Nursing Staff' Perception Regarding Factors Influencing Their Performance in General Hospital

Introduction

The performance of nurses is always under scrutiny; this is because nurses perform delicate work that is related to the well-being of human. Nurses are care givers for patient care whether it is at home, hospital, care centers, or anywhere; and giving care is a job that has to be done thoroughly and properly because if not it may cost someone’s life. Therefore, the performance of nurses is an important aspect of making sure that people receive quality service and receive it promptly when this service is required. The performance of nurses differs from one area to another depending on the kind of resources and professional advancement facilities availability ⁽¹⁾.

It is necessary to improve the level of performance for first-line health workers or those who are continuously in contact with the clients, community and patients at all levels of health care. The performance of a health organization depends on the knowledge, skills, and motivation of individuals. Thus, it is important for employers to provide suitable working conditions to ensure that the performance of employees meets the desired standards. It is widely acknowledged that health workers are not producing the desired output of health interventions ⁽²⁾.

Job performance is considered as the measurement of the quality and quantity of human capital which was held by the organization; where there is signification due to the reflection to government performance⁽³⁾. Monil, (2011)⁽⁴⁾defined performance as a completion in a productivity of system in the form of service or good.

Perception is the process, which attributes meaning to incoming stimuli through the human senses; it constitutes of two factors, the stimuli and the individual factors. Knowledge of the perceptual process is essential since the manner in which users of a product and service interpret the information that is affected by their cognitive understanding in which they have established in their minds ⁽⁵⁾.

The issue of employees' performance in relation to achieving organizational goals has occupied management's attention for a long time. Differences in levels of employees' performance are attributed to differences in skill and ability in one part and difference levels of motivation in another. Inadequate skills and ability are usually rectified through training and development ⁽⁶⁾.

Job performance is affected by many situational factors such as environmental characteristics, entrepreneurship dimensions, organization itself, coworkers, and internal factors. Internal factors refer to factors such as personality traits, attitudes, needs, preferences, motivations, entrepreneurship dimensions, and beliefs that motivate them to reacts to situational factors. Also job performance might be affected by other factors such as need to achievement, span of control, self-confidence, capacity, and interaction between these factors ⁽⁷⁾.

Significance of the study

Health care delivery is highly labor-intensive field. The quality, efficiency and equity of services are all dependent on the availability of skillful, competent and motivated health professionals when and where they are needed. There is a growing concern about the poor quality of health services rendered to the population. Also nursing staff is the largest personnel component in the public health sector and are deployed at all levels of the health care delivery system. This study is important because there is a little research that has been documented in Minia government concerning the perceived factors that influence nursing staff performance.

There was a study conducted at Cairo University by Abdelmaksoud, et al., (2017)⁽⁸⁾who found, that nurses perception about factors affecting on their performance were mostly for staff development factor (63.7%) and motivational factor (49.1%). While Njambi(2014)⁽⁹⁾found in his study at University of Nairobi that perceived management style has low levels of influence employees' performance.

Aim of the study:

The aim of the study is to identify nursing staff perception regarding factors influencing their performance at Minia General Hospital.

Subjects and Methods

Research design

A descriptive research design was utilized in this study.

Research question

What are factors influencing performance of nursing staff?

Setting:

The study was conduct at all departments of Minia General Hospital in Minia city.

Subjects:

The subjects of study sample was included all nursing staffs who working at Minia General Hospital during the period of data collection, the total number was (N=251)

Tool of the study:-

One tool was used to collect the data of this study which consisted of two parts as follow:-

Part I: personal data sheet

It was used to collect personal data about the study participants. It included data as age, gender, Educational qualification, years of experience, and name of clinical department.

Part II: Factors Influencing Employee Performance Questionnaire: This part was developed by Kothari (2004)⁽¹⁰⁾, and included (25items) divided into 4 dimensions as follows: Rewards Effect (8 items),Job design influence, (5 items), Training and development opportunities (5 items), and Management style (7 items).Each statement was measured by three point Likert scale ranging as (1=Small extent, 2=Moderate extent, and3= Great extent).

The researcher added some factors that could influence the performance of nurses based on the jury modification and this included: organization policies (10 items) which developed by Zinbarg (2005)⁽¹¹⁾, work environment and supplies (8 items) developed by Hicks& Adams (2003)⁽¹²⁾, and work relations (6 items) developed by Ikramullah Shad’s (2007)⁽¹³⁾. Each of these statements were measured by three point Likert scale ranging as (1 = Disagree, 2 = uncertain, 3 = agree). Thus, the final tool included 49 items divided into 7 dimensions

The scoring system of total performance factors was ranged from 49 to 147distributed as follows:

• From 49 to 81 indicated low perception of factor influencing nursing performance.
• From 82 to 114 indicated moderate perception of factor influencing nursing performance
• From 115 to 147 indicated high perception of factor influencing nursing performance.

Validity of Tool:

The tool was tested for the content validity by a jury of 5 experts in the field of nursing administration; two assistants' professors of nursing administration at faculty of nursing, Minia University; and three assistant professors of nursing administration at faculty of nursing, Assuit University. The necessary modifications were done for their content coverage, clarity, wording length, format, and overall appearance.

Reliability of Tool:

Internal consistency the questionnaires was assessed with the Cronbach's alpha coefficient. Cronbach's alpha coefficient of 0.00 indicates no reliability and a coefficient of 1.00 indicates perfect reliability. The tool was tested for its reliability using Cronbach's alpha test. The alpha coefficients for the seven dimensions for this study were: rewards Effect (α= 0.736), job design influence (α= 0.683), training and development opportunities (α= 0.957), management style (α= 0.857), organization policies (α= 0.740), work environment and supplies (α= 0.699) and work relations (α= 0.706); and the Alpha coefficient for the tool was (0.954).

Procedures

• A written initial approval was obtained from the research ethics committee of the Faculty of Nursing, Minia University.
• Approval to conduct the study was obtained from the director and from nursing director of Minia General Hospital to collect data.
• Tool was adopted and modified by the researcher and then it was translated into Arabic.
• Tool was submitted to a jury of 5 experts in the field of nursing administration to determine its applicability and content validity.
• A pilot study was done and the tool was tested for its reliability using Cronbach's alpha test.
• A group interview was done by researcher to explain the nature and purpose of the study to respondents.
• The time required for filling the tool was estimated after conducting pilot study; and it was between20 to 30 minutes approximately.
• Data were collected in two days a week, it was lasted for two months, and each group interview consisted of ten nurses approximately and last for thirty minutes.
• Data was collected from the beginning October to the end of November 2018.

Ethical Considerations:

• Permission to collect data from the hospital was requested from the relevant authorities before the study was initiated. The request clearly stated the purpose of the study and the type of access needed.
• In keeping with ethical requirements the researcher ensured that the respondents’ briefing message was fair, honest and open about the intent of the study and disclosed the methods to be used in the study.
• In the covering letter, the respondents were briefed about the research objectives prior to the study, and were informed that the study’s findings would be made available upon request. The brief included provisions relating to the respondents’ right to privacy, confidentiality and integrity.
• Respondents were informed that their participation in the study was voluntary and anonymous.
• Respondents were also informed that they could withdraw from the study at any time. Anonymity of the respondents was guaranteed as it was not possible to identify individual respondents.

Statistical design

Upon completion of data collection, the data were scored, tabulated and analyzed through data entry and analysis by computer using the "statistical package for Social Sciences" version 21 to analyze. Data were presented using descriptive statics in the form of percentages, frequency, mean and standard deviation. Inferential statistical testes of significance such as Friedman's ANOVA, Pearson correlation, and independent t-test were used to identify group differences and the relations among the study variables. The p value >0.05indicates non-significant result while. The p value 0.05indicates significant result and is highly significant at (p<0.01) level.

Results

Table (1) Percentage distribution of the personal data of nursing staff (N=251)

Figure (1) Nursing staff classification according to their working departments

The table (1) shows that, more than half (59%) of staff nurse age was ranged from (20-30) years old and about (23.5%) was aged (> 42) years with mean age (33.04+10.49); and the majority (80.5%) of them were females. In addition the table reveals regarding to the qualification that more than one third of staff nurses (41%) have Diploma degree, while (24%)have Bachelor degree; concerning the years of experience among staff nurses it was noted that nearly two thirds (61%) of staff nurse had (1-10)years of experience, while the only (6%) of staff nurse had(>33) years of experience.

Figure (1) shows distribution of nursing staff according to clinical departments there were (16.7%) in surgical unit,(6%)in maternity unit,(3.2%)in pediatric unit,(10.4%) in out-patient unit, (3.6%) in medical unit, (13.9%) in critical intensive care, (5.2%) in operation room, (11.6%) in hemodialysis unit, (16.7%) in NICU, (4%) in orthopedic unit and (8.8%) in emergency room.

Table (2) Mean scores of staff nurses perception as regard to factor influencing performance

Table (2) indicates that the highest mean score is for organization policies(21.79+3.08)and lowest mean score was for training and development opportunities(9.84+3.11). the same table revealed that, The maximum number was for organization policies factor (28);while the minimum number were for job design influence and training, and development opportunities factor(5).Moreover, the nursing staff perceived the most factors influencing on their performance according to their perception was “organization policies(1), work environment and supplies(2), reward effect(3), management style(4), work relation(5), job design influence(6) and training and development opportunities(7) respectively.

Table (3): Levels of staff nurses perception total scores regarding to factors influencing their performance (N=251)

Table (3) indicates that two thirds (71.7%) of staff nurse had moderate level of perception, (23.9%) of staff nurse had low level of perception; while only (4.4%) of staff nurse had high level of perception regarding the total score of factors that influencing nurses' performance. In addition, it was noted that the most factors had highest level perception was for organization policies (35.1%), followed by ''job design influence'' (28.3%), then ''training and development opportunities'' (27.5%). while the most factors had lowest level of perception was ''reward effect'' (65.3%), followed by ''management style'' (61%), then ''work environment and supplies'' (51%).

Table (4) the correlation between the factors influencing performance dimensionsand personal data (N=251)

The table (4) shows that there were statistically significant correlations between age and factors influence performance in favor to ''job design'' (R=0.174,p=0.006), ''reward effect'' (R=0.129,p=0.042), ''training'' (R=0.265,p=0.000), and ''work relation'' (R=0.155,p=0.014). The gender had no statistically significant correlations with factors influence performance except for factor '' workplace environment'' (R=0.292,p=0.000). In relation to educational qualifications, it was found that there were statistically significant negative correlations with factors influence performance in favor to ''training'' (R=0.174-,p=0.006), ''organization policies'' (R=0.143-,p=0.023) and ''work relation'' (R=0.271-,p=0.000).

Regarding to years of experiences, it was observed that there were statistically significant positive correlations with factors influence performance in favor to ''job design'' (R=0.156,p=0.013), ''training'' (R=0.253,p=0.006), and ''work relation'' (R=0.146,p=0.009).In relation to department, it was found that there were statistically significant negative correlations with all factors influence performance.