Workplace dignity amongst clinical nurses

This study provides insights from data on dignity experiences by clinical nurses within the current study setting. Overall, the results highlight that inherent value and general dignity were the highest-scored constructs while indignity and respectful interaction scored the lowest. The data reveal that the construct of general dignity received the highest mean score (5.52 ± 1.46). This possibly aligns with a positive professional practice environment of the study setting. The item “I have dignity at work” scored even higher (5.63 ± 1.40), reflecting a positive perception of personal dignity among the participants possibly attributed to a positive practice environment. Froneman et al. [19] conducted a phenomenological study on enhancing the professional dignity of midwives and reported that the working environment plays a crucial role in shaping the professional dignity of midwives. A supportive and positive environment is essential for fostering a strong sense of professional dignity and ensuring high-quality nursing care. According to Combrinck et al. [14], excessive workloads and unfavorable nurse-to-patient ratios create substantial challenges for nurses, making it difficult to provide the high-quality care expected in their roles. This strain not only affects the nurses’ ability to deliver optimal care but also contributes to increased stress and job dissatisfaction, further exacerbating the difficulties faced in maintaining nursing standards.

The nursing practice environment is key to quality of care and patient satisfaction [38]. A stressful environment decreases the quality of care, patient satisfaction, and patient safety [39]. Sharif et al. [38] discuss, that nurses’ psychological wellbeing is critical and directly related to the quality of patient care delivered. Therefore, managers need to address factors relating to negativity in the workplace, whether it is a lack of support, perceived unfairness, or distress if they want a high standard of care to be delivered [17, 40]. According to Faulkner & Laschinger [41] and Purdy et al. [42], essential components of healthcare work environments incorporate intra- and interprofessional relationships, communication with patients and their families, and the general organizational setting. Disrespect for individuals’ dignity frequently manifests in both intra- and interprofessional interactions [13, 43, 44]. Within intra-professional relationships, younger nurses [45], in particular, are susceptible to horizontal [46] and lateral violence [47], which include disruptive behaviors like bullying, infighting, and verbal abuse. These issues can lead to significant stress and frustration, obstructing the proper development of professional dignity [48].

Specific findings related to questions (13, and 14) with means of 5.46 ± 1.5; 5.47 ± 1.4; and 5.63 ± 1.4) respectively highlight that nurses perceived that work was a source of dignity and being treated with respect at work. Workers’ perceptions of their work environment have an important influence on job-related outcomes such as job satisfaction [49‐51]. Sainz et al. [36] study reported on worker job satisfaction and worker dignity where job satisfaction is strongly related to working conditions and work relationships are strongly influenced by the work environment. Dignity at work is a basic and unconditional requirement for each person and independent of the characteristics of specific tasks that workers perform [11, 33]. It could be negatively affected when the work environment is hostile [52]. Both job satisfaction and dignity could therefore be reduced in negative work environments [36].

The construct of respectful interaction had the lowest mean score (5.21 ± 1.21), with the item “People at work communicate with me respectfully” recording the lowest individual score (5.14 ± 1.27). Numerous studies indicated that dignity at work is maintained or restored by numerous connections and relations at work but above all co-worker relationships were seen as the most fundamental [48, 53, 54] Khademi et al. [18] identified disrespect as a prominent issue for nurses in their interactions with managers, physicians, and patients’ relatives, encompassing behaviors that ranged from subtle humiliation to outright physical confrontations. Lawless and Moss [55] showed that interactions with patients, colleagues, or managers can influence the preservation, maintenance, or undermining of conditions affecting nurses’ dignity. In this current study, the relatively lower scores related to respectful interaction may indicate areas where interventions could improve workplace culture and communication practices.

The construct of indignity even though negatively worded, showed a relatively significant overall mean score (2.66 ± 1.22), with items such as “I am treated in undignifying ways at work” scoring particularly low (2.29 ± 1.02) and “people at work treat me like a second-class citizen” (3.64 ± 1.83). This finding could suggest that while there are instances of indignity, they are less frequent compared to the overall perception of dignity. Further, this study’s findings can be explained using Hall et al. [56]’ theoretical framework of marginalization in nursing. According to Hall et al. [55], the conceptual definition of marginalization in nursing refers to “a process that results in groups being peripheralized because of several factors, including a person’s identity, experiences, and associations. Within this theoretical framework, the sub-concept of power refers to those in power over those who have been peripherilized which is hierarchical and bidirectional. This results in those on the periphery (i.e., the marginalized) using secrecy to conceal any differences that create and maintain environments and marginalized social groups. Hall’s conceptual framework could be a possible explanation for this [56, 57].

Additionally, the distribution of nationality—41.5% Saudi and 58.5% non-Saudi—provides a glimpse into the multicultural environment of the institution. Expatriate nurses from different cultural and, linguistic backgrounds mainly staff the healthcare system in Saudi Arabia [58]. The Saudi cultural context and society have its own unique set of characteristics that shape the lifestyle of its population, namely customs, traditions, values, and beliefs. Further, people’s beliefs and attitudes are intrinsically linked to Islamic and Arabic tribal traditions. In the Saudi culture, what healthcare professionals must do for patients and what the family of the patient wants may lead to many conflicts between nursing staff, patients, and family members. This highlights the cultural differences between people of different cultural backgrounds [59] that could affect WD.

The statistically significant results highlighted greater years of experience working in the current organization and as a registered nurse, which resulted in nurses having higher WD. Najafi et al. [60] conducted a study on respect and dignity from physicians, colleagues, patients, and their family members, for nurses with different levels of experience. The study findings revealed the highest rate of dignity violation was reported in nurses with inadequate clinical care experience. Concerning the area of professional independence, nurses with insufficient clinical experience had lower confidence to consult with physicians in comparison with experienced nursing staff (P < 0.04). In the area of respect, nurses with lower levels of experience captured less respect from physicians compared to experienced nurses (P < 0.04). Amudha et al. [61] found that doctors preferred to work with only experienced nurses whilst patients tended to rely more on competent nurses to support them in their healthcare needs. Less experienced nurses perceived that they were treated differently as compared to experienced nurses. Although the current study only included clinical nurses with more than six months of experience, it is worth reporting the findings by Sawafta et al. [62] and Baloyi et al. [63] who showed that newly qualified registered nurses feel belittled and disrespected in their units and commonly experienced more stressors within the workplace. According to the study by Klinner et al. [64], respect was the most common aspect that all study participants associated with the concept of dignity i.e. respect for others, mutual respect, and a culture of respect. This was reiterated by Sakar et al. [65], who reported that, when employees feel respected and, valued by their colleagues, supervisors, and the organization, they are more likely to experience a sense of autonomy, respect, and fairness in their professional relationships. This results in enhanced job satisfaction, motivation, and overall well-being which is directly related to dignity.