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Nurses quality of work life: scale development and validation

Article  in  Journal of Economic and Administrative Sciences · February 2021

DOI: 10.1108/JEAS-09-2020-0154

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Nurses quality of work life: scale Nurses quality

of work life
development and validation
Nanjundeswaraswamy T.S.
Mechanical Engineering, JSS Academy of Technical Education, Bangalore, India

Abstract
Received 2 September 2020
Purpose – This is a systematically conducted study to design, develop and validate a measuring instrument to Revised 23 December 2020
assess the nurses quality of work life (QWL) and determine the vital components of nurses’ QWL. Accepted 8 February 2021
Design/methodology/approach – In this methodical study, vital dimensions of nurses QWL are identified
using Pareto analysis; data and information were collected from 474 nurses through the structured
questionnaire. By conducting exploratory factor analysis (EFA), the number of dimensions and items was
reduced. Through the confirmatory factor analysis (CFA) using SPSS 21 software, nine predominant
dimensions were confirmed, they are work environment, working condition, work–life balance, compensation,
relationship and cooperation, stress at work, job satisfaction, career development and organization culture.
Additional structural equation modeling (SEM) was done to determine the interrelationships between extracted
nine components using AMOS. By performing different statistical tests like reliability test, content validity,
construct validity, convergent, divergent validity and multicollinearity, the proposed nine-component nurses
QWL instrument was validated.
Findings – The proposed measurement model explained 73.18% of total variance; reliability of the instrument
Cronbach’s alpha value is 0.902. Model fit indices like chi-square df (CMIN) 5 685, df 5 523, CMIN/DF 5 1.310,
goodness-of-fit index (GFI) 5 0.965, adjusted goodness-of-fit index (AGFI) 5 0.937, parsimony goodness-of-fit
index (PGFI) 5 0.918, incremental fir index (IFI) 5 0.933, Tucker–Lewis index (TLI) 5 0.921, comparative fit
index (CFI) 5 0.931 and root mean square error of approximation (RMSEA) 5 0.036 fulfill the acceptable
criteria. The nine factors nurses QWL measuring instrument is reliable and statistically valid.
Research limitations/implications – Data were collected from 474 nurses, poor responses and time
constraints.
Practical implications – Hospitals are trying to improve the quality of patient caring by enhancing the
nurses’ skill sets, knowledge and attitude to meet global challenges. In this unstable business environment,
hospitals face challenges like the high attrition rate and skilled nurses shortage. In this scenario, this study
provides a valid instrument to measure the QWL of nurses to know the status of QWL, which will help to build
a strategic plan to improve retention rate and to attract the talented workforce to the hospitals.
Originality/value – As a result, the scale developed in this study contributes to the body of the literature on
nurses QWL. It seems to be more advantageous for carrying out further research in this field.
Keywords Nurses quality of work life, Validity, Reliability, Pareto analysis, EFA, CFA
Paper type Research paper

Introduction
The health of the nurses is at risk due to many reasons such as pathogens, harmful chemicals,
radiations (Dos Santos and Beresin, 2009), the timing of work, shift work (Zhao et al., 2010),
long hour standing and sitting leads to musculoskeletal disorders (Rong, 2008) and work
stress (Kaewpheang et al., 2006). These risk factors directly influence the quality of medical
care taken to the patients by the nurses (Tzeng et al., 2009; Guler and Kuzu, 2009).
A method or process is required to address these risk issues of nurses to enhance the
quality and efficiency of medical care through the humanized job design; in a holistic view,
this process is known as quality of work life (QWL). In the competitive environment, through
humanized job design methods, it is possible to retain skilled and talented employees
(Nanjundeswaraswamy, 2016). According to Nowrouzi et al. (2016), the QWL of nurses
directly impacts the quality of care services of patients.
QWL of nurses is not only confined to organizational boundaries, but it also includes the Journal of Economic and
Administrative Sciences
personal life of nurses (Bakal et al., 2003). While analyzing the nurses’ QWL, the social, physical © Emerald Publishing Limited
1026-4116
and psychological needs of individuals should be considered (Lu et al., 2007; Cole et al., 2005). DOI 10.1108/JEAS-09-2020-0154
JEAS QWL of nurses is a multidimensional facet; it includes a wide variety of drives or
components. Many researchers conducted numerous types of research on QWL of nurses, its
drives and their effects on the organization and employees. In these research studies, it is
identified that there are many differences in the selection of dimension, development of
measuring instrument and validation of the constructs.
This research followed standard methodology for the development and validation of
measuring scale, which suits to QWL of nurses. In this research, through an exhaustive
literature survey, vital components of nurses QWL were identified; by using Pareto analysis,
predominant components were selected. Based on the eigenvalues, items were reduced in
exploratory factor analysis (EFA). Through the confirmatory factor analysis (CFA)
measurement model, fitness was verified, and structural equation modeling (SEM) was
done to determine the interrelationships between extracted components using AMOS.

Literature review
In this part, a thorough literature survey was done considering only studies related to QWL of
nurses, conducted in the different parts of the globe.
Brooks (2001) developed a scale to measure the QWL of nurses; the scale was designed in
the six points Likert scale. Brooks’ scale consists of four dimensions with 42 items, namely,
home/work life, work organization/design, work conditions/contention and work world; the
scale explains 38% of total variance with Cronbach’s alpha coefficient of 0.83.
From the literature, it is evident that the many subsequent researchers used the Brooks
scale with small modifications; such research studies (Abadi et al., 2020; Suleiman et al., 2019;
Alharbi et al., 2019; Devi and Hajamohideen, 2018; Kaddourah et al., 2018; Venkataraman
et al., 2018; Akter et al., 2018; Nayak et al., 2018; Kelbiso et al., 2017; Motamed-Jahromi et al.,
2017; Kelbiso et al., 2017, 2017; Morsy and Sabra, 2015; S€okmen, 2015; Almalki et al., 2012)
used four dimensions to measure the QWL of employees such as home/work life, work
organization/design, work conditions/contention and work world.
Walton (1975) developed an instrument to measure the QWL; it consists of seven
components such as adequate and fair compensation, constitutionalism in the work
organization, immediate opportunity to use and develop human capacities, opportunity for
continued growth and security, social relevance of work life, safe and healthy working
conditions, social integration in the work organization, work and total life space.
Hsu and Kernohan (2006) measured the QWL of nurses by considering five factors like
human relation aspects, self-actualization, organizational aspects, socioeconomic relevance
and demography. Van Laar et al. (2007) constructed a measuring scale for QWL of nurses; the
instrument consists of six factors with 23 items specifically, job and career satisfaction,
general well-being, home–work interface, stress at work, control at work and working
conditions; the validated scale explains 67.21% of the total variance and with Cronbach’s
alpha of 0.96.
Van Laar et al. (2007) considered six dimensions of QWL to quantify among nurses such as
control at work, general well-being, home–work interface, job and career satisfaction, stress
at work and working conditions.
Research like Dos Santos and Bersin (2009), Tzeng et al. (2009), Wallapa Boonrod (2009),
Hsu and Kernohan (2006) designed the instrument to specific dimensions such as social
relations, psychological, physical and environment to measure QWL.
Vagharseyyedin et al. (2011) suggested six predictors of nurses QWL like leadership
styles, salary, the relationship among coworkers, shift work, workload and demographic
characteristics. Mosadeghrad et al. (2011) considered nine factors to measure the QWL of
nurses, namely, communication, disturbance handling, job promotion, job security, job proud,
job stress, motivation, participation and wages.
 Zeng et al. (2011) in their research used the work-related quality of life (WRQL) scale of Nurses quality
Van Laar et al. (2007) to determine QWL of nurses. The study proposed five-factor scales with of work life
22 items such as job and career satisfaction, general well-being, home–work interface, stress
at work and working conditions; the validated scale explains 59.9% of the total variance and
Cronbach’s alpha 0.92.
Sirisawasd et al. (2014) explored a seven factors model with 34 items, such as employee
engagement, control at work, home–work interface, general well-being, job and career
satisfaction, working conditions and stress at work. The principal component analysis (PCA)
results indicated that these seven factors explain 59% of the total variance. The overall
Cronbach’s alpha value was 0.925.
Sirin and Sokmen (2015) designed a scale to quantify the QWL of nurses; the scale consists
of five dimensions with 35 items, namely, work environment, relations with managers, work
conditions, job perception and support services; the designed scale explains 42.33% of the
total variance with Cronbach’s alpha coefficient of 0.89.
Many research such as Naji et al. (2018), Jahanbani et al. (2018), Moradi et al. (2014) used the
seven-component instrument of Walton (1975) to measure the nurses QWL.
Hu et al.’s (2019) research grouped the factors that affect nurses QWL into five groups
such as demographic factors, personal–psychological factors, family factors, working factors
and organizational factors.
From the literature survey, it is evident that the instruments developed by Brooks (2001)
and Walton (1975) were extensively used by the different researchers to measure the QWL of
nurses, and on the other hand, few researchers used their own scale for measurement by
considering the various components (see Table 1). These scales and selected components are
debatable in the current competitive environment by considering the various theories like
Maslow’ need theory and Herzberg’s motivation-hygiene theory. Once the living standards of
employees change, an employee’s need also varies if these needs are not fulfilled, it directly
influences the QWL of employees.
Organizations need to consider different components or drives of nurses QWL with the
changed consequence and then only it is possible to attract and retain talented nurses. Hence,
there is a requirement to revise the existing nurses QWL scale by considering the changing
global economic scenarios and labor market.
The conceptualization of the nurse’s QWL adapted in our study is from Swamy et al.
(2015). According to them, QWL is a multidimensional construct; it influences the degrees of
fulfillments of employees, how they manage their personal and professional life. Based on
that concept, “quality of work life of nurses is the extent to which nurses can satisfy their
individual needs through their knowledge in their work while fulfilling the
organization’s goals.”
Thus, the objective of this research is to develop a specific instrument that is more suitable
to measure the QWL of nurses for different culture and society by large and validate the
instrument.

Methodology
To achieve the stated objective of the research, scale development and validation to measure
the nurses QWL, a comprehensive literature review on QWL of nurses was conducted by
considering the published journal, conference and published thesis; based on the frequency of
usage of the constructs of QWL, 31 constructs were selected for the study. Using Pareto
analysis, the vital dimension of nurses QWL was identified based on the 80:20 principle;
among selected 31 dimensions, 15 predominant dimensions were selected. An instrument is
designed by considering these specified 15 dimensions. Data related to QWL of nurses were
collected through the structured questionnaires; collected data were subjected to EFA to
JEAS Sl
No Dimensions
1 Employee engagement
2 Control at work
3 General well-being
4 Job satisfaction
5 Working condition
6 Stress at work
7 Organizational
commitment
8 Work design
9 Work context
10 Work environment
11 Socioeconomic
relevance
12 Organizational aspects
Table 1. 13 Aspects of one’s
Dimensions of nurses personal life
QWL considered by
various researchers
Authors
Sirisawasd et al. (2014), Lin et al. (2013)
Wang et al. (2020), Venkataraman et al. (2018), Sirisawasd et al. (2014),
Opollo et al. (2014), Lin et al. (2013), Van Laar et al. (2007)
Chiou-Fen et al. (2020), Wang et al. (2020), Hu et al. (2020), Sirisawasd et al.
(2014), Opollo et al. (2014), Lin et al. (2013), Zeng et al. (2011), Van Laar et al.
(2007)
Ruhana (2020), Wang et al. (2020), Fanya et al. (2020), Hu et al. (2020), Aristi
et al. (2018), Naji (2018), Sankar (2018), Taware and Patil (2018), Thakre et al.
(2017), Seada and Banan (2016), Khera (2015), Sirisawasd et al. (2014),
Opollo et al. (2014), Lin et al. (2013), Zeng et al. (2011), Van Laar et al. (2007),
Saraji and Dargahi (2006), Hossain and Islam (1999), Baba and Jamal (1991),
Smith et al. (1981)
Ruhana (2020), Sulastri and Pompey (2020), Wang et al. (2020), Hu et al.
(2020), Gurdogan and Uslusoy (2019), Albaqawi (2018), Hashempour et al.
(2018), Nayak et al. (2018), Venkataraman et al. (2018), Jahanbani et al.
(2018), Naji et al. (2018), Alan and Yildirim (2015), Lee et al. (2015),
Sirisawasd et al. (2014), Opollo et al. (2014), Lin et al. (2013), Zeng et al. (2011),
Mosadeghrad (2013), Almalki et al. (2012), Dehghan Nayeri et al. (2011),
Vagharseyyedin et al. (2011), Van Laar et al. (2007), Saraji and Dargahi
(2006)
Wang et al. (2020), Hu et al. (2020), Raeissi et al. (2019), Nazari et al. (2019),
Taware and Patil (2018), Sirisawasd et al. (2014), Opollo et al. (2014), Lin et al.
(2013), Zeng et al. (2011), Mosadeghrad et al. (2011), Van Laar et al. (2007),
Saraji and Dargahi (2006), Baba and Jamal (1991), Smith et al. (1981)
Eren and Hisar (2016), Ellis and Pompili (2002), Baba and Jamal (1991),
Smith et al. (1981)
Hu et al. (2020), Gurdogan and Uslusoy (2019), Alharbi et al. (2019),
Venkataraman et al. (2018), Brooks and Anderson (2005), Moradi et al.
(2014)
Abadi et al. (2020), Chiou-Fen et al. (2020), Sulastri and Pompey (2020), Hu
et al. (2020), Raeissi et al. (2019), Alharbi et al. (2019), Venkataraman et al.
(2018), Kelbiso et al. (2017), Saif (2016), Moradi et al. (2014), Mosadeghrad
(2013), Almalki et al. (2012), Mosadeghrad et al. (2011), Hsu and Kernohan
(2006), Brooks and Anderson (2005)
Chiou-Fen et al. (2020), Permarupan et al. (2020), Sulastri and Pompey
(2020), Abadi et al. (2020), Mansourlakouraj et al. (2019), Alharbi et al. (2019),
Suresh (2019), Gurdogan and Uslusoy (2019), Albaqawi (2018), Aristi et al.
(2018), Hashempour et al. (2018), Jahanbani et al. (2018), Taware and Patil
(2018), Nayak et al. (2018), Wara et al. (2018), Naji (2018), Kelbiso et al. (2017),
Seada and Banan (2016), Saif (2016), Alan and Yildirim (2015), Moradi et al.
(2014), Sirisawasd et al. (2014), Lin et al. (2013), Mosadeghrad (2013),
Almalki et al. (2012), Wara et al. (2018), Thakre et al. (2017), Alan and
Yildirim (2015), Moradi et al. (2014), Van Laar et al. (2007), Rose et al. (2006),
Hsu and Kernohan (2006), Saraji and Dargahi (2006), Brooks and Anderson
(2005), Ellis and Pompili (2002)
Alan and Yildirim (2015), Hsu and Kernohan (2006)
Suresh (2019), Hsu and Kernohan (2006)
Abadi et al. (2020), Rose et al. (2006), Hsu and Kernohan (2006)
(continued )
Sl
Nurses quality
No Dimensions Authors of work life
14 Organizations culture Permarupan et al. (2020), Fanya et al. (2020), Mansourlakouraj et al. (2019),
Aristi et al. (2018), Jahanbani et al. (2018), Taware and Patil (2018),
Hashempour et al. (2018), Thakre et al. (2017), Seada and Banan (2016), Lee
et al. (2015), Mosadeghrad (2013), Almalki et al. (2012), Dehghan Nayeri et al.
(2011), Ellis and Pompili (2002)
15 Relationship and Chiou-Fen et al. (2020), Fanya et al. (2020), Permarupan et al. (2020), Sulastri
cooperation and Pompey (2020), Gurdogan and Uslusoy (2019), Hashempour et al.
(2018), Albaqawi (2018), Taware and Patil (2018), Nayak et al. (2018), Naji
et al. (2018), Aristi et al. (2018), Thakre et al. (2017), Seada and Banan (2016),
Moradi et al. (2014), Lee et al. (2015), Mosadeghrad (2013), Almalki et al.
(2012), Dehghan Nayeri et al. (2011), Vagharseyyedin et al. (2011), Saraji and
Dargahi (2006), Ellis and Pompili (2002)
16 Training and Aristi et al. (2018), Nayak et al. (2018), Naji et al. (2018), Thakre et al. (2017),
development Seada and Banan (2016), Saif (2016), Moradi et al. (2014), Saraji and Dargahi
(2006)
17 Compensation Ruhana (2020)., Chiou-Fen et al. (2020), Fanya et al. (2020), Permarupan et al.
(2020), Mansourlakouraj et al. (2019), Suresh (2019), Raeissi et al. (2019),
Nazari et al. (2019), Wara et al. (2018), Aristi et al. (2018), Hashempour et al.
(2018), Jahanbani et al. (2018), Naji et al. (2018), Nayak et al. (2018), Thakre
et al. (2017), Seada and Banan (2016), Saif (2016), Moradi et al. (2014), Kelbiso
et al. (2017), Moradi et al. (2014), Mosadeghrad (2013), Almalki et al. (2012),
Vagharseyyedin et al. (2011), Mosadeghrad et al. (2011), Saraji and Dargahi
(2006)
18 Facilities Chiou-Fen et al. (2020), Sulastri and Pompey (2020), Hu et al. (2020),
Gurdogan and Uslusoy (2019), Albaqawi (2018), Aristi et al. (2018), Taware
and Patil (2018), Wara et al. (2018), Thakre et al. (2017), Seada and Banan
(2016), Opollo et al. (2014), Van Laar et al. (2007)
19 Autonomy of work Albaqawi (2018), Aristi et al. (2018), Thakre et al. (2017), Kelbiso et al. (2017),
Seada and Banan (2016), Saif (2016), Moradi et al. (2014), Mosadeghrad
(2013), Almalki et al. (2012)
20 Adequacy of resources Aristi et al. (2018), Thakre et al. (2017), Seada and Banan (2016)
21 Job security Raeissi et al. (2019), Nazari et al. (2019), Mansourlakouraj et al. (2019), Wara
et al. (2018), Aristi et al. (2018), Naji et al. (2018), Hashempour et al. (2018),
Jahanbani et al. (2018), Seada and Banan (2016), Saif (2016), Moradi et al.
(2014), Mosadeghrad et al. (2011), Saraji and Dargahi (2006)
22 Flexible work schedule Kelbiso et al. (2017), Saif (2016);Moradi et al. (2014), Moradi et al. (2014),
Mosadeghrad (2013), Almalki et al. (2012), Vagharseyyedin et al. (2011)
23 Employee involvement Raeissi et al. (2019), Nazari et al. (2019), Wara et al. (2018), Mosadeghrad et al.
(2011), Baba and Jamal (1991)
24 Career development Ruhana (2020), Chiou-Fen et al. (2020), Wang et al. (2020), Fanya et al. (2020),
Permarupan et al. (2020), Nazari et al. (2019), Mansourlakouraj et al. (2019),
Suresh (2019), Raeissi et al. (2019), Wara et al. (2018), Hashempour et al.
(2018), Jahanbani et al. (2018), Nayak et al. (2018), Naji et al. (2018), Aristi
et al. (2018), Kelbiso et al. (2017), Seada and Banan (2016), Saif (2016), Lee
et al. (2015), Moradi et al. (2014), Opollo et al. (2014), Mosadeghrad (2013),
Almalki et al. (2012), Mosadeghrad (2013), Almalki et al. (2012), Dehghan
Nayeri et al. (2011), Van Laar et al. (2007), Saraji and Dargahi (2006), Ellis
and Pompili (2002)
25 Social relevance Permarupan et al. (2020), Mansourlakouraj et al. (2019), Wara et al. (2018),
Jahanbani et al. (2018)
26 Grievances Sulastri et al. (2020), Raeissi et al. (2019), Wara et al. (2018), Taware and Patil
(2018), Mosadeghrad et al. (2011), Baba and Jamal (1991)

(continued ) Table 1.
JEAS Sl
No Dimensions Authors

27 Leadership styles Ruhana et al. (2020), Chiou-Fen et al. (2020), Sulastri and Pompey (2020),
Suresh (2019), Vagharseyyedin et al. (2011), Saraji and Dargahi (2006)
28 Work–life balance Permarupan et al. (2020), Fanya et al. (2020), Wang et al. (2020), Hu et al.
(2020), Suresh (2019), Alharbi et al. (2019), Mansourlakouraj et al. (2019),
Venkataraman et al. (2018), Naji (2018), Hashempour et al. (2018), Taware
and Patil (2018), Jahanbani et al. (2018), Sirisawasd et al. (2014), Moradi et al.
(2014), Opollo et al. (2014), Gillet et al. (2013), Lin et al. (2013), Almalki et al.
(2012), Vagharseyyedin et al. (2011), Zeng et al. (2011), Van Laar et al. (2007),
Saraji and Dargahi (2006), Baba and Jamal (1991), Brooks and Anderson
(2005)
29 Communication Chiou-Fen et al. (2020), Nazari et al. (2019), Raeissi et al. (2019), Wara et al.
(2018), Mosadeghrad et al. (2011)
30 Motivation Raeissi et al. (2019), Nazari et al. (2019), Mosadeghrad et al. (2011)
31 Poor staffing Chiou-Fen et al. (2020), Kelbiso et al. (2017), Moradi et al. (2014),
Table 1. Mosadeghrad (2013), Almalki et al. (2012)

reduce the number of items; to validate the selected factors, CFA was implemented using
SPSS software, and to check whether the measurement model fits, AMOS software was used.

Identification of vital dimensions of nurses QWL using Pareto analysis

From the exhaustive literature survey, 31 components were selected based on the frequency
of usage of these components by various researchers such as adequacy of resources, aspects
of one’s personal life, autonomy of work, career development, communication, compensation,
control at work, employee engagement, employee involvement, facilities, flexible work
schedule, general well-being, grievances, job satisfaction, job security, leadership styles,
motivation, organizational aspects, organizational commitment, organizations culture, poor
staffing, relationship and cooperation, social relevance, socioeconomic relevance, stress at
work, training and development, work context, work design, work environment, work–life
balance, working condition.
The 31 nurses QWL components were listed based on the frequency of usage by the
researcher; cumulative frequency and cumulative frequency percentage were calculated, and
it is represented in Table 2.
Pareto analysis is a decision-making technique used to identify the vital components
based on the frequency and to limit the number of vital components that affect the system.
Research studies (Azizaman et al., 2015; Fonseca, 2015; Oza and Shiroya, 2015; Talib and
Rahman, 2010) claim that components which occupy 80% of cumulative percentage while
useful many occupy 20% of occurrences.
From the 31 components, the total frequency of consideration is 340, and the first 15
components frequency is cumulatively 80%. Hence, it is concluded that the first 15
components are the vital components, and they were coined as useful by many researchers. It
is shown in Figure 1. The outcome of Pareto analysis was 15 frequently used nurses QWL
components, and they were work environment, career development, compensation, work–life
balance, working condition, relationship and cooperation, job satisfaction, work context,
organization culture, stress at work, job security, facilities, autonomy of work, general well-
being and training and development.

Development of a scale to measure the nurses quality of work life

Questionnaire design. The survey method was adopted to collect the data. By considering the
15 vital components identified in Pareto analysis, a draft questionnaire was designed in the
 % Cumulative
Nurses quality
Rank QWL dimensions Frequency frequency frequency Cumulative % of work life
C1 Work environment 35 10.3 35 10
C2 Career development 29 8.5 64 19
C3 Compensation 25 7.4 89 26
C4 Work–life balance 24 7.1 113 33
C5 Working condition 23 6.8 136 40
C6 Relationship and co 21 6.2 157 46
operation
C7 Job satisfaction 20 5.9 177 52
C8 Work context 15 4.4 192 56
C9 Organizations culture 15 4.4 207 61
C10 Stress at work 14 4.1 221 65
C11 Job security 13 3.8 234 69
C12 Facilities 12 3.5 246 72
C13 Autonomy of work 9 2.6 255 75
C14 General well-being 8 2.4 263 77
C15 Training and development 8 2.4 271 80
C16 Flexible work schedule 7 2.1 278 82
C17 Control at work 6 1.8 284 84
C18 Work design 6 1.8 290 85
C19 Grievances 6 1.8 296 87
C20 Leadership styles 6 1.8 302 89
C21 Employee involvement 5 1.5 307 90
C22 Communication 5 1.5 312 92
C23 Poor staffing 5 1.5 317 93
C24 Organizational commitment 4 1.2 321 94
C25 Social relevance 4 1.2 325 96
C26 Aspects of one’s personal life 3 0.9 328 96 Table 2.
C27 Adequacy of resources 3 0.9 331 97 Nurses QWL
C28 Motivation 3 0.9 334 98 dimensions with
C29 Employee engagement 2 0.6 336 99 frequency of
C30 Socioeconomic relevance 2 0.6 338 99 consideration by
C31 Organizational aspects 2 0.6 340 100 various researchers

five points Likert scale, where “5” is “strongly agree” and “1” is “strongly disagree.” The
instrument consists of 15 components with 75 items; care was taken in such a way that each
component should consist of a minimum of five items in the scale. Before collecting data, the
content in the draft questionnaire was discussed with a few hospital authorities, nurses and
academicians to avoid complex vocabulary and biased answers. By incorporating all the
suggestions, the questionnaire was fine-tuned, and the final version of the questionnaire was
developed both in English and in the native language Kannada.
The selected 15 nurses QWL components were work environment, career development,
compensation, work–life balance, working condition, relationship and cooperation, job
satisfaction, work context, organization culture, stress at work, job security, facilities,
autonomy of work, general well-being and training and development.
The nurses QWL scale consists of two parts. The first part of the questionnaire was
designed to collect the general demographical factor of the nurses and hospital; the second
part of the questionnaire consists of 75 items of 15 QWL components. To reduce the bias in
responses of respondents, few items were intentionally negatively worded; finally, during the
analysis, these items responses were reverse scored.
The finalized nurses QWL questionnaire was distributed to 600 nurses working in the
different hospitals; 494 questionnaires were returned, and 474 validly filled questionnaires
 40 100
JEAS
90
35

80

Frequency of Consideration
30
70

Cumulative Frequency %
25
60

20 50

40
15

30
10
20

5
10
Figure 1.
Pareto diagram of
0 0
nurses QWL C1 C2 C3 C4 C5 C6 C7 C8 C9 C10 C11 C12 C13 C14 C15 C16 C17 C18 C19 C20 C21 C22 C23 C24 C25 C26 C27 C28 C29 C30 C31
components Frequency 35 29 25 24 23 21 20 15 15 14 13 12 9 8 8 7 6 6 6 6 5 5 5 4 4 3 3 3 2 2 2
Cum Frq % 10 19 26 33 40 46 52 56 61 65 69 72 75 77 80 82 84 85 87 89 90 92 93 94 96 96 97 98 99 99 100

were considered for the analysis and remaining were discarded because of inappropriate
responses.
Sampling adequacy test. Kaiser-Meyer-Olkin (KMO) test was conducted to check the
adequacy of the sample to perform EFA. KMO test measures the adequacy of the sample for
individual variables in the model and also for the entire model. For the collected data, the
KMO value is 0.817. According to Kaiser and Rice (1974), if the sample is adequate, KMO
value should be more than 0.6; that is to say, sample is adequate to perform factor analysis in
the present study; test data were represented in Table 3.
Barlett’s test of sphericity was conducted on the collected data, the test statistics were
approximate chi-square value 2956.973, degrees of freedom 0.666, significance level 0.000
indicates values are within an acceptable range, that is, there exist non-zero correlations at the
significance level of 0.000, it indicates data were sufficient and non-sphericity to conduct the
factor analysis.

Extraction of predominant components of nurse’s quality of work life using exploratory

factor analysis
To reduce the number of items and to find out the predominant components in the proposed
measuring instrument, EFA under the principal component method using varimax rotation is
suitable (Hair et al., 1998). In the present study, EFA was implemented to know the
dimensionalities of 75 items from which 15 components were analyzed using PCA using
varimax rotation. The EFA grouped the ten components whose eigenvalue was more than 1,
and item loadings greater than 0.5 were included; these components explain 73.18% of the
total variance, it is shown in Table 4. These ten grouped components were named based on

Kaiser-Meyer-Olkin measure of sampling adequacy 0.817

Table 3. Bartlett’s test of sphericity Approx. chi-square 2956.973

KMO and Df 666
Bartlett’s test Significance 0.000
Total variance explained
Initial eigenvalues Extraction sums of squared loadings Rotation sums of squared loadings
Component Total % of variance Cumulative % Total % of variance Cumulative % Total % of variance Cumulative %

1 11.588 24.655 24.655 11.588 24.655 24.655 7.281 15.492 15.492

2 8.991 19.130 43.785 8.991 19.130 43.785 6.651 14.151 29.642
3 3.292 7.004 50.788 3.292 7.004 50.788 5.110 10.873 40.515
4 2.609 5.552 56.340 2.609 5.552 56.340 4.862 10.346 50.861
5 2.002 4.260 60.600 2.002 4.260 60.600 2.086 4.439 55.299
6 1.544 3.285 63.885 1.544 3.285 63.885 2.048 4.358 59.657
7 1.176 2.502 66.387 1.176 2.502 66.387 2.031 4.322 63.979
8 1.146 2.439 68.826 1.146 2.439 68.826 1.553 3.305 67.284
9 1.043 2.218 71.044 1.043 2.218 71.044 1.416 3.013 70.297
10 1.005 2.138 73.182 1.005 2.138 73.182 1.356 2.885 73.182
11 0.857 1.824 75.007
12 0.833 1.772 76.778
13 0.774 1.648 78.426
14 0.762 1.622 80.048
15 0.677 1.441 81.489
16 0.664 1.413 82.902
17 0.643 1.369 84.271
18 0.628 1.337 85.608
19 0.587 1.249 86.857
20 0.576 1.225 88.082
21 0.560 1.192 89.274
22 0.538 1.145 90.419
23 0.514 1.094 91.513
24 0.491 1.044 92.557
25 0.474 1.008 93.565
26 0.457 0.971 94.536
27 0.445 0.947 95.483
28 0.441 0.937 96.420
29 0.415 0.883 97.303
30 0.385 0.820 98.123

(continued )
Nurses quality
of work life

Table 4.

component analysis
Summary of principal
 JEAS

Table 4.
Total variance explained
Initial eigenvalues Extraction sums of squared loadings Rotation sums of squared loadings
Component Total % of variance Cumulative % Total % of variance Cumulative % Total % of variance Cumulative %

31 0.366 0.778 98.901

32 0.351 0.748 99.649
33 0.073 0.155 99.803
34 0.027 0.057 99.861
35 0.019 0.041 99.902
36 0.017 0.036 99.938
37 0.000 0.001 100.000

Note(s): Extraction method: principal component analysis

the relevance of items, they were work environment (WE), working condition (WC), work–life Nurses quality
balance (WLB), compensation (Comp), relationship and cooperation (RC), stress at work (SW), of work life
job satisfaction (JS), job security (JSe), career development (CD) and organization culture (OC).
To assess the significance of the data for the measurement of each component,
commonalities extracted from the factor analysis were reviewed. If the item loading is more
than 0.5, it is an indication of the appropriate data set (Stewart, 1981); in this research, item
loading ranges from 0.512 to 0.816. For the final instrument, 37 items were considered whose
factor loading value is more than 0.5. Table 5 represents the extraction of ten components
along with 37 items.
The reliability of the instrument was measured using Cronbach’s alpha value, it is 0.902; it
is indicated that the proposed instrument has good reliability, and it is statistically acceptable
when it is more than 0.7 (Nunnally, 1978).

Operational definitions of the constructs

The extracted ten components of QWL of nurses were defined clearly by considering the
measurable items and objectives of the study; it is represented as follows.
Work environment: Work environment of the nurses includes policies, procedures,
motivating atmosphere, information’s related to work and work empowerment, in addition to
this, societal opinion about the nurses, all these impact on the performance of the nurses.
Working condition: The working condition of the nurses which influences the performance
is physical working condition, overwork load and humanized work allocation.
Work–life balance: Vacation policy, flexible work timing, over time strategies and shift
method are most important constructs which influence the work–life balance of the nurses.
Compensation: Pay fixation based on the responsibility of work, qualification, the
experience of the nurses and rewards system based on the performance are the effective
compensation methods.
Relationship and cooperation: Proper guidance from the superiors and harmonious
relationship and extent of cooperation from the patients also impact on the performance of the
nurses.
Stress at work: Overstress, work pressure, achievable deadline and over control of nurses
by superiors influence the QWL.
Job satisfaction: Properly defined role and responsibility of work, adequate resources to
discharge the assigned duties by utilizing individual’s ability influence the satisfaction of
nurse’s work.
Job security: Secure in the job and low chance of dismissal influence the performance of the
nurses.
Career development: Financial support for higher education, permission to attend a job-
related training program to enhance and adopt new technology and unbiased promotion
policies are the important career development constructs of nurses.
Organization culture: Participative management styles, empowerment and work on the
strong ethical and values of the organizations create a superior culture in the organizations
which enhances the performance and productivity of the nurses.

Validation of the instrument

Factor analysis, convergent validity, discriminant validity and reliability test are the various
techniques to measure the credibility of the measuring instrument (Bagozzi and Phillips,
1982). For the present study, the validation of the instrument was verified using different
techniques such as CFA and SEM using AMOS, content validity test, convergent validity
test, average variance extracted (AVE), composite reliability (CR) and variance inflation
factor (VIF).
JEAS Eigen Accumulated
Factors Questions/items Weights values Variance variance

Work environment Society has a positive opinion about 0.763 7.281 15.492 15.492
(WE) us
Nursing policies and procedures 0.753
facilitate my job
My hospital work environment is 0.687
motivating
My hospital authority provides 0.610
enough information to discharge
my responsibilities
I am given a work empowerment 0.553
Working condition I am happy with the physical 0.730 6.651 14.151 29.642
(WC) working condition of my workplace
I am overworked 0.622
I do a lot of work irrelevant to 0.612
nursing
The number of nurses is adequate 0.559
in my unit
Work–life balance Policy for vacations is appropriate 0.796 5.110 10.873 40.515
(WLB) Flexible work timings are provided 0.743
to accommodate my family needs
Rotational shift methods help me to 0.733
manage family life
Less overtime helps me to spend 0.720
more time with my family
Compensation Hospital will pay salary by 0.729 4.862 10.346 50.861
(Comp) considering responsibilities at work
The hospital does a good job of 0.679
linking rewards to my job
performance
Qualification and experience 0.633
determine my salary
Annual increments will be provided 0.631
Relationship and Supervisor provides guidance to 0.816 2.086 4.439 55.299
cooperation (RC) perform my job
There is a harmonious relationship 0.732
with my colleagues
The relationship between 0.723
supervisor and me is very good
The patient extends their 0.570
cooperation to perform my nursing
job
Stress at work (SW) Always I feel overstressed in my 0.730 2.048 4.358 59.657
work
I faced inappropriate time work 0.669
pressures
Unachievable deadlines will be 0.529
imposed on me
Table 5. Excess control efforts by superiors 0.512
Summary of factor
analysis (continued )
 Eigen Accumulated
Nurses quality
Factors Questions/items Weights values Variance variance of work life
Job satisfaction (JS) I feel satisfied with my job 0.752 2.031 4.322 63.979
I have fixed and defined job 0.658
responsibility and role
Adequate resources are provided to 0.572
execute my job
I have an opportunity to use my 0.544
abilities at work
Job security (JSe) Feeling secure in the job 0.770 1.553 3.305 67.284
Low chances of dismissal due to 0.648
negligence in work
Career development Hospital will give permission and 0.756 1.416 3.013 70.297
(CD) financial support for higher
education
Hospital will permit me to attend 0.722
job-related training programs
There exist a time-bound promotion 0.591
and vertical elevation provisions
Organization I am involved in the decision- 0.747 1.356 2.885 73.182
culture (OC) making process that has effect on
my our work
Instead of enforcement, 0.613
empowerment will be provided to
us
Strong ethics and values exist in the 0.584
organization Table 5.

Confirmatory factor analysis for of nurses QWL dimensions

The factor extracted from the EFA can be confirmed once again through the CFA
€
(Ozpehlivan and Acar, 2016). To check the relationship between latent constructs and
observed variables, CFA is the most suitable technique (Byrne, 2001; Schumacher et al., 2004;
Suhr, 2006).
By using different fit indices, the proposed model was analyzed; some of the fit indices are
adjusted goodness-of-fit index (AGFI), comparative fit index, (CFI), goodness-of-fit index
(GIF), incremental fit index (IFI) and Tucker–Lewis index (TLI), all the model fit index should
be close to unity when the model is superior (Bentler and Bonett, 1987; Bentler, 1992).
Through the root mean square error of approximation (RMSEA), error was approximated;
these RMSEA should be less than 0.08 for the efficient and effective model (Browne and
Cudeck, 1993).
To check the validity of ten nurses QWL components extracted from EFA along with 37
items, CFA was conducted along with the maximum likelihood method using AMOS
software. During the CFA analysis, one of the component, job security, was deleted because it
has only two items, each latent factor should have minimum three indicators (Byrne, 2010,
2013), otherwise it leads to poor model fit. In CFA, nine factors with 35 items measurement
model were confirmed. The CFA for the individual factors explores the adequate fit, it is
represented in Figure 2, and all the fit indices fulfill the acceptable criteria, it is represented in
Table 6.
The proposed nine-factor measurement model, along with 35 factors, loading ranges
between 0.39 and 0.78. Factor loading more than 0.3 indicates the convergent validity (Brown,
2015; Hair et al., 2006). The proposed model fulfills the criteria of convergent validity. The R2
JEAS

Figure 2.
Measurement model
for nine components of
nurses quality of
work life
vales for the proposed nine-factor model fall in the range of 0.16–0.85; it represents the Nurses quality
percentage of variation in the 35 items; it is shown in Table 7. of work life
The outcome of the CFA explored the nine factors along with the 35 items loading; the test
statistics for the proposed measurement model were CMIN 5 685, df 5 523, CMIN/
DF 5 1.310; the value of CIMN/DF should be within 5 for the best model fit (Hair et al., 1998;
Bentler, 1992; Bentler and Bonett, 1987). GFI 5 0.965, AGFI 5 0.937, PGFI 5 0.918,
IFI 5 0.933, TLI 5 0.921 and CFI 5 0.931. For best model, all the fit indices should be more
than 0.9 (Hu and Bentler, 1999; Hair et al., 1998, 2006; Daire et al., 2008) and RMSEA 5 0.036, it
should be less than the 0.08 (Hair et al., 2006). For the proposed model, all the fit indices are
more than 0.9 and RMSEA value is less than 0.08, it explored that the proposed model is
suitable to measure the nurses QWL using nine components such as work environment,
working condition, work–life balance, compensation, relationship and cooperation, stress at
work, job satisfaction, career development and organization culture.

Content validity
Content validation is a method to identify the credibility of the designed measuring
instrument, that is, it measures the content or it is expected to measure (Olsen, 2004). For the
present study to check the content validity, Lawshe test was conducted. The designed nurses
QWL measuring instrument was circulated among 12 subject experts to give their opinion
about the content mentioned and content intended. Out of 12 experts, ten gave essential and
two gave not essential feedback. Based on the feedback, content validity ratio (CVR) was
measured using the following formula proposed by Lawshe (1975). ne represents the number
of the respondents who gave essential feedback and N represents the total number of experts
in the process.

Model fit QWL dimensions Acceptable

indices WE WC WLB COMP RC SW JS CD OC criteria range

χ 2/df 0.499 1.363 0.639 1.631 0.057 1.888 2.900 2.800 2.630 Less than 3
GFI 0.996 0.994 0.997 0.993 1.000 0.992 0.965 1.000 0.981 Greater than 0.9
AGFI 0.988 0.971 0.986 0.967 0.999 0.959 0.900 0.980 0.902
CFI 1.000 0.995 1.000 0.994 1.000 0.991 0.901 1.000 0.900 Table 6.
IFI 1.008 0.996 1.002 0.995 1.009 0.991 0.900 1.000 0.961 Model fit indices for
TLI 1.016 0.986 1.007 0.983 1.028 0.973 0.910 0.901 0.926 nine dimensions
RMSEA 0.000 0.039 0.000 0.052 0.000 0.061 0.078 0.079 0.076 Less than 0.08 of QWL

QWL dimensions Acceptable

Parameters WE WC WLB COMP RC SW JS CD OC criteria

Factor loading or 0.78 0.63 0.74 0.54 0.78 0.75 0.40 0.92 0.49 Greater than 0.30
Standardized 0.78 0.63 0.62 0.68 0.58 0.71 0.42 0.46 0.46 shows
coefficient estimates 0.55 0.67 0.76 0.60 0.67 0.58 0.70 0.39 0.67 convergent
0.65 0.54 0.80 0.83 0.56 0.53 0.73 validity
0.49
R-squared value 0.60 0.40 0.55 0.29 0.61 0.56 0.16 0.85 0.24 Table 7.
(percentage of 0.61 0.40 0.39 0.46 0.34 0.51 0.18 0.21 0.21 Standardized
variation) 0.30 0.45 0.58 0.36 0.45 0.34 0.49 0.16 0.45 coefficient estimates
0.42 0.29 0.65 0.69 0.31 0.28 0.53 and R2 values of nine
0.24 QWL dimensions
JEAS ne  N
CVR ¼ N
2

For the present study, CVR was 0.666, according to the Wilson et al. (2012) and Lawshe (1975),
if the CVR is more than 0.56, for the sample size 12 is acceptable. It indicates the content of the
design instrument is relevant to measure the nurses QWL.

Convergent validity
Convergent validity states that tests having the same or similar constructs should be highly
correlated (Chin and Yao, 2014). Convergent validity is also one of the construct validity.
Convergent validity is used to identify whether the constructs are different from one other.
There are two methods to check the convergent validity: first one is to correlate the scores
between two measurement tools and the second one is the correlation among subdomains
that are considered to measure the same construct. For the present study, correlation among
the items of each component was measured through the AVE and the reliability of each
dimension of QWL of nurses.
For the present study, AVE is ranging from 0.581 to 0.760 and reliability for each
dimensions ranges between 0.601 and 0.822, it is represented in Table 8. AVE and reliability
more than 0.50 are acceptable (Van Saane et al., 2003; Hair et al., 2010; Hair et al., 2009). In this
study, both AVE and reliability satisfy the acceptable range, that is, the proposed measuring
instrument fulfills the convergent validity criteria.

Discriminate validity
Discriminate validity is also one of the construct validity techniques; it refers to the proposed
dimensions which were specifically and autonomously different from each other (Bagozzi and
Phillips, 1982; Bryman and Bell, 2015). Discriminate validity can be gauged by comparing the
square root of AVE and the correlation coefficient between the dimensions. For the good
discriminate validity of the measuring instrument, the square root of AVE should be greater
than the correlation between the dimensions (Fornell and Larcker, 1981).
For the proposed eight dimensions nurses QWL measuring instrument, discriminate
validity test was examined, the test statistics was represented in Table 9. The results
explored that, the proposed eight dimensions measuring instrument, the square root of AVE
is more than the correlation coefficient between the dimensions. It can be concluded that the
proposed measuring instrument used for data collection to measure the nurses QWL.

Multicollinearity
Multicollinearity is defined as degrees of two or more independent variables are extremely
linearly related to each other in a multiple regression analysis. If the multicollinearity is more,

Dimensions of nurses quality of work Standard

Sl No life Mean deviation Reliability AVE CR

1 Work environment (WE) 4.37 0.51 0.782 0.660 0.807

2 Working condition (WC) 4.09 0.62 0.714 0.602 0.727
3 Work–life balance (WLB) 4.31 0.63 0.822 0.760 0.836
4 Compensation (COMP) 4.54 0.49 0.758 0.648 0.764
5 Relationship and cooperation (RC) 3.81 0.75 0.738 0.713 0.806
6 Stress at work (SW) 4.37 0.52 0.728 0.581 0.706
7 Job satisfaction (JS) 4.24 0.60 0.692 0.605 0.728
Table 8. 8 Career development (CD) 4.41 0.56 0.605 0.681 0.733
Convergent validity 9 Organization culture (OC) 4.34 0.49 0.601 0.625 0.687
 WE WC WLB COMP RC SW JS CD OC
Nurses quality
of work life
WE 0.812
WC 0.033 0.776
WLB 0.531 0.056 0.872
COMP 0.007 0.498 0.083 0.805
RC 0.316 0.052 0.328 0.023 0.844
SW 0.077 0.573 0.052 0.478 0.028 0.762
JS 0.008 0.447 0.068 0.217 0.138 0.449 0.778
CD 0.070 0.359 0.106 0.180 0.018 0.340 0.291 0.825 Table 9.
OC 0.445 0.029 0.297 0.075 0.256 0.016 0.073 0.018 0.791 Discriminate validity

it reduces the precision of the model. VIF indicates the degree of multicollinearity; if VIF is
more than 4, it indicates there is a problem with the multicollinearity (Hair et al., 2010; Ringle
et al., 2015; Salmeron and Gomez et al., 2016).
For the proposed nine components, VIF was calculated; it is represented in Table 10; it is
explored that VIF ranges between 1.146 and 1.850, it falls in the acceptable region, in addition
to that, VIF is less than 2, it an indication that the proposed nine dimensions were free from
multicollinearity.

Conclusion
For the hospital and clinic organization, it is a big challenge to retain talented nurses in this
competitive labor market. Through the effective humanized job design process concerning
the change in the technology and living standard, it is possible to increase the retention rate of
the nurses; this humanized job design process is known as QWL.
Quantification of nurses QWL is very challenging since it involves so many components;
moreover, these components are dynamic in nature. The nurses QWL influences the
efficiency and effectiveness of patient caring. According to Maslow’ needs theory and
Herzberg’s motivation-hygiene theory, once a specific need fulfills, the next order needs will
actuate for accomplishment among employees, this indicates that quality of work
components is vibrant and dynamic in nature. In the available literature, it is evident that
different researchers used a variety of QWL components to quantify the nurses QWL.
In this context, hospital organizations need to quantify the status of nurses QWL using a
valid and reliable measuring instrument, incorporating the predominant components of
nurses QWL.
The present research is an effort to design, develop a nurses QWL measuring instrument
and validate the same by considering various validation criteria. In this study, a thorough

Sl No Dimensions of nurses quality of work life VIF

1 Work environment –
9 Organization culture 1.146
5 Relationship and co operation 1.191
3 Work–life balance 1.218
8 Career development 1.226
7 Job satisfaction 1.425
4 Compensation 1.468 Table 10.
6 Stress at work 1.785 Variation inflation
2 Working condition 1.850 factor
JEAS literature survey of nurses QWL was done and listed 31 components of nurses QWL based on
the frequency of usage by various researchers. To identify the vital dimensions of nurses
QWL, Pareto analysis was performed; through Pareto analysis, 15 critical components were
identified, they are work environment, career development, compensation, work–life balance,
working condition, relationship and cooperation, job satisfaction, work context, organization
culture, stress at work, job security, facilities, autonomy of work, general well-being and
training and development.
A questionnaire was designed by considering these 15 components along with 75 items on
a five points Likert scale. The instrument is fine-tuned by taking inputs from the hospital
authorities, academicians and a few nurses. Data were collected from 474 nurses by using a
designed questionnaire.
Sample adequacy test was conducted to check the data adequacy for further analysis;
results of KMO test and Barlett’s test of sphericity gave a better acceptable value, it gives the
signal to conduct factor analysis.
To extract the predominant dimensions and reduce the number of items, EFA under the
principal component method using varimax rotation was performed. In total, ten components
along with 37 items were extracted whose eigenvalue is more than unity; these ten
components explained 73.18% of the total variance and they were work environment,
working condition, work–life balance, compensation, relationship and cooperation, stress at
work, job satisfaction, job security, career development and organization culture. The item
loading ranges from 0.512 to 0.816, and reliability of the instrument was measured using
Cronbach’s alpha value, it is 0.902.
To validate the instrument, CFA was conducted using SPSS 21; during the CFA,
one dimension, namely job security and its two items were deleted because of low loading.
The result of CFA explored the nine predominant nurses QWL components, which
were work environment, working condition, work–life balance, compensation,
relationship and cooperation, stress at work, job satisfaction, career development and
organization culture.
On the other hand, to know the interrelationships between extracted nine components,
SEM was performed. The results of SEM indicated that the entire proposed nine dimensions
model fulfills the acceptable criteria.
To validate the proposed nine components nurses QWL measuring instrument, various
statistical tests were conducted such as content validity, construct validity, convergent
validity, divergent validity and multicollinearity; the results indicated that the proposed nine-
component nurses QWL instrument is valid and reliable.

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Corresponding author
Nanjundeswaraswamy T.S. can be contacted at: nswamy.ts@gmail.com

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