Relationships between organizational commitments , supervisory support and job satisfaction of nurses in a public specialized hospital , Bangladesh

Objective: The descriptive correlational study aimed to examine the relationships between organizational commitment, supervisory support, and job satisfaction in a public specialized hospital in Bangladesh. Method: Data were collected by using self-administered questionnaires from the random samples of 126 nurses. The questionnaires included organizational commitment questionnaire, supervisory support questionnaire and job satisfaction Survey. The validity of questionnaires was checked by five experts. The validity of the questionnaires on organizational commitment, supervisory support, and job satisfaction were 0.91, 0.85, and 0.89, respectively. The Cronbach’s alpha coefficient of the questionnaires were 0.85, 0.85, and 0.82, respectively. Data were analyzed by using descriptive statistics and Pearson’s product moment correlation statistics. Results: The result of the study showed that nurses perceived a moderate level of organizational commitment (M = 3.57, SD = 0.48), supervisory support (M = 3.9, SD = 0.48), and job satisfaction (M = 4.06, SD = 0.51). There was a moderate positive significant correlation between organizational commitment and job satisfaction (r = 0.32, p < 0.01) and moderate positive significant correlation between supervisory support and job satisfaction (r = 0.26, p < 0.01). Conclusion: The results of this study are helpful for nurse administrator to enhance job satisfaction in context of organizational commitment and supervisory support. Nurse administrator can apply study result to improve nursing knowledge in different aspect of their profession. It might be helpful to enhance the nurse’s job satisfaction in Bangladesh.


Introduction
Job satisfaction has an important role to an employee in terms of health and wellbeing.It is human behavior and nurses are interested to work in the organization where they focus on peaceful behavior to the patient.Job satisfaction in nursing provides a supportive work environment, and health care facility to achieve better outcomes for nurses, patients, and organizations 1 .According to the International Council of Nurse [ICN] the shortage of nursing staff is the problem in the global scale from the past to the present 2 .It was stated that thirty seven percent of nurses reported that they felt ready to change jobs 3 .Nurses need to fulfill the high demand of public expectation with shortage of nursing staffs.These problems may affect job satisfaction of nurses.Job satisfaction of nurses is the vital elements of health care organization and it identifies extreme indicators of nurses' performance, motivation of work, and quality of care 4 .Hospitals with high job satisfaction scores have been reported to have high quality of care and favorable patient outcomes 5 .Nurses' job satisfaction and quality nursing care might involve interpersonal relationship with nurses' and influence on nursing practice environment 6 .Organizational commitment and supervisory supports play an important role for management Bangladesh Journal of Medical Science Vol. 15 No. 01 January '16.Page : 39-43  of hospital and it is excellent factors to hospitals due to the critical role that employees play in the provision of healthcare services 7 .It influences on staff behavior and it is the important factors that influence improvement of manager's performance 8 .Organizational commitment is one of the most important and crucial outcome of human resource strategies and employee commitment 9 .It maximizes the efficiency and the productivity of both the employees and the organization, which ultimately contribute to the effective functioning of hospital.Nurse supervisor have an important role through enhancing nurse's knowledge and skill to perform new nursing procedures, managing patients in clinical condition, providing quality patient care, and making decision in emergency situation.Nurse supervisors are responsible to provide supervision of nurses and ensure nurse's performances during their routine work and advise them to do better job 10 .Supervisory support provides administrative support and good characteristics of administrator such as attainable, helpful, supportive, caring, flexible, knowledgeable, experienced, and understanding of daily activities 11 .In Bangladesh, nurses work in government and nongovernment hospital.Job dissatisfaction is a serious problem in nursing profession in Bangladesh 12 .Nurses feel high work load, lower payment, less social security, lack of respect, lack of career paths, lack of promotional opportunities, inadequate supervision, work environment, and less use of informational technology in hospital 13 .Nurses have to do clerical rather than clinical work and may be poorly supervised.There is also the issue of nurse's low morale in Bangladesh 1213 .Higher nurse patient ratios often lead to decrease job satisfaction.There is only one National Ophthalmology Institute and Hospital in Bangladesh.The hospital situated in capital city of Bangladesh which provides referral and tertiary level of care.Based on above situations, the demand of public health care rapidly increased due to evolving disease complexity and increase public health care expectations compared to other general hospital.Finally, from the literature reviews, the problematic situation of nurses in Bangladesh and the inadequate nursing knowledge about job satisfaction of nurses.So the researcher would like to study about organizational commitment, supervisory support, and job satisfaction of nurses in specialized hospital in Bangladesh.It would be helpful to improve quality nursing practice, positive work attitude which enhances job satisfaction in relation to organizational commitment and supervisory support.

Materials and methods
The descriptive correlational study design was used to explore level and relationship between organizational commitment, supervisory support, and job satisfaction of nurses in public specialized hospital at Dhaka in Bangladesh.The population of the study was nurses who were working in National Institute of Ophthalmology and Hospital (NIO&H) in Dhaka, Bangladesh from April to May in 2014.Total 126 nurses were selected by using simple random sampling technique.The sample size was estimated by using theory and table of power analysis.The estimated sample size was calculated for an accepted minimum level of significance ( α ) of < .05,an expected power (1-β) of 0.80, and an estimated population effect size of 0.25 (ᵞ) 14 .The researcher considers using the small effect size (ᵞ) at .25, requiring a sample size of 126 nurses.It was also stated that when there is no relevant earlier finding, the researcher use conventions based on expectations of a small sample size 14 .In this study, the questionnaires contain four sections including Nurses' Demographic information Questionnaire, Job satisfaction Survey, Organizational Commitment Questionnaire, and Perception of Supervisory Support scale.The demographic information questionnaires developed by researcher.Researcher used to modify job satisfaction survey 15 to measure job satisfaction of nurses.The job satisfaction survey contains nine components and thirty six questionnaires.A summated rating scale used, with six choices per item ranging from strongly agree to strongly disagree.The organizational commitment questionnaires used by modified Meyer & Allen's Organizational Commitment Questionnaire 16 .The three components and twelve questionnaires were used.The questionnaires used five point of Likert scales to determine the commitment of participants in the hospital.The perception of Supervisory Support Scale 17 modified and used in this study to assess nurse perception of supervisory support in the hospital.It is based on a 5-point Likert scale ranging from 5 (strongly agree) to 1 (strongly disagree).The Content Validity Index (CVI) was performed by five experts were examined validity of questionnaires.
The five experts was nurse educator and experienced researcher from Faculty of Nursing, Burapha University, Thailand were examined Content Validity Index (CVI).The reliability of the instrument was examined through pilot study with 30 nurses in National Institute of Traumatology, Orthopaedic, and Rehabilitation (NITOR), Dhaka.The Cronbach's alpha coefficient value yielded from pilot study of job satisfaction (.85), organizational commitment (.85), and supervisory support (.82).Prior data collection, a written approval letter for data collection was obtained from the International Review Board (IRB), the Faculty of Nursing, Burapha University, Thailand.Permissions from the Director and Nursing Superintend of selected hospital (National Institute of Ophthalmology & Hospital) were granted.Following the completion of these formalities, eligible subjects were informed about the purposes and methods of study by providing a letter of explanation and invitation.To ensure the anonymity and confidentiality of the responses, no names attached to survey; instead their responses were coded so that had not been identified.Respondents were informed that participation of the study is voluntary and no remuneration for participation would be given.The return of the questionnaires had been considered implied consent to the participation in the study.They were informed that their responses are been kept confidential and only be used for the purposes of this study.The respondents were also assured that only the overall results were presented with the nursing administrators for the purposes of designing the needed the managerial interventions.Respondents were asked to places the completed questionnaire in the closed envelope provided and return to the nursing superintendent.Absolute confidentiality was censured by nurses returning their questionnaire to the nursing superintend anonymously.Data were analyzed by using statistical software.The alpha level for significance was set at .05;Data analysis was divided into two major sections: a) Descriptive statistics was used for frequency, percentage, mean, standard deviation, and range.b) Pearson's product-moment correlation coefficient (r) was used to examine the relationships between the organizational commitment, supervisory support, and job satisfaction.

Results
The demographic information of 126 subjects showed that more than fifty percent of subjects aged between 35 -45 years (53.17%).%), with the average age of 43.33 year.The largest portion of the subjects were female (97.62%) and married (92.06%).It was found that two-third of the subjects (65.87%) were Muslim.Most of them had diploma in nursing degree (68.25%), majority of the subjects had 11 -20 years of working experience in nursing (46.03%).Most of the subjects had monthly salary between 18,001 -24,000 Taka (40.46%) and had monthly salary higher than (24,001 TK 41.27%).The results of the study are the level of nurses job satisfaction (M = 4.06, SD = .51).Nurses were also reported that high satisfaction with the nature of work (M = 5.37, SD = .56)and supervision (M = 5.21, SD = .79).Nurses were revealed that low satisfaction with promotion (M = 2.72, SD = .73)and others dimension were moderate level.The study findings revealed that nurse's have moderate level of organizational commitment (M = 3.57, SD = .48).And nurses also reported that moderate level commitment of each dimension including affective (M = 4.48, SD = .46),continuance (M = 3.20, SD = .78),and normative commitment (M = 3.01, SD = =.72).The results of the study are that nurses have moderate level of supervisory support (M = 3.91, SD = .48)and nurses have also reported that emotional support high level (M = 4.69, SD = .47),support for client goal (M = 3.83, SD = .58)and professional developmental support (M = 3.20, SD = .74)were moderate level.The study result also revealed that organizational commitment had significant, moderate, and positive relationship with job satisfaction (r = .32,p < .01).Supervisory support and job satisfaction also had significant, moderate, and positive relationship (r = .26,p < .01).

Discussion of the study findings
The findings of the study are discussed in two sections.The level of organizational commitment, supervisory support, and job satisfaction are discussed first.Second, relationships between organizational commitment, supervisory support, and job satisfaction are discussed.

Level of organizational commitment, supervisory support, and job satisfaction
The findings of the study revealed that moderate level of organizational commitment.This means that their degree of loyalty to their hospitals is strong, they would happy to spend their time during working time in the hospital.The findings indicated that each aspect of organizational commitment to nurse's feeling of obligation to remain in the organization 16 .In this study, most of the participants' were female and married.Most of the nurse's age in this study in were above 35 years (90%) and had working experience more than 10 years (86%).It is the most productive time in service life.In this study, results reveal moderate level of supervisory support and it contains three dimension including higher level of emotional support, and moderate level of support for client goal achievement, and professional developmental support.Support for client goal achievement is the moderate level because of nurses (80%) gain new perspective on patient, recognize, and compare, clarity of patient's goal.Moderate level of professional developmental support because of nurses (75%) supported that supervisor discussed positively, their carrier development, and give feedback about their performance.Hospital provides modern training and uses modern equipment to promote dignity in care which enhances higher level of emotional support.So, nurses are enthusiastically obeying their rule and maintain dignity of services.The result of the study supports the previous studies that found 18 moderate level of nurses' supervisory support in the hospital.The findings revealed that moderate level of overall job satisfaction.The study findings congruent with other studies which found that nurses typically have moderate level of job satisfaction and it can be considered a good point at this moment in contrasts to previous studies 19 .In previous study, found that 63% nurse is low level of job satisfaction at one government and non-government hospital 20 .Most of the participants were female (97.62%), married (94.44%), and Muslim (65.87%).Several studies have found that women to be more satisfied than men, single women have less satisfied than married women 21 .Regarding overall moderate level of nurses' job satisfaction may have several reason including Muslims have religious restriction especially female person to touch other person, low social nursing and cultural 22 .

Relationship between organizational commitment, supervisory support, and job satisfaction
The result showed that total organizational commitment had moderate significantly positive relationship with nurse's job satisfaction.This result supports with the study hypothesis and rationale.The findings of the study are congruent with previous studies and support conceptual framework in this study.Previous research has found organizational commitment to be positively related to job satisfaction 23 .Job satisfaction has a comprehensive phenomenon with multiple factors, including pay, satisfaction, promotional opportunity, supervision, organizational commitment, work environment, training and relationship with job satisfaction 24 .The results from the study indicated organizational commitment may be causes of the longer the employees stay with an organization the more time they have to understand the organization and their relationship with it 25 .The result of this study revealed that supervisory support had moderate and significant positive relationship with job satisfaction.The results supported with the previous study, hypothesis, rationale, and conceptual framework in the study.Many researchers stated that supervisory support had a direct relationship with all employee outcomes includes job satisfaction, family satisfaction, and life satisfaction 262728 .Supervision is the component of job satisfaction and supervisory support is the relationship with job satisfaction.It was found that job satisfaction increases when employees get a positive support from supervisor.It has also observed the positive relationship among supervisory support and job satisfaction 29 .Conclusion The study result indicated that a positive relationship between organizational commitment and supervisory support were associated with job satisfaction in nurses.Job satisfaction of nursing is important to both health care providers and patients.The outcomes of this study will contribute to nursing education, nursing practice, nursing administration, and future nursing research in Bangladesh.Acknowledgement I would like to acknowledge to the Director of the Nursing services under the Ministry of Health and Family welfare, the Government of the people's republic of Bangladesh who gave me scholarship to study on the master in nursing science program.