WORKFORCE ISSUES

The relationships among social capital, organisational commitment

and customer-oriented prosocial behaviour of hospital nurses
Chiu-Ping Hsu, Chia-Wen Chang, Heng-Chiang Huang and Chi-Yun Chiang

Aims. This study examines the perceptions of registered nurses of social capital, organisational commitment and customer-
oriented prosocial behaviour. Additionally, this study also addresses a conceptual model for testing how registered nurses
perceptions of three types of social capital influence their organisational commitment, in turn intensifying customer-oriented
prosocial behaviour, including role-prescribed customer service and extra-role customer service.
Background. Customer-oriented prosocial behaviour explains differences in job satisfaction and job performance. However,
the critical role of customer orientation in the hospital setting has yet to be explored.
Design. Survey.
Methods. The survey was conducted to obtain data from registered nurses working for a large Taiwanese medical centre,
yielding 797 usable responses and a satisfactory response rate of 867%. The partial least squares method was adopted to obtain
parameter estimates and test proposed hypotheses.
Results. The study measurements display satisfactory reliability, as well as both convergent and discriminant validities. All
hypotheses were supported. Empirical results indicate that registered nurses perceptions of social capital were significantly
impacted the extent of organisational commitment, which in turn significantly influenced customer-oriented prosocial behaviour.
Conclusion. By stimulating nursing staff commitment, health care providers can urge them to pursue organisational goals and
provide high quality customer service. To enhance organisational commitment, health care managers should endeavour to create
interpersonal interaction platforms in addition to simply offering material rewards.
Relevance to clinical practice. Nurses act as contact employees for their patient customers in the hospital, and they are
required to provide patient safety and service quality. This study shows that nurses with high organisational commitment are
willing to provide customer-oriented prosocial activities, which in turn enhances patient satisfaction.

Key words: customer-oriented prosocial behaviour, evidence-based practice, hospital nurses, organisational commitment, social
capital

Accepted for publication: 21 November 2010

tions for the employee and organisation. Both employee and

Introduction
Organisational commitment served as a criterion variable for
an organisations sustaining and competitive advantage. The
degree of employee organisational commitment has implica-
organisation derive benefits from commitment employees
(Gormley & Kennerly 2010). Organisational commitment
has been shown to be a key cause of nurse job engagement
(McNeese-Smith 2001), job satisfaction (Lu et al. 2007),

Authors: Chiu-Ping Hsu, PhD Candidate, Department of
International Business, National Taiwan University, Taipei; Chia-
Wen Chang, PhD, Assistant Professor, Department of Business
Administration, Feng Chia University, Taichung; Heng-Chiang
Huang, PhD, Professor, Department of International Business,
National Taiwan University; Chi-Yun Chiang, PhD, Assistant
Professor, Department of Business Administration, Ming Chuan
University, Taipei, Taiwan
Correspondence: Chiu-Ping Hsu, PhD Candidate, Department of
International Business, National Taiwan University, 8F, Building I,
College of Management, No.1, Sec. 4, Roosevelt Rd., Taipei City
106, Taiwan. Telephone: +886 2 3366 4966.
E-mail: d94724003@ntu.edu.tw

 2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 13831392 1383
doi: 10.1111/j.1365-2702.2010.03672.x
C-P Hsu et al.
turnover (Castle 2006) and of organisational goal achieve-
ment, stability and innovation (Brown & Harvey 2006). Liou
and Cheng (2010) also found that creating a good organisa-
tional climate may increase nurses organisational commit-
ment and, in turn, decrease their intention to leave. Despite
the large amount of literature on the subject, there is little
theoretical and practical understanding of the customer-
related outcomes in the hospital setting. This study attempts
to address this under-researched problem.
Patients are increasingly vital in determining the success of
health care organisations (Ford & Fottler 2007). Concerns
about quality and safety in health care and the impacts of
nurses work conditions on patient outcomes have been
growing in recent years, particularly as health care in acute
care settings has become increasingly complex (Clarke &
Aiken 2008). Administrators have recently re-focused by
meeting patient customer needs, wants and desires, not only
to achieve positive clinical outcomes, but also to achieve
superior health care experiences (Ford et al. 1997). In health
care organisations, nurses act as contact employees for their
patient customers. Nurses fulfil multiple roles simultaneously
and are required to provide quality and safe patient care
with less support (Greggs-McQuilkin 2004). When contact
employees exhibit customer-oriented behaviour or a strong
intention to meet customer needs (Brown et al. 2002), they
are more likely to serve customers passionately, in turn
enhancing customer satisfaction. According to earlier re-
search (Lee et al. 2006) and our interview with the nurses,
this work argues that nurses who are committed to their own
health care organisations tend to comply with explicit
requirements regarding customer service and also tend to
make efforts that go beyond their job descriptions when
attempting to assist customers.
Previously, several authors have proposed multi-factors
likely to motivate organisational commitment, including the
DemandControlSupport (DCS) model, organisational jus-
tice (Rodwell et al. 2009), job satisfaction, organisational
culture and trust (Gregory et al. 2007). Recently, interpersonal
networks and interactions have begun to comprise a significant
part of nurse work environments and the establishment of
interpersonal relationships is widely believed to support
organisational competitiveness (Watson & Papamarcos
2002). Social capital has been conceptualised as a set of social
resources that resides in interpersonal relationships (Reed
et al. 2009). Previous studies demonstrate that social capital is
related to employee career success (Seibert et al. 2001), firm
value creation (Tsai & Ghoshal 1998) and sustainable
organisational advantage (Nahapiet & Ghoshal 1998).
In the field of nursing, the issue of social capital has also
been investigated since the mid-1990s. East (1998) indicated
1384  2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 13831392
that building social capital, as a public health issue, is
critical to improve the health of residents in a disadvantaged
urban neighbourhood. Cowley and Billings (1999) similarly
suggested that social capital is important to promoting
health, and several studies also showed that social capital
has a positive influence on health (Cannuscio et al. 2003,
Carlson & Chamberlain 2003, Pearce & Smith 2003,
Kritsotakis & Garmanikow 2004). Based on a social capital
perspective, Looman and Lindeke (2005) suggested four
practical ways for nurses to promote health: (1) create
opportunities for networking through bringing people
together for health purposes, encourage repeated contacts
and storytelling; (2) diffuse community-related health
knowledge; (3) build personal stock of social capital; (4)
practice vision therapy in nursing as a new intervention to
improve child and family health. Looman (2006) further
developed and tested a scale for measuring social capital
to establish consensus and precision of communication.
Concerned specifically with enhancing the relationship in
primary care practice, DiCicco-Bloom et al. (2007) develop
a model of social capital to improve patient care outcomes
and promote organisation success. Recently, Kowalski et al.
(2010) suggested that social capital in hospitals could be
regarded as a resource helping nurses against their emotional
exhaustion.
However, despite the numerous findings reported by
researchers regarding the relationship between social capital
and health, there has been little empirical research on the
relationship between social capital and organisational com-
mitment. This study identifies three dimensions of social
capital, examines their links to organisational commitment
and examines the role of commitment in shaping nurses
customer-oriented proclivity.
Background
The conceptual framework of this study delineates how
nurses perceptions of social capital serve to create organi-
sation commitment and in turn enhance nurse customer-
oriented prosocial behaviour. Based on previous works
(Nahapiet & Ghoshal 1998, Tsai & Ghoshal 1998, Watson
& Papamarcos 2002), this study classifies social capital into
three categories, namely social interaction, trust among
nurses and shared vision. Drawing on recent marketing
research on social capital (e.g. Nahapiet & Ghoshal 1998,
Tsai & Ghoshal 1998), organisational commitment (e.g.
McNeese-Smith 2001, Castle 2006, Rodwell et al. 2009) and
customer-oriented prosocial behaviour (e.g. Bettencourt &
Brown 1997, Lee et al. 2006), this work proposes the
conceptual framework shown in Fig. 1.
Workforce issues
Social capital Customer-oriented
Prosocial behavior
Social Role-prescribed
interaction customer service
H1a (+)
H2a (+)
H1b (+)
Trust among Organisational
nurses commitment
H2b (+) Extra-role
customer service
H1c (+)
Shared vision
Figure 1 Conceptual framework.
Relationship between social capital and organisational
commitment
The concept of social capital has become increasingly
important in the discipline of nursing. A growing number
of nurse scholars have invoked the concept of social capital as
a means of investigating challenging questions raised in the
nursing literature. Social capital is discussed from three
theoretical approaches in contemporary research, and each
approach is defined differently. First, the functional approach
is centrally concerned with social capital as a social resource
for expediting collaboration and corporate action (Coleman
1988, Putnam 1993). Such a beneficial resource exerts an
influence on the development of human capital (Cole-
man1998), firms performance (Baker 1990) and of geo-
graphical regions (Putnam 1993). The second theoretical
approach, which is network based, views social capital as
networks of relationships with a valuable resource (Bourdieu
1986). Social capital is embedded in structure and relation-
ships, and relationships are created through social affairs;
thus, interaction is a precondition to build and sustain social
capital (Bourdieu 1986). Recently, Grootaert et al. (2004)
have suggested a third approach, which may be considered a
multi-dimensional approach. By combining the elements of
the functional and network-based approaches, Grootaert
et al. (2004) introduced the SC-IQ concept covering six
dimensions for the purpose of measuring social capital.
There are many ways to conceptualise and operationally
define social capital. In this study, our definition of social
capital reflects the network-based approach and acknowl-
edges social capital as a concept rooted in the structure and
content of relationships. We adopt Nahapiet and Ghoshals
(1998) view in defining social capital as the sum of actual
and potential resources within, available through and
derived from the network of relationships possessed by an
individual or social unit. Social capital thus comprises both
the network and the assets that may be mobilised through
the network (p. 243). This study thus focuses on social
 2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 13831392
Prosocial behaviour of hospital nurses
capital arising from the network of relationships among
hospital nurses.
Prior research suggests that social capital is considered
critical to individual organisational commitment (Mowday
et al. 1979). Organisational commitment presents individual
psychological attachment to an organisation (Mowday et al.
1979, Gormley & Kennerly 2010). In a health care organi-
sation involving plenty of interpersonal interactions between
nurses, we argue that social capital, as perceived by nurses, is
able to influence individual commitment to the organisation.
Drawing on a review of previous research on social capital
(Watson & Papamarcos 2002), this study classifies three
dimensions of social capital, namely social interaction, trust
among nurses and shared vision, each of which is expounded
on below.
The structural aspect of social capital refers to the social
interactions among nurses, i.e. with whom and with what
frequency they share information and hold communicative
actions. It is reasonable to expect that social interaction
relates to organisational commitment. A network of rela-
tionships provides information on what is happening in the
organisation, access to power structures, emotional support
and friendship. This should increase the persons involvement
in the affairs of the organisation and attachment to the
organisation, hence affective organisational commitment
(Bozionelos 2008). Communicative actions not only serve
to transmit information, they also serve to construct the
persons perception of meaning and reality itself. The specific
values to which an organisation appeals when justifying its
actions or laying out its plans, allow person to understand
why certain events occur, influence the persons perception of
organisation justice and permit the person to share the
communicators perspective. Communicative actions, there-
fore, will have affects on organisational commitment (Wat-
son & Papamarcos 2002). Moen et al. (2008) also argued
that face-to-face interaction is beneficial for the establishment
of commitment.
Trust has become increasingly critical in influencing
organisational climate, employee performance and organisa-
tional commitment (Laschinger et al. 2008). Trust is critical
in successful social cooperation. Without an atmosphere of
trust, people are incapable and unwilling to cooperate
without strict behavioural control (Whitney 1994). Doney
and Cannon (1997) identified credibility and benevolence
as two critical elements of trust. Credibility refers to
individual belief that a trusted party (trustee) is capable of
fulfilling promised commitment, whereas benevolence
describes the inclination of the trustee to prioritise the
interests of trustors. Trust implies individual willingness
toward vulnerability (Rousseau et al. 1998) and subjective
1385
C-P Hsu et al.
perceptions of norms related to reciprocity (Watson &
Papamarcos 2002). When trust exists in interpersonal rela-
tionships, individuals will expose self-vulnerability based on
the belief that their peers will not take advantage of them.
Conversely, if an individual feels vulnerable in an organisa-
tion or does not trust that their work efforts will receive
appropriate reciprocation, their organisational attachment
will be reduced (Watson & Papamarcos 2002). Laschinger
et al. (2008) also argued that trust significantly impacts
organisational commitment.
Shared vision embraces the collective goals and aspirations
of organisational members (Tsai & Ghoshal 1998) and
generally notifies members of what is considered right and
wrong (Watson & Papamarcos 2002). According to Tsai
and Ghoshal (1998), a shared vision can prevent misunder-
standings in interpersonal communications and facilitate the
free exchange of ideas and resources. This study considers
shared vision as a precursor of nurse attachment to their
health care organisations. Previous works have shown that
shared vision can promote the integration of an entire
organisation (Orton & Weick 1990) and stimulate more
effective interpersonal cooperation (Starbuck 1983). Ravlin
and Meglino (1987) proposed that perceptions of organisa-
tional shared vision positively influence commitment to the
organisation. According to the above literature, we proposed
the following hypotheses:
H1a: Social interaction positively influences organisational
commitment.
H1b: Trust among nurses positively influences organisa-
tional commitment.
H1c: Shared vision positively influences organisational
commitment.
Relationship between organisational commitment and
customer-oriented prosocial behaviour
Customer-oriented prosocial behaviour is regarded as the
helpful behavior of service providers directed toward an
organisation or other individuals (Bettencourt & Brown
1997, p. 41). This behaviour forms part of the organisational
role of service providers. Furthermore, service providers
displaying customer-oriented prosocial behaviour desire to
promote the welfare of the organisation they belong to (Brief
& Motowidlo 1986). In the work of Bettencourt and Brown
(1997) on contact employees, prosocial behaviour includes
both role-prescribed and extra-role customer service compo-
nents. Lee et al. (2006) also agreed with Bettencourt and
Browns (1997) classifications. Role-prescribed customer
service captures the facets related to whether the required
actions of a service provider are clearly stated in organisa-
1386  2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 13831392
tional documents (for example, performance evaluation
forms and job descriptions) (Brief & Motowidlo 1986,
Bettencourt & Brown 1997). Meanwhile, the extra-role
customer service component examines whether contact
employees exceed their explicitly required expectations, such
as providing spontaneous exceptional services during service
encounters to boost customer satisfaction (Bitner et al. 1990,
Bettencourt & Brown 1997). This study measures customer-
oriented prosocial behaviour as organisational assistance
provided by nurses as well as their customer-orientation
behaviour.
Previous works have argued that organisational commit-
ment can encourage prosocial behaviour by service provid-
ers (MacKenzie et al. 1998). As Brief and Motowidlo
(1986) suggested, individuals who perceive strong bonds
with their organisations as part of their organisational role
are more inclined to engage in prosocial behaviour.
Furthermore, they are more likely to interact with custom-
ers in a prosocial manner, keeping organisational goals in
mind while doing so. As a liaison between patients and
doctors, the organisational attachment and commitment of
nurses can facilitate their empathetic, caring and patient-
centred behaviour. This study indicates that the extent to
which nurses are willing to engage in customer-orientated
prosocial behaviour is strongly stimulated by their organ-
isational commitment. Consequently, this study hypothes-
ises the following:
H2a: Organisational commitment positively influences
role-prescribed customer service.
H2b: Organisational commitment positively influences
extra-role customer service.
Methods
Measures
This study adapted measures from previous studies (e.g.
Smith et al. 1994, Bettencourt & Brown 1997, Leana & Pil
2006, Lee et al. 2006) to tap the concept of each construct
and made necessary modifications to fit the context of this
research. This research developed items for social capital
based on the manifestation of Smith et al. (1994), Lee et al.
(2006) and Leana and Pil (2006). Among these multi-item
scales of social capital, two items were used to assess social
interaction. Four items were respectively designed to evaluate
trust among nurses and shared vision. Moreover, another
four items were adapted to measure organisational commit-
ment used by Lee et al. (2006). Regarding role-prescribed
customer service and extra-role customer service, this study
individually adapted two three-item scales used by Betten-
Workforce issues Prosocial behaviour of hospital nurses

court and Brown (1997) to capture our concept of customer- Table 1 Sample demographics
oriented prosocial behaviour. Characteristic Number %

Gender
Ethical considerations Male 11 14
Female 784 984
This surveyed medical centre approved the study. We NA 2 03
composed a questionnaire, which was prefaced with a note Age
assuring the respondents of anonymity in their responses. All 2025 107 134
of the participants were also informed that the survey was 2630 627 787
3135 28 35
only for academic purposes. Our introduction to the ques-
3640 25 31
tionnaire discussed potential risks and stated that taking the >40 5 06
survey implied consent. Participants were informed that that NA 5 06
it was not obligatory to take part in the research (to include Highest level of education
the completion of the questionnaire) and that they could HS diploma 5 06
cease participation at any time with no penalty whatsoever. Associate 304 381
BS/BSN 426 534
Masters 47 59
Data collection NA 15 19
Marital status
A questionnaire survey was performed to gather data from Single 534 67
nurses in a major medical centre in northern Taiwan. The Married 258 322
NA 6 08
sample consists of 1026 full-time nurses. Respondents were
required to possess two characteristics: (1) over three months NA, not available; BSN, Bachelors of Science/Nursing.
of work experience in the medical centre; (2) completion of
new employee training. A total of 919 potential respondents
were thus identified. Each of the 919 participating nurses had BS/BSN degrees. Also, 67% of nurses who were surveyed
received a questionnaire. Anonymity was maintained in the were single. Table 1 details the demographics of the sample
data collecting process. We informed all nurses of the population.
purposes of the study. The respondents answered in total
anonymity, with no identifying information on the survey
Testing the model
instruments. The nurses returned the completed question-
naires in a return envelope. We researchers do not know, nor This study employed the partial least squares (PLS) Graph
does the supervisor, which respondent gave which answers. v3.0 program to estimate the parameters in the measurement
This procedure protected the identities of the respondents. and structural models. PLS path modelling is component
Besides, the hospitals name is being kept confidential. A gift based. It requires less stringent assumptions related to
worth approximately US$2 was given as a reward for measurement levels of the manifest variables, multivariate
participation. With the aid of top managements approval normality and sample size (Hulland 1999, Chin et al. 2003)
and support of this study, 825 contacts completed and than does the covariance-based approach to structural
returned the survey questionnaire. The period of data equation modelling (e.g. LISREL). We adopted the two-stage
collection was between August 2008April 2009. Among approach suggested by Hulland (1999), comprising both
the 825 returned questionnaires, this study obtained 797 measurement and structural models. The former reflects the
usable responses for subsequent analysis after discarding reliability and validity of the study measurements. The latter,
incomplete responses. The usable response rate was approx- on the other hand, illustrates the statistical support provided
imately 867%. for the hypothetical relationships among constructs. Such
relationships are used as a basis for discussion and identifying
managerial implications.
Results
To address the adequacy of the measurement model, this
study assesses the reliability, convergent validity and discri-
Sample profile
minant validity of individual items (Hulland 1999). First, the
Most respondents in this survey were 2630 years old item loadings that reflect the extent to which each construct is
(787%) and female (984%). Moreover, 534% of the nurses tapped by the study measures range from 083096 (for

 2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 13831392 1387
C-P Hsu et al.

Table 2 Items and measurement model estimates of the CRs ranged from 089096 in this study,
Standardise
significantly exceeding the value of 07 recommended by
Construct/items item loading CR AVE Hulland (1999). The estimates of AVEs were found to exceed
05 (range from 073088) and all lay within the acceptable
Social interaction
range stipulated by Hulland (1999), thus achieving significant
SI1 090* 089 080
SI2 088* convergent validity. All item loadings, CRs and AVEs are
Trust among nurses supported to indicate high reliability and convergent validity.
T1 088* 095 081 According to Hulland (1999), this study checks for discri-
T2 088* minant validity by examining whether the square roots of the
T3 092*
AVE for these constructs are larger than any other value of
T4 092*
Shared vision
their individual intercorrelated coefficients. Table 3 shows
SV1 091* 096 084 that the square root of the AVE for each construct along the
SV2 093* diagonal line is higher than any other value of its correlated
SV3 093* coefficients in the lower triangle area. This result clearly
SV4 091* demonstrates discriminant validity. Overall, these statistics
Organisational commitment
reveal that the construct measurements are sufficiently strong
OC1 083* 092 074
OC2 085* to enable subsequent structural model estimation.
OC3 087* The sign and significance level of each estimated path,
OC4 089* according to the PLS bootstrapping method, is shown in
Role-prescribed customer service Table 4. This study found that social interaction, trust among
RP1 093* 096 088
nurses and shared vision positively and significantly impact
PR2 096*
PR3 093*
organisational commitment and respectively have b coeffi-
Extra-role customer service cients of 013, 027 and 034, supporting H1a, H1b and H1c.
ER1 087* 089 073 Also, organisational commitment positively and significantly
ER2 084* impacts role-prescribed customer service (b = 034), leading
ER3 085* to H2a being supported. Moreover, organisational commit-
AVE, average variance extracted; CR, composite reliability. ment strongly and positively influences extra-role customer
*p < 0001. service (b = 054). As expected, support was found for H2b.

We obtained responses using five-point Likert scales, anchored by Table 4 summarises the studys results and shows how they
1 = strongly disagree and 5 = strongly agree.
support the hypotheses.

details, see Table 2), all exceeding the recommended thresh-

old value of 07 suggested by Hulland (1999). Second, this
study used the composite scale reliability (CR) and average
variances extracted (AVE) to assess the internal consistency
of constructs. While CR is analogous to the Cronbachs
alpha, the AVE denotes the amount of variance captured by
the measure of a construct relative to random measurement
error (Fornell & Larcker 1981). Table 2 shows that the
Discussion
This study identified support for the proposed comprehensive
model using nurses as a sample. Particularly, this study has
made contributions in the following ways. First, relationship
is considered an asset for those involved in the social action
field (Baker 1990) and social capital is generally embedded in
interpersonal relationships (Coleman 1988). Social capital is

Table 3 Square roots of average variance extracted (AVE) and correlation matrix

# Construct 1 2 3 4 5 6

1 Social interaction 089

2 Trust among nurses 053 09
3 Shared vision 053 082 092
4 Organisation commitment 045 061 063 086
5 Role-prescribed customer service 023 041 036 039 094
6 Extra-role customer service 031 043 041 054 075 085

Diagonal elements in bold are the square roots of the AVE.

1388  2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 13831392
Workforce issues
Table 4 Results of partial least squares analysis
Hypothesis
H1a: Social interaction Organisation commitment
H1b: Trust among nurses Organisation commitment
H1c: Shared vision Organisation commitment
H2a: Organisation commitment Role-prescribed customer service
H2b: Organisation commitment Extra-role customer service
*p < 005, **p < 001, ***p < 0001.
connected with employee attachment to the organisation.
This connection, however, is only partly understood. This
lack of understanding is more pronounced in hospital
settings. This empirical study proposes that social capital is
critical in augmenting nurse organisational commitment. The
study findings indicate that, for health care organisations,
interpersonal interaction facilitates interpersonal networking
for individuals with similar working experiences and thus
satisfies nurses needs for social support or approval as well as
a sense of attachment. This result has considerable manage-
rial implications, because it suggests that greater health care
manager efforts and resources should be dedicated to
improving the design of interpersonal interaction platforms,
in addition to simply offering material rewards.
Second, social capital is demonstrated to elicit emotional
connections among members, increasing cohesion between
these like-minded people and the organisation. Among the
three dimensions of social capital, the findings of this study
reveal that shared vision has a higher predictive power.
Generally, shared vision can provide a foundation for
organisational norm. Coleman (1988) stated that when a
norm exists and is effective, it constitutes a powerful, though
sometimes fragile, form of social capital. Hospital executives
thus must establish a shared vision among nurses to foster
organisational commitment.
Third, this study applied the concept of customer-
oriented prosocial behaviour in health care management.
Empirically, this work found that nurses with high com-
mitment tend to engage in customer-oriented prosocial
activities, including role-prescribed customer service
(namely they do what is explicitly required in job descrip-
tions and other prescriptive rules) and extra-role customer
service (namely they are willing to go beyond the call of
duty to help customers). Health care administrators and
managers should increase their efforts to develop organi-
sational commitment to encourage nursing staff to pursue
organisational goals and serve customers passionately.
Owing to the importance of organisational commitment,
health care managers should also shift from a transactional
 2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 13831392
Prosocial behaviour of hospital nurses
Standardised Expected
Coefficients t-value Sign Results
013* 197 + Supported
027** 300 + Supported
034*** 367 + Supported
034*** 591 + Supported
054*** 907 + Supported
orientation to a focus on relationship building. While the
former focuses on achieving short-term goals, the latter
emphasises the importance of relationship building in
achieving long-term goals. Massive future managerial
challenges exist as health care providers formulate rela-
tionship-oriented strategies.
Despite the above contributions, we acknowledge the
limitations of this study and stress the need for caution in
interpreting the results. First, the data for this study were
collected cross-sectionally and hypothesis testing with such
survey design may produce measurable associations between
variables. The directions of influence among variables of this
study were hypothesised in accordance with the theoretical
foundations and practices in the nursing setting. Further
research could re-examine the possibility of reversed hypoth-
esised relationships among variables or could use longitudinal
data to re-examine our research framework. Moreover,
despite the rigorous attention to detail aimed at ensuring
the credibility and appropriateness of the collected data, the
potential for single source bias exists for this study as the
nurses were the primary source of information. Third,
previous studies have observed that patient customers signif-
icantly determine the success of health care organisations
(Ford & Fottler 2007). Bitner et al. (1990) empirically found
that unsatisfactory encounters result from employee unwill-
ingness to respond to service failure. To maintain customer
satisfaction, hospital administrators should examine what
factors are likely to lead to higher nurses motivation to deal
with patient complaints and pursue service recovery. This
opens up a new area for researchers. Further researchers
should consider that nurses will have negative feelings when
facing customer complaints or correcting service failures for
which others are responsible. The organisational conditions
likely to attenuate the negative feelings of nurses remain a
researchable issue. Finally, further research is necessary to
examine the consequences of customer-orientated prosocial
behaviour of nurses, such as organisational profits, customer
satisfaction and customer loyalty.
1389
C-P Hsu et al.

To complete certain tasks successfully, nursing services in

Conclusion
This study showed that the three types of social capital
perceived by nurses could influence their organisational
commitment. Furthermore, this study examined the key
influences on nurse customer-oriented prosocial behaviour
and found that highly committed nurses pursued certain goals
advocated by the organisation. Highly committed nurses are
generally closely engaged in customer-oriented prosocial
behaviour, including role-prescribed and extra-role customer
services.
Relevance to clinical practice
Organisational commitment means the strength of an
individuals identification with and involvement in a partic-
ular organisation (Porter et al. 1974, p. 604). It is important
for hospitals because nurses with higher levels of organisa-
tional commitment would devote themselves to the hospitals
and work harder. Organisational commitment may take a
long time to develop and this study points out the importance
of social capital (social interaction, trust among nurses and
shared vision) in facilitating the organisational commitment
of nurses.
Healthcare service usually requires nurses to cooperate on a
group basis to follow a seamless care-providing process. Every
nurse assumes particular duty-fulfilling responsibilities and
helps their colleagues to cultivate teamwork; where social
interaction and trust among nurses are critical. Managers
could design some activities for nurses, such as group training
events and occasions for experience and knowledge sharing,
thus encouraging nurses to interact frequently, openly and
amicably. A supportive climate may induce a positive emotion,
reduce a nurses suspicion of partners and foster cooperative
behaviour.
different departments must be synchronised. In such situa-
tions, a clearly held shared vision could effectively guide
nurses to collaborate on the best direction and the collective
goals. The administrators should draw up a well-defined
vision and communicate it to the nurses. To encourage all
nurses to identify with and internalise the hospitals vision,
the administrators could illustrate and remind the nurses of
the vision regularly.
Our findings indicate that nurses with higher levels of
organisational commitment would likely exhibit role-pre-
scribed as well as extra-role customer service behaviour.
Such behaviour could improve the efficiency and effective-
ness of healthcare service process and boost patient
satisfaction. To cultivate a climate of customer-oriented
prosocial behaviour, managers need to offer some incen-
tives. The managers could praise publicly those who
perform well and provide motivations such as monetary
award. In the end, such incentive-driven prosocial behaviour
may lead to improved organisational performance.
Acknowledgements
The authors appreciate the editor and two anonymous
reviewers for comments made on an earlier draft of this
article.
Contributions
Study design: CPH, HCH; data collection and analysis: CPH,
CWC and manuscript preparation: CPH, CWC, HCH, CYC.
Conflict of interest
We declare that we have no conflict of interest.

References
Baker WE (1990) Market networks and
corporate behavior. American Journal
of Sociology 96, 589625.
Bettencourt LA & Brown SW (1997) Con-
tact employees: relationships among
workplace fairness, job satisfaction and
prosocial service behaviors. Journal of
Retailing 73, 3961.
Bitner MJ, Booms BH & Tetreault MS
(1990) The service encounter: diag-
nosing favorable and unfavorable
incidents. Journal of Marketing 54,
7184.
Bourdieu P (1986) The forms of capital. In
Handbook of Theory and Research for
the Sociology of Education (Richardson
JG ed.). Greenwood, New York, pp.
241258.
Bozionelos N (2008) Intra-organizational
network resources: how they relate to
career success and organizational com-
mitment. Personnel Review 37, 249
263.
Brief AP & Motowidlo SJ (1986) Prosocial
organizational behaviors. Academy of
Management Review 11, 710725.
Brown DR & Harvey DF (2006) An Expe-
riential Approach to Organization
Development. Pearson Prentice Hall,
Upper Saddle River, N. J.
Brown TJ, Mowen JC, Donavan DT &
Licata JW (2002) The customer orien-
tation of service workers: personality
trait effects on self-and supervisor per-
formance ratings. Journal of Marketing
Research 39, 110119.
Cannuscio C, Block J & Kawachi I (2003)
Social capital and successful aging: the

1390  2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 13831392
Workforce issues
role of senior housing. Annals of
Internal Medicine 135, 395399.
Carlson ED & Chamberlain RM (2003)
Social capital, health and health dis-
parities. Journal of Nursing Scholarship
35, 325331.
Castle NG (2006) Organizational commit-
ment and turnover of nursing home
administrators. Health Care Manage-
ment Review 31, 156165.
Chin WW, Marcolin BL & Newsted PR
(2003) A partial least squares latent
variable modeling approach for mea-
suring interaction effects: results from a
Monte Carlo simulation study and an
electronic-mail emotion/adoption study.
Information Systems Research 14, 189
217.
Clarke SP & Aiken LH (2008) An interna-
tional hospital outcomes research
agenda focused on nursing: lessons
from a decade of collaboration. Journal
of Clinical Nursing 17, 33173323.
Coleman JS (1988) Social capital in the
creation of human capital. American
Journal of Sociology 94, 95120.
Cowley S & Billings JR (1999) Resources
revisited: salutogenesis from a lay per-
spective. Journal of Advanced Nursing
29, 9941004.
DiCicco-Bloom B, Frederickson K, OMal-
ley D, Shaw E, Crosson JC & Looney
JA (2007) Developing a model of social
capital: relationship in primary care.
Advances in Nursing Science 30, E13
E24.
Doney PM & Cannon JP (1997) An exam-
ination of the nature of trust in
buyerseller relationships. Journal of
Marketing 61, 3551.
East L (1998) The quality of social rela-
tionships as a public health issue:
exploring the relationship between
health and community in a disadvan-
taged neighbourhood. Health and
Social Care in the Community 6, 189
195.
Ford RC & Fottler MD (2007) Creating
customer-focused health care organiza-
tions. Health Care Management Re-
view 32, 1833.
Ford RC, Bach SA & Fotler MD (1997)
Methods of measuring patient satisfac-
tion in health care organizations.
Health Care Management Review 22,
7489.
Fornell C & Larcker DF (1981) Evaluating
structural equation models with unob-
 2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 13831392
servable variables and measurement
error. Journal of Marketing Research
18, 3950.
Gormley DK & Kennerly S (2010) Influence
of work role and perceptions of climate
on faculty organizational commitment.
Journal of Professional Nursing 26,
108115.
Greggs-McQuilkin D (2004) The stressful
world of nursing. Medsurg Nursing 13,
141189.
Gregory DM, Way CY, LeFort S, Barrett
BJ & Parfrey PS (2007) Predictors of
registered nurses organizational com-
mitment and intent to stay. Health
Care Management Review 32, 119
127.
Grootaert C, Narayan D, Jones VN &
Woolcock M (2004) Measuring Social
Capital: An Integrated Questionnaire.
World Bank Social Capital Thematic
Group, Washington.
Hulland J (1999) Use of partial least squares
(PLS) in strategic management research:
a review of four recent studies. Strategic
Management Journal 20, 195204.
Kowalski C, Ommen O, Driller E, Ernst-
mann N, Wirtz MA, Kohler T & Pfaff
H (2010) Burnout in nurses-the rela-
tionship between social capital in hos-
pitals and emotional exhaustion.
Journal of Clinical Nursing 19, 1654
1663.
Kritsotakis G & Garmanikow E (2004)
What is social capital and how does it
relate to health? International Journal
of Nursing Studies 41, 4350.
Laschinger HKS, Finegan J & Shamian J
(2008) The impact of workplace
empowerment, organizational trust on
staff nurses work satisfaction and
organizational commitment. Health
Care Management Review 33, 723.
Leana CR & Pil FK (2006) Social capital
and organizational performance: evi-
dence from urban public schools.
Organization Science 17, 353416.
Lee YK, Nam JH, Park DH & Lee KA
(2006) What factors influence cus-
tomer-oriented prosocial behavior of
customer-contact employees? The
Journal of Services Marketing 20, 251
264.
Liou SR & Cheng CY (2010) Organisa-
tional climate, organisational commit-
ment and intention to leave amongst
hospital nurses in Taiwan. Journal of
Clinical Nursing 19, 16351644.
Prosocial behaviour of hospital nurses
Looman WS (2006) Developing and testing
of the social capital scale for families of
children with special health care needs.
Research in Nursing & Health 29, 325
336.
Looman WS & Lindeke LL (2005) Health
and social context: social capitals util-
ity as a construct for nursing and health
promotion. Journal of Pediatric Health
Care 19, 9094.
Lu KY, Chang LC & Wu HL (2007) Rela-
tionships between professional com-
mitment, job satisfaction and work
stress in public health nurses in Taiwan.
Journal of Professional Nursing 23,
110116.
MacKenzie SB, Podsakoff PM & Ahearne
M (1998) Some possible antecedents
and consequences of in-role and extra-
role salesperson performance. Journal
of Marketing 62, 8798.
McNeese-Smith DK (2001) A nursing
shortage: building organizational com-
mitment among nurses. Journal of
Healthcare Management 46, 173187.
Moen , Madsen TK & Aspelund A (2008)
The importance of the internet busi-
ness-to-business markets. International
Marketing Review 25, 487503.
Mowday RT, Steers RW & Porter LW
(1979) The measurement of organiza-
tional commitment. Journal of Voca-
tional Behavior 14, 224247.
Nahapiet J & Ghoshal S (1998) Social cap-
ital, intellectual capital and the organi-
zational advantage. The Academy of
Management Review 23, 242266.
Orton JD & Weick KE (1990) Loosely
coupled systems: a reconceptualization.
Academy of Management Review 15,
203223.
Pearce N & Smith GD (2003) Is social
capital the key to inequalities in health?
American Journal of Public Health 93,
122129.
Porter LW, Steers RM, Mowday RT &
Boulian PV (1974) Organizational
commitment, job satisfaction and
turnover among psychiatric technicians.
Journal of Applied Psychology 59, 603
609.
Putnam RD (1993) The prosperous com-
munity: social capital and public life.
American Prospect 13, 3542.
Ravlin E & Meglino B (1987) Issues of work
values measurement. Research in Cor-
porate Social Performance and Policy
9, 153183.
1391
C-P Hsu et al.

Reed KK, Srinivasan N & Doty DH (2009)
Adapting human and social capital to
impact performance: some empirical
findings from the U.S. personal banking
sector. Journal of Managerial Issues 21,
3659.
Rodwell J, Noblet A, Demir D & Steane P
(2009) The impact of the work condi-
tions of allied health professionals on
satisfaction, commitment and psycho-
logical distress. Health Care Manage-
ment Review 34, 273283.
Rousseau D, Sitkin S, Burt R & Camerer C
(1998) Not so different afterall: a cross
discipline view of trust. Academy of
Management Review 23, 393404.
Seibert SE, Maria LK & Robert CL (2001)
A social capital theory of career success.
The Academy of Management Journal
44, 219237.
Smith KG, Smith KA, Olian JD, Sims JHP,
OBannon DP & Scully JA (1994) Top
management team demography and
process: the role of social integration
and communication. Administrative
Science Quarterly 39, 412438.
Starbuck WH (1983) Organizations as ac-
tion generators. American Sociological
Review 48, 91102.
Tsai W & Ghoshal S (1998) Social capital
and value creation: the role of intra-
firm networks. Academy of Manage-
ment Journal 41, 464476.
Watson GW & Papamarcos SD (2002)
Social capital and organizational
commitment. Journal of Business
Psychology 16, 537551.
Whitney J (1994) The Trust Factor.
McGraw-Hill, New York.

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