Working Conditions and Productivity among Nurses in Selected Hospitals in Southwest Nigeria

Introduction

Work is very important to people and it plays a fundamental role in their lives. Work provides for basic sustenance needs and decent living conditions, but above all work is an activity through which an individual fits into a livelihood, creates new relations, uses his/her talents, learns and develops his/her identity and a sense of belonging.¹ Work can therefore be seen as a major activity for human beings that meets several needs in their lives. These needs include economic survival, life satisfaction and the provision of a sense of reality. The workplace is a complex environment with different situations, such as having too much or too little to do, being subjected to conflicting demands, feeling distracted by family problems, and working for demanding and unhelpful managers.² Furthermore, McConnell opined that physical working conditions such as heating, lighting, furnishing, space, noise, and equipment can also create stress for employees.² The physical environment of the health care facility greatly influences the physical and mental health of all those who are in that facility. The physical environment influences how nurses deliver health care services; it influences the patients' well-being; and it influences in achieving the facility's goals.³ Nurses are working in health care organizations that are battling with staff shortages, increasing patient loads, shrinking reimbursement and growing regulatory pressure.⁴ Therefore, nurses face a variety of stressful working conditions while meeting the physical and psychological needs of patients. Managers need to assess the work environment and the working conditions, and they need to take action to improve them. As nursing staff is exposed to stressful working conditions on an ongoing basis, it has an impact on their well-being and the quality of patient care work performance.³ Hospital workers face a variety of highly stressful working conditions while meeting the physical and psychological needs of patients. The nursing professionals also suffer higher levels of stress and are at an increased risk of burnout. And, according to Leka, Griffiths and Coxstate, workers who are stressed do not perform well because they are poorly motivated and are likely to be unhealthy.⁵ The work environment and the working conditions are very important in any organization. If employees have a negative perception of their working environment, they are likely to be absent, have stress-related illnesses, and their work performance, productivity and commitment tend to be lowered. On the other hand, organizations that have a friendly, trusting and safe environment, experience greater productivity, communication, creativity and financial health.⁶ Most nursing errors occur when an individual nurse is stressed, overwhelmed or lacking assistive support. Assistive personnel play a vital role in reducing nurse burnout and clinical errors; however the delegation of direct and indirect care to assistive nursing personnel can be a hefty task.⁷ Nevertheless, work stress and burnout remain significant concerns in nursing, affecting both individuals and organizations.⁸

According to Asuquo, Ackley Akpan-Idiok, and Ijabula, workplace policies that promote nurse's autonomy, good nursing leadership and supervision, and implement WHO nurse-patient ratio of 1:4 can facilitate a stress free work environment for nurses that translates to positive health for nurses, decreased lack of job satisfaction, increased productivity, efficiency and quality of care.⁹ Gandi, Wai, Karick, and Dagona showed no gender differences in burnout levels among Nigerian nurses, who experience medium to high levels of emotional exhaustion, medium levels of depersonalization and high levels of personal accomplishment.¹⁰ Work-home interference (WHI) and home-work interference (HWI) were found to mediate the relationship between work characteristics and burnout. The meditational relationship differs between genders. The study calls for further research into gender and burnout among the caring professions, especially in under-developed and developing economies of the world.¹⁰ Therefore, this study was conducted to explore the perceived impact of working conditions on productivity of nursing staff in two hospitals in South Western state of Nigeria, as a follow up of these two studies conducted in different selected regions of Nigeria.

Methods

The study locations were Adeoyo Maternity Hospital (AMH) and Oluyoro Catholic Hospital (OCH) both located in Ibadan, Oyo State, Southwest Nigeria. AMH was one of the earliest hospitals established in Nigeria by the British colonial administration in 1923. It was established mainly for the care of pregnant mothers and children. The hospital specifically takes care of pregnancies, delivery cases and health conditions affecting mothers and their children; minor medical ailments are also attended to at the hospital. It is mostly referred to as the “baby hospital of the region.” The patient inflow is about 2,000 per week. Oyo State government subsidizes the cost of care in the hospital. OCH, on the other hand, was established by the Catholic Christian missionaries in the 1940s. The hospital takes care of all cases affecting the health of the people, including maternal and child care. OCH strictly runs on a fee-for-service model and it serves as an alternative source of care for people in Ibadan and environs during the occasional industrial strike embarked upon by health workers. The patient inflow is about 500 per week. The study adopted the descriptive survey design. This was a simple descriptive cross-sectional study comprising of a sample of 200 Nurses. Participants were randomly selected from the two hospitals. One hundred participants were drawn from each hospital. Data on perceived impact of working conditions on productivity were collected using a structured questionnaire administered in English language. The reliability of the questionnaire was determined using the test-retest method at two week-intervals. Responses from participants at the two locations were merged and jointly analyzed. Analysis was completed using Microsoft Excel (Microsoft Corporation, 2013) and presented with simple statistics including frequencies and percentages. The study was carried out in June 2015 and was approved by the ethical board of the Ministry of Health Oyo State and by the University College Hospital, Ibadan, Nigeria.

Results

Discussion

Majority of the respondents agreed that their workplace has a warm, friendly and a pleasant atmosphere; that they are happy with work environment and working condition. Kreitzer et al. opined that organizations that have friendly, trusting, and safe environments experience greater productivity, communication, and financial health.⁶ Gerber et al. indicated that working conditions are created by the interaction of employees with their organizational climate, and includes psychological as well as physical working conditions.¹¹ Furthermore, Gerber et al. stated that a supportive work environment attracts individuals into the health professions, encourages them to remain in the health workforce and enables them to perform effectively.¹¹ Lewy, in his study, also affirmed that hospital workers face a variety of highly stressful working conditions while meeting the physical and psychological needs of patients.¹² This is supported by the perception of the respondents from this study that work stress among nurses is high and impacts the nurses' health. Schoombie et al. argue that nurses form the largest part of the healthcare workforce and they are likely to influence the experience and quality of care for patients the most.¹³ Therefore, nurses suffer higher levels of stress and are at risk of burnout regardless of whether the stress was perceived positively or negatively, which may contribute to illness eventually.⁸

A majority of the respondents agreed that work stress causes increased rate of absenteeism among nurses, high staff turnout and deterioration in quality of service provided to patients. This finding supports Lewy, who indicated that the nature of the physical condition under which employees work is important to output.¹² Bornstein stated that in organizations where employees are exposed to stressful working conditions, productivity is negatively influenced and that there is a negative impact on the delivery of service.¹⁴ On the other hand, if working conditions were good, productivity increased and there was a positive impact on the delivery of service.¹⁵ In fact, work environment related issues have been prioritized in labor policy debates throughout the industrialized nations. Improving the general work environment has been declared a target of the European Union, as stated in the consolidated version of the Treaty establishing the European Community.¹⁶ This study has a number of limitations and our results must be interpreted with caution. Our study was a cross-sectional study; thus, we are unable to make any causal inferences. The study was conducted at two locations, so our findings cannot be generalized across the country. Finally, our study presented simple descriptive statistics to capture the items of interest. Future studies should explore other potential factors that may impact the findings of the present study.

Conclusion and Implications for Translation

From the findings of the study, it can be concluded that stress arising from poor working conditions can have an adverse impact on the organization. The most common detrimental effects on the organization are increased absenteeism, high turnover, and deterioration in the morale, job satisfaction and job performance of employees. In order to improve the organization's effectiveness, the employer must implement strategies that are beneficial to both the employees and the health organization. Nurses face a variety of highly stressful working conditions while meeting the physical and psychological needs of patients. Nurses form the largest part of the health care workforce and they are likely to influence the experience and quality of care for patients the most. The nursing professionals also suffer higher levels of stress and are at an increased risk of burnout. The work environment and the working conditions are very important in any organization. If employees have a negative perception of their working environment they are likely to be absent, have stress-related illnesses, and their work performance, productivity and commitment tend to be lowered. On the other hand, organizations that have a friendly, trusting and safe environment, experience greater productivity, communication, creativity and financial health.