Quality of work life and turnover intention in primary healthcare organisations : a cross-sectional study of registered nurses in Saudi Arabia

Purpose: The purpose of this study was to improve the retention of primary healthcare (PHC) nurses through exploring and assessing their quality of work life (QWL) and turnover intention. Design and methods: A cross-sectional survey design was used in this study. Data were collected using a questionnaire comprising four sections (Brooks’ survey of Quality of Nursing Work Life [QNWL], Anticipated Turnover Intention, open-ended questions and demographic characteristics). A convenience sample was recruited from 143 PHC centres in Jazan, Saudi Arabia. A response rate of 87% (n = 508/585) was achieved. The SPSS v17 for Windows and NVivo 8 were used for analysis purposes. Procedures and tests used in this study to analyse the quantitative data were descriptive statistics, t-test, ANOVA, General Linear Model (GLM) univariate analysis, standard multiple regression, and hierarchical multiple regression. Qualitative data obtained from responses to the open-ended questions were analysed using the NVivo 8. Findings: Quantitative findings suggested that PHC nurses were dissatisfied with their work life. Respondents’ scores ranged between 45 and 218 (mean = 139.45), which is lower than the average total score on Brooks’ Survey (147). Major influencing factors were classified under four dimensions. First, work life/home life factors: unsuitable working hours, lack of facilities for nurses, inability to balance work with family needs and inadequacy of vacations’ policy. Second, work design factors: high workload, insufficient workforce numbers, lack of autonomy and undertaking many non-nursing tasks. Third, work context factors: management practices, lack of development opportunities, and inappropriate working environment in terms of the level of security, patient care supplies and unavailability of recreation room. Finally, work world factors: negative public image of nursing, and inadequate payment. More positively, nurses were notably satisfied with their co-workers. Conversely, 40.4% (n = 205) of the respondents indicated that they intended to leave their current employment. The relationships between QWL and demographic variables of gender, age, marital status, dependent children, dependent adults, nationality, ethnicity, nursing tenure, organisational tenure, positional tenure, and payment per month were significant (p < .05). The eta squared test for these demographics indicates a small to medium effect size of the variation in QWL scores. Using the GLM univariate analysis, education level was also significantly related to the QWL (p < .05). The relationships between turnover intention and demographic variables including gender, age, marital status, dependent children, education level, nursing tenure, organisational tenure, positional tenure, and payment per month were significant (p < .05). The eta squared test for these demographics indicates a small to moderate effect size of the variation in the turnover intention scores. Using the GLM univariate analysis, the dependent adults’ variable was also significantly related to turnover intention (p < .05). Turnover intention was significantly related to QWL. Using standard multiple regression, 26% of the variance in turnover intention was explained by the QWL F (4,491), 43.71, p < .001, with R² = .263. Further analysis using hierarchical multiple regression found that the total variance explained by the model as a whole (demographics and QWL) was 32.1%, F (17.433) = 12.04, p < .001. QWL explained an additional 19% of the variance in turnover intention, after controlling for demographic variables, R squared change =.19, F change (4, 433) = 30.190, p < .001. The work context variable makes the strongest unique contribution (-.387) to explain the turnover intention, followed by the work design dimension (-.112). The qualitative findings reaffirmed the quantitative findings in terms of QWL and turnover intention. However, the home life/work life and work world dimensions were of great important to both QWL and turnover intention. The qualitative findings revealed a number of new factors that were not included in the survey questionnaire. These included being away from family, lack of family support, social and cultural aspects, accommodation facilities, transportation, building and infrastructure of PHC, nature of work, job instability, privacy at work, patients and community, and distance between home and workplace. Conclusion: Creating and maintaining a healthy work life for PHC nurses is very important to improve their work satisfaction, reduce turnover, enhance productivity and improve nursing care outcomes. Improving these factors could lead to a higher QWL and increase retention rates and therefore reinforcing the stabilisation of the nursing workforce. Significance of the research: Many countries are examining strategies to attract and retain the health care workforce, particularly nurses. This study identified factors that influence the QWL of PHC nurses as well as their turnover intention. It also determined the significant relationship between QWL and turnover intention. In addition, the present study tested Brooks’ survey of QNWL on PHC nurses for the first time. The qualitative findings of this study revealed a number of new variables regarding QWL and turnover intention of PHC nurses. These variables could be used to improve current survey instruments or to develop new research surveys. The study findings could be also used to develop and appropriately implement plans to improve QWL. This may help to enhance the home and work environments of PHC nurses, improve individual and organisational performance, and increase nurses’ commitment. This study contributes to the existing body of research knowledge by presenting new data and findings from a different country and healthcare system. It is the first of its kind in Saudi Arabia, especially in the field of PHC. It has examined the relationship between QWL and turnover intention of PHC nurses for the first time using nursing instruments. The study also offers a fresh explanation (new framework) of the relationship between QWL and turnover intention among PHC nurses, which could be used or tested by researchers in other settings. Implications for further research: Review of the extant literature reveals little in-depth research on the PHC workforce, especially in terms of QWL and organisational turnover in developing countries. Further research is required to develop a QWL tool for PHC nurses, taking into consideration the findings of the current study along with the local culture. Moreover, the revised theoretical framework of the current study could be tested in further research in other regions, countries or healthcare systems in order to identify its ability to predict the level of PHC nurses’ QWL and their intention to leave. There is a need to conduct longitudinal research on PHC organisations to gain an in-depth understanding of the determents of and changes in QWL and turnover intention of PHC nurses at various points of time. An intervention study is required to improve QWL and retention among PHC nurses using the findings of the current study. This would help to assess the impact of such strategies on reducing turnover of PHC nurses. Focusing on the location of the current study, it would be valuable to conduct another study in five years’ time to examine the percentage of actual turnover among PHC nurses compared with the reported turnover intention in the current study. Further in-depth research would also be useful to assess the impact of the local culture on the perception of expatriate nurses towards their QWL and their turnover intention. A comparative study is required between PHC centres and hospitals as well as the public and private health sector agencies in terms of QWL and turnover intention of nursing personnel. Findings may differ from sector to sector according to variations in health systems, working environments and the case mix of patients.

Accounting at home in developing economies : Current practices and implications for the accounting professional

We determine the extent of accounting at home in developing economies in this research. We then consider the role of the accounting profession may have in promoting accounting values at home. A language of business, accounting today plays a fundamental support role within the business community to evaluate the impact past decisions, and foresees directions for future initiatives. Sound accounting practices are fundamental to ensure symmetrical information dissemination across various stakeholders. Accounting literature has sought to investigate a number of questions that attempt to improve the practice of accounting in the corporate world. Equally, we must obtain adequate understanding of how we use accounting in our everyday life, and how accounting could assist the people most affected by the effects of accounting scandals, economic conditions, and corporate collapses.

Principals’ and teacher leaders’ perceptions of their role and interaction under current Chinese reform : a case study in Shandong province

This study aims to explore the perceptions of principals and teacher leaders regarding their roles and the interaction between these roles in Chinese urban primary schools at the time of unprecedented curriculum reform. This involves a complexity of factors such as the influence of globalisation, the impact of traditional Chinese cultural attitudes towards education through Confucianism, and the implementation requirements of the current education reforms. All of these wider contextual factors help to shape the leadership practices that are described in the study. A qualitative exploratory case study approach has been utilised to undertake this investigation. The conceptual framework for this study draws upon scholars‘ work from Western countries but has been adapted in order to address three research questions for the study‘s focus on the context in Shandong province, Mainland China. Three research questions were addressed: First, what are principals‘ perceptions of their leadership roles in Mainland China under current educational reform? Second, what are teacher leaders‘ perceptions of their leadership roles in Mainland China under current educational reform? And finally, what are principals‘ and teacher leaders‘ perceptions of how their roles interact? With reference to the principals in the study, the findings confirm Gurr‘s (2008) comprehensive leadership model relating to four roles, specifically, learning and teaching, symbolic and cultural awareness, future orientation, and accountability. Significantly, some sub-roles that emerge from the data are uniquely Chinese. For example, school culture construction is a very deliberate process in which principals and their staff talked openly about and were involved in creating a positive school climate comprising spiritual, material, and system dimensions. Another finding relates to school feature construction. This refers to the process that principals and staff used to make their schools distinctive and different from other schools and included such features as the school‘s philosophy and the school-based curriculum. In seeking to understand the nature of teacher leadership in Chinese primary schools, this research confirms some findings identified in Western literature. For instance, teacher leaders in Shandong province were involved in decision-making, working with parents and community members, undertaking and planning professional development for staff, and mediating between colleagues (Day & Harris, 2002; Harrison & Killion, 2007; Leithwood, Jantzi, & Steinbach, 1999; Muijs & Harris, 2006; Smylie, 1992). However, some new aspects, such as a heightened awareness of the importance of accountability, emerge from this study. The study‘s conceptual framework also draws upon some significant insights from micropolitics and, in particular, two core constructs, namely cooperation and conflict (Blase, 1991), to explore the interactions between principals and teacher leaders. In this study, principals and teacher leaders employed exchange and facilitation as two strategies in cooperative processes; and they adopted enforcement and compromise in conflictive processes. Finally, the study‘s findings indicate that principals and teacher leaders were developing new ways of interacting in response to the requirements of significant education reform. Most principals were exercising their power through (Blase, 1991) their teacher leaders who in turn, were working in alignment with their principals to achieve the desired outcomes in schools. It was significant that this form of 'parallel leadership' (Crowther, Ferguson, & Ham, 2009) characterised the teacher leadership roles at this period of change to the curriculum in Mainland China.

Evaluation of green public road procurement in Australia : current practices and gaps to fill

Public road authorities have a key responsibility in driving initiatives for reducing greenhouse gas (GHG) emissions in the road construction project lifecycle. A coherent and efficient chain of procurement processes and methods is needed to convert green policies into tangible actions that capture the potential for GHG reduction. Yet, many infrastructure clients lack developed methodologies regarding green procurement practices. Designing more efficient solutions for green procurement requires an evaluation of the current initiatives and stages of development. A mapping of the current GHG reduction initiatives in Australian public road procurement is presented in this paper. The study includes the five largest Australian state road authorities, which cover 94% of the total 817,089 km of Australian main roads (not local) and account for 96% of the total A$13 billion annual major road construction and maintenance expenditure. The state road authorities’ green procurement processes and tools are evaluated based on interviews and a review of documents. Altogether 12 people, comprising 1-3 people of each organisation, participated in the interviews and provided documents. An evaluation matrix was developed for mapping the findings across the lifecycle of road construction project delivery. The results show how Australian state road authorities drive decisions with an impact on GHG emissions on the strategic planning phase, project development phase, and project implementation phase. The road authorities demonstrate varying levels of advancement in their green procurement methodologies. Six major gaps in the current green procurement processes are identified and, respectively, six recommendations for future research and development are suggested. The greatest gaps remain in the project development phase, which has a critical role in fixing the project (GHG reduction) goals, identifying risks and opportunities, and selecting the contractor to deliver the project. Specifically, the role of mass-haul optimisation as a part of GHG minimisation was reviewed, and mass-haul management was found to be an underutilised element with GHG reduction potential.

Sustainable retirement living : what matters

There is a growing demand for sustainable retirement villages in Australia due to an increasing number of ageing population and public acceptance of sustainable development. This research aims to gain a better understanding of retirees’ understanding about sustainable retirement living and their attitudes towards sustainable developments via a questionnaire survey approach. The results showed that the current and potential residents of retirement villages are generally very conscious of unsustainable resource consumption and would like their residences and community to be more environmentally friendly and energy efficient. The cost of energy supply is a concern to majority of respondents. Education is required to residents about recycling household waste and how to use available facilities. A better understanding of retirees’ awareness and attitudes towards sustainability issues helps to improve the sustainable developments of retirement villages in the future.

Flexible airport terminal design : towards a framework

Flexibility is a key driver of any successful design, specifically in highly unpredictable environment such as airport terminal. Ever growing aviation industry requires airport terminals to be planned and constructed in such a way that will allow flexibility for future design, alteration and redevelopment. The concept of flexibility in terminal design is a relatively new initiative, where existing rules or guidelines are not adequate to assist designers. A shift towards flexible design concept would allow terminal buildings to be designed to accommodate future changes and to make passengers’ journey as simple, timely and hassle free as possible. Currently available research indicates that a theoretical framework on flexible design approach for airport terminals would facilitate the future design process. The generic principles of flexibility are investigated in the current research to incorporate flexible design approaches within the process of an airport terminal design. A conceptual framework is proposed herein, which is expected to ascertain flexibility to current passenger terminal facilities within their corresponding locations as well as in future design and expansion.

Sustainable retirement living : what matters

There is a growing demand for sustainable retirement villages in Australia due to an increasing number of ageing population and public acceptance of sustainable development. This research aims to gain a better understanding of retirees’ understanding about sustainable retirement living and their attitudes towards sustainable developments via a questionnaire survey approach. The results showed that the current and potential residents of retirement villages are generally very conscious of unsustainable resource consumption and would like their residences and community to be more environmentally friendly and energy efficient. The cost of energy supply is a concern to majority of respondents. Education is required to residents about recycling household waste and how to use available facilities. A better understanding of retirees’ awareness and attitudes towards sustainability issues helps to improve the sustainable developments of retirement villages in the future.

Internet Child Abuse: Current Research, Policy and Practice

Internet Child Abuse: Current Research and Policy provides a timely overview of international policy, legislation and offender management and treatment practice in the area of Internet child abuse. Internet use has grown considerably over the last five years, and information technology now forms a core part of the formal education system in many countries. There is however, increasing evidence that the Internet is used by some adults to access children and young people in order to ‘groom’ them for the purposes of sexual abuse; as well as to produce and distribute indecent illegal images of children. This book presents and assesses the most recent and current research on internet child abuse, addressing: its nature, the behaviour and treatment of its perpetrators, international policy, legislation and protection, and policing. It will be required reading for an international audience of academics, researchers, policy-makers and criminal justice practitioners with interests in this area.

Separation/Divorce Sexual Assault: The Current State of Social Scientific Knowledge

Many contend that the logical solution to woman abuse in marriage/cohabitation is for women to exit through legal separation, divorce, or other means. However, a growing body of empirical work shows that separation or divorce does not necessarily solve the problem of woman abuse. For example, in addition to experiencing lethal or nonlethal forms of physical violence and psychological abuse, many women who try to leave, or who have left their male partners, are sexually assaulted. The main objective of this paper is to critically review the extant empirical and theoretical work on separation/divorcesexual assault. Suggestions for future research and theorizing are also provided.

Towards determining soft tissue properties for modelling spine surgery : current progress and challenges

Current complication rates for adolescent scoliosis surgery necessitate the development of better surgical planning tools to improve outcomes. Here we present our approach to developing finite element models of the thoracolumbar spine for deformity surgery simulation, with patient-specific model anatomy based on low-dose pre-operative computed tomography scans. In a first step towards defining patient-specific tissue properties, an initial 'benchmark' set of properties were used to simulate a clinically performed pre-operative spinal flexibility assessment, the fulcrum bending radiograph. Clinical data for ten patients were compared with the simulated results for this assessment and in cases where these data differed by more than 10%, soft tissue properties for the costo-vertebral joint (CVJt) were altered to achieve better agreement. Results from these analyses showed that changing the CVJt stiffness resulted in acceptable agreement between clinical and simulated flexibility in two of the six cases. In light of these results and those of our previous studies in this area, it is suggested that spinal flexibility in the fulcrum bending test is not governed by any single soft tissue structure acting in isolation. More detailed biomechanical characterisation of the fulcrum bending test is required to provide better data for determination of patient-specific soft tissue properties.