Positive work environments increase retention of nurses and improve quality of care. Understanding of reality of Japanese staff nurses’ perceptions of their work environments helps us to clarify the issues to address in order to improve nurses’ work environments in Japan.
Purpose:
This study aimed to identify staff nurses’ perceptions of their work environments and to obtain suggestions to improve their workplaces.
Methods:
We conducted a nationwide survey using the Hatarakiyasusa Scale for Staff Nurses (HS-SNs), which can be used to evaluate staff nurses’ hatarakiyasusa, a Japanese concept of expressing one’s positive or agreeable perceptions about situations or other factors that make one’s workplace positive, in their nursing units. The HS-SNs is a 1–5 Likert-type scale; “hardly true = 1” to “mostly true = 5”, constructed with 38 items asking about the degree of hatarakiyasusa. Because the HS-SNs was developed based on qualitative studies focusing on Japanese staff nurses’ perceptions of hatarakiyasusa, the HS-SNs reflects their perceptions of their work environments faithfully. The reliability and validity of the scale was confirmed by the authors.
The HS-SNs was sent to 1,118 nurses working at 81 hospitals throughout Japan and collected by anonymous individual posting. The survey was conducted from July to September 2016.
Descriptive statistics were calculated using SPSS (ver.24). High and low score domains were settled according to mean scores and standard deviations of the total items; if the mean score of an item was below “mean score minus 1SD”, the item was classified into the low score domain; if it was between “mean score minus 1SD” and “mean score plus 1SD”, it was classified into the middle domain; and, if it exceeded “mean score plus 1SD”, it was classified into the high score domain.
Results:
Six hundred and five nurses responded (response rate 54.1%), and 459 valid responses were analyzed statistically. Locations and operators of hospitals and types of nursing units of the sample were varied. The obtainable score range of each item is 1 to 5 (total score 38 to 190). The range of scores on the HS-SNs obtained through this survey was 54 to 173, and the mean score was 118.46 (SD = 20.39).
Seven items (18.4%) were classified into the high score domain: [Q1. There are colleagues or nurse managers who willingly respond to requests to communicate about work situations in my workplace] (3.85), [Q4. There are collaborative relationships between me and colleagues] (3.78), [Q2. There are colleagues or nurse managers who give instructions appropriately in my workplace] (3.72), [Q9. There are opportunities to talk with personnel for the purpose of problem-solving] (3.54), [Q14. Nurse managers or colleagues respond positively to requests to exercise one’s occupational rights] (3.53), [Q15. Nurse managers coordinate working hours taking into consideration individuals’ circumstances] (3.48), and [Q11. Encouragement and appreciation are expressed between personnel] (3.47).
Six items (15.8%) were classified into the low score domain: [Q38. Payment properly reflects the quality and quantity of work done] (2.49), [Q22. The number of staff is suitable for the quality and quantity of work] (2.49), [Q12. Rarely hear verbal abuse/blaming of other personnel] (2.50), [Q17. Am able to start and finish work at a fixed time] (2.68), [Q18. Ward meetings or activities such as committees are held within working hours] (2.70), and [Q33. Orders to relocate are made reflecting one’s opinion or willingness] (2.76).
Discussion:
Items [1], [2], [4], [11], and [14] were classified into the high score domain. These items could be improved by one’s mindfulness. It appears that many staff nurses recognized the presence of colleagues or nurse managers who willingly support them. Items [11] and [14] ask about interaction, which could foster smooth relationships between nurses, or inter-professional collaboration. Item [4] is related to the quality of relationships affected by the quality of daily interactions. It is important that all personnel understand the importance of these aspects. Item [9] was also classified into the high score domain. This indicated that many staff nurses tended to have opportunities to talk about problems occurring in their workplaces in some way. It is important that individuals consciously make good use of those opportunities and involve themselves in discussions. Another item classified into the high score domain was [15]. This item could be improved by nurse managers’ efforts to understand staff nurses’ circumstances, which impact their work.
On the other hand, item [12] was classified into the low domain. This indicated that many staff witness verbal abuse or blaming of other personnel in their workplaces and that these hindered realization of a positive workplace. Fostering a respectful attitude toward others and enhancing ethical sensitivity of individuals are essential for all personnel. Items [17], [18], [22], [33] and [38] were also classified into the low score domain. These items are related to management. It should be stressed that managers need respect for the workers. The results also indicate that the reality that staff nurses are facing is a shortage of workforce and being overwhelmed by work situations. It is one of the most serious issues, which Japan’s super-aging society is facing. Also, the score of [18] highlighted the problem that many staff nurses answered that ward meetings or activities such as committees were implemented in extra hours. Although ward meetings or organizational activities are important for ensuring quality of care, the result showed that these activities conducted in extra hours increase the burden for staff as well.
Conclusion:
The mean total score of the HS-SNs obtained through this survey was 118.46 (SD = 20.39). Seven items (18.4%) were classified into the high score domain, and six items (15.8%) were classified into the low score domain. The results of this study will be useful for finding measures or strategies for improving nurses’ work environments in Japan.