The aim of the current study was to examine the Bedouin physicians' and nurses' views on nursing as a profession and its relationship to the working environment characteristics represented by team working, nurses' autonomy, authority and involvement in organizational decision-making.
Methods:
Sample: 201 Bedouin physicians and nurses from southern Israel participated in this study, with average age of 35.32 (SD=9.77); seniority at work - 9.88 (SD=8.83) years; 139 (69.2%) were clinical staff members and the rest (30.8%) held combined managerial and clinical positions; worked full-time – 88.1%; 32% - worked in the community healthcare clinics. Most of the participants were married (78.6%) and lived in permanent settlements (83.5%). Of the sample, 58.7% were nurses (81% of them - women), 41.3% - physicians (10.8% - women). Most of the nurses held an academic degree (72%).
Tools: The participants completed self-administered questionnaire consisted of three parts examining: a) personal views on nursing as a profession created by the authors, b) characteristics of nursing work environment (sub-scales from Nursing Work Index, Aiken, 2001) and c) socio-demographic data. The tools were validated through the expert-validation process and demonstrated good internal reliability (Alpha Cronbach between .80-.92).
Procedure: The data were collected after the ethical approval. 250 questionnaires were distributed by electronic mail, 201 were returned (compliance rate of 80.4%).
Results:
The main study findings indicated that:
- The nurses demonstrated more positive and up-to-date views towards nursing as a profession and its importance and contribution to the quality of clinical care than physicians (4.30 v 3.96, 1-5 scale; t=5.52, r<.001).
- Physicians ranked the work environment as more positive than nurses (physicians-nurses team working, nurses' autonomy and authority, and their involvement in organizational decision-making) (3.98 v 3.94; t=2.46, p<.05)
- Professionals who held combined clinical and managerial position ranked higher the importance and contribution of nurses to the quality of care as compared to those who held clinical position only (t=2.77; p<.01).
- Positive correlation between the perceptions and views towards nursing as profession and working environment variable (r=25, p<.001). Therefore, the higher working environments were ranked, the more positive views on nursing as a profession was reported.
- Factor analysis of the questionnaire on personal views on nursing as a profession revealed three main elements that addressed a) contribution of nursing to policy-making and management of healthcare system, b) clinical contribution of nursing and c) the degree of subordination of nurses to physician orders (autonomy of nurses).
- Nurses and physicians who live in recognized settlement, perceived nurses' contribution to the clinical care and management of the system as more positive that their colleagues who live in unrecognized settlements.
- To examine the contribution of independent variables to the explanation of views on policy and leadership elements of nursing practice (dependent variable), multiple regression analysis (Stepwise method) was performed. It was found that perceptions of working environment and nurses' contribution to the clinical care quality (t=4.51; p<.001 and t=8.86, p<.001, respectively) explained 37.9% (R2=.379) of the dependent variable. Therefore, more positive working environment and perception of nurses as a clinical authority were related to the perception of nurses as policy-makers and leaders in healthcare system.
Conclusion:
Our study results provide new evidence for differences in perceptions regarding professional nursing and work environment among Bedouin physicians and nurses. Managers who supervise multicultural teams, with different beliefs, values, and behavior styles, need not only foster work environment with respectful communication but also be aware how cultural background can affect individuals' interactions with colleagues, team members and with patients, address the disparities and eliminate differences in perspectives.
Effective collaboration in the working environment requires mutual respect, open communication and equitable, shared decision-making and can be obtained by encouraging and increasing nurse's independence at work, strengthen her self-confidence and expand her authority.