Concept analysis of professional commitment in Iranian nurses

Abstract

Aim:

Professional commitment has been widely discussed during the last decade. There is no comprehensive definition about “professional commitment in Iranian nurses.” Hence, this study was conducted with the aim of analyzing the concept of professional commitment in Iranian nurses.

Materials and Methods:

Hybrid model was used in three phases. Firstly, in the theoretical phase, data were retrieved from the CINHAl, MEDLINE, PubMed, OVID, Google scholar, and SID databases. The literature search used the keywords “professional commitment” and “nursing.” The final sample included 27 papers published in English between 2001 and 2011.Secondly, in the fieldwork phase, deep interviews with five clinical nurses were carried out, and thirdly, in the final analytical phase, the obtained data from theoretical and fieldwork phases were combined and a comprehensive analysis was conducted.

Results:

Loyalty and tendency to remain in the profession and responsibility to the professional issues were extracted in theoretical phase. Commitment to promote caring abilities, satisfying of being a nurse, and belonging to the nursing profession were obtained in fieldwork phase. Finally, two main themes including “commitment to offering the best nursing care” and “commitment to promotion of the nursing profession” were extracted.

Conclusion:

Nursing is a humanistic profession; it has some particular characteristics due to the profession’s nature. In this paper, a definition composed of two main dimensions of professional commitment in nursing has been introduced.

INTRODUCTION

Nursing is a humanistic profession. It is recognized as a profession because of having a unique scientific body, needs for theoretical educations, practical skill, and professional autonomy.[1] This profession has specific criteria including strong commitment to offering services to the society, belief in each individual’s respect and value, commitment to the education, and autonomy. Commitment is the main concept of these criteria.[2]

Commitment is viewed as a major variable to positive employee relations. It also has important consequences in health care services.[3] Strong commitment to a profession is in relation to job satisfaction and intention to remain.[4] High committed nurses are more responsible for delivering health care for the patients.[5] Calista Roy (2000) mentioned it as an invisible force through which nursing managers could adequately handle the 21^st century trends and issues.[6] The professional commitment construct is important because it contributes to our understanding of how people develop, make sense of, and integrate their multiple work-related commitments, including those that go beyond organizational boundaries.[7]

Through literature review search it was found that there is no study on this concept in Iranian nurses, although sufficient and rich studies concentrated on professional commitment in other countries are rare.[8–10]

Nursing in Iran has its own challenges and characters. Commitment to nursing profession contains special dimensions and definition. Clarifying the meaning of professional commitment in Iranian nurses would enable understand its dimensions, characteristics, and affective factors. This study was designed and conducted with an aim of analyzing professional commitment concept in Iranian nurses.

MATERIALS AND METHODS

Data of this study were obtained from a larger study conducted as doctoral dissertation. The research proposal was approved by the ethical committee of Tehran University of Medical Sciences. In this study, concept analysis was conducted using the hybrid model. The model merges theoretical analysis with empirical observations and emphasizes on essential aspects of the definition and measurement. It is especially useful in studying significant and central phenomena in nursing.[11] Since this study aims to reveal essential aspects of definition and measurement of professional commitment in Iranian nurses, the hybrid model of concept analysis would be the best method to choose. The method of the hybrid model is oriented toward developing concepts through a qualitative investigation using participant observation and interviews of phenomena taking place in situ.[12]

This method is composed of three phases including theoretical, fieldwork, and analysis phase. In this study, the three phases for concept analysis of professional commitment were employed as follows.

Theoretical phase

The first sources for the analysis were papers harvested from the CINAHL, MEDLINE, PubMed, and OVID. We used these databases because the main focus of analysis was in nursing profession and these are the most suitable databases for searching nursing terms, and also they are sufficiently large. Because of limitation of full-text papers and to increase the samples that we could study, Google Scholar was searched expansively. In addition, Scientific Information Databases (SID) was searched for further relevant papers to capture an Iranian consensus on the concept.

A search using the terms “professional commitment” and “nursing” was conducted and limited to journal articles in English or Persian languages, published between 2001 and 2011. The overall number of papers was 512. After reviewing the abstracts, the only papers that contained “professional commitment” and for which we could access the full texts were used for analysis. The overall sample number was 27.

All the texts found were studied according to the concept of professional commitment to map out the essential elements of definition and measurement. All the selected texts were read and re-read for various definitions and landmarks of its measurements. Finally, a working definition for the fieldwork phase was identified by the researchers, based on the literatures reviewed.

Fieldwork phase

Through hybrid model, measurements and definitions are highlighted more than describing a concept.[11] In this phase, the research questions focus on the meaning of and measurable characters of professional commitment in Iranian nurses context. To gather deep and rich data, interviews were conducted with five clinical nurses having a mean work experience of 15 years. In this model, a large number of participants are not preferred; indeed, three to six interviews seem to be perfectly enough.[11] The sample included one male and the others were females with age ranging from 39 to 52 years. In order to increase data diversity, participants were chosen from five university hospitals in Tehran and Rasht.

Wilson model was used in the selection of the participants.[11] Participant numbers 1, 2, and 4 were chosen as model cases; participant number 5 was regarded as a contrary case and participant number 3 as a borderline case. A model case is an individual who is a quintessential of the studied concept. A contrary case cannot be an indicator of the expected concept and is not regarded with the studied characteristics; finally, a borderline case is the participant who contributes to the research with his/her particular features.[11] Participants 1, 2, and 4 were nurses who chose nursing as a favorite profession and worked as a nurse out of their interest. All of them were members of nursing organizations and their colleagues knew them as a role model for other nurses. Participant number 5 (known as contrary case) said that she had entered nursing without any motivation to and understanding of the profession. She had left the job after 7 years of working as a nurse. The borderline case in this study was someone who had worked for 14 years in a hospital, was occupied as a head nurse for 5 years, and her colleagues supposed her as a committed nurse. However, she herself claimed that she would leave the career whenever she would find an opportunity and she never encouraged anybody to be a nurse.

The first researcher contacted each of the potential participants to explain the objectives. If they agreed to take part in the research, an interview was scheduled. Before each interview, the interviewees scrutinized the informed consent forms. They were offered some information about their freedom of choice to either participate or leave the research at any moment, and finally, the permission for recording their voice was acquired. To respect privacy of the information, participants’ names were removed and numerical codes were used instead of them.

Data were gathered through semi-structured interviews for which each one took 45-60 min in one or two sessions. In order to ensure that the objectives of the study are obtained, the interviews were performed based on a particular interview guideline designed by the researchers of the study. Some of the open questions were.

“What does professional commitment mean to you?” “In your idea, what are the characteristics of a professionally committed nurse?” “What criteria should be considered to measure the professional commitment?”

All interviews were conducted by the first researcher in a private room in participants’ work units. The interviews were recorded by a pocket recorder and immediately transcribed after completion of each interview. Detailed field notes, including information about the context or environment of each interview, and theoretical memos were made from each interview. Fieldwork went on for 4 months from June till September in 2011.

Data were analyzed by content analysis approach. The transcribed interviews were initially read and re-read several times to obtain a comprehensive view of the data. Texts were then read line by line, separating passages into sections concerning similar content. The text was divided into smaller units of analysis that could be reviewed. Meaningful statements and paragraphs were identified and underlined as the units of analysis. A code was assigned to each meaningful statement and paragraph. Codes were freely generated. The various codes were compared on the basis of similarities and differences and grouped into categories.

The transcripts were read again to validate the codes and categories. For the purpose of abstraction, the relationships between categories were identified and major themes came up. Categories and themes were discussed among all researchers of the study.

The researchers tried to enhance the transferability of the study through rich descriptions and offering some samples taken from participants’ statements, as well as elaborate focusing on their expressions and taking notes from them during the interviews. Credibility was established by a team-based approach to analyze data. Team-based coding, indicating excellent levels of agreement/disagreement in interpretation, was resolved through discussion. Participants received copies of their interview transcripts for comments. No one elected to make changes or to cancel any information.

Final analytical phase

The emerged codes and categories obtained from the fieldwork phase were integrated with the ideas gleaned from the literature review. We noticed that professional commitment was an important concept to nursing. Some significant managerial and organizational factors can affect professional commitment. On the other hand, nursing is a humanistic profession and most of the nurses devote themselves to caring of others. They only try to help, without thinking about professional or organizational issues.

In the final analytical phase, the categories emerged from fieldwork were compared and contrasted with the data from theoretical phase and combined as clusters for a thorough analysis.

RESULTS

The findings of theoretical phase

Literature review

Although the meaning of commitment has been discussed in many social sciences and management texts, the texts introducing the specific meaning of professional commitment are rare,[9,10] and the meaning of professional commitment in nursing has not been specifically introduced in the searched texts. According to the literature, there are two distinct meanings for the concept of professional commitment in nursing: (1) Loyalty and tendency to remain in the profession, (2) responsibility to t he professional issues and challenges. These definitions were apparent through agreement and disagreement among the existing definitions.

Loyalty and tendency to remain in the profession

Professional commitment is a person’s pledge, promise, or resolution toward his/her profession.[13] Professional commitment in nursing is defined as intention to continue working as a nurse.[14] It is the way in which the individuals think about the profession and show their loyalty to the given career.[15] It involves a group of characteristics which are different from one career to another and include a particular career staffs’ identification, autonomy, and receptivity of the professional values and goals.[10] Nogueras (2006) defines professional commitment as a predictor for intention to leave the profession.[16] Chang et al. (2006) showed that higher the commitment that the nurses had, lower was their intention to leave the nursing profession.[17] People demonstrating high levels of professional commitment usually stay in their work for a long time.[18] Professional commitment has implications for employees’ decision to continue or discontinue membership of their profession.[19]

Responsibility to the profession issues and challenges

Professional commitment means involvement in the profession.[13] They refer to committed individuals believe in goals and values of the career and are inclined to show significant efforts in professional activities and are proud of their career.[10,20] Professional commitment can be viewed as identification of and involvement with a particular profession.[14,21]

Professional individuals with stronger commitment try to develop professional values.[15] Professional commitment is believing in and accepting professional goals and values, tendency for making significant efforts in the job, membership in the profession, having the sense of pride for the career,[15,20] and striving for professional activities.[15]

Due to close meaning of the professional commitment and organizational commitment, a distinction between each of these concepts is required. Organizational commitment means that the individuals should regard the organizational goals as their own goals, hope to stay in the organization, and assume the organization as their identifier.[22,23] Professional commitment is beyond a commitment for a particular organization[5] and implies the individuals’ perspective toward their profession and the motivation that they have to stay in their job. Once people try to promote their profession, they have professional commitment whether along with organizational commitment or not. Although some researchers know professional commitment as a counterpart for organizational commitment, some believe that these two commitments are aligned in one direction.[24]

The working definition of professional commitment in nursing

Based on the reviewed literatures in the first phase; researchers of this study found a tentative working definition for professional commitment. Professional commitment in nursing is a complex phenomenon comprising intention to stay and work as a nurse, feeling responsibility for the profession, participating in professional workgroups, and tendency to career promotion.

The data obtained from fieldwork phase

The initial codes obtained from the interviews were deeply analyzed and explored. Finally, three main themes including “commitment to promote caring abilities,” “satisfying of being a nurse,” and “belonging to the nursing profession” emerged. The findings of this phase have been presented in Table 1.

Table 1.

Themes and categories obtained from fieldwork phase

Commitment to promote caring abilities

Promotion of caring abilities was the main concept that participants were committed to. They mentioned that professional commitment means commitment to offering the best care. Participant no. 1 said:

“We know that caring is the essence of nursing. So ,I try to offer the best care to my patients. It’s my commitment.”

This theme was composed of two categories: knowledge and skill development, and interpersonal skills development. The knowledge and skill development included codes emphasizing on nurses’ strive for further learning and updating their knowledge to offer the best caring services to the patients:

“If I don’t know something, I study about it; I search it, to have good nursing knowledge.” (Participant no. 2)

They assumed that professional commitment is striving for offering the knowledge-based caring. They also mentioned that caring based on routines is unresponsiveness.

Another category in this theme is development of interpersonal skills which is mainly focused on relationship with the patients. One of the participants stated thus:

“I think that if I want to work as a committed nurse, I should have the best communications with the patients; respect them; and support them.” (Participant no. 3)

This category consisted of three subcategories including altruism, making good deeds, and selflessness. In the opinion of clinical nurses, professional commitment is made of these three aspects of nurses’ behavior, and they assume interpersonal skills as the indicator and basis for commitment.

Satisfying of being a nurse

This theme is composed of two main categories including: “Having pride of being a nurse” and “loyalty to the nursing profession.”

In the category of “having pride of being a nurse,” the codes such as loving nursing, introducing the self as a nurse, and being recognized as a skillful person among the family and friends emerged. One of the participants stated thus:

“It’s my honor that I am a nurse I am proud of my profession.” (Participant no. 4)

Loyalty to the job was another category in this theme. In the participants’ perspective, professional commitment demands staying at and being loyal to nursing:

“If I have no physical or mental problem, I will work for 30 years in this job. Because I think this is the only place in which I could be useful and helpful for other people.” (Participant no. 1)

On the contrary, participant no. 3, answered the question, “If you had another chance, would you choose nursing as a job again?,” stated emphatically thus:

“No, never! If I were a bit more brave or self-confident, I would have left this job.”

And participant no. 5 said:

“Every moment of this job is filled with stress. Nurses always think about leaving their job. Is this a job? Here you have to suffer the pains from dusk to dawn!”

Nurses mentioned that they could not be committed nurses when they feel no satisfaction in nursing.

Belonging to the nursing profession

The participants claimed that nursing became their identity, they know themselves as committed nurses because they devote themselves to this profession:

“It’s all of my life. Most of time I am here because I feel myself in a position in which I could be useful for a poor patient.” (Participant no. 2)

Otherwise, some of them felt no belonging. Participant no. 5 said thus:

“Sometimes I think why I am working here. For whom I am doing these services? For a bunch of ungrateful people? Now I don’t care about anything. I do only my tasks.”

The data obtained in this phase were combined with those of literature review phase, and the emerged categories were also searched in the texts. After completion of literature review and fieldwork phases, the final analysis phase (with the goal of combining the findings of two previous phases) started.

Final analysis phase: Conceptual analysis by combining the data obtained from texts and fieldwork

As evident from Table 1 and the data from the in-depth interviews with the subjects of this study, the concept of professional commitment in nursing has two main dimensions: Commitment to offering the best nursing care and commitment to promotion of the profession.

These two dimensions are introduced as follows:

1. Commitment to offering the best nursing care:

   1. Development of the knowledge and experience: Studying and learning more, participation in seminars and scientific meetings, and participating in nursing researches
   2. Development of the superior human virtues: Including altruism, selflessness, and making good deeds for creation of a right respect-oriented relationship between the nurse and the patient

2. Commitment to promotion of the nursing profession: This theme includes three main subthemes:

   1. Having pride of being a nurse: According to the participants’ opinion, a person is committed to the profession who believes it and is being proud of being in this profession
   2. Feeling responsibility: Professional individuals feel responsibility toward the challenges and issues of the profession. They try to spend all their potentials to improve their profession. Feeling responsibility is known as most important aspect of professional commitment
   3. Loyalty and tendency to remain in the profession: Active participation in the profession and not tending to leave the job. As shown in the field study phase, the tendency to leave or stay is the criterion for being committed to the profession.

Conceptual structure of this section is also shown in Table 2.

Table 2.

Conceptual analysis of professional commitment in nursing

DISCUSSION

Findings of this study support other researchers who suggested that professional commitment is an attitude toward a profession and compliance with values and professional objectives.[10,15]

Commitment to offering the best nursing care

Iran is an Islamic country and religion has a powerful influence on people’s attitudes and practices. As shown in this study, nurses think that there is a call to do good deeds. In another qualitative study, it was shown that clinical nurses in Iran assume their professional commitment as a result of their religious beliefs.[25] A shared sense of vocational commitment and altruism strengthened their commitment. The essence and goal of the nursing is offering the best care service to the patients, which requires human communication and interpersonal skills based on loving the humans.[26] In Iran, nursing education and practice have been influenced by historical, religious, and cultural status.[27] In Islamic trainings, paying attention to human needs is deemed valuable. Religious instructions are completely in consistence with nursing values and principles. McNeese and Crook (2003) suggested that “values direct the priorities we live by and are related to employee loyalty and commitment. Most of the nurses enter this profession on the behalf of altruism and value of helping others.”[28] In the literature, professional commitment has been introduced as accepting the values and goals of the profession and trying for their realization.[1,8,10,29]

Commitment to promotion of the profession

The findings of this study revealed promotion of the profession as an attributes of professional commitment. Professional commitment is revealed in other studies as making noticeable efforts.[10,15] From the findings of literature review and fieldwork phases, loyalty to the profession and tendency to stay as a nurse are the main attributes for professional commitment in nursing. It has been shown in other studies too. Researchers showed that commitment is one of the immediate antecedents of intention to leave the workplace and turnover; the higher the nurses’ commitment, the lower their intention to leave.[1,4,8,10,15,18,30–33] Findings of fieldwork also showed that nurses who have professional commitment are proud with nursing as a high-level profession. Professional commitment is reported in other studies as having pride and eagerly working,[15,34,35] and tendency to permanent learning in the profession.[4,8,36]

Findings of this study showed that the familiar aspect of professional commitment in Iranian nurses is commitment to offering health care to the patients. For instance, a nurse who is very committed to patient care but is not rather concerned about professional issues is regarded as a professionally committed nurse. Literature review revealed that professionally committed nurses not only offer the best caring service to the patients, but also are concerned with profession promotion.[10,15]

Another issue is that nursing managers and organizational cultures can influence nurses’ commitment. When nurses feel that they are not appreciated in their work, they would not assume themselves as committed to the nursing profession (but yet, they do nursing). It seems that there is a relationship between Iranian nurses’ professional commitment and the role of organizations and managements.

Limitations of the study

The findings of this study are limited because of lack of access on full text of all required papers and texts. Also, field part of this study is on nursing staffs working in Iran and the data have been gathered through interviews and analyzed by qualitative method, so it has the inherent limitations of qualitative methods in transferability.

CONCLUSION

In this study, the meaning of professional commitment was analyzed using the hybrid method. Through combination of two phases, including literature review and fieldwork, the aspects including accepting the goals and values of the profession, tendency for making significant efforts for the career, loyalty, membership in professional organizations and institutes, having pride and eagerly working in the profession are recognized as characteristics of professional commitment. The participants in this study viewed professional commitment in nursing as offering the best nursing care and having characteristics such as altruism, making good deeds, and selflessness. It seems that the results of this study would assist in devising a tool for assessing professional commitment in Iranian clinical nurses.