Spousal Involvement in the Workplace of Doctors: What Is Defined as Appropriate or Inappropriate ()
1. Background
Doctors spend a significant amount of time at work. The well-being of doctors in the workplace is key to productivity, patient management, and ultimately patient satisfaction [1] . Doctors’ well-being is greatly influenced by the social support he/she receives from their families especially their spouses [2] . Involvement of spouses in partners work place including doctors can take different forms and come with different intentions. Positive spousal support at home and in the workplace is invaluable to preserve both physical and mental health and can come in the form of counsel, direction, understanding, or practical assistance. Social support has been reported to assist in the management of life’s stresses, foster resiliency, and strongly promote a sense of community [2] [3] [4] . In modern medicine, the definition of “work time” is complex. Typical physician duties include patient contact, administrative tasks, charting, teaching, meetings, and community outreach activities’ and; the addition of mobile technology also means that work time can easily creep into life time [5] . Maintaining a healthy work/family balance is imperative to achieving physical, mental, and emotional well-being for the doctor, her spouse, and children [1] [3] [6] . Unresolved family conflicts can affect productivity in the workplace, In addition, it can lead to depression, anxiety disorders, and substance abuse which can further strain family and workplace relationships negatively, impact productivity, and even endanger lives [5] [6] [7] [8] [9] . Conflicts at the workplace should be handled with internal organizational mechanisms without involving spouses to avoid complicating and further straining workplace relationships. Family issues on the other hand, should not be brought into a work environment. We did not find any literature that evaluated the involvement of spouses in workplaces.
This survey is aimed at identifying the frequency, circumstances, nature, and predisposing factors that facilitate the involvement of Doctors’ spouses in their workplace. It is hoped that the findings of this study will help define acceptable levels of spousal involvement with issues in the workplace of their partners and highlight potential outcomes of degrees of spousal involvement in doctors’ workplaces.
2. Methods
This was a cross-sectional study using a pre-tested online Google Form to collect data, see Appendix. The link for the Google Form was widely populated on many doctors’ social media platforms. The survey ran over 5weeks from 2nd July 2023 to 11th August 2023. This survey was part of pre-conference planning activities to generate data for a segment of the 23rd Biennial Conference and scientific meeting of the Medical Women Association of Nigeria. Ethical clearance for the online survey was obtained from the local organizing committee of the conference. All doctors were eligible to fill out the forms. The information retrieved from the questionnaire includes the Respondent’s occupation, carder, age, location, and type of workplace, if they have witnessed a spouse being involved in the workplace, the frequency of the incident, identification of whose spouse was involved, their perception of the appropriateness of the witnessed incident. The cadre, age, and sex of the doctor whose spouse got involved in the workplace. The age, academic qualification, and occupation of the spouse who got involved in the doctor’s workplace. Description of the circumstances for which the spouse got involved, Identification of who invited the spouse to the workplace, and respondents perceived reason for which the spouse got involved in the doctor’s workplace. The questionnaire also collected information on the outcome and effect of spousal involvement in the workplace. The cadre description of the Doctors includes the following: Consultant (A doctor who has completed postgraduate training and appointed to work as a specialist in a hospital), Senior registrar (A doctor in the clinical postgraduate training program who has passed her membership examinations), Registrar (A doctor who is in a clinical postgraduate training program who has not passed the membership examinations), Medical Officer (A doctor who is working in the hospital and is not on the clinical postgraduate training program track), Medical Academician (A doctor who is not practicing clinical medicine but strictly in the academia).
Responses were exported into an Excel spreadsheet and analyzed using SPSS version 23. Results were presented in simple frequency tables while the test of association was done using odds ratio and confidence intervals. The level of significance was set at P value of 0.05.
3. Results
A total of 83 persons responded to the survey and they were all doctors. The majority of the doctors who responded were consultants 57 (68.7%), and worked in Tertiary health institutions 50 (60.2%). Most of the respondents practiced in the Southern part of Nigeria 56 (67.5%) while 23 (27.7%) practiced in the northern part. Four (4.8%) respondents practiced outside Nigeria. Their age ranged from 26 years to 70 years with the majority of the respondents 37 (44.6%) aged between 41 to 50 years (Table 1).
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Table 1. Characteristics of respondents.
3.1. Frequency of Spousal Involvement in the Workplace
Among the respondents, 60 (72.3%) had witnessed a doctor’s spouse being involved in the workplace either personally or as an observer. The number of incidents reported per respondent ranged from 1 to 10. The majority 46 (55.4%) reported only one incident, and they were reporting on behalf of their colleague 39 (47%), only 14 (16.9%) of the reported incidents happened directly to the respondents making them self-reported incidents (Table 2).
3.2. Description of Spousal Involvement in the Workplace and Outcomes
The most common reason for spousal involvement in the workplace was to protect the spouse from what they perceived as a threat 34 (54.0%), followed equally by non-work-related spousal support or acts of kindness, Report of family issues to doctor’s colleagues and Deliberate verbal or physical altercation with spouse, 7 (11.1%). In the majority of the cases, the spouse came unsolicited, the age range of the doctor whose spouse got involved in the workplace and the age range of the spouse was the same at 41 - 51 years with a frequency of 18 (28.6%)
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Table 2. Frequency of spousal involvement in the workplace.
and 30 (40%) respectively. The spouses of both consultants and registrars were equally the ones most frequently involved in the workplace 16 (25.4%). The majority of the spouses who got involved in the work were reported to have tertiary education 56 (88.9%) and they worked in the healthcare industry 20 (31.7%), although the occupation of most of the spouses who got involved in the workplace was not known 16 (25.4%). The most common perceived enablers of spousal involvement in the doctors’ workplace were an expression of love for a spouse, 34 (54.0%) followed by ignorance of boundaries of spouses in the workplace, 17 (27.0%) and exertion of control by a spouse, 14 (22.2%) (Table 3).
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Table 3. Description of spousal Involvement in the workplace and outcomes.
3.3. Perception and Outcome of Spousal Involvement
Twenty-nine (46%) of the respondents described the reported spousal involvement at the workplace as inappropriate while 33 (52.4%) thought they were appropriate. From the respondents’ point of view, the most common outcome of spousal involvement at the workplace was bringing more tension at the workplace or adding more complication to the situation 28 (44.4%), the second common outcome was bringing a resolution to work-related conflict 18 (28.6%). From the institutional point of view, the most common outcome of spousal involvement
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Table 4. Perception and outcome of spousal involvement.
was the resolution of conflict 24 (38.1), followed by complication of the situation 17 (27%) (Table 4).
3.4. Factors Associated with the Perception of Inappropriate Spousal Involvement in the Workplace
Incidents of spousal involvement reported on behalf of other recipients (OR: 7.36 (95% CI: 1.48, 36.44) P: 0.007), a deliberate verbal or physical altercation with spouse (OR: 8.34 (95% CI: 1.13, 204.8) P: 0.04), ignorance of boundaries in the workplace (OR: 6.09 (95% CI: 1.70, 21.79) P: 0.003) and exertion of control by the spouse (OR: 11.2 (95% CI: 2.26, 56.41) P: 0.002) were significantly associated with higher odds of perceived inappropriate spousal involvement in the workplace while expression of love for spouse with acts of kindness was significantly associated with a lowered odds of perceived inappropriate spousal involvement (OR: 0.11 (95% CI: 0.03, 0.36) P: 0.0001) (Table 5). On the other hand, the respondents’ age, type, and location of institution did not significantly affect the perception of inappropriate spousal involvement in the workplace (P > 0.05). Similarly, spouses who did non-work-related acts of kindness, those who reported family issues to the doctor’s colleagues, those who were invited by the
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Table 5. Factors associated with the perception of inappropriate spousal involvement in the workplace.
doctor, their place of work and age were not significantly associated with the perception of inappropriate spousal involvement in the workplace (P > 0.05) (Table 5).
4. Discussion
This survey among doctors identified that spousal involvement in the workplace of doctors was relatively common. It showed the reasons doctor’s spouses got involved in their workplace and also described what was perceived as inappropriate spousal involvement in the workplace. It further identified the outcomes and impact of involvement of doctor’s spouses in their workplace.
This study population involved doctors mostly living and working within Nigeria with the majority (66.5%) domiciled in the southern states of the country. There was a wide distribution of ages with over half in the active childbearing ages and 9.6% aged within the elderly population. This wide distribution of age groups would bring generational diversity to the responses received by the survey. The cadres of the respondents ranged from consultants to medical officers and there was no significant association between these variables and the perception of inappropriate spousal involvement in social interaction. These differences if they exist, could result in stereotyping in the workplace as well as contrasting communication and work styles [10] .
Those who reported an incident of spousal involvement in the workplace were significantly more likely to perceive it as inappropriate as opposed to self-reporting. This is because a neutral party is more likely to be objective about the pros and cons of an incident as opposed to the person involved who may not be objective. It also helps the doctor see that once they involve their spouse in the workplace, others are affected by that decision. Understanding what is perceived as inappropriate and appropriate spousal involvement would help all workers maintain a good working environment concerning relationships and energy in the workplace. There is however limited literature on this aspect of workplace ethics and this study has shown that there is a need to have an understanding of what is acceptable conduct of a spouse in the workplace of their partner, a clear definition of the boundaries of acceptable involvement from the partners’ colleague’s perspective. The focus of this paper was specifically on the workplace of doctors.
Seventy-two percent of doctors had witnessed a doctor’s spouse being involved in the workplace either personally or as an observer. Spousal involvement in the workplace to give social support has been associated with improved physical and mental health outcomes and greater life satisfaction. In addition, social support has been reported to assist in the management of life’s stresses, foster resiliency, and strongly promote a sense of community [1] [2] . The balance between work and life/relationships can be challenging, especially in modern times. It is important to maintain this balance as too much attention on either area can be disadvantageous to the other, however, with the perfect balance, having a happy marriage can spill over into the work environment, resulting in satisfaction both at work and at home [3] . Positive descriptions for spousal involvement in the workplace reported in this study included protection of spouses from what they perceived as a threat and non-work-related spousal support or acts of kindness. Over half of the doctors reported the perceived enabler of spousal involvement that they witnessed was an expression of love for their spouse. This study shows that the hospital community which is also the workplace of the majority of the doctors understands, and positively welcomes incidences in which the doctor’s spouse shows acts of kindness and support in the workplace.
On the other hand, ignorance of the boundaries of a spouse within the workplace can lead to the spouse interfering with the flow of work or performing duties that they are not empowered to perform either from an administrative or medical perspective. In this study, two doctors reported helping a spouse carry out delegated work which could involve performing a medical procedure. While one could argue that the spouse could have been a doctor, the spouse may not have the authorization to perform any medical procedure in the department or institution in which they helped. It is important to reiterate the fact that authorization and privileges in the workplace are not acquired by marriage while maintaining an expected degree of courtesy to the spouse of a doctor. A senior doctor in an administrative office could have privileges and junior colleagues that report to them, it would however not be appropriate for the spouse to assume that they could carry out the same administrative functions or give directives in the same capacity. It is therefore not surprising that this survey identified ignorance of workplace boundaries by the spouse as one of the significant enablers of inappropriate spousal involvement in the workplace.
Spousal conflict refers to overt opposition between spouses that is identified by the spouses as a disagreement or a source of difficulty in the relationship [4] which can also occur in the workplace. Conflict presenting as a deliberate verbal or physical altercation with spouse as well as reporting family issues to doctor’s colleagues which interfered with workflow was noted in this survey. Conflict in marriage is inevitable, this is because the personal beliefs and habits of one person could annoy the other, regardless of the degree of love. Conflict acceptance and resolution ultimately occur in a healthy relationship [7] . Marital conflict has been linked to depressive symptoms, anxiety disorders, eating disorders, episodic drinking, binge drinking, and alcoholism [6] [7] . Even if the initial marital conflict occurred at home, it could spill over into the workplace as demonstrated in this study. The workplace, however, is not the place to display family conflict and neither is it a place to resolve marital conflict especially when it involves open verbal or physical altercations which this study has shown to be significantly perceived as an inappropriate behavior of spouses in the workplace of doctors.
Conflict in any workplace reduces productivity if this occurs in hospitals or clinics, it can affect health service delivery outcomes. Addressing conflicts in the workplace should be handled with all the internal mechanisms available within the workplace. Involvement of doctor’s spouses in conflict resolution at work should not be advocated as only 38.1% of interviewed doctors reported resolution of the conflict. The spousal involvement in conflict at the workplace was thought to complicate the situation more while 15.9% reported subsequent avoidance of colleague and exclusion from responsibilities in the hospital as their response to the incidence. The workplace should be safe and comfortable for all workers and physical safety is most often prioritized, however, the social and organizational circumstances in which workers perform their assignments should also be considered [8] . We are humans with degree of emotions and certain social interactions can make doctors and indeed all workers uncomfortable in the workplace whether they are involved in the interaction or they are just witnesses to the interaction [11] .
In conclusion, Spousal involvement in the workplace is relatively common. Expression of love for the spouse with acts of kindness was perceived as appropriate while deliberate verbal or physical altercation with spouse is inappropriate in the workplace. The majority of the incidences of inappropriate spousal involvement in the workplace are identified and characterized by the coworker who witnessed the incident. Ignorance of the boundaries of the workplace and exertion of control by the spouse were significant enablers of inappropriate spousal involvement in the workplace of doctors.
5. Limitations of This Study
This was an online survey via Google form and it was accessible to many doctors because it was available on multiple doctor’s platforms; however, only doctors with interest in the topic would take out time to fill out the form making our respondent population skewed, as a result, this study will not be able to identify the true incident rate of spousal involvement in the workplace of doctors.
Appendix: Spousal Involvement in Doctors’ Workplace
Dear Colleagues, The Scientific committee of 23rd Biennial Conference and scientific meeting of Medical Women Association of Nigeria is conducting a survey on Spousal involvement in the workplace of Doctors. This survey is aimed at identifying the frequency, the circumstances, nature and the predisposing factors that facilitate involvement of Doctors’ spouses in their workplace. It is hoped that the findings of this study would help define acceptable level of spousal involvement with issues in the workplace of their partners and highlight potential outcomes of degrees of spousal involvement in doctors’ workplace.
Please note that all responses are anonymous and emails would not be stored.
*Indicates required question.
1. Are you a doctor*
Mark only one oval.
Yes
No
2. Indicate your cadre*
Mark only one oval.
Consultant
Medical academician
Senior Registrar
Registrar
Medical Officer
House Officer
Other cadre
3. How old are you in years?*
4. What option best describes your primary place of work?*
Mark only one oval.
Private health facility
Government health care facility
Tertiary Institutions
Non-governmental Organizations
Health management facilities
Others (Specify)
5. Which region of Nigeria describes the location of your place of Work?*
Mark only one oval.
North West Nigeria
North East Nigeria
North Central Nigeria
South West Nigeria
South East Nigeria
South South Nigeria
Others
6. If you selected “Others” in the previous question (Q4), in which country is your place of work located?
7. Have you witnessed a doctor’s spouse being involved in the workplace either * personally or as an observer?
Mark only one oval.
Yes
No
8. How would you best describe the frequency of involvement of doctors’ spouses* in their workplace?
Check all that apply.
Never
At least once in 5 years
At least once a year
Two or more times a month
At least once a Month
At least once a week
Two or more times a week
At least once a day
9. In the incident that comes to your mind in which a spouse was involved in a doctors’ workplace, who was the recipient?
Check all that apply.
Yourself
A junior colleague under your supervision
A personal friend
A senior colleague
Other:
10. If you witnessed more than one incident in the previous question (Q7), please state those involved and how many times e.g. (a friend: 7times)
11. In your opinion, the involvement of the spouse in the incident being referred to, could best be classified as which of the following? Mark only one oval.
Appropriate
Inappropriate
12. The Doctor whose spouse got involved is identified as what gender in the workplace?
Mark only one oval.
Female
Male
13. From your observation, what is the gender of the doctor’s spouse who got involved in the work place?
Mark only one oval.
Female
Male
14. What was the purpose for which the Doctors’ spouse got involved?
Mark only one oval.
To protect the doctor from what they percieved as threat
To report family issues to the doctor’s colleagues
To engage the spouse in settling family squabbles between them selves
Deliberate verbal or physical altercation with spouse
Others
15. If you selected “Others” in the previous question (Q11) on other situation in which a doctor’s spouse got involved), please describe it below?
16. In the situation in which the doctors spouse got involved, who do you think invited the spouse?
Mark only one oval.
The Doctor invited their spouse
The spouse came unsolicited
17. Please estimate the age range of the Doctor whose spouse got involved in the workplace
Mark only one oval.
21 - 30 years
31- 40 years
41 - 50 years
51 - 60 years
60 - 70 years
70 - 80 years
>80 years
18. Please estimate the age range of the Doctor’s spouse who got involved in the workplace
Mark only one oval.
21 -30 years
31- 40 years
41 - 50 years
51- 60 years
60 - 70 years
70 - 80 years
>80 years
19. What was the cadre of the Doctor whose spouse got involved in the workplace
Mark only one oval.
Consultant
Medical academician
Senior Registrar
Registrar
Medical Officer
House Officer
Other cadre
20. What was the highest educational qualification of the Spouse who got involved in the workplace?
Mark only one oval.
Tertiary
Secondary
Primary
No formal education
Do not know
21. What was the occupation of the Spouse who got involved in the Doctors’ workplace?
22. Is there any peculiar dynamic that you think could have facilitated or enabled the doctors’ spouse to interfere in their workplace?
Check all that apply.
Exertion of control by spouse
High political or finacial influence of spouse
Expression of love for spouse
Ignorance on boundaries of spouses in the workplace
Do not know
Others
23. If you selected “Others” in the previous question (Q16), on any peculiar dynamic that you think could have facilitated or enabled the doctors’ spouse to interfere in their work place, please describe it below.
24. In your opinion, what effect or outcome did the spouse’s involvement have on the doctor’s workplace?
Mark only one oval.
Resolution of conflict
Tension at the workplace or complication of the situation
Do not know
None
Other
25. If you selected “Others” in the previous question (Q17) on “Was there any workplace effect or outcome of the doctors’ spouse involvement from a personal point of view” please describe it below.
26. From an institutional point of view or other colleagues’ point of view, what effect or outcome did the spouse’s involvement have on the doctor’s workplace?
Mark only one oval.
Welcomed with resolution of the issue
Unwelcomed with no effect
Complicated the situation and increased tension
Avoidance of collegue and exclusion from responsibilities
Others
27. If you selected “Others” in the previous question (Q18), on “From an institutional point of view or other colleagues’ point of view, what effect or outcome did the spouse’s involvement have on the doctor’s workplace?” Please describe it below