Othman 2012

Social support and work engagement: a study of Malaysian nurses

NORAINI OTHMAN BBA , M S c (M g t ) , P h D 1 and AIZZAT MOHD NASURDIN B . S c ( A g r i b u s i n e s s ) , M B A , P h D 2

1Senior Lecturer, School of Business Management, College of Business, Universiti Utara Malaysia, Kedah DarulAman, and 2Professor, School of Management, Universiti Sains Malaysia, Pulau Pinang, Malaysia

Background

Organizations, especially those in the health-care

industry, face unprecedented challenges and competi-

tive pressures. The rising costs of health care, an aging

society with diverse needs and care requirements, new

types of illnesses and ailments, and advancement in

technology have placed greater demands on hospitals

and their employees especially the public hospitals. On

the front line of this dynamic landscape are the nursing

professionals who must deal with increased calls for

improved patient care and efficiency gains, while at the

same time coping with job stress, fatigue and burnout

(Luthans et al. 2008, Chen et al. 2009).

In the Ninth Malaysian Plan, the government has

given higher priority to improving the health status of

Malaysians and several measures were implemented to

enhance the delivery system and improve the scope and

quality of health care in both public and private sectors

(Kanapathy 2003). Moreover, the government also

Correspondence

Noraini Othman

School of Business Management

College of Business

Universiti Utara Malaysia

06010 UUM, Sintok

Kedah Darul Aman

Malaysia

E-mail: [email protected]

OTHMAN N. & MOHD NASURDIN A . (2012) Journal of Nursing Management

Social support and work engagement: a study of Malaysian nurses

Aim This study addressed the question of whether social support (supervisorsupport and co-worker support) could contribute to the variance in workengagement.

Background Nurses, as customer-contact employees, play an important role in

representing the organizations competence. Their attitudes and behaviour towardpatients has a significant influence on patients satisfaction and perception of qualityof service.

Methods The sample comprised 402 staff nurses working in three general hospitals

in Peninsular Malaysia. Variables included demographic information, Utrecht Work

Engagement Scale and Social Support Scale. Data analysis included descriptive

statistics, correlations and regression analysis.

Results Findings indicated that supervisor support was positively related to work

engagement. Co-worker support was found to have no effect on work engagement.

Conclusions Supervisory support is an important predictor of work engagement for

nurses.

Implications for nursing management Nursing management should provide more

training to nurse supervisors and develop nurse mentoring programmes to

encourage more support to nurses.

Keywords: co-worker support, nurses, social support, supervisor support, workengagement

Accepted for publication: 18 May 2012

Journal of Nursing Management, 2012

DOI: 10.1111/j.1365-2834.2012.01448.x 2012 Blackwell Publishing Ltd 1

announced several actions regarding health industry

such as promoting Malaysia as an attractive destination

for health tourism and improving the health status of

local individuals, families and communities (Economic

Planning Unit 2006). Accordingly, public hospitals need

adequate numbers of competent and experienced cus-

tomer-contact employees (e.g. nurses and doctors) to

enable them to participate actively in these pro-

grammes. Within health-care organizations, customer-

contact employees play an important role in providing

quality services to the patients, thus influencing the

success of the organization. Nursing is an important

profession to study as nurses performance has a greatimpact on the nature and quality of service provided to

the patients (Cohen & Golan 2007, Chen et al. 2009,

Purdy et al. 2010).

Previous studies have identified nurses attitudes andbehaviours as significant in determining the quality of

health-care services (Cohen & Golan 2007, Al-Ahmadi

2008). According to Moritz et al. (1989) and Wil-

loughby (2011), contributions made by nurses help

portray their organizations competence in health carebecause they spend most of their time directly with

patients. In addition, the quality of nursing care has a

strong effect on health-care organizations ability toprovide professional services to the desired standard

(Moritz et al. 1989, Mcsherry & Douglas 2011).

Hence, nurses should employ a favourable attitude in

the form of work engagement. Work engagement has

been acknowledged as one of the positive states that is

considered to be the exact opposite of burnout based on

the emergence of positive psychology the scientific

study of human strength and optimal functioning pro-

posed by Seligman and Csikszentmihalyi (2000). Schau-

feli et al. (2006a) argued that engaged employees are

energetic and have an effective relationship with their

work activities, and are therefore able to cope effectively

with their job demands. A study by Schaufeli and Van

Rhenen (2006) has found that engaged employees are

more productive as they often experienced positive

emotions. Generally, organizations expect their employ-

ees to be proactive and show initiative, be greatly in-

volved in their work and be committed to high-quality

performance standards. Thus, these organizations re-

quire employees who feel energetic and dedicated, and

are absorbed by their work (Bakker & Schaufeli 2008).

To encourage high work engagement within the

nursing workforce, nurses as boundary-spanners of

health-care organizations need to have greater job re-

sources. Bakker and Schaufeli (2008) argued that job

resources are assumed to have a motivational potential,

which can lead to low cynicism, high work engagement

and excellent performance. In particular, job resources

might have either an extrinsic motivational role, as they

are instrumental in achieving work goals, or have an

intrinsic motivational role, as they promote employeesgrowth, learning and development. As nurses jobs willalways contain elements of stressful, difficult situations

and episodes of hardship, job resources are important

elements to help nurses deal with their daily work

activities.

Few studies have investigated the antecedents of work

engagement (Bakker et al. 2005, Mauno et al. 2005,

Hakanen et al. 2006, Langelaan et al. 2006, Llorens

et al. 2007). According to Mauno et al. (2007), re-

search on work engagement has remained scarce be-

cause the concept is rather new. Furthermore, they

argue that investigating work engagement among

health-care employees is a worthwhile starting point

and nursing, in particular, is generally considered to be

characterized by an especially high level of employee

engagement and commitment (Hakanen 2004, Mauno

et al. 2005). Given the emerging trend of positive psy-

chology in the literature (Luthans 2002a,b), this study

attempts to examine the role of job resources (supervi-

sor support and co-worker support) as antecedents of

work engagement among Malaysian nurses.

Literature review

Work engagement

Work engagement refers to a positive, fulfilling, work-related state of mind that is characterized by vigour,

dedication and absorption (Schaufeli & Bakker 2004).Vigour is a state where individuals experience a high

degree of energy, a strong work ethic and an ability to

persevere when confronted with challenging work

(Schaufeli & Bakker 2004). Dedicated individuals have

an enthusiastic attitude and are motivated and proud of

their work. These individuals also perceive their work

to be important and they describe difficulties as chal-

lenges rather than strains. Absorption in work is being

fully immersed in work and feeling happy about oneswork roles. Individuals who are absorbed in their work

perceive time to pass quickly and find it difficult to

separate themselves from work (Schaufeli & Bakker

2004).

According to Bakker et al. (2008), work engagement

is essential as engaged employees: (1) experience plea-

sure, joy and enthusiasm; (2) enjoy good physical and

psychological health; (3) have better job performance;

(4) show increased ability to create job and personal

resources; and (5) have the capability to transfer their

N. Othman and A. M. Nasurdin

2012 Blackwell Publishing Ltd2 Journal of Nursing Management

engagement to others. Past research has provided evi-

dence that work engagement can be measured reliably

(Schaufeli & Van Rhenen 2006). In addition, work

engagement can be discriminated from related concepts

such as workaholism (Schaufeli et al. 2008), jobinvolvement and organizational commitment (Hallberg

& Schaufeli 2006).

Numerous studies have provided empirical evidence

on the relationship between work engagement and

work-related outcomes. For example, work engagement

has been found to be positively related to customer

loyalty and employee performance (Salanova et al.

2005, Halbesleben 2010), job satisfaction and organi-

zational citizenship behaviour (Saks 2006, Babcock-

Roberson & Strickland 2010), in-role performance

(Schaufeli et al. 2006b), employee proactive behaviours

(Salanova & Schaufeli 2008), financial returns

(Xanthopoulou et al. 2009), employee retention (Saks

2006, Halbesleben 2010) and employee well-being

(Halbesleben 2010).

Social support

Social support has been defined as the overall level ofhelpful social interaction available on the job from both

co-workers and supervisors (Karasek & Theorell1990). Supervisory support is a social exchange con-

struct, in which employees perceive the degree to whichsupervisors value their contributions and care about

their well-being (Eisenberger et al. 2002). Social ex-change theory posits that if employees perceive that

their supervisor supports and cares for their well-being,

they would feel attached to the organization and feel

obligated to return the favour to their supervisor bystaying in the organization. The relationship with a

supervisor is considered as one of the main elements of

employees work environment (Van der Heijden et al.2010). As stated by Blancero et al. (1996), good

supervisory feedback and constructive communication

between the supervisors and subordinates may increase

employees capabilities.Hobfoll and Shirom (2000) argued that social sup-

port is considered as a potential to obtain resources

beyond those directly possessed by an individual. Social

support has been defined in many ways (Schwarzer

et al. 2004), such as resources provided by others,

coping assistance, an exchange of resources and a

personality trait (Schwarzer & Knoll 2007). When

employees observe their supervisors as supportive, they

believe that their supervisor has concern for their feel-

ings and needs, will provide help and positive feedback,

and assist them in career development (House 1981,

Langford et al. 1997). Conservation of Resources

(COR) theory posits that social support in workplace

restricts the negative impact of emotional exhaustion

related with stressful job-related activities. Several

scholars, such as Sarason et al. (1990) and Kaufmann

and Beehr (1986), found that social support is an

effective resource for assisting employees to cope with

stress, and for their well-being. When employees per-

ceive the absence of support (e.g. feedback) in the

workplace, they will not be able to make investments

for resource gain, while employees who are given po-

sitive feedback regarding their job performance are

likely to look for opportunities to develop new skills

and form relevant plans of action (Hobfoll & Shirom

2000, Westman et al. 2005).

Furthermore, Meijiman and Mulder (1998) noted

that job resources such as social support can also play

an extrinsic motivational role as a resourceful work

environment will develop an individuals willingness todedicate ones efforts and abilities to the work task.Hence, the task will be completed successfully and the

work goal will be achieved. For example, co-worker

support and performance feedback will increase the

likelihood of being successful in achieving ones workgoals. Thus, either through the basic satisfaction of

needs or through the accomplishment of work goals, a

positive outcome may be achieved and work engage-

ment would be expected to increase (Schaufeli & Bak-

ker 2004, Schaufeli & Salanova 2007).

Social support has been also found to be an important

antecedent of work engagement (Bakker et al. 2003,

Schaufeli & Bakker 2004, Hakanen et al. 2006, Kor-

unka et al. 2009). For example, Schaufeli and Bakker

(2004) conducted a study among employees from four

different Dutch service organizations: an insurance

company, a pension fund company, an occupational

health and safety service and a home-care institution. In

their study, job resources that included social support

from colleagues and performance feedback were found

to be associated with work engagement. In a study by

Hakanen et al. (2006) among a sample of over 2000

Finnish teachers, supervisory support was found to be

positively linked to work engagement. Similar results

were reported by Llorens et al. (2006) in a Spanish

context. However, De Lange et al. (2008) did not find

any relationship between co-worker support and work

engagement.

In a health-care setting, nurse supervisors are not only

responsible for facilitating learning and enhancing the

understanding of the clinical job performed by the

nurses (Severinsson & Hallberg 1996), they are also

responsible for helping the nurses to increase their skills

Social support and work engagement in Malaysia

2012 Blackwell Publishing LtdJournal of Nursing Management 3

and communication with patients (Severinsson 1996).

Therefore, when nurses in public hospitals perceive

their supervisors as supportive (showing concern for

their feelings and needs, and providing help, informa-

tion, and constructive feedback), these nurses will feel

obliged to reciprocate by showing a favourable attitude

in the form of work engagement. As the nursing pro-

fession is regarded as an emotionally demanding work

environment, the quality of teamwork and co-worker

support is very important (Sherony & Green 2002, Van

der Heijden et al. 2008). Employees who observe a high

level of co-worker support will view the workplace as a

supportive environment in which they have abundant

opportunities to learn from their co-workers.

From this discussion, we propose two hypotheses: (1)

supervisor support will be positively and strongly re-

lated to nurses work engagement; (2) co-worker sup-port will be positively and strongly related to nurseswork engagement.

Method

Samples and procedures

After approval from the Medical Research Ethical

Committee (MREC), Malaysian Ministry of Health

(MOH), 466 questionnaires were distributed to the

nurses with the assistance of the matrons office ofthe three main public hospitals in Peninsular Malaysia.

The distribution and collection of the completed ques-

tionnaires took about 1 month from mid December

2009 to mid January 2010. Of the 466 questionnaires

distributed, 402 were returned, yielding a response rate

of 86.27%.

Instruments

For the purpose of this study, two instruments were

used to measure the study variables. All items were

rated using Likert scales.

Work engagement

Work engagement was measured using the shortened

nine-item version of the Utrecht Work Engagement

Scale (UWES-9) developed by Schaufeli and Bakker

(2003). This UWES-9 consists of three underlying

dimensions, which are measured with three items each:

vigour, dedication and absorption. Respondents re-

ported on a seven-point Likert scale ranging from

1 = never to 7 = always. The Cronbachs alpha coef-ficient for this scale is 0.90. For the purpose of analyses,

an overall work engagement factor score was com-

puted. Schaufeli and Bakker (2003) argued that the

total score for work engagement may sometimes be

more practical in empirical research because of the

moderate to high correlations between the dimensions.

Social support

A scale by Susskind et al. (2003), which includes

supervisor support (four items) and co-worker support

(three items) was used to measure social support. This

measure was also used in established studies (Susskind

et al. 2000, 2007). According to Susskind et al. (2007),

the functions of support in service-based organization

derive from two sources: supervisor support and co-

worker support. All items were measured on a seven-

point Likert scale ranging from 1 = strongly disagreeto 7 = strongly agree. The Cronbachs alpha coeffi-cients for these two types of supports were 0.95 and

0.94, respectively.

Demographic factors

Demographic information such as gender, marital

status, age, race, organizational tenure, job tenure and

educational qualification were also requested.

Data analysis

The Statistical Package for Social Sciences (Version 12;

SPSS Inc., Chicago, IL, USA) was used to perform the

descriptive and inferential statistical analyses. Internal

consistency reliability was assessed using Cronbachsalpha. Pearsons correlation analysis and regressionanalysis were used to test the research hypotheses. The

strength and direction of relationships between vari-

ables were measured using Pearsons correlation anal-ysis. Regression analysis was then carried out to

estimate the variance in work engagement that could be

explained by social support (supervisor support and co-

worker support).

Results

Profile of respondents

Of the 402 respondents, six (1.5%) were males and 396

(98.5%) were females. Most of the respondents (263

staff nurses or 65.4%) were married, while the

remainder were unmarried. The mean age of the

respondents was 30.72 years (SD 7.31). In terms of

ethnicity, the majority of the respondents were Malays

(90.0%), followed by Indians (5.5%), Chinese (3.0%)

and other races (1.5%). Of the respondents, 305



(75.9%) had basic training and 97 (24.1%) had post-

basic training. The mean value for organizational tenure

was 5.92 years (SD 6.04). and the mean value for job

tenure was 6.96 years (SD 6.77). The profile of

respondents of this study is summarized in Table 1.

Means, standard deviations, reliabilities andcorrelation of the study variables

Descriptive statistics such as mean scores, standard

deviations, reliabilities and intercorrelations of the

study variables are provided in Table 2.

As shown in Table 2, on average, the level of work

engagement (mean = 5.38, SD 0.90), and supervisor

support (mean = 5.02, SD 1.07) was slightly high. In

contrast, the mean value for co-worker support

(mean = 4.81, SD 0.91) was found to be moderate. The

reliability coefficients for the study variables were above

0.60, which meets the minimum acceptable standard of

0.6 for exploratory research, as suggested by Hair et al.

(2006). Meanwhile, correlations between the study

variables were found to be significant (P < 0.01).

Regression results

Hierarchical regression analysis was conducted to test

the two hypotheses of this study. Demographic vari-

ables such as age, marital status, education, organiza-

tional tenure and job tenure were statistically controlled

(Koyuncu et al. 2006, Mauno et al. 2007). The result of

the analysis is summarized in Table 3.

As shown in Table 3, based on model 1, the control

variables accounted for 3% of the variance in work

engagement (r2 = 0.03, F-change = 2.54, P < 0.01). Of

the five control variables, only marital status was sig-

nificantly related to work engagement ( = 0.12,

P < 0.05). This indicates that nurses who are married

were highly engaged in their work compared with

unmarried nurses. In model 2, by adding the two pre-

dictor variables, the r2-value increased to 0.12. This

result shows that the predictor variables were able to

explain an additional 9% of the variance related to

work engagement (r2-change = 0.09, F-change = 13.40,

P < 0.01). This study demonstrated acceptable value of

r2 for psychosocial studies. However, Hair et al. (2006)

recommended that the greater the r2 value, the stronger

would be the predictor in explaining the variations of

the dependent variables. Of the two predictor variables,

supervisor support ( = 0.14, P < 0.01) was found to

Table 1Profile of respondents

Demographicvariable Category Frequency Percentage

Gender Female 396 98.5Male 6 1.5

Marital status Married 263 65.4Unmarried 139 34.6

Ethnicity Malay 362 90.0Indian 22 5.5Chinese 12 3.0Others 6 1.5

Educational Basic training 305 75.9Qualification Post basic training 97 24.1

Mean SDAge (year) 30.72 7.31Organizationaltenure (year)

5.92 6.04

Job tenure(year)

6.96 6.77

Table 2Descriptive statistics, correlations, and reliabilities of the studyvariables

Variables Mean SDWork

engagementSupervisorsupport

Co-workersupport

Workengagement

5.38 0.90 (0.84)

Supervisorsupport

5.02 1.07 0.20** (0.75)

Co-workersupport

4.81 0.91 0.13** 0.39** (0.66)

*P < 0.05, **P < 0.01. Data in parentheses denote the reliabilitycoefficients for the study variables.

Table 3Regression results of social support on work engagement

Independent variables

Work engagement(dependent variable)

Model 1standard b

Model 2standard b

Step 1: Control variablesAge )0.06 )0.03Marital status )0.12** )0.12*Education 0.01 0.04Organizational tenure 0.03 )0.01Job tenure 0.20 0.17

Step 2: Predictor variablesSupervisor support 0.14**Co-worker support 0.05

F-value 2.54 6.76R2 0.03 0.12Adjusted r2 0.02 0.10r2-change 0.03 0.09F-change 2.54** 13.40**

*P < 0.05, **P < 0.01. Dummy coded: marital status (unmarried = 0,married = 1); and education (basic training = 0, post basictraining = 1).



have a positive and significant relationship with work

engagement, thereby, supporting hypothesis 1. Mean-

while, the effect of co-worker support on work

engagement was not significant. The non-existence of a

relationship between co-worker support and work

engagement leads to the rejection of hypothesis 2.

Limitations

Only two predictor variables (supervisor support and

co-worker support) were examined, but other job re-

sources such as performance feedback, supervisory

coaching, rewards, career advancement and job control

may play an important role in predicting work

engagement in health-care settings. Future researchers

may wish to expand the scope of this study by focusing

on these variables. In addition, this study is limited to

staff nurses working in public hospitals in Peninsular

Malaysia. The same research could be expanded and

replicated among other health-care personnel from

public and private hospitals. A larger sample in the

same industry would improve the generalization of the

findings.

Conclusions

The main purpose of this study was to investigate the

effects of social support (supervisor support and co-

worker support) on work engagement among Malay-

sian public hospital nurses. Our findings revealed that

supervisor support was a significant predictor of work

engagement. This finding is consistent with those of

previous researchers (Hakanen et al. 2006, Llorens et al.

2006). In health-care settings, nurse supervisors are not

only responsible for facilitating learning and enhancing

the understanding of the clinical job performed by the

nurses (Severinsson & Hallberg 1996), they also help

nurses to increase their skills and communication with

patients (Severinsson 1996). Hence, this study has con-

tributed to enriching the body of knowledge on work

engagement literature within the nursing context.

Furthermore, job resources (e.g. supervisory support)

can play an extrinsic motivational role, because a

resourceful work environment will drive an individualswillingness to contribute their efforts and abilities to the

work task. The availability of job resources will ensure

that an individuals task will be successfully imple-mented. Therefore, this study concurs with Blaus(1964) social exchange theory. In other words, this

study has empirically supported the social exchange

theory developed by Blau (1964), which posited that

when nurses in public hospitals perceive their supervi-

sors as supportive, showing concern for their feelings

and needs, and providing help, information and con-

structive feedback, these nurses will feel obliged to

reciprocate by displaying a favourable attitude in the

form of work engagement.

However, co-worker support was found to be unre-

lated to work engagement. This finding is consistent

with the results of other researchers (De Lange et al.

2008). In todays health-care practice environment, therole of a nurse has become more complicated, with

various responsibilities (Mrayyan 2006). As boundary-

spanners, nurses have to deal with many people around

them, such as nursing management, doctors, patients,

supervisors and co-workers; hence, these nurses might

not be able to develop closer relationships with their co-

workers. Furthermore, their tight and busy work sche-

dule may restrict them from providing support to their

co-workers. These factors may have accounted for the

lack of relationship between co-worker support and

work engagement.

Implications for nursing management

As supervisory support influences work engagement, it

would be worthwhile for the Malaysian Ministry of

Health and nursing management to provide more

training for nurse supervisors to encourage a greater

range of support to nurses. Moreover, effective nurse

mentoring programmes may promote and develop

strong social support networks among nurse supervisors

and nurses. This will enable the nurse supervisors to

provide greater support in terms of showing concern for

staff nurses feelings and needs, providing help andinformation, and providing constructive feedback.

Appropriate amounts of supervisory support to nurses

will enable them to become more engaged in their work.

Source of funding

This study was funded by Ministry of Higher Education

(MOHE) and Universiti Sains Malaysia.

Ethical approval

Ethical approval was granted from Medical Research

Ethical Committee (MREC),Ministry ofHealth (MOH).

Acknowledgements

The authors gratefully acknowledge Malaysian Higher Edu-cation and Universiti Utara Malaysia for doctoral sponsorshipand study leave, and Universiti Sains Malaysia for the USM-



RU-PRGS grant to undertake this research. Appreciation isalso extended to Malaysian Ministry of Health for grantingpermission to conduct this research.

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