literature review on job dissatisfaction

• Research article
• Open access
• Published: 18 September 2020

Determinants of nurse job dissatisfaction - findings from a cross-sectional survey analysis in the UK

• Michaela Senek   ORCID: orcid.org/0000-0003-4226-2220 1 ,
• Steven Robertson 1 ,
• Tony Ryan 1 ,
• Rachel King 1 ,
• Emily Wood 1 ,
• Bethany Taylor 1 &
• Angela Tod 1  

BMC Nursing volume  19 , Article number:  88 ( 2020 ) Cite this article

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A lower recruitment and high turnover rate of registered nurses have resulted in a global shortage of nurses. In the UK, prior to the COVID-19 epidemic, nurses’ intention to leave rates were between 30 and 50% suggesting a high level of job dissatisfaction.

In this study, we analysed data from a cross-sectional mixed-methods survey developed by the Royal College of Nursing and administered to the nursing workforce across all four UK nations, to explore the levels of dissatisfaction and demoralisation- one of the predictors of nurses’ intention to leave. We carried out logistic regression analysis on available data in order to determine what impacts job dissatisfaction.

In total, 1742 nurses responded to questions about working conditions on their last shift. We found that nearly two-thirds of respondents were demoralised . Nurses were five times more likely (OR 5.08, 95% CI: 3.82–6.60) to feel demoralised if they reported missed care. A perceived lack of support had nearly the same impact on the level of demoralisation (OR 4.8, 95% CI: 3.67–6.38). These findings were reflected in the qualitative findings where RNs reported how staffing issues and failures in leadership , left them feeling disempowered and demoralised.

A large proportion of nurses reported feeling dissatisfied and demoralised. In order to reduce the negative impact of dissatisfaction and improve retention, more research needs to investigate the relationship dynamics within healthcare teams and how the burden experienced by RNs when unsupported by managers impacts on their ability to provide safe, good-quality care. These findings predate the current Covid-19 pandemic outbreak which may have had a further detrimental effect on job satisfaction in the UK and other nation’s nursing workforce.

Peer Review reports

The shortage of registered nurses (RNs) is a pressing issue across all four countries within the UK, with a similar trend and concern being observed across Europe and globally [ 1 , 2 ]. In the UK, a drop in recruitment and retention of qualified nursing staff, as well as a rise in patient acuity, have been identified as main reasons for this workforce crisis [ 3 ]. The Rising Pressure report by the Health Foundation in 2017 showed that there was a 0.2% drop in the number of registered nurses, with a median leaver rate of around 15% in National Health Service (NHS) organisations [ 4 ]. Similarly, the Royal College of Nursing, UK, reported that from September 2017 to September 2018 there were 2532 more RN leavers than joiners in the nursing workforce. As a result, there were approximately 40,000 unfilled RN vacancies in 2019 [ 5 ]. Globally, the shortage of RNs was estimated to be 5.8 million [ 6 ].

Such shortages place health care systems under a burden during what might be termed ‘typical’ conditions. However, these systems come under extraordinary strain when hospital and community services are placed under ‘atypical’ conditions, such as those witnessed during the recent Covid-19 outbreak.

A review of systematic reviews of determinants of nurses’ intention to leave, found that the majority of included studies made a distinction between individual and organisational determinants of intention to leave. Individual determinants include age, gender, marital status, educational attainment, stress, burnout, commitment, job satisfaction, low serum cholesterol, weight and sleep disturbance [ 7 ]. Organisational determinants have centred on malfunctioning management and lack of supervision [ 8 ]. On an individual level, among all the multiple determinants of turnover in adult nursing, job dissatisfaction and nurse stress were some of the most important factors identified in the literature. For instance, individual studies by Larrabee et al., have shown that job dissatisfaction is predictive of both the intention to leave as well as actual turnover [ 9 ].

Whilst several studies have sought to address the range of predictors of intention to leave, some have furthered the field by use of a theoretical approach. One such attempt provides a link between job satisfaction and nurse turnover behaviour [ 10 ]. The theory categorised economic factors (pay, job market and training), structural factors (work environment, work context), and individual factors (psychological, demographic) as major determinants of nurses’ job satisfaction that influence behavioural intentions and turnover [ 11 ].

Further, a review by Coomper et al., that explored the components of job satisfaction and their impact on intention to leave, identified stress and leadership as main components that have the strongest impact on dissatisfaction among adult nurses and turnover. Whilst education and level of pay were found to be inconsistent, stress and leadership were identified as the best predictors of lack of satisfaction and intention to leave [ 10 ]. Previous literature has demonstrated the importance of leadership which is ethical and fair. Ozden et al. have raised the importance of fair leadership and leaders’ awareness of power-sharing and their effect on nurses’ job satisfaction in challenging times [ 12 ]. The findings showed that lack of fairness and ethical leadership can have particularly bad consequences on nurses during difficult times such as the COVID-19 pandemic [ 13 ].

Prevalence of job dissatisfaction among RNs was further highlighted through findings of a cross-sectional survey of 488 hospitals across Europe and the United States, which explored the level of dissatisfaction among RNs and associated outcomes. It found that job dissatisfaction was highest in Greece (56%), followed by Ireland (42%) and England (39%). Notably, a higher patient to nurse ratio (more than 10:1 in Greece and more than 8:1 for the latter two), as well as poor work environment, was reported in these countries [ 14 ].

A recent review of systematic reviews, exploring interventions to reduce adult nursing turnover, concluded that more high-quality primary research is needed to inform decision-making by human resource managers and organisations to improve retention strategies. The study included 9 systematic reviews in total. The review did not have definite findings due to the poor quality of evidence. Seven reviews were rated as moderate and two as being of poor quality. The main reasons for reviews being in the moderate rather than strong evidence category were the lack of publication of a review protocol , unclear search strategy performed , the failure to have two reviewers check the selection and data extraction and not providing a list of both included and excluded primary studies. More high-quality research would allow a better understanding the current main causes of RNs dissatisfaction based on primary research and is therefore pivotal to address this issue [ 15 ].

The aim of this study was to undertake a secondary analysis of a large UK wide data set in order to assess a set of self-reported individual and organisational predictors of nurses’ satisfaction/ dissatisfaction. We defined overall job satisfaction as a sum of all individual and organisational determinants and proposed to test a set of potential determinants, both individual and organisational, to see if and how they are associated with overall self-reported RN satisfaction. These data were collected during 2017, ahead of recent global pandemic conditions. Research about the determinants of dissatisfaction, as one of the predictors of nurses’ intention to leave is becomes even more relevant during a pandemic crisis such as COVID-19.

Whilst we recognise that there are many factors involved in nurses’ intention to leave, we have used the data available to us. In this study, we cannot predict ‘intention to leave’ but we are exploring job satisfaction as one of the previously known determinants of the intention to leave within a cohort of adult acute RNs.

This study presents findings from a secondary analysis of an online-based cross-sectional survey of registered nurses from across the UK developed and administered by the RCN in May 2017 [ 16 ]. The RCN is the UK’s largest professional nursing body consisting of 450,000 members of registered and non-registered nursing and health care staff. A report from the survey, produced by the RCN and covering all questionnaire domains, is available on the RCN website [ 5 ].

We deployed an explanatory mixed methods study design. We began by descriptively exploring responses in the first part of the questionnaire. We then conducted a multivariate logistic regression modelling of the available data. From this, we initially developed a framework, and subsequently a thematic analysis, of the qualitative data. Finally, we (re)applied this to the quantitative data in a cyclical manner. The method therefore followed a process closely aligned with abductive reasoning. Definitions of abductive reasoning vary, however, all recognise it as a process where there is a cyclical and creative movement between the formulation of hypotheses and observed phenomena [ 17 , 18 ]. While some identify the challenges of utilising abduction in qualitative studies [ 19 ], it is a form of reasoning well suited to mixed methods research as it develops claims supported from both deductive and inductively sourced evidence, in situations where the research is not driven exclusively by theory or by data [ 20 ].

Study population

In May 2017, a staff survey of RN’s was carried out by the Royal College of Nursing (RCN). The survey was developed by the RCN, sent to all RCN members and was advertised on social media. The sample therefore consisted of both RCN members and non-members across the UK. The final sample responses comprised of 29,345 nurses. For the purpose of analysis, we identified from the data base and then included adult acute care nurses, which comprised 7040 RNs in total. In the UK, adult acute care covers all aspects of medical and surgical hospital in-patient care for those over 18 years of age but does not usually include in-patient mental health care. In order to provide a clear research focus on a specific group of RNs, we excluded RNs from the community, children’s nursing, mental health nursing and learning disabilities sectors. These settings will be analysed in subsequent pieces of work. The questionnaire did not ask the respondents to identify the specific hospital that they worked in for reasons of anonymity. It also did not ask for any demographic details. As a result, we were unable to carry out our analysis at the level of hospital and NHS trusts or consider the impact of demographics.

Data sharing agreement and ethics

Before work commenced, a data sharing agreement was obtained between The University of Sheffield and the RCN. All data was anonymised prior to being shared with the research team. Ethical approval was obtained on 27/08/2019 from the University of Sheffield (Reference Number 026774) to conduct a secondary analysis of the anonymised RCN survey.

Measured outcomes

We aimed to assess the determinants of the overall nurse dissatisfaction (with the job). In the survey, all responses were relating to RNs experience of their most recent shift.

The binary outcome of Demoralised or Not Demoralised was derived from response to the question: I felt demoralised (after my last shift). The RCN designed the survey and chose the phrasing of this question. The respondents could Agree, Strongly Agree, Disagree, Strongly Disagree with the statement. The Agree and Strongly Agree were merged as was Disagree and Strongly Disagree. We use the term Demoralisation , whilst recognising that Dissatisfaction is the more common variable used to predict intention to leave and turnover . However, respondents were in fact reporting on feeling Demoralised, which is a much stronger sentiment.

We aimed to test all independent variables available from the survey that have been identified in previous literature as determinants of nurse job dissatisfaction and demoralisation. The dependent variable was tested against all available independent variables in Table  1 .

Respondents were also requested to respond to an open question asking them to describe and/or give examples of their last shift and any concerns or challenges they were able to observe. There was no word limit set on the length of replies to the open response question. These varied considerably in length and the amount of detail provided from a couple of sentences to 1–2 paragraphs. Due to the large amount of data from 1747 responses, 400 pages, we randomly sampled 10 pages of data for the analysis. This resulted in descriptive, narrative data from 368 individuals (20%) in total. While no formal test of data saturation was performed, a member of the team checked the emerging coding against a further 10 pages of data and no new codes were noted. In addition, Braun & Clarke suggest that for qualitative analysis of open question survey responses, a sample size of over 100 respondents is required for a large project [ 21 ]. We are therefore confident that with the responses from 368 individuals, and from checking an additional 10% of the data, that data saturation was achieved.

Data analysis

An explanatory analysis was used to draw conclusions about the findings from the survey. In the first part of the analysis, we conducted univariate analysis with independent variables from the survey in order to assess the relationship and best model for predicting job dissatisfaction and demoralisation. A normality test showed that data was normally distributed for all responses. We then carried out a backwards logistic regression in order to select variables that best predict the model in order to determine which variables most affect nurses feeling Demoralised/Not Demoralised. We identified determinants that were most associated with affecting demoralisation.

From this point, a set of categories based on the findings from the regression modelling were used as an initial framework to organise and explore the qualitative data. Specifically, narratives around what led to dissatisfaction and feeling demoralised within this data set were considered. The qualitative data set was then further coded into sub themes and then overarching themes. Quirkos (v2.3) was used to assist in this phase of the analysis.

For the qualitative analysis, responses were analysed from 368 respondents who were representative of the overall respondents in terms of their clinical setting e.g. medicine, surgery. No analysis was performed to break down findings by these two clinical settings. Three researchers [SR, TR, MS] coded the responses.

The final stage of analysis was to more fully integrate the two data sets. Following processes of abduction [ 17 ], we aimed to understand the complexity of the interrelationships that exist between our data sets and the interpretations of them. We did this in order to integrate surface (semantic) and deep (latent) structures of a phenomenon; in this case understanding the determinants of job satisfaction. In practice, this process was achieved by research team meetings to iteratively align the quantitative and qualitative data sets and their analysis while simultaneously incorporating previous empirical work into these critical discussions. Again, in line with abduction, this allowed the juxtaposition of what is familiar with that not so familiar in order to generate robust explanations (that can be further tested) [ 17 ].

For reasons of flow and clarity, the results are presented as the two separate data sets and the more integrative analytical work is presented in the discussion.

Initially there were 7040 Adult Acute RNs in our sample. Out of those, 67.6% responded to the question on whether they felt demoralised ( N  = 4770), whilst the remaining 32.4% chose ‘Neither Agree or Disagree’ option, which was treated as ‘choose not to say’ and therefore as a missing value. Of the 4770 responses, 63.8% of RNs reported feeling demoralised , whilst 36.2% reported feeling not demoralised (see Table  2 ).

To test the associations with nurses’ demoralisation we included the following determinants in the model:

In the binary logistic regression analysis, there were 3023 missing cases, or ‘neither agree or disagree’ options selected for at least one of the variables. These were treated as ‘no response/ ‘choose not to say’ due to the nature of the question and was therefore noted as ‘missing response’. The respondents who chose not to respond to this question could therefore not be included in the analysis. As a result, in total, 1747 valid cases were in the final analysis.

The overall model was statistically significant x 2 (6) = 959,519, p  < 0.001, predicting 82.7% of all cases.

Missed care ( p  < 0.001), lack of adequate support and supervision ( p  < 0.001), understaffed shift ( p  = 0.001), inability to take a break (p < 0.001), worked overtime ( p  < 0.001), action taken when concerns were raised ( p  < 0.001), were all significantly related to demoralisation.

Respondents who reported missed care, that is having to leave necessary care undone , were five times more likely to report being Demoralised (OR [5.02] 95% CI:3.67, 6.38). The RNs were 4.8 times more likely to be demoralised if there was a lack of support (OR [4.8], 95% CI: 3.67, 6.38). Other factors that were significantly associated were; whether action was taken after they raised concern , if they could not take a break , if they had to work overtime and if the shift was understaffed (see Table  3 ). Perceived high absence/sickness, percentage of temporary staff on the shift and number of patients seen, were excluded from the model.

Qualitative findings

Responses were analysed from 368 respondents who were representative of the overall respondents in terms of their clinical setting e.g. medicine, surgery. No analysis was performed to break down findings by these two clinical settings. Three researchers [SR, TR, MS] coded the responses and those codes were subsequently grouped into 16 sub-themes. Further analysis revealed four main themes; Staffing Issues , Lack of Support , Risk , and Personal Impact (see Fig.  1 ). We describe each of the four themes below, using extracts from the data set to illuminate and confirm theme meanings. While each of these themes were reasonably equally weighted in terms of the number of responses made, as we will show, the first three seem to act synergistically to produce the depth of feeling expressed in the fourth theme. It is important to note that the analysis here, like the quantitative analysis, focused on dissatisfaction and demoralisation. Positive data, particularly relating to the first two themes, was also present and likely reflects the experiences of those 36% of RN’s who did not report feeing demoralised.

• Staffing issues

All respondents discussed staffing issues in their daily work and the challenges faced as a result. They spoke about a lack of adequate staff numbers, which resulted in higher than manageable patient to nurse ratios, and of the detrimental impact of this for both patients and staff:

‘We are chronically understaffed, and I feel this regularly has a negative impact on patient care and staff wellbeing. We have patients that deteriorate quickly as well as a number of confused and high falls risk patients. I believe the lack of staff contributes to not being able to provide the highest level of care.’

An aspect of this theme is the reference to personal, physical and emotional consequences of maintaining one’s professional role under such conditions and how these impact upon the quality of care provided:

‘All staff are human and can only take so much of doing more than their workload. People end up being off sick due to exhaustion and stress. It's an impossible situation. Bottom line is understaffing to save money is as good as a chocolate tea pot. Eventually the staff left will melt and we'll be left with nothing but a mess.’

Respondents described challenges which resulted from rota gaps as well as instances where, if they did have a full complement of staff, staffing resources would then be moved to cover gaps in other areas of the hospital. They described attempts to fill such rota gaps with temporary agency and bank staff. This posed a separate set of challenges due to the temporary nurse’s lack of familiarity with the ward and the patients:

‘I have to work with a different nurse every shift. It's stressful trying to supervise bank or agency nurses as well as doing my own work. They aren't allowed to use certain pieces of equipment such as blood sugar monitoring or infusion pumps.’

This theme demonstrates the challenging situations faced by RNs in their daily work. It demonstrates the complexity of this issue that leads to feelings of frustration and despair due to a lack of staff who are adequately trained and familiar with the ward setting.

Failures in leadership and Organisational support

This theme describes the negative feelings attributed to a lack of support from hospital management, as experienced by respondents. This lack of support was experienced in a range of ways from simple disregard to being made to feel incompetent and even blamed for the poor state of patient care. The disregard encountered by RN’s was not only for themselves but also, they felt, extended to a disregard for patient’s needs:

‘I feel our patients are behind us, but I do feel that upper management are disengaged with patients & staff’s real concerns and issues.’

This apparent disconnect and disregard led to struggles with respondents trying to secure necessary staff or develop systems to help cope with excess workload. Such efforts were often undermined by managers leaving respondents disempowered and dissatisfied:

‘Our site manager is unable to help us and refuses to let us save beds the night before knowing that we have these patients coming in.’ ‘I have seen a large number of staff leave due to the pressures of being understaffed and the ward manager not helping on the ward. Nurses feel quite negative about matrons as they are not seen to do anything about understaffing.’

At its worst, this disregard of concerns, and struggle to get support in providing quality patient care, was reflected back on the respondents in ways that led to stress, blame and feelings of professional vulnerability:

‘Staff are made to feel incompetent by management when things are not done. It gets put down to poor time management on the nurses’ part. Went home from that shift feeling sad for the patients, angry with the management, absolutely exhausted and dreading the next shift.’ ‘I try to do everything, but nothing is achieved. And yet the threat of disciplinary action hangs over nurses if anything goes wrong. […] We don't challenge and yet we are being challenged by the government and hospital bosses.’

What is being described in this theme are broken relationships between respondents in the clinical area and those senior managers they rely on to provide practical and emotional support in delivering safe and effective care. Rather than being heard by those with the ability to help, many respondents report a perceived lack of action, or worse, actions that challenge their commitment and leave them feeling intimidated and demoralised.

Risk to self/others

The understaffing and lack of support noted above generate risks to both the respondents and the patients they care for. In this theme, respondents give detailed accounts of the ways in which necessary care is left undone and the risk this poses to patients as well as the risks that they face during their day-to-day work. Examples provided point to the immediate risks to patient well-being and to the subsequent impact on the wider health care system.

‘Looking after 15 patients you cannot meet patients’ needs, results in cutting corners and not always delivering safe care. This results in extra pressures due to the bigger patient workload. Wound dressings are not being renewed when they should be which results in further infections and extra time in hospital.’ ‘I often have to look after 10 patients and the medication round takes so long to administer, some patients have medication up to 2 hours late. I also cannot check observations as frequently as I would prefer.’

As well as describing observations about the increased risk of adverse events to patients, RNs described risks to themselves. They noted that whilst they tried to care for their patients, their own health and safety was not prioritised and was therefore at risk. They often described putting themselves in situations where their own safety was being jeopardized:

‘I received a needle stick injury at work. Patient who was needle phobic knocked needle into me. I was unable to follow correct procedures after injury. No staff cover for me to go to A&E straight away (I had to go 2 days later- waited 3hrs to be seen) to have procedural blood tests done.’

Respondents noted the primary and secondary impact of not being afforded enough resources to carry out the care they aspire to. The primary impact is noted in relation to patient care, with a secondary consequence for themselves:

‘I am feeling sick with stress and fear for patient safety.’

The respondents spoke about being in situations where they had to make choices between their own safety, versus the safety of their patients. The situation described below is an example where highly vulnerable patients, and a vulnerable staff member, were left risk-exposed by chronic under-resourcing:

‘When I left work there was no night nurse to hand over to for the 2 bays of patients I was looking after, should have been one bay and a side room. I'm 36 weeks pregnant in an acute respiratory ward. I stayed for half an hour to wait whilst they tried to find a cover nurse but sadly the whole hospital was in the same situation. I was told to go by the nurse in charge that shift. This left 2 nurses looking after 35 patients. 4 of which are high dependency on NIV. Not safe!’

This theme demonstrates the awareness of a heightened risk of adverse outcomes when staffing resources are short. Respondents recounted not only awareness of times when they were failing to deliver adequate patient care but also of the times when they had to make choices between safe patient care and their own wellbeing – usually erring toward neglecting their own wellbeing and putting patients first. This compromise between the patients care and safety and their own wellbeing led to mental distress, anxiety and extreme feeling of dissatisfaction; in short, it had a significant personal impact for these nurses.

Personal impact

The three themes described above point to a set of resource and organisational conditions that often resulted in the failure to deliver the best care. Collectively, these have huge personal impact on the respondents with concomitant consequences for their wellbeing and job satisfaction. Respondents described strong feelings of despair and being demoralised and highlighted how these feelings about their job impacted both their personal and their professional lives:

‘Emotionally exhausted after shift, being in a bad mood to family, crying at home because of the pressures. Feeling physically unwell during shift as no time to rest/take break for air or drink of water. Depressing knowing that you won't leave work on time. Busy workdays are good and can make you feel energised and positive but being overstretched on every single shift and worrying about mistakes being made is exhausting.’

They described scenarios which lead them to consider ways in which they can leave or change their professions. They also described scenarios which had led their colleagues to leave the profession:

‘We stated that 2 registered nurses to look after 19 patients (11 of whom were post-operative) and 10 of whom needed discharging later in the day… I have been qualified for one year and I have already started the process of going into a different career. I will have given up nursing within the next 18 months.’

The observations which the respondents describe suggest that the obstacles faced during work have a profound negative influence on their lives. The negative experiences during their working hours diffuses into their after-work hours impacting their personal and home life to an extent that they are struggling to deal with. The situations which form an overall experience leave them feeling a sense of despair and hopelessness; these then form the basis for their intentions to leave. The quote below draws together findings from the first three themes showing how they collectively build to create strong feelings of dissatisfaction and demoralisation that impact on personal life:

‘Some days nursing affects my whole life. I'm tired, I'm demoralised and I'm stressed. I try my hardest to give my best to my patients, but every day is like spinning plates and it feels like if my concerns are raised to managers then I am to blame for not coping or managing my workload properly. It affects my family life as some days I wake up at 2am worrying about something work related. We have a high sickness rate, so we are down on staff and we have a high turnover of staff as people are always leaving.’

Ultimately, as this quote and theme suggest, intentions to leave may become actions once the personal and professional situation becomes unmanageable and the losses become far more than benefits of doing a job that they describe as one that they once loved.

Summary of findings

The results from the survey show that nurses were most likely to feel demoralised if they missed care, followed by if they reported lack of support and Lack of action when concerns are raised . Being Unable to take a break, Understaffing , and Having to work overtime were also significant factors.

Qualitative findings demonstrate significant concerns about inadequate staffing and how this leads to demoralisation and dissatisfaction when safe and effective care cannot be provided. These feeling are compounded by a lack of managerial support which can lead to feelings of stress, blame and professional vulnerability. Staff often have to make choices between risks to the patient and risk to their own wellbeing. In such situations nurses tend to prioritise patients. The inability to provide quality care, have concerns addressed by management, take breaks and finish on time take a personal toll on nurses leading them to consider leaving the job and the profession.

Results here provide a picture of the factors that generated demoralisation among nurses in the UK in the period leading up to the COVID-19 pandemic. A recent review of the experience of nurses during epidemics associated with respiratory conditions, revealed that the quality of leadership and organisational factors, as well as staffing resources, leading into such events has a significant impact upon how the health care system is able to perform [ 22 ]. With this in mind, our paper is useful in being in a position to describe the conditions many nurses were working under at the time of the Covid-19 pandemic onset, and from which we can begin to understand the healthcare system’s operational performance during these events.

While our quantitative data showed that leaving necessary care undone and lack of support were the factors most likely to impact on feeling demoralised (and therefore on job dissatisfaction), the qualitative data suggest a strong emphasis on adequate staffing. On closer consideration, it becomes apparent that it is not understaffing per se that is the main issue of concern but the consequences of this and the lack of support to avoid or prevent these consequences. The primary focus of the nurse is on the ability to provide safe and effective patient care and dissatisfaction and feeling demoralised occurs when this cannot be achieved and those in more senior positions do not respond to their expressed concerns. Given that missed care has been seen as the mediator linking lower registered nurse staffing levels with increased patient mortality [ 23 ], it seems no surprise that not being able to provide adequate care is one of the greatest predictors of job dissatisfaction among the respondents [ 24 ].

In light of our findings of the impact of missed care on dissatisfaction and feeling demoralised, any approach aimed at increasing RNs’ satisfaction and retention should focus on interventions which allow RN’s to provide safe and effective nursing care. In addition to evidence that understaffing increases the occurrence of missed care and therefore job satisfaction, Senek et al. have recently demonstrated that ensuring adequate staffing numbers by covering rota gaps only with temporary staff (agency and bank staff) does not necessarily lower the occurrence of missed care [ 25 ]. In recent years, a solution to severe understaffing has been to deploy temporary agency and bank RNs, who often rotate between specialities and hospital sites. This temporary deployment means that they are often not familiar with the setting, staff or patient groups they are working with. Not surprisingly then, it has been shown that there is more missed care on shifts that have higher proportions of temporary staff than on understaffed shifts [ 25 ]. Therefore, in order to ensure that RNs can achieve a satisfactory level of quality care provision, it is not only adequate staffing levels but also the right type of permanent staff, which allows for continuity of care and team building that can reduce the occurrence of missed care. As indicated by our findings, this has a significant impact on RN’s satisfaction, and the likelihood of RN’s remaining in the profession [ 10 ].

The importance of not being able to take a break (OR = 2.0) and working overtime (OR = 1.8) can also be accounted for in this way. The quotes provided mention these issues, but they are a secondary narrative to the primary concern of being able to provide adequate, safe and effective care. These also link into another important finding, that of the choices nurses are forced to make when staffing levels are low, support is lacking and patient care is therefore at risk. Missing breaks and working overtime are resorted to in order to ensure necessary patient care is not missed, or at least to minimise the amount that is missed. In this way, they represent a secondary, but still important, mechanism in generating job dissatisfaction by forcing nurses to choose between their own needs and those of their patients. This resonates with previous findings which showed that nurses’ inability to take breaks was due to patient load , unpredictability of patient needs and reluctance to burden other nurses [ 26 ].

Collectively, the inability to provide quality care, have concerns addressed by management, take breaks and finish on time take a personal toll on nurses. It impacts their physical and mental wellbeing. It leaves them feeling undervalued, disempowered, intimidated, and vulnerable to committing clinical errors and the professional and personal consequence of this. It affects their relationships outside of work and, ultimately, it leads them to consider whether to leave the job and even the profession. Similar findings have been reported where psychological disempowerment of RNs resulted in job dissatisfaction, lack of organisational trust and staff nurse burnout [ 27 , 28 ]. Although the questionnaire did not specifically ask whether the respondent intends to leave the profession, these factors have previously been reported to contribute to RNs job dissatisfaction which is a predictor of intention to leave [ 7 ].

These findings have relevance for how managers and organisations may consider staffing and supporting nurses. Sellgren et al. have shown that nurses job satisfaction is lower when managers are ‘invisible’ whereas strong facilitative leadership behaviours create an environment that increases job satisfaction [ 29 ]. They further note that when managers lead with kindness and respect, and in ways that demonstrate ethical leadership [ 12 , 13 ], it is more likely that staff also demonstrate the same behaviour towards the patients. Similarly, Morsiani et al. demonstrated that when managers adopted leadership styles focused on monitoring and intervening to correct errors it has negative impact on nurses’ levels of job satisfaction whereas transformational leadership styles that involve respect and care for others improve staff satisfaction [ 30 ]. It may also be worth managers taking a collective nursing team view on what constitutes sufficient numbers and mix of staff when planning the nursing roster. Adams and Bond showed that when staff considered there were sufficient numbers of skilled staff rostered and organized appropriately, nurses’ job satisfaction was greater [ 31 ]. Importantly, they also linked this to non-hierarchical leadership styles and management that was respectful and patient-centred [ 32 ].

We have reported on the level of RNs work morale before the COVID-19 pandemic. During and post pandemic it is predicted that strain and work-related stress are much greater, as reported in previous health emergencies. For instance, during and following the Severe Acute Respiratory Syndrome (SARS) outbreak, Taiwanese RNs reported high levels of stress, even more so in moderate-risk areas than those working in high-risk areas [ 33 ]. A cross-sectional survey reported that nearly 8% of the nurses thought they should not care for SARS patients and considered resignation, mainly due to increased work stress and perceived risk of fatality. These findings are important in view of the current COVID-19 pandemic and any future impending outbreaks [ 34 ]. Prior to the COVID-19 pandemic, UK RNs intention to leave rates were reported to be between 30 and 50%. The evidence-base from studies on SARS and Middle Eastern Respiratory Syndrome (MERS) epidemic outbreaks in South Korea [ 35 ] suggests that this phenomenon is exacerbated in a deadly disease outbreak. Currently, in the UK, concerns over safety, reported lack of personal protective equipment and high fatality rate of health care professionals will further increase work-related stress during the COVID-19 pandemic. The unprecedented crisis caused by the pandemic may therefore have a further negative impact on nurse retention.

Limitations

The variables that were tested from the survey were mainly job-related, interpersonal, and organisational factors. The personal and individual factors such as age, gender and level of experience were not available to us and could therefore not be included in the analysis. Similarly, we cannot be sure that the qualitative data represents an accurate spread of views from across the adult nursing population.

Future direction of research

It seems clear that further research is needed to address the root causes of RN’s dissatisfaction. Future work should investigate the relationship dynamics within healthcare teams and how the burden experienced by RNs when unsupported by managers impacts on their ability to provide safe and effective care. Our data shows that RNs feel that there is limited recognition of the wider issue of understaffing and, when the issue is raised, they are often intimidated into continuing to work under these difficult conditions. In this instance, we have demonstrated their issues with management, but we recognise that RNs are part of a health care team that consists of many different roles. Therefore, to address this wider issue, there needs to be involvement of the whole team and all stakeholders involved. However, these issues will forever remain if RNs are experiencing severe workloads and poor staffing levels that put their patients at risk due to missed care [ 36 ]. Understaffing is an underlying issue, which needs to be recognised. For this to be dealt with effectively, it is not enough to train more people to be nurses when the dissatisfaction and the leaving-rate is high for those who are currently in the profession.

A high proportion of feeling demoralised and dissatisfied was reported by registered nurses and was most likely to occur as a result of missed care and lack of support and action when concerns were raised about this. Whilst some of these findings are consistent with those from previous studies, their level of impact and the mechanisms by which they cause a detrimental effect on nurses’ moral and job satisfaction have not previously been fully discussed. Addressing the issues highlighted here will be important in addressing the root causes of RN dissatisfaction and thereby improving retention and reducing the high turnover rate among nurses. We intend that this paper contributes to the national and international debate about how the profession is regarded by governments and organisations involved in healthcare, both during pandemic conditions and during periods of recovery.

Availability of data and materials

The survey data analysed in this study was not publicly available. The data that support the findings of this study are available from Royal College of Nursing, but restrictions apply to the availability of these data. To access the data, we obtained a Data Sharing Agreement and Ethical Approval for the current study.

Abbreviations

National Health Service

Registered Nurse

Royal College of Nursing

Severe Acute Respiratory Syndrome

Middle East Respiratory Syndrome

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Acknowledgements

We would like to thank the Royal College of Nursing for allowing us to complete this secondary analysis of their data and to acknowledge Claire Helm and Julian Russell for their role in the design of the original survey. We would also like to thank the Statistical Service Unit, University of Sheffield for their support and guidance with the statistical analysis.

The project was funded by the Royal College of Nursing (RCN) as part of the Strategic Research Alliance (SRA) between the RCN and the University of Sheffield. The views expressed are those of the author(s), and not necessarily those of the RCN or the University of Sheffield.

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MS conceived the idea, planning and analysis, along with SR and TR. RK, EW, BT and AT discussed the results and contributed to the interpretation of the data and writing of the manuscript. All authors have approved the manuscript for submission.

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Senek, M., Robertson, S., Ryan, T. et al. Determinants of nurse job dissatisfaction - findings from a cross-sectional survey analysis in the UK. BMC Nurs 19 , 88 (2020). https://doi.org/10.1186/s12912-020-00481-3

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Job Dissatisfaction and Its Predictors among Healthcare Workers of ‘Type 2 Health Clinics’ in North-Eastern Malaysia

Mohd ikhwan azmi.

1 Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu 16150, Kelantan, Malaysia

Mohd Nazri Shafei

Anees abdul hamid.

2 Kelantan State Health Department, Ministry of Health Malaysia, Kota Bharu 15200, Kelantan, Malaysia

Associated Data

There is no reported data.

It is crucial to comprehend factors associated to job dissatisfaction among healthcare workers (HCWs) in Malaysia’s primary health clinics, especially those working in ‘Type 2 Health Clinics’ which cater for populations of >50,000 and a daily average number of patients between 500 and 800. It is essential to ensure that effective strategies can be proposed to promote job satisfaction. A total of 314 HCWs from ‘Type 2 Health Clinics’ in north-eastern Malaysia consented to participate in this cross-sectional study, conducted between October 2020 and December 2021. The Job Satisfaction Survey was used to assess job dissatisfaction. The prevalence of job dissatisfaction was 35.7%. The significant factors associated with job dissatisfaction were younger age and those who were dissatisfied with their yearly performance mark. Targeted interventional activities for young HCWs and for those who are dissatisfied with their yearly performance mark are recommended to improve job satisfaction.

1. Introduction

Job dissatisfaction consists of one’s cognitive, emotional, and behavioral response to their job [ 1 ]. It was discovered that agreeableness (the traits of cooperation and likeableness), extraversions (the traits of being assertive, enthusiastic, and energetic), and conscientiousness (the traits of high level of organization, hard work, and goal persuasion) are related to job satisfaction, whereas neuroticism (the traits of lack of emotional stability and lack of positive psychological adjustment) and lack of openness to experience (the trait of unconventionality) are related to job dissatisfaction [ 2 ]. Apart from that, job dissatisfaction also has been linked to workers’ level of autonomy in how they act, given their skill set and work expectations. It also has to do with employees’ psychological challenges in carrying out their duties [ 3 ]. Job dissatisfaction can have a negative impact on both the organization and the people receiving the services. It can jeopardize patients’ safety and treatment, being related to poor job performance and absenteeism amongst healthcare workers (HCWs) [ 4 ]. Hence, it is important to determine job dissatisfaction, especially among HCWs.

In Malaysia, the primary health clinic is an important structure in the public healthcare system as it provides curative, promotive, and rehabilitative care services. However, there is a noticeable shortage of HCWs in primary health clinics, as most of them leave for the private sector or leave the healthcare system entirely [ 5 ]. This can lead to an imbalance between those who provide healthcare services and those who require healthcare services, which contributes to occupational stress and leads to job dissatisfaction, which later leads to quitting [ 6 , 7 ]. Apart from that, poor job performance may jeopardize patients’ safety and care [ 4 ]. Hence, it is important to determine the prevalence of job dissatisfaction and to identify its predictors among HCWs in Malaysia.

2. Literature Review

2.1. job dissatisfaction and healthcare workers.

Internationally, two studies conducted in Ethiopia found that the prevalence of job dissatisfaction was around 46% [ 8 , 9 ]. However, Behmann et al. (2012) found that the prevalence of job dissatisfaction among primary care physicians in Germany was slightly lower at 36% [ 10 ]. In a local Malaysian context, Manan et al. (2015) reported that 48% of pharmacists in Negeri Sembilan, Selangor, and Perak were unsatisfied with their job, and found that HCWs aged 35 and older and who had worked more than seven years’ experience are more likely to be satisfied with their jobs [ 11 ]. Aidalina M. (2015), who studied the brain drain phenomenon of physicians in the public and private sector in Selangor and Kuala Lumpur, found that 35.6% were dissatisfied with their work and 55% of those respondents felt neutral about public-sector job satisfaction, driving them to leave the public sector to work in the private sector [ 12 ].

Numerous factors can contribute to job dissatisfaction, such as co-workers, supervisors, work, and promotion [ 13 ]. Job dissatisfaction was found to be associated with age when being both a young and an old worker (near retirement age) [ 11 , 14 ]. Interestingly, looking at the years of employment, it was noted that the longer the worker’s work experience, the more satisfied they were with their job [ 14 , 15 ]. However, it was also found that those who work for more than ten years are less satisfied than young workers [ 10 ]. Other than that, gender dominance is subjected to conflicting studies in regards to job dissatisfaction. There were studies that found no gender difference with job dissatisfaction [ 10 , 11 , 14 ] and studies that also found that females were more prone to job dissatisfaction than males [ 12 , 16 ].

One of the elements that influenced job satisfaction for public servants in Malaysia was satisfaction with their yearly performance mark, which is an annual assessment report, often known as ‘Laporan Nilaian Prestasi Tahunan’ (LNPT). LNPT, according to Malaysia’s Public Service Department, aims to improve employee motivation and performance and identify employee potential, and can be used for employee promotion, training, and placement, as well as to effect salary increment. The supervisor evaluated the workers once a year as a means of providing feedback in which they try to identify their subordinates’ areas for improvement, assist them with further training, and help them learn new skills to accomplish their job [ 17 ]. A study in Indonesia discovered a high link between perceived supervisor support and job satisfaction, indicating a meaningful association [ 18 ]. Aside from reducing worker burnout and increasing job happiness, excellent support also helps employees feel more secure in achieving their work goals [ 19 ].

Apart from that, job-related factors also contributed to job dissatisfaction [ 20 ]. In depth, they can be divided into intrinsic variables of co-workers, supervision, and work itself, and extrinsic variables of salary and advancement [ 13 ]. Working environment plays an important role as an unfavorable working environment contributes to job dissatisfaction [ 10 , 16 ]. Aside from that, those working under appropriate and supportive supervision and colleagues are more pleased with their job compared to those who do not [ 9 , 21 ]. In a local context, job-related factors also play a role in job dissatisfaction as a study involving Malaysia’s family physicians in 2016 found that Malaysian family physicians were dissatisfied with their salary, recognition, and their working conditions [ 22 ].

2.2. Primary Health Clinic in Malaysia

According to the Family Health Development Unit, Ministry of Health, Malaysia under the Primer Infrastructure Development Sector, a health clinic can be divided into seven types depending on its catchment population and daily average number of patients. It provides services such as the out-patient department, accident and emergency, maternal and child health, dental, rehabilitation, radiography, laboratories, and pharmacy [ 23 ]. Table 1 shows the types of primary health clinic in Malaysia

Primary health clinic types in Malaysia.

3. Materials and Methods

3.1. study design and population.

A cross-sectional study was conducted between October 2020 and December 2021. It was held at all ‘Type 2 Health Clinics’ in north-eastern Malaysia which also have two different clinic working systems. Two of the clinics adopt a shift system, namely Health Clinic A and Health Clinic B, and two adopt a non-shift system, namely Health Clinic C and Health Clinic D. These clinics were chosen as their catchment population was >50,000 and their daily average number of patients was between 500 and 800 [ 23 ]. Using a two-proportion formula, with a 95% confidence interval, 5% precision, and allowing a 10% non-response rate or data entry error, the required sample size was 335 ( p = 0.63) [ 24 ]. All available HCWs were included in the study as the required sample size exceeded the number of the workers in those clinics.

3.2. Data Collection and Research Tool

A proforma as attached in Appendix A was designed to gather sociodemographic data such as age, education level, and years of employment. The Job Satisfaction Survey (JSS) was used to assess job satisfaction among the respondents. The JSS was developed by Paul E. Spector in 1985 and is commonly used in many fields, including healthcare services. It has nine facets and a 36-item scale to evaluate employee attitudes toward their job and its various aspects. The facets were pay, promotion, contingent rewards, operating procedures, supervision, nature of work, fringe benefits, communication, and co-workers. Each item had six options, varying from “strongly disagree” to “strongly agree” [ 25 ]. In this study, the JSS scored the Likert scale of minimum and maximum score as satisfied (144–216) and dissatisfied (36–143). Based on a systemic review conducted in 2003, it was found that the JSS has adequate validity and reliability. The discriminant validity was 0.19–0.59 and convergent validity was 0.61–0.80, whereas the internal consistency was 0.91 and test–retest was 0.71 [ 26 ]. The Malay language version was translated by Tan Soo Luan in 2010 with reported similar internal consistency of Cronbach’s α 0.84 when compared to its English version [ 27 ]. Permission to use the questionnaire was obtained before conducting the study.

In this study, a HCW was defined as a person whose work involves contact with a patient or with blood or other body fluids from a patient in a healthcare, laboratory, or public safety situation at a health clinic [ 28 ]. We included all ‘Type 2 Health Clinics’ HCWs aged 18 and above who had worked for at least three months in the current clinic’s working system. Those who did not complete at least 80% of the questionnaire data were excluded.

3.3. Procedure

The questionnaire was distributed to all HCWs working in all ‘Type 2 Health Clinics’ in north-eastern Malaysia. Initially, the selected health clinics were informed through a letter that was sent through the ‘Kelantan State Health Department’ explaining the study that will be conducted to the clinic’s manager, who will convey the information to all HCWs at their clinic. The research team then scheduled a face-to-face session with the help of the clinic’s manager with their respective HCWs. The session explained the research objectives and procedures, voluntariness, and anonymity. They were then given enough time to consider their participation, signed the consent form, and answered the questionnaire given. Any questions that arose were entertained by the research team during the session.

3.4. Data Analyses

For data entry and analysis, IBM SPSS version 26.0 was used. Data were checked and cleaned once they were entered. In descriptive analyses, data were analyzed and presented as frequency ( n ) and percentage (%). Simple and multiple logistic regression was used to find the predictor of job dissatisfaction as the outcome was categorical and binary of either job dissatisfaction or job satisfaction. Forward LR and Backward LR were used to compare and identify the final model of factors associated with job dissatisfaction. It was then checked for multicollinearity, interaction, and the model’s fitness. The final model was presented as a p -value and adjusted OR. A p -value of less than 0.05 was set as the level of significance.

3.5. Ethical Consideration

Ethical approval for this study was obtained from the Medical Research and Ethics Committee (MREC), Ministry of Health, Malaysia, with identification number NMRR-20-2574-57270 (IIR). Ethical approval was also obtained from the Human Research Ethics Committee (JEPeM), Universiti Sains Malaysia (USM), (USM/JEPeM/2 0110577). Written consent was obtained from participants prior to the study. Only the researcher can access the data and participant anonymity was applied to ensure the confidentiality of the data.

The respond rate was 84.9% (314/370). The mean (SD) age of the HCWs was 40.6 (7.81) years old, and duration of employment was 15.7 (7.58) years. A total of 219 (69.7%) of them completed tertiary education and 284 (90.4%) were satisfied with their yearly performance mark. Table 2 shows the sociodemographic characteristics of the respondents.

Sociodemographic characteristics of the healthcare workers in ‘Type 2 Health Clinics’ in north-eastern Malaysia ( n = 314).

A total of 69 (22.0%) of the HCWs in the shift clinics’ working system and 43 (13.7%) in the non-shift clinics’ working system in ‘Type 2 Health Clinics’ in north-eastern Malaysia were dissatisfied with their job. Table 3 provides the details.

Proportion of job dissatisfaction among healthcare workers working in different health clinics’ working systems ( n = 314).

The top two job dissatisfaction factors among HCWs in ‘Type 2 Health Clinics’ in north-eastern Malaysia according to JSS facets were related to operating conditions (61.8%) and benefits (55.4%). Table 4 provides the details.

Proportion of various levels of satisfaction towards job-related factors among healthcare workers in ‘Type 2 Health Clinics’ ( n = 314).

The variables from simple logistic regression with a p -value less than 0.25, which were age, gender, race, monthly income, and yearly performance mark, were selected and further analyzed using multiple logistic regression to determine the associated factors. Multiple logistic regression shows that age in years (Adj. OR 0.91; 95% CI: 0.83,0.99, p = 0.037) and dissatisfaction with yearly performance mark (Adj. OR 14.80; 95% CI: 3.43,63.763, p < 0.001) predicts job dissatisfaction. It can be interpretated as the HCWs working in ‘Type 2 Health Clinics’ in north-eastern Malaysia had 9.4% lower odds of job dissatisfaction as they got older, and those dissatisfied with their yearly performance mark were 14.8 times more likely to develop job dissatisfaction after being adjusted for age. Table 5 shows the details for both simple and multiple logistic regressions.

Simple and multiple logistic regression analysis for factors associated with job dissatisfaction among healthcare workers working in ‘Type 2 Health Clinics’ in north-eastern Malaysia.

a Simple Logistic Regression; b Multiple Logistic Regression; Constant = 0.601; Forward LR and Backward LR method; No interaction and no multicollinearity; Hosmer–Lemeshow Test is not significant, p -value = 0.465; Classification Table 93.5%; Area Receiver Operating Characteristics (ROC) 76.4%.

5. Discussion

Our study showed that 35.7% of HCWs in ‘Type 2 Health Clinics’ in north-eastern Malaysia were dissatisfied. This finding, however, shows a lower prevalence as compared to the international and local studies where the prevalence of job dissatisfaction ranged from 46% to 48% [ 8 , 9 ]. The prevalence of dissatisfaction in this study may be contributed by the differences in the HCWs studied in terms of health system organization, geographical area, and socioeconomic population that the healthcare workers served. This could also be because a particular HCW was hired based on their qualifications for specific job tasks where the qualifications met the job requirements. According to another local study, management must ensure that their employees are placed based on their skills, qualifications, and abilities. If they are not, job dissatisfaction may arise, and stress and burnout may result [ 11 ].

Apart from that, looking specifically into the clinics’ working systems, it was found that only 22.0% of respondents were dissatisfied with the shift clinics’ working system and 13.7% with the non-shift system health clinics. Although the shift clinics’ working system was newly introduced in June 2020 amidst the COVID-19 pandemic, the HCWs already seem to be adapting themselves well, as showed by the lower proportion of job dissatisfaction comparing to those in the non-shift clinics’ working system [ 29 ]. A study discovered that, although there were varieties of factors that can influence the length of an employee’s adaptation process to a new working system, the process itself usually takes approximately one month to a year [ 30 ].

Age was one of the factors linked with job dissatisfaction among HCWs. Both being a young and an old professional (nearing retirement age) were linked to job dissatisfaction. Numerous types of research have been conducted on the topic of age and job dissatisfaction. These studies found that HCWs under 35 are more likely than those 35 and older to be dissatisfied with their jobs [ 11 , 14 ]. However, other studies showed that HCWs beyond the age of 40 are more likely to be dissatisfied with their jobs [ 10 , 31 ]. This study found that age is one of the factors that contributed to job dissatisfaction among HCWs in ‘Type 2 Health Clinics’ in north-eastern Malaysia. It was found that the HCWs with older age were 9.4% less likely to develop job dissatisfaction than those with younger age by a year after being adjusted for the yearly performance mark. Similarly, a study conducted in Greece and Ireland discovered that as one gets older, satisfaction improves [ 21 , 32 ]. This finding may also have been influenced by the fact that as their age increases, the HCWs become more accustomed to the job and working conditions and have more authority over it. This finding was in line with a local study that discovered worker satisfaction was related to working conditions, career development, and freedom from supervision [ 33 ].

Laura L. Carstensen’s socioemotional selectivity theory stated that, following ageing, a shift in motivation influences cognitive processing more positively. Hence, older people are more likely to experience positive emotions. Ng and Feldman (2010) found that age is linked to job attitudes, and their meta-analysis found that age is positively related to job satisfaction [ 34 ]. Our finding could be attributed to Malaysia’s functioning healthcare system, which is built on time-based promotion, especially for doctors, dental officers, and pharmacists [ 5 ]. This method ensures that those who enter the workforce are given a job scope or description appropriate for their entry-level position, allowing them to adjust gradually to the job’s demand. The job scope would gradually increase with seniority and the potential to advance, thus decreasing job dissatisfaction.

This study also discovered that there was a link between job dissatisfaction and yearly performance marks. The yearly performance mark was a type of feedback from a supervisor to a supervisee about their work performance, which influenced promotions, additional training, and pay increase [ 17 ]. After being adjusted for age, it was discovered that HCWs in the surveyed health clinics who were unsatisfied with their yearly performance mark were 14.8 times more likely to develop job dissatisfaction than those who were satisfied. Several studies have found a strong correlation between supervisor support and job satisfaction. According to studies conducted in Greece and Ethiopia, healthcare workers who received enough support were more satisfied with their jobs than those who did not receive such support [ 4 , 21 ]. Winarto and Chalidyanto (2020) revealed a substantial link between the job satisfaction of employees with solid supervisory support compared to employees who lacked support. Furthermore, competent supervision assists employees by preventing employee burnout and confidently fulfilling work objectives [ 18 ].

Looking into job-related factors, working conditions and benefits were the top two factors from JSS facets that scored the highest proportion related to job dissatisfaction. These findings were in line with several job dissatisfaction studies that found most of the job dissatisfaction was related to working conditions and benefits [ 10 , 16 ]. In this essence, when implementing certain policies and procedures, they must be adaptable in accordance with the worker’s workload and working conditions, for example, by ensuring the physical environment and equipment are suitable for the new policy to be implemented. Aside from that, the HCWs in this study may have found that the benefits that they received from their job were insufficient compared to their workload or to those of a worker from another place. Hence, it was critical to assign appropriate personnel to specific jobs based on their qualifications and skills with comparable benefits as other places, for example by ensuring the benefit was comparable between the public and private healthcare system.

Data from the Human Resources for Health Country Profiles 2015 Malaysia showed that females dominate Malaysia’s healthcare system. They discovered that females make up 97% of nurses, 75% of pharmacists, and 60% of doctors [ 35 ]. This study found that 73.9% of our respondents were females and no significant association was found between gender and job dissatisfaction. Similarly, several local and overseas studies also found no significant association between gender and job satisfaction [ 15 , 36 , 37 ]. A workforce dominated by a certain gender seems to provide greater support and understanding of each other’s physiological and psychological requirements. However, looking at our and other findings, it appears that this does not affect satisfaction or dissatisfaction in the workplace.

Some studies discovered a link between minority races and job dissatisfaction. Hispanic and Black nurses were found to be more likely than White nurses to resign in a study of nurses in the United States. Black nurses were also more dissatisfied with their jobs than White nurses [ 38 ]. Female and non-Bumiputera doctors were three times more likely to leave the public health service in Malaysia. This was due to dissatisfaction with several factors including benefits, compensation, promotions, work operations, family obligations, and personal challenges [ 12 ]. However, this study found no association between race and job dissatisfaction. The respondents’ geography and religion could explain this. The majority race in Malaysia and most respondents in this study in the north-eastern region were Malay–Muslim Bumiputera. Hence, they share a standard belief system and practices, leading to increased understanding and tolerance in the workplace.

All in all, a well-defined job scope of a certain job category at the clinic must be established and maintained to improve present healthcare services and increase job satisfaction. Younger workers must be trained regularly to help them appreciate and understand their jobs better, increasing their level of satisfaction. Regular meetings between employees and bosses should be held to review and discuss issues as they arise. Furthermore, any adjustments or new implementations of specific programs must be thoroughly addressed so that all employees understand the objective and why the changes are necessary to gain their complete support and reduce dissatisfaction.

6. Conclusions

Job dissatisfaction among HCWs at ‘Type 2 Health Clinics’ in north-eastern Malaysia was moderately high. Actions taken to reduce job dissatisfaction must be targeted at young HCWs and those that are dissatisfied with their yearly performance mark to ensure that job satisfaction improves. It is important to ensure they can retain workers in the healthcare system amidst the shortage of HCWs in public primary healthcare in Malaysia.

There were a few limitations for this study. First, this study was conducted at a selected type of health clinic according to their catchment population and services provided in north-eastern Malaysia. This can limit the findings on the associated factors since the findings are specific to types of health clinic and location, which may influence the factors. Additionally, it employed primary data collection methods which were influenced by the honesty and accuracy of the respondents’ answers.

Future research can be conducted among healthcare workers at health clinics, particularly those with different working systems such as shift and non-shift working systems, to fully understand the level of dissatisfaction, associated factors, and how to improve it. This type of study can be conducted with a bigger sample size and population to fully comprehend the dissatisfaction among healthcare workers at health clinics. We also recommend future qualitative research to fully grasp why job dissatisfaction occurs and the healthcare workers’ opinions on improving the situation. This permits fresh insights for policymakers to improve job satisfaction.

Acknowledgments

The authors would like to take this opportunity to thank Universiti Sains Malaysia and Kelantan State Health Department for the ethical clearance and opportunity to conduct this study. We also would like to thank the Director General of Health, Malaysia, for his permission to publish this article.

Funding Statement

This research received no external funding.

Author Contributions

Conceptualization, M.I.A., A.D., M.N.S. and A.A.H.; Formal analysis, M.I.A. and A.D.; Investigation, M.I.A., A.D. and A.A.H.; Methodology, M.I.A., A.D., M.N.S. and A.A.H.; Supervision, A.D. and M.N.S.; Writing—original draft, M.I.A., A.D., M.N.S. and A.A.H.; Writing—review and editing, M.I.A., A.D., M.N.S. and A.A.H. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board (or Ethics Committee) of the Medical Research and Ethics Committee (MREC), Ministry of Health, Malaysia, with identification number NMRR-20-2574-57270 (IIR) on 30 December 2020. Ethical approval was also obtained from the Human Research Ethics Committee (JEPeM), Universiti Sains Malaysia (USM), (USM/JEPeM/2 0110577) on 11 January 2021.

Informed Consent Statement

Informed consent and consent to published was obtained from all participants involved in the study.

Data Availability Statement

Conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Determinants of Job Satisfaction: A Review of Empirical Literature

• Prof. Thomas Katua Ngui
• Mar 16, 2023
• Human resource management

Prof. Thomas Katua Ngui United States International University – Africa, KENYA

The commonly held opinion is that “a satisfied worker is a productive worker”. There is a reciprocal relationship between satisfaction and performance; this means that satisfaction causes performance and performance causes satisfaction. When an employee is satisfied with their job they commit their energies and effort towards achievement of organizational goals sometimes at the expense of their personal goals. The purpose of this study is to find out the factors that influence the level of job satisfaction among the workforce. Increased job satisfaction will motivate employees to achieve the organizational goals. A satisfied work force will create a pleasant atmosphere within the organization to perform well (Pushpakumari, 2008).  Low job satisfaction could cause employees to move away from their jobs, search for new jobs, or change their existing jobs and careers. The degree of organizational loyalty of employee is higher when employee job satisfaction increased (Javed, Balouch & Hassan, 2014). It is therefore, very critical for organizations to approach their performance improvement goal from the employee job satisfaction point. For this to happen effectively, it is necessary for the managers to understand the factors that determine job satisfaction among employees. Studies have shown that job satisfaction is influenced by a variety of factors- both internal and external to the organization. This study sought to review literature on the factors that determine or influence job satisfaction. From the study it was found that job satisfaction is an outcome of different factors like pay, the work itself, job security, supervision, leadership styles, relationships with co-workers and opportunities for promotions. The findings of this study will help managers at all levels to play a key role in improving the levels of job satisfaction among employees within their jurisdictions. This in turn will lead to higher performance both at the individual, team and organizational levels.

Key Words: Job security, Job satisfaction; Performance

INTRODUCTION

With increased technological growth and globalization of markets the business environment has become very competitive and complex. This requires organizations to up their game in order to remain competitive and survive in the changed business environment. To succeed in this very turbulent market, most organizations have invested in acquisition of high quality resources that are valuable, unique, non- imitable and rare in order to sustain their competitiveness. Such resources include human, physical, technological and financial resources. Among the identified resources, the human resources have been found to be the best source of sustainable competitive advantage. The success of any organization depends on the satisfaction of its workforce (Mekonin & Teklu, 2021).

Every organization’s success indeed depends on employee satisfaction on job as their effort has been paid off ( Khaira, Afifah, Shariff & Sima, 2021) . Leaders today believe that impressive human resource is the power factor of an organization. This is because human resources are unique and cannot be copied. Human resource is an active resource which has emotions and can react differently to different situations. Human resource is considered as the most important asset which serves as the engine for providing a sustainable source of energy and service delivery in the organization (Muhammad & Wajidi, 2013). The importance of intellectual capital has increased to the point of being one of the most valuable assets that must be better understood in order to be developed (Ouedraogo & ALeclerc, 2013).  This is largely because the human resource is an active resource that has the capability to activate other resources in pursuit of organizational goals/ objectives. It is also very unique and cannot be copied.

The millennium generation employees (millennials) have different expectations from the job environment compared to the expectations of the previous generation of workers. For this new generation of employees to be productive and to unleash their full potential, they should be satisfied with their job. This requires managers to be very cautious while dealing with the millennials and also to understand their needs/ expectations in order to fully benefit from their skills and knowledge. Job satisfaction is a result of employees’ perception of how well their job provides those things which are viewed as important (Ndulue & Ekechukwu, 2016). If the human resource or employees are happy and contended with the moves and actions of the employer, they do their best for the best of the organization (Khan, Nawaz, Aleem & Hamed, 2012). A satisfied work force will create a pleasant atmosphere within the organization to perform well (Pushpakumari, 2008).

There is a reciprocal relationship between satisfaction and performance; this means that satisfaction and performance influence each other. Increased job satisfaction will motivate employees to achieve the organizational goals. When employees perform well and achieve the organizational goals they are also likely to be motivated by the improved performance which in turn leads to higher job satisfaction. The factors that contribute to the positive morale and attitude also result in a higher degree of job satisfaction (Saranya, 2014). A highly satisfied work force is absolutely necessary for achieving a high level of performance in an organization. Satisfied workers tend to extend more effort to job performance, then work harder and better (Pushpakumari, 2008). Job satisfaction is an important factor for improving effectiveness and also a person’s satisfaction in a company. Job satisfaction is achieved from situations a person experience in his job, so factors such as management method, organization policy and structure, job conditions and type of relation with coworkers are important (Weiss, 2002).

Many studies have been done on the relationship between job satisfaction and performance, for example, Khan, Nawaz, Aleem and Hamed, (2012); Revenio Jr. (2016); Ndulue and Ekechukwu (2016) and Bakotic, (2016) have all done studies on this topic. However, due to the changing nature of the work environment as a result of advancement in technology and the changed expectation of the current millennial employee, this topic remains a topic of interest and requires continuous research in order to meet the psychological needs of the new category of employees whose expectations are quite different from those of the previous generation of workers. The purpose of this paper is to review literature on the factors that influence level of job satisfaction among the workforce and its effects on performance.

Job satisfaction

Job satisfaction is an affective or emotional response towards various facets of one’s job (Ndulue & Ekechukwu, 2016). Cranny, Smith and Stone (2014) defined job satisfaction as employees’ emotional state regarding the job, considering what they expected and what they actually got out of it. According to Willem, (2007) job satisfaction shows the relation between human expectations and advantages taken from job. Vroom (1964) as cited in Revenio Jr. (2016) defines job satisfaction as an “effective orientations on the part of the individuals towards work roles which they are presently occupying”. Job satisfaction is a positive emotional state that arises from the employee’s work or practical experience, and results in job satisfaction from the realization of the extent to which the employees work provides the things that he or she considers important (Hareem, 2013). According to Spector (1997) job satisfaction shows peoples emotion about their job generally or about some parts of it (i.e. organization, job, supervisory, coworkers, salary and income and promotions). Job satisfaction describes the positive or negative attitude of a person regarding his employment and work environment (Weiss, 2002; Greenberg, 2008). This could be both psychological as well as physiological factors (Revenio Jr., 2016).

Satisfaction is a complex and multifaceted concept (Revenio Jr., 2016) that is influenced by both internal and external environmental factors. Work environment is an important determinant of job satisfaction of employees (Herzberg, 1968; Spector, 2008).  Existing literature and research results show that job satisfaction is influenced by a variety of factors- both internal and external to the organization. The organizations have a level of control over the internal factors, however, they have very limited or no control of the external environmental factors that influence job satisfaction. Different factors within the working environment such as wages, working hours, autonomy given to employees, organizational structure and communication between employees and management may affect job satisfaction (Lane, Esser, Holte, & Anne, 2010). Therefore, the organization should strive to improve on the factors that they have control over in order to increase the level of job satisfaction. At the same time they should try as much as possible to support those responsible for the external environment to improve it. This may call for initiatives that are similar to the existing public-private partnerships.

The results of a study by Dawal and Taha, (2015) showed that job and environmental factors are significantly related to job satisfaction. Job satisfaction is an outcome of different factors like pay, promotion, the work itself, supervision, relationships with co-workers and opportunities for promotions (Opkara, 2002). Ndulue and Ekechukwu, (2016) have also identified pay, the work itself, promotions, supervision, workgroup, and working conditions as the factors that influence job satisfaction. The level of job satisfaction is affected by intrinsic and extrinsic motivating factors, the quality of supervision, social relationships with work group and the degree to which individuals succeed or fail in their work (Armstrong, 2006).

Pay, the work itself, promotions, supervision, workgroup and working conditions have a great influence on the level of an employee’s satisfaction with the job (Luthans, 1985). According to Saranya, (2014) the important factors that contribute to the higher level of job satisfaction are challenging and responsible job, numerous promotional opportunities, impartial treatment by the management, creativity and innovative ideas of job security, attractive salary and perks, freedom in work situation, participative management and welfare facilities like medical, uniform, canteen etc. Smith, Kendall and Hullin (1969) expressed the five aspects that can be used to determine job satisfaction as; being satisfied from job (i.e. interesting tasks and opportunities for learning and training), being satisfied from supervisor (i.e. technical and managing abilities and their considerations about employees), being satisfied from coworkers (technical qualification and support they show), being satisfied from promotion (achieving real opportunity to advance), being satisfied from income (amount of income, its equality and way of paying to staff).

Other researchers who have investigated the factors that affect job satisfaction include Tabassum, Khan, Sherani, and Khan, (2016) who say that the major determinants of job satisfaction are basically nine facets which are pay, promotion, supervision, fringe benefits, contingent rewards, operating procedures, co-workers, nature of works and communication. Purcell, Kinnie, Hutchinson, Rayton, and Swart, (2003) also did a research and found that the key factors affecting job satisfaction were career opportunities, job influence, team work and job challenge. According to Revenio Jr. (2016) leadership style also has a great role in the employee’s level of job satisfaction. Brudney and Coundry (1993) have also explained different variables that influence performance of the employees in the organization. They included factors such as pay, organization commitment, relationship between pay and performance, etc. Working conditions have positive impact on job satisfaction (Guest, 2004; Silla, Gracia & Peiro, 2005). Job satisfaction is adversely affected by factors such as lack of promotion, working conditions, low job security and low level of autonomy (Guest, 2004; Silla et al., 2005).

It is essential for an organization to motivate their employees to work hard for achieving the organizational goals and objectives. According to Jerrell, Coggburn, Battaglio Jr., and Bradbury, (2014) how an organization manages conflict also has a bearing on employee job satisfaction.

Empirical Review

Various studies have been done on the factors affecting job satisfaction. Some of the factors researched about include job security, leadership/ supervision styles, salaries, promotion opportunities among others.  Javed, Balouch and Hassan, (2014) did a study on the determinants of job satisfaction and its impact on employee performance and turnover intentions. The results of the study showed a significant positive association of employee empowerment, workplace environment, job loyalty and job performance with job satisfaction. The results show that employee empowerment has a significant positive relationship and it contributes more than 37% to job satisfaction. Therefore, when an employee is given autonomy in business decisions then his satisfaction level will rise. Furthermore, there was a significant negative relationship between job satisfaction and turnover intention. According to the result of the study, job satisfaction has a significant negative relationship with turnover intentions contributing more than 32% to turnover intentions. Whenever there is low level of employee satisfaction in any organization, the employees of that organization will intentionally leave that organization.

Cheginy, Isfahani, Mohseni, Khakian and Khosravizadeh (2014) did a study to investigate the factors influencing job satisfaction among hospital personnel. The results of the study showed that there is a significant relationship between job satisfaction and personnel’s perceptions about their work conditions, satisfaction with supervision, satisfaction with coworkers, satisfaction with work nature and satisfaction with salary and advantage. Rukh, Choundhary and Abbasi (2015) did a study on the analysis of factors affecting employee satisfaction in Pakistan. Research findings indicated the significant factors that affect the satisfaction level of employees as pay, promotion, relation with employees, relation with supervisor, work stress and job security. The results further showed that the median group differences existed between responses based on age, work experience, salary and designation (i.e. job position/rank) of employees. Job satisfaction was also positively and significantly associated with job related factors such as pay, promotion, relation with employees, relation with supervisor, work stress and job security. From the study they concluded that job satisfaction of employees was significantly affected by demographic, financial and non-financial factors. Employees who are older than 50 years, with greater experience, and in higher management positions were more satisfied with pay, promotion, work stress, work condition and working environment. The employees’ departments did not play any significant role in affecting satisfaction levels.

Viñas-Bardolet, Velazco and Torrent-Sellens (2013) did a study on the determinants of Job Satisfaction, the Role of Knowledge-based work: An illustration from Spain and found that job satisfaction, depends on worker attributes, financial and non-financial job characteristics. The results also show that net monthly income is a positive and highly significant variable in explaining job satisfaction. Evidence suggests that financial and non-financial (work organisation and work intensity) job dimensions are the most important determinants of knowledge-based workers satisfaction in Spain. Mosadegh Rad and De Moraes (2009) did a study to investigate the specific factors associated with job satisfaction and dissatisfaction in employees at the Isfahan University Hospitals (lUHs) in Isfahan, Iran. The study also focused on revealing homogeneous demographic characteristics that these employees exhibited, and which affect their satisfaction level. It was found that overall employees were moderately satisfied with their jobs, and more satisfied with the following aspects of their current work situation: supervision, job identity and co-workers. The lowest satisfaction scores were found for benefits, contingent rewards, communication, salaries, work conditions and promotion. Motivating factors included loyalty to employees, job security, good pay, good working conditions, tactful discipline, involvement, recognition and promotion.

Job security is a significant determinant of job satisfaction. Job security provides workers with a much-needed sense of structure (Woods, 2018). The effect of job security on worker job satisfaction is different depending on whether perceived job loss occurs (or not), whether job openings are scarce or whether job openings are plentiful (Artz & Kaya, 2014). In the results of their study Artz & Kaya (2014) showed that three measures of job security increase private sector worker job satisfaction, and reduce worker incentives to quit. Few workers quit when job openings are relatively scarce (during contractions) than when job openings are relatively plentiful (during expansions). People want to know their job is available for as long as they wish to hold it. When job security decreases, satisfaction and performance levels also take a hit. Results of a study by Reisel, Probst, Chia, Maloles and König, (2010) on the effects of job insecurity on job satisfaction, organizational citizenship behavior, deviant behavior, and negative emotions of employees show that job insecurity is negatively related to satisfaction and that job insecurity has both direct and indirect effects on work behaviors and emotions.

The work environment has also been researched in relation to job satisfaction. Raziq and Maulabakhsh, (2015) did a study on the Impact of Working Environment on Job Satisfaction and found a positive relationship between working environment and employee job satisfaction. Their study concluded that the businesses need to realize the importance of good working environment for maximizing the level of job satisfaction.  Other results have also shown that there is a positive link between work environment and intrinsic aspect of the job satisfaction. According to Javed, Balouch, and Hassan, (2014) work place environment has a positive relation with job satisfaction and it contributes 16% to job satisfaction. Since it has a positive impact on job satisfaction so it shows that when an employee is given favorable and clean environment then his/her satisfaction level rises. Bakotic and Babic (2013) found that the workers who work under difficult working conditions, are dissatisfied through this work environment.

Promotions are also an important aspect of a worker’s career and life, affecting other facets of the work experience. With regard to promotions some studies have also been done by various researchers. Malik, Danish and Munir, (2012) did a study  to determine the impact of pay and promotion on job satisfaction in higher education institutes of Pakistan and found that pay has significant influence on job satisfaction but the promotion has less influence and partially significant to the job satisfaction. Kosteas (2007) did a study on job Satisfaction and Promotions and found that promotions have a lasting, but diminishing impact on job satisfaction. Kosteas (2007) also find a strong, negative correlation between quits and both job satisfaction and promotion expectations. Promotion has a positive impact on job satisfaction (Nguyen et al., 2003; Teseema & Soeters, 2006). Khan and Mishra, (2013) also did a research on promotion as job satisfaction, a study on Colleges of Muscat, Sultanate Of Oman and the research findings indicate that academic teaching employees where satisfied with the promotion. There was a significant difference in the level of satisfaction. Analysis showed that promotion has a modest and positive effect on job satisfaction.

Mabaso and Dlamini (2017) did a study on the impact of compensation and benefits on job satisfaction and found a positive and significant effect of compensation on job satisfaction (p = 0.263). Moreover, they found that there was no significant effect between benefits and job satisfaction. Therefore, only compensation significantly predicted job satisfaction among academic staff. A study by Usman, Akbar and Ramzan (2013) on the effect of salary and stress on job satisfaction of teachers in District Sialkot, Pakistan found that from the two independent variables (salary and stress) only salary of the teachers was significantly affecting the job satisfaction of teachers. Financial rewards (salary) were found to significantly affect job satisfaction of teachers. Based on the findings of the study by Usman, Akbar and Ramzan (2013) it means that if employees are not given proper salary in time, they would be highly dissatisfied with their jobs and may ultimately start thinking of leaving the profession. This is due to the fact that cost of living is highly increasing in Pakistan. Other results of a study by Muhammed zia Ur Rehman, (2010) found that job satisfaction was significantly related with extrinsic rewards (salary and other benefits). Arian, Soleimani and Oghazian (2018) did a study on job satisfaction and the factors affecting satisfaction in nurse educators and found that there is a positive correlation between job satisfaction and promotion opportunities and that those professors with a high level of job satisfaction had a higher pay and salary. Job satisfaction of bank officers is significantly dependent upon compensation, promotion opportunities, rewards, relation with boss and coworkers. The study found that compensation is the main factor affecting job satisfaction, and it also has significant relationships with job involvement and promotion. Some evidence that workers who are dissatisfied with their bosses are more sensitive to their compensation in deciding on whether they are satisfied with their job was also established from the study.

An affable relationship between supervisor and employee leads to job satisfaction. According to the Essays, UK (November 2013) an amiable supervisor-employee relationship builds the employee’s morale, which makes him to feel affective about his job, especially when his efforts are recognized and rewarded. This brings him satisfaction in his job. Thus, the employee strives to achieve both organizational and personal goals.

A study by Nidadhavolu, Akhila, (2018) on the impact of leadership styles on employee job satisfaction and organizational commitment in the construction sector in India proved that an organization’s leadership style strongly influences employee job satisfaction and organizational commitment. The application of transformational leadership style leads to stronger job satisfaction. This finding established that leadership has a major influence on work outcome and job satisfaction in the company. The employees are most satisfied when they see their leaders possess both relation-oriented and task-oriented behaviors. The study also highlighted a laissez-faire leadership style is a consequence of job satisfaction. The findings show that the laissez-faire leadership style could result in low interpersonal relationships, resulting in weak employee job satisfaction and productivity levels. The research findings found that out of the three construction companies chosen for the study, the laissez-faire leadership style had a negative influence on job satisfaction and organizational commitment on the employees of two companies. Whereas, the transformational leadership style had a positive impact on the employees of one company. The study also discovered the negative influence of upper-management leadership style on employees has a negative influence on organization performance.

Saleem, (2015) did a study on the impact of leadership styles on job satisfaction and mediating role of perceived organizational politics. Research findings revealed that transformational leadership has a positive impact on job satisfaction and transactional leadership has a negative impact on job satisfaction. The findings also suggest that, perceived organizational politics partially mediate the relationship between both leadership styles and job satisfaction.

Sarwar, Mumtaz, Batool and Ikram, (2015) also did a study on the impact of leadership styles on job satisfaction and organizational commitment. This study tested the effects of both transactional and transformational leadership styles of supervisors/ managers on job satisfaction and organizational commitment of employees. Data was collected from the managers and employees working in IT research and development department in Pakistan. The results of the study revealed a positive effect of both transformational and transactional leadership on job satisfaction and organizational commitment, but this effect is more in case of transactional leadership.

Chien- Wen Tsai (2008) did a study on leadership style and employee’s job satisfaction in international tourist hotels. Through correlation analysis, this research found that employees are more satisfied under consideration-style-leadership than construction-style-leadership. After controlling for differences in salary, employees appear to prefer consideration-style-leadership. No matter what the leadership style is, employees’ job satisfaction does not relate towards their coworkers. Besides, employees have different perceptions on work, salary, and overall satisfaction depending on their education level and seniority.

Bulitia, Godrick (2006) did a survey of supervision styles and employee job satisfaction in commercial banks in Kenya. The findings of this study showed a high correlation between supervision styles and job satisfaction. All the correlated statements between supervision styles and job satisfaction had +1 correlation coefficient. This gave a perfect positive correlation meaning the two variables supervision styles and job satisfaction move together in the completely linear manner. However, based on the study results by Bulitia, Godrick (2006) there is need for line managers to improve the use of supervision styles and relationship with employee job satisfaction in Commercial banks in Kenya. For them to improve and succeed in their supervision styles there should be changes at the individual and organizational levels. At individual level improving line managers’ supervision styles, would involve basic education and specific job related training. They should also be encouraged to enhance their skills through continuous self-learning. At organizational level top management should provide appropriate reinforcements for line managers in learning about and improving their supervision styles (Bulitia, Godrick, 2006).

Ayodele, Ekemode and Kajimo-Shakantu (2020) investigated the job satisfaction levels of real estate firms’ employees and the relationship between employees’ personal and demographic characteristics and their job satisfaction levels. Data were analyzed using both descriptive and inferential statistical techniques. The result showed that financial consideration/personal accomplishment was the most important factor influencing employees’ level of satisfaction, followed by work environment skill variety/organizational culture, feedback/fairness, work passion and supervision/workload/work-life balance. The results of the analysis also showed that demographic factors such as age, marital status, academic qualification, management level, years spent under the current line manager, remuneration and number of firm branches had a significant relationship with job satisfaction.

Park (2020) did a study to investigate the direct effects of supervisor satisfaction, public service motivation, and job characteristics on job satisfaction and the indirect effects mediated by organizational commitment. The survey data used for the empirical analysis was collected from central government agencies in the Republic of Korea. The study found that all three factors indirectly affect job satisfaction through organizational commitment. Only job characteristics were found to directly affect job satisfaction (Park, 2020).

Another study done by Abdelmoula and Boudabbous (2021) with the aim of identifying the factors that affect the job satisfaction of professional accountants. The study examined the relative effects of intrinsic and extrinsic factors on job satisfaction among accounting professionals using the principal component analysis (PCA) and multiple regression methods of data analysis. The results of the study showed that three intrinsic factors, namely achievement, the work itself, recognition, along with four extrinsic ones, i.e., salary, relationship with supervisor and co-workers, working conditions, and the company policy, significantly affect the job satisfaction. However, promotion, growth and recognition do not have a significant effect on job satisfaction.

The study by Hussain and Diaz, (2021) identified factors affecting employee job satisfaction in the University of Karachi using a survey questionnaire data. The study found that a generous rewards and compensation packages lead to job satisfaction and are affected by promotion and job security. Good working relationship with co-workers also contributes to employee job satisfaction. The study also found that good working environment also contributes to employee motivation, and is influenced by better facilities, and training and development. Finally, good supervision provides motivation that enhances the quality of output and employee performance.

Jędrzejczak-Gas and Wyrwa (2020) conducted a study to analyze and evaluate environmental factors shaping job satisfaction in a company from the TSL industry. For the study the correlation between general job satisfaction and particular factors of job satisfaction was examined. The values of Spearman’s rank correlation coefficients and Kendall’s tau coefficients were also calculated. The results of the study show that the two most important factors necessary to achieve job satisfaction are access to information necessary for proper performance of work and independence in performing the entrusted tasks.

Okuwa (2019) examined the determinants of job satisfaction and job turnover intention of the workers of selected banks in Ibadan. Multiple sampling methods were used to select the sample (purposive sampling method was employed to select 12 banks that have the highest number of branches in Ibadan, while random sampling technique was used to select 20 respondents from each of the bank). The results showed that adequacy of salary, safety in work place, possibility of promotion, and interpersonal relations among the staff were the factors that enhanced job satisfaction. However, long working hours, job insecurity and conflicts between office and family schedules reduced the job satisfaction of the bankers.

Using an explanatory research design with a quantitative research approach Mekonin and Teklu (2021) did a study to investigate the determinants of employee job satisfaction in the case of kirkos sub-city of Addis Ababa city administration. The data for the study was collected using a structured close-ended questions from a sample of 310 randomly selected employees and was analyzed using inferential statistics with the aid of Statistical Packages for Social Scientists (SPSS) version 23.0. Multiple regression and ANOVA analysis techniques were also used to explain the nature and effects between employees’ job satisfaction and (Gender, Age, Academic level, Work experience, Work position, pay and benefit, working environment, promotion opportunity, relation with supervisors, trust in leadership). The study found that there is a significant effect with pay and benefit, working environment, Promotion opportunities, relation with supervisors, work experience, and trust in leadership to employees’ job satisfaction and regression analysis result indicated that 81.6% of the variation on the employees’ job satisfaction can be explained by the composite measure the independent variables.

Senek. et al. (2020) analyzed data from a cross-sectional mixed-methods survey to investigate the Determinants of nurse job dissatisfaction – findings from a cross-sectional survey analysis in the UK . Logistic regression analysis of the data was done in order to determine what impacts job dissatisfaction. The study found that nearly two-thirds of nurses were dissatisfied and demoralized.

Monica, Devi and Mohapatra (2020) did a study on Determinants of Job Satisfaction.  Using a sample of 150 respondents and data collected using questionnaire method the study examined whether job characteristics (JC) and individual characteristics (IC) have an effect on worker’s job satisfaction (JS). The result suggest that job characteristics and self-efficacy are significant predictors of job satisfaction (JS).

Khaira, Afifah; Shariff, and Sima, (2021) did a study on the determinants of employee job satisfaction in Malaysia . This study aimed to determine demographic factors (gender and living areas), education and skills, work environment and compensation as the determinants of employee job satisfaction. Data collected from 132 employees from various sectors in Malaysia was analyzed using Pearson’s correlation and the Ordinal Logistic Regression. From the study it was concluded that living area, education qualification and skills and compensation are significant and considered important factors to meet their job satisfaction compared to gender and work environment.

Ranatunga, (2020) did a study to identify the relationship between pay, promotion, supervision, co-workers and work itself of job satisfaction and job performance among employees in classified hotels. A structured questionnaire was used to collect data from 150 non–executive employees selected using the convenience sampling method. Frequencies, univariate analysis, Pearson’s correlation, T-test and multiple regression analysis as well as multivariate analysis were used in the study. The study concluded that there is a significant positive relationship between selected factors of job satisfaction and job performance. The results of the correlation coefficient showed that pay, promotion, co-workers, supervision, work itself has a significant positive relationship with job performance and it emphasized that pay and co-workers have a strong relationship with job performance. According to the multiple regression analysis, the model was strongly fitted to the data and 40.6% variance of job performance was explained by pay, promotion, co-workers, supervision and work itself of job satisfaction.

Parveen, Maimani, and Kassim (2016) did a study to examine the effects of demographic characteristics on the QWL dimensions and satisfaction, and the relationships between the QWL dimensions and satisfaction, and between satisfaction and retention among nurses and other health care professionals Saudi Arabia.  A sample of 360 nurses and other health care professionals was collected in Jeddah, in Saudi Arabia and the data collected was analysed using multivariate analysis of variance and structural equation modeling were used to test the hypotheses. The results of the study show that there is a significant difference between demographic and QWL dimensions and satisfaction. Satisfaction with personal growth and salary package were found to have significant positive impacts on overall retention.

Jigme, and Namgyal, (2021) did a study to determine the relationship between the determinants of job satisfaction such as work environment, pay and allowances, promotion, training and development, and job satisfaction in the Bhutanese context. Data from a sample of 76 civil servants were collected through a questionnaire survey and Google form and analyzed using SPSS 23. The Pearson correlation analysis was performed to find out the relationship between the independent variables (determinants of job satisfaction) and a dependent variable (job satisfaction). Linear regression and multiple regression analysis were also performed to understand the strength and types of relationship. The results of Pearson correlation and regression analysis indicate that the work environment (rp = 0.603, p < 0.01, R 2 = 0.364, B = 0.460), and training and development (rp = 0.583, p < 0.01, R 2 = 0.340, B = 0.383) have strong significant positive relationships with job satisfaction. However, other determinants such as pay and allowances (rp = 0.436, p < 0.01, R 2 = 0.190, B = 0.283) and promotion (rp = 0.395, p < 0.01, R 2 = 0.156, B = 0.288) have moderate relationships with job satisfaction. The result for multiple regression analysis shows that all the determinants have a strong correlation (R = 0.624, R 2 = 0.481, p < 0.01) with job satisfaction and these determinants determine 48.1 percent of the total satisfaction level perceived by the employee. The findings indicate that the work environment is the strongest predictor of job satisfaction as compared to other determinants.

Mensah, Amrago, Asare, Yeboah and Donkor (2020) did a study to investigate the factors affecting job satisfaction amongst workers of the poultry sub-sector: a test of equity theory in the Dormaa Municipality in the Bono Region of Ghana. The multistage sampling technique was employed in collecting data from 100 poultry workers with the aid of a structured questionnaire. The logit model was employed in modeling the factors affecting job satisfaction. The empirical findings reveal that occupational level, pay, and relationships with co-workers were the statistically significant determinants of job satisfaction.

Subarto, Solihin, and Qurbani, (2021) did a study on the determinants of job satisfaction and its implications for the lecturers performance. The purpose of the study was to examine the positive effects of leadership style, work environment, and organizational climate on lecturer performance through Pamulang University’s job satisfaction.  The quantitative research method was used and data was collected using survey questionnaires distributed to a sample of 135 respondents selected using a proportional random sampling. Statistical analysis was done using the partial least squares (PLS). From the results of the analysis it was found that leadership style, work environment, and organizational climate have an impact on job satisfaction. Leadership style, work environment, and organizational atmosphere also affect the performance of lecturers. Job satisfaction affects the performance of lecturers and can mediate the influence of leadership style, work environment, and organizational climate on lecturer performance.

From this study it is concluded that the factors that contribute to the positive morale and attitude also result in a higher degree of job satisfaction (Saranya, 2014). The review has shown that the major determinants of job satisfaction are basically nine facets which are pay, promotion, supervision, fringe benefits, contingent rewards, operating procedures, co-workers, nature of works and communication. Job Satisfaction is thus derived from and is the result of many interrelated factors which cannot be completely isolated from one another for analytical purposes. Job Satisfaction is the essential component for employee motivation and encouragement towards better performance (Vroom, 1964). A highly satisfied work force is absolutely necessary for achieving a high level of performance in an organization. Satisfied employees are more likely to be friendly and responsive which attracts customers while dissatisfied employees can lead to customer dissatisfaction (Mahmud, Hasan, and Asif, 2014). It is therefore necessary for organizations to ensure that the above determinants are provided at the required levels to ensure optimum satisfaction of employees. Of all the major job satisfaction areas, satisfaction with the nature of the work itself—which includes job challenge, autonomy, variety, and scope—best predicts overall job satisfaction, as well as other important outcomes like employee retention (Fried & Ferris, 1987; Parisi & Weiner, 1999 as quoted in Ram, (2013).

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JOB SATISFACTION: A LITERATURE REVIEW

Job satisfaction represents one of the most complex areas facing today's managers when it comes to managing their employees. Many studies have demonstrated an unusually large impact on the job satisfaction on the motivation of workers, while the level of motivation has an impact on productivity, and hence also on performance of business organizations.Unfortunately, in our region, job satisfaction has not still received the proper attention from neither scholars nor managers of various business organizations.

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Ravina Sawant

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Purpose: To investigates the causes of job satisfaction among the employees of different organizations and how can maximize the performance of employees through job satisfaction. Design/ Methodology - Questionnaires were designed and distributed to all the employees of different organization. This measures perceived levels of job satisfaction amongst the employees of organizations and potential effects of job satisfaction on the performance of employees. Practical implications-The findings of this research emphasis on organization culture, work place conditions and job rank in order to optimize the performance of the employees through job satisfaction. There is also a need to undertake longitudinal research to investigate Findings: Findings suggested that there is a positive relationship exists between stress, time management and Family conflict problems. Increase in lack of support from family increase the stress level of a student similarly if a student could not manage its time this also increase the stress of a student. Research limitations- The research was carried out in five organizations and therefore results cannot be generalized to cover the whole organization sector. Value-This research paper highlights the causes of job satisfaction and their positive impacts on employee’s performance. Key Words- Job satisfaction, Organization culture, Job rank, Work place conditions.

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The objective of this paper is to investigate the relationship between these three variables namely: Job performance, job satisfaction and motivation with the help of theoretical models and literatures. Although many studies had already been conducted on job satisfaction and job performance, its relationship is still subject to much hated debates to specifically determine the extent of its relationship. With regards to motivation, results showed that, monetary consideration is by far more important than other motivation strategies which emphasized the aspect of addressing the economic needs of the individuals. However motivation like that of Herzberg had proven that pay is not the sole indicator of employee motivation. Furthermore, it was also proven that job satisfaction, job performance and motivation interact with each other and functioned interdependently such that the process is circular rather than linear. When job satisfaction and performance is linked with group performance, the outcome revealed that higher job satisfaction leads to higher performance although it is not always the case. Working together is the key to achieve desirable outcomes which means that employees should not be kept in isolation but should be encouraged to work together to effectively achieve the goals and success whether in group or the organization as a whole.

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Job satisfaction among hospital nurses: A literature review

Affiliations.

• 1 Peking University School of Nursing, #38 Xueyuan Road, Hai Dian District, Beijing 100191, PR China. Electronic address: [email protected].
• 2 Peking University School of Nursing, #38 Xueyuan Road, Hai Dian District, Beijing 100191, PR China. Electronic address: [email protected].
• 3 King's College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, United Kingdom. Electronic address: [email protected].
• PMID: 30928718
• DOI: 10.1016/j.ijnurstu.2019.01.011

Background: Globally there are mounting concerns about nurses' job satisfaction because of its pivotal role in nurse turnover and the quality of care of patients.

Objectives: To identify a more comprehensive and extensive knowledge of the job satisfaction of qualified general nurses working in acute care hospitals and its associated factors drawing upon empirical literature published in the last five years.

Design: Literature review.

Data sources: A comprehensive electronic database search was conducted in PubMed (2012-2017), Web of Science (2012-2017), CINAHL (2012-2017), Embase (2012-2017), PsycINFO (2012-2017) and the Applied Social Sciences Index (2012-2017), CNKI (2012-2017), WanFang (2012-2017), SinoMed (2012-2017) and VIP (2012-2017) to retrieve relevant articles published in both English and Chinese between January 2012 and October 2017.

Review methods: Key terms and phrases associated with job satisfaction, occupational stress, professional commitment, role conflict and role ambiguity were utilized in the subject search in combination with nurses following guidelines for searching the OVID interface. The abstracts or full texts of research papers were reviewed prior to their inclusion in the review according to inclusion criteria and quality assessment using the Strobe guidelines.

Results: A total of 59 papers were included in this review. The impact of job satisfaction upon sickness absence, turnover intention, as well as the influencing factors of job satisfaction such as working shift and leadership, job performance, organizational commitment, effort and reward style has been identified in a number of research studies yielding equivocal findings. Job satisfaction of hospital nurses is closely related to work environment, structural empowerment, organizational commitment, professional commitment, job stress, patient satisfaction, patient-nurse ratios, social capital, evidence-based practice and ethnic background. Various mediating or moderating pathways have been identified with nurses' job satisfaction being mediated by various factors.

Conclusions: It is vital to increase nurses' job satisfaction because this has the potential both to improve patients' perceptions of care quality and ensure an adequate nursing workforce. The indirect relationships and predictors of job satisfaction contribute to a more comprehensive understanding of the complex phenomenon of job satisfaction, which in turn may aid the development of effective strategies to address the nursing shortage and increase the quality of patient care.

Keywords: Influencing factor; Job satisfaction; Mediator; Nurses; Predictor; Related factor.

Copyright © 2019 Elsevier Ltd. All rights reserved.

Publication types

• Job Satisfaction*
• Nursing Staff, Hospital / psychology*
• Personnel Turnover
• Quality of Health Care