due to socio-economic difference and quality of work life among nurses working in Jourdan, Taiwan and Ethiopia [20, 24, 25].

The findings in this study also indicated that job satisfaction (β =.089, p< .001*) is positively associated with nurses level of commitment to their profession. This result is supported with a study conducted at northern Iran [25], Jordan [32] and Italy [37]. The similarity of this study may inform concerned body should work to improve job satisfaction. The similarity also confirmed satisfaction with once job may have strong relationship with professional commitment.

Organizational Commitment was strongly significantly associated with professional commitment (β =.276, p≤0.001). The finding is similar with the study done in Ontario Canada [36] and Jordan [32]. In both study area those nurses who have better level of organizational commitment have better level of professional commitment. The similarity might be due to the relationship between an individual’s commitment to his/her organization and professional commitment where ever the country is. Each and every health care organization should consider and work on organizational factors that negatively affect nurses’ level of organizational commitment.
Conclusion and Recommendation
Only one third of nurses have higher level of professional commitment. Position, job satisfaction and Organizational commitment were identified as factors associated with professional commitment.

Natural characteristics of nursing care and increased prevalence of chronic illnesses from time to time and community needs of quality nursing care needs better level of professional commitment from nurse professionals. So nurse managers and hospital administrative body should focus in order to improve nurse’s level of professional commitment to improve quality of nursing care. Retention Strategies that focuses on creating organizational commitment awareness should be implemented. Nurse administrators should develop better system that helps to increase nurses’ job satisfaction and organizational commitment. Ethiopian Nursing Associations (ENA) with Ministry of Health should support and encourage large scale study in order to have more representative finding the overall status of professional commitment level.
Conflict of Interests
All authors declared that they have no conflict of interests. Jimma University covered only the survey cost for this study and there is no any funding organization.
Authors’ Contribution
Admasu Belay and Dagmawit Birhanu conceived and designed the protocol. Admasu Belay, Dagmawit Birhanu and Yeshitila Belay contributed on data analysis. Lolemo Kelbiso and Yeshitila Belay wrote the draft and prepared manuscript. Admasu Belay approved it. All authors read and approved the final paper.
Acknowledgments
The authors would like to acknowledge Jimma University for funding this research. They also thank study participants, data collectors, nursing service directors and Jimma Zone Hospital managers.
ReferencesTop
  1. Mrayyan MT. Reported incidence, causes, and reporting of medication errors in teaching hospitals in Jordan: a comparative study. Contemporary Nurse. 2012; 41(2): 216-232. DOI: 10.5172/conu.2012.41.2.216
  2. Chen SL, Chang SM, Lin HS, Chen CH. Post-SARS knowledge sharing and professional commitment in nursing profession. J Clin Nurs. 2009; 18(12): 1738–1745. DOI: 10.1111/j.1365-2702.2008.02488.x
  3. Teng CI, Lotus Shyu YI, Chang HY. Moderating effects of professional commitment on hospital nurses in Taiwan. J Prof Nurs. 2007; 23(1): 47–54. DOI:10.1016/j.profnurs.2006.10.002
  4. LLapa-Rodríguez EO, Trevizan MA, Shinyashiki GT. Conceptual reflections about organizational and professional commitment in the health sector. Rev Lat Am Enfermagem. 2008; 16(3): 484–488. DOI: 10.1590/S0104-11692008000300024 
  5. Nogueras DJ. Occupational commitment, education, and experience as a predictor of intent to leave the nursing profession. Nurs Econ. 2006; 24(2): 86–93.
  6. Chang CS, Du PL, Huang IC. Nurses’ perception of severe acute respiratory syndrome: Relationship between commitment and intention to leave nursing. J Adv Nurs. 2006; 54(2):171–179. DOI: 10.1111/j.1365-2648.2006.03796.x
  7. Gould D, Fontenla M. Commitment to nursing: Results of a qualitative interview study. J Nurs Manag. 2006; 14(3): 213–221. DOI: 10.1111/j.1365-2934.2006.00577.x
  8. Bagraim JJ. The dimensionality of professional commitment. SA J Ind Psychol. 2003; 29(2): 6–9.
  9. Dehghani H. Salimi T. Hooshyar M. Falahzadeh H. “The Impact of Reducing Working Hours Instruction on Nurses’ Organizational Commitment in the Intensive Care Wards of Valiasr (PBUH) Hospital of Birjand” Scientific Journal of Nursing and Midwifery, Yazd, 3: 190-199.
  10. Safaa Mohamed El-Demerdash , Afaf Abdelaziz Basal , Ghada Abdelsalam Aldeeb. The Relationship between Burnout and Organizational Commitment among Nurses at Tanta University Hospitals, Journal of Nursing and Health Science. 2013; 2(6): 20-28.
  11. Khanian Najafabadi, A. Investigating the Relationship between Clinical Competence and Job Satisfaction of Nurses Working in Martyr Mohammad Montazeri Hospital, City of Najafabad in 2013. 2014.
  12. Donkor NT, Andrews LD. Ethics, culture and nursing practice in Ghana. International Nursing Review. 2011; 58(1): 109-114. DOI : 10.1111/j.1466-7657.2010.00852
  13. Khanian Najafabadi, A. Investigating the Relationship between Clinical Competence, level of commitment and Job Satisfaction of Nurses Working in Martyr Mohammad Montazeri Hospital, City of Najafabad in 2013. 2014.
  14. Istomina N, Suominen T, Razbadauskas A, Martinkėnas A, Ritta M, Leino-Kilpi H. Competence of nurses and factors associated with it. Medicina (Kaunas).  2011; 47 (4): 230-237.
  15. Asghari E, Khaleghdost T, Kazemnejad A, Askari  F, “Relationship between Nurses’ Attitudes towards Learning Organization Principles and Organizational Commitment” Journal of the Faculty of Nursing of Tehran University of Medical Sciences (Hayat) 2013; 18(5): 23-32.
  16. Dehghan Nayeri N, Salehi T. Principles of Nursing Management, Publication of Bashari in Collaboration with the Publication of Tohfeh. 2009; 238.
  17. Abdul Sattar Khan, Farooq Jan. The Study of Organization Commitment and Job Satisfaction among Hospital Nurses. A Survey of District Hospitals of Dera Ismail Khan. Global Journals Inc. (USA). 2015; 15(1):  Version 1.0
  18. Velickovic VM, Visnjic A, Jovic S, Radulovic O, Sargic C, Mihajlovic J, et al. Organizational commitment and job satisfaction among nurses in Serbia: A factor analysis.  Nurs Outlook. 2014; 62(6): 415-427. DOI: 10.1016/j.outlook.2014.05.003
  19. Al-enezi N, Chowdhury RI, Shah MA, Al-otabi M. Job satisfaction of nurses with multicultural backgrounds: a questionnaire survey in Kuwait. Appl Nurs Res. 2009; 22(2): 94-100. DOI: 10.1016/j.apnr.2007.05.005
  20. Abdul Sattar Khan, Farooq Jan. The Study of Organization Commitment and Job Satisfaction among Hospital Nurses. A Survey of District Hospitals of Dera Ismail Khan. Global Journal of Management and Business Research. 2015; 15(1): Version 1.0. 17-28.
  21. Teng CI, Shyu YI, Chang HY. Moderating effects of professional commitment on hospital nurses in Taiwan. Journal of Professional Nursing. 2007; 23(1): 47–54. DOI: 10.1016/j.profnurs.2006.10.002
  22. Olatunji SO, Mokuolu BO. The influence of sex, marital status, and tenure of service on job stress, and job satisfaction of health workers in a Nigerian Federal Health Institution. African Research Review. 2014; 8(1): 126-133.
  23. Nabizadeh, Gharaghozaz Z, Atashzadeh Shorideh F, Khazaie N, Alavimajd H. Evaluation of Organizational and professional Commitment Ratio of Clinical Nurses. Journal of Nursing Management. 2013; 2: 41-48.
  24. Zaid Al-Hamdan, Heyam Dalky, Jehan Al-Ramadneh. Nurses' Professional Commitment and Its Effect on Patient Safety among Jordanian Registered Nurses. Global Journal of Health Science. 2018; 10(1): 111-119. DOI:10.5539/gjhs.v10n1p111
  25. Eskandari M, Heidari Gorji MA. Can work-related stress and job satisfaction affect job commitment among nurses? A cross-sectional study.  F1000 Research, 2018; 7:218. 1-8. DOI: 10.12688/f1000research.12595.1
  26. Gebremariam Hailemicael Nima, Mirkuzie Woldie Kerie, Gebeyehu Tsega Nebeb. Organizational Commitment of Health Professionals and Associated Factors in Government Health Facilities of Gurage Zone, South Ethiopia. Clinical Medicine Research. 2016; 5(5): 82-90. DOI:10.11648/j.cmr.20160505.11
  27. Wikipedia. Jimma Zone - Wikipedia, the free encyclopedia is avalable at https://en.wikipedia.org/wiki/Jimma_Zone . 2010.
  28. BoFED Oromiya Bureau of Finance and Economic Development. Addis Ababa E. General Profile of the Oromiya National Regional State , BoFED , 2008. 2008;1–15.
  29. Abebe M, Alemseged F. Hematologic abormalities among children on Haart, in Jimma University Specialized Hospital, Southwestern ethiopia. Ethiop J Health Sci. 2009; 19(9): 83–89. DOI: 10.4314/ejhs.v19i2.69420
  30. Hamdan ZA, Dalky H, Al-ramadneh J. Nurses  Professional Commitment and Its Effect on Patient Safety. 2017;10(1):111–119.
  31. Shu-Fang Vivienne Wu , Mei-Chen Lee , Shu-Yuan Liang , Yeu-Hui Chuang , Yu-Ying Lu, Meng-Ping Wu. Self-effi cacy, professional commitment, and job satisfaction of diabetic medical care personnel. 2012; 43(1): 38–46.
  32. Teng C, Dai Y, Shyu YL, Wong MK, Chu TL, Tsai YH.  Professional Commitment , Patient Safety , and Patient-Perceived Care Quality. J Nurs Scholarsh. 2009; 41(3):301-309. DOI: 10.1111/j.1547-5069.2009.01289.x
  33. Mahmoud AlHussami. Predictors of nurses ’ commitment to health care organisations. Australian Journal Of Advanced Nursing. 26(4):36–48.
  34. Health W, Hsu H, Wang P, Lin L, Shih W, Lin MH. Exploring the Relationship Between Professional Commitment and Job Satisfaction Among Nurses. Workplace Health Saf. 2015; 63(9): 392-398. DOI: 10.1177/2165079915591400
  35. Eskandari M, Ali M, Gorji H. Can work-related stress and job satisfaction affect job commitment among nurses ? A cross-sectional study [ version 1 ; referees : 1 approved with reservations ]. Floo Res. 2018; (7):1–8. DOI: 10.12688/f1000research.12595.1
  36. Satoh M, Watanabe I, Asakura K. Factors Related to Affective Occupational Commitment among Japanese Nurses. Open J Nurs. 2017; 7(2): 449–462. DOI10.4236/ojn.2017.73035
  37. Caricati L, Sala RL, Marletta G, Pelosi G, Ampollini M, Fabbri A, et al. Work climate , work values and professional commitment as predictors of job satisfaction in nurses. J Nurs Manag. 2014; 22(8):984-994. DOI: 10.1111/jonm.12079
 
Listing : ICMJE   

Creative Commons License Open Access by Symbiosis is licensed under a Creative Commons Attribution 3.0 Unported License