Predictors of nurse’s happiness:a systematic review

Judie Arulappan*, Suthan Pandarakutty, Blessy Praha Valsaraj

aDepartment of Maternal and Child Health, College of Nursing, Sultan Qaboos University, Al Khoud, Muscat 66, Sultanate of Oman

bLecturer of Nursing, University of Buraimi, Al Buraimi, Buraimi 890, Sultanate of Oman

cDepartment of Community and Mental Health, College of Nursing, Sultan Qaboos University, Al Khoud, Muscat 66, Sultanate of Oman

Abstract: Objective: An acute shortage of nurses exists all over the world. Part of this shortage appears to be due to nurses’ low job satisfaction,low retention, and high turnover. Happiness at work is identified as a contributing factor that determines the shortage of nurses across the world. This paper critically appraised the existing scientific articles that assessed the individual and organizational predictors of happiness among nurses.

Keywords: predictors • factors • happiness • joy • well-being • life satisfaction • nurses • registered nurses

1. Introduction

Happiness is a fundamental human feeling that is essential for the well-being and development of any individual, society, and an organization. Happiness is“an emotional or affective state that is characterized by feelings of enjoyment and satisfaction, which is often equated with morale, contentment, well-being,life satisfaction, successful aging, quality of life, and the good life.”1Happiness brings positive self-concept,physical, psychological, and social well-being, brings better hope for the future, and positive attitude toward oneself and others, improves relationship with the family and society, motivates to serve others, provides better decision-making ability, and brings more creativity.2,3Happiness is one of the critical factors essential for achieving a satisfactory performance and increased output, leading to economic, cultural, social, and political development.4Several countries including France,Canada, and the United Kingdom have recently used national happiness index as an indicator of national success.5

Happiness is directly linked to the work environment because people are spending most of their time in their job, which is greatly contributing to their happiness and well-being.6Happier people are more satisfied in their life, experience less burnout at workplace, absent less,are reluctant to leave their jobs, have stronger interpersonal and communication skills, and are dedicated to their organization.7,8When people are happy in their workplace, not only do they have a sense of well-being,optimism, and hope for the future but it also benefits the organization. Satisfied workers are innovative and productive and can make positive choices and strengthen their relationships with others.9Nursing profession has been listed in the top 40 high-stress jobs.10As nurses are involved in caring, they have to be happy in order to be more productive to deliver high-quality nursing care.11,12It has been reported that 7.4% of the nurses are absent each week due to stress-induced deterioration or impairment, which is 80% higher than that of other occupational classes.13It is also highlighted that only one in seven nurses is happy when they are working in hospitals,14and one out of every five nurses leave their job in the first 5 years due to work stress.15

Nurses are unhappy due to the constant exposure to patient’s pain and sufferings, the uncertainty of patient’s conditions, caring for death and dying patients, lack of resources in the workplace, inadequate peer and organizational support, lack of understanding and communication with their supervisors and physicians, lack of staff, and poor teamwork.16–18These factors add more physical and mental strain on the nurses and lead to the development of depression, inability to perform job duties, reduction in the standard of care, increased conflicts in the work environment, dissatisfaction in the job,and even chances of leaving the profession.19,20Nurses are also suffering from a greater level of physical, mental, and family disruptions including changes in daily routine activities such as sleep, anger, agitation, fatigue,misery, displeasure, desperation, feeling of inadequacy,depression, and changes in role function.21Nurses experience negative impacts of high workload including delayed prescription of care, increased drug problems, and inadequate patient education.22Nurses also reported having heavy workload, insufficient staff, aging nurse workforce, policies and management systems not helping nurses, inadequate pay, lack of resources and supplies, limited job opportunities, limited educational opportunities, and poor working conditions.23,24Therefore, happiness of nurses is a critical factor influencing employee turnover and is related to vocational calling,work independence, and professional nursing values.25

Healthy Nurse’s Year, 2017, emphasized the need for empowering nurses to achieve happiness in both their personal and professional lives.26Nurses should be helped in discovering the things that give them energy and make their lives enjoyable and build highquality and comfortable work atmosphere.27As happy employees maintain a good relationship with everyone in the organization, make the right decisions, are more creative, and are beneficial,10understanding the factors that promote their happiness is the key in planning and delivering appropriate strategies to make them happy and to develop a sense of well-being. Understanding the individual and organizational predictors of nurse’s happiness will not only provide the baseline data but also serve as evidence to the organizations to plan and design strategies to make the nurses happier, retain them, and make them more productive at their workplace in order to deliver high-quality nursing care. This will bring innovations and research contributions to the nursing profession, and the entire community can benefit from it.

Though understanding both the individual and organizational predictors of nurse’s happiness is very essential to recognize the reasons for their low job satisfaction, low retention, and high turnover, a limited number of studies have been conducted in this area.Most of the studies have been conducted on the stress,job satisfaction, burnout, and mental health aspects of nurses. However, to the best of our knowledge, no systematic review has been carried out on the predictors of nurses’ happiness. Therefore, this review will systematically bring out all the possible predictors of nurses’happiness in order to identify the possible strategies to enhance the nurses’ happiness. Thus, the objective of this review was to investigate the potential individual and organizational predictors of nurses’ happiness, specifically, to address the research question “What are the factors that may influence the happiness among nurses working at various hospitals?”

2. Methods

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations.27This systematic review was used to appraise and synthesize articles that examined the predictors of nurses’ happiness among the nurses working in hospitals.

2.1. Search strategies

Electronic databases such as Scopus, Medline, CINAHL,PsychINFO, and Pubmed Central were used to identify relevant articles. The keywords included were “predictors,” or “factors,” “happiness,” or “joy,” or “well-being,”or “life satisfaction,” “nurse,” or “registered nurse,” and“individual or organizational.”

2.2. Inclusion and exclusion criteria

The research studies were included based on the following criteria: (1) the study measured the predictors or factors influencing nurse’s happiness, (2) the participants were qualified registered nurses (male or female of any age) who were working in the hospitals or clinics, (3) full-texted and peer-reviewed articles that were published in English language, and (4) published between August 2010 and August 2020. Articles that did not assess the predictors of nurses’ happiness or that assessed general aspects of nurses’ happiness and the articles that assessed nurses’ stress, burnout, and job satisfaction were excluded from this review. Studies published before 2010, studies that did not have study protocols, studies that had no or insufficient outcomes,studies in a language other than English, unpublished studies, pilot studies, thesis, and dissertations were not included in the current systematic review.

2.3. Search outcomes

The systematic search yielded 1513 articles. After removing duplicates, reading titles, and abstracts, it was found that 875 articles were not relevant to the objective of the review, leaving 52 items for full-text review. After the review of 52 full-texted articles, only 13 articles that met all the inclusion criteria were included in the systematic review28–40(Figure 1).

2.4. Appraisal of methodological quality

The methodological quality of each descriptive studies(cross-sectional, correlational, and descriptive-comparative studies) was assessed using the adapted versions of the Newcastle-Ottawa Quality Assessment Scale.41For each cross-sectional, correlational, and descriptive-comparative analysis, the maximum achievable score was 8. We included four sample selection items,one comparability item, and two outcome measurement items. A high score in the category was awarded while meeting all requirements in the category. Studies that met <50% of the requirements were considered to have a low score, except for the comparability criterion of a cross-sectional sample. The methodological quality of each quasi-experimental and qualitative studies was evaluated by the Mixed Methods Appraisal Tool (MMAT).42The quasi-experimental studies were assessed on the basis of the existence of selection bias,the suitability of the measurements, the presence of the control group, and the completeness of the outcome results. The quality scores of all the included quasiexperimental and qualitative studies were good to excellent, ranging from 75% to 100%.

2.5. Data extraction and synthesis

The selection process began by reading the titles and summaries of each article. All the titles and abstracts of the retrieved papers were screened after the elimination of duplicates. For eligibility, full-text articles of potentially relevant studies were analyzed, and two authors independently performed data extraction. The authors then collected relevant data from the articles and consolidated it into an article review matrix (Table 1). Column variables in the table were authors, country, year,purpose, research approach, relevant findings, possible predictors of happiness, and quality assessment scores.

2.6. Research methods

2.6.1. Research design

Six of the included studies used cross-sectional research designs,29,30,32,34,36,39two adopted descriptive-comparative designs,31,40two used correlational designs,28,35two had quasi-experimental designs,33,37and one had qualitative research design.38

2.6.2. Study settings and sample size

Five of the studies originated from Iran,33,34,36,37and the remaining studies were conducted in Saudi Arabia,32Turkey,28Peru,29South Korea,30Poland,31China,35the United States of America,38Iceland,39and Pakistan.40All the studies were conducted in hospitals and included registered staff nurses as the samples. The sample size varied from 32 to 620 and included male and female hospital nurses (Table 1).

2.6.3. Measures of happiness

Four of the studies used the Oxford Happiness Questionnaire (OHQ),28,30,33,36two studies used The Happiness Scale by Fordyce (1988),34,38one qualitative research used semi-structured interview,39and the remaining studies used the following scales: List of Personal Values (LPV) scale by Juczyński (2001),31Scale of Happiness by Alarcón (2006),29Happiness subscale by Warr et al. (1979),32Life Satisfaction Index A (LSIA)by Neugarten (1961),37Life Satisfaction Ladder Scale by Robinson and Strauser (2002)40and the Multiple Happiness Questionnaire (MHQ).35

3. Results

In this systematic review, 13 studies28–40were chosen(Table 1) and a thematic analysis was done. The authors categorized various predictors from 13 studies28–40into two main domains: (1) Organizational or job-related predictors and (2) personal predictors including psychological, family, social, and spiritual factors.

Figure 1. Literature search flowchart.

3.1. Organizational or job-related predictors

Eight of the included studies stated that the nurses’happiness primarily depends on the work-related factors.29–32,36–38,40Studies have shown that nurses’ job position, working style, and working units significantly affected the nurses’ happiness and their quality of life.28,37Autonomy in carrying out job duties and other job-related tasks significantly contributed to nurses’happiness.29Four studies reported the working unit, satisfaction with salary, the time duration of working in the current ward, job shift, satisfaction with physician’s conduct and performance, and having a second job offer as the significant predictors of nurses’ happiness.32,33,36,37Awareness of job duties and types of hospitals the nurses work were considered as job-related predictors for nurses’ happiness.31In addition, professional pride,professional titles, and preferred job duties were found to be the predictors for nurses’ happiness.30,35,38,39

3.2. Personal predictors including psychological, family, social, and spiritual predictors

Eight of the included studies discussed the personal factors that affected the nurses’ happiness.28–30,32–37Some of the personal factors of happiness identified included a positive sense of life, personal fulfillment,and joy of living.28Individual subjective estimation of nurses’ health status is found to be a strong predictor of their happiness. Two studies added quality of life as a significant predictor for nurses’ happiness.30,32Age,gender, marital status, and educational level of the nurses also were considered as the predictors for their happiness.32,36It’s interesting to note journaling as a novel predictor of nurses’ happiness.37Furthermore, life skills education including effective communication, selfawareness, anger management, and coping with stress were considered as the other predictors for nurses’happiness.33

Besides the factors reported above, satisfaction with mental health and positive emotions were identified as strongest predictors for nurses’ happiness.32,34,37

Emotional intelligence and spiritual wellness also are reported as essential predictors for nurses’ happiness. Having a healthy family, good peer relationships,and social well-being are essential for nurses’ happiness.29,30,34–36,38Nurses engaging in a family, social, and peer relationships are considered to be happy.34,38Additionally, working with children and opportunities to help others are the essential factors for happiness.38Finally,hardiness is one of the most significant predictors for nurses’ happiness.36

Qualityassessments(Max8% and100%)6 7 6 7 5 Predictorsof nurse’shappiness Job positions, workingunits,working styles, andinterpersonal relationships.A positivesenseof life, personal fulfillment, andjoyof living.Individualsubjective estimation oftheirhealth status, hierarchyoriented cultural factors, autonomy inperforming jobduties, and numberof job-relatedtasks.Successfulfamily life,goodhealth, andfavorite profession/work performed.Awareness of jobduties,competent in doingthejob, job security, typesof hospitals, and interpersonal relationships.Finding Approach There wasasignificantpositive relationshipfoundbetweenthequality ofwork-lifeandhappiness. Thestudy suggested to reviseandreorganize work environmentsandto make thenecessary regulations forincreasing both happiness and generallife satisfactionamongnurses workingin thehospitals.The studyshowed that overall35%of nurseswere nothappyin termsof “positive sense of life,” “personalfulfillment,” and“joyof living.” The “personalfulfillment”factoris severely affected; >65% were reportedthat they were nothappyin terms of “personalfulfillment.” However, >90%ofthenurses said that they arehappyin terms of “lifesatisfaction.”The result showed that nurses working intheLTChospital were nothappy. The study suggestedthat personal health improvement programs fornurses and autonomyin performing jobduties are requiredto increase happinessamong nurses.The studyfoundthat satisfactionof nurses was basedon thefollowing factors:effective family life (3.83points), good health(3.55points), preferredprofession/workperformed(2.05points), andless commonlyagood material conditions(1.48 points)(P =0.010).The studydemonstrated apositive correlation betweennurses’ jobawareness oftheirduties andtheirhappinessand a stronger positive relationship between nurses’ happinessandtypesof hospitals.Nursesworkingin privatehospitals werehappierthan thenurses workingin governmenthospitals.Location: Turkey Setting: Ahospital in Edirne Design: Descriptive-comparativestudy Duration: —Sample: 345nurses Instrument: OHQ.Location: Peru Setting: AlbertoSeguín Escobedo EsSalud National Hospital at Arequipacity.Design: Correlationalstudy Duration: November 2017 to April 2018 (6 months)Sample: 83 staffnurses.Instrument: Scaleof Happinessby Alarcón (2006).Location: SouthKorea Setting: LTChospitals Design: Cross-sectionalstudy Duration: —Sample: 226staffnurses Instrument: OHQ Location: Poland Setting: TheMedicalUniversityof LublinandUniversity of Business and Enterprisein Ostrowiec-Świętokrzyski.Design: Cross-sectionalstudy Duration: 2014 to 2015 Sample: 191nurses Instrument: LPVscaleby Z. Juczyński(2001).Location: SaudiArabia Setting: King AbdEl Aziz governmental hospitalandPrivateInternational Medical Center in Jeddah.Design: Descriptive-comparativestudy Duration: —Sample: 500registered nurses Instrument: Happinesssubscale, by Warret al. (1979).Purpose Author/Year Toresearch therelationship between nurses’ happinessand quality of work-life.Gurdoganand Uslusoy (2020)28 Todescribe happinessfactors and analyzetheexisting relationships betweenthese factors amongnurses workingat various hospitals.Duche Pérez&Rivera Galdos, (2019)29 Toexploretheeffectsof thetype oforganizational culture, job satisfaction, andjobstress on nurses’ happiness.Hwang 2018)30 Deluga et al. (2018)31To evaluate theimportance ofwell-being in thepersonal hierarchy of thebeliefsof the nurse, includingsociodemographic factors.Toexaminetherelationship between nurses’ happiness and theawarenessof their workin government andprivate hospitals.Yahya Alhakami and Ghazi Baker(2018)32

(Continued)

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Table 1. Article review matrix.

4. Discussion

This systematic review was aimed at identifying both the individual and organizational predictors of nurses’happiness. To our knowledge, this is the first systematic review that has explored all the predictors of nurses’ happiness from various studies across the world. Studies included in this analysis showed that the overall level of nurses’ happiness was moderate.32,34–36Similar findings have been reported in a few more studies.43–45However,two studies reported contrary findings: in one study, the level of nurses’ happiness was a little above the average,46whereas in another study, the nurses’ happiness was below the average level.47These differences could be due to various factors in the settings where these studies have been conducted. However, further studies are recommended to identify the reasons for higher and lower levels of happiness among nurses.

In our analysis, organizational or workplace-related factors were found to be the predictors of nurses’ happiness. These include job satisfaction, types of hospitals,working units, job positions, working styles, time duration of working in the current ward, work shift, autonomy in performing job duties, number of job-related tasks,awareness of job duties, job satisfaction, satisfaction with salary, satisfaction with physician’s conduct and performance, work experience, job competencies,having second job offer, and experience as professional pride.28,29–32,36–38Similar findings are reported in another two studies.47,48In a recent concept analysis,it is shown that the work environment including personal, work-related, and workplace-related factors are the critical elements that promote nurses’ happiness.10Lin et al. (2011)23also confirmed that heavy workloads,inadequate staff, aging nurse workforce, policies, and management systems not helping nurses, inadequate pay, lack of resources and supplies, limited job opportunities, limited educational opportunities, and poor working conditions as the work place-related factors that predict the nurses’ happiness. There is a positive association between the quality of work-life and the nurses’happiness.49Nurses who are stressed more in their job experience a lower level of happiness due to a lower level of energy and difficulty in maintaining a balance between the professional and personal lives.50Creating conducive working environment is very much important in enhancing the happiness of nurses.

We identified working unit and workload as the significant predictors of nurses’ happiness.28,36–38Nurses working in the surgical unit found to have low level of happiness and reduced quality of life.51In contrast,another study stated that the nurses working in the surgical units reported to be happier than those working in the medical wards.52Further data is needed to confirm these contradictory findings of the study. Several studies have shown that the nurses working in ICU and Critical Care Units (CCU) were not happy and reported to have a high level of job stress, anxiety, depression,burnout, and lower level of happiness than the nurses working in other units.48,53–55In another study conducted in Iran with 21,767 ICU nurses, the nurses working in ICU were found to be less happy.56This data is alarming and indicating the need to identify the reasons for low level of happiness among nurses working in CCU. We,therefore, recommend additional data to confirm these results and develop strategies to improve the satisfaction and happiness of nurses working in ICU and CCU.

Al Sinawi et al. (2016)57stated that the nurses working in medical, surgical and obstetrics/gynecology wards were not happy due to excessive stress and burnout. Ghanbary and Bqayy (2010)58mentioned that the nurses working in the cancer care units were not happy and exposed to a higher level of stress and occupational burnout. Besides, studies also have reported that work shift and workload are affecting the quality of sleep, family relationships, and quality of life of nurses.59On the contrary, two studies have shown that there was no correlation between the nurses’ happiness and the working unit or ward.44,48Therefore, the reasons for the contradictory findings need to be tested in future studies. The nurses who were aware of their job duties, who were competent in their job, were having a feeling of job security, and had more work experience were found to be happier.4,6Toode et al. (2014)60and Warr (2013)61also reported similar findings. Blumberga and Olava(2016)62confirmed that the nurses with job security and more work experience show better coping with workrelated stress, which promoted their independence and self-confidence and resulted in overall happiness.Therefore, nurses should be well oriented to their duties and should be trained well to develop their clinical competencies. This, in turn, will improve their job satisfaction and happiness.

Supportive work environment, professional autonomy, and professional titles are identified as the predictors of nurses’ happiness30,34,38Another two studies also confirmed that happiness at work was positively linked to a healthy work environment. If the organization has a fair rewarding system, has good collaboration with the staff, is committed and appreciates one’s hard work, the employees would be happy. However, if the organization does not have a fair system of functioning,it would negatively cause stress and burnout, frequent absenteeism in work, job dissatisfaction, and emotional dysfunction.60,63Therefore, supportive organization is essential to improve the happiness of the nurses. Laschinger et al. (2014)64stated that if a nurse leader creates a supportive work environment, it will lead to improved work productivity and enhanced general well-being of nurses. Mousavi et al. (2019)65reported that there was a positive, significant association between professional autonomy and nurses’ happiness. Furthermore, professional titles and clear job descriptions could increase the happiness of nurses.66As professional autonomy is considered to be an important predictor of happiness of nurses, the authors recommend organizations to consider strategies to enhance the autonomy of nurses.

Likewise, monthly salary is reported to be a significant predictor of nurses’ happiness.32,36Consistent findings have been reported in another two studies.67,68Nurses salary is found to be increasing the level of their happiness and directly influencing the quality of health care delivery and productivity of work in their organization.69Low salary exacerbates depression and family conflicts, and it results in social isolation,ill health, and divorce.70We recommend the healthcare organizations to consider increasing the salary of nurses to make them happy and satisfied, which will enhance their work productivity. Maintaining harmonious and supportive interpersonal relationships among co-workers helps to relieve stress and maintain a positive emotion and happiness among nurses.28,31,32,38Also, happiness depends on the mutual appreciation between colleagues, gratitude, love, and support that help to reduce work-related stress and maintain a harmonious relationship with others.71Cooperative interpersonal relationships with doctors, supervisors, and other nurses also significantly contribute to nurses’happiness.72This makes it very evident that harmonious interpersonal relationship is indispensable to enhance happiness among nurses.

The second major theme identified in our analysis is the personal predictors. Nurses’ age, gender, marital status, education, quality of life, positive sense of life,personal fulfillment, the joy of living, individual subjective estimation of their health status, life skills education,journaling, and hardiness were identified as personal predictors of nurses happiness.28–30,32–37Three of the studies indicated that the age, gender, education, and marital status were directly associated with the nurses’happiness.32,36,38In another two studies, age, gender,education, and marital status were significantly correlated with the nurses’ happiness.73,74Marital well-being is an important factor for job satisfaction and happiness of nurses.75On the contrary, two studies showed that the age, gender, education, marital status, and work experience were not related to nurses’ happiness.48,76These contradictory findings need to be investigated further to find the reason for conflicting findings.

Quality of life was considered to be another predictor of nurses’ happiness.28,32,34Similar results are found in one more study.59The quality-of-life-determining factors identified in the aforementioned studies were adequate nutrition, a non-hazardous environment, and a long and healthy life.77Sleep is one of the primary components of quality of life. Nursing staff with good sleep were happier compared to those with poor sleep. Majority of the nursing staff were found to be unhappy due to poor sleep.78This clearly shows how sleep is important in predicting nurses’ happiness. Therefore, their sleeping pattern has to be improve to be happy and healthy.

Life satisfaction and personal fulfillment are found to be the personal predictors of nurses’ happiness.28,35,36Liu et al. (2018)79also reported that the nurses who were happy in their life achieved higher levels of life satisfaction. In addition, happiness is strongly associated with personal fulfillment. Life satisfaction also depends on the nurses’ personal values to life, personality, passion,empathy toward patient care, and dedication to work,which further contribute to their happiness.80Strategies including life skills education, such as effective communication, self-awareness, anger management, and coping with stress, significantly improve the nurses’happiness.33,81,82Hardi-attitude and journaling help the nurses to cope up with stressful situation, improve personal life, enhance job satisfaction, and improve the colleague’s interaction and happiness.35,37,83In order to have happiness and life satisfaction, the nurses need to have positive values to life and should develop passion toward the nursing profession.

In addition to the personal predictors mentioned above, psychological, family, social, and spiritual predictors including the successful family life, satisfaction with mental health, positive emotion, emotional intelligence,friendly relationships, working with children and opportunities to help others, engaging in social relations, hierarchy-oriented cultural factors, and spiritual wellness were found predicting the happiness of nurses.29,30,32,34,38,39Another two studies also demonstrated that mental health was directly related to nurses’ happiness and life satisfaction.67,84Australian nurses were not happy due to depression and job stress.85In the United Kingdom,mental health was the main factor than the workplace factor that correlates with the nurses’ happiness.86Nurse’s negative emotions were significantly associated with nurses’ happiness. Negative emotions identified were excessive job stress, misunderstanding with doctors and co-workers, nurses’ educational level, and patients’ mental status.87Nurses who experienced lower emotional stress and higher personal accomplishment experienced greater life satisfaction and happiness.88This data very clearly demarcates that the mental health of nurses should be taken care off in order to make them happy and have life satisfaction.

Besides the abovementioned factors, happiness also depends on a successful family and marital relationship.30,36Lewicka et al. (2013)89reported that family relationship, good health, physical and mental fitness,love and friendship, knowledge and wisdom, intelligence and mental acuity, joy and satisfaction as the contributing factors for nurses’ happiness. It is reported that the married people are happier than those who are unmarried, widowed, or separated.90Moreover, another study reported that happiness is directly related to family relationships and it improves emotional health of nurses.88Thus, having a happy and harmonious family life is essential for the nurses to be happy. Nurses’ happiness and satisfaction with life is related to caring and engaging with children, the opportunity to help others, maintaining a good social relationship, having professional pride, and working with people having high professional ambitions.38,91Family and social support are extremely important for nurses to maintain emotional balance and are moderately or strongly correlated with happiness and life satisfaction.67Therefore, nurses should be provided with opportunities to maintain good social relationship and should be treated with respect in the society as they maintain high professional values.

Spiritual health was directly related to the nurses’happiness.39Happiness is greatly linked to all dimensions of spiritual health and nurses’ happiness.92,93Nurses with higher spiritual intelligence are happier in their lives.94Spirituality also significantly improves their job performance including their clinical competence and quality of nursing care.95,96The nurses with higher spiritual well-being had a positive attitude and were able to provide better spiritual care to the patients.97All these evidences very clearly signify the need to enhance the spiritual well-being of the nurses. The organizations are required to understand the spiritual needs of the nurses and should provide opportunities for the nurses to provide spiritually augmented nursing care to their patients.

4.1. Reporting implications and future research recommendations

The nurse managers should create a healthy work environment for the nurses by ensuring adequate managerial support for them, providing staff appreciation,providing adequate staffing and resources, providing mutual respect and communication, creating a healthy doctor–nurse interaction, taking nurses’ suggestions into consideration, enhancing job autonomy, and teamwork, which will enhance positive emotional experiences, job satisfaction, and enhances overall happiness of nurses. In addition, nurses’ salaries and working conditions should be improved, which will definitely improve the nurses’ happiness. Therefore, the nurse managers and policymakers should consider the factors that affect the nurses’ happiness and plan appropriate interventions to reduce their stress and burnout and enhance their happiness, quality of life, and enthusiasm that improve productivity and delivery of quality nursing care.If such strategies are implemented, the job satisfaction of nurses shall be improved, their retention rates shall be increased, and their shortage can be minimized.Therefore, future interventional studies are required to increase the nurses’ happiness, mental health, and health-related quality of life.

4.2. Limitations of the review

Our search is restricted to examining the studies that are relevant only to registered nurses working in the hospitals, and the nurse supervisors, nurse managers,nurse educators, and student nurses’ happiness were not studied; therefore, the findings of this study cannot be generalized to all the nurse population. Also, the search was restricted to studies published in the English language, and we have excluded 9 similar studies in other languages; therefore, it is possible that additional studies might present different findings. Also, there is a challenge in finding all relevant studies because of very limited studies available on nurses’ happiness; however,we have included all the possible studies to the best of our knowledge. The search was also limited to the years from 2010 to 2020; hence, early seminal studies may have been overlooked. We could not conduct a metaanalysis to create a sense of correlation because the option for statistical analysis differed across studies.

5. Conclusions

Our review found various organizational and personal predictors that were responsible for nurses’ happiness.This data could be used by the hospital administrators and nurse managers to effectively plan strategies to improve the overall happiness of nurses. Nurses’happiness shall be enhanced by reducing job-related stress, improving job satisfaction and mental health,and creating enthusiasm among nurses. This will improve the retention of nurses and reduce the turnover of nurses.

Authors’ contributions

Dr. Judie Arulappan and Mr. Suthan Pandarakutty conceptualized and designed the study. Mr. Suthan Pandarakutty and Dr. Judie Arulappan conducted the literature review. Dr. Blessy Prabha Valsaraj resolved disagreements between Mr. Suthan Pandarakutty and Dr. Judie Arulappan. Dr. Blessy Prabha Valsaraj was also consulted when the first two authors encountered issues in assessing the study quality. Dr. Judie Arulappan and Mr. Suthan Pandarakutty led the interpretation of findings and drafted the manuscript. Dr. Judie Arulappan and Dr. Blessy Prabha Valsaraj critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Ethical approval

Ethical issues are not involved in this paper.

Conflicts of interest

All contributing authors declare no conflicts of interest.