Journal of Arak University of Medical Sciences

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The Effect of the Perceived Organizational Climate on Job Burnout According to the Moderating Role of Social Support in the Employees of Selected Health Centers in Arak City

Atefeh Nobakht, Azita Salarian, Nader Khalesi,
Volume 27, Issue 5 (12-2024)

Abstract

Introduction: In a stressful work environment, individuals experience burnout; meanwhile, social support helps to reduce burnout. Therefore, the current research has investigated the effect of organizational climate on the burnout of employees of selected healthcare centers in Arak City, considering the moderating role of social support in 2023.
Methods: The current research is applied, exploratory, and developmental in terms of purpose. Random sampling and based on Cochran's formula from 134 healthcare workers working in the health center, the questionnaire was completed. Demographic information forms, Maslach's (1993) job burnout questionnaire, Halpin and Kraft's (1963) organizational climate questionnaire, and Zimmet's (1988) perceived social support questionnaire were used to collect data. The results of model structure reliability tests, Cronbach's alpha values, composite reliability values, and rho_a, which indicate the internal correlation of questions of a variable within the model, are higher than 0.7 and have acceptable structure reliability. All the values of the HTMT index were less than the permissible value of 0.9 and were at a satisfactorylevel. Consequently, this test also confirmed the divergent validity.
Results: The results with P > 0.001 and a 99% confidence level of the organizational atmosphere had an inverse effect on emotional burnout and depersonalization and directly impacted individual success. The perceived social support variable did not have a moderating role on the causal relationship of organizational climate with emotional burnout and depersonalization and its direction was reversed. However, it had a strengthening role in individual success and direct direction. In other words, people with more social support have more powerful personal success and vice versa.
Conclusions: Organizational climate is one of the variables of job burnout, and people with higher social support have less job burnout. Therefore, it is suggested that managers conduct in-service training focusing on the components of job burnout and perceived organizational climate. In addition, friendly relations should be established with employees to increase social support, and rewards and welfare measures should be granted.

The Loud Silence of Nurses: Is Our Voice Being Heard?

Mir Amirhossein Seyednazari, Amir Mohammad Dorosti,
Volume 28, Issue 3 (8-2025)

Abstract

In global healthcare systems, nurses are recognized as the main pillars of care, but their voices, despite their vital role, are often lost amidst a cacophony of loud silences. This silence does not signify tranquility, but rather reflects hidden pressures, unexpressed fears, and an imposed passivity in the face of structures that limit the freedom of expression.
"Organizational silence," a concept recognized for years in the fields of management and organizational psychology, has become a global crisis in nursing. According to a qualitative meta-synthesis, over 91% of nurses have experienced organizational silence at least once in their professional careers [1].
The causes of silence among nurses are multifaceted. Part of it stems from defensive silence, meaning a nurse refrains from speaking up before superiors or in hierarchical structures for fear of negative consequences. At other times, we encounter acquiescent silence, where the nurse believes that speaking out is futile and will not bring about any change. Previous experiences of having concerns ignored or autocratic leadership styles reinforce this feeling [1,2]. Furthermore, in some cultures, such as Japan or Egypt, prioritizing group harmony over individual expression leads to the normalization of silence [3].
Silence is not just an individual reaction but a response to an inefficient work environment. Nurses who feel their voices are not heard eventually experience job burnout, decreased motivation, and ultimately, leave the profession [2,3,4]. In a study from Spain, half of the nurses surveyed had considered leaving the profession [3,5]. Job burnout not only harms the nurse's mental health but also reduces the quality of patient care. Fatigue, reduced concentration, and impaired communication with patients increase the risk of clinical errors [1,6].
This vicious cycle of silence and its consequences creates a downward spiral in healthcare organizations:
Silence on staff or resource shortages → Increased stress and workload → Job burnout → Decreased quality of care → Intensified dissatisfaction → More silence.
If nurses feel that their concerns are ignored even when expressed, silence becomes an adaptive strategy [4].
Meanwhile, the financial impact of nurse turnover is also significant. According to estimates, the turnover cost for a single nurse in the United States is over $44,000, and hospitals lose an average of $3.6 to $6.1 million annually due to nurse turnover [7]. This substantial figure provides an economic incentive for systemic interventions to reduce silence and retain human resources.
Solving this problem is not possible through individual training or psychological resilience alone. Although strengthening skills like professional assertiveness can be effective, it will not be sustainable without structural and cultural support [4]. Creating psychological safety in the workplace—where nurses can freely express their concerns without fear of punishment—is a vital starting point for change [6].
Leaders of healthcare organizations play a key role in shaping or dismantling a culture of silence. When managers interact with nurses with empathy, a listening ear, and responsiveness, trust is built, and the space for expression becomes safer. A transformational leadership style, participation in decision-making, and the creation of professional growth paths are among the most important factors in retaining nurses and reducing silence [8].
There is also a need for macro-level policymaking at national and international levels. Programs like the "Global Nursing Workforce," which focuses on supporting the sustainability of the profession, can be effective in addressing the root causes of the problem [7]. Moreover, new guidelines from bodies such as The Joint Commission on preventing workplace violence (effective July 2024), which define requirements for reporting and accountability, can serve as models for combating silence on other issues as well [8].
Ultimately, organizational silence in nursing is not just a communication issue; it is an alarming indicator of the ethical, psychological, and systemic health of healthcare institutions. This phenomenon should be considered an "organizational vital sign." The healthcare system has a duty not only to listen but to act. The voices of nurses must lead to decisions, policies, and structural reforms, so that their silence is no longer loud, but is transformed into an effective cry on the path to improvement.

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