Quality of nursing work life and turnover intention among nurses of tertiary care hospitals in Riyadh: a cross-sectional survey

Health organizations in many countries have faced some difficulties like shortage of health experts, and increase the turnover rate, especially amongst nurses. Nurse turnover has a negative impact on the ability to encounter the patient needs and deliver high standards of care [1]. Additionally, the turnover of nurses leads to insufficient staffing, which increases the workloads and stress on other staff [2‐4]. Consequently, this may lead to serious variations in nurse’s behavior towards their jobs causing low work satisfaction and productivity, and then shifting to another organization. As well, insufficient nurse staffing leads to poor patient outcomes, like increased patient mortality and infection rates error rates might be increased [5, 6]. The previous research in the health field has concentrated on answering these issues and their related causes [4, 5]. Some studies have shown the impact of quality of work life on the commitment of nurses and other health professionals [4, 7, 8]. The quality of nursing work life (QNWL) defined as the degree to which registered nurses can satisfy important personal needs through their experiences in their work organization while achieving the organization’s goals [9]. Evaluating QNWL permits organizations to realize how challenges in work environments affect nurse’s job satisfaction and commitments [10]. The high quality of work life is crucial for organizations to appeal to new employees and maintain their workforces. However, reliable information on the quality of work life and turnover intention of nurses is limited in Saudi Arabia. In an in-depth review of literature proposes that there is a remarkable increase in the rate of nurse organizational turnover supplemented via an insignificant increase in nursing resource [7, 9]. In Saudi Arabia, nurses come from different countries, some of which may be unharmonious with the culture of Saudi Arabia. The previous study reported that non-Arabic speaking nurses are at a shortcoming as care providers for people in public because of the language barrier and cultural variances [11]. Such challenges for nurses alongside other causes linked to the organization generate a high level of stress which adversely affects the quality of their working life. Another study conducted by Alhusaini and Alamri et al. indicated that the majority of foreign nurses move to industrialized countries after attaining enough experience [12, 13]. In consequent of, competition to attract competent nurses, Saudi Arabia might miss experienced nurses who may choose to work with other establishments that deliver right working environments. It is integral for a policymaker to assess their quality of work life and to understand their organizational and career intentions, which may improve the nurses’ work satisfaction and productivity, which subsequently improve the health services being delivered to their patients. Thus, the objectives of this study were to assess the QNWL, to explore the nurses’ turnover intention and to examine the correlation between QNWL and nurses’ turnover intention.

A representative sample of 400 nurses was invited to participants in this study, out of whom 364 nurses were recruited (response rate is 91%). Respondents’ demographic characteristics were presented in Table 1. A total of 329 (90.4%) of respondents were females. Two hundred thirty 236 (64.8%) nurses are married, and 149 (40.9%) respondents had family members living in KSA. The majority of participants 198 (54.5%) had between 1 to 5 years of clinical experience in Saudi Arabia and were Filipino 206 (56.6%).

According to ATS criteria of cutoff (> 3.5) intent to leave the current position, our data shows that 94% of participants were willing to leave the current job. Moreover, QNWL criteria of cutoff (≤ 4.2) satisfaction towards the QWL revealed that 54.7% of participated nurses were dissatisfied with the quality of work life. There is no significant difference between the answers given by the respondent’s nurses were working in different departments in the two different hospitals.

Table 2 shows the association of demographic characteristics with the cut off levels of the QNWL and ATS scales. The majority of male nurses 21 (60%) were satisfied with the QNWL than females 144 (43.8%). Among the age group, the majority of nurses were dissatisfied with the QNWL except in the age group 31–40 years. Moreover, about 75 (61.5%) of the never married nurses were dissatisfied with the QNWL compared to 120 (50.8) who were married. The majority of nurses with associate degree 4 (80) and those with less than 5 years of experience were reported dissatisfaction with QNWL. Nurses with a monthly income of more than 15,000 SAR 3 (100%) were all satisfied with QNWL. Overall, a significant difference was found between satisfactory nurse status and total years of nursing experience (p = 0.025), total years of nursing experience in Saudi Arabia (p = < 0.001), and monthly income (p = 0.005). However, further logistic regression analysis showed that nurses who have been working in Saudi Arabia between 11 and 15 years were the only satisfied (p = 0.006) with QNWL among other nurses. Also, nurses with monthly income less than 5000 and 5000–10,000 Saudi Riyal were found to exhibit an effect on nurses’ satisfaction (p = < 0.001; for both) about QNWL.

Regarding the anticipated turnover intention, the majority of males 30 (85.7%) and females 312 (94.8%) have the intention to turnover. Moreover, the vast majority of nurses at their different demographic characteristics have reported the intention to turnover. Also, the statistically significant difference was only found between nurse intention to turnover with gender (p = 0.031) and total years working in the current position (p = 0.002). Nevertheless, logistic regression analysis showed that charge nurse position (p = < 0.001) and total years working in the current position (p = 0.017) were found to exhibit an effect on nurses’ intention to turnover (Table 2).

Table 3 shows that among the 199 nurses who were dissatisfied with the QNWL, about 188 (94.5) of them have the intention to turnover. Moreover, 154 (93.3) out of 165 nurses who reported satisfaction with QNWL indicated the intention to turnover. The correlation between QNWL and ATS for binary variables was a week (r = − 0.024) and statistically not significant (p = 0.206).

This study provides an initial step in understanding the work life of nurses in tertiary care sitting and shed light on an important topic which if not assessed and well managed by an organization might have a negative impact on the ability to meet the patient needs and deliver high standards of care. Our study revealed that the majority (54.7%) of respondents was dissatisfied with their work life and 94% have turnover intention. Our result is higher than reported in previous studies on nurses’ turnover intention. A study carried out by Brooks et al., to assess the QNWL of staff nurses using the same scale reported nursing dissatisfaction with their work life [17]. In Saudi Arabia, a study conducted by Almalki et al., on 508 primary health care nurses, reported that the participants were dissatisfied with their work life, with nearly 40% showing a turnover intention [19]. In Sweden, a prospective study on 1417 nurses showed that every fifth nurse intended to leave their profession after 5 years [20]. In a study based on 6469 hospital nurses in seven European countries, reported that nurses have reward frustration with higher turnover intentions [21]. Our results were critical and alarming, however, these findings could be explained by the fact that the majority of the nurse in the study sites were expatriate nurses from different countries.

Previous studies reported monthly income, length of work experience, and organization tenure as important predictors of employees’ satisfaction with QWL [22, 23]. Our results showed that total years of nursing experience, total years of nursing experience in Saudi Arabia, and monthly income significantly affect nurses’ satisfaction about QNWL. This could be explained by that nurses with more work experience have more stability in their job and thus experience a better QNWL. However, previous studies conducted by Nayeri et al. and Boonrod revealed that they could not found a significant association between QNWL and the length of work experience [24, 25].

Consistent with previous studies our results showed that gender, total years working in the current position were also affecting nurses’ intention to turnover [17, 24]. While, other studies reported no relationship between gender and employees’ intention to leave their work [25, 26].

Although previous studies confirmed the significance of family to the view of the nurses to their QNWL [1, 17], the results of the present study showed no significant association between QNWL and neither family member living in KSA nor marital status. Similarly, two studies have also found that QWL has no significant relationship with marital status [23, 24].

In the present study we examined the correlation between QNWL and ATS. Although the work context dimension makes the strongest contribution to explaining turnover intention, our results showed no correlation between QNWL and ATS. On the contrary, prior studies reported that the intention to turnover could be explained by the nurse’s satisfaction with QNWL [27, 28]. In previous studies based on 1283 hospital nurses in Taiwan and 740 nurses in Iran reported that nurses’ QWLs were significantly negatively associated with nurses’ turnover intentions [29, 30].

Efficacious QNWL strategies in healthcare settings can enhance employees’ self-esteem and organizational efficiency. Furthermore, QNWL can advance the quality of care provided in addition to staffing and preservation of the nursing workforce. This high rate of turnover intention ought to motivate the nursing leaders to develop appropriate and efficient strategies to combat this serious issue and improve the nurses work conditions and their QNWL, which consequently, will enable the nurses to perform better care for their patients.

The strengths of the study that it can be generalizable to the nursing staff working at tertiary hospitals in Riyadh city as the study was conducted at two out of four reputable tertiary hospitals in Riyadh city, Saudi Arabia. Furthermore, the possibility of non-response bias is very little as the response rate is high (91%). While, the limitations that the study is a cross-sectional and data collected using self- administer scales. Therefore, further studies should be carried out with more objective instruments.

Further studies are needed to understand and improve nurses’ QNWL and retention. It would be valuable to conduct longitudinal and interventional studies to assess the definite turnover amongst nurses paralleled with described turnover intention in the present study. Additional an in-depth study is required to explore the effect of social and cultural norms on the perception of expatriate nurses towards QNWL and turnover intention.

The QNWL and nurse turnover are challenging issues for healthcare organizations because of the consequences and impact on patient care. Our study provides critical findings low indication satisfaction of nurses with their QNWL and a high turnover intention. The results of this study could be used as a guide for the development of regulations and practical strategies to enhance QNWL and to decrease the turnover.