Influencing Factors and Improvement Strategy to the Quality of Nursing Work Life: A Review ()
1. Introduction
The research on the quality of work life was initially put forward by the American Automobile Industry Association. It emphasized that enterprises should pay more attention to the occupational health of employees than their own economic benefits [1]. In the medical environment, the quality of work life can make positive contributions to medical institutions, medical staff and patients, such as higher patient satisfaction [2]. With the development of aging population, the workload of nursing has increased, the relationship between nurses and patients has become increasingly severe, and the brain drain of nursing personnel has intensified. These have become important factors affecting the construction and development of nursing disciplines [3] [4] [5] [6] [7]. As a provider of nursing services, nurses lack attention to their own physical and mental health [8]. The quality of nursing work life is a comprehensive evaluation of the quality of working life of nurses. It can negatively predict the turnover tendency of nurses, enhance organizational commitment, increase output efficiency, and improve the quality of nursing service [9] [10] [11]. Therefore, paying attention to the quality of nursing work life is closely related to their quality of work, nursing services and sustainable development of hospitals.
2. Definition of Quality of Nursing Work Life
The quality of work life is a subjective experience, which is influenced by personal feelings and perceptions. It emphasizes the material and spiritual satisfaction of individuals in organizational work [12] [13]. The quality of nursing work life refers to the degree to which the important personal needs of nurses are met by their experience in organizational work while working hard to achieve organizational goals [14].
3. Influencing Factors of Quality of Nursing Work Life
3.1. General Demographic Factors
General demographic factors affecting the quality of nursing work life are listed in Table 1. Age, nursing age, department, job title, salary, education level, marital status, etc., can affect the quality of nursing work life. Nurses with married, older age and longer nursing age are the backbone of hospital nursing work, they are responsible for teaching, scientific research and take care of families and children besides nursing work, these factors often lead to the decline of nurses’ physical fitness, energy and quality of work life [15]. Zhang et al. investigated the quality of nursing work life in a second-class hospital in Wuhan by self-designed scale, the results showed that nurses with lower professional titles had poor perceived quality of work life, at the same time, compared with nurses with an annual salary of less than 40,000, nurses with an annual salary of more than 40,000 had higher quality of work life [16]. Chen et al. investigated the quality of work life of intensive care unit（ICU）nurses, the results showed that ICU nurses with bachelor degree or above had the higher quality of work and life, which is significantly higher than those with secondary vocational education, because the higher the education level of nurses, the more attention they received in hospitals, and the higher satisfaction they perceived in terms of life security and respect [17]. Another study found that the total score of quality of nursing
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Table 1. General demographic factors affecting the quality of nursing work life.
work life in emergency department was lower than that of nurses in general department [18].
3.2. Personal Psychological Factors
Psychological resilience refers to the process in which an individual actively copes with adversity, trauma or other major stresses [19]. The research of Hegney showed that psychological resilience was positively correlated with the quality of nursing work life [20]. Zhu et al. found that the psychological resilience and quality of nursing work life in operating room and emergency department were in the lower middle level, and the psychological resilience was positively correlated with the quality of work life [4] [21].
Psychological empowerment refers to the empowered individual’s inner experience of work significance, self-efficacy, autonomy and work impact, and it is the individual’s psychological response to the cognitive status of work role [22]. Improving the level of psychological empowerment of nurses can improve their working enthusiasm and the quality of work life. Sparks et al. found that psychological empowerment was a predictor of the quality of nursing work life [23]. And another study showed that psychological empowerment was positively correlated with the quality of nursing work life. When nurses were empowered by psychological empowerment, positive attitudes, behaviors and organizational outcomes were produced [24].
3.3. Family Factors
Nursing work has the characteristics of high labor intensity, overload operation and frequent shifts. Nurses have been under stress for a long time. It is difficult for them to adjust the time and energy into work and family reasonably. It is easy to cause nurses to increase their turnover tendency, job burnout, and decrease the quality of marriage, resulting imbalance between work and family life [25]. Huang et al. found that about 80% of nurses thought they had no time to take care of their families, and more than 60% of nurses felt exhausted after work [26]. Another survey showed that work-family conflict of nurses was negatively correlated with the quality of work life (P < 0.01) [27].
3.4. Working Factors
Maddalena et al. studied the factors affecting the quality of work life of Canadian new nurses through qualitative interviews, it was found that new nurses were highly motivated to provide high-quality care, but they wound encounter many stressors, which were aggravated by staff shortage and heavy workload and wound reduce their quality of work life [28].
A study showed that 80.1% of emergency nurses had experienced workplace violence, 87.7% of emergency nurses had workplace tension, and there were significant differences in the scores of the quality of work life of emergency nurses with different workplace violence and workplace tension (P < 0.05) [18]. Another study showed that nurses’ job insecurity and its dimensions were negatively correlated with the quality of work life (P < 0.001) [9].
3.5. Organizational Factors
Nowrouzi et al. reviewed literatures on the relationship between internal and external variables of the quality of nursing work life in the United States and Canada from 2004 to 2014, and found that the factors affecting the quality of working life were not only the salary or workload of nurses, but also the healthy and safe organizational environment [29]. Opollo’s survey showed that poor organizational environment was a key factor leading to low quality of work life and high frustration among Ugandan nurses [30]. Lin et al. surveyed 381 medical workers in Taiwan and found that the organizational environment was positively correlated with the quality of nursing work life [31].
Yao et al. conducted a questionnaire survey on 416 nurses in Yunnan hospitals, the results showed that seven dimensions of organizational culture (competition, performance evaluation, stability, social responsibility, support, innovation and motivation) were positively correlated with the quality of nursing work life (P < 0.01), indicating that organizational culture could improve the quality of nursing work life (P < 0.01), and ultimately provided high-quality care for patients [32].
4. Improvement Strategy to the Quality of Nursing Work Life
4.1. Strengthen Mental Health Management
Strengthen Mental Health Management Nursing managers should attach importance to nurses’ ability to cope with occupational stress, carry out psychological counseling, understand the methods of maintaining nurses’ physical and mental health and professional psychological quality, and provide psychological assistance when necessary. At the same time, nurses can carry out appropriate outdoor collective activities, cultivate a harmonious organizational atmosphere, create a place to vent their emotions and pressures, urge them to adopt positive strategies to alleviate work pressure, so as to improve nurses’ adaptability and quality of work life [33].
4.2. Flexible Scheduling and Teamwork
Nursing managers should fully understand the work and family situation of nurses, rationally allocate manpower according to the actual situation, seniority and ability of nurses, in order to reduce the workload of nurses [21]. Individualized intervention for nurses with different seniority, because junior nurses are more energetic and less of clinical experience, nursing managers can increase the frequencies of night shift and provide professional knowledge and skills training for them so as to improve their salary and enrich clinical experience, while the frequencies of night shift can be reduced and guidance and coordination work can be increased for senior nurses. At the same time, nursing managers should rationally arrange the work collocation of nurses with different seniority, give full play to their respective advantages, stimulate their work enthusiasm, enhance team cohesion and collaboration ability through team cooperation [18] [34].
4.3. Provide Opportunities for Development
Hinno et al. found that nurses in the Netherlands identified career development opportunities and adequate staffing as key factors in a healthy workplace [35]. A study showed that due to lack of experience and opportunities for continuing education, the job satisfaction of graduates declined after one year of work, while continuing education can improve job satisfaction and work ability, promote them to adapt to the nursing work environment as soon as possible, and ensure professional practice and patient safety [29]. In addition, hospital managers should attach importance to the professional status of nurses, and guide nurses to formulate reasonable career planning to realize their own value [36]. Create opportunities for nurses to show their strengths, encourage them to attend academic conferences and specialized training courses, go out for further study, in order to set up a high-quality talent team.
4.4. Strengthen Organization Construction
In hospital management, excellent nursing managers play a key role in creating a positive and healthy working environment, and have great significance in reducing the turnover rate of nurses and improving their job satisfaction [37]. At the same time, medical staff need to improve their own awareness of prevention education, enhance security forces to ensure personal safety. In the construction of organizational culture, improving the construction of nursing culture is the focus of nursing managers. Nursing organizational culture is the sum of common values, codes of conduct and institutional carriers formed gradually in a specific nursing environment [38]. Objective standards and clear responsibilities are the basis of scientific culture. Managers should establish scientific and reasonable system objectives and standardize nursing behavior. In addition, various cultural activities can be carried out to learn advanced nursing philosophy, so that nurses can clearly define their professional mission. Positive nursing organizational culture can guide nurses correctly. When nurses approve the construction of nursing culture in their organization, they will constantly stimulate work enthusiasm and improve their job satisfaction and quality of work life [39].
5. Summary
To sum up, the low quality of nursing work life is a global problem. Nursing managers should pay more attention to the quality of nursing work life and choose scientific and effective measures. Retrieval literature found that there were few studies on improving the quality of nursing work life in China. It was suggested that researchers could carry out relevant studies to improve the quality of nursing work life, stabilize the nurses’ team and promote the sustainable development of nursing.
Funding Projects
Scientific Research Fund of Hubei Health and Family Planning Commission (WJ2018H231); Scientific Research Fund of Jingzhou Science and Technology Bureau (2017-97).