INTRODUCTION:

As we move further into the twenty first century, it is becoming absolutely clear that the effective management of an organization’s human resources is a major source of competitive advantage and may even be the single most important determinant of an organization’s performance long-term.

Organizations have also started to realize that their success is dependent on their ability to attract, develop and retain talented employees which is a critical factor in developing a high- performance organization. ¹Hence, the human resource is the most important and the most valuable asset of any organization and the success and failure of every organization strongly depend on the performance of its human resource.

Hospital, as an organization that play an important role in health of people in society also rely more on human resource than any other organizations because they are labor intensive in nature. In Hospital, among the various health personnel, nurses are of great importance. ² They are important member in a health team and have various roles such as caring, supporting, treating, coordinating, advising, managing, educating, and conducting research for better patient outcome.³ India is facing acute shortage of nurses. The nurse-population ratio is low compared to other countries. The ratio is 1: 1100 in India and 1:100-150 in Europe. The Nurse to doctor ratio is almost 1.5:1 while it is 3:1 in developed countries.⁴It is estimated that India is facing 40-50% shortage of nurses due to demand outstripping supply and many female nurses prefer to work overseas for higher compensation and better working condition. According to the report of the National commission on macroeconomic and health, around 3.25 lakh nurses would be required by 2015.⁵ The major cause apart from economic factor is job dissatisfaction among nurses.⁶

Generally, in most of the hospitals, nurses are caring for the most acutely ill patients in a work environment in which the workload is physically and emotionally exhausting, the workplace is stressful and unpredictable, respect from administrators and medical doctors is deficient and staffing shortages are recurrent. Such working conditions may lead to dissatisfaction of nursing workforce with their job.⁷If nurses are satisfied with their job then it leads to quality of care and patient satisfaction and if they are dissatisfied then it leads to absenteeism, poor performance and turnover.

Job Satisfaction can be considered as a global feeling about the job or as a related constellation of attitudes about various aspects or facets of the job. The global approach is used when the overall attitude is of interest while the facet approach is used to explore which parts of the job produce satisfaction or dissatisfaction. People may have different evaluative responses towards each facet of the job. Based on the review of the most popular job satisfaction instruments, Spector (1997) summarized the following facets of job satisfaction: appreciation, communication, co-workers, fringe beneﬁts, job conditions, nature of the work itself ,the nature of the organization itself, an organization’s policies and procedures, pay, personal growth, promotion opportunities, recognition, security and supervision.⁸ A wide body of empirical literature supports the relationship between the work conditions that provide important context for the nursing work with a variety of patient, nurse and organizational outcomes. Work conditions examined in various studies have ranged from staffing and resource adequacy as well as the support of managers and administrators and outcomes have included turnover and job satisfaction. A recently reported large study of 617 and 488 hospitals from the US and 12 European countries respectively confirmed the impact of hospital work conditions on quality of care and job satisfaction of nurses.⁹

This paper aims to assess the influence of work conditions on level of job satisfaction among hospital nurses. The findings of this study should provide information to nursing administration on developing and promoting a work condition conducive to nurses, thereby increasing productivity, job satisfaction, retention and the quality of patient care.

OBJECTIVES:

The objectives of the study are:

• To study the various work conditions of the nurses working in the hospital.

• To determine the relationship of socio-demographic variable with job satisfaction.

• To determine the work conditions which significantly influences the hospital nurses’ job satisfaction.

OPERATIONAL DEFINITIONS:

• Job satisfaction: degree to which one is satisfied and generally likes one’s job

• Work conditions: a set of variables reflect attitudes towards the environment surrounding the job and the actual performance of the job.

• Variables in this set are:

Group cohesion: General sense of individual wanting to stay in particular group

Nurse - physician collaboration: Nurse - physician sharing of responsibility for problem solving and decision making related to patient care.

Work relation: Perception of team work that exists within the work environment.

Workload: Perception of having adequate time to provide quality care to the patient

Quality of care: Satisfaction with the perceived ability to provide quality individualized patient care.

Team respect: Perception of being respected by the team for knowledge and competency

Physical working environment: Perception of adequacy of physical work environment and resources to accomplish the job

Staffing: Perception of the adequacy of staffing and ability to work a satisfying schedule

Job competence: Perception of one’s competency to perform the job

Job stress: Conflict resulting from the disconnection between an individual’s perception of the demands of the position and the ability or inability to meet those demands.

MATERIALS AND METHODS:

The research approach selected for the study is an exploratory correlation design used to determine the relationship between work conditions and the job satisfaction of the nurses of a tertiary level Public hospital, Varanasi, Uttar Pradesh. Exploratory research is an extension of descriptive research that focuses more directly on the discovery of the relationships, focusing on an existing phenomenon of interest, thus facilitating a richer understanding of new phenomenon that is being investigated.

Research setting:

A 1200 bedded, tertiary level Public hospital of Varanasi, Uttar Pradesh with the nursing strength of 398 was selected for the study. It caters to a large section of the population of Eastern Uttar Pradesh.

Study population:

In the present study, the population comprised of all the nursing staff working in different departments at different administrative level in the Hospital.

Sample and Sampling technique:

Purposive sampling technique was used for the selection of the participants for the study applying planned inclusion and exclusion criteria for the sample. The following inclusion criteria were observed in selecting the sample subjects:

1. Nursing personnel having minimum one year of work experience in the Hospital.

2. Available during the data collection period.

3. Willing to participate in the study.

Sample size: The sample size for the study was 200.

Research tool: The research tool was developed by means of reviewing the related literature extensively, informal discussions with nursing administrators and consulting the supervisor. The structured questionnaire was developed for measuring the job satisfaction.

Variables under study:

Independent Variable: Work conditions which includes Group cohesion, Nurse-physician collaboration, Work relation, Workload, Quality of care, Team respect, Physical working environment, Staffing, Job competence and Job stress.

Dependent Variable: Job satisfaction amongst nursing personnel.

Description of the Tool: Questionnaire is in the format of 5 point Likert scale. The Questionnaire was divided into two parts:

Part A consists of questions related to socio demographic profile of the nursing personnel.

Part B consists of 58 statements related to nurses’ perception about various work conditions.

The words disagree and agree in the questionnaire are assumed to be meant dissatisfied and satisfied respectively. The scoring of the item ranges from 1 to 5 point. 5 being the highest (i.e. highly satisfied) and 1 being the lowest score (i.e. highly dissatisfied) and for negative item the reverse scoring was done.

Validity and Reliability:

To ensure the content validity of the tool, it was submitted to the experts in the field of Public Administration, Hospital Administration and Nursing. The experts were requested to review and verify these items for adequacy, relevance, clarity, suitability and meaningfulness. With minor modification in items as suggested by the experts the tool was finalized. The translation of the tool in Hindi was done as most of the nurses were Hindi speaking and they understand Hindi much better in comparison to English. Reliability was computed using Cronbach alpha. The reliability coefficient was found to be 0.84. The tool was found to be valid and reliable. The table 1.1 summarizes the study variables including means, SD and internal consistency estimate (Cronbach’s alpha) for each scale and subscale measuring the variables.

Table 1: Variables: Means, SD and Internal Consistency Reliabilities (N=200)

Variables	Number of items (58)	Mean	SD	Cronbach’s Alpha
Outcome Variable Job Satisfaction	9	3.96	.677	.709
Work Characteristics Group Cohesion	4	3.74	.739	.839
Nurse-physical collaboration	4	3.92	.882	.772
Work Relation	6	3.43	.617	.745
Work Load	7	3.07	.789	.735
Quality of Care	6	3.40	.570	.803
Job Competence	3	3.82	.653	.764
Team Respect	3	3.85	.624	.709
Physical Work Environment	3	2.85	1.050	.739
Staffing	3	2.64	1.018	.803
Job Stress	10	3.6	.770	.759

Data Analysis:

The study was based on quantitative methodology. For statistical analysis, SPSS 16.0 was used. Difference between individual variables was analyzed using ANOVA, while linear correlation coefficient was used to identify the relationship between the studied variables. Multiple and stepwise linear regression analysis was used to determine the impact of studied independent

Table 2: Descriptive statistics of job satisfaction score by selected socio-demographic characteristics

S.No	Variables	F	%	Mean	SD	F value	t-value	P value
1	Age
	21-30	24	12	35.66	5.83	1.553	-	0.202
	31-40	80	40	34.61	5.9
	41-50	58	29	36.22	6.14
	51-60	38	19	36.97	6.46
2	Sex
	Male	21	10.5	37.14	7.22	-	1.183	0.238
	Female	179	89.5	35.48	5.95	-	1.183	0.238
3	Designation
	Staff Nurse	166	83	35.43	6.08	1.159		0.316
	Sister / ANS	34	17	36.51	6.13	1.159		0.316
4	Year of Service
	01-10	44	22	35.63	5.78	0.416		0.742
	11-20	82	41	35.56	6.35
	21-30	61	30.5	35.4	6
	31-40	13	6.5	37.46	6.34
5	Area of Work
	Surgical	23	11.5	33.43	6.95	1.431		0.235
	Medical	62	31	35.8	6.43
	Specialized	96	48	36.23	5.43
	Critical	19	9.5	34.89	6.86
6	Education
	Up to 10th class	7	3.5	35.85	6.14	0.134		0.939
	Up to 12th class	127	63.5	35.52	5.95
	Graduate	48	24	35.64	6.46
	Post Graduate	18	9	36.5	6.55
7	Prof Qualification
	GNM	184	92	35.69	6.18		0.319	0.75
	BSc. Nursing	16	8	35.18	5.12		0.319	0.75
8	Marital status
	Married	180	90	35.55	6.15	0.585		0.558
	Unmarried	17	8.5	37.05	5.84
	Widowed/Divorce	3	1.5	34	4
9	Habitat
	Rural	30	15	37.8	5.67		2.108	0.036*
	Urban	170	85	35.27	6.1		2.108	0.036*
10	Family Type
	Nuclear	113	56.5	35.77	5.85		0.326	0.745
	Joint	87	43.5	35.49	6.42		0.326	0.745
11	Residence
	Hostel	31	15.5	36.22	6.43	1.431		0.235
	Government accommodation	48	24	34.1	5.55
	Private accommodation	121	60.5	36.12	6.16

*p<.05

The Bar diagram in figure 1 showed the overall job satisfaction level of the hospital nurses with the work conditions. 3% were highly satisfied, 24.5% were moderately, 59% low satisfied and 13.5 % were not satisfied.

Figure 1

To assess the relationship between work conditions and job satisfaction of hospital nurses’ linear correlation coefficient was used. Table 3 gives the results of linear correlation coefficient. Six work conditions variables have significant influence on job satisfaction- Job stress (r = 0.611, p<.01), quality of care (r =0.524,p<.01), workload (r = 0.410, p<.01), job competence (r= 0.184, p<.01), work relation ( r= 0.182, p<.01) and team respect (r = 0.143, p<.05).

Table 3: Linear correlation coefficient of work condition with job satisfaction

Independent	R	P
Group Cohesion	0.081	0.255
Nurse Physician Collaboration	0.105	0.14
Work Relation	0.182**	0.01
Workload	0.410**	0.000
Quality Of Care	0.524**	0.000
Team Respect	0.143**	0.044
Physical Work Environment	0.076	0.282
Staffing	0.017	0.806
job competence	0.184**	0.009
job stress	0.611**	0.000

**. Correlation is significant at the 0.01 level (2-tailed).

*. Correlation is significant at the 0.05 level (2-tailed).

Table 4: Stepwise and multiple linear regression analysis

Independent	Regression Coefficient	Regression Constant	R²x 100
Job Stress	0.57	15.22	44.9
+ Quality Of Care	0.465 job stress 0.409 Quality Of Care	10.46	48.6
Total Job stress Quality of care Workload Job competence Work relation Team respect			53.8

Using stepwise regression analysis a model for predicting nurses’ job satisfaction was developed (Table 4). In a final model it is evident that job stress and quality of care appear to have the greatest importance in explaining the variance in job satisfaction.(44.9% by job stress,48.6% by job stress and quality of care both and rest 5.2% of total 53.8% by rest of the significant work conditions variable like workload, job competence, work relation and team respect.

Figure 2

Figure 3

The scatter diagram with trend line in figure 2 showed the relationship between job stress and job satisfaction of the nurses. It means that job stress influences the level of nurses 'job satisfaction. In figure 3, the trend line in scatter diagram showed the same positive relationship between quality of care and nurses’ job satisfaction.

DISCUSSION:

The purpose of this study was to explore the influence of work conditions on hospital nurses’ job satisfaction.

The demographic description of the respondents showed

that equal percentage of nurses were in age group below

40 years and above 40 years. Majority of them were females and have Diploma in General Nursing and Midwifery. Only 8% were having Bachelor degree in Nursing which showed poor availability of educational opportunity for the nurses, in the hospital..

In the examination of the mean scores for the study variables, all of means were above the scale midpoints with the exception of the variables related to physical work environment (mean= 2.85,scale of 1-5)and satisfaction with staffing (mean=2.64, scale of 1-5). It showed that the nurses were not satisfied with the staffing pattern and the physical work environment prevailing in the hospital. This finding is consistent with the findings of Aiken et.al (2008) which stated that hospital with poor care environment had a higher percentage of nurses reporting high burnout levels and dissatisfaction with their jobs. ¹⁰ The mean scores for the variable workload (mean=3.07) was slightly above the midpoint indicating that nurses were least satisfied with the workload they have in the hospital. According to Roelen et al. (2008), colleagues, working conditions, and workload were positively related to overall job satisfaction¹¹Many other studies have shown that inadequate resources, lack of staffing, excessive workloads are significant stressors that negatively influence nurses’ job satisfaction.^12-14

In the present study, the respondents were relatively satisfied with the cohesiveness of their work group (mean = 3.74), collaborating with physicians (mean = 3.92), being respected by their peer group (mean= 3.85). Job satisfaction also seems to be associated with work group culture. A positive work group culture promotes teamwork, cooperation and productivity, and conveys a feeling of satisfaction. This relationship had been consistently supported in the literature.^15,16

There is no significant relationship between the socio-demographic variables and job satisfaction except the type of habitat. Adam and Bond (2000) conducted a study on Hospital nurses’ job satisfaction in England and the findings showed that individual nurse characteristics had no association with job satisfaction.¹⁷ It was observed that relatively nurses living in rural area (mean score 37.8) were more satisfied than nurses living in urban area (mean score 35.27) at the level of p < .05. This is supported by the study conducted by Molinari DL and Monserud MA (2008).¹⁸The finding suggested that nurses from rural background are more satisfied and intended to remain employed.

The study reveals that the overall level of satisfaction of nurses of this hospital with work conditions was low in 59%, moderate in 24.5%, high in 3% and rest 13.5% were not satisfied. Whereas Golbasi et al, found a medium satisfaction level in Turkish Hospital. ¹⁹ The level of satisfaction varies from country to country as indicated by a comparative analytical report conducted by European foundation in 2007 that the high degrees of dissatisfaction exist in Greece, Italy and Spain in contrast with very high shares (90% or more) of employees who are satisfied with their job in Denmark, France, Ireland, the Netherlands and in Austria.²⁰

The work condition which influences the nurses’ job satisfaction was analysed using stepwise regression and it is evident that job stress and quality of care appear to have the greatest importance in explaining the variance in job satisfaction whereas workload, work relation, job competence and team respect have significant influence on nurses’ job satisfaction but weak. Job stress as a main factor influencing the job satisfaction is illustrated in a study conducted by Chen et al. (2007) to find the relationship between stress and job satisfaction in five acute care teaching hospitals in Taiwan. They surveyed on 129 nurse specialists. They found that stress variables predicted 24.8% of the variance in job satisfaction.²¹The second important variable was quality of care which also had significant influence on job satisfaction of hospital nurses. Kvist et al. studied job satisfaction among nurses in Finland and they observed the most satisfied nursing staff members were those who considered the quality of care provided by their working unit to be excellent.²² This relationship between job satisfaction and quality of care has been observed in previous related studies also.^23-26

Third variable which was found to be effecting the job satisfaction was job competence. Many studies are based on the assumption that job satisfaction and job competence are interwoven.^27,28 They concluded that people who are satisfied with their jobs tend to perform better.

Fourth variable, workload had significant impact on nurse's job satisfaction in the study. A report by the Robert Wood Johnson Foundation found that among nurses main concern was their increased daily workload.⁷The increase in work intensity was noted to be physically demanding and emotionally exhausting and caused concern among nurses for the quality of care they were providing to patients.²⁹ Nurses are often dissatisfied when they are unable to provide enough bedside nursing care to their patients. Conversely, meeting patient's needs, finishing all work activities and providing good patient care were related to job satisfaction among nurses.³⁰

Other variable like work relation and team respect also had significant but weak effect on job satisfaction. Some studies reported that being respected and a valued member of the team most often was observed by nurses as having the strongest influence on their level of job satisfaction. ³¹

Our study findings suggest that at the hospital-level or unit-level, nurse administrators and nurses together in their specific roles should try to establish important work conditions like work relation, team respect, job competence which enhances their job satisfaction and reduces the risks for job dissatisfaction. The results also suggest that the factors such as job stress and workload need to be minimized in order to enhance job satisfaction. If nurses are to be enticed to remain in their organizations and in the countries in which they are educated, more attention needs to be paid to remedying those factors found to be related to dissatisfaction and intention to leave. Without adequate numbers of nurses to sustain health care organizations, high quality patient care is jeopardized, despite other resources and organizational efforts.

This study has several limitations. The influence of work conditions as predictor of job satisfaction was only predictor studied in the present study. Secondly the information collected is based on perception of respondent. Thirdly, the employee may have fear to reveal the negative aspect of the job. Lastly, the research included a sample of nurses from tertiary level Public hospital of Varanasi so the data findings cannot be generalized to the whole population of nurses working in Eastern Uttar Pradesh.

CONCLUSION:

With constantly changing health system, hospitals will have to recognize the importance of nurses’ job satisfaction. One of the key challenges for every organization is to maintain the satisfaction of employees and increase their motivation. Satisfied employees play a crucial role in an organisational success. Management effort should focus on improving nurses’ work conditions through detailed research planning, effective management, and removal of work constraints that effect nursing practice and by providing educational opportunities.

ACKNOWLEDGEMENT:

Author acknowledges contribution of hospital administrators, nursing administrators and nursing personnel of the concerned hospital for their cooperation in carrying out this research study.

CONFLICT OF INTEREST:

None

SOURCE OF FUNDING:

None

ETHICAL CLEARANCE:

Permission was obtained from the authority of ethical committee of the concerned hospital.

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Received on 30.01.2015 Modified on 22.02.2015

Int. J. Adv. Nur. Management 3(2): April- June, 2015; Page 91-98