|Year : 2021 | Volume
| Issue : 1 | Page : 70-74
Impact of quality of nursing work life on turn over intention among staff nurses working in selected private hospital of South-Western Rajasthan
Swati Negi1, Hitesh Vaishnav1, Ranjit Nagar1, Chris Thomas2
1 Final Year B.Sc Nursing Student, Saroj Lalji Mehrotra Global Nursing College, Abu Road, Rajasthan, India
2 Assistant Professor, Saroj Lalji Mehrotra Global Nursing College, Abu Road, Rajasthan, India
|Date of Submission||19-Mar-2020|
|Date of Decision||18-Jun-2020|
|Date of Acceptance||20-Oct-2020|
|Date of Web Publication||07-Jul-2021|
Mr. Chris Thomas
Department of Psychiatry Nursing, Saroj Lalji Mehrotra Global Nursing College, Abu Road - 307 510, Rajasthan
Source of Support: None, Conflict of Interest: None
Quality of work life (QWL) refers to an employee's satisfaction with working life. A high QWL is critical for healthcare organisations to attract and retain qualified, committed and motivated employees. The QWL and nurse turnover are challenging issues for health care organisation because of the consequences and impact on patient care. Low satisfaction of nurses with their quality of working life results in a high intention to leave. The objectives were to assess the level of quality of nursing work life (QNWL), to identify the turn over intention among staff nurses, to find out the association between QNWL, turn over intention and selected work-related characteristics and to determine the correlation between QNWL and turn over intention to leave the job among staff nurses. The research approach used was quantitative and the research design was non-experimental, correlational design. The data were collected from 100 staff nurses selected from private hospitals of South-Western Rajasthan using non-probability purposive sampling technique. The data were collected with the help of Brooks and Anderson's QNWL scale and Anticipated Turnover Scale. The highest percentage (58%) of staff nurses had moderate QNWL, 42% have high QNWL and none of the staff nurse had low QNWL. Majority (60%) of the staff nurses had the intent to leave. There was a significant association between current nursing position and QWNL (P < 0.05). Findings revealed that there was significant association between nursing position, type of unit and intention to leave and there was high significant association between salary, nature of job and intention to leave the job (P < 0.05). There was weak significant positive correlation (r = 0.33) between level of QNWL and level of intention to leave. Work-related characteristics can influence QNWL and intention to leave.
Keywords: Nursing, staff nurses, turnover intention, work life
|How to cite this article:|
Negi S, Vaishnav H, Nagar R, Thomas C. Impact of quality of nursing work life on turn over intention among staff nurses working in selected private hospital of South-Western Rajasthan. Indian J Cont Nsg Edn 2021;22:70-4
|How to cite this URL:|
Negi S, Vaishnav H, Nagar R, Thomas C. Impact of quality of nursing work life on turn over intention among staff nurses working in selected private hospital of South-Western Rajasthan. Indian J Cont Nsg Edn [serial online] 2021 [cited 2021 Aug 1];22:70-4. Available from: https://www.ijcne.org/text.asp?2021/22/1/70/320815
| Introduction|| |
Hospitals have a major role in the health agency in regard to quickening the improvement of well-being of the population. Hospitals are essential to improve the quality of health service. Nursing is a profession which has a vital role in the hospital as part of health care delivery system. Nursing is a calling to serve humankind. Nursing is a profession which is centered around the care of individuals, family, group and community so that they may achieve optimum health, well-being and ultimately improve the quality of life (QOL).
Quality of work life (QWL) is a new concept which is characterised as the general nature of an individual's work life. QOL incorporates overall health, personal satisfaction, social relationship, financial conditions and psychological well-being of an individual. Quality of Nursing Work Life (QNWL) is defined as a degree to which nurses can satisfy their important personal and working needs in the organisation where they work by accomplishing their organisational objectives, so that they can make effective contributions towards their organisation.
The scarcity of qualified nurses is highlighted as a major issue in many health care organisations and turnover rate is increased among nurses. Nurses with less satisfaction with their QWL have high turnover intention which has a negative effect on the patient care. Every organisation needs to assess QNWL to explore and understand about nurses recruitment and retention.
A cross-sectional study was conducted to determine the QNWL among nurses working in selected private hospitals at Thanjavur, Tamil Nadu. The study was conducted on 253 nurses from selected five hospitals. The tool used was Brooks QNWL. The results showed that 67.2% of the nurses were dissatisfied with the quality of their work life. The majority of the respondents (88.5%), were not able to balance work life with their family desires. The educational status, monthly income, working unit and work environment were strong predictors of QWL among nurses (P < 0.05). The findings reported that perception of nurses about the quality of their work life can be modified if health care managers are considerate of the key issues surrounding QNWL.
In another study by Al-Tannir et al., the correlation between QNWL and nurses turnover intention was explored on 364 nurses in Saudi Arabia. The study found that nurses were dissatisfied with their work life (54.7%). Almost 94.5% with dissatisfied QNWL indicated a turnover intention from their current hospital, and 93.3% of nurses who reported satisfaction with QNWL also indicated the intention to turnover.
With the consideration of above literatures, it has been found that poor support system, poor work life condition, job dissatisfaction, high workload cause low QWL among nurses which lead to high absenteeism and high turnover. Currently, shortage of qualified nurses, high turnover rates, poor retention is on-going problems for private health care organisation. During clinical posting, researchers have overheard some nurses discussing about leaving the private job since they face a higher workload, experience conflicts and are underpaid compared to Government organisation. Due to lack of job satisfaction, their QWL gets affected and because of frustration they plan to leave the job. Hence, this study was done to assess the impact of QNWL on turnover intention among staff nurses working in selected private hospitals of South Western Rajasthan.
| Methodology|| |
The research approach used was quantitative and research design was non-experimental, correlational design. The data were collected from 100 staff nurses of selected four private hospitals of South-Western Rajasthan. Sample size was calculated using Raosoft sample size calculator with 5% margin of error and 95% confidence interval. The population of staff nurses who met the inclusion and exclusion criteria were only 135. Only private hospitals were selected because the literature suggested that turnover intentions were more common in private hospitals rather than in Government hospitals. The participants were recruited using non-probability convenience sampling technique. Staff nurses who had experience of more than 1 year were included in the study. Those who were working in the post of Chief Nursing Officer/Nursing Superintendent and staff nurses who were in notice period of resignation were excluded from the study.
The data were collected with the help of Brooks and Anderson's QNWL Scale and anticipated turnover scale (ATS). QNWL is a self-administered questionnaire which has 42 items and it has four subscales which focus on work life or home life (7 items), work design (10 items), work context (20 items) and work world (5 items). It was scored on a six-point Likert scale in terms of strongly disagree, moderately disagree, disagree, agree, moderately agree and strongly agree. The minimum score was 42 and the maximum score was 252. The scores were interpreted as 42–84-low QWL, 85–168-moderate QWL, and 16–252-high QWL. The reliability of the scale is 0.90 and the construct validity is 0.89. ATS is a 12-item self-administered questionnaire developed by Hinshaw et al. to identify turn over intention among nurses. It was scored on a seven point Likert scale in terms of strongly agree, moderately agree, slightly agree, uncertain, slightly disagree, moderately disagree and strongly disagree. If a participant chooses “agree strongly” to a positively scored item, the answer equals to 7. “Strongly disagree” on an item is coded as “1.” The inverse is true for negative items. All items have “uncertain” equal to 4 on the 7-point Likert scale. Items are either positive or negative: items 2, 4, 5, 7, 11 and 12 are positive, while 1, 3, 6, 8, 9 and 10 are negative. Nurses with an ATS score ≥4.0 were categorised as intent to leave, while those with an ATS score <4.0 were categorised as without intent to leave. The reliability estimated with Cronbach's α was 0.85.
Before data collection, ethical approval was obtained from Institutional Ethical and Research Committee and permission from Directors of selected private hospitals in South Western Rajasthan. An informed consent was obtained from the participants. The data were collected during morning shift, when nurses had committed to spend half an hour, as per their convenient time or if possible after their duty hours. The data collection was completed in 3 weeks. Frequency, mean, mean percentage, median, standard deviation were used for describing baseline data and work-related characteristics and assessing QNWL and ATS. Chi-square test was used to determine the association between turnover intention and work-related characteristics. Karl Pearson's correlation coefficient was used to identify the correlation between QNWL and ATS.
| Results|| |
Demographic data revealed that highest percentage (36%) of nurses were in the age group of 26–30 years and only 6% were between 41 and 45 years, 49% were female staff nurses, 50% were single, 50% were married, maximum (38%) of them had two children and 59% of them were living in joint family. About half the proportion of them (56%) were having qualification of General Nursing and Midwifery, 25% B. Sc Nursing, 9% Auxiliary Nurse Midwife and 7% had qualification of M. Sc Nursing. Majority (91%) of them had chosen the profession on their own interest.
As far as work-related characteristics were concerned, majority of the staff nurses (62%) had <3 years of experience, 12% had an experience of 7–10 years and only 11% had an experience of more than 10 years. Most of them (74%) were staff nurses, 14% were senior staff nurses, 5% were nursing supervisor and 7% were nurse educators. Majority of them (40%) were working in general ward, 25% were working in private ward, 23% were working in neonatal intensive care unit/intensive care unit, 8% were working in Operation theatre and only 1% were working in casualty and outpatient department. Among them 55% were permanent in job, 36% were in the temporary positions and 9% were contractual. Majority (70%) of the nurses had flexible duty schedule.
[Figure 1] shows that 58% of staff nurses reported moderate QNWL, 42% reported high QNWL and none of staff nurses had low QNWL.
|Figure 1: Distribution of staff nurses according to their quality of nursing|
Click here to view
The highest mean score (75.58 ± 11.66) and median (interquartile range) 66 (81.75–68) which is 69.98% was obtained in the area of work context which falls in the category of moderate level of QNWL. Other dimension like work life, work design and work world were also falling in the category of moderate level of QNWL [Table 1].
|Table 1: Dimension-wise comparison of mean, standard deviation, median, inter quartile range and mean percentage of quality of nursing work-life among staff nurses|
Click here to view
[Figure 2] reveals that 60% of staff nurses had an intention to leave, whereas 40% of them did not have intention to leave their job.
|Figure 2: Distribution of staff nurses according to their turnover intention|
Click here to view
[Table 2] reveals that there was significant association between nursing position, type of unit and intention to leave and there was highly significant association found between salary and nature of job as calculated Chi-square value is more than the table value at P < 0.05.
|Table 2: Association between turnover intention and selected work-related characteristics|
Click here to view
Karl Pearson's coefficient of correlation analysis between level of QNWL and turnover intention shows a significant positive relationship between level of QNWL and intention to leave (r = 0.33, P < 0.05) [Figure 3].
|Figure 3: Correlation between quality of nursing work life and turn over intention|
Click here to view
| Discussion|| |
This study gives an understanding about the QNWL among nurses working in private hospitals and its impact on their intention to leave the job or not. Our study revealed that the majority (58%) of staff nurses has moderate QNWL and (42%) have high QNWL. Moderate QNWL was observed in all dimensions such as work design, work life, work context and work world. Similar to these findings, a study conducted by Suleiman et al., on QNWL and related factors among emergency nurses in Jordan reported that the participants scored moderate levels on all QNWL subscales. This study reported that there is increased workload for nurses which resulted in exhaustion and there is imbalance between work life and home life. There were inadequate nurses in the hospitals and due to heavy workload, they were not satisfied with their job and they felt that they do not provide quality patient care. In our study, in work life dimensions, maximum (55%) nurses reported that rotating schedules negatively affect their life. In work design dimension, nurses (65%) revealed that their workload was too heavy and thus was not able to provide good quality patient care. In terms of work context, they (46%) expressed that sometimes they received less support from the management.
The majority (60%) of staff nurses was intent to leave and 40% did not intent to leave their job. The reasons for intention to leave the job were expressed as job insecurity by 55% of nurses. However, lack of good opportunities and strict managerial policies also made them to think about leaving the job. The findings are supported by a study conducted by Sokhanvar et al., on hospital nurses' job security and turnover intention and factors contributing to their turnover intention showed that around one-third of them intended to leave their profession. They revealed that organisational injustice, job prospect and stability, lack of career advancement opportunities and inappropriate work environment were the major reasons behind their turnover intention.
Our study suggested that there was significant association between nursing position, type of unit and turnover intention and there was highly significant association between salary and nature of job. The findings are supported by a study conducted by Almalki on QWL and turnover intention in Primary Healthcare Organisations who found that the relationship between QNWL and demographic variables of gender, age, nursing tenure, positional tenure and payment per month were significant (P < 0.05). The relationship between turnover intention and demographic variables including nursing tenure, positional tenure and payment per month were significant (P < 0.05). Turnover intention was significantly related to QNWL.
In the present study, correlation analysis between level of QNWL and turnover intention shows that there was weak significant correlation (r = 0.33), which reveals weak positive relationship between of QNWL and level of turnover intention. Moderate QWL score was related to higher turnover intention revealing that moderate levels of QNWL is not adequate to retain staff nurses in their jobs. Similar results have been published by a study conducted by Zarei et al., on the relationship between working life quality and turnover intention among hospital staff who found that quality of working life can significantly affect employee turnover. Even those who report satisfaction can have intention to turnover which shows that multiple factors influence QNWL and intention to leave.
This study emphasises the importance of improving and sustaining QWL for nurses to enhance maximum retention of nurses. Clear job descriptions, rewards, good and resourceful working environment and distributed work load with adequate number of staff will improve QWL and these aspects should be addressed by the administrative personnel of any health care organisation. Assessing QNWL also should become an ongoing exercise to evaluate, monitor and improve work life for nurses.
| Conclusion|| |
The study was conducted to assess the impact of QNWL on turnover intention among staff nurses of selected hospitals of South-Western Rajasthan. There was a moderate level of QNWL and the majority of staff nurses were intent to leave. Work-related characteristics can influence QNWL and turnover intention. There is a significant correlation between QNWL and turnover intention. A happy and healthy employee will make good decision and positively contribute to organisational goals. High QWL will not only attract young and new nurses but also retain the existing experienced nurses. Every hospital can encourage autonomy among their nurses and can adopt fair reward system to retain the nurses, thus turnover intention rate can be reduced to minimum level. Ample opportunities must be provided in hospital to develop competencies of nurses which play a vital role in providing quality care to clients which in turn will reflect in the QNWL.
We would like to express our gratitude to the management of selected hospitals for giving permission to conduct study. We are equally grateful to the participants who participated in the study and gave their valuable time.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Hardjanti IW, Dewanto A, Noermijati N. Influence of quality of work life towards psychological well-being and turnover intention of nurses and midwives in hospital. Nat Pub Health J 2017;12:7-14.
Dayma DL, Mohan M. Psychological well-being of nursing staff employed in government and private hospitals. Int J Educ Manage Stud 2017;7:27.
Venkataraman S, Anbazhagan S, Anbazhagan S. Quality of nursing work life among staff nurses in a tertiary care hospital in Puducherry. Int J Community Med Public Health 2018;5:3853-9.
Kaddourah B, Abu-Shaheen AK, Al-Tannir M. Quality of nursing work life and turnover intention among nurses of tertiary care hospitals in Riyadh: A cross-sectional survey. BMC Nurs 2018;17:43.
Devi BR, Hajamohideen OM. A study on quality of work life among nurses working in private hospitals an Thanjavur, Tamilnadu. IOSR J Buss Manag 2018;20:61-3.
Brooks BA. Development of an Instrument to Measure Quality of Nurses' Worklife. [Ph.D. Thesis] Illinois, USA: University of Illinois at Chicago, Health Sciences Center; 2001.
Gerber RM, Hinshaw AS, Atwood JR. Anticipated turnover among nursing staff. Ariz Nurse 1983;36:5, 8.
Suleiman K, Hijazi Z, Al Kalaldeh M, Abu Sharour L. Quality of nursing work life and related factors among emergency nurses in Jordan. J Occup Health 2019;61:398-406.
Sokhanvar M, Kakemam E, Chegini Z, Sarbakhsh P. Hospital nurses' job security and turnover intention and factors contributing to their turnover intention: A cross-Sectional study. Nurs Midwifery Stud 2018;7:133-40. [Full text]
Almalki MJ. Quality of Work Life and Turnover Intention in Primary Health Care Organization: A Cross-Sectional Study of Registered Nurses in Saudi Arabia. [Ph.D. Thesis] Australia: Queensland University of Technology; 2012.
Zarei E, Najafi M, Rajaee R. The relationship between working life quality and turnover intention among hospital staff. J Health Field 2014;2:25-31.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]