Purpose This study finds out if a satisfied physician will show citizenship behaviour (OCB) in a work environment where psychological contract breach (PCB) exist. Design/methodology/approach Quantitative data from 214 physicians across 26 health-care units were analysed. Research philosophy was positivism, research design was explanatory and study design was cross-sectional. Preliminary tests were conducted. Reflective measurement and structural models were examined. PLS algorithm tool and bootstrapping procedure were utilised. Control variables were sex, age, employment type and tenure. A significant level was set at 5%. Smart PLS 2.0M.3 software was employed. Findings The scientist found support for a significant moderating effect of PCB on the nexus between job satisfaction (JST) and OCB, such that PCB demoralised a satisfied physician in showing OCB. In contrast, a fulfilled psychological contract motivated satisfied physicians to exhibit OCB. Practical implications PCB, if not addressed, may lead satisfied physicians to show low OCB, which has devastating effects for health-care organisations and their patients. Creating balanced, fulfilled and harmonious relationship within physicians will transform the workplace into a more meaningful and purposeful atmosphere. Originality/value This study offers empirical health-care literature on the moderating effect of PCB, a psychosocial stressor, on the direct relationship between JST and OCB, integrating and lengthening the social exchange theory, resource-based theory and activation theory.
Background Task-shifting has been implemented in the United States, Canada, Australia and New Zealand and increasingly in Europe. A cross-country comparison of task-shifting has been lacking across Europe. We assessed task-shifting practices in Europe and other OECD countries, and secondly, performed correlation analyses with OECD data. Methods A survey was developed, pilot tested and sent to 109 country informants in 39 countries covering Europe, the United States, Canada, Australia and New Zealand (response rate 85.3%). Country informants were chosen based on a pre-defined set of criteria. Countries levels of implementation was correlated with OECD secondary data: physician and nurse ratios, education, and primary mode of financing (fee-for-service vs other). Results Eleven countries have implemented extensive task-shifting (Australia, Canada, New Zealand, the Netherlands, US, UK (England, Wales, N. Ireland, Scotland), Finland, Ireland), measured by authority to diagnose, refer, treat and prescribe. However, countries' levels of regulation and financing varied, as did training requirements. The majority of countries showed emerging, yet limited task-shifting where nurses took up some advanced roles within confined boundaries. Five countries did not implement task-shifting. Conclusions Countries most advanced showed variations of the regulatory contexts, which may impact on nurses' practice patterns. Countries with decentralized regulation resulted in uneven levels of implementation, posing barriers to an efficient use of this workforce. Countries in early development stages focused primarily on adapting training capacity. From an international and especially, EU perspective, harmonizing competencies and training – in those countries showing similar levels of advanced practice – will be an important step to ensure the quality of care, avoid potential skill-loss and facilitate the recognition of education in increasingly connected labor markets. Key messages Task-shifting from physicians to nurses is an increasing workforce trend in Europe, however, extent of task-shifting and levels of implementation vary An enabling policy context involves up-to-date regulation, quality education pipeline and a supportive financing structure