Enhancing Nurse Performance in Iranian Hospitals: Expert and Stakeholder Insights on Key Influencing Factors

Vahideh Rostami, Nahid Hatam, Mohammad Amin Bahrami, Mahnaz Rakhshan, Azad Shokri

Abstract


Background: Nurses play a critical role in healthcare delivery and public health advancement, yet they face numerous challenges such as work pressure, financial constraints, job‑related stress, and burnout. This research aims to identify the factors that influence enhancing nurses’ performance in Iranian hospitals, as perceived by experts and stakeholders. Materials and Methods: This qualitative study, conducted in 2024, employed conventional content analysis. Participants included nurses, hospital administrators, human resources specialists, and healthcare policymakers, selected through targeted sampling from university hospitals with varied performance metrics. Data were collected via semistructured interviews and analyzed in three stages: identifying themes, comparing concepts, and categorizing subthemes to extract core concepts. Results: The analysis revealed seven primary themes, 21 subthemes, and 70 specific issues. Key themes included skill and occupational knowledge, job satisfaction, organizational structure and managerial support, nurse involvement and roles, professional growth, standards and service excellence, and professional proficiency in nursing. For instance, the theme of Job Knowledge and Skills encompassed subthemes such as the necessity of domain‑specific knowledge, the development of learning opportunities, and the importance of continuing education. Conclusions: The findings indicate that improving nurses’ performance requires a multifaceted approach, focusing on skill and knowledge enhancement, increased job satisfaction, stronger managerial and organizational support, and pathways for professional growth. Continuous educational improving working conditions and robust professional networks are essential to elevate nursing quality and job satisfaction. These insights can inform the development of effective policies to enhance nurses’ performance and improve the overall quality of healthcare services.


Keywords


Hospitals, Iran, job satisfaction, nurse’s role, nursing care, qualitative research

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References


Parry, Y. Community Nursing and Global Health. In: Liamputtong P. (eds) Handbook of Social Sciences and Global Public Health. Springer, Cham. 2023. Available from: https://doi. org/10.1007/978-3-031-25110-8_12. [Last accessed on 2024 Oct 21].

Bayat M, Shokri A, Khodadost M, Fattahi H, Mirbahaeddin E, Harirchi I, et al. Factors influencing medical specialists’ dual practice in the Islamic Republic of Iran. East Mediterr Health J 2018;24:877 87.

Asadi H, Barati O, Garavand A, Joyani Y, Kahkesh MB, Afsarimanesh N, et al. Challenges facing hospital human resources during the COVID 19 pandemic: A qualitative study in Iran. Int J Human Rights Healthc 2022;15:489 98.

Alshammari MH, Alenezi A. Nursing workforce competencies and job satisfaction: The role of technology integration, self efficacy, social support, and prior experience. BMC Nurs 2023;22:308.

Yasin YM, Kerr MS, Wong CA, Bélanger CH. Factors affecting nurses’ job satisfaction in rural and urban acute care settings: A PRISMA systematic review. J Adv Nur 2020;76:963 79.

Varasteh S, Esmaeili M, Mazaheri M. Factors affecting Iranian nurses’ intention to leave or stay in the profession during the COVID‐19 pandemic. Int Nurs Rev 2022;69:139 49.

Lee EK, Kim JS. Nursing stress factors affecting turnover intention among hospital nurses. Int J Nurs Pract 2020;26:e12819.

Kahya E, Oral N. Measurement of clinical nurse performance: Developing a tool including contextual items. J Nurs Educ Pract 2018;8:112.

Salehi T, Emamzadeh Ghasemi H. The assay of quality of nursing staff development programs at Tehran University medical sciences hospitals from the perspective of nurses. Iran J Nurs Res 2014;9:39 47.

Dehghani A, Mosalanejad L, Dehghan Nayeri N. Factors affecting professional ethics in nursing practice in Iran: A qualitative study. BMC Med Ethics 2015;16:1 7.

Sandehang PM, Hariyati RTS, Rachmawati IN. Nurse career mapping: A qualitative case study of a new hospital. BMC Nursing 2019;18:1 9.

Saunders, B, Sim J, Kingstone T, Baker S, Waterfield J, et al. Saturation in qualitative research: Exploring its conceptualization and operationalization. Qual Quant 2018;52:1893 907.

Gholipour K, Shokri A, Yarahmadi AA, Tabrizi JS, Iezadi S, Naghibi D. Barriers to community participation in primary health care of district health: A qualitative study. BMC Primary Care 2023;24:117.

Pope C, Ziebland S, Mays N. Qualitative research in health care: Analysing qualitative data. BMJ 2000;320:114 6.

Griscti O, Jacono J. Effectiveness of continuing education programmes in nursing: Literature review. J Adv Nur 2006;55:449 56.

Salmani Z, Shiri H, Mofrad MN, Nasiri M. The effect of nursing communication skills training on satisfaction of patients undergoing hemodialysis. J Pharm Res Int 2020;31:1 8.

van Manen AS, Aarts S, Metzelthin SF, Verbeek H, Hamers JPH, Zwakhalen SMG. A communication model for nursing staff working in dementia care: Results of a scoping review. Int J Nurs Stud 2021;113:103776.

Wu XV, Chan YS, Tan KHS, Wang W. A systematic review of online learning programs for nurse preceptors. Nurse Educ Today 2018;60:11 22.

Lu H, Zhao Y, While A. Job satisfaction among hospital nurses: A literature review. Int J Nurs Stud 2019;94:21 31.

You LM, Aiken LH, Sloane DM, Liu K, He GP, Hu Y, et al. Hospital nursing, care quality, and patient satisfaction: Cross sectional surveys of nurses and patients in hospitals in China and Europe. Int J Nurs Stud 2013;50:154 61.

García‐Sierra R, Fernández‐Castro J. Relationships between leadership, structural empowerment, and engagement in nurses. J Adv Nur 2018;74:2809 19.

Aloisio LD, Coughlin M, Squires JE. Individual and organizational factors of nurses’ job satisfaction in long term care: A systematic review. Int J Nurs Stud 2021;123:104073.

Akinwale OE, George OJ. Work environment and job satisfaction among nurses in government tertiary hospitals in Nigeria. Rajagiri Manag J 2020;14:71 92.

Cicolini G, Comparcini D, Simonetti V. Workplace empowerment and nurses’ job satisfaction: A systematic literature review. J Nurs Manag 2014;22:855 71.

Labrague LJ, McEnroe Petitte DM, Tsaras K, Cruz JP, Colet PC, Gloe DS, et al. Organizational commitment and turnover intention among rural nurses in the Philippines: Implications for nursing management. Int J Nurs Sci 2018;5:403 8.

Gensimore MM, Maduro RS, Morgan MK, McGee GW, Zimbro KS. The effect of nurse practice environment on retention and quality of care via burnout, work characteristics, and resilience: A moderated mediation model. J Nurs Adm 2020;50:546 53.

Wei H, Sewell KA, Woody G, Rose MA. The state of the science of nurse work environments in the United States: A systematic review. Int J Nurs Sci 2018;5:287 300.

Van Bogaert P, Peremans L, Van Heusden D, Verspuy M, Kureckova V, Van de Cruys Z, et al. Predictors of burnout, work engagement and nurse reported job outcomes and quality of care: A mixed method study. BMC Nursing 2017;16:1 14.

Kutney Lee A, Germack H, Hatfield L, Kelly S, Maguire P, Dierkes A, et al. Nurse engagement in shared governance and patient and nurse outcomes. J Nurs Adm 2016;46:605 12.

Laschinger HKS, Wong CA, Grau AL. Authentic leadership, empowerment and burnout: A comparison in new graduates and experienced nurses. J Nurs Manag 2013;21:541 52.

Kutney Lee A, Stimpfel AW, Sloane DM, Cimiotti JP, Quinn LW, Aiken LH. Changes in patient and nurse outcomes associated with magnet hospital recognition. Med Care 2015;53:550 7.

Egerod I, Kaldan G, Nordentoft S, Larsen A, Herling SF, Thomsen T, et al. Skills, competencies, and policies for advanced practice critical care nursing in Europe: A scoping review. Nurse Educ Pract 2021;54:103142.

Robert Fraser M, BMgmt PA. Social media and nurses: Insights for promoting health for individual and professional use. Online J Issues Nurs 2014;19:131.

Price S, Reichert C. The importance of continuing professional development to career satisfaction and patient care: Meeting the needs of novice to mid to late career nurses throughout their career span. Adm Sci 2017;7:17.

Halm MA. Specialty certification: A path to improving outcomes. Am J Crit Care 2021;30:156 60.

Tomajan K. Advocating for nurses and nursing. Online J Issues Nurs 2012;17:4.

Whitehead L, Ghosh M, Walker DK, Bloxsome D, Vafeas C, Wilkinson A. The relationship between specialty nurse certification and patient, nurse and organizational outcomes: A systematic review. Int J Nurs Stud 2019;93:1 11.

Aiken LH, Sermeus W, Van den Heede K, Sloane DM, Busse R, McKee M, et al. Patient safety, satisfaction, and quality of hospital care: Cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ 2012;344:e1717.

Aiken LH, Sloane DM, Bruyneel L, Van den Heede K, Griffiths P, Busse R, et al. Nurse staffing and education and hospital mortality in nine European countries: A retrospective observational study. Lancet 2014;383:1824 30.

Ferguson CC, Lamb G. A scholarly pathway in quality improvement and patient safety. Acad Med 2015;90:1358 62.

Liu Y, Aungsuroch Y, Yunibhand J. Job satisfaction in nursing: A concept analysis study. Int Nurs Rev 2016;63:84 91.

Aghajani Inche Kikanloo A, Jalali K, Asadi Z, Shokrpour N, Amiri M, Bazrafkan L. Emotional intelligence skills: Is nurses’ stress and professional competence related to their emotional intelligence training? A quasi experimental study. J Adv Med Educ Prof 2019;7:138.

Jafaraghaee F, Mehrdad N, Parvizy S. Influencing factors on professional commitment in Iranian nurses: A qualitative study. Iran J Nurs Midwifery Res 2014;19:301 8.

Zamanzadeh V, Valizadeh L, Neshat H. Challenges of human resources management in nursing in Iran: A qualitative content analysis. Nursing Open 2020;7:319 25.

Ghavidel F, Fallahi Khoshknab M, Molavynejad S, Zarea K. The role of organizational factors in nurse burnout: Experiences from Iranian nurses working in psychiatric wards. J Family Med Prim Care 2019;8:3893 9.

Numminen O, Repo H, Leino Kilpi H. Moral courage in nursing: A concept analysis. Nurs Ethics 2017;24:878 91.

Berger S, Saut AM, Berssaneti FT. Using patient feedback to drive quality improvement in hospitals: A qualitative study. BMJ Open 2020;10:e037641.

Mueller SA, Naragon RM, Smith RR. The relationship between nursing students’ perceptions of staff nurses’ attitudes towards them and self-efficacy in sophomore-and senior-level nursing students. Available from: http://ideaexchange.uakron.edu/honors_ research_projects/202. [Last accessed on 2025 Nov 11].


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