Job Satisfaction Among Hospital Nurses Revisited

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International Journal of Nursing Studies 49 (2012) 1017–1038

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b satisfaction among hospital nurses revisited: A systematic review§

ng Lu a, K. Louise Barriball b, Xian Zhang a, Alison E. While b,*

ing University School of Nursing, #38 Xueyuan Road, Hai Dian District, Beijing 100191, PR China

g’s College London, Florence Nightingale School of Nursing and Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, United Kingdom

What is already known about the topic?

he widespread nursing shortage and nurses’ highrnover has become a global issue.b satisfaction among nurses has been identified as a

ey factor in nurses’ recruitment and retention but amprehensive understanding of nurses’ job satisfaction

nd its related factors remains elusive.

What this paper adds

� Empirical evidence relating to nurses’ job satisfactionindicates the need for continued improvement in nurses’working lives.� The review identifies the sources of nurses’ job satisfac-

tion, its effect and the related factors affecting nurses’ jobsatisfaction.� The lack of a comprehensive and causal model reflecting

moderators or moderator of job satisfaction in nursing isa major shortcoming, undermining the development ofinterventions to improve nurse retention.

1. Introduction

The widespread nursing shortage and nurses’ highturnover is a global issue (Kingma, 2007) which is of

T I C L E I N F O

le history:

ived 15 July 2011

ived in revised form 9 November 2011

pted 15 November 2011

ords:

satisfaction

stress

essional identification

perception

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A B S T R A C T

Background: The current nursing shortage and high turnover is of great concern in many

countries because of its impact upon the efficiency and effectiveness of any healthcare

delivery system. Recruitment and retention of nurses are persistent problems associated

with job satisfaction.

Objective: To update review paper published in 2005.

Design: This paper analyses 100 papers relating to job satisfaction among hospital nurses

derived from systematic searches of seven databases covering English and Chinese

language publications 1966–2011 (updating the original paper with 46 additional studies

published 2004–2011).

Findings: Despite varying levels of job satisfaction across studies, sources and effects of

job satisfaction were similar. Hospital nurse job satisfaction is closely related to

working conditions and the organizational environment, job stress, role conflict and

ambiguity, role perception and role content, organizational and professional commit-

ment.

Conclusions: More research is required to understand the relative importance of the many

identified factors relating to job satisfaction of hospital nurses. It is argued that the absence

of a robust causal model reflecting moderators or moderator is undermining the

development of interventions to improve nurse retention.

� 2011 Elsevier Ltd. All rights reserved.

This is a revised and updated version of Lu, H., While, A.E., Barriball,

2005. Job satisfaction among nurses: a literature review. Interna-

al Journal of Nursing Studies 42 (2), 211–227.Corresponding author.

E-mail addresses: [email protected] (H. Lu),

[email protected] (K.L. Barriball), [email protected]

hang), [email protected] (A.E. While).

Contents lists available at SciVerse ScienceDirect

International Journal of Nursing Studies

journal homepage: www.elsevier.com/ijns

0-7489/$ – see front matter � 2011 Elsevier Ltd. All rights reserved.

10.1016/j.ijnurstu.2011.11.009

http://dx.doi.org/10.1016/j.ijnurstu.2011.11.009

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H. Lu et al. / International Journal of Nursing Studies 49 (2012) 1017–10381018

increasing importance to both the developed and devel-oping countries (Aiken et al., 2001; Fang, 2001; Lu et al.,2002; Zangaro and Soeken, 2007). In light of this, concernabout recruitment and retention of nursing staff isincreasing in a number of countries (Kingma, 2007). Whilenumerous factors have been linked to nurses’ turnover, jobsatisfaction is the most frequently cited (Cavanagh andCoffin, 1992; Blegen, 1993; Irvine and Evans, 1995), andtherefore merits attention. This review updates a previousreview (Lu et al., 2005) and examines the extensiveempirical literature regarding the job satisfaction ofqualified general nurses working in hospitals and itsassociated factors.

2. The definition of job satisfaction

Job satisfaction is a most frequently studied variable inorganizational behaviour research, and also a centralvariable in both research and theory of organizationalphenomena ranging from job design to supervision(Spector, 1997). The traditional model of job satisfactionfocuses on all the feelings that an individual has about his/her job. However, what makes a job satisfying ordissatisfying does not depend only on the nature of thejob, but also on the expectations that individuals have ofwhat their job should provide.

Thus job satisfaction is the affective orientation that anemployee has towards his or her work (Price, 2001). It canbe considered as a global feeling about the job or as arelated constellation of attitudes about various aspects orfacets of the job. The global approach is used when theoverall attitude is of interest while the facet approach isused to explore which parts of the job produce satisfactionor dissatisfaction. Based on the review of the most popularjob satisfaction instruments, Spector (1997) summarized

the following facets of job satisfaction: appreciation,communication, co-workers, fringe benefits, job condi-tions, nature of the work itself, the nature of theorganization itself, an organization’s policies and proce-dures, pay, personal growth, promotion opportunities,recognition, security and supervision.

3. Identification of the literature

The literature relating to job satisfaction and nurseswas identified through electronic databases using thesame method as in the previous review (Lu et al., 2005).The electronic databases used to obtain the relevantliterature were: CINAHL (1982–2011), Medline (1966–2011), PsycINFO (1974–2011) and British Nursing Index(1985–2011), the Applied Social Science Index (2004–2011). Chinese databases such as the China MedicalAcademic Conference (1985–2011) and China AcademicJournal (1985–2011) were also used. To maximize theamount of relevant literature, key terms and phrasesassociated with job satisfaction, occupational stress,professional commitment, role conflict and role ambiguitywere utilized in the subject search in combination withnurses following guidelines for searching the OVID inter-face. This identified a total of 2435 published researchpapers from all the databases searched. The abstracts orfull texts of the papers were reviewed prior to theirinclusion in the review. Inclusion criteria were: qualifiedgeneral nurses working in acute care hospitals. Exclusioncriteria were: student nurses, nurse assistants andqualified nurses working in specialized care settings inhospitals, other health care settings or non-adult health-care. Two thousand and two hundred and fifth-four paperswere deemed not relevant and 81 papers were of poorquality with reference to the Strobe guidelines (Altman

Records identified andscreened through databasesearching before 2004(n =1189)

Records identified andscreened through databasesearching ≥ 2004(n=1246)

Full-text papers assessedfor eligibility (n =54 )

Full-text papers assessed for eligibility (n = 46)

Full-text papers excluded (n =1135)• Irrelevance(for sample/population reasons) n=1088• Poor quality(design, instrument, statistical analysis) n=47

Full-text papers excluded (n =1178)• Irrelevance (for sample/population reasons) (n=1166)• Poor quality (design, instrument,statistical analysis)(n=34)

Papers included in this updated review(n =100)

Fig. 1. The flow diagram illustrating the selection of publication.

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H. Lu et al. / International Journal of Nursing Studies 49 (2012) 1017–1038 1019

l., 2007). A total of 100 papers were included in thisiew (Fig. 1).

ob satisfaction and its sources

Job satisfaction has been found to be related toformance within the work setting (Landeweerd andmans, 1988) and therefore researchers have attempted

identify the various components of job satisfaction,asure the relative importance of each component of jobsfaction and examine what effect these componentse on workers’ productivity (Burnard et al., 1999). Age of sources of job satisfaction among nurses haven reported from quantitative studies as well aslitative studies.

Aiken et al. (2001) found job dissatisfaction amongses was highest in the United States (41%) followed bytland (38%), England (36%), Canada (33%) and Germany%). One third of nurses in England and Scotland andre than one fifth in the United States planned on leavingir job within 12 months of data collection. Moreking, however, was that 27–54% of nurses underyears of age planned on leaving within 12 months ofa collection in all countries. Regarding the work climate,y about one third of nurses in Canada and Scotland feltt they participated in developing their own workedules in comparison with more than half in the otheree countries. When compared with other countries, theses in Germany (61%) reported that they were moresfied with the opportunities for advancement while theses in the United States (57%) and Canada (69%) feltre satisfied with their salaries.Similarly, Adamson et al. (1995) found that Britishses perceived themselves to be more dissatisfied thantralian nurses (p < 0.001). The British nurses perceivedir professional status to be lower (p < 0.01), theirtionship with hospital administrators to be poorer

0.01), and their working conditions to be less adequaten Australian nurses (p < 0.01). They also reported moreflict between the idealized perspective of work gaineding training and actual work practice (p < 0.01), andre less satisfied with their professional organization

0.01). The British nurses were also more concernedut the lack of communication between nurses andtors (p < 0.01) and reported being less respected byer allied health professionals, hospital administrators

doctors (p < 0.01). However, there was no overallificant difference between the Australian and British

ses regarding perceived level of autonomy of thedical profession.Different measurements regarding nurses’ job satisfac-

show various sources of satisfaction. The findingsived from different studies using the same scales arere valuable in providing comparative information,ticularly some cross-culture data. For example, thems et al.’s (1995) Ward Organizational Features Scales

re used in a set of studies to collect information fromses about their perceptions of the various aspects ofrd life and the impact which they had on careanization (Tovey and Adams, 1999; Adams and Bond,0). The tool comprised six sets of measures comprising

14 sub-scales rated on a 4-point Likert scale: physicalenvironment of the ward, professional nursing practice,professional working relationships, ward leadership,nurses’ influence and job satisfaction. The test–retestreliabilities of the scales were good with a correlationcoefficient of 0.7 or above (Adams et al., 1995).

Utilizing this questionnaire, Tovey and Adams (1999)found that key sources of nurses’ dissatisfaction includedworking relationships, particularly those with manage-ment, lack of staff, professional concerns about poorstandards of care and external work pressure. Adams andBond (2000) found that most nurses positively ratedaspects of ward services, facilities and layout (mean > 3,respectively). The highest correlations were foundbetween job satisfaction and cohesion of the ward nursingteam (p < 0.001), staff organization (p < 0.001), the level ofprofessional practice achieved within the ward (p < 0.001)and collaboration with medical staff (p < 0.001). Further-more, the most important contributors to nurses’ jobsatisfaction were the degree of cohesion existing amongward nurses (R2 = 0.26), the degree of collaboration withmedical staff (R2 = 0.20) and perception of staff organiza-tion (R2 = 0.20).

Nolan et al.’s (1995) Job Satisfaction Questionnaire wasalso utilized in a series of studies in the different countriesto assess nurses’ job satisfaction and morale (Nolan et al.,1995, 1998; Lundh, 1999). It comprises 16 items addres-sing aspects of the work environment, perceptions ofchange in the last 12 months and overall satisfaction andmorale. Nolan et al. (1995) found that level of jobsatisfaction had remained stable and two factors weredominant in nurses’ understanding of satisfaction andmorale, namely: the perceived ability to deliver goodpatient care and good collegiate relationships with co-workers. Together, these accounted for more than 50% ofall the additional positive comments received. Nolan et al.(1998) further found that 85% of respondents consideredthat their work was interesting, and this was one of themost significant factors influencing job satisfaction.Regarding job satisfaction and morale, 35% of respondentsconsidered that their job satisfaction had decreased in thelast year and 69% felt that overall morale had fallen.

Similarly, Lundh’s (1999) study showed that over 90% ofrespondents saw their work as interesting and mostrespondents also thought that they received respect fromtheir superiors (68%). Conversely, however, 55% ofrespondents reported that leadership within the organiza-tion was not seen to be particularly democratic withlimited opportunities to influence the decisions ofmanagers. In addition, nearly three quarters of respon-dents reported that their levels of stress had increased overthe last 12 months, while important aspects of their jobsatisfaction, such as satisfaction with pay and satisfactionwith overall working conditions had fallen.

In addition to providing a general outline of reportedjob satisfaction, Price (2002) explored key areas of jobsatisfaction using the Mueller and McCloskey (1990a,b)Satisfaction Scale which comprises 31 items on eightdimensions: extrinsic rewards, scheduling, balance offamily and work, co-workers, interaction opportunities,professional opportunities, praise and recognition, control


and responsibility. The global scale’s correlation coefficientwas reported as 0.89 and the validity ranged from 0.53 to0.75, with the scale correlating positively with severalestablished satisfaction scales. The results demonstratedthat More than half of the respondents (58%) weregenerally satisfied with their jobs and most satisfied withco-workers and extrinsic rewards (mean = 3.8 and 3.5,respectively) and most dissatisfied with the amount ofcontrol and responsibility that they had and withprofessional opportunities (mean = 2.7 and 2.6, respec-tively). The individual items with which nurses were mostsatisfied were: annual leave, nursing peers and hoursworked (79%, 78% and 76% of respondents scored 4 or 5,respectively), with most dissatisfaction relating to: com-pensation for working weekends and control over workconditions and childcare facilities (55%, 55% and 46% ofrespondents scored 1 or 2, respectively). Using the samescale, Wang (2002) found that Chinese nurses were moredissatisfied than satisfied (mean = 2.51) with most dis-satisfaction with pay (mean = 1.85) and job promotion(mean = 1.97). Similarly, in Zheng and Liu’s (2010a) study,the average score of Chinese nurses’ job satisfaction was2.70, and their highest satisfaction was related to co-workers, while most dissatisfaction was with pay(mean = 1.98) and job promotion (mean = 2.32).

From another point of view, Lee’s (1998) cross-sectionalsurvey examined the level of job satisfaction regarding sixjob components (autonomy, professional status, pay,interaction, task requirements and organizational policies)using the Index of Work Satisfaction (Stamps andPiedmonte, 1986). The results showed that nurses weredissatisfied more than satisfied (mean = 3.46) and reportedmost satisfaction with professional status (mean = 4.17)and most dissatisfaction with task requirements(mean = 2.81). The level of need for autonomy was belowthe mid-score of the sub-scale with no significant relation-ship (between their satisfaction with job autonomy andtheir individual need for autonomy).

Similarly, Bjork et al. (2007) used this scale to describejob satisfaction among hospital nurses in Norway andfound that interaction, pay and autonomy were ranked asthe three most desirable components of job satisfaction.Nurses were most satisfied with professional status(mean = 5.50), interaction (mean = 5.48) and autonomy(mean = 5.05), while most dissatisfied with pay(mean = 2.62). Penz et al. (2008) also explored predictorsof job satisfaction among rural acute care registered nursesusing the Index of Work Satisfaction, the Home Commu-nity Satisfaction scale (Henderson-Betkus and MacLeod,2004), together with specially designed individual andwork characteristics scale. Four factors including availableand up-to-date equipment and supplies (17%), greatersatisfaction with scheduling and shifts (7%), lowerpsychological job demands (5%), and greater satisfactionwith their home community (4%) explained 33% of thevariance in job satisfaction.

Tzeng (2002a,b) has also noted that expectation andreality may be sources of nurses’ dissatisfaction. TheNurses’ Job Satisfaction and the Perceived ImportanceQuestionnaire was specially designed for the studycomprised 8 job satisfaction scales and 8 importance

indicators (indirect working environment, direct workingenvironment, salary and promotion, self-growth, challen-ging work, interaction with patients, leadership style andworking atmosphere). Pearson correlation analysesrevealed that, except for the scale of indirect workingenvironment, all the scales were statistically and sig-nificantly correlated to their corresponding scales(p � 0.05). The nurse sample identified factors such asindirect working environment (a hospital’s policies,benefits, leisure activities, housing, parking and vacationpolicy), salary and promotion as very important butstrongly dissatisfying.

Kuhar et al. (2004) developed, tested and implementedthe Meaningful Retention Strategy Inventory (MRSI) in amulti-hospital system. The MRSI comprises 59 itemsreflecting 8 common attributes contributing to jobsatisfaction: autonomy, communication, administrative,recognition, working conditions, professional practice,scheduling/staffing issues and pay/benefits and is reportedto have good content validity and reliability. The studyresults were used to guide decisions relating to site-specific retention strategies. De Gieter et al. (2010) alsoexamined the relationship between psychological rewardand nurses’ job outcomes and found that satisfaction withpsychological rewards from the head nurse has astatistically significant influence on nurses’ turnoverintention (p < 0.001) and job satisfaction (p < 0.001)whereas pay satisfaction was not related.

Qualitative studies have also contributed to our under-standing of job satisfaction. Sjogren et al. (2005) found thatworking conditions (working schedule, management andrelationships with co-workers), salary and professionaldevelopment were the dominant reasons both for leavingand considering a return. In addition, a focus groupmethodology was used by Tourangeau et al. (2010) toidentify nurse reported determinants of intention toremain employed. Nurse assessments of satisfactionwithin eight thematic categories were found to influenceintentions to remain employed: relationships with co-workers, condition of the work environment, relationshipwith and support from one’s manager, work rewards,organizational support and practices, physical and psy-chological responses to work, patient relationships andother job content, and external factors (Table 1).

In conclusion, job satisfaction of nurses is an importantconcept as levels of job satisfaction may impact upon theglobal nursing workforce. Although the reported studiesdiffered regarding levels of job satisfaction among nurses,the literature reveals that the sources of job satisfaction arerelatively similar, e.g., physical working conditions,relationships with fellow workers and managers, staffingand scheduling, pay, promotion, job security, responsi-bility, the recognition from managers and hours of work(Table 2).

5. Effects of job satisfaction of nurses on absenteeism,burnout, turnover and intention to quit

Absenteeism is an important problem for healthcareproviders because it is costly and related to preventable jobstress (Matrunola, 1996). The impact of job satisfaction

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n nursing absenteeism, burnout and nurses’ intentionquit and turnover has been explored in a number ofearch studies yielding equivocal findings.Siu (2002), predictors of job satisfaction and absen-ism in two samples of Hong Kong nurses, Journal of

anced Nursing 40 (2002) (2), pp. 218–229. Full Text viassRef jView Record in Scopusj cited By in Scopus (36)’s (2002) study of nurses in Hong Kong found thatolvement (the degree of commitment displayedards employees by the organization) (p < 0.05), job

isfaction (p < 0.05), psychological distress (p < 0.01) age (p < 0.01) were significant predictors of absen-

ism for sample 1; and organization (the interactionween the worker and the organization) (p < 0.01),olvement (p < 0.05) and occupational type (p < 0.001)re significant predictors of absenteeism for sample 2.

inconsistent findings may be explained by thetively small sample sizes, the unmatched genderos, the unmatched occupational type, the relatively

response rate in sample 2 (57%) and the use of self-ort sickness-absence. Such inconclusive results sug-t that further research in this area should belicated among other Chinese nurses. Conversely,trunola’s (1996) study of English nurses found thatre was no relationship between job satisfaction andenteeism, however, generalization of the findingsds to be treated with caution owing to the smallple.

Lee et al.’s (2003) South Korean study showed that thest frequently mentioned reasons for nurses’ intendingeave their jobs were work overload, rotating shifts andflict in interpersonal relationships. A total of 24%, 15%

and 35% of variance regarding depersonalization, emo-tional exhaustion and personal accomplishment, respec-tively, was explained by the individual characteristics, jobstress and personal resources. It was particularly note-worthy that nurses who experienced higher job stressshowed lower cognitive empathy and empowerment, andworked on night shifts at tertiary hospitals were morelikely to experience burnout.

Regarding the effect of job satisfaction on nurseturnover, there are some similar findings across thedifferent studies. Cavanagh (1990) found that US publichospital nurse turnover could be predicted using kinshipresponsibility, promotion, salary and instrumental com-munication (p < 0.05). Cavanagh and Coffin (1992) furtherfound job satisfaction and participation at work to beimportant variables in the turnover process with fourvariables significantly related to intent to stay (p < 0.05):job satisfaction (r = 0.338), kinship responsibilities(r = 0.123), pay (r = 0.086) and opportunity (r = �0.072).However, these findings do not conclusively support thePrice and Mueller’s (1981) model of nursing turnover.

Gauci Borda and Norman (1997a) found a significantpositive relationship between job satisfaction and intent tostay (p < 0.005) and negative relationships between jobsatisfaction and frequency of 1 day absence and short-termabsence (lasting 3 days or less) (p < 0.05, respectively)among Maltese nurses. In a study of Canadian nursesSourdif (2004) explored the associations between intent tostay and various predictors and identified strong linearrelationships between satisfaction at work and satisfactionwith administration (p < 0.01), satisfaction with adminis-tration and organizational commitment (p < 0.01), and

le 1

rces of nurses’ job satisfaction.

urces of job satisfaction Key empirical sources

orking conditions Adamson et al. (1995), Nolan et al. (1995), Tovey and Adams (1999), Adams and Bond (2000),

Tzeng (2002a,b), Kuhar et al. (2004), Penz et al. (2008), Tourangeau et al. (2010)

teraction Adamson et al. (1995), Nolan et al. (1995), Lee (1998), Tovey and Adams (1999),

Adams and Bond (2000), Aiken et al. (2001), Price (2002), Tzeng (2002a,b), Wang (2002),

Kuhar et al. (2004), Sjogren et al. (2005), Tourangeau et al. (2010)

lationships with patients

lationships with co-workers

lationships with managers

ork itself Nolan et al. (1995, 1998), Lee (1998), Lundh (1999), Tovey and Adams (1999),

Adams and Bond (2000), Price (2002), Tzeng (2002a,b), Wang (2002), Kuhar et al. (2004),

Sjogren et al. (2005), Penz et al. (2008)

orkload; staffing; scheduling and shifts;

challenging work; routinization; task

requirements (abilities, skills, etc.);

psychological job demands

muneration (pay, salary) Adamson et al. (1995), Nolan et al. (1995), Lee (1998), Aiken et al. (2001), Price (2002),

Tzeng (2002a,b), Wang (2002), Kuhar et al. (2004), Sjogren et al. (2005), Tourangeau et al. (2010)

lf-growth and promotion Nolan et al. (1995), Lee (1998), Aiken et al. (2001), Price (2002), Tzeng (2002a,b),

Wang (2002), Kuhar et al. (2004), Sjogren et al. (2005)

ofessional training; opportunities of

advancement; job promotion;

personal achievement

ychological rewards: praise;

recognition; encouragement

Nolan et al. (1995), Lundh (1999), Aiken et al. (2001), Price (2002), Wang (2002),

Kuhar et al. (2004), De Gieter et al. (2010), Tourangeau et al. (2010)

ntrol and responsibility; autonomy;

decision-making

Nolan et al. (1995, 1998), Lee (1998), Price (2002), Wang (2002), Kuhar et al. (2004)

b security Nolan et al. (1995, 1998)

adership styles; organizational policies Lee (1998), Tzeng (2002a,b), Kuhar et al. (2004), Sjogren et al. (2005), Tourangeau et al. (2010)

Table 2

Summary of included studies regarding sources of nurses’ job satisfaction.

Author(s)

Location

Sample and response rate Instruments Key findings Comments

Adams and Bond (2000)

England

834 nurses of clinical grade C and

above (57% response rate)

Adams et al.’s (1995) ward

organizational features

scales

Most important contributors to nurses’ job satisfaction

were the degree of cohesion (R2 = 0.20) and perception

of staff organization (R2 = 0.20)

Adamson et al. (1995)

Australia and England

133 Australian nurses

(83% response rate)

108 British nurses

(78% response rate)

Specially designed scales:

Nurses’ dissatisfaction

scale, medical autonomy

scale, medical authority

scale

British nurses were more dissatisfied than Australian

nurses (p< 0.001)

British nurses perceived their professional status to be

lower, their relationship with hospital administrators to

be poorer and their working conditions to be less

adequate than Australian nurses

Medical dominance is a barrier

to both Australian and British

nurses’ workplace satisfaction

Aiken et al. (2001)

USA, Canada, England,

Scotland and Germany

43,329 nurses

(42–53% response rate)

Specially designed nurses’

working perceptions

questionnaire, Maslach

and Jackson’s (1986)

burnout inventory

Job dissatisfaction among nurses was highest in USA.

German nurses were more satisfied with the

opportunities for advancement while US and Canadian

nurses (69%) felt more satisfied with their salaries

Similar core problems in nurses’

work design and workforce

management

Lee (1998) Hong Kong 136 acute hospital nurses and 54

chronic hospital nurses

(response rates of 45% and 83%

respectively)

Stamps and Piedmonte’s

(1986) index of work

satisfaction, Edward’s

(1959) personal

preference schedule

(EPPS)

Nurses more dissatisfied than satisfied

No significant relationship between satisfaction with

job autonomy and individual need for autonomy

Lundh (1999) Sweden 439 nurses, 83 laboratory

technologists, 31 midwives and

72 managers (59% response rate)

Nolan et al.’s (1995) Job

satisfaction questionnaire

Nurses’ levels of stress had increased

Satisfaction with pay and overall working conditions

had fallen

Nolan et al. (1995) Wales 676 nurses, midwives and health

visitors (41% response rate)

Nolan et al.’s (1995) Job


Job satisfaction had remained stable

Falling confidence in the future of the NHS

Nolan et al. (1998) England 518 nurses (35% response rate) Nolan et al.’s (1995) job


35% considered that their job satisfaction had decreased

in the last year and 69% felt that overall morale had

fallen

Price (2002) England 141 E-grade nurses in a large

teaching hospital (82% response

rate)

Mueller and McCloskey

(1990a,b) satisfaction

scale

58% were generally satisfied with their job

Highest satisfaction was related to co-workers and

extrinsic rewards and most dissatisfaction was with the

amount of control and responsibility they had and with

professional opportunities

Caution needed re. sample bias

with only one grade of nurses

working in acute wards

represented

Tovey and Adams (1999) England 20 ward leaders and 110 nurses

of grades C–F

Adams et al.’s (1995) ward

organizational features

scales

Key sources of dissatisfaction: working relationships,

lack of staff, professional concerns about poor standards

of care and external work pressure

Random subset of 130 comments

from the main study (Adams

et al., 1995)

Tzeng (2002b) Taiwan 786 nurses (76% response rate) Tzeng’s (2002b) nurses’

job satisfaction and the

perceived importance

questionnaire

Indirect working environment, salary and promotion

were very important but strongly dissatisfying

Wang (2002) Mainland China 191 nurses (100% response rate) Mueller and McCloskey

(1990a,b) satisfaction

scale

Nurses were more dissatisfied than satisfied and mostly

dissatisfied with pay and job promotion

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Kuhar et al. (2004) USA 971 staff nurses and 182 nurse

leaders (36% response rate)

Specially designed:

Meaningful Retention

Strategy Inventory (MRSI)

MRSI reflects 8 common attributes contributing to job

satisfaction: autonomy, communication,

administrative, recognition, working conditions,

professional practice, scheduling/staffing issues, and

pay/benefits. Results showed that it has good content

validity and reliability. Results used to guide decisions in

the implementation of site-specific retention strategies

Sjogren et al. (2005) Sweden 288 nurses who had left nursing

care

Two open-ended

questions

Working conditions (working schedule, management

and relationship with co-workers), salary and

professional development were the dominating reasons

both for leaving and considering a return

Bjork et al. (2007) Norway 2095 nurses working at four

hospital (45.5% response rate)

Stamps (1997) Index of

Work Satisfaction

Interaction, pay and autonomy were ranked as the three

most desirable components of job satisfaction. Nurses

were most satisfied with professional status

(mean = 5.50), interaction (mean = 5.48) and autonomy

(mean = 5.05), while most dissatisfied with pay

(mean = 2.62)

Penz et al. (2008) Canada 944 rural hospital acute care

nurses

Stamps (1997) Index of

Work Satisfaction, Home

Community Satisfaction

scale (Henderson-Betkus

and MacLeod, 2004).

Four factors including available and up-to-date

equipment and supplies (17%), greater satisfaction with

scheduling and shifts (7%), lower psychological job

demands (5%), and greater satisfaction with their home

community (4%) explained 33% of the variance in job

satisfaction

Sub-sample of larger study

(Stewart et al., 2005)

De Gieter et al. (2010)

Belgium

337 nurses working for a diverse

sample of Belgian hospitals

(response rate not reported)

Psychological Reward

Satisfaction Scale(PReSS)

(De Gieter et al., 2008),

commitment to

occupation questionnaire

(Meyer et al., 1993)

Satisfaction with psychological rewards (compliment

and respect) from the head nurse turned out to be the

only statistically significant predictor of turnover

intention (R2 = 0.19; b =�0.38, p< 0.001)and job

satisfaction (R2 = 0.24; b = 0.42, p< 0.001)

Tourangeau et al. (2010)

Canada

13 focus groups involving 78

nurses working in two Canadian

provinces

Nurse assessments of satisfaction within 8 thematic

categories found to influence intentions to remain

employed: (1) relationships with co-workers, (2)

condition of the work environment, (3) relationship

with and support from one’s manager, (4) work rewards,

(5) organizational support and practices, (6) physical

and psychological responses to work, (7) patient

relationships and other job content, and (8) external

factors

H.

Lu et

al.

/ In

terna

tion

al

Jou

rna

l o

f N

ursin

g Stu

dies

49

(20

12

) 1

01

7–

10

38

1

02

3

Table 3

Summary of included studies regarding effects of nurses’ job satisfaction.

Code study Sample and response rate Instruments Key findings 2Comments

Cavanagh (1990) USA 232 hospital nurses (38.5%

response rate)

Price and Mueller’s (1981)

turnover scale

Combination of the variables accounted for 36.8%

(p< 0.05) of the explained variance in turnover rate

Cavanagh and Coffin

(1992) USA

221 nurses (response rates:

80.5% in a public hospital and

19.5% in a private hospital)


turnover scale

Factors related to intention to stay: job satisfaction,

kinship responsibilities, pay and opportunity

Job satisfaction was a key determinant in the turnover

process


model of nursing turnover

was not conclusively

supported

Gauci Borda and Norman

(1997a) Malta

171 nurses (67% response rate) Lyons’ (1971) global satisfaction

scale, Mueller and McCloskey’s

(1990a,b) satisfaction scale,

Redfern’s (1981) propensity to

leave index

Significant positive relationship between job

satisfaction and intention to stay (r = 0.48, p< 0.005)

and negative relationships between job satisfaction and

frequency of 1 day/short-term absence (r =�0.14,

p< 0.05, respectively)

Model of absence and

turnover (Gauci Borda and

Norman, 1997b) was not

totally supported

Lee et al. (2003)

South Korea

178 nurses (81% response rate) Maslach and Jackson’s (1981)

burnout inventory, Mehrabian’s

(1994) emotional empathy scale,

Barrett-Lennard’s (1978)

empathy scale

A total of 24%, 15% and 35% of variance in

depersonalization, emotional exhaustion and personal

accomplishment respectively explained by the predictor

variables

Lu et al. (2002) Taiwan 21,971 nurses (86.2% response

rate)

Specially designed scales:

professional commitment scale,

job satisfaction scale, intention

to quit scale

Job satisfaction was positively correlated with

professional commitment and negatively correlatively

correlated with intention to leave the organization and

profession

38.4% of nurses had the intention to leave the

organization and 30.4% intending to leave the profession

because of lack of job satisfaction

Further research needed

to explore the effect of

organizational

commitment regarding

any interrelationships

Matrunola (1996)

England

34 nurses working within an

elderly care unit (68% response

rate)

Matrunola’s (1996) job

satisfaction questionnaire,

Maslach and Jackson’s (1981)

burnout inventory, Beck et al.’s

(1974) hopelessness scale

No significant relationship between job satisfaction and

absenteeism

Small sample size limits

generalisability

Siu (2002) Hong Kong Sample 1: 144 nurses (100%

response rate)

Sample 2: 114 nurses (57%

response rate)

Siu and Cooper’s (1998)

psychological distress scale

Job satisfaction was a significant predictor of

absenteeism in sample 1; while no similar result was

found in sample 2

Replication needed

among other Chinese

nurses

Tzeng (2002a) Taiwan 648 nurses (82% response rate) General job satisfaction was significant predictor of

nurses’ intention to quit

Wu et al. (2000) Mainland,

China

382 nurses (92.5% response rate) Job stress scale (specially

designed)

There was a positive and significant relationship

between job stress and intention to quit (r = 0.46,

p< 0.05)

Further research is needed

to confirm the findings

Yin and Yang (2002) Taiwan Meta-analysis of 129 studies

relating to hospital nurses’

turnover from 1978 to 1998

Strongest factors related to nurse turnover were job

satisfaction, autonomy, opportunities for promotion, job

stress, pay group cohesion, marital status and

educational level

Indicates need for studies

using the same measures

for satisfaction and the

related variables

Sourdif (2004)

Canada

108 registered nurses (48.9%

response rate)

Nurses’ Intent to Stay

Questionnaire (Taunton et al.,

1997)

There were strong linear relationships between

satisfaction at work and satisfaction with

administration (r = 0.667; p< 0.01), satisfaction with

administration and organizational commitment

(r = 0.602; p< 0.01), and work group cohesion (r = 0.505;

p< 0.01)

Satisfaction at work (b = 0.268) and satisfaction with

administration (b = 0.284) together explained 25.5% of

the variance of intent to stay

H.

Lu et

al.

/ In

terna

tion

al

Jou

rna

l o

f N

ursin

g Stu

dies

49

(20

12

) 1

01

7–

10

38

10

24

Lee

et

al.

(20

04

)1

94

sta

ffn

urs

es

(88

%re

spo

nse

Sta

mp

se

ta

l.(1

97

8)

Ind

ex

of

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rksa

tisf

act

ion

wit

hp

rofe

ssio

na

lst

atu

s,sh

ift


work group cohesion (p < 0.01). Satisfaction at work(b = 0.268) and satisfaction with administration(b = 0.284) explained together 25.5% of the variance ofintent to stay. Tourangeau and Cranley (2006) furtherreported 12 predictors from four categories (job satisfac-tion, personal characteristics of nurses, work groupcohesion and collaboration, and organizational commit-ment) explained 34% of variance in Canadian nurses’intention to remain employed. The strongest predictorswere nurse age (p < 0.001), years of employment in thecurrent hospital (p < 0.001) and overall nurse job satisfac-tion (p < 0.001).

Yin and Yang’s (2002) meta-analysis of 129 studies alsofound that the strongest individual and organizationalfactors related to nurse turnover were job satisfaction(p < 0.05), autonomy (p < 0.05), advancement opportunity(p < 0.05), job stress (p < 0.05), pay (p < 0.05), groupcohesion (p < 0.05), marital status (p < 0.05) and educa-tional level (p < 0.05). Similarly, Wu et al. (2000) reported apositive and significant relationship between job stressand intention to quit among Mainland Chinese nurses(p < 0.05). Using the multiple regression, Tzeng (2002a)reported that institution (privately owned local hospital),age of the youngest child, level of education (e.g., diplomaand associate degree), salary and promotion, general jobsatisfaction and general job happiness were significantpredictors of Taiwanese nurses’ intention to quit (theNagelkerke Pseudo R2 = 0.410).

The influence of job satisfaction on intention to leavethe nursing profession was examined in Lu et al.’s (2002)study of Taiwanese nurses which reported that jobsatisfaction was positively correlated with professionalcommitment (p < 0.01) and negatively correlated withintention to leave the organization and profession(p < 0.01). In the discriminant analysis, 38.4% of the nursescould be classified as having the intention to leave theirorganization and 30.4% as intending to leave the professionbecause of lack of job satisfaction. Lynn and Redman(2005) further found that financial status, organizationalcommitment, job and professional satisfaction explained42% of variance in American nurses’ intention to leave theircurrent position with financial status and professionalsatisfaction explaining 45% of variance in nurse intentionto leave nursing. Chan et al. (2009) investigated factorsassociated with nurses’ intention to leave their currentemployment in Macao with 39.0% indicating an intentionto leave their current employment, with age, workexperience, work place and job satisfaction being sig-nificant risk factors for intention to leave. Nurses whoscored as unsatisfied on pay and benefits were 4.14 timesmore likely to have the intention to leave than nurses whoscored as satisfied (p < 0.001).

Furthermore, Lee et al.’s (2004) South Korean studyidentified that work outcomes such as job satisfaction andburnout can affect nurses’ overall life satisfaction. Speci-fically, work satisfaction with professional status, shiftpatterns, emotional exhaustion and personal accomplish-ment explained 30% of the variance in life satisfaction.

In summary, most published research from variouscountries indicates that job satisfaction is a significantpredictor of nursing absenteeism, burnout, turnover and

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intention to quit, however, there have been someinconsistent findings (Table 3).

6. Related factors to job satisfaction of nurses

Job satisfaction is a complex phenomenon, as evidencedby the findings already discussed. The identification ofthese factors and exploration of their effects on jobsatisfaction has the potential to refine the theoreticalmodels of nurses’ job satisfaction and aid the developmentof management interventions. Blegen’s (1993) meta-analysis of 48 studies found that job satisfaction wasmost strongly associated with stress (r = �0.61) andorganizational commitment (r = 0.53). Seven variableshad correlations between 0.20 and 0.50: communicationwith supervisor, autonomy, recognition, routinization,communication with peers, fairness and locus of control;and four variables had very weak correlations: age(r = 0.13), years of experience (r = 0.09), education(r = �0.07) and professionalism (r = 0.06). Zangaro andSoeken’s (2007) meta-analysis, which built on Blegen’s(1993), also found that job satisfaction was most stronglycorrelated with job stress (ES = �0.43), followed by nurse–physician collaboration (ES = 0.37), and autonomy(ES = 0.30). It is noteworthy that both Blegen’s (1993)and Zangaro and Soeken’s (2007) meta-analyses includedstudies across a range of settings which were notexclusively hospitals.

A causal model of job satisfaction has been tested in Chuet al.’s (2003) study of Taiwanese nurses, Seo et al.’s (2004)study of South Korean nurses and Zheng and Liu’s (2010b)study of Chinese nurses. This model included 11 indepen-dent variables namely: job involvement, positive affectiv-ity, negative affectivity, autonomy, distributive justice,procedural justice, job stress (role ambiguity, role conflict,workload and resource inadequacy), pay, promotionalchances, routinization and social support. Chu et al. (2003)found that, with the exception of pay (p > 0.05), all of theindependent variables were significantly related to jobsatisfaction (p < 0.05). Seven of the exogenous variableswere the major determinants of job satisfaction accordingto Pearson’s correlation coefficients: positive affectivity(r = 0.452), routinization (r = �0.441), resource inadequacy(r = �0.341), negative affectivity (r = �0.333), role ambi-guity (r = �0.327), supervisor support (r = 0.325) and co-worker support (r = 0.309). The regression results indicatedthat six of the exogenous variables hypothesized to impactupon job satisfaction were significant: routinization(b = �0.286, p < 0.001), positive affectivity (b = 0.266,p < 0.001), involvement (b = 0.147, p < 0.01), negativeaffectivity (b = �0.118, p < 0.05), co-worker support(b = 0.118, p < 0.05) and role ambiguity (b = �0.018,p < 0.05). The exogenous variables in this model explained45% of the association of variance in job satisfaction.

Seo et al. (2004) also found a reasonable fit between thecausal model and the data (CFI = 0.904, IFI = 0.907). Whenconsidering all of the independent variables (Model 1),seven variables had statistically significant net effects onjob satisfaction (p < 0.05): positive affectivity, supervisorysupport, pay, routinization, negative affectivity, workload

b = �0.250, b = �0.213, b = �0.211, b = �0.105, respec-tively). Model 1 explained about 53% of the variance insatisfaction, but when the psychological variables (positiveand negative affectivity) were not included (Model 2), jobopportunity was no longer significant (p > 0.05). Pay andsupervisor support positively impacted upon job satisfac-tion (b = 0.185, b = 0.164, respectively) while routinizationand workload negatively impacted upon it (b = �0.347,b = �0.24, respectively). Model 2 explained 40% of thevariance in satisfaction. When Zheng and Liu (2010b)partly tested this causal model among Chinese nurses inBeijing, 13 variables from four categories (job character-istics, working conditions, personal characteristics andorganizational factors) explained 56.2% of the variance injob satisfaction. Autonomy (b = 0.141), job involvement(b = 0.259), hospital management and organizationalsupport (b = 0.189), and person-job fit (b = 0.255) werethe four most significant predictors of job satisfaction.

Many studies have also stressed the relationshipbetween work conditions, organizational environmentand job satisfaction. Gelsema et al. (2006) conducted alongitudinal study to explore the impact of work conditionchanges on job outcomes among Dutch nurses. Thefindings revealed that changes in job conditions predicted8%, 11%, 16% and 35% of variance of respectively somaticcomplaints, psychological distress, emotional exhaustionand job satisfaction. More specifically, increases in skilldiscretion (b = 0.18), decision authority (b = 0.19), socialsupport supervisor (b = 0.22), reward (b = 0.21) and com-munication (b = 0.15), are associated with an increase injob satisfaction over time (p < 0.001), while increases inwork time pressure (b = 0.31) and physical demand(b = 0.14), result in more emotional exhaustion over time(p < 0.001).

Laschinger (2004) tested an exploratory model of theantecedents and consequences of Canadian nurses’perceptions of respect in hospitals and found that nurses’perception of respect were significantly related toorganizational environment characteristics: interactionaljustice (r = 0.72), structural empowerment (r = 0.47) andglobal empowerment (r = 0.47). In addition, job stressresulting from workplace factors, such as lack of recogni-tion (r = �0.38), poor interpersonal working relationships(r = �0.58), and heavy workload (r = �0.24) were alsosignificantly related to respect. Nurses’ perception ofrespect were significantly correlated with job satisfaction(r = 0.52) and intentions to leave within the next12 months (r = �0.24), as well as work effectivenessindicators. More recently, Laschinger et al. (2011) devel-oped a multi-level model of structural empowermentexamining the effect of nursing unit leadership qualityand structural empowerment on nurses’ experiences ofburnout and job satisfaction. The findings revealed thatnurses’ shared perceptions of leader–member exchangequality on their units positively influenced their sharedperceptions of unit structural empowerment (b = 0.25,p < 0.05) (Level 2), which resulted in significantly higherlevels of individual nurse job satisfaction (b = 0.30,p < 0.05) (Level 1). The results were consistent withLaschinger’s (2008) earlier study which reported that
structural empowerment had a positive direct effect on and job opportunity (b = 0.286, b = 0.11, b = 0.095,

thenuralsonur(p <

(r =

betsatinursuperabettionposwowoshiKwidenurjob(OR(OR(ORwh(ORfreqwemo

pranurandwe(ORof

levintethahigfrompro(p <

ext(20expbutstafForrelaexpandstroandsati

witandrelainv


level of job satisfaction (b = 0.45) and perceivedsing care quality (b = 0.27). Similar relationships were

found in Cai and Zhou’s (2009) study of Chineseses with structural empowerment being positively

0.01) related to the perceived job satisfaction 0.56) and turnover intention (r = �0.31).AbuAlRub et al. (2009) investigated the relationshipsween social support from supervisors/co-workers, jobsfaction and intent to stay among Jordanian hospitalses. They found that the correlation between socialport from supervisors and job satisfaction was mod-tely positive (r = 0.35, p < 0.001), while the correlationween social support from co-workers and job satisfac-

was not significant. There were also a significantlyitive relationship (p < 0.001) between intent to stay atrk and social support from both supervisors and co-rkers (r = 0.37, r = 0.25, respectively). Similar relation-ps were also reported by van der Heijden et al. (2010).ak et al. (2010) established a multivariate model tontify predictors of job satisfaction among South Koreanses. This model explained 43% of variance for nurses’

satisfaction. Specifically, satisfaction with profession = 11.93, p < 0.001), opportunity for promotion = 2.27, p < 0.05) and organizational support = 1.04, p < 0.05) had positive effects on job satisfaction,ile negative effects were associated with burnout

= 0.92, p < 0.05). However, pay, work environment,uency of shift change and perceived quality of care

re not significant predictors of job satisfaction in thisdel.Van Bogaert et al. (2010) investigated the impacts ofctice environment factors and burnout on Belgianses’ job outcomes and found that hospital management

organizational support, and emotional exhaustionre two significant predictors of nurses’ job satisfaction

= 6.96, OR = 0.89, respectively) while positive ratingsnurse–physician relationships (OR = 1.81) and lowerels of emotional exhaustion (OR = 0.94) predictedntion to stay in nursing. Brady-Schwartz (2005) found

t Magnet hospital nurses demonstrated significantlyher levels of overall job satisfaction compared to nurses

non-Magnet facilities (p < 0.001) arising from thefessional opportunities in the work environment

0.001), control and responsibility (p < 0.001) andrinsic rewards (p < 0.001). Chen and Johantgen10) established six structural regression models tolore the relationship between Magnet Hospital attri-es and nurses’ job satisfaction among 3182 registeredf nurses from Germany and Belgium. Four Magnetces (management style, autonomy, interdisciplinarytionships and professional development) were able tolain the variance of job satisfaction in both individual

hospital levels, with personnel policies having thengest effect (b = 0.96) on nurse-level job satisfaction

management style (b = 0.84) on hospital level jobsfaction.Organizational commitment refers to identificationh and loyalty to the organization and its goals (Blau

Boal, 1987) which Mowday et al. (1979) defined as thetive strength of an individual’s identification with and

olvement in a particular organization. In particular,

commitment is characterized by three factors: a strongbelief in and an acceptance of the organization’s goals andvalues; a willingness to exert considerable effort on behalfof the organization; and a strong desire to maintainmembership in the organization. Organizational commit-ment has been found to be positively related to the jobsatisfaction of hospital nurses (Blegen, 1993; Al-Aameri,2000). Knoop (1995) found that organizational commit-ment was related to overall job satisfaction (p < 0.001),satisfaction with work (p < 0.001), promotion opportunity(p < 0.001), supervision (p < 0.001), co-workers(p < 0.001) and pay (p < 0.01) among Canadian nurses.Furthermore, the regression analysis revealed that orga-nizational commitment explained 41% of the variance injob satisfaction.

Chang et al. (2007) found that the gap between careerneeds and career development programmes made sig-nificant (p < 0.01) contributions to organizational com-mitment (b = �0.209) and turnover intention (b = 0.183).Organizational commitment made significant (p < 0.01)negative contributions to turnover intention (b = �0.453).Guleryuz et al. (2008) also found that emotional intelli-gence was significantly (p < 0.01) and positively related tojob satisfaction and organizational commitment(p < 0.01). Job satisfaction was significantly related toorganizational commitment (p < 0.01) and served as amediator between emotional intelligence and organiza-tional commitment.

Professional commitment is a person’s involvement,pledge, promise or resolution towards his/her profession(Fang, 2001). It has an incremental effect on a profes-sional’s intention to leave the organization (Blau and Lunz,1998). Therefore, enhancing professional commitment innursing has the potential to produce benefits for both theindividual and their organization (Cohen, 1998, 1999).Furthermore, professional commitment is positivelyrelated to the job satisfaction of nurses (Lu et al., 2000;Jones, 2000). For example, Fang’s (2001) study ofSingaporean nurses demonstrated that job satisfactionwas significantly and positively related to organizationalcommitment (p < 0.01), professional commitment(p < 0.01) and supervisor satisfaction (p < 0.05) andnegatively related to job stress (p < 0.01), turnovercognition (p < 0.01) and intention to quit (p < 0.01). About41% of the variance in turnover cognition was explained bythe mentioned antecedents, however, the contributions ofjob stress, organizational commitment and professionalcommitment to job satisfaction were not identified.

Interestingly, Packard and Motowidlo (1987) found thatstress and job satisfaction in the US were not directlyrelated and that stress, primarily acting through depres-sion, was associated with lower levels of job performance.Job satisfaction correlated with depression (p < 0.01),hostility (p < 0.01), subjective stress (p < 0.01), frequencyof stressful events (p < 0.01), intensity of stressful events(p < 0.05) and anxiety (p < 0.05). Multiple regressionanalysis showed that depression had a strong effect onjob satisfaction (p < 0.01) and hostility (p < 0.01) and fearof negative evaluation (p < 0.01) had weaker direct effects,but other factors showed no significant impacts upon jobsatisfaction. However, Larrabee et al. (2010) found that


stress resiliency was a predictor of psychological empow-erment, situational stress, and job satisfaction. The causalmodel identified six significant predictors, namely: situa-tional stress and personal stress (job stress), psychologicalempowerment, necessitating and skill recognition (stressresiliency), years since RN graduation which togetherexplained 59% of the variance in job satisfaction (p < 0.05)with psychological empowerment (b = 0.46) as the stron-gest predictor.

In addition, the nurses’ roles within their worksituations and its effect on job satisfaction were also ofprimary concern with role conflict and ambiguity being themain sources of job stress (Hingley and Cooper, 1986). Roleconflict is defined in terms of the dimensions ofcongruency-incongruency or compatibility – incompat-ibility in the requirements of the role, where congruency ofcompatibility is judged relative to a set of standards orconditions which impinge upon role performance. Roleambiguity is the predictability of the outcome or responsesto one’s behaviour and the existence or clarity ofbehavioural requirements, often in terms of inputs fromthe environment, which would serve to guide behaviourand provide knowledge that the behaviour is appropriate(Rizzo et al., 1970). Role conflict and ambiguity aresignificantly related to job stress, organizational commit-ment, job satisfaction and intentions to leave the nursingprofession (Rosse and Rosse, 1981). Role discrepancy alsocontributes to nurses’ intention to quit their jobs. Nurses’intention to quit their jobs also increased when they had alow desire to engage in nursing roles and when they onlyperformed a few roles (Takase et al., 2006).

Dailey (1990) found that tension discharge rate, roleambiguity and role conflict were significant predictors ofexperienced stress symptoms (b = 0.24, 0.15, 0.08, respec-tively) among US nurses. Together, the three produced anoverall multiple R2 value of 0.47 (p < 0.001). On the otherhand, the most significant predictor of intention to quitwas experienced job-induced stress symptoms (b = 0.36),followed by tension discharge rate (b = 0.22). Roleambiguity (b = 0.13) and role conflict (b = 0.04) were alsosignificant predictors of intention to quit. The regressionmodel explained 75% of the variance in intention to quit(p < 0.001). Ho et al.’s (2009) study revealed that nurses’job rotation had a positive influence on job satisfaction(p < 0.01) and organizational commitment (p < 0.01) whilenurses’ role stress had a negative influence on jobsatisfaction (r = �0.52, p < 0.01) and organizational com-mitment (p < 0.01).

Lu et al. (2007a) explored nurses’ views regardingdifferent components of their working lives in MainlandChina. The results revealed that 53.7% of the nurses weresatisfied with their jobs and 15% felt moderate to extremeoccupational stress. The majority of the sample reported ahigh level of organizational commitment (63.7%) andprofessional commitment (85.9%) and only 5.9% and 10.0%,respectively reported role conflict and role ambiguity oftenor very often. Nurses with a Bachelor degree reported alower level of professional commitment and greater levelof role conflict than those with a diploma or associatedegree (p < 0.05). These findings suggested that nurses’educational background should be considered as an

important factor in understanding nurses’ working livesand may indicate the need for a clinical career ladder fornursing staff in Mainland China.

Mitchell’s (1994) US study found that there was not asignificant linear association between a nurse’s jobsatisfaction and the correlation between work role valuesand actual work roles (p > 0.05). This may be attributed toseveral factors. Firstly, the mean correlation (r = 0.58)between work roles and work role values was weak andnon-significant and secondly, the scores of job satisfactiondid not have a normal distribution with 54% of therespondents having a high level of satisfaction. Further-more, the work roles in the study questionnaire were nottested for validity and reliability. Therefore, furtherexplanation of the relationship between personal workrole values and actual work roles is needed in relation tonurses’ expressed job satisfaction.

Lu et al. (2007b) developed a model of job satisfaction inMainland China. About 40% of the variance in jobsatisfaction could be explained by the set of independentvariables including organizational commitment, occupa-tional stress, professional commitment, role conflict, roleambiguity, educational level, age and working years(R2 = 0.396). This model was tested in her another study(Lu, 2008) where 50.7% of the variance in job satisfactioncould be explained by the set of independent variablesincluding organizational commitment, professional com-mitment, occupational stress, role conflict and ambiguity.Organizational commitment (p < 0.001) had the strongestimpact on job satisfaction, followed by occupational stress(p < 0.001) and role ambiguity (p < 0.001). In addition,nurses’ role perception and actual role content influencedjob satisfaction as well as occupational stress, role conflictand role ambiguity (p < 0.05) (Lu et al., 2008). In general,the respondents who reported that they should do theroles itemized were more satisfied with their job with lowlevels of occupational stress, role conflict and roleambiguity (p < 0.05) compared to those who reportedthat they sometimes undertook those roles (p < 0.05).

Other factors relating to nurses’ job satisfaction havealso been explored. Nurse staffing is an important factorinfluencing various job outcomes (Rafferty et al., 2007;Kanai-Pak et al., 2008). According to Kanai-Pak et al.’s(2008) large cross-sectional survey of 5956 staff nurses inJapan, 56% of nurses scored high on burnout, 60% weredissatisfied with their jobs and 59% ranked quality of careas only fair or poor. The odds on high burnout, jobdissatisfaction and poor-fair quality of care were twice ashigh in hospitals with 50% of inexperienced nursescompared to those with 20% inexperienced nurses and40% higher in hospitals where nurses had less satisfactoryrelations with physicians. Nurses in poorly staffedhospitals were 50% more likely to exhibit burnout, twiceas likely to be dissatisfied and 75% more likely to reportpoor or fair quality care than nurses in better staffedhospitals. Similarly in Rafferty et al.’s (2007) study patientswere 26% more likely to die in hospitals where nurses hadthe heaviest patient loads. The nurses in the hospitals withthe heaviest workloads were between 71% and 92% morelikely to show negative job outcomes (burnout and jobdissatisfaction) and to rate the quality of care as low and

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eriorating. These studies highlight the importance ofquate and qualified nursing staff to improve nurses’ jobsfaction and quality of nursing care.In addition, significant positive correlations wereected between professional satisfaction and self-eem (r = 0.249–0.313, p < 0.01) in Karanikola et al.’s07) study. Goldman and Tabak (2010) found that thegruence of ethical climates explained 32.1% of theiance in job satisfaction with caring fit (b = �0.38) andependent fit (b = �0.22) being the two significantdictors of job satisfaction. Findings from various

studies have indicated that organizational citizenshipbehaviours (Chang et al., 2011), nurse caring (Burtson andStichler, 2010), coping strategies (Golbasi et al., 2008)were also related factors to nurses’ job satisfaction (Tables4 and 5).

In summary, much research has revealed that jobsatisfaction of hospital nurses is closely related to workingconditions and organizational environment, job stress, roleconflict and ambiguity, role perception and role content,organizational commitment and professional commitment(Table 6).

le 4

ted factors to job satisfaction of nurses.

lated factors Key empirical sources

bstantial to very strong relationship

with job satisfaction (correlation coefficient > 0.5)

Packard and Motowidlo (1987), Blegen (1993), Knoop (1995), Adams

and Bond (2000), Fang (2001), Laschinger (2004), Cai and Zhou (2009),

Chang et al. (2011), Ho et al. (2009), Guleryuz et al. (2008)

b stress; organizational commitment;

depression; cohesion of the ward nursing

team; structural empowerment; organizational

citizenship behaviours; job rotation; role stress; respect

oderate to substantial relationship with

job satisfaction (correlation coefficient 0.2–0.5)

Packard and Motowidlo (1987), Blegen (1993), Knoop (1995), Adams

and Bond (2000), Fang (2001), Chu et al. (2003), Zangaro and Soeken (2007),

Karanikola et al. (2007), Guleryuz et al. (2008), AbuAlRub et al. (2009),

van der Heijden et al. (2010), Burtson and Stichler (2010)

fectivity; role ambiguity; professional

commitment; routinization; supervisor/co-worker

support; collaboration with medical staff; job

performance; job involvement; hostility staff

organization; autonomy; recognition; fairness;

locus of control; communication with

supervisor/peers; emotional intelligence,

nurse caring, self-esteem

ght relationship with job satisfaction

(correlation coefficient < 0.2)

Packard and Motowidlo (1987), Blegen (1993), Fang (2001), Lu et al. (2002),

Chu et al. (2003); Golbasi et al. (2008)

le conflict; job involvement; age; year of

experience; educational level; professionalism;

anxiety; supervisor satisfaction; coping strategies

le 5

ictors of job satisfaction among nurses.

edictors Key empirical sources

pression Packard and Motowidlo (1987)

ganizational commitment Knoop (1995)

hesion existing among ward nurses; collaboration of medical staff; perceptions of professional practice;

team building skills of the ward managers

Adams and Bond (2000)

ganizational commitment; job stress; supervisor satisfaction Fang (2001)

ychological distress; occupational type (psychiatric/general); the physical conditions in the work area Siu (2002)

utinization; affectivity; job involvement; co-worker support; educational level Chu et al. (2003)

ill discretion; decision authority; social support supervisor; reward; communication Gelsema et al. (2006)

rse staffing Rafferty et al. (2007),

Kanai-Pak et al. (2008)

ganizational commitment; occupational stress; professional commitment; role conflict; role ambiguity Lu et al. (2007b, 2008)

tonomy; feedback; job involvement; management; support from leaders; resource adequacy;

nurse staffing; relationships with co-workers; children; shifts; educational level; person-job fit;

work department; patient number; bed utilization

Zheng and Liu (2010b)

tisfaction with profession; opportunity for promotion; organizational support; burnout Kwak et al. (2010)

uational stress and personal stress (job stress);

psychological empowerment; necessitating and skill recognition(stress resiliency);

years since RN graduation

Larrabee et al. (2010)

anagement style; autonomy; interdisciplinary relationships; professional development Chen and Johantgen (2010)

hical climates Goldman and Tabak (2010)

rceptions of leader-member exchange quality; structural empowerment Laschinger et al. (2011)

Table 6

Summary of included studies regarding related factors to job satisfaction of nurses.

Code study Sample and

response rate

Instruments Key findings Comments

Blegen (1993) Meta-analysis 48

quantitative

studies from 1977

to 1991

Job satisfaction was most strongly associated with

stress (r =�0.61) and organizational commitment

(r = 0.53)

40 general hospital nurse studies; the

other 8 studies involved public health

nurses, nurses from long-term care

facilities and an outpatient clinic

Chu et al. (2003)

Taiwan

308 nurses (75%

response rate)

The items from Price and Mueller (1986b),

Watson et al. (1987), Cyphert (1990), Kim

et al. (1996) and Price (2001)

6 variables had significant impact job satisfaction:

routinization, positive affectivity, involvement,

negative affectivity, co-worker support and role

ambiguity, which explained 45% of the variance in

satisfaction

Impact of work unit on job satisfaction

should be considered

Dailey (1990) USA 116 nurses (38.7%

response rate)

Rose et al.’s (1978) Tension Discharge Rate

Scale, Rizzo et al.’s (1970) Role Conflict and

Ambiguity Scale, Symptoms of Stress Index

The regression model explained 75% of the variance

in intention to quit

Fang (2001) Singapore 180 nurses (90%

response rate)

Mowday et al.’s (1979) Organizational

Commitment Scale, Fang’s (2001) Professional

Commitment Scale, Fang’s (2001) Nursing

Turnover Scale

Job satisfaction was significantly and positively

related to organizational commitment, professional

commitment and negatively related to job stress

Contributions of job stress, organizational

commitment and professional

commitment to satisfaction were not

identified

Knoop (1995) Canada 171 nurse

educators and

nurses (70%

response rate)

Mowday et al.’s (1979) organizational

Commitment Questionnaire, Kanungo’s

(1982) Graphic Job Involvement, Iris and

Barrett’s (1972) Job Satisfaction Scale

Organizational commitment was related to overall

job satisfaction (r = 0.64, p< 0.001) and explained

41% of the variance in job satisfaction

Impact of professional commitment upon

job satisfaction should be taken into

account

Mitchell (1994) USA 201 nurses (33%

response rate)

Weiss et al.’s (1967) Minnesota Satisfaction

Questionnaire, Benner’s (1984) Work Role

Scale

No significant linear association between a nurse’s

job satisfaction

Correlation between work role values and actual

work roles (p> 0.05)

Further explanation of the non-

relationship is needed

Packard and Motowidlo

(1987) USA

206 nurses (56%

response rate)

Price and Mueller’s (1981) Job Satisfaction

Scale, Others from Motowidlo et al. (1986)

Job satisfaction correlated with depression, hostility,

subjective stress, frequency of stressful events,

intensity of stressful events and anxiety

Model of job satisfaction was reasonable

but incomplete

Seo et al. (2004)

South Korea

353 nurses (65.4%

response rate)

The items from Kahn et al. (1964), Rizzo et al.

(1970), House (1981), Breaugh (1985),

Watson and Tellegen (1985), etc.

A reasonable fit between the causal model and the

data. All of the variables explained 53% of the

variance in satisfaction

Model could be used in Korean work

organizations

Gelsema et al. (2006)

The Netherlands

Time 1: 807 nurses

(64% response rate)

Time 2: 381 nurses

(61% response rate)

The Leiden Quality of Work Life Questionnaire

for nurses (LQWLQ-N; Maes et al., 1999),

validated Dutch client version of the Maslach

Burnout Inventory (Schaufeli and Van

Dierendonck, 1994), validated Dutch version

of the SCL-90 (Arrindel and Ettema, 1986)

Increases in skill discretion (b = 0.18), decision

authority (b = 0.19), social support supervisor

(b = 0.22), reward (b = 0.21) and communication

(b = 0.15), are associated with an increase in job

satisfaction over time (R2 = 0.35), while increases in

work time pressure (b = 0.31) and physical demand

(b = 0.14), result in more emotional exhaustion over

time (R2 = 0.16)

Zangaro and Soeken

(2007)

Meta-analysis 31

quantitative

studies published

from 1991–2003

Job satisfaction was most strongly correlated with

job stress (ES =� 0.43), followed by nurse–physician

collaboration (ES = 0.37), and autonomy (ES = 0.30)

20 studies conducted in hospitals and 10

conducted in specialized units. One study

was conducted in multiple sites (i.e., public

hospitals, private hospitals, nursing

homes, and nursing and community-based

agencies)

H.

Lu et

al.

/ In

terna

tion

al

Jou

rna

l o

f N

ursin

g Stu

dies

49

(20

12

) 1

01

7–

10

38

10

30

Chang et al. (2007) Taiwan 431 nurses (28.7%

response rate)

Blau et al.’s (1993) index of work

commitment, Mobley et al. (1978) turnover

intention scale, specially designed: career

needs and career development programmes

questionnaire

Gap between career needs and career development

programmes made significant contributions to

organizational commitment (b =�0.209, p< 0.01)

and turnover intention (b = 0.183, p< 0.01)

Organizational commitment made significant

negative contributions to turnover

intention(b =�0.453, p< 0.01)

Rafferty et al. (2007)

England

3984 nurses (49.4%

response rate)

Emotional Exhaustion Scale of Maslach and

Jackson’s (1986) burnout inventory, specially

designed: nurse staffing questionnaire, job

satisfaction and quality of care questionnaire

Patients where nurses had the heaviest patient loads

were 26% more likely to die.

Nurses with the heaviest workloads were between

71% and 92% more likely to show negative job

outcomes (burnout and job dissatisfaction) and to

rate the quality of care as low and deteriorating

Kanai-Pak et al. (2008) Japan 5956 nurses

working in 19 acute

care hospitals (84%

response rate)

Emotional Exhaustion Scale of Maslach and

Jackson’s (1986) burnout inventory, Nursing

Work Index-Revised (Aiken and Patrician,

2000; Lake, 2002)

Odds on high burnout, job dissatisfaction and poor-

fair quality of care were twice as high in hospitals

with 50% inexperienced nurses than with 20%

inexperienced nurses and 40% higher in hospitals

where nurses had less satisfactory relations with

physicians. Nurses in poorly staffed hospitals were

50% more likely to exhibit burnout, twice as likely to

be dissatisfied and 75% more likely to report poor or

fair quality care than nurses in better staffed

hospitals

Lu et al. (2007b,

2008) China

512 nurses (81%

response rate)

Job Satisfaction Scale (Warr et al., 1979),

Organizational Commitment Scale (Mowday

et al., 1979), Nurses’ Occupational Stress Scale

(Hingley and Cooper, 1986), Professional

Identification Scale (Brown et al., 1986), Role

Conflict and Ambiguity Scale (Rizzo et al.,

1970), Nurse’s Role Perception Scale derived

from the King’s Nurse Performance Scale

(Fitzpatrick et al., 1997)

40% of the variance in job satisfaction explained by

the set of independent variables including

organizational commitment, occupational stress,

professional commitment, role conflict, role

ambiguity, educational level, age and working years

(R2 = 0.396). Nurses’ role perception and actual role

content influenced job satisfaction as well as

occupational stress, role conflict and role ambiguity

(p< 0.05)

Lu (2008) Beijing, China 258 nurses (97%

response rate)

Same scales as above 50.7% of the variance in job satisfaction explained by

the set of independent variables including

organizational commitment, professional

commitment, occupational stress, role conflict and

ambiguity. Organizational commitment (b = 0.518,

p< 0.001) had the strongest impact on job

satisfaction, followed by occupational stress

(b =�0.147, p< 0.001) and role ambiguity

(b =�0.103, p< 0.001)

Golbasi et al.

(2008) Turkey

186 nurses (74.4%

response rate)

Weiss et al. (1967) Minnesota Satisfaction

Questionnaire (MSQ), Siva (1991) Turkish

version of the WCI

Significant positive relationship between job

satisfaction and dimensions of Ways of Coping

Inventory ‘self-condent approach’ (r = 0.181) and

‘optimistic approach’ (r = 0.175) and negative

relation between job satisfaction and dimensions of

the ‘helpless approach’ (r =�0.220)

Guleryuz et al.

(2008) Turkey

267 nurses (48.5%

response rate)

Wong and Law (2002) Emotional Intelligence

Questionnaire, Mowday et al. (1979)

Organizational Commitment Scale, Hackman

and Oldham’s (1975) Job Diagnostic Survey

(JDS)

Emotional intelligence was significantly and

positively related to job satisfaction (r = 0.236;

p< 0.01) and organizational commitment (r = 0.229;

p< 0.01). Job satisfaction was significantly related to

organizational commitment (r = 0.667; p< 0.01)

H.

Lu et

al.

/ In

terna

tion

al

Jou

rna

l o

f N

ursin

g Stu

dies

49

(20

12

) 1

01

7–

10

38

1

03

1

Table 6 (Continued )

Code study Sample and

response rate

Instruments Key findings Comments

Laschinger (2008)

Ontario, Canada

234 staff nurses

(58.5% response

rate)

Laschinger et al. (2001) Conditions for Work

Effectiveness Questionnaire-II (CWEQ-II),

Lake’s (2002) Professional Environment Scale,

Hackman and Oldham’s (1975) Job Diagnostic

Survey (JDS)

Magnet hospital characteristics mediated the effect

of structural empowerment on job satisfaction and

nurses’ perceptions of patient care quality. Staffing

adequacy (r1 = 0.23, r2 = 0.29) and structural

empowerment (r1 = 0.45, r2 = 0.27) had positive

direct effect on level of job satisfaction and perceived

nursing care quality

Laschinger et al. (2011)

Ontario, Canada

3156 staff nurses

from 217 units (40%

response rate)


Effectiveness Questionnaire-II (CWEQ-II),

Maslach and Jackson’s (1996) burnout

inventory, Laschinger et al. (2001) Global

Satisfaction Scale

Nurses’ shared perceptions of leader-member

exchange quality on their units positively influenced

their shared perceptions of unit structural

empowerment (b = 0.25, p< 0 .05) (Level 2), which

resulted in significantly higher levels of individual

nurse job satisfaction (b = 0.30, p< 0.05) (Level 1)

AbuAlRub et al.

(2009) Jordan

288 nurses from

public hospitals

(50–80% response

rate) and 195

nurses from private

hospitals (40–60%

response rate)

McCloskey and Mueller (1990) Satisfaction

Scale, Sargent & Terry (2000) Social Support

Scale, McCloskey & McCain (1987) Intent to

Stay Scale

Reported means of the ‘job satisfaction’ scale and

‘intention to stay at work’ scale for the nurses of

private hospitals were significantly higher than

those of the nurses of public hospitals (p< 0.01). The

correlation between social support from supervisors

and job satisfaction was moderately positive

(r = 0.35, p< 0.001), while the correlation between

social support from co-workers and job satisfaction

was insignificant (p> 0.05)

Ho et al. (2009) Taiwan 532 nurses working

in two large

hospitals (81.8%

response rate)

Specially designed: Job Rotation scale, Role

Stress scale, Job Satisfaction scale,

Organizational Commitment scale

Nurses’ job rotation had a positive influence on job

satisfaction (r = 0.51) and organizational

commitment (r = 0.46). Nurses’ role stress had a

negative influence on job satisfaction (r =�0.52) and

organizational commitment (r =�0.79)

Cai and Zhou (2009)

Mainland, China

189 staff nurses

(98.4% response

rate)


Effectiveness Questionnaire (CWEQ-II), Peng

and Liu (2008) Global Job Satisfaction

Questionnaire

Zhang et al. (2005) Chinese version of

Michigan Organizational Assessment

Questionnaire

Structural empowerment positively related to the

perceived job satisfaction (r = 0.56) and turnover

intention (r =�0.31)

Goldman and Tabak

(2010) Israel

95 graduate nurses

(response rate not

reported)

Specially designed: ethical climate and job


Congruence of ethical climates explained 32.1% of

the variance in job satisfaction, with caring and

independent fit as the strongest predictor

Van Bogaert et al.

(2010) Belgium

546 staff nurses

(66% response rate)

Nursing Work Index-Revised (Aiken and

Patrician, 2000), Burnout Inventory Human

Service Survey (MBI-VL) (Maslach & Jackson,

1996; Vlerick, 1996; Van Bogaert et al., 2009)

Hospital management and organizational support,

emotional exhaustion were 2 significant predictors

of nurses’ job satisfaction (OR = 6.96, OR = 0.89,

respectively). Positive ratings of nurse–physician

relationships (OR = 1.81) and lower levels of

emotional exhaustion (OR = 0.94) predicted

intention to stay nursing

van der Heijden et al. (2010)

Europe (8 countries)

17,524 registered

female nurses

Job satisfaction scale originated from

Kristensen (2000), specially designed social

support from direct supervisor and close

colleagues questionnaire, one item for

intention to leave the profession

Social support from direct superiors, and from close

colleagues are significantly and positively related

with job satisfaction (r1 = 0.26–0.37, r2 = 0.13–0.19,

p< 0.001), and negatively with intention to leave the

nursing profession (r1 =�0.11 to �0.22, r2 =�0.07 to

�0.15, p< 0.05)

Part of a large European study on nurses’

intention to leave their profession (NEXT,

Nurses Early Exit, Hasselhorn et al., 2003).

H.

Lu et

al.

/ In

terna

tion

al

Jou

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(20

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s,H. Lu et al. / International Journal of Nursing Studies 49 (2012) 1017–1038 1033

7. Conclusion

Most member states of the WHO have reported nurseresource difficulties (Kingma, 2007). Developed countriesare faced with the double challenge of having an ageingnurse workforce and increasing demand for nursing carefrom an ageing population (Buchan, 2001). Internationalmigration of nurses has increased as nurses pursueopportunities for improved pay and opportunities in thewake of the global liberalization of trade spurred on bydeveloped countries increasing their international recruit-ment to meet their health-care workforce needs and in sodoing creating a ‘skills drain’ in many developing countries(Kingma, 2007). This increased mobility of the nursingworkforce means that factors which contribute to nurses’turnover merit attention. Job satisfaction among nurseshas been identified as a key factor in nurses’ turnover withthe empirical literature suggesting that it is related to anumber of organizational, professional and personalvariables.

This review was limited to general acute hospitalsettings and therefore care needs to be taken regarding itsapplication to other care settings and other elements of thequalified nursing workforce such as specialist nurses andmental health nurses. Nonetheless the literature indicatescommon issues across the world although it is possiblethat different issues have greater significance in differentcountries due to the social context of the different labourmarkets. Further the literature suggests that work relatedstress is increasing over time in the wake of healthcarerestructuring and technological change (Zangaro andSoeken, 2007) with increased levels of work related stressand associated lower levels of satisfaction with rewardpackages and working conditions being consistent acrossstudies. Current workforce shortages are likely to placegreater demands upon nurses which might be expected toincrease their work related stress and may reduce thequality of workplace relationships which has emerged asan important source of job satisfaction and contributes toorganizational commitment. The lower levels of jobsatisfaction among nurses with tertiary education arenoteworthy as such nurses probably represent the mostwell-educated element of the nursing workforce and thefuture leadership of the profession. Also noteworthy is thelower job satisfaction of those who had unfulfilledexpectations regarding nursing work which suggests thatsome nurses retain an idealized view of nursing despitemost initial nurse education including extended periods ofclinical practice to prevent reality shock on entry into theworkforce.

The current worldwide shortage of nurses highlightsthe importance of understanding the impact and inter-relationships of the identified variables if healthcareorganizations are to implement interventions to improvethe retention of their nursing workforce. Although severalmodels of job satisfaction have been postulated, thesemodels require further testing especially regarding therelative contribution of different factors especially in thedifferent contexts of countries. The literature suggests thatthe moderators or mediators in these models need to beidentified in further studies thereby providing clearer

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causal relationships between the predictors and jobsatisfaction. The lack of a comprehensive and causal modelof job satisfaction in nursing is a major shortcoming andwithout which effective management interventions can-not be developed or tested.

Conflict of interest

There are no conflicts of interest.

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