Journal of Workplace Behavioral Health

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Links connecting nurses’ planned behavior,

burnout, job satisfaction, and organizational
citizenship behavior

N. Gökhan Torlak, Cemil Kuzey, Muhammet Sait Dinç & Taylan Budur

To cite this article: N. Gökhan Torlak, Cemil Kuzey, Muhammet Sait Dinç & Taylan
Budur (2021) Links connecting nurses’ planned behavior, burnout, job satisfaction, and
organizational citizenship behavior, Journal of Workplace Behavioral Health, 36:1, 77-103, DOI:
10.1080/15555240.2020.1862675

To link to this article: https://doi.org/10.1080/15555240.2020.1862675

Published online: 03 Feb 2021.

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JOURNAL OF WORKPLACE BEHAVIORAL HEALTH
2021, VOL. 36, NO. 1, 77–103
https://doi.org/10.1080/15555240.2020.1862675

Links connecting nurses’ planned behavior, burnout,

job satisfaction, and organizational citizenship behavior
€khan Torlaka
N. Go , Cemil Kuzeyb , Muhammet Sait Dinçc , and
Taylan Budurd
a
Department of Business Administration, Dog € udar, Istanbul, Turkey;
uş University, Usk€
b
Department of Computer Science and Information Systems, Arthur J. Bauernfeind College of
Business, Murray State University, Murray, Kentucky, USA; cDepartment of Human Resource
Management, American University of the Middle East, Kuwait City, Kuwait; dDepartment of
Business and Management, Tishk International University, Sulaimania, Iraq

ABSTRACT ARTICLE HISTORY

This study aims to investigate the relationships between the Received 7 April 2020
planned behavior, burnout, overall job satisfaction, and organ- Accepted 8 December 2020
izational citizenship behavior of nurses in three public hospi-
KEYWORDS
tals in Iraq. The methodology included descriptive statistics,
Burnout; healthcare
PLS-based-SEM, and mediation analysis. An assessment of data organization; job
collected from a survey based on an interview with 428 nurses satisfaction; nursing;
participating showed that the attitude of the nurses toward organizational citizenship
their behavior significantly positively affected their burnout behavior; planned behavior
and overall job satisfaction, while their subjective norm and
perceived behavioral control significantly positively influenced
burnout. The burnout experienced by the nurses significantly
negatively impacted their citizenship behavior, while overall;
their job satisfaction significantly positively affected their citi-
zenship behavior. Though the nurses’ burnout partially medi-
ated the relationships between their planned behavior and
citizenship behavior, their overall job satisfaction partially
mediated the association between their subjective norm/per-
ceived behavioral control and citizenship behavior.

Introduction
One of the authors of this paper witnessed several common difficulties
encountered by some of the nurses working in the Shar, Shorush, and
Emergency public hospitals in Sulaimania, Iraq. After the ISIS attacks, polit-
ical and economic turmoil arose. The civil war, which led to a considerable
number of casualties as well as distressed civilians, generated an intimidat-
ing atmosphere, causing repercussions throughout the whole country. To be
specific, nurses in public hospitals received low, irregular wages, and were
overwhelmed by busy schedules. Their clinical supervision, as well as soci-
ability, was reduced; training and skill improvement activities ceased;

CONTACT N. G€ okhan Torlak ntorlak@dogus.edu.tr uş

Department of Business Administration, Dog
University, Bosna Bulvari, No.140, Istanbul, Turkey.
ß 2021 Taylor & Francis Group, LLC
78 N. G. TORLAK ET AL.

workplace pressure increased; and finally, know-how, chaos, fatigue, and

obstacles became dominating issues interfering with task execution. This
situation created a significant nursing shortage that reduced patient care
and increased mandatory overtime and medical errors in task performance.
Consequently, nurses became edgy, apprehensive, aimless, uncaring, isolated,
drained, and developed a distaste toward their jobs.
The nurses’ discontent associated with various features of their jobs, their
emotional collapse, and their resulting isolation adversely affected relation-
ships with their colleagues and lessened their sincere interest in hospital
concerns. They lost interest in supporting their colleagues by way of prob-
lem-solving, task performance, resolving conflict, or addressing problems in
other units, despite their needed skills. Above all, their most worrying
issues were depleted energy, loneliness, fatigue, lack of teamwork, and
adverse working conditions that led to mental and physical difficulties. For
example, low self-esteem, severe headaches, and sleeping disruptions cre-
ated a loss of interest in hospital affairs.
Based upon the research site observations, the theory of planned behav-
ior (TPB) seemed to be an appropriate conceptual framework for circum-
stances within which the nurses did not perceive of themselves as being
able to assert control over their behavior within the public hospitals in
Iraq. The TPB emphasizes the behavioral achievement of an individual
which is an outcome of perceived behavioral control combined with inten-
tion. Behavioral, normative, and control beliefs influence attitude toward
behavior (ATB), subjective norm (SN), and perceived behavioral control
(PBC) that shape intentions (Ajzen, 1991). The TPB has been extensively
investigated within the health sector, ranging from the effects of smoking,
healthy eating, and/or child abuse to mental health and the education of
professionals (Bakari et al., 2017; Casper, 2007; Feng & Wu, 2005; Godin,
Valois, Lepage, & Desharnais, 1992; Povey, Conner, Sparks, James, &
Shepherd, 2000; Randall & Gibson, 1991; Samad, 2018).
As discovered by Lee, Ashford, and Bobko (1990) and Lam, Baum, and
Pine (2003), there is a positive relationship between TPB and overall job
satisfaction (OJS) in the health and tourism sectors. Accordingly, nurses
were unable, while under pressure, to display the job dissatisfaction that
ultimately led to staff turnover and shortages (Ajzen, 1991; Blegen, 1993;
Delobelle et al., 2011; Irvine & Evans, 1995; Lu, Barriball, Zhang, &
While, 2012).
As revealed by Schaufeli and van Dierendonck (1993), burnout (BO) is an
unclear disorder that manifests over 100 symptoms. Specifically, nursing
could produce the majority of those effects concerning emotional, mental,
physical, and spiritual fatigue, all of which arose from the complex nature
and intensity of requirements within the profession. Similarly, Lyndon (2016)
 JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 79

detected that the emotional exhaustion, cynical detachment, and physical

fatigue experienced by healthcare professionals harmed their cognitive func-
tions, affecting their ability to perform appropriately, thus potentiating a
menace to both healthcare quality and patient safety.
Furthermore, in today’s competitive business environment, it is impera-
tive that organizations retain members who are able and willing to put in
extra effort beyond their contractual duties, thus delivering other benefits
that achieve efficiency, effectiveness, and viability. The cooperative and dis-
cretionary behavior of employees or organizational citizenship behavior
(OCB) makes it possible for organizations to survive (LePine, Erez, &
Johnson, 2002). Organ (1988) and Chahal and Mehta (2010) did extensive
research on the antecedents of OCB. Likewise, Organ and Ryan (1995),
Organ, Podsakoff, and MacKenzie (2005), Fassina, Jones, and Uggerslev
(2008), and Lambert (2010) detected a strong relationship between OJS and
OCB. In healthcare settings, Tsai and Wu (2010) and Ng et al. (2019)
found a significant positive correlation between the OJS and OCB
of nurses.
The work-related challenges faced by the nurses developed a connection
that led to their exhaustion, demotivation, and strongly decreased OCB
(Cropanzano, Rupp, & Byrne, 2003; Şeşen, Çetin, & Basım, 2011). Notably,
Gilbert, Laschinger, and Leiter (2010) and Huang, You, and Tsai (2012)
analyzed BO, OJS, and OCB in nursing extensively.
This study claimed that BO and OJS mediate the relationship between
TPB and OCB. Civil war, excessive workload, shift work, uncomfortable
working conditions, emotional stress, improper supervision, disharmony,
staff shortages, low patient-to-nurse ratio, and small, overdue salaries led to
a dislike for their jobs and colleagues, creating unhappiness for nurses in
the public hospitals in Sulaimania. The BO observations are evident in the
works of Bakker and Heuven (2006), Maslach and Leiter (2008), Tunc and
Kutanis (2009), Awa, Plaumann, and Walter (2010), Sharma et al. (2014),
and Weiner (2014). Likewise, the OJS observations are evident in the work
of Chiu and Chen (2005). Therefore, the nurses in these three public hospi-
tals could not engage in work activities beyond the minimum required for
their task, which was corroborated by the work of van Emmerik, Jawahar,
and Stone (2005). Consequently, the BO and OJS of the nurses preceded
the withdrawal of their OCB.
Given the specific difficulties that were observed at the research sites and
the prior studies discussed in this paper, the public hospitals in Iraq might
consider the relationships among TPB, BO, and OJS that influence OCB in
order to elevate the attitudes and behavior of their nurses.
This paper includes six sections. Section “Theoretical framework and
hypotheses” describes the TPB, BO, OJS, and OCB research into the
80 N. G. TORLAK ET AL.

relationships between the elements of TPB, BO, OJS, and OCB in health-
care and other sectors, as well as developing hypotheses based upon site
observations, together with prior studies. Section “Research methodology”
explains the proposed model, the sample, and the methods that were
employed. Section “Data analysis and research findings” shows data prepro-
cessing, descriptive statistics, measurement model assessments, partial least
square structural equation modeling, mediation analyses, and empirical
findings. Section “Discussion” compares the outcome of this study with
prior works, summarizes the theoretical and practical implications, and sets
out the limitations of this study and proposals for further research. Finally,
Section “Conclusion” describes recommendations from the managerial
perspective.

Theoretical framework and hypotheses

Theory of planned behavior (TPB)
The TPB emphasizes behavioral achievement through estimating a person’s
intention to be involved in a certain way and their willpower to create that
behavior. The former refers to motivational elements affecting behavior;
whereas, the latter refers to behavioral control in which an individual uses
self-control. TPB includes three types of beliefs (i.e., behavioral, normative,
and control), leading to a change in intention and behavior: attitude toward
behavior (ATB), subjective norm (SN), and perceived behavioral control
(PBC) (Ajzen, 1991).

Attitude toward behavior (ATB)

The attitude is an individual’s positive or negative feeling and the resulting
evaluation toward performing a behavior (Ajzen, 1991). As noted by Certo
and Certo (2005), personal beliefs estimate current attitudes in the disposi-
tional approach. A human resource approach can make changes in task
design, work autonomy, or level of task challenges that alter the workplace
situation to the extent such that an employee’s beliefs and comfort level
are changed.

Subjective norm (SN)

SN refers to the perception that peers, including parents, friends, or men-
tors, etc. expect an individual to perform predictably. Normative beliefs
within a cultural context affect peer beliefs that shape SN (Ajzen, 1991).
Noted by Certo and Certo (2005), the attitudes and beliefs of peers influ-
ence an employee’s attitude toward the job within the social influence
 JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 81

approach. So, an employee’s SN changes when the attitudes and beliefs of

his/her peers have changed.

Perceived behavioral control (PBC)

An individual’s perception of the relative complexity in executing a behav-
ior rests upon experience, resources, knowledge, self-efficacy, and antici-
pated obstacles. Anticipations of behavioral control differ, depending upon
situations and actions. Therefore, an individual’s control beliefs affect his/
her anticipated behavioral control (Ajzen, 1991).

Burnout (BO)
BO is a syndrome of emotional exhaustion and cynicism about the value of
one’s occupation and doubt of one’s capacity to perform (Maslach and
Jackson, 1981; Maslach, Jackson, & Leiter, 1996). Maslach and Jackson
(1982, 1986) and Schaufeli, Leiter, and Maslach (2009) considered BO in
human services and various occupations due to social, economic, and cul-
tural developments. Maslach and Jackson (1986) defined BO as a three-
dimensional syndrome of emotional exhaustion, depersonalization, and
reduced personal accomplishment. Emotional exhaustion refers to depleted
energy and drained sensation due to stressful interpersonal communication
with others. The dehumanization of others through one’s cynical and
uncaring attitudes characterizes depersonalization. Finally, reduced personal
accomplishment refers to the tendency of evaluating one’s work negatively,
leading to a lack of motivation and self-esteem.

Overall job satisfaction (OJS)

As noted by Oshagbemi (2000) and Judge and Church (2000), OJS refers to
good feelings about a job, resulting from an evaluation of its characteristics
that include the nature of work, administration style, relationships with
coworkers, remuneration, working conditions, and job security. Besides,
Adams (1965) revealed that fair pay, assignments, promotions, and growth
opportunities within the workplace are significantly related to OJS.

Organizational citizenship behavior (OCB)

OCB is a voluntary employee behavior, which eases the accomplishment of
organizational goals. It supports the social system of an organization that
relies upon task performance. OCB includes five elements: altruism, con-
scientiousness, civic virtue, courtesy, and sportsmanship. Altruism refers to
personally supporting a colleague in problem-solving or task execution.
82 N. G. TORLAK ET AL.

Conscientiousness facilitates extra assistance in one’s work performance

and following the standards and codes of the organization, that combined,
define a good worker. Civic virtue is related to the strong interest evi-
denced by an employee in organizational actions and concerns. Courtesy is
attributed to candid and thoughtful attitudes and preventing work-related
conflicts and uneasiness. Finally, sportsmanship relates to an employee’s
patience and recognition under personally intolerable circumstances
(Organ, 1988, 1997).

Literature review
There was no research reported in the literature regarding the planned behav-
ior (PB) and BO relationship. However, given the research site observations,
the civil war, combined with the complex nature and intensity of the practice
of nursing, affected the nurses’ tasks, peer relationships, and confidence
adversely, resulting in their exhaustion, uncaring attitudes, physical fatigue,
and diminished self-esteem. Therefore, the researchers formulated the follow-
ing hypotheses:
H1. PB has a significantly positive association with BO.
H1a. ATB has a significantly positive association with BO.
H1b. SN has a significantly positive association with BO.
H1c. PBC has a significantly positive association with BO.

Regarding the PB-OJS relationship, as noted by Lam et al. (2003), SN sig-

nificantly and positively affected OJS within the process of socialization of
new employees. Likewise, Lee et al. (1990) found that people with high levels
of Type A behavior and PBC performed well and had greater job satisfaction.
Additionally, Benrazavi and Silong (2013) found a strong positive correlation
between the willingness of employees to work in teams, based upon TPB and
their job satisfaction. Javadi, Kadkhodaee, Yaghoubi, Maroufi, and Shams
(2013) demonstrated that SN positively affected the safety awareness of most
nurses, while PBC was effective in surgical wards and intensive-care units
within hospitals. Finally, the nurses’ high workload in the three public hospi-
tals adversely affected their beliefs and changed their level of challenge and
comfort at work. Given the research site observation and the prior studies, the
researchers developed the following hypotheses:
H2. PB has a significantly positive association with OJS.
H2a. ATB has a significantly positive association with OJS.
H2b. SN has a significantly positive association with OJS.
H2c. PBC has a significantly positive association with OJS.
 JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 83

Bakker, Demerouti, and Verbeke (2004) found that job demands and job
resources influenced employee exhaustion and disengagement that pre-
dicted in-role and extra-role performance. Chang, Johnson, and Yang
(2007) found that when people are emotionally exhausted, they concentrate
on overcoming work demands in that they would avoid helping others.
Cropanzano, Rupp, and Byrne (2003), van Emmerik et al. (2005), and Jang
et al. (2020) also showed that emotional exhaustion significantly and nega-
tively affects OCB. Likewise, Gilbert et al. (2010) found that emotional
exhaustion significantly mediates the empowerment-OCB relationship of
healthcare professionals. Şeşen et al. (2011) detected that reduced personal
accomplishment affects OCB, while emotional exhaustion and depersonal-
ization has no significant effect. Job satisfaction mediates the BO-OCB rela-
tionship. Similarly, Chiu and Tsai (2006) revealed that emotional
exhaustion and diminished personal accomplishment significantly impacts
OCB, though depersonalization does not. However, van Emmerik et al.
(2005) noted that only reduced personal accomplishment negatively affects
OCB in three professional organizations. Moreover, job involvement medi-
ates the BO-OCB relationship in the hospitality industry. Finally, Liang
(2012) found BO influences OCB. Therefore, the researchers developed the
following hypothesis:
H3. BO has a significantly negative association with OCB.

Dinc (2018) detected a strong positive relationship between OJS and

OCB in public and private university settings. Rezaiean, Givi, Givi, and
Nasrabadi (2010) also found that OJS positively affects OCB within hospi-
tals and health centers. Likewise, as noted by Huang et al. (2012), the per-
ception by nurses of their ethical climate affects OJS and organizational
commitment, leading to higher OCB within hospitals. Park et al. (2009),
Tsai and Wu (2010), and Ng et al. (2019) showed that the nurses’ OJS sig-
nificantly and positively influenced OCB. Jung and Yoon (2015) also
uncovered that the hope of employees significantly influences OJS, which
in turn positively affects OCB in the hospitality industry. Finally,
Subhadrabandhu (2012) and Ottmar and Zucchero (2018) found a strong
relationship between OJS and OCB. Given the research site observations
and the prior studies, the researchers formulated the following hypothesis:
H4. OJS has a significantly positive association with OCB.

Nash, Edwards, and Nebauer (1993) detected that ATB, SN, and PBC
affects the nurses’ intentions to conduct pain assessment. Ko et al. (2004)
also revealed that the variables of PB, including self-efficacy, attitude, years
of work experience and remuneration contributes significantly to the
nurses’ intentions in volunteering to care for SARS patients. Moreover,
Gagnon, Cassista, and Gagnon (2015) noted that only ATB and PBC
84 N. G. TORLAK ET AL.

supported the nurses’ intentions to follow clinical guideline recommenda-

tions concerning the use of filter needles in preparation for the parenteral
medication in a university medical center. Finally, Kortteisto et al. (2010)
uncovered that ATB, SN, and PBC were associated with the intentions of
healthcare professionals to use clinical practice guidelines in the area of
their specialization for decisions on patient care.
As noted by Lyndon (2016), emotional exhaustion, cynical detachment,
and physical fatigue impair the cognitive functions of nurses, threatening
both the quality of healthcare and patient safety. O’Mahony (2011) also
found that high emotional exhaustion and depersonalization are signifi-
cantly related to the nature of the nurses’ work environment. Similarly,
Tunc and Kutanis (2009) and Awa et al. (2010) noted that uncaring atti-
tudes that arose from excessive job demands and workload led nurses to
disengage from their work, which was highly evident in the public hos-
pitals in Iraq. Furthermore, a lack of adequate clinical supervision, staff
shortages, frustration, and a low patient-to-nurse ratio in public hospitals
in Sulaimania was described in the works of Bakker and Heuven (2006),
Sharma et al. (2014), Maslach and Leiter (2008), and Weiner (2014).
Gilbert et al. (2010) also found that BO partially mediated the relation-
ship between structural empowerment and OCB among healthcare pro-
fessionals. Therefore, the researchers developed the following hypotheses:
H5. BO mediates the relationship between PB and OCB.
H5a. BO mediates the relationship between ATB and OCB.
H5b. BO mediates the relationship between SN and OCB.
H5c. BO mediates the relationship between PBC and OCB.

As revealed by Eatough, Chang, Miloslavic, and Johnson (2011), role

stressors (e.g., role ambiguity, role conflict, and role overload) are nega-
tively related to OCB. Tsai and Wu (2010) and Ng et al. (2019) also found
that the nurses’ OJS significantly affected OCB. However, Chiu and Chen
(2005) found that intrinsic job satisfaction mediates the relationship
between job variety, job significance, and OCB. Due to the civil war in
Sulamania, the nurses in public hospitals were confronted by a high work-
load, low self-esteem, and improper supervision that led to their dissatisfac-
tion and unwillingness to support others at work. Given the observation
and the prior studies, the researchers developed the following hypotheses:
H6. OJS mediates the relationship between PB and OCB.
H6a. OJS mediates the relationship between ATB and OCB.
H6b. OJS mediates the relationship between SN and OCB.
H6c. OJS mediates the relationship between PBC and OCB.
 JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 85

Figure 1. The proposed model.

Research methodology
Proposed model
The authors employed structural equation modeling (SEM) to test the
hypothetical relationships of the proposed model, illustrated in Figure 1.

Sample
The authors used a self-administrated questionnaire data collection meth-
odology. The original measures were in English, therefore, the authors used
a parallel translation method to measure the items of the study correctly.
For this, a person who was an expert in English and Kurdish translated the
questionnaire from English into Kurdish. Another person who was a lan-
guage expert translated the Kurdish translation back into English to ensure
that the questions were correct. The authors sent questionnaires to 1,000
nurses, randomly selected, working in the three public hospitals in
Sulaimania. Only 450 nurses returned the questionnaire, amounting to a
45% response rate. Due to a high percentage of missing values, the authors
eliminated ten returned questionnaires.
The researchers collected the data via interviews from the three public
hospitals, namely Sahar, Shorush, and Emergency. The rate of participation
in the survey was low due to the economic crisis that led to the unavailabil-
ity of personnel during working hours. The researchers selected participants
who were knowledgeable in the field of healthcare as nurses to participate
in the survey. This study aims to understand the impact upon nurses’ PB
of their BO and OJS, which affects OCB.
86 N. G. TORLAK ET AL.

The authors performed power analysis for the structural equation model-
ing (Cohen, 1988; Westland, 2010), using the online calculator (Soper,
2020) to determine the minimum required sample size. The suggested set-
ting of the power analysis incorporated the effect size as 0.10 (Cohen,
1988), the power level as 0.80 (Cohen, 1988), the number of latent variables
as 8, and the number of observed variables as 51. Accordingly, the result of
the power analysis indicated that the minimum sample size was 264. The
final sample was significantly larger than the required minimum samples
based upon the power analysis, with 438 observations.

Measures
In the survey (Table A1), the questions for PB were concerned with three
items. They were ATB, SN, and PBC scales that included ten questions.
ATB that consisted of three questions, with a Cronbach’s alpha value of
0.69, was developed by the authors, following Ajzen’s (2002) guidelines. SN
that comprised four questions with a Cronbach’s alpha value of 0.79 was
developed by the authors, following Ajzen’s (2002) guidelines. Likewise,
PBC that included three questions, with a Cronbach’s alpha value of 0.71,
was developed by the authors, following Ajzen’s (2002) guideline.
Furthermore, BO is based on emotional exhaustion, personal accomplish-
ments, and depersonalization, and comprised five questions, with a
Cronbach’s alpha value of 0.78, which the authors adopted from the study
of Maslach and Jackson (1981). OJS included three questions, with a
Cronbach’s alpha value of 0.81, which the authors adopted from Fu and
Deshpande (2014), who adapted the three item-version scale from Cellucci
and Devries (1978). Finally, OCB consisted of five questions, with a
Cronbach’s alpha value of .78, which the authors adopted from Organ and
Lingl (1995).
The items were assessed using five-point Likert scales for which “strongly
agree” was represented by 5, while “strongly disagree” was represented
by 1.

Data analysis and research findings

Preprocessing of data
Initially, preprocessing of data, which constitutes a crucial step before
attempting to test hypothetical relationships, was performed to prepare the
data set for analysis. Therefore, the authors performed missing data ana-
lysis, imputation of missing values, determination of univariate and multi-
variate outliers, and investigation of unengaged respondents. Little’s MCAR
(v2 ¼ 2719.59; df: 2365, p-value: .07) test showed that there was a random
 JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 87

Table 1. Descriptive statistics.

Variables Categories n %
Age level Younger than 20 24 5.48
21–25 158 36.07
26–30 130 29.68
31–35 76 17.35
36–40 22 5.02
Older than 40 28 6.39
Total 438 100.00
Gender Male 203 46.35
Female 235 53.65
Total 438 100.00
Marital status Married 268 61.19
Unmarried 170 38.81
Total 438 100.00
Education level High school 49 11.19
BA 312 71.23
MSc 40 9.13
PhD 37 8.45
Total 438 100.00
Employment sector Public 243 55.48
Private 195 44.52
Total 438 100.00
Experience (years) Less than 5 250 57.08
6–10 130 29.68
11–15 23 5.25
16–20 30 6.85
20 or more 5 1.14
Total 438 100.00

missing data in the data set. The missing values were imputed using linear
regression as the model for scale variables. Furthermore, there were no
univariate or multivariate outliers, in that the authors investigated using
Z-score with greater than 3.2 and Mahalanobis D2. Besides, the authors
eliminated two unengaged respondents. The values of variance inflation
factors (VIFs) ranged between 1.029 and 1.268, which were significantly
lower than the cut off value of 11. Therefore, there was no multicollinearity
issue. After a data screening process and the elimination of two unengaged
respondents, the final sample size was 438.

Descriptive statistics
Table 1 illustrates that 36.07% of participants were between 21 and 25 years,
30% were between 25 and 30 years, while only 6.39% were above 40 years.
Approximately 54% of the participants were female; 46% were male. 61% of
the participants were married; 39% were unmarried. As to their education
level, the majority of participants (71.23%) had a BA degree, while only
8.45% had a Ph.D. degree. Almost 55.5% of the participants were employed
in the public sector, while 44.5% had a job in the private sector. Finally, in
terms of their work experience, 57.1% had less than five years, approximately
30% had between six and ten years, and 1% had more than twenty years.
88 N. G. TORLAK ET AL.

Table 2. PLS-Based factor loadings of measurement model.

Items ATB SN PBC BO OJS OCB
ATB1 0.74 0.26 0.29 0.24 0.25 0.26
ATB4 0.71 0.31 0.15 0.24 0.17 0.27
ATB6 0.81 0.35 0.39 0.36 0.31 0.31
SN1 0.45 0.76 0.39 0.43 0.15 0.44
SN2 0.34 0.86 0.32 0.35 0.12 0.42
SN3 0.23 0.79 0.23 0.27 0.12 0.24
SN4 0.20 0.72 0.28 0.29 0.11 0.36
PBC1 0.36 0.37 0.83 0.46 0.12 0.48
PBC2 0.29 0.31 0.84 0.50 0.16 0.48
PBC4 0.27 0.27 0.70 0.30 0.12 0.36
BO10 0.29 0.34 0.35 0.70 0.15 0.30
BO11 0.31 0.37 0.38 0.82 0.22 0.53
BO12 0.19 0.25 0.34 0.76 0.15 0.42
BO13 0.27 0.31 0.44 0.71 0.11 0.51
BO09 0.34 0.33 0.47 0.71 0.15 0.42
OJS2 0.29 0.16 0.15 0.16 0.92 0.17
OJS3 0.23 0.14 0.16 0.27 0.72 0.22
OJS1 0.33 0.12 0.13 0.13 0.93 0.16
OCB1 0.44 0.39 0.33 0.38 0.18 0.70
OCB3 0.28 0.39 0.44 0.44 0.18 0.76
OCB6 0.28 0.34 0.49 0.48 0.11 0.76
OCB8 0.20 0.30 0.36 0.43 0.17 0.73
OCB9 0.20 0.34 0.45 0.48 0.15 0.73
The bold values represent the extracted factor loadings of each latent variable based on corresponding items at
row level.

Measurement model assessment

Factor loadings
The authors provided the Partial Least Square (PLS) based factor loading in
Table 2, which initially included 51 items. 28 items were subsequently elim-
inated, since the factor loadings were lower than the recommended thresh-
old value of .7 (Chin, 1998). Accordingly, 23 items remained for analysis
which satisfied the individual item reliability base, since the factor loading
of the items was higher than or equal to 0.70 (Chin, 1998). The value of
items loaded under the particular factors was higher than the cross-loading
values, together with the row-level and the column level. The proposed
model allowed six latent variables (factors): ATB, SN, PBC, BO, OJS, and
OCB. The PLS-based factor loadings ranged between 0.70 and 0.93.

Confirmatory factor analysis (CFA)

To understand construct reliability, validity, and model fit of the proposed
research model as recommended by Fornel and Larcker (1981), the authors
combined the six factors into a single model. Table 3 illustrates the stand-
ardized regression weights, t-stats values of items corresponding to each
latent variable, and model fit measures. The CFA analysis with maximum
likelihood approach indicated Chi-square/df was 2.65, the goodness of fit
index was 0.91, the adjusted goodness of fit index was 0.88, the compara-
tive fit index was 0.92, the incremental fit index was 0.92, the Tucker-Lewis
 JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 89

Table 3. Confirmatory factor analysis.

Construct Items Standardized regression weights t-Stats.
ATB ATB1 0.52 Scaling
ATB4 0.54 7.42
ATB6 0.68 8.06
SN SN1 0.71 Scaling
SN2 0.80 11.45
SN3 0.77 11.47
SN4 0.66 10.03
PBC PBC1 0.73 Scaling
PBC2 0.70 12.18
PBC4 0.52 9.39
BO BO9 0.65 Scaling
BO10 0.58 11.54
BO11 0.71 10.43
BO12 0.58 8.54
BO13 0.71 9.19
OJS OJS1 0.94 Scaling
OJS2 0.92 24.78
OJS3 0.66 10.15
OCB OCB1 0.61 Scaling
OCB3 0.67 10.52
OCB6 0.69 10.87
OCB8 0.60 9.77
OCB9 0.66 10.05
v2 ðdf ¼136Þ ¼ 536:01, p < :001; v2 =df ¼ 2.65; GFI ¼ 0.91; AGFI ¼ 0.88; NFI ¼ 89; CFI ¼ 0.92; RFI ¼ 0.87; IFI ¼
0.92 TLI ¼ 0.90; RMSEA ¼ 0.049; SRMR ¼ 0.053.

index was 0.90, the root mean square error of approximation was 0.049,
and the standardized root mean square residual was 0.053. The results
showed that the fit indices met the threshold values recommended by
Bagozzi and Youjae (1988), and Hu and Bentler (1999). Therefore, the
model fit was satisfied.

Measurement model. The authors used the reflective indicator approach to

establish the association between the latent variable and its indicators.
Dropping an item from the analysis created no impact upon the construct;
the correlation between the latent variable and the individual indicators
was exceptionally high, and variation in the construct caused variation in
the item measured (Podsakoff, MacKenzie, Lee, & Podsakoff, 2003).
The authors investigated the reliability and validity of the measurement
model before testing the hypothesis. Table 4 illustrates the correlation coef-
ficients, descriptive statistics, average variance extracted values (AVE), com-
posite reliability (CR), Cronbach’s Alphas, and the square root of average
variance extracted value at the diagonal of the matrix of each latent vari-
able, all of which investigated the internal consistency, reliability, and con-
structs validity (Hair, Anderson, Tatham, & Black, 2010). Cronbach’s alpha
that ranged between 0.69 and 0.81; and CR that ranged between 0.79and
0.89 assessed the reliability of the constructs. Both were near or above the
threshold value of 0.70 (Nunnally & Bernstein, 1994). Although Cronbach’s
alpha value of ATB was significantly less than 0.70 threshold value, ATB’s
90 N. G. TORLAK ET AL.

Table 4. Descriptive statistics, correlation analysis and reliability measures of varia-

bles (N ¼ 438).
Latent variables Mean S.D. 1 2 3 4 5 6
1) ATB 3.95 0.78 0.75
2) SN 3.93 0.79 0.38 0.78
3) PBC 4.14 0.68 0.37 0.38 0.78
4) BO 3.99 0.66 0.37 0.42 0.52 0.73
5) OJS 3.29 0.78 0.08 0.11 0.15 0.16 0.86
6) OCB 4.29 0.61 0.37 0.45 0.45 0.51 0.17 0.73
AVE 0.56 0.61 0.61 0.54 0.74 0.54
CR 0.79 0.86 0.82 0.85 0.89 0.85
Cronbach’s Alpha 0.69 0.79 0.71 0.78 0.81 0.78
Note: The elements on the diagonal are the square root of AVE, while the elements on the off-diagonals are the
correlations between latent variables; p < .05; p < .01.
The bold values represent the square root of AVE.

CR was well above the threshold value of 0.70. Besides, the authors deter-
mined the construct validity through convergent and discriminant validity
and examined factor loadings and AVE to determine convergent validity.
The values of the factor loading of the construct were all greater than the
cutoff value of 0.70. Also, the values of AVE ranged between 0.61 and 0.85,
which was far above the threshold value of 0.50. Given the factor loading
and AVE scores, convergent validity was satisfied. Besides, the authors eval-
uated the discriminant validity using the values of the square root of AVE,
which had to be greater than any of the inter-construct correlations. The
results revealed that the square root of AVE values on the diagonal of the
correlation matrix was higher than the inter-correlation. Therefore, dis-
criminant validity was equally satisfied.

Structural equation modeling (SEM)

To test the proposed hypothesis, the authors used the PLS-SEM because it
is a soft-modeling-approach with less rigid distributional assumptions on
data. PLS-SEM provides an alternative to covariance-based SEM by maxi-
mizing the explained variance of endogenous latent variables. The authors
used the Smart PLS v.2 with the bootstrapping resampling method for test-
ing the statistical significance of paths (Ringle, Wende, & Will, 2005).
Besides, the authors used the bootstrapping method with 5000 resamples,
as recommended by Henseler, Ringle, and Sinkovics (2009), to generate
t-statistics and find standard errors for determining coefficients.
Table 5 and Figure 2 indicate that ATB significantly and positively
impacted BO (b ¼ 0.134, p < .01) and OJS (b ¼ 0.310, p < .01). SN signifi-
cantly and positively affected BO (b ¼ 0.222, p < .01), while it had no sig-
nificant relationship with OJS (b ¼ 0.019, p>.05). Likewise, while PBC
significantly and positively influenced BO (b ¼ 0.406, p<.01), it had no
statistically significant effect on OJS at a 95% confidence level (b¼0.042,
p > .05). Finally, BO (b ¼ 0.587, p < .05) significantly and negatively
 JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 91

Table 5. PLS-SEM analysis results.

Hypothesis Paths Beta t-Stat. Results
H1a ATB ! BO 0.134 2.81 Supported
H1b SN ! BO 0.222 5.41 Supported
H1c PBC ! BO 0.406 8.47 Supported
H2a ATB ! OJS 0.310 5.59 Supported
H2b SN ! OJS 0.019 0.54 Not supported
H2c PBC ! OJS 0.042 1.02 Not supported
H3 BO ! OCB 0.587 2.20 Supported
H4 OJS ! OCB 0.086 2.25 Supported
p < .05; p < .01.

affected OCB, while OJS (b ¼ 0.086, p < .05) significantly and positively
impacted OCB. Therefore, the data supported H1a, H1b, and H1c, fully
supporting H1. The data also supported H2a, but did not support H2b and
H2c, therefore, H2 was partially supported. Finally, the authors supported
H3 and H4.
The assessment of each predictive relevance, explanatory power, and
predictive power is vital for PLS-SEM analysis (Chin, 1998). Table 6
illustrates the results of the explained variance (R2) and predictive rele-
vance (Q2). The authors denoted the explanatory power of SEM by the
proportion of variance in dependent variables, described by the variation
in independent latent variables. Moreover, the authors classified R2-val-
ues as substantial (>0.26); moderate (between 0.13 and 0.26); and weak
(<0.13). The results showed the explained variance of BO was .20, of
OJS was 0.09, and of OCB was 0.21. Therefore, BO and OCB were
moderate, while OJS was weak.
The authors performed the Q2-test (Geisser, 1975; Stone, 1974) to ana-
lyze the predictive relevance of endogenous latent variables. The Q2-test
shows the degree to which the model and its parameter estimates repro-
duce the observed values. The values of Q2 were obtained either by using
construct cross-validated communality or construct cross-validated redun-
dancy (Fornell & Cha, 1993). Based upon Chin’s (1998) suggestion, the
authors used the construct cross-validated redundancy method in Smart-
PLS (v2) to obtain the values of Q2 by blindfolding one case at a time and
then re-estimating the model parameters using the remaining cases, then
finally predicting the omitted case values based on the remaining parame-
ters (Sellin & Versand, 1989). The authors found the endogenous variables
with positive Q2 value to retain a predictive relevance, while considering
endogenous variables with a negative Q2 value indicated an absence of pre-
dictive relevance. Table 6 illustrates the results of the Q2-test for the pre-
dictive relevance of endogenous latent variables. The Q2 value of BO was
0.20, of OJS was 0.09, and of OCB was 0.21, which were all considerably
higher than zero. Therefore, the results supported the proposed model’s
predictive relevance for the endogenous constructs—BO, OJS, and OCB.
92 N. G. TORLAK ET AL.

Figure 2. The results of hypothetical relationships (p < .05; p < .01).

Table 6. Predictive power and relevance of endogenous constructs.

Endogenous latent variables Q2 R2
BO 0.20 0.37
OJS 0.09 0.12
OCB 0.21 0.39

Mediation analysis
The authors employed parallel multiple mediation analysis, utilizing model
4 of the PROCESS macro (Hayes, 2013) to test the proposed multiple
mediation model: the effect of PB on OCB through BO and OJS. The bias-
corrected bootstrapping method was employed to estimate the interval of
indirect effects, since it is an assumption-free approach regarding the
sampling distributing shape of indirect effect, and it has better control of
Type-I errors. Preacher and Hayes (2008) recommended 5000 bootstraps
resample to obtain the effects, with 95% bias-corrected confidence intervals
of the effects in the mediation analysis. The authors considered the
obtained effect statistically significant if its confidence interval does not
include zero. For parallel mediation analysis using the PROCESS macro,
the authors defined PB, including ATB, SN, and PBC as an independent
variable, BO and OJS as multiple mediators, and OCB as the dependent
variable. Table 7 illustrates the direct and indirect effects with the 95%
bias-corrected lower limit confidence interval (LLCI) and the upper limit
confidence intervals. Initially, the authors investigated the effects of ATB,
SN, and PBC on OCB through BO. The indirect effects were all statistically
significant since zero is excluded in the 95% bias-corrected confidence
intervals. The results showed BO partially mediated the relationship
between ATB-SN-PBC and OCB since the direct effects were also statistic-
ally significant at the 95% confidence level.
Similarly, the authors investigated the effects of ATB, SN, and PBC on
OCB through OJS. Accordingly, OJS partially mediated the relationship
 JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 93

Table 7. Mediation analysis results.

Hypothesis Direct effect Indirect effect Result
H5a) ATB!BO!OCB 0.16; LLCI ¼ 0.24, ULCI ¼ 0.37 0.15; LLCI ¼ 0.09, ULCI ¼ 0.22 Partial mediation
H5b) SN!BO!OCB 0.21; LLCI ¼ 0.14, ULCI ¼ 0.27 0.16; LLCI ¼ 0.11, ULCI ¼ 0.22 Partial mediation
H5c) PBC!BO!OCB 0.31; LLCI ¼ 0.23, ULCI ¼ 0.38 0.20; LLCI ¼ 0.14, ULCI ¼ 0.26 Partial mediation
H6a) ATB!OJS!OCB 0.30; LLCI ¼ 0.23, ULCI ¼ 0.36 0.009; LLCI¼ -0.002, ULCI ¼ 0.033 No mediation
H6b) SN!OJS!OCB 0.35; LLCI ¼ 0.29, ULCI ¼ 0.42 0.011; LLCI ¼ 0.001, ULCI ¼ 0.033 Partial mediation
H6c) PBC!OJS!OCB 0.49; LLCI ¼ 0.42, ULCI ¼ 0.56 0.012; LLCI ¼ 0.001, ULCI ¼ 0.035 Partial mediation
Note: The intervals are based on the 95% bias-corrected confidence intervals; LLCI: lower limit confidence inter-
val; ULCI: upper limit confidence interval.

between SN and OCB, as well as between PBC and OCB, since the direct
effects were statistically significant at the 95% confidence level. However,
OJS did not mediate the relationship between ATB and OCB, since the
indirect impact was not statistically significant; the 95% bias-corrected
interval included zero. The results indicated that the data supported H5a,
H5b, and H5c, so fully supported H5. Finally, the data supported H6b and
H6c, but did not support H6a, therefore, H6 was partially supported.

Discussion
The significant and positive influences of ATB, SN, and PBC on BO indi-
cated that the civil war and its effects upon nursing in Iraq at that time
created feelings of exhaustion, cynical detachment, as well as physical and
mental fatigue among the nurses. No such relationship was reported in the
literature. The significant positive effect of ATB upon OJS in this research
was similar to the results of the works of Delobelle et al. (2011), Benrazavi
and Silong (2013), and Lu et al. (2012). However, the absence of significant
relationships between SN and OJS and between PBC and OJS shown in
this paper were at variance with the results of Lee et al. (1990), Lam et al.
(2003), and Javadi et al. (2013). Due to high unemployment and poverty in
Iraq, nurses perceived themselves to be the sole breadwinners for their fam-
ilies and ignored their coworkers’ attitudes and their talents.
The findings of a significant negative relationship between BO and OCB
in this study were similar to the results of works of Cropanzano et al.
(2003), van Emmerik et al. (2005), Chiu and Tsai (2006), Chang et al.
(2007), Gilbert et al. (2010), Liang (2012), Huang et al. (2012), and Jang
et al. (2020). However, the negative relationship between BO and OCB was
not paralleled by the outcome of the research by van Emmerik et al. (2005)
and Şeşen et al. (2011). The negative relationship between BO and OCB
was constituted by way of the high workload, irregular compensation and
inequality of the nurses, accompanied by the limited resources available
within the public hospitals.
The significant positive relationship between OJS and OCB is
consistent with the findings of Park et al. (2009), Tsai and Wu (2010),
94 N. G. TORLAK ET AL.

Rezaiean et al. (2010), Huang et al. (2012), Subhadrabandhu (2012), Jung

and Yoon (2015), Dinc (2018), Ottmar and Zucchero (2018), and Ng et al.
(2019). Nurses not satisfied with their pay, learning opportunities, work
conditions, workload, clinical supervision, and/or coworkers in the public
hospitals are unlikely to put extra effort into their work or assist others to
solve their problems.
Moreover, the partial mediating role of BO between ATB and OCB, SN
and OCB, and PBC and OCB was not reported in the literature. However,
the civil war that led to the excessive workload and job demands, distress,
staff shortages, inadequate clinical supervision, and a low patient-to-nurse
ratio made nurses exhausted, unconcerned, and feeling worthless, all of
which adversely affected their extra-role behavior in the public hospitals.
Finally, the partial mediation of OJS between SN and OCB and between
PBC and OCB, as well as the absence of mediation of OJS between ATB
and OCB were inconsistent with the result of the conclusions of Chiu and
Chen (2005). The satisfaction of nurses with their compensation, supervi-
sion, workload, shift work, work conditions, growth opportunity, and
coworkers could contribute to a reliance upon their colleagues and foster
self-confidence, all of which can generate willing assistance in problem-
solving and interest in organizational concerns.

Theoretical implications
Although many empirical studies in the health sector have investigated the
TPB (Bakari, Hunjra, & Niazi, 2017; Casper, 2007; Feng & Wu, 2005;
Godin et al., 1992; Povey et al., 2000; Randall & Gibson, 1991; Samad,
2018), there was little literature considering the relationship between TPB
and the nurses’ expressions of BO, OJS, and OCB. This study shows that
the destructive work environment in Iraq shaped the distress and dissatis-
faction of the nurses, limiting their good intentions for their jobs, resulting
in the absence of extra-role behavior in healthcare. However, the hospital
management might have made efforts to enhance the nurses’ job satisfac-
tion, which could lead to extra-role behavior.
BO and OJS had considerable mediating effects on the relationship
between TPB and OCB. Although many studies regarding nursing investi-
gated the mediating effect of BO (Gilbert et al., 2010) and OJS (Chiu &
Chen, 2005) upon other work-related antecedents experienced by nurses
and OCB, there was no study analyzing the mediating effect of BO and
OJS upon the relationship between TPB and OCB. This study indicates
that BO and OJS are indeed such mediators.
 JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 95

Practical implications
Regarding the mediating role of OJS upon the relationship between TPB
and OCB, hospital management might search for ways to increase OJS.
According to Smith et al. (1969), there are several methods with which to
appease individuals, such as adequate compensation, promotions, and har-
mony among coworkers. Due to the fragile economy of Iraq, the monthly
income of nurses working at public hospitals was low. The hospital man-
agement could encourage friendliness among coworkers, provide steady,
adequate pay, enhance the quality of supervision, offer supportive and com-
fortable work conditions, establish employment security, and deliver ave-
nues producing learning, promotion, and growth.
Hospital management might focus on ways to decrease the BO of nurses.
Reduction in the workload and job demands while creating adequacy in
the number of nurses and clinical supervision might lower the BO associ-
ated with medical errors, poor patient care, patient dissatisfaction, and
mortality rates. Furthermore, as noted by Siegall and McDonald (2004), a
reasonable response to BO is to shift resources from being inadequate into
areas promising a better payback. Hospital management might transfer
nurses to other units, reducing their requirements to enable the accom-
plishment of their duties, as well as rearranging workloads, shift work, and
mandatory overtime to decrease their BO, and, in turn, increase their OCB.
The study was limited to the public hospitals in Sulaimania and consid-
ered the responses of a moderate number of respondents. Therefore, the
results cannot be generalized for the whole of Iraq. However, the study was
original in terms of analyzing the relationships between PB, BO, OJS, and
OCB. Furthermore, the study, which excluded the effects of the economic
crisis observed in Iraq on PB of nurses, might influence authorities to
adopt psychosocial methods to secure the nurses’ citizenship behavior and
patients’ health, both for private and public healthcare organizations in
Iraq. The forthcoming studies might investigate the model of this research
in other hospitals in different countries to obtain more realistic results.

Conclusion
Given the importance of OCB to organizations (LePine et al., 2002), this
study examines the effect of PB on OCB through BO and OJS among
nurses working in three public hospitals in Sulaimani. The results of the
research indicated that ATB has a significantly positive association with BO
and OJS. SN and PBC retain significant positive relationships with BO but
have no association with OJS. Therefore, the hospital management could
adopt policies making jobs attractive, improve relationships between col-
leagues, and increase involvement in projects which demonstrate experience
96 N. G. TORLAK ET AL.

and talent, which could partially remove the exhaustion, cynicism, aloof-
ness, and discouragement experienced by the nurses in attempting their
tasks. Likewise, increasing skill variety, administering work activities, and
providing direct information on task execution could produce satisfaction
on the job. However, the nurses’ perceptions of social pressure that are
fueled by peer beliefs and self-belief in their talent will not affect their feel-
ings in terms of either being positive or negative toward various aspects of
their job. Therefore, hospital management could disregard peer and control
beliefs when designing individual positions.
BO had a significantly negative relationship with OCB, while OJS
retained a significant and positive association with OCB. Therefore, hos-
pital management might define the nurses’ positions in terms of autonomy
within the job, feedback received while on the job, and teaching job-related
skills that can partially remove the exhaustion, detachment, and physical
fatigue of the nurses while on the job. In doing so, nurses may provide per-
sonal aid and extra help to their colleagues in problem-solving, demon-
strate a strong interest in organizational concerns, and possess considerate
attitudes or patience under intolerable circumstances. Moreover, having
responsibility on the job, social support in task execution, respect and
friendliness among coworkers, avenues for learning and growth, steady and
substantial compensation, supportive work conditions, and employment
security would likely enhance the nurses’ desire to assist their colleagues
and create a strong interest in organizational concerns.
Finally, BO partially mediated the relationships between PB (ATB-SN-
PBC) and OCB. Therefore, hospital management could avoid stressors
deriving from any of the work or non-work situations, or personality that
can lead to BO. Managers might keep an eye on the division of labor, work
process standardization, clinical supervision styles, nurse shortages, work-
loads, night shifts, training, and organizational socialization processes. As
well, hospital management could develop policies regarding family events,
economics, colleague relationships, and the wellbeing of healthcare staff
that would override extraordinary demands that make nurses personally
incapacitated or physically and mentally exhausted. As a result, nurses
could remove any resistance to requests for extra assistance from their col-
leagues and demonstrate an interest in organizational affairs.
Likewise, OJS partially mediated the relationships between SN and OCB
and between PBC and OCB. Therefore, hospital management might con-
sider peer relationship and job enrichment methods that do not discrimin-
ate against any who may be silenced or alienated in terms of their work,
supervision, harmony, growth, learning, compensation, work conditions, or
job or employment security. The possible effect of ignoring these factors
 JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 97

means that nurses could become unfriendly, diminish any interest in

organizational affairs and abandon sincerity.

ORCID
N. G€okhan Torlak http://orcid.org/0000-0003-1229-0554
Cemil Kuzey http://orcid.org/0000-0003-0141-1744
Muhammet Sait Dinç http://orcid.org/0000-0002-1146-5474
Taylan Budur http://orcid.org/0000-0001-8123-4404

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Appendix
Table A1. Items: ATB, SN, PBC, BO, OJS, and OCB.
ATB
1. Working in this hospital helps improve my skills. 1 2 3 4 5
2. Working in this hospital provides me opportunity to interact with a skilled physician. 1 2 3 4 5
3. Working in this hospital takes much of my time. 1 2 3 4 5
4. Working in this hospital injects self-confidence, self-discipline and self-satisfaction. 1 2 3 4 5
5. Working in this hospital brings about missed activities outside. 1 2 3 4 5
6. Working in this hospital helps me to gain a valuable job experience. 1 2 3 4 5
SN
1. My supervisor thinks that I should follow my duties/responsibilities precisely. 1 2 3 4 5
2. My coworkers think that I should follow my duties/responsibilities precisely. 1 2 3 4 5
3. My subordinates think that I should follow my duties/responsibilities precisely. 1 2 3 4 5
4. My close friends think that I should follow my duties/responsibilities precisely. 1 2 3 4 5
5. My parents think that I should follow my duties/responsibilities precisely. 1 2 3 4 5
PBC
1. I am prepared to handle the difficulties in my job. 1 2 3 4 5
2. I have sufficient knowledge to perform my tasks. 1 2 3 4 5
3. I often feel that I am overwhelmed and overloaded at work. 1 2 3 4 5
4. I follow the steps in the medical treatment process based on past experience. 1 2 3 4 5
5. I often feel tired at work. 1 2 3 4 5
6. I have enough amount of discipline at work. 1 2 3 4 5
BO
1. Working with others is an emotional strain for me. 1 2 3 4 5
2. I feel that I am burned out from my job. 1 2 3 4 5
3. I am emotionally drained from my job at the end of the day. 1 2 3 4 5
4. I feel that I treat some patients as if they are impersonal objects. 1 2 3 4 5
5. I feel that I have become more callous toward my coworkers. 1 2 3 4 5
6. I am becoming less sympathetic to others at work. 1 2 3 4 5
7. The vast majority of time at work, I treat all patients and staff with respect. 1 2 3 4 5
8. I feel that my coworkers value my assistance. 1 2 3 4 5
9. I feel that I am effective in solving problems at work. 1 2 3 4 5
10. I feel that I am a positive influence at this hospital. 1 2 3 4 5
11. I have the ability to deal effectively with the problems of patients. 1 2 3 4 5
12. I feel that I am positively influencing patients with my work here. 1 2 3 4 5
13. I feel that I can create a relaxed atmosphere with patients. 1 2 3 4 5
OJS
1. I frequently think about quitting this job. 1 2 3 4 5
2. I am satisfied with the activities I perform every day. 1 2 3 4 5
3. Generally speaking, I am very satisfied with this job. 1 2 3 4 5
OCB
1. I always follow the rules of the hospital and unit. 1 2 3 4 5
2. I demonstrate concern about the image of the hospital. 1 2 3 4 5
3. I always treat hospital property with care. 1 2 3 4 5
4. I attend and participate in meetings regarding the hospital. 1 2 3 4 5
5. I respect the rights of others. 1 2 3 4 5
6. I never abuse coworkers’ rights and privileges. 1 2 3 4 5
7. I stay informed about hospital. 1 2 3 4 5
8. I maintain a clean workplace. 1 2 3 4 5
9. I help others who have been absent. 1 2 3 4 5
10. I help others who have heavy workloads. 1 2 3 4 5
11. I help make others productive. 1 2 3 4 5
12. I offer suggestions to improve operations. 1 2 3 4 5
13. I help orient new people. 1 2 3 4 5
14. I share personal property with others to help their work. 1 2 3 4 5
15. My attendance at work is above average. 1 2 3 4 5
16. I give advance notice when unable to come to work. 1 2 3 4 5
17. I am always on time. 1 2 3 4 5
18. I always complete work on time. 1 2 3 4 5