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Work-Life Balance among Teaching Hospital Nurses in Malaysia

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 Global Journal of Health Science; Vol. 9, No. 8; 2017
ISSN 1916-9736 E-ISSN 1916-9744
Published by Canadian Center of Science and Education

Work-Life Balance among Teaching Hospital Nurses in Malaysia

Mohd Said Nurumal1, Sachiko Makabe2, Farah Ilyani Che Jamaludin1, Hairil Fahmi Mohd Yusof1,
Khin Thandar Aung1 & Yanika Kowitlawakul3
1
International Islamic University Malaysia, Malaysia
2
Akita University, Japan
3
National University of Singapore, Singapore
Correspondence: Mohd Said Nurumal, Department of Critical Care Nursing, Kulliyyah of Nursing, International
Islamic University Malaysia, PO Box 141, 25710 Kuantan, Pahang , Malaysia.

Received: February 27, 2017 Accepted: April 23, 2017 Online Published: July 10, 2017
doi:10.5539/gjhs.v9n9p81 URL: https://doi.org/10.5539/gjhs.v9n9p81

IRB Approval Number 313/20/4/10 - IREC351 - 20130319

Abstract
Extreme workload and poor working environment have a negative impact on the emotional and physical statuses
among nurses. The study has contributed to evaluate work-life balance and its related factors among teaching
hospital nurses. It was aimed to examine the work-life balance and its related factors among teaching hospital
nurses. A cross-sectional study using a universal sampling technique was conducted. 1002 nurses were included
from the Teaching hospital of Klang Valley, Malaysia. The instrument was adapted from NIOSH Generic Job
Stress Questionnaire and QoL questionnaire from WHO, and it was used to measure the quality of work-life
balance. Non-work activities, job requirement, supervisor support, job satisfaction, manageability, social and
environmental variables have independently influenced work-life balance among nurses. Furthermore, quality of
life variables has positively influenced the work-life balance (P<0.050). Work life balance and organizational
commitment can have a positive relationship. Whereas, Nurses working in fixed shifts were observed with greater
work-life balance as compared to the nurses working in multiple shifts. A friendly environment in the professional
sector plays a major role for developing motivation and enthusiasm among workers.
Keywords: environment, nurses, teaching, workload, work-life balance, Malaysia
1. Introduction
Work-life balance is an idea that includes the prioritizing between the lifestyle and work along with balancing
career and lifestyle together, which often seems a difficult goal in an individual’s life. Working environment
offered by an employer has a significant influence on the emotional health of the workers. The engagement of
employees to promote programs has the substantial impact on the performance of employees (Anitha, 2014; Engel
et al., 2014). Numerous researches have indicated that the employees would have a higher level of participation
and motivation towards job matters, when their employers offer a good working environment (Engel et al., 2014;
Timilsina Bhandari et al., 2015; Hinami et al., 2012). The staff ultimately relies on the management and their
practices for job satisfaction (Buerhaus et al., 2015). Nevertheless, excessive workload and poor working
environment affects greatly on psychological aspects due to ever-growing trends of the healthcare industry
nowadays (Engel et al., 2014).
Buerhaus et al. (2015) has identified that excessive working hours within clinical settings for nurses can cause
severe depression and imbalance hormones. As a result, the nurses tend to consume more food, smoke frequently
and drink alcoholic beverages to eradicate fatigue, stress and sleepiness from their life (Antunes et al., 2010;
Spiegel et al., 2009). Different studies have shown that nurses tend to make more errors during work like needle
stick injuries and medication errors, which may also cause patient dissatisfaction (Stimpfel et al., 2012;
Kunaviktikul et al., 2015; Trinkoff et al., 2011).
A study conducted by Sakthivel & Jayakrishnan (Sakthivel & Jayakrishnan, 2012) has indicated that the work-life
balance among nurses is an important phenomenon because of providing healthcare to the patients. Focusing on
the work-life balance as the main variable, it has been evaluated from the recent research that job satisfaction and
work-life balance in the nursing profession are important factors for the delivery of quality healthcare among
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patients (Azeem & Altalhi, 2015; Azeem & Akhtar, 2014).

The study has the potential to contribute in the nursing practice along with evidence based practices by recognizing
the crucial factors, leading to work-life imbalance, experienced by nurses in Malaysia. It has intended to identify
the requirements to restructure the working conditions of the nurses, and to lessen schedule irregularity and work
imbalance. These two aspects have been considered as the main factors that led to increase in stress and resulted in
negative attitudes and poor psychological health.
1.1 Aim of Study
The general objective of the study is to examine work-life balance and its related factors among teaching hospital
nurses. In addition, the specific objective is to identify factors of social demography, jobs nature, and quality of life
towards work-life balance among nurses.
2. Study Background
The study has introduced a conceptual framework, which described the factors influencing the job satisfaction and
work-life balance. A good place to work without stress, better satisfaction and motivation, reduced absenteeism,
and lower turnover should be controlled by the hospital administration. The conceptual framework has proposed
certain job related factors among nurses as shown in Figure 1.

Figure 1. Conceptual framework of factors influencing nurses’ intention to stay

2.1 Social Factors
Shu-Yu et al. (2014) mentioned that there is no relationship between the marital status and work-life balance. Even
though the married population dominated the study, it did not present the factor for influencing work-life balance.
It is further evaluated that the irregular sleeping pattern of nurses might affect the personal role in the family;
consequently, having inadequate time spending for their family (Spiegel et al., 2009; Stimpfel et al., 2012;
Kunaviktikul et al., 2015). Moreover, long working hours have affected energy level after work, so nurses seemed
to have difficulty in compensating time with their family (Almalki et al., 2012).
HA1: Quality of Life is significantly influenced from the physical, psychological, social and environmental factors
among nurses.
2.2 Health Factors
An epidemiological study showed an association between long working hours and obesity. Nurses, who work

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under pressure and long working hours, tend to compensate their stressful work-life, sleepiness, and fatigue by
consuming more foods and alcoholic drink (Antunes et al., 2010). By the time, nurses who practically used to have
such kind of lifestyles would be obese and have chronic diseases like diabetic mellitus and hypertension (Spiegel et
al., 2009). A study by Stimpfel et al. (2012) has examined the information from different states of nurses, their
patients, and hospitals. It has been reported that shifts greater than thirteen hours were interconnected to the
dissatisfaction of patients. Particularly, patients observed that nurses were not interacting well and they were
unable to provide help, whenever they needed. The results showed that nurses had greater risk of burnout, in case
of working more than thirteen hours per day. Relatively, less sleep increases the chances for reduced job
performance, obesity, and wide range of chronic diseases (Caruso, 2014). A review on shift works and obesity by
Antunes et al. (2010) has concluded that there is a comparable epidemiological evidence for a relationship between
obesity and shift work. Long working hours and obesity have been examined by few studies and concluded that
there is a positive association between obesity and long working hours (Bannai & Tamakoshi, 2014; Solovieva et
al., 2013; Luckhaupt et al., 2014).
HA2: There is a positive association between chronic and mental diseases and long working hours among nurses.
2.3 Role Factors
Nurses, who have currently become a major group in the health care system, are reflected as a severe group and
observed suffering from the poor quality of work-life balance. The stakeholders of healthcare have suggested that
nurses’ practitioners could help to mitigate the adverse impact of primary healthcare (Buerhaus et al., 2015). As a
result, Malaysian nurses tend to migrate developed countries, which offer greater working environment, better
career pathway, and better lifestyles (Timilsina Bhandari et al., 2015; Hinami et al., 2012; Buerhaus at al., 2015;
Barnett et al., 2010).
HA3: Imbalance between the personal and organizational commitments will lead to some negative consequences
among nurses.
2.4 Management Factors
Makabe et al. (2015) mentioned that work shift pattern resulted in inadequate period for nurses in getting enough
rest between the shift. As the transition period between shifts is fast, it might distort the brain activity from
wakefulness to sleep (Smith et al., 1999). Wilkins (2007) stated that sleep deprivation turned nurses to have low
concentration level and cannot communicate in good manners with clients. This aspect might be one of the
important causes which burn out syndrome between patients and nurses (Engel et al., 2014).
HA4: Work shift flexibility assist nurses to work and communicate with patients in good manners
3. Methodology
3.1 Study Design and Participants
The study opted a cross-sectional research design and involved 1002 respondents from University Malaya Medical
Centre (UMMC), Petaling Jaya, Selangor. The survey was conducted in one of the teaching hospitals in Klang
Valley. The survey questionnaires were distributed among 1002 nurses working in the hospital. The quantitative
research design was opted to analyze the data through SPSS (Statistical Package of Social Sciences). Nurses,
working in the UMMC, were included in the study regardless of their caste, religion, language, and other
socio-demographic background. Both married and unmarried nurses were included; however, nurses, who have
left working at UMMC, were excluded. Nurses from different educational background were also included. The
study was commenced only among female employees and included hospital nurses of all positions ranging from
lower rank to the top rank, who were working currently in hospitals. The data was collected from the nurses, who
were not on leave and performing their duties in the hospitals at the time of data collection. The respondents, who
understand Malay and English language and provided the consent to participate in the study, were included.
Moreover, the boxes were kept safely and were impossible for the completed questionnaires to be visible or
collected by others. After a month, the boxes were collected from the nursing offices for the analysis. Meanwhile,
the data of each respondent was kept private and confidential.
The age of respondents was ranged from 20 to 59 years with the mean age 28.84 (SD= 8.86). Regarding gender,
majority of respondents were female (94.0%); while, men were only 6.0%. Respectively, the total number of 773
nurses (77.1%) was from a diploma educational background. While, another 167 nurses (16.7%) were from
certificate level, and 62 nurses (6.2%) were from degree and master educational background. Meanwhile, the total
number of nurses per shift in average were 6.67 (SD=3.10). Additionally, an average total number of healthcare
assistants were 3.26 (SD=3.28). In the day shift, the average time of the official break in minutes was 33.23 (SD=

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18.04) and for the unofficial break was 14.53 (SD= 10.58). In contrary, the average time of official breaks in night
shift was 40.58 (SD= 17.63) and for the unofficial break was 32.39 (SD= 17.76). The percentage of annual leaves
taken by the participants was 62.6%.

Table 1. Association between socio demographic characteristics and work life balance (N=1002)
Socio Demographic r-value p-value
Age 0.02 .470
Experiences (months) 0.02 .584
Mean SD t-value p-value
Gender 1.52 .130
Woman 14.15 2.96
Man 13.55 2.95
F-stat (df) p-value
Marital Status 0.43 (2) .651
Married 14.06 2.98
Single; Never Married 14.14 2.85
Single; Divorced 14.55 4.08
Religion 0.76 (2) .516
Buddhism 14.52 2.05
Others 13.48 3.50
Muslim 14.13 2.97
Hindu 13.66 2.98
Educational Level 1.72 (2) .180
Certificate 14.49 3.03
Diploma 14.02 2.97
Degree & Master 14.21 2.66

3.2 Measurement
The questionnaire was adapted by NIOSH Generic Job Stress Questionnaire (Deguchi et al., 2016) and also
composed with Sense of Coherence (SOC) questionnaires from the original author, Antonousky (Shu-Yu et al.,
2014) and Quality of Life questionnaires from WHO (Smoth et al., 1999). 25 variables were established from the
questionnaire and computed accordingly as in the previous version of study (Deguchi et al., 2016). The reliability
test was examined in a pilot study involving 20 nurses, who did not participated in the main study. The Cronbach’s
Alpha was 0.97, which exceeded requirement value of 0.70 (Deguchi et al., 2016).
3.3 Procedure
Universal sampling approach has been applied in the study. Firstly, the objectives and potential benefits of the
study have been focused through permission letter and the proposal was sent to the Director of Clinical Research
Centre (CRC) of UMMC. Nurse Managers in each unit distributed the questionnaire to the nurses, according to the
inclusion criteria. The respondents were allowed to complete the survey within a month. However, duration time
for filling in the assessment was only 20-30 minutes.
3.4 Data Analysis
Raw data from the questionnaire was entered into the Statistical Package of Social Science (SPSS) version 20. The
level of significance chosen for all analysis was P<.05. Multiple Linear Regression tests were applied to model the
relationship between variables of interest. While, one way ANOVA test was applied to determine the association
between job nature and work-life balance. Afterwards, Pearson Correlation test was used to determine a
relationship between continuous data. Age, experiences, number of nurses and assistant nurses, break hour,
overtime hours, annual leaves, control scale, non-work activities, job requirement, social support, mental demand,
doctor-nurse relationship, job satisfaction were obtained. Balance of work and private life, sense of coherence and

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quality of life towards work-life balance have also been assessed.

4. Results
The relationship between socio-demographic characteristics and work-life balance has been presented. However,
none of the characteristics have shown significant value (p-value= .050) to relate with work-life balance. For
instance, marital status did not show any significant value (P<.050). It was similar to educational level as the
P-value was .180, which exceeded the maximum p-value as shown in table 1.
The fixed shift showed a significant association towards work-life balance (p-value= .038). Nurses, who were
working in fixed shift, have greater work-life balance score (mean=14.33, SD= 2.69) as compared to nurses that
are not working in fixed shift (mean= 13.94, SD=2.82). Moreover, there was a significant relationship between
annual leaves and work-life balance (p-value=.018, r-value=0.08). All of the four sub-categories showed a
significant relationship into work-life balance with task control (p-value<.001, r-value= -0.17), decision control
(p-value<.001, r-value= -0.14), physical environment control (p-value<.001, r-value= -0.12), and resource control
(p-value<.001, r-value= -0.13). Furthermore, non-work activities of nurses presented a significant relationship
with work-life balance (p-value=.002, r-value= -0.10). Job requirement has also been observed with significant
relationship regarding work-life balance (p-value<.001, r-value= -0.19) as shown in Table 2.
The Quality of life (QoL) has been assessed in four variables, including physical, psychological, social and
environmental. All the four variables were significantly related to work-life balance where (P<.050). There is a
significant linear relationship between non-work activities and WLB (p<.001). There is a significant linear
relationship between job requirements and WLB (p<.001). Those with scores of 10 in WLB will have 1 less square
in job requirements. There is a significant linear relationship between supervisor support and WLB (p<.001).
There is a significant linear relationship between management and WLB (p<.001). Nurses who have the higher
level of manageability of their work will have higher levels of WLB. There is a significant linear relationship
between social life and WLB (p<.001). There is a significant linear relationship between environmental support
and WLB (p<.001). Nurses who claimed to have good environmental support were observed with highest score of
their WLB. With 7 significant variables, the model explained 25.0% of the variation of the WLB in the study
sample. (R2= 0.25) as shown in Table 3.

Table 2. Association between Job Nature and Work-life Balance (N=1002)

F-stat (df) p-value
Nurse Manager 13.78 2.69
Senior Staff Nurse 14.12 3.04
Staff Nurse 14.13 2.97
Work shift .45 (2) .637
Rotating Shift 14.13 2.98
Permanent Shift 14.05 2.86
Office Hour 13.65 2.71
Unit Type 2.01 (2) .134
OPD 14.27 3.06
Ward 13.92 2.93
ICU/OR/Cardiac 13.80 2.24
r-value p-value
Number of Beds -0.04 .176
Total Registered Nurses -0.07 .034*
Total Assistant Nurse -0.04 .160
Break during working hour
Official Day Break 0.07 .030*
Official Night Break 0.02 .573
Unofficial Day Break 0.02 .573
* Other variables are mentioned in the detailed table
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Table 3. Multivariable Analysis of Respondents (N=1002)

Quality Of Life R-value p-value
Physical 0.15 <.001*
Psychological 0.08 .013*
Social 0.15 <.001*
Environment 0.21 <.001*
MLR (Multiple Linear Regression)
Variables 95.0% CI
Adj. B t-stat. p-value
Lower Upper
Fixed Shift 0.29 -0.04 0.63 1.74 .082
Total Registered Nurses -0.001 -0.04 0.02 -0.48 .631
Official Day Break 0.001 -0.005 0.01 0.83 .404
Annual Leaves 0.001 -0.003 0.01 1.08 .281
Task Control -0.241 -0.68 0.20 -1.07 .284
Decision Control -0.23 -0.63 0.18 -1.10 .268
Physical Environment
-0.17 -0.51 0.18 -0.95 .343
Control
Resource Control -0.15 -0.51 0.21 -0.81 .416
Non-work Activities -0.20 -0.30 -0.09 -3.52 <.001*
Job Requirement -0.12 -0.18 -0.06 -3.86 <.001*
*Other variables have been discussed in the detailed tables

The analysis was based on multiple regressions, which has predicted the work-life-balance in the form of equation:
Work-life balance= 13.78 – (0.20× Non-work activities) – (0.12 × Job requirements) – (0.09 × Supervisor support)
+ (1.78 × Job satisfaction) + (0.14 × Manageability) + (0.01 × Social variable in QoL) + (0.02 × Environmental
variable in QoL). It is understandable that any imbalance between the personal and organizational commitments
along with inefficiency in managing the priorities of life would lead to some serious consequences in every
variable. The outcomes would result in the form of reduced job satisfaction, poor productivity and performance,
low level of commitment towards the organization, increase in absenteeism and an ultimate intention to leave the
organization. Thus, the work-life balance and the perception of the employee well-being have been recognized as
an essential element for the success and growth of both; the employee and the organization. Work shift flexibility
assist nurses to work and communicate with patients in good manners, so hypothesis 4 has been accepted.
5. Discussion
The present study has focused on the work-life balance among teaching hospital nurses in Malaysia. The factors
related to the work-life imbalance among nurses have been evaluated, which may assist the healthcare
management to decrease the workload among the nurses. The above conducted tests for analysis have suggested
that there is a need to carefully monitor the level of all factors regarding work place, demographic, motivation,
stress and other benefits to enhance the quality of life among nurses. This practice is expected to provide
satisfaction in the personal life of nurses.
Nurses, working in fixed shifts, were observed with greater work-life balance as compared to the nurses working in
rotational shifts or multiple shifts. The results also supported the outcomes of past study, which observed that the
fixed shift significantly affects work-life balance (Makabe et al., 2015). However, the results were not consistent,
when defining the relationship between work shift patterns towards work-life balance. Meanwhile, there was a
significant relationship between total registered nurse (RN), break during working hour, and overtime hours
towards work-life balance. Such finding was similar to previous studies, where all of these three variables were
interrelated and significantly affected work-life balance among nurses (Kunaviktikul et al., 2015; Almalki et al.,
2012; Smith et al., 1999). Shortage of nurses was identified as the main problem. Due to the shortage of staff,
nurses are also given non-nursing tasks (Almalki et al., 2012).
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According to the present study, there is also a positive influence of annual leaves on work-life balance among
nurses. Physical, psychological, social and environmental factors were observed to be significantly associated with
the work-life balance. According to a study, a large number of nurses spent most of the time on work as compared
to private life, so they have poor work life pattern (Makabe et al., 2015). Only 36.9% of nurses from the population
study can balance their working time and private life. Whereas, almost 63.1% of the nurses have poor work-life
balance; thus, it increased the rate of turnover, poor job satisfaction, and ultimately poor Quality of Life (QoL)
(Hinami et al., 2012). The present study can be compared with the previous study conducted by Makabe (Makabe
et al., 2015) in Japan, where the prevalence of improper proportion between work life and private life among
nurses was very poor. The maintenance and development of data source regarding the nurse’s workforce would
expand the chances of policy researchers to understand the clinical practices (Almalki et al., 2012).
Regarding control scale that assessed autonomous power, the result could be comparable to the previous findings.
For certain extent, it causes job dissatisfaction and frustration among nurses. Other studies in Thailand also
presented nurses as an individual, who have been given power and opportunity to acquire good spirit, more
enthusiasm, less stress and more commitment in the task (Antunes et al., 2010; Spiegel et al., 2009; Stimpfel et al.,
2012; Kunaviktikul et al. 2015; Trinkoff et al., 2011; Shu-Yu et al., 2014; Makabe at al., 2015; Smith et al., 1999;
Deguchi et al., 2016).
Experiences and educational level play significant roles in determining association with the work-life balance,
where it can affect nurses physically, psychologically and socially. Experience and high education of nurses have
shown high order thinking skills in managing conflicts as compared to non-experienced and low educational level
of nurses (Almalki et al., 2012; Haus & Smolensky, 2006). Ministry of Health indicated that Malaysia would be in
critical shortage of nurses in the year 2020, due to the massive loss of Malaysian nurses through migration to other
countries (Barnett et al., 2010). Ironically, the nurses’ ratio to population of Malaysia as required by the WHO,
which is 1:200 (Chu & Moy, 2015).
WHO has indicated that South American countries have a ratio of 1.25 nurses for every 1000 population. Southeast
Asian countries mostly indicated ratios of below than 3.30 nurses for every 1000 population except Singapore,
which is a developed country with 9.60 nurses for 1000 population (Kimman et al., 2012; Gaughan et al., 2013).
Makabe et al. (2015) agreed that steps should be taken to solve problems of the workplace itself and create positive
work-life balance to find solution for turnover among developing countries’ nurses.
Social support was significant in determining association with the working environment. The study was related to
previous studies, which showed a lack of supervisor guidance, poor peer support, and de-motivated family
members were determinants in defining the level of job dissatisfaction (Buerhaus et al., 2015). Due to the
challenging job of nurses, this group of people need accompany in dealing with the stress at work place and home.
Nurses working in internal and external wards especially the married ones experiences greater stress (Chiang &
Chang, 2012).
Serious attention has been given to the concept of work-life balance by different organizations, researchers, and
HR practitioners. The main reason for this attraction could be due to the increasing demand of work along with
increased family demands. This study has attempted to identify the work-life balance in the nursing sector and to
investigate the issues that are faced with their possible outcomes. Additionally, the study has also endeavored to
identify new score and possible scope for further research with a notion to achieve better modeling and to ensure
higher work-life balance and delivery of performance. In conclusion, non-work activities, job requirement, SV
support, job satisfaction, manageability, social and environmental variables are significantly associated with
work-life balance. Therefore, necessary measures should be taken to eradicate the issues that have affected
personal life satisfaction and their work periodically.
This kind of research could be initiated among both private and government hospitals of several different common
departments including the OP, ICU, Medical and Surgery; therefore, the research would be helpful to obtain a
wider picture regarding work life balance among female nurses in different departments of hospital.
Acknowledgment
The author is very thankful to World Health Organization(WHO) for granted us to use their instrument and to all
the associated personnel in any reference that contributed in/for the purpose of this research. Further, this research
holds no conflict of interest and is partially funded by Akita University.
Ethical Consideration
The research got approval from the Kuliyyah of Nursing Research Committee, IIUM first, and then proceeded
with International Islamic University Malaysia Research Committee (IREC). Moreover, the permission has also
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been obtained by IRB committee to conduct the study. Thus, after gaining the approval from IREC and IRB, the
research had been sent to the University Malaya Medical Centre (UMMC) and finally approached to each
nursing department and units in the hospital.
Competing Interests Statement
The authors declare that they have no competing or potential conflicts of interest.
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