Open access peer-reviewed chapter

Hospital Ethical Climate and Its Influence on Clinical Nurses’ Perception on Their Organizational Citizenship Performance

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Teketel Ermias Geltore

Submitted: 30 June 2022 Reviewed: 25 August 2022 Published: 11 July 2023

DOI: 10.5772/intechopen.107384

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Frontiers in Clinical Trials

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Healthcare development mainly depends on nurses’ activities, since nurses often take much time in contacting patients during clinical activities. Their awareness of the hospital’s moral climate disturbs nurses’ attitudes and associated ethical concerns. Hospital ethical climates have become a crucial working area element for nurses to prepare and apply ethical judgments. The ethical climate is one feature of an institution that denotes the collective insights of morally correct activities and techniques of handling ethically varied conduct. Better consciousness of the difficulty of ethical problems in the health facility situation has powered attention to nursing ethics. Yet, there is insufficient data on the connection between nurses’ awareness of the ethical climate worldwide. Hospital ethical climate has been studied in several industrial countries for decades but has only been investigated in some developing countries in the past two decades. In general, the chapter explained the perception of nurses and correlation between hospital ethical climate and job satisfaction, and dimensions of job design.


  • ethical climates
  • nurses
  • ethics
  • hospital
  • nursing
  • profession

1. Introduction

Nurses making the biggest group of experts in the healthcare delivery system, who communicate broadly with patients. They are well-thought-out and a backbone of the healthcare system in terms of provision of the quality of services to patients. Thus, it is significant for nurses to have a great sense of welfare and success in the face of recent encounters and difficulties [1, 2].

Employees are the fundamental asset of health-care facilities. Nurses are the chief human resources in healthcare organizations, who play a pivotal role in providing unceasing great quality care [3]. Ethical climate denotes the collective views of ethically correct conduct and way of treating ethically deviated actions [4]. Organizational climate is defined as the recurring patterns of behavior and feelings that describe life in the organization that is more linked to atmosphere and values [5, 6].

Every day, when nurses perform their daily activities, they face different types of problems and issues that might be unpredictable with their perceptions. Due to clinical diagnosis and treatments, nurses have repeated ethical concerns with patients, attendants, and other staffs. For instance, because the staff number of nurses is inconsistent with the needs of patients, thus then, the nurses who should provide broad services for patients can only address limited treatment tasks that are ordered by the physicians, consequently, this results in ethical problems. They also suffer from physical illness, mental disorder, and emotional exhaustion [7, 8, 9, 10, 11, 12, 13, 14, 15].

Moreover, nurses might encounter numerous ambiguous beliefs that might affect provision of quality of care [16, 17, 18, 19]. Scarcity of medical equipment and complex clinical problems in the therapeutic system has directed an increment in the ethical difficulties encountered by nurses. In addition, sometimes ethical issues arise when procedures are performed without informed consent from the patient, during this time nurses will be exposed to internal as well as external controls to reply to the desires of patients [20, 21].

Furthermore, advance in technology, greater improvement in management and intervention, reduced hospitalization capacity, and an increase of awareness in patients about their rights have led to focus on an improved ethical climate [22]. Organizational citizenship manners are both social and psychological activity, which is favorable to sustaining and improving the quality of care [23, 24, 25].

Nursing activities are associated with organizational work climate in various angles. Within the hospital setting, the nurses’ activities are documented as an integral component in the provision of quality health care and it is very important in terms of individual choices, such as promotion and retention [26]. Performance is the process of assessing how well employees accomplish their tasks as per a set of standards and providing that evidence to responsible bodies, and nurses’ performance is defined as how well the task is performed in line with a set norm. It denotes the forthcoming possibility to carry out certain actions in order to fruitfully attain set goals within the given time frame and constraints of the stakeholders [27, 28, 29]. Structural citizenship manners comprise a group of professional conducts, which are not a portion of the character’s proper responsibilities. It is done by the employees lacking the formal development system of the institute. Yet, it points to effective and improved fulfillment of organizational roles and responsibilities [30].

Moral philosophy with core values is very vital for nurses while they provide services, including the consideration of the patient’s wants, needs, and preferences. Therefore, nursing has been considered to be an ethical-laden practice [31, 32]. Moral sensitivity is the ability to become aware of patients’ vulnerability and recognize ethical conflicts. Thus, it is considered the first step in ethical decision-making [33, 34, 35, 36, 37, 38]. The aim of this chapter is to provide information on hospital ethical climate and its influence on clinical nurses’ perception on their organizational citizenship performance. This chapter recognized the ethical climate and job satisfaction among clinical nurses and dimensions of job design.


2. Ethical climate and job satisfaction among clinical nurses

According to the studies conducted in different countries, job satisfaction is a complex and multidimensional thought which denotes an internal state of mind of an individual. The level of job happiness is determined by the difference between what a person adds to his or her job and what he or she anticipates [39, 40]. The finding of different studies showed that ethical standards in an organization encourage esteem among the staff members and make them more motived and committed to their performance, which results in job satisfaction and organizational success. In addition, it produces a sense of possession and diminishes loneliness in employees, which increases the accomplishment of the organization [20, 41, 42, 43, 44, 45, 46, 47].

The study results showed that job satisfaction of employees leads to several positive behavioral outcomes at work. Like, it brings about productive work behavior, enables employees to satisfy customers/patients, and creates customer experience at work. Furthermore, the concept of satisfaction for healthcare employees has been described as a positive feeling of contentment that individuals obtain from their job while working for a corporate organization. The importance of job satisfaction of nurses on patients’ provision of care, patient satisfaction, patient result, and overall healthcare provision cannot be over-underlined, as employee’s job satisfaction is critical in the day-to-day lifecycle of the employees. It has been well-known that low job satisfaction is the chief source of employee turnover among healthcare service workers [48, 49]. Proposed that job satisfaction is an employee’s feeling about his or her work environment, which includes the job itself, supervisor, workgroup, organization, and life [50, 51].

On the other hand, poor job satisfaction and improper ethical climate are factors that promote understaffed wards, loss of motivation, and increase nurses’ turnover [41, 52, 53]. A study conducted in Ethiopia showed that more than half of nurses responded that they were not satisfied with their jobs [54]. According to the study done in Iran, the result revealed that nurses’ perception of ethical climate and job satisfaction in hospital was at a moderate level [41].

The study finding showed that improved nurses’ perception of the hospital’s ethical climates could enhance their organizational citizenship behavior and at the same time it has a critical role in promoting job satisfaction and organizational commitment of nurses [42, 55]. Provided that place of work concerns remains to be seen as a major cause of the healthcare shortage it is clear that a positive ethical climate is a significant element of nurses’ job satisfaction [56].

The satisfaction of healthcare workers is seriously affected, especially in developing countries, which is the major justification for turnover intention to foreign countries where they will be appreciated and provided with better working conditions [57].

Studies results revealed that the association between the work environment and job satisfaction across varied background grounds. The idea of the work environment and job satisfaction is to grow with time owing to its impact on the larger society [58, 59, 60, 61]. The main factors that affect job satisfaction and nurses’ assessments of the quality of care provided at the case team level are the practice environment and the availability of adequate resources [22, 62, 63].

Positive climate in hospitals may decline moods of being alone and it has a positive impact on output and patient satisfaction. A positive ethical climate improves job satisfaction, decreasing turnover, and nursing shortages [64, 65]. Satisfied nurses tend to be more fruitful and dedicated to their employers, and a direct correlation has been shown between staff satisfaction and patient satisfaction in health-care organizations [66, 67].

Self-worth has been recognized as a defensive factor alongside psychological suffering among nurses, and is positively correlated with nurses’ well-being and is related to job satisfaction through both direct and indirect effects [9, 10, 11, 12].


3. Dimensions of job design

Hackman and Oldham, suggest five dimensions of job design that influence on psychology mechanisms that profit employees and job results. It takes into consideration employees different sights as curbing factors of association between job features and job outcome factors [67]. In this regard, they established the five job characteristics as follows:

3.1 Skill variety

This explains the extent to which a job demands various skills, ability and capacity from an individual employee in achieving a set task. This is said to drive employee satisfaction when an employee has the necessary skills to perform a certain task and opportunity for training where there is a deficiency of required skills.

3.2 Task identity

It describes the aspect in which job demands realizing complete and identifying the part of the job task that will help in accomplishing the work from beginning to the end with a visible, marked, and positive outcome. This also is said to motivate employees and gear them to be happy on the job.

3.3 Task significance

This emphasizes the extent to which a job has a cogent influence on the well-being of other employees, or how it affects other employees, within and outside the firm. In other words, employees’ understanding of several other individuals who depend on the work they are performing is a crucial point in their satisfaction.

3.4 Job autonomy

This describes the degree of independent judgment to make informed decisions and discretion regarding the assigned task given to individual employees. In other words, the liberty to expand on the job and responsibilities is given to the employees to perform their duties and functions effectively. Autonomy in the workplace provides employees with a sense of job ownership and makes them feel in charge of the work, which largely steers up the satisfaction in an individual employee.

3.5 Job feedback

It explains a process by which reporting managers, superiors, and peers at work offer constructive suggestions to employees on the assigned task, which allows improvement and possible enhanced productive work behavior. According to the theorist, this stimulates the dedication of employees and makes them happy on the job (Figure 1).

Figure 1.

Job characteristics model.


4. Conclusion

As the major motor in the change of health-care system, nurses have more interaction time with patients in day-to-day clinical activities.

Hospital ethical climates have become a crucial working area element for nurses to prepare and apply ethical judgments.

Health-care professionals have a cluster of principles and attitudes that consist of acknowledgments, feelings, and actions, which are a reflection of one’s professional values.

Effective nurses’ nature is a positive professional attitude and professional values.

Job satisfaction is indispensable in the daily life of the workforce, and the mechanism that drives job satisfaction requires the attention of the management of corporate organizations.


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Written By

Teketel Ermias Geltore

Submitted: 30 June 2022 Reviewed: 25 August 2022 Published: 11 July 2023