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.

Addressing quality teaching in hard to staff settings : the Exceptional Teachers for Disadvantaged Schools Project

This Exceptional Teachers for Disadvantaged Schools (ETDS) project sets out to design a new model of Australian teacher education responding to recent demands for quality education in low SES and disadvantaged schools. The project moves teacher education from the ‘missionary’ (Larabee, 2010) or deficit (Comber and Kamler 2004; Flessa, 2007) approaches, towards a focus on notions of quality and academic excellence. Rice (2008, p.1) argues for a need to place more of the “very best teachers into the most challenging schools”, yet the problem is not merely one of training more teachers, for disadvantaged schools already receive disproportionate numbers of beginning teachers (Connell, 1994; Vickers & Ferfolja, 2006). Rather, Grossman and Loeb (2010, p. 245) argue the problem centers on the common practice of “[p]lacing the least experienced teachers with the most needy students”. This paper reports on the first year trial of the project. The ETDS project is at present, the only mainstream Australian teacher education model that targets cohorts of academically high achieving pre-service teachers with the overt aim of preparing graduates of the program to teach in disadvantaged schools. At the end of its first year, the ETDS program graduated 20 new teachers, each of whom had over the previous 18 months engaged with a specialized curriculum and carefully monitored/scaffolded practicum placements in disadvantaged schools around Brisbane, Australia.

A case of community safety : displacing complex ‘social’ problems in Fortitude Valley

Public dialogue regarding the high concentration of drug use and crime in inner city locations is frequently legitimised through visibility of drug-using populations and a perception of high crime rates. The public space known as the Brunswick Street Mall (Valley mall), located in the inner city Brisbane suburb of Fortitude Valley, has long provided the focal point for discussions regarding the problem of illicit drug use and antisocial behaviour in Brisbane. During the late 1990s a range of stakeholders in Fortitude Valley became mobilised to tackle crime and illicit drugs. In particular they wanted to dismantle popular perceptions of the area as representing the dark and unsafe side of Brisbane. The aim of this campaign was to instil a sense of safety in the area and dislodge Fortitude Valley from its reputation as a =symbolic location of danger‘. This thesis is a case study about an urban site that became contested by the diverse aims of a range of stakeholders who were invested in an urban renewal program and community safety project. This case study makes visible a number of actors that were lured from their existing roles in an indeterminable number of heterogeneous networks in order to create a community safety network. The following analysis of the community safety network emphasises some specific actors: history, ideas, technologies, materialities and displacements. The case study relies on the work of Foucault, Latour, Callon and Law to draw out the rationalities, background contingencies and the attempts to impose order and translate a number of entities into the community safety project in Fortitude Valley. The results of this research show that the community safety project is a case of ontological politics. Specifically the data indicates that both the (reality) problem of safety and the (knowledge) solution to safety were created simultaneously. This thesis explores the idea that while violence continues to occur in the Valley, evidence that community safety got done is located through mapping its displacement and eventual disappearance. As such, this thesis argues that community safety is a =collateral reality‘.

Middle school social sciences : exploring teachers’ conceptions of essential knowledge

This study examines teachers’ conceptions of essential knowledge in the humanities and social sciences, commonly referred to as "social education", in the middle years of schooling. Social education has long been a highly contested area of the curriculum in Australia. In Queensland, social education comprises the integrated learning area of Studies of Society and Environment (SOSE). However, the new Australian Curriculum marks a return to discipline-based study of history and geography. This phenomenographic study addresses a perceived lack of understanding in the current research literature in Australia of the nature of middle school teachers’ professional knowledge for teaching the social sciences. Teachers are conceptualised in this study as curriculum makers in the classroom and, as such, their conceptions of essential knowledge are significant. Shulman’s (1986, 1987) theory of teachers’ knowledge forms the theoretical foundation of the study, which is contextualised in Federal and State education policies and the literature on the middle phase of schooling. Transcripts of interviews conducted with a group of thirty-one Queensland middle school teachers of SOSE were subjected to phenomenographic analysis, revealing seven qualitatively different categories of description. Essential aspects of knowledge for social education emerging from the study were: (1) discipline-based knowledge; (2) curriculum knowledge; (3) knowledge derived from teaching experience; (4) knowledge of middle years learners; (5) knowledge of integration; (6) knowledge of current affairs; and (7) knowledge invested in teacher identity. The three dimensions of variation that linked and differentiated the categories were: (1) content; (2) inquiry learning; and (3) teacher autonomy. These findings are presented as an outcome space where the categories are grouped as knowledge of the learning area, knowledge of contexts and knowledge of self as teacher. The results of the study suggest that social education teachers’ identity and knowledge of self are critical aspects of their knowledge as curriculum makers. The results illustrate that the professional and personal domains intersect, extending Shulman’s (1986, 1987) original theorisation of teachers’ knowledge into the personal arena. Further, middle years teachers’ conceptions of essential knowledge reveal a practice-based theorisation of knowledge for social education that fits the goals of middle schooling. The research concludes that attention to teacher identity in teacher education and in-service professional development has considerable potential to grow teachers’ knowledge in the social sciences and enhance their capacity for school-based curriculum leadership.

Is there an inverted U-shape relationship between job demands and work engagement : the moderating role of social support

Purpose - The purpose of this paper is to examine the possibility of an inverted U-shaped relationship between job demands and work engagement, and whether social support moderates this relationship. Design/methodology/approach – This study uses 307 technical and information technology (IT) managers who responded to an online survey. Multiple regressions are employed to examine linear and curvilinear relationship among variables. Findings – Overall, results support the applicability of the quadratic effect of job demands on employee engagement. However, only supervisor support, not colleague support, moderated the relationship between job demands and work engagement. Originality/value – The paper is the first to shed light on the quadratic effect of job demands on work engagement. The findings have noteworthy implications for managers to design optimal job demands that increase employee engagement.

Management strategies to harness cultural diversity on Australian constructions sites : a social identity perspective

Construction sites around the world employ large numbers of people from diverse cultural backgrounds. The effective management of this cultural diversity has important implications for the productivity, safety, health and welfare of construction workers and for the performance and reputation of firms which employ them. The findings of a three year, multi-staged study of cultural diversity management practices on construction sites are critiqued using social identity theory. This reveals that so called "best-practice" diversity management strategies may have an opposite effect to that intended. It is concluded that the management of diversity on construction projects would benefit from being informed by social identity research.

Leveraging social network data for analytical CRM strategies : the introduction of social BI

The skyrocketing trend for social media on the Internet greatly alters analytical Customer Relationship Management (CRM). Against this backdrop, the purpose of this paper is to advance the conceptual design of Business Intelligence (BI) systems with data identified from social networks. We develop an integrated social network data model, based on an in-depth analysis of Facebook. The data model can inform the design of data warehouses in order to offer new opportunities for CRM analyses, leading to a more consistent and richer picture of customers? characteristics, needs, wants, and demands. Four major contributions are offered. First, Social CRM and Social BI are introduced as emerging fields of research. Second, we develop a conceptual data model to identify and systematize the data available on online social networks. Third, based on the identified data, we design a multidimensional data model as an early contribution to the conceptual design of Social BI systems and demonstrate its application by developing management reports in a retail scenario. Fourth, intellectual challenges for advancing Social CRM and Social BI are discussed.

Web 2.0, social networking and the courts

In the last decade or so, we have witnessed the growth of web 2.0 technology and social networking platforms, and their rapid rise in popularity as methods of social interaction and communication. Yet, platforms such as Facebook and Twitter are not just online social phenomena, but can impact on the way the law and courts operate. This article highlights the issues that legal practitioners and courts need to be aware of in engaging with this technology, and suggests possible ways forward.

Dealing with unfinished business : preparing pre-service social education teachers for curriculum change

Pre-service teacher education is unfinished business. New social education teachers face the challenge of fluid policy environments in which curriculum content and pedagogy are continually changing. The evolving Australian curriculum is the most recent example of such fluidity with its emphasis on shifting the educational agenda to a focus on discipline-based approaches. This paper addresses the concerns of final year pre-service and early career social education teachers, in terms of their professional development needs, by drawing on the findings of a pilot study with students and recent graduates from a university in south-east Queensland. It concludes that social education curriculum units which embed links to professional practice and professional development in teaching, learning and assessment may provide the way forward for enhancing the transition to practice for beginning teachers and assist them in navigating constant change.

Cellular settings mediating Src Substrate switching between Focal Adhesion Kinase Tyrosine 861 and CUB-domain-containing protein 1 (CDCP1) Tyrosine 734

Reciprocal interactions between Src family kinases (SFKs) and focal adhesion kinase (FAK) are critical during changes in cell attachment. Recently it has been recognized that another SFK substrate, CUB-domain-containing protein 1 (CDCP1), is differentially phosphorylated during these events. However, the molecular processes underlying SFK-mediated phosphorylation of CDCP1 are poorly understood. Here we identify a novel mechanism in which FAK tyrosine 861 and CDCP1-Tyr-734 compete as SFK substrates and demonstrate cellular settings in which SFKs switch between these sites. Our results show that stable CDCP1 expression induces robust SFK-mediated phosphorylation of CDCP1-Tyr-734 with concomitant loss of p-FAK-Tyr-861 in adherent HeLa cells. SFK substrate switching in these cells is dependent on the level of expression of CDCP1 and is also dependent on CDCP1-Tyr-734 but is independent of CDCP1-Tyr-743 and -Tyr-762. In HeLa CDCP1 cells, engagement of SFKs with CDCP1 is accompanied by an increase in phosphorylation of Src-Tyr-416 and a change in cell morphology to a fibroblastic appearance dependent on CDCP1-Tyr-734. SFK switching between FAK-Tyr-861 and CDCP1-Tyr-734 also occurs during changes in adhesion of colorectal cancer cell lines endogenously expressing these two proteins. Consistently, increased p-FAK-Tyr-861 levels and a more epithelial morphology are seen in colon cancer SW480 cells silenced for CDCP1. Unlike protein kinase Cδ, FAK does not appear to form a trimeric complex with Src and CDCP1. These data demonstrate novel aspects of the dynamics of SFK-mediated cell signaling that may be relevant during cancer progression.

Privacy by design : Does it matter for social networks?

Privacy is an important component of freedom and plays a key role in protecting fundamental human rights. It is becoming increasingly difficult to ignore the fact that without appropriate levels of privacy, a person’s rights are diminished. Users want to protect their privacy - particularly in “privacy invasive” areas such as social networks. However, Social Network users seldom know how to protect their own privacy through online mechanisms. What is required is an emerging concept that provides users legitimate control over their own personal information, whilst preserving and maintaining the advantages of engaging with online services such as Social Networks. This paper reviews “Privacy by Design (PbD)” and shows how it applies to diverse privacy areas. Such an approach will move towards mitigating many of the privacy issues in online information systems and can be a potential pathway for protecting users’ personal information. The research has also posed many questions in need of further investigation for different open source distributed Social Networks. Findings from this research will lead to a novel distributed architecture that provides more transparent and accountable privacy for the users of online information systems.