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Abstract Health care organizations have recently focused more on organizational climate due to the pressure of the health care sector reform. Healthcare organizations are obliged to look for ways to be more flexible, adaptive, and competitive in today’s volatile climate and fierce competition as they deal with competitive challenges and quickly evolving markets. Healthcare facilities are increasingly recognizing that their most significant resource is the human factor. Success depends on the workforce’s capacity to come up with creative ideas and operational strategies that exceed competitors. Organizational climate has a beneficial influence on performance, therefore, when nurses operate in a climate where they feel more liberated to carry out their duties, have more control over their thoughts and work procedures, it leads to higher productivity. Nurses’ involvement motivates them to give more effort, which lowers conflicts and grievances and increases productivity. The ”backbone of good organizational climate where people are diligent, ethical, and accountable” is said to be involved nurses. Aim of the study The present study aims to assess nurses’ perception of organizational climate and its relationship with their involvement in decision making and work productivity. Setting The study was conducted in all medical and surgical care units at Alexandria Main University Hospital, surgical care units (N=12) includes head and neck, gastrointestinal tract, vascular, oncology, cosmetics, neurosurgery, nose and ear, ophthalmology, liver and gallbladder, cardiothoracic, anal and colon and urology unit, medical units (N=10) includes cardiology, gastroenterology, endocrinology, hematology, dermatology, gerontology, nephrology, rheumatology, liver diseases and diabetes departments. Subjects The target population of this study included all nurses who provide direct and indirect nursing care at the previously mentioned units and who were available at the time of data collection(N=342). from this total target population, nurses with more than one year of experience in the current working unit and accepting to participate in this study (N=297) out of (N=342) were included in this study. They were classified as 195 nurses in surgical care units and 102 nurses in medical care units. Tools Three tools were utilized for data collection as follows: Tool I: Organizational Climate Measure (OCM). It was developed by Patterson (2005). It was adapted, validated and used by Maus (2018) to examine organizational climate within hospitals as perceived by nurses. The validated version of this tool (Maus 2018) was adopted by the researcher. It consists of 34 items divided into seven domains classified as follows, Welfare (4items), Autonomy (5items), Involvement (6items), Effort (5items), Training (4items), Integration (5items), Supervisory support (5items). Nurses’ responses were measured on a 4-point Likert scale ranging from (1) Definitely false to (4) Definitely true. The overall score was ranging from (34- 136). The score ranged from (34-68) indicated poor organizational climate, score ranged from (69-102) revealed good organizational climate, and score from (103- 136) indicated excellent organizational climate. Cronbach’s alpha coefficient for internal consistency reliability of the tool was 0.762. Tool II: The Decisional Involvement Scale. It was developed by Havens &Vasey (2005) to assess the level of nurses’ involvement in decision-making. It was adopted by the researcher. It consists of 21 items classified into six domains classified as follows, Unit staffing(2items), quality of professional practice (4items), professional recruitment (3items), unit governance and leadership (6items), quality of support staff practice (3items), collaboration or liaison activities (3items). Nurses’ responses were measured on a 5-point Likert scale ranging from (1) Administration –management only to (5) Staff nurses only. The overall score was ranging from (21-105). The score ranged from (21-49) indicated low decisional involvement, score ranged from (50-77) revealed moderate decisional involvement, and score ranged from (78-105) indicated high decisional involvement. Cronbach’s alpha coefficient for internal consistency reliability of the tool was 0.725. Tool (III): Healthcare Productivity Survey (HPS) It was developed by Gillespie et al., (2010) to measure work productivity as perceived by nurses. It was adopted by the researcher. It consists of 29 items classified into four domains as follows, cognitive demands (5items), Handle/Manage Workload (6items), Support and Communication with Patients and Visitors (7items), Safety and Competency (11items). Nurses’ responses were measured on a 5-point Likert scale ranging from (-2) Decreased productivity to (+2) Increased productivity. The overall score was ranging from (-58) to (+58). The score ranged from (-58) to (-20) indicated low work productivity, score ranged from (-19) to (+20) revealed moderate work productivity, and score ranged from (+21) to (+58) indicated high work productivity. Cronbach’s alpha coefficient for internal consistency reliability of the tool was 0.940. In addition, personal and work-related characteristics data sheet was developed by the researcher. It included items related to gender, age, marital status, current working unit, educational qualification, years of experience in nursing profession, years of experience in this hospital, years of experience in the current working unit. Method An approval for conducting the study was obtained from the Research Ethics Committee of the Faculty of Nursing, Alexandria University. Permission for carrying out the study was obtained from the Dean of Faculty of Nursing, Alexandria University, and the hospital administrators to collect the necessary data. Study tools were translated into Arabic, back to back translation (Arabic- English) was done. The study tools were tested for its content validity by a jury consisted of five experts in the field of the study. Internal consistency of the study tools was examined using Cronbach’s alpha co-efficient test. The results of the three tools revealed that they are reliable. A pilot study was conducted on 10 % of nurses (N=35) rather than study subjects, to check and ensure the clarity of the tools, applicability, feasibility, identify obstacles and problems that may be encountered during data collection and no modification was done in the tools. Data collection Data were collected from the staff nurses through self -administered questionnaire. It was hand delivered to the study subjects in the work setting after explaining the aim of the study. The questionnaire was completed in the existence of the researcher to ensure the objectivity of staff nurses’ responses, noncontamination of their viewpoints, and to check that all items were answered completely and accurately. For completion of the questionnaire, each study subject consumed approximately from 15- 20 minutes. Data collection took a period of two months starting from 3/12/2022 - 2/2/2023. The following were the most important results of the present study: The majority (88.2%) of studied nurses perceived their organizational climate as good. There was statistically significant relationship found between levels of organizational climate and demographic characteristics of nurses regarding age, sex, marital status, level of education and working unit. Moreover, less than half (43.1%) of the studied nurses had a moderate level of decision involvement. There was statistically significant association between nurses’ demographic characteristics and levels of their decision involvement regarding age, marital status, level of education, working unit and years of experience. Furthermore, more than three quarters of nurses (78.5%) had high level of total health care productivity. In addition, there was significant relation found between studied nurses’ basic characteristics and levels of their work productivity regarding marital status and working unit only. Furthermore, there was a high level of work productivity with excellent organizational climate. Moreover, a high level of decision involvement was associated with excellent organizational climate. In addition, there were statistically significant positive low relationships between organizational climate, decision involvement and work productivity. Recommendations Recommendations were given focused on the results of the current study to address nurses’ organizational climate and improve nurses’ decision involvement and work productivity. For nursing administrators: arrange for workshops and training programs to nurses to explain importance of organizational climate in decision making and work productivity, implement change strategies that will enhance nurses’ organizational climate, such as flexible scheduling and clear feedback, encourage open and transparent communication to improve nurses’ decision-making abilities and use interactive teaching strategies as brainstorming to improve critical thinking skills and decision-making abilities. For first line nurse manager: provide successful compensation plans such as flexible working hours, hold regular meetings to get nurses’ feedback and to involve them in decisions, encourage nurses to attend training programs and workshops to develop decision making abilities and provide supportive organizational climate through availability of adequate staff and resources. For staff nurses: attend regular training programs, workshops and online training to enhance decision making abilities and work productivity, attend courses about organizational climate and work productivity to overcome possible obstacles to achieve better organizational growth and participate in decision making and solve their problems at the unit. |