Effect of Human Resources Management Training Program for Nurse Managers on Staff Nurses’ Attitudes toward Organizational Change ()
1. Introduction
Organizations today are in constant economic, technological, social, demographic and legal changes. Compliance with managing these changes constitutes the foundations for survival of organizations and their success in worldwide competition. Human resources management (HRM) plays interdependent roles in organizational, social and economic aspects. All functions of human resources management play a major role in reaching organizational targets and sustaining the organization (Hussein & Aykan, 2016).
Human resource management (HRM) is the management of human resources or an organization’s workforce. It is the practices, systems, and policies that influence the behavior, performance, and attitudes of employees. Human resource management concerning with selecting human resource needs, screening, recruiting, training, rewarding, appraising as well as managing work relations, safety and health, and fairness concerns (Armstrong, 2014).
The basic HR practices used by successful organizations are organization design and development, job design, workforce resourcing, learning and development, performance, and reward management, and managing employment relations (Kupor, 2020).
Change management is an approach to transitioning or shifting individuals, teams and organizations from a current state to a desired future state. Employee resistance is the most often mentioned problem encountered when trying to implement change; however for an organization to change, it is essential that the employees of that organization also change (Malik, 2018).
Attitudes reflect an individual’s tendency to feel, think or behave in a positive or negative manner towards the object of the attitude. In times of change, if the employees of the organization accept the change or believe it will bring benefits, they will probably adapt rapidly to the new system of work. In contrast, negative attitudes towards change may have the contrary effect, decreasing the probability of adaptation to the proposed changes, there are three responses that reflect organizational change, attitude of cynicism to change: clearly reflects opposition; fear: describes a negative attitude to change; and acceptance: favorable attitude to change, covers positive behaviors and beliefs in relation to organizational changes (Neiva et al., 2019).
Positive employee attitudes towards change, as well as supportive employee behavior, have been identified as important success factors for health care organizational changes even though such changes are often driven by economic and technological goals. Health care organizations rely on human resource management (HRM) practices to support ongoing organizational change (Bouckenooghe et al., 2015; Raeder & Bokova, 2019).
2. Significance of the Study
Exploring the human resources management may provide greater insight about change and positive attitudes toward organizational change in health care as some research has explored the roles of human resource managers during change while no research has studied HRM practices influence on employees’ behaviors and attitudes in the specific context of change in health care organizations (Repischak & Hughes, 2016). Moreover, there had been no evidence of conducting previous studies on the effect of human resources management training program for nurse managers on staff nurses’ attitudes toward organizational change at Suez Canal University hospitals. So, it is important to determine the effect of human resources management training program for nurse managers on staff nurses’ attitudes toward organizational change. For these reasons this study will be done.
2.1. The Aim of the Study
The current study aims to assess the effect of human resources management training program for nurse managers on staff nurses’ attitudes toward organizational change at Suez Canal University hospitals.
2.2. Research Hypothesis
Human resources management practices of nurse managers will positively affect staff nurses’ attitudes toward organizational change in the study group
3. Subjects and Methods
3.1. Technical Design
The technical design included the study design, setting, sample and data collection tools.
3.2. Study Design
The quasi-experimental research design was used in the conduction of this study.
3.3. Study Setting
All inpatient units in Suez Canal University hospitals are in three buildings: The Educational Building, Specialized Surgeries Building and The Oncology Building.
3.4. Study Sample
To collect data for the present study two groups were used:
· All the available nurse managers worked at previously mentioned setting: 64 nurse managers (26 head nurses, 25 assistant head nurses, 7 supervisors, one staff development manager, one quality assurance manager, one infection control manager, two vice nursing service director and one nursing service director).
· 140 staff nurses worked in the same units of head nurses and were chosen using simple random sampling.
The number of staff nurses (sample size) was calculated by the following equation:
n = (Za)2 × p q/d2 (Sahai & Khurshid, 1996).
where:
n = sample size.
Za = the value of standard normal distribution for type I error probability for the sided test and equals 1.96.
p = positive attitudes toward organizational change = 25% (Vakola & Nikolaou, 2005).
q = 1 − p
d2 = the accuracy of estimate = .1.
So, according to the calculations the sample size ≅ 70 subjects.
70 participants were in study group and 70 participants were in control group.
Selection of staff nurses in the departments was based on simple random sample and the percentage of them should not be less than 20%.
The study subjects were randomly divided into two groups as the following:
1) Study group: 32 nurse managers, head nurses and their assistants and 70 Staff nurses affiliated to study group worked in the same units of head nurses from study group.
2) Control group: 32 nurse managers, head nurses and their assistants and 70 Staff nurses affiliated to control group worked in the same units of head nurses from control group.
3.5. Tools of Data Collection
Tool I: Human Resources Management Practices questionnaire. It was modified by researcher based on (Demo et al., 2012; Khalil, 2014), used three times through program phases and consists of two parts:
Part I: consisted of personal and job characteristics of the nurse managers work at previously mentioned setting included, age, gender, department, educational qualification, job position, years of experiences and attending training courses in human resources management.
Part II: Human Resources Management Practices (HRMPs), rating scale. It was modified by researcher based on (Demo et al., 2012; Khalil, 2014) to assess human resources management practices of nurse managers. This part consisted of 68 items under 9 main practices as follow:
· Human resource planning (6 items).
· Job analysis (8 items).
· Recruitment and selection (7 items).
· Training, development, and education (9 items).
· Competency-based performance evaluation (11 items).
· Work relations (6 items).
· Safety and security (9 items).
· Compensation and rewards (5 items).
· Organizational development and change (7 items).
Scoring system of the scale:
The human resources management practices responses were measured on a 5-point Likert scale ranging from one (very poor) to five (excellent), where five score was given for excellent response, four score was given for very good response, three score was given for good response, two score was given for poor response and one score was given for very poor response. Scoring: the total score was calculated by summing up and converted into a percent score. The total scores (68 × 5 = 340) were given for all statements. The mean and standard deviation was calculated and then converted into percentage; ≥85% as excellent; ≥75% as very good; ≥55% as good and <55% as poor (Demo et al., 2012).
Tool II: staff nurses’ attitudes towards organizational change questionnaire:
This tool was designed to assess staff nurses’ attitudes toward organizational change work at Suez Canal university hospitals. This tool was used three times through program phases. It consisted of the following two parts:
Part I: consisted of personal and job characteristics of the staff nurses work at previously mentioned setting included age, gender, department, educational qualification, and years of experiences.
Part II: attitudes toward organizational change scale, rating scale, it was developed by Neiva et al. (2005) and translated by researcher, to assess staff nurses’ attitudes toward organizational change. This part consisted of 35 items (9 positive and 26 negative) as follow:
1) Negative attitudes include:
· Cynicism behavior (18 items).
· Fear behavior (8 items).
2) Positive attitudes include Acceptance behavior (9 items).
Scoring system of the scale:
The staff nurses’ attitudes toward organizational change responses were measured on a 5-point Likert scale ranging from zero (strongly disagree) to four (strongly agree), where four score was given for strongly agree response, three score was given for agree response, two score was given for indifferent response, one score was given for disagree response and zero score was given for strongly disagree response. Scoring: the mean and standard deviation was calculated and then converted into percentage; the negatively stated items (cynicism and fear attitude) were reversed <50% and positive attitudes (acceptance attitude) ≥50% (Vakola & Nikolaou, 2005).
3.6. Reliability of the Tool
The study’s questionnaires were examined for reliability by measuring the internal consistency of items using Cronbach’s alpha coefficient test. The questionnaires were proved reliable where .981 for HRMPs questionnaire and .821 for staff nurses’ attitudes toward organizational change, respectively.
3.7. Validity of the Tool
The study’s questionnaires were translated into Arabic and examined for translation, content validity and relevance to Egyptian culture by five experts in the field of study from administration departments at Faculty of Nursing, Mansoura University and the Faculty of Commerce, Faculty of Education at Suez Canal University. Then, tools were back translated into English. The back-translations were reviewed by members of the jury to ensure accuracy and minimize potential threats to the study’s validity.
3.8. Field Work
Data collection was carried out during the period from the beginning of (July 2019 to the end of April 2021). Data were collected by the researcher using the study questionnaires, which were distributed individually to nurse managers and their nursing staff before, immediate after and after with three months training programs. Development of HRMPs training program: The training program of HRMPs covered the following topics: concepts of HRM and HRM practices which are HR planning, job analysis, recruitment and selection, training and development, competency-based performance evaluation, safety and security, work relations, compensation and rewards and organizational development. This period extended from the beginning of July to the end of September 2020.
Implementation of HRMPs training program: The program was implemented throughout three weeks in October 2020 two days per week, one session was offered daily, and each session took approximately three hours. A total of 6 sessions with total 18 hours were conducted to cover the content. The nurse managers received basic information and participated in learning discussions and role-playing situations related to the topic. Teaching aids used were data show, and flip chart. The researcher distributed a booklet about content of the program to nurse managers from study group.
3.9. Administrative Design
Official permission to conduct the study was addressed by the dean of faculty of nursing to the managers of Suez Canal university hospitals and obtained their permission for conducting this study and collecting data were issued, after explaining and clarifying the nature and purpose of the study
3.10. Ethical Considerations
Approval of the Scientific Ethics Committee was on 18 September 2017. Informed consent was gained from the study participants by eliciting the study purpose before asking them to participate in the study. They also assured about the anonymity and confidentiality of the information collected, and that it would be used only for scientific research. The researcher emphasizes that their participation will voluntary, and each participant had the right to refuse to participate and to withdraw from the study at any time without giving any justification.
3.11. Statistical Design
The collected data were scored, tabulated, and analyzed using IBM SPSS software package version 20.0. Frequency and percentages were used for describing demographic characteristics. Arithmetic means and standard deviations (SD) were used as descriptive statistics for quantifying variables under study. F repeated measures ANOVA was used to assess difference across time pre-post, follow up, N2 Partial eta squared to assess the effect size of intervention across time in three time periods (pre-post-follow up), LSD is used for multiple comparison for pair wise comparison between time periods of both control and study group and Cronbach’s Alpha. All statistical analyses were performed using an alpha error of P < .05; P-values < .05 were considered significant.
4. Results
Table 1 Illustrates the socio demographic characteristics of the nurse managers. For study group, half (50%) of nurse managers ranged from 30 and less than 40 years, near than two thirds (65%) of them were head nurses and their assistant, half (50%) of them had 10 and less than 20 years of experience. For control group, near than half (43.8%) of nurse managers ranged from 30 and less than 40 years, 84.4% of them were head nurses and their assistant, near than half (43.8%) of them had one and less than 10 years of experience. The majority of both groups had Bachelor of Nursing, was females and hadn’t attended training courses in the field of human resources management.
Table 2 demonstrates the socio demographic characteristics of the staff nurses. For staff nurses affiliated to study group, the mean age of staff nurses was 27.47 ± 3.62, 77.1% of them were females, the mean years of experience were 9.22 ± 5.05, and more than half (54.3%) of them had nursing school. For staff nurses affiliated to control group, the mean age of staff nurses was 27.65 ± 3.73, 84.3% of them were females, the mean years of experience were 9.95 ± 4.32, and near than three quarter (74.3%) of them had nursing school.
Table 3 reveals that the total mean percent of human resources management post program for the study group of nurse managers was 78.17% while in control group was 43.8% and as observed from the table, there were significant differences between study and control groups of nurse managers’ post and follow up program.
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Table 1. Socio demographic characteristics of nurse managers in the study and control groups (n = 32).
χ2 = is chisquare test; # = is mannwittney u test; P value is significiant ≤ .05.
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Table 2. Socio demographic characteristics of staff nurses affiliated to study and control groups (n = 70).
χ2 = is chisquare test; # = is mannwittney u test; P value is significiant ≤ .05.
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Table 3. Comparison between the study and control groups of nurse managers regarding their total scores of human resources management through program phases (n = 32).
F test is repeated measures ANOVA, P value is significant < .05, η2 is Partial Eta Squared, Sig. bAdjustment for multiple comparisons: Least Significant Difference (equivalent to no adjustments).
Table 4 shows that, there were statistically significant differences between staff nurses affiliated to study and control groups regarding their attitudes toward organizational change: fear and acceptance total scores post and follow up program. The mean percent of cynicism attitude was 53.5% preprogram and decreased to 45.5% post program then decreased to 44.75 follow up program while, the mean percent of fear attitude was 77% preprogram and decreased to 46.25% post program then slightly increased to 60.25% follow up program and finally the mean percent of acceptance attitude was 55.5% preprogram and increased to 93.25% at post program then decreased to 68% follow up program.
Table 5 clarified that, there was a statistically significant positive relationship between total score of nurse managers’ human resources management practices and total score of acceptance attitude of staff nurses affiliated to study group post program. While there was a statistically significant negative relationship between total score of nurse managers’ human resources management practices and total score of cynicism attitude and fear attitude of staff nurses affiliated to study group post program.
Figure 1 clarifies that combined cynicism and fear attitudes total mean score for staff nurses affiliated to study group decreased at post program as compared with staff nurses affiliated to control group.
Figure 2 demonstrates the total mean scores of acceptance attitude of staff nurses affiliated to study group in relation to staff nurses affiliated to control group post program.
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Table 4. Comparison between staff nurses affiliated to study and control groups regarding their attitudes toward organizational change: cynicism, fear and acceptance attitudes through program phases (n = 70).
F test is repeated measures ANOVA, P value is significant < .05, η2 is Partial Eta Squared, bAdjustment for multiple comparisons: Least Significant Difference (equivalent to no adjustments).
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Table 5. Relationship between total score of nurse managers’ human resources management practices and their staff nurses’ attitudes toward organizational change: Acceptance, Cynicism and Fear attitudes through program phases.
* Significant at P < 0.05.
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Figure 1. Combined cynicism and fear attitudes of staff nurses affiliated to study and control groups post program (n = 70).
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Figure 2. Acceptance attitudes of staff nurses affiliated to study and control groups post program.
5. Discussion
As regards the total score of human resources management (HRM) practices, the present study revealed that there was statistically improvement post and follow-up program for study group regarding all human resources management (HRM) practices, also there were statistical differences between study and control group post and follow up program. These finding could be due to the effect of training program about human resource management practices for study group of nurse managers.
This result was in agreement with Uduma et al. (2017) who study the impact of a human resource management intervention on the capacity of supervisors to support and supervise their staff at health facility level, they revealed an improvement in working environment by targeting managers and their approach to human resources management (HRM) that were determined through changes in the perceptions and experiences of supervisors and health workers in the facilities selected for participation in the study, it found that the end-line samples had generally higher scores than the corresponding baseline samples for both supervisors and health workers after intervention package, which includes workshops and intensive training.
Regarding staff nurses’ attitudes toward organizational change, the first attitude was the cynicism attitude, the result of the current study revealed that there was slight decrease in the total score of cynicism attitude post and follow-up program as perceived by staff nurses affiliated to study group, and there was statistical difference pre, post and follow up program for staff nurses affiliated to study group. While there was no statistical difference regarding total score of cynicism attitude between staff nurses affiliated to study and control group. This result could be due to nurse managers who received the training program are the key communicators to staff nurses at lower levels in the hospitals but that isn’t enough, presence of guiding power and support from the top level of management is essential to carry out the change initiatives especially in case of cynicism.
This result was in the same line with Brown & Cregan (2008) who carried out a study entitled “organizational change cynicism: the role of employee involvement” which revealed that information sharing had negative impact on organizational change cynicism while information provided by management associated with greater employee understanding of management decisions and lower level of organizational cynicism. Also, Behazad (2020) study of employee cynicism and organizational change, clarified that employees who had confidence and trust in management policies and procedures tend to support change management processes and had a low cynicism level towards the organization.
Concerning fear attitude, there was statistically significant difference regarding fear attitude between staff nurses affiliated to study and control group post and follow-up program.
These results could be interpreted as fear usually generated as a result of poor work environment and absence of sound retention practices which are the key health human resources challenges that can be resolved through effective implementation of human resource management practices that result in improving the relationship between nurse managers and staff nurses and improving work environment and in turn eliminate staff nurses fear.
Relatively similar result by Vakola and Nikolaou (2005), they study attitudes towards organizational change: what is the role of employees’ stress and commitment? They indicated that bad work relationships were a very significant inhibitor of employees’ positive attitudes towards organizational change. Also, Neiva et al. (2019) carried out a study entitled “attributes of the organizational change and its influence on attitudes toward organizational change and well-being at work: a longitudinal study” they revealed that attitudes of fear were affected by the lack of planning perceived early in the process of change and respondents’ well-being throughout the three phases of the study.
As regards acceptance attitude, the finding of the current study clarified that there were significant increase regarding acceptance attitude post and follow-up program for staff nurses affiliated to study group, and there was significant statistical difference regarding acceptance attitude between staff nurses affiliated to study and control group post and follow up program.
From researcher point of view, this result could be interpreted as training program on HR practices enable the nurse managers to foster the importance of planning and job analysis that eliminate work ambiguity in their department, create supportive and healthy environment based on performance feedback, availability of fair rewards, advancement opportunities and purposeful work relations that in turn reduce fear and enhance acceptance behaviors.
These findings were supported by Saravia (2015) carried out a study entitled “attitudes of cynicism, fear and acceptance with organizational change in Lima” which revealed decrease in negative attitudes and low fear behavior while reporting high acceptance attitude toward organizational change. Furthermore, the results of Neiva et al. (2019) clarified that attitudes of acceptance were positively affected by planning perceived early well-being throughout the three phases of the study.
The present study revealed that there were statistically significant differences regarding the combined cynicism and fear attitudes toward organizational change post and follow-up program for staff nurses affiliated with to study and control group, also, there were statistically significant differences regarding acceptance attitude toward organizational change post and follow up program for staff nurses affiliated to study and control group This result could be due to staff nurses affiliated to study group influenced by HRM practices that were practiced by their nurse managers after the training program.
The preceding finding is in congruence with Tummers et al. (2013) who carried out a study entitled “connecting human resources management (HRM) and change management: how HR practices can stimulate change readiness” they revealed that three perceived HR practices are particularly effective for improving attitudes toward organizational change: autonomy, participation in decision-making, and teamwork. These practices are connected to increased levels in employee involvement, perceived self-control, and feelings of being recognized or appreciated.
The results of the present study clarified that there was a statistically significant positive relationship between nurse managers’ human resources management practices and acceptance attitude toward organizational change for staff nurses affiliated with to study group post program. While there was a statistically significant negative relationship between nurse managers’ human resources management practices and cynicism attitude, fear attitude respectively for staff nurses affiliated to study group post program.
Raeder and Bokova (2019) who carried out a study entitled “committed to change? human resource management practices and attitudes towards organizational change” they found that human resources management (HRM) practices showed a clear positive relationship with affective and normative commitment to change, and a clear negative relationship with continuance commitment to change. Also, Abd-Elraof (2015) studied the strategic human resource management practices within the process of change, and found positive relationship between HRM and change.
These results were also supported by Giauque (2014) who carried out a study entitled “Attitudes toward organizational change among public middle managers” found that work relationship, employee voice and participation and work life balance were positively and significantly related to positive attitudes toward organizational change.
Finally, the result of the present study revealed that human resource management practices had a positive effect on staff nurses’ attitudes toward organizational change and deriving positive attitudes toward organizational change.
In agreement with previous studies of Zaleska and Menezes (2007); Adeniji et al. (2013) ; Kaya et al. (2014) ; Tummers et al. (2013); Repischak and Hughes (2016), Korff et al. (2017), they found that human resource management practices were a strong predictor for affecting attitudes toward organizational change and human resources management (HRM) practices cause higher levels of proactive behavior and vitality and thus readiness for organizational change.
6. Conclusion
Based on the finding of the current study, it was concluded that the human resource management practices had a positive effect on staff nurses’ attitudes toward organizational change, and this confirms the research hypothesis which stated that implementation of human resources management training program for nurse managers will affect positively on staff nurses’ attitudes toward organizational change in the study group.
7. Recommendations
In the light of the study findings, the following can be recommended:
· Establish human resources department instead of staff development department that focuses on implementing all human resources management practices, not just the training.
· Generalize implementation of the human resource management training program for the rest of nurse managers who worked in the hospital (control group).
· Engage the nursing staff in decision-making and problem-solving in order to give them more confidence and foster positive attitudes toward change.
· Further research using longitudinal study to focus on studying HRM practices in different times of change, such as downsizing, mergers, cultural or technological change.
· Further research is to study the effective combination of HRM practices that support change and eliminate the negative attitude toward change.
8. Limitations of the Study
Firstly, it was quite difficult to collect the data from a larger sample because of nurse managers’ and staff nurses’ schedules and the availability of free time. Secondly, the difficulty to examine the relationship between human resources management and attitudes toward organizational change at times of change.