Introduction

Quality of Work Life (QWL) has recently become a necessary variable to analyze, since it expresses the worker's feelings in relation to the various components that make up the work context where she works, including the possibility of professional development, recognition for the objectives achieved, fair remuneration and job stability. ^{(1, 2)}

The literature also refers to components such as relationships with colleagues and superiors, the physical and psychological work environment, autonomy, work-family balance, opportunity to commit and actively participate in the organization, all elements that support worker satisfaction and motivation, influence QWL. ^{(3, 4)}

Defining QWL is complex, where approaches are diverse such as dimensions from which QWL is described; thus, for Gonzales et al. it is “a multidimensional concept that is achieved when the worker satisfies his needs for security, institutional support, well-being, development through work and leisure time management”. ^{(5, 6)}

From a positive point of view, QWL influences important aspects of the psychological and socio-professional development of the worker, generating motivation to work, enabling adaptation to changes within the work environment, promoting creativity and innovation; while in a negative sense, for instance, it can lead to dissatisfaction, errors, absenteeism, and stress. ⁷

In relation to QWL in the health services work context, this is a topic of great interest, since evidence has shown its direct influence on the quality of care provided, ⁸ as well as on the life of the personnel. Regarding the nursing context, its changes can have serious effects on the personal life of the nurse, as well as on the provision of care, which, when deficient, can negatively affect the patient’s care and safety. ^{(9, 10)}

Accordingly, Brooks et al. cited by Wang et al. ¹¹ stated that nurses' QWL is the extent to which they satisfy their significant individual needs through experience as they achieve the organization's objectives, so that achieving a good QWL influences performance, organizational commitment, patient safety and satisfaction, and also satisfaction has an impact on reducing absenteeism, burnout and leaving the profession. ^10,12,13

In Latin America, as in the rest of the world, nurses comprises the largest professional group within the health systems. ¹⁴ However, studies on nurses' QWL have been scarce but they have evidenced the characteristics of the QWL of health personnel, including nurses, Thus, the meta-analysis carried out by Caicedo ⁵ found low QWL about the healthcare workers in Latin American countries, where the causes of this low level may be deficiencies in contractual and working conditions, dissatisfaction with salary, scarcity of supplies and work tools, and work overload.

Another study performed in Brazil found that QWL was evaluated as neither good nor bad, with unsatisfactory aspects being health services and social assistance, time off, personal and professional development, freedom of expression, fringe benefits, working hours, working conditions and opportunities for professional progress. ¹⁵

The World Health Organization (WHO) points out that nurses are fundamental professionals within health systems, for the achievement of institutional and regional objectives in the health of the population, so a critical analysis of their QWL is a priority.

Studies report that the QWL of nurses is not among the best, finding that its levels range from medium to low, influenced by sociodemographic and work factors such as age, educational level, number of children, dependents, work experience, ¹⁶ work shifts, insufficient number of personnel, high levels of psychological burden generated by time pressure, responsibility for the health and life of the patient, and presence of physical and emotional violence. ¹⁷

Therefore, this review was aimed to identify the existing literature on the levels of satisfaction and dissatisfaction with the Quality of Work Life of nurses in Latin America.

Materials and methods

The method applied was the Integrative Literature Review, following the six steps proposed by Ganong ¹⁸ for its development: 1) selection of the research question, 2) establishment of inclusion and exclusion criteria and sample selection, 3) representation of the selected studies in the corresponding format, 4) critical analysis of the results, 5) interpretation of the results, 6) dissemination of the results.

The research question was prepared according to the Population Context of Interest Strategy (PICo). The following structure was seen: P: Professional nurses, I: Quality of Work Life, Co: hospitals. Thus, the following question was asked: What are the levels of satisfaction and dissatisfaction with QWL of nurses, factors that influence it and health consequences reported by scientific evidence?

The adopted inclusion criteria were primary articles fully available online, during the period of time ranging from January 2011 to August 2021, in English, Spanish and Portuguese, articles with one or more key words in the title and abstract. The exclusion criteria were non-primary articles, opinion articles, letters to the editor, brief communications, editorials, review articles and those that did not answer the research question.

The search and selection of the studies was performed by the researcher in the US National Institutes of Health (PubMed), Scientific Electronic Library Online (SciELO), Virtual Health Library (VHL) and Google Scholar databases, which responded to the research question. For the search, some combinations with the following Health Sciences Descriptors (DeCS) and Medical Subject Headings (Mesh) were used, like quality of life, work, nurse, and health personnel combined through the Boolean operator “and”, with the following algorithms: quality of life and work and nurse, quality of life and work and health personnel, in English, Spanish and Portuguese.

The search in the databases identified 4072 articles; after eliminating duplicates, 4064 were potentially eligible. After reading the titles and abstracts, 4049 studies were excluded because they were neither from the region nor relevant to the study, leaving 15 studies, 13 of which met the inclusion and exclusion criteria.

The search and study selection process was simplified through the flow chart recommended by Preferred Reporting of Systematic Reviews and Meta-Analysis, which is shown below (see Figure 1).

Figure 1: Flowchart of the search and selection of articles included in the review 

The assessment and synthesis of the 13 selected articles was performed descriptively in three categories. The main ideas of the authors of the publications used in the development of this study were safeguarded.

Results

Thirteen articles were selected for this review, all published in international journals, eight in nursing journals, four in health sciences journals and one in biological sciences journals. Of these, ten were located in the VHL database, one in SciELO and two in Google Scholar. All were associated with the topic of QWL in Latin American nurses.

In terms of the country where the studies were performed, seven were carried out in Brazil, four in Mexico and one study in Chile and Peru, respectively.

Regarding the design of the studies, 13 corresponded to the quantitative approach, with a cross-sectional, descriptive design and 7 were correlational. Eleven of the studies were performed on nursing personnel and 2 on health personnel, including nurses.

Regarding the sample, it corresponded to a total of 2142 participants in the study, the largest number of participants corresponded to the studies performed by Quintana-Zavala with 345 participants and the smallest number belonged to the study by Delgado-García et al with 20 participants.

Among the evaluation instruments applied to assess QWL, five used the QWL-GOHISALO Questionnaire, one applied, respectively, the WHOQOL-BREF questionnaire, Walton's Model QWL; TQWL-42; QVT Visual Analog Scale; QWLW-78; Quality of Nursing Work Life (QNWL) and the Work-BREF Questionnaire.

The matrix of characteristics of the 13 articles is presented below (Table 1 1a) and includes authors, title, objective, study design, sample, instrument used to measure the QWL construct, country, year of publication and identification basis of the article.

Table 1: Characteristics of the articles included in the review 

^Source: Own elaboration (2022)

For a better understanding and discussion, the articles included in this review are summarized in three categories that, in the opinion of the authors and the literature reviewed, clearly explain relevant aspects of the subject.

Discussion

The review reveals the limited information on the subject in Latin America, a region made up of 20 countries, where 4 countries have generated some knowledge on nurses' QWL. From these diverse work contexts, they express their degree of satisfaction and dissatisfaction with it, as well as refer to factors that influence it and the consequences when QWL is not adequate.

In reference to the degree of satisfaction and dissatisfaction that nurses report with their QWL, the results of this review range from high to medium to low levels for the most part. These results are consistent with studies performed outside the Latin American region, including the study by Kaddourah et al. which found that more than half of the nurses in two health institutions in Riyadh Saudi Arabia reported being dissatisfied with their quality of work life (54.7 %). ³¹

There have been studies performed in Ethiopia and Saudi Arabia by Kelviso et al. and Almalki et al. respectively, whose results also describe nurses' dissatisfaction with their QWL. ^32,33 Added to this there is the study by Dehghan Neyeri et al. who identified an average level of QWL for clinical nurses working in the hospitals of the University of Medical Sciences in Tehran. ³⁴

The results found in the study region show the experience of nurses with respect to the characteristics of the work context where they work. On the one hand, all the organizational efforts to improve the productivity and well-being of the workers converge; on the other hand, it responds to a negative work environment that generates dissatisfaction.³⁵ The situation is increased by the advance of precariousness, labor vulnerability, deterioration of working conditions, extension of the working day, increase of the workload and disintegration of health teams as a result of the reforms in the health sector in Latin America. ³⁶ In this part of the world, health and safety at work for health personnel and specifically for nurses has been neglected. In this sense, it is a necessary phenomenon to investigate given the repercussions that job dissatisfaction can have on the quality of patient care and patient safety. ^9,37,38

Among the work factors that influence a low QWL of nurses are social support, remuneration, work environment and employment conditions. ^20,23,25 Regarding working conditions, according to Acosta cited by Ubaque et al., intrinsic factors concerning the work itself, the person and extrinsic factors classified as material, organizational and psychosocial, are of special importance because of the documented implication they have on the quality of care provided to patients. ^39,40 Likewise, they influence failures in care, dissatisfaction, stress, absenteeism, and repercussions on the health of nursing professionals. ^39,41

In this regard, the study performed by Milanes and Bustamante found that the working conditions of nursing personnel were deficient in relation to economic compensation, support personnel, physical infrastructure of the work centers, materials and equipment in the workplace and high workload. ⁴² Therefore, the generation of positive working conditions requires commitment from management, personnel and the development of a corresponding infrastructure to support such environment. ⁴³

The review also shows that social support is a factor in the perception of low QWL by nurses, which, as pointed out by Karasec cited by Orgambídez-Ramos et al., represents the worker's experience in relation to the social climate of the workplace, where coworkers and superiors support each other. ^44,45

For nursing, the perception of social support has been found to be related to the quality of care provided by the nurse, the intention to leave the organization, professional performance and job satisfaction, as shown in the study by Orgambídez et al. where the support of the supervisor, colleagues and job involvement were positive and significant predictors of satisfaction. ^44,46

Another factor described by the nurses in this review that influences QWL was remuneration, which although it is not the only element of motivation at work, it does represent a necessary human need to be satisfied, since it is related to the survival of the individual, allowing her to satisfy basic needs such as food, clothing, and housing for herself and her family. ^47-49

This is consistent with the review study by Vagharseyyedin et al. which identified how salary and fringe benefits were very important for nurses. Meanwhile, Nowrousi et al. found that job satisfaction was related among other factors to salary, which, being low, significantly reduced nurse loyalty. ^10,50

In the assessment of satisfaction with QWL by dimensions, the low levels of institutional support, job security, job satisfaction, wellbeing achieved, personal development and free time management stand out. ^23,29 The institutional support dimension observes components such as support from superiors, positive feedback from colleagues, development opportunities in the workplace, and its low level of perception by nurses could be explained by deficits in the aforementioned components. ²² In this sense, a study performed in Chile agrees, where a slight tendency towards satisfaction was found in the subscales, activities, supervisor or supervisor and group with whom the nurses interact more closely, although in the subscales promotions and career advancement the tendency was towards dissatisfaction.⁵¹

Another dimension with very low levels of satisfaction was the administration of free time, which influences the organization of time for the development of recreational activities such as rest and family interaction. Within this context, the study performed by Gonzales and García revealed that one of the most affected dimensions was the management of free time, attributable to the mostly female gender of the nursing personnel, which goes hand in hand with the care of others and domestic activities. ⁵²

The study has limitations, among them the limited literature available in databases on the subject in Latin America. Also, the lack of inclusion of studies from other databases is considered a limitation.

Conclusion

QWL in Latin American nurses ranged from medium to low levels, evidencing nurses' dissatisfaction with aspects such as the working and psychosocial conditions in which they work. These aspects pose challenges for health institutions, given that QWL influences the quality of care. Knowledge of these conditions has implications for the improvement of nursing clinical practice. Likewise, it raises the need to integrate aspects related to Occupational Health and Safety in the health context into teaching, in order to promote the promotion and prevention of occupational health, a debt in Latin America, particularly for health personnel, such as nurses.

Also, the results of the review add to the scarce knowledge that exists about QWL among nurses in the region. Good QWL is associated with the well-being and health of nurses, but it has a negative influence on problems such as work stress. The study highlights the need to study the subject in greater depth, to incorporate more information in health institutions, and to have an impact on the development of public policies for the improvement of QWL. Undoubtedly, it will have an impact on the quality of care, patient safety and the health of the nurse.