Relation between Nurses' Workplace Ostracism and their Organizational Commitment

Background: Addressing workplace ostracism is essential for promoting a positive workplace, fostering nurses' commitment to the organization, and ultimately enhancing patient care outcomes. Aim of the study: To assess the relationship between nurses’ workplace ostracism and their organizational commitment. Research design: A descriptive correlational design was used. Setting: The study was conducted in all in-patient care units at Tanta University Main Hospital. Subjects: a convenient sample of all (N=911) nurses who were working in previous settings and were available during the time of data collection Tools: Two tools used to collect the data, Nurses' Workplace Ostracism Structured Questionnaire and Organizational Commitment Structured Questionnaire. Results: 28.9% of nurses had a high level of total workplace ostracism, 62.2% of nurses had high level of total organizational commitment, 84% of nurses had moderate level of affective dimension and 76.45% had high level of continuance dimension and 51.5% of them had high level of normative dimensions. Conclusion: There was a negative significant correlation between nurses’ experience of workplace ostracism and their organizational commitment. Recommendations: Provide supportive environment that prevent ostracism in workplace such as reporting system of ostracism, policies that prevent ostracism and supporting systems for ostracism victims.


Introduction
Nurses in a hospital workplace work together to support each other for mutual benefit and for the benefit of the work.These benefits such as working in teams, proving their value and being a part of a successful hospital, which provide a good income, the opportunity for development and secure employment.Nurses are socially bound to work together and contribute to the same goals through their competent work .
( 2 , 1 ) Workplace mistreatment is any interpersonal situation in which nurse initiates counter normative negative actions or desists normative positive actions toward another nurse.Ostracism is a phenomenon that is observed not only in humans but also in the animal kingdom, characterized by the weaker members of the herd are rejected and ostracized by stronger members to promote the survival of the herd.In humans ostracism can take a variety of forms and with varying consequences, it Vol.31.No. 4 (Suppl 1) ,November 2023 include exclusionary behaviors such as lack of eye contact or limited verbal communication which cause distress, pain and to threaten some fundamental human needs such as belonging, selfesteem, control and meaningful existence .
( 3,4 ) Workplace ostracism is defined as "the extent to which an individual perceives that he or she is ignored or excluded by others at work, as well as "when an individual or group omits to take actions that engage another organizational member when it is socially acceptable to do so.These two definitions reflect that ostracism could be caused by both action (excluding) as well as inaction (omission of inclusion), but they also reflect that ostracism can be defined by perceptions.Workplace ostracism is a kind of "cold violence" in which nurses perceive that they are excluded by others in hospitals, which affects both nurses and their organizations .
( 4,5 ) Ostracism as part of a larger family of social mistreatment constructs, it is the extent to which "an individual or a group neglects to take actions that engage another organizational member when it is customary or socially appropriate to do so it damages a nurses' sense of wellbeing and negatively impacts on their commitment toward their work and organization .
( 6,7 ) Hospital commitment refers to the connection or bond nurses have with their hospitals.It is also the hospital staff'psychological view towards their attachment to the hospital they are working for.It refers to having loyalty to the employing hospital, identifying with its core values, and having a cognitive desire for meaningful involvement in their hospital.Commitment is supporting hospital's objectives, making effort to fulfill its goals, and having tendency to continue its membership.One of the challenges faced by modern organizations includes maintaining nurse commitment in the current business environment.Nurses with lower level of commitment leave the organization as soon as they find another chance .

Significance of study
In healthcare organizations workplace ostracism experienced by nurses in their interaction with work peers is crucial and can affect healthcare organization's existence and productivity.It makes workplace not ideal and decrease loyalty to organization and nurses became low committed to organization.Being ostracized is a prevalent phenomenon amongst nursing professionals who always need quality interaction to perform their jobs effectively as healthcare providers.So this study aims to explore the relationship between nurses' workplace ostracism and their levels of organizational commitment .Aim of the study Determine the relationship between nurses's workplace ostracism and their organizational commitment.

Subjects and method Design
A descriptive correlational research design was used in the present study.Such design fits the nature of the problem under investigation.; Bozeman and Perrewé (2001) (14)

Nurses' total levels of experiencing workplace ostracism
The results of the current study revealed that more than half of nurses had low level of total workplace ostracism.This result may be due to more than half of nurses had low levels of both task and personal ostracism.From the researcher's point of view these results may be due to workplace ostracism is a subjective perception of a nurse and each nurse has different perceptions and responses to ostracism.who found that about two thirds reported suffering from workplace ostracism.While more than quarter of nurses had high level of total workplace ostracism.That could be due to more than quarter had high levels of both task and personal ostracism.This could be due to more than one third of nurses were less than thirty years of age and had less than ten years of experience so they were unable to express their negative emotions related to their work colleague and know how seriously this could affect overall work environment.These results supported with the study conducted by Scott et al. (2014) (19) who reported that a high level of isolation and ostracism in workplace.Therefore, it provides evidence that workplace ostracism is a widespread phenomenon.The present study results also showed that almost two thirds and more than half of nurses had low workplace ostracism according to task and personal ostracism dimensions.While more than quarter of nurses experienced high levels of both personal and task ostracism.This may be due to a considerable percent were given responsibilities beyond their job description.These results cohort with the study by Ahmed et al. (2020) (20) reported that about two thirds of studied nurses had moderate level of workplace ostracism, while one fifth of nurses had low workplace ostracism.Also, a study performed by Chen & Li (2019) (21) stated that about half of studied nurses suffered from personal ostracism at workplace.

Nurses' experiencing of workplace task ostracism dimension
The present study results indicated that more than two fifth of nurses agreed that they experienced giving some colleagues responsibilities beyond a job description; they didn't coordinate the effort with some colleagues and limiting the provision of assistance on question with some colleagues.This results may be due to majority of them had diploma and associate degree level of education thus they might lack the communication skills and were in oriented about the significant impact of silence and ignoring others as their nursing undergraduate were limited to only two years.In addition shortage of staff, role ambiguity, job description is poorly defined, conflict between nurses, and heavy workloads that can create tensions among nurses, which  (26) which reported that the largest proportion of studied nurses had failing to respond to the individual and had problems in the giving of assistance on question with each other which isn't socially appropriate.

Nurses' experiencing of workplace personal ostracism dimension
The current study findings demonstrated that more than two fifth of nurses agreed that they experienced keeping silence when some colleagues enter, avoiding interacting with some colleagues and didn't ask some colleagues about their desire for something when going out to rest.From the researcher's point of view these results may be due to some personal traits of nurses such as inability to manage conflict, lack in self-confidence, inability to confront ostracized person or initiate assertive communication and deal professionally,.In the same line, El-Guindy et al. (2022) (27) reported that more than half of the staff nurses studied had experience of excluded from conversations, keeping silence at workplace with other nurses, In this concern, Söyük et al. (2019) (28) mentioned that individuals not invited to social events and limit interacting with some nurses Also, Sarwar et al. (2020) (29) ; Abubakar et al. (2018) (30) stated that nurses were not interacting and not share question with each other, excluded from conversations and not inviting to project meetings.

Nurses' total levels of organizational commitment
The current study result reflected that more than three fifth of nurses had high level of total organizational commitment.This result may be due to high percent and more than half of nurses had high levels of continuance and normative dimensions of organizational commitment.While around one fifth of nurses had low level of total organizational commitment that could be due to around one fifth of nurses had low level of organizational normative continuance and affective commitment.This result may be due to nurses were unsatisfied about their job, pay, benefits and promotion.They found that current job responsibilities became routine and suffer from block of chances for higher administrative position.In this concern, Miedaner et al. (2018) (31) ; Karem et al. (2019) (32) mentioned that organizational support from leader had a stronger effect on Vol. 31.No. 4 (Suppl 1) ,November 2023 commitment for nurses.Individual support by leaders and colleagues was shown to influence organizational commitment more strongly.Also, the degree of autonomy in the units and perceived quality of care had a larger impact on the nurses' organizational commitment.These results were consistent with a study conducted by Cao et al. (2019) (33)   and reported that nurses' organizational commitment were in the medium to high level.On the other hand, these results were conducted by Al-Haroon et al. (2020) (34) which reflected that most nurses showed a moderate level of job commitment.Also, Labrague et al. (2018) (35) mentioned that nurses were moderately committed.This may be due to cultural variations across different studied subjects in terms of organizational commitment perceptions and the diversity of assessment scales used in different studies.

Regarding
nurses' affective dimension of organizational commitment, the present study represented that more than three quarters of nurses perceived that they were agreed that they didn't feel like a part of the family of their hospital.This may be due to nurses weren't satisfied about their supervisor also they weren't satisfied with their communication.Also our results revealed that more than two fifths of them were disagreed about didn't feel a 'strong' sense of belonging to their hospital.This may be due to the majority of nurses were married females from rural areas so their first commitment was for their families and personal life.
This result matched with a study carried out by Timalsina et al. (36) (2018) (37) whose stated that a majority of respondents had feeling of not being a part of their hospital and there was no emotional attachment towards the hospital.Study from Dinc et al. (2018) (38) which reported that the largest proportion of studied nurses feel a sense of belonging to their hospital and nurses have high level of active commitment and the chances of nurses staying with the hospital for long are high.

Concerning
nurses' normative dimension of organizational commitment, the results of the present study indicated that the highest percentage of nurses agreed about jumping from hospital to another not unethical to them and getting another offer for a better job elsewhere would not make them feel to leave their hospital.This can be justified as nurses opportunities to grow and develop professionally in this hospital in limited so, finding new opportunity to grow professionally or improve personal income don't contradict with their professional principles.Staying in one hospital is better for people careers and believing in the value of remaining loyal to one hospital.This may be due to the majority of nurses were married females have a stable life so it is not easy to them to change their workplace.While more than two fifth of nurses were disagreed that thinking that major reason to work in this hospital was feeling a sense of moral obligation to remain.This may be due to supervisors weren't able to satisfy all nurses in the same manner and at the same time and nurses view their work opportunity as a business chance in a highly completion labor.This result was congruent with the study results conducted by Cherian et al. (2018) (39) which reported that the largest proportion of studied nurses supported moving from hospital to another workplace or change your hospital workplace not unethical to nurses and Li et al. (2021) (40) reported that remaining in the same hospital which indicated that this commitment is based on a belief in the moral or ethical responsibilities to stay, support the organization, getting another offer for a job consider not indicate to leave their hospital and normative commitment is based on ethical responsibilities to stay and support the organization.As regard nurses' continuance dimension of organizational commitment, the current study showed that the highest percentage of nurses were agreed that it wouldn't be too costly for them to leave our hospital now, major reason to work for this hospital is that leaving would require considerable personal sacrifice, they were not afraid about quitting my job without having another one and it is very hard to leave my hospital right now even if they wanted to.Majority of the study subjects were married females living in rural area having a stable life it will be difficult for them to quiet this hospital and searching for a new opportunity in different place, this will upset their personal life.A study conducted by Al-Haroon et al. (2020) (41) found that most of the studied nurses supported that nurses think that leaving a hospital wouldn't be costly for them and showed high level of nurses not afraid about quitting the job and hospital A study from Sepahvand et al. (2020) (42)   Bell and Sheridan (2020) (43) reportd that staying in the hospital is better than leave it and continuance commitment is nurses consider that leaving a hospital would be costly and they want to stay in the hospital for a longer period of time because they feel they must stay.

Correlation between nurses' workplace ostracism and organizational commitment
The current study clarified that there was a negative significant correlation between nurses' experience of workplace ostracism and their organizational commitment.This could be attributed to that all dimensions of organizational commitment were affected by workplace ostracism.From the researcher's point of view ostracism negatively affected nurses' desire to work at their hospital and remain in the nursing profession because of the dissatisfaction it created, the stressors of the nursing profession could decrease nurses' motivation to stay at their current hospital and lack of basic need fulfillment.Nurses may consider working at another hospital to escape their fellow nurses who ostracize them.It is possible that ostracism's negative effects on commitment are due to a lack of social support available at work.Social support, or the availability of social support, has been shown to alleviate the negative effects of stress and promote overall wellbeing.In this concern, Mattar et al. (2022) (44) mentioned that workplace ostracism is one of the major factors that may impact nurses' engagement.When individuals experience ostracism, they will be stressed out, which, in severe situations, can lead to cognitive and functional impairment.Also, Chung (2018) (45) ; Li (2018) (46) stated that in the workplace, ostracism can dramatically affect interpersonal behaviour and harm job performance.

Relation between nurses' personal data and nurses' workplace ostracism
The results of the present study displayed that there were significant positive relations between nurses' workplace ostracism and their age, work unit, education level, years of experience and number of children.This can be interpreted as older nurses had low level of ostracism as they can deal with conflict and mange ostracized person.Also, to be more educated and having more children enables nurses to manage stressful situation.In addition majority of nurses were working in neuropsychiatric, cardiac and oncology units in which the natural of patient care in these units require nurse to be more wisdom and patience and decrease levels of committing ostracism to the staff.

Relation between nurses' personal data and organizational commitment
The present study reflected that there were significant relations between nurses' organizational commitment and their work unit and education level, while there was no significant relation with nurses' age, gender, marital status, residency, years of experience, and number of children.This can be explained as nurses who working in units as majority of these nurses were working in neuro-psychiatric, cardiac and oncology units in which the natural of work in these unit and working with patient critically ill and in some cases at the late stage of life make these nurses more able to deal with stress and conflict and mange ostracized individuals.Some researches support this relationship.For example, Sepahvand et al. (2017) (47) stated that there was no significant statistical difference among age, marital status and organizational commitment and its dimensions.In the same line, a study performed by Khodadadei and Salehi (2018) (48) supported this finding by indicating that, there was a significant relation between nurses' educational level and their organizational commitment.Also, Gholami et al. (2019) (49) mentioned that, in terms of nurses' characteristics, it was shown that there were statistical relationships between the levels of organizational commitment and nurses' education and work unit.In contrast, a study carried out by Berberoglu (2018) (50) stated that, there was a significant relation between nurses' organizational commitment and their age and years of experience.Also, Cherian et al. (2018) (51) found that there was no statistical relation between nurses' education and work unit and their organizational commitment.The mistreatment of others is regarded as a threat to relationships and effectiveness in the workplace.Ostracism is prevalent in organizations and has a destructive influence on nurses and it threatens the need to belong and loyalty to organization.Reducing Ostracism is one way to avoid conflict and exclusion and to excel at one's job, as this allows Vol. 31.No. 4 (Suppl 1) ,November 2023 employees to effectively show their organization and colleagues their contributions.unit and working with patient critically ill and in some cases at the late stage of life make these nurses more able to deal with stress and conflict and mange ostracized individuals.
Based on the findings of present study it was concluded that there was a negative significant correlation between nurses' experience of workplace ostracism and their organizational commitment at Tanta University Main Hospital.More than half of nurses had a low level of total workplace ostracism, while more than quarter of nurses had high level of total workplace ostracism.More than three fifth of nurses had high level of total organizational commitment, While around one fifth of nurses had low levels of total organizational commitment.

Recommendations:
Provide supportive environment that prevent ostracism in workplace such as reporting system of ostracism, policies that prevent ostracism and supporting systems for ostracism victims.

Figure ( 2
Figure (2): Nurses 'total levels of organizational commitment (n = 911) These results supported with the study conducted by Gharaei et al. (2020) ostracism of certain individuals.This finding supported by Elhanafy et al. (2022) (22) ; Abd Allah et al. (2021) (23) whose study revealed that more than half of the staff nurses studied had avoiding contact, refusing interaction and giving responsibilities not related to their job description.This finding also was supported with Zahid et al. (2021) (24) who stated that study subjects had kept silent toward hospital members and not coordinated the work with each other.These findings supported by Ahmed et al. (2020) (25) Mlika et al. (2017)

Table ( 1): Nurses' personal data (n = 911)
As regard to continuance commitment, the high Vol.31.No. 4 (Suppl 1) ,November 2023 percent of nurses (83.5%, 83.2%, 82.4% and 81.4%) perceived that they were agreed about It wouldn't be too costly for us to leave our hospital now, major reason to work for this hospital is that leaving would require considerable personal sacrifice .I am not afraid about quitting my job without having another one and It is very hard to leave my hospital right now even if I wanted to respectively.Only23.4% of nurses were disagreed about our life would be disrupted if we decided to leave our hospital now .

Percentage Low workplace ostracism Moderate workplace ostracism High workplace ostracism
 2 : Chi square test *: Statistically significant at p ≤ 0.05