The Influence of Role Conflict, Head Nurses' Super Leadership, and Nursing Organizational Culture on Organizational Commitment of Male Nurses

The number of men choosing to become nurses is increasing on account of improved awareness of nursing as a profession, changes in job stereotyping, and preference for stable jobs owing to a rise in the unemployment rate [1]. The number of male nurses in Korea increased from 829 in 2004 to 24,546 in 2021 [2]. However, male nurses were rejected by patients and often had to take up non-nursing tasks that required physical strength, causing them to be disappointed with their jobs and resulting in decreased organizational commitment [3].

Organizational commitment refers to employees’ identification with the organization and the fulfillment of their obligations and commitment to organizational performance [4]. Low organizational commitment increases job stress, leading to a negative attitude toward work and burnout, which makes employees consider moving to another organization [5]. According to a previous study, organizational commitment is likely to be lower among male nurses than female nurses [6]. In addition, the turnover rate of male nurses was 27.1%, which was higher than the average nurse turnover rate of 12.6% in 2016 [7]. Therefore, it is necessary to devise interventions to examine the factors that influence and enhance organizational commitment among male nurses. Glisson and Durick [8] divided the factors influencing organizational commitment into personal, job-related, and organizational factors. This study used the same classification of factors that influence organizational commitment among male nurses.

Personal factors need to be further validated as researchers have reported contradictory findings regarding the influence of age, marital status, position, salary satisfaction, and hospital type on male nurses’ organizational commitment [6, 9]. Role conflict, as a job-related factor, refers to the incompatibility of requirements and expectations from a role [10]. Male nurses also experience rejection from patients [5]. In Korea, male nurses often work as assistants to physicians and surgeons; however, their authority and obligations are not clearly defined, leading to role conflicts [3]. Thus, it is necessary to explore role conflict perceived by male nurses and its influence on organizational commitment.

Super leadership and organizational culture affect organizational commitment [11]. Super leadership is defined as leadership that leads all members of an organization to do their best at work with a master spirit [11]. According to Manz and Sims [12], super leadership is necessary to improve organizational commitment because a leader helps members recognize their goals clearly and motivates them by stimulating and encouraging self-leadership. A previous study reported that head nurse super leadership promotes nurses’ self-leadership and maximizes their potential, ensuring a high level of thinking and action strategies as well as acceptance of and trust in the organization’s values and goals [13]. However, studies on the relationship between super leadership and organizational commitment among male nurses are lacking.

Organizational culture has also been reported to increase participation and commitment among nurses to improve organizational performance by enhancing productivity and strengthening bonds and unity among members [14]. A relationship exists between the behavior of organizational members and organizational culture [4], and a nursing organizational culture that motivates members and enables them to exert their maximum abilities has a significant correlation with nurses’ job satisfaction and organizational commitment [15]. Moreover, only a few studies have examined male nurses perception of the culture of nursing organizations and how this perception influences their organizational commitment.

Therefore, this study aimed to explore the factors influencing organizational commitment among male nurses, including their general characteristics, role conflict, head nurse super leadership, and nursing organizational culture.

This study aimed to investigate the factors that influence organizational commitment among male nurses. The level of organizational commitment among the participants was 3.23, which was slightly higher than the 3.08 in the study on general hospital nurses using the same tools by Kim [17]. As the previous study was conducted mostly with female nurses, the finding contradicts the result that male nurses tend to have lower organizational commitment in nursing organizations with a higher proportion of women [6]. It is necessary to assess the trend of change through future research, to investigate whether the changes can be attributed to the overall improvement of the nursing environment and work system or the change in the profession of male nurses.

Significant differences were observed in organizational commitment according to age, average monthly income, total career duration, current hospital experience, position, department, and number of beds among personal factors. The reason for this may be that as nurses get older, gain more years of experience, and attain a higher position, they are likely to understand their jobs better, show increased productivity, display an increased need for job stability, have greater satisfaction with the organization owing to improved welfare benefits, and express a greater desire to stay with the organization [9]. Magnet hospitals generally implement a strategy to improve nurses' organizational commitment through salaries, and since the results of this study also indicated a relationship between income and organizational commitment, support from hospitals and national policies is needed [19].

The number of beds and working departments were significant factors that influenced male nurses’ organizational commitment. In a study targeting male nurses [20], hospital type and working department were significantly associated with organizational commitment. Moreover, nurses in small- and medium-sized hospitals have low organizational commitment and high turnover rates owing to a lack of wages, promotion opportunities, and opportunities for self-development, and increased working hours and workload [21]. To solve this problem, the Philippine nursing community is attempting to improve the working environment through appropriate manpower placement, providing career opportunities to male nurses, and establishing a fair compensation system [6]. In future research, it is also necessary to confirm the impact of organizational commitment, including hospital welfare, flexible working patterns, educational programs, nursing workload, positive managerial leadership, and organizational culture.

Male nurses working in operating rooms had lower organizational commitment than those working in other departments. This was similar to the results of a study on male nurses in which organizational commitment was low among those working in an anesthesiology unit [6]. Male nurses tend to be more proud when working themselves instead of being instructed on what to do, and their organizational commitment is likely to increase when they are satisfied with performing professional tasks [22]. Several male nurses work as physician assistants in operating rooms and anesthesia departments and may consequently have low organizational commitment owing to performing auxiliary and cooperative work with doctors [21]. Further studies are required to identify the nursing experience of male nurses working as physician assistants or in operating rooms.

The level of role conflict in this study was 2.64, which is an important job-related factor influencing organizational commitment, similar to the results of previous studies [23]. Many male nurses experience role conflict because they are expected to perform work that they find undesirable, such as working in special departments, or performing doctor-dependent tasks and non-nursing tasks [7]. When providing care for female patients, physical contact may be misunderstood as inappropriate or they may experience rejection for being male, regardless of their nursing ability [24]. For these tasks, the boundaries of authority and responsibility are not clearly defined; thus, organizational commitment is reduced [22]. In 2016, the turnover rate of male nurses was 27.1%, which was higher than the average nurse turnover rate of 12.6%[7]. Therefore, it is necessary to resolve role conflicts that arise among male nurses and improve their job satisfaction and organizational commitment.

In this study, head nurse super leadership, as an organizational factor, had a significant influence on organizational commitment. This result is consistent with those of a previous study [25] that reported that nurse managers’ leadership affects nurses’ organizational commitment. Head nurse super leadership helps individual nurses increase their job competence and motivation to control their work and perform better as self-leaders, thereby increasing their organizational commitment [26]. A previous study [27] reported that the core competencies of managers’ super leadership are coaching and communicative support, and through this, super leadership buffers the negative influence of the organization and enhances employees’ enjoyment and immersion in the work. Therefore, it is necessary to enhance head nurse super leadership by including coaching and communication competency-building content in education and training programs for head nurses.

In this study, innovation-oriented culture had the largest influence on organizational commitment, perhaps because male nurses actively engaged in organizational change to emphasize their merits in a nursing organization with a conservative culture, accepting these changes flexibly and immersing themselves in the nursing organization [5]. In contrast, previous studies found task-oriented culture to be a significant factor that lowered the job satisfaction of male nurses [28]. “The Innovation Road Map: A Guide for Nurse Leaders,” a guidebook on nursing innovation published in the US, recommends that nurse leaders embrace the following characteristics to promote an innovation-oriented culture: divergent thinking, risk-taking behavior, willingness to learn from failure, and agility and flexibility in designing solutions [29]. As nursing leaders establish and implement guidelines and roadmaps for innovation, the nursing organizational culture will be more innovative and can influence organizational members.

However, relation-oriented culture did not have a significant influence on organizational commitment in this study. In female-dominant occupations, it was reported that male nurses experienced feelings of isolation, enmity from female colleagues, and underestimation of masculinity [30]. Therefore, a relation-oriented culture in a nursing organization dominated by women may not significantly influence male nurses' organizational commitment. Future studies on how nurses' perceptions of nursing organizational culture differ according to gender and their effects are also needed.

This study found that organizational culture, head nurse super leadership, role conflict, department, and number of beds influenced male nurses' organizational commitment. Nevertheless, this study’s limitations must be considered. First, it included only male nurses; therefore, comparisons with female nurses could not be drawn. Future studies must consider undertaking a comparative study of both male and female nurses’ organizational commitment. Second, the study did not separately assess male nurses who assisted physicians. This group may not perform holistic care for patients, and head nurses may have been surveyed as managers. Therefore, it is necessary to identify physician-assistant male nurses separately in future studies. Third, male nurses were conveniently selected through online recruitment for this study, which may affect the generalization of the results. It is necessary to expand the research by applying stratified sampling according to hospital type, region, and age. Fourth, the reported level of organizational commitment may differ from the actual level. In addition, the reliability of the nursing organizational culture tool used in this study was low. Therefore, it is necessary to explore more objective measurement tools and other tools that reflect the work situation and organizational culture characteristics of nurses in Korea.

This study indicated that innovation-oriented culture and head nurse super leadership are the main factors that positively influence male nurses' organizational commitment. In addition, task-oriented culture and role conflict decreased male nurses' organizational commitment. Therefore, based on these results, it is necessary to build an innovation-oriented culture in nursing organizations and facilitate head nurse super leadership competency. Furthermore, we propose a qualitative study that analyzes the causes of male nurses' role conflict in depth and a study that implements interventions.