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Defining quality of nursing work life

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Defining Quality of Nursing
Work Life
}
Executive Summary
Since cost pressure to in-
crease productivity is unlikely
to ease, more sophisticated
approaches to driving organi-
zational performance while
recruiting and retaining a
fragile workforce are needed.
} Quality of Nursing Work Life
(QNWL) is a construct with
theoretical ties to Quality of
Work Life (QWL), a construct
that has been more extensive-
ly studied and validated as a
tool to better understand and
effect drivers of productivity
and professional fulfillment.
} Socio-technical systems (STS)
theory promotes a parallel
approach to addressing social
aspects of the work environ-
ment, such as recruitment,
socialization, and retention,
while addressing technical
aspects of work, such as the
policies, systems, and tools
supporting work, as a means
to achieve maximum organi-
zational efficiency and work-
force stability.
} While the QNWL has been
less extensively studied than
the QWL, it is closely parallel
to the QWL and offers more
direct and useful feedback to
leaders aspiring to manage
employee and organizational
outcomes.
NURSING ECONOMIC$/November-December 2005/Vol. 23/No. 6
HE PRESSURE TO PROVIDE
T more and better service
using the same or reduced
resources is likely to con-
tinue in the health care industry
for the foreseeable future. Given
changes in third-party reimburse-
ment, particularly set reimburse-
ment amounts for a given diagno-
sis, increased competition from
other health care facilities, and
managed care requirements, health
care organizations must improve
productivity for organizational
survival. However, increased pro-
ductivity is likely to be fleeting if
achieved at the expense of the
quality of employees’ work life.
Nurses are the single largest
employee cohort in hospitals.
Landmark studies have examined
the work of nurses, the cyclical
shortages that plague the profes-
sion, and Magnet facilities, yet the
recommendations have either not
been instituted or implemented
temporarily during a “crisis” to
alleviate the acute shortage at that
time. The profession needs to
resolve the ongoing and funda-
mental work life concerns of staff
nurses in long-term, meaningful
ways (Brooks, 2001).
Empirical referents for quality
of work life (QWL) have been
reported, but the closely related
Beth A. Brooks
Mary Ann Anderson
construct, quality of nursing work
life (QNWL), is less well devel-
oped, although some conceptual
mapping has been done (Attridge
& Callahan, 1990; Villeneuve et
al., 1995). Preliminary evidence
suggests that improvement of
QNWL is prerequisite to increased
productivity in hospitals. Thus,
the QNWL is in need of scholarly
investigation. The purpose of this
article is to explore the concept
components of the QNWL.
Theoretical Origins of Quality of
Nursing Work Life
The socio-technical systems
(STS) theory gives rise to many
theoretical antecedents of QNWL.
Developed in the 1950s, STS
posits that organizations fully
engaging employees in work design
promote employee fulfillment while
simultaneously achieving organiza-
tional goals. The term, quality of
work life (QWL), was coined in
settings using the STS approach
BETH A. BROOKS, PhD, RN, CHE, is a
Senior Partner, Health Care, JWT
Employment Communications, Chicago,
IL.
MARY ANN ANDERSON, PhD, RN, is an
Associate Professor, University of Illinois
at Chicago College of Nursing, Chicago, IL.
319
 to work design (Davis & Trist,
1974). STS theory has emerged as
a significant approach to design-
ing organizations, especially at
the interface of technology and
people. Productivity is improved
and humans are enriched through
a design process that focuses on
the interdependencies among
people, technology, and the envi-
ronment. In contrast to both tradi-
tional and behavioral approaches,
which emphasize individual
motivation rather than organiza-
tional features, STS theory recom-
mends simultaneous modification
of technical and social systems to
create work designs that can lead
both to greater task productivity
and to increased fulfillment of
organization members (Hackman,
1980).
In viewing organizations as
open and living systems interact-
ing with the environment, STS
emphasizes that organizations are
embedded in, and affected by, an
outside environment (Cherns,
1976). Thus, the way in which
work is accomplished in any
given organization is inextricably
linked to society at large. At the
same time, the organization’s
internal environment has social
and technical subsystems, as well
as physical design and work set-
tings, which act together to influ-
ence and produce the outcome
(product or service). Socio-techni-
cal systems theory defines an
organization’s environment as
having two components, the
social and technical subsystems.
Social subsystem of STS. The
social subsystem, comprising peo-
ple who work in the organization
and the relationships among
them, must be able to attain the
goals of the organization, adapt to
the environment, integrate the
activities of the people in the
organization, and provide for con-
tinued occupation of the essential
roles through recruitment, social-
ization, and retention (Cherns,
1976). More broadly, the social
subsystem includes the reasons
that organizational members
320
choose to work in the organiza-
tion, their attitudes toward it,
their expectations of it, patterns
of supervisory-subordinate rela-
tionships, skill levels of employ-
ees, and the nature of the sub-
groups within the population. In
short, the social subsystem
encompasses all of the human
qualities that members of an orga-
nization bring with them to work.
The STS theorists contend that
the surest way to direct the efforts
of organizational members to-
ward organizational goals is to
identify the needs that people
bring with them to the workplace,
and incorporate the means to
meet those needs through the
design of the technology and the
work itself (Cherns, 1976; Davis &
Trist, 1974; Pasmore, Francis,
Haldeman, & Shani, 1982). For
example, health care organiza-
tions using a STS approach to
decrease nursing staff turnover at
the unit level might gather staff
feedback so that nurse managers
can become more skilled at
retaining staff on their units.
Technical subsystem of STS.
Similarly, the technical subsys-
tem of an organization consists of
the tools, techniques, procedures,
skills, knowledge, and devices
used by members of the social
subsystem to accomplish the
organization’s tasks. The most
direct impact of technology is
upon organizational productivity;
this is not surprising since organi-
zations acquire technology to
increase speed and efficiency
(Pasmore et al., 1982). Technology
also affects the location of the
workers, the motions required to
operate equipment, and the
behaviors required to keep the
whole system running smoothly.
Roles and responsibilities devel-
op for those who are designated to
manage the equipment and people
assigned to operate it. Historically,
STS analysis has been applied pri-
marily to organizations employ-
ing physical technologies such as
coal mining or the automobile
industry (Cherns & Davis, 1975;
NURSING ECONOMIC$/November-December 2005/Vol. 23/No. 6
Emery & Trist, 1965; O’Toole,
1974; Trist, 1983; Trist &
Bamforth, 1951). White collar and
service-oriented organizations
have been studied only infre-
quently (Happ, 1993; Pasmore,
Petee, & Bastian, 1986; Song, Daly,
Rudy, Douglas, & Dyer, 1997;
Tonges, 1992) and more recent
research using STS to redesign
the technology-staff interface in
health care settings was not
found.
Theoretical assumptions of
STS. Socio-technical systems the-
ory is based on two underlying
assumptions: (a) organizational
performance can be improved by
allowing employees at lower lev-
els to assume more responsibility
for their efforts, and (b) employ-
ees will become more responsible
and self-directed as their work
offers opportunities to fulfill
important psychological needs,
such as learning, growth, self-
esteem and significance in their
working lives (Pasmore et al.,
1982). The major objective of the
STS theory approach to organiza-
tional change is to optimize joint-
ly the organizational goals and the
needs of the employees (Cherns &
Davis, 1975).
The open-systems approach,
in which technical as well as
social aspects of the organization
are recognized, offers a sound
starting point for studying and
(re)designing productive organi-
zations while meeting the needs
of employees. Although STS re-
searchers have generally reported
positive effects (for example 87%
of the interventions with produc-
tivity data show an improvement
in productivity [Pasmore et al.,
1982]), this approach does have
its drawbacks (Van Der Zwaan,
1975).
Criticisms include a lack of
coherence between theoretical
concepts, ambiguous definitions
of social and technical subsys-
tems, unclear boundaries between
organization and the environ-
ment, and a preponderance of
research on the social subsystem

Quality of Work Life Empirical Referents
Walton (1975)
Adequate, fair compensation
Safe, healthy working conditions
Growth
Security
Social Integration
Constitutionalism
Work life
Social relevance of work
that ignores the technical subsys-
tem (Adler & Docherty, 1998;
Pasmore, 1988; Van der Zwaan,
1994). In a meta-analysis of 17
socio-technical studies, the im-
pact of socio-technical interven-
tions, although positive, varied
greatly across studies (Beekun,
1989). Productivity was moderated
by variations in the use of
autonomous work groups, changes
in the technological system,
changes in the pay system, and
the scope of the change.
The concept, quality of work
life, arose from the theoretical
underpinning of the socio-techni-
cal systems theory. The quality of
work life is improved by allowing
employees to assume more
responsibility for their efforts
while providing opportunities to
fulfill important psychological
needs, two assumptions underly-
ing STS theory.
Such premises may be extrap-
olated to the health care setting in
which nurses are employed. The
concept then becomes the quality
of nursing work life (QNWL), and
includes both social and technical
aspects of health care work envi-
ronments. Aspects that address
social issues of concern to nurses
who work in hospitals may include
supervisory-subordinate relation-
ships, nurse-physician relation-
ships, skill levels of employees,
and workers’ attitudes and expec-
tations of the work environment.
Technical aspects of work may
NURSING ECONOMIC$/November-December 2005/Vol. 23/No. 6
Table 1.
Taylor (1978)
Adequate, fair compensation
Safe, healthy working conditions
Growth
Security
Social integration
Constitutionalism
Work life
Social relevance of work
Employer’s QWL
Societal QWL
include procedures, skills, knowl-
edge, technology, and equipment.
According to Cronbach and
Meehl (1955), whenever no uni-
verse of content is accepted as
entirely adequate to define a con-
struct, the empirical referents
need to be explicitly delineated
and the nomological net sur-
rounding the construct must be
identified. This review of STS
provides the theoretical under-
pinnings for the construct QNWL
and begins to establish the nomo-
logical net. Further theoretical
markers for the construct of
QNWL may be found in the liter-
ature of the more general, yet
closely related concept, quality of
work life.
Quality of work life. Com-
prehensive delineation of the
QWL concept is found in three
major works: Walton (1975),
Taylor (1978), and Levine, Taylor,
and Davis (1984) (see Table 1).
Not all empirical referents are
uniformly salient for all employee
groups, and different sets of
empirical referents for different
groups of workers are required.
Although speculative and a pri-
ori, Walton (1975) was the first to
propose eight dimensions and
empirical referents based on stud-
ies of workers and their experi-
ences at work. Taylor (1978) con-
ducted the first empirical exami-
nation using factor analysis to
investigate the underlying struc-
ture of QWL. Items were added to
Levine, Taylor, & Davis (1984)
Adequate, fair compensation
Safe, healthy working conditions
Use of capabilities
Security
Social Integration
Constitutionalism
Work life
Social relevance of work
Employer’s QWL
Societal QWL
include the employer and society
at large, as recommended by
Seashore (1975). Levine et al.
(1984) defined and measured
QWL in an insurance company
from the perspective of white-col-
lar employees. Seven significant
predictors of QWL were found: (a)
the degree to which superiors
treat employees with respect and
have confidence in their abilities,
(b) variety in daily work routine,
(c) challenge of work, (d) present
work leads to future opportuni-
ties, (e) self-esteem, (f) extent to
which life outside of work affects
life at work, and (g) the extent to
which work contributes to soci-
ety.
Inferences can be drawn about
QWL from the fit between the pat-
terns of data in Table 1. Thus, fair
compensation, safe and healthy
working conditions, use and
development of human capabili-
ties, security, social integration,
constitutionalism, favorable work
life interaction with home life,
and social relevance of work are
contained in the nomological net,
or the pattern of relationships that
permit naming the QWL construct
(Cronbach & Meehl, 1955).
Other researchers have attempt-
ed to measure QWL in a variety of
settings using combinations of vari-
ous questionnaires. Job satisfac-
tion (Baba & Jamal, 1991; Efraty &
Sirgy, 1990; Igbaria, Parasuraman,
& Badawy, 1994; Studt, 1998),
organizational commitment (Baba
321
 Table 2. & Jamal, 1991; Igbaria et al., 1994),
Quality of Nursing Work Life Empirical Referents alienation (Efraty & Sirgy, 1990),
job stress (Baba & Jamal, 1991),
Attridge & Callahan 1990 Villeneuve et al., 1995 organizational identification
Characteristics of the organization Work setting issues
(Efraty & Sirgy, 1990), job involve-
Nature of nursing work The work itself ment (Baba & Jamal, 1991; Efraty
Acknowledgment of value Personal satisfaction and feelings & Sirgy, 1990; Igbaria et al., 1994;
Human and other resources about work Studt, 1998), and finally work
Collegial relationships Work life/Home life Interactions role ambiguity, conflict, and over-
Self-career development Management/Leadership issues load (Baba & Jamal, 1991) were
Societal/Work world issues proxy measures of QWL.
Significant overlap may be found
in the referents of QWL.
Figure 1. Quality of Nursing Work Life
Factors Influencing Quality of Nursing Work Life
A network of relationships
including the STS theory, early
QWL studies, and prior conceptu-
alizations of QNWL implicitly
define the construct (Attridge &
Callahan, 1990; O’Brien-Pallas &
Baumann, 1992; Villeneuve et al.,
1995). A comparison of the dimen-
sions and referents of QNWL is
displayed in Table 2. Char-
acteristics of a quality work envi-
ronment as defined by nurses for
nurses were identified and priori-
tized into seven dimensions
(Attridge & Callahan, 1990), simi-
lar to Walton’s (1975) eight QWL
dimensions. Further qualitative
research by Villenueve et al.
(1995) supported the empirical
referents of QNWL reported by
prior investigators (Attridge &
Callahan, 1990). Similar themes
and referents emerged, and again,
overlap was apparent.
Integration of the evidence
concerning QWL (see Table 1) and
the QNWL (see Table 2) yields
consistent descriptive dimensions
and referents. Issues such as
staffing, workload, physical or
verbal abuse, safety, availability of
technology or equipment, contin-
uing education, respect, and
scope of practice are inherently a
part of QNWL. The framework in
Figure 1 was synthesized into
NOTE: From "Quality of Nursing Worklife Issues--A Unifying Framework," by
L. O'Brien-Pallas and A. Baumann, 1992, Canadian Journal of Nursing
four dimensions: (a) work life-
Administration, 5(2), 13. Copyright 1992 by Canadian Journal of Nursing home life, (b) work design, (c)
Administration. Reprinted with permission. work context, and (d) work world
(Baumann & O’Brien-Pallas, 1993;
O’Brien-Pallas, Baumann, &
Villeneuve, 1994).

322 NURSING ECONOMIC$/November-December 2005/Vol. 23/No. 6

 Table 3.
Four Dimensions of the Conceptual Framework with Related Instrument Items

Work Life/Home Life Dimension • Friendships with my co-workers are important to

Defined as the interface between the life experiences
of nurses in their place of work and in the home.
Instrument items:
• I am able to balance work with my family needs.
• I am able to arrange for child-care when I am at
work.
• I have energy left after work.
• I feel that rotating schedules negatively affect my
life.
• My organization’s policy for family-leave time is
adequate.
• I am able to arrange for day care for my elderly
parents.
• I am able to arrange for day care when my child
is ill.
Work Design Dimension
Defined as the composition of nursing work and
describes the actual work nurses do. Instrument items:
• I receive a sufficient amount of assistance from
unlicensed support personnel.
• I am satisfied with my job.
• My workload is too heavy.
• I have autonomy to make patient care decisions.
• I perform many non-nursing tasks.
• I experience many interruptions in my daily work
routine.
• I have enough time to do my job well.
• There are enough RNs in my work setting.
• I am able to provide good quality patient care.
• I receive quality assistance from unlicensed sup-
port personnel
Work Context Dimension
Defined as the practice settings in which nurses work
and explores the impact of the work environment on
both nurse and patient systems. Instrument items:
• I am able to communicate well with my nurse
manager/supervisor.
• I have adequate patient care supplies and equip-
ment.
• My nurse manager/supervisor provides adequate
supervision.
me.
• My work setting provides career advancement
opportunities
• I feel like there is teamwork in my work setting.
• I feel like I belong to the “work family.”
• I am able to communicate with other therapists
(physical, respiratory, etc.).
• I receive feedback on my performance from my
nurse manager/supervisor.
• I am able to participate in decisions made by my
nurse manager/supervisor.
• I feel respected by physicians in my work setting.
• The nurses’ lounge/break-area/locker room in my
setting is comfortable.
• I have access to degree completion programs
through my work setting.
• I receive support to attend in-services and contin-
uing education programs.
• I communicate well with the physicians in my
work setting.
• I am recognized for my accomplishments by my
nurse manager/supervisor.
• Nursing policies and procedures facilitate my
work.
• I feel the security department provides a secure
environment.
• I feel safe from personal harm (physical, emo-
tional, or verbal) at work.
• I feel that upper-level management has respect
for nursing.
Work World Dimension
Defined as the effects of broad societal influences and
changes on the practice of nursing. Instrument items:
• I believe that, in general, society has the correct
image of nurses.
• My salary is adequate for my job given the cur-
rent job market conditions.
• I would be able to find the same job in another
organization with about the same salary and ben-
efits.
• I feel my job is secure.
• I believe my work impacts the lives of
patients/families.

A Quality of Nursing Work Life
Framework
Further synthesis and recon-
ceptualization resulted in the pro-
posed framework for QNWL (see
Table 3) (Brooks, 2001). Quality of
nursing work life is the degree to
which registered nurses are able to
satisfy important personal needs
through their experiences in their
work organization while achiev-
ing the organization’s goals
(Brooks, 2001). The four dimen-
sions are further defined by a syn-
thesis of referents from prior work
in STS, the QWL, and QNWL.
The first is termed the work
life-home life dimension or the
interface between the nurses’
work and home life. Since nurses
are primarily female, this dimen-
sion reflects the role of mother
(child care), daughter (elderly par-
ent care), and spouse (family
needs, available energy). The work
design dimension is the composi-
tion of nursing work, or the actual
work nurses do. Here are items
that define nurses’ immediate
work environment such as work-
load, staffing, and autonomy. The
practice settings in which nurses

NURSING ECONOMIC$/November-December 2005/Vol. 23/No. 6 323

 work and the impact of the work
environment on both nurse and
patient systems is the work con-
text dimension. Closely aligned to
the work design dimension, the
work context dimension is broad-
er. It includes relationships with
supervisory personnel, co-work-
ers, inter-disciplinary health team
colleagues, the provision of
resources to do the job, and pro-
motion of lifelong learning by the
institution. The fourth dimension,
the work world, is defined as the
effects of broad societal influences
and change on the practice of
nursing (Baumann & O’Brien-
Pallas, 1993; O’Brien-Pallas et al.,
1994). The image of the profes-
sion, economic issues, and job
security are concerns of most
employees, regardless of role or
setting (see Table 3).
Organization of items in such
a fashion permits exploration of
the phenomenon from the per-
spective of RNs as well as docu-
mentation of the empirical refer-
ents underlying the framework.
Validation is also possible via
instrument development using the
dimensions and items.
Comparing and Contrasting QWL
And QNWL
Empirical referents for QWL
have been reported and QNWL is
a closely related concept. Some
may find that the concepts are so
closely related that they are identi-
cal. However, even though occupa-
tion-specific conceptualizations
have the disadvantage of limiting
comparisons across occupations,
they have the important advantage
of better delineating the items
most relevant to the particular
occupation. Occupation-specific
conceptualizations that lead to
questionnaires which include sub-
scales and items that are specifi-
cally tailored to a particular pro-
fession can provide valuable infor-
mation in a particular setting.
Since early QWL conceptualiza-
tions studied populations and
contexts inappropriate for RNs,
examining the concept for nursing
324
was key to questionnaire develop-
ment. Once qualitative research
defined QNWL, aspects of nursing
work and the work environments
that were unique to QNWL
emerged, based most often on gen-
der roles. Some maintain that
greater amounts of variance can be
understood when input from
workers is used when designing a
questionnaire, rather than ques-
tionnaires designed solely by
experts (Levine et al., 1984).
Discussion
The need to improve organiza-
tional productivity in the health
care industry is a recurring theme
in the literature, and as the largest
employee group, nurses are key
players. Prior investigations clear-
ly link improved hospital produc-
tivity to a better quality of work
life. The degree to which RNs are
able to satisfy important personal
needs through work experiences,
while simultaneously achieving
the organization’s goals, is the
quality of nursing work life
(Brooks, 2001). There is a work
life-home life component as well
as a work design, context, and
world component to the quality of
nursing work life. There is also
significant theoretical support for
quality of nursing work life, with
origins in the socio-technical sys-
tems theory. However, measure-
ment is problematic (Robertson,
1990).
As in QWL, there is no single
reliable and valid questionnaire to
assess QNWL and a combination
of various instruments has been
used for measurement. These
include job satisfaction (Al’aitah,
Cameron, Armstrong-Stassen &
Horsburgh, 1999; Freeman &
O’Brien-Pallas, 1998; Hood &
Smith, 1994; Smith, 1981; Smith
& Mitry, 1983; Spence-Laschinger,
Finegan, Shamian, & Almost, 2001;
Woodcox, Isaacs, Underwood, &
Chambers, 1994); organizational
commitment (Spence-Laschinger
et al., 2001; Smith, 1981); job ten-
sion (Smith, 1981; Smith & Mitry,
1983); job involvement (Hood &
NURSING ECONOMIC$/November-December 2005/Vol. 23/No. 6
Smith, 1994); job strain (Spence-
Laschinger et al., 2001); organiza-
tional climate (Smith & Mitry,
1983); role stress (Woodcox et al.,
1994); and, finally, propensity to
remain (Al’aitah et al., 1999; Hood
& Smith, 1994). Like the QWL
research, proxy measures of
QNWL were used with substantial
overlap in the referents.
Better comprehension of
QNWL will facilitate the develop-
ment of an instrument to measure
QNWL so that studies can be
designed to measure the effective-
ness of work redesign efforts
intended to both improve nurses’
QNWL and organizational produc-
tivity. Furthermore, an instrument
to measure QNWL will enable
organizations to measure the qual-
ity of nurses’ work life to uncover
those areas to change, enhance, or
implement new programs designed
to improve nursing work life. More
importantly, organizations will be
able to move past the limitations of
job satisfaction research (Brooks et
al., 2005) and assess the quality of
the work life of nurses (Brooks,
2004).
Some recent work has con-
fused QNWL with job satisfaction
(Gifford, Zammuto & Goodman,
2002; Knox & Irving, 1997).
Conventional job satisfaction
research, historically used in nurs-
ing, focuses on employees’ likes
and dislikes and sees the solution
to problems as something for man-
agement to “fix” (Davis, 1971;
Seashore, 1975; Taylor, 1977;
Walton, 1975). Many organiza-
tions still measure job satisfaction,
even though research has consis-
tently demonstrated that high sat-
isfaction does not necessarily lead
to higher levels of performance or
improved patient outcomes (Good-
ell & Coeling, 1994; Iaffaldano &
Muchinsky, 1985; Nadler &
Lawler, 1983; Organ, 1988; Taylor
& Felton, 1993). In fact, as much as
30% of the variance explained in
job satisfaction surveys is a func-
tion of personality, something an
employer can do little to change
(Agho, 1993; Arvey, Bouchard,
Segal, & Abraham, 1989; Judge,
1993; Judge & Hulin, 1993;
Tellegen et al., 1988). Moreover,
much of the job satisfaction litera-
ture is not anchored in theory.
Thus, job satisfaction is an unsat-
isfactory construct to assess either
the jobs themselves or employees’
feelings about work (Davis, 1975;
Taylor, 1977), unlike QNWL.
Implications for Nurse Leaders
The conceptual components
outlined here provide nurse lead-
ers with clues about discretionary
employee benefits that enhance
the work life of nurses. In collabo-
ration with their colleagues in
human resources, nurse leaders
can develop and implement
employee benefit programs that
would improve the work life of
nurses. Programs that enable nurs-
es to balance work with their fam-
ily needs, decrease rotating shifts,
bonus programs for off-shifts, on-
site child care, on-site ill child
care, on-site day care for elderly
parents, and on-site degree com-
pletion programs are important
(Brooks, 2001).
Other clues gleaned from this
concept analysis provide informa-
tion that could be used to improve
the work environment. Some staff
nurses worry about workplace
security, being safe from personal
harm, and express concerns that
nurse managers are inadequately
prepared for their role. In a recent
study, only 50% (n=187) of the
respondents agreed they were able
to participate in decisions made
by the nurse manager (Brooks,
2001). These findings point to
areas that nurse leaders can
strengthen and improve that
reflect similar issues uncovered in
a classic Magnet hospital study
(Kellogg Foundation, 1989) and
other more recent attempts to
understand what contributes to a
quality work life for nurses.
Furthermore, nurse leaders may
re-examine the utility of job satis-
faction surveys in light of the ben-
efits of assessing the quality of
nursing work life described here.
NURSING ECONOMIC$/November-December 2005/Vol. 23/No. 6
Conclusion
This conceptual overview of
the QNWL clearly suggests com-
plexity and opportunity. As an
entity, QNWL has strong theoreti-
cal roots and legitimacy. It has
engendered significant interest in
the organizational literature.
Much of the complexity stems
from the overlapping, vaguely
defined, and poorly measured
empirical referents. Job satisfac-
tion is not analogous to the
QNWL, and only hinders compre-
hension. Despite limitations and
flaws, prior work suggests the
importance of the construct to the
practice of nursing, and thus to
the success of the organizations in
which nurses work. Clearly, there
appears to be a basic set of needs
and work environment character-
istics that are universally impor-
tant for all nurses, but the impor-
tance of any particular need is not
well understood (Davis & Relations, 10, 176-193.
Thorburn, 1999; McGirr & Bakker,
2000). The preceding concept
analysis is a useful starting point
for further investigations. $
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Mission Statement
Nursing Economic$® advances nursing leadership in health care, with a focus on
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best practices in health care management, economics, and policymaking. The journal
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