The relationship between work climate and nurse ...

Nurse Education Today 39 (2016) 1–6

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The relationship between work climate and nurse educators' use of information technology GonenAyala a,⁎, Lev-AriLilac b a b

Nursing Department, School of Social and Community Sciences, Ruppin Academic Center, Emeq-Hefer, Israel Behavioral Sciences Department, School of Social and Community Sciences, Ruppin Academic Center, Emeq-Hefer, Israel

a r t i c l e

i n f o

Article history: Accepted 21 January 2016 Available online xxxx Keywords: Work climate Nurse educators Use of IT Attitudes Self-efficacy Innovativeness

a b s t r a c t Understanding organizational behavior and the attitudes of individuals in organizations is crucial for policymakers and managers. Work climate is a major part of these constructs. The main goal of this study was to examine the perceptions of academic nurse educators about their work climate, concerning the use of information technology (IT), including examining a number of variables such as self-efficacy, innovativeness, attitudes, intention to use, and actual use of information technology. Method: This study used a quantitative research design, using written and online surveys submitted to 109 academic nurse educators working at ten different academic nursing schools in Israel. Results: The relationship between work climate and actual use of IT was mediated by personality characteristics such as attitude toward using IT, self-efficacy, and innovativeness. Work climate positively predicted both selfefficacy and attitudes toward IT, but did not directly predict innovativeness and did not predict actual use. Conclusion: Policymakers and managers should consider work climate and personality characteristics as important factors in their efforts to promote IT use in nursing. As a result, nurse educators would become better acquainted with new technologies, and their acceptance of IT would improve. The organization would benefit from a better work environment and from enhanced performance. © 2016 Elsevier Ltd. All rights reserved.

Introduction The use of information technology (IT) has become very common in our daily activities, including their immense use in health care institutes. It is, therefore, critically important that nurse educators have the knowledge and competences to use IT at their workplaces. Nurse educators and their use of IT are the focus of this study. We believe that nurse educators are the most important group in nursing, concerning this issue. It is their responsibility to build, design, and mold future nurses. Nurse educators are the first to introduce the nursing profession to the students, and it is the duty of faculty heads to train nurse educators properly in order to produce a professional nursing graduate (Gonen et al. 2014). Successful implementation and use of IT can be accomplished by understanding the way that the end users – nurse educators – act, and to find the factors that might advance or hinder their acceptance of technological changes. In order to achieve this target, the authors examined the relationships between IT knowledge and competencies of nurse educators and three categories of human factors: work climate, subjective norms, ⁎ Corresponding author at: Ruppin Academic Center, Emeq-Hefer, Israel. Tel.: +972 537002525; fax: +972 98996661. E-mail addresses: [email protected], [email protected] (A. Gonen), [email protected] (L. Lev-Ari).

http://dx.doi.org/10.1016/j.nedt.2016.01.018 0260-6917/© 2016 Elsevier Ltd. All rights reserved.

and perceived level of threat and challenge. The present study, examining work climate, is the first part of this series. Literature Review Work climate has been a research subject for many years because of its importance in analyzing and understanding organizational behavior and the attitudes of individuals in organizations. Mitchell et al. (2012) commented that despite tremendous investments in IT, many technological interventions in organizations fail because employees do not fully accept and use IT. Herzberg's classic two-factor theory of job satisfaction maintains that there are two factors that affect job satisfaction: hygiene factors that surround doing the job such as interpersonal relations, physical work conditions, salary, and company policy, and motivation factors that lead to positive job attitudes. Following this theory, the opposite of dissatisfaction is no dissatisfaction. The satisfaction of hygiene needs can prevent dissatisfaction and poor performance, but the satisfaction of motivation factors improves productivity (Herzberg et al. 1957). Herzberg's theory focuses on work climate. Herzberg wanted to create the opportunity for employees to take part in planning, performing, and evaluating their work. He concentrated on the importance of internal job factors such as motivating forces for employees and on increasing job enrichment for employees (Evans and OlumideAluko 2010). For this reason, organizational climate, one of the

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A. Gonen, L. Lev-Ari / Nurse Education Today 39 (2016) 1–6

influential factors in organizations, should also be considered a crucial factor for successful implementation of IT. Rafferty (2003) described organizational climate as the internal environment experienced by the employees. It can be defined as the shared perceptions of employees concerning practices, procedures, and behaviors that are rewarded and supported in the workplace. Individuals' behaviors and perceptions are influenced by their environments. For this reason, it is possible to refer to work climate as one of the subjective norms/factors that can predict human behavior, namely using IT in the workplace. Students' and teachers' acceptance levels of e-learning in classrooms have been well-studied (Liaw et al. 2007; Park 2009; Yuen and Ma 2008), and according to Lee et al. (2009), if a user experiences positive acceptance toward using e-learning, the outcome tends to be successful. The theoretic basis of this research is Ajzen's classic Planned Behavior Theory, which provides a general direction to measure attitudes and behavior (Ajzen 1991). The Planned Behavior Theory incorporates components of behavior such as attitudes, subjective norms, self-efficacy, intention and actual use. Table 1 includes the definitions of these components, including work climate. Attitude to behavior relates to the degree of an individual's positive or negative assessment of behavior/planned behavior. The term ‘attitude’ indicates an important concept in human behavior. It is one of the most common terms of social psychology, and is used to explain various human behaviors, primarily social behavior. A person learns from experience how the social environment responds to his/her reactions and behaves accordingly. Work climate is the key component to improve organizational effectiveness. Nurse educators would like to receive responsibility, positive feedback on performance, support, warmth, friendliness, and a sense of belonging. García et al. (2013) studied nursing organizational climate in public and private hospitals. They claim that the characteristics of the human resources and management have a significant impact on the perception of the climate. Koivunen et al. (2015) examined team climate and attitudes toward using IT, and they mention that asserting team climate and supporting innovative operations may lead to more positive attitudes toward IT. Consequently, work climate is an importance and significant issue to be brought into consideration before beginning any new project. In summary, departmental/organizational climate is a major and significant element of the day-to-day reality of nurse educators. Self-efficacy is behavioral ability and control, the individual's perceived ease or difficulty to perform a certain action and the perception of his/her capacity to behave in a way that produces an effect. The behavioral control component is the individual's resources and possibilities that dictate his/her tendency to behavioral achievement and success. Self-efficacy reflects one's belief (whether realistic or not) in one's ability to perform a certain task. The term was coined by Bandura (1977), as part of his Social Learning Theory. This study

examined whether the perception of the ease or difficulty to use IT by nurse educators would affect attitudes and use of IT. Many studies emphasize the connection between the two, and state that the greater the sense of self-efficacy, the more positive the attitudes toward using IT (Bond 2009; Cardoza and Hood 2012; Tung and Chang 2008; Wu and Tsai 2006). Innovativeness was defined by Agarwal and Prasad (1998) as an individual's willingness to try out new information technologies. Although it is not part of the original classic theory of planned behavior, Agarwal and Prasad (1998) contend that it has undeniable value as an additional component that is connected with IT use. Rogers (1995), founder of the Diffusion of Innovations Theory, characterized five types of change efforts: a. risk-takers; b. first adopters; c. early maturity; d. late maturity; and e. opposers. Innovativeness can be expressed in various ways such as interest in technological innovation and intention to buy new gadgets. A tendency to innovativeness should have a positive relationship with attitudes toward computer use, as was presented by Shoham and Gonen (2008) and by Hsu et al. (2009). Accordingly, this study explored how these factors related to the nurse educator's attitudes and use of IT. IT use and intention to use: Ajzen (1991) claimed that behavior intention is the degree to which people are willing to try, and the degree of effort they plan to invest, in order to perform a behavior, which is affected by attitudes, social influence, and behavioral control. Measuring users' attitudes toward and their intention to use IT appears to be worthwhile when we would like to make predictions. When a study looks for explanations, a measure of actual use of IT is needed (Maillet et al. 2015). Maillet et al. (2015) also claim that not many studies measured the actual use of IT in healthcare settings, but, instead, many nursing studies examined nurses' behavior intentions (notable among them: Chow et al. 2013; Shoham and Gonen (2008); Tung and Chang 2008). Today, using IT in the workplace is very common, although there are differences in the quality of use. The quality of use is on a continuum starting with simple IT competencies and ending with very advanced IT tools. Examining the use of IT by nurse educators must consider this continuum. Thus, research in this area usually asks questions pertaining to three sets of use: the most popular is surfing the net and using email, the second is using Microsoft Office applications, and the third is using advanced software like Moodle (a popular tool in education) or healthcare software. In conclusion, a number of factors have been associated with acceptance of IT, namely the level of IT skills among professionals (Yu et al. 2009), the quality and usefulness of applications (Hsiao et al. 2011), managers' support of IT implementation processes (Courtney et al. 2008; Koivunen et al. 2009; Yu et al. 2009), and lack of organizational support (Yarbrough and Smith 2007). We believe that there is great importance to create a friendly and useful work environment for nurse educators, which will enable to motivate and reward the provision of high quality service for them and for the profession.

Table 1 Concepts definitions. Concept

Concept definition

1 2 3

Attitude to behavior Innovativeness Intention to use

4

Self-efficacy

5

Using information technology

6

Work climate

Behavior relates to the degree of an individual's positive or negative assessment of behavior/planned behavior (Ajzen 1991). Innovativeness was defined by Agarwal and Prasad (1998) as an individual's willingness to try out new information technologies. Ajzen (1991) claimed that behavior intention is the degree to which people are willing to try, and the degree of effort they plan to invest, in order to perform a behavior, which is affected by attitudes, social influence, and behavioral control. The term was coined by Bandura (1977), as part of his Social Learning Theory. Self-efficacy reflects one's belief in one's ability to perform a certain task. Performing a behavior (like information technology), which is affected by attitudes, social influence, and behavioral control (Ajzen 1991). The shared perceptions of employees concerning practices, procedures, and behaviors that are rewarded and supported in the workplace (Rafferty 2003).


Aim of this Research The main goal of this study was to examine nurse educators' perceptions about their work climate (departmental and organizational climates) concerning the use of IT, including examining a number of variables such as self-efficacy, innovativeness, attitudes, intention to use and actual use of IT. This information provides insights about the nurse educator's behavior, regarding work with informatics systems, and points out the characteristics of the relationship between IT use and specific personal and professional factors. Research Hypotheses and Objectives 1. There will be a positive correlation between the nurse educators' perception of their work climate and their attitudes toward using IT, sense of innovativeness, sense of self-efficacy, and actual use of IT. 2. Nurse educators' perception of their work climate, their attitudes toward using IT, their sense of innovativeness and sense of selfefficacy will predict actual IT use. 3. An integrative research model will explain the importance of work climate concerning nurse educators' use of IT and other variables. Methods Research Design This study represents a correlative, quantitative research paradigm. Participants and Procedure The data was collected in 2015. The study population consisted of academic nurse educators working at ten different academic nursing schools in Israel (out of 20 nursing academic schools in Israel). Using convenience sampling, the authors approached the academic nursing department's principals and invited their school to participate in the study. All principals agreed. The principals were consequently requested to approach nursing staff faculty in each institution and ask them to participate. Participation of nursing staff was voluntary and the data was anonymous. We used an online survey and hardcopy questionnaires in order to encourage those who were deterred by technology to participate. Both the online survey and the questionnaire were accompanied by an introductory letter including information about the purpose of the study, assurance of confidentiality, and each nurse was asked to sign informed consent. Out of the 150 questionnaires, 109 were returned (total response rate 72.5%). To be appointed a nurse educator in Israel, the minimum academic degree must be a Master's degree, which explains why their average years of experience were 16, and the average age was 46. Ethical Consideration The research was approved by the Ethics Committee of the academic institution. Health professionals participated on a voluntary basis, and their rights to anonymity and confidentiality were ensured. Each nurse was asked to sign an informed consent. Measures The survey instrument was organized into four groups of questions: background demographic factors such as age, seniority, and religion; organizational factors such as work climate; personality factors such as attitude toward using IT, self-efficacy, and innovativeness; and behavioral factors such as intention to use and actual use of IT. Background characteristics were taken from Ajzen and Fishbein (1980), adapted to Hebrew in Shoham and Gonen's (2008) study: work climate, subjective norms, self-efficacy and innovativeness. The

3

reliability and validity of the measures have been investigated, and have been proven meaningful and practical (Shoham and Gonen 2008). Work climate was measured with seven items. Items were based on a 5-point Likert scale, in which 1 = ‘do not agree at all’ and 5 = ‘totally agree’. The scale had good reliability; Cronbach's alpha = .76. Factor analysis confirmed a one-factor solution explaining 41.71% of the variance. Attitude toward using IT was measured using the Nurses' Attitudes toward Computerization questionnaire (Stronge and Brodt 1985). The questionnaire consists of 19 questions on a 5-point Likert scale in which 1 = ‘do not agree at all’ and 5 = ‘totally agree’. The questionnaire has been acclaimed among the nursing community for its focus on nursing, its simplicity, and its ease of use (Gonen et al. 2014; Jacques 2002; Shoham and Gonen 2008) and has good reliability; Cronbach's alpha = .89. Factor analysis confirmed a one-factor solution explaining 34.00% of the variance. Sense of innovativeness was measured with a scale that was used by Shoham and Gonen (2008). The scale consists of three questions on a 5-point Likert scale in which 1 = ‘do not agree at all’ and 5 = ‘totally agree’, and has good psychometric properties; Cronbach's alpha = .78. Factor analysis confirmed a one-factor solution explaining 70.51% of the variance. Sense of self-efficacy was measured with a scale that was used by Shoham and Gonen (2008). The scale consists of two questions on a 5-point Likert scale in which 1 = ‘do not agree at all’ and 5 = ‘totally agree’, and has good psychometric properties; Cronbach's alpha = .41. Factor analysis confirmed a one-factor solution explaining 63.80% of the variance. The scale of actual IT use was constructed for this study by the authors, and was measured by asking respondents to indicate the extent of their knowledge and use of MS-Office (Word, Excel, etc.; four items; Cronbach's alpha = .82.); email and surfing the internet (two items; Cronbach's alpha = .83), and complicated educational and healthcare software (two items; Cronbach's alpha = .83). The reliability of the combined three scales of IT use was .83. Results Our first hypothesis concerned correlations between work climate, attitudes toward using IT, intention to use, self-efficacy, innovativeness and actual use of IT. Table 2 shows the correlations between the indices. Positive correlations between innovativeness, attitudes, selfefficacy, and intentions emerged, meaning that the higher the innovativeness, the more positive the attitudes, the higher the sense of efficacy, and the more intention there is to use IT. Positive correlations also emerged between innovativeness and actual use of IT. Positive attitudes toward using IT, and sense of self-efficacy, were both also positively correlated with actual use of IT. Positive correlations were also found between work climate and attitudes, self-efficacy and intention to use, but not with actual use. The second hypothesis examined which variables would best predict the actual use of IT. The variables were divided into three groups of

Table 2 Pearson correlations between work climate, personality characteristics, intention to use IT and actual use of IT. Innovativeness Self-efficacy Attitudes Intention Actual toward IT to use IT IT use Work climate .07 Innovativeness Self-efficacy Attitudes toward IT Intention to use IT ⁎ p b .05. ⁎⁎ p b .01. ⁎⁎⁎ p b .001.

.23⁎ .36⁎⁎⁎

.37⁎⁎⁎ .39⁎⁎⁎ .47⁎⁎⁎

.24⁎ .26⁎⁎ .34⁎⁎⁎ .60⁎⁎⁎

.07 .43⁎⁎ .59⁎⁎⁎ .28⁎⁎ .11

4


factors: organizational factors (work climate), personality factors (attitudes, innovativeness, and self-efficacy), and behavioral factors (intention to use and actual use). This hypothesis was tested using a hierarchical regression model in which actual IT use was the dependent variable. Age, seniority, and work climate were entered in the first step, followed by innovativeness, sense of efficacy, and attitudes toward IT, and in the last step intention to use was entered. Table 3 shows the outcomes of the regression analysis. As can be seen in Table 3, age, seniority and work climate did not predict actual use of IT. Introducing personality characteristics (innovativeness, sense of self-efficacy and attitudes toward IT) did, however, make the model statistically significant, explaining 41% of the variance in actual use of IT. Both innovativeness and self-efficacy positively predicted actual use of IT. However, attitudes toward IT did not predict actual use. In the last step, intention to use was introduced into our model. Contradictory to our hypothesis, intention to use did not significantly contribute to our model, and was not found to positively predict actual use. The main purpose of our study was to build a research model that would explain the behavior process of using IT, focusing on the influence and impact of the work climate. We hypothesized that personality characteristics (innovativeness, attitudes, and self-efficacy) would mediate the relationship between demographic and organizational indices and actual use. We also hypothesized that intention to use IT would mediate the relationship between personality characteristics (innovativeness, attitudes and self-efficacy) and actual use. Fig. 1 depicts our SEM model. The Chi-square Goodness-of-Fit index presented an excellent fit for the data, (n; p = .96; Normed Fit Index (NFI) = .98; Root Mean Square Error of Approximation (RMSEA) = .00). The statistically significant path coefficients are provided as standardized estimates in Fig. 1. Work climate positively predicted both self-efficacy and attitudes toward IT, but did not predict innovativeness and did not predict actual use of IT. Self-efficacy and attitudes toward IT were both partial mediators between work climate and actual use. Seniority positively predicted innovativeness, and age was removed from the model, as it had no predictive power. Demographic indices were not highly predictive of actual use. Self-efficacy and innovativeness both strongly predicted actual use but these were not mediated by intention to use, as hypothesized.

Table 3 Model summary — Hierarchical Regression Analysis predicting actual IT use from demographic data, personality characteristics, and intention to use.

Step 1 Age Seniority Work climate Step 2 Age Seniority Work climate Innovativeness Self-efficacy Attitudes toward IT Step 3 Age Seniority Work climate Innovativeness Self-efficacy Attitudes toward IT Intention to use IT N = 109. ⁎ p b .05. ⁎⁎ p b 01. ⁎⁎⁎ p b .001.

R2

Adj. R2

.02

.00

.44

.46

⁎⁎

.41

.41

ΔR2

F

β

t

.13 −.02 .09

.86 −.12 .89

−.008 .03 −.07 .23 .53 .04

−.07 .22 −.83 2.47⁎ 5.40⁎⁎⁎

.02 .02 −.06 .21 .55 .09 −.13

.13 .14 −.74 2.34⁎ 5.57⁎⁎⁎

(3,94) = .65

.42⁎⁎⁎

.01

(6,91) = 12.13⁎⁎⁎

(7,90) = 10.73⁎⁎⁎

.41

.91 −1.32

Discussion This study represents some interesting work toward moving information technology into the workplace in Israel. The article adds valuable information to improve the work climate of the nurse educator, and its results should be generalized and used by policymakers and/or managers in nursing faculties for its innovative ideas that increase the body of knowledge on nursing education. Work Climate Work climate is an important component in understanding organizational attitudes and behavior (Mitchell et al. 2012). Many technological interventions in organizations fail because employees do not fully accept and use IT. This is why one of the influencing factors in organizations, organizational climate, should be considered as a crucial factor for successful implementation of IT in the nursing profession. Based on this study, a number of relationships were confirmed. This study confirmed that the relationship between work climate and actual use of IT is mediated by personality characteristics: attitude toward using IT, self-efficacy and innovativeness. This finding replicates the finding of Yoo et al. (2012), in which they empirically substantiated previous theoretical suggestions concerning the relationship between organizational climate and employees' perceptions of using technologies in South Korea. This finding stresses the importance of addressing organizational issues when integrating IT into workplaces. Lee et al. (2009) also strengthen the understanding that if a user perceives a positive acceptance toward using e-learning, the outcome tends to be successful. Work climate positively predicted both self-efficacy and attitudes toward using IT. These findings help to identify the role that these factors have in influencing the acceptance of IT, thus enabling policymakers and educational institutions to assess and plan a successful, efficient and expert use of IT by nurse educators. These results emphasize the importance of checking and enhancing the work climate before embarking on a change. Personality & Demographic factors The results of this study confirm the role of innovativeness and selfefficacy in the acceptance of IT use. These two factors were shown to have a positive effect on the attitudes and actual use of IT. This means that nurse educators, who perceive using IT as a way to offer an advantage to students' learning or their own teaching, will have positive attitudes toward this issue, and will learn and foster a more professional development. A nurse educator, who has high self-efficacy, has more selfconfidence and feels she is capable to learn and use IT. This finding about self-efficacy is strengthened by García et al. (2013), who claim that the characteristics of human resources and management have a significant impact on the perception of the work climate. In addition, Koivunen et al. (2015) mention that asserting team climate and supporting innovative operations may lead to positive attitudes toward IT. The same principle applies to the sense of innovativeness. A nurse educator with a high sense of innovativeness has a desire to learn new methods, and as a teacher, whose profession is based on sharing and giving, she might be willing to teach and help her co-workers. Many studies emphasize the connection between innovativeness and attitudes, and state that the greater the sense of self-efficacy, the more positive the attitudes toward using IT (Bond 2009; Cardoza and Hood 2012; Gonen et al. 2014; Hsu et al. 2009; Shoham and Gonen 2008; Tung and Chang 2008; Wu and Tsai 2006). Although a number of studies have shown that intention to use IT predicts actual use (Chow et al. 2013; Shoham and Gonen 2008; Tung and Chang 2008), our findings indicated that intention to use IT only mediated the relationship between attitudes toward IT and actual use


5

.04

.21*

Self-efficacy

Work climate

.55*** .38**

.36***

.44 .43**

Actual use

.07 .28***

Seniority

.27**

Innovativeness

-.18* .40** .13 Attitudes towards IT

.37** .61***

Intention to use IT

Note: *p