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Nursing Friendly Hospital: Improving Working Environments for Nurses in the Eastern Province of Saudi Arabia

Kholood Mohammed Mugharbel, Suad Saif Al-Dossary*, Afaf Saeed Al-Sadoun, Ali Ahmed Al-Masmoom, Aminah Mediodia Blancaflor, Dana Bader Al-Orimy, Fouzeya Khalid Al-Shammery, Horiya Abdulaziz Alzuwaiyed, Maryam Ahmed Alkhalaf, Raja Khamis Al-Shamsi, Rana Majed Alsadah

Performance Improvement Supervisor, Directorate of Health Affairs Eastern Province

Abstract: This descriptive study reveals how nurses working in Eastern Province hospitals rate their work environments in comparison to nurse-friendly hospital standards. Methods: This study was conducted on 115 nurses volunteering to participate in this study out of 200 male and female nurses working in inpatient departments in two hospitals in the Eastern Province. Data were collected using the Personal Information Form and the Modified Nursing Work Index. Numbers, percentages, means, standard deviations, and one-way analysis of variance was used to evaluate the data. Results: Among nurse-friendly hospital criteria, “Relationships with coworkers” had the highest average score, and "competitive pay" and the zero-tolerance policy for nurse abuse had the lowest average score. The nurses' evaluations provided statistically significant differences with regard to personal and occupational variables. Lastly, nurses in the study found most nurse-friendly hospital standards adequate but believed several areas needed improvement.

Keywords: nurse, work environment, job satisfaction

Received February 25, 2023; Revised April 02, 2023; Accepted April 13, 2023

Citation: Kholood Mohammed Mugharbel, Suad Saif Al-Dossary, Afaf Saeed Al-Sadoun, Ali Ahmed Al-Masmoom, Aminah Mediodia Blancaflor, Dana Bader Al-Orimy, Fouzeya Khalid Al-Shammery, Horiya Abdulaziz Alzuwaiyed, Maryam Ahmed Alkhalaf, Raja Khamis Al-Shamsi, Rana Majed Alsadah, Nursing Friendly Hospital: Improving Working Environments for Nurses in the Eastern Province of Saudi Arabia. American Journal of Nursing Research, 11 (2). 82-86. January 2023. doi:10.12691/ajnr-11-2-2

1. Introduction

Nurses are healthcare workers who care for and are in contact with patients for as long as 24 hours a day. In providing healthcare services, nurses often encounter occupational hazards such as infectious work environments, rigorous workloads, and challenging patients and patient families [1] (Donaldson, 2008). Being constantly exposed to these hazards can lead to severe emotional distress, which can lead to increased risks associated with the workplace. Studies have shown a relationship between increased stress and job satisfaction, which has been shown to be an important factor in delivering quality care [2] (Lee et al. 2014). Other studies have also shown a positive correlation between hospital employees’ job satisfaction, job performance and organizational success. The American Nurses Association (ANA) is one of the largest governing bodies that was created to advance and protect the role of nurses in their workplace [3] (Smith SA, 2014). The ANA’s Magnet Recognition Program is currently the gold standard in designating institutions worldwide on the bases of nursing satisfaction and best practice that leads to quality patient care. However, due to the difficulty of attaining recognition and ensuring a positive work environment, the Texas Nurses Association introduced an alternative standard in 2008; the Nurse-Friendly Hospital Standard. The Nurse Friendly Hospital Standard consists of 12 major elements to be regulated; nursing practices, the safety of the work environment, systems of patient care, professional development of nurses, advanced nursing qualifications, mentoring, competitive wages, respect and recognitions, work-life balance, and policies against abuse, Quality initiatives, Middle management accountability. [4] (Meraviglia, 2008). The health sector is undergoing rapid changes due to the new strategies proposed by the Saudi Arabian government after the announcement of the Saudi 2030 Vision. Reforming healthcare utilizing standards like the Magnet Recognition Program and the Nurse Friendly Hospital standard is in alignment with the reformation strategies of the 2030 Vision. Understanding the increasing job satisfaction and one way to do that is examining hospitals in the region. There are currently only two hospitals in Saudi Arabia recognized by the Magnet Recognition Program and the Nurse Friendly Hospital standard; King Fahad Specialist Hospital Dammam (KFSHD) and King Faisal Specialist Hospital and Research Centre (KFSHRC) in Riyadh and Jeddah [5] (Lovering, 2013), respectively. Examining the perceptions of nurses towards their hospital can have positive implications for the future. Identifying elements of the nurses’ work environment that fulfil the criteria of the Nurse Friendly Standard can be an indication of potentially fulfilling more difficult standards like the Magnet Recognition Program. Therefore, the purpose of this study is to examine the perception of nurses employed by General Hospitals in the Dammam and Qatif regions of their respective hospital work environments.

2. Literature Review

2.1. Study by Mary Peeler 2015

This study aimed to discover the work environment that affects the job satisfaction of nurse's in the hospital environment. The theoretical approach was used for this study, and the mock survey was used to examine the factors in the acute care hospital associated with the nurse's job. The study sample consisted of 130 male and female nurses from the study population. The study reached the following results: The nurses were not satisfied with their current job due to the absence of important environmental factors affecting the job satisfaction of the nurses. [6] (Peeler, 2015)

2.2. Mohammad Suliman, Maen Aljezawi Study 2017

The Study aimed to investigate nurses’ perceptions of the nursing work environment in Jordanian hospitals. A cross- sectional and descriptive design was used. A sample of 500 nurses were recruited. A sum of 382 out of 500 nurses from three health care sectors in Jordan responded to the questionnaires (response rate = 76.4%). The results indicate that nurses working in the public hospitals had significantly better perceptions about their work environment than nurses working in private and university hospitals. [7] (Suleiman & Aljezawi, 2017).

2.3. Charles Michael Study 2018

This study aimed to evaluate the effectiveness of implementing purposive recognition-based hospital resource planning in a non-traditional nursing work environment. The content analysis of this study was used to evaluate the effectiveness of experimental hospital resource planning for a period of three months in improving job satisfaction and productivity. The study reached the following results: There is a significant increase in job satisfaction, as 89% of the participants reported satisfaction with hospital resource planning, the types of recognition granted, and that hospitals are nursing-friendly. [8] (Combs, 2018)

2.4. Study by Ayah Hijazi, Manal Ibrahim, Wafaa Shukri, Hayam al-Sharif in 2021

This study aimed for the purpose of clarifying and defining the concept of the work environment and its factors, and the negative and positive work environment. In this study, the researcher used concept analysis, defining the objectives of concept analysis, and defining the concept of work environment factors. The study concluded that a positive work environment significantly improves organizational outcomes, employee turnover decreases, work sharing among nurse's increases, and hospitals are nursing-friendly. [9] (Hijazi et al., 2021).

3. Methods

A cross-sectional study design was implemented using a questionnaire survey distributed to 115 nurses across two hospitals in the Eastern Province of Saudi Arabia. Data were collected between April 2022 to June 2022.

4. Participants

The criteria for participating in the study included being a nurse, being assigned inpatient care, as well as being employed at either the Dammam or Qatif General Hospitals in the Eastern Province of Saudi Arabia. Table 1 demonstrates the general characteristics of the participants.

Table 1. Participant Characteristics

5. Procedure

Surveys were distributed using an electronic personal information questionnaire form [10] (Er & Sokmen, 2018). The Personal Information Form consists of questions about the descriptive and occupational characteristics of the nurses including age, education, specialty, professional experiences, adequacy of physical aspects of their work environments and their satisfaction with the department in which they work. The Friendly Hospital Standards Index, known as the Adapted Nursing Work Index (Adapted NWI-R), was prepared in 2008 through a revision of the Nursing Work Index-Revised (NWI-R) Items and Practice Environment Scale and by matching the right items to each Nurse-Friendly Hospital standard with the help of professionals. It consists of 12 sub-criteria. Their validity and reliability were tested under the principles described in the literature. [11] (Garson, 2002).

6. Data Analysis

Data were expressed as means and standard deviations, and analyzed in SPSS (IBM SPSS Statistics, Version 25.0. Armonk, NY: IBM Corp). Cronbach's Alpha: The findings suggest that there is no need to revise or eliminate the items of: supervisor relationship, professional advancement opportunities, relationships with coworkers, or nursing practice monitoring because each statement is relevant to its area and the overall statements are related to the questionnaire (Table 2). Except for the salary variable where in the reliability of this variable is negative which means that the correlations between variables are very weak or negative. One probable reason for this is the small sample size. Even when the sample is large enough, chances are high that the sample mean may not be equal to the population mean, and this can turn up into a negative alpha although, no matter what, there is always some sampling variability in reliability estimates [12] (Graham, 2006). The Author obtained more data and removed some of the items which showed highly negative correlations.

Table 2. tested reliability coefficients for the distributed questionnaire utilizing Cronbach's Alpha

7. Results

Table 1 shows that 68.7% of participants are female nurses and 36.5% of them are in the age range of 30-39 years. The majority with a bachelor’s degree (52.2%), and 40% with a range of (10-19 years).

Table 3. Results of the Survey

Table 3 shows the results of the survey. Nurses’ perception of their work environment in hospitals in the Eastern Province of Saudi Arabia. The table shows that the question “Are you consistently treated with respect from your co-workers?” got the highest arithmetic mean with a value of (2.54), while the question “Is there a zero-tolerance policy for nurse abuse?” got the lowest arithmetic means with a value of (1.82).

8. Discussion

In this study, the authors discuss nurses' perception of the presence of Nursing Friendly Hospital criteria before and after the survey so The results obtained regarding the standards of nursing-friendly hospitals and the characteristics of the nurses participating in the study may be similar in other studies. a smellier study has been taken in the United States indicated that Nurse shortage, the nature of the work environment, and employers' expectations and attitudes, among other factors, influence both nurse retention and the quality of patient care. The Nurse-Friendly Hospital Project was designed to improve nurses' work environment in rural and small hospitals in Texas. Findings demonstrate improvements in nurse retention, nurse staffing, and quality of care. [13] (Meraviglia, 2009). The results of this study revealed similarities and differences with the existing national and international literature. Between 2008-2017 this issue was discussed as follows. Launched the Nurse Friendly Hospital (Nursing Friendly Hospital) project to help create a positive work environment for nurses. The Nurse Friendly Project aims to improve the work environment in the hospital to ensure quality patient care and to assist in the development and satisfaction of nurses. The Texas Nurses Association strives to advance the profession and promote nursing excellence by helping nurses achieve quality patient care by establishing a nurse-friendly hospital standard. Implementing nurse-friendly hospital standards in the hospital workplace creates a context in which nurses can provide and evaluate quality patient care. The Texas Friendly Hospital Project has implemented nursing standards in 18 hospitals. Participating hospitals received consulting visits from Nursing Friendly Hospitals team members on strategies for adopting Nursing Friendly standards in their policies and practices. Results from project data show positive changes in nurses' perception of their work environment and slight improvement in nurse retention. By comparing a survey of nurses in two hospitals in the Eastern Province of Saudi Arabia, it is clear that the standards for nursing-friendly hospitals, developed by the Texas Nursing Association, are actually applied in hospital policies and procedures. culture, except for a competitive pay policy and a zero-tolerance policy for nurse abuse. They have the lowest average and needs improvement. There is a similar study conducted in two hospitals in Saudi Arabia, one is a military hospital and the other is a general hospital. The nursing practice environment and nurses' work outcomes were better in military hospitals compared to general hospitals. Overall, 53% of the participants had high burnout, 39% were dissatisfied, and 26% intended to quit their job. Path analysis showed that the nursing practice environment and the patient-to-nurse ratio were predictors of burnout and job dissatisfaction, which in the turn leads to the intention to leave. [14] (Ambani et al., 2020). While this study proved that the nurses' relationship with their superiors, their satisfaction with the work environment and the retention of nurses amounted to 61.2%. In all studies, the nurses found most of the nurse-friendly hospital criteria adequate, needing to be believed that several areas need a little improvement.

9. Implications

In alignment with the results of this study, the authors suggest the following; 1) To further examine hospitals to assess the working conditions of nurses with respect to nurse-friendly hospital criteria. 2) To make the necessary changes to nursing services in accordance with nurse-friendly hospital criteria. 3) To Encourage all members of the nursing profession to contribute to the development of hospital policies that can then support a positive work environment. The results can be utilized by nurse managers to improve the quality of nursing services, achieve positive patient outcomes and have satisfied nurses. Assessing nurse-friendly hospital criteria, which were designed to improve the work environment of nurses, can bring about improvements in nurse retention and staffing, quality of care, work environment, safety of patients and nurses and provision of quality nursing services, resulting in the overall development of the nursing profession.

10. Limitations

Sampling for the study was based on location convenience, therefore, it was limited to nurses working in two general hospitals in the Eastern province. Also, exploring the working conditions of the nurses was limited to the personal statements of nurses, therefore, the results of the study may only be applicable to those regions. However, future research can utilize the results of this study to further explore perceptions of nurses to ensure quality patient care and eligibility for international recognition.

11. Conclusion

The purpose of this study was to investigate how nurses working in Eastern Province hospitals evaluate their work environments in comparison to nurse-friendly hospital standards. The results showed that among the hospital's nurse-friendly criteria, "relationships with co-workers" received the highest average score, and the "competitive pay" policy and zero-tolerance policy for nurse abuse received the lowest average score. The nurses' ratings provided a statistically significant difference in terms of personal and occupational variables, the nurse's in the study found most nurse-friendly hospital standards to be adequate, but they believed that several areas needed improvement. The results of this study were consistent with other studies conducted in several hospitals in the United States of America and in the Kingdom of Saudi Arabia. Moreover, a positive perception of the work environment is associated with a number of working conditions, such as social support, workload, and administrative support. In addition, some characteristics of nurses such as age, education level plays an important role. It is critical to improve working conditions and create professional development opportunities to produce a more satisfied nurse who is willing to keep his/her current job and provide better quality care.

Ethical Approval

Approval of the Ethics Committee of the Eye Specialist Hospital in Dhahran. (IRB No. 1122 and dated 14.09.2022). was obtained. Written permission was obtained from the nurses involved.

Conflict of Interest

The authors declare no conflict-of-interest.

References

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