897637

research-article2020
WJNXXX10.1177/0193945919897637Western Journal of Nursing ResearchOrgambídez et al.

Original Research
Western Journal of Nursing Research

Linking Self-efficacy to Quality of Working 1­–8

© The Author(s) 2020
Article reuse guidelines:
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https://doi.org/10.1177/0193945919897637
DOI: 10.1177/0193945919897637
journals.sagepub.com/home/wjn

Alejandro Orgambídez1 , Yolanda Borrego2,

and Octavio Vázquez-Aguado3

Abstract
The aim of this study was to explore the effect of work engagement, as an intermediary variable, on the relationship between
self-efficacy, and job satisfaction and affective organizational commitment as individual indicators of quality of working life
(QWL). A cross-sectional correlational design was utilized assessing a convenience sample of 321 nursing staff. All participants
were employed in public hospitals and had more than five months of professional experience in the same hospital. Mediation
analysis was performed using path analysis and bootstrapping confidence intervals (percentile-corrected). Work engagement
partially mediated the relation between self-efficacy and job satisfaction, and fully mediated the relation between self-efficacy
and affective organizational commitment. Self-efficacy seems to be an important predictor of QWL in nursing staff, although
its effect is partially mediated (e.g., job satisfaction) or fully mediated (e.g., affective commitment) by work engagement.

Keywords
self-efficacy, work engagement, job satisfaction, personnel loyalty, nursing staff

The investigation of job satisfaction and affective commit-
ment with the organization, indicators of the quality of work-
ing life (QWL; Nowrouzi et al., 2016), is of special importance
due to its relation to the well-being and health of nursing staff
(Nowrouzi et al., 2016) and with their intention to remain in
health organizations (De Simone, Planta, & Cicotto, 2018;
Ruiller & Van Der Heijden, 2016). These aspects are key
antecedents of the quality of health care in the nursing context
(Aiken, Sloane, Bruyneel, Van den Heede, & Sermeus, 2013;
Karami, Farokhzadian, & Foroughameri, 2017). In this sense,
the Job Demands-Resources (JD-R) model (Schaufeli, 2017)
suggests that job satisfaction and affective organizational
commitment are the result of high presence of engagement
and self-efficacy in the workplace. Consequently, the objec-
tive of this study was to analyze the relationships between
beliefs of success, engagement at work, job satisfaction, and
affective commitment with the organization among nursing
staff in the south of Spain. Taking the JD-R model as a refer-
ence, it was assumed that work engagement plays a mediator
role between self-efficacy (personal resource), and job satis-
faction and affective organizational commitment as individ-
ual indicators of QWL.
QWL can be defined as “a way of thinking about people,
work, and organizations involving a concern for employees,
well-being and organizational effectiveness” (Cummings &
Worley, 1997, p. 24). QWL becomes especially relevant in
the context of nursing because it is an important antecedent
of the permanence of nursing teams in hospitals and the qual-
ity of health care (Baik & Zierler, 2019; Karami et al., 2017).
Amongst the numerous QWL indicators (Nowrouzi et al.,
2016), the role of job satisfaction and affective commitment
with the organization should be noted. Job satisfaction and
affective organizational commitment are considered as indi-
vidual and subjective indicators of the perceived QWL, since
they reflect how nurses experience and develop in his/her
workplace.
Job satisfaction is “the degree of affect toward a job and
its main components” (Cicolini, Comparcini, & Simonetti,
2014, p. 855), while affective commitment refers to the
extent to which a nurse identifies with their company, that is,
to say the emotional bond with the organization (Meyer,
Allen, & Smith, 1993). High levels of affective organiza-
tional commitment and job satisfaction in nursing staff are
1
Department of Social Psychology, Faculty of Psychology, University of
Málaga, Málaga, Spain
2
Department of Social and Educational Psychology, Faculty of Social
Work, University of Huelva, Huelva, Spain
3
Department of Social Work, Faculty of Social Work, University of
Huelva, Huelva, Spain
Corresponding Author:
Alejandro Orgambídez, Department of Social Psychology, Faculty of
Psychology, University of Málaga, Campus de Teatinos s/n, Málaga, 29071,
Spain.
Email: aorgambidez@uma.es
2 Western Journal of Nursing Research 00(0)
Figure 1.  Hypothesized model of the study based on the JD-R
model
Source: Schaufeli (2017).
closely linked to a stronger desire to remain in health units
and hospitals (Baik & Zierler, 2019; Karami et al., 2017),
which in turn contributes significantly to the quality of health
care (Aiken et al., 2012; Karami et al., 2017).
In this respect, the JD-R model provides an integrative
framework with broad empirical support for the study of
affective organizational commitment and job satisfaction
(Schaufeli, 2017). According to Schaufeli (2017), these
QWL indicators are the result of high levels of engagement
at work. Work engagement is defined as “a positive, fulfill-
ing, work-related state of mind that is characterized by vigor,
dedication, and absorption” (Schaufeli, Salanova, González-
Romá, & Bakker, 2002, p. 74). High levels of energy, job
involvement, and concentration on tasks are features of
nurses who are engaged in their work (Halbesleben, 2010).
Work engagement has proven to be an important predictor
of job satisfaction and of affective organizational commit-
ment in nursing staff (Brunetto et al., 2013; Santos, Chambel,
& Castanheira, 2016; Van Bogaert, Wouters, Willems,
Mondelaers, & Clarke, 2013). Elevated energy, dedication,
and concentration levels in the workplace improve profes-
sional performance, leading to positive feelings and experi-
ences at work. The positive experiences increase the
perception of job satisfaction and foster the appearance of a
strong emotional bond with the organization. Therefore, we
propose the following hypotheses:
Hypothesis 1a: Work engagement is positively related to
job satisfaction.
Hypothesis 1b: Work engagement is positively related to
affective organizational commitment.
Numerous studies have confirmed that job and personal
resources foster engagement at work (Halbesleben, 2010;
Schaufeli, 2017): The more the resources are available in the
workplace, the greater the probability that nurses will be
engaged. Job resources are all the aspects of the job which
facilitate the fulfillment of tasks and help to deal with
demands and difficulties (e.g., emotional support from super-
visor and co-workers), while personal resources are an indi-
vidual’s positive qualities which allow them to cope with
work demands in a better way (e.g., optimism, resilience).
Within personal resources in the context of nursing, per-
ceived self-efficacy or “people’s beliefs in their capability to
exercise some measure of control over their own function-
ing” (Bandura, 2001, p. 10) is highlighted. When nurses
believe in their capabilities to perform clinical tasks with
skill, they tend to perceive work demands as challenges to be
mastered rather than threats to be avoided. High levels of
self-efficacy are associated with greater levels of work
engagement in nursing staff (De Simone et al., 2018;
Schaufeli, 2017; Ventura, Salanova, & Llorens, 2015). Self-
efficacy determines the amount of work and the effort that is
invested in tasks. If self-efficacy is high, nurses devote more
time and energy to a task, they involve themselves more and
they focus more easily. Consequently, we propose the fol-
lowing hypothesis:
Hypothesis 2: Self-efficacy is positively related to work
engagement.
The JD-R model provides a conceptual framework which
facilitates the understanding of the relations between per-
ceived self-efficacy, engagement at work, job satisfaction,
and affective commitment with the company. According to
this model, engagement functions as a mediating variable
between personal resources (e.g., self-efficacy) and individ-
ual indicators of QWL (e.g., job satisfaction, affective com-
mitment; Schaufeli, 2017; Figure 1).
The belief on the accomplishment of clinical tasks with a
high degree of success leads to greater investment of energy,
effort, and time at work, which means nurses involve them-
selves more and focus more easily. Similarly, vigor, dedica-
tion, and involvement improve professional performance,
making the appearance of positive experiences and feelings
more likely (e.g., enjoyment, pleasure). Experiencing posi-
tive feelings leads to higher levels of job satisfaction and the
emergence of a powerful positive link with the company.
In this respect, various studies with nursing samples have
analyzed the mediator role of work engagement. On the one
hand, De Simone et al. (2018) observed that engagement par-
tially mediated the effect of self-efficacy on job satisfaction
among Italian nurses. A partial mediation was also discerned
by Mache, Vitzthum, Klapp, and Danzer (2014), although
with a sample of German surgeons. On the other hand, some
studies (De Simone et al., 2018; Peng et al., 2013; Shahpouri,
Namdari, & Ahmad, 2016) have confirmed that work engage-
ment functioned as a mediator in the relationship between
perceived self-efficacy and affective organizational commit-
ment in nursing staff.
The disparity of results regarding the mediator role of
work engagement in nursing staff and the lack of research of
this area in Spain, coupled with the importance of the study
of QWL, justifies the objective of this study. The aim was to
explore the effect of work engagement as an intermediary
variable on the relation between self-efficacy, and job satis-
faction and affective organizational commitment in Spanish
nurses. Our intention is to increase knowledge of the JD-R
Orgambídez et al. 3
model in nursing staff in order to obtain useful implications
for Human Resources managers and health care administra-
tors. Therefore, we proposed the following hypotheses:
Hypothesis 3a: The positive relation between self-
efficacy and job satisfaction is mediated by work
engagement.
Hypothesis 3b: The positive relation between self-effi-
cacy and affective organizational commitment is medi-
ated by work engagement.
Methods
Design and Sample
We used a transversal descriptive-correlational study with
surveys. Registered nurses and nursing assistants, members
of a national nursing union, were selected as potential par-
ticipants. The selection criteria for the convenience sampling
were the following: (a) to be employed in a public hospital;
and (b) to have more than six months professional experi-
ence in the same position and in the same hospital. A total of
525 participants who fulfilled the indicated criteria were
invited to participate in the study, obtaining a final conve-
nience sample of 321 participants (61.14% response rate).
The program Mc_Power (Schoemann, Boulton, & Short,
2017) was used to carry out power analysis based on Monte
Carlo simulations. A total of 5,000 replications with 20,000
draws for replication were selected to ensure power and sam-
ple sizes estimates. The Monte Carlo simulations’ results
showed that approximately 210 participants were necessary
to detect the hypothesized direct and indirect effects with a
standard power of .80 (1 – β).
Measures
Self-efficacy.  The General Self-Efficacy (GES) Scale (Scholz,
Gutiérrez, Sud, & Schwarzer, 2002), in its Spanish version,
was utilized to assess self-efficacy at work. The participants
responded to the 10 items (e.g., “I can always manage to
solve difficult problems if I try hard enough”) using a
response scale from 0 (never) to 6 (always). The GSE scale
has shown satisfactory reliability with Cronbach’s alpha
coefficients ranging from .81 to .84 (Scholz et al., 2002). The
Cronbach’s alpha score was .94 in the present study.
Work Engagement. The Utrecht Work Engagement Scale
(UWES; Schaufeli et al., 2002)—in a short, nine-item ver-
sion—was used to measure work engagement. The nine
items are grouped into three dimensions: vigor (e.g., “At
work, I feel strong and vigorous”, three items), dedication
(e.g., “I am proud of the work that I do”, three items), and
absorption (e.g., “I am immersed in my work”, three items).
According to Bakker and Leiter (2010), the use of the com-
posite score of the reduced version of the UWES is recom-
mended instead of a score by dimension. The participants
responded to the items using a response scale from 0 (never)
to 6 (always). The reduced version of the UWES has good
psychometric properties including reliability, with Cron-
bach’s alpha coefficients above .90 (Moodie, Dolan, &
Burke, 2014). The reliability coefficient (Cronbach’s alpha)
was .91 in the present study.
Job Satisfaction.  The Job Satisfaction Scale S10/12 in Spanish
(Meliá & Peiró, 1989) was utilized to evaluate job satisfac-
tion. The S10/12 is composed of 12 items (e.g., “The satis-
faction with the personal relationships with your supervisor”)
about satisfaction with supervision, with the physical envi-
ronment and with the benefits received from the organiza-
tion. The items were responded using a scale from 1 (very
dissatisfied) to 7 (very satisfied). The Cronbach’s alpha score
was .90 in the present study, consistent with the coefficient of
.88 obtained by García-Izquierdo, Sáez, and Llor (2000).
Affective Organizational Commitment. The Organizational
Commitment Scale (Meyer et al., 1993), in its Spanish ver-
sion (de Frutos, Ruiz, & San Martín, 1998), was used to
evaluate the emotional bond with the organization. The par-
ticipants responded to the six items related to affective com-
mitment (e.g., “I would be very happy to spend the rest of my
career with this organization”) using a response scale from 1
(totally disagree) to 7 (totally agree). The Cronbach’s alpha
score was .89 in the present study, consistent with the value
of .84 registered by Moodie et al. (2014).
Procedure
The regional office of a voluntary national nursing union was
contacted to request their participation in the study. Following
the presentation of the study and the research questionnaire,
and the subsequent approval of the nursing union’s ethic
committee (Ethical approval Ref: 2016-032-FDN -
Foundation for the Development of Nursing, Spain), the
researchers obtained permission to give the questionnaires to
union members. The data collection took place during train-
ing courses which were organized and taught by the union
for its members, registered nurses and nursing assistants.
Data Analysis
The data were analyzed with the STATA v.13 statistical pro-
gram, assuming a level of significance of .05 (two-tailed).
First of all, the measurement model of the scales was checked
using confirmatory factor analyses (CFAs). Next, the mean
and standards deviations of the variables, the correlation
coefficient (Pearson’s r), and the consistency coefficients
(Cronbach’s alpha) of the instruments were calculated.
Path analysis and mediation analysis were carried out to
evaluate the model of the study by examining the relationships
between self-efficacy (exogenous and predictor variable),
work engagement (endogenous and mediator variable), and
job satisfaction and affective organizational commitment
4 Western Journal of Nursing Research 00(0)
Table 1.  Summary of means, standard deviations, and
correlations of the study variables (N = 321).
M SD 1 2 3 4
1. Self-efficacy 4.51 1.03 1.00  
2. Work engagement 4.02 1.28 0.43 1.00  
3. Job satisfaction 4.61 1.13 0.35 0.41 1.00   efficacy (10 items), work engagement (9 items), job satisfac-
4. A
 ffective organizational 4.91 1.35 0.29 0.44 0.42 1.00
commitment
Note: Correlation coefficients were all significant (p < .01).
(endogenous variables and results). Mediation analysis test a
hypothetical causal chain where one variable X (self-efficacy)
affects a second variable M (work engagement) and, in turn,
that variable affects third variables Y (job satisfaction) and Z
(affective commitment). In this sense, mediator variables are
used to explain the how and why of a relationship between
other variables. Some fit indices were used to test the adjust-
ment of the mediation model (Hayes, 2013): Tucker–Lewis
index (TLI) and comparative fit index (CFI) over .90, and
standardized root mean square residual (SRMR) and root
mean square error of approximation (RMSEA) under .08.
We used bootstrapping for the analysis of the indirect
effects of the mediation model. According to Hayes (2013),
this method has more statistical power than other mediation
techniques (e.g., Sobel test). Bootstrapping is a non-paramet-
ric method based on resampling with replacement which is
done many times, for example, 10,000 times. The indirect
effect is calculated in each of these samples and a sampling
distribution can be created, allowing to determine estimates
and confidence intervals (Hayes, 2013). If zero does not fail
between the bootstrapping intervals, it can be concluded that
there is a significant indirect effect (p < .05). Percentile-
corrected (PC) confidence intervals (10,000 samples) were
calculated to test the significance or nonsignificance of the
mediation effects.
Results
Sample Characteristics
The mean age of the sample was 39.43 years (SD = 9.57),
ranging from 21 to 58 years. In total, 198 (61.68%) of the par-
ticipants were women compared with 123 (38.32%) men. A
total of 52.27 percent of the participants (n = 171) were regis-
tered nurses, while 46.73 percent (n = 147) were nursing
assistants. No significant statistical differences between men
and women were obtained depending on their professional
category: X2(1) = 0.88, p = .31. The average for professional
experience was around nine years (M = 9.36, SD = 7.17).
Measurement Models
Two measurement models were tested using CFAs to check
the relationships between the latent variables and their
measures. In the first model (M1), the items of the four scales
were forced to saturate on one common factor. The adjust-
ment of the M1 model was unsatisfactory: X2(629) =
5,1660.33, p < .01, TLI = .40, CFI = .43, SRMR = .14, and
RMSEA = .15 [90% CI = .14 – .16]. The second model (M2)
assumed the existence of four factors corresponding to self-
tion (12 items), and affective organizational commitment (6
items). The adjustment of the M2 model was better than the
adjustment of the M1 model: X2(419) = 1,042.02, p < .01,
TLI = .90, CFI = .91, SRMR = .06, and RMSEA = .07 [905
CI = .06 – .08], and can be acceptable according to Schreiber
et al. (2006). Consequently, the four variables can be consid-
ered as independent psychological constructs.
Descriptive Statistics and Correlations
Table 1 presents the means, standard deviations, and correla-
tions of all the variables. In general, the nursing profession-
als expressed moderated levels of self-efficacy (M = 4.51,
SD = 1.03) and work engagement (M = 4.02, SD = 1.28).
The participants were relatively satisfied with their jobs (M
= 4.61, SD = 1.13) and affectively committed with the orga-
nization (M = 4.91, SD = 1.35). Correlation analyses
showed positive and significant (p < .01) relationships
between self-efficacy and work engagement (r = .43), job
satisfaction (r = 0.35) and affective organizational commit-
ment (r = .29). In the same way, work engagement was posi-
tively related to job satisfaction (r = .41, p < .01) and
affective organizational commitment (r = .44, p < .01).
Mediation Analyses
We used the path analysis technique for testing the mediation
model (Figure 2). Maximum likelihood was chosen as the
estimation method for the analysis. The adjustment of the
model was unsatisfactory: X2(3) = 40.43, p < .01, TLI =
.67, CFI = .83, SRMR = .08, and RMSEA = .20 [90% CI =
.15 – .23]. The indices of modification suggested the inclu-
sion of the following paths: one from self-efficacy to job sat-
isfaction, and one from job satisfaction to affective
commitment. Given that the inclusion of the proposed paths
makes theoretical sense, the paths were incorporated into the
model and put to the test again.
The final model (Figure 3) showed a good fit: X2(1) =
1.87, p = .17, TLI = .98, CFI = .99, SRMR = .02, and
RMSEA = .05 [90% CI = .00 – .17]. The model explained
the following percentages of variance: 18 percent of engage-
ment, 21 percent of job satisfaction, and 27 percent of affec-
tive commitment with the organization.
Job satisfaction was significantly (p < .01) predicted by
work engagement (β = .33), confirming Hypothesis 1a, and
by self-efficacy (β = .21, p < .01). Affective organizational
commitment was significantly (p < .01) predicted by work
engagement (β = .35), supporting Hypothesis 1b, and by job
Orgambídez et al. 5
Figure 2.  Hypothesized model with standardized path estimates
(N = 321)
Note: All coefficients are significant (p < .01).
Figure 3.  Modified model with standardized path estimates
(N = 321)
Note: All coefficients are significant (p < .01).
satisfaction (β = .28, p < .01). With regard to work engage-
ment, it was significantly (p < .01) predicted by self-efficacy
(β = .43), confirming Hypothesis 2.
Regarding the mediating effect of work engagement (Table
2), the results showed two indirect effects, through work
engagement, since zero was not included in the confidence
intervals: (a) an indirect effect of self-efficacy on job satisfac-
tion [PC 95% CI = 0.08 – 0.19]; and (b) an indirect effect of
self-efficacy on affective organizational commitment [PC
95% CI = 0.15 – 0.29]. Self-efficacy had direct and indirect
effects, through work engagement, on job satisfaction (partial
mediation), partially confirming Hypothesis 3a. A total of
59.37 percent of the effect was direct (0.19/0.32), whereas
40.63 percent of the effect was indirect (0.13/0.21). However,
affective organizational commitment was totally explained by
self-efficacy through work engagement (full mediation), sup-
porting Hypothesis 3b. It was also observed as an indirect
effect of work engagement on affective commitment through
job satisfaction [PC 95% CI = 0.05 – 0.15].
Discussion
Using the JD-R model as a conceptual framework, the objec-
tive of this study was to explore the effect of work engage-
ment as an intermediary variable on the relationship between
self-efficacy, as a personal resource at work, and job satisfac-
tion and affective commitment with the company as individ-
ual indicators of QWL. Our results do not confirm that work
engagement fully mediates the relationship between a per-
sonal resource and organizational results as the JD-R model
assumes. Self-efficacy had both a direct and an indirect
effect, through work engagement, on job satisfaction.
Moreover, engagement at work totally mediated the relation-
ship between self-efficacy and affective commitment. In this
sense, the beliefs of success and engagement at work are
important antecedents of QWL in this sample of nursing
staff.
Although the findings of this study need to be replicated
in a more in-depth way, the obtained results have significant
implications for the theory, research, and practice for nursing
management. With respect to the theoretical implications,
the absence of a fully mediation of work engagement could
suggest the existence of other mediating variables. Work
engagement could be an affective mediator, while certain
cognitive variables (e.g., psychological empowerment) could
also act as mediators between personal resources at work
(e.g., self-efficacy) and organizational results (e.g., job satis-
faction, organizational commitment; Zigarmi, Nimon,
Houson, Witt, & Diehl, 2011).
With regard to Hypotheses 1a and 1b, the findings con-
firmed the two hypotheses: Work engagement was an impor-
tant antecedent of both job satisfaction and affective
organizational commitment. Increased levels of concentra-
tion, involvement, and energy in the workplace foster good
professional performance and the appearance of positive
feelings associated with the position. Consequently, job sat-
isfaction levels rise and the emotional link with the organiza-
tion is strengthened. Our results are consistent with those
observed in previous studies with samples of nurses from
different countries (Brunetto et al., 2013; Santos et al., 2016;
Van Bogaert et al., 2013).
Hypothesis 2 suggested that self-efficacy was positively
connected to work engagement. The results demonstrated
that perceived self-efficacy was an important predictor of
work engagement, in line with the research carried out by
Ventura et al. (2015) and De Simone et al. (2018). If nurses’
beliefs of efficacy are high, they invest more time and effort
in tasks, even when faced with difficulties, thus facilitating
the emergence of increased levels of engagement at work.
The results of our study partially confirmed Hypothesis
3a and fully confirmed Hypothesis 3b. Regarding
Hypothesis 3a, work engagement partially mediated the
effect of self-efficacy on job satisfaction. Both direct and
indirect effects, through work engagement, were observed.
The direct effect could be explained by the role of self-
efficacy on the control of job demands and the resulting
experience of positive consequences (Bandura, 2001;
Schaufeli, 2017). Nurses tend to perceive professional
demands as challenges and not as something stressful when
they experience high levels of self-efficacy, coupling better
6 Western Journal of Nursing Research 00(0)
Table 2.  Effects of self-efficacy on work engagement, job satisfaction and affective commitment among hospital nursing staff (N = 321).
Direct Effect
PC 95% CI
Work engagement
 Self-efficacy → 0.40 [0.28 – 0.52]
Job satisfaction
  Work engagement → 0.33 [0.22 – 0.44]
 Self-efficacy → 0.19 [0.07 – 0.31]
Affective O. commitment
  Job satisfaction → 0.26 [0.15 – 0.40]
  Work engagement → 0.33 [0.22 – 0.44]
 Self-efficacy → (no path)
Notes: PC 95% CI: percentile-corrected confidence interval (10,000 samples).
*p < .05 (zero is not included in the interval).
performance with lower stress levels and, consequently,
experiencing greater satisfaction at work.
As far as the indirect effect is concerned, higher levels of
self-efficacy facilitate higher perceptions of engagement at
work, which boost task achievement. This leads to the
appearance of positive experiences and feelings, which in
turn results in greater job satisfaction (Schaufeli, 2017). In
this sense, the partial mediation is consistent with the find-
ings of Mache et al. (2014) and De Simone et al. (2018).
With regard to Hypothesis 3b, a full mediation was
observed in the relationship between self-efficacy, work
engagement and affective commitment. Self-efficacy influ-
enced work engagement, which in turn influenced affective
organizational commitment. This full mediation is consistent
with the results obtained by De Simone et al. (2018),
Shahpouri et al. (2016), and Peng et al. (2013). High beliefs
of efficacy generate high levels of work engagement, which
allows performing tasks successfully. A better nursing perfor-
mance is related to greater identification with the company,
strengthening the emotional bond with the organization.
It should be noted that affective commitment was indi-
rectly predicted by work engagement through job satisfac-
tion. A positive work evaluation, as a consequence of
experiencing work engagement, could also lead to the cre-
ation of a strong emotional link with the organization. These
direct and indirect effects of work engagement on affective
commitment are in line with the results observed by De
Simone et al. (2018). These authors reported that job satis-
faction and work engagement had a direct negative effect on
hospital turnover intention, and an indirect effect of work
engagement on turnover intention through job satisfaction.
According to De Simone et al. (2018), work engagement and
job satisfaction are two of the main predictors of nurses’ vol-
untary turnover, strongly related to affective organizational
commitment.
Some limitations need to be taking account in this
research. First, the correlational design of the study only
allows us to refer to variance hypotheses and not causal ones
Indirect Effect Total Effect
PC 95% CI PC 95% CI
(no path) 0.40 [0.28 – 0.52]
(no path) 0.33 [0.22 – 0.44]
0.13 [0.08 – 0.19]* 0.32 [0.22 – 0.45]
(no path) 0.26 [0.15 – 0.40]
0.09 [0.05 – 0.15]* 0.42 [0.32 – 0.52]
0.22 [0.15 – 0.29]* 0.22 [0.15 – 0.29]
among the studied variables. Second, cross-sectional designs
with questionnaires are specially vulnerable to information
inaccuracies or biases (e.g., socially desirable responses).
Third, the study has been carried out with a sample that com-
bines registered nurses and nursing assistants. Job responsi-
bilities and role requirements are very different for registered
nurses and nursing assistants, and may affect the relation-
ships between the variables studied. Finally, uncontrolled
third variables, such as instrumental and emotional support
of colleagues and supervisors, could lie behind the relation-
ships between the variables in the study.
Future longitudinal studies should focus on investigating
the underlying processes between beliefs of success, engage-
ment at work, job satisfaction, and affective organizational
commitment over an extended period. The inclusion of new
variables, like Vroom’s expectation concept, may clarify the
mechanisms which are present between self-efficacy and
engagement at work. Finally, it would be necessary to com-
pare different roles in nursing and their effect on the rela-
tionships between self-efficacy, work engagement, job
satisfaction and organizational commitment.
This study contributes to a greater knowledge of the fac-
tors associated with job satisfaction and organizational com-
mitment in nursing. Self-efficacy seems to be an important
predictor of QWL, although its effects is partially mediated
(e.g., job satisfaction) or fully mediated (e.g., affective com-
mitment). In this sense, our results provide practical implica-
tions for health care services.
Our findings suggest that developing self-efficacy
increases levels of satisfaction and commitment through
work engagement in the nursing context. Following
Bandura’s (2001) recommendations, nurses and executives
health care can implement different strategies for improving
efficacy beliefs. The first strategy focuses on providing suc-
cessful experiences. Repeated success in clinical tasks
increases beliefs of efficacy. Under proper supervision and
in certain situations, nurses can perform certain complex
clinical tasks successfully (e.g., assisting doctors during
Orgambídez et al. 7
surgery) that strengthen their perception of competence at
work. In this sense, the role of supervisors is key as they
should: (a) take into account the level and ability of their
subordinates to adjust tasks; (b) provide adequate feedback
to enable learning and skills development; and (c) set realis-
tic and challenging goals and objectives to raise the levels of
self-efficacy of the group.
The second strategy focuses on vicarious experiences.
Seeing another person do something successfully increases
the sense of personal effectiveness. The importance of men-
tors, who convey effective coping strategies at work and help
nurses feel able to cope with the same tasks, is noteworthy in
the nursing context. The third strategy is verbal persuasion.
Social reinforcement and positive criticism are an important
source of self-efficacy. A strong climate of social support in
the teams, managed positively by the supervisor, allows the
emergence of mutual aid processes (e.g., how to successfully
manage complex situations with patients) that improve the
beliefs of effectiveness. Finally, the fourth strategy refers to
positive emotional states. Success beliefs depend on positive
emotional states (e.g., positive mood, enjoyment). One of the
emotional states related to self-efficacy is flow at work, a
feeling of enjoyment based on the accomplishment of moti-
vating tasks. An adequate distribution and definition of tasks
and roles, and the design of interesting and meaningful tasks
facilitate the experiences of flow in the workplace, consoli-
dating the beliefs of effectiveness in the work.
Declaration of Conflicting Interests
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, author-
ship, and/or publication of this article.
Ethical Approval
This study was approved by the ethics committee of the Foundation
for the Development of Nursing, Spain (Ref: 2016-032-FDN)
ORCID iD
Alejandro Orgambídez https://orcid.org/0000-0003-3785-4336
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