This study aimed to identify the effects of JE in clinical nurses and that of PNOC on WE. Moreover, the study aimed to provide basic data to develop measures to improve WE in clinical nurses.
In this study, the average WE was 2.94 points out of 6 points, which was less than half the maximum possible score. In a study of general hospital nurses in Korea (25) that used the same scale, the score was 3.08. Additionally, it was 4.60 in a study with Spanish nurses (26), and 4.40 in a study with Egyptian nurses (27). Although a direct comparison is difficult, Korean nurses were observed to have a relatively low WE compared to nurses in other countries. WE increased with age and clinical experience, similar to the results of previous studies (19). In WE, higher age and clinical experience is associated with higher knowledge and experience of nursing, resulting in higher skill levels. As these experienced nurses can flexibly cope with various situations in the hospital, they may find pleasure in the work itself and become immersed in it (28). Therefore, the policies and systems for career development should be reorganized so that nurses can inspire WE to create a working environment to induce long-term employment. Moreover, higher health levels were associated with higher WE. Lower health levels may result in greater physical and mental burden of patient care (29). Therefore, it is necessary to create an autonomous working environment and provide healthcare support to nurses.
In this study, the average score for JE was 3.79 out of five points. However, the scale used for JE was relatively new and was only developed in 2020 for nurses. Therefore, few studies have used the scale, and therefore making comparisons is difficult. In the subdomains of JE, the average score of the role and professionalism of caring was the highest, and the average score of respect and recognition of the organization were the lowest. Thus, there is a gap between nurses who have a high value for their work and expertise but a low level of feeling that they are respected by the hospital organization. Nurses working in clinics experience difficulties communicating with various departments and confusion about their roles and identities during periods of excessive work, and therefore, they do not feel valued at their jobs which results in negative sentiments of the value and expertise of their work (30). Nurses feel rewarded and proud when they are provided an environment where they can demonstrate their abilities and expand their skills while applying their professional knowledge to various situations. Hospitals should identify factors that hinder nurses’ JE and develop interventions for them. Moreover, the study highlights the need for measures to promote JE in nurse education.
JE had a direct impact on WE, and WE was observed to increase when nurses themselves considered rewards and self-worth important in their jobs and evaluated them highly. These results are similar to the that of a study that reported higher intrinsic value of evaluating one’s work as unique and altruistic was associated with higher WE (31). Saks (32) reported that nurses worked enthusiastically when their work was considered necessary in the organization and recognized by others. Praise and acknowledgement for their abilities in the organization affected their immersion and satisfaction in the organization (33). Therefore, confirming the positive evaluation or expectation level of nurses for their jobs is important (11, 14).
In this study, PNOC had a mediating role on the effect of JE on WE. Thus, higher JE was associated with higher WE. Additionally, WE was reported to further improve as nurses’ JE was weighted by PNOC. Direct comparison with previous studies is difficult, as there are no similar studies. However, a previous study reported that perceived organizational support has a positive effect on self-esteem and professional benefit (34). Furthermore, PNOC was observed to influence WE (35) by understanding and predicting each other’s behaviour through active mutual exchanges among members. However, another study with a different order of variables (36) reported that self-esteem mediates perceived organizational support and affects the intention to remain.
In this study, PNOC had a positive moderating effect of JE on WE, however, this was not statistically significant. As shown in Fig. 1, as JE increases, WE increases, and the slope is the same. Furthermore, Yu et al. (37) reported a positive moderating effect on subjective well-being between self-esteem and perceived organizational support, and that people with high self-esteem had a larger slope toward subjective well-being. Kim et al. (38) reported that organizational justice had a positive moderating effect on self-efficacy and nursing performance. In the case of high organizational justice and self-efficacy, nursing performance increased rapidly compared to the group with low self-efficacy, consistent with the findings of this study. However, there was a difference in the results of Kim et al.’s study and this study which may be due to the different components of the concepts of JE and self-esteem. Self-esteem includes feeling the value assigned to oneself, self-acceptance, including one’s mistakes, and ability to cope with situations (39), and is the result of a subjective self-evaluation (40). Since the social structure is associated with self-esteem (41), self-esteem is based on one’s expectations to take certain actions within a family or organization and feedback from the other person about oneself. Therefore, a person with high self-esteem desires to be recognized by others, resulting in an interaction effect with PNOC. JE is based on social trust and respect, and the social image of the job, social reliability of the job, and extrinsic values all together become the driving force for maintaining the job (11). Thus, the value of an individual's ability can interact with PNOC, however, JE, which includes the social perception of the job that an individual feels, does not have an interaction effect with PNOC. Thus, this study revealed that PNOC had a mediating effect on JE, but no moderating effect. Therefore, an individual's self-assessed beliefs and values about their job improve WE through organizational leadership and trust-based organizational relationships. However, it does not change the social image of the job, social trust, or extrinsic value.
In this study, the average PNOC score was 3.54 points out of 5 points. Moreover, trust-based organizational relationships had the highest score at 3.72 points compared to other areas. In previous studies, relation-oriented culture (42), a sub-domain of nursing organizational culture, had a similar result with 3.68 points out of 5 points. Understanding and empathic relationships based on trust act as positive factors that can flexibly solve problems, even during conflict (18). A fair management system had the lowest PNOC score with 3.30 points. Unfairness in an organization affects trust, and the consequent damage to trust leads to negative behaviour in the organization (43). Thus, fair distribution and procedures result in a perception of being rewarded for one’s efforts, influencing the behaviour of members and the organization’s behaviour. Therefore, to improve nurses' perception of fair treatment, nursing managers need to provide general nurses with opportunities to participate in decision-making and provide their opinions through proper communication to be actively reflected on. In addition, hospital organizations need to establish a fair and consistent evaluation system for determining compensation, personnel evaluation, and promotion.
This study has several limitations. First, since the participants were limited to nurses from two hospitals in the same region, the results of the study could vary depending on the size and specialty of the hospital, which limits generalization. Second, nurses in management positions were excluded. Therefore, the average clinical experience was 5.54 years, which is a low level of experience, making it difficult to represent all nurses. Third, the research period was more than two years after the start of the COVID-19 pandemic in 2020, and many nurses were exhausted; therefore, it is difficult to generalize the results to other periods. Despite these limitations, nurses fulfilled their duties despite the threat of COVID-19 infection, which was motivated by JE (44). Moreover, studies on JE are almost non-existent. Therefore, it is important to study the relationship between JE, PNOC, and WE.
Based on this study, we suggest the following: First, since JE influences WE, a plan to promote JE is needed. JE is based on choosing a job and learning. Therefore, it is necessary to develop education programs that recognize the importance and necessity of JE, starting with student education. In hospitals, identifying the factors that hinder JE and managing their mediating factors, is important. Second, as PNOC had a mediating effect between JE and WE, providing a positive nurses’ organizational culture is important. Nurses can easily burn out in a negative organizational culture during shift work and heavy workloads. Therefore, it is necessary to facilitate development of trust between colleagues, provide positive leadership, and strive to provide fair compensation. Third, PNOC did not have a moderating effect on JE and WE, however, a policy that can increase social trust and extrinsic value of JE nurses is needed.