Quality of Work Life of Public School Nurses in the Philippines

Background: School nurses play a crucial role in the provision of comprehensive health services to the school population. A balanced quality of work life (QWL) with favorable conditions that support and uphold employee satisfaction is imperative for school nurses to maximize their provision of care for their clientele. Among the many nursing specialties, research among school nurses is not given much attention. Purpose: This study aimed to determine the QWL of public school nurses in the Philippines. Methods: This study utilized a descriptive correlational research design with 57 public school nurses as study participants. Self-reported data were gathered utilizing Walton’s QWL scale. Data were analyzed using the Mann-Whitney U test, Kruskal-Wallis test, and Spearman–rank correlation coefficient. Results: Results indicated that public school nurses had high QWL (M=4.16). Among the eight subscales, opportunities at work (M=4.04) and social integration at work (M=4.03) had the lowest mean scores. There were no significant differences in the QWL according to sex (p=0.929), marital status (p=0.326), educational attainment (p=0.391) and length of work experience (p=0.059), while there was a significant relationship between age (p=0.005) and QWL of public school nurses. Conclusion: Public school nurses generally have a high QWL. Nevertheless, to further improve their QWL, it is recommended that public school nurses must be provided with more chances for continuous professional growth and opportunities for better social integration.


BACKGROUND
Quality of work life (QWL) refers to the personnel's reaction to work and its essential outcome in relation to job satisfaction and psychological health.This definition of QWL emphasizes personal outcomes, work experiences, and how to improve work to meet the individual needs of employees (Walton, 1973cited in Kermansaravi, Navidian, Rigi, & Yaghoubinia, 2015).Improving the QWL is a comprehensive process to improve employees' quality of life at work and is essential in attracting and retaining employees (Saraji & Dargahi, 2006).research and were given the freedom whether to participate or not in the study.Written informed consent was obtained from each participant to indicate their voluntary participation and involvement in the study.Survey forms were enclosed in a brown envelope, and participants were instructed to seal the envelope before returning the filled in questionnaires.The Declaration of Helsinki (World Medical Association, 2001) and the National Ethical Guidelines for Health and Health-Related Research (Philippine Health Research Ethics Board, 2017) guided the researchers in the ethical conduct of the study.

Socio-demographic characteristics of the respondents
Table 1 shows that the median age of the participants was 34 years old.Majority were young adults (56.1%), females (71.9%), married (64.9%) and with a Bachelor's degree (75.4%).Moreover, the majority worked as a public school nurse for less than 1 year (57.9%).All public school nurses 57 (100%) were employed as Nurse II permanent employees with a Salary Grade of 15.Nurse II is the position title for public school nurses in the Philippine Department of Education School Health and Nutrition Units in the Schools Division with a corresponding compensation of Salary Grade 15.Differences in the QWL of public school nurses Table 3 shows the significant differences in the QWL of public school nurses in terms of socio-demographic and work-related characteristics.The results revealed that there were no significant differences in the QWL of public school nurses when classified according to their sex (p=0.929),marital status (p=0.326),educational attainment (p=0.391) and length of work experience (p=0.059).However, the Mann-Whitney U test indicated that the QWL of public school nurses was significantly higher for middle to older adults than for young adults (p=0.005).Correlation between age, length of work experience and QWL Table 4 shows the Spearman's rho correlation results for the significant relationship between age and QWL and length of work experience and QWL of public school nurses.Statistical analysis revealed that there was no significant relationship between the length of work experience as a public school nurse and QWL (p=0.052) while there was a significant relationship between age and QWL (p=0.005).

DISCUSSION
This study investigated the QWL of public school nurses.It was demonstrated in this study that the QWL of public school nurses as a whole was high.This means that public school nurses generally appreciate their job and are contended with the different aspects of their work life.The result of this study is congruent with the findings of some studies in the local setting that investigated the work setting and satisfaction of hospital nurses.Dones, Paguio, Bonito, Balabagno, and Pagsibigan (2016) discovered that although nurses reported the lowest positive responses in physiologic and safety needs, the overall job satisfaction of Filipino nurses was high.Similarly, Lapeña, Tuppal, Loo, and Abe (2017) found that nurses working in a tertiary hospital in Manila, Philippines, had high work satisfaction.However, there were also reports that Filipino nurses were not quiet contended with their work.For instance, Rosales, Labrague, and Rosales (2013) disclosed that staff nurses in Samar, Philippines were slightly unsatisfied with their job.
Public school nurses in the Philippines are not the only school nurses reporting high QWL or satisfaction at work.Previous researches on QWL specific to nurses working in the school setting also support the result of the present study.Nurses working in a public school in the State of Illinois were most satisfied with their professional status and autonomy.Nurses are more satisfied with their job when they believe that they can positively impact students' health (Guenette, 2014).Public school nurses in this study likewise had very high QWL in the aspect of social relevance and use of capacities at work.Use of capacities at work relates to how work provides certain autonomy and how skills and knowledge are being used at work (Timossi et al., 2008;Fernandes, Martins, Caixeta, Costa Filho, Braga, & Antonialli, 2017).Moreover, a study among Polish school nurses also characterized school nurses having a high level of job satisfaction (Zborowska-Dulat et al., 2018).A much earlier study likewise disclosed that majority of school nurses expressed contentment with their jobs and were satisfied with their present positions, although issues related salary, control issues, coping, and role strain were mentioned (Junious, Johnson, Peters, Markham, Kelder, & Yacoubian, 2004).
Meanwhile, this study also revealed that public school nurses had high QWL in terms of the space that work occupies in their life.This dimension of QWL is directly related to the balance between time devoted to work and personal life or work-life balance (Fernandes et al., 2017;Timossi et al., 2008).School nurse work schedule was identified as a factor influencing school nurses' decision to enter school nursing in a study among school nurses in a large, urban school district in the U.S. (Smith & Firmin, 2009).Nonetheless, time-workload-caseload was considered a top barrier that impacts school nurses' ability to practice school nursing (Davis, 2018).
In this study, while public school nurses had an overall high QWL, among the eight (8) subscales, they ranked lowest in opportunities provided at work and social integration.Opportunities provided at work relates to opportunities for professional growth, such as participation in trainings and chances for further studies (Timossi et al., 2008).Public school nurses at the Department of Education in the Philippines, however, have limited opportunities for rank promotion.This possibly explains why public school nurses in this study rated aspect of opportunities provided at work of least quality.Moreover, most of the public school nurses in this study only had a Bachelor's degree.School nurses may also desire for further degree advancement and be given more chances to attend seminars and trainings to enhance their competencies.
On the other hand, social integration corresponds to the absence of discrimination at work and focuses on relationship and commitment with colleagues and supervisors (Fernandes et al., 2017;Timossi et al., 2008).Public school nurses are deployed in different public elementary and secondary schools all over the province.Most of the time, they are in the field delivering school-based health services to their clientele.As a result, they may have less time to work closely with their supervisors and fellow public school nurses.
Comparing the findings of this study with the QWL of hospital nurses in other countries or elsewhere, the result of this study is incongruent with most of the findings in the literature.School nurses reported better QWL than hospital nurses.For instance, staff nurses in Egypt had low-level QWL (Morsy & Sabra, 2015) and nurses in public health facilities in South Ethiopia were dissatisfied with their QWL (Kelbiso, Belay, & Woldie, 2017).Results of studies in India among nurses in several hospitals (Battu & Chakravarthy, 2014), in government and private hospitals (Suresh, 2013), in a tertiary care hospital (Hemanathan, Sreelekha, Prakasam, & Golda, 2017) and in private sectors (Fasla, 2017) revealed a moderate level QWL.Moderate level QWL was also disclosed among nurses in Iran (Moradi, Maghaminejad, & Azizi-fini, 2012;Nayeri, Salehi, & Noghabi, 2011) and Bangladesh (Akter, Akkadechanunt, Chontawan, & Klunklin, 2018).On the contrary, nurses in Latvia described their work life quality as satisfactory (Blumberga & Olava, 2016) and QWL was at the customary level among nurses in Saudi Arabia (Albaqawi, 2018).This result of the study provides insights that the school work setting is different from the hospital work environment.Public school nurses commonly deal with promotive and preventive aspects of the health of the school population while nurses working in the hospital deal with curative components of care and acute cases.Public school nursing is a highly autonomous practice with less direct supervision from physicians.Moreover, public school nurses have regular working hours compared to the shifting work schedule of hospital nurses.Given these variations in the scope of practice and work environment between school nurses and hospital nurses, public school nurses appear to have better QWL.
The results of this present investigation demonstrated that age was significantly related to QWL and that middle to older age public school nurses aged 36 to 63 years old had higher QWL than their younger counterparts.An aspect of QWL, particularly work condition, was similarly found to be associated with age in an earlier study (Albaqawi, 2018).McNeese-Smith and van Servellen (2000) emphasized that mature nurses have better job satisfaction, productivity, and commitment to the organization.In contrast, while age was significantly associated with QWL in the study of Hemanathan et al. (2017), it was shared that the younger age group (21-30) of hospital nurses in India was associated with QWL.
Prior work of scholars conducted elsewhere also disclosed inconsistent findings.One study noted that age and years of experience had no significant relationship with QWL among nurses working in public health facilities in South Ethiopia (Kelbiso et al., 2017).On the other hand, another study disclosed that experience was related to QWL while age was not associated with QWL among hospital nurses in India (Thakre, Thakre, & Thakre, 2017) and in Iran (Moradi et al., 2012).With these contrasting findings, caution is warranted when interpreting the result of this aspect of the study.It must be noted that the distribution of the participants in this study could be a possible factor why there is a significant difference in age while significant difference cannot be appreciated in length of work experience.More than half of the participants in this study were newly hired, having less than a year of experience as a public school nurse.It was only recently that more permanent positions were opened for public school nurses by the Department of Education.The number of public school nurses needed to serve public schools in the Philippines is expected to rise if Senate Bill No. 663 (2016) and House Bill No. 7824 (2018) will be enacted into law.Cost-benefit study of school nursing services found school nursing to be a cost-beneficial investment of public money (Wang, Vernon-Smiley, Gapinski, Desisto, Maughan, & Sheetz, 2014).Likewise, the U.S. National Association of School Nurses recommends that students should have access to a full-time baccalaureate-prepared registered nurse (Willgerodt, Brock, & Maughan, 2018).
This study has its limitations.Further research may be conducted in a larger sample among nurses working in the school setting, including those in the private sector.Moreover, the study may have benefited from additional qualitative investigation to validate the findings of the study.Also, while Walton's QWL scale has been used in studies conducted elsewhere, further validation of the scale is recommended if administered among Filipino nurses.In addition, although a direct comparison of the QWL of nurses in different work settings was not promising, this study provided insights on the possible variations on the QWL between nurses in the hospital and school settings.Nonetheless, this study sheds light on the QWL situation of nurses Nurse Media Journal of Nursing, 9(1), 2019, 9 Copyright © 2019, NMJN, p-ISSN 2087-7811, e-ISSN 2406-8799 entrusted to promote the health of the school population.This study also provides evidence that can enlighten school leadership and policymakers to devise ways of improving the QWL of school nurses.

CONCLUSION
Public school nurses have high QWL.Age is a significant factor related to the QWL of public school nurses.The older the nurses, the more they appreciate working in a public school setting.Nevertheless, opportunities at work and social integration are perceived to be of least quality aspects of the public school nurses' work life.Public school nurses must be provided with added opportunities for continuous professional development and be given more chances for better social integration to further improve their QWL.

Table 1 .
Socio-demographic and work-related characteristics of public school nurses

Table 4 .
Correlation between age, length of work experience and QWL