Nurse Professional Commitment as a Mediator Between ProQOL, Resilience, and Retention Intentions among Filipino Nurses
Ejay H. Ignacio1*, Carlo Bryan C. Borrico2, Ergie Pepito Inocian3
1UPMC Schools of Nursing, UPMC Hamot, Erie, PA 16550, United States Keywords: Intention to Stay; Nurses; Professional Commitment; Professional Quality of Life; Resilience In the United States (U.S.), nursing staff shortages are expected to continue in the coming years, attributed to an increasing population over the age of 65, with an estimated 73% increase from 41 million in 2011 to 71 million in 2019. The national percentage for nursing staff turnover rates increases from 8.8 % to 37.0%, depending on location and nursing specialisation (Woodward & Willgerodt, 2022). Filipino immigrant nurses play an integral part in the healthcare systems of the U.S. In fact, Filipino registered nurses comprised a sizeable segment of internationally educated nurses in the U.S., comprising around 40% of the total expatriate nurses in the country or about 4% of the total nursing workforce (Nazareno et al., 2021; Hayne, Gerhardt & Davis, 2009). In short, roughly 1 out of 20 RNs in the U.S. are from the Philippines. Thus, Filipino nurses in the U.S. may be greatly affected by the changing landscape of healthcare system delivery, threatening their intention to stay at their current job. Professional quality of life in this study was defined into two components: compassion fatigue and compassion satisfaction (Stamm, 2005). Resilience is the person’s capability to face work- related adversity effectively and remain optimistic, which has been recognised by nurse managers in establishing a collaborative and supportive healthy workplace (García-Moyano et al., 2019; Huston, 2019; Kester & Wei, 2018). Nurse professional commitment denotes an intrinsic desire or commitment to work as a professional nurse as well as their acceptance of their roles, duties, and responsibilities as a nurse (Duran et al., 2021; García-Moyano et al., 2019; Huston, 2019). Despite high professional commitment, Nurses can experience challenges and adversities to work-related stress, such as increased workload, sudden change of schedule, and stressful working environment (Hendy et al., 2024). A review of Literature was conducted using the following databases: CINAHL, PubMed, and Google Scholar to search for published studies related to professional nurse commitment, professional quality of life, resilience, and intention to stay at their current job among nurses. Most of the studies focused on the quality of professional life among nurses working in primary healthcare in the community (Laserna et al., 2022). While there is a large body of research about nursing turnover in the United States, these studies mainly included newly graduated nurses or did not specifically consider the immigrant nurses (Church, He & Yarbrough, 2018; Blegen et al., 2017; Brewer et al., 2012). Many studies conducted about nursing professional commitment are only conducted. This study utilised a cross-sectional, quantitative, and non-experimental research design with mediation analysis. A causal predictive approach was employed to examine the mediating role of nurse professional commitment in the relationship between nurses’ professional quality of life and resilience and their intention to stay at their current job among Filipino registered nurses in the United States. A cross-sectional design was used, wherein data were collected at a single point in time. This is a quantitative study, as it relies on numerical data gathered to measure professional commitment, quality of life, resilience, and intent to stay. The analysis involved statistical techniques to examine relationships and mediation effects. Additionally, this research is non- experimental, meaning that it does not involve intervention, manipulation of variables, or experimental controls. The target population was chosen using the convenience sampling technique. This strategy has the advantage of allowing researchers to swiftly discover and recruit participants. Because this study was conducted with internet-recruited people who freely participated, traditional sampling could still provide appropriate information in the sense that the major inclusions were: (a) Filipino registered nurses (both US and Philippines) currently employed in a hospital for more than one year in Pennsylvania, United States, (b) >18 years old and above, and (c) voluntarily consenting to participate in the study. According to the hospitals' database, around 1,500 registered nurses, of which around 25% are Filipino nurses, are employed by the large tertiary hospital in Pennsylvania. The estimated total population of participants is 375. The researcher employed Sobel’s Sample Size Estimation, which determines the necessary sample size to detect indirect effects in a mediation model. The calculations were based on the following statistical parameters:Statistical power: 0.80 (indicating an 80% chance of detecting an effect if one exists) Alpha level (α): 0.05 (representing a 5% probability of Type I error) Predictor (X) → Mediator (M): 0.30 Mediator (M) → Outcome (Y): 0.30 Predictor (X) → Outcome (Y): 0.30 Based on these parameters, the estimated minimum sample sizes required for each relationship in the mediation model were as follows: Path X → M (Predictor to Mediator): 167 participants Path M → Y (Mediator to Outcome): 67 participants Path X → Y (Predictor to Outcome): 68 participants These values were determined to ensure that the study had sufficient statistical power to detect significant mediation effects. The Sobel test, a widely recognized method for testing mediation and used to assess the significance of indirect effects (Baron & Kenny, 1986). The research instruments used for this study were (1) Nurses’ Professional Commitment Inventory (NPCI); (2) Professional Quality of Life; (3) Resilience Scale; and (4) Intent to Stay Scale. Nurse’s professional commitment was measured using the Nurses’ Professional Commitment Inventory (NPCI). It has 26 items with 3 factors, namely, i) professional attachment, ii) professional performance, and iii) internalisation of the profession. The items of the scale can reveal nurses’ strengths and weaknesses related to professional commitment. The Cronbach’s alpha value of NPCI was 0.92, and the test-retest intraclass correlation coefficient was 0.88, both confirming the acceptable reliability of the inventory (Jafaraghaee, et al., 2021). The second is the Professional Quality of Life (ProQoL) Scale. This is a 5-point Likert-type scale with a 30-item scale that measures a person’s perceived quality of life. The Cronbach’s alpha value of the ProQoL instrument ranged from 0.75 to 0.88 (Stamm, 2005). Third is the Resilience Scale for nurses, which is a 22-item tool that measures the resilience of nurses. The tool has four (4) principal factors consist of positivity in nursing which has eight(8) items; an interpersonal skill which has five (5) items, having an anchor in personal life, which has five (5) items, and response to novelty which has four (4) items. The overall Cronbach's alpha of the tool ranged from 0.84 to 0.87 (Ihara et al., 2010). Lastly, the McCain’s Intent to Stay Scale with five-item subscale. The instrument is used to assess a nurse’s perception of the likelihood to stay in her or his current job (McClosky 1990). The overall Cronbach's alpha of the tool ranged from .75 to .91 (AbuAlrub, Omar & AlZaru, 2009; Mrayyan, 2005). Participants were recruited through an online questionnaire that provided the study’s goals, objectives, informed consent, and the condition of confidentiality. Informed consent was gained, and if they were not willing to participate, they were obliged to exit the survey. The participants were asked to answer an online survey in Google Forms with 83 questions, which may take 15-20 minutes. Participants were also aware that they could withdraw anytime from the study. The data was downloaded in aggregate form using a spreadsheet application to avoid identification in relation to individual responses. The purpose and nature of the study, risks and inconveniences, benefits, financial considerations, confidentiality, and voluntariness of participation were disclosed to create a safe space for both the participant and the researcher. Contact information of the researcher, researcher’s adviser and the institutional ethical review board was made available to answer any queries or concerns of the participants. The researcher conducted a data consistency check and completeness as soon as the participants completed the instruments. If some questions are left unanswered, participants will be asked to fill in the blanks by contacting them through email. The researcher employed bootstrapping using SPSS through the Sobel test. Moreover, Partial Least Square- Structural Equation Modelling was utilised to test the mediating effect of nurse professional commitment in the predicting effect of professional quality of life and resilience on the intention to stay at current job among Filipino nurses in the United States. The response of the clinical professionals was collated and analysed using WARP PLS version 4. Moreover, to test the mediation, the researcher adopted the Baron and Kenny (1986) four-step approach, as cited by Vanderweele (2015), in which several regression analyses were conducted, and the significance of the coefficients was examined at each step. Step 1: Conduct a simple regression analysis with X predicting Y to test for path c alone. Step 2: Conduct a simple regression analysis with X predicting M to test for path a. Step 3: Conduct a simple regression analysis with M predicting Y to test the significance of path b alone Step 4: Conduct a multiple regression analysis with X and M predicting Y. The researchers obtained ethical clearance from the Review Board of Holy Angel University Institutional, USA with the reference number of 2023-020-EHIGNACIO-MEDEFFECT of NURSEPROFESSIONALCOMMITMENT on 10th May 2023. Multiple regression analyses were conducted to assess each component of the proposed mediation model. Compassion Satisfaction is not significantly related to Intention to Stay, B=-0.060, t (119) = -0.681, p > 0.05 (see table 1). Table 1: Professional Quality of Life as Predictor to Intention to Stay Variable B SE β t p Compassion Satisfaction -0.060 0.089 -0.061 -0.681 0.497 Burnout -0.323 0.110 -0.279 -2.94 0.004 Secondary traumatic stress -0.304 0.084 -0.366 -3.60 0.000 R = 0.545a; R2=0 .297; p £ 0.05; B= Unstandardized Coefficient; SE= Standard Error Table 2 shows that Resilience is not significantly related to Intention to Stay, B= -0.025, t (119)= -0.101, p >0 .05. Table 2: Resilience as Predictor to Intention to Stay Variable B SE β t p Positivity in nursing -0.025 0.248 -0.016 -0.101 0.920 Interpersonal skills 0.853 0.261 0.689 3.27 0.001 Having an anchor in personal life 0.465 0.204 0.430 2.28 0.024 Response to novelty 0.772 0.573 0.541 1.35 0.181 Resilience -0.025 0.248 -0.016 -0.101 0.920 R =0 .545a; R2= 0.297; p£ 0.05; B= Unstandardized Coefficient; SE= Standard Error; β =Standardized Coefficient Table 3 shows that Burnout, B= 0.044, t (119) = 0.913, p > 0.05, and Secondary traumatic stress, B=0.046, t (119) = 1.26, p > 0.05 are not significantly related to Professional Commitment. Table 3: Professional Quality of Life as Predictor to Professional Commitment Variable B SE β t p Compassion Satisfaction 0.846 0.039 0.953 2.75 0.000 Burnout 0.044 0.048 0.043 0.913 0.363 Secondary traumatic stress 0.046 0.037 0.062 1.26 0.212 R = 0.912a; R2= 0.831; p £ 0.05; B= Unstandardized Coefficient; SE= Standard Error Table 4 shows that Resilience, B= 0.452, t (119) = 3.50, p <0.05 is significantly related to Professional Commitment. Table 4: Resilience as Predictor to Professional Commitment Variable B SE β t p Positivity in nursing 0.452 0.129 0.332 3.50 0.001 Interpersonal skills 0.045 0.136 0.040 0.328 0.743 Having an anchor in personal life 0.286 0.106 -0.295 2.69 0.008 Response to novelty 1.75 0.299 1.37 5.85 0.000 Resilience 0.452 0.129 -0.332 3.50 001 R =0 .880a; R2=0 .774; p £ 0.05; B= Unstandardized Coefficient; SE= Standard Error Table 5 shows that Professional Performance, B= -0.287, t (119) = -0.650, p > 0.05, and Professional Commitment, B= -0.601, t (119) = -1.06, p > 0.05, are not significantly related to Intention to Stay. Table 5: Professional Commitment as Predictor to Intention to Stay Variable B SE β t p Professional Attachment 1.07 0.300 0.960 3.56 0.001 Professional Performance -0.287 0.441 -0.239 -.650 0.517 Professional commitment -0.601 0.565 -0.538 -1.06 0.290 R =0 .372a; R2=0 .139; p £ 0.05; B= Unstandardized Coefficient; SE= Standard Error A mediation analysis was conducted to examine the effect of professional quality of life on intention to stay through the mediator variable, Professional Commitment. Table 6 shows that Professional Quality of Life had a significant positive direct effect on Intention to Stay, b= 0.5190, SE=0.2111, t=2.458, p=.0554, suggesting that higher Professional Quality of Life is associated with a greater intention to stay. The indirect effect of professional quality of life on Intention to stay through professional commitment was negative, b=−0.3071, SE=0.2833, t=2.38, p=0.0189. Despite being negative, the effect was statistically significant, indicating that professional commitment partially mediates the relationship between professional quality of life and intention to stay. Table 6: Predicting Effect of Professional Quality of Life on Intention to Stay Via Mediator Variable Professional Commitment Effect Effect Size SE t p 95% CI Direct effect of X on Y 0.5190 0.2111 2.458 0.0554 0.1009 0.9372 Indirect effect(s) of X on Y -0.3071 0.2833 -0.9214 0.1709 Total effect of X on Y 0.2120 0.0890 2.380 0.0189 0.0356 0.3883 Sobel test statistic(z): -0.9080, p=0.000; p £ 0.05; SE= Standard Error; CI= Coefficient Interval The total effect of professional quality of life on intention to stay, combining both direct and indirect effects, was positive and significant, b=0.2120, SE=0.0890, t=2.46, p=0.0356. This indicates that overall, Professional Quality of Life positively influences Intention to Stay, with Professional Commitment playing a mediating role. Finally, the Sobel test statistic for the indirect effect was z=−0.9080, p=0.000, supporting the significance of the mediation. These findings suggest that professional quality of life affects intention to stay both directly and indirectly, with professional commitment serving as a significant mediator in this relationship. A mediation analysis was conducted to examine the effect of Resilience on Intention to Stay through the mediator variable, Professional Commitment. Table 7 shows a significant positive direct effect of Resilience on Intention to Stay, b=0.9987, SE=0.2327, t=4.29, p=0.0600. This suggests that higher levels of Resilience are associated with a greater intention to stay. The indirect effect of Resilience on Intention to Stay through Professional Commitment was negative, b=−0.5632, SE=0.2279, t=3.48, p=0.0007, indicating that Professional Commitment partially mediates this relationship. Despite the negative direction of the indirect effect, it was statistically significant, suggesting that Professional Commitment plays an important role in the mediation process. Table 7: Predicting Effect of Resilience on Intention to Stay Via Mediator Variable Professional Commitment Effect Effect Size SE t p 95% CI Direct effect of X on Y 0.9987 0.2327 4.2909 0.0600 0.5377 1.460 Indirect effect(s) of X on Y -0.5632 0.2279 -1.048 0.1460 Total effect of X on Y 0.4355 0.1250 3.4833 0.0007 0.1879 0.6831 Sobel test statistic(z): -0.9080, p=0.000; p £ 0.05; SE= Standard Error; CI= Coefficient Interval The total effect of Resilience on Intention to Stay, combining both direct and indirect effects, was positive and significant, b=0.4355, SE=0.1250, t=3.48, p=0.0007. This indicates that resilience positively influences intention to stay, with professional commitment mediating part of this effect. Finally, the Sobel test statistic for the indirect effect was z=−0.9080, p=0.000, providing further support for the significance of the mediation model. These findings suggest that resilience influences intention to stay both directly and indirectly, with professional commitment acting as a significant mediator in this relationship. The mediating effects of nurse professional commitment in the predicting effect of professional quality of life and resilience on the intention to stay at current job among nurses. Multiple regression analyses were conducted to assess each component of the proposed mediation model. Compassion satisfaction was not significantly related to intention to stay, but significant regression equations were found for burnout and secondary traumatic stress. Wu, Wang and Luo (2020) noted that experienced and compassionate nurses are negatively related to turnover intention. Job dissatisfaction from poor practice environments, such as increased workloads and emotional exhaustion, significantly contributes to turnover intention, especially in the Philippines. Factors like low quality of life, increased job stress, poor well-being, and unfavourable working conditions escalate turnover intentions. Turnover rate and intention are influenced by both job characteristics and personal attributes of registered nurses (Figure 1). Consequently, registered nurses often work in challenging and high-stress environments, facing stressors from patient, family, and staff interactions, as well as organizational dynamics. These stressors can lead to burnout and poorer physical and mental health. However, resilience did not significantly influence the intention to stay, nor did positivity in nursing or response to novelty. Significant regression equations were found for interpersonal skills and having an anchor in personal life. These findings contradict Kaewboonchoo et al. (2014), who found resilience inversely related to job stress and positively related to the intent to stay. Enhancing workplace social support could increase the intent to stay and reduce nursing turnover. A significant regression equation was found on compassion satisfaction on professional commitment. This indicates that quality of life significantly predicts professional commitment. Several studies have been conducted to show the relationship between the quality of work-life and organizational commitment. For instance, Hashempour et al. (2018) stated that the quality of work-life influences organizational commitment. Abebe and Assemie (2023) further supported the findings that significant a regression equation was found on compassion satisfaction on professional commitment. Therefore, professional quality of life is positively related to employees' organizational commitment (Figure 1). Interpersonal skills were found not to be significant to professional commitment. A significant regression equation was found on domains positivity in nursing, having an anchor in personal life, response to novelty, and resilience in general. Professional commitment and resilience have been identified as key factors contributing to retention. Nurses who did not intend to leave their job showed higher professional commitment and higher job satisfaction compared with those who reported an intention to leave (Wu, Wang & Luo, 2020). It may be argued that those who do not intend to leave their job will feel morally and emotionally obligated to continue their service in the organisation and at the same time appear satisfied with their work (Figure 1). Professional quality of life does not have a direct effect on the intention to stay, indicating its inability to significantly predict the intention to stay on its own. This suggests the need for a mediating variable to explain the relationship between professional quality of life and intention to stay. Using the Sobel test and Hayes' SPSS Process Macro, the findings revealed a significant indirect effect through professional commitment, which plays a mediating role in this relationship. Furthermore, the proposed model demonstrated a statistically significant total effect—encompassing both the direct and indirect effects—thereby supporting the overall predictive power of the model. Consequently, resilience was found not to be significant on intention to stay. This is coincided with the regression findings that resilience didn’t predicts one's intention to stay and the inability of professional quality of life to significantly predicts intention to stay. The mediating effects of professional commitment, resilience have predicting effect on the intention to stay. This is further supported by statistically significant effect in terms of the total effect. The mediating role of professional commitment in the predicting effects of professional quality of life and resilience on intention to stay accept the hypothesis. Being committed to one's profession and being resilience alone would not influence one's decision to stay on one's job. It may further be explained by inclusion of the mediating variables such as professional commitment. Findings were supported with Yu et al. (2021) that professional commitment had a complete mediating effect between social support and intention to stay and between resilience and intention to stay. And professional commitment was highly positively correlated to intention to stay (Figure 2). Figure 2: Mediating Model Similarly, Wei et al. (2021) explored the Professional Commitment reduces nurses' turnover intention indirect through personal and organisational values paths. For a nurse, Professional commitment means a desire and an intention to stay in a nursing profession for the purpose of providing effective care and services to patients (Duran et al., 2021). As a complex phenomenon, professional commitment is associated with a nurse’s understanding and acceptance of their professional roles, duties, and responsibilities, as well as their dedication to nursing (Huston, 2019). Dissemination of the study’s findings may serve as a guide for hospitals and nurse managers, especially to the nurse leaders of the hospital which would help them to increase nurses’ satisfaction by paying more attention to nurses who have the intention of leaving the profession. Nurse leaders should not only distinguish between offering incentives and rewards to nurses or improving nurses' resilience to encourage them to stay at work but also place importance on nurses' professional commitment. The research output would facilitate the creation of educational or professional programs about the importance of integration of the professional commitment in the organizational culture. This will positively contribute to establishing a healthy work-family balance, such as flexible working hours, increased staff, and decreased workload. Furthermore, to increase the number of committed nurses to their profession, the faculty of the schools of nursing will develop an enhanced curriculum with the integration of professional commitment as a nurse. The study was conducted with Filipino registered nurses (both US and Philippines) currently employed in a hospital for more than one year in Pennsylvania, United States, and had a small sample. Therefore, the results of the study cannot be generalised to registered nurses. It is recommended that the study be made with both private and public universities and larger sample groups. The study utilised a convenience sampling method, which, while practical for recruiting participants efficiently, introduces limitations related to generalisability and potential sampling bias. Convenience sampling relies on the availability and willingness of participants rather than a randomized selection process, which may lead to an overrepresentation of certain groups and underrepresentation of others. It was found that professional quality of life and resilience didn’t significantly predict one's intention to stay. This is further supported with the non-significance in terms of direct effect. The inability of professional quality of life and resilience to significantly predict intention to stay (regression and direct effect) indicates that there are other variables such as professional commitment mediates the predicting effect of professional quality of life and resilience to intention to stay. Understanding the professional quality of life helps nurse managers to effectively address nurse burnout, compassion fatigue and improve compassion satisfaction. Information about nurse resilience will assist Filipino nurses in the US adapt to the current work environment. Lastly, knowledge of nursing professional commitment will facilitate nursing leaders to further engage nurses in achieving the organizational vision, mission, goals and objectives. Based on the above analyses, the following recommendations for future research can be considered: To gain a deeper understanding of how mediating role of professional commitment in the predicting effects of Professional Quality of Life and Resilience on Intention to Stay, a qualitative study relating to the study could be considered. It would be worthwhile to conduct a longitudinal study. It is also recommended to conduct studies to examine the impact of educational environments and nursing faculty as role models on the cultivation of these professional values in nursing students. These studies will enhance and improve the understanding of the subject's details. Lastly, comparative research in another region may support or refute the findings in this study. The researchers also acknowledged that no conflicts of interest and sponsorship were involved in conducting the study. Moreover, former students of the researcher from the same institution were not asked to participate in the survey to prevent bias or coercion. The authors express sincere gratitude to Dr. Karen Morahan, Nursing Director of the UPMC Jameson School of Nursing at UPMC Hamot, for her empowering leadership, compassionate support, encouragement, and understanding throughout the course of this research. The authors also extend heartfelt thanks to Holy Angel University, particularly to Dr. Wendy Acebedo, Dr. Violeta Lopez, Dr. Lucille Sunga, Dr. Maria Cynthia Leigh, and Dr. Precious Marquez, for their scholarly insights and valuable suggestions that significantly contributed to the refinement and development of this work. Abebe, A, & Assemie, A. (2023). Quality of work life and organizational commitment of the academic staff in Ethiopian universities. Heliyon, 9(4). https://doi.org/10.1016/j.heliyon.2023.e15139 AbuAlRub, R. F., Omari, F. H., & Al-Zaru, I. M. (2009). Support, satisfaction and retention among Jordanian nurses in private and public hospitals. International Nursing Review, 56(3), 326–332. https://doi.org/10.1111/j.1466-7657.2009.00718.x Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182. https://doi.org/10.1037/0022- 3514.51.6.1173 Blegen, M. A., Spector, N., Lynn, M. R., Barnsteiner, J., & Ulrich, B. T. (2017). Newly Licensed RN Retention: Hospital and Nurse Characteristics. The Journal of Nursing Administration, 47(10), 508–514. https://doi.org/10.1097/NNA.0000000000000523 Brewer, C. S., Kovner, C. T., Greene, W., Tukov-Shuser, M., & Djukic, M. (2012). Predictors of actual turnover in a national sample of newly licensed registered nurses employed in hospitals. Journal of Advanced Nursing, 68(3), 521–538. https://doi.org/10.1111/j.1365- 2648.2011.05753.x Church, C. D., He, Z., & Yarbrough, S. (2018). Factors influencing organizational commitment and turnover in nurse residents. Journal of Continuing Education in Nursing, 49(10), 482–488. https://doi.org/10.3928/00220124-20180918-09 Duran, S., Celik, I., Ertugrul, B., Ok, S., & Albayrak, S. (2021). Factors affecting nurses' professional commitment during the COVID-19 pandemic: A cross-sectional study. Journal of Nursing Management, 29(7), 1906–1915. https://doi.org/10.1111/jonm.13327 García-Moyano, L., Altisent, R., Pellicer-García, B., Guerrero-Portillo, S., Arrazola-Alberdi, O., & Delgado-Marroquín, M. T. (2019). A concept analysis of professional commitment in nursing. Nursing Ethics, 26(3), 778-797. https://doi.org/10.1177/0969733017720847 Hashempour, R., Hosseinpour, Ghahremanlou, H., Etemadi, S., Poursadeghiyan, M. (2018). The relationship between quality of work life and organizational commitment of Iranian emergency nurses. Health Emergencies Disasters, 4(1), 49–54. https://doi.org/10.32598/hdq.4.1.49 Hayne, A. N., Gerhardt, C., & Davis, J. (2009). Filipino nurses in the United States: recruitment, retention, occupational stress, and job satisfaction. Journal of transcultural nursing: official journal of the Transcultural Nursing Society, 20(3), 313–322.https://doi.org/10.1177/1043659609334927 Hendy, A., Abdel Fattah, H. A., Abouelela, M. A., Atia, G. A. E., Alshammari, M. S. S., Hables,R. M. M., Alzahrani, N. S., Hendy, A., & Almarwani, A. M. (2024). Nursing professional commitment as a mediator of the relationship between work environment and missed nursing care among nurses: a cross-sectional analysis. SAGE Open Nursing, 10. https://doi.org/10.1177/23779608231226063 Huston, C. J. (2019). Professional issues in nursing: Challenges and opportunities (5th ed.). Lippincott Williams & Wilkins, US. Retrieved from: https://www.amazon.com/Professional- Issues-Nursing-Challenges-Opportunities/dp/1496398181. Accessed on 25th February 2024. Ihara, H., Ogata, H., Inuzuka, A., Ohta, N., Nagai, T., & Mizuno, M. (2010). Development and psychometric validation of the resilience scale for nurses. Japanese Journal of General Hospital Psychiatry, 22(3), 210-220. https://doi.org/10.11258/JJGHP.22.210 Jafaraghaee, F., Ebadi, A., Dehghanzadeh, S., & Mehrdad, N. (2021). Development and psychometric testing of nurses' professional commitment inventory. Medical Journal of the Islamic Republic of Iran. 35, 127 https://doi.org/10.47176/mjiri.35.127 Kaewboonchoo, O., Yingyuad, B., Rawiworrakul, T., & Jinayon, A. (2014). Job stress and intent to stay at work among registered female nurses working in Thai hospitals. Journal of Occupational Health, 56(2), 93–99. https://doi.org/10.1539/joh.12-0204-oa Kester, K., & Wei, H. (2018). Building nurse resilience. Nursing Management, 49(6), 42–45. https://doi.org/10.1097/01.NUMA.0000533768.28005.36 Laserna Jiménez, C., Casado Montañés, I., Carol, M., Guix-Comellas, E. M., & Fabrellas, N. (2022). Quality of professional life of primary healthcare nurses: A systematic review. Journal of Clinical Nursing, 31(9-10), 1097–1112. https://doi.org/10.1111/jocn.16015 Mrayyan, M. T. (2005). Nurse job satisfaction and retention: Comparing public to private hospitals in Jordan. Journal of Nursing Management, 13(1), 40-50.https://doi.org/10.1111/j.1365-2834.2004.00453.x Nazareno, J., Yoshioka, E., Adia, A. C., Restar, A., Operario, D., & Choy, C. C. (2021). From imperialism to inpatient care: Work differences of Filipino and White registered nurses in the United States and implications for COVID-19 through an intersectional lens. Gender, Work and Organization, 28(4), 1426–1446. https://doi.org/10.1111/gwao.12657 Stamm, B. H. (2005). The Professional Quality of Life Scale: Compassion Satisfaction, Burnout & Compassion Fatigue/Secondary Trauma Scales. Lutherville, MD: Sidran Press. Retrieved from: https://proqol.org/proqol-manual. Accessed on 25th February 2024. VanderWeele, T. J. (2015). Explanation in causal inference: Methods for mediation and interaction. Oxford University Press. Retrieved from: https://www.amazon.com/Explanation- Causal-Inference-Mediation-Interaction/dp/0199325871. Accessed on 21st February 2024. Wei, W., Gan, M., Liu, Y., Yang, M., & Liu, J. (2021). Mediating effects of nurses' personal and organizational values between organizational commitment and turnover: Cross-sectional study. PloS One, 16(10). https://doi.org/10.1371/journal.pone.0258387 Woodward, K. F., & Willgerodt, M. (2022). A systematic review of registered nurse turnover and retention in the United States. Nursing Outlook, 70(4), 664–678. https://doi.org/10.1016/j.outlook.2022.04.005 Wu, Y., Wang, J., & Luo, Y. (2020). The relationship between professional commitment, organizational commitment, and job satisfaction among nurses: A cross-sectional study. Journal of Nursing Management, 28(4), 789-797. https://doi.org/10.1111/jonm.13000 Yu, H., Huang, C., Chin, Y., Shen, Y., Chiang, Y., Chang, C., & Lou, J. (2021). The Mediating Effects of Nursing Professional Commitment on the Relationship between Social Support, Resilience, and Intention to Stay among Newly Graduated Male Nurses: A Cross-Sectional Questionnaire Survey. International Journal of Environmental Research and Public Health, 18(14). https://doi.org/10.3390/ijerph18147546
2Holy Angel University, Angeles City, 2009 Pampanga, Philippines
3Duquesne University, Pittsburgh, PA 15282, United States
*Corresponding Author’s Email: ignacioe@upmc.eduABSTRACT
Background: The current global nursing shortage is an important issue with significant implications for nursing practice. Increased nurse turnover will yield five percent of the total annual hospital operating costs, estimated to be around 5 trillion dollars annually due to the cost of hiring and training new nursing staff. In the United States, Filipino immigrant nurses play an integral part in the healthcare systems to patch the critical staffing gaps. The changing landscape of healthcare system delivery in the United States, threatens Filipino nurses to stay at their current jobs. This study aimed to explore the mediating effects of nurse professional commitment in the predicting effect of nurses’ professional quality of life and resilience on intention to stay at current work among Filipino registered nurses in the United States. Methods: Causal predictive with mediation analysis was used to determine the mediating effects of nurse professional commitment in the predicting effect of professional quality of life and resilience on intention to stay at current work among Filipino registered nurses in the US. The target population was chosen using the convenience sampling technique based on the inclusion criteria: (a) Filipino registered nurses (both US and Philippines) currently employed in a hospital for more than one year in Pennsylvania, United States, (b) >18 years old and above. The statistical tool was treated using partial least square- Structural Equation Modelling to test the mediating effect of nurse professional commitment in the predicting effect of professional quality of life and resilience on the intention to stay at current work among Filipino nurses in the United States. To test the mediation, the researcher adopted Baron and Kenny four step approach. Results: It was found that professional quality of life and resilience didn’t significantly predict one's intention to stay. This is further supported with the non- significance in terms of direct effect. The inability of professional quality of life and resilience to significantly predict intention to stay (regression and direct effect) indicates that there are other variables such as professional commitment mediates the predicting effect of professional quality of life and resilience to intention to stay. Conclusion: The mediating role of professional commitment in the predicting effects of professional quality of life and resilience on intention to stay reflected the significance in terms of indirect effect and total effect. This indicates that being committed to one's profession and being resilient alone would not influence one's decision to stay in one's job.
INTRODUCTION
METHODOLOGY
Research Design
Sample and Setting
Effect sizes:
Research Instruments
Data Collection Procedure
Data Analysis
Ethical Consideration
RESULTS
Professional Quality of Life as Predictor to Intention to Stay
Resilience as predictor to intention to stay
Professional quality of life as a predictor to professional commitment
Resilience as predictor to professional commitment
Professional Commitment as Predictor to Intention to Stay
Predicting effect of professional quality of life on intention to stay via mediator variable professional commitment
Predicting effect of resilience on intention to stay via mediator variable professional commitment
DISCUSSION
Professional quality of life significantly predicts professional commitment
Resilience significantly predicts professional commitment
Predicting the effect of professional quality of life on intention to stay via mediator variable professional commitment
Predicting the effect of resilience on intention to stay via mediator variable professional commitment
Implications
Limitation
CONCLUSION
The mediating role of professional commitment in predicting the effects of professional quality of life and resilience on intention to stay reflected the significance in terms of indirect effect and total effect. This indicates that being committed to one's profession and being resilient alone would not influence one's decision to stay in one's job. It may be further explained by inclusion of the mediating variables such as professional commitment.Conflict of Interest
ACKNOWLEDGEMENT
REFERENCES