Nurses Performance – Effect of Work Environment, Work Life Balance and Compensation in Health Care Units- An Empirical Evidence
1Dr.S. Umamaheswari , 2Mrs .M .Jayaseely , 3Dr.A.Chandrasekar
1Assistant Professor, School of Management Studies, Sathyabama Institute of Science and Technology, Chennai.
2 Assistant Professor, School of Management Studies, Sathyabama Institute of Science and Technology, Chennai,
3Dr.A.Chandrasekar, Professor & Head, Department of CSE, st,Joseph’s College of Engineering, Chennai.
Abstract
Nurses play an crucialfunction and are the pillar of powerin the healthcare network. Nurses act as teacher, caregiver and critical thinkers however it isn't always an smoothprocess. It is frequently taxing and tiring both mentally and physically. This paper investigates the results of Working Environment, Work Life balance and compensation with jobsatisfaction of nurses in much less attended medium sized hospitals in and round Chennai in India. Further it additionally examines the mediating results of processsatisfaction with relationshipamong proposed elements and performance. 420 data are collectedusing the questionnaire. From the evaluationit isdetermined that the processsatisfactionpartially mediates the connectionamong the factorsindexed and performance. Further, Implication to managers, futurestudies proposals is additionally incorporated.
Keywords: Work Environment, Work life balance, Compensation, Job satisfaction, Nurses performance
INTRODUCTION
In an environment characterized by continuous changes and expectation of high quality service among patients at an affordable cost and also health care professionals are dealing with the most precious thing in this world- ―the human life‖, their performance plays an vital role in hospital set up.
As improved performance of health care staff is linked to the hospital’s sustainable development and lack of performance affects its survival, more importance is being given to their performance. Among health care professionals nurses are the single biggest group(kamal 2011) and nurses are the first approachable staff for attending patient’s needs, and their performance issues are associated to the safety of patients special importance is being given to their performance.
Medical care is a service industry and differs from others because of its works requirements, which includes talents and variety of expertise (Fang et. al 2009). As employees performance is related to their activities performed to attain objectives and targets of the organization (Motowidlo et.al 1999), During hospitalization though nurses look after our loved ones around the clock, (Alam Mohammad,2009) most of the medical institutions neglect nurses and not giving much importance to them (Pillay,2009). Availability of only 1.30 numbers of nurses for every 1000 population in India when compared to 14 in developed countries (oped , 2015) and unfulfilled health targets created more opportunities for Indian nurses. But, because of non-attractive salary, shift schedules and social perception of nurses, this profession is not attracting men and women considerably While health care is
delivered by a team of skilled professionals including nurses, India's medical lobby prevents the attempt to grant Indian nurses any privileges (Sharma ,2014)and this created a major dissatisfaction among Indian nurses. Today many employees are having dissatisfied towards their job, which affects their performance (Mowday et. al 2013). Job dissatisfaction motivates mobilization to find out suitable jobs, resulted in highest migration of Indian nurses in the world, next to Phillipines accounting nearly 6.40lakhs in 2011 and projected increase at the coming years (Irudaya Rajan and Nair, 2013). Consequently affects national health care targets (li.et.al 2014).
Nurses are the only health care practitioners available to many individuals in their lives and are very significant in resolving their satisfaction (International Council of Nurses. 2013) and their job satisfaction plays an important role in delivering high-quality health care.
(Olatunji SO and Mokuolu BO,2014).Several studies support that job satisfaction of nurses is a pre dominant factor having positive impact on performance (Fang et.al.2009,Platin et.al 201, sameera kousar et.al, 2018). It can also be argued that work satisfaction of nurses plays an important role and if the satisfaction of nurses with their job is substantially greater, they will completely devote their attention to their job, enhancing their performance.
This made researchers to predict the ways to increase nurse’s job satisfaction. According to the theories related to job satisfaction (Maslow,1954 , Herzberg,1966) an individual is said to be satisfied
a. If his /her specific requirements are met b. Values that must be attained.
The current human resource practices found that Work environment(WE), work life balance (WLB) and Compensation(CN) are the variables most relevant in providing job satisfaction(JS) for nurses in health care sector, since these factors demonstrate either hospital’s care on their specific requirements or provides positive feeling of attainment of their values. This article tries to fill the gap in the literature by examine the effects of WE,WLB and CN over job satisfaction of nurses working Chennai medium size health care units a sector which is less attended as well as to find out the effects of JS on nurses on performance. Moreover this also investigate whether JS mediates the effects of these factors on performance
MOTIVATION TO RESEARCH
The health care sector in India is undergoing a lot of modifications because of development in clinical technology, earnings incomes mentality, demographic and hole in education service. Though Indian nurses play an crucial position in health care industry, challenges they face at working location impacts their overall performance in rendering best care patients, there through affecting reputation to that specific health care unit. Indian nurses also are disenchanted because of life of disparity among the excessive obligation of process and lower remuneration.
Although health care is furnished with the aid of using a crew of certified experts consisting of nurses, the steps taken to offer any privileges to Indian nurses is avoided with the aid of using Indian Medical Lobby (Sharma, 2014). Challenges like prolonged operating hours lesser remunerations as compared to advanced nations creates dissatisfaction among Indian nurses. This dissatisfaction degenerate nurses performance (Mowday et.al, 2013).
Compared to 14 European countries, the ratio of nurses per 1,000 population in India is 1.3.
(oped 2015).Which creates overload also indirectly affects their performance. Since
Nurses performance is directly connected to quality patient care there is an urge need to ascertain the factors which can improve performance of nurses.
REVIEW OF LITERATURE Work environment job satisfaction
Several studies to explore the connection between Job satisfaction and work environment were made on hospital based nurses and results are documented, and work environment factor associated to nurse’s job satisfaction both in rural and concrete nursing units.
The right environment facilities helps nurses to figure enthusiastically, consequently increases their job satisfaction (Djukic et.al,2014) and a satisfying work environment is positively associated with nurses’ job satisfaction (Cicolini et.al 2014)According to ( Boafo,2018) work environments which are safe and avoids work place violence also enhance nurses Job satisfaction. The proposition is as follows
H1 – work environment is related to job satisfaction.
Compensation – Job satisfaction
Nurses while joining in a hospital, most of them keen on their salary and other financial benefits and if they are satisfied they are psychologically happy about their job and discrepancy between high responsibility of the job and low pay leads to dissatisfaction. The studies relating compensation and job satisfaction, revealed that pay and other financial benefits are positively correlated to nurses job satisfaction (Kreitner and Kinicki , 2006, Chien and Yick 2016, Al Momani,2017)
The proposition is as follows
H2 – compensation is related to job satisfaction.
Work life balance Job Satisfaction
Work life balance involves balancing career demands with personal and family needs and work life balance is increasingly a crucial factor for workers job satisfaction.
Employees who have good balance between work and life exerts 21% more work than the employees who does not maintain balance and it ranks number one issue for employees.( Kehl, 2002) High quality work life is positively correlated to nurses job satisfaction (Morsey and sabra, 2015, Abdirahman , 2018).
therefore hypothesis is
H3 –work life balance is related to job satisfaction.
Job Satisfaction - Performance
Job satisfaction of nurses in health care organization is an important issue as satisfied are more productive and committed to their profession and results in quality patient care (Zaghloul et.al 2008). There is significant positive relationship between job satisfaction and nurses performance (Fang et.al, 2009, Platis et.al 2015, Inuwa, 2016) and dissatisfaction on their job degenerate their performance ability ( Mowday et. al 2013).
so H4 –Job satisfaction is related to performance.
MEDIATING ROLE OF JOB SATISFACTION
Simultaneous effects on performance of employees by various factors and job satisfaction are done by many researchers. Several studies concluded that job satisfaction mediates the connection between antecedents of job satisfaction with employee performance (Muhammad Asad Khan et.al 2019).Given that proposed factors are associated with job
satisfaction and job satisfaction associated with performance, it's possible that job satisfaction mediates the connection between proposed factors and performance. The proposition is as follows
H5: Job satisfaction will mediate the connection between proposed factors and performance.
H5: Job satisfaction will mediate the relationship between proposed factors and performance.
METHODOLOGY Sample and procedures
Nurses working in medium size health care units in and around Chennai city, India were used for survey. The researcher managed to distribute questionnaire to fifteen hospitals, located in several places, each of them having 30-40 nurses after giving assurance of anonymity. Each hospital was provided 40 questionnaire forms with a quick note indicating the aim of the research. The distribution and collection of forms were conducted by the researcher with the assistance of few administrative staff.
Totally 600 questionnaire were distributed to nurses and 460 usable questionnaire were received back representing a response rate of 78%, the choice of the nurses was supported the sampling . Around 60¾longs to 20-30 age groups 30% are between 30-40 age and 10% is quite 40 years around 70% are having nursing qualification ranges from nursing certificate to degree. Around 60% falls under 5-15 years of experience.
Measurement
The independent variables proposed within the study are WLB, CN and that wE and therefore the outcome variables are job satisfaction and nurse’s performance. Totally 24 questions exists within the questionnaire besides questions associated with personnel details. Work life balance was measured utilizing 5 items adopted from (Atkinson, 2011, Olafsdottir, 2008).This factor’s reliability coefficient (α=0.742) exhibits good level of support to adopted.
Compensation was measured using 5 items adopted from (lam at al., 2015) The reliability coefficient (α) of the items is 0.754 which is above the acceptance level of 0.700 and provides support. Work environment was measured utilizing 5 items adopted from (Chew, 2004). The reliability coefficient (α) is 0.716 which is above the acceptance level of 0.700 and provides support. Job satisfaction items were adopted from (Inuwa, 2016) that consists of 6 items. The reliability coefficient (α = 0.784) gives good level of support. Finally job performance was measured using 3 items adopted from (Netemeyer and Maxham, 2007).The reliability coefficient is 0.706 gives good level of support. Likert- scale range from 1- 5 likert sclae is used and nurses were asked to reply . The collected data were analyze using SPSS.
Content validity checked and because the factor loading of all the factors were above 0.40 taken for analysis. Common methods variance is a priority for this study and the five variables WLB,CN,WE,JS and nurses performance comprising of 24 items rated by nurses were put into unroated factor solution and assessed that no single factor is representing the bulk of variance. Though Harmans one factor test cannot fully eliminate common method variance, it doesn't affect the findings of the results (Ertürk , 2014).
RESULT
From table 1 it is found that alphavaries from 0.706 to 0.784 and more than acceptable value of (0.700) all the variables are correlated and ranges from 0.506 to 0.707). The proposed factors are also significantly related to JS and performance.
Table 1. Correlation Matrix of the proposed factors
factors Mean Alpha 1 2 3 4 5
Work life balance 21.27 0.742 1.00
Compensation 21.08 0.754 0.506*
*
1.00 1.00
Work environment
18.54 0.716 0.514*
*
0.626*
*
1.00
Job satisfaction 24.56 0.784 0.707*
*
0.516*
*
0.636*
*
1.00
Nurses performance
22.40 0706 0.607** 0.686*
*
0.517*
*
0.644*
*
1.00
**p<0.01
Source: primary data
Table 2: Multi linear regression analysis of job satisfaction on proposed factors
Factors P Standardized
Beta
t R Adjus
ted R2 F
Work life balance 0.002*
* 0.286 6.245 0.802 0.762 238.562**
Compensation 0.000
**
0.374 7.016
Work environment 0.008
**
0.276 6.158
**p<0.01
Source: primary data
It is noted from the Table 2 that significant variance has been exerted on JS by the proposed factors and they are predictors of JS and provides support to the hypothesis H1, H2, H3.
Table 3: Multiple regression analysis of nurse’s performance on proposed factors
**p<0.01
Source: primary data
Factors P SD T r R2 F
Job satisfaction 0.000** 0.676 18.165 0.667 0.445 284.627*
*
Work Life balance 0.000** 0.288 5.276 0.784 0.615 189.748**
Compensation 0.000** 0.467 11.764
Work environment 0.002** 0.264 4.647
Table3 reveals that the analysis using regression tool exhibits significant variance of JS on performance p=0.000,R2=0.445 and positively related with it, and supports hypothesis H4. To determine the relationship between proposed factors and nurses performance all the factor are regressed simultaneously and the proposed factors gives significant amount of variance in nurses performance( p=0.000, R2= 0.615).All the three factors, compensation (p=0.000)WLB(P=0.006) and WE (p=0.002) are significant predictors of nurses performance.
To decide mediating impact of JS on the proposed factors and nurses performance (Sobel ,1995) study have been performed to examine the mediating impact of JS on the connection among the 3 elements WLB ,WE and compensation with nurses performance The results support the mediation.(WLB, Z=7.72, p<0.01),compensation (Z=6.74,P,0.01),WE (Z=5.64,P<0.01) To reinforce JS’s meditation effect (Aroian,1947) test is also conducted and this also supports mediation WLB (z=7.70,p<0.01),compensation (Z=6.73,p<0.01) WE = (Z== 5.62P<0.01). and provides partial support to the hypothesis H5
DISCUSSION
The purpose of this study was to see the impact of WLB, compensation and that wEover JS among nurses working in medium size health care units in and around Chennai city ,India also on verify the consequences of JS on performance. Further, it also investigates whether JS mediates the consequences of the above factors on performance. The analysis proposing JS as variable and therefore the proposed factors as independent variables show that each one the three factors are positively associated with nurse’s JS. 58.1% of variance in JS justifies that each one the proposed factors are influential and crucial and desire to tend top priority and also indicates that JS is extremely essential because it leads to raised performance of nurses (Inuwa ,2016) and their positive attitudes towards their organization is useful to realize the targets. Nurses are influenced by present day’s environmental changes which successively affects the factors influencing JS.
The predominate factor positively related to JS is compensation and this coincides (Chien and Yick, 2016).Reasonable salary and other monetary benefits offered by the hospital’s along side unbiased rewards permanently work makes nurses to feel happy and this increases their satisfaction towards their job. This highlights hospital’s support for compensation to meets JS. subsequent predominate factor positively associated with JS is WLB and this coincides with previous findings of (Abdirahman,2018).Nurses feel that hospitals flexible work policies option for timing changes are much needful for his or her life and also to work back work family conflicts. Nurses who enjoy such facilities feel happy over their job which successively increases their satisfaction. This highlights the importance of hospital’s support towards WLB to understad JS.
The findings that indicates WE because the predictor of JS coincide with findings (Boafo, 2018). Nurses expect support and encouragement from hospital heads to unfold their potential. Availability of reasonable work freedom, reasonable workloads, and sufficient work space provides satisfaction towards their job. This highlights the importance of hospital’s support for WE to meet JS.
In summary, hospital authorities got to extent their support to the factors WLB, compensation and that we to enhance nurses satisfaction towards their job. Secondly, this analysis provides evidence that JS is positively associated with nurse’s performance and this result coincides with earlier finding (Inuwa,2016 ) .This indicates the necessity to extend JS of nurses for his or her improved performance and this may provide guidelines to the health care units in India where migration of nurses are high. Thirdly, MLR outcomes indicated that
CN ,WLB and that we are significantly associated with nurse’s performance and compensation emerged because the strongest predictor which coincides with previous findings (Nagaraju and pooja,2017).The next variable positively associated with performance is WLB which coincides with earlier finding( Kheled adnan bataineh, 2019 ). and that wE also positively associated with performance and coincides with earlier findings of (umamaheswari .S, 2018)
Finally, JS partially mediates the connection of three factors CN, WLB and that we with nurse’s performance. In other way, they're getting indirect effects on performance also through mediator variable, JS
IMPLICATIONS
This research provides some suggestions to enhance nurse’s performance in health care units.
This provides the knowledge about JS which is crucial for better performance. This research indicates that organizational support for WLB, compensation and that which increases JS, is important . Hence, hospital authorities should give more importance to the above factors for improving better relationship with their nurses, so as to reinforce their satisfaction which successively increases their performance. Assurance to the nurses that no reverse effect on the usage of concessions and proper communication can improve their job satisfaction and performance.
LIMITATIONS AND FUTURE STUDY
This research provides some suggestions to enhance nurse’s performance in health care units.. This research indicates that organizational support for WLB, compensation and which increases JS, is increases . Hence, hospital authorities should give more importance to the above factors for improving better relationship with their nurses, so as to reinforce their satisfaction which successively increases their performance. Assurance to the nurses that no reverse effect on the usage of concessions and proper communication can improve their job satisfaction and performance.
CONCLUSION
Although performance of nurses is extremely crucial for hospitals not much empirical studies were made on medium size health care units. This research fills gap within the literature. The findings provide evidence that nurse’s job satisfaction increases their performance in Chennai based medium health care units. The study also illustrates that compensation, work life balance work environment are the influencing determinants highly relevant in predicting nurses JS, Additionally, the results of the study gives evidence that JS partially mediates the connection between proposed factors and nurses performance
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