ORIGINAL RESEARCH
Learning and development: promoting nurses’ performance and work
attitudes
Anya Johnson, Helena Hong, Markus Groth & Sharon K. Parker
Accepted for publication 3 September 2010
Correspondence to A. Johnson:
e-mail: anya.johnson@unsw.edu.au
Anya Johnson PhD
Research Fellow
Australian School of Business,
The University of New South Wales,
Sydney, New South Wales, Australia
Helena Hong PhD
Research Fellow
Australian School of Business,
The University of New South Wales,
Sydney, New South Wales, Australia
Markus Groth PhD
Associate Professor
Australian School of Business,
The University of New South Wales,
Sydney, New South Wales, Australia
Sharon K. Parker PhD
Winthrop Professor
UWA Business School,
University of Western Australia,
Perth, Western Australia, Australia
JOHNSON A., HONG H., GROTH M. & PARKER S.K. (2011) Learning and
development: promoting nurses’ performance and work attitudes. Journal of
Advanced Nursing 67(3), 609–620. doi: 10.1111/j.1365-2648.2010.05487.x
Abstract
Aim. This paper is a report of a study of the relations of coaching and developing
clinical practice on nurses’ work place attitudes and self-reported performance, as
mediated by role breadth self-efficacy and flexible role orientation.
Background. Previous research into the effectiveness of nurses’ learning and
development activities has mainly focused on specific skill and knowledge acquisi-
tion outcomes. Few studies investigate the relationship between learning and
development activities and work attitudes or performance, or explore mediating
mechanisms in this process. Previous literature suggests that malleable cognitive and
motivational constructs may be important mechanisms for improving work atti-
tudes and proactive performance.
Method. We surveyed 404 qualified nurses from a large, metropolitan public
hospital in Australia in 2006 using validated measures from previous research.
Descriptive statistics, correlation analysis and hierarchical regression analyses were
conducted.
Results. The results show a clear association between learning and development
activities and work attitudes and performance. Developing clinical practice
improved self-rated performance and coaching improved work attitudes. In addi-
tion, role breadth self-efficacy and flexible role orientation mediated these rela-
tionships and emerge as important mechanisms in the link between learning and
development and work attitudes and performance.
Conclusion. Investment in learning and development activities for nurses improves
outcomes for nurses, the organization and patients.
Keywords: job satisfaction, learning and development programme, nurses,
organizational commitment, work attitudes
Introduction
In Australia and other developed nations, the healthcare
services are often depicted as ‘in crisis’, desperately short of
money and staff and facing enormous challenges, such as an
ageing population, increasing levels of chronic disease and
rising expectations from various stakeholders [National
Health and Hospitals Reform Commission (NHHRC) 2008].
 2010 The Authors
Journal of Advanced Nursing  2010 Blackwell Publishing Ltd 609
JAN JOURNAL OF ADVANCED NURSING

In the face of these challenges, there is growing appreciation of
the critical role that nurses, the largest employee group in most
healthcare organizations, play in dealing effectively with the
demands of modern health care. There is also increasing
recognition of the importance of investing in nurses’ learning,
training and development as a means of enhancing hospital
viability and effectiveness (Whyte et al. 2000).
Learning is often referred to as an experience giving rise
to a relatively permanent change in knowledge, skills or
attitudes, whereas training involves systematic efforts to assist
learning through instruction. Development, on the other
hand, involves many forms of learning and training at both
individual and group levels (Maurer & Tarulli 1994). For the
purpose of this paper, we refer to learning and development
(hereafter, referred to as L&D) as relating to specific training
activities provided by a hospital or external agency.
Background
Numerous types of L&D activities are found in hospitals,
with the expectation that they will lead to more satisfied,
committed staff and improved patient care. Unfortunately,
there has been relatively little systematic research investigat-
ing the outcomes of nurses’ involvement in L&D activities
that will help to justify the expense of such opportunities
(Barriball et al. 1992). In the study reported in this paper, we
empirically tested whether nurses’ self-reported participation
in two relatively distinct types of L&D activities (specifically,
coaching and developing clinical practice) in a large public
hospital affected nurse work attitudes and performance. We
further investigated the psychological mechanisms of this
process. The theoretical framework is shown in Figure 1.
Learning and development outcomes: work attitudes and
performance
There is widespread evidence in the applied psychology
literature that participation in L&D activities is associated
with positive work attitudes, including higher organizational
commitment and job satisfaction (Mikkelsen et al. 1999) and
organizational outcomes, such as recruitment and retention
(Lund & Borg 1999). Providing employees with continuous
L&D opportunities – a process sometimes referred to as being
a ‘learning organization’ – have also been linked to positive
financial outcomes for organizations (Ellinger et al. 2002).
Surprisingly, in the nursing literature there are few empir-
ical studies addressing work attitude outcomes. Much of the
research addresses only skill-based outcomes and knowledge
acquisition (Ferguson 1994). In a review of the nursing
literature on L&D, Barriball et al. (1992) argue the need to
evaluate broader psychological outcomes such as work
attitudes. Other researchers have also suggested the potential
for L&D opportunities to improve the rates of staff retention,
attract back nurses who have left the service (Mackereth
1989), and prevent burnout (Crotty 1987). There is also some
evidence of improved self-confidence (Bignell & Crotty 1988)
and personal satisfaction (Turner 1991) as a result of
participating in L&D programmes.
In terms of performance outcomes, according to Griffin
et al. (2007) employee performance is multidimensional, and
includes typical or core performance and higher level
proactive performance. Core performance refers to perform-
ing tasks which are a requirement of the job (i.e., meeting
expectations) and providing effective patient care. Proactive
performance, on the other hand, is about self-starting and
forward thinking to prevent, rather than react to, workplace
problems (e.g., to make suggestions to improve patients’
long-term recovery) (Parker et al. 2006, Parker and Collins
2010). This aligns with the movement towards ‘person-
centred care’ (McCormack & McCance 2006), which
requires empowering nurses to go beyond their core task
responsibilities and to accept greater accountability and
responsibility for the delivery of patient care through critical
thinking, reflective practices and application of clinical skills.
As with work attitudes, there has been comparatively little
empirical attention to whether L&D activities are effective in
improving performance outcomes. Yu et al. (2008) investi-
gated nurses’ proactivity, and found that participation in a
workplace coaching programme over a 6-month period
was associated with statistically significantly enhanced
Learning &
Development
Professional
development activity:
Coaching
Organizational
development activity:
Developing clinical
practice
Mediating
mechanisms
Role breadth self
efficacy
Flexible role
orientation
Nursing
outcomes
Work attitudes
Performance
 Job satisfaction
 Organizational commitment
 Core task performance
 Quality patient care
 Proactive patient care
Figure 1 Theoretical framework.
A. Johnson et al.
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610 Journal of Advanced Nursing  2010 Blackwell Publishing Ltd

proactivity, core performance, goal-attainment and motiva-
tion. In relation to core performance, empirical results are
mixed. For example, although two United Kingdom studies
showed that specific L&D programmes can improve clinical
practice and enhance patient care (Bignell & Crotty 1988,
Hughes 1990), other evidence suggests otherwise (Stanton &
Crotty 1991). In addition, few researchers have controlled for
age, tenure or seniority, factors which probably influence
participation in L&D activities and work attitudes and
performance. In a review of the literature, Perry (1995)
concluded that studies of the relationship between continuing
professional education and enhanced practice in nursing were
inconclusive and in need of further empirical investigation.
Are all learning and development activities equal?
The mixed results in relation to L&D outcomes may, in part,
be due to a lack of research comparing outcomes for different
types of L&D activities. With most hospitals facing budget
constraints, a more informed approach to commissioning
L&D is called for.
In general, the psychological literature distinguishes
between two main types of L&D activities: organizational-
development activities (hereafter, referred to as ODAs) and
professional-development activities (hereafter, referred to as
PDAs). ODAs focus on organization-specific initiatives,
which are designed to help nurses learn and apply organiza-
tionally relevant skills or information. Examples include
quality improvement projects, evidence-based practice work-
shops and the development of clinical standards. PDAs, on
the other hand, focus on profession-based initiatives, such as
continuing education or attending workshops, designed to
facilitate individual learning and applying professionally
relevant skills or information. Examples include coaching,
career development and mentorship activities.
A review of the organizational literature suggests that
relatively more empirical work has focused on ODAs than on
PDAs. Moreover, few researchers have examined ODAs and
PDAs simultaneously. An exception is Blau et al. (2008), who
compared differential antecedents of self-report participation
in ODAs vs. PDAs and found that positive feelings about
one’s organization related to increased participation in
ODAs, while positive feelings about one’s occupation related
to increased participation in PDAs.
Building on Blau et al.’s findings, we propose that partic-
ipating in ODAs and PDAs will have positive, although
possibly different, outcomes for nurses. However, there is
little evidence on which to predict how the outcomes of these
activities will differ. We examined two distinct activities:
developing clinical practice vs. coaching as exemplars of
ODAs and PDAs, respectively. Developing clinical practice
focused on nurse participation in the development and use of
clinical standards and protocols to help reduce inappropriate
variations in practice and ensure higher quality care. The
coaching activities, on the other hand, focused on facilitating
participants’ development through setting goals, developing
action plans, monitoring progress and evaluating outcomes
(Yu et al. 2008). They included both group and individual
coaching sessions which involved personal or career-related
development plans.
An important initial question was whether these two
activities are effective in promoting positive work attitudes
and performance:
Hypotheses 1(a-e): Nurses’ involvement in coaching and developing
clinical practice (controlling age, tenure and seniority) will be
positively related to: (a) job satisfaction, (b) commitment, (c) core
performance, (d) quality patient care and (e) proactive patient care.
Cognitive mediators of L&D: How do L&D activities
translate into positive work attitudes and performance?
In addition to examining the direct effect of L&D activities
on work attitudes and performance, we proposed that this
relationship was driven by two key cognitive mechanisms:
flexible role orientation and role breadth self-efficacy.
Flexible role orientation refers to nurses’ perceptions of
their roles in terms of whether they feel responsible for work
beyond their immediate operational tasks. Narrow role
orientations are often characterized by the phrase ‘That’s
not my job’. Narrow role orientation is a learned response to
early job experiences (Karasek & Theorell 1990), where
using initiative may have been penalized as overstepping
boundaries, and where nurses may have observed more
experienced nurses using very narrow role orientations. Over
the last 25 years, health care has moved to having an
increasingly flexible workforce, with a greater strategic
orientation focusing on innovation, preventive problem-
solving and a culture of continuous improvement (Parker
et al. 1997). This change has required nurses to change their
view of their own work responsibilities. To embody a
broader and more proactive approach, nurses need to take
ownership and feel responsibility for work beyond their
immediate assigned tasks, and to adopt a flexible rather than
a narrow role orientation (Parker 2007).
Based on this evidence, we expected both types of L&D
activities to counteract narrow role orientations. Specifically,
we expected coaching to broaden role orientation through
support for initiation of new projects, setting goals and
exploring career options, and developing clinical practice to
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Journal of Advanced Nursing  2010 Blackwell Publishing Ltd 611

broaden role orientation through a focus on improving
existing practice. In both cases, thinking ‘outside the box’ and
being rewarded for putting new ideas into practice was
expected to encourage and promote a more flexible role
orientation.
A second cognitive motivational process that has been
shown to be important in explaining performance, and to a
lesser extent work attitudes, is role breadth self-efficacy
(Parker 1998). In general, self-efficacy is characterized as
judgment or beliefs that individuals have about their capa-
bility to perform a particular task and has been found to be a
strong predictor of behaviour (Bandura 1986, Stajkovich &
Luthans 1998). Role breadth self-efficacy is a type of self-
efficacy that has been shown to be particularly important for
the development of proactive work behaviour (Parker 1998,
Axtell & Parker 2003), especially in the contexts of employee
innovation (Axtell et al. 2000) and proactive performance
(Griffin et al. 2007). Role breadth self-efficacy is not about
actually performing more proactive behaviours, but rather
about a nurse’s perceived capability to perform them.
Bandura (1986) suggested that self-efficacy can be enhanced
through vicarious experience (seeing others model the
behaviours), persuasion (coaches and instructors) or enactive
mastery (repeated performance accomplishments in incre-
mental steps). Furthermore, there is evidence that organiza-
tions can enhance role breadth self-efficacy. For example,
Axtell and Parker (2003) found that being involved in active
improvement groups and having increased control over tasks
enhances role breadth self-efficacy. Furthermore, they found
that involvement in L&D activities increases role breadth
self-efficacy, although they did not examine whether this
translated into improved performance and work attitudes.
Based on this evidence, we proposed that different types of
L&D activities can enhance role breadth self-efficacy,
enabling nurses to respond to more challenging, dynamic
and complex environments, which will lead to improved
work attitudes and more proactive performance:
Hypotheses 2(a-e): Flexible role orientation and role breadth self-
efficacy will mediate the relationship between coaching and devel-
oping clinical practice (controlling age, tenure and seniority) and (a)
job satisfaction, (b) commitment, (c) core performance, (d) quality
patient care and (e) proactive patient care.
The study
Aim
The aim of the study was to examine the relations of coaching
and developing clinical practice on nurses’ work place
attitudes and self-reported performance, as mediated by role
breadth self-efficacy and flexible role orientation.
Design
A cross-sectional correlational survey design was adopted
and the study was conducted at a large metropolitan hospital
in Australia with over 400 beds and approximately 45,000
admissions per year.
Participants
The participants were 404 nurses, who provided information
about their participation in L&D activities offered at the
hospital. The sample was broadly representative of the
hospital, with a response rate of around 53%, which is in
line with typical response rates for this type of research
(Baruch 1999). Nurses of all grades and teams were repre-
sented. A statistical power calculation for multiple regression
with alpha set at 0Æ05, with seven independent variables and
small effect size (Cohen 1988) of ƒ2 = 0Æ10 suggested that a
sample size of 127 participants would provide 80% power to
detect an effect.
Data collection
The data were collected in 2006 as part of a wider
organizational-development project. We distributed ques-
tionnaires during ward meetings, and time was allocated for
nurses to complete them. Questionnaires were either col-
lected by the researchers or mailed via a reply paid envelope.
Measures
We sought biographical information and data on partici-
pants’ prior involvement in hospital-wide L&D activities,
and measured work attitudes, performance and mediating
cognitive processes. Unless otherwise indicated, the latter
were measured on 5-point Likert-type scales, where higher
numbers indicated greater extent of, or greater agreement
with, the construct. Nearly, all measures were taken from the
literature and had been validated in previous research.
Internal consistency estimates for all multi-item measures
were satisfactory, with Cronbach’s alpha values ranging from
0Æ77 to 0Æ91 (see Table 1).
Biographical information
Participants indicated their age, gender, seniority (ranging
from Enrolled Nurse to Nurse Manager/Co-Director) and
length of employment at the hospital (tenure).
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612 Journal of Advanced Nursing  2010 Blackwell Publishing Ltd

tasks include ‘analysing a long-term problem to find a solu-
tion’. Flexible role orientation was measured with a 5-item
scale adapted from Parker et al. (1997), using the interviews
described above. Nurses indicated the extent to which they
felt personal concern for problems that might occur, such as
‘a lack of team work within your ward’.
Ethical considerations
The study was approved by university and hospital ethics
committees. Written informed consent was obtained,
participation was voluntary and confidential. Codes were
substituted for names during data entry.
Data analysis
We first analysed the data (using SPSS 15) to generate
descriptive statistics, correlation coefficients and Cronbach’s
alpha reliability coefficients. Confirmatory factor analysis
(CFA) was also conducted to assess the discriminant and
convergent validity of our measures. To conduct hierarchical
regression analyses, for each respondent, an average value of
scale items was computed for each measure. To estimate
how much of the total variance in the outcome variables
could be explained by a group of explanatory variables when
the effect of other explanatory variables had been accounted
for, three hierarchical multiple linear regression analyses
were conducted following Baron and Kenny’s (1986)
method. In step 1 of Regression 1, demographic variables
were entered to control for their effect on both the
explanatory variables and outcomes. The two L&D vari-
ables were added in step 2 to measure their direct effect on
the outcomes, as specified in hypothesis 1. In Regression 2,
we repeated these two steps using the two proposed
cognitive mediators as outcome measures to test the direct
effect of the L&D variables on the mediators. The full model
(Regression 3) measured the variance each mediator
accounted for in the association between the L&D activities
and work attitude and performance outcomes, as specified in
hypothesis 2.
Results
Descriptive statistics
Eighty-five per cent of participants were female, with an
average age of 36 years (ranging from 19 to 64 years) and
average tenure at the hospital of 5Æ7 years. Eighty-one per
cent of participants worked full-time, 16% part-time and 3%
were casual workers. The mean values, standard deviations,
Cronbach’s alpha and correlations for all variables are shown
in Table 1. One hundred twenty-eight nurses had partici-
pated in developing clinical practice and 187 in coaching and
career development activities. Seventy-seven had participated
in both L&D activities. Not surprisingly, senior nurses who
had worked at the hospital longer were statistically signifi-
cantly more likely to have participated in both types of L&D
activities in the previous year (r = 0Æ20, P < 0Æ01 and
r = 0Æ32, P < 0Æ01) and to have higher levels of role breadth
self-efficacy (r = 0Æ39, P < 0Æ01) and flexible role orientation
(r = 0Æ39, P < 0Æ01). Interestingly, seniority had a negative
association with task performance (r = 0Æ12, P < 0Æ05),
but a statistically significant positive association with quality
patient care (r = 0Æ14, P < 0Æ01) and proactive patient care
(r = 0Æ18, P < 0Æ01). Tenure was also statistically signifi-
cantly related to L&D activities (r = 0Æ15, P < 0Æ01 and
r = 0Æ11, P < 0Æ05), role breadth self-efficacy (r = 0Æ20,
P < 0Æ01), flexible role orientation (r = 0Æ13, P < 0Æ01)
and organizational commitment (r = 0Æ15, P < 0Æ01). How-
ever, it was not related to the performance measures. Finally,
age was statistically significantly associated with coaching
activities (r = 0Æ17, P < 0Æ01), role breadth self-efficacy
(r = 0Æ20, P < 0Æ01), flexible role orientation (r = 0Æ11,
P < 0Æ05) and organizational commitment (r = 0Æ16,
P < 0Æ01). Gender was not related to any of our study
variables and was therefore excluded from further analysis.
All other demographic variables were included in the
regression analyses to control for their influence.
Interestingly, there was no statistically significant relation-
ship between the two L&D activities, (r = 0Æ09, n.s.),
indicating that these two types of activities are separate.
There were low to moderate intercorrelations between our
outcome variables, suggesting that multi-collinearity was not
a serious problem (Kennedy 1980, Tsui et al. 1995).
To assess the convergent and discriminant validity of our
constructs, a measurement model of all multi-item measures
was subjected to CFA. The overall fit statistics for our model
indicated a good fit to the data: v2(356, N = 404) = 706Æ49,
P < 0Æ00; comparative fit index = 0Æ93; incremental fit
index = 0Æ93; root mean square error of approxima-
tion = 0Æ05. The model fit was statistically significantly better
than that for a one-factor model: (Dv2[21] = 2871Æ35,
P < 0Æ00).
To provide further evidence of the discriminant validity of
constructs in our measurement model, we followed the
procedures outlined by Fornell and Larcker (1981), who
suggested that the average variance extracted for two
constructs should exceed the square of the correlation
between the constructs to demonstrate discriminant validity.
All constructs showed sufficient discriminant validity.
A. Johnson et al.
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614 Journal of Advanced Nursing  2010 Blackwell Publishing Ltd

Regression analysis
Hierarchical regression analyses were conducted to test our
study hypotheses. Hypothesis 1 suggested that nurses’
involvement in both coaching and developing clinical practice
activities would be positively related to their work attitudes
(job satisfaction and commitment) and performance (core
performance, quality and proactive patient care). To test this
hypothesis, we conducted hierarchical regression analyses
with age, tenure and seniority entered as control variables
in the first step, and both coaching and developing clinical
practice entered in the second step. The results are shown
in Models 1 of Table 2 (for work attitude outcomes) and
Table 3 (for performance outcomes). As can be seen
in Table 2, the regression of work attitude outcomes on
L&D variables revealed that coaching activities were a
statistically significant positive predictor of both job satisfac-
tion (b = 0Æ20, P < 0Æ01), and commitment (b = 0Æ15,
P < 0Æ01). Results for developing clinical practice, on the
other hand, were not statistically significant. In other words,
only one of the L&D activities, coaching, had a positive
relationship with work attitudes, whereas participation in
developing clinical practice did not.
As shown in Model 1 of Table 3, the results for perfor-
mance outcomes were reversed, with developing clinical
practice – but not coaching – emerging as a statistically
significant predictor of core performance (b = 0Æ12,
P < 0Æ05), and a marginally statistically significant predictor
of quality patient care (b = 0Æ10, P < 0Æ08), and proactive
patient care (b = 0Æ12, P < 0Æ06). Thus, we found differen-
tial relationships between the two types of L&D activities
and work attitudes and performance. Whereas coaching
activities seemed mainly to affect nurses’ work attitudes,
developing clinical practice activities appeared to be a main
driver of performance.
Hypothesis 2 suggested that two cognitive mechanisms,
flexible role orientation and role breadth self-efficacy, would
mediate the relationship between L&D activities and work
attitudes and performance. To test this hypothesis, we
followed Baron and Kenny’s (1986) approach to testing for
mediation described earlier. As shown in Models 2 of
Tables 2 and 3, the regression of role breadth self-efficacy
and flexible role orientation revealed that coaching was
positively associated with flexible role orientation (b = 0Æ10,
P < 0Æ07), and developing clinical practice was positively
associated with both flexible role orientation (b = 0Æ12,
Table 2 Standardized regression coefficients (bs) from the hierarchical regression analysis for work attitude outcomes (N = 404)
Independent variables
Model 1 Model 2 Model 3
Job
satisfaction Commitment
Flexible role
orientation
Role breadth
self-efficacy Job satisfaction Commitment
Step 1: Control variables
Age 0Æ01 0Æ08 0Æ03 0Æ11 0Æ02 0Æ07
Tenure 0Æ02 0Æ07 0Æ02 0Æ02 0Æ01 0Æ06
Seniority 0Æ00 0Æ05 0Æ30** 0Æ34** 0Æ06 0Æ00
R2 0Æ01 0Æ04 0Æ13 0Æ17 0Æ00 0Æ03
Adjusted R2 0Æ00 0Æ03 0Æ12 0Æ16 0Æ01 0Æ02
DR2 0Æ01 0Æ04** 0Æ13** 0Æ17** 0Æ00 0Æ03*
Step 2: Main effects
PDA: coaching 0Æ20** 0Æ15** 0Æ10 0Æ05 0Æ18** 0Æ14*
ODA: developing clinical practice 0Æ00 0Æ03 0Æ12* 0Æ11* 0Æ00 0Æ02
R2 0Æ04 0Æ06 0Æ15 0Æ18 0Æ04 0Æ05
Adjusted R2 0Æ03 0Æ04 0Æ14 0Æ17 0Æ02 0Æ03
DR2 0Æ04** 0Æ02* 0Æ02* 0Æ02 0Æ03** 0Æ02*
Step 3: Mediator
Flexible role orientation 0Æ20** 0Æ18**
Role breadth self-efficacy 0Æ07 0Æ08
R2 0Æ07 0Æ07
Adjusted R2 0Æ05 0Æ05
DR2 0Æ03** 0Æ03**
*P < 0Æ05; **P < 0Æ01; P < 0Æ10.
Coded as 1 = Enrolled Nurse, 2 = Registered Nurse, 3 = Clinical Nurse Specialist, 4 = Nurse Educator/Clinical Nurse Consultant/Nurse Unit
Manager, 5 = Nurse Manager/Co-Director.
ODAs, organizational-development activities; PDAs, professional-development activities. All standardized regression coefficients (bs) are from
the final step in the hierarchical regression.
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Journal of Advanced Nursing  2010 Blackwell Publishing Ltd 615

P< 0Æ05) and role breadth self-efficacy (b = 0Æ11, P < 0Æ05).
Finally, Model 3 of Table 2 shows flexible role orientation as
a statistically significant predictor of job satisfaction
(b = 0Æ20, P < 0Æ01) and commitment (b = 0Æ18, P < 0Æ01)
when controlling for L&D activities. A comparison of the
main effect in Model 1 with the main effect in Model 3
showed support for a partial mediating effect. Thus, our
results show that flexible role orientation partially mediates
the effects of coaching on nurses’ work attitude measures.
We followed the same procedure, with our performance
outcomes with the full Model 3 in Table 3 showing that role
breadth self-efficacy predicted core performance (b = 0Æ20,
P < 0Æ01), quality patient care (b = 0Æ35, P < 0Æ01), and
proactive patient care (b = 0Æ31, P < 0Æ01), once L&D
activities were controlled for. A comparison of the main
effect in Model 1 with the main effect in Model 3 showed
support for full mediating effects. Specifically, adding role
breadth self-efficacy as a predictor of core performance
reduced the effects of developing clinical practice on change
in core performance, and adding both role breadth self-
efficacy and flexible role orientation as predictors of quality
and proactive patient care reduced the effects of developing
clinical practice on change in quality and proactive care.
Overall, these results offer partial support for Hypotheses 2
in showing that role breadth self-efficacy and flexible role
orientation appeared to be a driving force in the relationship
between nurses’ participation in L&D activities and resulting
work attitude and performance outcomes.
Discussion
Study limitations
Several limitations of this research should be acknowledged.
The study was cross-sectional and therefore we cannot
completely rule out reverse causality, in that having higher
job satisfaction and commitment may create a more flexible
outlook on work role, which in turn may increase the
likelihood of seeking out coaching opportunities. The same
could apply to the performance outcomes. However, the
differential effect on the psychological mechanisms and
outcomes tends to mitigate against the possibility of reverse
Table 3 Standardized regression coefficients (bs) from the hierarchical regression analysis for performance outcomes (N = 404)
Independent variables
Model 1 Model 2 Model 3
Core
performance
Quality
care
Proactive
care
Flexible role
orientation
Role breadth
self-efficacy
Core
performance
Quality
care
Proactive
care
Step 1: Control variables
Age 0Æ00 0Æ05 0Æ05 0Æ03 0Æ11 0Æ12 0Æ01 0Æ01
Tenure 0Æ10 0Æ03 0Æ03 0Æ02 0Æ02 0Æ10 0Æ02 0Æ02
Seniority 0Æ24** 0Æ07 0Æ17** 0Æ30** 0Æ34** 0Æ34** 0Æ12 0Æ01
R2 0Æ03 0Æ02 0Æ04 0Æ13 0Æ17 0Æ04 0Æ01 0Æ04
Adjusted R2 0Æ03 0Æ01 0Æ03 0Æ12 0Æ16 0Æ03 0Æ00 0Æ03
DR2 0Æ03** 0Æ02 0Æ04** 0Æ13** 0Æ17** 0Æ04** 0Æ01 0Æ04**
Step 2: Main effects
PDA: coaching 0Æ06 0Æ06 0Æ01 0Æ10 0Æ05 0Æ04 0Æ05 0Æ02
ODA: developing
clinical practice
0Æ12* 0Æ10 0Æ12 0Æ12* 0Æ11* 0Æ09 0Æ04 0Æ05
R2 0Æ05 0Æ03 0Æ05 0Æ15 0Æ18 0Æ05 0Æ03 0Æ05
Adjusted R2 0Æ04 0Æ01 0Æ04 0Æ14 0Æ17 0Æ04 0Æ01 0Æ04
DR2 0Æ02* 0Æ01 0Æ01 0Æ02* 0Æ02 0Æ02 0Æ02 0Æ01
Step 3: Mediator
Flexible role orientation 0Æ09 0Æ16** 0Æ20**
Role breadth self-efficacy 0Æ20** 0Æ35** 0Æ31**
R2 0Æ10 0Æ18 0Æ20
Adjusted R2 0Æ08 0Æ16 0Æ18
DR2 0Æ05** 0Æ15** 0Æ14**
*P < 0Æ05; **P < 0Æ01; P < 0Æ10.
Coded as 1 = Enrolled Nurse, 2 = Registered Nurse, 3 = Clinical Nursing Specialist, 4 = Nurse Educator/Clinical Nurse Consultant/Nurse Unit
Manager, 5 = Nurse Manager/Co-Director.
ODA, organizational-development activities; PDA, professional-development activities. All standardized regression coefficients (bs) are from the
final step in the hierarchical regression.
A. Johnson et al.
 2010 The Authors
616 Journal of Advanced Nursing  2010 Blackwell Publishing Ltd

causality. Another limitation was that all the variables were
measured at the same time, which can lead to common
method variance. However, the nurses were asked about their
previous involvement in a predefined list of L&D activities.
This type of response is unlikely to be influenced in the same
way as responses to attitudinal survey items. However,
longitudinal data are needed to examine further the effects of
these variables on the outcomes. Finally, all the data were
self-reports, which is also vulnerable to biases. Ideally, it
would have been better to use external ratings of perfor-
mance and other more objective measures.
Effects of L&D
Much of the research into the effects of L&D has shown
mixed results (Hutton 1987). Some has shown that general
L&D opportunities have positive effects on work attitudes
and patient care (Bignell & Crotty 1988, Hughes 1990,
Turner 1991). However, there is a lack of research linking
specific L&D opportunities to specific outcomes. Our results
provide more clarity about the specific effects of L&D
activities. From a theoretical perspective, it contributes by
distinguishing the effect of two different types of L&D
activities: PDAs and ODAs. Previous literature (e.g., Blau
et al. 2008) has demonstrated preliminary evidence of
differential antecedents to participation in these two types
of L&D activities. However, to our knowledge this is the first
demonstration of differential outcomes of participation in
PDAs and ODAs. Thus, our results suggest that there is
considerable utility in identifying the extent to which a
particular L&D activity is focused on professional develop-
ment vs. organizationally significant skills, and matching
activities to desired outcomes, for example, as identified
through individual professional-development plans.
From a practical perspective, there are two key messages.
The first is that we were able to identify overarching benefits
to organizations from having offered L&D activities to their
nursing staff. This is very encouraging for a number of
reasons. First, while L&D is often offered to nurses to fulfil
accreditation requirements or to ‘sign off’ formally on a set of
skills, our results show that it will also translate into
improved work attitudes such as job satisfaction and
commitment and increased overall performance. While the
effect sizes were relatively small (ranging from 2% to 4% of
the additional variance explained in work attitudes and 2%
of additional variance explained in performance), they will
nevertheless make a difference to nurses’ well-being and
engagement with their work. The second reason is that this
research provides some guidance in choosing different types
of L&D activities to achieve specific outcomes. When
retaining and attracting nurses is a priority, PDAs are likely
to be more effective in achieving this aim. On the other hand,
if the priority is to develop a more proactive workforce with a
greater emphasis on performance, ODAs are likely to give the
greatest return on investment. From a practical perspective,
What is already known about this topic
• Research on nurses’ participation in learning and
development activities is primarily descriptive and
focuses on skill and knowledge acquisition.
• There are mixed findings about whether learning and
development enhance work attitudes and performance.
• Cognitive and motivational beliefs about an individual’s
ability and confidence to work flexibly and beyond
narrow role definitions affect work attitudes and
performance outcomes.
What this paper adds
• Involvement in professional-development activities,
such as coaching and career development improved
work attitudes and involvement in organizational-
development activities, such as developing clinical
practice increases performance outcomes.
• Coaching enhanced a flexible role orientation, which in
turn enhanced work attitudes, such as job satisfaction
and organizational commitment.
• Developing clinical practice enhanced both flexible role
orientation and role breadth self-efficacy, which in turn
enhanced quality patient care and proactive patient
care.
Implications for practice and/or policy
• Investment in nurses’ participation in learning and
development activities can result in positive
organizational outcomes, such as higher job
satisfaction, commitment and improved quality of
patient care.
• When retaining and attracting nurses is a priority,
professional-development activities may be more
effective, whereas when developing proactive patient
care is important, organizational-development activities
may be more effective.
• Flexible role orientation and role breadth self-efficacy,
both malleable constructs, can be elicited through
learning and development opportunities, which in turn
can lead to positive changes in performance and work
attitudes.
JAN: ORIGINAL RESEARCH L&D – promoting nurses’ performance and work attitudes
 2010 The Authors
Journal of Advanced Nursing  2010 Blackwell Publishing Ltd 617

greater understanding of the effect of different types of L&D
activities would be useful in matching staff learning needs to
design and planning training activities. Finally, our results
also suggest that ODAs on their own will not automatically
improve work attitudes, just as only providing PDAs will not
automatically improve work performance.
Interestingly, the pattern of results in our study is not
entirely consistent with previous research. For example, Yu
et al. (2008) found that participation in a relatively long-term
(6 months) solution-focused, cognitive behavioural work-
place coaching programme was associated with enhanced
proactive and core performance and role breadth self-
efficacy, but not work attitudes. However, Yu et al. (2008)
investigated a small group of senior nurses working in
management roles, which may explain the different results. In
our study, coaching activities did not lead to measurable
performance effects. One possible interpretation is that
coaching may have to be highly structured, specific and
focused to achieve performance outcomes.
When nurses participate in L&D that is designed for the
purpose of developing clinical practice, the effects are seen in
increased performance and a more proactive approach to
patient care. That this type of activity may encourage a more
proactive approach that goes beyond the immediate effective
delivery of clinical practice is very encouraging.
Another main contribution of our research is to identify
role breadth self-efficacy and flexible role orientation as two
key cognitive mechanisms through which participation in
L&D activities enhances both work attitudes and perfor-
mance outcomes. Our results suggest that L&D activities
enhance different cognitive motivational states, which in turn
lead to improved outcomes. This finding is in line with
previous research showing that flexible role orientation is
critical for developing proactive performance in other indus-
tries (Parker 2007). Our results suggest that the intervening
cognitive motivational mechanisms are both malleable con-
structs that can be elicited through L&D opportunities,
which in turn can lead to changes in performance.
Conclusion
Overall, these results suggest that if L&D activities increase
cognitive and motivational constructs, such as role breadth
self-efficacy and flexible role orientation, knowledge and skills
gained will flow through to work attitudes and performance,
and in particular proactive performance. In this study, the
coaching activities enabled nurses to look at potential
opportunities for themselves and the organization and to
think beyond their current role. This may provide different
perspectives and enable new insights which feed into a greater
job satisfaction and commitment. Developing clinical prac-
tice, on the other hand, may increase belief in nurses’ ability to
work with more advanced skills and to expand their view of
their roles, resulting in improved and more proactive patient
care. With this knowledge, nurse managers and educators can
intentionally include opportunities for increasing these two
cognitive and motivational constructs to facilitate translating
L&D activities into improved performance and work atti-
tudes and, ultimately, well-being.
Acknowledgements
We would like to thank Nickolas Yu, and the team of nurse
facilitators for their thoughtful insights and positive energy
and Anna Thornton, for her vision, encouragement and
support. We would also like to thank all the nurses who
participated, and the Australian Research Council for
supporting this research.
Funding
This research was supported under Australian Research
Council’s Linkage Projects funding scheme (project number
LP0776767).
Conflict of interest
No conflict of interest has been declared by the authors.
Author contributions
SKP, AJ and HH were responsible for the study conception
and design. AJ and HH performed the data collection. AJ,
HH and MG performed the data analysis. AJ and HH were
responsible for the drafting of the manuscript. MG and SKP
made critical revisions to the paper for important intellectual
content. AJ, HH, MG and SKP provided statistical expertise.
SKP obtained funding.
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