Quality of Work Life and Associated Factors among Nurses Working in Wollega Zones Governmental Hospitals, West Ethiopia, 2018

Quality of work-life refers to the extent to which members of a work organization can satisfy their personal needs through their work experience in the organization. High quality of working life is critical for healthcare organizations to attract and retain qualied, committed and motivated employees and also lead to high task performance. However, there are few studies regarding quality of work life among nurses in Ethiopia. The objective of this study was to assess quality of work life and associated factors among nurses working in Wollega Zones governmental hospitals, 2018. based study was conducted on in The were regression analysis was conducted to identify factors associated with quality of working life of nurses. Statistical signicance was declared at p<0.05.


Abstract
Background Quality of work-life refers to the extent to which members of a work organization can satisfy their personal needs through their work experience in the organization. High quality of working life is critical for healthcare organizations to attract and retain quali ed, committed and motivated employees and also lead to high task performance. However, there are few studies regarding quality of work life among nurses in Ethiopia. The objective of this study was to assess quality of work life and associated factors among nurses working in Wollega Zones governmental hospitals, 2018.

Methods
Institutional based cross -sectional study design was conducted on 212 nurses working in wollega zones governmental hospitals from November to December, 2018. The study participants were selected by using simple random sampling techniques. The data was entered into Epi data version 3.1 and then exported into Statistical Package for the Social Sciences window version 20.0 for analysis. Multiple regression analysis was conducted to identify factors associated with quality of working life of nurses. Statistical signi cance was declared at p<0.05.

Result
A total of 212 nurses were involved in the study. The study revealed that about 108(50.5% of nurses have good quality of work life. Income and dependent family were signi cantly associated with quality of work life. In this study, Nurses who have no dependent family were 2.72 (AOR 2.72, 95% CI: 1.38, 5.38) times more likely to have good quality of work life compared to those who have dependent family. Nurses whose monthly income 446-5294 were 2.39(AOR 2.39 95% CI: 1.08, 5.37) times more likely to have good quality of work life compared to those who got less than 3653.

Conclusion
Nearly half of nurses were dissatis ed with the quality of their work life . The study revealed that monthly income and presence of dependent family showed signi cant association with quality of work life.
Bringing up and maintaining a higher level of quality of work life among nurses is a key to promote job satisfaction and enhance quality of patient care.

Background
Quality of work-life refers to the degree to which members of a work organization can satisfy their personal needs through their work experience in the organization. It covers the person's feelings about every aspect of work including economic rewards, bene ts, security, internal & external equity, working conditions, career opportunity, decision authority, organizational & interpersonal relationships, which are very meaningful in a person's life [1]. According to Brooks, quality of nursing work life is the degree to which registered nurses are able to satisfy important personal needs through their experiences in their work organization while achieving the organization's goals [2].
Quality of working life is normally considered as the real work situations including employee salary, facilities, health and safety issues, participating in decision making, management approach and job diversity and exibility [3].Quality of work life contains 4 dimensions: Work Life/Home Life, Work Design Dimension, Work Context Dimension and Work World Dimension. Work Life/Home Life is de ned as the interface between the life experiences of nurses in their place of work and in the home. Work Design is de ned as the composition of nursing work and describes the actual work nurses do. Work Context is de ned as the practice settings in which nurses' work and explores the impact of the work environment on both nurse and patient systems and Work World is de ned as the effects of broad societal in uences and changes on the practice of nursing [4].
Nursing is a very demanding profession and they have a vital role in delivering health care. Nurses are the most diverse and most abundant workforces in the health care system, they are responsible for and to make a quick decision about patient care and well-being. Improving the quality of working life of staff nurses is important to improve quality of care of the patients. The rapidly changing health care environment has had a consequence on the nursing work environment, workload, and quality of nursing work life [5,6].
As indicated by studies conducted worldwide, more than one -third of respondents have a low level of quality of work life. About 45.7% of nurses in Iran have a low level of quality of work-life, in India, about 29.3% reported low level of quality of work-life [6,7].
High quality of working life (QWL) is signi cant for healthcare organizations to attract and retain quali ed, committed and motivated employees and also lead to high task performance [8,9]. Designing jobs exclusively for the needs of technology without recognizing the needs of workers is a challenge. The intervention which considers Quality of Work-Life helps the organization to use their worker's full potential, ensures comprehensive participation and engagement of workers, makes work easier, improves quality and increases e ciency [10,11].. Improvement of quality of work-life among health care providers speci cally nurses positively affecting patient outcomes [12]. Satis ed employees are working with more interest and they have more faithful to their organization. The dissatisfaction of nurses with their quality of work-life is the factors to leave their organization and may lead them to nd another career opportunity [13].
Few studies were conducted previously on job satisfaction but it focuses mainly on likes and dislikes of the employee, the nursing work environment is not addressed in job satisfaction, today the quality of work-life gained much acceptance in the nursing profession [14]. However; little is known about the quality of work-life of nurses in Ethiopia. This cross -sectional study was conducted to assess the quality of work life and associated factors among nurses working in governmental hospitals of wollega zones.

Methods And Materials
Study setting and population The study was conducted in governmental Hospitals of Wollega Zones at Nekemte referral Hospital, Wollega University referral hospital, Ghimbi hospital, Nedjo Hospital, Shambu hospital, Dembi Dollo hospital and Arjo hospital from November to December 2018. Institution based cross -sectional study design was used. All nurses working in Wollega Zones governmental hospitals was source population and all sampled nurses from the total of nurses working in Wollega Zones governmental hospitals was the study population. Nurses who have been working for more than 6 months in the hospital were included in the study.

Sample Size Determination
The sample size of the study was calculated using formula for estimation of single population proportion. Since the source population was 458 nurses which were less than 10,000, nite population correction was needed and adding 10% non-response rate, the nal sample becomes 230. The study participants were selected by simple random sampling methods.

Data Collection Tool And Procedures
A self-administered questionnaire that has two parts was applied for data collection. The rst part contains socio-demographic characteristics such as sex, age, marital status, educational status, the experience of work, monthly income, dependent family (child/adult), and work unit. Part two contains questions related to the quality of work life. It was adapted from Brook's quality of work life questionnaire scale to measure the quality of working life [4]. It contains 42 items divided into four subscales: (a) work life/home life, (b) work design, (c) work context and (d) work world. The instrument asks respondent nurses how much they agree or disagree with each item on a 6-point scale, with 1 indicating 'strongly disagree', 2 'moderately disagree', 3 'disagree', 4 'agree', 5 'moderately agree', and 6 'strongly agree'. The 6point scale was merged to two categories as agree and disagree. Agree category contains positive responses (agree, moderately agree and strongly agree), and disagree category contains negative responses (strongly disagree, moderately disagree and disagree) [4,15]. In this study, cronbach's alpha for quality of work life items was checked and found to be 0.928, which was in the acceptable level.

Data processing and analysis
After data collection, each questionnaire was checked visually for completeness and then entered into Epi Data Version 3.1 and was analyzed using SPSS version 20.0. Univariate descriptive analyses like percentages and frequency distributions were used in the form of tables and graphs to summarize the variables mean and the standard deviation was computed as well. A bivariate logistic regression analysis was carried out to assess association between the dependent and all the independent variables to identify candidate for multivariable analysis. Variables signi cant at p < 0.25were considered as candidate for the multivariable logistic regression analysis and then independent variables, which had a statistically signi cant association with the dependent variable at P < 0.05, were entered to the nal regression model. Results were reported as the odds ratios (OR) with respective 95% CI.

Data Quality Control
The training was given for the supervisors to control the quality of the data to be collected. Pre-test was done on nurses working in Nekemte health center by taking 5% of sample size prior to the actual data collection and some modi cation were made.

Result
Socio-demographic characteristics of the respondents A total of 212 nurses were involved in the study and provide a response rate of 92.17%. From a total of 212 nurses majority of them 130(61.3%) were male. The mean age of the respondent was (28.36 + 4.1).
More than half, 57.5% of the study participants were between ages of 25-29 categories. Majority of the study participants 149(70.3%) were got married, about 140(66%) of them have Bachelor degree. Majority of the study participants 87(41%) had 6-10 years of work experience. Majority of them, 59(27.8%) nurses answered as they earned between 3653 to 4446 Ethiopian Birr. Majority of the study participants 163(76.9%) have dependent family. More than half of the study participants were working in inpatient (Table 1).

Work Life Dimension
In this study about 111(52.4%) of nurses were responded as they are able to balance their work with family needs. However, more than half of nurses 125(59%) were not satis ed with their organizational policy for family leave.

Work Design Dimension
More than half of nurses 125(59%) were not received adequate assistance from unlicensed support personnel. About 107(50.5%) were not satis ed with their job. Majority, 159(75%) of nurses responded as their work is too heavy. About 168(79.2%) responded as they have autonomy in patient care decision and more than half 120(56.6%) responded as they perform many non-nursing tasks.

Work Context Dimension
In these contexts almost in all items nurses was responded as they are satis ed except in some items. About 118(55.7%) nurses were not satis ed with lounge/break-area/locker room in their setting. About more than half 50.5% nurses responded as upper level management has respect for nurses.

Work world dimension
About 112(52.8%) of nurses responded as society has good image for their profession. However; majority of the nurses, 142(67%) were dissatis ed with their salary. More than half of them 123(58%) feel as their job is secure (Table 3). have low level of QWL (Fig. 1).

Factors associated with Quality of work life
In bivariate analysis, marital status, work experience, income and dependent family showed signi cant association at p-value of 0.   (16). Again study conducted in Hong Kong showed as respondents had a slightly higher than average score on the quality of work life (17). However; study conducted in Ethiopia, Hawassa town nurses showed about 67.2% of nurses were dissatis ed by their work life, and their level of quality life was lower than this study (18). The reason for the discrepancy between these studies might be the difference in institution facilities.
In this study monthly income and having dependent family showed signi cant association with good quality of work life. The current study showed a signi cant association between monthly income and quality of work life. Nurses with higher monthly payment were more satis ed with their work life. About 67% of nurses reported as their salary is not adequate for their job given the current job market conditions and majority of them 142(67%) dissatis ed with their salary. This is supported with the nding of Saudi Arabia (15), Ethiopia (18), Iran (7) and Thailand (19).
Nurses who have dependent family were not satis ed with their quality of work life. About 101(47.6%) of nurses reported as they are not balance their work with their family needs and more than half 125(59%) of them were not satis ed with adequacy of their organization's policy for family-leave time. This is supported with the ndings of Saudi Arabia (15) and Bangalore Hospital (20). This indicated that nurses need time to give care to their family; they should balance their work-life with their family needs.
In this study age, educational level, work experience, work unit, sex and marital status didn't show statistical signi cance at p-value 0.05. But in different studies these variables showed signi cant association with quality of work life. Educational level showed signi cant association with quality of work life. Study conducted in Saudi Arabia, Hawassa Town and Theni & Dindigul district (15, 18 and 21) showed, nurses with higher educational level were reported a better quality of work life. In contrary to this, study conducted at west Bengal, India showed Nurses with lower education level experienced better QWL than nurses with higher education (16). Regarding work experience, more experienced nurses were more satis ed with their QWL (15, 22, and 23). The difference between the current and above mentioned study might be due to the difference in health institution setup and policy of the countries.

Limitation
Due to the cross-sectional nature of the data, the study cannot show cause and effect relationship between quality of work-life and socio-demographic characteristics. Due to the lack of adequate similar studies in our country, the comparison was made with other countries ndings.

Conclusions
Nearly, half of nurses were dissatis ed with the quality of their work life. The study revealed that monthly income and dependent family showed a signi cant association with the quality of work life. Bringing up and maintaining a higher level of quality of work-life among nurses is a key to promote job satisfaction and enhance the quality of patient care.