Nursing organizational climates in public and private hospitals

Article Nursing organizational climates in public and private hospitals I Garcı ´a Garcı ´a, RF Castillo and ES Santa-Ba ´rbara University of Granada, Spain Abstract Background: Researchers study climate to gain an understanding of the psychological environment of organizations, especially in healthcare institutions. Climate is considered to be the set of recurring patterns of individual and group behaviour in an organization. There is evidence confirming a relationship between ethical climate within organizations and job satisfaction. Objectives: The aim of this study is to describe organizational climate for nursing personnel in public and private hospitals and to confirm the relationships among the climate variables of such hospitals. Materials and methods: A correlational study was carried out to measure the organizational climate of one public hospital and two private hospitals in Granada. The Work Environment Scale was used for data collection. The Work Environment Scale includes 10 scales, ranging from 0 to 9, which were used to evaluate social, demographic and organizational climate variables. In this study, 386 subjects were surveyed in three hospitals. Results: A total of 87% of the participants were female and 16% were male. Most participants were nurses (65.6%), followed by nursing aides (20%), and technicians (14.4%). The results obtained reflected different patterns of organizational climate formation, based on hospital type (i.e. public or private) within the Spanish context. Most of the dimensions were below the midpoint of the scale. Discussion and conclusions: In conclusion, in public hospitals, there is a greater specialization and the organizational climate is more salient than in the private hospitals. In addition, in the public hospitals, the characteristics of the human resources and their management can have a significant impact on the perception of the climate, which gives greater importance to the organizational climate as decisive of the ethical climate. Keywords Nursing, organizational climate, public and private hospitals Introduction The concept of organizational climate was first proposed by Lewin, Lippitt and White in the 1930s. It is now widely used to describe the environment of the workplace in terms of the behaviour, abilities and Corresponding author: RF Castillo, Facultad de Ciencias de la Salud, Dapartamento de Enfermerı ´a, Universidad de Granada, Paseo de la Marina, 116, C.P. 51001, Ceuta, Spain. Email: [email protected] Nursing Ethics 2014, Vol. 21(4) 437–446 ªThe Author(s) 2013 Reprints and permission: sagepub.co.uk/journalsPermissions.nav 10.1177/0969733013503680 nej.sagepub.com at Biblioteca Universitaria de Granada on December 11, 2016nej.sagepub.comDownloaded from feelings that characterize social interaction within an organization. 1 Generally speaking, a healthy organizational environment is populated by individuals who feel welcomed and respected, and who are capable of developing their potential to successfully contribute to the aims of the organization as a whole. The relationship between organizational climate and different work outcomes has been widely studied, 2,3 particularly by researchers who wish to understand and address ‘life’ in working organizations. 4 Organizational climate is often defined as the shared perceptions of organizational members about their work environment. 5 There are various theoretical approaches to climate formation, which address the issue from different vantage points. Such perspectives have been identified as objective, subjective and interactionist. 6 In the objective/structural approach to climate formation, organizational conditions determine members’ attitudes, values and perceptions of events inside the organization. Therefore, from this perspective, climate is regarded as a manifestation of organizational structure. For example, in Arnetz et al., 7 the size of the work team has a significantly negative effect on climate dimensions such as support and innovation. These authors underline the need to study other organizational characteristics that may influence organizational climate perceptions. Our study thus measured the proportion of variability stemming from structural variables. The subjective approach asserts that the origin of climate is in the individual. Thus, climate is an attribute of the individual, and its subjective nature is highlighted. This approach is based on the premise that the individual interprets and responds to situational variables that are meaningful for the person from a psychological point of view. 8 In this sense, our study measured the proportion to which human characteristics account for organizational climate. The interactionist approach is a combination of the objective and subjective perspectives. In this case, interaction between organizational and individual characteristics is a determining factor of organizational climate. 9 The objectives of this research were the following: 1. To identify which variables determine organizational climate in public and private hospitals; 2. To measure the proportion to which these variables account for organizational climate. Method Design As part of this research, a correlational study was carried out to measure the organizational climate of one public hospital and two private hospitals in Granada (Spain). A hospital is defined as public or private, depending on its source of funding. Public hospitals are funded by social security, mutual insurance companies for public employees and other entities. In contrast, the money to run private hospitals comes from patients, private insurance companies, mutual funds for accidents at work and occupational illness, companies associated with the social security system and other sources. In this study, Hospital A is a public hospital with 536 beds and 1788 professionals. Hospitals B and C are private hospitals with fewer beds and professionals. More specifically, Hospital B has 111 beds and 167 professionals, and Hospital C has 77 beds and 225 professionals. Scenario and sample In the public hospital, the sample was randomized, whereas in the two private hospitals, a convenience sampling was used. The three resulting subsamples were the following: n¼320 (Hospital A), n¼50 (Hospital 438 Nursing Ethics 21(4) 438 at Biblioteca Universitaria de Granada on December 11, 2016nej.sagepub.comDownloaded from B) and n¼23 (Hospital C). The total number of participating health professionals (nurses, nursing aides and nursing technicians) was 393. The response rate was 92.35%(363 valid questionnaires). Different recruitment methods were employed since it was not possible to guarantee a randomized sample in the three hospitals. Given the characteristics of the public hospitals and the mutual similarity of the private hospitals, we opted for different sampling procedures. Ethical considerations The authorization to carry out this study was requested and obtained from hospital management. For data collection purposes, the researchers then contacted the subjects in the sample and gave them the questionnaire. When the questionnaire was filled out, the subjects returned it to the researchers in a sealed envelope. Health professionals participated on a voluntary basis, and their rights to anonymity and confidentiality were ensured. Instrument A self-administered questionnaire was devised ad hoc for this research. The first part of the questionnaire collected demographic and work data. It included items pertaining to sex, age, marital status, number of children and their ages, seniority at the hospital, professional category, work shift, type of contract and functional area. The second part of the questionnaire included the Work Environment Scale (WES), adapted to the Spanish context by TEA Publishing House. 10 The internal consistency (KR-21) that was calculated for each subscale ranged from 0.69 to 0.86. The WES consists of 90 items with two possible responses: true or false. Certain items have an inverse scoring. The WES measures 10 dimensions of organizational climate. Responses to each dimension can range from 0 to 9. According to Moos et al., 10 the dimensions of organizational climate can be defined as follows: Involvement. The extent to which employees care for the activity of the company they work for and commit themselves to it (e.g. work is really stimulating). Cohesion. The extent to which employees help each other and are kind to colleagues (e.g. people strive to help those newly hired feel at ease). Support. The extent to which managers help and encourage personnel to create a good social climate (e.g. managers usually congratulate an employee who does something well). Autonomy. The extent to which employees are encouraged to be self-sufficient and take initiative on their own (e.g. people can use their own initiative to do things). Organization. The extent to which good planning, efficiency and completion of tasks is stressed (e.g. employees are very keen to complete tasks). Pressure. The extent to which urgency or pressure at work dominates the working environment (e.g. there is constant pressure not to stop working). Clarity. The extent to which the expectations about daily tasks are known and working rules and plans are explained (e.g. the details of the assigned tasks are usually explained to employees). Control. The extent to which managers use rules and pressure to have employees under control (e.g. managers control staff continuously with a very strict monitoring system). Innovation. The extent to which variety, change and new approaches are stressed (e.g. doing things differently is assessed positively). Comfort. The extent to which the physical environment contributes to set up a nice working environment (e.g. the working environment is nice and looks modern). Garcı ´aetal. 439 439 at Biblioteca Universitaria de Granada on December 11, 2016nej.sagepub.comDownloaded from Data analysis The data were processed with the software application SPSS v. 15. Descriptive statistics were used as well as Student’s t-test, analysis of variance (ANOVA) and simple linear regression. For the multivariate analysis, the strategy to select the variables for each model entailed the application of the forward stepwise method. For the purpose of this analysis, variables such as marital status, professional category, work shift, type of contract and functional area – which are represented by more than two categories – became ‘dummy variables’ with values for each category (false ¼0 and true ¼1). In addition, for the multivariate analysis, only variables with p0.20 in the bivariate analysis were considered. This criterion to include variables in the regression model is based on other research. Results Characteristics of the sample The Hospital A sample was composed of 320 professionals, 297 (92.81%) of whom submitted valid questionnaires. Of these respondents, 259 (87.5%) were female with ages ranging from 24 to 64 years (mean ¼ 46.31; standard deviation (SD) ¼7.18). Most participants were nurses (168; 56.6%), followed by nursing aides (99; 33.3%) and technicians (30; 10.1%). The seniority of the professionals was 0–39 years (mean ¼ 19.05; SD ¼9.78) (see Table 1). The Hospital B sample was composed of 45 participants, 90%of whom submitted valid questionnaires. As in the previous case, this sample was mostly made up of females (42; 93.3%). The participants were nursing aides (26; 57.8%), technicians (11; 24.4%) and nurses (8; 17.8%). The age of these healthcare professionals was in the range of 26–61 years (mean ¼44.93; SD ¼8.61). Job seniority ranged from 1 to 31 years (mean ¼19.73; SD ¼10.45) (see Table 1). The Hospital C sample was composed of 21 nursing professionals, 92%of whom submitted valid questionnaires. As in the other samples, the respondents were mainly females (20), most of whom were nursing aides (13; 61.9%), nurses (6; 28.6%) and technicians (2; 9.5%). Their ages were 21–60 years (mean ¼ 36.56; SD ¼11.93). Job seniority ranged from 1 to 36 years (mean ¼14.58; SD ¼13.98) (see Table 1). Organizational climate scores Table 2 lists the mean scores, SDs and range for each dimension in all the hospitals. Bivariate analyses The model included all the variables with p0.20 in the bivariate analysis. This method permitted us to control all the potentially relevant independent variables. A bivariate analysis of the organizational climate dimensions was performed by using two hospital categories (i.e. public and private). As previously mentioned, Hospital A was a public hospital, and Hospitals B and C were private hospitals. This analytical procedure allowed us to compare the mean scores obtained in each of the 10 climate dimensions. For example, mean scores were compared in these 10 dimensions, based on the sex of the participants, after which the statistical significance of the difference between both mean scores was analysed. Student’s t-test was run for dichotomous variables (‘sex’, ‘with or without children 5 years old’, ‘with or without children between 6 and 10 years old’ and ‘with or without children 11 years old’). For polychotomous variables (‘marital status’, ‘professional category’, ‘type of contract’, ‘work shift’ and ‘functional area’), an ANOVA test was applied. For ‘age’ and ‘seniority’, a univariate linear regression was used (see Table 3). 440 Nursing Ethics 21(4) 440 at Biblioteca Universitaria de Granada on December 11, 2016nej.sagepub.comDownloaded from Multivariate analysis Variables with p0.20 were used for the bivariate analysis. This analysis was performed to test the proportion to which predicting variables explain the result variables, namely, the 10 dimensions of organizational climate. A total of 10 linear regressions in both hospital categories (public/private) were performed for this purpose. (See Table 4 for the results of the 20 multivariate linear regressions.) In the private hospitals, Involvement, Cohesion, Autonomy and Organization were explained by personal individual characteristics (having children above 11 years of age and/or below 5 years of age, single marital status and age). Support, pressure and control were not included since they did not comply with the criterion of significance. In contrast, clarity and comfort were determined by both individual characteristics (being single) and structural characteristics (working in the X-ray service and working in the night shift) of the organization. Innovation was explained solely by one structural characteristic (working in the surgical hospitalization ward). In the public hospital, Control was not included in this analysis since it did not comply with the criterion of significance. It is important to highlight that Involvement, Pressure, Innovation and Comfort were explained by the structural characteristics related to the organization of the centre, that is, working in surgical hospitalization, operating rooms, the X-ray service and the emergency room, or belonging to a specific professional category. However, Organization and Clarity were determined by individual characteristics Table 1. Demographic characteristics of the sample. Characteristics Hospital A (public) Hospital B (private) Hospital C (private) Total n¼297 (%) n¼45 (%) n¼21 (%) N¼363 (%) Marital status Single 64 (21.7) 5 (11.1) 10 (4.6) 79 (21.9) Married/living together 199 (67.5) 31 (68.9) 8 (38.1) 238 (65.9) Divorced/separated 27 (9.2) 8 (17.8) 1 (4.8) 36 (10) Widower/widow 5 (1.7) 1 (2.2) 2 (9.5) 8 (2.2) Children 0–5 years old 54 (18.2) 4 (8.9) 1 (4.8) 59 (16.3) 6–10 years old 53 (17.8) 2 (4.4) 1 (4.8) 56 (15.4) 11þyears old 165 (55.6) 31 (68.9) 7 (33.3) 203 (55.9) Work shift Fixed morning 57 (19.3) 7 (15.6) 2 (9.5) 66 (18.2) Fixed night 8 (2.7) 1 (2.2) 3 (14.3) 12 (3.3) Normal rotating shift 0 (0) 36 (80) 15 (71.4) 51 (14.1) Anti-stress rotating shift 205 (69.3) 0 (0) 0 (0) 205 (56.5) Other 26 (8.8) 1 (2.2) 1 (4.8) 28 (7.7) Type of contract Permanent contract 192 (64.9) 37 (86) 12 (60) 241 (67.1) Temporary 58 (19.6) 0 (0) 0 (0) 58 (16.2) Substitute 46 (15.5) 6 (14) 8 (40) 60 (16.7) Functional area External practice 24 (8.3) 2 (4.7) 26 (7.4) Medical hospitalization 113 (39.2) 24 (55.8) 10 (47.6) 147 (41.8) Surgical hospitalization 62 (21.5) 3 (7) 3 (14.3) 68 (19.3) Laboratory 25 (8.7) 3 (7) 1 (4.8) 29 (8.2) Operating rooms 16 (5.6) 6 (14) 6 (28.6) 28 (8) Radiology 13 (4.5) 1 (2.3) 0 (0) 14 (4) Emergency/resuscitation 35 (12.2) 4 (9.3) 1 (4.8) 40 (11.4) Garcı ´aetal. 441 441 at Biblioteca Universitaria de Granada on December 11, 2016nej.sagepub.comDownloaded from (having children above 11 years of age and being male). Finally, Cohesion, Support and Autonomy were explained by a combination of personal individual characteristics (being male and single) and structural organizational characteristics (working in the medical and surgical hospitalization wards, operating rooms and the emergency room). Although no comparisons were made between public and private hospitals, there was a similar perception of climate in both types of hospital. However, the perception of professionals seemed to reflect that there was more Innovation, Comfort, Pressure and Control in the private hospitals than in the public one. Of 10, 9 climate dimensions were explained by some of the variables analysed. In both cases, Control was the only dimension that was not influenced by any of the individual/organizational characteristics. Limitations One limitation of this research is evidently related to the size and composition of the samples in the private hospitals. The random sampling consisted of a number of units that was considered representative of the Table 2. Organizational climate in the three selected hospitals. Organizational climate dimensions Hospital A (public), n¼297 Hospital B (private), n¼45 Hospital C (private), n¼21 Total, N¼363 Involvement Mean (SD) 3.51 (2.24) 2.47 (1.51) 5.43 (2.31) 3.49 (2.24) Range 0–9 0–7 0–9 0–9 Cohesion Mean (SD) 3.76 (2.02) 3.47 (1.44) 4.38 (1.46) 3.76 (1.93) Range 0–9 1–6 2–7 0–9 Support Mean (SD) 2.63 (2.02) 2.20 (1.76) 2.52 (1.91) 2.57 (1.98) Range 0–8 0–7 0–7 0–8 Autonomy Mean (SD) 2.84 (2.03) 1.36 (1.13) 3.14 (2.03) 2.67 (2.00) Range 0–8 0–4 0–8 0–8 Organization Mean (SD) 6.26 (1.94) 5.49 (1.75) 7.71 (1.48) 6.25 (1.94) Range 0–9 1–9 4–9 0–9 Pressure Mean (SD) 5.70 (2.05) 6.98 (1.32) 6.00 (1.67) 5.88 (1.95) Range 0–9 4–9 3–8 0–9 Clarity Mean (SD) 3.50 (1.82) 2.47 (1.37) 3.76 (2.14) 3.39 (1.81) Range 0–9 0–7 1–8 0–9 Control Mean (SD) 5.38 (1.82) 6.22 (1.55) 6.14 (1.62) 5.53 (1.79) Range 1–9 3–9 2–9 1–9 Innovation Mean (SD) 1.90 (1.73) 1.80 (1.29) 2.52 (2.04) 1.92 (1.70) Range 0–8 0–6 0–6 0–8 Comfort Mean (SD) 2.74 (2.05) 3.62 (1.55) 3.57 (2.63) 2.90 (2.50) Range 0–9 1–7 1–8 0–9 SD: standard deviation. 442 Nursing Ethics 21(4) 442 at Biblioteca Universitaria de Granada on December 11, 2016nej.sagepub.comDownloaded from Table 3. Bivariate analysis on the organizational climate and the demographic characteristics selected according to the hospital category (public or private). Climate dimensions Involvement Cohesion Support Autonomy Organization Pressure Clarity Control Innovation Comfort Public hospital (n¼297) Sex a 1.379* 2.298* 1.486* 3.533* 1.788* 0.525 3.880* 0.369 1.125 0.663 5-year-old children a 1.109 0.540 0.873 0.630 1.215 0.676 1.797* 0.385 1.880* 0.028 6- to 10-year-old children a 0.448 0.779 0.076 0.382 0.918 0.120 1.341* 1.190 0.765 0.187 11-year-old children a 0.505 0.929 0.920 0.021 2.718 0.656 2.161 1.365 1.195 0.917 Marital status b 0.447 1.293 2.099* 0.681 0.738. 0.911 0.664 1.742* 0.708 1.231 Professional category b 2.961* 0.525 1.861* 2.198* 0.743 0.536 1.730* 0.496 3.103* 2.561* Type of contract b 0.555 1.978* 5.701* 3.247* 0.779 1.782* 1.280 0.078 2.215* 0.950 Work shift b 1.631* 0.397 0.547 0.079 1.331 0.072 0.288 0.915 0.579 0.529 Functional area b 2.740* 3.134* 1.869* 2.423* 1.033 5.179* 1.038 1.443* 1.266 3.064* Age c 0.034 0.103* 0.134* 0.014 0.064 0.031 0.008 0.065 0.092* 0.035 Seniority at the hospital c 0.036 0.138* 0.164* 0.029 0.039 0.020 0.041 0.107* 0.083* 0.010 Private hospitals (n¼66) Sex a 1.225 3.344* 0.060 1.011 0.467 1.623* 1.638* 1.257 1.266 0.112 5 year children a 2.285* 1.500* 0.904 0.445 3.304* 0.205 2.011* 0.588 0.922 1.455* 6- to 10-year old children a 1.645* 0.107 5.935* 0.972 0.778 1.184 0.889 0.530 1.538* 1.164 11-year-old children a 3.065* 1.130 1.178 1.826* 0.414 0.771 1.947* 0.394 1.369* 1.336* Marital status b 3.763* 2.317* 1.635* 1.965* 2.295* 0.766 2.068* 0.328 0.461 2.735* Professional category b 0.649 0.796 0.646 0.105 0.752 0.933 1.868* 0.223 0.147 0.482 Type of contract b 2.193* 0.199 0.068 1.321 2.939* 0.969 1.404 0.044 0.755 1.750* Work shift b 0.392 0.667 1.051 0.232 1.074 0.357 0.676 1.338 0.310 1.622* Functional area b 1.455 1.280 0.845 0.625 0.495 2.797* 1.559* 1.449 1.766* 0.255 Age c 0.306* 0.091 0.019 0.348* 0.131 0.003 0.280* 0.055 0.128 0.202 Seniority at the hospital c 0.177* 0.085 0.069 0.153 0.169* 0.015 0.184* 0.081 0.094 0.102 ANOVA: analysis of variance. a Student’s (t). b ANOVA (F). c Univariate linear regression (b). *p0.20. 443 at Biblioteca Universitaria de Granada on December 11, 2016nej.sagepub.comDownloaded from nursing staff population in the public hospital. Nevertheless, although the nursing staff from two private hospitals participated in this study, the final sample was thought to be rather small for the analysis of certain variables. In addition, a convenience sampling was performed in both private hospitals, which obviously limited potential generalizations and inference-making with regard to the entire population. Discussion The analyses in our study showed that the variables perceived as significantly affecting the organizational climate in private hospitals were mainly those related to personal individual characteristics. These results support the subjective perspective in the definition of climate. 11 On the contrary, other characteristics that were more closely related to organization were less influential in these centres. In the public hospital, seven organizational characteristics were found to influence the perception of climate dimensions. This result supports Arnetz et al., 7 who highlight the influence of structural factors on organizational climate formation. However, the question is why did the results in the private hospitals differ from those in the public hospital. More specifically, why do certain individual/structural variables explain the perception of most of the climate dimensions in one hospital or the other? In the public hospital, almost 60%of the staff sample consisted of nurses (a higher professional category), whereas about 30%of the sample were nursing aides and 10%were technicians. In contrast, most of the sample in the private hospitals was composed of nursing aides (approximately 60%) and technicians. Table 4. Multivariate linear regression of climate dimensions and social and demographic variables in public hospital. Public hospital Climate dimensions Predicting variables BbtR 2 DR 2 Involvement F. a.: surgical hospitalization 0.946 0.172 2.985** 0.020 0.020 Professional category: nurse 0.601 0.133 2.337* 0.039 0.019 F. a.: operating rooms 1.375 0.136 2.366* 0.055 0.016 F. a.: X-rays 1.391 0.129 2.240* 0.071 0.016 Cohesion F. a.: medical hospitalization 0.964 0.230 3.718*** 0.032 0.032 Sex: male 0.955 0.159 2.684** 0.056 0.023 F. a.: emergencies 0.871 0.138 2.228* 0.073 0.017 Support Type of contract: substitute 1.284 0.226 3.803*** 0.035 0.035 F. a.: surgical hospitalization 1.033 0.198 3.332*** 0.065 0.031 P. category: auxiliary nurse 0.684 0.156 2.663** 0.086 0.020 Marital status: separated 0.993 0.141 2.406* 0.105 0.019 Autonomy Sex: male 1.015 0.167 2.940** 0.026 .026 Type of contract: substitute 0.806 0.144 2.500* 0.045 0.018 F. a.: surgical hospitalization 0.720 0.145 2.511* 0.061 0.017 F. a.: operating rooms 1.251 0.137 0.137* 0.080 0.018 Organization Having 11-year-old children 0.611 0.157 2.697** 0.025 0.025 Pressure F. a.: surgical hospitalization 1.373 0.272 4.820*** 0.074 0.074 Clarity Sex: male 1.041 0.191 3.332*** 0.036 0.036 Having 11-year-old children 0.452 0.124 2.164* 0.051 0.015 Innovation P. category: auxiliary nurse 0.509 0.137 2.259* 0.019 0.019 Comfort F. a.: surgical hospitalization 1.063 0.211 3.641*** 0.031 0.031 P. category: auxiliary nurse 0.646 0.147 2.592** 0.050 0.019 F. a.: emergencies 0.921 0.146 2.518* 0.071 0.020 F. a.: functional area; P.: professional. *p< 0.05; **p< 0.01; ***p< 0.001. 444 Nursing Ethics 21(4) 444 at Biblioteca Universitaria de Granada on December 11, 2016nej.sagepub.comDownloaded from The characteristics describing nursing personnel in the public hospital (in comparison with the private ones) were quite different as well as the proportion of professional categories at the hospital. Generally speaking, the public hospital employed more nursing staff to care for and assist patients and their families. In contrast to the context in private hospitals, the staff in the public hospital was more specialized in their respective tasks and services. Consequently, our results seem to indicate that in the private hospitals, nursing professionals are expected to be more versatile in their work and in the variety of tasks that they are expected to perform. In our opinion, in public hospitals, where the personnel are more specialized in tasks and services, organizational factors are more salient in the perception of climate. In contrast, in private hospitals, where the nursing staff is expected to be more flexible and adapt to organizational needs, personal individual factors seem to be more important. At the beginning of this article, we reviewed the main perspectives on climate formation: (1) the objective perspective (based on structural factors), (2) the subjective perspective (based on personal individual variables) and (3) the interactionist perspective (a combination of the other two perspectives). The purpose of this study was to discover which perspective best accounted for nursing climate in public and private hospitals. Our results are interesting because those for the public hospital are linked to the objective perspective, whereas those for the private hospitals are linked to the subjective perspective. It is our assertion that certain characteristics of human resources and their management may significantly influence climate perception, thus conferring greater relevance to one approach or the other. Conclusion Nurses play an important role in the smooth functioning and operation of private and public hospitals, where the organizational climate is part of human resource policies. Such policies stem from a rising awareness of the psychological, physical and emotional needs of employees. For this reason, a healthy organizational climate has a positive impact on the motivation of the nursing staff since it reinforces the quality and excellence of the healthcare services provided to patients and their families. 12 Social psychologists and ethicists have observed that there is positive correlation between acceptable ethical behaviour and the impact of the organizational climate. When motivation is greater, this also results in deeper organizational loyalty, less work absenteeism, high-quality patient care and a more harmonious relation between staff members. 13 Evidently, further research on factors that influence organizational climate is needed to ascertain which dimensions should be modified to achieve a healthier climate. In other words, it is important to determine which individual and organizational characteristics most actively contribute to an improved organizational climate in hospitals. This would permit the comparison of results at a broader level. Since our research interest in this study was the climate perception of nursing staff, not all professional categories were included in the samples. Future research could thus include a wider range of professional categories working in hospitals in order to verify our hypothesis that job specialization versus versatility may be related to the perception of organizational climate. Conflict of interest The authors declare that there is no conflict of interest. Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Garcı ´aetal. 445 445 at Biblioteca Universitaria de Granada on December 11, 2016nej.sagepub.comDownloaded from