Soc Psychiatry Psychiatr Epidemiol (2004) 39 : 576580

DOI 10.1007/s00127-004-0791-z

ORIGINAL PAPER

J. I. Rssberg . Eiring S. Friis

Work environment and job satisfaction

A psychometric evaluation of the Working Environment Scale-10

Accepted: 18 February 2004

Abstract Background The working environment in mental health wards has been shown to have profound effects on the health and work stability of mental health workers. Despite an apparent need for regular measurement of work environment,development of short and reliable instruments for such measurements has been largely neglected. The aim of the present study was to evaluate the psychometric properties of the Working Environment Scale-10 (WES-10). Methods During the period 1990 through 2000, a total of 640 staff members on 42 wards for psychotic patients completed the WES-10. To establish the number of subscales, a factor analysis was carried out.The internal consistency of the subscales was calculated as Cronbachs alpha.We also collected data concerning satisfaction with the ward, its patients and staff, and for how long the respondents had worked and expected to continue to work at the ward. Results We identified four subscales named: Self Realization, Workload, Conflict and Nervousness. The psychometric properties of the subscales proved to be acceptable. All the subscales were significantly correlated with at least one satisfaction item, and/or the time the staff expected to continue at the ward. Most notably, the Self Realization subscale was strongly correlated to general satisfaction with the ward, and to the time the staff expected to work on the ward in the future,while Conflict was strongly negatively correlated with liking for staff. Conclusion The WES-10 appears to measure four clinically meaningful subscales. It seems well suited for use in further research and for evaluation of clinical milieus. Key words work environment psychometrics staff members satisfaction questionnaires
J. I. Rssberg, MD () . Eiring, MD S. Friis, MD, PhD Dept. of Psychiatry Ullevaal University Hospital 0407 Oslo, Norway Tel.: +47-22/118370 Fax: +47-22/117848 E-Mail: j.i.rxssberg@psykiatri.uio.no

Introduction
An extensive literature has been generated about the milieu in which health professionals work and the impact it has on both mental and physical health [15]. The potentially stressful nature of mental health work has been amply demonstrated. Several studies have reported a high level of burnout and poor mental health among psychiatric staff members [611]. A poor work environment has proved to be associated with reduced job satisfaction, absenteeism, somatic complaints, burnout and depression [1217]. It has been reported how a poor work environment might influence the work performance negatively [18], and promote negative and cynical attitudes towards patients and colleagues [19]. A poor work environment is probably one of the main reasons for the high staff turnover rate [1, 20, 21] and poor inpatient satisfaction and outcome [22, 23]. Against this background, there is an obvious need for regular studies of the work environment on psychiatric wards. As pointed out by Burnard et al. [24], the working environment should be regularly measured, as one way to measure service quality. Measures of the working environment and job satisfaction may also be useful benchmarks for evaluating future changes and developments in the psychiatric wards, and to monitor and improve the clinical working environment. To regularly study the working environment, we need an instrument that is clinically meaningful, easy to use and with acceptable psychometric properties. To be clinically meaningful, the instrument has to measure the central dimensions. Reviewing the literature, it seems that previous studies have identified three core dimensions named: Workload (Work pressure, Task requirements) [2, 21, 2426], Personal growth (Professional growth, Support, Achievement value and growth) [14, 21, 26] and Conflict [2, 25, 27]. Some studies come up with additional dimensions like safety, role clarity, salary, work hazards, home-work conflict, professional status and organizational issues [7, 14, 21, 24, 25].

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Many of the original instruments seem to have been so large and complex that they have been difficult to use. Consequently, many studies of the working environment tend to have small and unrepresentative samples of psychiatric staff members [8]. Admittedly, several working environment scales have been used in short forms to facilitate ease of use or they have been changed to become more suitable for mental health workers [28], but, as indicated in a recent review, analysis of the psychometric properties of different instruments seems mostly to be lacking [6]. To overcome many of the previous difficulties, we have developed a short and user-friendly ten-item working environment scale. We collected data from a large number of psychiatric staff members on 42 different psychiatric wards. The main aims of this study were to evaluate the psychometric properties of the Working Environment Scale-10 (WES-10) on a ward level. We decided to examine whether the WES-10 measures clinically meaningful subscales worth using in future research and in a clinical context.Another objective was to examine how these subscales were related to general job satisfaction and the staff members intention to leave their job. More specifically, we wanted to answer the following questions: 1. Does the factor structure of the WES-10 point to specific subscales? 2. What are the internal consistencies, mean scores, standard deviations, and intercorrelations of the subscales? 3. What is the relationship between the WES-10 subscales and the staff members general satisfaction with the psychiatric ward, liking for patients and staff? 4. What is the relationship between the WES-10 subscale scores and how long the staff members have worked at the psychiatric wards and how long they intend to work at the wards?

Statistics To establish the number of subscales of the WES-10, we carried out a factor analysis (PCA) with varimax rotation. For each factor, we made a corresponding subscale. Items were included into the subscales if they had a loading on the corresponding factor 0.50 and if the difference between this loading and the highest loading on non-corresponding factors was 0.05. The internal consistency of the subscales was calculated as Cronbachs alpha. We calculated the Corrected Item Total subscale Correlation (CITC) for the subscale, which comprised four items. Pearson correlations were used to assess the relationships between the subscales and between the subscales and the other variables.

Results
A total of 105 individual therapists and 529 nursing staff members completed the WES-10. A total of six staff members did not report whether they were individual therapists or nursing staff. All staff members were included in the study except for night staff. The limitation was due to difficulties in obtaining an acceptable number of completed questionnaires from the latter group of employees. All staff members were asked for how long they had worked at the psychiatric ward and how long they expected to work on the ward. A total of 15 % of the staff members had been employed less than 6 months, 22 % between 6 months and 18 months and 20 % between 18 months and 3 years. Of the staff members, 43 % had been employed more than 3 years. A total of 15 % were planning to quit their jobs during the following 6 months.An additional 15 % were planning to quit before 1 year had passed. The largest group, 47 %, thought they would continue to work at the same psychiatric ward somewhere between 1 and 3 years. A total of 23 % were planning to continue for more than 3 years. For each ward, we calculated the percentage of staff members who had been working: (a) for less than 18 months, and (b) for more than 3 years. We also calculated the percentage that intended to continue: (a) for less than 1 year, and (b) for more than 3 years. The factor analysis revealed four factors with an Eigenvalue > 1. These four factors accounted for 79 % of the variance. The factor loadings of the items are listed in Table 1. The four subscales were named: Self Realization, Workload, Conflict and Nervousness. The Self Realization subscale explained 37 % of the variance and comprised four items (items 1, 2, 5 and 6). This subscale measures to what extent the staff members feel supported, whether they achieve more confidence and whether they experience being able to use their knowledge working on the ward. The Workload subscale explained 19 % of the variance and comprised two items (items 9 and 10). This subscale measures the number of tasks imposed on the staff members and also to what extent they feel they should have been on several places at the same time. The last two subscales, Conflict and Nervousness, each comprised two items and explained respectively 13 % and 12 % of the variance. The Conflict

Subjects and methods

During the period 1990 through 2000, a total of 640 staff members on 42 wards for psychotic patients completed the WES-10. The WES-10 is a self-report questionnaire and comprises the ten items displayed in Appendix 1. Three items (items 1, 2 and 3) were taken from the Personal Development Scale developed by Moos [29]. The other seven items were developed by a clinical research group at Ullevaal University Hospital (1981) with the intention to evaluate the restructuring of an acute ward [30]. The items comprising the WES-10 were rated on a five-point scale ranging from 1, not at all or never, to 5, very often or to a large extent. This study included wards where more than two-thirds of the patients were diagnosed in the psychotic spectrum of mental diseases. Most of the wards were short-term (n = 36), but some intermediate and long-term wards (n = 6) were also included. Three questions were applied to capture general satisfaction with the milieu. The questions were rated on a five-point scale ranging from 1, not at all, to 5, very much, and were: (1) How satisfied are you with this ward?, (2) How much do you like the patients on this ward? and (3) How much do you like the staff on this ward?. The mean and SD concerning these three questions were respectively: 4.03 (0.33), 4.20 (0.20) and 4.43 (0.21).

578 Table 1 The factor loadings for each item. Only factor loadings 0.30 are included Items from the WES-10 1 2 3 4 5 6 7 8 9 10 I 0.82 0.86 0.45 0.63 0.91 0.32 0.43 0.83 0.85 0.91 0.91 0.94 0.63 II III IV How satisfied are you with this ward? Self Realization Conflict Workload Nervousness 0.56** 0.41** 0.20 0.30 How much do you like the patients on this ward? 0.49** 0.16 0.15 0.27 How much do you like the staff on this ward 0.40** 0.61** 0.17 0.15 Table 3 The intercorrelations between the four subscales and general satisfaction with the psychiatric wards, patients and staff members

** Correlation is significant at the 0.01 level (2-tailed) * Correlation is significant at the 0.05 level (2-tailed)

Table 4 The correlations between the four subscales and how long the staff members have been employed and how long they expect to work at the psychiatric ward % worked < 18 months Self Realization Conflict Workload Nervousness 0.16 0.05 0.37* 0.17 % worked > 3 years 0.07 0.15 0.26 0.05 % intend to continue < 1 year 0.38* 0.25 0.28 0.38* % intend to continue > 3 years 0.32* 0.26 0.29 0.25

subscale measures to what extent the staff members experience conflicts and loyalty problems among them (items 7 and 8). The Nervousness subscale measures to what extent the staff members are worried about going to work and to what extent they feel nervous or tense on the ward (items 3 and 4). All the items were included in the subscales. The psychometric properties of the subscales proved to be satisfactory. Cronbachs alpha for the four subscales were: Self Realization: 0.85, Workload: 0.84, Conflict: 0.69 and Nervousness: 0.66. The four items in the Self Realization subscale had a mean CITC of 0.52. The intercorrelations between the two items comprising the last three subscales were respectively: Workload: 0.72, Conflict: 0.53 and Nervousness: 0.49. The mean scores and standard deviations for the four subscales were respectively: Self Realization: 3.73 (0.23), Workload: 3.41 (0.36), Conflict: 2.06 (0.28) and Nervousness: 1.98 (0.21). As seen from Table 2, the subscales were only moderately intercorrelated (range: 0.130.37, median: 0.30). As seen from Table 3, the Self Realization subscale was most strongly correlated with general satisfaction and liking for the patients. The Conflict subscale was most strongly correlated (negatively) with liking for the other staff members. Table 4 shows that only the Workload subscale was significantly correlated with the time staff members had worked at the ward. This subscale showed a moderate negative correlation with the percentage that had worked less than 18 months at the ward. Two subscales
Table 2 The intercorrelations between the four subscales Self Realization Self Realization Conflict Workload Nervous X Conflict 0.37* X Workload 0.13 0.20 X Nervousness 0.35* 0.34* 0.25 X

* Correlation is significant at the 0.05 level (2-tailed)

(Self Realization and Nervousness) were significantly related to the time the staff expected to work on the ward in the future. The relationship was most pronounced for Self Realization, which was moderately negatively correlated with the percentage who intended to continue less than 1 year, and positively with the percentage who intended to continue for more than 3 years.

Discussion
The main finding of this study is that the WES-10 features acceptable psychometric properties on a ward level.Although not directly compared to other scales,the results of this study clearly indicate that the core aspects of the working environment can be captured with an easy-to-use instrument that only comprises ten items. The instrument seems well suited for use in research and evaluation as it reliably measures four clinically meaningful subscales. The validity is demonstrated by the fact that Conflict was strongly negatively correlated with liking for staff, while Self Realization was fairly strongly positively correlated with liking for patients. Furthermore, three of the four WES subscales were significantly related to general satisfaction with the ward. It also makes sense that Nervousness was significantly related to a high percentage who intended to continue at the unit for less than 1 year. It seems that the WES-10 is able to capture the core dimensions of the working environment. The Workload and Conflict subscales frequently appear in other stud-

* Correlation is significant at the 0.05 level (2-tailed)

579

ies and the importance of measuring these two dimensions of the work environment is widely described [2, 25, 27]. The Self Realization subscale measures the same aspect of the work environment as the Professional growth, Personal growth, Support and Achievement value and growth dimensions of other studies [21, 26, 31]. The Nervousness subscale, measuring how nervous or tense the staff members feel at the psychiatric ward, seems to appear less frequently in other studies. It obviously measures an important dimension and is probably strongly correlated with several issues of safety and insecurity, which, in some studies, have proved to be important factors of the work environment [28]. By only including ten items in the WES-10, some of the previously reported dimensions (e. g. salary, management issues, safety issues, and home-work conflicts) are not captured by this instrument. It could be argued that a suitable instrument should include more items, thus making the measurement of more aspects of the working environment possible. However, the main aim of this study was not to develop an instrument that was able to capture all possible aspects of the work environment, but to examine and evaluate a short and easy-touse instrument that captures the core dimensions. The short format, evaluated in this study, leaves an opportunity to use other instruments that capture other aspects of inpatient treatment without overloading the staff members. Three of the four subscales captured in this study comprised only two items. By aggregating the data on ward level, it was still possible to achieve acceptable reliability. To achieve reliable results on an individual level would probably have needed a much more extensive instrument comprising more items. However, as also supported by the findings of Melchior et al. [32], a consensual perception of the working environment provides enough information to capture in what way most of the psychiatric staff members perceive the work environment. This can be achieved by using a short, easy-to-use instrument.In this cross-sectional study,we did not conduct any analyses on the test/retest reliability of the WES-10. This important subject needs to be examined in other studies with the WES-10. This study clearly indicates that the working environment is strongly related to staff satisfaction. To what extent the work environment, as perceived by staff, is related to inpatient satisfaction and outcome is still unclear [23, 33, 34]. To our knowledge only two studies [35, 36] have examined the relationship between the psychosocial ward climate and the working environment. No clear conclusion could be drawn from the two studies. The WES-10 seems well worth using in future studies of this topic.

Appendix 1
The Working Environment Scale 10 (WES-10) [Friis, 1981] Please mark the answer you think best describes what you feel. 1. Does what you do on the ward give you a chance to see how good your abilities really are? Not at all To a small To some To a large To a very extent extent extent large extent 2. Does what you do on the ward help you to have more confidence in yourself? Not at all To a small To some To a large To a very extent extent extent large extent 3. To what extent do you feel nervous or tense on this ward? Not at all To a small To some To a large To a very extent extent extent large extent 4. How often does it happen that you are worried about going to work? Very often Often Occasionally Rarely Never 5. To what extent do you feel that you get the support you need, when you are faced with difficult treatment problems? Very often Often Occasionally Rarely Never 6. To what extent do you find that you can use yourself, your knowledge and experience in the work here on this ward? Not at all To a small To some To a large To a very extent extent extent large extent 7. To what extent do you find that the patient treatment is complicated by conflicts among the staff members? Not at all To a small To some To a large To a very extent extent extent large extent 8. To what extent do you find that it can be difficult to reconcile loyalty towards your team with loyalty towards your own profession? Not at all To a small To some To a large To a very extent extent extent large extent 9. What do you think about the number of tasks imposed on you? Far too few Too few Sufficient Too many Far too many 10. How often does it happen that you have a feeling that you should have been on several places at the same time? Very often Often Occasionally Rarely Never

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