|Year : 2019 | Volume
| Issue : 3 | Page : 167-181
Nurses' job satisfaction: A multi-center study
Khalid Abdullah Aljohani
Department of Community Health Nursing, Nursing College, Taibah University, Madinah, Saudi Arabia
|Date of Web Publication||9-Dec-2019|
Dr. Khalid Abdullah Aljohani
Nursing College, Taibah University, Madinah
Source of Support: None, Conflict of Interest: None
Introduction: Nurses, including expatriates, comprise the majority of Saudi health-care providers. Therefore, the need to measure their satisfaction within the Saudi context is critical for improving patient outcomes and productivity within the health-care system. This study aims to measure nurse job satisfaction in several Ministry of Health (MOH) and Saudi Arabian organizations. Materials and Methods: A multi-center, cross-sectional study design was utilized to recruit nurses from public hospitals and primary health-care centers in five cities across Saudi Arabia. Data were collected from October 1 to November 15, 2016, through an electronic questionnaire. The study instrument was adapted from former MOH surveys. Descriptive and analytical analyses were utilized. Results: A total of 2418 nurses responded with a response rate of 69%. Overall satisfaction level was low to moderate. Only a small portion of the participants demonstrated overall satisfaction in all domains, and living conditions were significantly low. Predictors of satisfaction were studied based on location and job title. Conclusions: The study revealed a low-to-moderate level of job satisfaction with a need to improve nurses' living conditions. Comparisons among the study locations revealed areas in need of improvement. Further studies are needed to explore methods through which to enact these improvements.
Keywords: Job satisfaction, nursing, Saudi Arabia, work environment
|How to cite this article:|
Aljohani KA. Nurses' job satisfaction: A multi-center study. Saudi J Health Sci 2019;8:167-81
| Introduction|| |
According to the Ministry of Health (MOH) in Saudi Arabia, there are 95,379 nurses, representing 58% of the workforce in the Saudi public health-care system. Improvements in systematic processes or outcomes cannot be achieved without addressing nurses' concerns as a key aspect of driving change and creating improvements. Numerous studies identified job satisfaction as the main predictor of better performance among nurses.,,,, In addition, the job satisfaction of nurses was recently linked to a lower risk of mortality.,
In Saudi Arabia, nurses' job satisfaction has been investigated in different settings.,, Earlier studies on nurse satisfaction in Saudi Arabia were mainly undertaken in one geographic location,, and used translated or modified international data collection instruments., However, the nursing context in Saudi Arabia is unique because nurses live in MOH accommodations. Therefore, living conditions may be a major factor that has not been previously explored and that may contribute to nurses' satisfaction or negatively affect their performance. The aim of the current study is to measure nurses' satisfaction in five Saudi Arabian cities. Nurse satisfaction instruments will focus on specific domains, including living conditions, work environment, professional growth, financial benefits, safety, and holidays.
| Materials and Methods|| |
A cross-sectional study design was utilized to explore nurse satisfaction in five Saudi cities. Criteria for the selected study locations included Saudi regions with a large geographical catchment that may contribute to higher participation rates and the increased cooperation of nursing and research authorities. Therefore, regions around Madinah were selected. The total nurse populations were 6385, 7114, 4935, 7150, and 5738 in the cities of Makkah, Jeddah, Taif, Madinah, and Buraidah, respectively. Calculating the sample size as clusters using 95% confidence interval with a margin of error of 5%, the sample sizes were 363, 365, 357, 365, and 361 for Makkah, Jeddah, Taif, Madinah, and Buraidah, respectively. The total sample size was 1811 participants. To overcome potential challenges regarding participant response rate, the study's invitation letter and an electronic version of the study questionnaire was sent to 3000 nurses. Samples were identified using regional nursing administration resources in each study location. The criteria for inclusion were nurses who work at MOH facilities and who are currently working in clinical practices. Due to organizational and cultural differences between MOH, tertiary, and private healthcare organizations, part-time and private sector nurses were excluded. Part-time nurses may have contaminated the study sample because they may have worked in tertiary healthcare organizations at the time of their part-time job at the MOH. Ethical approval to undertake this study was given by the Madinah health directorate (No. 20160125). Participation in the study was voluntary; therefore, responding to the study questionnaire was accepted as consent to the participant. No names or identifiable data were collected. Data were collected from October 1 to November 15, 2016.
The study instrument was adapted from earlier MOH surveys used internally by different health-care organizations. The main domains of those surveys were identified to construct the study instrument. Content validity was assured by a panel of four expert nurse managers. A pilot study with 37 participants revealed acceptable reliability and the validity of the instrument. Based on the current study, the repeated Cronbach's alpha for the entire main scale was 0.83. The study instrument consisted of two sections, which were sociodemographic characteristics and the main nursing satisfaction scale. The main section included five subscales: living condition (seven items), professional growth (10 items), work environment (six items), financial benefits (three items), flexible holidays (three items), organized entertainment activities (two items), and interdisciplinary teamwork (two items). Participants responded to these questions using a three-point Likert scale ranging from 1 (dissatisfied), 2 (average), and 3 (satisfied).
Data collection processes began by sending the study package to participate in nursing administration departments. The packages included information on the study, a poster, and an electronic link. These departments then sent the packages to their nursing staff through E-mail. The link directed potential participants to the study's electronic questionnaire within the researcher's account on the Monkey Survey website. Participants were asked to open the link to participate and respond to the questionnaire with an estimated total response time of 7–10 min. Statistical analyses were performed using the SPSS, version 20.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistics were utilized to describe participants' characteristics in terms of frequency and percentage. In addition, ordinal regression analyses were utilized to identify predictive variables.
| Results|| |
A total of 2418 nurses responded to the electronic questionnaire, resulting in a response rate of 69%. The numbers of the study participants from Buraidah, Madinah, Taif, Jeddah, and Makkah were 39.8%, 28.7%, 15.6%, 10.7%, and 5.2%, respectively. The majority were MOH employees (1795; 74.3%), whereas the rest were under a Hospital Operation Program contract. Women made up 75.2% of the sample (1,818), and Saudi nationals represented 62.9% (1520) [Table 1]. Around 70% of the sample population worked in specialized areas, including critical care, emergency, and kidney units.
The overall satisfaction score revealed that 12.7% of participants were satisfied [Table 2]. More importantly, satisfaction with living conditions was supported by only 33 respondents (1.3%). Nurses who are Saudi nationals do not live in MOH accommodations; therefore, the percentages for the subscales of living conditions and organized entertainment activities are limited to non-Saudi participants. Professional growth was the highest-ranked subscale for nonsatisfied respondents (46.3%). It is difficult to provide results for subscale items, and hence, more detailed data will be provided as online materials for interested researchers.
[Table 3] shows the predictive variables for the ordinal regression model. Only three domains were included in the equation: working environment, compensation and benefits, and organizational development. The other satisfaction dimensions included in the ordinal logistic regression model had no statistically significant effect. [Table 3] displays the factors that contributed to satisfaction in terms of working environment and conditions. Residence in Madinah (P = 0.042) and a role as a charge nurse (P = 0.001) were both variables that significantly improved the model/prediction. However, the model explained 15.8% of the variance in the working environment and correctly classified 78.2% of the cases. More specifically, those in Madinah were 1.97 times more likely to be satisfied than those in Taif, and charge nurses were 0.301 times less likely to be satisfied.
For financial benefits, staff nurses (P = 0.016), charge nurses (P = 0.032), those with a nursing diploma (P = 0.048), associate nurses (P = 0.12), and Saudi nationals (P = 0.005) added significantly to the model/prediction and explained 6.8% of the variance. Staff nurses and charge nurses were 0.663 and 0.644 times, respectively, less satisfied when compared to supervisors. Meanwhile, those who had earned a diploma or an associate degree were 2.56 and 3.35 times, respectively, more satisfied than those who had earned a postgraduate degree. Finally, organizational development as a contributing factor for satisfaction showed that Makkah (P = 0.013), Qassim (P = 0.003), hospitals (P = 0.020), staff nurses (P = 0.002), and Saudi nationals (P = 0.017) added significantly to the model/prediction (33.4%), which helped to correctly classify 83.2% of cases. Those in Makkah were 15.96 times more likely to be satisfied than those in Taif. Nurses in Qassim were 4.44 times more satisfied when compared to those in Taif. Furthermore, nurses in hospitals were 6.82 times more likely to be satisfied. Staff nurses were 0.235 times less likely to be satisfied, while Saudi nurses were 0.278 times less likely to be satisfied than non-Saudi nurses.
| Discussion|| |
The current study collected data from 2418 nurses, which is a larger sample size than those used by previous studies., Sample characteristics in this study were similar to previous studies in terms of marital status and high proportions of female participants.,, In general, the sample characteristics were similar to earlier studies performed in Saudi Arabia.
The job satisfaction of international nurses is a driving force for stability in any health-care system. In Saudi Arabia, satisfaction with living conditions for expatriate nurses may have greater importance due to cultural differences. In addition, Saudi healthcare organizations (especially governmental ones) provide nurses with accommodations enclosed within their workplace facilities. Therefore, including nurses' living conditions and accommodations in the current study contributes to an address of nurses' needs. The current study was undertaken in metropolitan areas where accommodation conditions and services tend to be more sophisticated than those in remote areas. In other words, in this study, nurses' job satisfaction with respect to MOH accommodations is expected to be higher than that of nurses living in remote accommodations where logistical services are expected to be minimal.
The study included 856 participants (35.4%) living in MOH accommodations. Interestingly, only 8.3% of the participants were satisfied with the general condition of these accommodations, which raises concerns about their quality despite the MOH's initiatives to improve them. In addition, food services are provided by private companies, which costs the MOH a significant amount and are added to hospitals' expenditures. This study's results show minimal nurse satisfaction with food variety, quality, and quantity, indicating that the MOH food suppliers' services are inefficient. More importantly, the low percentages of satisfied nurses may raise questions, such as are nurses involved in or consulted about their food services? How effective are MOH monitoring programs? This study recommends involving nurses in evaluations of their accommodations in terms of direct or logistical services.
The results of the current study support the findings of earlier studies that argued poor accommodations were one of the causes of turnover among expatriate nurses. To improve this, one strategy involves expanding the scope of the house matrons' responsibilities. In general, house matrons are nurses assigned to manage accommodations, which includes providing supportive services to temporary nurses. Nurses who work as matrons do not receive professional training in hospitality and are mainly dependent on their own experience to manage day-to-day activities. Furthermore, they do not deal with administrative issues. For example, they may report dysfunctional household appliances to general housing directors, but they do not have the authority to directly follow-up with the designated parties to fix the issue. Therefore, this study recommends providing professional hospitality training for current house matrons.
Years ago, nurses would stay in their accommodations most of the time except for going to work or scheduled entertainment activities. However, regulations have changed, and nurses are no longer required to stay in their accommodations. Following official approval for safety reasons, they can stay out for days. In addition, they are offered official shopping outings and visits to tourist spots. In some cases, nursing shortages may limit a nurse's ability to participate in these activities or stay in these accommodations. In the current study, nurses' job satisfaction with respect to entertainment, accommodation cleanliness, and general living conditions were 3.7%, 8.3%, and 6.5%, respectively. There was no evidence that a gym or other entertainment activities were available in the study locations. The researcher suggests that future studies utilize qualitative approaches to explore nurses' experiences living in MOH accommodations.
Working environment is a cornerstone of nurses' job satisfaction, and it is a core subscale examined in nursing satisfaction literature.,, A positive work environment and magnet organizations encourage nurses to implement care based on their full scope of practice and qualifications, which, in turn, makes nurses the backbone of any restructuring or improvements made in a health system. Satisfaction with interdisciplinary teamwork regarding physician collaboration and ability to discuss patients' needs was lower than expected. However, the major cause of work environment dissatisfaction was a lack of both adequate staff and medical supplies. A large proportion of the study participants felt that they did not have enough time to perform nursing duties. A lack of staff and sufficient time to perform duties may lead to increased coping efforts, in which nurses extend their work hours or take irregular days off. Exposing nurses to such work environments may lead to chronic fatigue, poor physical performance, and ineffective communication.
Nurses' work environments are susceptible to violence, which falls under the definition of occupational health and safety hazards for workplace violence. Internationally, 45% of nurses have experienced some sort of violence. Therefore, nurses' need for effective security services is crucial, especially considering that expatriate nurses may not speak the national language and may be more susceptible to miscommunications with patients and their family members. There were a small proportion of nurses who were dissatisfied with security services, which may indicate the degree to which nurses are exposed to workplace violence and their need for institutional support. However, this topic needs further exploration in future studies.
Participants' satisfaction with their professional growth opportunities was lower than earlier national studies estimated it to be (46%–60%)., This could be the result of a lack of adequate staff, which may reduce in-service education attendance. However, nurses' professional growth may require a more sophisticated exploration in future studies.
Financial incentives did not have any significant influence on long-term job satisfaction. In the current study, satisfaction with financial incentives was only 21%. This percentage is similar to earlier studies in which satisfaction ranged from 22% to 52%., In general, nurses sign a contract that includes a financial package before they proceed with the employment. Therefore, nurses have clear expectations of their financial compensation. However, dissatisfaction could be a result of the expanding nursing market in which nurses are highly needed in the USA, Australia, and Europe and are being offered competitive financial advantages. MOH decision-makers are encouraged to explore future options in terms of increasing financial packages and identifying alternative nurses' workforce sources including the Saudization of nursing profession.
In accordance with a study among critical care nurses, the current study showed that charge nurses and staff nurses were overall dissatisfied with their compensation packages and benefits. This is likely because nurses receive similar compensation as nonclinical allied professionals, such as hospital administrative staff. In light of the extensive work they perform and the contributions they make, nurses often feel that their work is not properly rewarded, which may contribute to diminishing their job satisfaction. Therefore, this study recommends MOH intervention to manage potential consequences, such as increased nurse turnover.
Regarding the study's limitations, the cross-sectional design does not support the identification of a causal relationship. More importantly, the study sample does not represent all Saudi Arabian regions; therefore, the generalizability of the study outcomes is limited.
| Conclusions|| |
This study revealed a low-to-moderate level of job satisfaction among nurses, which highlights the need for further systemic MOH initiatives to improve various satisfaction-related domains. This study's measurements of nurses' job satisfaction revealed a significant need to improve nurses' accommodations and develop international standards that enhance their living conditions. Policy and decision-makers within the MOH should consider nurses' satisfaction to be a key performance indicator. Monitoring such an indicator may decrease the turnover rate of MOH nurses and lower workforce expenses. Furthermore, allowing nurses to evaluate the services they receive, including accommodation logistics and nutritional services, may increase MOH logistic services outcomes and enhance contracting efficiency. Further studies are encouraged to explore nurses' living conditions, especially in remote areas.
The researcher would like to thank all participants for their time and inputs. Special thanks to charge nurses, nursing directors, and regional nursing directors for their support.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]