International Journal of Public Health Science (IJPHS)

Vol. 13, No. 1, March 2024, pp. 228~238

ISSN: 2252-8806, DOI: 10.11591/ijphs.v13i1.23633  228

Maintaining altruism among nursing professionals

Priyanka Koul1, Ankit Singh2

1
Market Research, Knowledge Services, ZS India, Gurugram, India
2
MBA (Hospital and Healthcare Management), Symbiosis Institute of Health Sciences, Symbiosis International (Deemed University),
Lavale, Pune, Maharashtra, India

Article Info ABSTRACT

Article history: The demanding hospital work environment has increased the need for
organizational citizenship behaviour (OCB). It’s essential to maintain the
Received Jul 12, 2023 altruistic behaviour of nursing professionals towards each other to enhance
Revised Aug 16, 2023 the patient experience and provide quality healthcare service to patients
Accepted Aug 27, 2023 efficiently. This quantitative study explored the relationships between OCB
constructs based on social identity theory (SIT) and system justification
theory (SJT). This study is empirical and cross-sectional in nature; structural
Keywords: equation modeling is performed on two hundred twenty-two nursing
professional responses, using IBM AMOS V.22 to test the hypothesized
Altruism model. Conscientiousness has a mediating effect on the relationship between
Civic virtue civic virtue and altruism (Indirect effect=0.19, Boot SE=.057, lower-level
Conscientiousness confidence interval (LLCI)=.0940, upper-level confidence interval
OCB (ULCI)=.3144). Moreover, sportsmanship had a mediating effect on the
Sportsmanship relationship between civic virtue and altruism with an Indirect effect=-0.06,
Boot SE=.023, LLCI=-0.1159, ULCI=-0.0222). The results supported the
hypothesis that civic virtue and altruism are directly related and found that
conscientiousness and sportsmanship mediate the relationship between civic
virtue and altruism. The findings suggest that employees with higher
sportsmanship tend to reduce their altruistic behavior in the long run.
This is an open access article under the CC BY-SA license.

Corresponding Author:
Ankit Singh
Associate Professor, Symbiosis Institute of Health Sciences, A Constituent of Symbiosis International
(Deemed University), Lavale, Hill Base, Pune, Maharashtra, India, 412115
Email: [email protected]

1. INTRODUCTION
In the current competitive healthcare market, nursing behavior can be crucial in differentiating the
institution's healthcare services from its competitors. Operational Excellence in nursing care delivery and
overall patient care would be hard to bring without a cohesive nursing workforce thriving on extending help
and cooperation to their teammates in needful times. Altruistic behavior, a key construct of organizational
citizenship behavior (OCB), measures the readiness to help people around you; the other constructs of OCB
include sportsmanship, civic virtue, conscientiousness, and courtesy.
OCB refers to the extra-role behavior exhibited in the work setting, which is different from the usual
duties, non-formally prescribed, and significant for the organization. The hospital industry is human-
resources intensive because of its service nature; therefore, OCB has become highly relevant in healthcare
settings. Additionally, healthcare organizations are considered unsafe places and prone to medical errors.
Every year 2,51,454 deaths occur due to medical errors, making it the third leading cause of death in the USA
[1]. Literature suggests that primary reasons for medical errors include miscommunication, an act of
commission, and the act of omission [2]. Primarily, medical errors result from cognitive mistakes in decision-
making, skill-based errors, or performance and knowledge deficits [3].

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Int J Public Health Sci ISSN: 2252-8806  229

Moreover, the altruistic behavior of nursing employees is found to improve the safety culture of the
healthcare organization. However, its believed that altruism for nursing professionals means supporting
patients and nursing concerns driven by internal values rather than the expectation of social rewards or
avoiding punishment; moreover, individuals scoring high on altruism as motivation are likely to choose
nursing professions [4]. Empathy is considered the precursor of altruistic behavior. However, things have
changed with the corporatization of healthcare services. Nurses understanding of altruism has become
ambiguous and ambivalent; moreover, nursing professionals have reported experiencing criticism from their
colleagues for acting altruistically [5]; this raises the question, when all the employees are working for the
same organization, what are the related organizational factors influencing altruism in the workplace?
Therefore, this study is conceptualized with a focus on the organizational citizenship behavior of nurses in
the studied hospital.
The OCB can be understood as behaviors outside an individual's job profile and are carried out to
improve the organization's task performance or effective functioning. OCB is a widely researched topic, but
earlier work primarily focused on OCB's antecedents. The OCB antecedents include variables such as job
satisfaction, leader supportiveness, organizational commitment, perceived fairness, and personality [6]–[9].
Maintaining altruistic behaviour among nursing professionals is crucial for organization's survival and
growth.
To the best of our knowledge, no prior research has been conducted to assess the interlinkages of
OCB constructs. The knowledge about the inter-relationship of altruism with other OCB constructs will help
healthcare organizations take suitable measures to enhance it, and it is important to investigate the factors
responsible for maintaining the altruistic behavior of nursing professionals. Therefore, this study attempts to
explore the relationship between the conceptual dimensions of OCB, i.e., "altruism" (helping others) with
other dimensions such as "sportsmanship" (positive attitude, avoiding complaining), "conscientiousness"
(exemplary attendance, and punctuality), and "civic virtue" (active participation in the organization).
The later sections of the article are divided into subsections; section two describes the literature
review and the description of the OCB conceptual dimensions; section three contains the detail of the
proposed model and the hypothesis development and section four highlights the methods adopted; section
five presents the results attained and section six and seven present the discussion and the conclusion
consecutively.
This study makes a novel contribution to the body of knowledge by describing the phenomenon of
“altruistic behavior depletion,” which occurs due to the unwillingness of employees to provide “free rides” to
co-workers and the “sucker effect.” The nursing supervisors need to note that due to the perceived inequity,
nurses working under challenging conditions tend to compare themselves with a "referent other" doing
similar work; with the help of a mental ratio of outcomes and inputs. Hence, as an immediate measure,
healthcare managers should strive to make nurses' work environment equitable and fair. Additionally, nursing
supervisors should train the nurses to build a “culture of camaraderie” and enhance communication channels
between management and employees to enable them to share their concerns and stress-inducing factors.
OCB roles can neither be reinforced based on role obligations nor be included in the contractual
guarantee of compensation. The OCB examples include helping co-workers, voluntariness for work,
suggesting innovative suggestions for improving the department and the organization at large, not exploiting
the workers' rights, not taking unnecessary breaks, and attending elective meetings. Variables such as “job
satisfaction,” “pay satisfaction,” “trust in management and peers,” and “organizational commitments” are the
antecedents of OCB. Similarly, Organizational commitment, psychological empowerment, and
organizational identification mediate for OCB. Lastly, variables such as intrinsic motivation, justice, norms
of reciprocity, and workload act as moderators [9].
Altruism is the extra role dimension of OCB. Altruism can be explained as the voluntariness to help
fellow colleagues and co-workers, resulting in good professional relationships [10]. It is also considered the
readiness to extend help to people [11]. An example of altruism is the initiative of the experienced employee
to come forward and show the newly hired the workplace and brief him about the requirements of the job;
this action will help the supervisor to focus on the more important job and will also improve the organization
efficiency and productivity [12].
Researchers argue that altruism is predicted by variables such as personality, early learning
experiences, and social considerations [13]. It is also argued that prosocial behaviour such as altruism, is
positively correlated with extraversion and is negatively correlated with neuroticism [14]. Individuals scoring
high on the extroversion dimension have more intense positive mood reactions after engaging in altruistic
behaviour. Altruism promotes employee efficiency and enhances teamwork [15].
Courtesy is best described as being conscious of how one's behaviour affects other person's jobs
[11]. It also includes discretionary behaviors preventing work-related conflicts with others [16]. Courtesy
includes behaviors such as "advance notice for non-routine demands," enabling co-workers to efficiently plan
and schedule their efforts, resulting in reduced chances of wastage of efforts and negative experiences [7]. It
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also includes informing others about decisions and actions which may affect them [17]. Earlier work suggests
no significant linkage between moods and courtesy behaviour [18].
Sportsmanship is the “willingness to tolerate inevitable inconveniences and impositions of work
without complaining or indicating grievances” [19]. Sportsmanship behavior is also believed to relieve the
manager of dealing with petty work-related complaints. It endures inevitable complications and overworking
without complaining about it [19]. One of the researchers has also described it as “always finding right with
what the organization is doing” [11].
Lack of sportsmanship harms group cohesiveness and negatively affects the work atmosphere [20].
Employees who exhibit sportsmanship demonstrate a willingness to adopt newer challenges and prepare the
organization for the future. They also act as role models and improve the co-worker's morale by setting an
example [20]. Sportsmanship is also described as the willingness to sacrifice personal interest for group
interest.
Conscientiousness refers to “obeying work rules, job performance, and attendance” [21]. Employees
demonstrating conscientious behavior are informed about the latest products and services offered [22]. It is
also explained as one's willingness to conform to the organization's roles to maintain the social order [7]. It
can be summarized as “Believing in giving an honest day's work for an honest day's pay” [11]. Employees
exhibiting this behaviour are likely to maintain predictable and consistent work schedules.
Civic virtue Includes sharing valuable ideas and suggestions for improving the effectiveness of the
department of the organization. Behaviors such as attending optional or elective meetings which are not
compulsory but are helpful in the interest of the organization [11]. It is also called active participation in the
organization’s affairs; by participating in the larger issues involving the organization [19]. Employees
exhibiting civic virtue participate in the organization's governance and engage in policy debates, showcasing
constructive involvement in the organization's political process [19], [21].
Social identity theory (SIT) postulates that a person's self-concept comprises personal identity
(individual characteristics, past experiences), and social identity (group characteristics and group
classification [23]. Both personal identity and social identity are important for an individual as they improve
the self-esteem and self-worth of an individual.
SIT also implies that individuals wish to view themselves positively and extend this motivation to
include their group membership or identities by categorizing themselves and others in various social
categories, including organizational membership [24]. “Psychological Group” is defined as “a collection of
people who share the same social identification or define themselves in terms of the same social category
membership.” Such individuals are not required to interact with each other and do not strive for liking or
acceptance from other group members. The conceptual component “Civic Virtue” can be related to the social
identity theory, where people take pride in their association with the organization and take active measures to
improve the organization's effectiveness by participating in the governance of the organization.
Therefore, the hypothesis proposed is: i) H 1: There is a positive association between civic virtue
and contentiousness, ii) H 2: There is a positive association between civic virtue and sportsmanship, iii) H 3:
There is a positive association between civic virtue and altruism.
The system justification theory (SJT) postulates that people are motivated to defend, justify, and
legitimize the existing system or the social structure so as to prevent the anxiety (palliative function) arising
from recognizing its flaws or inherent problems [25]. This preference for the status quo is driven by loss
aversion, where the status-quo acts as the reference point, and any deviation from it is perceived as a loss.
System justification can be understood as the psychological process wherein social arrangements are
legitimized even at the expense of personal or group interests [26], [27] have argued that dimensions such as
sportsmanship and conscientiousness originate from the preference for the system's status quo or SJT.
It is argued that sportsmanship is not always driven by the willingness of the employees but due to
the reluctance to acknowledge the negative aspects of the system resulting in downplaying the significance of
systems flaws to avoid the anxiety and discomfort arising from the acknowledgment of organizational
problems [27]. Similarly, conscientiousness, which refers to compliance with corporate rules, can be
explained by SJT. Employee's adherence to the organizational rules and code of conduct is vital;
nevertheless, mindless obedience can result in ineffective or unethical outcomes. Such unethical behavior is
ignored in the organization when employees believe start rationalizing it [27]. The hypothesis based on the
conceptualized model are mentioned:
H 4: The association between civic virtue and altruism is mediated by conscientiousness.
H 5: The association between civic virtue and altruism is mediated by Sportsmanship
H 6: There is a positive association between conscientiousness and altruism.
H 7: There is a positive association between sportsmanship and altruism
Hence based on the above-mentioned hypothesis, a conceptualized model is developed; see Figure 1.

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Figure 1. Conceptualized model

2. METHOD
The nature of the study is empirical and cross-sectional in nature. The study was carried out in
tertiary care, 348-bed hospital in Mohali City, India. The duration of the study was from July 2022 to
September 2022. The self-reported questionnaire consisted of five dimensions of OCB was used for the data
collection [21], [28], with civic virtue (4 items) “I attend functions that are not required, but help the
organization image,” conscientiousness (3 items) “I believe in giving an honest day's work for an honest
day's pay,” courtesy (3 items) “I try to avoid creating problems for co-workers,” altruism (4 items) “I help
orient new people even though it is not required” and sportsmanship (5 items) "I always focus on what's
wrong, rather than the positive side"; hence a total of 19 items were there in the questionnaire. All the
questions were based on 5 points Likert scale, ranging from (1) "Strongly Disagree" to (5) "Strongly Agree."
This study complied with the ethical principles and related considerations.
The informed consent was taken from the respondents, assuring them about the privacy and
confidentiality of the data. The sampling frame was the nurses working in the hospital. All the hospital
nursing staff were approached for their responses, including those working evening and night shifts. All 260
nurses in the hospital agreed to participate in the survey, out of which 38 responses were discarded due to
incomplete responses. A total of 222 complete responses were considered for the final analysis. According to
Hair et al. 2017, It is recommended to make a sample size provision of 10 respondents per item [29];
moreover, sample size recommendations for structural equation modelling (SEM) range from 40-240
samples [30] thus a sample size of 222 is adequate for 14 items and 4 constructs. The data analysis was
performed on IBM AMOS V.22. The data were assessed for common method bias, reliability, and validity
analysis in the first phase. Furthermore, Hayes Process Macro 3.4 was used for mediation analysis.

3. RESULTS
The sample consisted of 4.9% males and 95.9% females. 75.2% of the respondents were in the age
group 20-29 years. 45% of the nurses were diploma holders, followed by 52.7 bachelors and 2.3% masters.
Around 70.3% of the respondents were married, and 29.7% of the respondents were unmarried. The 74.3% of
nurses had work experience in the 1-5 years range, followed by 13.1% 6-10 years and 3.6% 11 years and
above. Lastly, around 96.9% of the nurses were staff nurses, followed by 2.3% of intern nurses and 1.8% of
nurses holding managerial designations. The descriptive analysis of the five constructs revealed that the
hospital nurses scored highest on conscientiousness (M=4.03), followed by courtesy (M=3.85), Altruism
(M=3.74), civic virtue (M=3.31), and sportsmanship (M=2.5), with the overall OCB mean score of 3.49 as
presented in Table 1.

Table 1. Descriptive analysis of the constructs

Construct Maximum Mean and Std. deviation Rank
Civic virtue 4.38 3.31 (0.57) 4
Courtesy 4.85 3.85 (0.67) 2
Conscientiousness 4.98 4.03 (0.66) 1
Altruism 4.61 3.74 (0.58) 3
Sportsmanship 4.69 2.51 (0.84) 5
Ocb 4.42 3.49 (0.45)

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The SEM assumptions were checked and found acceptable for the analysis. The skewness and
kurtosis values were less than 2 and 3, establishing that the data were normally distributed [31]. The
Common method bias (CMB) threatens the validity of the conclusions made on statistical results [32]
Harman's single factor test was performed. The first factor explained the 24.09 % variance, lower than the
threshold of 50 %, thus ruling out the presence of CMB [33]. The study did not encounter multicollinearity
issues as the correlation between any two variables is higher than 0.80 [34]. The highest correlation between
the two variables was 0.68 as shown in Table 2. The Cronbach alpha of the subscale was found to be (0.83)
for conscientiousness (0.87) for sportsmanship, (0.83) courtesy, (0.87) Altruism, and (0.81) civic virtue. All
the values were higher than the cut-off value of 0.7 as presented in Table 3.

Table 2. Multicollinearity analysis

Correlations
Civic Virtue Conscientiousness Altruism Sportsmanship
Civic virtue 1 .490** .676** .241**
Conscientiousness .490** 1 .682** 0
Altruism .676** .682** 1 -.165*
Sportsmanship .241** 0 -.165* 1
**Correlation is significant at the 0.01 level (2-tailed)
*Correlation is significant at the 0.05 level (2-tailed)

Table 3. Constructs factor loadings and Cronbach alpha

Construct Item Factor loadings Cronbach Alpha
Sportsmanship SPM5 .850 0.83
SPM4 .817
SPM2 .810
SPM1 .808
SPM3 .749
Altruism ALT3 .871 0.81
ALT4 .822
ALT1 .783
ALT2 .717
Conscientiousness CONC1 .855 0.87
CONC2 .811
CONC3 .803
Civic virtue CV2 .842 0.81
CV1 .829

The composite reliability of the constructs ranged from 0.76-0.87, which is higher than the
stipulated value of 0.70 [35], thus ensuring the internal consistency of the constructs. Similarly, the Average
Variance Extracted (AVE) ranged from 0.56-0.63 for all the constructs higher than the stipulated value of
0.50 [34]. Furthermore, the discriminant validity is ensured by comprising the squared correlation of AVE
with the individual constructs. As shown in Table 4, values of AVE range from 0.56 to 0.63, whereas the
diagonal values ranged from 0.74 to 0.79, indicating that the diagonal variables are greater than other AVE
values, thus ensuring the adequacy of discriminant validity for all constructs [36] as shown in Table 4.

Table 4. Reliability and validity analysis

CR AVE MSV MaxR(H) SPM ALT CONC CV
SPM 0.864 0.561 0.047 0.879 0.749* 0.217
ALT 0.875 0.637 0.365 0.878 -0.151† 0.798* 0.598
CONC 0.832 0.625 0.365 0.843 -0.048 0.604 0.790* 0.435
CV 0.766 0.621 0.358 0.768 0.788*
SPM=Sportsmanship, ALT=Altruism, CONC=Conscientiousness, CV=Civic Virtue, CR=Composite Reliability, AVE=Average
Variance Extracted, MSV=Maximum Shared Variance, MaxR(H)=Maximum Reliability, (*) Square Root of AVE

The results of the structural model provided a good fit for the data (x2/df=2.02, GFI=0.92,
NFI=0.91, CFI=0.95, TLI 0.93, root mean square error of approximation (RMSEA) 0.068, standardized root
mean square residual (SRMR)=0.64). The various fit indices used for model testing, such as good of fit index
(GFI), normed fit index (NFI), comparative fit index (CFI), and tucker–lewis index (TLI), exceeded the
recommended threshold of 0.90, and the RMSEA and SRMR values were below the prescribed value of 0.08
[37], thus ensuring data suitability and models fitness as shown in Table 5.

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Table 5. Model fit indices

Fit indices Model Cut-off values
x2/df 2.02 3
GFI .920 0.90
NFI .912 0.90
CFI .953 0.90
TLI .939 0.90
RMSEA .068 0.08
SRMR .064 0.08

The direct effect of civic virtue on altruism was found to be significant (effect=0.55, t=11.79,
p<0.01). The association between civic virtue and conscientiousness was found to be significant (effect=0.57,
t=8.94, p<0.01). The association between civic virtue and sportsmanship was found to be significant
(effect=0.35, t=3.73, p<0.01). Similarly, the association between conscientiousness and altruism was found to
be significant (effect=0.33, t=8.12, p<0.01). The association between sportsmanship and altruism was found
to be significant (effect=-0.19, t=-6.9, p<0.01). Thus the hypothesis H1, H2, H3, H5 and H7 were accepted as
shown in Table 6.

Table 6. Direct and indirect effects and hypothesis testing

Parameters Coefficient t value SE Lower Upper p-value Hypothesis
Direct effects
CONC <- CV .57 8.94 .064 .4481 .7015 .00 Supported
SPM <- CV .35 3.73 .095 .1686 .5450 .00 Supported
ALT <-CONC .33 8.12 .041 .2541 .4168 .00 Supported
ALT <-SPM -.19 -6.9 .027 -.2465 -.1370 .00 Supported
ALT <- CV .55 11.7909 .0473 .4646 .6511 .00 Supported
Indirect Effects Effect Lower Upper Boot SE
ALT<-CONC<-CV .19 .0940 .3144 .057 Supported
ALT<-SPM <-CV -.06 -.1159 -.0222 .023 Supported
Direct effect (c ) .557
Total indirect effect .124
Total effect ( c') 0.681
SPM=Sportsmanship, ALT=Altruism, CONC=Conscientiousness, CV=Civic virtue

The mediating effect on conscientiousness on the relationship between civic virtue and altruism was
found to be significant with (Indirect effect=0.19, Boot SE=.057, LLCI=.0940, ULCI=.3144). Similarly, the
mediation effect on sportsmanship on the relationship between civic virtue and altruism was found to be
significant with (Indirect effect=-0.06,Boot SE=.023, LLCI=.-0.1159, ULCI=.-0.0222). Thus the hypotheses
H4 and H5 were accepted. Figure 2, depicts the hypothesized model as shown in Figure 2.

Figure 2. Path model

4. DISCUSSION
The analysis of the individual constructs of the OCB revealed that the nurse had scored maximum
on conscientiousness, followed by courtesy, altruism, civic virtue, and sportsmanship. This finding is
comparable with another study carried out in Turkey, where the nurses gave maximum scores for
conscientiousness. However, there is a slight difference as the nurses scored lowest in sportsmanship in the
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present study, whereas, in the study carried out in Turkey, it was for courtesy [38]. The plausible explanation
for this is that the present study was carried out during the second COVID-19 wave in India, and therefore
the inflow of patients in that period was high. At the same time, many nursing staff had COVID-19 patients
in their families and then also, due to organizational commitments and requirements, could devote the
required time to the care of family members. This argument is substantiated by the fact that recurring daily
negative events diminish the positive affect and lead to the depletion of sportsmanship behavior [39].
The overall OCB score for the nurses was found to be 3.49±0.49, which is on the lower side and
denotes a weak level. The differences in the OCB scores noted in the study with the previous studies [39] can
be explained by the differences in personality traits, organizational environment, and nationality [10]. It is
also to be highlighted that researchers have noted that employees exhibit organizational citizenship behavior
as an impression management tactic and have received better grades in OCB from their supervisors and were
better liked by their supervisors [39]; additionally, in times of COVID-19 when the majority of healthcare
workers were overburdened with the work, it was difficult and non-rewarding to create fake impressions, as
the supervisor will also be occupied and overlooks such acts.
The study attempted to understand the OCB variables influencing altruistic behavior amongst
tertiary care hospital nurses. A hypothesized model was created based on the SIT and SJT. It was
hypothesized that civic virtue (sense of belongingness) to the organization would affect altruism (helping
peers and co-workers); however, this relationship was hypothesized to be mediated by sportsmanship
(willingness to tolerate inevitable inconveniences and impositions of work) and conscientiousness
(willingness to conform with the organization's roles to maintain the social order).
Sportsmanship and Concentiousess variables originate from the preference for the status quo [27]. In
this study, it was found that civic virtue is associated with altruism. The employees demonstrating civic
virtue have a strong sense of belonging to the organization, as supported by social identity theory, resulting in
a strong feeling of group membership amongst employees of the same organization. This finding is supported
by shared group membership promoting altruism for the in-group members [40]. The social exchange theory
propagates exchange as a bidirectional transaction, where employees respond to increase their chances of
receiving a benefit [41].
The logical explanation of civic virtue's effect on altruism is the social exchange phenomenon,
where employees indulge in positive political behavior and choose to exercise altruistic behavior as they
expect a benefit or reciprocation in return. This is consistent with the earlier finding where it was found that
there is a positive association between social exchange and altruism [41]. Similarly, it was found that the
relationship between civic virtue and conscientiousness is positively associated. The logical explanation is
that an individual who wishes to demonstrate his contribution to the organization's growth with his ideas,
opinions, and participation in organizational affairs needs to be well-organized in his work and be well-
informed about the products and services offered by the organization [42].
The current study also confirms the positive association between civic virtue and sportsmanship, as the
employees who are committed and engaged to the organization are ready to absorb and tolerate the inevitable
inconveniences and impositions of work. This finding is consistent with the system justification theory
imposition, wherein individuals accept suboptimal conditions and avoid acknowledging negative aspects of
their work system [27]. Additionally, a negative association was found between sportsmanship and altruism,
which is also the key finding of this study and confirms the arguments of Proudfoot&Kay that “Observed
instances of sportsmanship may not always be a result of employees conscious decision to quietly endure less
than optimal organizational functioning while privately acknowledging that these conditions are suboptimal.”
Hence, when employees are aware of the sub-optimal optimal work settings in the organization and
accept it as a part of work-life, consistent with system justification theory, they get less inclined to extend
their help to other co-workers and colleagues; this “altruistic behaviour depletion” phenomenon originating
from sportsmanship behavior is detrimental to the organization's interest in the long run. This finding is also
consistent with the equity theory, where employees compare themselves with a "referent other" doing similar
work; with the help of a mental ratio of outcomes and inputs. When inequity is experienced, the employees in
that unbalanced state are motivated to regain their equity [43]. Thus, employees exhibiting sportsmanship
accept the impositions of work as a part of work and expect every "referent other" to tolerate it; therefore,
they reduce their altruistic behavior.
In this study, it was found that sportsmanship mediates the relationship between civic virtue and
altruism. In the absence of sportsmanship, the direction of association between civic virtue and altruism is
positive; however, when sportsmanship is introduced as a mediator, the relationship becomes negative with
an indirect effect of -0.06. This again supports our argument that sportsmanship behavior is ideal in the short
term [39], and in the long term, it has a negative effect on altruistic behavior. Therefore, employees shouldn't
be left alone to tackle the negative effects of job demands, but the supervisors should intervene quickly and
make efforts to reduce the job demands as it directly affects the employees' well-being [44].

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Early researchers have also noted the relationship between “social loafing” or “free-riding behavior”
leading to the “sucker effect” [45]. Social loafing means the tendency of the team members to deliberately
withhold their efforts while working in a group rather than individually [46]. The two primary causes of
social loafing are “free-riding” and the “sucker effect”. Free-riding behavior represents the personal choice of
limiting their efforts in a group assignment as no one can measure their individual contributions; similarly,
the sucker effect represents the fearful decision of limiting efforts by a team member as he/she doesn't want
to be used by the other team members. The overall effect of the sucker effect is a reduction in group
productivity and loss of morale. Additionally, negative social cues have been found to decrease group
performance [47].
Therefore, the logical conclusion states that even though nurses at the individual level are willing to
accommodate and tolerate the job demands, they reduce their altruistic behavior due to the fear of providing
free-ride to someone and the composite sucker effect. Altruistic behavior also denotes team bonding and
team cohesion; in times of demanding situations such as COVID-19, when this study was carried out, it was
found that the employees were not willing to help their team members, which, if done, would have provided
relief to many team members and have also resulted into increase in team productivity. This argument is
supported by an earlier work that states that an increase in the altruistic behaviour of employees results in an
increase in co-worker’s social loafing [45]. The same study also postulates that an increase in co-worker’s
social loafing results in an increase in the social loafing of the employee exhibiting altruistic behaviour.
Therefore, employees who exhibit sportsmanship behavior by tolerating the nuances of work also note
the social loafing behavior of their team members. On the contrary, conscientiousness was found to mediate the
relationship between civic virtue and altruism with an indirect positive effect of 0.19, thus confirming the
presence of partial mediation [48]. Furnham et al. noted that employees exhibiting prudence and inquisitive
behavior (conscientiousness) about people are psychologically mature. Such employees also firmly believe in
“what goes around comes around” and tend to see the “bigger picture” [49]. They exhibit altruistic behavior as
they see the potential implications of such acts, which improves their acceptance amongst the team members,
resulting in positive impressions and task achievements. Furthermore, conscientiousness is found to be
negatively associated with social loafing [50]. Thus, employees who exhibit conscientious behavior are less
susceptible to the “sucker effect” and more prone to showcase altruistic behavior.
The hospital administrators and healthcare managers should focus on the nurses' work environment
and job demands in healthcare institutions. Hospital administrators can expect the nurses to tolerate the work
impositions in the short term; however, immediate measures should be taken on priority to change or reduce
the ill effects of additional job demands. If not addressed on time, work-related harmful impositions will
result in the depletion of the altruistic behavior of the employees.
Additionally, nursing supervisors and hospital administrators should take adequate measures to
reduce social loafing and existing nurses’ “free-riding” behavior. The measures which can be adopted to
reduce social loafing include “identifiability of individual contribution,” “anticipated external evaluation,”
and instilling the belief of “indispensability of individuals performance to the group [47]. Furthermore,
designing “difficult challenging and intrinsically motivating tasks.” Nursing supervisors should take training
sessions for the nurses to create a positive set of attitude towards work and colleagues, thus resulting in the
creation of the “culture of camaraderie” [50].
Nursing professionals should intrinsically feel self-responsibility towards their work and co-
workers, enhancing perceived accountability and a sense of responsibility. It is advisable that the senior staff
in the department should be sensitized to exhibit appropriate behavior through effective communication with
new joiners and leading up with example by coming ahead to take up additional responsibilities rather than
assigning their work to the new joiners.
Nursing supervisors and superintendents should regularly take stock of the motives, such as
prosocial values and organizational concerns, as these are found to affect social loafing and OCB [49]
significantly [49]. Employees scoring low on prosocial values and administrative considerations are likelier
to exhibit social loafing. Employees who exhibit altruistic behavior should be rewarded quarterly with
monetary and non-monetary means. Similarly, communication channels between the management and
employees should be enhanced, and employees should be encouraged to share suggestions to ease work-
related stress and unfavorable and unwanted job demands.
There are a few limitations in this work, firstly, it is carried out during COVID-19, which is an
extraordinary situation, and hence there is a possibility that there could be a difference in the demonstrated
behavior in the usual times. Moreover, this study is carried out in a single hospital setting; hence the
generalizability of the study findings is limited. Therefore, in the future, another study should be carried out
with a representative sample of nursing professionals from different types of hospitals, such as public and
private, accredited or non-accredited, single-specialty, and multispecialty hospitals in the post-COVID-19
period.

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In the future, a study can be done with the suggested interventions such as “identifiability of
individual contribution”, instilling the belief of “indispensability of individuals performance to the group,
“anticipated external evaluation”, creating a culture of “camaraderie”, regular assessment of “prosocial
values” and “organizational concerns.” These interventions are expected to keep social loafing and the sucker
effect under check; afterward, the relationship between sportsmanship and altruism should be explored.

5. CONCLUSION
This study fills the literature gap of interlinkages between the OCB constructs. This study highlights
the mediating effect of conscientiousness and sportsmanship on the relationship between civic virtue and
altruistic behavior. Employees exhibiting conscientiousness-related behavior are more likely to exhibit team
spirit by showcasing more altruistic behavior, whereas employees with low conscientiousness scores are
more likely to indulge in social loafing. Similarly, virtues such as sportsmanship can be expected from the
employees in the short run but not in the long run, as it results in “ altruistic behavior depletion,” which
occurs due to the unwillingness of employees to provide “free rides” to co-workers and the “sucker effect”.
Additionally, when the demanding job conditions continue in the long run, nursing employees
accept it’s a part of their work-life, and due to the system justification effect, they get less inclined to assist
co-workers. Furthermore, due to the perceived inequity, nurses working in such difficult conditions tend to
compare themselves with a “referent other” doing similar work; with the help of a mental ratio of outcomes
and inputs. When inequity is experienced, the employees in that unbalanced state get motivated to regain
their equity. Therefore, they expect every other co-worker to experience the same problems and thus
withhold their altruistic behavior.

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BIOGRAPHIES OF AUTHORS

Priyanka Koul is a knowledge service senior associate at ZS India. She is

Skilled in Pharmaceutical Sales, Healthcare, and Neuropsychiatric therapy area. Strong
business development professional with MBA focused on Hospital and Healthcare. She has
completed her MBA (HHM) in the year 2022 from Symbiosis Institute of Health Sciences,
Symbiosis International (Deemed University). She can be contacted at email:
[email protected].

Ankit Singh is a Full Associate Professor of Hospital and Healthcare

Management at Symbiosis International (Deemed) University in Pune, Maharasthra India.
He has published over 35 research articles in Scopus, WoS indexed Journals and, 7 ABDC
indexed journals. His interests include Healthcare Operations, Healthcare Marketing, and
the Organizational Behaviour of Healthcare Workers. He can be contacted at email:
[email protected].

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