ORIGINAL REPORT JUMMEC 2020:23(Suppl 1)

HOSPITAL NURSES’ PSYCHOLOGICAL CAPITAL AND WORK

ENGAGEMENT – ARE THEY REALLY RELATED? THE CASE OF AN
INDONESIAN HOSPITAL
Percunda AD, Putri NK
Department of Health Policy and Administration, Faculty of Public Health, Universitas Airlangga
Surabaya, Indonesia

Correspondence:
Alita Dewi Percunda
Department of Health Policy and Administration,
Faculty of Public Health, Universitas Airlangga,
Surabaya, East Java, Indonesia
Email: [email protected]

Abstract
Background: Nurses’ excellent job performance is vital for the hospitals’ healthcare services,
particularly in achieving a standardized medical care comprising of patient safety. Studies have
noted this preference by asserting that psychological capital is one of the antecedents of
excellent work performance. Yet, little has been focused on the work performance of nurses
in this aspect.

Aims: This study thus aims to analyze the relationship of psychological capital and work
engagement among nurses attached to an urban general hospital in Indonesia.

Methods: A questionnaire (PCQ-24) was used to measure the psychological capital variable
and work engagement (Utrecht Work Engagement Scale) among 165 clinical nurses working
in the inpatients’ ward. The simple random sampling approach was applied and a total of 91
questionnaires were found to be suitable for analysis. The descriptive values and linear
regression were utilized for detecting the correlation coefficients of each variable.

Results: Findings indicate that most of the respondents were females (71.4%) who were
mainly aged between 31-39 years old (42.9%) and the highest component in their
psychological capital was hope (64.8%) while their work engagement was vigor (82.4%).
Overall, it can be said that psychological capital was significantly correlated to vigor and
dedication in work engagement (p<0.05). There was no correlation between hope (p=0.104),
and resilience (p=0.159) with absorption of work engagement. Conclusion: Psychological
capital variables were correlated to work engagement except for some variables. Low
absorption in the nurses’ work engagement could be caused by their high work load at
hospitals. Nurses’ job characteristics at the hospitals may be the cause of this finding.

Keywords: Nurse, Psychological capital, Work engagement

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Introduction initiative, responsible, and have work

With the development of the medical and excellence. Undoubtedly, nurses who are
health services in Indonesia, there is now a energetic, and dedicated to their work tend to
need to improve the quality of the nursing absorb their work well, hence they are more
services provided by hospitals. Undoubtedly, work-engaged (8). Therefore, retaining skillful
the health care system is affected by its health and nurses who are engaged in their
care professionals. Therefore, for the health profession is an important issue for hospitals
care system to reach a high quality in services, (9).
hospitals would require nursing staffs who are
competent (1). The total number of nurses Work engagement is defined as a positive,
currently serving in Indonesia, as of 2017, was fulfilling, work-related state of mind. It is
345,276 with an estimated total population of characterized by vigor, dedication, and
261,890,872 people (2). This is in combination absorption. Vigor is characterized by high
with the number of midwifery nurses which levels of energy, and mental resilience while
amounts to 198,110. This means that the working. Dedication is being strongly involved
density of the nurses and midwifery nurses is in one’s work, and experiencing a sense of
20.75 per 10.000 population. This number is significance, enthusiasm, and challenge.
still far below the WHO standard of 40 nurses Absorption is being fully concentrated, and
and midwifery nurses per 10.000 population happily engrossed in one’s work, whereby time
(3). This fact gives us an understanding of the passes quickly, and where one has difficulties
shortage of nurses in Indonesia. About 58.26% in detaching oneself from work. Engaged
of the total number of nurses work in hospitals, employees have high levels of energy; they are
thus they mainly serve as the health care enthusiastic about their work (10,11), and they
professionals in hospitals. Among all the have the genuine willingness to contribute to
professions in Indonesia, about 48.36% of organizational success.
them or 223, 257 of them are nurses who work
in the hospital sector (2). Engaged employees can perform better
because they have more positive emotions,
The sustainability of nurses is necessary but it better health status, and heightened resources
is often hindered by their work overload, (12). Engaged employees have also been
limited resources, lack of promotion, and the shown to be more creative, perform better,
lack of development opportunities opened to has positive organizational citizenship
nurses (1). Nursing is considered a stressful behavior, and they consider client satisfaction.
job, and nurses have been noted to carry high Nonetheless, one’s work engagement may also
scores of stress related to their workplace, as fluctuate within the individual, across time and
compared to other professions (4). The nursing conditions (13). The level of one’s work
profession is very much linked to stress and engagement may differ, depending on one’s
psychological disease (5) with the common personal resources, work characteristics, and
problem being their high work-related stress, job experiences (14). Thus, the nurses’ work
burnout, and poor health. Nurses usually work engagement may also vary depending on their
in a problematic environment, which over work settings, age and work experiences (7).
time, would lower their work performance,
and their ability to offer excellent patient care Engagement can be seen as a constructive
(6). indicator of the employee’s commitment (1).
The nurses’ work engagement can affect their
Work engagement is therefore, an important attitude towards their patients in a more
element for nurses since they are constantly in positive manner. Thus, low work engagement
touch with the various social systems within is likely to affect the patients’ health adversely,
the society (1). Low work engagement has thereby decreasing the quality of the nursing
been reported among nurses (7), but yet services (15). The relationship between the
hospitals expect nurses to be proactive, nurses’ job resources, and their work

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engagement can be partially mediated by their characteristic of work engagement, as

basic needs and satisfaction (16). This suggests summarized in Figure 1.
that a person’s individual characteristics have
some influence in his/her work engagement,
independently (7).

Engaged employees have been noted to carry

higher levels of personal resources (13), one of
which is their psychological resources. The
individual’s psychological capital is a form of
capital that reflects the individual’s internal
resources and these can be drawn upon so as
to allow the individual to succeed in what
he/she does (17).
Psychological capital (PsyCap) is defined as the Figure 1: Conceptual Model
individual’s positive psychological state of
development. (7) characterized it as having the
confidence (efficacy) to take on challenges, Methods
and the ability to exert the necessary effort so This study is quantitative in design; it is a cross-
as to succeed at challenging tasks (18). This sectional study based on a self-reported
characteristic of the individual enables the questionnaire which consists of two sections.
person to make positive attributions Respondents were recruited based on simple
(optimism) about succeeding now, and in the random sampling, and data were extracted
future (14). Such individuals persevere since December 2018. Utrecht’s Work
towards their goals, and when necessary, Engagement Scale (UWES) consisting of 16
redirect their paths towards their goals (hope) items were categorized into three subscales of
in order to succeed, and (4) when engulfed vigor, dedication, and absorption. These were
with problems and adversity, they are able to utilised to measure the nurses’ level of work
sustain and bounce back, and even beyond engagement. The questionnaire applied has
(resiliency), to attain success (19). PsyCap is the been validated in several countries (10,11).
main predictor of work engagement (18), The PsyCap questionnaire (PCQ) developed by
hence it is important to study the relationship Luthans comprising 24 items were categorized.
between PsyCap and work engagement (8). They were utilized to measure the nurses’
psychological capital into four subscales of
Empirical studies looking at the relationship efficacy, hope, resilience, and optimism. Each
between PsyCap and work engagement among question used the 6-point Likert scale for
nurses (20) are far in between. Of those studies responses. The research site involved the
that do, many were mainly concentrated on Bhayangkara Kediri Hospital located in East
Western countries (9). Thus, it is imperative Java, Indonesia. It is characterized as a general
that more research be conducted on Asian military-based hospital with a total of 165
countries so as to gather more evidence that nurses working at the inpatient wards. A total
can help us to better understand about the of 100 nurses served as respondents. But upon
relationship of the antecedents of nurses’ work screening only 91 of the questionnaires were
engagement and other factors (21), for found suitable for analysis, and nine were
instance, PsyCap. incomplete. The SPSS software version 25 was
used to generate the descriptive and
This study aims to contribute to literature with inferential analysis. Cronbach’s alpha for
regards to our understanding of nurses’ reliability showed sig > 0.06, and Pearson’s
PsyCap and their work engagement. In this correlation for validity showed sig < 0.05, for all
study, we examine the correlation of each data. Thus the data used for this study were
psychological capital variables with each both reliable and valid.

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Ethical Approval outcome is consistent with other studies (22),

This study obtained ethical approval from the such as Aboshaiqah who looked at nurses in
Health Research Ethics Committee, Faculty of Saudi Arabia, especially those in the military
Public Health Universitas Airlangga, Indonesia force hospitals. Likewise, Aboshaiqah also
(No: 613-KEPK). noted dedication to have the highest score (7).
Nonetheless, the overall score for work
Results engagement of this study was found to be
In this study, each of the respondents (N=100) more competitive than other empirical
were given a questionnaire during their shift at research (10,11). For instance, our findings of
the Inpatient wards of Bhayangkara Kediri dedication for work engagement showed a
hospital. The questionnaires were then score of 4.593 (SD .548). It was lower than that
collected and checked for their contents. The of Lepistö, with 4.98 (SD .87) (22), but
completed and valid questionnaires were nevertheless, higher than the score
utilised for the SPSS entries. It was found that determined by Aboshaiqah, with 4.1 (SD 1.0)
more than three quarters of the respondents (7), Wan, with 3.54 (SD 1.49) (9), and Wang’s
(N=65) were females. Majority were in the age score of 3.44 (15). Using the 7-point Likert
range between 31 to 39 years old (N=39) and scale, Jenaro’s study showed that the mean for
the length of their work experiences ranged vigor was 3.47 (SD 1.44), for dedication was
between 6 to 10 years (N=28). Their profile is 3.89 (SD 1.42), and for absorption was 3.48 (SD
displayed in Table 1. 1.37). While some of the findings of previous
studies correlated with our current study,
others did not. This suggests that there could
Table 1: Respondent Characteristics be some discrepancies which need to be
further explored (21). Table 2 presents the
Characteristics N (%) results for the questionnaire analysis.
Sex
Female 65 (71.4%)
Male 26 (28.6%) Table 2: Descriptive Analysis
Age
≤ 30 years 37 (40.6%)
Variables Mean SD
31-39 years 39 (42.9%)
Psychological Capital 3.976 .449
≥ 40 years 15 (16.5%)
Hope 4.062 .512
Length of work
Self-Efficacy 4.006 .521
≤ 5 years 26 (28.6%)
Resilience 3.883 .567
6 -10 years 28 (30.7%)
Optimism 3.954 .550
11-15 years 22 (24.2%)
Work Engagement 4.593 .548
16-20 years 7 (7.7%)
Vigor 4.672 .650
> 20 years 8 (8.8%)
Dedication 4.850 .665
Absorption 4.235 .735

The descriptive analysis showed that the

overall mean of the nurses’ psychological To obtain the calculations, the result score
capital score was 3.976 (SD .449) and hope was from each question in the questionnaire was
the highest subscale, with a mean of 4.062 (SD classified as low, average, and high, for each
.512). From the results, we also know that subscale’s total amount. From the score of
resilience has the least mean of 3.883 (SD each subscale of the nurses’ psychological
.567). The overall mean for work engagement capital, we realized that the nurses have high
was 4.593 (SD .548) while the highest subscale hopes and self-efficacy, but average optimism,
was dedication, with a mean of 4.850 (SD .665). and low resilience. From the score of each
Absorption was at the lowest with a mean of subscale of the nurses’ work engagement, we
4.235 (SD .735). The result generated from this noticed that the nurses have high levels of
study showed more emphasis on dedication,
which was higher than vigor or absorption. This

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vigor and dedication, but an average level of Table 4: Linear Regression Analysis
absorption. Table 3 further illustrates this. Work Engagement
Psychological Vigor Dedication Absorption
Capital
Table 3: Subscale Categories Result Hope .000 .000 .104
Self-Efficacy .000 .000 .005
Variables Low Average High Resilience .004 .044 .159
Psychological Capital Optimism .000 .000 .026
Hope 7 25 59
(7.7%) (27.5%) (64.8%)
Self Efficacy 3 30 58 Discussion
(3.3%) (33%) (63.7%) According to studies, psychological capital
Resilience 43 24 24 captures the motivation and capability which
(47.3%) (26.4%) (26.4%) then drives the interaction with job constraints
Optimism 22 39 30 and opportunities (23). PsyCap has been
(24.2%) (42.9%) (33%) shown to be correlated to innovative
Work Engagement performance, employee well-being,
Vigor 4 12 75 commitment to organization, and creativity
(4.4%) (13.2%) (82.4%) (24). It appears that if employees were self-
Dedication 4 15 72
efficacious, they would also show the right
(4.4%) (16.5%) (79.1%) skills and abilities to achieve better
performance. In this regard, nurses’ high levels
Absorption 23 51 17
(25.3%) (56%) (18.7%)
of hope would ensure that the nurses have the
will and the means to accomplish a specific
goal. Literature has shown that optimists are
employees who make positive internal
These results differ from those of Bogaert attributions, with regards to their current and
which showed high levels in all the three future success while resilient individuals are
elements (6). The study by Jenaro showed that those who are able to adapt to challenging
33% of the nurses experienced high circumstances positively (25). These
dedication, 20.4% experienced high vigor, and individuals work by looking forward to a
36.7% experienced high absorption (21). positive future, in spite of serious threats,
setbacks, or maladjustment (17). They also
We further analyzed the correlation of each tend to maintain a positive attitude, with the
psychological capital subscale with each work ability to bounce back when faced with
engagement subscale, by using linear problems and adversity (12). They also
regression (t-test). The outcome showed the maintain a positive perspective in most
correlation for all subscale (p < 0.05) except for circumstances with more capabilities to solve
hope (sig .104), and resilience (sig .159) with problems when confronted with challenging
absorption. Although the overall score of situations. Their resilience enables them to
PsyCap was significantly correlated to the continue fighting (12). Further, employees who
overall score of work engagement (sig .000), are self-efficacious, hopeful, optimist, and
these results were different from Wang (15) resilient (PsyCap), generally feel energetic, and
which showed that self-efficacy, and resilience dedicated to their work whilst immersed in
were not significantly associated with vigor, their profession (25). This makes work easier to
dedication, and absorption (15). The manage since time seems to fly (10,11). In this
significance of each correlation can be seen in regard, the nurses who were respondents in
Table 4. this study could be described as those with
high work engagement (13). Clearly, PsyCap
influenced the strength of the emotional
relationship between employees and

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organizations directly, and also, their values Some ways to improve work engagement are
and goals (17). Employees with high PsyCap to emphasize on feedback (14) through which
tend to be more engaged with more vigor; they nurses can share their insights as to how
are strongly involved, and engrossed in their processes should be improved, and also their
work (25). Engagement is evidently influenced inspiring stories about patients. Finding
by the internal capability of the individuals to meaning in their work makes the nurses feel
use their existing resources, such as PsyCap more energized, and this can increase work
(17). engagement (1). Moreover, work engagement
may also be influenced by other factors such as
Based on this, PsyCap may be considered as an work experience, peer support, good
effective personal resource for nurses to leadership, and communication (7). Therefore,
improve their work engagement. The effects of hospitals need to take these factors into
PsyCap have been found to be different across account because the nurses’ job demands and
occupational groups, but PsyCap and its their lack of resources can create more stress,
components have been found to act as and mental and physical ill-being (23).
mediators for work engagement (15). Greater
psychological empowerment may increase the This study has shown that the highest score
likelihood of the nurses to advance their among the 91 nurses of one Indonesian
education beyond what they have, and this can hospital was their dedication. In this regard,
also bring benefits to them as well as their work dedication is assumed to be the major
patients, not to mention the hospitals. Highly element of work engagement because of its
motivated and engaged nurses are critical for positive impact on the nurses. Dedicated
hospital success (24). nurses perceived their duties to be important,
and so difficulties would be seen as challenges.
Engagement is also related to customer Dedication, however, would help these nurses
satisfaction, in-role performance, and financial to find innovative ways of managing their
returns (26), hence, engagement may be challenges. The inter-disciplinary team
included as the fifth element in the Balanced focusing on the quality of care have been
Score Card (17). Other consequences of work predicted by dedication (7), and vigor and
engagement include: customer loyalty, general dedication have been predicted by job
health, organizationally valued job outcomes, satisfaction, high quality work life, low social
turnover intentions, extra-role performance, dysfunction, and low problems associated with
and job satisfaction (24). Engaged employees patient care (21).
tend to work hard (vigor), are involved
(dedicated), and feel happily engrossed Nurses’ work engagement can thus, be
(absorption) (10,11) with better job safety predicted on three levels: organizational level,
experiences (14). Engaged employees also task level, and personal-level. The main
tend to be more aware of the organizational dimension of the nurses’ job characteristics
context; they are also more likely to improve such as task variety, task identity, task
their role performances (1). Therefore, the significance, autonomy, and job feedback can
services provided by such nurses will be of increase their perception of work
considerable importance, particularly at a time meaningfulness. This can drive the nurses to be
when there is a short supply of nurses, more engaged (9). PsyCap can improve the
aggravated by the reduction in health care nurses’ engagement by reducing their role
provisions (7). Good patient care requires stress which is mediated by their job demands.
engaged nurses who are dedicated, energized, Likewise, resilience and optimism can help the
and absorbed (9). Based on this, it is important nurses to have positive insights of their jobs,
to have nurses with high PsyCap and well and so have a better psychological well-being.
engaged in their work; this will reduce the high Hope and efficacy are also required by the
turnover rate and contribute to a competitive nurses when dealing with higher job demands
health care environment (20). via positive psychological resources (23).

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Low vigor in nurses may be due to their high their job characteristics and other personal
physical, and psychological demands while the resources. Therefore, future research looking
lack of rewards such as promotion, stability, at this kind of relationship is still needed, so as
respect, and income may reduce the nurses’ to reveal a more comprehensive model for
dedication and their work absorption (15). So application.
far, the relationship between PsyCap, and
work engagement has been mostly theoretical Acknowledgment
(25). Each component of PsyCap has been The researchers would like to thank all the
conceptually related to work engagement. The nurses who participated in this study, and the
development of engagement is dependent on Bhayangkara Kediri Hospital and its
the development of PsyCap, over time (18) but management for their support in this project.
some studies (24) have found a significant and
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