Do “your angels” weep? Level up of job satisfaction among nurses

INTRODUCTION

Remember the last time you were admitted in a hospital? The air around the hospital is not something anyone would want to savour for long, yet amidst all the grey clouds, there are the nurses with their healing smile who nurse you back to health and you leave with a relieved heart. But the vague thoughts remain; her experiences in her profession?, Are the nurses with their healing smile and caring heart truly satisfied with their job?

Satisfaction is defined by how employees feel about their jobs and different aspects of their jobs.¹ Job satisfaction is one of the important variables in work and organizational psychology, is regarded as an indicator of working-life quality and is a crucial variable used to determine the quality of health-care systems.² Many studies have shown that job satisfaction can be influenced by a wide variety of factors such as salary, work environment, promotion etc.³ Thus, "a satisfied worker is more likely to be creative, flexible, innovative, and loyal”.⁴ The job satisfaction of health-care workers have a positive association with patients' satisfaction and contributes a great deal to the continuity of care.⁵ On the other hand, job dissatisfaction has a negative impact on the structure and work flow of organizations.⁶

Nurses are at more risk than other working groups due to more communication with patients, long and rotating work shifts, and the resulting exhaustion.⁷ Improving the psychological conditions of the workplace and paying attention to these factors can prevent many difficulties and increase the employees' health.⁸

Job satisfaction depicts the difference in the individuals’ expectation and the experience he actually gets from the job.⁹ Life satisfaction and job satisfaction are inter related to each other.¹⁰ Job satisfaction of the employees are crucial in an organization’s success.¹¹ Nurses plays a pivotal role in patient care and hence the job satisfaction will affect the quality of patient care. A topic of such importance needs to be addressed more rigorously in the current health care scenario where burnouts are quite common and the mental health of the health care workers are often ignored. This study intends to evaluate the job satisfaction among health care workers and to identify factors that contribute to their professional satisfaction in a tertiary care teaching hospital. The results of this study hopes to lay the foundation for future studies and discussion on the topic which can be the basis for interventions to improve the work experience in the health care community.

METHODS

This hospital based cross sectional study was conducted to assess the job satisfaction and the factors influencing job satisfaction among nursing officers employed at hospitals in Alappuzha district. The Minnesota job satisfaction scale was used to assess the job satisfaction and the data was collected using Google forms during October-November 2022.

The sample size was calculated by taking the mean score of job satisfaction among nurses as 62.94±14.24 and was estimated using the statistical formula:

n = Z_1-α/2²SD/d².

The prevalence for sample size calculation was taken from a similar study conducted by Abadi et al.¹² aimed to explore the relationship between several work-related risk factors and job satisfaction in Iranian nurses. The calculated sample size was 51 with an alpha error of 5% and absolute precision of 4 and the final sample size was fixed to be 63. The study variables included sociodemographic variables like age, sex, institution, years of experience and Minnesota job satisfaction questionnaire was used to assess job satisfaction. The nature of the study was explained and consent was obtained from the study participants. Privacy and confidentiality of all information collected were maintained throughout the study.

Minnesota job satisfaction questionnaire has 20 items which are used to score job satisfaction. Level of satisfaction is measured using a Likert scale ranging from 1 to 5 of which 1 is very dissatisfied, 2 is dissatisfied, 3 is indifferent, 4 is satisfied and 5 is very satisfied. For categorization, if the sum of the responses of different items is divided by the total number of items is 1.0-2.0, the respondent was classified as dissatisfied. If the respondent's average score is 2.01-3.0, then the respondent’s level of job satisfaction was classified as indifferent and if the average is 3.01-5.00, respondent was classified as satisfied.

Data was entered in Microsoft excel and analysed using SPSS trial version 26 software. All qualitative variables were expressed as frequencies and percentages and quantitative variables as mean with standard deviation. The statistical significance of association between various factors and the level of job satisfaction was tested using the Pearson chi-square test for qualitative variables and a p value less than 0.05 was considered as statistically significant.

RESULTS

The mean age of study participants was 36.06±6.17 years and ranged between 23 and 51 years and all of them were working as nursing officers and 54 (87.3%) were permanent employees. Mean years of experience of the study participants was 8.5±5.7 years. Majority 26 (41.27%) of them were posted in inpatient wards, 15.9%, in operation theatres, 15.9% in ICU and 11.1% in casualty and 15.9% in other areas like dialysis unit and palliative care (Table 1).

Majority of them 26 (41.27%) said that they never experienced assault or abuse in their work place but 21 (33.3%) were dissatisfied with their duty affecting sleep time. Almost half of them 31 (49.2%) felt that they are being over worked and 28 (44.4%) of the study participants were found to be dissatisfied with the amount of time they spent with their family. Majority of them 27 (42.86%) felt that their pay was not sufficient to meet the financial needs in a month (Table 2).

Minnesota job satisfaction questionnaire was used to assess job satisfaction among nurses and 46 (73.02%) of the study participants were satisfied, 27% were neutral and none of them were dissatisfied. Mean of total job satisfaction score was 3.34±0.52 with range between 2.25 and 4.45.

Around 35 (55.5%) of them were satisfied with the ability to keep them busy all the time at their work, 27 (42.86%) were not satisfied with the independence provided at their job and 30 (47.6%) 25% were satisfied with the variety in their job. About 39 (61.9%) of the study participants were satisfied with the social status provided by their job. Almost three fourth of them 45 (71.4%) were satisfied with their supervisor’s human relationship with them. More than half of the study participants 39 (61.9%) were satisfied with job security provided at their work.

Majority 52 (82.52%) were satisfied with the chance to do things for other people at work. Around 25 (39.7%) were satisfied with the institutional practices and policies at their work. Only 20 (31.7%) of the study participants were satisfied with the pay provided for them. Of all study participants, 22 (34.9%) were dissatisfied with the working conditions at the work. About 45 (71.4%) of the study participants were satisfied with other co-workers at work. More than half of the study participants 34 (53.97%) were satisfied with the recognition they get from their work (Table 3).

Bi variable analysis was done to find the factors associated with job satisfaction of nurses (Table 4). The outcome variable was job satisfaction, whether satisfied or not. Having time to spend with family, sufficient sleep during work, not being overworked, not faced any assault at work and able to meet financial needs of the family were found to be associated with job satisfaction with significant p value (Table 4).

^a Fisher’s exact test.

DISCUSSION

Job satisfaction is an important part of a nurse’s life that can significantly have an effect on patient care, performance, productivity and commitment to the job as well as the organisation. Satisfaction of the patient depends on the satisfaction of the care provider. This study aimed to understand the job satisfaction of nurses and some of the factors associated with job satisfaction of nurses. The study was conducted among 63 nurses from Alappuzha district majority of the participants from Government T. D. Medical College of Alappuzha and it was found that 73% of the nurses in Alappuzha were satisfied with their job and 27% were having neutral level of satisfaction towards their job. These results were similar to a study conducted among 100 nurses in the tertiary care hospital in Maharashtra by Mohit et al where 75.3% were highly satisfied with their job.¹³

When comparing the results of another study done among 152 randomly recruited Palestinian nurses by Abushaikha et al. It was found that job satisfaction and burnout are the problems in the area of human service.¹⁴ Most of the study participants showed moderate job satisfaction (84.2 %). It was also found that participants had low satisfaction level in compensation (59.2%), company policies and practices (28.9%) and advancement (41.4%) domains. Moderate level of job satisfaction with authority (85.5%) and responsibility (78.3%). Whereas in our study, the participants are dissatisfied with independence (42.9%) and compensation provided by the organisation for their work (46%).

The results of a cross sectional study done by Hind AI-Haroon et al among 337 nurses showed that 48% were satisfied and only 22% of them were dissatisfied with their jobs.¹⁵ The participants were satisfied with intrinsic and extrinsic factors of the job. The study also showed that job satisfaction is related to demographic factors like age, sex and nationality. Older age, male participants and participants belonging to Saudi have higher level of job satisfaction. Whereas in our study, job satisfaction is not related to demographic factors like age, working sector, designation, years of experience and currently posted department. Instead, it was found that job satisfaction was significantly associated with factors like assault in work place, sleep satisfaction, perceived over working and pay.

In a study conducted using a modified version of the Minnesota job satisfaction questionnaire in 500 nurses in 9 Ministry of Health hospitals in Riyadh, Kingdom of Saudi Arabia showed that there were no difference in overall job satisfaction according to the income which is inconsistent with the results in our study where a significant association was found. Also, job satisfaction is positively correlated with years of experience in the above study, whereas in our study , no significant association was found between job satisfaction and years of experience.¹⁶

From our study, a significant association was found between job satisfaction and salary, this result is consistent with the result of a previous study conducted by Kinzl et al on anesthetists.² The study also pointed out that the factors which showed highest levels of satisfaction included the freedom to choose one’s method of working, and the amount of responsibility, which is similar to the results obtained from our study. Dissatisfaction with one’s salary seems to be a common issues as it is evident from various other studies.^17,18

In a web-based survey of marital quality and job satisfaction among Chinese nurses by Yan-Qiong Ouyang et al showed that monthly income and time spend with family were positively associated with job satisfaction , a similar result was obtained from our study.¹⁹

In a study conducted among Australian nurses and midwives by Dorrian et al, no significant association was found between sleep quality and job satisfaction this is in contrast with our study, where a significant association was found.²⁰

Results from a study conducted in Slovenian hospitals by Lorber et al showed that the lowest levels of satisfaction were shown for pay level, amount of praise and level of trust, involvement in the decision-making process, concern for employees’ well-being, opportunities for promotion, and leadership, and the highest were shown for satisfaction with the job and with coworkers.¹¹ Similar results were obtained by Sveinsdottir et al, who showed that nurses were most satisfied with their coworkers and head nurses, and least satisfied with their opportunities for promotion and pay level.²¹ These results align with the findings of our study where the majority of the participants showed satisfaction in their relation with coworkers and when it comes to income per month a significant association was found with job satisfaction.

The findings from our study shows that 33.3% of the participants have faced assault or abuse at work, establishing a dedicated and trained security force at hospitals to prevent the assault against health care workers, special training to nurses to manage such adverse condition like self-defense training and equipping them with self defense gadgets may be beneficial.

Around 36% of the participants were dissatisfied with their sleep duration and 60% of the participants were dissatisfied with the amount of time spent with their family. The authorities should take measures to avoid staff shortage, by proper reporting of vacancies and hiring new workers to fill in the gap, and there should be an organized system to assign shifts and manage the working hours of the nurses.

Only one-third of the study participants were satisfied with their working conditions (34.9%), responsibility (36.5%), advancement (34.9%), institutional policies and practices (39.7%), moral values (42.9%). 42.8% of the participants were dissatisfied with independence and 46% were dissatisfied with compensation. The nurses should have a say in decisions that affect their work. An elected representative of the nurses must be made a part of the body that takes decision regarding new hospital policies, promotions and rules that affect their work. The scenarios of over burden of responsibility, due to staff shortage, can be minimised by proper filling of vacancies and employing competent supervisors. The nurses should be rigorously trained and repeatedly reminded of holding on to their moral values, this can be done by modifying the academic curriculum by emphasising the importance of moral principles in health care and conducting a mandatory moral and ethical principle workshop for healthcare workers at institution levels. Regarding the working conditions, it can be improved by creating a safe environment for the nurses to work, this in turn can be achieved by improving the safety measures at work place, setting up an internal committee, with the authority to take action, to address the problems faced by nurses at work place. To address the mental stress, peer-support sessions, service of psychological counsellors should be made available to staff and the nurses should get ample time for themselves to address their mental health needs, which is crucial for their mental well being and such a situation can be possible only if there is the availability of sufficient work force, which in turn can be addressed by measures suggested earlier.

CONCLUSION

Job satisfaction is a key factor that promotes an organisation’s success and it is determined by one’s expectations at work and the actual experience of the job. Low levels of satisfaction with independence at work and compensation provided at job can be intimated to the stakeholders to improve the performance of the staff. High levels of satisfaction with responsibility, career advancement, working conditions, institutional policies and practices as seen in this study can go a long way in sustaining happiness and well-being at workplace.

ACKNOWLEDGEMENTS

We would like to thank Mr. Sujithraj U. Mallan, Mr. Prabhu Balakrishna, Ms. Mariya Antony, Mr. Karthik Dev M., Mr. Roshan Das G., Dr. Amritha, Mr. Melwin Pauly, Mr. Daniel C. J., Mr. Adith Krishna P. K., Dr. Meenu Sara John, Mr. Abhijit, Dr. Rejani P. P., Dr. Nisha S. Author would like to thank Department of Community Medicine and the Nurses union of Government TD Medical College Hospital.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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