A meta-analysis of relationships between organizational culture, organizational climate, and nurse work outcomes

Abstract

Background. There is a constant debate regarding delineation of the concepts of organizational culture (OC) and organizational climate (OCL). The inconsistent measure of OC and OCL and the mixed use of these two terms in empirical studies are reflections of this problem. The results of empirical studies, though inconsistent, show that OC and OCL can influence nurses' job satisfaction and turnover, and therefore, indirectly create an impact on patients' satisfaction. A meta-analysis on this subject would clarify OC and OCL concepts, the impact on nurses' job satisfaction and turnover in healthcare settings and provide empirical support for managerial decision-making. Purpose. The purposes of this study were to examine and estimate the following in the U.S. hospital nursing population: (1) the relationships among OC, OCL and nurse work outcomes (job satisfaction and turnover), and (2) moderators that influence the relationships among OC, OCL and nurse work outcomes. Method. This study was conducted by meta-analysis. An extensive literature search of 35 computerized databases, footnote chasing, and search by author was performed to locate primary studies that were published before February, 2007 and examined relationships among OC, OCL, and two nurse work outcomes of hospital nurses in the U.S. The three cultural patterns of the Organizational Culture Inventory and the organizational climate elements proposed by Kopelman et al. (1990) provided taxonomies for merging diverse OC and OCL measures. Major analytical procedures included: (1) estimation of between study homogeneity and pooled effect sizes; (2) omit a study analysis; (3) cumulative analysis; (4) subgroup analysis; (5) meta-regression; (6) sensitivity analysis; and, (7) assessment of publication bias. Moderators were evaluated under subgroup analysis and meta-regression procedures. Moderators included the type of organizational culture measurement instrument used, publication year, professional level, region, number of hospitals, type of nursing units, random sampling, hospital under redesign, survey given by manager, survey collected at work, and survey response rate. Results. In all 6769 citations were reviewed, 15 unpublished doctoral dissertations and 17 published journal articles were located for this meta-analysis study. Results showed significant but small to moderate relationships between three OC patterns and nurse job satisfaction. A "constructive organizational culture" pattern had the strongest strength of relationship (WES = .37) to satisfaction and low turnover. The pooled effects of the relationships between six OCL elements and nurse job satisfaction were also significant with sizes from small to large (WES = .29 ∼ .5 1). Of the relationship with nurse job satisfaction, only primary studies in the "aggressive/defensive culture" study group and "reward orientation climate" study group were homogenous. The major moderators that contributed to between study heterogeneity of these relationships were region, number of hospitals in the study, type of nursing unit, and random sampling. Major knowledge gaps were found for three relationships: OC and nurse turnover, OCL and nurse turnover, OC and OCL. Conclusion. Meta-analytical results indicate relationships between OC and nurse job satisfaction as well as OCL and nurse job satisfaction. Healthcare organizations should promote a constructive culture and a humanistic, productive climate to positively affect nurse job satisfaction. Attempts should be made to reduce organizational cultures that are aggressive/defensive or passive/defensive because of their negative relationship with nurse job satisfaction. More studies are needed to reveal the relationship among OC, OCL and nurse turnover.