This study aimed to examine the relationship between PSC and QWL among nurses working in hospital wards for patients with COVID-19 in selected hospitals located in the cities of Shiraz and Bushehr, southern Iran. To the best of authors’ knowledge, no study had so far explored this relationship in Iranian nursing community. Most surveys had been merely performed in Western countries with different cultures and socioeconomic structures. With regard to the role of these factors influencing individuals’ perceptions of their profession and its consequences, the results of the given studies could not be extended to nurses working in Iran. Innovation and fulfillment of this research in such critical times was thus among the strengths of the present study.
The results of this study correspondingly demonstrated that two-thirds of the nurses had poor WLQ. Among the WLQ subscales, job and career satisfaction and stress at work had also obtained the highest mean scores and home-work interface had been assigned with the lowest mean score. Other studies among Iranian nurses working in tertiary hospitals in the city of Tehran(5), those involved in the city of Kashan(9), and the ones operating in intensive care units (ICUs) in the city of Tehran(4), had further revealed that more than half of the nurses had reported their QWL at moderate-to-low levels. Kelbiso et al. (2017), in a study on nurses working in hospitals and health care centers in Nigeria had further reported that QWL in two-thirds of the cases had been at an unsatisfactory level(23), which was in line with the results of the present study. It should be noted that quality of life can be under the influence of numerous factors such as salary and benefits, demographic variables, occupational safety and health events, work-related stress, job security and discipline in the workplace, adjusted hygiene conditions, basic amenities, and job prospects(4, 5, 9). Therefore, low QWL in these nurses can be affected by the current critical situation at the time of COVID-19 outbreak and the increase in work pressure and stress induced by unidentified aspects of the disease.
As mentioned, the subscale of job and career satisfaction received the highest mean score with items encompassing concepts related to existence of opportunities for progress and job promotion, training courses, chances to use one’s ability, as well as being appreciated by managers. In the nursing system at tertiary hospitals affiliated to universities of medical sciences, continuous in-service training was also provided for nurses in different job categories. The given training could accordingly improve their job competency and provide a chance for job promotion and better adaptation, and ultimately better QWL, which could in turn justify the results and the high mean score of job and career satisfaction. Nemati et al. (2020) in a study on levels of awareness in nurses working in hospitals in the city of Shiraz, southern Iran, had further reported that nurses had a high level of awareness of COVID-19. These individuals had generally received this training through hospitals where they were working for, the Ministry of Health and Medical Education, and the Internet(20). This issue could be also raised in explaining the role of work location, because working in the hospitals of the city of Shiraz had resulted in a better QWL than the ones based in the city of Bushehr as maintained in the study findings. Tertiary hospitals in big cities such as Shiraz were equipped with good medical facilities, specialized teams, and structured work plans, which could provide better conditions for employees’ QWL in the current critical situation. In line with these results, Moradi et al. (2014) had also considered hospitals as one of the factors affecting QWL(9).
Moreover, stress at work obtained a lower mean score compared with other subscales. The content of the items related to this subscale was associated with stress and pressure on nurses in terms of high-volume and long working hours. Due to the prevalence of COVID-19 and the current critical times, the working situation of nurses in all hospitals, especially those designated as referral centers for these patients in each province, had been severely affected. Pressure, work-related stress, and long working hours with special conditions such as wearing protective clothing and having worries about being infected with the virus had further led to a lower mean score assigned to stress at work among the QWL subscales(18). In agreement with these results, studies by Lu et al. (2020) and Lai et al. (2020) in China had similarly reported high psychological stress and burden on treatment teams, particularly nurses working at the frontlines fighting against COVID-19(18, 19).
The study results also showed that the nurses had a low mean score in terms of home-work interface, which could be explained by the fact that more than three-quarters of the participants in this study were female, mostly married. Due to the current critical situation as well as the pressure and long working hours and sometimes hospital stays and not going home to prevent the virus from spreading to other family members, the nurses’ in-house roles had been affected, so this imbalance could influence their QWL. With regard to the dominant culture in the cities (southern Iran) examined in this study, wherein women were playing the leading roles at home and they were in charge of doing house chores and caring for children and the elderly, work pressure on working women, particularly nurses with their own working conditions and difficulties, were greater(24). With reference to the culture of the Iranian society, the burden of these roles on Iranian female nurses is more than other Western countries, because family members, with a much broader meaning than husband and children, have duties and obligations. From the perspective of traditional society, these responsibilities have been assigned to women(25). With regard to several studies, pressures cause conflicts between the roles of these women as a spouse or a mother and the duties of an official nurse(26, 27). Therefore, in Iran, wherein a large number of nurses are women, the position of family in Iranian culture and Islam is of great importance and work-life balance, especially for married women, is significant. In order to create this balance, it is suggested to generate better supportive infrastructure by the government and the workplace and to pass legislations to protect these women.
Furthermore, this study revealed that PSC was an important predictor of QWL in nurses. In this regard, Cown et al. (2008), in their longitudinal study, had found that PSC was a strong predictor of job satisfaction in nurses, so that the importance of the role of PSC on the amount of salary paid as an external factor of job satisfaction was more significant with longer stability(11). Based on other surveys, internal factors such as job satisfaction and PSC could also have an active role in manifestations of symptoms of burnout among nurses, and PSC was a buffer to deal with challenging working conditions(15).
This study had limitations such as its cross-sectional nature, which constrained the interpretation of the causal relationship between the variables in this study. To understand the causal relationship between these variables, it is necessary to design and conduct longitudinal studies. The presence of a group of non-caring nurses in this study to compare them with the group concerned can additionally elucidate the role of caring for patients with COVID-19 in PSC and QWL in nurses, which is suggested to be addressed in further investigations.