Nurse Staffing Ratios, Non-Clinical Workload and Job Satisfaction among Registered Nurses in Private Haemodialysis Centres in Sarawak: Mediating Effects of Workload and Moderating Influence of Work Environment

Nurse satisfaction has a significant impact on the quality of care provided, the retention of the workforce, and the overall functioning of the organization. In specialized private hemodialysis settings, inadequate staffing and an increasing assignment of non-clinical duties may worsen nurse satisfaction and create an unstable workforce. Although there is more evidence each year about the connection between nurse workplace conditions and outcomes, there are very few, if any, studies in private hemodialysis settings, and those in geographically large systems like Sarawak are lacking.
This study examines the influence of nurse-patient staffing ratios and the non-clinical task burden on the job satisfaction of registered renal nurses working in private hemodialysis centers. For this study, workload was examined as a mediator, and the work environment was assessed as a moderator.
A quantitative, cross-sectional design was employed with a sample of 141 registered renal post-basic nurses selected using proportionate stratified random sampling from 25 private hemodialysis centers in Sarawak, Malaysia. Data was collected using validated structured questionnaires, and analysis was conducted using IBM SPSS Statistics to employ descriptive statistics, Pearson correlation, multiple regression, mediation analysis, and moderation analysis.
The results showed that the non-clinical task burden was a strong predictor of job satisfaction. The workload fully mediated the staffing ratio and job satisfaction. The work environment did not show a moderating effect.
The results of this study show that the optimal distribution of workload and the right staffing of the renal nursing workforce is essential to stabilize the renal nursing workforce in specialized settings.

Business Administration, Human Resource Management

1. Linda H. Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of the American Medical Association, 288(16), 1987–1993. https://doi.org/10.1001/jama.288.16.1987 [Google Scholar] [Crossref]

2. Linda H. Aiken, L. H., Sloane, D. M., Bruyneel, L., Van den Heede, K., Griffiths, P., Busse, R., Diomidous, M., Kinnunen, J., Kozka, M., Lesaffre, E., McHugh, M. D., Moreno-Casbas, M. T., Rafferty, A. M., Schwendimann, R., Scott, P. A., Tishelman, C., Van Achterberg, T., & Sermeus, W. (2014). Nurse staffing and education and hospital mortality in nine European countries: A retrospective observational study. The Lancet, 383(9931), 1824–1830. [Google Scholar] [Crossref]

3. https://doi.org/10.1016/S0140-6736(13)62631-8 [Google Scholar] [Crossref]

4. Arnold B. Bakker, A. B., & Demerouti, E. (2007). The Job Demands–Resources model: State of the art. Journal of Managerial Psychology, 22(3), 309–328. https://doi.org/10.1108/02683940710733115 [Google Scholar] [Crossref]

5. Tom L. Beauchamp, T. L., & James F. Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press. [Google Scholar] [Crossref]

6. Demerouti, E., Bakker, A. B., Nachreiner, F., & Schaufeli, W. B. (2001). The Job Demands–Resources model of burnout. Journal of Applied Psychology, 86(3), 499–512. https://doi.org/10.1037/0021-9010.86.3.499 [Google Scholar] [Crossref]

7. Field, A. (2018). Discovering statistics using IBM SPSS statistics (5th ed.). Sage Publications. [Google Scholar] [Crossref]

8. Frederick Herzberg, F. (1968). One more time: How do you motivate employees? Harvard Business Review, 46(1), 53–62. [Google Scholar] [Crossref]

9. Hayes, A. F. (2022). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (3rd ed.). Guilford Press. [Google Scholar] [Crossref]

10. Jameton, A. (1984). Nursing practice: The ethical issues. Prentice Hall. [Google Scholar] [Crossref]

11. Kutney-Lee, A., Sloane, D. M., & Aiken, L. H. (2013). An increase in the number of nurses with baccalaureate degrees is linked to lower rates of postsurgery mortality. Health Affairs, 32(3), 579–586. https://doi.org/10.1377/hlthaff.2012.0504 [Google Scholar] [Crossref]

12. Eileen T. Lake, E. T. (2002). Development of the Practice Environment Scale of the Nursing Work Index. Research in Nursing & Health, 25(3), 176–188. https://doi.org/10.1002/nur.10032 [Google Scholar] [Crossref]

13. Eileen T. Lake, E. T., Sanders, J., Duan, R., Riman, K. A., Schoenauer, K. M., & Chen, Y. (2019). A meta-analysis of the associations between the nurse work environment in hospitals and 4 sets of outcomes. Medical Care, 57(5), 353–361. https://doi.org/10.1097/MLR.0000000000001109 [Google Scholar] [Crossref]

14. Laschinger, H. K. S., & Leiter, M. P. (2006). The impact of nursing work environments on patient safety outcomes. Journal of Nursing Administration, 36(5), 259–267. [Google Scholar] [Crossref]

15. Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Wolters Kluwer. [Google Scholar] [Crossref]

16. Rushton, C. H. (2016). Moral resilience: Transforming moral suffering in healthcare. Oxford University Press. [Google Scholar] [Crossref]

17. Schaufeli, W. B., & Taris, T. W. (2014). A critical review of the Job Demands–Resources model. In G. Bauer & O. Hämmig (Eds.), Bridging occupational, organisational and public health (pp. 43–68). Springer. [Google Scholar] [Crossref]

18. Sekaran, U., & Bougie, R. (2019). Research methods for business: A skill-building approach (8th ed.). Wiley. [Google Scholar] [Crossref]

19. Tabachnick, B. G., & Fidell, L. S. (2019). Using multivariate statistics (7th ed.). Pearson. [Google Scholar] [Crossref]

20. Van Bogaert, P., Kowalski, C., Weeks, S. M., Van heusden, D., & Clarke, S. P. (2014). The relationship between nurse practice environment, nurse work characteristics, burnout and job outcome. Journal of Advanced Nursing, 70(7), 1667–1677. https://doi.org/10.1111/jan.12377 [Google Scholar] [Crossref]

21. World Health Organisation. (2020). State of the world’s nursing 2020: Investing in education, jobs and leadership. World Health Organisation. [Google Scholar] [Crossref]

• Is Strike Relevant in the Modern Era? Evidence from Indian Manufacturing, IT/Ites, FMCG, Electronics and Emerging Sectors
• A Qualitative Exploration of Work-Life Balance Among Private Universities Lecturers in Klang Valley
• Leadership Styles and Employee Motivation: Examining the Impact on Job Satisfaction and Turnover
• Human Resource Management, Organizational Culture, and Good Governance Practices: A Structural Equation Model on Service Orientation among Government-Owned and Controlled Corporation in Davao Region
• Cost of Silence: Exploring the Impact of Organisational Silence on Employee Engagement