How does a work environment affect job performance of nurses

International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 - 6510(Online),
Volume 6, Issue 3, March (2015), pp. 87-95 © IAEME
87
HOW DOES A WORK ENVIRONMENT AFFECT JOB
PERFORMANCE OF NURSES
Dr. Aditi Jain
Assistant Professor, Business Studies, Department of Commerce
THE IIS University, Jaipur, Rajasthan
Ms. Shivani Gambhir
Research Scholar, Department of Commerce
The IIS University, Jaipur, Rajasthan
ABSTRACT
Employees productivity and work quality is adversely troubled by the work environment
factors of the organizations such as stress, conflicts, disharmony, lack of communication , ineffective
decision making, coordination and many more which opens a dispute in almost all the organizations
globally. The health sector is one of the most sensitive and upcoming sectors of economy and nurses
are said to play the key role in this sector. “Nurse”, considered to be synonymous of “Care” should
be highly respected and esteemed for rendering us their services for a noble cause to cure us, heal us,
to keep us safe and protected. Being the edifice of health care sector and advocates of patients, it
becomes the significant responsibility of health care departments to enrich and enlarge their job
profiles. Nurses should be provided with a healthy and cordial work environment in the hospitals, so
that they can give the best output and prosper in their jobs. They can said to be the life blood of the
health care and then positive work environment factor is the heart that pumps it. So, if health care
sector wants to fulfil its vision, they necessarily ought to realize and fulfil the needs and desires of
INTERNATIONAL JOURNAL OF MANAGEMENT (IJM)
ISSN 0976-6502 (Print)
ISSN 0976-6510 (Online)
Volume 6, Issue 3, March (2015), pp. 87-95
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Journal Impact Factor (2015): 7.9270 (Calculated by GISI)
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88
the nurses who work round the clock for our well being. Thus, it is essential to reorganize work
environment and eradicate as many impediments as possible for cordial work environment and job
satisfaction of nurses. Studies have proved that stumpy control over work atmosphere is negatively
correlated with nurse’s quality of care and patient satisfaction. Hence, the study is designed to
highlight some of the problems of nurses work environment that directly affects their job outcomes.
Key Words: - Nurses, Work environment, Health care, Job performance.
INTRODUCTION
“It is wrong to keep quiet about what is harmful.”
Columbian of Leinster
Moral and Political Activist, Missionary Teacher.
As the saying goes “Health is Wealth”; health is considered as most vital phenomenon
which determines the prosperity and progress of the country at large. The health care industry is one
of the largest and upcoming sectors in the world. In order to maintain a equilibrium between delivery
and reception of health services, various policies, regulations and strategies have come up to enrich
this fast growing profession. Nurses, as they are the nervous centre of the health world play a pivotal
role in enlargement and success of the healthcare sector. They are considered to be patient’s
advocates and linkage between doctors and patients for being at the lowest hierarchy of health sector
and always in constant and close touch with the patients and families. Nurses are always thought of
while we talk of health care sector. They are the crusaders for our good health and always try their
best to keep us safe and protected the ones who never give up or take any excuse to evade their
services. Moreover, they are the key components of health care sector and have a significant role in
upgrading its standard and enhancing patient care and safety.
Poor or deficient work environment jeopardizes many aspects of health care delivery. There
is a mounting evidence that unhealthy work environment contributes to increased cost to the
organization in terms of increased cases of medical negligence, dissatisfied patients, conflicts,
turnover and poor reputation of the hospitals. Unpleasant, demoralising and unsafe work conditions
in the workplace rots the entire system of almost every organization. Hence, creation of healthy work
environment is imperative to ensure patient safety, enhance retention of staff and maintain
organisational profitability and goodwill. Nursing is the profession most trusted to act honestly and
ethically. Five times since 1999, nurses have topped Gallup’s annual survey of honesty and ethics
among all professions [1]. The American Association of Critical Care Nurses has committed to
acting boldly, deliberately and relentlessly until issues that obstruct creation of healthy work
environment are resolved. AACN defined 2 strategic platforms that now guide the Associations work
initiative as:
1. Work and care environment must be safe, healing and humane, respectful of rights,
responsibilities, needs and contributions of patients, their families, nurses and all other
health professionals.
2. Excellence in acute and critical care nursing practice is driven by the needs of the patients
and their families and is achieved when nurse’s competencies are matched to their needs
[2].
Thus, in the lieu of crucial role played by the nurses in the health care it becomes obligatory
for health leaders to provide the requisites facilities and incentives to the nurses that can be
the key drivers of their performances.

89
OBJECTIVES OF THE STUDY
• To study the various work environment factors of nurses.
• To analyse the effects of work environment on the job performance of the nurses.
• To suggest the benefits of a cordial work place for the organization and nurses.
ESSENTIALS OF CORDIAL WORK ENVIRONMENT
Certain principles are necessary to abide by for creating and maintaining an enriched work
environment in the health care sector for nurses. These principles if applied ethically and in good
concern will make the nurses more devoted, honest and willing in the delivery of their services. The
contribution of nurses in true spirits in the service to the mankind cannot be undervalued and needed
to be held in high esteem by the health leaders and even the society. They are the ones who still work
on the principles of “service to mankind is service to god”. The sensitive role performed by the
nurses in the health care can be clearly explained by this statement “Constant attention by a good
nurse may be just as important as a major operation done by a surgeon.” Dag Hammarskjold.
Considering the noble services provided by the nurses to us, the contribution of nurses in true
spirits in the service to the mankind cannot be undervalued and needed to be held in high esteem by
the health leaders and even the society. Health leaders should share an understanding that an
optimistic work environment not only empowers the employees but it is also beneficial in enhancing
patient’s satisfaction and wellbeing of the society. Thus, significant standards for establishing and
sustaining the positive work environment that inspire the nurses to reach their goal and also help
organizations to expand and grow are:
1. VALUABLE COMMUNICATION
Regular, valuable and effective communication is mandatory for optimal organization and
patient outcome. Communication is” information” and information is “life”. To survive in this
competitive world, we need to have an incessant communication in and among the organization.
Clinical skills require expert and valuable communication at all levels of organization and including
written, oral and non verbal communication. Patients in the care of clinically expert professionals

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suffer medical errors with alarming frequency [3]. Nearly three in four errors are caused by the
factors associated with the interpersonal interactions [4]. In addition, according to data from the Joint
Commission on Accreditation of Healthcare Organizations, breakdown in team communication is a
top contributor to sentinel events [5]. Be it conflict with others, or between their own personal and
professional values, skilled communication supports the ethical obligation to seek resolution that
preserves a nurse’s professional integrity while ensuring patient safety and best interest [6]. Thus,
effective communication should be very much clear, timely and precise.
Key Elements
• Effective communication leads to achieving desired outcomes with economy in cost, time and
resources.
• Effective communication inculcates the good interpersonal and team relationship.
• Effective communication leads to increased goodwill, profitability and reputation of the
organization.
• Effective communication leads to increased innovation and increased ability to face the
problems and situations effectively.
• Effective communication in the health care leads to healthy job outcomes with increase in
patient satisfaction and less of medical negligence.
2. EFFECTIVE DECISION MAKING
Nurses are considered to be patient’s advocates and they are also the vital link between the
patients and doctors so, it is critical to involve the nurses in the clinical decision making. The nurses
are assigned the primary responsibilities of patient care by the physicians, pharmacists and
administrators. However, only 8% of the physicians recognize nurses as part of the decision making
team. [7]. Other research report that a majority of nurses feel relatively powerless to change things
they dislike in their work environment [8]. This lack of empowerment act as an obstacle in the way
of nurses exercising their full potential and skills in delivering quality outputs. Failure to incorporate
the experienced perspective of nurses in clinical and operational decisions may result in costly errors,
jeopardize patient safety and threaten the financial viability of healthcare organizations [9]. Nurses
believe that they provide quality nursing care and are accountable for their own practice [10]. Their
success is recognized by the national programs such as AACN Beacon Award for Critical Care
Excellence. The Magnet Nursing Services Recognition Program and the Baldrige National Quality
Program [11].
Key Elements
• Enhanced decisional involvement of nurses will result in fewer psychosomatic and physical
complaints and documented physical disorders [12].
• Staff nurse decisional involvement is associated with positive patient outcomes, including a
higher nurse-perceived quality of patient care [13].
• Participative management of the nurses is associated with greater nurse satisfaction[14].
• Promotion of staff nurse involvement in decision making will improve the culture of work
organizations [15].
• Participative management of nurses will lead to increase in organizational commitment and
morale of nurses.

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3. LOWER ATTRITION LEVEL
Nursing service is the backbone of the success of health care sector. They are the first one
talked of when we think of health care [16]. The patient satisfaction and profitability of the hospitals
depend upon the work efficiency of the nurses. However, a shortage of nurses hampers the smooth
functioning of health care. Deficits of the nurses are mainly due to lousy and unhealthy work
environment. An energetic and cordial work environment can be key factor for lower attrition level
of the nurses. Positive work environment energizes the nurses to give their best outputs to health care
and society. Understanding the effect of work environment on nurse attitudes and behaviours are
relevant to staff retention, organizations can then introduce the strategies to correct work
environment deficiencies [17].
Key Elements
• Over duty, continues working hours, exploitations, work-life imbalances, poor recognition and
poor pay are the major negative work environment factors leading to the nurses’ high attrition
level.
• Reduction in attrition level will result in lower administrative and operational cost to
organizations resulting in higher profitability of organization.
• Low rate of attrition will overcome the problem of nursing shortages considering the high
demand and scarcity of nurses.
• It will result in less of medical negligence by nurses and higher job stability and morale of
nurses.
4. SIGNIFICANT RECOGNITION
Majority of nurses are dissatisfied with the recognition they receive from their employer.
Recognition of one’s achievements and contributions are essential requirement for personal and
professional growth. Lack of recognition leads to discontent, poor morale, reduced productivity and
suboptimal care outcomes. Inadequate recognition is cited as a primary reason for turnover among
the employees and is linked to decreasing nurse satisfaction [18-20]. Hospitals recognized for
attracting and retaining nurses emphasize personal growth and development and provide multiple
rewards for expertise and opportunities for clinical advancement [21].
Key Elements
• Meaningful recognition system should include processes which validate that recognition is
meaningful to those being acknowledged [22].
• Healthcare organizations following comprehensive recognition system inculcates excellent
work culture.
• Nurses if recognized for their contributions and achievements leads to work pride and
organizational commitments.
• If nurses inside the health care departments feel noticeable and appreciated, they will extend
the same approach and devotion to the people outside (Patients).
5. SUITABLE STAFFING
Suitable staffing ensures the balance between patient needs and nurse competencies.
Inappropriate staffing is one of the most harmful threats to patient safety and to the wellbeing of

92
nurses. Evidences suggest that better patient outcomes result when a higher proportion of care hours
are provided by registered nurses, as compared with care by licensed practical nurses or nursing
assistants [23].
The likelihood of death or serious complications after surgery increases when fewer nurses
are assigned to care for patients [24]. Inadequate staffing leads to nurse dissatisfaction, increased
attrition level and depersonalisation. Moreover, it hampers the quality of care leading to wastage of
hospital time and resources. Because the condition of critically ill patients rapidly and continuously
fluctuates, flexibility of nurse staffing that goes beyond fix nurse- to- patient ratios is imperative
[25].
Thus, organizations must engage in dramatic innovation to devise and systematically test new
staffing models [26].
Key Elements
• Sound staffing polices of health care organisations leads nurses to generate effective and
desired quality care.
• The mismatch between patient needs and nurse competencies can lead to most harmful threats
to patient safety as likelihood of death or serious complications after surgery increases when
fewer nurses are assigned to care for the patients [27].
• Inappropriate staffing results in increased negligence and errors as nurses feel overstressed and
overburdened due to high workloads.
• Adequate and appropriate staffing generates healthy outcomes for both the patients and
organizations.
6. SAFETY COMES FIRST
Nursing profession has been reported to have the more possibility of sexual exploitation in
the clinical field because majority of nurses are still women (Lee et al., 2011). The nursing
professionals are exposed to sexual harassment more considering their precarious position of being
in a weak position in the authority during the clinical training (Bronner et al 2003). Moreover, nurses
are also prone to work place violence because they are on the front line of the health care system and
in closest contact with the patients and their relatives. The most commonly encountered violence is
verbal abuse [28, 29]. Work place violence and sexual abuse have a negative correlation with job
satisfaction and job outcomes. International studies have reported that the prevalence of work place
violence against nurses in work place setting varied from 10% to 50% and even up to 87%. [30-32].
They are also instrumental for increase in the suicidal tendencies among the nursing professionals.
Key Elements
• Work place violence and sexual abuse leads to suicidal thoughts among the medical
professionals.
• On the job physical or verbal abuse gives way to high burnout and depersonalisation of the job.
• Quality of medical services offered by the nurse’s depreciates leading to high negligence and
absenteeism because of work place conflicts and violence.
• Sexual abuse and work place conflicts results in high operational and legal cost to the
organization as more of turnovers and criminal cases can be registered in the name of
organizations and individuals working in it.

93
7. CORDIAL INTER PERSONAL RELATIONS
People devote a majority of their time in the organization and thus, work place is like a
family to them. Work helps them infuse meaning to their life and it’s not just a way to earn money
for livelihood. As a result work place relations have a tremendous impact on not only the job
satisfaction but also on general well being. A harmonious and amicable relationship with supervisors
and colleagues is vital in overall job satisfaction. Inter personal conflict has shown to have positive
relationship with counter productive work behaviour and in some cases, it is found to be one of the
strongest predictors of CWB out of a variety of other work place stressors (Bayram, Gursakal &
Bilgel, 2009). The strain associated with inter personal conflict at work has also been shown to be
related to increased absenteeism (Giebels & Janssen, 2005). Additionally, mistreatment between
supervisors and their subordinates has been shown to negatively impact overall performance as well
as extra role performance (Aquin & Bommer, 2003). Thus, harmonious inter personal relations have
influencing effect on employee behaviour relevant to the organization.
Key Elements
• It is rightly said “It’s all done with the people”. If human resource is ignored, nothing else will
work well as it could have had.
• If nurses will collaborate well then the organization too will have a competitive edge.
• A healthy work culture will be created due to amicable inter personal relationships leading to
high effectiveness and productivity of nurses and hospitals both.
• The best talent also comes out with synergistic exchanges.
BENEFITS OF PLEASANT WORK ENVIRONMENT
To the hospitals To the nurses
1. Positive image High self esteem
2. High good will Increased job satisfaction
3. Improved employee morale Increase in pride and dedication towards
work
4. Reduced employee turnover Improved sense of well being
5. High work quality Cordial inter personal relations
6. Economy in resources time and cost Reduction in job stress and burnout
7. High customer satisfaction High service out comes
8. Reduced health care/insurance cost Improved health with less of stress and
depression
9. Reduced risk of litigation Increase in well being of patients and
community
CONCLUSION
Thus, the aforesaid standards are the barometer for measuring the performance and
development of almost all the clinical nurses and health departments worldwide. Safe and ethical
work environment are imperative for generating excellent outcomes in form of high productivity,
superior work quality and optimal care for patient and society if adopted at every level of the
organization from top to bottom. Success will further be assured if the employees themselves abide

94
by these work standards and consider it their sole responsibility and personal obligation. They should
also have the will and understanding to follow and practice these norms.
Thus, it is rightly said “Our environment the world in which we live and work, is a mirror
of our attitudes and expectations” - Earl Nightingale.
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