The Impact of Compulsory Citizenship Behavior on Organizational Silence in Nurses: The Roles of Presenteeism and Psychological Inflexibility

Abstract

Background: Compulsory citizenship behavior (CCB) and organizational silence are prevalent among nurses, undermining nursing care quality and potentially threatening patient safety. Prior studies have shown that CCB can lead to employee silence; however, this relationship has not been examined among nurses, and the underlying mechanisms and boundary conditions remain unclear. Aim: This study aimed to test whether presenteeism mediates the association between CCB and organizational silence, with psychological inflexibility serving as a moderator of this process. Methods: A cross-sectional study was conducted among nurses recruited via convenience sampling from three hospitals in Xi’an, Shaanxi Province, China. Four questionnaires were administered to assess CCB, presenteeism, organizational silence, and psychological inflexibility. A total of 400 valid responses were analyzed using Hayes’ PROCESS macro in SPSS to test a moderated mediation model. Results: Presenteeism mediated the relationship between CCB and organizational silence (β = 0.085, 95% CI: 0.039–0.131). Psychological inflexibility moderated the association between CCB and presenteeism: the positive effect of CCB on presenteeism was stronger among nurses high in psychological inflexibility (simple slope = 0.398, p < 0.001) than among those low in psychological inflexibility (simple slope = 0.217, p < 0.001). Conclusion: Presenteeism helps explain how CCB relates to organizational silence among Chinese nurses, and psychological inflexibility strengthens the adverse effect of CCB on presenteeism. Reductions in CCB and presenteeism may be associated with lower levels of organizational silence. Implications for Nursing Management: To improve nursing care and public health, healthcare managers should consider interventions aimed at reducing nurses’ experiences of CCB and presenteeism to help decrease organizational silence. In addition, strategies to reduce psychological inflexibility may help nurses better cope with demanding tasks and stressful work environments.