Quality of work life and turnover intention among primary health care nurses

Quality of Work Life for Health Care Providers

The commitment of health professionals, nurses included, has been found to be profoundly influenced by their Quality of Work Life. Yet, there is limited information on QWL and intention of the turnover of primary health care nurses. This study aims at establishing the relationship between QWL and the turn over intention of the primary health care providers (nurses, physicians, etc.) in Riyadh.

There will be a survey that cuts across the spectrum of nursing practice. Brooks' survey 'Quality of Nursing Work Life' will be used to collect data, establish the expected scale of their turnover and use data questions based on demographics. The sample that took part in the study was identified with the application of purposive quota approach. The participants selected will be requested to attend take part in interviews, following the survey activity. The primary health care providers in three of Riyadh's hospitals filled the questionnaire with responses. The analysis of data will be done using the windows SPSS v 17 by applying general Linear Model, descriptive statistics, Univariate Analysis, hierarchical multiple and standard multiple regressions.

Conclusion of the Study

The study seeks to show that the creation of a Healthy Work Life is critical in ensuring high quality primary health care service from nurses, and guaranteeing better outcomes, along with limiting their turnover by affording them satisfaction with their work.

1. Introduction

1.1. Background of the study

The problem of turnover is a common concern in numerous health organizations. This trend, obviously, has negative implications for health care institutions and the profession itself. Note that this turnover sometimes incorporates nurses quitting the profession and pursuing other careers. Turnover of nurses is a critical issue because it affects the quality and quantity of health care provision care (Hayes, O'Brien-Pallas, Duffield, Shamian, Buchan, Hughes, & ...Stone, 2006). This trend also reduces staffing levels in health care institutions. Eventually, there is a heightened level of stress among the few remaining nurses because they have to work more to meet the same level of delivery. This scenario is a perfect recipe for lack of work satisfaction among some groups of nurses. Such disenfranchisement leads to lower productivity and the eventual departure of experienced personnel. Once the experienced staff members starts to leave, the health care institutions have to do with the less experienced ones. This in turn increases the incidence of error and patient dissatisfaction with the quality of service (Almalki, Fitzgerald & Clark, 2012).

1.2. Problem Statement

QWL is an important tool in helping health managers in institutions establish the effect of home and work environments on the delivery of the nurses within these institutions in terms of work satisfaction, commitment and intention to quit (Jian-An, Hsu-Huei, Hin-Yeung & Jhen-Long, 2009). According to Ramesh, Nisha, Josephine, Thomas & Joseph (2013), a high QWL is necessary if organizations are to attract new employees to their set ups and retain the current ones, (Ramesh, Nisha Josephine, Thomas and Joseph (2013). The only hindrance in Riyadh to achieving such a feat is the limited research level in QWL and failure to probe into the turnover intentions of primary health care providers.

1.2 What is the Significance?

The research findings in this study may go towards helping the health care sector in Riyadh establish strategies and practice standards, including facilitating environments that help in the retention of primary health care providers not only in the institutions they operate from, but also from quitting the profession altogether. This will stem the propensity for primary health care providers in Saudi Arabia to join other careers that are more fulfilling elsewhere (Almalki et al., 2012).

1.3. The Objectives

The study was aimed at establishing the Quality of Work Life of primary health care nurses in three health care institutions in Riyadh City. It is also meant to probe the factors that influence the nurses' Quality of Work Life (Nowrouzi, Lightfoot, Carter, Lariviere, Rukholm, Schinke & Belanger-Gardner, 2015).

2. Literature Review

There have been numerous studies around the area of QWL with respect to nurses. However, most of these efforts have been concentrated in the western world. Riyadh does not have any reported or published study that seeks to establish the relationship between QWL and the delivery, satisfaction and even turnover intention among nurses in the primary health care category. Therefore, the need to conduct a study that explores such relationships is not only important, but urgent in different health institutions in Riyadh. Saudi Arabia is, especially, rife for such a study owing to the fact that it falls behind in homegrown primary health care providers. The situation is aggravated by the fact that there is also an increased turnover rate among health care professionals in Riyadh (Abu-Zinadah, (2006).

A few results of researches done in some facilities in Saudi Arabia show that primary health care nurses, and nurses in general, are not happy with their work (Al Juhani & Kishk, 2006; El-Gilany & Al-Wehady, 2001). One study done in the Al-Madinah area aiming to establish work satisfaction among primary health care nurses and other professionals indicated that 52.4% of the nurses were very dissatisfied with their work. Such a scenario is a sure recipe for compromised performance and consequent poor health service outcomes, among the patients under the care of the unsatisfied professionals. The turnover intention among such people is definitely high; A prospect that is real (Almalki et al., 2012).

The Primary Health Care in Saudi Arabia

The public health care approach is a health concept that has been fully embraced by Saudi Arabia. The country is a clear leader in respect to the Middle Eastern region (Almalki et al., 2012). Primary health care centres are the places patients go to get primary health care service. They offer lots of curative and preventive services. There is a clear referral structure system in which patients who exhibit complications beyond the capacity of a health care facility are referred to a higher level of health care facility. The referral system is systematic and hierarchical, so that the patients who require complex procedures and high levels of health care are referred to the appropriate health care facility expected to provide that level of health care service. These ultimate referral hospitals are referred to as referral hospitals (Almalki et al., 2011). However, the system of command and communication across these levels is not clearly defined or organized. According to one Ministry of Health finding in 2009, 89% of patients who visited health care facilities attended primary health care centres. The total number of patients who made these visits was in excess of 54 million (Almalki et al., 2011, 2012).

Following such realities, the ministry of health has initiated several projects aimed at enhancing primary health care service and the general health care sector performance. The human aspect is essential in the success of health care provision. Therefore, those in decision making positions must focus their energies in establishing better QWL for the primary health care professionals. They must first establish these relationships before they take steps that affect the operations in the health care institutions. Focus on QWL would aid the case of providing better health care services.

Theoretical Framework

There is a theoretical basis for guiding this study. The four prong quality model; the quality nursing Work life is used. It espouses the need to address all the forces that play at the heart of the life of health care providers, .i.e. work life, work design, home life etc. It also employs various demographic variables outlined in the literature review. These variables are closely linked to the satisfaction of nurses and the turnover intention among health care professionals, especially primary health care providers (Almalki et al., 2012).

2.1. Sampling

Quota sampling will be applied to collect samples. It will be based on the populations in each health facility. The actual nurse or physician that needs to participate will be picked through random sampling. Purposive techniques will be used to recruit participants. Contacts will be requested in the final question so that they can be reached for follow up interviews. The final sample was picked from three health facilities in Riyadh, Saudi Arabia (Brooks, 2001).

1.4 Collection of Data

This survey will be availed to the public health care nurses via the PHC department in Riyadh. Each of the selected nurses will be given a pack, which will constitute, a cover letter, the questionnaire and, an envelope. The purpose of the cover letter will be to avail the contacts of the researchers and explain the steps to maintain confidentiality. Each of the respondents will be required to seal completed surveys separately; after which all surveys from the same health facility will be sealed in a single large envelope and mailed back to the department of PHC via internal mail service (Almalki et al., 2012; Barbosa Teles et al., 20140).

Ethics

Approval for adhering to ethics was accorded by the ethics boards of the university and the hospitals where the surveys were to be done. All participating subjects were required to fill and sign consent documents to participate in the study (Nowrouzi et al., 2015).

Analysis

Methods of descriptive statistics, GLM, standard multiple regression, t-test, hierarchical multiple, univariate analysis, ANOVA, will be applied through SPSS v17 for windows to analyze all data collected.

Conclusion

QWL influences the turnover of nurses in health facilities. The level of turnover intention for PHC nurses will be established through this study. The results of this study could be applied for enforcing better QWL and reducing the turnover intention rates.