Original Manuscript

Nursing Ethics
2020, Vol. 27(1) 273–288
Nurses’ perception of organizational ª The Author(s) 2019
Article reuse guidelines:
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justice and its relationship to their 10.1177/0969733019834978
journals.sagepub.com/home/nej
workplace deviance

Ebtsam Aly Abou Hashish

Faculty of Nursing, Alexandria University, Egypt; King Saud bin Abdul-Aziz University for Health Sciences,
Jeddah, Saudi Arabia

Abstract
Background: Today, healthcare organizations are challenged to retain nurses’ generation and to maintain
justice that is a predictor of nurses’ behaviors in their work environment. Acquiring knowledge about the
level of organizational justice and workplace deviance could help in identifying factors amenable for change
that can make a difference in enhancing nurses’ dedication and loyalty to their organizations.
Aim: The aim of this study was to investigate nurses’ perception of organisational justice and workplace
deviance in their hospital, and to determine the relationship between perceived organisational justice and
workplace deviance.
Methods: A cross-sectional design was used with a convenient sample of all nurses (N ¼ 400) who were
working in inpatient care units at two Egyptian hospitals affiliated to the university and private health sectors
in Alexandria governorate, Egypt. Organisational justice and workplace deviance questionnaires proved
valid and reliable to measure studied variables. Descriptive analysis, Student’s t-test, Pearson correlation (r),
and regression analysis (R2) were used for statistical analysis.
Ethical considerations: This study was approved by the Ethics Committee at the Faculty of Nursing,
Alexandria University. Informed consent, information confidentiality, and voluntary participation were
guaranteed.
Results: This study showed that overall nurses’ perceptions of organisational justice and workplace
deviance are lower than the average. Organisational justice significantly related negatively to workplace
deviance (r ¼ 0.152, p ¼ 0.002) and organisational justice as an independent variable contributed a
significant predictive power of workplace deviance (R2 ¼ 0.023).
Conclusions: This study highlighted important implications for hospital and nurse managers to create and
maintain a healthy and supportive work environment that promotes organisational justice and decreases
workplace deviance. To achieve this, a culture of respectful communication, justice in policies, and a proper
procedure for allocating resources, workload, and rewards systems is a must. Educational interventions to
increase nurses’ awareness of workplace deviance and its potential consequences and coping strategies are
imperative for the health of the nursing profession.

Keywords
Hospitals, nurses, organizational justice, workplace deviance

Corresponding author: Ebtsam Aly Abou Hashish, Nursing Administration Department, Faculty of Nursing, Alexandria University,
Edmon Fremon St. Smouha, Alexandria 21527, Egypt; College of Nursing, King Saud bin Abdul-Aziz University for Health Sciences,
Jeddah 21423, Kingdom of Saudi Arabia.
Emails: ebtsam_ss@hotmail.com; abouhashisheb@ngha.med.sa
274 Nursing Ethics 27(1)

Introduction
Healthcare institutions are challenged with skillful staff who are looking for respect as well as a better
work environment. Working at these settings occupies a significant part in nurses’ lives and their
physical and emotional well-being.1,2 Recently, nurses have turned out to be more attentive of their
rights to be fairly treated.3 Perception about organizational fairness with employees was identified as
organizational justice (OJ)4 that can be in the form of equal employment opportunities, reasonable
pay systems, equal development chances, and provision of adequate information regarding the orga-
nization and its decisions.5
Organisational justice is defined as the nurses’ perception of how fairly or unfairly healthcare orga-
nizations are treating them.6 It is one of the crucial props for organizational success and the main
contributor to achieving job satisfaction among nurses.7 Numerous studies on organisational justice
clarified that fairness perception results in several emotional, attitudinal, and behavioral outcomes.8 The
current study concerns with investigating a behavioral outcome, namely workplace deviance (WPD), that
has been proven by many studies as it is a yield of injustice perceived by employees in the organizational
setting. Researchers have identified various antecedents that contribute to workplace deviance, and
organisational justice/organizational injustice is one of these antecedents.9,10 Yet, to the knowledge of
the author, no published national study in Egypt has explored the nature of the explicit relationship that
could exist between nurses’ perception of organisational justice and their experience of workplace
deviance in hospitals. Therefore, it is a timely topic for research. Acquiring knowledge about this
relationship and the level of organisational justice and workplace deviance could help in identifying
factors amenable for change in the work environment that can help organizational leaders to deal effec-
tively within dysfunctional behaviors and make a difference in enhancing nurses’ dedication and loyalty
to their organization.11

Theoretical and conceptual framework

The present study was guided by two conceptualizations of work-related variables, namely organisational
justice by Colquitt12 and workplace deviance by Robinson and Bennett.13

Organisational justice. The organisational justice literature is largely influenced by Adam’s14 equity theory
(1965) that contended that individuals evaluate the extent of fairness in the outcomes allocation, policies
and procedures, and in the interactions they practiced with supervisors and colleagues. As indicated by
Adam,14 people make a comparison of their perceived rewards/allocations to their perceived contributions
and efforts and the same happened in case of their colleagues’ perceived rewards/allocations and perceived
contributions and efforts. If an individual perceives injustice and unfair treatment in such a comparison,
frustration and resentment developed in his or her mind, which consequently led to behavioral and psy-
chological negative reactions and increased the chances of workplace deviance.9,14
To measure organisational justice, diverse models have been developed. The most famous model
was that identified by Colquitt12 who illuminated the three dimensions or components of organisa-
tional justice that influence employees’ perception about justice and injustice at the workplace as
interactional, procedural, and distributive justice. Interactional justice refers to the connections
between nurse managers and nurses, and how nurse managers treat nurses in daily activities and
decision making and how they keep nurses informed about procedures and approaches used to
distribute outcomes such as results of the evaluation process, salary increase or incentives. Procedural
justice refers to the equality of applying regulations, laws and policies in the organization and the
performance appraisal process. Distributive justice refers to the distribution of resources and workload
Hashish 275

among nurses. Definitely, organisational justice is concerned with the ways in which nurses determine
whether they have been treated fairly within their organization and the ways in which those determi-
nations impact other work-related variables.15 In the current study, these components will be used to
measure organisational justice.

Workplace deviance. The notion of workplace deviance was intended to setback a vast assortment of
practices that proposed to cause harm to the organization or its members.3 Robinson and Bennett13 intro-
duced and defined workplace deviance as “the voluntary behavior that violates significant organizational
norms and threatens the well-being of the organization, its members, or both” (p. 556).13 workplace
deviance among employees becomes a common problem in work organizations.13,16 The main driver of
the growing interest in workplace deviance for researchers and practitioners is because of its increasing
prevalence in the workplace and incredible cost linked with this behavior.17
Several workplace deviance frameworks distinguish between behaviors directed at individuals and the
organization and this two-factors structure has been empirically bolstered. Therefore, a topology developed
by Robinson and Bennett13 has received more attention from scholars. It is very comprehensive and self-
explanatory. It has two dimensions through which the deviance of employees can be assessed: organiza-
tional deviance and interpersonal deviance.13,16 Organizational deviance reflects any behavior that violates
significant organizational norms and is directed toward the organization itself. On the other hand, inter-
personal deviance can mainly be defined as the deviant behaviors directed toward the individual members
of an organization (bosses, coworkers, or customers). The casualties of such behaviors can lead to employ-
ees experiencing stress and hence exhibiting diminished efficiency, lost work time, and a mostly high
turnover rate.18 Therefore, interpersonal deviance is a critical type of deviance. To examine the deviant acts
that are organizational and interpersonal in nature, Bennett and Robinson16 developed a scale to measure
both dimensions. Given the large empirical evidence supporting this distinction, it is noteworthy to gain
some more insight into the characteristics and nature of each type of behavior and the relationship of the two
categories with organisational justice.18

Significance of the study

Nurses have been considered as the key employees at healthcare organizations, and as they have very close
relationships with patients, their perception of justice must be seriously considered as it may affect the
quality of care.18 In its study, the World Health Organization (WHO)19 highlighted that nursing is one of the
skilled professions in Egypt; however, nurses often face challenging workplace conditions with little
institutional recognition or support and demotivation due to low salaries, besides other challenges such
as shortage of personnel, heavy workload, indefinite duties, and insufficient equipment that have brought
about dissatisfaction with work and feelings of frustration.20
A literature review revealed that so far few studies exist that have researched organisational justice and
workplace deviance together. 17,18,21 However, the impact of organisational justice on workplace
deviance was not assessed by any of the studies.21 The extent to which the previous research findings
of organisational justice studies can be generalized to other countries as well as to nurses is still not well
explored.8 Such indications demand to identify the influence of organisational justice on workplace
deviance in a different context and culture like Egypt, especially with previous researches claiming that
a lack of fair practices and stress are key determinants of workplace deviant behavior.22 Given this
prevalence, it was of keen interest to the author of this study to analyze workplace deviance as a result
of its expanding predominance and negative effect on individuals and organizations, coupled with its
vastly detrimental financial, psychological, and social effects.23 It is of foremost importance to gain
insight into workplace deviance among Egyptian nurses.
276 Nursing Ethics 27(1)

Moreover, owing to differences that could exist among different hospital environments, the author aimed
at carrying out this study by examining the relationship between nurses’ perceived organisational justice
and workplace deviance in two different hospitals (private and university). A comparison of the university
and private institutions might also prove useful to identify how organisational justice and workplace
deviance vary according to the type of the organizational setting. In general, this study is significant for
hospitals, nurses, and nurse managers as it could help to gain insight into the impact of nurses’ perceptions
of organisational justice on their workplace deviance that will enable administrators to distinguish and
anticipate when employees are behaving good or bad at work. It will help them develop intervention
strategies toward improving these perceptions and empowering practices to decrease the potential and
actual workplace deviant behaviors.

Research hypothesis
In the light of above reviewed literature, this study suggested that a positive approach toward nurses’
perception of organisational justice at the workplace can make them satisfied and can reduce workplace
deviance. Thus, the following hypotheses will be tested toward the fulfillment of the research objectives of
the study (Figure 1).

HP1a. organisational justice is negatively associated with nurses’ workplace deviance.

HP1b. organisational justice can significantly make a contribution to the prediction of nurses’ work-
place deviance.

Organizational justice (IV) Workplace deviance (DV)

- Interactional justice - Organizational deviance

- Procedural justice
- Interpersonal deviance
- Distributive justice

r, R2

Figure 1. Study framework.

r: relationship, R2: regression coefficient, IV: independent variable, DV: dependent variable.

Aim of the study

The aim of this study was twofold:

 To investigate nurses’ perception of organisational justice and workplace deviance in their hospitals.
 To determine the relationship between organisational justice (interactional, procedural, and distri-
butive) and workplace deviance (organizational and interpersonal).
Hashish 277

Material and methods

Research design and setting
A descriptive correlational research design using a cross-sectional survey was conducted in all inpatient
care units at two well-known Egyptian hospitals in the Alexandria governorate (the second capital of
Egypt): (1) The Main University Hospital (hospital A, non-profit hospital) is affiliated to the university
health sector. It is the principal teaching hospital in Alexandria with the largest number of nursing work-
force. This hospital provides free nursing and medical services for patients coming from many governorates
in addition to its educational role. (2) The Madina Women’s Hospital (hospital B, for-profit hospital) is
affiliated to the private health sector. It is one of the most known private hospitals that provides women with
the support and state-of-the-art paid medical services.

Participants
A convenience, non-probability sample of all staff nurses working at the previously mentioned hospitals
was invited to participate in the study (N ¼ 600). Out of the 600 nurses who received the questionnaire, 400
nurses returned them. The valid response rate was 66.67%. Their responses were classified as follows:
hospital A, n ¼ 300 and hospital B, n ¼ 100.

Study instruments
Data gathering tools included the three following instruments.

Demographic questionnaire. A demographic and work characteristics form for nurses was developed in this
study including questions related to gender, age, working unit, educational level, work experience, working
hours per week, extra work shifts, and the number of assigned patients per shift.

Organisational justice questionnaire. An organisational justice questionnaire was developed by Colquitt12 to

measure perceived organisational justice. It includes 20 items covering three dimensions of interactional
justice (9 items), procedural justice (6 items), and distributive justice (5 items) that collectively form the total
organisational justice. This scale assesses the extent to which the respondents’ experiences reflect attributes of
fair interactions, procedures, and outcomes along with a 7-point Likert-type scale ranging from 1 ¼ to a small
extent to 7 ¼ to a great extent. The mean value in this questionnaire ranges from 1 to 7. The higher the mean
score of the participants, the more perceived organisational justice is represented. Moreover, the total orga-
nisational justice mean score and the mean score of each dimension is reported separately.

Workplace deviance questionnaire. A workplace deviance questionnaire was developed by Bennett and
Robinson16 to measure organizational and interpersonal deviance. The questionnaire contains 19 items:
12 items report deviant acts that target the organization and 7 items report deviant acts that target the
members of the organization. It assesses the frequency with which the respondents engage in behaviors that
are harmful to the organization or other employees on a 7-point scale ranging from 1 ¼ never to 7 ¼ daily.
The mean value in this questionnaire ranges from 1 to 7. The higher the mean score of the participants, the
more the workplace deviance. The value of mean for the responses on a 7-point Likert-type scale for both
organisational justice and workplace deviance questionnaires were as follows: 1–3 ¼ low mean; >3–5 ¼
moderate mean; >5–7 ¼ high mean. Permission was obtained to use study instruments.
278 Nursing Ethics 27(1)

Validity and reliability

To determine the validity and reliability of the study instruments, several methods were used. First, tools
were translated into Arabic to suit the Egyptian culture. To identify the content validity and the fluency of
the translation, the questionnaires were given to a jury of five academic members who are experts in the
field of study. According to their recommendations, some items were modified for clarity. Second, tools
were back-translated into English by language experts. The back-translations were reviewed by the author
and members of the jury to ensure accuracy and to minimize potential threats to the study’s validity.
Similarly, to identify the face validity via a quantitative technique, the questionnaire was given to five
qualified nurses– similar to the sample chosen; however, no modification was needed to the questionnaires.
Also, a pilot study was conducted with 50 nurses (10%) who were excluded from the study to ensure the
clarity and applicability of the tools and to estimate the time required to complete the study questionnaires.
In light of the findings of the pilot study, few changes were made to the final tools. In addition, all study tools
were tested for internal reliability using Cronbach’s alpha correlation coefficient. The results proved the
tools to be reliable with a correlational coefficient of 0.980 and 0.973 for organisational justice and work-
place deviance, respectively.

Data collection
Written approval was obtained from the administrative authorities in the identified hospitals to collect the
necessary data. The questionnaires were hand-delivered to the participants by the author with relevant
instructions to complete the survey. Participants were given one week to complete the survey. The author
then went to each hospital to collect the completed surveys, which were usually left with the unit nurse
manager. Those unable to complete the survey in the one-week time were given a week extension, after
which the author again visited each facility and collected the completed questionnaires. During the third
week, all the remaining questionnaires were collected. The estimated time to complete the questionnaires
was 20 minutes. Data were collected from the nurses using the study questionnaires after obtaining their
acceptance over a period of 4 months in 2016.

Ethical considerations
Approval was obtained from the Ethics Committee at the Faculty of Nursing, Alexandria University. The
author explained the aim of the study to all participants. Privacy of the participants and confidentiality of
data were maintained, and subjects’ informed consent was obtained. The anonymity of the participants and
the right to withdraw from the study at any time were granted.

Data analysis
Data were coded by the author and statistically analyzed using IBM SPSS (Statistical Package for the Social
Science) version 22. Data on nurses’ general characteristics, perceived organisational justice, and work-
place deviance are summarized using descriptive statistics such as frequencies, percentages, mean and
standard deviation. Student’s t-test was used to compare the mean of nurses’ groups at the two studied
hospitals regarding their perception of organisational justice and workplace deviance. Pearson correlation
coefficient analysis (r) was used to test the nature of the relationship between the study variables. Regres-
sion analysis (R2) was used to test the predictive power of the independent variable (organisational justice)
on the dependent variable (workplace deviance). R2 change was tested with F- test and analyses of variance
(ANOVAs). A significant F value for R2 meant that the organisational justice added a significant prediction
of workplace deviance. The level of statistical significance was set at p < 0.05.
Hashish 279

Table 1. Nurses’ distribution according to their demographic and work-related characteristics (N ¼ 400).

Main university hospital Madina hospital Total

(n ¼ 300) (n ¼ 100) (N ¼ 400)

Demographic and work-related characteristics No. % No. % No. %

Gender
Male 62 20.7 2 2.0 64 16.0
Female 238 79.3 98 98.0 336 84.0
Age (years)
<30 169 56.3 72 72.0 241 60.25
30 – 40 102 34.0 24 24.0 126 31.5
41 – 50 23 7.7 4 4.0 27 6.75
>50 6 2.0 0 0.0 6 1.5
Working unit
Medical 90 30.0 5 5.0 95 23.75
Surgical 78 26.0 30 30.0 108 27.0
ICUs 126 42.0 15 15.0 141 35.25
Multi-specialty 6 2.0 50 50.0 56 14.0
Educational level
Bachelor of nursing science 83 27.7 23 23.0 116 29.0
Diploma of technical health institute 95 31.7 59 59.0 154 38.5
Diploma of secondary technical nursing school 112 37.4 18 18.0 130 32.5
Years of experience
<5 100 33.3 53 53.0 153 38.25
5 – 10 123 41.0 41 41.0 164 41.0
>10 77 25.7 6 6.0 83 20.75
Working hours per week
36 125 41.7 15 15.0 140 35.0
37 – 48 94 31.3 13 13.0 107 26.75
>48 81 27.0 72 72.0 153 38.25
Extra work shifts
Yes 148 49.3 82 82.0 230 57.5
No 152 50.7 18 18. 170 42.5
No of assigned patients/shift
1–3 129 43.0 72 72.0 201 50.25
4–8 119 37.7 22 22.0 141 35.25
>8 52 17.3 6 6.0 58 14.5

Result
Background characteristics of the participants
The highest proportion (84%) of studied nurses were female representing 79.3% and 98% at the Main
University hospital and Madina hospital, respectively. About two-thirds (60.25%) of nurses were aged
younger than 30 years, representing 56.3% and 72% in the main University hospital and Madina hospital,
respectively. Nurses were distributed across different working care units within each hospital with 42%
working in intensive care units (ICUs) at the Main University hospital, and half of the nurses at Madina
hospital working in multi-specialty units. Overall, 37.4% of nurses at the Main University hospital held a
diploma of Secondary Technical Nursing school and 59.0% of nurses at Madina hospital held a diploma of
280 Nursing Ethics 27(1)

Table 2. Mean score of organizational justice and workplace deviance as perceived by nurses at study hospitals.

Main university hospital Madina hospital

Variables Overall mean + SD mean + SD mean + SD t p

Overall organisational justice 2.14 + 1.23 1.61 + 0.70 3.76 + 1.06 18.934 <0.001*
Interactional justice 2.20 + 1.33 1.62 + 0.78 3.93 + 1.11 19.272 <0.001*
Procedural justice 2.16 + 1.29 1.61 + 0.76 3.81 + 1.13 18.097 <0.001*
Distributive justice 2.03 + 1.20 1.57 + 0.71 3.39 + 1.35 12.873 <0.001*
Overall workplace deviance 1.29 + 0.80 1.33 + 0.92 1.19 + 0.22 2.499 0.013*
Organizational deviance 1.33 + 0.82 1.37 + 0.94 1.23 + 0.25 2.286 0.023*
Interpersonal deviance 1.23 + 0.83 1.26 + 0.94 1.11 + 0.24 2.586 0.010*
t, p: t and p values of the student t-test for comparison between the two hospitals.
Value of mean for the response on a 7-point Likert-type scale: 1–3 ¼ low mean; >3–5 ¼ moderate mean; >5–7 ¼ high mean.
*Statistically significant at p  0.05.

Technical Health Institute. Moreover, 41.0% of nurses had between 5 and 10 years of experience in each
hospital. In all, 41.7% of nurses at the Main University hospital worked less than 36 hours per week, while
72% of nurses at Madina hospital worked more than 48 hours per week. Around 49.3% and 82% of nurses
took an extra shift, and 43% and 72% were assigned 1 to 3 patients per shift in the Main University hospital
and Madina hospital, respectively (Table 1).

Nurses’ perception of organisational justice and workplace deviance at the study hospitals
Regarding nurses’ perception of the study variables, Table 2 reveals that the mean value and standard
deviation of nurses’ perception of overall organisational justice were lower than average (2.14 + 1.23). As
for workplace deviance, the mean value for the overall scale also reveals that the nurses rated themselves
low in demonstrating overall workplace deviance (1.29 + 0.80). However, when comparing the mean value
of these variables between the studied hospitals, significant differences were found between nurses’ groups
at the hospitals regarding their perception of overall organisational justice (t ¼ 18.934, p < 0.001) and
workplace deviance (t ¼ 2.499, p ¼ 0.013). Nurses at the Madina hospital (private hospital) perceived
moderate organisational justice (3.76 + 1.06) significantly as compared to nurses in the Main University
hospital who reported a low mean of organisational justice (1.61 + 0.70). The same trend was reflected
along the entire dimensions of interactional, procedural, and distributive justice (p < 0.001). Although the
overall mean of perceived workplace deviance and its dimensions was lower than average in both hospitals,
nurses at the Main University hospital reported a slightly higher mean of workplace deviance (1.33 + 0.92)
as compared to nurses at Madina hospital (1.19 + 0.22). The same trend was reflected in both organiza-
tional (p ¼ 0.023) and interpersonal deviance dimensions (p ¼ 0.010).
In addition, Table 2 reveals that interactional justice has the highest mean (1.62 + 0.78, 3.93 + 1.11),
while distributive justice has the lowest mean (1.57 + 0.71,3.39 + 1.35) at the Main University hospital
and Madina hospital, respectively. As for workplace deviance, the mean for organizational deviance
dimension (1.37 + 0.94,1.23 + 0.25) was slightly higher than interpersonal deviance (1.26 + 0.94,
1.11 + 0.24) at the Main University and Madina hospitals, respectively. For additional values see Table 2.

Correlation and regression analysis between organisational justice and workplace deviance
Table 3 reveals a significant weak negative correlation between perceived overall organisational justice and
workplace deviance in both the overall scores (r ¼ 0.152, p ¼ 0.002) and the related dimensions of
Hashish 281

Table 3. Correlation between overall organizational justice and overall workplace deviance.

Variables Organizational deviance Interpersonal dDeviance Overall workplace deviance

Interactional justice r 0.148 0.133 0.147

P 0.003* 0.008* 0.003*
Procedural justice r 0.142 0.131 0.141
P 0.005* 0.009* 0.005*
Distributive justice r 0.152 0.140 0.151
P 0.002* 0.005* 0.002*
Overall organisational justice r 0.153 0.139 0.152
P 0.002* 0.005* 0.002*
Value of Pearson correlation coefficient: r ¼ 0.1 weak relationship; r ¼ 0.3 moderate relationship; r ¼ 0.5 strong relationship.
*Statistically significant at p  0.05.

Table 4. Multivariate regression analysis between overall organizational justice and overall workplace deviance.

Variable Beta Sig. R R2

Interactional justice 0.089 0.512 0.152 0.023

Procedural justice 0.029 0.843
Distributive justice 0.103 0.292
Overall organisational justice 0.152 0.002*
R ¼ 0.152, R2 ¼ 0.023, F ¼ 9.439, p ¼ 0.002*

B: the coefficient estimate; SE: standard error; t: t-test value; r: pearson correlation coefficient; R2: regression coefficient; F: F-test
(ANOVA); ANOVA: analysis of variance.
*Statistically significant at p  0.05.

organisational justice (interactional, procedural, and distributive) with organizational and interpersonal
deviance dimensions scores (p < 0.05). This means that the higher the perception of organisational justice,
the lower the workplace deviance. In addition, Table 4 reveals the regression coefficient value between
organisational justice and its related dimensions as independent variables and overall workplace deviance
as a dependent variable where R2 ¼ 0.023. This means that organisational justice significantly contributes to
the prediction of 2.3% of the explained variance of workplace deviance where the regression model is
significant (F ¼ 9.439, p ¼ 0.002).

Discussion
One of the incredible challenges confronting healthcare organizations is to maintain high workplace justice
that is a predictor of nurses’ behaviors. Understanding how justice or injustice in an organization affects the
attitudes and behaviors of nurses is essential. Hence, the current study aimed to investigate how nurses
perceive organisational justice and workplace deviance in their hospitals and how these variables relate to
each other.
Despite the fact that the mean values of perceived organisational justice and workplace deviance, as well
their related dimensions, were lower than average in both hospitals, the current research revealed that nurses
at the private hospital perceived organisational justice significantly higher compared to nurses in the
university hospital, whereas nurses at the university hospital reported higher workplace deviance as com-
pared to nurses in the private hospital. This result could be attributed to the differences in the workplace
climate and resource allocation between these hospitals. It is obvious that the atmosphere and environment
282 Nursing Ethics 27(1)

of the private hospital can overcome the difficult terms of nursing and, as a result, nurses might feel more
fairness in organizations. In private hospitals, work processes, the performance assessment system, and duty
descriptions are more detailed and clearer. Meanwhile, the environment of the university hospital has
proven to be more exposed to organizational injustice because of the shortage of nurses, work overload,
and nurse managers’ personal attitude and behavior.18 Similarly, Seyrek and Ekici24 indicated in their study
that the nurses who work in university hospitals are treated much more unjustly than the nurses who work in
private hospitals in terms of all forms of justice (p < 0.001). Also, the nurses who work in university
hospitals are exposed to negative behavior much more in their workplace. Moreover, Yüksel18 reported that
it was observed that most nurses working in private hospitals had been less exposed to psychologically
unjust behavior than those in university hospitals. Likewise, Ahmed et al.25 specified factors such as
workload, shortage of nurses, the ongoing changes in the health sector in Egypt, which involves adjustment
prerequisites for accreditation, patient rights, and financing, leading to a requirement for greater levels of
alertness and hence increased the workload for nurses and nurse managers. Therefore, increased stress and
pressure on nurses might in turn result in increased tendency for their negative behaviors. This result
corresponds with the literature and proves the fact that there is a statistically meaningful difference between
the nurses who work in university and private hospitals in terms of exposure to intimidation. In this context,
findings reported by Fathabad et al.26 and Ito et al.27 estimated the mean of the perceived organisational
justice to be higher than average. Also Mohamed et al.2 illustrated that nurses had a moderate level of
perceived organisational justice, while Haghighinezhad et al.20 indicated that nurses rated organisational
justice as low.
Interactional justice in this research secured the highest mean value, while distributive justice was found
to be the lowest perceived dimension. This perception of interactional justice among Egyptian nurses could
be associated with their personality traits and a social and humanitarian nature as reported by Ahmed et al.25
and Khalifa and Hassan.28 Social interaction is highly appreciated among Egyptian nurses and interpersonal
relationships including trust and respect are valued by nurses as such issues help in the creation of a social
identity and a feeling of bonding among the members of the organization. This result is in line with that of
Khalifa and Hassan28 who found that the Egyptian nurses viewed interactional justice and the collaboration
between colleagues, dignity, and respect as essential. Also, this result is consistent with Mahmoud and
Ibrahim29 and Abu Elanain30 who found that interactional justice constituted the highest mean percent score
of the studied nurses in an Egyptian hospital.
With regard to distributive justice, the low nurses’ perception of this type could be explained in the light
of the findings of several studies,25,26,29,31 which declared that unequal distribution of incentives, inequity
between the effort nurses exerted and the salaries they received, unfair salary rises, widened gap between
payments to nurses and doctors, the increased workload, the personal bias and favoritism of the superiors,
and lack of their involvement in the decision-making process exaggerated the feeling of distributive
injustice. However, this result is inconsistent with Ito et al.27 who declared that procedural justice had the
highest mean among nurses. In light of these inconsistencies, it is noteworthy to consider that procedural
justice also takes center stage along with interactional and distributive justice. Positive reinforcement of
procedural justice will keep employees away from unfair means of getting benefits, and thus it will ensure
reduction in workplace deviance too.21
As for workplace deviance, it is observed that the level of workplace deviance is lower than the average
mean. One justification may be related to the use of a self-report to measure workplace deviance, as it
appeared that nurses underestimated the actual level of workplace deviance. Nurses might respond inaccu-
rately to under-report deviance in an effort to engage in impression management and avoid blame. This
result could be supported by Yüksel18 who elucidated that it would be quite normal for the employees to be
unwilling to answer a survey on such a sensitive subject. This is due to the fact that justice perception and
deviant behaviors in the workplace are considered as unmentionable subjects in the working environment
Hashish 283

and discussing these subjects may create serious problems with the management. Similarly, Liu and Ding32
found that deviance behaviors were infrequently reported. Although this low mean of workplace deviance,
result should be taken cautiously, even a small amount of deviance may lead to irreparable consequences.
Nurses reported organizational deviance behaviors slightly higher than interpersonal deviance. Organi-
zational deviance dimension includes deviant behaviors such as leaving early, taking excessive breaks,
sabotaging equipment, and lying about hours worked. Likewise, poor attendance; misuse of time, resources,
and information; taking property from work without permission; intentionally working slower; and neglect-
ing supervisor’s instructions are among these behaviors.16,18 This result might be explained by the
reasoning that organizational variables were more likely to explain organizational deviance, whereas
individual-related variables were more prone to explain interpersonal deviance. In general, nurses deemed
their organizations as their sources of power and support. If they felt that their organization was unsuppor-
tive and did not care for their welfare or recognize their contribution, they felt more comfortable to report
deviance toward the organization rather than admitting deviance against their coworkers as they believed
their coworkers did not have the power to improve the negative conditions in the organization. This result is
consistent with Liu and Ding32 who found that organizational deviance mean was rated higher than inter-
personal deviance mean. Also, Bayin et al.33 reported that the mean score of nurses’ organizational deviance
is considerably lower than the mean value. The results of the study by Liu and Ding32 delineated that
employees who perceived low levels of organizational support were likely to experience frustration to
achieve their goals, leading to deviant behaviors. Also, Chen et al.34 implied that when employees perceived
the organization to be supportive, it increased their job response and ultimately reduced their tendency to
engage in workplace deviance. In this regard, the findings of this study constitute a valuable asset for the
hospital and nurse managers to guide and direct their future actions with a view to eradicate the workplace
deviance as an undesired condition in terms of both employees and organizations and to take preventive
measures. Through a better understanding of factors that influence workplace deviance, organizations may
be able to reduce the occurrence of deviance. Therefore, nurse managers should create a supportive work
environment among their personnel. They should identify reasons and the ways of preventing workplace
deviance.2
As expected, the findings of this study unveiled a statistically significant negative correlation between
perceived organisational justice, and its dimensions of interactional, procedural, and distributive justice,
with workplace deviance, and its dimensions of organizational and interpersonal deviance. The results
further indicated that perceived organisational justice has a predictive value for employees’ deviance.
Regression coefficient value revealed that 2.3% of the explained variance of workplace deviance is
accounted negatively by organisational justice. Although the values of correlation and regression in this
study are low, it seems that organisational justice can affect workplace deviance. Given this approved
negative significant correlation, it can be inferred that the development of fairness perception, organisa-
tional justice, and supportive work environment conditions would cause nurses to avoid being engaged in
workplace deviant behaviors, while the existence of perceived injustice in an organization’s environment
will certainly lead to workplace deviant behavior. Therefore, the current research hypotheses have been
accepted. Similar findings were reported by Dar,9 Baig and Ullah,21 and Alias and Rasdi35 who found that
both organizational and interpersonal deviance were negatively and significantly correlated with organisa-
tional justice and it is worth noticing as they indicate that a possible causal relationship may exist between
justice and deviance in the reported direction. Also, Holtz and Harold36 and Ferris et al.37 confirmed the
strong association between the proposed variables and indicated that employees with strong justice orienta-
tions are unlikely to engage in workplace deviance. Moreover, Mohamed et al.2 illustrated that nurses who
perceive low organisational justice behave negatively toward their colleagues and organizations.
In this context, Haghighinezhad et al.20 recommended that certain managerial strategies need to be
adopted such as optimization of effective communication skills, changing of attitude toward nurses, and
284 Nursing Ethics 27(1)

paying more attention to their opinions. Increasing the reward, revision of procedures and guidelines, and
reducing work hours could be useful in the long run for the health of nurses and the nursing profession.
Nurse managers can resolve the issue of workplace deviance by ensuring fairness in rewards distribution
(distributional justice), making policies with equal benefits to all stakeholders (procedural justice), and
providing all the necessary information to the employees (interactional justice). Also, Olsen et al.38 rec-
ommended that the hospital administration should develop strategies related to improving resources and job
demands that influence nurses’ outcomes.

Strengths, limitations, and future studies

One of the valuable contributions of this study to management practices concerns the importance of justice
perceptions of the nurses in shaping their behaviors and the important role organisational justice plays in the
determination of workplace deviance among nurses. Nevertheless, this study has a few limitations. First,
workplace deviance was measured using self-reported data. Respondents may “fake good” under the
influence of social desirability bias and may manipulate the realities in answering the questions to avoid
being criticized. This perception may make the responses of the participants biased, and thus affect the
actual relationships that exist between the variables being studied. Given that many instances of workplace
deviance go unreported and unseen, this subsequently constrains the validity of the reports. Further research
should try to employ multiple sources of information on deviance behaviors. Second, the recruitment
method relied on convenience sampling and may not be truly representative of the nursing population.
However, future studies ought to go beyond this study to validate the effect of organisational justice on
workplace deviance in a wider context and different samples using other methods of data collection. Third,
the study examined the impact of one workplace-related factor only on workplace deviance. It would have
been useful to examine the impact of certain other individual-related variables that might provide a more
integrated picture about the antecedents of workplace deviance.

Conclusion
The findings of this study constitute a valuable asset for the hospital and nurse managers to guide and
direct their future action with a view to eradicating the negative results of workplace deviance through
organisational justice. In conclusion, this study has made its own impact on the existing literature on how
organisational justice influences workplace deviant behaviors among Egyptian nurses in university and
private hospitals. The results show that nurses’ perception of organisational justice is significantly related
to their workplace deviance and organisational justice as an independent variable contributes a significant
predictive power of workplace deviance and can reduce these behaviors directly. Meanwhile, the results
of this study show that the nurses’ perceptions of organisational justice and workplace deviance are low
than the average mean in the studied hospitals; however, it has been seen that the nurses’ perception of
organisational justice is higher in the private hospital than the university hospital, so nurses are less
exposed to workplace deviant behaviors in the private hospital. Interactional justice in this research
secured the highest mean, while distributive justice was found to be the lowest perceived dimension.
Also, organizational deviance was reported to be slightly higher than interpersonal deviance.

Recommendation
The study findings draw attention to the fact that there are paucities in organisational justice and tendency
for more workplace deviance. Hence the following implications are highlighted.
Hashish 285

Implications for nurse managers.

 Nurse managers have to create and maintain a healthy and supportive work environment that
promotes organisational justice and decreases workplace deviance. A culture of respectful commu-
nication and a blame-free environment are important where organizational policies and justice in
allocating resources and workload are judiciously followed. In addition, the application of perfor-
mance appraisal regulations and providing rewards for achievements are helpful strategies.
 Nurse managers should keep nurses informed about hospital policies, rules, regulations, and proce-
dures and approaches used to distribute outcomes such as rewards and opportunities for develop-
ment. Also, they should provide support to nurses who experienced deviant behaviors to reduce
adverse outcomes on their performance and satisfaction.
Implications for hospital managers.
 Hospital managers have to appropriately address disruptive behavior in the workplace by setting
aside a regular time for confidence building sessions and enhanced conflict management and conflict
resolution strategies.
 The organizations should adopt zero-tolerance policies that include appropriate investigation and
due processes necessary to provide adequate safeguards to nurses and others who are accused of
deviance.
 Specifically, hospital and nurse managers should inspire educational strategies to increase nurses’
awareness of the problems with deviant behaviors in the workplace and its potential consequences
and related coping measures that could be useful in the long run for the health of the nursing
profession.
Recommendations for future studies. Due to the stated limitations of the study, the following future researches
were suggested:
 Future research should increase the sample size and number of the researched institutions to better
tap the nature of relationships.
 Future researchers can be conducted using a triangulation, mixed approach (both qualitative and
quantitative research) to better understand and appreciate the relationship that exists among sensitive
variables such as organisational justice and workplace deviance.
 Many other variables acting as mediators, such as organizational support, ethical work climate,
employee training, and so on, should be investigated. The relationship of justice may also have to
be studied with various positive outcomes such as organization citizenship behavior, employee’s
commitment, loyalty, job performance, quality of care, and work productivity.
 Furthermore, future research could be done to identify the effect of nurses’ individual-and work-
related characteristics such as gender, working unit, educational level, working hours per week, extra
work shifts, number of assigned patients per shift, and personality traits on study variables. A further
insight into how situational and individual-related factors interact with each other to predict work-
place deviance might prove useful in developing a more comprehensive approach.

The message of this study on a global level for nursing and healthcare.
 Given the impact of perceived organisational justice on the quality of care, the findings of this study
imply that it is necessary for managers to take steps to increase the perceived organisational justice
and make the nurses feel they are valuable and respectful members of the institution, so that they can
work productively and in harmony with their managers and colleagues and avoid being engaged in
deviant or disruptive behaviors toward the organization or its members.
286 Nursing Ethics 27(1)

 There is a need to heighten awareness of the problem of workplace deviance among health service
managers and the general public, and to carry out appropriate control strategies for preventing it.
Therefore, for organizations to restrain the occurrence of workplace deviance, it is imperative for the
managements to create and maintain management systems, policies, procedures, and strategies that
are aimed at promoting organizational support and justice, which will in turn promote positive
organizational outcomes.

Acknowledgements
We would like to thank the editor and reviewers of Journal of Nursing Ethics; their valuable comments
helped to refine this research article in a better form. We would like to thank all participants who agreed to
participate in this research study.

Conflict of interest
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or
publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD
Ebtsam Aly Abou Hashish https://orcid.org/0000-0003-0492-7615

References
1. Jafari P and Bidarian S. The relationship between organizational justice and organizational citizenship behavior.
Procd Soc Behv 2012; 47: 1815–1820.
2. Mohamed H, Higazee M and Goda S. Organizational justice and workplace bullying: the experience of nurses. Am
J Nurs Res 2018; 6(4): 208–213.
3. Mathur SP. Organizational justice and organizational citizenship behavior among store executives. Hum Resour
Manage Res 2013; 3(4): 124–149.
4. Brockner J. A contemporary look at organizational justice: multiplying insult times injury. New York: Routledge,
2011.
5. Cole MS, Bernerth B, Walter F, et al. Organizational justice and individuals’ withdrawal: unlocking the influence
of emotional exhaustion. J Manage Stud 2010; 47(3): 367–390.
6. Lambert EG, Hogan NL and Cheeseman K. Strain-based work-family conflict and its relationship with perceptions
of distributive and procedural justice among correctional staff. J Police Crim Psychol 2013; 28(1): 35–47.
7. Fatt C, Khin E and Heng T. The impact of organizational justice on employees’ job satisfaction: the Malaysian
companies perspectives. Am J Econ Bus Admin 2010; 2(1): 56–63.
8. Aboul-Ela G. Analyzing the relationships between organization justice dimensions and selected organizational
outcomes—empirical research study. Bus Manage Rev 2014; 5(2): 34–44.
9. Dar N. The impact of distributive (in) justice on deviance at workplace in public sector organizations of pakistan
with the mediation of perceived organizational support. Arab J Bus Manag Rev 2017; 7: 309.
10. Nasir M and Bashir A. Examining workplace deviance in public sector organizations of Pakistan. Int J Soc Econ
2012; 39: 240–253.
11. Abou Hashish EA. Relationship between ethical work climate and nurses’ perception of organizational support,
commitment, job satisfaction and turnover intent. Nurs Ethics 2017; 24(2): 151–166.
Hashish 287

12. Colquitt JA. On the dimensionality of organizational justice: a construct validation of a measure. J Appl Psychol
2001; 86(3): 386–400.
13. Robinson SL and Bennett RJ. A typology of deviant workplace behaviors: a multidimensional scaling study. Acad
Manage J 1995; 38: 555–572.
14. Adam JS. Inequity in social exchange. In: Berkovitz L (ed.) Advances in experimental social psychology, vol. 2.
New York: Academic Press, 1965, pp. 267–299.
15. Al-Zu’bi HA. A study of relationship between organizational justice and job satisfaction. Int J Bus Manage 2010;
5(12): 102–109.
16. Bennett RJ and Robinson SL. Development of a measure of workplace deviance. J Appl Psychol 2000; 85(3):
349–360.
17. Faheem M and Mahmud N. The effects of organizational justice on workplace deviance and job satisfaction of
employees: evidence from a public sector hospital of Pakistan. Mediterr J Soc Sci 2015; 6(5): 342–352.
18. Yüksel S. The impact of perceptions of ethical work climates and organizational justice on workplace deviance.
Unpublished Doctoral Dissertation, Middle East Technical University, Ankara, 2012.
19. World Health Organization (WHO). Egypt nursing profile, 2012, http://www.emro.who.int/images/stories/cah/
fact_sheet/Nursing_Profile.pdf
20. Haghighinezhad G, Atashzadeh-Shoorideh F, Ashktorab T, et al. Relationship between perceived organizational
justice and moral distress in intensive care unit nurses. Nurs Ethics 2019; 26(2): 460–470.
21. Baig F and Ullah Z. Curing workplace deviance through organizational justice in the mediating role of job
satisfaction: the case of NGOs in Pakistan. Sarhad J Manage Sci 2017; 3(1): 1–22.
22. Omar F, Halim F, Zainah A, et al. Stress and job satisfaction as antecedents of workplace deviant behavior. World
Appl Sci J 2011; 12: 46–51.
23. Ahmad A and Omar Z. Reducing deviant behavior through workplace spirituality and job satisfaction. Asian Soc
Sci 2014; 10(19): 107–112.
24. Seyrek H and Ekici D. Nurses’ perception of organizational justice and its effect on bullying behavior in the
hospitals of Turkey. Hosp Pract Res 2017; 2(3): 72–78.
25. Ahmed A and Fadel K, Ghallab S, et al. effect of organizational justice and trust on nurses: commitment at Assiut
University Hospitals. New York Sci J 2014; 7(10): 103–114.
26. Fathabad HS, Yazdanpanah A, Hessam S, et al. Organizational justice and the shortage of nurses in medical &
educational hospitals, in Urmia-2014. Glob J Health Sci 2016; 8(2): 99–105.
27. Ito Y, Nakamura S, Kimura R, et al. Relationship between organizational justice and psychological distress among
hospital nurses. Kitasato Med J 2015; 45(1): 38–44.
28. Khalifa S and Hassan N. The relationship between organizational justice and citizenship behavior as perceived by
medical-surgical care nurses. IOSR J Nurs Health Sci 2018; 7(4): 31–37.
29. Mahmoud A and Ibrahim S. Factors in nurses’ organizational citizenship behavior. IOSR J Nurs Health Sci 2016;
5(2): 22–28.
30. Abu Elanain M. Work locus of control and interactional justice as mediators of the relationship between openness
to experience and organizational citizenship behavior. Cross Cult Manag 2010; 17(2): 170–192.
31. Tourani S, Khosravizadeh O, Omrani A, et al. The relationship between organizational justice and turnover
intention of hospital nurses in Iran. Mater Sociomed 2016; 28(3): 205–209.
32. Liu NT and Ding CG. General ethical judgments perceived organizational support, interactional justice, and
workplace deviance. Int J Hum Resour Man 2012; 23(13): 2712–2735.
33. Bayin G and Terekli Yeşilaydin G. Analysis of nurses’ organizational deviant behavior: an example of a university
hospital. J Bus Res: Türk 2014; 6(3): 81–107.
34. Chen C, Chen MY and Liu YC. Negative affectivity and workplace deviance: the moderating role of ethical
climate. Int J Hum Resour Man 2013; 24(15): 2894–2910.
288 Nursing Ethics 27(1)

35. Alias M and Rasdi RM. Organizational predictors of workplace deviance among support staff. Procd Soc Behv
2015; 172: 126–133.
36. Holtz B and Harold C. Interpersonal justice and deviance: the moderating effects of interpersonal justice values and
justice orientation. J Manage 2013; 39(2): 339–365.
37. Ferris DL, Spence JR, Brown DJ, et al. Interpersonal injustice and workplace deviance the role of esteem threat. J
Manage 2012; 38(6): 1788–1811.
38. Olsen E, Bjaalid G and Mikkelsen A. Work climate and the mediating role of workplace bullying related to job
performance, job satisfaction, and work ability: a study among hospital nurses. J Adv Nurs 2017; 73(11):
2709–2719.