http://e-journal.unair.ac.id/JNERS | 195 Jurnal Ners Vol. 14, No. 3, Special Issue 2019 http://dx.doi.org/10.20473/jn.v14i3(si).17056 This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License Systematic Review Factors Affecting the Organizational Commitment of Nurses in Comprehensive Health Services: A Systematic Review Erfan Rofiqi1, Rahayu Tri Nuritasari1 and Pipit Festi Wiliyanarti2 1 Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia 2 Faculty of Health Sciences, Muhammadiyah University of Surabaya, Surabaya, Indonesia ABSTRACT Introduction: Organization commitment is an important variable in understanding employee behavior that has a serious effect on organizational performance. Employees not only have to have expertise, empowerment and competence, but they also have to have organizational commitment. Therefore, the level of attachment and commitment of the nurses to their organization can influence their clinical competence. The research was conducted to identify the factors that influence nursing organizational commitment. Methods: The literature review employed the Scopus, ScienceDirect, Pubmed, Ebsco and CINAHL databases to retrieve original articles published between 1999 and 2017. The method used to arrange the literature review started with the topic selection and then the reviewer determined the following keywords: organization commitment, commitment, nursing, health and factors of commitment. Out of the 2.134 articles found, there were 15 journals with a cross- sectional study design that discussed the organizational commitment of nurses. Results: The organizational commitment of care is influenced by many factors, both internal and external. These factors include leadership style, compensation, career development, organizational culture /climate, spiritual health and learning organizations. Conclusion: The factors found above can increase the commitment of nurse organizations in comprehensive health services. ARTICLE HISTORY Received: December 26, 2019 Accepted: December 31, 2019 KEYWORDS organizational commitment; health services; nursing CONTACT Erfan Rofiqi  erfan.rofiqi-2018@fkp.unair.ac.id  Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia Cite this as: Rofiqi, E., Nuritasari, R. T., & Wiliyanarti, P. F. (2019). Factors Affecting the Organizational Commitment of Nurses in Comprehensive Health Services: A Systematic Review. Jurnal Ners, 14(3si), 195-198. doi:http://dx.doi.org/10.20473/jn.v14i3(si).17056 INTRODUCTION In today's modern world, the role of human resources in developing a country is very important. In addition, they believe that the most important capital of any organization is its human resources. In this case, nurses are counted as the largest and most important human resource in health organizations(Yang, Liu, Chen, & Pan, 2014). Nursing is one of the most important professions in the hospital which is influenced by several factors, one of which is organizational commitment. Organizational commitment is an important variable in understanding employee behavior that has a serious effect on organizational performance(Labrague et al., 2018). We have defined organizational commitment as a psychological relationship between the employees and/or organizations where there is a small possibility of them voluntarily leaving the organization. The commitment model has 3 components that have been built as interpretations of the existing research. The component models are as follows: affective commitment, ongoing commitment and normative commitment(Amin, Barati, & Ghoroghchian, 2016). Each component is associated with an appropriate psychological state. Affective commitment refers to a positive emotional relationship between the employees and the organization. From an organizational aspect, this is the type of relationship that is liked by the employees because an employee who is committed affectively wants to remain a part of the organization. Thus, they accept the organizational goals. Continuous commitment refers to the psychological state in which the employee has the choice to stay or leave the https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/ mailto:erfan.rofiqi-2018@fkp.unair.ac.id http://dx.doi.org/10.20473/jn.v14i3(si). E. ROFIQI, ET AL. 196 | pISSN: 1858-3598  eISSN: 2502-5791 organization. This choice is not the result of a sense of association with the organization but from the fact that staying in the organization is more beneficial than leaving the organization. Normative commitment refers to the psychological state of the employees where they feel obligated to remain in the organization. This three-component model of organizational commitment is the most widely accepted model. To achieve the health system goals, the workforce not only involves expertise, empowerment and competence but also a high level of attachment, organizational commitment and the willingness to engage in outside activities and predetermined tasks. Therefore, the level of attachment and the commitment of nurses to the organization can influence their clinical competence(J. Zhou et al., 2018). In order to achieve a satisfactory level of health organization management, one must consider employee job satisfaction and organizational commitment. These two factors must be continuously measured and monitored, starting from the recruitment of new staff. In addition to continued measurements and monitoring, it is necessary to identify the other factors that directly or indirectly affect employee job satisfaction and organizational commitment(Erdogan & Yildirim, 2018). There are several things that can affect employee commitment, i.e. compensation, career development and organizational culture. MATERIALS AND METHODS The literature review employed the Scopus, ScienceDirect, Pubmed, Ebsco and CINAHL databases to retrieve the original articles published between 1999 and 2017. The method used in arranging literature review started with the topic selection. Then the determined keywords were used: organization commitment, commitment, nursing, health and the factors of commitment. Out of the 2.134 found, there were 15 journals with a cross- sectional study design that discussed the organizational commitment of the nurse. The journals that met the inclusion criteria were collected and examined systematically. RESULTS Based on the search results, we obtained as many as 15 journals that were in accordance with the objectives of the study. We then carried out screening based on eligibility in accordance with the inclusion and exclusion criteria for further review. After a study of the quality of the 15 articles was carried out, then the data extraction was conducted. Data extraction was done by analyzing the data based on the name of the author, the design, population, intervention and results. The total number of respondents in this review was 6,903 nurses who worked in hospitals, both primary nurses and executive nurses. The area in this study was a hospital. DISCUSSION Based on the journal analysis, it was found that organizational commitment was influenced by several things that are closely related to one another in the service process, especially in the field of nursing. Several studies have been conducted to identify the factors that influence the nurses in organizational commitment. For example, leadership style, compensation, career development, organizational culture, supervisor support and so on. In this systematic review, we will discuss the comparison between each of these factors in terms of increasing nurse organization commitment. Leadership Style Significant relationships were found between the organizational commitment of the nursing staff and its correlation with transformational leadership, which indicates that the staff became more committed to their hospital when their manager displayed the characteristics of transformational leadership. The effective leadership style influences the response of the individual nurses in the workplace and their organizational commitment(Al- Yami, Galdas, & Watson, 2018). Transformational leadership style has a positive and direct relationship with the level of organizational commitment and retention, with a significant impact on patient outcomes and the survival of the health organizations(Al-Yami et al., 2018) Compensation, Career Development There was a direct impact from compensation, career development and organizational culture on the commitment of the nurses at Suaka Insan Hospital simultaneously. The coefficient of determination was 0.945, which meant that 94.5% of the nurses' commitment was influenced by compensation and career development. Hani Handoko (2005) stated that compensation was important for the employees because the amount of it reflected the quantity of their working performance, and it supported their families and communities. Compensation was defined as a form of reward given to the employees as a form of remuneration for the contribution they made to the organization. Career development variables could be measured by the indicators as according to Keith Davis and Werther, W.B in Mangkuprawira (2002) i.e. their study of a group of employees revealed there to be 5 related aspects such as fairness in their career, attention with supervision, an awareness of opportunities, interest in the workers and career satisfactional. Organizational Culture The efforts to improve the organizational culture could be a valuable strategy for increasing organizational commitment(Amin et al., 2016). Thus, managers must try to understand the organizational culture and its factors in order to increase the organizational commitment of their staff. Managers JURNAL NERS http://e-journal.unair.ac.id/JNERS | 197 could create a positive and desired culture for the staff in order to increase their responsibility to the organization, to try to achieve the organizational goals (normative commitment), to create emotional ties and to enjoy being in the organization (affective commitment). In addition, because change starts from oneself, the managers had to be familiar with the goals of the organization and they had to be committed to achieving it. Thus it became a good example for the staff to create influence and motivation with their behavior. Our research confirmed the correlation between organizational culture and some aspects of organizational commitment, which had to be considered regarding the planning of human resource management strategies in hospitals. Spiritual Health The results of all of the hypotheses put forward in this study showed that spiritual health had an effect on the nurses' attitudes towards spiritual care, professional commitment and caring itself. Indeed, the attitude of the nurses in our study focused on spiritual care increased professional commitment and their ability to care. Nurses who had a more positive attitude towards spiritual care tended to have better professional commitment and caring abilities. In addition, we proved that the nurses' attitudes towards spiritual care could mediate their spiritual health, spiritual commitment and spiritual health relationship(J. Zhou et al., 2018; Y. Zhou et al., 2014). Learning organization We found there to be a statistically significant positive correlation between internal marketing and the existence of learning organizations. Through statistical analysis, we also found that internal marketing mediates between the existence of organizational learning and commitment. 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