Job Satisfaction among Nurses’ in Saudi Arabia

 

Izzeddin A. Bdair1, Mohammad N. Alshloul2

1Assistant Professor of Critical Health Nursing and Head of Nursing Department at Al-Ghad International Colleges for Applied Medical Sciences – Abha/KSA.

2Al-Ghad International Colleges for Applied Medical Sciences – Abha/KSA.

*Corresponding Author E-mail: Izzaden_1986@yahoo.com, iabubdair@gc.edu.sa, abhav@gc.edu.sa

 

ABSTRACT:

Background: Job satisfaction among nurses is a topic of global concern. Nurses are at risk for low job satisfaction. Job satisfaction is associated with nurses’ performance, outcomes, turnover, and quality of care. Objective: This study aimed to investigate job satisfaction and contributing factors among nurses. Methods: A cross-sectional, descriptive, and correlational design was used. A convenient sample of 280 nurses working in two health care institutions at Abha was enrolled. The McCloskey-Mueller Satisfaction Scale was used. Science direct, EBSCO and CINALH data bases were used for literature. Data were collected between January and March 2020 at Abha, south region of Saudi Arabia. Result: The sample included 280 participants (62.5% female and 37.5% male). The overall mean satisfaction of the study participants was (104.24±24.61). According to satisfaction factors, the highest mean was attained in the satisfaction with co-workers and the lowest mean was satisfaction with family/work balance. Conclusion: The findings reveal that the nurses are moderately satisfied with their work environment. However, some factors of dissatisfaction were noted such as compensation for working weekends and opportunities to write and publish nursing research. Implications for Nursing and Health Policy. Support is needed from nurse stakeholders to treat nurses’ job satisfaction as a key concept within productive healthcare organizations to increase nurses’ dedication to stay and enhance quality of nurses’ life and nursing care. Therefore, the current study recommended that the health care system administers should work on improvement of modifiable factors that affect positively nurses’ job satisfaction.

 

KEYWORDS: Administration, job satisfaction, nurses, retention, turnover, work environment.

 

 


INTRODUCTION:

Nurses are the largest healthcare workforce in the healthcare system and they significantly contribute to the delivery of patient care1. Globally, nursing has been recognized as one of the stressful professions and highly susceptible to job dissatisfaction2.

 

Job satisfaction is defined as the cognitive and behavioral components of employees’ comfort with their job3. Nurses' job satisfaction has a positive impact on improving the quality, effectiveness, and efficiency of the provided nursing care and directly associated with patients’ satisfaction4. Therefore, the need to assess job satisfaction is crucial for improving patient care. Several studies showed that nurse’ job satisfaction is considered an important predictor for intention to leave their current work5-7. Job dissatisfaction has negative impacts on nurses, patients, and health organizations. Job dissatisfaction may end with poor nurses’ health, absenteeism, and turnover8, reduces the quality of nursing care services9.

Recently, there has been extensive growth in the healthcare system in Saudi Arabia; yet enhancing the nurses' performance by improving their job satisfaction receives little attention. Many studies focus on the job satisfaction of nurses in general, but not enough information is available on the current satisfaction levels of nurses in Abha. As nurses have a significant role in health care institutions; it seems essential to investigate the contributing factors that affect their job satisfaction.

 

Many contributing factors lead to nurses' job dissatisfaction including internal and external factors. Muhawish, Salem, and Baker have shown that role ambiguity, unfair treatment of nurses, personality types, insufficient work conditions, low-payment, criticism, conflicts and stress as major causes of low nurses' satisfaction10. Matos and Colleagues reported that salary, duty schedule, work environment, co-workers, staffing, supervisors, and physicians are the main factors that affect nurses' job satisfaction11. Other contributing factors include unsatisfactory pay12, high workloads within limited time pressures, lack of social support, and violence from patients13, lack of recognition14, and ineffective communication15;16.

 

Chien and Yick investigated nurses’ job satisfaction and its correlates and concluded that older nurses and those with more working experience were more satisfied than younger colleagues (2). In terms of clinical experience, some studies reported that nurses with more clinical experiences are more satisfied than those with lower experience17 while other authors reported that junior nurses have a higher level of job satisfaction18. Fuqua reported that working in a productive team where nurses help each other and provide emotional support have higher job satisfaction19.

 

To provide high-quality patient care; nurses’ job satisfaction needs to be kept high. Therefore, nurse managers can implement several actions to increase nurses’ job satisfaction and investigate the dissatisfaction factors20. There are several positive satisfaction determinants including control over clinical practice, decision-making and institution support21, good payment 22, fair workload23, providing nurses with more opportunities with fair treatment and remuneration and involving nurses in the decision-making process19;24. Giving incentives to nurses is one of the main strategies to increase nurses’ job satisfaction25. Nurses encounter stressful situations that require nurses to make daily basis decisions, therefore, effective communication is a vital factor to improve nurses' job satisfaction and then the quality of nursing care19;26. In addition, organizational management, commitment, empowerment and payment styles also influence nurses' satisfaction22.

 

However, there is little knowledge about the level of nurses' job satisfaction and the relationship between nurses' job satisfaction and demographic data in KSA. The present study aimed to assess the level of job satisfaction and contributing factors among nurses who work in selected hospitals in Abha city, KSA. It is believed that studying job satisfaction will provide nurse managers with important information to consider in their planning.

 

MATERIAL AND METHODS:

Design, Sample, and Settings:

This study used a cross-sectional and descriptive design. A convenience sample of 280 nurses was enrolled. The inclusion criteria were: nurses had to be active workers, hospital-based with more than one year of clinical experience, and willing to collaborate. The study was limited to full-time professional nurses. The study was conducted at two different institutions including public and psychiatric hospitals in Abha, KSA.

 

Ethical consideration:

Institutional Review Board (IRB) approvals were obtained from all studied institutions (IRB approval numbers are: 20191106 and 2112019). Study participants were informed about the study’s purpose, freedom to withdraw and voluntary nature through an introductory letter. A written consent form was obtained. Anonymity and confidentiality of participants and data were maintained.

 

Instruments:

Demographic data including age, gender, marital status, level of education, and experience were collected. The McCloskey-Mueller Satisfaction Scale (MMSS) was used. The MMSS scale composed of 31 items that were classified into 8 categories including satisfaction with extrinsic rewards, scheduling, family/work balance, co-workers, interaction, professional opportunities, praise/ recognition, and control/responsibility. The items are measured on a five-point Likert scale ranging from 1 which indicates very dissatisfied to 5 which indicates very satisfied. MMSS is a validated tool that commonly used in many nurses' satisfaction studies. The Cronbach’s alpha for the global scale was 0.8927. The Arabic version of MMSS was established and tested for reliability and validity. Permission to use the tool was also obtained.

 

Data Collection and Analysis Procedures:

Data was collected through filling a questionnaire that takes about 15 minutes. Data was analyzed according to the appropriate statistical test. Data were entered and analyzed using the SPSS Statistical package version 21 (SPSS, 2012). Descriptive statistics were computed to describe nurses' demographic characteristics. The t-test, ANOVA, and Pearson correlation tests were used to compare nurses' stress and job satisfaction in relation to their demographics. In all statistical tests, a value of p< 0.05 was considered significant.

 

Table 1: Distribution of Socio-demographic characteristics of the participants (N=280)

Variable

No.

%

Sector

Public Hospital

164

58.6

Psychiatric Hospital

116

41.4

Age Groups

<= 30 years

125

44.6

>30 years

155

55.4

Gender

Male

105

37.5

Female

175

62.5

Marital Status

Married

163

58.2

Single

106

37.9

Others

11

3.9

Nurse Nationality

Saudi

180

64.3

Non-Saudi

100

35.7

Nurse Education

 

Diploma

100

35.7

Bachelor

170

60.7

Postgraduate

10

3.6

Nurse Experience

 

≤ 5 year

102

36.4

6 to 10 years

103

36.8

>10 years

75

26.8

Working Position

 

Administrative

15

5.4

Supervisors

27

9.6

Bedside nurse

238

85.0

Working Unit

 

Administrative

21

7.5

Medical- surgical

44

15.7

Intensive unit

47

16.8

ER

49

17.5

Psychiatric units

80

28.6

Others

39

13.9

Work rotation

 

Fixed

122

43.6

Rotating

158

56.4

Duty time

 

Day shift

105

37.5

Night Shift

42

15.0

Both

133

47.5

 

RESULTS:

Socio-Demographic Characteristics and work-related variables of the participants:

Demographic characteristics and work-related variables of the participated nurses were presented in Table 1. A total of 400 questionnaires were distributed, 280 questionnaires were returned completed with a response rate of 70.0%. Of the total of 280 nurses, most of the nurses were females (n=175, 62.5%), older than 30 years (n=155, 55.4%), married (n=163, 58.2%), Saudi nurses (n=180, 64.3%) and had a bachelor’s degree in nursing (n=170, 60.7%).

 

Participants’ level of job satisfaction:

Job satisfaction for each sub-scale was analyzed. The highest mean was attained in satisfaction with co-workers. While the lowest mean was in the subscale of satisfaction with family/work balance. The overall mean satisfaction of the study participants was 104.24.43 (SD = 24.61). The overall mean for all items was 3.37 out of 5.0.

 

 

Regarding the items, nurses were satisfied with 18 items (more than mean) and dissatisfied with 11 items (less than mean). The highest three satisfying items were relationships with nursing peers (3.98), physicians that nurses work with (3.81), and methods of care delivery (3.79). The three most dissatisfying items were child-care facilities (2.44), opportunities to write and publish nursing research (2.80), and compensation for working weekends (2.85). Only about one-quarter (23.2%) of participants were very satisfied with their payment, 20.4 % with vacation, 17.5% with a benefits package, 14.6% with opportunity for part-time work, 12.9% with compensation for working weekends, and 15.7% with interaction with nursing colleagues and 16.4% with the amount of encouragement and positive feedback, as shown in Table 2.

 

Relationship between total satisfaction score with demographic variables:

Table 3 shows the results of the relationship between job satisfaction and demographic variables of the nurse in this study. Female nurses (p=0.000), Saudi nurses (p=0.000), post-graduate were significantly more satisfied in their job. Other demographic variables such as nurse's age and marital status were not significant. According to work-related variables, nurses who work at the psychiatric hospital (p=0.000), administrators, and supervisors (p=0.000) and nurses who attend fixed duty (p=0.011) had significantly more job satisfaction levels. Other variables such as work experience and duty time were not significant. In terms of education level, the highest educated nurses with post-graduate studies were significantly more satisfied (p=0.000). Regarding the working unit, nurses who work in administrative units reported more job satisfaction levels more than nurses who work in other units.

 

DISCUSSION:

The present paper addressed the current level and contributing factors of job satisfaction among nurses. To our knowledge, this is the first study on job satisfaction among nurses employed at healthcare institutions at Abha, KSA. The current findings revealed that nurses in studied hospitals have indicated that they are moderately satisfied with their job. However, only slightly higher than the neutral point (mean = 3.37). This is in line with the results of Blaauw and colleagues found that healthcare workers were generally satisfied with their current jobs28. A more recent study revealed that the overall satisfaction level among nurses in Saudi Arabia was low to moderate29. In contrast, Alsubaie and Isouard reviewed the job satisfaction of nursing staff in Saudi hospitals and concluded that the majority of nurses were satisfied with their job30. As compared with Sansoni et al. (2016) our study participants had a higher satisfaction 31.

 


Table 2: Number and percentage distribution of satisfaction scale items (N=280)

Item

Very Dissatisfied

N (%)

Moderate Dissatisfied

N (%)

Neutral
N (%)

Moderate Satisfied N (%)

Very Satisfied

N (%)

Mean

1.      Salary

34 (12.1)

28(10.0)

36(12.9)

117(41.8)

65(23.2)

3.54

2.      Vacation

29(10.4)

44(15.7)

36(12.9)

114(40.7)

57(20.4)

3.45

3.      Benefits package (insurance, Retirement)

41(14.6)

37(13.2)

72(25.7)

81(28.9)

49.(17.5)

3.21

4.      Hours that you work

19(6.8)

40(14.3)

51(18.2)

102(36.4)

68(24.3)

3.57

5.      Flexibility in scheduling your hours

21(7.5)

29(10.4)

53(18.9)

113(40.4)

64(22.9)

3.61

6.      Opportunity to work straight days

27(9.6)

27(9.6)

61(21.8)

102(36.4)

63(22.5)

3.53

7.      Opportunity for part-time work

61(21.8)

38(13.6)

87(31.1)

53(18.9)

41(14.6)

2.91

8.      Weekends off per month

45(16.1)

44(15.7)

56(20.0)

68(24.3)

67(23.9)

3.24

9.      Flexibility in scheduling your weekends off

39(13.9)

46(16.4)

58(20.7)

77(27.5)

60(21.4)

3.26

10.   Compensation for working weekends

64(22.9)

45(16.1)

77(27.5)

58(20.7)

36(12.9)

2.85

11.   Maternity leave time

47(16.8)

28(10.0)

149(53.2)

28(10.0)

28(10.0)

2.86

12.   Child care facilities

94(33.6)

18(6.4)

132(47.1)

23(8.2)

13(4.6)

2.44

13.   Your immediate supervisor

26(9.3)

23(8.2)

46(16.4)

100(35.7)

85(30.4)

3.7

14.   Your nursing peers

4(1.4)

14(5.0)

61(21.8)

106(37.9)

95(33.9)

3.98

15.   The physicians you work with

8(2.9)

23(8.2)

59(21.1)

113(40.4)

77(27.5)

3.81

16.   The delivery of care method used on your unit (functional, team, primary)

7(2.5)

23(8.2)

62(22.1)

117(41.8)

71(25.4)

3.79

17.   Opportunities for social contact at work

14(5.0)

21(7.5)

79(28.2)

96(34.3)

70(25.0)

3.67

18.   Opportunities for social contact with your colleagues after work

19(6.8)

19(6.8)

72(25.7)

100(35.7)

70(25.0)

3.65

19.   Opportunities to interact Professionally with other disciplines

15(5.4)

32(11.4)

82(29.3)

94(33.6)

57(20.4)

3.52

20.   Opportunities to interact with faculty of the College of Nursing

34(12.1)

34(12.1)

92(32.9)

76(27.1)

44(15.7)

3.22

21.   Opportunities to belong to department and institutional committees

24(15.0)

37(13.2)

94(33.6)

69(24.6)

38(13.6)

3.09

22.   Control over what goes on in your work setting

22(7.9)

42(15.0)

58(20.7)

102(36.4)

56(20.0)

3.76

23.   Opportunities for career Advancement

42(15.0)

33(11.8)

69(24.6)

85(30.4)

51(18.2)

3.25

24.   Recognition for your work from Superiors

34(12.1)

39(13.9)

72(25.7)

76(27.1)

59(21.1)

3.31

25.   Recognition of your work from Peers

20(7.1)

30(10.7)

62(22.1)

102(36.4)

66(23.6)

3.59

26.   Amount of encouragement and positive feedback

30(10.7)

53(18.9)

73(26.1)

78(27.9)

46(16.4)

3.20

27.   Opportunities to participate in nursing research

50(17.9)

46(16.4)

85(30.4)

57(20.4)

42(15.0)

2.98

28.   Opportunities to write and publish nursing research

64(22.9)

48(17.1)

85(30.4)

47(16.8)

36(12.9)

2.80

29.   Your amount of responsibility

15(5.4)

20(7.1)

62(22.1)

104(37.1)

79(28.2)

3.76

30.   Your control over work conditions

21(7.5)

30(10.7)

68(24.3)

93(33.2)

68(24.3)

3.56

31.   Your participation in organizational decision making

37(13.2)

32(11.4)

56(20.0)

83(29.6)

72(25.7)

3.43

 

Table 3: Relationship between total score of satisfaction with demographic variables (N=280)

Variable

M ± (SD)

t/F test

p-value

Sector

Public Hospital

98.86±25.80

-4.49

0.000*

Psychiatric Hospital

111.84±20.64

Age Groups

<= 30 years

102.42±21.39

-1.11

0.268

>30 years

105.70±26.90

Gender

Male

113.90±19.64

5.33

0.000*

Female

98.45±24.50

Marital Status

Married

105.78±25.23

1.005

0.367

Single

101.58±23.20

Others

107.0±28.42

Nurse Nationality

Saudi

109.88±21.78

5.40

0.000*

Non-Saudi

94.08±26.19

Nurse Education

 

Diploma

110.55 ±22.58

8.084

0.000*

Bachelor

99.72±24.66

Postgraduate

117.90±24.49

Nurse Experience

 

≤ 5 year

103.79±22.00

1.724

0.180

6 to 10 years

101.60±26.00

>10 years

108.47±25.73

Working Position

 

Administrative

120.07±22.10

11.319

0.000*

Supervisors

120.44±20.44

Bedside nurse

101.40±24.17

Working Unit

 

Administrative

126.76±19.61

11.014

0.000*

Medical-surgical

90.84±29.04

Intensive unit

98.96±24.65

ER

96.16±23.38

Psychiatric units

111.83±19.30

Others

108.18±18.56

Work rotation

 

Fixed

1.8.49±23.79

2.57

0.011*

Rotating

100.96±24.79

Duty time

 

Day shift

108.60 ±22.25

2.680

0.070

Night Shift

102.10±25.15

Both

101.47±25.86

* Significant (p <0.05)

 


Significant findings in this study are that the majority of nurses were satisfied with their relationships with their peers, immediate supervisors, and other colleagues. These results validated the findings of a study by Brayer et al. (2017) that indicated nurses reported high levels of satisfaction regarding interactions with workmates26. However, the results showed that nurses had the lowest mean satisfaction with family/work balance.

 

Item analysis of the satisfaction scale showed that less than a quarter of nurses were very satisfied with their salary, vacation, work hours, flexibility in work schedule, the opportunity to work straight days, control over work conditions, recognition, amount of responsibility, and participation in organizational decision making. Muhawish and colleagues studied job satisfaction among the multicultural nursing workforce at Riyadh, KSA. Their results supported the current results that nurses' job satisfaction was relatively low, and payment and benefits were the main contributors to dissatisfaction32.

 

In our findings, the average scores of job satisfaction were found to be higher in those who are female, Saudi, above 30 years of age, have post-graduate degrees, have more than 10 years of clinical experience, and those who are married. Previous studies have stated that nurses with more experience tend to have more job satisfaction and passion to work33;34. These results might be related to their accumulative skills in handling work situations. Meanwhile, consistent with previous research, the current study has shown no significant differences in overall satisfaction gender, marital status and type of facility28.

 

Regarding the employment-related variables, those who are in managerial positions, work in psychiatric units, and on fixed duty shifts showed higher scores of job satisfaction. These results were supported by the work of Aslan and Yildirim and Halcomb et al. which indicated that socio-economic and employment characteristics have an impact on staff job satisfaction33;35. For instance, nurses with higher education levels have been shown better performance and more satisfaction level36. However, contradictory findings were documented that among staff working in psychiatric units, nurses reported the lowest rating of job satisfaction37.

 

Participant stated several job satisfaction factors highly including the interaction with nursing peers and other collogues, amount of responsibility, work hours, and recognition. Close collaboration among staff nurses was cited as one of the determinants of job satisfaction38. In contrast, the greatest sources of dissatisfaction among studied nurses were factors concerning the lack of child care facilities and the lack of opportunities to write and publish nursing research.

 

Another significant predictor for job satisfaction was the working position. Previous literature showed that nurses in managerial positions were more dissatisfied because of more responsibilities and role conflicts. The findings of this study found that active bedside nurses were more dissatisfied than nurses in managerial positions due to several factors including workload, a lower pay, rotating shifts, and attending duty over holidays. Parallel to the institutional efforts, conducting workshops to improve nurses' communication skills, competencies, stress management, decision making, and scientific research may enhance nurses' job satisfaction.

 

As the results recognized, lacking the chance to participate in research activities, compensation for working weekends, maternity leave, weekends off per month were main aspects of study participants job dissatisfaction. Furthermore, many nurses were not satisfied enough in their pay and vacation which negatively diminish job satisfaction. Studies showed that the work environment is the main determinant for job satisfaction and nurses’ intention to stay at work. Job satisfaction is a multifactorial process that requires the collaboration of all healthcare systems. The findings identified several sources of and job dissatisfaction that might negatively affect the quality of patient care and nurses’ intent to stay. Nursing leaders should consider these results informative and take the appropriate actions to address and improve nurses ’satisfaction in the work environment.

 

A suggestion for further nursing research would be to replicate this study using a larger and more heterogeneous sample from different sectors is recommended to provide a more inclusive picture of nurses' job satisfaction. Conducting a qualitative study in this regard is also recommended to obtain a better understanding of determinants of satisfaction, sources of dissatisfaction, and proposed suggestions to overcome.

 

CONCLUSION:

The aim of the current research was to investigate job satisfaction and contributing factors among nurses. Nursing is a highly stressful profession. Therefore, support and appreciation of their superiors are essential steps to avoid dissatisfaction. Nurses are exposed to low job satisfaction due to inadequate and high-pressure work conditions and many administrative stressors. Low job satisfaction results affect nurses’ performance, increase turnover and results in low quality of patients’ care. Previous studies have drawn the same conclusions. Nurses’ mangers have to work on culture change and implement the appropriate actions that empower nurses and improve their job satisfaction.

 

IMPLICATIONS FOR NURSING AND HEALTH POLICY:

Implications from the study indicated that support is needed from nurse stakeholders to create a culture change that treats nurses’ job satisfaction as priority. By viewing job satisfaction as a key concept for productive healthcare organizations, improving nurses’ job satisfaction will be a fundamental part of the health care professional’s dedication to stay and provide higher level of nursing care.  the need for further actions to improve in an effort to strengthen their retaining nursing staff and enhancing quality of nurses’ life and nursing care. Therefore, the current study recommended that the health care system administers should work on improvement of modifiable factors that affect positively nurses’ job satisfaction.

 

LIMITATIONS:

The study has several limitations. First of all, is using a descriptive cross-sectional design which could not infer the causal relationships among the variables. Also, the sample did not include the private sector which may not be a representative and affect the generalization of results. Since the satisfaction is affected by emotional responses and status, a response bias might affect the results. Finally, Saudi nurses are usually of high socio-economic standards; therefore, it has an impact on job satisfaction.

 

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Received on 21.01.2021          Modified on 05.02.2021

Accepted on 19.02.2021     ©AandV Publications All right reserved

Int.  J. of Advances in Nur. Management. 2021; 9(2):204-210.

DOI: 10.5958/2454-2652.2021.00046.9