2022 年 4 巻 1 号 論文ID: 2021-0012-OA
Objectives: This study aims to clarify whether work engagement mediates the relationship between job resources (i.e., supervisor support, coworker support, and job control) and work-to-family positive spillover (WFPS) for home-visiting nursing staff. Methods: This cross-sectional study surveyed 15 male and 152 female participating home-visit nursing staff across 108 home-visit nursing stations in Fukuoka Prefecture, Japan. In February 2019, each participant provided informed consent and sociodemographic information, and answered three scales, including the short-form version of the Utrecht Work Engagement Scale in Japanese, the Japanese version of the Survey Work-Home Interaction – Nijmegen (J-SWING), and the Job Content Questionnaire (JCQ-22). We evaluated supervisor support, coworker support, and job control as job resources using the JCQ-22’s subscale. We then evaluated WFPS using the J-SWING’s subscale. The hypothesized model was then tested using structural equation modeling. Results: Job resources were positively related to work engagement among the home-visit nursing staff; in turn, work engagement was positively related to WFPS. Job resources had no significant relationship with WFPS. These results suggest that work engagement mediates the relationship between job resources and WFPS. Conclusions: This study found that job resources were not directly related to WFPS for home-visit nursing staff. However, work engagement mediated the relationship between job resources and WFPS.
The turnover rate of home-visiting nurses (19.1% in 20171)) is the highest among various types of nursing staff (the turnover rate of hospital nurses in 2019 was 10.7%2)). It is suggested that “low job satisfaction,” “working for a hospital affiliated home-visit nursing agency,” and “small allocation of service users per nurse” were related to the turnover factor of visiting nursing staff3). In Japan, the average age of home-visit nursing staff is 47.0 years, and 98.5% are women4). Various types of nursing staff in their 40s often leave their jobs due to life events, such as marriage, pregnancy/childbirth, and child-rearing5). Therefore, home-visiting nursing staff turnover is likely associated with their overall work-life balance6). It is suggested that the turnover rate can be reduced by allowing home-visit nursing staff to fulfill their roles at home (e.g., caregiving and childcare)7).
Work engagement is a positive psychological state that is related to peoples’ work commitment, characterized by their vigor, dedication, and absorption8). Employees with a high degree of work engagement often have a healthier work-life balance9). The work-life balance of various kinds of employees is associated with their overall work engagement10). Some nursing studies have shown that work engagement is also associated with employee outcomes, such as turnover rate11), job satisfaction12), work productivity13), burnout14), and mental health15). Further, job resources (e.g., job control, supervisor and coworker support) contribute to providing engagement among hospital nurses16,17). A previous study on work engagement for home-visit nursing staff showed that supervisors’ support may increase work engagement18,19).
Work-family spillover, which includes work-life balance, refers to any event or situation arising in one’s role in either their “job domain” or their “family domain” wherein one of these areas affects the circumstances of a person’s role(s) in the other20). Work-family spillover has both positive and negative dimensions. Negative spillover evolved from the deficiency hypothesis21), and positive spillover evolved from the role expansionist theory22). Previous studies among home-visit nursing staff suggest that work-related negative factors, such as job demand, may have increased psychological distress via work-to-family negative spillover (WFNS) and family-to-work negative spillover (FWNS)23). Previous studies among nurses have shown that job resources were positively associated with work-to-family positive spillover (WFPS) (i.e., work-to-family enrichment)24). WFPS refers to cases wherein the impact from one’s workplace on one’s family life is positive20). Especially in home-visit nursing, since the enrichment of staff’s family life is related to the reduction of turnover7), it is important to think of an approach that enhances positive factors related to work and increases WFPS.
An overview of previous studies suggests that both work engagement and WFPS are affected by job resources. Bakker and Demerouti suggest that work engagement mediates the relationship between job resources and employees’ work-life balance theoretically20). In addition, work engagement increased life satisfaction through WFPS (i.e., work-family facilitation)25). A study of home-visiting nurses suggested that work schedules that fit with home-visit nurses’ private lives increased their work engagement26). Therefore, the hypothesis that work engagement mediates the relationship between job resources and WFPS is conceivable. However, no study has revealed the relationship between job resources, work engagement, and WFPS among nurses and home visit-nursing staff. This study aimed to assess whether work engagement mediates the relationship between job resources and WFPS among Japanese home-visit nursing staff. In this regard, Figure 1 provides a framework using part of the spillover-crossover model. This hypothetical model includes the hypothetical construct containing two pathways, as shown below with WFPS as an outcome:
Hypotheses 1: Job resources have a positive relationship with WFPS.
Hypotheses 2: Job resources have a positive relationship with WFPS through work engagement.
Hypothesized conceptual framework; relationship between job resources, work-to-family positive spillover, and work engagement. Note: Solid lines show positive relationships
This cross-sectional study surveyed 1,022 nursing staff from 108 of the 181 total home-visit nursing stations in Fukuoka Prefecture, Japan, via standard mail. Before the survey, we called the administrator of the home-visit nursing station and obtained permission to conduct this study. In February 2019, documents explaining the aim and methods of this study, along with a consent form and self-administered questionnaires, were mailed to 108 home-visit nursing stations within the prefecture. The respective administrators then distributed the questionnaires to respondents, who were asked to use the enclosed reply envelopes to return their responses directly to the researchers.
Measurement tools Work engagementWork engagement was assessed using the short version of the Utrecht Work Engagement Scale (UWES)8), which has previously been validated for use in Japan27). The UWES contains three subscales that reflect the underlying dimensions of engagement, including vigor (three items), dedication (three items), and absorption (three items). In this study, all items were scored on a 7-point Likert scale (0=“never”; 6=“always”). Scores for each of the three subscales were then totaled to produce a final score. The Cronbach’s α coefficients were 0.91, 0.82, and 0.86 for vigor, dedication, and absorption, respectively.
Work and family spillover effectsWFPS was measured using five items from the Japanese version of the Survey Work-Home Interaction – Nijmegen (J-SWING)28). The J-SWING contains four subscales, including WFNS, FWNS, WFPS, and family-to-work positive spillover (FWPS). This study only used the WFPS (five items). Each item was scored using a 4-point Likert scale (0=“never”; 3=“always”). Item scores were then added to produce a total score, with higher scores indicating greater WFPS. The J-SWING has previously been verified for both reliability and validity28). In this study, the WFPS item received a Cronbach’s α of 0.77.
Job control, supervisor support, and coworker supportThe Japanese version of the Job Content Questionnaire (JCQ-22) was used to measure job control (nine items), supervisor support (four items), and coworker support (four items). All items were rated using a 4-point scale (1=“strongly disagree”; 4=“strongly agree”). The Japanese version of the JCQ-22 was previously verified for both reliability and validity29). In this study, the questionnaire received Cronbach’s α scores of 0.58, 0.90, and 0.84 for job control, supervisor support, and coworker support, respectively.
Sociodemographic factorsRespondents also provided their sociodemographic information, including sex, age, occupation (i.e., nurse, associate nurse, public health nurse, nursing-care specialist, physiotherapist, occupational therapist, speech therapist, clerical staff, nursing assistant, or mental health worker), employment status (full-time or part-time), marital status (married or unmarried), and household members.
Statistical analysisOur data were analyzed using structural equation modeling (SEM) techniques with the AMOS software package version 23 (IBM Corp., Armonk, NY, USA). To test our hypotheses, we examined whether individual paths, as well as indirect relationships, were significant. The following statistical analyses were performed to construct a model that served as the basis of a subsequent covariance structure analysis. Correlation coefficients were calculated between the following variables (Pearson’s product-moment correlation coefficient):
a. UWES subscale scores (vigor, dedication, and absorption)
b. WFPS item scores
c. JCQ-22 subscale scores (job control, supervisor support, and coworker support)
We created a basic hypothetical model based on the analysis results. Job resources (job control, supervisor support, and coworker support) influenced WFPS and work engagement, while work engagement mediated the relationship between job resources and WFPS (see Figure 1). The SEM was then performed. The maximum likelihood method was used for the parameter estimate.
We fixed the variance of job resources of exogenous latent variables to 1. Further, one of the paths to the observed variables of the endogenous latent variables WFPS and work engagement was fixed at 1. Next to the chi-square (χ2) statistic, we inspected the goodness of fit index (GFI) and the root mean square error of approximation (RMSEA). In addition, three fit indices that are less sensitive to sample size were used: the comparative fit index (CFI), the incremental fit index (IFI), and the Tucker-Lewis index (TLI). For each of these statistics, values of 0.90 are regarded acceptable and of 0.95 or higher are indicative of good fit30), except for the RMSEA, for which values of 0.05 indicate good fit and values up to 0.1 represent reasonable errors of approximation31). We excluded the three participants who were managers from the sensitivity analysis to ensure the accuracy of the results. The IBM SPSS statistics software for Windows (version 24; IBM Corp.) and Amos 23 software were used to conduct the statistical analyses.
Ethical considerationsThis study was approved by the Fukuoka University Medical Ethics Committee (approval number: 2018M079). All managers working at participating nursing stations permitted us to conduct this investigation. We also requested their administrators to assure respondents that participation was not compulsory. Finally, we considered that consent to participate was given by answering the survey and replying to the survey form.
Of the 1,022 total home-visit nursing staff recruited for participation, 245 returned responses (collection rate, 23.9%). Of those, 167 complete responses were used in the analysis (15 males [9.0%] and 152 females [91%]; average age, 45.7 [standard deviation {SD},8.0] years). With respect to occupation, 146 were nurses (87.4%), while 21 reported other titles of employment (12.6%). As for marital status, 126 were married (75.4%), while 41 were unmarried (24.6%). Finally, the average number of persons per household was 3.4 (SD, 1.4).
| n (%) or mean (SD) | ||
|---|---|---|
| Sex | Male | 15 ( 9.0) |
| Female | 152 (91.0) | |
| Age, years | 45.7 ( 8.0) | |
| Occupation | Nurse | 146 (87.4) |
| Other | 21 (12.6) | |
| Employment status | Full-time | 116 (69.4) |
| Part-time | 51 (30.6) | |
| Marital status | Married | 126 (75.4) |
| Unmarried | 41(24.6) | |
| Number of household members | 3.4 ( 1.4) |
Table 2 shows the average values for each scale score, correlations between scales, and respective Cronbach’s α values.
| mean | SD | 1 | 2 | 3 | 4 | 5 | 6 | Cronbach’s α | |
|---|---|---|---|---|---|---|---|---|---|
| 1. Vigor | 9.0 | 4.0 | 0.91 | ||||||
| 2. Dedication | 10.9 | 3.5 | 0.842** | 0.82 | |||||
| 3. Absorption | 8.3 | 3.7 | 0.767** | 0.790** | 0.86 | ||||
| 4. Work-to-family positive spillover (WFPS) | 6.2 | 2.9 | 0.395** | 0.379** | 0.338** | 0.77 | |||
| 5. Job control | 69.1 | 7.5 | 0.337** | 0.341** | 0.395** | 0.291** | 0.58 | ||
| 6. Supervisor support | 11.7 | 2.3 | 0.313** | 0.379** | 0.295** | 0.250** | 0.278** | 0.90 | |
| 7. Coworker support | 12.5 | 1.8 | 0.363** | 0.342** | 0.268** | 0.203** | 0.225** | 0.462** | 0.84 |
WFPS (r=0.395), coworker support (r=0.363), job control (r=0.337), and supervisor support (r=0.313) showed moderate correlation with vigor; while WFPS (r=0.379), supervisor support (r=0.379), coworker support (r=0.342), and job control (r=0.341) showed moderate correlation with dedication; both job control (r=0.395) and WFPS (r=0.338) showed moderate correlation with absorption.
Relationship between job resources, WFPS, and work engagementModel 1 did not meet some criteria (GFI, AGFI, and TLI) of goodness of fit, but was found to generally pass the goodness of fit test. The goodness-of-fit values for the model are: χ2 (41)=99.510, p<0.001, GFI =0.897, AGFI=0.834, CFI =0.924, IFI=0.925, TLI=0.897, and RMSEA=0.093.
Model 1
According to Model 1, job resources had a significant and direct effect on work engagement (β=0.62, p<0.001). The direct pathway from work engagement to WFPS (β=0.29, p=0.033) was also significant. However, the direct pathway from job resources to WFPS was not significant (β=0.24, p=0.109).
These results suggest that work engagement mediates job resources (i.e., supervisor support, coworker support, and job control) while positively impacting WFPS. Among the job resource variables affecting work engagement, supervisor support was the strongest overall (β=0.66, p<0.001).
Sensitivity analysisParticipants included three managers who were excluded from the SEM analysis (n=164); however, those results were similar to the analysis that included all participants. The goodness-of-fit values for the model were χ2 (41)=96.777, p<0.001, GFI=0.897, AGFI=0.835, CFI=0.927, IFI=0.928, TLI=0.902, and RMSEA=0.091.
This study analyzed the relationships among job resources, work engagement, and WFPS for home-visit nursing staff, specifically through two routes that were proposed based on part of the spillover-crossover model. The first assumed that job resources (i.e., supervisor support, coworker support, and job control) were positively related to work engagement and WFPS, while the second assumed that work engagement mediated the relationship between job resources and WFPS. The analysis results by SEM were as follows. While this study hypothesized that job resources was directly related to WFPS, only a non-significant relationship was found. Moreover, job resources were positively associated with work engagement, specifically, with WFPS. Results ultimately showed that job resources completely mediated work engagement and were positively related to WFPS. In previous studies, job control was associated with WFPS32), but this study could not clarify the association due to the low Cronbach’s α for job control.
Work engagement refers to a positive psychological state in the job context but does not reflect any factors related to family life. On the other hand, WFPS refers to a fulfilling family life that is influenced by positive job-related factors. In this study, work engagement was positively associated with job resources, so it appeared to have a positive relationship with family life. This supports previous studies showing a positive relationship between work engagement and work-life balance (i.e., WFPS and work-to-family facilitation)10,20). Further, while previous research has clarified the relationship between job resources and WFPS28), this study expanded on the literature by finding that work engagement mediated the relationship between job resources and WFPS.
Absorption is a work engagement factor that refers to a state of “concentration and immersion in work”8). In this regard, some researchers have pointed out that absorption shares attributes with the condition known as workaholism33). Contrarily, workaholics are compulsively engaged in their work, while absorption merely describes an attraction to work. Although the concepts are associated with different approaches, previous research has suggested that absorption and workaholism are similar in that affected individuals have difficulty disengaging from work34). However, it should be noted that workaholics often experience increased amounts of work-to-family conflict and adverse psychological stress responses35). The positive relationship between work engagement and WFPS found in this study may suggest further differences between the concepts of workaholism and absorption.
We also found that job resources were an important factor for enhancing both work engagement and WFPS. Especially among job resources, it appears that supervisors can positively influence home-visit nursing staff by ensuring support, which has positive effects on work-life balance through the mediator of work engagement. Supervisor support is important for improving the work-life balance of home-visit nursing staff and may help to prevent turnover.
This study had some limitations. First, all participants were recruited from Fukuoka Prefecture; regionality may have affected the results. The environment surrounding home-visit nursing (e.g., the number of home-visit nursing staff and the number of home-visit nursing users) may differ depending on the region. In addition, the response rate was low, thereby limiting generalizability. Second, the relatively small sample size prevented us from adjusting for certain attributes (e.g., sex, employment status, marital status) during analysis. Further, since the job control Cronbach’s α was low, it may be necessary to verify the cross-validity for similar participants in the future. The goodness of fit of the path diagram may be improved by increasing the reliability of the job control scale. Moreover, for a large part of our model, we used a cross-sectional design that precludes causal inferences. We need to carry out a longitudinal study using the model obtained in this study. In addition, since the hypothesis of this study used a part of the spillover-crossover model, other aspects of this model could not be assessed. Future research should conduct random sampling at home-visit nursing stations throughout Japan. Longitudinal research is also needed to identify causal relationships between the variables. In this study, we also did not investigate the data and factors related to turnover intention. Therefore, it would be interesting for future research to include WFPS outcomes, such as turnover intentions.
Practical implicationsAccording to a statistic shared in the 2018 Health Administration Report, home-visit nurses in Japan account for 4.2% of all nurses36). By age group, more than 90% of nurses in their 20s work in hospitals; however, as nurses’ ages increase from the 30s to the 40s, the percentage of those working at home-visit nursing stations also tends to increase (according to the 2012 Health Administration Report)37). Thus, most of the home-visit nursing staff are women in their 40s38). Women in their 40s often have many roles in the home, such as providing both childcare and caregiving. Nursing staff in their 40s may have changed their workplaces to allow them to fulfill their roles at home as well as at work. Therefore, home-visit nursing staff might have more flexibility in meeting their work and family needs compared to hospital nurses39), and supervisor support is one of the most important job resources for accommodating home-visit nursing staff, so they can meet both work and family needs. Namely, supervisor support in the home-visit nursing workplace is a starting point for a positive approach to managing work and family life. Furthermore, our results suggest that increasing work engagement may increase WFPS. Therefore, it is necessary to not only enrich job resources, but also pay attention to interventions that enhance work engagement, for example, “Civility, Respect, and Engagement in the Workplace” programs40) and job crafting intervention programs41), as interventions that increase work engagement may increase WFPS. The findings of this study may apply not only to home-visit nursing staff, but also to workers with diverse roles at home.
This study found that job resources (i.e., supervisor support, coworker support, and job control) were not directly related to WFPS for home-visit nursing staff. However, work engagement mediated the relationship between job resources and WFPS.
This study was partly funded by the Research Promotion Department of Fukuoka University (issue no. 167110). We express our sincere gratitude to the representatives and staff members of all participating home-visit nursing stations for their cooperation.
None.
