The relationship between the healthy work environment and intention to stay among nurses working in public hospitals in Muscat, Oman

Al Yahyaei, Asma Salim (2022). The relationship between the healthy work environment and intention to stay among nurses working in public hospitals in Muscat, Oman. University of Birmingham. Ph.D.

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Background: Staffing shortages are affecting an increasing number of health services globally. Predictions suggest that the shortages will worsen in the future. There is a broad consensus that leaders at all levels must do more to support and develop current employees. In Oman, published data suggests there is an ~ 30% shortfall in the required number of nurses to meet the population health demand. More attention is being given, to explore the factors associated with intention to leave. There is a scarcity of research to inform why nurses decide to stay. Understanding the factors that predict nurses’ intention to stay would help organisations plan retention strategies more effectively.
Aim: This thesis reports a PhD study that aimed to; explore the concept of a healthy work environment, review the literature pertaining to intention to stay/leave and the healthy work environment and finally it investigated the relationship between intention to stay and the healthy work environment among nurses working in three public hospitals in Muscat, Oman.
Methods: A multi-method, multi-phased, study consisting of a concept analysis using Walker and Avant’s framework was used to define the concept of the healthy work environment (HWE) and identify its attributes (phase one); a systematic review to identify, select, quality assess, extract and synthesise the findings reported in published papers which examined the relationship between the work environment and nurses’ intention to stay (ITS) in the acute healthcare setting (phase two), two steps of piloting including assessment of potential tools and evaluation of their clarity, suitability and acceptability to be used in the Omani healthcare setting. Finally, a cross-sectional survey to investigate the impact between the healthy work environment and other independent variables on the nurses’ intention to stay using path analysis.
Results: Five attributes of the healthy work environment were identified from the literature and were used to define the concept and build the study’s conceptual framework relating to intention to stay. In the systematic review, four main categories were identified that related to intention to stay: individual indicators (personal and professional), organisation/profile, work environment, and patient related. Several work environment variables were identified in the review and were significantly associated with nurses’ intention to stay, such as leadership practice, empowerment, nursing workload and team interaction. Based on the reviews’ findings and the previous intention to stay’s framework, a proposed framework was developed and tested. The final model explained 63% of the variance in regard to intention to stay and furthermore showed that organisation commitment, nurses’ satisfaction, and healthy work environment’ attributes have a substantial effect on nurses' intention to stay. Leadership and empowerment had the strongest impact on intention to stay among the HWE’s subscales. Nurses’ satisfaction and organisation commitment were indirectly associated to intention to stay through the nursing profession characteristics.
Discussion: Based on the results from the PhD study, a number of issues were identified including the role of leadership, empowerment and team working, global nursing workforce initiatives to ‘fill the gap’ as well as public and professional perceptions of nursing. Several issues related to Oman and the International nursing workforce shortage were discussed. Recommendations include a need to share, customise and utilise International initiatives which embrace the retention of nurses’ and enhance role empowerment, such as Magnet accreditation. Further recommendations were provided relating to future research.
Conclusion: With current and projected nursing workforce shortages, there is a need to retain nurses in healthcare organisations. Although, improved salary payments are likely to assist organisations attract talented nurses, organisations need to do more than that, to retain them. The factors that attract nurses are not necessarily the factors that will retain them. Establishing and maintaining a healthy work environment, where nurses are allowed to practice independently and grow professionally, will enhance intention to stay and therefore are recommended as a worthwhile investment.

Type of Work: Thesis (Doctorates > Ph.D.)
Award Type: Doctorates > Ph.D.
Licence: All rights reserved
College/Faculty: Colleges (2008 onwards) > College of Medical & Dental Sciences
School or Department: School of Nursing
Funders: Other
Other Funders: Sultan Qaboos University
Subjects: R Medicine > RT Nursing


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