DOI: 10.1111/nuf.

12260

ORIGINAL ARTICLE

Perceptions of organizational support and its impact on nurses’

job outcomes
Leodoro J. Labrague DM, RN1 Denise M. McEnroe Petitte PhD, RN2
Michael C. Leocadio DNM, RN3 Peter Van Bogaert PhD, RN4
Konstantinos Tsaras PhD, RN5

1 Sultan Qaboos University, Muscat, Oman

2 Kent State University, Tuscarawas, OH, USA

Abstract
3 Emilio Aguinaldo College, Manila, Philippines
Problem: Strong organizational support can promote a sense of well-being and positive work

4 University of Antwerp, Antwerp, Belgium

behaviors in nurses. However, despite the importance of organizational support in nursing, this

5 Technological Educational Institutes of Thes-

topic remains unexplored in the Philippines.
saly, Thessaly, Greece Purpose: The aim of this study was to examine the impact of organizational support perceptions
Correspondence on nurses’ work outcomes (organizational commitment, work autonomy, work performance, job
Leodoro J. Labrague, DM, RN, Al Khoudh,
satisfaction, job stress, and turnover intention).
Muscat, Oman.
Email: Leo7_ci@yahoo.com Methods: A descriptive, cross-sectional research design was adopted in this study to collect data
from one hundred eighty (180) nurses in the Philippines during the months of September 2015 to
December 2015. Seven standardized tools were used: the Job Satisfaction Index, the Job Stress
Scale, the Burnout Measure Scale, the Work Autonomy Scale, the Six Dimension Scale of Nurs-
ing Performance, the Turnover Intention Inventory Scale, and the Perception of Organizational
Support Scale.

Findings: Nurses employed in government-owned hospitals perceived low levels of organizational

support as compared to private hospitals. Significant correlations were identified between per-
ceived organizational support (POS), hospital bed capacity, and nurses’ work status. No signifi-
cant correlations were found between perceived organizational supportand the six outcomes per-
ceived by nurses in the Philippines (organizational commitment, work performance, job autonomy,
job satisfaction, job stress, and turnover intention).

Conclusion: Perceptions of organizational support were low in Filipino nurses compared to find-
ings in other international studies. Perceived organizational support did not influence job out-
comes in nurses.

KEYWORDS
job satisfaction, job stress, nurses, organizational commitment, organizational support, the Philip-
pines, turnover intention, work autonomy, work performance

1 INTRODUCTION and eventually their productivity.5,6 Nurses’ turnover is costly for

the organization as it entails additional costs for temporary overtime,
The continuing trends in the nursing shortage around the world orientation and training for new staff, recruitment, advertising, and
pose a threat on the quality of patient care services. This prob- hiring.3,4 The approximation of turnover costs ranges from $20,561
lem is further aggravated by the continuous turnover in nurses (USA) up to $48,790 (Australia) per nurse turnover.7 As a valuable
in many countries. It is estimated that as high as 68% of nurses asset in any healthcare institution, organizational efforts must be
reported leaving their hospital workplace.1,2 High turnover in nurses made to keep nurses and maintain a skilled and seasoned nursing
is attributed to high incidence of medical errors, adverse patient workforce.
events and errors, and low quality of patient care.3,4 It also affects The quality of the work environment plays an important role in
the morale of the remaining staff, reduces their motivation to work, explaining turnover and dissatisfaction in nurses through adequate

Nurs Forum. 2018;1–8. wileyonlinelibrary.com/journal/nuf 

c 2018 Wiley Periodicals, Inc. 1
2 LABRAGUE ET AL .

staffing, positive working relationships, higher job autonomy, and ade- 3 NURSING SITUATION
quate organizational support services.8–10 Critical in creating a work IN THE PHILIPPINES
environment for nurses is a strong nursing and hospital leadership that
supports daily professional practice and well-being of nurses. The Philippines is considered a top global source of nurses30,31 with
about 90% of the Philippine nurses working abroad32 such as in the
United States of America, United Kingdom, Saudi Arabia, Australia, and
2 REVIEW OF LITERATURE New Zealand. A number of factors have driven this trend. Nurses in a
recent study of Castro-Palaganas et al.33 cited dismal working condi-
Perceived Organizational Support (POS) is broadly defined as the tions and limited career opportunities as major factors in the migration
extent to which the organization values, respects, and cares for the decision in nurses. This situation is further exacerbated by a poor work-
employees’ well-being in addition to their contributions and services ing environment which predisposes them to develop burnout.34 Other
which extend into the organization. Perceived organizational sup- factors include such concerns as low salaries, lack of a benefit pack-
port manifests itself in various ways such as fair or equal treatment, age, high patient–nurse ratios, lack of opportunities and professional
adequate supervisor support, and opportunities for organizational growth, and poor enforcement of nursing laws.30,35,36 All these fac-
rewards and supportive work conditions.11–13 tors are known antecedents of POS.12,13 Even with these known issues,
Burgeoning evidence has demonstrated the positive impact orga- the profession is still struggling to push for legislative and executive
nizational support has on nurses’ work outcomes.12 A supportive actions. There are 200,000 unemployed nurses in the country and yet
and empowering work environment impacts a sense of support and those who work in government and private hospitals are overworked
satisfaction at work in Canadian middle level nurse managers.14 In and underpaid.37 Because of the inadequate organizational support,
Italy, strong organizational support had a strong positive impact on in local and national magnitude, Filipino nurses will always experience
nurses’ assessment of competence through affective commitment.15 In burnout, job dissatisfaction and high turnover rate; and unless these
another study, nurses who perceived higher POS for nursing practice problems are not addressed, they will continually leave.33,34 This has
were more likely to report higher levels of job engagement and orga- had adverse consequences on the provision of healthcare services in
nizational citizenship behaviors than those perceiving organizational the Philippines. There is a loss in its experienced and skilled workers
support to be weak.16 Furthermore, a higher level of POS positively which are now being replaced by new and inexperienced nurses while
related to work engagement and organizational citizenship behavior17 there is an increase in the workloads at healthcare facilities. This, in
and contributed to innovative behaviors in nurses (Ko et al., 201518 turn, has had a negative impact on the provision of quality care for
and autonomy.19 A higher POS can therefore increase the intentions patients.32
in the nurse.20,21
Weak POS has been associated with a variety of negative emo-
tional outcomes. Lower levels of POS has been associated to a decline 4 THEORETICAL FRAMEWORK
in nurses’ job satisfaction and higher burnout scores in a group of
nurses working at twenty-three (23) acute hospitals in South Korea.22 This study is anchored on the Organizational Support Theory (OST)
In Jordan, Higazee et al.23 examined the relationship between nurse's of Eisenberger, Huntington, Hutchison and Sowa.38 The theory is one
job stress and organizational support. Nurses were more likely to of the most influential paradigms for understanding organizational
experience stress with when they perceive low concerns and sup- behavior. According to this theory, employees and employers indulge
port from the organization. Conversely, an increased perception of in a high-quality relationship and contribute to each party's well-
organizational support were a significant protective factor against being. When an employee is perceived by their organization to be gen-
burnout among Chinese and Italian nurses.24–26 Furthermore, higher uinely caring, supportive, compassionate, helpful, and has concern for
levels of POS contributed to the employees’ sense of professional self- their well-being, they will reciprocate this by helping the organization
concepts,21,25 sense of belonging,27 and increased their levels of opti- achieve its goals and objectives by being productive, committed, and
mism, hope, and self-efficacy28 which are necessary to improve the efficient.39 Conversely, a work environment that is not supportive and
nurses’ job satisfaction and organizational commitments. highly political may result in highly demotivated, ineffective, and dis-
There is a plethora of evidence around the world linking higher POS satisfied employees.40
to nurses’ job outcomes such as job satisfaction,14 competence,15 job OST emphasizes that employment is an exchange of the effort
engagement,16 innovative behaviors,20,29 intention to stay,20,21 and and commitment of the employees to their employer's tangible bene-
burnout.22 However, it can be noted that there is a paucity of literature fits, social resources and even those intangible aspects such as those
examining organizational support perceptions in nurses in relations absence of emotional and mental exhaustion because of a positive
to job autonomy19 and work commitment.27 Given the pervasiveness working environment (Kurtessis et al., 2015). Aside from the social
and importance of organizational support in the healthcare workplace, nature of the Organizational Support Theory, the capacity of POS
nursing in particular, this phenomenon needs to be examined more to fulfill socio-emotional needs can also lead to self-enhancement—
comprehensively and extensively in order to gauge how much health- an attribute that conveys affiliation, approval, developed self-esteem
care organizations in the country provides support, value, and respects and emotional support—factors that enhances outcomes such as
its nurses as an important entity in the organization. organizational commitment, work autonomy, work performance, job
LABRAGUE ET AL . 3

satisfaction, job stress, and turnover intention.14–16 Therefore, the point Likert-type scale ranging from one (1) meaning strongly disagree
OST was the most suitable framework that links all the variables under to seven (7) meaning strongly agree. The POS has been widely used and
scrutiny through this study. the scale was found to be reliable with a Cronbach's alpha of 0.90 based
on the previous study.16 In the current study, the Cronbach's alpha was
0.88.
5 SIGNIFICANCE AND AIM OF THE STUDY The Organizational Commitment Questionnaire, developed by
Meyer, Allen, and Smith41 was used to measure the nurses’ commit-
With the increasing trend in migration of Filipino nurses aboard, exam-
ment to the organization. The questionnaire is a twenty-three (23)
ination of nurses’ perspective of organizational support and its impact
item scale and was designed primarily to capture the employees’ extent
on their job outcomes may provide a clearer picture of this critical
of perceived attachment and belongingness to the organization. It is
issue and may guide policy makers in formulating sustainable solu-
divided into three (3) dimensions: affective (8 items), continuance (9
tions to improve nurses’ retention. Thus, this study aimed to exam-
items), and normative (6 items). In answering the questionnaire, the
ine the impact of organizational support perceptions on nurses’ work
nurses were asked to rate each OCQ items on the scale on a five (5)
outcomes (organizational commitment, work autonomy, work perfor-
point Likert scale ranging from (1), meaning “strongly disagree” to (5),
mance, job satisfaction, job stress, and turnover intention). Further,
meaning “strongly agree.” The Cronbach's alpha in the current study
the influence of nurses’ individual and organizational characteristics
was 0.91.
on their perceptions of organizational support was identified. In this
Job satisfaction in nurses was assessed using the Job Satisfaction
study, the authors hypothesized that “perceptions of organizational
Index (JSI) developed by Schriesheim and Tsui.42 This tool is a six
support predict work outcomes in nurses.”
(6) item questionnaire designed to measure satisfaction with work in
nurses and contains five (5) satisfaction facets: nature of the work,
supervision, co-workers, pay, and opportunities for promotion. The
6 METHODOLOGY
tool uses a five (5) point Likert scale ranging from one (1) (strongly dis-
agree) to five (5) (strongly agree). The JSI scale was found to be reliable
6.1 Research design
with a Cronbach's alpha of 0.85 based on the previous study.40 In the
This study utilized a descriptive, cross-sectional research design. current study, the Cronbach's alpha was 0.85.
Job stress was examined using the short-form Job Stress Scale43
6.2 Samples and settings This tool was designed to capture the nurses’ experience of distress as
a consequence of their work along with the accompanying psycholog-
Two hundred (200) nurses were recruited to participate in the study
ical and physiological responses. Respondents were asked to indicate
from nine (9) hospitals in Samar Island, the third island of the Philip-
the magnitude to which they agree or disagree with the JSS items on
pines during the months of September 2015 to December 2015. One
a five (5) point Likert scale ranging from one (1), meaning “strongly dis-
hundred eighty (180) responded or a response rate of 90% (response
agree” to five (5), meaning “strongly agree.” The tool was tested for reli-
rate in 9 hospitals ranged from 85% to 100%). The Sloven's formula was
ability and found to be 0.88 as reported previously.40 Cronbach's alpha
used in calculating for the sample size. The required sample size was
in the current study was 0.90.
one hundred sixty (160) based on ±5% with 95% confidence interval. In
Intent to leave was measured using the six (6) item Turnover Inten-
data collection, a two (2) stage sampling procedure was used in recruit-
tion Inventory Scale, a scale tested by Farrell and Rusbult.44 Nurses
ing samples. To determine the number of respondents per hospital,
were asked to rate each item on the scale with a five (5) point Lik-
stratified sampling was employed and a convenience sampling was cho-
ert scale ranging from one (1) “strongly disagree” to five (5) “strongly
sen selecting the respondents per hospital. Respondents were selected
agree”. The scales’ Cronbach's alpha was 0.92 as previously reported.40
based on the following inclusion criteria: (1) a registered nurse, (2)
Cronbach's alpha in the present study was 0.92.
working as hospital nurse, (3) could either be a permanent, casual or
Nurses’ work performance was measured using the Six Dimension
contractual, and (4) consented to participate in the study.
Scale of Nursing Performance.45 This measure consisted of forty-two
(42) items on a five (5) point scale ranging from zero (0) meaning not
6.3 Measures
very well to four (4) meaning very well. The scale is comprised of six
Seven self-reporting scales were used to collect the data: Perceived subscales (52 items): leadership (5 items), critical care (7 items), teach-
Organizational Support (POS), Organizational Commitment Ques- ing and collaboration (11 items), planning and evaluation (7 items),
tionnaire (OCQ), Job Satisfaction Index (JSI), Job Stress Scale (JSS), and interpersonal relations and communication (12 items). The scales’
Turnover Intention Inventory Scale (TIIS), Six Dimension Scale of Cronbach's alpha was 0.95 as previously reported.45 Cronbach's alpha
Nursing Performance (SDSNP), and Work Autonomy Scale (WAS). in the present study was 0.92.
The short version of the Perceived Organizational Support scale To measure the extent to which a job allows the freedom, inde-
was utilized to examine the nurses’ perceptions concerning the degree pendence, and discretions to the work schedules, make decisions and
to which the organization values and cares for their well-being.38 The select the methods used to perform tasks, the researcher utilized the
tool consisted of thirty six (36) items in which nurses were asked to Work Autonomy Scale developed by Breaugh.46 The tool measured
indicate their degree of agreement and disagreement on a seven (7) facets of work autonomy; method autonomy, scheduling autonomy,
4 LABRAGUE ET AL .

and criteria autonomy. The scale consisted of nine (9) items; each work tion (t = 2.036, p = 0.043). Further, no correlations were found between
autonomy facet was represented by three (3) items. The scale was POS and nurse work outcomes such as job satisfaction, job autonomy,
measured on a five (5) point Likert scale (1 = strongly disagree to organizational commitment, turnover intention, job stress, and work
5 = strongly agree). Reliability coefficient was 0.93 as reported in the performance. A multivariate analysis with stepwise linear regression
previous study.46 model was tested to determine significant predictors of POS. Among
the different predictor variables, the adjusted coefficient of the multi-
6.4 Ethical consideration and data collection ple determination (adjusted R2 ) of the statistical model indicated that
3.5% of the POS variance was explained by the hospital bed capacity
Ethical clearance was granted by the Health Ethics Committee of
(𝛽 = 0.064, p = 0.009) (Table 2).
Samar State University (the Philippines). Researchers communicated
To test for the hypothesis “perceptions of organizational support
with the respective hospital directors and chief nurses of the selected
predict work outcomes in nurses,” multiple linear regression analy-
hospitals for permission to conduct the study. After obtaining approval,
ses were done. The regression model showed no statistically signifi-
the researchers asked the consent of the participants and the survey
cant correlations between POS and nurses’ work outcomes such as job
enclosed in a sealed envelope was given to them. Prior to data collec-
satisfaction (𝛽 = -0.167, p = 0.176), organizational commitment (𝛽 =
tion, the researchers informed the participants regarding the research
−0.034, p = 0.491), turnover intention (𝛽 = −0.060, p = 0.139), job
objectives, the nature and risks of the study, and how to complete the
stress (𝛽 = 0.148, p = 0.473), and work performance (𝛽 = 0.086,
questionnaire. Data was collected from the participants during their
p = 0.130). Based on the result, the hypothesis is therefore rejected
breaks which took them 30–45 min to complete the survey. During
(Table 3).
submission, the researchers checked for completeness of question-
naires. Confidentiality and anonymity of the participants were main-
tained using a code number on the questionnaire.
8 DISCUSSION

6.5 Data analysis This paper examined the impact of organizational support on nurses’
Statistical Package for the Social Sciences (SPSS) version 22 was outcomes such as organizational commitment, work autonomy, work
used in performing the statistical analysis. Descriptive and inferential performance, job satisfaction, and job stress. Furthermore, the authors
statistical tools were used to analyze the data collected. Data were also examined the individual and organizational factors that may
quantified using the mean, standard deviation (SD), and percentage. explain the nurses’ perceptions of POS. In this study, the overall mean
Independent t-test, Pearson correlation coefficient, and linear and score for the POS was 2.97, which is below the midpoint and had small
multiple regressions were used to examine the direct and indirect variability suggesting lower POS in nurses. Comparing these findings
relationships between the dependent and independent variable/s. with previous studies using the same scale, it is obvious that the mean
Significance level was set at 0.05. score in this study was lower than what had been reported in previous
studies.16,24–26
There is much research linking nurses’ individual and organizational
7 RESULT factors to POS. Studies internationally identified age, personality,
years of work experience, job tenure, gender, job conditions, rewards,
One hundred eighty (180) nurses participated in the study during and salary as significant predictors of POS17 (Laschinger et al., 2006).47
the four (4) months of data collection. The majority of the respon- Using standard multivariate linear regression, bed capacities predicted
dents were female (n = 142, 78.9%), aged between 20 and 29 years the nurses’ perceptions of organizational support suggesting a higher
(n = 121, 67.2%), with a baccalaureate degree (n = 172, 95.6%), and POS in nurses working in a high bed capacity institution. Furthermore,
had a monthly income of less than $100 a month. Further, the major- the independent t-test found significant differences in the POS mean
ity of the participants held a staff nurse position (n = 153, 85%) and scores between nurses working in public and private hospitals with
had been employed for one (1) to five (5) years (n = 121, 67.2%) in sec- higher POS noted in nurses working in private institutions.
ondary (n = 136, 75.6%) and public hospitals (n = 132, 73.33%). In the Philippines, there is a huge disparity in the distribution of
Individual mean values were computed for each item on the POS healthcare workers in the government and private sector with more
scale which ranged from 2.698 to 3.38, with a mean score of 2.97 out nurses employed in private sectors as a result of the inability of the
a possible mean score of 5. Table 1 reflects the correlation between government to create enough nursing positions.48 As a consequence,
the POS Scale and nurses’ variables. Pearson r correlation coefficient nurses are exposed to stress—inducing situations such as a higher
showed statistically significant correlation between the POS and hos- patient–nurse ratios and higher acuity workloads.35,49 In addition,
pital bed capacity (also known as the number of hospital beds which a most government-owned institutions, especially in the rural areas,
hospital has been constructed to contain) (r = 0.203, p = 0.009). Fur- have less sophisticated hospital equipment and supplies as a result of
ther, bivariate analysis showed significant differences in the POS mean a huge disparity in the budget allocation for healthcare in the coun-
scores between nurses employed in a government-owned hospital and try with higher budgets allocated to hospitals in urban areas.48,50,51
those nurses in a private hospital (t = 2.030, p = 0.041) and nurses hold- Moreover, this group of nurses earns a comparably lower pay and often
ing a temporary position and those nurses holding a permanent posi- have less opportunities for professional growth as compared to nurses
LABRAGUE ET AL . 5

TA B L E 1 Correlation between POS scale and nurses’ variables

Variables Organizational support (mean ± SD) Pearson's r t p-Value

Gender 0.135 –1.750 0.082
Male 2.87 ± 0.31
Female 2.99 ± 0.39
Age (years) 0.023 0.768
Educational level –0.001 0.013 0.990
BS 2.97 ± 0.38
MA/MS 2.96 ± 0.16
Work status 0.002
Temporary position 2.84 ± 0.34 2.036 0.043a
Permanent position 2.96 ± 0.16
Income (in US$) 0.063 0.420
Job tenure (years) 0.048 0.540
Hospital category –0.055 0.704 0.482
Government-owned 2.84 ± 0.37 2.030 0.041a
Privately owned 2.93 ± 0.39
Hospital level 0.140 –1.805 0.073
Primary 2.80 ± 0.27
Secondary/tertiary 2.98 ± 0.38
Bed capacity 0.203 0.009a
a
p < 0.05; ** p < 0.01.

TA B L E 2 Stepwise linear regression: predictors of organizational support in nurses

Predictor variable 𝜷 (95% CI) SE-b p-Value Partial 𝜼2 Adjusted R2

Bed capacity 0.064 (0.016–0.112) 0.024 0.009* 0.203 0.035

Note: The nurses' organizational commitment was the dependent variable. 𝛽 is the unstandardized coefficients. SE-b is the standard error.
F = 7.067; **p < 0.01

TA B L E 3 Linear regression result of perceived organizational support (independent variable) on nurses’ work outcomes (dependent variables)

Work outcomes Constant (𝜶) Coefficient 𝜷 (95% CI) SE-b p-Value R2

Job Satisfaction Index 3.627 –0.167 (–0.411 to 0.076) 0.123 0.176 0.011
Organizational Commitment Scale 3.227 –0.034 (–0.132 to 0.064) 0.050 0.491 0.003
Turnover Intention Scale 2.596 –0.060 (–0.335 to 0.215) 0.139 0.667 0.001
Job Stress Scale 2.426 0.106 (–0.185 to 0.398) 0.148 0.473 0.003
Work Performance Scale 2.962 0.131 (–0.039 to 0.300) 0.086 0.130 0.014

Note: The nurses' work outcomes was the dependent variable. 𝛽 is the unstandardized coefficients; SE-b is the standard error.

working in the urban areas in spite of having higher workloads.35,49 ers under temporary contract normally work with the same workloads
In addition, private hospitals have more structured policies, processes or even higher than that of nurses holding permanent status; how-
and procedures, highly structured programs for professional nursing ever, they received comparably a decreased amount of compensation
development, and a comparably higher number of nurses employed as and benefits. Casual employed nurses usually lacked legitimacy in their
compared to hospitals owned by the government.35,49,51 According to position, have a lesser chance for advancement within the organiza-
the literature, POS is influenced by a number of factors such as fair- tion, and were seldom included in any decision making processes.52,53
ness, adequate supervisor and co-worker support, and opportunities In addition, treatment of these nurses are not usually positive as they
for organizational rewards and supportive work conditions.12,13 These are used to “fill in” for staffing and the regular nurses need to pick up
factors may explain the low POS in this study's samples. the pace for them as they are not always familiar with the routines of
Bivariate analysis also revealed lower POS in nurses with tempo- the system.
rary status although this relationship did not remain significant in the In addition, because of their temporary status, these nurses have
multivariate analysis. Nevertheless, a lower level of POS in this group lesser autonomy to choose the type of shift and when they wanted
of nurses might be explained as a consequence of lack of recogni- to work as most of them are assigned to work either during the night
tion, autonomy, advancement, and flexibility in their positions. Work- or on weekends. The control of the decisions and job security, which
6 LABRAGUE ET AL .

are uncommon in the casual nurse's routines, are seen to contribute 8.1 Limitations
to higher perceptions of organizational support52 (Laschinger et al.,
This study employed the most practical way of data collection,
2006). In addition, casually employed nurses are often confronted with
the descriptive cross-sectional design. Considering the nature and
realities such as low salaries, heavy workloads, higher job stress lev-
dynamic of the construct being studied (organizational support and the
els, staffing problems, and lack of professional opportunities that posi-
six (6) constructs), a longitudinal research design is necessary to track
tion them to leave. These factors are known to weaken work commit-
how these construct changes, develops, or deteriorates in time. Fur-
ments and work motivation among employees.54 Certainly, this finding
ther, this study is limited to nurses working in a rural province in the
warrants further investigation to explore the needs of casual/part-time
Philippines and exclusion of nurses from urban provinces may affect
nurses and how employers can better support them.
generalization of the study's findings. As the survey questionnaire used
An intuitive link between the POS and the various nurses’ out-
was lengthy, it might have influenced the response rate and the qual-
comes has been previously demonstrated in a number of studies
ity of responses of the nurses. In addition, the use of a self-reporting
internationally.14–17,20,21,23–27,29 The literature suggested that a sup-
questionnaire may have restricted responses of the respondents. Thus,
portive nurse practice environment was characterized by positive
a qualitative study may have been more useful in obtaining more accu-
nurse–physician relations, strong nurse management at the unit level,
rate perceptions of the participants.
and a sufficient hospital and organizational support, all of which had
a strong positive impact on the quality of care provided by the nurse.
It was also noted that positive job outcomes such as job satisfaction,
8.2 Implication for nursing practice and policy
work performance, organizational commitment, and turnover inten-
tions were overtly present in the actions perceived by the nurse.9,10 At the national level, the well-being of the nurses can be promoted and
Although a vast number of studies supported the relationship, the find- their work conditions can be improved by increasing health financing,
ings of this study revealed that POS did not contribute to or explain any improving salaries and compensation of nurses, and establishing good
of the six outcomes in the nurses. This may be explained by the cur- governance practices would enhance the welfare and well-being of Fil-
rent nursing employment situation in the country. Despite the increas- ipino nurses.33 In addition, the nursing association or union in the coun-
ing supply of nurses in the Philippines, nursing positions are scarce as try, through its political advocacy, can better support nurses by lobby-
are opportunities for promotion as no additional positions or employ- ing programs and initiatives in the Philippine congress to advance the
ment opportunities are created in the government and private hospi- welfare and improve the quality of nurses’ work environment. Though
tals nationwide37,40 leaving nurses with no alternative options but to there has been a comprehensive law and support groups that ensure
stay in their current job than being jobless. This finding corroborated appropriate funding and a quality healthcare system through nursing,
with that of Dones et al.55 where despite the lower perceptions of the implications of such promulgated policy is yet to be realized.
support from their organization, the sample of the Philippine nurses On the managerial level, nurse managers can better support nurses
in their study remained committed, satisfied with their jobs, and per- and enhance further their performance by maintaining nurse–patient
formed well as they have no job options if they leave their current ratios and protecting staff from a variety of stressors. Enhancing POS
jobs. Additionally, enjoyment and love in their job was also cited as a in nurses can also be accomplished through a variety of strategies,
factor that contributed to high job satisfaction and the intention to organizational rewards and working conditions such as autonomy,
stay in their current jobs despite their lower organizational support professional development opportunities, pay, and promotion.13 In
perceptions.55 addition, hospital and nurse leaders play an important role in pro-
It is important to note, that there may have also other additional moting supportive structures for daily professional practice with the
factors, which have not been taken into account in this study that can capacity to adapt innovations and improvements that will promote
affect job outcomes such as the generosity of the organization relative positive nurse, patient and organizational outcomes. Implementation
to its resources, the intent to aid the employee actively, and the extent of hospital policies that foster positive working relationships, higher
to which the resources appear to benefit the employee more than the job autonomy in nurses, and adequate organizational support ser-
organization.56 In addition, nurses’ personal attributes such as confi- vices maybe an asset. In addition, nurse managers may also increase
dence, optimism, hope, and resilience also play a vital role in reduc- support perceptions and commitment among their staff by reward-
ing their work stress and intention to quit.57 Nurses’ personal drive ing their contributions and caring about their well-being as well as
toward development and self-enhancement, their coping strategies, concentrating on training strategies that improve work-related skills.
and their innate nature to improve subjective well-being and behav-
iors can also be seen as stronger forces or motivators to sustain a pos-
8.3 Implication for future research
itive view toward the organization. Certainly, inclusion of these fac-
tors in future research may give a better insight of the issue under A wider cross section of this study utilizing diverse nurses from all
study. Further, outcomes in this study contradicted the Organizational over the country may yield comprehensive and generalized findings.
Support Theory, which suggested that when an employee perceived Although some personal and organizational factors were considered in
being valued by the organization, they would in turn feel obliged to this study, other factors such as political, economic, socio-cultural were
reciprocate the same by helping the organization achieve its goals and not taken into account. Inclusion of these factors in future research
objectives. may give a better perspective of the issue.
LABRAGUE ET AL . 7

8.4 Implication for nursing education 4. O'Brein-Pallas A, Murphy GT, Shamian J, Li X, Hayes LJ. Impact and
determinants of nurse turnover: A pan-Canadian study. J Nurs Manag.
Nursing academe can play an important role in preparing future nurses 2010;18:1073–1086.
by strengthening their capacity to push for legislative and professional 5. Hayes LJ, O'Brien-Pallas L, Duffield C, et al. Nurse turnover: A litera-
actions for their welfare. Nursing education must highlight the need for ture review–an update. Int J Nurs Stud. 2012;49:887–905.
strong leadership and management competence to enhance the capac- 6. Jones CBCB, Gates M. The costs and benefits of nurse turnover: A
ity of nurses to voice their concerns, increase their impetus to fight business case for nurse retention. Online J Issues Nurs. 2007;12:Article
4.
for their personal and professional rights, and to strategize measures
to elevate apprehensions to organizations and even at the national 7. Duffield CM, Roche MA, Homer C, Buchan J, Dimitrelis S. A compar-
ative review of nurse turnover rates and costs across countries. J Adv
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The authors would like to express their heartfelt thanks to Dr. Shinaka satisfaction. J Nurs Manag. 2006;14:13–22.

Alawa for her expertise. 15. Battistelli A, Galletta M, Vandenberghe C, Odoardi C. Perceived orga-
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FUNDING 2016;24:E44–E53.

This study was not funded. 16. Gupta V, Agarwal UA, Khatri N. The relationships between perceived
organizational support, affective commitment, psychological contract
breach, organizational citizenship behavior and work engagement. J
CONFLICT OF INTERESTS Adv Nurs. 2016;72:2806–2817.

Authors declare no conflict of interest 17. Mathumbu D, Dodd N. Perceived organizational support, work
engagement and organisational citizenship behaviour of nurses at Vic-
toria Hospital. J Psychol. 2013;4:87–93.
ORCID
18. Ko YK, Yu S, Kang KH. Organizational culture and organizational sup-
Leodoro J. Labrague DM, RN port as factors affecting the innovative behaviors of general hospital
http://orcid.org/0000-0003-0315-4438 nurses. J Korean Acad Nurs Adm, 2015:21(2):223–231.
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