NURSES PERCEPTION OF JOB SATISFACTION, JOB STRESS IN A CRITICAL CARE ENVIRONMENT
INTRODUCTION
Nurses are crucial in the health sector and the entire global system. The purpose of the study stems from relative events affecting job satisfaction and job stress especially noticed among nurses in critical care environment. Increasing health care costs alongside shortage of nurses have presented the government and health administrators with a Herculean task of maintaining qualitative health delivery. The race to get quality personnel’s, nurses in the health sector is becoming difficult, this indirectly affects the level of job satisfaction, job stress and the quality of health care delivery. (Bonn, 1997; Contino, 2002).
The concept of job satisfaction is of immense importance to nurses, satisfied nurses are therefore more willing to stay in the field of nursing and the organization that assures job satisfaction and a relative low job stress. (Urden, 1999)
Shortage of nurses and relative stress on the available nurses makes the issue of professionalism and quality service delivery a hoax in the health care system. These results in relative job stress and eventually pave way for anger; stress is a predictor of job dissatisfaction. (Thomas, 2004).
The classic job satisfaction research of Fredrick Hertzberg’s Motivation Versus Hygiene theory plays a crucial role in reminding managers and administrators of the best way to approach nurses’ job satisfaction.
Job Satisfaction goes a long way to ensure nurses stay in an organization for a long period, from several nurses experience unsatisfactory conditions and inadequate staffing affects service delivery. (Thomas, 2004). In 48 studies with a total of 15,048 nurses statistical data revealed that stress is the highest variable among 13 variables various researches had researched on responsible for job dissatisfaction. (Blegen, 1993; cited by Thomas 2004).
The aforementioned problems opens up or provides the basis for the research which basically centres on job satisfaction and job stress in an age of shortage of nurses and mobility of nurses from one organization to another due to unsatisfactory job conditions.
BACKGROUND
Job satisfaction is a factor that paves way for the decision of a nurse to stay in a particular organization for a long period; it also reduces the risk of job stress and job dissatisfaction.
Identifying the major problems have continually received a more open minded research in the field of nursing yielding no significant resolutions or outcomes. Nurses have been dedicated to providing quality services, but the work environment needs to be guarded by policies and incentives to ensure quality health delivery.
As opined by (Laschinger et al, 2001) an inconducive work milieu hinders attempts to improve patient satisfaction because higher degree of job satisfaction equals to higher quality of nursing care.
A study reveals that there will be an estimated shortage of registered nurses with a BSN of 1,119,000 and likewise an estimated shortage of registered nurses with a MSN or Doctorate of 507,000 by 2010. (Upeniks, 2003) What can be deduced from the foregoing is a relative shortage of skilled and professional nurses which connotes a decline in quality service delivery.
Nursing shortages have been theorized by several factors, the most important are the new jobs open to women and the fact that the average age of a nurse is 46 years old, the wages at the average age also shrinks except the nurse goes into a management position. (Coile, 2001)
The variables of age, commitment, communication with peers and supervisors, professionalism, stress and years of experience are all related to our duo position of research; job satisfaction and job stress. (Blegen, 1993) Belgen submitted that job stress and commitment are strongly related to job satisfaction.
A strong link between job satisfaction and the behavioural intent of a nurse to maintain the present employment or respond to other job offers warrants a research, especially during the era of shortage of nurses. Job stress depicts the level of stress and unfavourable conditions in work place which includes illness, decline in overall quality of care, job dissatisfaction, and absenteeism. (Schwab, 1996) Job stress ultimately leads to job dissatisfaction which creates a behavioural intent to leave the present job, this happens when the demands of the job or job milieu exceeds the capacity of the nurse to respond effectively and professionally.
PURPOSE OF THE STUDY
The aims of the study are to:
- assess the level of respondents experience about the concept of job satisfaction.
- examine the relationship between motivation and hygiene factors and job satisfaction from the theoretical viewpoint.
- the relationship between job stress, job satisfaction and the reasons for the shortage of nurses.
- examine the relationship of job stress and job dissatisfaction to the intent of leaving for another job.
STATEMENT PROBLEM
The research in the field of finding the best way to attain job satisfaction among nurses is on the increase , however research on factors affecting job satisfaction in the health care industry and solutions have been neglected; this affects administrators in curbing the problem of shortage of staffs and adopting appropriate policies to stem the tide.
The main point therefore is the effect of having knowledge of the relevant job dissatisfaction and job stress in the health sectors and the adoption of favourable policies to overcome the problems.
The factors that would be examined in this research are the professional work environment, professional relationships, professional role enactments and incentives. (Whitley &Putzier, 1994). The factors would further help in analysing the theoretical position in relation with the factual side of the research objectives. The accumulating effect is the understanding of the nurse’s plight and an improvement of the working environment and incentives.
SIGNIFICANCE OF THE STUDY
The study seeks to provide policy makers and administrators a view of the unpublicised effect of job stress and satisfaction and its impact on quality service delivery through empirical method and quantitative method.
Increased stress or inconducive job environment increases the likelihood of staff shortages and poor health delivery. This is costly to health institution as changes are effected without the proper knowledge of the causation which primarily has to do with staff welfare. Administrators should focus more on the stress related factors and incentives to increase job satisfaction which would give a better result to the changes in organizations. (Tzeng, 2002)
For nurses in clinical practice, the rapid increase of staffs affected by stress, lack of satisfaction or both cases reduces the quality of care and increases the risk of mortality in critical care sections. The awareness of the situation or condition of the nurses in critical care units reduces the level of stress and dissatisfaction if addressed properly. (Mee & Robinson, 2003)
The impact of the research on nursing education enlightens prospective nurses about work related stress, management of stress and relationship of nurses with administrators in terms of communicating the perceived deficiencies and advocating for changes. Awareness of the problems in nursing practice makes it easier for the nurses and administrators to address the problems before they aggravate.
DEFINITION OF MAJOR TERMS
Job Satisfaction
This connotes the satisfaction or positive feeling of nurses towards their employment. (Price&Muller, 1981)
Job Dissatisfaction
This is the feeling of unhappiness and lack of satisfaction as measured by the patient’s progress or recovery. (Whitley&Putzier, 1994)
Nursing Job Stress
Nursing job stress is an internal cue in the physical social or psychological milieu that threatens the equilibrium and performance level of an individual. (Toft&Anderson, 1981)
THEORETICAL FRAMEWORK
The research would adopt a duo theoretical position in explaining the interrelationship of job satisfaction and job stress on nurses in critical care.
The Herzberg theory of motivation and hygiene which depicts the diverse needs of man including self actualization or psychological growth and avoidance of pain. (Herzberg, 1966). His research examined the individual factors which pave way for other factors that lead to job dissatisfaction.
The theory states that motivation factors included achievement, recognition, work itself, responsibility and advancement. The hygiene thesis relates more to the dissatisfiers than satisfiers ; it concerns a temporal change of individuals attitude towards their job and plays a role in avoiding the perceived dissatisfiers, the short term nature of these factors leads to job dissatisfaction.(Herzberg, 1959) The dissatisfiers include hospital management policies and government policies, personnel relations, working conditions , supervision and salaries.
The Cognitive Relational theory (Lazarus, 1984, 1989) and Roy adaptation model (Roy, 1984) centres on stress. Lazarus submits that stress and stress response are not static but an individual’s response is dynamic in several circumstances or situations. The process of stress and duration relies heavily on the individual interaction with internal and external environment as these environments are dynamic depending on the events or circumstance.
The cognitive process is defined by how an individual appraises an event or stressor to determine if the stressor is harmful, threatening or a challenge; this further puts the individual into evaluating the strength of a stressor in relation to the available resources. A stressor is harmful when harm had occurred already, a stressor was threatening if harm had not yet occurred but was expected due to lack of resources.
Lazarus identified two coping categories; the first is problem-focused coping, centred on actions such as seeking for information or altering behaviour, the other centred on emotion focused coping aimed at reducing emotions associated to person-stressor interaction. Another school of thought identified job stressors in the nursing work environment. Work related stressors are of three dimensions; the institutional level, the unit level and the patient level. (Cohen-Mansfield, 1995). Another School of thought much in compliance with the Job Stress Scale (JSS) ; which are to measure the physical work environment, competence, staffing and team respect.(Leveck &Jone 1996) .
However, other factors related to nursing job stress are heavy workload, urgency and critical nature of work to be performed, demise of patients, role conflict, lack of autonomy in practice, lack of social support, insufficient knowledge or expertise in the specialization, rapidly changing nursing environment. (Hemingway & Smith, 1999; Tovey & Adams, 1999).
The Roy adaptation model states that the environment and the person provide the system input. (Roy, 1984) The response control processes are the coping mechanisms with regulator subsystem, cognator subsystem, effectors were physiological function, self-concept, role function and interdependence. In this research, both the external stressors connected to the job of nursing in the hospital environment and internal adaptive levels of the nurses in the sample pave way system input. The nurses’ individual coping mechanisms and regulator, cognator subsystem control the emotional psychological effectors that produce the output of effective or ineffective adaptation. Job satisfaction and Job stress are indicators of the effectiveness of adaptation in the nursing populace.
LITERATURE REVIEW
This section seeks to make a review of relevant key words according to the perspective of several authors and in compliance with the goal of the research. Hezberg’s theory as it affects job satisfaction and stress would be analysed with the Cognitive Relational Theory and Adaptation model as the main theoretical framework.
An examination of the impact of nurse working related stress alongside job satisfaction and mood disturbance by an urban and regional medical institutions in Australia.
A sample of 129 nurses from private and public hospital from the nursing sector was used for the study; the average length of the respondents was 16 years. The data collection strategy was mainly standardized questionnaires and open-ended questions which were filled at home and posted by to the researcher. (Healy &McKay, 1999, 2000)
The Standardized questionnaires included the nursing stress scale (NSS), the ways of coping (WOCQ), the coping humour scale (CHS), the job satisfaction scale of the nurse stress index, and the profile of mood states (POMS). The study used the NSS relied majorly on the variable of nursing stress. Reliability coefficients for the study reveals (total scales α = .92; sub-scale range α = .78 to α = .91) was higher when compared to a similar study by coefficient .89 and sub-scales coefficients ranging from .64 to .77 (Gray-Toft and Anderson 1981) The NSS index measured the dependent variable of job satisfaction with a submission of reliability coefficient as α = .81 (Healy & McKay, 1999, 2000)
The study however discloses a small but significant negative correlation (r = -.22, p<.05) between the variables of reported nursing stress and job satisfaction. It discloses when stress levels increased then job satisfaction decreased. The aftermath of the dichotomy between job satisfaction and job stress and mood disturbance was examined using hierarchical multiple regression. Job satisfaction was simply 17 percent of the total variance (R2 = .17, F = 8.9, p = <.001) but had no connecting or interrelated effect with stress. The researches therefore submitted that job satisfaction paves way for a good mood towards work and responsibility but it is not an adequate tool to overcome negative mood created by job stress. (Healy & McKay, 1999, 2000)
The Nursing stress scale (NSS) might be a significant variable in the research and study of nursing job stress but it is limited by measuring the frequency and not the intensity of stressful events; Variables such as health risks such as needle sticks of the nurses as stress related variables are used by NSS, but it must be noted that this risks are not incessant and they are experienced by virtually all nurses and have a negative aftermath on the nurses involved.
Furthermore, the dependence on self reporting and the moderate sample size are significant deficiencies or limitations of the research.
The nurse patient relationship as it affects job satisfaction, in a study of the nurse patient relationship, the patient’s scales except education before discharge correlated (0.826 to 0.965 correlation coefficient; alpha 0.05, two-tailed) with at least one of the nurses’ factors for job satisfaction. (Tzeng &Ketefian, 2002) Total job Satisfaction correlated with patient satisfaction in terms of management of pain and discomfort. General happiness with patient satisfaction and contentment with care, health services, management of pain and discomfort and management of care. (Tzeng &Ketefian, 2002)
The results of the aforementioned research reveals that hospital administration could improve patient satisfaction and affect nurse satisfaction.(Ibid)
Other literatures addressing nurses job satisfaction, the research by (McNeese-Smith, 1999) examined factors that relate to nurses job dissatisfaction and satisfaction through a qualitative research design, the study was conducted by researches in private rooms to gather information from respondents through audio taped interviews and semi –structured questionnaire. The 30 nurses used as respondent were in six different units in the hospital in California.3 of the different units were found to have a high job satisfaction and the other 3 a low job satisfaction by the researchers. The research was not the first aiming at job satisfaction; purposive sampling however was used to choose nurses who participated in previous studies in order to increase the chances of getting a clear opinion about job satisfaction. The variable of age and year in service was crucial in this research as the respondents were 93 percent female, had an average age of 43 years old and had 16 years experience in nursing with an average of 11 years in the facility or unit where the research was being conducted. Other factors included education, ethnic nationality and place of study, for instance most of the respondents, about 67 percent received education outside the United States.
The use of content analysis on data accumulated through transcription of audio interviews reveal that factors causing job satisfaction and factors causing job dissatisfaction points to a fact that individual differences and personal characteristics made some nurses to identify either some themes and completely disagree with some themes. It was common for dissatisfied nurses to see something as a burden when another satisfied nurse sees the same as a challenge. This deficiency in the research identifies the need to consider individual differences and needs or reactions to work related stress. The several categories and variables in the research do not recognize individual traits or differences.
The research had three categories related to job satisfaction , the first had to deal with actual work and patient care which includes providing care, recognition from patients and families, feeling and recognizing improvements in patients health , the environment is also crucial if it
is pleasant and dynamic, a balanced workload with appropriate instruments and workforce and able to meet the patients demand.
Other categories dealt with in the research include personal factors which relates to nurses welfare which affects the nurse service delivery. (Several factors determine this, a convenient work place, adequate and experienced staffs, financial benefits for the nurse and family, promotion of nurses, personal values and religious convictions).
A study on job stress as it affects the variable of job satisfaction in a Pediatric Intensive Care Unit (PICU) nurses using a cross sectional descriptive design , the aim of the study was to explore the effect of personal attributes , unit characteristics and work milieu on the nurses’ job satisfaction. Another part of the study was to identify stressors unique to the paediatric intensive care settings. (Bratt et al, 2000)
Other variables considered are leadership style, nurse physician collaboration and different PICU characteristics were added to show PICU practice milieu. (Ibid, Bratt et al).
An extension of the study was conducted through a sample in 1973, were PICU nurses were recruited from a paediatric acute care hospitals in the United States and Canada. The data was collected within a period of three months, self- report questionnaires were applied, and however the exact instruments were not stated. An open-ended question concerning unique stressors in the PICU concluded the data collection phase.
The response rate on all questionnaires was 70 percent, reliability for each instrument was examined by applying Cronbach’s coefficient alpha and produced acceptable estimates (α = .83 to .96) .The shortage of staff and intent to leave a hospital for another is related with the behavioural differences correlates with actual unit turnover rates. (Bratt et al., 2000).
Limitations of this study were cross sectional design and the lack of gender distinction in the demographic data, the cross sectional design does not represent the perceptions of different variables. Gender may affect the perception of job stress and satisfaction and eventually affects the outcome of the analysis.
A comparison of job stress and satisfaction in a sample (N=143) of health visitors (HV) , district nurses (DN) ,and Community Psychiatric Nurses (CPN) usually in urban areas and some rural areas of the health industry in England. Stress levels were measured using the general health questionnaire- 12(GHQ-12) which has estimated coefficients for reliability and yielded valid results among nurses and medical students. A 5-point Likert scale measured job satisfaction. The researchers further developed a 47 item questionnaire to measure factors paving way for job stress and satisfaction. (Snelgrove, 1998)
The general level of stress as depicted by the GHQ-12 discloses that HVs and DNs were experiencing high level of stress. Average scores on job satisfaction data depicts how HVs perceived the least satisfaction while the DNs and CPNs perceived moderate job satisfaction.
Stress and Satisfaction were correlated using Pearson Product Coefficient (p < .05). Correlations though small were found ranging between P = .001 to .042. The sample disclosed sources of significant stress as ongoing emotional and physical strain of long term care clients and families alongside lack of management support in dynamic work roles, sources of job dissatisfactions were also related to lack of management support and adequate information in a changing and dynamic work environment. Improving supervisory support and adequate staffing could reduce job stress in critical care units. (Snelgrove, 1998).
METHODOLOGY
The methodology section of this proposal depicts the design of the study, the setting where it took place especially when it has to do with quantitative analysis, the instruments involved in data collection and also procedures that were used for data collection. It includes the data analysis and the description and analysis of the way the data was used.
The study design is based on a non-experimental (based on the fact that no new changes were introduced), quantitative design with a convenience sample.
The purpose of the design is to establish a relationship between the independent and dependent variables. The independent variables are the motivation and hygiene factors while the dependent factors were job satisfaction and job stress.
The questions would be aimed at achieving a qualitative piece fostered by demographic, educational level, years of expertise questionnaire. The setting of the study is a medical centre in London.
The medical centre is a critical care unit, the sample would be taken from 2 telemetry units in the medical centre, the unit 1 has 30 beds and unit 2 has 24 beds.
The units as investigated before writing the proposal have a very similar staffing, physical layout, and availability of equipment. Nurses were usually asked to rotate around these units due to shortage of staff. Nurses for this study, (N=30) were recruited from a critical care centre, the nurses for the research fulfilled the following criteria: (a) employed full time (defined as working at least 32 hours per week) in direct patient care on-patient units, (b) employed at the hospital at least 6 months, (c) Registered nurses (RN) and Licensed Practical nurses (LPN). Exclusion criteria consisted of (a) part-time employees, (b) management
personnel
These criteria would be used because the respondents would be well-oriented to the
Organization, pass the initial stress of working in a new environment, and working in
similar situations. Full time employees were used due to potentially different stress
experienced by part time employment. Registered nurses and Licensed Practical nurses
would be used because both of these groups encounter many of the same stressors and are
both seen by the public as “nurses”. Nurses in management positions were excluded
because there are differences in stressors related to job responsibilities.
A convenience sample design was used to get participants for the research from the 2 telemetry units; there were approximately 30 full time and part time registered nurses with various educational backgrounds and levels of experience who were relevant to the theme of the research. Nurses who were not directly involved in this unit, patient care, the nurse managers and administrators were excluded.
Two instruments would be used in the research, the first being a demographic questionnaire designed by the researcher, the questionnaire would include diverse variables such as age, nursing experience, education, job satisfaction, job stress, (what aspects of the nursing jobs leads to satisfaction and dissatisfaction?).
The Work Quality Index (WQI) would be used as developed by (Whitley and Putzier, 1994) to measure the job satisfaction of nurses working in critical care units. The tool was developed by the Commission on Accreditation of Health Care Organizations to set a standard towards health staff welfare. The WQI is a 38-item, 7-point Likert Scale that measures the satisfaction of nurses in relation to their work environment. The instrument has 6 subscales: (i) professional work environment, (ii) Autonomy of Practice, (iii) Work Worth to self and others, (iv) Professional relationships, (v) Professional role enactment and (f) Benefits.
LIMITATION OF THE STUDY
First is the financial constraint of embarking on a broad based research and time limit, due to this factor the convenience sampling design would be used to overcome time and financial barriers.
This form of sampling design coupled with a small sample size significantly limited the ability to generalize the results of the study to the entire target population. The results of the study were also difficult to generalize because the sample was limited to only one facility. The job satisfaction of these nurses could have been affected by their particular culture, the policies of their particular hospital, or the facility’s administration. Another limitation was extraneous variables related to the setting of the study. Potential variables beyond the researcher’s control include, but are not limited to environmental factors, stress levels, and mood of the respondent.
Response bias was also a potential limitation because employees may have feared retaliation
from hospital administration for low levels of satisfaction.
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