The nursing working environment is an important subsystem in the hospital environment. A good working environment could have a positive impact on nurses. However, the work-family conflict and unsatisfactory working environment could significantly reduce their working enthusiasm, efficacy as well as the overall quality of the nursing, increase their fatigue, and thereby compromise their career status.

To explore the possible status quo and to analyze the correlation between work environment perception and the work-family conflict among nurses in the operating room.

A total of 312 operating room nurses from two first-class hospitals at Grade 2 and two first-class hospitals at Grade 3 in China from May to September 2017 were included in this research using the cluster sampling method. The data, including the general information questionnaire, the practice environment scale of the nursing work index (PES-NWI), and the work-family conflict scale, were systematically collected. Pearson correlation analysis was applied to analyze the correlation between the two scores, with influencing factors analyzed by hierarchical regression analysis.

A total of 312 questionnaires were issued, and the response rate and effective questionnaire rate were both 96.15% (300/312). The total scores of the PES-NWI scale and the work-family conflict scale were 3.07 ± 0.43 (vs maximum up to 4 points) and 52.32 ± 8.79 (vs maximum up to 90 points), respectively. The scores of the PES-NWI scale were negatively correlated with that of work-family conflict scale (all P < 0.05). The perception of the nursing work environment and the number of night shifts per month were the major factors contributing to the work-family conflict (all P < 0.05).

The nursing work environment and the work-family conflict among nurses in the operating room were both found at a medium level with a negative correlation between the two.

As a complex system integrating biotechnology and psychosocial activities, the tense working environment and complex contradictions in the hospital can significantly undermine the mental health of medical staff[1]. The nurse working environment is an important subsystem within the hospital environment, which is a platform for nurses to provide efficient nursing service and to improve the nursing quality. A good working environment could have a positive impact on nurses[2]. In recent years, a number of studies have shown that a good nurse-working environment can promote improvement in job performance, cause alleviation of job burnout, and lead to a reduction in the turnover rate and thus subsequently improve patient outcomes[1-3]. Additionally, compared with other departments, operating room nurses endure heavy workload, high pressure, and irregular scheduling. Moreover, with an increase of age and seniority levels, they play more critical roles in hospitals and their families, such as nursing decision makers, caregivers, mothers, etc., resulting in the potential conflict between their work and family, namely work-family conflict[4,5]. The work-family conflict may, to some extent, reduce their efficacy, working enthusiasm as well as the quality of service, increase their fatigue, and compromise their career status[6-8]. A few clinical studies have found that most operating room nurses feel guilty about not spending adequate time with their families, which can undermine the quality of nursing, while a comfortable working environment could significantly aid to reduce the sense of job burnout and effectively mobilize their work enthusiasm[9,10]. Previous research from nearly 100000 nurses in has countries has shown that poor hospital work environments are common and are associated with nurse outcomes such as job-related burnout and with patient outcomes such as mortality[11]. Against such a backdrop, the aim of this study was to analyze systematically the effect of the perception in the nursing work environment on their work-family conflict among operating room nurses. Our findings also pointed to specific areas that hospital leaders and policy-makers could target in efforts to preserve the nurse workforce and improve quality and safety of care, namely improved staffing, better nurse and physician relations, more involvement of nurses in hospital decisions, and greater managerial support of those who provide clinical care at the operation room.

In this paper we studied the associations between nurse practice environment dimensions, work-family conflict, and the influencing factors using hierarchical regression analysis. The nursing work environment is an important factor for ensuring optimal quality in nursing[2]. It refers to the place where nurses provide nursing services and supporting system in work. It is a conjunction of the nursing staff configuration, hospital management practice, organizational culture, and work plan design. The majority of operating room nurses are female, who suffer hard while dealing with different patients suffering from acute and critical diseases every day[9]. In view of the long-term overloaded and high work pressure environment as well as irregular lifestyle, operating room nurses are generally perceived to be involved in a high-risk profession[9,13].

A number of clinical studies have found that long-term excessive work pressure can effectively induce stress-related physical and mental diseases as well as various systematic organ responses, thereby leading to compromised individual behaviors, body resistance, job burnout, rapid turnover, absence from work, and unsatisfactory performance[15]. In this study, the average total score of PES-NWI was 3.07 ± 0.43. The score for the ability of nursing managers and the type of leadership was the highest, whereas the score for nurses participating in the hospital affairs was the lowest. This indicated that the operating room nurses gave medium evaluation of nursing work environment, which indicated the existence of a harmonious atmosphere. The management model, rules, and regulations were clear and stable. It may be partially explained by the respect among nurses when working in the operation room and a high degree of cooperation and communication between them and other stakeholders. Besides, both doctors and nurses were motivated together by a common interest to ensure that the patients receive high-quality nursing and to perform noticeably well under pressure. Operating room nurses were able to communicate effectively with anesthesiologists and surgeons, so as to ensure a better treatment and effective nursing care[16]. In addition, nurses were relatively less satisfied with the material support such as the manpower and other material resources. At present, most of the hospitals in China are controlled by the department heads, and nurses have low participation in the management of the hospital affairs. Therefore, it is recommended for the managers to improve the working mode of nurses, to train specialized nurses, to allocate the human and material resources rationally, and to adjust scheduling systems to promote a greater satisfaction among nurses with the working environment[17-19].

Work-family conflict is a special form of role conflict, which can deeply affect nurses’ life and family satisfaction, subjective well-being, and overall job satisfaction. In severe cases, it can endanger an individual’s physical and mental health[9]. In this study, the total score of work-family conflict among operating room nurses was 52.32 ± 8.79, which was found to be at the medium level. The scores of each dimension in turn included time, pressure, and behavior patterns. Interestingly, it was noted that the score of work-family conflict was significantly higher than that of family-work conflict. The reasons might refer to the nature of the work in operating room: (1) The workload assigned is generally “heavy”, and the operating room nurses are in a state of long-term high concentration. They are overloaded physically and mentally, coupled with weekly night shift frequency and regularly expected professionalism[20]; (2) Working on operation room calls for great cares. As the state changes rapidly during illness and critical diseases, the nurses should effectively improve their theoretical knowledge and the practical skills constantly to avoid adverse events such as medical disputes; and (3) Working time is “tight”. Due to the need to communicate with the surgeons and anesthesiologists and the likely emergency situations during the operation, it is necessary for nurses to make pre-judgments and administer treatment in the shortest possible time[21,22].

Additionally, Table 3 showed that perception of the nursing work environment was negatively correlated with the work-family conflict. This indicated that the better the nursing work environment could lead to a significantly lower work-family conflict. An accountable reason for this observation is that in an amicable and comfortable working environment, nurses often find themselves in a good state both physically and mentally, thus resulting in improved performance and also perceive a sense of professional value. More important, the nursing services provided are observable and easily understood by patients and their families and are also recognized by the society, leading to significant reduction in work-family conflict[23,24]. In addition, this study found that more night shifts per month brought about more serious work-family conflict. Therefore, this report proposed the following suggestions for alleviating the work-family conflict of nurses: (1) Individual operating room nurses should allocate their energy and time reasonably, conduct the job of family cycle planning and career development planning carefully, balance the relationship between family and work, and determine the priorities at the different stages of life. For many roles, there should be some foci and motivation. They should analyze the potential major roles at a particular stage, so as to make good self-judgment, learn to decompress themselves, adjust their mentality, and thereby accept their own deficiencies to get the maximal support from their families; and (2) The nurse managers should communicate with the nurses actively, establish a multi-layered communication mechanisms, know the work attitudes of the nurses, try to find about their difficulties in maintaining life and work balance, pay attention to the work-family conflict, and promote their overall social support and belonging. In addition, in order to help the nurses master their daily timetable, the system of work sharing and reasonable scheduling should be carefully formulated according to the work-family conflict of the nurses to reduce the unnecessary pressure on their work and family[25].

However, due to the medical level and the severity of patient’s disease, the nurses’ perception in the working environment could be adversely affected to a certain extent and to some degree. Thus, this study has some limitations about the evaluation of perception of nurses on overall working environment[26]. We will study in the future the potential impact of different grades of the hospitals and severity of the patient’s conditions on the nurse’s perception of the overall working environment to explore further the different confounding factors affecting the perception of the nurse’s working environment.

In conclusion, nursing work environment of nurses in the operating room and work-family conflict in this study were both at medium levels, and there was found a negative correlation between the two. The nurses should explore stress compensatory mechanisms actively and plan their schedule accordingly. Nursing managers should make efforts to establish a good nursing work environment and formulate systemic interventions for mitigating the various influencing factors, so as to promote the successful development of nurses’ career, alleviate conflicts, and achieve “win-win” results between nurses and patients.