• Tyrone Perreira, Whitney Berta, Liane Ginsburg, Jan Barnsley, and Monique Herbert.
• Tyrone Perreira, PhD, is Post-Doctoral Fellow, Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada. E-mail: ty.perreira@utoronto.ca. Whitney Berta, PhD, is Associate Professor, Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada. Liane Ginsburg, PhD, is Associate Professor, School of Health Policy & Management, York University, Toronto, Ontario, Canada. Jan Barnsley, PhD, is Associate Professor, Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada. Monique Herbert, PhD, is Assistant Lecturer, Department of Psychology, York University, Toronto, Ontario, Canada.
• Health Care Manage Rev. 2018 Oct 1; 43 (4): 315-327.

BackgroundWork attitudes have been associated with work productivity. In health care, poor work attitudes have been linked to poor performance, decreased patient safety, and quality care. Hence, the importance, ascribed in the literature, of work that clearly identifies the relationships between and among work attitudes and work behaviors linked to performance.PurposeThe purpose of this study is to better understand the relationships between work attitudes-perceived organizational justice, perceived organizational support (POS), affective commitment-consistently associated with a key type of performance outcome among nurses' organizational citizenship behaviors (OCBs).MethodologyA survey was developed and administered to frontline nurses working in the province of Ontario, Canada. Data analysis used path analytic techniques.ResultsDirect associations were identified between interpersonal justice and POS, procedural justice and POS, and POS and affective commitment to both one's supervisor and one's co-workers. Affective commitment to patients and career was directly associated with OCBs. Affective commitment to one's co-worker was directly associated with OCBs directed toward individuals, as affective commitment to one's organization was with OCBs directed toward the organization. Finally, OCBIs and OCBs were directly associated.ConclusionsExamining the relationships of these constructs in a single model is novel and provides new information regarding their complexity. Findings suggest that prior approaches to studying these relationships may have been undernuanced, and conceptualizations may have led to somewhat inaccurate conclusions regarding their associations.Practice ImplicationsWith limited resources, knowledge of nurse work attitudes can inform human resource practices and operational policies involving training programs in employee communication, transparency, interaction, support, and performance evaluation.

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