Abstract
Abstract
Background
Organizational commitment and the nursing practice environment are interdependent determinants of workforce stability, yet few studies test this relationship with mixed-methods evidence in Saudi Arabia’s cluster-hospital structure. This study set out to characterize organizational commitment and the nursing work environment at Makkah Cluster Hospitals, to test whether the work environment predicts each commitment component independent of sociodemographic characteristics, and to examine nurse managers’ perceptions of these constructs.
Methods
A mixed-methods design was used. In the quantitative phase, 259 nurses completed an anonymous survey using the Organizational Commitment Questionnaire (OCQ) and the Practice Environment Scale of the Nursing Work Index (PES-NWI). Gender, marital status, education, age, and PES-NWI score were entered into three multiple linear regression models, one per commitment subscale. Twenty nurse managers were then interviewed and the transcripts were analyzed thematically.
Results
Commitment was moderate-to-high overall (M = 4.20, SD = 0.66), led by affective commitment (M = 4.45), then normative (M = 4.17) and continuance commitment (M = 3.99). The work environment was rated moderately favorable (M = 3.60, SD = 1.00). All three regression models were significant (R² = 0.155–0.264, p < 0.001); the work environment alone predicted affective (β = 0.379), continuance (β = 0.425), and normative commitment (β = 0.499, largest effect), with no sociodemographic predictor significant. Four qualitative themes — leadership, fairness, resourcing, and communication — mirrored this pattern, tying loyalty to conditions rather than to traits.
Conclusions
The work environment was the sole significant predictor of all three commitment dimensions, strongest for normative commitment, and was corroborated by nurse managers’ accounts. These findings indicate that modifiable workplace conditions, rather than demographic characteristics, may offer the more informative targets for organizational efforts intended to support nurses’ commitment in cluster-hospital settings.