Nurses’ work environment and intent to leave in Lebanese hospitals: Implications for policy and practice
Introduction
Nurses’ work environment has been highlighted as a priority for health care organizations given its importance in improving retention and reducing shortages (Shields and Ward, 2001, Zurn et al., 2004, El-Jardali et al., 2009a). Researchers have established that poor work environments are the primary underlying cause for nurses’ attrition and turnover, and that healthy work environments improve nurses’ well-being and satisfaction and contribute to improving retention (O’Brien-Pallas et al., 2003, Baumann et al., 2001, Shamian and El-Jardali, 2007). Enhancing the quality of nurses’ work environments is critical in light of the existing global shortages of qualified nurses (Aiken et al., 2004), particularly in developing countries (El-Jardali et al., 2008). The dual burden of shortages and poor work environments threatens quality of patient care and places additional pressure on resource-stretched health care systems (Kingma, 2007, Labonte et al., 2006, Aiken et al., 2002). Creating safer and more attractive work environments is pivotal for reducing high nursing turnover rates and subsequent shortages. This requires a better understanding of the interplay between the various aspects of the nurses’ work environment and how they relate to nurses’ intent to quit their current job to pursue other opportunities whether in the country or abroad (El-Jardali et al., 2009b). This paper systematically examines the various aspects of nurses’ work environment and how it relates to intent to leave within the context of Lebanese hospitals.
Section snippets
Background
Healthy work environments have been defined as mechanisms, programs, policies, initiatives, actions and practices that provide health workers with the physical, mental, psychological and organizational conditions that can improve their health and well-being (Shamian and El-Jardali, 2007). This is linked to better quality of care, enhanced patient safety and societal outcomes in addition to better organizational performance (Griffin et al., 2006 as cited in Shamian and El-Jardali, 2007, page 7).
Objective
The objective of this study is to systematically examine the various aspects of nurses’ work environment in Lebanese hospitals and how they relate to nurses’ intent to leave their jobs. A secondary objective is to assess the utility and validity of the NWI-R within the context of the EMR.
Study design
A cross-sectional design was utilized to survey nurses currently practicing in Lebanese hospitals. Nurses were eligible to participate in this study if they had at least 1 year of work experience in the hospital and if they had completed one of the following educational programs: Bachelors of Science in Nursing (BSN), or Baccalaureate Technique (BT), or Technique Superior (TS), or License Technique (LT) and Diploma. Nursing programs in Lebanon are of two types, university programs which provide
Univariate analysis
Table 1 details the distribution of means and standard deviations across the six subscales. The subscale with the highest mean score was the one measuring nurse/physician relationships (mean = 2.99, SD = 0.60). The subscale with the lowest mean score was the one measuring control (mean = 2.56, SD = 0.56). Results indicate that although nurses were satisfied with their interaction and relationship with physicians, they were displeased with the control they have over their work.
Bivariate analysis
A comparison of means was
Discussion
Study findings indicate that Lebanese nurses are facing critical work environment issues, some of which are strongly associated with intent to leave. Low agreement scores on the subscale measuring participation were highly associated with intent to leave the country and the hospital. This indicates a need to involve nurses in decisions related to their professional practice. Involving nurses in such decisions, even simple aspects of their profession such as scheduling, can empower them, improve
Conclusions
Several work environment issues facing nurses in Lebanese hospitals have been unearthed in this study, including: degree of nurses’ participation, control and career development; particularly for younger nurses who are at a higher risk of turnover and migration.
The aforementioned issues are not beyond the control of nursing stakeholders and do not necessarily require substantial financial investment. However, they require a paradigm shift in the way some of the organizations view their nursing
Acknowledgements
Authors would like to thank the Eastern Mediterranean Regional Office of the World Health Organization for funding this project and the Lebanese Order of Nurses for their support of this national research. Authors would also like to thank Ms. Mirvat Merhi for her assistance in managing the project, distributing the questionnaires and collecting data in addition to Ms. Hala El-Khoury and Ms. Lama El-Jizi for data entry. The authors would also like to thank Ms. Randa Rustom for assistance with
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2019, Journal of Nursing RegulationCitation Excerpt :The latter finding is similar to the results of a descriptive study of healthcare service institutions across the United States that revealed that certified nurse aids in 11 states were doing tasks beyond the basic care tasks listed in the Code of Federal Regulations (McMullen et al., 2015) With regard to score variances by demographic factors, the findings related to young nurses having lower scores than older nurses, as well as married nurses having higher scores than single nurses, align with the results of a study by El-Jardali et al. (2011). The study revealed that Lebanese RNs who are young (less than 30 years old), have less than 6 years of experience, and are single have the lowest scores in work participation; the authors attributed that finding to their demotivation and their intent to leave and find better job opportunities outside Lebanon.
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2018, International Journal of Nursing SciencesCitation Excerpt :Other studies also support these results [25]. A study on this subject reported that a low level of nurses' participation in decisions in their work environment leads to professional burnout [28]. El-Jardali et al. found statistically significant differences between nurses with and without accreditation who worked in hospitals [28].
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