Predictors of professional quality of life among nurses–A cross sectional study

A good practice environment is a vital aspect of the staffing and retention of health care workers, especially of nurses affecting patient care. This study investigates the predictors of nurses’ Professional Quality of Life working in public hospitals and private hospitals. A cross-sectional design was utilized, including 374 nurses conveniently sampling selected in two public hospitals and two private hospitals in the Philippines using a Practice Environment Scale of the Nursing Work Index and Professional Quality of Life scale having a good psychometric property, respectively. The overall mean score for practice environment for Nurses is at a low level, whereas the mean Professional Quality of Life score was at a moderate level. Age is significantly associated with the burnout subscale (r=-0.119, p<0.021) and with secondary traumatic stress (r=-0.193, p<0.001). Monthly salary is significantly associated with the compassion satisfaction subscale (r=-0.140, p=0.007) and STS (r=0.107, p=0.038). Meanwhile, the working hours' figure is significantly associated with compassion satisfaction subscale (r=-0.133, p=0.010). Finally, the practice environment of nurses shown is significantly associated with compassion satisfaction subscale (r=-0.426, p=0.007) and secondary traumatic stress (r=0.524, p<0.001). Filipino nurses have a lower practice environment and moderate professional quality of life. The predictors of the professional quality of life of nurses were age, monthly salary, working hours, and their practice environment. Specifically, the higher the salary and the shorter the working hours, the better their professional quality of life. Additionally, the poorer the practice environment, the lower the professional quality of life.


Introduction
*In recent years, progressive improvement of the quality of the practice environment (PE) has played an integral part in ensuring both patient safety and the well-being of health care professionals (Lambrou et al., 2014). A positive PE is a vital aspect of the staffing and retention of health care workers, especially of nurses; it affects the quality of patient care (Lambrou et al., 2014). The PE in which nurses carry out their tasks and duties, collaborating with other health care workers in caring for patients, is called the professional PE (Lake, 2002). A positive PE is important for nurses and nursing administrators as it enables them to apply correct quality assessment (Lambrou et al., 2014). According to the ANCC (2008), a good PE involves "working with other competent nurses, good nurse-physician relationships, nurse autonomy and accountability, supportive nurse managers and supervisors, control over nursing practice and work environment, support for education, research and evidence-based practice, adequate nurse staffing and high-quality patient care (ANCC, 2008). Furthermore, there is rising evidence showing a favorable PE leading to positive work satisfaction, lower burnout, and stress level.
Similarly, instituting positive PE in the clinical setting is of vital importance for ProQOL. Another study reported that nurses' perceptions of their PE are influenced their Professional Quality of Life (ProQOL), defined as satisfaction felt by nurses related to their profession (Stamm, 2010). If nurses are satisfied with their profession, they can provide a positive, safe working environment. Thus, optimal service towards clients' needs could be achieved. Hence, a safe PE optimal nursing care gives nurses ProQOL positively. According to Stamm (2010), ProQOL offers health care professionals stability between compassion satisfaction (the optimistic job role aspects) and compassion fatigue (the negative aspects, subdivided into burnout and secondary traumatic stress). ProQOL is important for both the carers and the recipients of care (Alshehry et al., 2019). Negative ProQOL among nurses induces negative attributes in the way patients are handled (Stamm, 2010). For example, if there is poor PE of nurses, nursing care is not optimal, nurses fail to recognize secondary traumatic stress symptoms, thus compromising nurse's ProQOL and quality of patient care (Alshehry et al., 2019). In the study of Lambrou et al. (2014), a positive PE can accomplish workers' individual needs by offering optimistic communication within physical and mental wellbeing. When the worker's needs were not met, they might experience work stress and burnout, which negatively affects the worker's job performance. Unhealthy PE for nurses can create "stressed, fatigued, unable to use their critical thinking skills," allowed for higher incidences of errors, failures, and injuries lead to their inability to protect their patients, which significantly affects their quality of work life.
Aside from PE, some demographic factors also affecting nurses ProQOL were also reported worldwide. For instance, one study in Korea found that nurses' ProQOL has shown that affecting nursing performance increase together with longer work experience, older nurses, a postgraduate education level (Han and Park, 2013). One study in Spain reported that nurses are at risk for negative ProQOL because of excessive workload and working environment (Gascon et al., 2013).
In another study, Latvian nurses reported that age, gender, length of service in occupation affect nurses' ProQOL (Circenis et al., 2013). A study among Korean nurses found that marital status, educational attainment, age, work experience, work position were influential factors of ProQOL . Therefore, positive reinforcement of the above-mentioned variables is needed to improve nurses' ProQOL.
The Philippines, like many other countries, faces challenges to the quality of PE; this affects ProQOL adversely among health care professionals, especially among nurses. Because of these challenges, the country has reformed its health service delivery and health regulation.
These reforms were mostly to address the healthcare system's deprived availability, inequity, and ineffectiveness (Romualdez, 2011). The country's health healthcare system is composed mainly of public hospitals and private hospitals. Private hospitals are the more expensive option tend to have better quality in health service because of the much better equipped and complete technology facilities.
Since of the expensive cost of private healthcare, the people who have low or no income address their health needs in public hospitals, which are free of the hospital. Despite low health costs in public hospitals, it is a challenge for patients to receive necessary care because of less bed capacity, a high inflow of patients, a lack of nurse staffing. Above this, it resulted in poor PEs among nurses, which they are subjected to stress and may not be able to provide safe care. According to Dones et al. (2016), in addition, The Filipino Healthcare System is "fragmented," meaning that it has limited availability of basic health care so that the provision of patient treatment is also limited (Romualdez, 2011). It is, therefore, very likely that poor PE would affect nurses' ProQOL.
In modern health care development environments, the need for positive PE among nurses should be continually promoted, but nurses are most likely to experience a lower ProQOL, which can influence their PE negatively (Alshehry et al., 2019). While the nursing practice environment has been the focus of several studies, it has not been defined explicitly in the context of ProQOL (Velasco-Ferrer and Conde, 2015), and there has been no detailed investigation of the influence of PE on Filipino nurses and their ProQOL. Nurses with poor PEs at risk of burnout and secondary traumatic stress, which are components of ProQOL, causing diminished work productivity, decreased health wellbeing, and turn to higher turnover (Velasco-Ferrer and Conde, 2015). Meanwhile, improved PE is connected with reduced hospital mortality, a positive working environment promoting nurses' satisfaction, and better ProQOL (Tamayo et al., 2016). The Philippines is a major source of nurses employed overseas (Acevedo-Garcia and Almeida, 2012; Cheng, 2009), so it is important to know how Filipino nurses' PE affects their ProQOL. An examination of nurses' views of their PE and ProQOL will help to identify issues and problems and to propose ways to overcome them. Clarifying these associations could contribute valuable insight information for nursing administration in addressing the issue of ProQOL among nurses.
The aim of this study is to describe a nurse's perception of their practice environment and their professional quality of life. Additionally, it determines whether a nurse's practice environment and demographic variables predict the professional quality of life. The research questions are as follows: 1. What is the nurse's perception of their practice environment and their professional quality of life? 2. Is there an association between the nurse's practice environment and demographic characteristics towards their professional quality of life?
The hypothesis of this research are as follows: 1. Nurses' demographic characteristics positively affect their ProQOL. 2. Nurse's practice environment positively affects their ProQOL.

Study design
The study used a cross-sectional design in order to determine whether the nurse's PE and its demographic variables influence ProQOL.

Sampling and data collection
The researchers collected from all nurses working from the four tertiary hospitals in Northern Philippines that were conveniently selected. These hospitals are all tertiary, and each has a bed capacity for 300 to 400 patients. These tertiary hospitals provide a full complement of services such as obstetrics, gynecology, pediatrics, surgery, general medicine, and psychiatry, with all the medical specialties and medico-surgical services represented.
To be included, a nurse had to: (1) be licensed, (2) have hospital experience at least six months, (3) working in public and private hospitals, and (4) consent to partake in the study. A total of 543 nurses working in working in public and private hospitals were invited to participate; 374 surveys were received completely (response rate=68.87%). This study was directed after receiving approval from the Ethics Review Committee of each health care institution (ERCHRB-2019-165). Next, the survey sent to each department was approved by each department's manager. Informed consent was implied by participation in the survey. Each survey also included a cover letter explaining the study purpose, the right to refuse to participate, and that participation implies consent. The confidentiality of the participants was protected by no identification of participants in the survey forms. The surveys were then distributed to each nursing staff member, along with a detailed cover letter. A blank manila envelope was left in the room for survey collection, and the researcher left the room while participants were filling out the surveys. Upon completion of the surveys, a selected member at the meeting would present the sealed manila envelope to the researcher. Survey collection started in September 2019 -December 2019.

Questionnaire
The self-administered questionnaire used to gather data from the respondents was made up of three sections:  Demographic profile: This section contains the respondent's age, gender, marital status, the highest level of educational achievement, years of experience as a registered nurse, current hospital, monthly salary, hours worked per week, and hospital type.  The practice environment scale of the nursing work index (PES-NWI): This 31-item scale examines the workplace organizational characteristics using a 4-point Likert scale (1=strongly disagree; 4=strongly agree) (Lake, 2002). The researcher sought permission for the authors to use the survey tool and obtained approval via email. The scale constitutes measures five domains "collegial nurse-doctor relationships; nurse manager ability, leadership, and support of nurses; nursing foundations for quality of care; nurse participation in hospital affairs; and staffing and resource adequacy." The mean score was calculated from the item score, with a higher score indicating a perceived higher-quality practice environment (Lake, 2002). Specifically, domain scores at or above the midpoint of 2.5 indicate that domain as "favorable" or "positive" (Lake, 2002). The tool has displayed good have demonstrated excellent reliability and validity in hospitals worldwide such as Australia (Roche and Duffield, 2010), Cyprus (Efstathiou et al., 2018), Japan (Anzai et al., 2014), and Portugal (Ferreira and Martins, 2014). Each of the tool subscales satisfactory internal consistency (Ogata et al., 2018). In this study, Cronbach's alpha was 0.81.  Professional Quality of Life (ProQOL): This tool assesses the feelings (positive and negative effects) of dealing with people experiencing tremendously traumatic events (Stamm, 2010). This tool is openly available for non-commercial and research purposes. The tool is composed of three different 10-item subscales (Compassion Satisfaction (CS) and Compassion fatigue (CF) composed of two subscales: Burnout (BO) and Secondary Traumatic Stress (STS). Items are rated on a 5-point scale (1=never to 5=very often). A summation of all scale items was used. For example, CS=summation items (3,6,12,16,18,20,22,24,27,30). BO=summation items (1,4,8,10,15,17,19,21,26,29). STS= summation items= (2,5,7,9,11,13,14,23,25,28 (Stamm, 2010). This scale has a good psychometric property and used internationally such as Australia (Heritage et al., 2018), Canada (Geoffrion et al., 2019), translated into several languages, such as Spanish version and Portuguese versions (Galiana et al., 2017), Iranian version (Hassan et al., 2019), and Hebrew version (Samson et al., 2016). In this study, the tool is remarkably reliable (CS subscale, a=0.81; BS subscale, a=0.73; STS subscales, a=0.76).

Data analysis
The data were analyzed with SPSS version 25.0 software (SPSS Inc., Chicago, IL, USA). Descriptive statistics (i.e., mean, standard deviation, frequency, and percentage) were used to analyze the demographic characteristics. To identify the association between nurse demographic characteristics and PE toward perceived ProQOL, an independent sample t-test, a one-way analysis of variance with posthoc Tukey HSD test, and a Pearson's product-moment correlation were conducted. All measures at interval or ratio level were normal distribution. A multivariate multiple regression analysis was conducted to analyze the multivariate effect of demographic and work-related characteristics and of PE toward perceived ProQOL. Multiple regression analyses were conducted to assess the relationship between the demographic and work-related characteristics and PE to their perceived ProQOL. A p-value of <0.05 was considered significant.  The perceived PE of nurses is reflected in Table 2. The subscale PE was rank based on their respective mean; the highest mean score was rated as rank 1. The subscale "Staffing and Resource Adequacy (SRA)" was rated as rank 1 (M=2.14, SD=0.60), next subscale "Nurse Participation in Hospital Affairs (NPHA)" was rated as rank 2 (M=1.99, SD=0.43), then subscale "Nursing Foundation for Quality Care (NFQC)" was rated as rank 3 (M=1.94, SD=0.41), while subscale "Nurse Manager Ability, Leadership, and Support of Nurses (NMALSN)" was rated as rank 34 (M=1.89, SD=0.45). Lastly, the subscale "Collegial Nurse-Physician Relations (CNPR)" was rated as rank 5 (M=1.79, SD=0.47). The overall mean score for PE for Nurses is 1.93 (SD=0.41), which is interpreted as low PE. For ProQOL, the mean Compassion Satisfaction (CS) was 38.48 (SD=5.27), followed by Secondary Traumatic Stress (STS) (M=32.38, SD=7.50) and the Burnout (BO) subscale (M=27.05, SD=3.84). The overall mean ProQOL score was 32.63(M=4.66), which is interpreted as a moderate ProQOL (Table 3). The association between nurses' demographic characteristics and the PE toward ProQOL is shown in Table 4. The assumption test score of all measures at interval or ratio level were normal distribution.

Discussion
This study found that Filipino nurses perceive a low PE-the environments to which they are exposed are not always favorable to their practice. Their perceived PE is much lower than those found by studies in Japan (Ogata et al., 2018), Egypt (Mahran, 2017), and Europe (Leineweber et al., 2016), all of which used the same measuring tool. In the Philippines, unfavorable nursing PE has given rise to greater stress, fatigue, and inability to use critical thinking skills; it has engendered greater incidences of errors, failures, injuries, reported job dissatisfaction, and burnout at all job levels. According to Dones et al. (2016), lower PE may be due to inadequate professional development and inadequate numbers of competent staff. The Philippine health care environment faces significant challenges from the nation's geography, susceptibility to natural disasters, and hospital financing issues, all of which could lead to poor PE (Romualdez, 2011). Note. *p<.05 significance; **p<.000 significance This is congruent with the results of a previous study's findings that health care systems in developing countries are less likely than those in wealthier countries to receive effective health care PE (Hall et al., 2014). A positive PE ensures highquality patient care and improves nurses' work motivation, performance, and well-being, as well as fostering a higher employee retention rate (Hall et al., 2014).
Explicitly, the Staffing and Resource Adequacy (SRA) PE subscale was rated the highest in this study. The cause could be the trend to increase the numbers of nursing schools all over the Philippines; this has contributed to the overproduction of nursing graduates. About 100,000 Filipino nurses were unemployed in November 2008; this appeared likely to increase by almost 50% in under two years, implying that the supply of nurses would become greater than demand in the health care setting. This is worth noting since a lack of staff resources and equipment has a negative influence on patient care quality and the performance of nurses. A lack of nursing staff gives rise to a heavy workload, burnout, and job stress, all of which can hinder proper patient care management; they can also lead to increased risk of inpatient complications and complaints (Hall et al., 2014).
The "Collegial Nurse-Physician Relations" PE subscale was rated the lowest of all the subscales. Possible explanations for this include the care workers' hierarchical relationship and differences in health care workers' communication styles or educational backgrounds. These differences could lead to misunderstandings of the nurse-physician relations role, lack of collegiality, or discomfort in working within the nurse-physician relationship (Wang et al., 2018). Failure to overcome these problems could have serious consequences for patient care and staff retention. A descriptive study by Wang et al. (2018) showed that a poor nursephysician relationship inhibits teamwork, thus impacting patient care by affecting safety, efficiency, and accuracy. Leineweber et al. (2016) found that nurses who worked in environments with little or no collaboration had lower job satisfaction and greater intention to leave. Low nursing retention leads to the increased cost to the organization, as it has to recruit and train new nurses, as well as to a fractured team, again leading to impaired patient outcomes and decreased satisfaction for both patients and staff (Leineweber et al., 2016). A lack of understanding of the nurse-physician relationship can also be a deterrent to the pursuit of advanced practice nursing. By embracing collaboration, long-term conflict resolutions can be achieved, and beneficial interpersonal relationships fostered (Wang et al., 2018).
Another important finding was that Filipino nurses perceived higher compassion satisfaction and lower burnout and secondary traumatic stress level. This finding broadly supports the one study conducted among 86 Australian nurses who work in the emergency unit and suggests that a higher prevalence of compassion satisfaction and greater ability to take care of those who suffer (O'Callaghan et al., 2020). Similar findings were also reported in another study conducted in Australia working in an ICU unit (O'Callaghan et al., 2020). It is consistently reported from empirical data nurses experiencing high compassion satisfaction levels have lower BO and STS scores (Stamm, 2010). On the other hand, if nurses reported higher burnout and secondary traumatic stress scores, then lower compassion satisfaction scores will be noted, leading to higher depression, anxiety levels (Duarte, 2017).
Overall, Filipino nurses perceived a higher moderate ProQOL. This finding is affirming to those in earlier findings in Portugal (Duarte, 2017), Latvia (Circenis et al., 2013), and South Africa (Wentzel and Brysiewicz, 2018), but slightly lower than that of one study in Korea . These variances could be credited to cultural and health care differences between the Philippines and other countries. According to the World Health Organization (WHO, 2007), the Filipino Healthcare System is "fragmented." This implies that basic medical care is unavailable in the entire country, as limited hospital number, inadequate treatments, and are insufficiently accessible for patients. In addition, as nurses constantly witness the suffering and pain of the patients, this supports the idea that nurses may be at particular risk of developing compassion fatigue. Thus, nurses may need to regulate their capability to sympathize with their patients so that their compassion does not impact their wellbeing.
This study revealed that the perceived ProQOL of nurses varies significantly according to age, monthly salary, working hours (per week), and PE. Age is significantly associated and is a predictor of ProQOL. Specifically, the result indicated that the older the nurses, the lower the BO and STS. This is worth noting since younger employees might be new to the organizational environment, labor policies, interpersonal support, and even leadership and management in the workplace. It is also possible that younger employees are still learning to fit into their PE and adjusting (Geoffrion et al., 2019). It is also probable they might experience harsh working conditions and lesser autonomy compared to older employees (Galiana et al., 2017). In other studies, it was pointed out that older employees have higher social support from colleagues, greater control over one's job, and feedback than younger employees (Hsu, 2019). The study of Arteche et al. (2019) noted that when people grow older, they experience greater selfefficacy and have positive coping strategies experience which can help even in high-stress and burnout situations. This implies that working with older nurses and supervising them to the younger nurses would help maintain work engagement and lower stress and burnout. Nevertheless, the reasons for the differences between the younger and older nurses regarding the ProQOL was not extensively included in the study. Exploration about experiences of nurses regarding their ProQOl using qualitative study warrants further attention.
Overall, this finding reported a moderate ProQol among nurses. Similar results were found in earlier studies in Korea , Spain, and Brazil (Galiana et al., 2017). At an average (27.19±6.222) years of age, the Filipino nurses in the study were considered to be young adults; they had average CS and BO and STS. Nurses' ProQOL of life has an impact on patients' health (Stamm, 2010). The analyses of Duarte (2017) suggested that nurses are at risk of experiencing compassion fatigue but do not struggle with it and do not show as tough workers. According to Almazan et al. (2019), nursing is professed as a laborious, complicated, and very demanding profession; and there are many other responsibilities that could have negative consequences for nurses' ProQOL.
Monthly salary is significantly connected with the CS subscale and with STS; it is a significant predictor of ProQOL. The result is similar to those of previous researches by Heritage et al. (2018) and Galiana et al. (2017). However, the result differs from Bloomquist et al. (2015). This might be caused by differences in the monthly salary schemes. Nevertheless, a higher monthly salary represents higher compassion satisfaction and job ability, making the nurse enjoy helping others. Bloomquist et al. (2015) suggested that higher salaries and responsibilities made employees consider themselves more successful and gave them better job satisfaction. It is certain that higher salaries tend to increase work performance so that higher pay often leads to greater work effort. In addition, higher monthly salaries make employees feel satisfied and fulfilled, with a greater chance to grow professionally.
The number of working hours is significantly associated with Compassion Satisfaction subscale and is a significant predictor of ProQOL. This result means that the longer nurses' working hours are, the poorer their ProQOL will be. Other empirical data support this finding . This study found the average working hours to be 44.33 hours, more than the 40 standard working hours of an average employee. According to Alamri and Almazan (2018), working more than 40 hours a week reduces productivity, leads to poor work performance, lowers work motivation, and creates a higher intention to leave. Almazan et al. (2019) reported that the risks or errors begin to increase when shift durations exceeded 40 hours. Working longer hours is also linked with poor mental health, increased anxiety levels, and depression (O'Callaghan et al., 2020). According to Villar (2017), overworked employees lose their productive ability and a higher chance to leave the current job workplace fulfillment. People working more than 40 hours per week are 60% experience more health problems than those working fewer than 40 hours (Villar, 2017). It is possible that working fewer than 40 hours also means fewer errors and less exhaustion amongst all levels of employees.
Finally, the PE Nursing Foundation for Quality Care (NFQC) subscale is significantly related, and a predictor of ProQOL. This might explain why a lower PE means a lower ProQOL. It is worth noting that a good PE ensures the safety of employees, can improve the emotions of staff, and aids them to enhance their mental and physical health, thereby increasing the sense of competence and job satisfaction (Lambrou et al., 2014). It also seems that an emphasis on the ability of nurses to make decisions and provision of facilities to improve their working conditions can improve their professional performance and increase job satisfaction, consequently increasing ProQOL (Duarte, 2017). However, a perception of the PE as stressful has a negative implication for nurses' ProQOL. This result is similar to empirical data showing that poor ProQOL is higher in hospitals with poor PEs, while hospitals with better and more favorable PEs have better ProQOL (Alshehry et al., 2019;Kim et al., 2015). PEs are venues that support work excellence, but a poor PE can result in higher intention to leave, lack of continuity of patient care, and poor ProQOL. A PE without its nurses' support to perform nursing care practice hinders good service delivery to patients (Choi et al., 2012). Nurses reported higher job satisfaction and higher ProQOL in hospitals with better PE (Dones et al., 2016).
The limitations of the study were collected in two public hospitals and two private hospitals in the Philippines. The study used self-reporting measurement by means of a questionnaire survey, resulting in desirability bias. Therefore, respondents should be selected within their full understanding about the study, adding an option "no" or "undecided" or "I don't know," which gives them a more honest response than trying to fit their response into somewhat that doesn't sit right. Also, the researcher wasn't able to distinguish between demographic variable association (e.g., private and public hospital.) to ProQOL. Hence this a recommendation for further studies.
The use of cross-sectional design also limits the study, which does not offer a thoughtful understanding of whether the PE and ProQOL prevalence changes over time. Long-term studies could be explored in order to identify the relationship between nurses' PE and the ProQOL on a follow-up basis. The majority of nurses work in a private hospital (15%) and a lower response rate, which also limits the generalization of results. In addition, only 4 hospitals were included in the study also limits the generalization of results. Therefore, a replication of such studies to other geographical areas in the country is warranted.

Conclusion
This study describes the nurse's perception of their practice environment and their professional quality of life. Additionally, it determines whether the nurse's practice environment predicts the professional quality of life. Filipino nurses have lower PE and moderate ProQOL. The ProQOL of nurses is associated with their age, monthly salary, working hours, and PE. Specifically, the higher the salary and the shorter the working hours, the better their ProQOL. In addition, the poorer the PE, the lower the ProQOL. The results provide precious visions and guidance for improving the PE of Filipino nurses as an important factor in influencing their ProQOL.

Implications for further research, policy, and practice
The study findings can be used to guide the creation of policies aimed at ensuring continuous PE development. These may include organizational initiatives such as shared goals, opportunities to learn, reward schemes, promotion in order to increase salary, and good relations between physicians and nurses. These factors all play a part in creating a healthy, staff-focused workplace. The development of strong, consistent teamwork, with such features as clear communication, respect, outlined responsibilities and process, and feedback meetings, will positively affect the team atmosphere and teamwork skills.
It is also suggested that increases in full-time employment and part-time employees' reduction could provide a consistent workplace environment, and the opportunity to familiarize with colleague skills and strengths, continuity of patient care. Also, investing time and resources in nurses' training to encourage an error-free culture within the workplace. Next, leadership behaviors can contribute to a more positive PE by creating a stable, supported by the whole organization. Strong, evident leadership promotes staff unity, which is significant to avoid conflict, which leads to burnout, and stress reduced the overall wellbeing of nurses.
It is also recommended to purchase useful technology as well as better facilities and equipment, enabling the provision of patient care that meets safety standards (Circenis et al., 2013). Higher wages, better benefit packages (bonuses and loyalty pay), and better career opportunities could be added for effective ProQOL improvement. Finally, a reduction in working time to eight hours a day will create more opportunities for nurses to realize their potential in all manner of activities, including some within the work sphere. Therefore, improvement of PE, working hours' balance, and higher salary could improve nurses' ProQOL Finally, future research regarding how to provide fair salary and job security affecting the ProQOL, and it may affect the performance of nurses, so that the management and the Human resources department must reconsider this issue. Examination of the impact of shorter working hours in relation to ProQOL could be warranted in the future their professional quality of life.

Conflict of interest
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.