Relation between Quality of Nursing Work Life and Organizational Commitment

INTRODUCTION

The goal of the health care system is to provide the physical, psychological, and social health for the people, and at the same time create an environment in which the health staff can deliver higher quality and more effective services. Moreover, nurses spend several hours a day in the work environment; thus, quality of work life and organizational commitment are two important components for nursing staff, and dissatisfaction of these issues affects their other roles at home and community (Hashempour, et al., 2018).

Quality of work life (QWL) is a subjective phenomenon that is impacted by personal perceptions and feelings. It refers to attitude towards the job and general satisfaction with work life and feelings of being valued and respected within the organization. Positive working environment and fulfillment of staff needs will lead to retain the current employees and improve the performance of the organization and organizational commitment. Therefore, the organizations should realize “what is required” to retain qualified nurses and to create and maintain suitable working environment that supports competent performance of nursing care (Pio & Tampi, 2018).

Also, it is necessary to consider not only the diverse and complicated dimensions that create individual, group, and organizational needs and desires; but also individual and group differences in terms of high-quality working conditions, when dealing with keeping good employees. Thus, organization should have program to improve the quality of work life program which include any improvement in the organizational culture that support the growth and development of employees in the organization (Ong, et al., 2019).

Subsequently, the nurses' dissatisfaction with their own work life can cause problems such as job dissatisfaction, emotional exhaustion, burnout, job turnover, and poor commitment to the organization. These factors would in turn affect the quality of care provided by nurses. Also, the organization’s success in achieving its goal depends on the quality of human resources. Therefore, attention should be paid to the nurses’ physical and emotional needs. The quality of nursing work life (QNWL) reflects the extent of nurse's satisfaction with important personal needs as growth and safety. Thus, the manager must become less of a supervisor and more of a coach or helper available to provide assistance and support when the need arises (Kowitlawkul, et al., 2019).

Regular assessment of QWL can potentially provide organizations with important information about the welfare of their employees, such as job satisfaction, general well-being, work-related stress and the homework interface. Focusing on improving QWL to increase the happiness and satisfaction of employees can result in many advantages for the employee, organization and consumers. These include improving quality of care, increasing the productivity of both the individual and the organization, and strengthening organizational commitment, (Liu et al., 2018).

Organizational commitment is one of the basic concepts that describe the relationship between an employee and an organization. Organizational commitment is an important occupational and organizational attitude that has drawn researchers’ interests in organizational behavior courses in recent years because it is an important variable in understanding employee’s behavior. Organizational commitment can be defined simply as loyalties to the values and goals of the organization, sense of belonging, dependency, and moral obligation to stay in the organization (Ramdhani, et al., 2017).

Also, Organizational commitment is defined as loyalties to the values and goals of the organization, sense of belonging, dependency, and moral commitment to remain in their organization. The organizational commitment is influenced by work life quality. When the employees are satisfied with their work life, they will be more obligated and stay in their organization; in which the individual’s work life quality had a direct effect on organizational commitment (Osemeke, 2016).

Engagement and retention of sufficient and well-committed nurses are needed for providing safe and effective health care. Leaders should always take into consideration cultural differences, job satisfaction and commitment of staff nurse while framing policies. Nursing leaders must be equipped with the information needed to contribution in making a workplace attract the new nurses, retain the nurses they already has, and searching for ways to re-engineer the healthcare system particularly by providing supportive environment to staff, improve quality of work life, to have good practice and commitment from their staff members (Akter, et al., 2018).

Significance of the Study

Absence of (QWL) leads to dissatisfaction in job, increases absenteeism, lack of motivation and morale, increased accident rates, lack of productivity, lack of organizational commitment, etc. Further it helps in attracting and retaining efficient and effective employees for right job profile, which in turn leads to employees and organizations’ success. The Work Life balance must be maintained effectively to ensure that all employees are working at their peak potential and free from stress (Beloor, et al., 2017).

Moreover, preliminary evidence suggests that the improvement of QNWL is prerequisite to increased productivity in hospitals. Thus, the QNWL is in need of scholarly investigation.  Moradi et al., (2014) reported from their study results that 60% of nurses reported that they had moderate level of quality of working life while 37.1% and 2% had undesirable and good quality of working life, respectively. Also, Lateef, et al., (2021) present in their study about the "Relationship between Quality of Work Life, Psycho-Social Safety Climate and Nursing Staff Work Engagement and Organizational Commitment" and concluded that there was a negative but not significant correlation between quality of work life and organizational commitment. So, the purpose of this article is to explore the relation between quality of Nursing work life and organizational commitment among staff nurses.

Aim of the Study

The aim of the current study was to assess the relation between quality of Nursing work life and organizational commitment among staff nurses.  

Research Questions

1. What are the staff nurses' levels about quality of Nursing work life?
2. What are the levels of staff nurses about organizational commitment?
3. Is there a relation between quality of Nursing work life and organizational commitment?

SUBJECT and METHODS

Research Design

Descriptive cross-sectional research design was used to achieve the aim of the current study.

Setting

The study was conducted in Chest Diseases Hospital, at El-sabah region, Kuwait city, in Kuwait. The hospital consists from 5 building: the main building which include three floors, the outpatients building which include three floors, the pulmonary rehabilitation building which include three floors, the radiology building which include three floors, and the medical records building which include two floors. The hospital beds capacity are 322.

Subjects

Study subject was included a representative sample 30% of total staff nurses who working at Chest Diseases Hospital, at Kuwait. The study subjects were selected randomly from all units and departments (N=193)

Data Collection Tools

Data was collected by using two tools which are self-administered tools and include the following:

Tool (I) it was included two parts as follows:

Part I: Personal data sheet which included information about staff nurses such as: age, gender, nationality, education level, years of experience in nursing, years of experience in current department, and unit.

Part II: Brook’s Quality of Nursing Work Life Survey:

This tool was developed by Brooks and Anderson (2005) to assess the Quality of nursing work life. The tool contained 42 statements about nursing work life, divided into four dimensions as: Work Life-Home life (seven items), Work Design (10 items), Work context (20 items), and Work World (five items). The response for each item was measured on a five-point scale: "strongly agree=5," "agree=4," "uncertain=3," "disagree=2," and "strongly disagree=1."  The score ranged from (42) to (210) and divided as (42 to 98) indicated low QWL, from (99 to 154) indicated moderate QWL level, from (155-210) indicated high QWL.

Tool ІІ: The Organizational Commitment of the Staff Nurses Questionnaire:  

This tool developed by Meyer et al. (1993)and was adopted by the researcher. It included 18 items divided to three factors of organizational commitment (affective, continuance, and normative). Each factor includes 6 items and was measured using five-point Likert scale (1= strongly disagree, 2= disagree 3= neutral, 4= agree, 5 = strongly agree); and there were Four items negatively worded and scoring were reversed. The scoring system was ranged from 18 to 90, and divided as follows; from (18 to 42) indicated low organizational commitment level, from (43 to 66) indicated moderate organizational commitment level, and from (67 to 90) indicated high organizational commitment level. 

Validity of the tools:

Tools were tested for the content validity by a jury of (5) experts in the field of Nursing Administration and no necessary modifications were done. The jury composed of two Assistant Professors from Faculty of Nursing, Minia University; and three Professors from Chest Diseases Hospital, at Kuwait. Each of the expert panel was asked to examine the instruments for content coverage, clarity, wording, length, format, and overall appearance. No necessary modification was done from jury panel.

Reliability of the tools

Reliability of the tools was performed to confirm consistency of tool. The internal consistency measured to identify the extent to which the items of the tools measured the same concept and correlate with each other by Cronbach’s alpha test that revealed good internal reliability for the tools; and it was (0.867) for Brook’s Quality of Nursing Work Life Survey, and was (0.833) for Organizational Commitment of the Staff Nurses Questionnaire

Pilot Study

A pilot study was conducted on 10% (19 nurse's staff) of participants to ascertain the clarity, comprehensiveness, and applicability of the tools as well as to estimate the appropriate time required to fill the questionnaire. Based on pilot study there was no modification done, and it was added to final results.

Data Collection Procedure

v An official letter was granted from the Nursing Faculty Dean at Minia University, ministry of Health – Kuwait and the director of Chest Diseases Hospital, at Kuwait.

v Written approvals were obtained from Director of Chest Diseases Hospital, at Kuwait after explaining the purpose of the study.

v The tools were distributed to all the participants after explaining the purpose and process of data collection. Tools were directly administered and supervised by the researcher with the assistance of head nurse for each department.

v The researcher distributed the study self-administered tools to the participants through morning and evening shift during the working days. 

v Participants were given from 20 minute to 30 minutes to answer the tools. They were allowed to discuss with researcher any item that needs more clarification. 

v The data collection was performed from staff nurses of Chest Diseases Hospital, at Kuwait during the period of 6 months from the beginning of December 2018 to the beginning June 2019. 

Administrative design

A written initial approval was obtained from the Research Ethics Committee of the Faculty of Nursing, Minia University. An official letter was granted from Faculty Dean, Ministry Of Health – Kuwait and director of Chest Diseases Hospital, at Kuwait.

Ethical Consideration

The participants were informed that their participation in the study was completely voluntary and there was no harm if they do not participate in the study. Informed consent was obtained from staff nurses after explaining the nature and benefits of the study. Each tool was coded, and participants' name was not appearing on the sheets for the purpose of anonymity and confidentiality.

Data statistical analysis

Data entry was done using compatible personal computer. Statistical analysis done by using statistical package of social science (SPSS, IBM) version 25 and excel for figures. The content of each tool was analyzed, categorized, and then coded. Data were presented using descriptive statistics in the form of frequencies and percentages for qualitative variables and; means and standard deviations for quantitative variables.

Statistical significance used at P value

Correlation is used to test the nature and strength of relation between two quantitative variables. The spearman correlation co-efficient (RHO) is expressed as the Pearson coefficient. The sign of the co-efficient indicates the nature of relation (positive/ negative) while the value indicates the strength of relation as follows: Weak correlation for Rho less than 0.25, fair correlation for rho of value between 0.25-0.499 and moderate correlation for values between 0.50-0.74 and strong correlation for values more than 0.74.

RESULTS

Table (1): Distribution of the staff nurses according to their personal data (n= 193)

Table (1): presents that (43.0%) of staff nurse's age are between 29 - < 39 with mean age 41.9 ± 7.5 years; there are (52.8%) of them have Nursing secondary school of nursing (diploma), and there are (46.1%) of them have from 11 to 20 years of experience in the nursing field and current department.

Figure (1): Distribution of the staff nurses according to their nationality (n = 193).

Figure (1) shows that the (87.6%) of the staff nurses nationality are Indian and the minority of them are Filipina, Egyptian, Indonesian, Syrian, Jordanian, and Iranian (5.2%, 2.6%, 2.6%, and 2.0% respectively).

Figure (2): Distribution of the staff nurses according to their gender (n = 193)

Figure (2) shows that (79.8%) of the staff nurses are female and only (20.2%) of them are male.

Figure (3): Distribution of the staff nurses according to their work unit (n = 193)

Figure (3) displays that the (53.9%) of the staff nurses work in the cardiology ward and the minority of them work in pulmonary rehabilitation (1.0%).

Table (2): Distribution of Staff Nurses Level of quality of work life and its domains (n= 193)

Table (2): presents that (58.0%) of staff nurses have high level to work life dimension; and there are (81.3%) of the staff nurses have moderate level to work design dimension. Regarding work context, there are (81.3%, 96.4%, 80.3%, and 84.5%) of staff nurses have high level for all sub-dimensions as: Management and supervision, Co –workers, Development opportunities, and Work environment respectively; and for the total of work context dimension there are (83.9%) of the staff nurses have high level.

Also, there are (63.7%) of staff nurses have moderate level to work world dimension. Speaking about total score of quality of work life, there are (57.0%) of staff nurses have moderate level to the total quality of work life; and (43.0%) have high level to the total quality of work life.

Table (3): Distribution of Staff Nurses Level Organizational Commitment dimensions (n=193)

Table (3) presents that (92.2%) of staff nurses have moderate level to affective commitment dimension, as well less than (71.0% & 69.9%) of them have moderate level to the continuance and normative commitment to the organization respectively. Concerning total organizational commitment, there are (86.5%) of staff nurses have moderate level of total organizational commitment; while only (13.5%) of them have low level of total organizational commitment.

Table (4): Correlations matrix between the quality of nursing work life of staff nurses' and their organizational commitment

*Correlation is significant at the 0.05 level          **Correlation is significant at the 0.01 level

Table (4) presents that there are positive associations between total organizational commitment of the nurse's staff and their work life, work design, work context , work world, and total quality of nursing work life  (r=0.265, P  < 0.0001; r=0.389, P  < 0.0001; r=0.360, P  < 0.0001; r=0.329, P  < 0.0001; r=0.454, P  < 0.0001 respectively). Also, there are positive associations between total quality of nursing work life of staff nurses and their affective, continuance and normative commitment (r= 0.172, P < 0.017; r= 0.374, P < 0.0001; and r= 0.478, P < 0.0001 respectively).