Quality of work life and factors associated with it among nurses in public hospitals, Iran – Journal of the Egyptian Public Health Association

This study demonstrated that the mean score of QWL was 2.62, which was a low level. Likewise, 69.3% of nurses perceived their QWL as low. These results are in line with other similar researches in Iran [3, 17], while the QWL as perceived by nurses in Bangladesh, China, Canada, and Taiwan was at moderate level [2, 9, 18, 19]. Also, the results of this study were consistent with the results of three studies in Ethiopia, Egypt, and Nigeria [11, 20, 21]. There may be differences related to societal values, economic conditions, employment structures, and management of Iranian hospitals compared to other countries.

The low QWL in this study may be due to a reform made in the Iranian health system with the current implementation of the Health Sector Evolution Plan (HSEP). Inequity in wages and workload are the consequences associated with this reform [22]. Salarvand et al. came to the conclusion that the HSEP has led to increasing workloads, capped salaries, staff shortages, and negative impacts on physical, mental, social, and professional outcomes which were previously identified as factors that decreased hospital nurses’ work satisfaction. Furthermore, the implementation of this reform has intensified the burnout among nurses [23].

The most important reasons of low QWL were inadequate and unfair payment, lack of solving staff problems by organization and absence of management support, job insecurity, high job stress, unfair promotion policies, and lack of participation in decision-making. These results are consistent with Mosadeghrad’s studies (2013, 2011) in Iran [3, 17].

Salaries and financial supports were identified to be determining factors in the dissatisfaction of respondents with their QWL. Though it has been demonstrated that salary is not the main incentive for employees [24], behavioral theorists such as Herzberg and Maslow show that fulfilling basic needs is necessary because people cannot focus on their higher needs unless basic their needs are satisfied [1, 5]. Accordingly, some studies have shown that wages, financial benefits, and equality in pay were very crucial to nurses [1, 5, 25], and the lack of such benefits may have effect on the job satisfaction, performance, and commitment of nurses [26, 27].

The nurses in this study were not satisfied with the chances for professional development (i.e., opportunity to further education, career advancement, and access to continuing education). This result is consistent with previous nursing studies in Iran [3, 28]. Hart’s study showed that respondents who participated in an educational course were less likely to quit their positions than those who did not attend in any program [29]. Another factor that was reported in prior studies was nurses’ dissatisfaction with career advancement [1, 28]. Similarly, Rout’s study in the north-west of England revealed insufficiency of opportunities for career development and low amounts of job satisfaction among the nurses [30]. A study in Ethiopia reported that the promotion opportunities and professional growth had an influential impact on the QWL of nurses [11].

Lack of solving staff problems by the organization and the paucity of managerial support were found to be problematic issues in the QWL. These problematic areas included weakness of supervision, feedback, involvement in making decisions, and respect shown by management. Sufficient procedural guidelines and working policies are also influential in this regard. Approximately, 78% of nurses believed that their hospital managers do not reply to staffs’ concerns in Atefi et al.’s study in Iran [28]. Similarly, Mirzabeigi et al. concluded that Iranian nurses complained about managerial issues [31]. In former researches, nursing administration practices were identified to be related to the quality of care, personnel productivity, staff satisfaction, and the intention to quit or stay [32,33,34,35].

Another key factor in the dissatisfaction of nurses with their QWL was high job stress. Several researches concluded that stress in the work environment decreases the level of QWL of nurses [3, 9, 17]. A study recently (2019) reported long working hours, shift work, under-staffing, inadequate pay, discrimination at work, unsupportive management, and poor communication as the major sources of occupational stress among Iranian nurses [36]. This type of stress may have deleterious impacts on a nurse’s physical as well as mental and emotional health [37]. Workplace stress can have negative impact on the quality of care [38].

Job insecurity was another main factor in the dissatisfaction of the QWL of nurses. This issue was identified in Mosadeghrad et al.’s study [17] as a key factor negatively influencing the QWL of hospital staff. Hsu and Kernohan also identified job insecurity as a factor affecting the QWL of nurses [5].

Our findings revealed that being younger, single, and male, having a lower educational level, and working in a teaching hospital were all associated with lower QWL levels. In line with other studies, male respondents had significantly lower mean scores of QWL than female nurses [3, 12]. The generally higher scores may be explained by the fact that males are the partner who is responsible for earning money to support the family. Another reason could be that in Iran, nursing has been viewed as a profession for women and it is traditionally more acceptable for women than for men [28].

Older nurses had significantly higher mean scores of QWL than younger nurses. Many studies have found that older respondents are more satisfied than younger [3, 9, 12, 28]. This may be related to the capability of older nurses in their adaptation to the workplace [39]. Apart from that, older staff are appreciated and understood by managers, and as a result, they appear to be more satisfied.

With regards to the marital status, single nurses had significantly lower mean scores of QWL than the others, a finding which is consistent [1, 3, 12] with former researches. This result may be attributable to the lack of the skills of the single nurses in coping with the challenges in the workplace and possibly to the fact that most of the married nurses lived with their families, which in turn increased their job satisfaction significantly [28].

This study found that the QWL of nurses with higher educational status was higher than nurses with lower educational status. These findings are in line with the results reported by studies conducted in Bangladesh and Ethiopia [9, 11]. However, this result is not parallel with the results of previous nursing studies in Iran [3, 12]. It is likely that nurses with higher education levels have higher expectations of their working life and consequently experience more emotional exhaustion when their work environment does not meet their expectations.

Working in teaching hospitals was also identified as a predictor of low QWL, as has been reported in a previous study [26]. Longer working hours contribute to greater burnout [40] and higher workloads in teaching hospitals, because of the requirements of student teaching programs and workplace demands [26].

4.1

Limitations

There are some limitations of the present study. First, the design of the present study was cross-sectional; future researches should apply other designs to confirm the results and explore the causality of relationships. Second, our study was conducted among nurses working in public hospitals, and therefore, the findings might not be generalized to private hospitals. Finally, in the present study, QWl was measured by self-report only which may not reflect the true picture of the QWL.