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Soc Psychiatry Psychiatr Epidemiol (2004) 39 : 576–580 DOI 10.1007/s00127-004-0791-z

■ Abstract Background The working environment inmental health wards has been shown to have profound ef-fects on the health and work stability of mental healthworkers. Despite an apparent need for regular measure-ment of work environment,development of short and re-liable instruments for such measurements has beenlargely neglected. The aim of the present study was toevaluate the psychometric properties of the Working En-vironment Scale-10 (WES-10). Methods During the pe-riod 1990 through 2000, a total of 640 staff members on42 wards for psychotic patients completed the WES-10.To establish the number of subscales, a factor analysiswas carried out.The internal consistency of the subscaleswas calculated as Cronbach’s alpha.We also collected dataconcerning satisfaction with the ward, its patients andstaff, and for how long the respondents had worked andexpected to continue to work at the ward. Results Weidentified four subscales named: Self Realization,Work-load,Conflict and Nervousness.The psychometric prop-erties of the subscales proved to be acceptable. All thesubscales were significantly correlated with at least onesatisfaction item, and/or the time the staff expected tocontinue at the ward. Most notably, the Self Realizationsubscale was strongly correlated to general satisfactionwith the ward, and to the time the staff expected to workon the ward in the future,while Conflict was strongly neg-atively correlated with liking for staff. Conclusion TheWES-10 appears to measure four clinically meaningfulsubscales. It seems well suited for use in further researchand for evaluation of clinical milieus.

■ Key words work environment – psychometrics – staffmembers – satisfaction – questionnaires

ORIGINAL PAPER

J. I. Røssberg · Ø. Eiring · S. Friis

Work environment and job satisfactionA psychometric evaluation of the Working Environment Scale-10

Accepted: 18 February 2004

SPPE

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Introduction

An extensive literature has been generated about the mi-lieu in which health professionals work and the impactit has on both mental and physical health [1–5]. The po-tentially stressful nature of mental health work has beenamply demonstrated. Several studies have reported ahigh level of burnout and poor mental health amongpsychiatric staff members [6–11].A poor work environ-ment has proved to be associated with reduced job sat-isfaction, absenteeism, somatic complaints, burnout anddepression [12–17]. It has been reported how a poorwork environment might influence the work perfor-mance negatively [18], and promote negative and cyni-cal attitudes towards patients and colleagues [19]. Apoor work environment is probably one of the main rea-sons for the high staff turnover rate [1, 20, 21] and poorinpatient satisfaction and outcome [22, 23].

Against this background, there is an obvious need forregular studies of the work environment on psychiatricwards.As pointed out by Burnard et al. [24], the workingenvironment should be regularly measured, as one wayto measure service quality. Measures of the working en-vironment and job satisfaction may also be usefulbenchmarks for evaluating future changes and develop-ments in the psychiatric wards, and to monitor and im-prove the clinical working environment.

To regularly study the working environment,we needan instrument that is clinically meaningful, easy to useand with acceptable psychometric properties.To be clin-ically meaningful, the instrument has to measure thecentral dimensions. Reviewing the literature, it seemsthat previous studies have identified three core dimen-sions named: Workload (Work pressure, Task require-ments) [2, 21, 24–26], Personal growth (Professionalgrowth, Support, Achievement value and growth) [14,21, 26] and Conflict [2, 25, 27]. Some studies come upwith additional dimensions like safety, role clarity,salary, work hazards, home-work conflict, professionalstatus and organizational issues [7, 14, 21, 24, 25].

J. I. Røssberg, MD (�) · Ø. Eiring, MD · S. Friis, MD, PhDDept. of PsychiatryUllevaal University Hospital0407 Oslo, NorwayTel.: +47-22/118370Fax: +47-22/117848E-Mail: [email protected]

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Many of the original instruments seem to have beenso large and complex that they have been difficult to use.Consequently, many studies of the working environ-ment tend to have small and unrepresentative samplesof psychiatric staff members [8]. Admittedly, severalworking environment scales have been used in shortforms to facilitate ease of use or they have been changedto become more suitable for mental health workers [28],but, as indicated in a recent review, analysis of the psy-chometric properties of different instruments seemsmostly to be lacking [6].

To overcome many of the previous difficulties, wehave developed a short and user-friendly ten-itemworking environment scale. We collected data from alarge number of psychiatric staff members on 42 differ-ent psychiatric wards. The main aims of this study wereto evaluate the psychometric properties of the WorkingEnvironment Scale-10 (WES-10) on a ward level.We de-cided to examine whether the WES-10 measures clini-cally meaningful subscales worth using in future re-search and in a clinical context.Another objective was toexamine how these subscales were related to general jobsatisfaction and the staff member’s intention to leavetheir job. More specifically, we wanted to answer the fol-lowing questions:1. Does the factor structure of the WES-10 point to spe-

cific subscales?2. What are the internal consistencies’, mean scores,

standard deviations,and intercorrelations of the sub-scales?

3. What is the relationship between the WES-10 sub-scales and the staff members’ general satisfactionwith the psychiatric ward, liking for patients andstaff?

4. What is the relationship between the WES-10 sub-scale scores and how long the staff members haveworked at the psychiatric wards and how long theyintend to work at the wards?

Subjects and methods

During the period 1990 through 2000, a total of 640 staff members on42 wards for psychotic patients completed the WES-10. The WES-10is a self-report questionnaire and comprises the ten items displayedin Appendix 1. Three items (items 1, 2 and 3) were taken from the Per-sonal Development Scale developed by Moos [29]. The other sevenitems were developed by a clinical research group at Ullevaal Univer-sity Hospital (1981) with the intention to evaluate the restructuring ofan acute ward [30]. The items comprising the WES-10 were rated ona five-point scale ranging from 1, not at all or never, to 5, very often orto a large extent.

This study included wards where more than two-thirds of the pa-tients were diagnosed in the psychotic spectrum of mental diseases.Most of the wards were short-term (n = 36), but some intermediateand long-term wards (n = 6) were also included.

Three questions were applied to capture general satisfaction withthe milieu. The questions were rated on a five-point scale rangingfrom 1, not at all, to 5, very much, and were: (1) “How satisfied are youwith this ward?”, (2) “How much do you like the patients on thisward?” and (3) “How much do you like the staff on this ward?”. Themean and SD concerning these three questions were respectively: 4.03(0.33), 4.20 (0.20) and 4.43 (0.21).

■ Statistics

To establish the number of subscales of the WES-10, we carried out afactor analysis (PCA) with varimax rotation. For each factor, we madea corresponding subscale. Items were included into the subscales ifthey had a loading on the corresponding factor ≥ 0.50 and if the dif-ference between this loading and the highest loading on non-corre-sponding factors was ≥ 0.05.

The internal consistency of the subscales was calculated as Cron-bach’s alpha. We calculated the Corrected Item Total subscale Corre-lation (CITC) for the subscale, which comprised four items. Pearsoncorrelations were used to assess the relationships between the sub-scales and between the subscales and the other variables.

Results

A total of 105 individual therapists and 529 nursing staffmembers completed the WES-10. A total of six staffmembers did not report whether they were individualtherapists or nursing staff. All staff members were in-cluded in the study except for night staff. The limitationwas due to difficulties in obtaining an acceptable num-ber of completed questionnaires from the latter group ofemployees.

All staff members were asked for how long they hadworked at the psychiatric ward and how long they ex-pected to work on the ward. A total of 15 % of the staffmembers had been employed less than 6 months, 22 %between 6 months and 18 months and 20 % between 18months and 3 years.Of the staff members,43 % had beenemployed more than 3 years. A total of 15 % were plan-ning to quit their jobs during the following 6 months.Anadditional 15 % were planning to quit before 1 year hadpassed.The largest group,47 %,thought they would con-tinue to work at the same psychiatric ward somewherebetween 1 and 3 years. A total of 23 % were planning tocontinue for more than 3 years. For each ward, we calcu-lated the percentage of staff members who had beenworking: (a) for less than 18 months, and (b) for morethan 3 years. We also calculated the percentage that in-tended to continue: (a) for less than 1 year, and (b) formore than 3 years.

The factor analysis revealed four factors with anEigenvalue > 1. These four factors accounted for 79 % ofthe variance. The factor loadings of the items are listedin Table 1. The four subscales were named: Self Realiza-tion, Workload, Conflict and Nervousness.

The Self Realization subscale explained 37 % of thevariance and comprised four items (items 1, 2, 5 and 6).This subscale measures to what extent the staff membersfeel supported, whether they achieve more confidenceand whether they experience being able to use theirknowledge working on the ward.The Workload subscaleexplained 19 % of the variance and comprised two items(items 9 and 10). This subscale measures the number oftasks imposed on the staff members and also to what ex-tent they feel they should have been on several places atthe same time. The last two subscales, Conflict and Ner-vousness, each comprised two items and explained re-spectively 13 % and 12 % of the variance. The Conflict

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subscale measures to what extent the staff members’ ex-perience conflicts and loyalty problems among them(items 7 and 8). The Nervousness subscale measures towhat extent the staff members are worried about goingto work and to what extent they feel nervous or tense onthe ward (items 3 and 4). All the items were included inthe subscales.

The psychometric properties of the subscales provedto be satisfactory. Cronbach’s alpha for the four sub-scales were: Self Realization: 0.85, Workload: 0.84, Con-flict: 0.69 and Nervousness: 0.66. The four items in theSelf Realization subscale had a mean CITC of 0.52. Theintercorrelations between the two items comprising thelast three subscales were respectively: Workload: 0.72,Conflict: 0.53 and Nervousness: 0.49.

The mean scores and standard deviations for the foursubscales were respectively: Self Realization: 3.73 (0.23),Workload: 3.41 (0.36), Conflict: 2.06 (0.28) and Nervous-ness: 1.98 (0.21).

As seen from Table 2, the subscales were only moder-ately intercorrelated (range: 0.13–0.37, median: 0.30).

As seen from Table 3, the Self Realization subscalewas most strongly correlated with general satisfactionand liking for the patients. The Conflict subscale wasmost strongly correlated (negatively) with liking for theother staff members.

Table 4 shows that only the Workload subscale wassignificantly correlated with the time staff members hadworked at the ward. This subscale showed a moderatenegative correlation with the percentage that hadworked less than 18 months at the ward. Two subscales

(Self Realization and Nervousness) were significantlyrelated to the time the staff expected to work on the wardin the future. The relationship was most pronounced forSelf Realization, which was moderately negatively corre-lated with the percentage who intended to continue lessthan 1 year, and positively with the percentage who in-tended to continue for more than 3 years.

Discussion

The main finding of this study is that the WES-10 fea-tures acceptable psychometric properties on a wardlevel.Although not directly compared to other scales, theresults of this study clearly indicate that the core aspectsof the working environment can be captured with aneasy-to-use instrument that only comprises ten items.The instrument seems well suited for use in research andevaluation as it reliably measures four clinically mean-ingful subscales.

The validity is demonstrated by the fact that Conflictwas strongly negatively correlated with liking for staff,while Self Realization was fairly strongly positively cor-related with liking for patients. Furthermore, three ofthe four WES subscales were significantly related to gen-eral satisfaction with the ward. It also makes sense thatNervousness was significantly related to a high percent-age who intended to continue at the unit for less than 1year.

It seems that the WES-10 is able to capture the coredimensions of the working environment. The Workloadand Conflict subscales frequently appear in other stud-

Table 1 The factor loadings for each item. Only factor loadings ≥ 0.30 are included

Items from the I II III IVWES-10

1 0.82

2 0.86

3 0.94

4 –0.45 0.32 0.63

5 0.63 –0.43

6 0.91

7 0.83

8 0.85

9 0.91

10 0.91

Table 2 The intercorrelations between the four subscales

Self Realization Conflict Workload Nervousness

Self Realization X –0.37* –0.13 –0.35*

Conflict X 0.20 0.34*

Workload X 0.25

Nervous X

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

Table 3 The intercorrelations between the four subscales and general satisfactionwith the psychiatric wards, patients and staff members

How satisfied How much do you How much do youare you with like the patients like the staff onthis ward? on this ward? this ward

Self Realization 0.56** 0.49** 0.40**

Conflict –0.41** –0.16 –0.61**

Workload –0.20 –0.15 0.17

Nervousness –0.30 –0.27 –0.15

** 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 mem-bers have been employed and how long they expect to work at the psychiatric ward

% worked % worked % intend % intend< 18 months > 3 years to continue to continue

< 1 year > 3 years

Self Realization –0.16 0.07 –0.38* 0.32*

Conflict –0.05 0.15 0.25 –0.26

Workload –0.37* 0.26 0.28 –0.29

Nervousness 0.17 –0.05 0.38* –0.25

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

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ies and the importance of measuring these two dimen-sions of the work environment is widely described [2,25,27]. The Self Realization subscale measures the same as-pect of the work environment as the Professionalgrowth, Personal growth, Support and Achievementvalue and growth dimensions of other studies [21, 26,31]. The Nervousness subscale, measuring how nervousor tense the staff members feel at the psychiatric ward,seems to appear less frequently in other studies. It obvi-ously measures an important dimension and is probablystrongly correlated with several issues of safety and in-security, which, in some studies, have proved to be im-portant factors of the work environment [28].

By only including ten items in the WES-10, some ofthe previously reported dimensions (e. g. salary, man-agement issues, safety issues, and home-work conflicts)are not captured by this instrument. It could be arguedthat a suitable instrument should include more items,thus making the measurement of more aspects of theworking environment possible. However, the main aimof this study was not to develop an instrument that wasable to capture all possible aspects of the work environ-ment, but to examine and evaluate a short and easy-to-use instrument that captures the core dimensions. Theshort format, evaluated in this study, leaves an opportu-nity to use other instruments that capture other aspectsof inpatient treatment without overloading the staffmembers.

Three of the four subscales captured in this studycomprised only two items. By aggregating the data onward level, it was still possible to achieve acceptable re-liability. To achieve reliable results on an individual levelwould probably have needed a much more extensive in-strument comprising more items. However, as also sup-ported by the findings of Melchior et al. [32], a consen-sual perception of the working environment providesenough information to capture in what way most of thepsychiatric staff members perceive the work environ-ment. This can be achieved by using a short, easy-to-useinstrument.In this cross-sectional study,we did not con-duct any analyses on the test/retest reliability of theWES-10. This important subject needs to be examinedin other studies with the WES-10. This study clearly in-dicates that the working environment is strongly relatedto staff satisfaction. To what extent the work environ-ment, as perceived by staff, is related to inpatient satis-faction and outcome is still unclear [23, 33, 34]. To ourknowledge only two studies [35, 36] have examined therelationship between the psychosocial ward climate andthe working environment. No clear conclusion could bedrawn from the two studies. The WES-10 seems wellworth 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 abili-ties 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 veryextent 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 veryextent 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 arefaced 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 ex-perience in the work here on this ward?



7. To what extent do you find that the patient treatment is complicated by con-flicts among the staff members?



8. To what extent do you find that it can be difficult to reconcile loyalty towardsyour team with loyalty towards your own profession?



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 beenon several places at the same time?

� � � � �Very often Often Occasionally Rarely Never

References

1. Schaefer JA, Moos RH (1996) Effects of work stressors and workclimate on Long term Care Staff ’s job morale and functioning.Res Nurs Health 19:63–73

2. Gray-Toft P, Anderson JG (1981) The Nursing Stress Scale: De-velopment of an Instrument. J Behav Assess 3:11–23

3. Decker FH (1997) Occupational and Non occupational Factors inJob Satisfaction and Psychological Distress Among Nurses. ResNurs Health 20:453–464

580

4. McNeese-Smith DK (1999) A content analysis of staff nurse de-scriptions of job satisfaction and dissatisfaction. J Adv Nurs 29:1332–1341

5. Baruch-Feldman C, Brondolo E, Ben-Dayan D, Schwartz J (2002)Sources of Social Support and Burnout, Job Satisfaction, andProductivity. J Occupational Health Psychol 7:84–93

6. Edwards D, Burnard P (2003) A systematic review of stress andstress management interventions for mental health nurses. J AdvNurs 42:169–200

7. Brown D, Leary J, Carson J, Bartlett H, Fagin L (1995) Stress andthe community mental health nurse: the development of a mea-sure. J Psychiatr Mental Health Nurs 2:9–12

8. Kilfedder CJ, Power KG, Wells TJ (2001) Burn out in psychiatricnursing. J Adv Nurs 34:383–396

9. Dawkins JE,Depp FC,Selzer NE (1985) Stress and the psychiatricnurse. J Psychosoc Nurs 23:9–15

10. Leiter MP,Harvie PL (1996) Burnout among mental health work-ers: A review and a research agenda. Int J Soc Psychiatry 42:90–101

11. Melchior MEW, Bours JJW, Schmitz P, Wittich Y (1997) Burnoutin Psychiatric Nursing: A metaanalysis of related variables. J Psy-chiatr Mental Health Nurs 4:193–201

12. McCowan B (2001) Self reported stress and its effects on nurses.Nurs Standard 42:33–38

13. Fagin L, Carson J, Leary J, De Villiers N, Bartlett H, O’Malley P,West M, McElfatrick S, Brown D (1996) Stress, Coping and Burnout in mental health nurses: Findings from three research stud-ies. Int J Soc Psychiatry 42:102–111

14. Onyett S, Pillinger T, Muijen M (1997) Job satisfaction andburnout among members of community mental health teams. JMental Health 6:65–66

15. Gulliver P, Towell D, Peck E (2003) Staff morale in the merger ofmental health and social care organizations in England. J Psy-chiatr Mental Health Nurs 10:101–107

16. Edwards D, Burnard P, Coyle D, Fothergill A, Hannigan A (2001)A stepwise multivariate analysis of factors that contribute tostress for mental health nurses working in the community. J AdvNurs 36:805–813

17. Jones JG,Janman K,Payne RL,Rick JT (1987) Some determinantsof stress among psychiatric nurses. Int J Nurs Stud 24:129–144

18. Landerweerd JA, Boumans NP (1988) Nurses’ work satisfactionand feelings of health and stress in three psychiatric depart-ments. Int J Nurs Stud 25:225–234

19. Maslach C, Jackson SE (1982) Burnout in Health Professions: ASocial Psychological Analysis. In: Sanders G, Suls J (eds) SocialPsychology of health and illness. Lawrence Erlbaum, Hillsdale,New Jersey, pp 227–251

20. Ito H, Eisen S, Sederer LI,Yamada O, Tachimori H (2001) Factorsaffecting psychiatric nurses’ intention to leave their current job.Psychiatr Serv 52:232–234

21. Alexander JA, Lichtenstein R, Oh HJ, Ullmann E (1998) A causalmodel of voluntary turnover among nursing personnel in long-term psychiatric settings. Res Nurs Health 21:415–427

22. Tzeng HM, Ketefian S, Redman RW (2002) Relationship ofnurses’ assessments of organizational culture, job satisfaction,and patient satisfaction with nursing care. Int J Nurs Studies 32:79–84

23. Atkins PM, Stevenson Marshall B, Javalgi RG (1996) Happy em-ployees lead to loyal patients. J Health Care Marketing 16:15–23

24. Burnard P, Morrison P, Phillips C (1999). Job satisfactionamongst nurses in an interim secure forensic unit in Wales. AustN Z J Mental Health Nurs 8:9–18

25. Cushway D, Tyler PA (1996) Development of a stress scale formental health professional. Br J Clin Psychol 35:279–295

26. Abraham IV, Foley TS (1984) The work environment scale andthe ward atmosphere scale (short forms): Psychometric data.Perceptual and Motor Skills 58:319–322

27. Davis MK (1974) Intrarole Conflict and Job Satisfaction on Psy-chiatric units. Nurs Res 23:482–488

28. Dallender J,Nolan P,Soares J,Thomsen S,Arnetz B (1999) A com-parative study of the perceptions of British mental health nursesand psychiatrists and their work environment. J Adv Nurs 29:36–43

29. Moos R (1974) Evaluating treatment environments: A social eco-logical approach. New York Wiley

30. Vaglum P, Karterud S, Jørstad J (1984). Institusjonsbehandling imoderne psykiatri. Universitetsforlaget, Oslo

31. Coffey M, Coleman M (2001) The relationship between supportand stress in forensic community mental health nursing. J AdvNurs 34:397–407

32. Melchior MEW, van den Berg AA, Halfens R, Abu Saad HH,Philipsen H, Gassman P (1997) Burnout and the work environ-ment of nurses in psychiatric long-stay care settings. Soc Psychi-atry Psychiatr Epidemiol 32:158–164

33. Anderson FD, Beard LW, Maloney JP (1998) A descriptive, corre-lational study of patient satisfaction, provider satisfaction andprovider workload at an army medical center. Military Med 163:90–94

34. Tzeng HM, Ketefian S (2002) The relationship between Nurses’Job Satisfaction and Inpatient Satisfaction: An ExploratoryStudy in a Taiwan Teaching Hospital. J Nurs Care Qual 16:39–49

35. Kirby SD,Pollock PH (1995) The relationship between a mediumsecure environment and occupational stress in forensic psychi-atric nurses. J Adv Nurs 22:862–867

36. Dorr D, Honea S, Pozner R (1980) Ward Atmosphere and job sat-isfaction. Am J Comm Psychol 8:455–461