Nurses are vital components of health-care systems, forming the largest group of professionals in a hospital [1]. As in many other countries, nurses in Iran are exposed to challenges such as short staffing, heavy workload, undefined responsibilities, shortage of equipment, and low pay [2], poor social status, and the difficulties of negotiating the gap between theory and practice [3], all of which ultimately influence the provision of high quality nursing care [3]. These conditions require a willingness to perform tasks beyond the defined duties and responsibilities, a phenomenon referred to as the “concept of organizational citizenship behavior” in the related literature [4, 5].
Organizational citizenship behavior (OCB) consists of a collection of voluntary behaviors which are not part of the individual’s formal duties. OCB is performed by the personnel without being directly considered by the formal progression system of the organization, yet, it leads to effective and improved fulfillment of organizational roles and responsibilities [4]. These include behaviors that employees voluntarily offer in accordance with their personal choices [6]. OCB is one of the most important factors in determining nurses’ behaviors, attitudes, and interactions to provide high quality services [7]. Altruism, conscientiousness, humility and courtesy, civic virtue, and sportsmanship are signs of the presence of OCB [8]. These voluntary extra-role behaviors may form on the basis of an ethical climate (EC) perceived directly or indirectly by the personnel [4].
EC is the common understanding of various activities and ethical procedures, which also contains an ethical content [9]. The EC is reflected in organizational policies, and is associated with ethical consequences [10]. The EC determines the ethical values and behavior of the organization that influence the ethics of employees. Thus, morally, employees are more likely to be influenced by the organizational climate than their teamwork climate [11, 12]. EC and some variables determine the degree to which decisions are made in the organization on the basis of ethical criteria [13], and provides a framework for ethical decision-making in clinical settings [14]. Consequently, an EC may affect the organizational goals positively via reinforcing the actions that meet or extend the ethical standards leading to better professional performance and improved commitment of the staff [15]. Research has shown that ethical climate has a positive and significant relationship with sportsmanship, civic virtue, and humility [16].
On the other hand, ethical leadership (EL) plays an important role in creating an ethical climate [17]. EL determines the effectiveness of leadership, Employees’ desire for more effort [18], ethical guidance, and occupational satisfaction in the staff through prioritizing moral and ethical codes [19, 20]. Ethical leaders act as role models, establishing clear ethical standards and acting on them. Also, they clarify the ethical standards for their employees and reinforce their behavior in accordance with predetermined ethical standards by rewarding them and counselling those who failed [21]. Employees who have accepted their leader as role model, exhibit behaviors in favor of the organization [21, 22], and encourage them to do more OCB. In other words, the reinforcing nature of ethical leaders make staff do More (frequently) OCB and ethical leaders promote some ethical behaviors by using reward and support to reinforce them, and reinforcement plays an important role in determining modeling effectiveness [23]. Thus, OCB is nurtured despite ethical leadership in the organization [24,25,26], and ethical leaders can play a significant role in enhancing OCB performance because they have the ability to inspire employees’ perceptions of fairness and integrity [23, 27, 28].
Effective leadership motives nurses to deliver high quality care. An ethical approach is indispensable to leadership in nursing [19, 20]. EL requires an ethical outlook, which is made visible through personal actions and interpersonal relations among the members of the team. It is also encouraged by mutual relations [29], and is defined as an attempt to spread justice, respect for other persons’ individual characteristics, and combining features of honesty and truthfulness [30]. Leaders should not just be concerned with their own benefits; rather, they should be aware of the consequences of decision-making for all individuals [31]. Nursing leaders have considered the ethical behavior as an important organizational issue. The leader ought to play a key role in improving ethical behaviors and climate [32]. When nurses feel they can approach their leaders, having confidence that they will make good decisions and resolve their problems, this will create a climate in which the staff are satisfied with their jobs and feel more commitment to their organization [15].
Social cognitive theory (SCT) suggests that one’s beliefs and motivations are formed on valuable Judgments [33, 34]. SCT is used as a theoretical underpinning to improve the understanding of the relationships between EL, EC and OCB. As leadership styles such as EL is one of antecedents of EC and it can lead to many outcomes i.e. OCB, this framework has been used for this research [35].
Research in this field has demonstrated that EL exerts a considerable effect on EC and personnel’s’ ethical behavior, and EL is recognized as a predictor of EC [11, 12], so, EC is positively correlated to the ethical behavior of the staff [36]. Although scholars agree that leaders play an important role in shaping the moral climate [11, 12, 37, 38], there is not much empirical evidence regarding the relationship between ethical leadership and ethical climate [37].
In this respect, other scholars believe that promotion of EC in health-care systems leads to better responses of nurses to ethical tensions and other causes of dissatisfaction in the work environment [13, 39]. Citizenship behavior is one of the outcomes of leadership, which results in greater organizational productivity [40], and enhances the efficacy of the organization. Additionally, it seems that EL exerts some effects on the positive attitudes of the staff such as organizational commitment, and occupational satisfaction leading to increased rate of OCB of the personnel [41]. Wu et al. assert that although various studies confirm the correlation between EL and variables such as OCB. Despite such rich results, little attention has been paid to the correlation between EL and social responsibility of the organization [42].
The Islamic Republic of Iran is a developing country with a population of about 80 million people located in the Middle East. Islam is the formal religion of this country, and an integration of Iranian-Islamic culture forms the Iranian identity and nature [29]. The Iranian civilization emphasizes the observation of ethical behavior, meritocracy, justice-based rights and fair payments, etc. with the Cyrus Chart of Ethics, dating from the time of the Neo-Babylonian Empire in 539 BC, being seen by many as establishing unprecedented principles of human rights. Islam, which is based on ethical principles of human nature provides us with a plethora of ethical and moral teachings, and emphasizes the observation of individuals’ rights with any position, religion, race, or ethnicity [43]. The entrance of religious disciplines and cultural beliefs of the Iranian nation in the health-care system led to the highlighting of ethical issues in the patient care protocol [29].
The nursing workforce at various levels is estimated to be around 150,000 in Iran, forming a considerable part of the health-care system personnel [29], while we need 500,000 nurses for caring of patients in hospitals [44]. Iranian nurses are almost 78.5% female and 21.5% male. Most of Iranian nurses (72%) have bachelor’s degree, master’s degree, and PhD degree [45]. Many Iranian nurses are not satisfied with their work due to an overwhelming workload, insufficient time and inadequate resources [2], inappropriate work conditions, lack of support, and discrimination in payments [46]. Given the issues mentioned above, this study embarked on investigating the correlation between nursing managers’ EL from the nurses’ perspective with EC and nurses’ OCB.
Aim
This study investigated the correlation between nursing managers’ EL from nurses’ perspective and EC and OCB. For this aim of study, a structural model of this study (Fig. 1) presented, and a hypothesis has been examined to test accuracy of this model.
Part 1: EL of nursing managers is related to the OCB from the nurses’ viewpoint.
Part 2: EC is related to OCB from the nurses’ viewpoint.
Part 3: EL of nursing managers is related to the EC from the nurses’ viewpoint.