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  • v.53(3); 2012 Jun

Job satisfaction of nurses and identifying factors of job satisfaction in Slovenian Hospitals

Mateja lorber.

1 University of Maribor, Faculty of Health Sciences, Maribor, Slovenia

Brigita Skela Savič

2 Dean of College of Nursing Jesenice, Faculty of Management Koper, University of Primorska, Koper, Slovenia

Associated Data

To determine the level of job satisfaction of nursing professionals in Slovenian hospitals and factors influencing job satisfaction in nursing.

The study included 4 hospitals selected from the hospital list comprising 26 hospitals in Slovenia. The employees of these hospitals represent 29.8% and 509 employees included in the study represent 6% of all employees in nursing in Slovenian hospitals. One structured survey questionnaire was administered to the leaders and the other to employees, both consisting 154 items evaluated on a 5 point Likert-type scale. We examined the correlation between independent variables (age, number of years of employment, behavior of leaders, personal characteristics of leaders, and managerial competencies of leaders) and the dependent variable (job satisfaction – satisfaction with the work, coworkers, management, pay, etc) by applying correlation analysis and multivariate regression analysis. In addition, factor analysis was used to establish characteristic components of the variables measured.

We found a medium level of job satisfaction in both leaders (3.49 ± 0.5) and employees (3.19 ± 0.6), however, there was a significant difference between their estimates ( t  = 3.237; P  = <0.001). Job satisfaction was explained by age ( P  < 0.05; β = 0.091), years of employment ( P  < 0.05; β = 0.193), personal characteristics of leaders ( P  < 0.001; β = 0.158), and managerial competencies of leaders ( P  < 0.000; β = 0.634) in 46% of cases. The factor analysis yielded four factors explaining 64% of the total job satisfaction variance.

Satisfied employees play a crucial role in an organization’s success, so health care organizations must be aware of the importance of employees’ job satisfaction. It is recommended to monitor employees’ job satisfaction levels on an annual basis.

Job satisfaction is determined by a comparison of one’s prior expectations about the job and the actual experience of the job ( 1 ). It has been found that job satisfaction relates to beliefs and emotions that individuals have about their work and their job ( 2 ). It has been described as an attitude with an affective and cognitive component ( 3 ). When establishing the level of job satisfaction, we should focus on how employees feel about their work and personal relationships in the workplace, and on how leaders influence employees’ satisfaction. Without a doubt, satisfied employees are the ultimate goal of every leader. On the other hand, the goal of every employee is to find the kind of work that matches their abilities and interests as closely as possible, enables them success, and provides them with opportunities for promotion. Satisfied employees tend to be more productive and committed to their employers, and a direct correlation has been shown between staff satisfaction and patient satisfaction in health care organizations ( 4 , 5 ).

Even though research has shown different levels of job satisfaction for nurses, satisfaction predictors tend to be relatively similar, and include working conditions, relationships with coworkers and leaders, pay, promotion, security of employment, responsibility, and working hours ( 2 , 6 - 16 ). In Slovenia, no studies on the effects of leadership style, personality characteristics, and managerial competencies of leaders on job satisfaction have been conducted. There was only some research about leadership style in health care institutions ( 17 - 19 ). Also organizational climate and organizational culture in nursing have been studied as well as job satisfaction in some institutions ( 20 - 24 ). Experts in Slovenia ( 17 , 18 , 25 - 27 ) point to the problem of lack of knowledge of leaders about leadership.

Because it affects not only quality of nursing but also patients’ satisfaction, the level of employees’ job satisfaction is very important for health care institutions. The aim of the study was to determine the level of job satisfaction of employees in nursing and to determine the influence of leadership in job satisfaction.

Sample and study design

Study took place in 2009 in 4 major Slovenian hospitals – University Clinical Center Maribor, General Hospital Celje, General Hospital Slovenj Gradec, and General hospital Murska Sobota. Five major Slovenian hospitals have been selected from the hospital list, but 1 refused to participate. Employees in the 4 participating hospitals represented 29.8% of employees in nursing in all Slovenian hospitals. The questionnaires (web-extra material) (web extra material 1) were distributed in the morning shift, by authors in one hospital and by research coordinators in other 3 hospitals. There were 750 questionnaires distributed, which amounts to 26.8% of 2802 employees in nursing in Slovenian hospitals that participated in the study and 8% of 9404 employees in nursing in all Slovenian hospitals. Hundred and ten questionnaires were sent to middle- and unit-level nurse leaders and 640 to other nursing employees. Nurse leaders were not selected randomly; the questionnaires were sent only to those who occupied the position of head of department, unit, or clinic, which means that purposive sampling was used. The maximum time for filling out the questionnaires was 14 days. Questionnaires were collected in specially designed boxes to ensure anonymity. Five hundred and nine questionnaires were correctly and completely filled out and the response rate was 68%. This sample represented 6% of all employees in nursing in Slovenian hospitals. The 4 hospitals had provided a written permission for research.

On the list of the Institute of Public Health of Republic of Slovenia, there are 26 hospitals. In the study in 2009 we wanted to include 5 (20%) of the 26 hospitals, so we asked every fifth hospital to participate and one of them refused. The other four hospitals employed 29.8% of all employees in nursing in Slovenian hospitals. Seven hundred and fifty questionnaires were distributed in the morning shift. Hundred and ten questionnaires were sent to middle and unit-level nurse leaders and 640 were sent to other employees in nursing. To ensure anonymity, questionnaires’ were collected in specially designed boxes. The response rate was 68%, because 509 questionnaires were completely filled out. Before the research, we obtained a written permission from the participating hospitals. This manuscript is part of a larger research, which has in part already been published ( 28 ).

Instruments

Two survey questionnaires with 154 closed-type items each were used, one for leaders and one for other employees in nursing. The questionnaires were prepared based on the literature on modern leadership and managerial competencies of nursing leaders and in cooperation with the O.K. Consulting (company for education and research of employees in all areas), and had been tested in a pilot study (10 leaders and 30 employees). Leaders self-assessed their leadership style, managerial competencies, and characteristics on a 5-point Likert-type scale ranging from 1 (strongly disagree) to 5 (strongly agree). Employees assessed the leadership style, managerial competencies, and characteristics of their immediate superior on a 5-point Likert-type scale ranging from 1 (strongly disagree) to 5 (strongly agree). The first part of the questionnaire included demographic data: sex, age, institution, years of employment, years of employment in a leading position, and the level of education.

In the study we used two questionnaires, one for leaders and one for other employees in nursing. The questionnaires were prepared in the cooperation with the O.K. Consulting (Company for education and research of employees) and also based on the literature on leadership and job satisfaction. We used 5-point Likert-type scale ranging from 1 to 5, with 1 meaning strongly disagree and 5 meaning strongly agree ( 29 ). Leaders evaluated themselves, while other employees evaluated their immediate superior. Both, leaders and employees evaluated their own level of job satisfaction.

The first part of the questionnaire included demographic data: sex, age, institution, years of employment, years of employment in the leading position, and the level of education. The second part of questionnaire was prepared after an overview of relevant literature on modern leadership and managerial competencies of nursing leaders ( 15 , 30 - 33 ). This part of the questionnaire contains items on managerial competencies and leadership style. Cronbach α was 0.798. In the third part of questionnaire, nursing leaders and nurses indicated their job satisfaction levels, which reflected the relevant theoretical background in the field ( 2 , 12 , 34 , 35 ). Cronbach α was 0.849.

Statistical analysis

The survey was based on quantitative methodology. For statistical analysis we used statistical program SPSS 16.0 (SPSS Inc., Chicago, IL, USA). Differences between individual variables were analyzed using the t test, while Person correlation was used to identify the relationship between the studied variables. We used factor analysis (principal component analysis) to establish characteristic of the studied variables. Job satisfaction levels among nursing professionals were determined with 20 questions and factor analysis (principal component analysis) was conducted to reduce the number of variables. In addition, the Kaiser-Meyer-Olkin test and Bartlett’s test were used to assess the appropriateness of using factor analysis and identify job satisfaction factors. For evaluation and examination of the screen chart, we continued to estimate with four factors. The value of Kaiser-Meyer-Olkin test statistics was 0.949, which shows the excellent suitability assessment. Multivariate regression analysis was used to determine the impact of studied independent variables on job satisfaction, and then the proportion of total variation for job satisfaction was explained with the selected independent variables.

The study included 96 nursing leaders and 413 other employees in nursing. There were 11 men and 498 women. Median age of leaders was 43.5 years (range 33-59) and of other employees 38 years (range 21-60). Leaders spend an average 10.1 years in the leading position, while other employees were employed in the participating hospital for average 16.5 years.

There were significant differences between leaders and employees in ten out of twenty questions on the level of job satisfaction ( Table 1 ). Nurse leaders had significantly higher satisfaction ( t  = 2.946; P  = 0.003) with the work (mean ± standard deviation, 4.27 ± 0.6), management of the organization (3.41±,0.9 t  = 2.854; P  = 0.004), their pay (2.93 ± 1.2, t  = 2.944; P  = 0.003), their status in the organization (3.56 ± 0.,9, t  = 3.981, P  < 0.001), their motivation for professional development (3.52 ± 0.8; t  = 3.131; P  = 0.002), the level of security and reliability of employment (3.94 ± 0.7; t  = 4.910; P  < 0.001), the assigned working hours (3.65 ± 0.8; t  = 3.108; P  = 0.002), and the ability to participate in the decision-making process (3.51 ± 0.6; t  = 3.949; P  < 0.001). Also, nurse leaders had significantly ( t  = 3.237; P  < 0.001) higher level of job satisfaction (3.49 ± 0.5) than nurses (3.29 ± 0.6).

Comparison of job satisfaction levels of leaders and employees in nursing

*Mean (on scale from 1 to 5).

Leaders and employees ranked ten most important factors influencing their job satisfaction and the most important factors were good workplace relationships, followed by pay, praise from the superiors, opportunities for promotion, education possibilities, superiors’ encouragement for work, good working conditions, work responsibility and professional challenges, work-connected freedom and independence, and more free time.

Correlation analysis of job satisfaction

Correlation analysis was conducted between job satisfaction of nursing leaders and nurses and their age, years of employment in nursing, type of job, level of education, personal characteristics of leaders (integrity, organization, team work, resoluteness, reliability, objectivity, responsibility, confidence, sociability, and ambition), leadership style, and managerial competencies of leaders (vision and goals, communication, conflict solving, motivation, interpersonal relations, team work, problem solving, social authority, delegation, decision making, controlling and introducing change, emotional intelligence, human resource development and quality). There was a slight positive correlation between job satisfaction of nurses and their level of education (r = 0.109; P  = 0.014), and a negative correlation between job satisfaction and the type of job (r = -0.127; P  = 0.004), which means that nurse leaders have higher job satisfaction than nurses, and that job satisfaction increases with the level of education. In addition, all examined managerial competencies of leaders (r = 0.626; P  < 0.001), leadership style (r = 0.514; P  < 0.001), and personal characteristics of leaders (r = 0.630; P  < 0.001) positively correlated with job satisfaction of nursing professionals ( Table 2 ).

Results of Pearson correlation analysis for job satisfaction

*Correlation is significant at the 0.01 level.

†Correlation is significant at the 0.05 level.

Factor analysis of job satisfaction

Assessment of job satisfaction was determined with twenty questions. We tried to reduce the number of variables with principal component analysis. The four factors extracted from the principal component analysis for job satisfaction explained 64% of job satisfaction variance ( Table 3 ). The first factor explained as much as 35% of the entire variance; the second factor explained 12%, the third factor 9%, and the fourth factor 8%. We decided to call the first factor motivation and concern for the welfare. In this factor, 9 items were ranked including both material and non-material motivation, with an emphasis on encouragement, praise, trust, control, punishment, and working conditions. The second factor was called leadership style. In this factor, 6 items were ranked including leaders, leadership style, decision making, and feedback. The third factor was called nurses’ professional development. In this factor, 3 items were ranked covering education opportunities, status in the organization, and development. The fourth factor was called cooperation and interpersonal relations. In this factor, 2 items were ranked including relationships with coworkers, leaders, and cooperation between nursing team members.

Rotated Factor Matrix for four factors of job satisfaction

Regression analysis of job satisfaction

Independent variables included age of respondents, years of employment at the current hospital, level of education, the readiness of leaders to organize seminars and courses, leadership style, personal characteristics of “good leaders,” and managerial competencies of leaders.

Job satisfaction for nurses in Slovenian hospitals was related to the age of respondents (β = 0.191; P  = 0.033), number of years they had worked at the current hospital (β = 0.193; P  = 0.033), selected personal characteristics of leaders (β = 0.158; P  < 0.001), and managerial competencies of leaders (β = 0.634; P  < 0.001). These predictors explained 45.7% of variance for the job satisfaction level of nurses ( Table 4 ).

Regression analysis results for job satisfaction (R 2  = 0.457)

*B = unstandardized coefficient.

†β = standardized multiple regression coefficient.

Of the factors included in the research, managerial competencies of leaders had the highest standardized regression coefficient (β = 0.634) and therefore influenced nurses’ job satisfaction most. Finally, we also used a regression equation to determine how selected factors influence the job satisfaction of nurses. The following regression model was made, based on regression analysis results:

Our research confirmed that job satisfaction of nurses in Slovenian hospitals was at a medium level. Golbasi et al also found a medium satisfaction level in Turkish hospitals ( 36 ). Nurses with a higher education have been shown to be more satisfied with their job than those with lower education ( 37 ). We found that nurse leaders were more satisfied with their job than other nurses. 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. Similar results were obtained by Sveinsdottir et al ( 38 ), who showed that nurses were most satisfied with their coworkers and head nurses, and least satisfied with their opportunities for promotion and pay level. For nursing professionals in Slovenian hospitals, pay level represented the second most important factor of job satisfaction. The pay dimension, which is not a function of organizational structure, was found to limit hospitals in improving nurses’ job satisfaction ( 39 ). The factor analysis for job satisfaction in our study yielded four factors, one of which, cooperation and interpersonal relations, explained 8% of the total variance. Nevertheless, respondents expressed a relatively low satisfaction level with personal relationships at their hospital and the leadership style of their immediate superior. Lu et al ( 2 ) identified a positive correlation between nurses’ job satisfaction and group cohesion at the workplace. The second factor in our study was leadership style, explaining 12% of total job satisfaction variance. Other studies reported that higher nurse job satisfaction was associated with leadership style focused on people and relationships ( 40 ), nurses’ autonomy, control over their practice and nursing leadership on the ward ( 41 ), and emotional intelligence of leaders ( 42 ). Lorber and Skela Savič ( 43 ) found that nurses in Slovenian hospitals wanted to be included in the decision-making process and in setting goals, while Skela Savič and Pagon ( 44 ) found that physicians and nurses estimated their level of personal involvement as low and indicated insufficient involvement in work teams. This means that Slovenian hospitals are not taking full advantage of the intellectual capital and experience of their employees.

Four factors extracted from the factor analysis (motivation, leadership style, professional development, and interpersonal relations) explained 64% of the total job satisfaction variance. Another study ( 34 ) also obtained four factors (collegial workplace, behavior, relational atmosphere, and outcomes of conflict), which explained 68% of total job satisfaction variance. Ning et al ( 45 ), Al-Almeri ( 4 ), and Skela Savič et al ( 20 ) found that nurses who viewed the working environment as empowering were more likely to provide high quality care, because satisfied employees perform better and are more productive. Enhancing empowerment in a supportive environment would allow nurses to experience satisfaction with their job. Kwak et al ( 46 ) also found that management and managerial support had a pronounced effect on nurses’ job satisfaction and the quality of care. Our research confirms that managerial competencies of leaders have the greatest effect on employees’ job satisfaction, explaining as much as 39% of total job satisfaction variance.

Like Sellgren et al ( 47 ), we also found that nurses’ job satisfaction correlated positively with leadership style, as well as managerial competencies and personal characteristics of leaders, which explained almost 46% of total job satisfaction variance for nurses. Blegen ( 11 ) and Al-Almeri ( 4 ) found that job satisfaction of hospital nurses correlated positively with organizational commitment, which explained 41% of variance in job satisfaction.

This study has several limitations. The research framework was based on theoretical findings dealing with leadership style, personal characteristics, managerial competencies of leaders, and the level of nurses’ job satisfaction, so we only studied the influence of some predictors of job satisfaction. The previously tested questionnaire was not used for this research; instead, we prepared most of the items ourselves and tested them before mailing out the questionnaires. The questions were closed-ended and respondents were asked to select one of the provided answers – the disadvantage of this system being a limited number of answers. The questionnaire, too, had certain limitations, such as a relatively long time required for its completion (over 15 minutes). Because the questionnaires were sent by mail and a researcher was not available in participating hospitals, respondents did not get any help in case they did not understand the items and no additional explanations were provided about the content or the manner of completion. Furthermore, the research included a sample of employees from only four Slovenian hospitals, so the data cannot be generalized to the whole population of Slovenian nurses working in hospitals. With constantly changing health system, hospitals will have to recognize the importance of employees’ job satisfaction. One of the key challenges for every organization is to maintain the satisfaction of employees and increase their motivation. This research should be conducted in all health institutions of Slovenia in the next few years; also it would be necessary to constantly monitor job satisfaction of all health care professionals.

Acknowledgments

Funding None.

Ethical approval All participating hospitals provided a written permissions for research.

Declaration of authorship ML is the author of the thesis on the basis of which this manuscript was created. BSS helped to write the manuscript.

Competing interests All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

Additional Material

  • Research article
  • Open access
  • Published: 15 October 2019

Understanding job satisfaction and motivation among nurses in public health facilities of Ethiopia: a cross-sectional study

  • Firew Ayalew 1 ,
  • Sharon Kibwana 2 ,
  • Shelemo Shawula 3 ,
  • Equlinet Misganaw 1 ,
  • Zeine Abosse 3 ,
  • Jos van Roosmalen 4 ,
  • Jelle Stekelenburg 5 , 6 ,
  • Young Mi Kim 2 ,
  • Mihereteab Teshome 1 &
  • Damtew Wolde Mariam 1  

BMC Nursing volume  18 , Article number:  46 ( 2019 ) Cite this article

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Poor job conditions and limited resources are reducing job satisfaction and motivation among nurses in low-income countries, which may affect the quality of services and attrition rates. The objective of this study was to examine job satisfaction, motivation and associated factors among nurses working in the public health facilities of Ethiopia, with the aim of improving performance and productivity in the health care system.

The study employed a cross-sectional two-stage cluster sampling design. From a random sample of 125 health facilities, 424 nurses were randomly selected for face-to-face interviews in all regions of Ethiopia. Nurses responded to questions about their overall job satisfaction and job conditions, including items related to intrinsic and extrinsic motivation, using a 5-point Likert scale. Multilevel analysis was performed to adjust for different clustering effects. Satisfaction levels (percent of respondents who were satisfied) were calculated for individual items, and composite mean scores (range: 1–5) were calculated for motivational factors. Adjusted odds ratios were computed to examine the association of these factors with overall job satisfaction.

Overall, 60.8% of nurses expressed satisfaction with their job. Composite mean scores for intrinsic and extrinsic motivational factors were 3.5 and 3.0, respectively. Job satisfaction levels were significantly higher for female nurses (65.6%, p  = 0.04), those older than 29 years (67.8%, p  = 0.048) and had over 10 years work experiences (68.8%, p  = 0.007). Satisfaction with remuneration (AOR = 2.04, 95% CI = 1.36, 3.06), recognition (AOR = 2.21; 95% CI = 1.38, 3.53), professional advancement (AOR = 1.54; 95% CI = 1.06, 2.29), features of the work itself (AOR = 1.65; 95% CI = 1.20, 2.91) and nurses’ work experiences from 5 to 10 years (AOR = 0.37, 95% CI = 0.17, 0.79) were significantly associated with overall job satisfaction after controlling for other predictors.

Conclusions

The study findings are signals for the Ministry of Health to strengthen the human resource management system and practices to improve nurses’ overall job satisfaction and motivation, especially among nurses with 5 to 10 years of experience on the job. Expanded recognition systems and opportunities for advancement are required to increase nurses’ job satisfaction and motivation. Equitable salary and fringe benefits are also needed to reduce their dissatisfaction with the job.

Peer Review reports

Ethiopia is the second most populous nation in Africa, with a life expectancy at birth of 65.5 years in 2016 [ 1 ]. The country has successfully scaled up multifaceted interventions in the health sector, expanded health science training institutions and universal health service coverage, and trained a massive health workforce as part of its efforts to achieve the Millennium Development Goals [ 2 ]. Remarkable achievements have been observed, including a 67% reduction in the under-five mortality rate (from 204 per 1000 live births in 1990 to 67 in 2016) [ 2 , 3 ] and a 70% reduction in the maternal mortality ratio (from 1400 per 100,000 live births in 1990 to 412 in 2016) [ 2 , 3 ]. Ethiopia has also made substantial progress in expanding the coverage of institutional delivery by skilled health providers from 5% in 2000 to 28% in 2016 [ 1 , 3 ]. However, this increase is very low compared with neighboring countries [ 1 ]. Morbidity and mortality due to malaria, HIV/AIDS, and tuberculosis have also declined [ 2 ].

Human resources are key elements for improving the performance of health care system. Sufficient numbers of competent and motivated health workers, and adequate resources and funding are important factors to achieve the national and international health related goals [ 4 ]. The Sustainable Development Goals (SDGs) call for countries to increase the aggregate density of physicians, nurses, and midwives to 4.45 per 1000 population to achieve health-related targets by 2030 [ 5 ]. Hence, the Federal Ministry of Health (FMoH) of Ethiopia launched a 2016–2025 strategic plan for human resources for health (HRH) to guide the country’s effort to develop, recruit, deploy, motivate and retain health workers [ 6 ]. Ethiopia succeeded in doubling the density of all categories of health professionals from 0.84 to 1.63 per 1000 population from 2010 to 2016; this figure is expected to rise to 3.0 per 1000 in 2025 [ 6 ].

The nursing workforce in Ethiopia plays an important role in providing direct primary health care in remote and rural areas, as well as high quality nursing care to patients in hospitals. Most nurses hold a diploma from a three-year program at a Technical and Vocational Education Training (TVET) institution. Other nurses hold bachelor’s and master’s degrees from a university; these programs require 4 years and 2 years of study, respectively. Nurses who graduated in diploma are eligible to continue the 4 years training program at university after they provide 2 years of services in clinical settings and successfully pass certificate of competence test. Similarly, nurses who graduated in bachelor’s degree can join the 2 years masters training program after they provide 2 years of services at health facility level and pass entrance examination. Nurses are the largest health provider cadre in Ethiopia, numbering 50,604 in 2016; their number is projected to reach 127,299 in 2025 [ 6 ]. Unpublished FMoH data show that currently, 92% of the nursing workforce in Ethiopia have diploma, 3% have bachelor’s degree and 5% have master’s degree. Hence the HRH projections show that Ethiopia will need to deploy an additional 24,558 bachelor-level and 344 masters-level nurses at primary health care facilities and specialized hospitals by 2025 to meet the needs of the country’s growing population [ 6 ]. The nurse-to-population ratio was 1 per 2132 people in 2016; this is considerably less than the ratio of 1 nurse per 967 people found in the neighboring country of Kenya [ 7 ]. Maldistribution, low job satisfaction and motivation, and high attrition rates pose major challenges for nurses and other health workers to provide quality health care services in remote and rural areas of Ethiopia [ 2 ].

Two types of factors – related to intrinsic and extrinsic motivation – primarily drive overall job satisfaction. Intrinsic motivational factors include achievement, recognition for achievement, features of the work itself, responsibility and personal growth or advancement. Extrinsic motivational factors are related to the job’s context and include policies and administration, supervision, interpersonal relationships, working conditions, salary, status, security, and personal life [ 8 ]. Intrinsic motivational factors are more powerful than extrinsic motivational factors at increasing job satisfaction and improving performance [ 8 ]. In contrast, extrinsic motivational factors do not provide long-term job satisfaction, rather they prevent dissatisfaction or unhappiness on the job [ 8 ]. Various studies indicate that low job satisfaction and poor motivation are the leading causes of nurses’ attritions and turnover intentions [ 9 , 10 , 11 ].

A recent systematic reviews conducted globally noted that a range of factors are affecting nurses’ job satisfaction, motivation and retention. The reported diverse factors include: nurses’ empowerment at workplace, working conditions, living conditions, career development, pay and other financial and non-financial incentives [ 12 , 13 , 14 ]. Another review concluded that enhancing nurses’ job satisfaction, motivation and retention have positive impact on quality of health care services, improving nursing work environment and reduction of organizational costs related to recruitment and hiring of new nurses for replacement [ 15 ]. Previous studies have also shown that nurses’ socio-demographic characteristics (e.g. age, sex, education, experience) and workplace characteristics are associated with health workers’ job satisfaction and motivation [ 16 , 17 , 18 , 19 , 20 ].

Globally, there is no shortage of studies on nurses’ job satisfaction, motivation and retention; however, most studies are descriptive and focused on specific nurses’ job conditions at hospitals, mainly in high income countries [ 15 ]. The weaknesses of these studies limit their power to produce generalizable findings for making evidence-based decisions for nursing workforce in low income countries [ 15 ]. According to the World Health Organization (WHO), additional research is needed to understand existing health worker retention schemes and HRH gaps in low-income countries to guide evidence-based policies to achieve the SDGs and universal health coverage [ 5 , 21 ]. This is certainly the case in Ethiopia, where previous small-scale studies have focused on specific districts, have largely been limited to hospital settings, and have employed a small number of job-related items; they have found mixed results regarding nurses’ job satisfaction, motivation, and retention [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. Moreover, the FMoH has identified many national-level HRH evidence gaps, including for nurses’ job satisfaction, motivation and retention [ 2 , 6 ].

The objective of this study was to examine job satisfaction, motivation, and associated factors among nurses working in the public health facilities of Ethiopia, with the aim of improving performance and productivity in the health care system. The specific research questions were: 1) What is the overall level of job satisfaction among nurses in Ethiopia, and how are nurses’ characteristics and job conditions associated with overall job satisfaction? 2) What are nurses’ perceptions of specific job conditions, and do they vary by nurses’ characteristics?

Study design, setting and sampling

A cross-sectional two-stage cluster sampling design was used. First, a random sample of public health facilities in all 11 regions of the country was selected, and then nurses were randomly selected at each facility in the sample.

In 2013, 45,509 nurses were serving in 3372 public health facilities in Ethiopia, including 127 hospitals and 3245 health centers [ 30 , 31 ]. A nationally representative sample size was calculated with the assumptions of 95% level of statistical confidence, 50% job satisfaction level (which was set at this level because of the lack of any prior national-level estimates of job satisfaction), 5% margin of error, and a default value of design effect 1.2, where there was no estimate found on design effect [ 30 , 32 ]. This yielded a sample size of 500 nurses, after adjusting for a 10% non-response rate.

The HRH strategic plan indicated that there were a minimum of five nurses stationed at each public health facility during the study period [ 6 ]. Based on a MEASURE Evaluation recommendation regarding sampling of health care providers per facility [ 32 ], we decided to invite four nurses at each of 125 health facilities to participate in the study in order to achieve the total sample of 500 nurses. The four nurses were selected at random from all those assigned to the facility. If fewer than four nurses were found at a facility during the data collection period, additional nurses were selected at the next facility.

The 125 health facilities in the sample were allocated proportionally to facility type (9 hospitals and 116 health centers) to each region to obtain heterogeneous information and perform subgroup analysis. Using a list of all health facilities in the country obtained from the FMoH, we then randomly selected 116 health centers from a total of 3245 health centers and 9 hospitals from a total of 127 hospitals.

Data collection instruments

The study used a structured questionnaire that was developed by Management Sciences for Health, an international non-governmental organization, and piloted in Uganda [ 33 ]. The FMoH and study team members reviewed and adapted the questionnaire to fit the Ethiopian context. The questionnaire was adapted to include additional background information related to the Ethiopian health care system and nurse’s characteristics. For example, variables such as nurses’ years of service obligation under the compulsory health service scheme and their socio-demographic characteristics (including family size, marital status, and work experience) were included. The questionnaire contained sections on job satisfaction, motivation and intention to leave the job. We used the job satisfaction and motivation sections to understand the levels and associated factors of job satisfaction and motivation. These included 34 questions on job conditions, a global rating of job satisfaction (“Considering everything I am satisfied with my job”) and 13 questions on nurses’ socio-demographic characteristics and employment (e.g., sex, age, years of service, educational qualifications, type of facility, and region). A 5-point Likert scale was used to respond to all questions (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, and 5 = strongly agree). The questionnaire was translated from English into Amharic and piloted in one public hospital with 10 health workers, including nurses, to check for clarity and flow of the questions and to ensure that respondents understood the questions. Minor changes were made to the questionnaire after the pilot test.

Data collection procedures

Data were collected in June 2014. Data collectors and supervisors were health professionals who had experience in data collection. A total of 24 data collectors and 11 supervisors were trained for 3 days on ethics, interview techniques, and data quality. During visits to each health facility, data collectors explained the purpose of the study to the facility manager, asked for a list of all nurses at that facility, and randomly selected four nurses for face-to-face interviews. Data collectors obtained verbal consent from nurses after informing them about the nature of the study and that their participation was voluntary. Then they scheduled individual interviews to avoid disruption of patient care. Data collectors conducted interviews in a private room to maintain confidentiality of nurses’ responses and protect their identity (name and identification number). Supervisors checked completed questionnaires in the field to ensure data quality.

Data management and analysis

Data were cleaned and entered into Epi-Info 7, and then exported to STATA 14.1 for statistical analysis. Further data cleaning was performed by reviewing the results of frequencies and percentages to examine data inconsistencies, missing cases and outliers.

Multilevel analysis was used to account for variations in job satisfaction and job conditions among nurses and at the health facility level. Two level nested structures were employed. The first level (randomly selected nurses) was nested within the randomly selected health facilities. The second level explored variability between facilities in job satisfaction and job conditions reported by nurses.

Initially exploratory factor analysis was performed to examine patterns among the job condition items and created subscales, but the analysis did not show meaningful item classifications. We used alternative approaches to classify the job condition items into intrinsic and extrinsic motivational factors subscales, based on expert opinion and published articles [ 8 , 34 , 35 , 36 ]. Twelve items were classified as intrinsic motivational factors, and they were grouped into 3 subscales: recognition (3 items), professional development (3 items), and features of the work itself (6 items). The other 22 items were classified as extrinsic motivational factors, and they were grouped into 5 subscales: remuneration (3 items), supervision (4 items), interpersonal relationship (3 items), work conditions (8 items), and living conditions (4 items). We combined the scores of the 5-point Likert scale items for each subscale and computed composite mean scores, ranging from 1 to 5.

Cronbach’s Alpha coefficient and average correlation between items were calculated to assess the reliability of items for each subscale. The coefficient has an acceptable value of 0 to 1; 0.7 or higher is a benchmark for items’ internal consistency, but in empirical studies a value of 0.6 or above is acceptable [ 37 ].

The key outcome variable was overall job satisfaction. Nurses’ responses were coded into dichotomous levels – with 1 = satisfied (combining responses of strongly agree and agree) and 0 = not satisfied (combining responses of neutral, strongly disagree, and disagree) – in order to improve statistical power for performing group comparisons and statistical tests; and to contribute to meaningful interpretation and presentation of results. Each job condition item was similarly coded into 1 (satisfied) and 0 (not satisfied).

Chi-square tests were performed to examine whether differences in overall job satisfaction by nurses’ characteristics were statistically significant after accounting for clustering effects. The relationship between dichotomous predictors (each job condition item, coded as 1 = satisfied; 0 = not satisfied) and the outcome variable (overall job satisfaction, coded as 1 = satisfied; 0 = not satisfied) was assessed using Tetrachoric correlation coefficient (TCC), which shows strengths of degree of relationship between intrinsic and extrinsic motivation items with overall job satisfaction [ 38 ]. Thus TCC is an important indicator to guide policy makers to prioritize interventions in order to increase nurse’s job satisfaction in limited resource settings. Independent sample t-tests and ANOVA were used to examine associations between nurses’ characteristics (sex, educational qualifications, facility type, and work experience) and composite mean scores on the intrinsic and extrinsic motivation subscales.

Multilevel bivariate logistic regression models were fitted to investigate the independent contributions of predictors to the outcome (overall job satisfaction). First, the null model with the outcome variable but without predictors was fitted to calculate the Intraclass Correlation Coefficient (ICC). The ICC is an indication of the need for multilevel analysis and shows the degree of dependency within two randomly selected nurses belonging to the same health facility and thus sharing similar facility characteristics [ 39 , 40 ]. The ICC ranges from a minimum of 0 if there is no correlation among responses from the same facility, suggesting that clustering is irrelevant, to a maximum of 1 if all responses from the same facility are identical, suggesting that clustering is important. Research shows that ICC generally does not exceed 0.20 for cross-sectional studies [ 40 ].

Multilevel multivariable logistic regression models were then fitted with combinations of nurses’ characteristics (sex, age, service years, educational qualification and type of health facility) and intrinsic and extrinsic motivation subscales to assess their independent effects on overall job satisfaction while controlling for other variables. Multicollinearity among predictors was checked before fitting the final model. Candidate predictors from the bivariate model were included in the multivariable model if their p value ≤0.25. Adjusted odds ratios (AORs) with 95% confidence intervals were performed. A p -value < 0.05 and 95% confidence intervals were considered for statistical significant.

Scale reliability and variation

Results of exploratory data analysis show that the Cronbach alpha coefficient for all job conditions was 0.89, with an average inter-item correlation of 0.20. Intrinsic and extrinsic motivational factors had Cronbach alpha coefficients of 0.80 and 0.84, respectively, suggesting that the measurement tools were internally consistent (Table 1 ).

The ICC values indicate that 22% of the total variation in responses to intrinsic motivational items reflected differences between facilities, while 78% reflected differences between nurses within facilities. Clustering by facility accounted for slightly more of the total variation in responses to extrinsic motivational items (29%) (Table 1 ).

Ethical considerations

Ethical approval was obtained from the Johns Hopkins School of Public Health Institutional Review Board (JHSPH IRB) (reference number 0005303), which met the criteria for exemption under 45 CFR 46.101(b), Category (5). In Ethiopia, we did not ask the National Research Ethics Review Committee (NRERC) to obtain ethical approval/waiver for the following two reasons: a) This study had no significant risks on study participants as approved by JHSPH IRB; b) NRERC is primarily focused on providing ethical decisions for clinical trials involving new drugs, experimental research and studies that require human biological specimens/samples. Instead of NRERC ethical approval, the human resources for health experts at FMoH reviewed the study protocol and granted permission to conduct the study. Verbal consent was obtained from each study participant as approved by JHSPH IRB. All study participants were received information on the study objectives and recruitment process. To protect participants from risks, the study did not record participants’ names, identification numbers and names of health facilities where he or she worked. Data collector interviewed study participant in a private room without disrupting patient care and other health service activities. After completing interview, data collectors put questionnaires in a sealed envelope to keep all answers confidential to anyone at the sample health facility or any other health facility. Data were also entered in a computer with unique random generated ID numbers given for each study participant.

Characteristics of study participants and level of job satisfaction

Of the 424 nurses who participated in the study, 390 worked at health centers and 34 at hospitals. Over half of respondents (52.8%) were female, 43.9% were between 25 to 29 years of age, and 61.8% had less than 5 years of work experience. A large majority (91.9%) of nurses worked at health centers, and 86.6% held a diploma. Overall, 60.8% (95% CI = 56.0, 65.5%) of nurses said they were satisfied with their jobs. A greater proportion of female than male nurses expressed satisfaction with their current jobs (65.6% [95% CI = 59.0, 71.8%] versus 55.5% [95% CI = 48.3, 62.5%], p  = 0.04). Job satisfaction levels were significantly higher for nurses older than 29 years (67.8% [95% CI = 56.7, 77.3%], p  = 0.048) and those with more than 10 years of work experience (68.8% [95% CI = 55.7, 80.1%], p  = 0.007) (Table 2 ).

Satisfaction with items related to intrinsic motivation

The proportion of nurses who were satisfied with job conditions related to intrinsic motivation was highest for community recognition (93%), features of the work itself (ranging from 60.9 to 77.9%), and access to coaching and mentoring (62%). The proportion was lowest for the availability of opportunities for promotion (28.3%) and receiving needed training (39.6%). There was no significant difference in satisfaction by facility type except for work load (61.8% for hospitals and 78.5% for health centers; p  < 0.05). Every item was associated with overall job satisfaction, but the strongest relationships were for “I feel that the organization values my work” (TCC = 0.51) and “I received recognition for doing good work” (TCC = 0.56) (Table 3 ).

Satisfaction with items related to extrinsic motivation

The proportion of nurses who were satisfied was extremely low for all items related to remuneration (ranging from 11.6 to 28.6%), moderate for supervision items (54.7 to 68.6%) and consistently high for items related to interpersonal relationships (78.3 to 97.2%). There were significant differences by facility type for fairness of salary compared to other staff, development of work plan with supervisor, and access to electricity and water. Most items were associated with overall job satisfaction; the strongest relationships were for “My supervisor applies personal policies and practices fairly to me” (TCC = 0.55) and “My salary package is fair” (TCC = 0.60). (Table 4 ).

Relationship between motivational subscales and nurses’ characteristics

Composite mean scores for intrinsic and extrinsic motivational factors were 3.5 and 3.0, respectively. Mean scores on intrinsic motivational subscales ranged from 2.9 (opportunities for development to 3.7 (features of the work itself). Mean scores on extrinsic motivational subscales ranged from 2.1 (for remuneration) to 4.4 (for interpersonal relationships) (Table 5 ).

Composite scores for both intrinsic and extrinsic motivational factors were significantly higher for female than male nurses. Female nurses also expressed significantly higher satisfaction with opportunities for development (3.0), features of the work itself (3.8) and work conditions (3.0). The score for remuneration was significantly lower for nurses with 5 to 10 years of service (1.9) than for either less experienced or more experienced colleagues (2.2 and 2.1, respectively). Nurses who worked at hospitals were more satisfied with working and living conditions than nurses who worked at health centers (Table 5 ).

Predictors of overall job satisfaction

In the bivariate analysis, all intrinsic and extrinsic motivational factors were associated with overall job satisfaction, as were nurse’s age and years of service. In the multivariable model, years of service remained significant along with four motivational factors. After controlling for other variables, nurses with 5 to 10 years of experience were less likely to be satisfied with their job than nurses with fewer years of experience (AOR = 0.37, 95% CI = 0.17, 0.79). Nurses were more likely to be satisfied with their job if they expressed greater satisfaction with remuneration (AOR = 2.04, 95% CI = 1.36, 3.06), recognition (AOR = 2.21; 95% CI = 1.38, 3.53), professional development (AOR = 1.54; 95% CI = 1.06, 2.29), and features of the work itself (AOR = 1.65; 95% CI = 1.20, 2.91) (Table 6 ).

This study found lower job satisfaction and motivation levels among nurses than previous research conducted in low- and middle-income countries, including studies in Nigeria [ 16 ], Slovenia [ 17 ], Cyprus [ 18 ], Ghana [ 19 ], Papua New Guinea [ 20 ] and one zone of Ethiopia [ 22 ]. There is a compelling need for policy makers to devise and institutionalize mechanisms to improve job satisfaction among public sector nurses in Ethiopia, based on the predictors of job satisfaction identified in this study.

Nurses with 5 to 10 years of service were less likely to be satisfied with their jobs than nurses with either less or more experience, which is consistent with previous studies in Slovenia [ 17 ], Cyprus [ 18 ] and South Africa [ 41 ]. One possible explanation is that nurses in Ethiopia – who are required to provide compulsory service for up to 5 years after graduation – may have higher expectations regarding pay, benefits, and continuing professional development once their compulsory service period is over; thus, they are likely to be dissatisfied if these expectations are not met. This should be a consideration for policy makers to design retention strategies for nurses; there should be an emphasis on satisfying and motivating nurses who complete their compulsory service.

The literature shows that recognition, professional advancement, and features of the work itself enhance motivation, job satisfaction, and retention among health workers in low- and middle-income countries [ 13 , 14 , 15 , 22 , 36 , 41 , 42 , 43 ]. This study confirms that these three intrinsic motivational factors are strong predictors of overall job satisfaction. In this study, nurses’ perceptions of organizational recognition were much less positive than their perceptions of community recognition. This suggests that creating mechanisms for facilities, supervisors, and colleagues to recognize nurses who perform well would be an inexpensive, yet effective way to increase job satisfaction and motivation; and improving health system performance [ 4 , 43 , 44 ]. Similarly, nurses’ perceptions of opportunities for training and promotion were more negative than their perceptions of onsite coaching and mentoring, suggesting that policy makers could improve motivation by expanding limited opportunities for training and creating pathways for promotion.

Remuneration (including salary and fringe benefits) was the only extrinsic motivational factor associated with overall job satisfaction and it received a very low score, suggesting that the salary and benefits package is an important source of dissatisfaction for nurses. This is consistent with the literature [ 15 , 16 , 20 , 26 , 41 , 45 , 46 , 47 , 48 , 49 ]. WHO [ 50 ] has concluded that low salaries may discourage people from entering health care professions and lead to dissatisfaction and poor motivation among existing health workers. In January 2017, the Ethiopian government increased salary for all public servants, including health care professionals, which may help address this critical issue. However, managers in the health sector, including facility managers, must ensure that salary increases are appropriately distributed and uniformly applied, given the perceived lack of fairness around salary. To address these perceptions, policy makers and health managers should also review and revisit human resource management (HRM) policies and improve awareness about pay scales and benefits across health workers with similar responsibilities.

Facility type was not a significant predictor of job satisfaction, but nurses’ perceptions of working and living conditions were significantly worse at health centers than hospitals, likely because health centers often lack essential supplies and equipment and are located in areas with limited access to good schooling for children, electricity, and clean water [ 2 ]. Given that most public sector nurses in Ethiopia are posted at health centers, policy makers should make an extra effort to provide a conducive work environment at health centers, including essential supplies and equipment, in order to satisfy, motivate and retain nurses in the public health care system.

WHO has recommended implementing a bundle of human resources management policies to improve health worker motivation, satisfaction, retention, and performance, which, in turn, may help health systems attain high and effective service coverage. Recommended policies provide for: job security, manageable workload, supportive supervision, opportunities for continuing education and professional development, enhanced career development pathways, incentives (e.g., hardship, housing, and education allowances), adequate facilities and working supplies, and improved occupational health and safety [ 5 , 15 , 16 , 21 , 51 ]. The International Council of Nurses [ 51 ] also suggests that remuneration alone (basic salary plus incentives) is not sufficient to retain, satisfy, and motivate health professionals. It must be combined with fair, equitable and transparent non-financial rewards like recognition for achievements, career and professional development and workload management.

Human resource management structure, capacity and practices are weak in Ethiopia, which contributes to low satisfaction, poor motivation, poor working conditions and high intention to leave the job [ 2 , 6 , 30 , 52 ]. The FMoH is trying to address mechanisms within its five-year (2016–2020) health sector transformation plan and ten year (2016–2025) HRH strategic plan to improve health care professionals’ including nurses’ motivation, satisfaction and performance [ 2 , 6 ]. Therefore, our findings guide the FMoH to provide holistic HRM interventions for attracting new graduates and retaining existing nursing staff to serve in primary health care units especially in remote and rural areas.

Strengths and limitations

We believe this study to be the first nationally representative investigation of nurses’ job satisfaction and motivation in Ethiopia’s public health facilities. The study employed a multilevel analysis to obtain precise estimates after adjusting for clustering effects. Thus, the study has power to generalize findings to the country and can be applied in low and middle-income countries to develop human resources for health retention strategy, including the nursing workforce. Although we did not triangulate with qualitative findings, we feel the data are comprehensive and sufficient to understand the situation with regard to nurses’ job satisfaction and motivation in the country. There are some limitations related to the sampling. The final sample size of 424 was less than expected 500 nurses, despite the provision made for a 10% non-response rate. Lack of evidence on study tool reliability and validity was also a limitation.

Contributions of the study findings to the local and global nursing communities

The study highlighted the national level of nurses’ job satisfaction and motivation; and its associated factors for the low income country-Ethiopia. The study findings inform the Ethiopian Ministry of Health, regional health bureaus, Ethiopian Nursing Association and other stakeholders who invest in the Ethiopian health sector to plan appropriate interventions that promote nurse retention within the public health sectors. The findings can also help other low and middle income countries to design appropriate nursing workforce retention strategy, especially for increasing availablity and competent nursing professionals to meet the aggregate density of 4.45 doctors, nurses and midwives per 1000 population by 2030 [ 5 ]. Our study will also provide unique contributions to the existing body of literature on nurses’ job satisfaction and motivation globally for the following reasons: a) the study used standard and rigorous research methods; employed a large sample size and was designed meticulously to provide credible nationally representative information for Ethiopia. It includes randomly selected hospitals and health centers located in rural and remote areas as well as urban areas. The study represents findings of a low income country where national studies of this scale are rarely conducted, thus adding a new perspective with precise estimates on nurses’ job satisfaction and motivation to the global literature could be helpful; b) we analyzed a combination of intrinsic and extrinsic motivational factors instead of specific job items in order to explore potential factors that associated with nurses’ job satisfaction. We believe that investigating all job conditions using established theory may guide policy makers and researchers to enhance nurses’ job satisfaction and motivation; and ultimately contributes to enhance nurses’ performance in nursing care quality; c) many studies (e.g. [ 9 , 16 , 22 , 23 , 41 ]) on this topic used conventional statistical analysis. However, we employed multilevel analysis to account for clustering effects in order to maximize the precision of estimates for making appropriate policies to increasing nurses’ job satisfaction and motivation. Others (students, researchers or policy makers) may learn from our analytical approaches for performing similar studies of job satisfaction and motivation; or similar health-related problems.

The study findings are signals for the FMoH and Regional Health Bureaus to strengthen the human resource management system and practices to improve nurses’ overall job satisfaction and motivation, especially among nurses with 5–10 years of experience on the job. Expanded recognition systems and opportunities for advancement are needed to increase nurses’ motivation and job satisfaction, while equitable and transparent salary and benefits packages are also needed to reduce their dissatisfaction with the job. The findings may serve as a benchmark for the government’s 10-year HRH strategic plan and to evaluate the effectiveness of various HRM interventions to be implemented from 2016 to 2025. Moreover, the study contributes to low- income countries to enhance performance of nurses and improving quality in nursing care. We recommend conducting a mixture of quantitative and qualitative research to explore reasons for low satisfaction related to remuneration, work conditions and living conditions for three groups of nurses: male nurses, nurses working in health centers, and nurses with 5 to 10 years of working experience.

Availability of data and materials

The questionnaires and datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Adjusted Odds Ratio

Crude Odds Ratio,

Federal Ministry of Health

Human Resources for Health

Human Resources Management

Intraclass correlation coefficient

Johns Hopkins School of Public Health Institutional Review Board

National Research Ethics Review Committee

Sustainable Development Goal

Southern Nations Nationalities and Peoples

Tetrachoric correlation coefficient

technical and vocational education and training

United States Agency for International Development

World Health Organization

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Acknowledgements

We acknowledge the Federal Ministry of Health of Ethiopia for reviewing the study design and giving permission to conduct the study and the United States Agency for International Development (USAID) for providing financial support to conduct the study. We are also grateful to Adrienne Kols for her critical review and editorial support of the manuscript. Finally, we would like to acknowledge the study participants, the data collectors and supervisors.

STROBE statement

We adhered to the STROBE (STrengthening the Reporting of OBservational Studies in Epidemiology) guideline to develop the manuscript.

This study was made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the Cooperative Agreement AID-663-A-12-00008. The contents are the responsibility of authors and do not necessarily reflect the views of USAID or the United States Government. USAID provided support in the form of salaries for authors, but did not have any additional role in the study design, data collection and analysis, interpretation of the data, or preparation of the manuscript. Respondents did not receive financial incentives for their participation in the study.

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Athena Institute, VU University, Amsterdam, the Netherlands

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Contributions

FA developed the study design, managed the data collection including provision of ethical issues and study participant recruitment process, performed the data analysis, interpreted the data, and wrote the manuscript. SK, SS, ZA, YM, EM, MT and DWM contributed to the development of study design and helped with interpretation of the data, wrote the manuscript. JS and JvR contributed to interpretation of the data, wrote the manuscript and critical review of the manuscript before submission. All authors read and approved the final manuscript.

Authors’ information

FA: MSc, MA, Monitoring, Evaluation and Research Director, Jhpiego Ethiopia. SK: MPH, project manager, Jhpiego USA. SS: MD, MPH, Senior HRM technical advisor, MSH Ethiopia. EM: MPH, Education and training advisor, Jhpiego Ethiopia. ZA: MPH, HRM advisor, MSH Ethiopia. JS: Professor, Department of Obstetrics and Gynecology, Leeuwarden Medical Centre and Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, the Netherlands. YMK: EdD, Senior Research and Evaluation Associate, Jhpiego USA. MT: MSN, MBA, team leader, Jhpiego Ethiopia. DWM: MD, MSc, Chief of Party, Jhpiego Ethiopia. JvR: Professor, Athena Institute, VU University Amsterdam, the Netherlands.

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Correspondence to Firew Ayalew .

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Ethical approval was obtained from the Johns Hopkins School of Public Health Institutional Review Board (JHSPH IRB) (reference number 0005303), which met the criteria for exemption under 45 CFR 46.101(b), Category (5). In Ethiopia, we did not ask the National Research Ethics Review Committee (NRERC) to obtain ethical approval/waiver for the following two reasons: a) This study had no significant risks on study participants as approved by JHSPH IRB; b) NRERC is primarily focused on providing ethical decisions for clinical trials involving new drugs, experimental research and studies that require human biological specimens/samples. Instead of NRERC ethical approval, the human resources for health experts at FMoH reviewed the study protocol and granted permission to conduct the study. In addition, the FMoH wrote support letter to all eleven regional health bureaus to collaborate with study team members during data collection period. In reference to the FMoH support letter, all regional health bureaus sent permission letters to health facility managers to facilitate data collection activities.

Verbal consent was obtained from each study participant as approved by JHSPH IRB. All study participants were received information on the study objectives and recruitment process. To protect participants from risks, the study did not record participants’ names, identification numbers and names of health facilities where he or she worked. Data collector interviewed study participant in a private room without disrupting patient care and other health service activities. After completing interview, data collectors put questionnaires in a sealed envelope to keep all answers confidential to anyone at the sample health facility or any other health facility. Data were also entered in a computer with unique random generated ID numbers given for each study participant.

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Ayalew, F., Kibwana, S., Shawula, S. et al. Understanding job satisfaction and motivation among nurses in public health facilities of Ethiopia: a cross-sectional study. BMC Nurs 18 , 46 (2019). https://doi.org/10.1186/s12912-019-0373-8

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Happiness, quality of working life, and job satisfaction among nurses working in emergency departments in Iran

  • Somayeh Javanmardnejad 1 ,
  • Razieh Bandari 2 ,
  • Majideh Heravi-Karimooi 3 ,
  • Nahid Rejeh 3 ,
  • Hamid Sharif Nia 4 &
  • Ali Montazeri 5 , 6  

Health and Quality of Life Outcomes volume  19 , Article number:  112 ( 2021 ) Cite this article

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Nurses have a vital role in the healthcare system. One of the basic steps to increase their happiness is to recognize factors such as job satisfaction and quality of working life. Therefore, the goal of the present study was to examine the relationship between happiness and quality of working life and job satisfaction among nursing personnel.

This descriptive study was carried out on 270 hospital nurses who worked in emergency departments in Iran. Nurses were recruited through the census method. Data collection instruments included the Oxford Happiness Inventory (OHI), the Quality of Work Life Questionnaire (QWL), and the Job Satisfaction Questionnaire (JSQ). Data were explored using descriptive statistics, and stepwise multiple linear regression analysis.

The mean age of participants was 30.1 ± 6.26 years. The mean happiness score was 38.5 ± 16.22, the mean Quality of Working Life (QWL) score was 84.3 ± 17.62, and the mean job satisfaction score was found to be 45.5 ± 13.57); corresponding to moderate levels of attributes. The results obtained from the ordinary least-square (OLS) regression indicated that happiness significantly was associated with economic status and satisfaction with closure (R 2 : 0.38).

Overall the current study found that nurses who work in emergency departments did not feel happy. Additionally, the findings suggest that their happiness were associated with their economic status, and closure over their duties.

Happiness is a positive feeling that is vital and significant to maintain health [ 1 ]. Even though the pursuit of happiness is as old as human history, research on the concept of happiness is relatively new [ 2 ]. Happiness is of great importance to all professions, particularly the nursing profession [ 3 ] because nurses are in direct and constant contact with patients and clients whose unique conditions require nurses to be altruistic, self-confident, dedicated, creative, kind, and energetic. All of these attributes are directly linked with happiness [ 4 ]. On the other hand, daily exposure to patients' pain and suffering, heavy workload, and poor working conditions impose high levels of occupational stress for nurses [ 5 ]. Occupational stress, in turn, undermines nurses' self-confidence and concentration, increases their irritability, brings them to sleep disorders and job burnout, and thereby, negatively affects their happiness and care quality [ 5 , 6 ].

Nurses’ happiness becomes important because happiness or unhappiness may affect nurses’ abilities to help patients [ 3 ]. Because nurses have responsibilities to holistically care for sick, wounded, traumatized, and weak patients in their charge, they may be prone to experience negative feelings while performing their work [ 7 , 8 ]. In addition, nurses often work in difficult circumstances, which include patient-related problems, heavy and intense workloads, staff shortages, an aging nursing workforce, ineffective policies that support nurses in administrative systems, inadequate supervisor support, unfair pay, poor working conditions, lack of resources and equipment to work effectively, limited career opportunities, limited educational opportunities, and unstable work environments. These difficult circumstances can have a daily impact on nurses’ emotional well-being and their ability to provide care [ 3 ].

Factors that influence happiness among nurses include positive and negative emotions, life satisfaction, personal and work-related dynamics. Of these, it has been shown that physical health status and the reasons behind entering nursing, friendly relationships, satisfaction with salary, workload, quality of life, the amount of clinical work experience, satisfaction with staff number in each shift, satisfaction with patients' and family members' feedbacks, satisfaction with the conduct and the performance of physicians, satisfaction with the conduct and the performance of colleagues, satisfaction with the conduct and the performance of the head-nurse, satisfaction with the conduct and the performance of hospital nursing office authorities, satisfaction with welfare facilities at workplace and job satisfaction are essential [ 3 , 9 , 10 ].

Because healthcare systems are among the largest service providers in the society [ 11 ], the improvement of the quality of working life of nursing personnel is an important factor in ensuring stability in the healthcare system. [ 12 ]. An optimum level of quality of working life enables nurses to provide high-quality services to patients, and this is only possible if they have proper good mental health, job satisfaction, and satisfaction with different areas of life. Therefore, the quality of life of a nurse both as a human being and as a person who takes care of other members of the society warrants special attention [ 13 ].

A good level of quality of working life for nurses is realized when they can satisfy their needs through working in the healthcare system and at the same time be able to achieve organizational objectives [ 14 ]. The quality of working life not only affects job satisfaction, but also influences other aspects of life, including family, and social relationships [ 15 ]. Therefore, it is argued that job satisfaction is a very important part of a nurse’s life, that influences her or his level of performance, early retirement, job transfers, organizational commitment, and also patient safety, and most importantly patient satisfaction [ 16 ]. Job satisfaction is an essential predictor of absence from work, occupational burnout, quitting the nursing profession, or intention to do so among nurses [ 17 ]. One of the essential steps in increasing productivity is to understand factors that are involved in job satisfaction, quality of life, and happiness of the nurses [ 18 ].

The emergency department is considered the heart of a hospital and has an essential status in the medical system due to the importance of early, high-quality, and effective care and because of the complex processes occurring in it. Emergency department nurses are faced with various problems that can affect their quality of working life, job satisfaction, and happiness. The present study aimed to explore the association between quality of working life and job satisfaction with happiness among emergency department nurses in Iran.

This was a cross-sectional study conducted among emergency department nurses in hospitals affiliated to Ilam University of Medical Sciences, Ilam, Iran, in 2018. The study aimed to investigate happiness, quality of working life, and job satisfaction.

Participants

All nurses working in emergency departments from all hospitals (n = 10) formed the study sample. However, the following inclusion and exclusion criteria were considered:

Inclusion criteria: at least have 6 months of experience working in an emergency department, and willingness to participate in the study. Exclusion criteria: working in other departments, and not willing to participate in the study.

The main investigator (SJ) attended all emergency departments on several occasions so that all nurses working in different shifts. The data collection was carried out at the beginning, middle, and end of each shift The data were collected using a number of self-reported questionnaires. Additionally, the demographic characteristics of participants including age, gender, marital status, employment status, work experience, monthly salary, and work shifts also were recorded. Incomplete questionnaires were excluded from the analysis.

The Oxford happiness inventory (OHI)

It contains 29 items and seven subscales, satisfaction with life, efficacy, sociability/empathy, positive outlook, well-being, cheerfulness, and self-esteem. Each item is rated on a 4-point scale ranging from 0 to 3 (‘I do not feel happy’ to ‘I am incredibly happy’). The total score ranges from 0 to 87 with a higher score indicating greater happiness [ 19 , 20 , 21 ]. The validity and reliability of the Persian OHI were verified in previous studies and its Cronbach's alpha was reported to be 0.98 [ 22 ].

The quality of work life questionnaire (QWL)

It has 35 items covering eight subscales: adequate and fair compensation (four items), safe and healthy working conditions (six items), the opportunity to use and develop human capacities (five items), opportunity to growth and security (four items), social integration in the work organization (four items), the constitution in the work organization (four items), work and total life span (three items), and social relevance of work life (five items) [ 23 ]. The items are rated on a five-point Likert-scale ranging from 1 (very dissatisfied) to 5 (very satisfied). The score on the QWL ranges from 175 (highest) to 35 (lowest) [ 24 ]. Walton reported reliability of 0.88 for the questionnaire. In Iran, acceptable values for Cronbach’s alpha were reported (ranging from 0.83 to 0.91) [ 25 ].

The job satisfaction questionnaire (JSQ)

It contains 14 items are rated on a Likert-scale from 1 (strongly disagree) to 5 (strongly agree). The JSQ contains four subscales that include satisfaction with information, satisfaction with variety, satisfaction with closure, and satisfaction with pay. A higher total score indicates the member has higher job satisfaction. Sample items in JSQ are as follows: I am satisfied with the information I receive from my superior about my job performance (satisfaction with information), I am satisfied with the variety of activities my job offer (satisfaction with variety), I am satisfied with the opportunities my job gives me to complete the tasks from beginning to end (satisfaction with closure; the opportunity to complete working tasks), and I am satisfied with the pay I receive for my job (satisfaction with pay). [ 26 ]. The JSQ has been validated in Iran and Cronbach’s alpha value of 0.85 for the questionnaire was reported [ 27 ]. In the present study, the reliability of the JSQ was assessed using the Cronbach’s alpha to make sure about its reliability. We found an alpha value of 0.92 that indicated good reliability for the questionnaire .

Statistical analysis

Data analyses were carried out using the SPSS software (v. 16.0) (SPSS Inc., Chicago, Illinois). The Kolmogorov–Smirnov test was used for normality assessment. Then, data analysis was performed in two steps. In the first step, descriptive statistics including frequency, mean, and standard deviation were used to explore the data. We also performed a correlation between happiness and all other variables to assess if a significant correlation exists. Consequently, in the second step, ordinary least square linear regression analysis was used to assess the relationship between happiness (dependent variable) and independent variables. In addition, collinearity diagnostics were reported. As such, we assumed if tolerance was between 0 to 1 and variance inflation factors (VIF) for each independent variable was less than 10 there were no concerns for multicollinearity [ 28 ]. All significant findings from correlation analyses were entered into the regression model. The level of significance in all analyses was set at less than 0.05.

Characteristics of the study sample

In all, there were 285 nurses working in emergency departments. Of these, 270 nurses agreed to participate in the study giving a response rate of 95%. The remaining 15 nurses were excluded based on exclusion criteria. The mean age of participants was 30.12 ± 6.26 years and the mean work experience of nurses was 1.23 ± 0.51 years. The majority of participants were female (57.4%), 50.4% were married, and 84.8% had a bachelor degree. In addition, 76.7% worked in rotating shifts (Table 1 ).

Happiness, quality of work life and job satisfaction: descriptive findings

The mean happiness score was 38.5 (SD = 16.22) and this for the Quality of Working Life (QWL) was 84.3 (SD = 17.62). In addition, the mean score for job satisfaction was found to be 45.5 (SD = 13.57). Overall the findings showed a moderate level of happiness, quality of working life, and job satisfaction for the study sample. The detailed results are presented in Table 2 .

Happiness, quality of work life and job satisfaction: correlations

The correlation between happiness, demographic information, quality of work life, and job satisfaction are presented in Tables 3 , 4 , 5 , respectively. The findings showed that economic status, the Quality of Working Life (QWL) subscales, and the Job Satisfaction Questionnaire (JSQ) subscales were significantly correlated with overall happiness (P < 0.05).

Determinants of happiness

The results obtained from linear regression indicated that only economic status (B = 0.129, 95% CI = 0.435–8.584, P = 0.030) and ‘satisfaction with closure’ (B = 0.21, 95% CI = 0.29–2.07, P = 0.009) were significant contributing factors to happiness among nurses working in emergency departments (R 2  = 0.38). Assumptions for multicollinearity were examined because of the combination of variables. The tolerance in the regression equation was less than 1.00, and the VIF in the final model was less than 2.50; thus, the assumptions for multicollinearity were not violated. The results are shown in Table 6 .

The findings indicated that overall nurses working in emergency departments felt a moderate level of happiness. Similarly, studies from Iran reported a moderate level of happiness among nursing students [ 29 , 30 , 31 ] or among hospital nurses [ 32 ].

However, there are also studies that reported Iranian nurses who worked in hospitals had low happiness [ 33 , 34 ], confirming that hospital nurses have low to moderate happiness probably due to negative feelings they experience during patient care delivery, difficult work conditions, high workload, ineffective managerial policies, limited managerial support, unfair payments, equipment shortage, and limited career advancement opportunities [ 9 ].

Happiness is considered as the personal perspective about a favorable and pleasant state [ 2 ]. Individuals with more pleasant feelings are more satisfied with their job. In fact, happy individuals evaluate their skills and abilities very positively and remember positive events more frequently than negative ones. Therefore, they exchange positive energy with others and their environment, improve their relationships with them, and therefore, feel more satisfied with their job, colleagues, and workplace.

The findings also showed that the nurses did not have an optimum level of quality of working life. Nevertheless, similar findings were reported from Iran where studies found the low quality of working life for nurses [ 35 , 36 ] suggesting that there might be the need to make some changes in a current health care environment [ 16 , 37 ].

Job satisfaction is considered to be an important part of nursing since it directly or indirectly could affect patients’ care. We found that the study participants had a low level of job satisfaction. Not surprisingly similar findings were reported by other investigators from Iran [ 38 , 39 , 40 , 41 ] which we believe should be taken as a serious issue by health authorities. It is argued that job dissatisfaction usually occurs when there are problems with incivility at the individual, collective and organizational levels and might differ in West and East [ 42 ].

The study results indicated a significant correlation between the quality of working life and happiness whereas some other studies found no significant relationship between quality of working life and happiness but found a positive correlation between the quality of working life and job satisfaction, indicating that improvement in the quality of working life could have a positive impact on the overall job satisfaction [ 43 ]. However, we found that there is a significant association between job satisfaction and happiness indicating that the more happiness, the more job satisfaction [ 34 , 44 ].

The results obtained showed that among independent variables that were entered into regression analysis only economic status, and ‘satisfaction with closure’ were the predictors of nurses' happiness.

It has been shown that those personal, work-related, and workplace-related factors were the most principal factors behind nurses' happiness [ 31 ]. Jun and Jo also found public sincere admiration of nursing, academic performance, physical health status, and the reasons behind entering nursing as the most significant factors contributing to nursing students' happiness [ 29 ]. Other predictors of nurses' happiness were economic status. Previous studies also reported a positive correlation between salary and happiness among different populations [ 45 , 46 , 47 ]. According to economic theory, living conditions, especially income have a lasting impression on happiness [ 48 ] and the results of various studies have confirmed this [ 49 ] Higher salary promotes nurses and their families’ welfare and therefore, eases their financial strain, helps them have an easier life, facilitates their task performance, and thereby, gives them a sense of happiness. Besides the amount of salary, satisfaction with salary was also a significant predictor of happiness among nursing personnel. Staff usually compares their own salaries with the salaries of other staff in or out of their organizations. Then, if they observe consistency between their own salaries and other staff's, they feel greater satisfaction with their salaries and greater happiness, and hence, will provide quality care. Moreover, consistency between workload and salary can contribute to their happiness [ 50 ].

The final factor behind nurses' happiness was their job satisfaction. This is in line with the findings of previous studies satisfaction with closure is the dimension of perceived job satisfaction, which determines how an employee perceives his/her job as a source of opportunity that provides him/her enough opportunity to complete the work from start to finish [ 31 , 51 , 52 , 53 ].

Limitations

This study had some limitations. The present study included only nurses working in the emergency departments in Ilam University of Medical Sciences and thus could not be generalized to all nurses. Additionally, although we performed linear regression analysis, the cross- sectional nature of the study should be considered when interpreting the results. Finally, one should note that performing such studies without any consideration for implementing specific interventions to improving the quality of working life among nurses working in emergency departments would not be advised given the importance of the finding in the current study. We recommend the future investigators take appropriate measures in this regard and contribute to increasing happiness among this population.

Overall the current study found that nurses who work in emergency departments moderate levels of happiness. Additionally, the findings suggest that their happiness was associated with their economic status and closure over their duties.

Availability of data and materials

The datasets are available from the corresponding authors on request.

Abbreviations

Quality of Work Life

Job Satisfaction Questionnaire

Oxford Happiness Inventory

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Acknowledgements

We thank all participants who made this study possible.

Author information

Authors and affiliations.

Faculty of Nursing and Midwifery, Shahed University, Tehran, Iran

Somayeh Javanmardnejad

Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran

Razieh Bandari

Elderly Care Research Center, Faculty of Nursing and Midwifery, Shahed University, Tehran, Iran

Majideh Heravi-Karimooi & Nahid Rejeh

School of Nursing and Midwifery Amol, Mazandaran University of Medical Sciences, Sari, Iran

Hamid Sharif Nia

Population Health Research Group, Health Metrics Research Centre, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran

Ali Montazeri

Faculty of Humanity Sciences, University of Science and Culture, Tehran, Iran

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Contributions

MHK was the study supervisor and contributed to all aspect of the study. SJ was data collection, RB was the main investigator and provided the first draft. NR was the study advisor and contributed to the study design, AM and RB critically reviewed the paper and provided the final draft. HSH was the statistical advisor and contributed to data analysis. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Majideh Heravi-Karimooi or Ali Montazeri .

Ethics declarations

Ethics approval and consent to participate.

The ethics committee of Shahed University approved the study. All participants signed informed consent form.

Consent for publication

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Javanmardnejad, S., Bandari, R., Heravi-Karimooi, M. et al. Happiness, quality of working life, and job satisfaction among nurses working in emergency departments in Iran. Health Qual Life Outcomes 19 , 112 (2021). https://doi.org/10.1186/s12955-021-01755-3

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Received : 09 March 2020

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Published : 01 April 2021

DOI : https://doi.org/10.1186/s12955-021-01755-3

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Job Satisfaction Among Registered Nurses – Pre-COVID

This brief provides information on job satisfaction among the 3,272,872 registered nurses (RNs) employed in the United States, based on the 2018 National Sample Survey of Registered Nurses (NSSRN).

The survey was administered between April and October 2018, with most information reported as of December 31, 2017. It does not reflect the impact of the COVID-19 pandemic on workforce morale. This brief will be updated when data from the 2022 NSSRN becomes available.

Most Nurses Were Satisfied or Extremely Satisfied

Exhibit 1. Job Satisfaction Among Registered Nurses, 2017

rn satisfaction exhibit 1

Detailed Description of Exhibit 1

The majority of registered nurses (RNs) were either moderately satisfied (48.7%) or extremely satisfied (40.3%) with their primary nursing position.

About 11% of nurses expressed some degree of dissatisfaction with their primary nursing position.

Job Satisfaction Varies by Area of Specialization

Exhibit 2. Share of Nurses Indicating Extremely Satisfied or Moderately Satisfied With Primary Nursing Position, Select Area of Specialty

rn satisfaction exhibit 2

Detailed Description of Exhibit 2

There is little difference in job satisfaction between nurses with and without patient care responsibilities.

  • Overall, 88.7% of RNs with patient care responsibilities indicated they were either extremely or moderately satisfied with their primary nursing position.
  • 90.2% of RNs without patient care responsibilities expressed satisfaction with their primary nursing position.

Among nurses with patient care responsibilities, satisfaction varies across areas of specialization, ranging from a low of 83.9% for psychiatric or mental health nurses (including substance abuse and counseling), to a high of 95.5% for RNs specializing in obstetrics.

Despite Generally High Levels of Job Satisfaction, Stress and Burnout Remain a Problem

Exhibit 3a. Most Commonly Cited Reasons for Leaving Primary Nursing Position After December 31, 2017

RNs No Longer Working in Nursing

rn satisfaction exhibit 3a

Detailed Description of Exhibit 3a

Exhibit 3b. RNs Still Employed in Nursing

rn satisfaction exhibit 3b

Detailed Description of Exhibit 3b

Despite generally high satisfaction among nurses, 12.8% of RNs left their primary nursing position between December 31, 2017, and the date they responded to the survey in 2018.

  • Of the RNs that left their primary nursing position, the majority (79.2%) continued to work in nursing.
  • Only 2.7% of RNs employed on December 31, 2017, left nursing altogether.

For those that left nursing, retirement was the most commonly given reason for leaving, followed by burnout, a stressful working environment, lack of good management or leadership, and inadequate staffing.

For those that left their primary position for another nursing position, lack of good management or leadership, a stressful working environment, and burnout were the most common reasons given.

More Than Half of RNs Have Considered Leaving Their Primary Position

Exhibit 4. Most Common Reasons Given for Considering Leaving Primary Nursing Position

rn satisfaction exhibit 4

Detailed Description of Exhibit 4

Of the RNs that remained in their primary nursing position between December 31, 2017, and the date they responded to the survey, more than half (54.6%) indicated that they have considered leaving their position at some point in the past. Nearly half (49.6%) indicated that they considered leaving their primary nursing position in the past year.

Better pay and benefits, burnout, inadequate staffing, a stressful work environment, and a lack of good management or leadership were the most common reasons cited for considering leaving.

Nearly Half of RNs Plan to Leave Their Primary Position in the Next 3 Years

Exhibit 5. When Do You Plan on Leaving Primary Nursing Position?

rn satisfaction exhibit 5

Detailed Description of Exhibit 5

For RNs that have considered leaving their primary nursing position, 18.2% plan to leave within the next year, while 27.4% indicated they plan to leave between one and three years from now.

Most RNs Plan to Continue in Nursing After Leaving Their Current Position

Exhibit 6. Majority of RNs Considering Leaving Primary Position Plan to Continue in Nursing

rn satisfaction exhibit 6

Detailed Description of Exhibit 6

Most RNs (68.2%) that have considered leaving their primary nursing position plan to continue in nursing after leaving their current position. Only 10.4% indicated that they planned to leave nursing altogether, while 21.3% were unsure if they would continue in nursing or not.

The Average Nurse Worked Nearly 3 Hours a Week Longer Than Scheduled in 2017

Exhibit 7. Average Number of Hours Scheduled and Worked in a Typical Week

rn satisfaction exhibit 7

Detailed Description of Exhibit 7

Another factor that may impact job satisfaction among RNs is scheduling and hours worked.

In 2017, the average nurse worked nearly three hours more than scheduled in a typical week (37.5 hours worked, compared to 34.9 hours scheduled).

Full-time nurses experienced a greater discrepancy between hours scheduled and hours worked than part-time nurses.

Nurses Earned a Median Income of $68,774 in 2017

Exhibit 8. Distribution of Earnings from Primary Nursing Position (Full-Time and Part-Time RNs)

rn satisfaction exhibit 8

Detailed Description of Exhibit 8

Better pay or benefits was a common reason cited by RNs for leaving or considering leaving their primary nursing position.

Overall, RNs earned a median income of $68,774 from their primary nursing position in 2017. Median earnings for full-time RNs were $73,929, while part-time RNs earned a median income of $39,985 from their primary nursing position. Exhibit 8 shows the distribution of earnings for all RNs in 2017.

The median annual earnings for RNs across all nursing-related employment was $69,898 for the year ended December 31, 2017.

11% of RNs Held More Than One Nursing Job in 2017

Exhibit 9. Overall Median Earnings From Nursing Employment, Nurses With Secondary Nursing Employment in 2017

rn satisfaction exhibit 9

Detailed Description of Exhibit 9

Nurses whose primary nursing position was part-time were slightly more likely to hold a secondary nursing position than their full-time counterparts (12.4% compared to 10.7%).

RNs with secondary nursing employment earned a combined median annual income of $87,843 from all nursing positions, a difference of nearly $20,000 compared to their earnings from their primary position ($67,896).

About the Data

The National Sample Survey of Registered Nurses (NSSRN) is the longest running survey of registered nurses (RNs) in the United States. Since its inaugural assessment in 1977, the NSSRN has provided educators, health workforce leaders, and policymakers with key details and developments of the nursing workforce supply and includes information on the demographics, educational attainment, licenses and certifications, and employment characteristics of RNs in the United States.

In collaboration with the U.S Census Bureau, the National Center for Health Workforce Analysis administered the 10th NSSRN data collection in 2018. From April 2018 to October 2018, a total of 50,273 registered nurses completed the survey via a web form or a paper questionnaire with an unweighted response rate of 50.1% (49.1% weighted). This survey gathered data from participants with active RN licenses from all U.S. states revealing a comprehensive look into the RN and Advanced Practice Register Nurse (APRN) workforce.

Planning is currently underway for the 2022 NSSRN, which will collect data on RNs with active licenses as of December 31, 2021. This survey will provide an important point of reference for understanding how the nursing profession is impacted by the COVID-19 pandemic. We will update this brief when data from the 2022 NSSRN is available.

To learn more about the NSSRN or to download data and reports, visit National Sample Survey of Registered Nurses (NSSRN) .

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