Amid complex care pathways and rising workload pressures, the ability of hospitals to retain an engaged nursing workforce is tied closely to workplace climate. Evidence from a large Egyptian university hospital indicates that two organisational features matter in tandem: a virtuous climate that foregrounds optimism, trust, compassion, integrity and forgiveness and a just culture that balances accountability with learning. Together these conditions align values, enhance psychological safety and support open communication. In a sample of 400 nurses across internal units and intensive care, organisational virtuousness and just culture predicted stronger occupational commitment, with just culture acting as a mediator. The analysis links ethical climates to the affective, normative and continuance dimensions of professional commitment, offering practical levers for leaders seeking to stabilise teams and sustain care quality.
Design, Setting and Measurement
A descriptive correlational cross-sectional design examined relationships among organisational virtuousness (OV), just culture (JC) and occupational commitment (OC) at Alexandria Main University Hospital, a public, non-profit teaching hospital with more than 6,760 beds and 23 critical care units. Convenience sampling followed structural equation modelling (SEM) guidance for models of moderate complexity, yielding 400 nurses with at least six months’ experience. Data were collected between April and June 2025 using validated instruments: the 15-item Organizational Virtuousness Scale assessing optimism, trust, compassion, integrity and forgiveness, the 24-item Occupational Commitment Survey capturing affective, normative and continuance facets, including accumulated costs and limited alternatives, and the 22-item Just Culture Assessment Tool measuring balance, openness, feedback and communication, event reporting quality and continuous improvement.
Must Read: Nurse-Centred Interoperability in Healthcare
Rigorous translation, back-translation and expert review ensured cultural relevance, with confirmatory factor analysis supporting construct validity. Sampling adequacy was high across tools, item loadings exceeded accepted thresholds and reliability indices were strong. Procedures minimised common method bias through anonymity, varied response formats, clear instructions and a pilot with 10% of the sample that required no changes. Questionnaires were administered in person, with completion in 15–20 minutes and researcher availability for clarifications. Analysis used IBM SPSS Statistics and AMOS, applying descriptive statistics, Pearson correlations, group comparisons, regression, confirmatory factor analysis and SEM to test direct and mediated paths from OV to OC via JC. Model fit was described as good to adequate based on standard indices and thresholds.
Key Findings on Virtue, Culture and Commitment
Participants had a mean age of 41.9 years, most were female and nearly two thirds reported at least 15 years in the profession. Two thirds worked in internal units and one third in intensive care. Perceptions of organisational virtue were generally positive: 71.0% fell in the moderate-to-high range, with forgiveness and optimism showing the strongest subscale means. Occupational commitment was also high, with 71.8% in the high category and notable strength across affective, normative and continuance components. Perceptions of just culture were particularly strong: 84.8% rated JC as high, underpinned by a pronounced emphasis on continuous improvement alongside openness, feedback and event reporting processes.
Bivariate analyses indicated positive associations among the three constructs. Organisational virtue correlated with both just culture and occupational commitment, while just culture showed a moderate positive association with occupational commitment. Multiple regression demonstrated that OV and JC jointly explained 15.5% of the variance in OC. Both were significant predictors, with JC the stronger predictor. This pattern suggests that while a values-based climate contributes directly to nurses’ professional attachment, the presence of an open, balanced and learning-oriented culture has a larger immediate influence on commitment.
SEM corroborated these relationships, indicating that OV influenced OC both directly and indirectly through JC. Indicators loaded strongly on their latent constructs. Within OV, integrity showed the strongest association among the virtue indicators alongside forgiveness, compassion and trust. Within OC, accumulated costs, normative and affective elements contributed substantially to the latent construct. Within JC, balance, feedback and communication, event reporting quality, openness and continuous improvement were all salient. The overall model exhibited good to adequate fit, and the mediated pathway from OV to OC via JC was supported, aligning with theoretical expectations of social exchange and organisational justice where fair processes and ethical climates foster trust, psychological safety and reciprocal commitment.
Practice, Management and Policy Implications
Findings position just culture as a practical mechanism through which organisational virtues are translated into day-to-day experience and, in turn, sustained professional commitment. At the practice level, environments that embed fairness, openness and learning help nurses feel safe to report, discuss and resolve errors while strengthening moral alignment with organisational values. Such climates can nurture reflective behaviours, peer support and continuous improvement that reinforce belonging and reduce intentions to leave.
For nursing management, leadership behaviours are central to modelling organisational virtue and operationalising just culture. Transparent decision-making, equitable treatment and non-punitive responses to mistakes cultivate psychological safety and trust. Structured feedback loops and learning-oriented routines can consolidate team cohesion and support the emotional and normative aspects of commitment identified in the data. Leadership development that builds ethical leadership, conflict resolution and emotional intelligence can further embed these practices and sustain them over time.
Education and policy offer additional levers. Integrating organisational virtue and just culture concepts into curricula through scenarios and case-based learning can prepare nurses to navigate ethical and cultural challenges in complex settings. At organisational and regulatory levels, embedding just culture principles into standards and certification frameworks and aligning policies with equity, ongoing education and ethical practice, provides a systemic basis for the climates associated with stronger commitment. While the cross-sectional design limits causal inference and self-report data may carry response bias, the large sample, validated instruments and SEM approach provide a robust platform for these implications across similar contexts.
An organisational environment that unites virtuous values with a just, learning-oriented culture is associated with higher occupational commitment among nurses. Organisational virtue contributes directly to professional attachment and, through just culture, reinforces the psychological safety and fairness that underpin engagement. For leaders facing persistent workforce pressures, prioritising fair processes, open communication and continuous improvement offers a tangible route to strengthen commitment without compromising accountability. Aligning practice, management development and policy with these elements can help stabilise teams, support resilience and sustain the standards of patient care that depend on a dedicated nursing workforce.
Source: BMC Nursing
Image Credit: iStock
