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Predictors of Organizational Commitment Among Certified Occupational Therapy Assistants Jane Painter, EdD, OTR/L Duane Akroyd, PhD, RT(R) Terri Barefoot, OTR/L Kerri Schemedeke, OTR/L N. Elizabeth Daniels, MS, OTR/L
ABSTRACT. The purpose of this correlational research study was to provide insights into specific extrinsic organizational rewards, extrinsic social rewards, and intrinsic rewards that lead to certified occupational therapy assistants’ (COTA) organizational commitment, and how managers and recruiters can utilize this knowledge in developing more effective COTA recruitment and retention strategies. The target population for this investigation included COTAs who worked full-time in North Carolina, South Carolina, and Virginia and were members of the American Occupational Therapy Association. Findings from this study indicated that predictors of COTAs’ organizational commitment were determined by intrinsically rewarding job tasks that were supported by their work environment, salary, and promotional opportunities. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: [email protected] ]
Jane Painter is Associate Professor, East Carolina University, Occupational Therapy Department, Belk Building, Greenville, NC 27858. Duane Akroyd is Associate Professor, North Carolina State University, Department of Adult Community College Education, P. O. Box 7801, Raleigh, NC 27693. Terri Barefoot is Staff OTR, Pitt County Memorial Hospital, Greenville, NC 27858. Kerri Schemedeke is Staff OTR, St. Mary’s Mercy Hospital, Enid, OK. N. Elizabeth Daniels is Clinical Instructor, East Carolina University, Occupational Therapy Department, Belk Building, Greenville, NC 27858. The authors would like to thank Anne Dickerson, PhD, OTR/L, FAOTA for her editorial assistance. Occupational Therapy in Health Care, Vol. 12(2/3) 2000 E 2000 by The Haworth Press, Inc. All rights reserved.
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KEYWORDS. Recruitment, retention, job design strategies
During the past decade, dramatic health care changes, governmental cutbacks, and the aging of America have created new employment opportunities and settings for certified occupational therapy assistants (COTAs) (Steib, 1996a; Steib, 1996b; Steib, 1997). Given the demand for COTAs and their changing health care working environments, it is critical for managers to develop successful COTA recruitment policies, retention and job design strategies, and other workplace initiatives. It has been suggested that organizational commitment may have an important influence on work related outcomes (i.e., attrition, absenteeism, burnout, tardiness, and job performance) particularly during times of organizational turmoil and change (Begley & Szajka, 1993; Griffin & Bateman, 1986; Mowday, Steers, Porter, & Boulian, 1974; Sneed & Herman, 1990). Furthermore, as health care organizations undergo major restructuring and the roles of health care professionals are redefined, health care managers should become more cognizant of predictors of employee organizational commitment that may enhance work related outcomes (Biggs, Flett, Voges, & Alpass, 1995). Therefore, the purpose of this correlational research study was to provide insights into the specific rewards that lead to certified occupational therapy assistants’ (COTA) organizational commitment, and how managers and recruiters can utilize this knowledge in developing more effective COTA recruitment and retention strategies. LITERATURE REVIEW Organizational Commitment According to Mowday, Steers, and Porter’s (1979) definition, organizational commitment is ‘‘the relative strength of an individual’s identification with and involvement in an organization’’ (p. 24). Arnold, Robertson, and Cooper (1991) suggest that committed employees believe in their organization’s norms and goals, display a strong desire to remain members of the organization, and demonstrate a willingness to extend considerable effort on behalf of the organization. Organizational commitment is an evolving construct that has been found to influence employee work related outcomes in various busi-
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ness and health care settings (Biggs et al., 1995; Mowday et al., 1979; Shouksmith, 1994). Some researchers have even contended that organizational commitment is the most influential predictor of employee turnover (Begley & Szajka, 1993; Mathieu & Zajac, 1990; Sneed & Herman, 1990). Others have found that increased employee absenteeism has also been associated with decreased organizational commitment (Begley & Szajka, 1993; Farrell & Stamm, 1988; Griffin & Bateman, 1986). Increased employee burnout has also been found to be inversely correlated with employee commitment (Leiter, 1988; Leiter, 1991; Jackson, Turner, & Briet, 1987). Work Rewards Behavioral and social scientists have suggested that various aspects of work create empirically and conceptually distinct clusters of work rewards that generally relate to extrinsic and intrinsic reward classifications (Alpander, 1990; Centers & Bugental, 1966; Katz & Van Maanen, 1977; Mottaz, 1981). Extrinsic organizational rewards (i.e., general working conditions, salary, promotional opportunities, fringe benefits) are factors provided by the organization to promote task performance. Extrinsic social rewards are derived from interactions with coworkers and supervisors. Intrinsic rewards (i.e., task autonomy, task involvement and task significance) include those benefits derived from the work itself and include autonomy to perform job tasks and the degree to which the job and its tasks are innately rewarding. Thus, work may be viewed as rewards derived from an individual’s interaction with the organization and job tasks. Using such a conceptualization of work rewards provides a logical framework of the work place in which to examine organizational commitment. An implication of the work dynamics in the health care environment is that employee commitment may influence the quality and quantity of services delivered. Thus, managers who ignore predictors of their employees’ commitment could create detrimental effects in relation to patient care and for their health care organization’s long term performance. With a few exceptions, research on organizational commitment among allied health professionals has not utilized multivariate designs with an extrinsic and intrinsic conceptualization of work rewards to explain or predict organizational commitment (Akhtar & Tan, 1994; Akroyd, Mulkey, & Utley-Smith, 1995; Painter & Akroyd, 1998). In
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fact, there have been no empirical studies of COTA’s organizational commitment, and only one study that investigated occupational therapists’ (OTR) organizational commitment (Painter & Akroyd, 1998). While both OTRs and COTAs work in similar health care settings, predictors of their commitment may differ since their job tasks are distinct from each other. Hence, a further understanding of COTAs’ work dynamics and organizational commitment is essential if appropriate recruitment policies, retention and job design strategies, and workplace initiatives are to be successful. Thus, the purpose of this study was to provide insights into specific extrinsic organizational rewards, extrinsic social rewards, and intrinsic rewards that lead to certified occupational therapy assistants’ (COTA) organizational commitment, and how managers and recruiters can utilize this knowledge in developing more effective COTA recruitment and retention strategies. The following research question was derived from the purpose: Which extrinsic organizational rewards (i.e., general working conditions, salary, promotional opportunities), extrinsic social rewards (i.e., supervision, COTA-coworkers and OTR-coworkers) and intrinsic rewards (i.e., task autonomy, task significance, and task involvement) are significant predictors of organizational commitment among full-time COTAs?
METHODS Population and Sample The target population for this investigation included COTAs who were members of the American Occupational Therapy Association, Inc. (AOTA) and were currently living in North Carolina, South Carolina, or Virginia. From information supplied by AOTA’s Research Department, a random sample of 412 COTAs was drawn from the population of all 1030 COTAs in North Carolina, South Carolina and Virginia. Coded questionnaires with cover letters explaining the purpose of the study and a postage paid response envelope were mailed to all 412 COTAs in the sample. A follow-up letter and questionnaire were sent to all non-respondents after two weeks. There were 209 respondents for a 51% response rate. The mean age of respondents was 36.6 years
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(SD = 9.5). The majority were white (93% or 195) and women (91% or 191). The highest level of OT education attained by respondents was the associate degree (94% or 194) while the remainder held certificates. The average salary was $31,056. On the average, the respondents had been practicing for five years and working in the most current health care setting for the past two years. The majority of the COTAs were working in skilled nursing facilities. Since the intent of the study was to determine the commitment of COTAs working full-time, only 149 respondents were used for analysis. Instrumentation The questionnaire used in this study was comprised of three sections. The first consisted of demographic questions related to work status, age, gender, race, years as a therapist, type of organization, and highest educational level. Extrinsic and intrinsic rewards. The second section of the questionnaire was Mottaz’s measure of extrinsic and intrinsic rewards and was initially developed in 1981. While Mottaz factor analyzed the initial scale to produce eight distinct factors (3 extrinsic organizational rewards, 2 extrinsic social rewards and 3 intrinsic rewards), his scales were slightly modified for this study. The coworkers variable was changed to two variables; COTA-coworkers and OTR-coworkers. Since the scales were modified, the questionnaires returned by COTAs were subjected to factor analysis using squared multiple correlations as prior communality estimates. The principal factor method was used to extract the factors, and this was followed by a promax (oblique) rotation. In interpreting the rotated factor pattern, an item was said to load on a given factor if the factor loading was .45 or greater for that factor, and was less than .30 on any other factor. Using the previous criteria, the final factor structure consisted of three extrinsic organizational rewards, three extrinsic social rewards and three intrinsic rewards. The number of factors was the same as the original instrument developed by Mottaz (1981), with the exception that coworkers, as modified, consisted of two factors (COTA-coworkers and OTR-coworkers), and questions not meeting the loading criteria described above were omitted. There were a total of 42 questions associated with the nine factors. There were 14 questions relating to the extrinsic organizational rewards (6 general working conditions, 4 promotional opportunities and
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4 salary). Seventeen questions were associated with extrinsic social rewards (6 COTA-coworkers, 5 OTR-coworkers and 6 supervision). Eleven questions were related to the intrinsic rewards (5 task involvement, 3 task significance and 3 task autonomy). A Likert-type scale ranging from strongly agree (4) to strongly disagree (1) was used for all questions. Each variable score was the summed total from all questions related to that variable. The reliability coefficients (Cronbach’s alpha) for the work reward variables are as follows: .75 for general working conditions, .92 for promotional opportunities, .84 for salary, .98 for COTA-coworkers, .95 for OTR-coworkers, .88 for supervision, .80 for autonomy, .84 for task involvement, and .83 for task significance. The previous reliability coefficients were all similar or higher than those reported by Mottaz (1981) in the original instrument. Organizational Commitment. The dependent variable, organizational commitment, was assessed in the third section of the questionnaire using Mowday et al.’s (1979) Organizational Commitment Questionnaire. It contained 15 Likert-type questions, with four response categories ranging from strongly agree (4) to strongly disagree (1). A higher score on this scale reflected a higher level of organizational commitment. Mowday, Steers and Porter (1979) reported a median reliability coefficient (Cronbach’s alpha) for the questionnaire of .90 with a range of .82 to .93 for 2,463 employees working in nine different public and private work organizations. Data Analysis Data from the questionnaires were entered into a data set using version 6.4 of PC-SAS (SAS Institute, Inc., 1987). Demographic information was reviewed using descriptive statistics. Forced entry multiple regression was used to determine the predictive ability of the independent variables (extrinsic and intrinsic rewards) upon COTAs’ organizational commitment. RESULTS Multiple regression analysis was used to analyze the data. Table 1 contains the results of the regression analysis. Together the work reward variables accounted for a significant percentage of the variance in COTA’s organizational commitment.
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TABLE 1. Results of Regression Analysis p
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Variables General Working Conditions Salary Promotional Opportunities Supervision COTA-Coworkers OT-Coworkers Autonomy Task Involvement Task Significance
.23 .21 .21 .07 .004 .07 .04 .41 .006
.0054* .0075* .0084* .4229 .9585 .3741 .6018 .0001* .9387
F (for model) = 7.24 p (for model) = .0001 R2 (for model) = .37 *indicates a p value < .05
Thus, the linear combination of work reward variables predicted COTA’s organizational commitment. However, only four of the nine work reward variables were significant predictors of COTAs’ organizational commitment. The relative contribution of each predictor variable can be determined by the magnitude of its associated standardized or scale free regression coefficient ( ). Values close to 1.0 indicate a very large contribution, while those close to zero indicate no contribution. The intrinsic work reward, task involvement, contributed more to the variance of COTAs’ organizational commitment than did any of the other three significant predictors. Each of the three extrinsic organizational rewards was a significant predictor of COTAs’ organizational commitment (see Table 1). The three extrinsic social rewards (COTA-coworkers, OTR-coworkers and supervision) and the two intrinsic rewards (task autonomy or task significance) were not significant predictors of COTAs’ organizational commitment. Discussion With the changing economic and political environment forcing health care practitioners to do more with less, extended care providers and COTAs will be utilized even more in the future than in the past (Joe, 1996; Steib, 1997). Therefore, in order to recruit and retain
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COTAs, employers should consider what intrinsic and extrinsic rewards commit COTAs to their organizations. Results from this study suggest that the intrinsic reward, task involvement, had the greatest influence upon the organizational commitment of full-time COTAs working in North Carolina, South Carolina, and Virginia. Additionally, the extrinsic rewards of general working conditions, salary, and promotional opportunities were significant predictors of COTAs’ organizational commitment.
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Task Involvement In this study, intrinsically self-rewarding tasks appear to have had the most significant influence on COTAs’ organizational commitment ( = 41). Due to the COTAs’ strong intrinsic orientation regarding job tasks, job re-design strategies may be useful to enhance COTAs’ job values. Intrinsic values of work and an increase in employee motivation may occur when jobs are modified so that they are challenging and stimulating (Hackman and Oldman, 1980). Furthermore, in order to achieve high internal work motivation, the work tasks must be meaningful to the individual employee. Results from this study suggest that COTAs intrinsically value their job tasks, and their potential for internal work motivation is high. COTA supervisors should seek to maximize work motivation and recognize the importance of those aspects of the COTA’s job that have the potential to further the COTA’s organizational commitment. The authors question if COTAs who change jobs, are frequently absent, or display or complain of burnout are not having this intrinsic reward met. COTA retention and recruitment may be increased through job re-design strategies that focus on meeting the intrinsic need of being involved in the job itself. This is especially true for COTAs since patient care is their primary duty. COTA managers should seek to clarify COTA effort-performance and role expectations through direct supervision and feedback, goal setting, and/or continuing education training. Each of these areas should be adjusted as the COTA moves from an entry-level position to an intermediate-level position, and lastly, to the advanced level (AOTA, 1994; Homminga, 1996; Roberts & Hunt, 1991). This managerial strategy encourages high achievement and enhances the COTA’s knowledge of what is expected in their task performance and facilitates involvement in their job duties.
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Encouraging active participation in the development of personal and departmental goals also assists the COTAs in meeting their individual needs, clarifies their roles within the department and organization, and provides an internal motivating force. This strategy can assist managers in meeting the individual intrinsic needs of each COTA as well as reveal what the COTA versus the OTR perceives as important and can accordingly lead to the development of an effective reward system for each level of practitioner. Freda (1992) suggests that the professional development needs of OTRs change with their years of experience, and the authors speculate that the same may be true of COTAs. Thus, providing growth opportunities such as clinical ladders, increased supervisory responsibilities with increasing experience, involvement in program development, and funding to further professional skills may help meet COTAs’ intrinsic needs as they progress through the professional growth continuum. Homminga (1996) strongly advises administrators and COTA supervisors to consider implementing a career ladder for COTAs since it not only enhances the COTAs’ clinical skills and meets their intrinsic needs, but is a motivating recruitment and retention tool. Additionally, Homminga (1996) suggests that COTAs must play an active role in their training and receive meaningful educational opportunities that will further their professional growth. For COTAs working in hospital settings, employers may want to consider offering them opportunities to rotate between specialty areas or teams, if available, to enhance COTA learning as well as prevent burnout in a specific, routine practice area. Lastly, administrators should consider service competency to ensure that the COTA’s skills are optimally utilized (Black, 1996; Schwope, 1997). This study found that the respondents, on the average, had been practicing for five years and had been employed at their current health care setting for two years. Based on AOTA’s Guide for Supervision of Occupational Therapy Personnel (1993), these COTAs are considered at an advanced level of practice and require only general supervision. Therefore, service competency that accompanies higher levels of practice may be associated with tasks that are increasingly rewarding. The authors acknowledge, however, that various practice situations may necessitate higher levels of supervision due to lower levels of service competency. By recognizing the COTA’s potential skill areas for which service competency can be established, administrators may maximize COTA task involvement.
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General Working Conditions General working conditions had a significant positive influence on COTAs’ organizational commitment although its contribution was rather low ( = .23). Findings from this study indicated that COTAs value a work setting that provided sufficient space to evaluate and treat patients and to store equipment and supplies needed for patient care. Further, resources and time to perform tasks were also important to COTAs. Since the interaction between people, equipment, and work flow is important, it is not surprising that COTAs’ organizational commitment was positively influenced by general working conditions. Since the majority of COTAs, both in this study and nationally, work in skilled nursing facilities, administrators and direct COTA supervisors should question whether or not their working environment is designed to meet the extrinsic needs of COTAs (Steib, 1997). If not, then appropriate job re-design strategies may be needed. For example, the work environment should be designed to allocate space for both patient care, paperwork, storage of supplies and equipment, work load, and work flow (Akhtar & Tan, 1994; Freda, 1992). Since the primary role of the COTA is patient treatment, employers should continuously update their therapeutic equipment to enhance patients’ functional performance. If the COTA rotates between various specialty areas or teams, each area should be sufficiently designed to meet both the patient’s and COTA’ s needs. Salary Salary had a significant positive influence on COTAs’ organizational commitment although its contribution was low ( = .21) . Since the majority of COTAs in this study worked in skilled nursing homes, perhaps their salary was at a higher level than salary levels in other health care settings. While most employees consider salary important, several decades of research has demonstrated that other work rewards have a greater impact on employee commitment. If an employee is satisfied with a given salary and perceives that salary to be in an acceptable range, then other predictors of organizational commitment may become more important in the employee’s view of their employer. Thus, administrators who wish to improve COTAs’ organizational commitment should not only provide a salary that meets the qualifica-
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tions of the COTA, but acknowledge that the COTA’s roles differ from the OTR’s roles. Further, administration should continue to develop strategies to enhance the rewarding and interesting nature of the COTA’s job tasks (involvement), and be supported by the work environment and promotional opportunities.
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Promotional Opportunities Promotional opportunities had a significant positive influence on COTAs’ organizational commitment although its contribution was low ( = .21). Perhaps COTAs have the extrinsic need to be recognized and rewarded for their advancement in professional skills. Since the majority of COTAs work in a skilled nursing facility, the authors question whether the COTAs working in skilled nursing facilities were hired by the facility itself or were working on a contract basis through a health care agency. Further, the authors speculate that promotional opportunities may differ if the COTA is hired by the facility itself or is a contract COTA. A career ladder as suggested by Homminga (1996) is one method that COTA managers may want to consider when re-designing the COTA’s job. Additionally, encouraging active participation from COTA(s) when developing this ladder system will assist them in meeting their extrinsic needs. Competency testing of the COTA’s professional skills offers managers and COTAs another avenue in providing promotional opportunities that will not only motivate the employee, but also enhance recruitment and retention strategies and decrease burnout. Lastly, the authors suggest that managers design promotional opportunities for COTAs even if the health care setting employs only one COTA. Although promotional opportunities did not seem to be a major factor in determining COTAs’ organizational commitment, strategies that provide incentives for promotion that also simultaneously involve COTAs in their jobs may further clarify their commitment to their organizations. Supervision Although supervision was not identified as a significant determinant of COTA’s organizational commitment, administrators and direct supervisors of COTAs should recognize that their supervisory skills
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and methods may indirectly determine whether the COTA’s intrinsic and extrinsic needs are met. The COTA should be proactive and assist management in developing these job re-design strategies. For example, allowing the COTA(s) to assist with the development of treatment protocols or program development not only promotes task involvement, but also enhances motivation and job performance. Direct COTA supervisors should also recognize the COTA’s accomplishments through verbal and/or written praise. If the OTR is not routinely at the site eight hours a day, then perhaps another OTR could act as a mentor and share information with the COTA’s direct supervisor. As mentioned earlier, management could also work directly with the COTA(s) to develop and implement a reward system that offers opportunities to use a variety of skills, talents, and education. Black (1996) suggested that OTRs be cognizant of the COTA’s educational background, responsibilities as designated by AOTA’s Occupational Therapy Roles document (1994), and competencies to ensure that the COTA’s skills are used to their optimal potential. This awareness will not only help meet the COTA’s professional needs, but also promote the working partnership between the OTR and COTA. Autonomy Autonomy was not a significant predictor of COTA’s organizational commitment. Under AOTA’s Occupational Therapy Roles document (1994), a COTA providing OT services must practice under supervision, and this criterion makes it unlikely that the COTA will be entirely autonomous. Perhaps knowing that OTR supervision would always be provided in practice determined why some people chose to become a COTA rather than an OTR. Restrictions placed on COTAs by state regulatory agencies and the health care setting itself may further decrease the COTA’s autonomy and lessen the need for this intrinsic reward. Co-Workers In the present study, co-worker support both from other COTAs and OTRs was not a significant determinant of organizational commitment among COTAs. Perhaps the intrinsic reward (task involvement), and the other extrinsic rewards (general working conditions, salary, and promotion-
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al opportunities) were being met, and therefore, co-worker support was not perceived as a significant determinant of their organizational commitment.
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Limitations The degree to which the findings from this study may be generalized to other COTAs or other regions is unknown. There could be other predictors that influence COTAs’ organizational commitment other than those that were included in this study. Results were based on data collected from those COTAs who returned the survey via mail service. Thus, those who did not participate in this study may have been either too busy to complete the survey, or had low commitment to their organization.
CONCLUSION This is the first empirical study that has investigated predictors of organizational commitment of COTAs working full-time in North Carolina, South Carolina, and Virginia. Thus, this study can provide current and future OT researchers a conceptual framework with which to further examine specific predictors of organizational commitment among COTAs. Findings from the present study have several implications for health care settings and certified occupational therapy assistants. First, designing a reward system should stimulate and support motivation by meeting the COTAs’ needs, ensuring equity, and reinforcing desirable behaviors. COTA supervisors might provide intrinsically rewarding job tasks that are supported by the work environment, equitable salary, and promotional opportunities. Secondly, findings from the present study may be utilized in developing strategies for COTA recruitment. Replication of this study among part-time COTAs in North Carolina, South Carolina, and Virginia may be beneficial to determine if determinants of organizational commitment among these COTAs differ from those who work full-time. Replication of this study could also be performed in other regions of the United States to determine whether predictors of organizational commitment among COTAs are regionspecific and/or work-setting specific. Within each region it may be helpful to compare the needs of COTAs working in urban versus rural
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areas because each area may create different needs and provide varying degrees of support for the COTA. Lastly, as more COTAs work in a variety of health care settings, it may be warranted to examine the predictors of COTAs’ organizational commitment in each type of health care setting. In conclusion, given the demand for COTAs and changing health care working environments, a better understanding of the COTA’s work dynamics and organizational commitment is essential if appropriate COTA recruitment policies, retention and job re-design strategies, and workplace initiatives are to be successful. REFERENCES Akhtar, S., & Tan, D. (1994). Reassessing and reconceptualizing the multidimensional nature of organizational commitment. Psychological Reports, 75(3), 1379-1390. Akroyd, D., Mulkey, W., & Utley-Smith, Q. (1995). The impact of work rewards on radiographers’ organizational commitment. Radiology Management, 17(2), 51-56. Alpander, G. (1990). Relationship between commitment to hospital goals and job satisfaction: A case study of a nursing department. Health Care Management Review, 15(4), 51-62. American Occupational Therapy Association, Inc. (1993). Occupational therapy roles. American Journal of Occupational Therapy, 45(12), 1087-1099. American Occupational Therapy Association, Inc. (1994). Guide for supervision of occupational therapy personnel. American Journal of Occupational Therapy 48(11), 1045-1046. Arnold, J., Robertson, I. T., & Cooper, C. L. (1991). Work psychology. London: Pitman. Begley, T. M., & Szajka, J. M. (1993). Panel analysis of the moderating effects of commitment on job satisfaction, intention to quit, and health following organizational change. Journal of Applied Psychology, 78, 552-556. Biggs, H., Flett, R., Voges, K., Alpass, F. (1995). Job satisfaction and distress in rehabilitation professionals: The role of organizational commitment and conflict. Journal of Applied Rehabilitation Counseling, 26(1), 41-46. Black, T. (1996). COTAs and OTRs as partners and teams. OT Practice, 1(3), 42-47. Centers, R. & Bugental, D. (1966). Intrinsic and extrinsic job motivation among different segments of the working population. Journal of Applied Psychology, 50, 193-197. Farrell, D., & Stamm, C. (1988). Meta-analysis of the correlates of employee absence. Human Relations, 41, 211-222. Freda, M., (1992). Retaining occupational therapists in rehabilitation settings: Influential factors. American Journal of Occupational Therapy, 46,(3), 240-245. Griffin, R. W., & Bateman, T. S. (1986). Job satisfaction and organizational commitment in C. L. Cooper & I. Robertson (Eds). International Review of Industrial and Organizational Psychology (pp. 157-188). New York: Wiley.
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Hackman, R. & Oldham, G. (1975). Development of the job diagnostic survey. Journal of Applied Psychology, 60, 159-170. Homminga, T. (1996). My journey as a COTA. OT Practice, 1(10), 39-41. Jackson, S., Turner, J., & Briet, A. (1987). Correlates of burnout among public service lawyers. Occupational Behavior, 8, 339-349. Joe, B. (1996). COTAs: Shaping the future of OT. OT Week, 10(47), 14-15. Katz, R. & Van Maanen, J. (1977). The loci of work satisfaction: Job interaction and policy. Human Relations, 30, 469-486. Leiter, M. (1991). Coping patterns as predictors of burnout: The function of control and escapist coping. Journal of Occupational Behavior, 12, 123-144. Leiter, M. (1988). Commitment as a function of stress reactions among nurses: A model of psychological evaluations of work settings. Canadian Journal of Mental Health, 7,115-132. Manthieu, J. & Zajac, D. (1990). A review and meta-analysis of the antecedents, correlates, and consequences on organizational commitment. Psychological Bulletin, 108, 171-194. Mottaz, C. (1981). Some determinants of work alienation. The Sociological Quarterly, 22, 515-529. Mowday, R. T., Steers, R. M., & Porter, L. W. (1979). The measurement of organizational commitment. Journal of Vocational Behavior, 14, 224-247. Mowday, R. T., Steers, R. M., Porter, L. W., & Boulian, P. V. (1974). Organizational commitment, job satisfaction, and turnover among psychiatric technicians. Journal of Applied Psychology, 59, 603-609. Painter, J. & Akroyd, D. (1998). Predictors of organizational commitment among occupational therapists. Occupational Therapy in Health Care, 11(2), 1-15. Roberts, K. H. & Hunt, D. M. (1991). Organizational behavior. Boston: PWS-Kent Publishing Company. SAS (1987). SAS/STAT guide. Cary, NC: Author. Schwope, C. (1997). Managed care: Choices for COTAs. OT Practice, 2(8), 36-39. Shouksmith, G. (1994). Variables related to organizational commitment in health professionals. Psychological Reports, 74, 704-711. Sneed, J., & Herman, C. M. (1990). Influence of job characteristics and organizational commitment on job satisfaction of hospital food service employees. Journal of the American Dietetic Association, 90, 1072-1076. Steib, P. A. (1996a). Work profile of new COTA grads. OT WEEK, 10(17), 18-19. Steib, P. A. (1996b). Skilled nursing facilities: Top employment setting for COTAs. OT WEEK, 10(47), 16-17. Steib, P. A. (1997). Work profile of new COTA grads. OT WEEK for Today’s Student, 4(1), 10-11.
Predictors of Organizational Commitment Among Certified Occupational Therapy Assistants Jane Painter, EdD, OTR/L Duane Akroyd, PhD, RT(R) Terri Barefoot, OTR/L Kerri Schemedeke, OTR/L N. Elizabeth Daniels, MS, OTR/L
ABSTRACT. The purpose of this correlational research study was to provide insights into specific extrinsic organizational rewards, extrinsic social rewards, and intrinsic rewards that lead to certified occupational therapy assistants’ (COTA) organizational commitment, and how managers and recruiters can utilize this knowledge in developing more effective COTA recruitment and retention strategies. The target population for this investigation included COTAs who worked full-time in North Carolina, South Carolina, and Virginia and were members of the American Occupational Therapy Association. Findings from this study indicated that predictors of COTAs’ organizational commitment were determined by intrinsically rewarding job tasks that were supported by their work environment, salary, and promotional opportunities. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: [email protected] ]
Jane Painter is Associate Professor, East Carolina University, Occupational Therapy Department, Belk Building, Greenville, NC 27858. Duane Akroyd is Associate Professor, North Carolina State University, Department of Adult Community College Education, P. O. Box 7801, Raleigh, NC 27693. Terri Barefoot is Staff OTR, Pitt County Memorial Hospital, Greenville, NC 27858. Kerri Schemedeke is Staff OTR, St. Mary’s Mercy Hospital, Enid, OK. N. Elizabeth Daniels is Clinical Instructor, East Carolina University, Occupational Therapy Department, Belk Building, Greenville, NC 27858. The authors would like to thank Anne Dickerson, PhD, OTR/L, FAOTA for her editorial assistance. Occupational Therapy in Health Care, Vol. 12(2/3) 2000 E 2000 by The Haworth Press, Inc. All rights reserved.
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KEYWORDS. Recruitment, retention, job design strategies
During the past decade, dramatic health care changes, governmental cutbacks, and the aging of America have created new employment opportunities and settings for certified occupational therapy assistants (COTAs) (Steib, 1996a; Steib, 1996b; Steib, 1997). Given the demand for COTAs and their changing health care working environments, it is critical for managers to develop successful COTA recruitment policies, retention and job design strategies, and other workplace initiatives. It has been suggested that organizational commitment may have an important influence on work related outcomes (i.e., attrition, absenteeism, burnout, tardiness, and job performance) particularly during times of organizational turmoil and change (Begley & Szajka, 1993; Griffin & Bateman, 1986; Mowday, Steers, Porter, & Boulian, 1974; Sneed & Herman, 1990). Furthermore, as health care organizations undergo major restructuring and the roles of health care professionals are redefined, health care managers should become more cognizant of predictors of employee organizational commitment that may enhance work related outcomes (Biggs, Flett, Voges, & Alpass, 1995). Therefore, the purpose of this correlational research study was to provide insights into the specific rewards that lead to certified occupational therapy assistants’ (COTA) organizational commitment, and how managers and recruiters can utilize this knowledge in developing more effective COTA recruitment and retention strategies. LITERATURE REVIEW Organizational Commitment According to Mowday, Steers, and Porter’s (1979) definition, organizational commitment is ‘‘the relative strength of an individual’s identification with and involvement in an organization’’ (p. 24). Arnold, Robertson, and Cooper (1991) suggest that committed employees believe in their organization’s norms and goals, display a strong desire to remain members of the organization, and demonstrate a willingness to extend considerable effort on behalf of the organization. Organizational commitment is an evolving construct that has been found to influence employee work related outcomes in various busi-
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ness and health care settings (Biggs et al., 1995; Mowday et al., 1979; Shouksmith, 1994). Some researchers have even contended that organizational commitment is the most influential predictor of employee turnover (Begley & Szajka, 1993; Mathieu & Zajac, 1990; Sneed & Herman, 1990). Others have found that increased employee absenteeism has also been associated with decreased organizational commitment (Begley & Szajka, 1993; Farrell & Stamm, 1988; Griffin & Bateman, 1986). Increased employee burnout has also been found to be inversely correlated with employee commitment (Leiter, 1988; Leiter, 1991; Jackson, Turner, & Briet, 1987). Work Rewards Behavioral and social scientists have suggested that various aspects of work create empirically and conceptually distinct clusters of work rewards that generally relate to extrinsic and intrinsic reward classifications (Alpander, 1990; Centers & Bugental, 1966; Katz & Van Maanen, 1977; Mottaz, 1981). Extrinsic organizational rewards (i.e., general working conditions, salary, promotional opportunities, fringe benefits) are factors provided by the organization to promote task performance. Extrinsic social rewards are derived from interactions with coworkers and supervisors. Intrinsic rewards (i.e., task autonomy, task involvement and task significance) include those benefits derived from the work itself and include autonomy to perform job tasks and the degree to which the job and its tasks are innately rewarding. Thus, work may be viewed as rewards derived from an individual’s interaction with the organization and job tasks. Using such a conceptualization of work rewards provides a logical framework of the work place in which to examine organizational commitment. An implication of the work dynamics in the health care environment is that employee commitment may influence the quality and quantity of services delivered. Thus, managers who ignore predictors of their employees’ commitment could create detrimental effects in relation to patient care and for their health care organization’s long term performance. With a few exceptions, research on organizational commitment among allied health professionals has not utilized multivariate designs with an extrinsic and intrinsic conceptualization of work rewards to explain or predict organizational commitment (Akhtar & Tan, 1994; Akroyd, Mulkey, & Utley-Smith, 1995; Painter & Akroyd, 1998). In
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fact, there have been no empirical studies of COTA’s organizational commitment, and only one study that investigated occupational therapists’ (OTR) organizational commitment (Painter & Akroyd, 1998). While both OTRs and COTAs work in similar health care settings, predictors of their commitment may differ since their job tasks are distinct from each other. Hence, a further understanding of COTAs’ work dynamics and organizational commitment is essential if appropriate recruitment policies, retention and job design strategies, and workplace initiatives are to be successful. Thus, the purpose of this study was to provide insights into specific extrinsic organizational rewards, extrinsic social rewards, and intrinsic rewards that lead to certified occupational therapy assistants’ (COTA) organizational commitment, and how managers and recruiters can utilize this knowledge in developing more effective COTA recruitment and retention strategies. The following research question was derived from the purpose: Which extrinsic organizational rewards (i.e., general working conditions, salary, promotional opportunities), extrinsic social rewards (i.e., supervision, COTA-coworkers and OTR-coworkers) and intrinsic rewards (i.e., task autonomy, task significance, and task involvement) are significant predictors of organizational commitment among full-time COTAs?
METHODS Population and Sample The target population for this investigation included COTAs who were members of the American Occupational Therapy Association, Inc. (AOTA) and were currently living in North Carolina, South Carolina, or Virginia. From information supplied by AOTA’s Research Department, a random sample of 412 COTAs was drawn from the population of all 1030 COTAs in North Carolina, South Carolina and Virginia. Coded questionnaires with cover letters explaining the purpose of the study and a postage paid response envelope were mailed to all 412 COTAs in the sample. A follow-up letter and questionnaire were sent to all non-respondents after two weeks. There were 209 respondents for a 51% response rate. The mean age of respondents was 36.6 years
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(SD = 9.5). The majority were white (93% or 195) and women (91% or 191). The highest level of OT education attained by respondents was the associate degree (94% or 194) while the remainder held certificates. The average salary was $31,056. On the average, the respondents had been practicing for five years and working in the most current health care setting for the past two years. The majority of the COTAs were working in skilled nursing facilities. Since the intent of the study was to determine the commitment of COTAs working full-time, only 149 respondents were used for analysis. Instrumentation The questionnaire used in this study was comprised of three sections. The first consisted of demographic questions related to work status, age, gender, race, years as a therapist, type of organization, and highest educational level. Extrinsic and intrinsic rewards. The second section of the questionnaire was Mottaz’s measure of extrinsic and intrinsic rewards and was initially developed in 1981. While Mottaz factor analyzed the initial scale to produce eight distinct factors (3 extrinsic organizational rewards, 2 extrinsic social rewards and 3 intrinsic rewards), his scales were slightly modified for this study. The coworkers variable was changed to two variables; COTA-coworkers and OTR-coworkers. Since the scales were modified, the questionnaires returned by COTAs were subjected to factor analysis using squared multiple correlations as prior communality estimates. The principal factor method was used to extract the factors, and this was followed by a promax (oblique) rotation. In interpreting the rotated factor pattern, an item was said to load on a given factor if the factor loading was .45 or greater for that factor, and was less than .30 on any other factor. Using the previous criteria, the final factor structure consisted of three extrinsic organizational rewards, three extrinsic social rewards and three intrinsic rewards. The number of factors was the same as the original instrument developed by Mottaz (1981), with the exception that coworkers, as modified, consisted of two factors (COTA-coworkers and OTR-coworkers), and questions not meeting the loading criteria described above were omitted. There were a total of 42 questions associated with the nine factors. There were 14 questions relating to the extrinsic organizational rewards (6 general working conditions, 4 promotional opportunities and
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4 salary). Seventeen questions were associated with extrinsic social rewards (6 COTA-coworkers, 5 OTR-coworkers and 6 supervision). Eleven questions were related to the intrinsic rewards (5 task involvement, 3 task significance and 3 task autonomy). A Likert-type scale ranging from strongly agree (4) to strongly disagree (1) was used for all questions. Each variable score was the summed total from all questions related to that variable. The reliability coefficients (Cronbach’s alpha) for the work reward variables are as follows: .75 for general working conditions, .92 for promotional opportunities, .84 for salary, .98 for COTA-coworkers, .95 for OTR-coworkers, .88 for supervision, .80 for autonomy, .84 for task involvement, and .83 for task significance. The previous reliability coefficients were all similar or higher than those reported by Mottaz (1981) in the original instrument. Organizational Commitment. The dependent variable, organizational commitment, was assessed in the third section of the questionnaire using Mowday et al.’s (1979) Organizational Commitment Questionnaire. It contained 15 Likert-type questions, with four response categories ranging from strongly agree (4) to strongly disagree (1). A higher score on this scale reflected a higher level of organizational commitment. Mowday, Steers and Porter (1979) reported a median reliability coefficient (Cronbach’s alpha) for the questionnaire of .90 with a range of .82 to .93 for 2,463 employees working in nine different public and private work organizations. Data Analysis Data from the questionnaires were entered into a data set using version 6.4 of PC-SAS (SAS Institute, Inc., 1987). Demographic information was reviewed using descriptive statistics. Forced entry multiple regression was used to determine the predictive ability of the independent variables (extrinsic and intrinsic rewards) upon COTAs’ organizational commitment. RESULTS Multiple regression analysis was used to analyze the data. Table 1 contains the results of the regression analysis. Together the work reward variables accounted for a significant percentage of the variance in COTA’s organizational commitment.
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TABLE 1. Results of Regression Analysis p
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Variables General Working Conditions Salary Promotional Opportunities Supervision COTA-Coworkers OT-Coworkers Autonomy Task Involvement Task Significance
.23 .21 .21 .07 .004 .07 .04 .41 .006
.0054* .0075* .0084* .4229 .9585 .3741 .6018 .0001* .9387
F (for model) = 7.24 p (for model) = .0001 R2 (for model) = .37 *indicates a p value < .05
Thus, the linear combination of work reward variables predicted COTA’s organizational commitment. However, only four of the nine work reward variables were significant predictors of COTAs’ organizational commitment. The relative contribution of each predictor variable can be determined by the magnitude of its associated standardized or scale free regression coefficient ( ). Values close to 1.0 indicate a very large contribution, while those close to zero indicate no contribution. The intrinsic work reward, task involvement, contributed more to the variance of COTAs’ organizational commitment than did any of the other three significant predictors. Each of the three extrinsic organizational rewards was a significant predictor of COTAs’ organizational commitment (see Table 1). The three extrinsic social rewards (COTA-coworkers, OTR-coworkers and supervision) and the two intrinsic rewards (task autonomy or task significance) were not significant predictors of COTAs’ organizational commitment. Discussion With the changing economic and political environment forcing health care practitioners to do more with less, extended care providers and COTAs will be utilized even more in the future than in the past (Joe, 1996; Steib, 1997). Therefore, in order to recruit and retain
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COTAs, employers should consider what intrinsic and extrinsic rewards commit COTAs to their organizations. Results from this study suggest that the intrinsic reward, task involvement, had the greatest influence upon the organizational commitment of full-time COTAs working in North Carolina, South Carolina, and Virginia. Additionally, the extrinsic rewards of general working conditions, salary, and promotional opportunities were significant predictors of COTAs’ organizational commitment.
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Task Involvement In this study, intrinsically self-rewarding tasks appear to have had the most significant influence on COTAs’ organizational commitment ( = 41). Due to the COTAs’ strong intrinsic orientation regarding job tasks, job re-design strategies may be useful to enhance COTAs’ job values. Intrinsic values of work and an increase in employee motivation may occur when jobs are modified so that they are challenging and stimulating (Hackman and Oldman, 1980). Furthermore, in order to achieve high internal work motivation, the work tasks must be meaningful to the individual employee. Results from this study suggest that COTAs intrinsically value their job tasks, and their potential for internal work motivation is high. COTA supervisors should seek to maximize work motivation and recognize the importance of those aspects of the COTA’s job that have the potential to further the COTA’s organizational commitment. The authors question if COTAs who change jobs, are frequently absent, or display or complain of burnout are not having this intrinsic reward met. COTA retention and recruitment may be increased through job re-design strategies that focus on meeting the intrinsic need of being involved in the job itself. This is especially true for COTAs since patient care is their primary duty. COTA managers should seek to clarify COTA effort-performance and role expectations through direct supervision and feedback, goal setting, and/or continuing education training. Each of these areas should be adjusted as the COTA moves from an entry-level position to an intermediate-level position, and lastly, to the advanced level (AOTA, 1994; Homminga, 1996; Roberts & Hunt, 1991). This managerial strategy encourages high achievement and enhances the COTA’s knowledge of what is expected in their task performance and facilitates involvement in their job duties.
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Encouraging active participation in the development of personal and departmental goals also assists the COTAs in meeting their individual needs, clarifies their roles within the department and organization, and provides an internal motivating force. This strategy can assist managers in meeting the individual intrinsic needs of each COTA as well as reveal what the COTA versus the OTR perceives as important and can accordingly lead to the development of an effective reward system for each level of practitioner. Freda (1992) suggests that the professional development needs of OTRs change with their years of experience, and the authors speculate that the same may be true of COTAs. Thus, providing growth opportunities such as clinical ladders, increased supervisory responsibilities with increasing experience, involvement in program development, and funding to further professional skills may help meet COTAs’ intrinsic needs as they progress through the professional growth continuum. Homminga (1996) strongly advises administrators and COTA supervisors to consider implementing a career ladder for COTAs since it not only enhances the COTAs’ clinical skills and meets their intrinsic needs, but is a motivating recruitment and retention tool. Additionally, Homminga (1996) suggests that COTAs must play an active role in their training and receive meaningful educational opportunities that will further their professional growth. For COTAs working in hospital settings, employers may want to consider offering them opportunities to rotate between specialty areas or teams, if available, to enhance COTA learning as well as prevent burnout in a specific, routine practice area. Lastly, administrators should consider service competency to ensure that the COTA’s skills are optimally utilized (Black, 1996; Schwope, 1997). This study found that the respondents, on the average, had been practicing for five years and had been employed at their current health care setting for two years. Based on AOTA’s Guide for Supervision of Occupational Therapy Personnel (1993), these COTAs are considered at an advanced level of practice and require only general supervision. Therefore, service competency that accompanies higher levels of practice may be associated with tasks that are increasingly rewarding. The authors acknowledge, however, that various practice situations may necessitate higher levels of supervision due to lower levels of service competency. By recognizing the COTA’s potential skill areas for which service competency can be established, administrators may maximize COTA task involvement.
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General Working Conditions General working conditions had a significant positive influence on COTAs’ organizational commitment although its contribution was rather low ( = .23). Findings from this study indicated that COTAs value a work setting that provided sufficient space to evaluate and treat patients and to store equipment and supplies needed for patient care. Further, resources and time to perform tasks were also important to COTAs. Since the interaction between people, equipment, and work flow is important, it is not surprising that COTAs’ organizational commitment was positively influenced by general working conditions. Since the majority of COTAs, both in this study and nationally, work in skilled nursing facilities, administrators and direct COTA supervisors should question whether or not their working environment is designed to meet the extrinsic needs of COTAs (Steib, 1997). If not, then appropriate job re-design strategies may be needed. For example, the work environment should be designed to allocate space for both patient care, paperwork, storage of supplies and equipment, work load, and work flow (Akhtar & Tan, 1994; Freda, 1992). Since the primary role of the COTA is patient treatment, employers should continuously update their therapeutic equipment to enhance patients’ functional performance. If the COTA rotates between various specialty areas or teams, each area should be sufficiently designed to meet both the patient’s and COTA’ s needs. Salary Salary had a significant positive influence on COTAs’ organizational commitment although its contribution was low ( = .21) . Since the majority of COTAs in this study worked in skilled nursing homes, perhaps their salary was at a higher level than salary levels in other health care settings. While most employees consider salary important, several decades of research has demonstrated that other work rewards have a greater impact on employee commitment. If an employee is satisfied with a given salary and perceives that salary to be in an acceptable range, then other predictors of organizational commitment may become more important in the employee’s view of their employer. Thus, administrators who wish to improve COTAs’ organizational commitment should not only provide a salary that meets the qualifica-
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tions of the COTA, but acknowledge that the COTA’s roles differ from the OTR’s roles. Further, administration should continue to develop strategies to enhance the rewarding and interesting nature of the COTA’s job tasks (involvement), and be supported by the work environment and promotional opportunities.
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Promotional Opportunities Promotional opportunities had a significant positive influence on COTAs’ organizational commitment although its contribution was low ( = .21). Perhaps COTAs have the extrinsic need to be recognized and rewarded for their advancement in professional skills. Since the majority of COTAs work in a skilled nursing facility, the authors question whether the COTAs working in skilled nursing facilities were hired by the facility itself or were working on a contract basis through a health care agency. Further, the authors speculate that promotional opportunities may differ if the COTA is hired by the facility itself or is a contract COTA. A career ladder as suggested by Homminga (1996) is one method that COTA managers may want to consider when re-designing the COTA’s job. Additionally, encouraging active participation from COTA(s) when developing this ladder system will assist them in meeting their extrinsic needs. Competency testing of the COTA’s professional skills offers managers and COTAs another avenue in providing promotional opportunities that will not only motivate the employee, but also enhance recruitment and retention strategies and decrease burnout. Lastly, the authors suggest that managers design promotional opportunities for COTAs even if the health care setting employs only one COTA. Although promotional opportunities did not seem to be a major factor in determining COTAs’ organizational commitment, strategies that provide incentives for promotion that also simultaneously involve COTAs in their jobs may further clarify their commitment to their organizations. Supervision Although supervision was not identified as a significant determinant of COTA’s organizational commitment, administrators and direct supervisors of COTAs should recognize that their supervisory skills
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and methods may indirectly determine whether the COTA’s intrinsic and extrinsic needs are met. The COTA should be proactive and assist management in developing these job re-design strategies. For example, allowing the COTA(s) to assist with the development of treatment protocols or program development not only promotes task involvement, but also enhances motivation and job performance. Direct COTA supervisors should also recognize the COTA’s accomplishments through verbal and/or written praise. If the OTR is not routinely at the site eight hours a day, then perhaps another OTR could act as a mentor and share information with the COTA’s direct supervisor. As mentioned earlier, management could also work directly with the COTA(s) to develop and implement a reward system that offers opportunities to use a variety of skills, talents, and education. Black (1996) suggested that OTRs be cognizant of the COTA’s educational background, responsibilities as designated by AOTA’s Occupational Therapy Roles document (1994), and competencies to ensure that the COTA’s skills are used to their optimal potential. This awareness will not only help meet the COTA’s professional needs, but also promote the working partnership between the OTR and COTA. Autonomy Autonomy was not a significant predictor of COTA’s organizational commitment. Under AOTA’s Occupational Therapy Roles document (1994), a COTA providing OT services must practice under supervision, and this criterion makes it unlikely that the COTA will be entirely autonomous. Perhaps knowing that OTR supervision would always be provided in practice determined why some people chose to become a COTA rather than an OTR. Restrictions placed on COTAs by state regulatory agencies and the health care setting itself may further decrease the COTA’s autonomy and lessen the need for this intrinsic reward. Co-Workers In the present study, co-worker support both from other COTAs and OTRs was not a significant determinant of organizational commitment among COTAs. Perhaps the intrinsic reward (task involvement), and the other extrinsic rewards (general working conditions, salary, and promotion-
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al opportunities) were being met, and therefore, co-worker support was not perceived as a significant determinant of their organizational commitment.
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Limitations The degree to which the findings from this study may be generalized to other COTAs or other regions is unknown. There could be other predictors that influence COTAs’ organizational commitment other than those that were included in this study. Results were based on data collected from those COTAs who returned the survey via mail service. Thus, those who did not participate in this study may have been either too busy to complete the survey, or had low commitment to their organization.
CONCLUSION This is the first empirical study that has investigated predictors of organizational commitment of COTAs working full-time in North Carolina, South Carolina, and Virginia. Thus, this study can provide current and future OT researchers a conceptual framework with which to further examine specific predictors of organizational commitment among COTAs. Findings from the present study have several implications for health care settings and certified occupational therapy assistants. First, designing a reward system should stimulate and support motivation by meeting the COTAs’ needs, ensuring equity, and reinforcing desirable behaviors. COTA supervisors might provide intrinsically rewarding job tasks that are supported by the work environment, equitable salary, and promotional opportunities. Secondly, findings from the present study may be utilized in developing strategies for COTA recruitment. Replication of this study among part-time COTAs in North Carolina, South Carolina, and Virginia may be beneficial to determine if determinants of organizational commitment among these COTAs differ from those who work full-time. Replication of this study could also be performed in other regions of the United States to determine whether predictors of organizational commitment among COTAs are regionspecific and/or work-setting specific. Within each region it may be helpful to compare the needs of COTAs working in urban versus rural
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areas because each area may create different needs and provide varying degrees of support for the COTA. Lastly, as more COTAs work in a variety of health care settings, it may be warranted to examine the predictors of COTAs’ organizational commitment in each type of health care setting. In conclusion, given the demand for COTAs and changing health care working environments, a better understanding of the COTA’s work dynamics and organizational commitment is essential if appropriate COTA recruitment policies, retention and job re-design strategies, and workplace initiatives are to be successful. REFERENCES Akhtar, S., & Tan, D. (1994). Reassessing and reconceptualizing the multidimensional nature of organizational commitment. Psychological Reports, 75(3), 1379-1390. Akroyd, D., Mulkey, W., & Utley-Smith, Q. (1995). The impact of work rewards on radiographers’ organizational commitment. Radiology Management, 17(2), 51-56. Alpander, G. (1990). Relationship between commitment to hospital goals and job satisfaction: A case study of a nursing department. Health Care Management Review, 15(4), 51-62. American Occupational Therapy Association, Inc. (1993). Occupational therapy roles. American Journal of Occupational Therapy, 45(12), 1087-1099. American Occupational Therapy Association, Inc. (1994). Guide for supervision of occupational therapy personnel. American Journal of Occupational Therapy 48(11), 1045-1046. Arnold, J., Robertson, I. T., & Cooper, C. L. (1991). Work psychology. London: Pitman. Begley, T. M., & Szajka, J. M. (1993). Panel analysis of the moderating effects of commitment on job satisfaction, intention to quit, and health following organizational change. Journal of Applied Psychology, 78, 552-556. Biggs, H., Flett, R., Voges, K., Alpass, F. (1995). Job satisfaction and distress in rehabilitation professionals: The role of organizational commitment and conflict. Journal of Applied Rehabilitation Counseling, 26(1), 41-46. Black, T. (1996). COTAs and OTRs as partners and teams. OT Practice, 1(3), 42-47. Centers, R. & Bugental, D. (1966). Intrinsic and extrinsic job motivation among different segments of the working population. Journal of Applied Psychology, 50, 193-197. Farrell, D., & Stamm, C. (1988). Meta-analysis of the correlates of employee absence. Human Relations, 41, 211-222. Freda, M., (1992). Retaining occupational therapists in rehabilitation settings: Influential factors. American Journal of Occupational Therapy, 46,(3), 240-245. Griffin, R. W., & Bateman, T. S. (1986). Job satisfaction and organizational commitment in C. L. Cooper & I. Robertson (Eds). International Review of Industrial and Organizational Psychology (pp. 157-188). New York: Wiley.
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Hackman, R. & Oldham, G. (1975). Development of the job diagnostic survey. Journal of Applied Psychology, 60, 159-170. Homminga, T. (1996). My journey as a COTA. OT Practice, 1(10), 39-41. Jackson, S., Turner, J., & Briet, A. (1987). Correlates of burnout among public service lawyers. Occupational Behavior, 8, 339-349. Joe, B. (1996). COTAs: Shaping the future of OT. OT Week, 10(47), 14-15. Katz, R. & Van Maanen, J. (1977). The loci of work satisfaction: Job interaction and policy. Human Relations, 30, 469-486. Leiter, M. (1991). Coping patterns as predictors of burnout: The function of control and escapist coping. Journal of Occupational Behavior, 12, 123-144. Leiter, M. (1988). Commitment as a function of stress reactions among nurses: A model of psychological evaluations of work settings. Canadian Journal of Mental Health, 7,115-132. Manthieu, J. & Zajac, D. (1990). A review and meta-analysis of the antecedents, correlates, and consequences on organizational commitment. Psychological Bulletin, 108, 171-194. Mottaz, C. (1981). Some determinants of work alienation. The Sociological Quarterly, 22, 515-529. Mowday, R. T., Steers, R. M., & Porter, L. W. (1979). The measurement of organizational commitment. Journal of Vocational Behavior, 14, 224-247. Mowday, R. T., Steers, R. M., Porter, L. W., & Boulian, P. V. (1974). Organizational commitment, job satisfaction, and turnover among psychiatric technicians. Journal of Applied Psychology, 59, 603-609. Painter, J. & Akroyd, D. (1998). Predictors of organizational commitment among occupational therapists. Occupational Therapy in Health Care, 11(2), 1-15. Roberts, K. H. & Hunt, D. M. (1991). Organizational behavior. Boston: PWS-Kent Publishing Company. SAS (1987). SAS/STAT guide. Cary, NC: Author. Schwope, C. (1997). Managed care: Choices for COTAs. OT Practice, 2(8), 36-39. Shouksmith, G. (1994). Variables related to organizational commitment in health professionals. Psychological Reports, 74, 704-711. Sneed, J., & Herman, C. M. (1990). Influence of job characteristics and organizational commitment on job satisfaction of hospital food service employees. Journal of the American Dietetic Association, 90, 1072-1076. Steib, P. A. (1996a). Work profile of new COTA grads. OT WEEK, 10(17), 18-19. Steib, P. A. (1996b). Skilled nursing facilities: Top employment setting for COTAs. OT WEEK, 10(47), 16-17. Steib, P. A. (1997). Work profile of new COTA grads. OT WEEK for Today’s Student, 4(1), 10-11.
