539175

research-article2014

TCNXXX10.1177/1043659614539175Journal of Transcultural NursingAn et al.

Research Department

Factors Affecting Job Satisfaction of Immigrant Korean Nurses

Journal of Transcultural Nursing 1­–10 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1043659614539175 tcn.sagepub.com

Ji-Young An, PhD, MPH, RN1, Sunkyung Cha, PhD, RN2, Hyunjung Moon, PhD, MPH, RN3, Jeanne S. Ruggiero, PhD, RN4, and Haeran Jang, PhD, RN5

Abstract Purpose: An increasing number of foreign-born nurses are working in the United States. Nurses’ job satisfaction is a critical issue for quality patient care. The purpose of this study was to examine factors affecting the job satisfaction of immigrant Korean nurses. Design: We used a cross-sectional mailed survey design. A convenience sample (n = 105) of members of the Greater New York Korean Nurses Association currently working or had previously worked in the United States completed the questionnaires. We used hierarchical regression to test the effects of acculturation and life satisfaction on job satisfaction. Results: Most participants were female (n = 98, 93.3%) aged 27 to 70 years (mean = 52.27 years, SD = 10.67). In the regression model, life satisfaction, self-esteem, and perceived stress predicted job satisfaction (F = 5.127, p < .001) and explained 44.5% of the variance of job satisfaction. Discussion and Conclusion: U.S. nurses need to gain insight into factors influencing job satisfaction in Korean nurses to promote retention and quality care. Keywords organizational factors, job satisfaction, life satisfaction, self-esteem, self-efficacy, immigrant Korean nurses

Introduction Nursing shortage and the migration of nurses have been considered a global concern around the world. The number of foreign-born nurses working in the United States has increased significantly in recent decades due to the U.S. nursing shortage (Shen et al., 2012; Sparacio, 2005). This shortage is projected, by 2025, to be twice as large as any of the other U.S. nursing shortages since the mid-1960s (Buerhaus, Auerbach, & Staiger, 2009). According to the 2008 National Sample Survey of Registered Nurses, about 5.6% of the estimated 3,063,162 U.S. registered nurses (RNs) or nearly 165,539 were internationally educated (Health Resources and Services Administration, 2010). Some researchers have estimated that the proportion of foreign-born nurses is 11.5% to 16.3% of the U.S. nursing workforce (Buerhaus et al., 2009; Paral, 2004). Many of these nurses are from Asia. According to the National Council of State Boards of Nursing (2008), the largest number of foreign-born nurse candidates for the National Council Licensure Examination-RN (NCLEX-RN) were from the Philippines (n = 21,499), followed by India (n = 5,370), and Korea (n = 1,906). The focus of this article will be on Korean immigrant nurses to the United States. Foreign-born nurses may experience language and communication difficulties, differences in culture-based lifestyles, lack of support, inadequate orientation, differences in

nursing practice, and inequality while they adapt to the American culture and work environment (Kawi & Xu, 2009). Korean nurses face a number of challenges when practicing nursing in the United States. Even after passing the NCLEX-RN and obtaining certification in written English language proficiency, there are other issues that they must contend with as they adjust to practicing in U.S. hospitals. Yi and Jezewski (2000) found that their sample of 12 Korean nurses went through an adjustment process comprised of five stages. They had to find ways to deal with psychological stress (which can be severe), overcome language barriers (American idioms, regional accents, and slang), learn American styles of interpersonal relationships, and accept American nursing practice styles and problem-solving methods. It can take as long as 5 to 10 years for Korean nurses to adjust to practicing in U.S. hospitals. They may also face 1

Inje University, Seoul, Korea Sun Moon University, Chungnam, Korea 3 Far East University, Chungbuk, Korea 4 Rutgers, The State University of New Jersey, Newark, NJ, USA 5 Joongbu University, Chungnam, Korea 2

Corresponding Author: Ji-Young An, u-Healthcare Design & Healthcare Service Design Development Program, Design Institute, Inje University, Room 710, Indangkwan, Supyo-ro 31, Jung-gu, Seoul 100-032, Korea Email: [email protected]

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other stressors such as cultural conflict as they interact and work with native-born American nurses, patients, and educators. Other communication issues stem from differences in Korean and U.S. societies. Korean society, as many other Asian societies, is collectivistic and there is much higher context communication among individuals. Conversely, Americans tend to be individualistic and lower context communicators (Robichaux, Dittmar, & Clark, 2005). It is important that U.S. nurses learn more about the Korean culture in order to help their Korean nurse colleagues to adjust to nursing practice in the United States It is particularly important to build intercultural relationships in patient care settings when there are large numbers of foreign-born nurses working in the organization (Giger & Davidhizar, 2002; Pacquiao, 2002). A lack of cultural understanding and failure to address emerging subcultural issues within U.S. patient care settings can have a negative effect on patient care and the job/life satisfaction of Korean nursing staff (Brown, 1998; Gordon & DiTomaso, 1992; Kingma, 2001; Pilette, 1989). Staff nurses and managers should strive to understand the cultures of foreign nurses and promote their professional socialization (Lee & Kim, 2002; Pacquiao, 2002). In summary, there are many Korean nurses working in the United States, which has intermittent nursing shortages. Promoting the acculturation and job satisfaction of Korean nurses, and retaining them, is vitally important to patient care and ultimately the U.S. health care system.

Literature Review Job satisfaction is defined as the positive affect an employee feels about his or her employment (Price & Mueller, 1986). Castañeda-Hidalgo et al. (2009) reported that job satisfaction is a widely studied subject because most individuals spend a large part of their lives at their place of employment. Understanding the factors that contribute to job satisfaction is important for improving the well-being of individuals. Physical and mental well-being were positively correlated with nurses’ job satisfaction (Blegen, 1993; CastañedaHidalgo et al., 2009). Internationally educated nurses (IENs) were less satisfied with their jobs than U.S. nurses, which may be an indication that IENs have different employment issues that deserve more in-depth investigation (Xu, 2010). Acculturation is a complex and multidimensional process in which one integrates the beliefs and cultural behaviors of another culture into one’s host culture (Ea, Itzhaki, Ehrenfeld, & Fitzpatrick, 2010). Successfully acculturated foreign-educated nurses (FENs) develop and adopt the individualistic value that defines the U.S. culture and become assertive in the workplace (Yi & Jezewski, 2000). FENs reported a sense of belonging at work and their communities-at-large and expressed a sense of personal and work satisfaction (Ea, 2006; Ea, Griffin, L’Eplattenier, & Fitzpatrick, 2008; Magnusdottir, 2005; Yi & Jezewski, 2000). Successful

acculturation among FENs leads to positive personal and work-related outcomes (Ea, 2006; Magnusdottir, 2005; Yi & Jezewski, 2000). However, the process by which FENs acculturate to host cultures is difficult, complex, and multidimensional. Pavot, Diener, Colvin, and Sandvik (1991) defined life satisfaction in their study as “a global evaluation by the person of his or her life” (p. 150). A happy, satisfying life can contribute to success at work (Lyubomirsky, King, & Diener, 2005). A career is recognized as an important aspect of life satisfaction because work provides an income for a satisfying life and promotes self-esteem when done well (Diener, Suh, Lucas, & Smith, 1999). Self-esteem was defined as self-assessment for the level of self-concept in a person’s life (Rosenberg, 1965). Individuals with strong self-esteem usually have high levels of individual achievement and job satisfaction (Park, 2000). Generally, the higher nurses’ self-esteem, the more they value their jobs and feel a sense of accomplishment. As a result, professional achievement will promote occupational confidence and development (Kwon & Yeun, 2007). Self-efficacy is a person’s belief in his or her ability to perform any action or behavior, face any difficulty, and withstand stress (Benight & Bandura, 2004). People with high self-efficacy work more effectively and cope well even when experiencing failure. They have better outcomes and tend to be satisfied with their jobs (Judge & Bono, 2001). In psychology, stress refers to a feeling of strain and pressure. Psychological stress occurs when an individual perceives that he or she is having difficulty adapting to environmental demands (Cohen, Janicki-Deverts, & Miller, 2007). Therefore, as a result, it is associated with job satisfaction, depression and anxiety, cardiovascular disease, cancer, and other adverse health outcomes (Blegen, 1993; Cohen et al., 2007; Kovner, Brewer, Wu, Cheng, & Suzuki, 2006). Based on the organizational support theory (Eisenberger, Huntington, Hutchison, & Sowa, 1986), perceived organizational support refers to the degree to which employees believe that their organization cares about their well-being and fulfills their socioeconomic needs and values their contribution. As a result, the organization’s readiness to reward in a positive reciprocity dynamic with employees will enhance employees’ performance. It is critical to obtain a high-quality workforce in a health care delivery system, especially in health care facilities located in large cities like New York, which already significantly depends on foreign-born nurses. The job satisfaction and life satisfaction of these nurses are important keys to motivate them to stay in the United States and may be influenced by multiple factors. As noted in previous research employing Filipino nurses (Ea, 2006; Ea et al., 2008), acculturation may play a significant role in the life satisfaction and job satisfaction of Korean nurses. However, these relationships have not been tested in immigrant Korean nurses in the United States.

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Figure 1.  Predictive model of nurses’ job satisfaction.

The purpose of this study, which modified the revised Price–Mueller model (Kovner et al., 2006), was to confirm the relationships among the factors affecting immigrant Korean nurses’ job satisfaction. In the model of this study (Figure 1), variables such as job satisfaction, demographic characteristics (e.g., age, education, marital status, and annual income), and organizational factors (perceived stress and perceived organizational support) were selected from the revised Price-Mueller model (Kovner et al., 2006). Factors such as length of U.S. residency, acculturation, life satisfaction, self-esteem, and self-efficacy were selected from the literature reviewed.

Theoretical Framework The predictive model of nurses’ job satisfaction (Figure 1) was proposed in this study, which was based on the revised Price–Mueller model (Kovner et al., 2006). Job satisfaction, defined as the extent to which employees like their work, is one of the most studied concepts in organizational research (Agho, Price, & Mueller, 1992).The Price–Mueller model is a job satisfaction model that provides a comprehensive framework for analyzing and understanding employees’ job satisfaction (Agho et al., 1992). Derived from economics, organizational psychology, and sociology, it is one of the first comprehensive causal models of job satisfaction tested in samples of nurses. The model’s key assumptions are as follows. Individuals value certain conditions in their jobs and if they encounter these conditions in their workplaces, they will be more satisfied with their jobs and less likely to resign. Individuals will give their time, energy, and effort to the employing organization if they receive what they want in exchange (Gurney, Mueller, & Price, 1997). Economists, psychologists, and sociologists disagree as to which assumption is most valued. The model has three dependent variables: job satisfaction, organizational commitment, and intent to leave. Job

satisfaction is given the most attention in the model. The independent variables are social support and integration, workplace stress, career advancement/opportunities for promotion, labor market opportunities (local and nonlocal), pay, professional values (such as autonomy), dispositions (such as positive or negative attitudes toward life and self image), and demographics (Gurney et al., 1997). The model was tested in a stratified sample of doctorally prepared nurses (n = 931; Gurney et al.,), recruited from Sigma Theta Tau, the International Honor Society of Nursing, and working in academic and health service settings. Significant variables that contributed to the variance of job satisfaction were work group cohesion, resource adequacy, local opportunities, variety, positive affectivity, negative affectivity, work motivation, career orientation, and performance selfimage. The model explained 56% of the variance in job satisfaction. Kovner et al. (2006) modified and tested the Price– Mueller model (Gurney et al., 1997) in a random sample of 1,538 nurses from 40 metropolitan statistical areas in 29 states using job satisfaction as the sole dependent variable and the following factors as independent variables: work setting (social support, job stress, promotional opportunities, professional values, work motivation and career orientation, direct patient care, job hazards, pay, and distributive justice), registered nurse characteristics (demographics and health), metropolitan statistical area characteristics (nursing specialties), and movement constraints. The independent variables that significantly contributed to job satisfaction were high autonomy, high distributive justice (fairness in rewards such as pay), high group cohesion, high promotional opportunities, high supervisor support, high work variety, low workto-family conflict (the degree that work interferes with family life), and low organizational constraint (degree to which situations or things interfere with an individual’s job performance). Actual pay did not contribute significantly to work satisfaction but fairness in pay (distributive justice) did contribute significantly to work satisfaction. The model explained 54% of the variance in job satisfaction.

Method Study Design This study used a cross-sectional mailed survey design with a convenience sample to describe job satisfaction and identify factors influencing job satisfaction in immigrant Korean nurses.

Subjects The population of the study was members of The Greater New York Korean Nurses Association (NYKNA). Eligibility criteria of this study included Korean nurses who (a) had received nursing education in Korea, (b) were currently

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working or had previously worked in the United States, (c) were living in the United States, nd (d) were able to read and write in English. Questionnaires were sent to a total of 700 members of the NYKNA, and 107 members responded to the questionnaires (response rate of 15.3%). One hundred and five immigrant Korean nurses who were currently working or had previously worked in the United States finally participated in the analysis of this study. Of the sample (n = 105), 84.8% provided direct patient care in hospital settings, 84.8% were currently employed as nurses, 34% were provided with a specific acculturation program by their employers, and 91.4% were actively licensed to practice as registered nurses in the United States. Based on G*power program (v. 3.1.5), 123 subjects were needed to detect a medium effect (.15) in primary outcomes with power of .80, a two-tailed alpha less than .05, and 11 predictors. Also, the lack of an updated mailing list of NYKNA resulted in this low response rate. Of the 700 survey questionnaire mailed, 119 questionnaires were returned due to wrong addresses and absent recipients; 474 had no response. Of the 107 questionnaires answered, 2 were incomplete, making the final sample of 105 respondents.

Measurements Data on the aforementioned psychological variables were gathered by mean of questionnaires. The operational definition of study concepts in this study are described as follows. Job satisfaction refers to an employee’s general affective evaluation of the job circumstances and was measured by the five-item Job Satisfaction Index (Brayfield & Rothe, 1951). This index has been used extensively by researchers and has sound psychometric properties. A 7-point scale was used, with 1 = strongly disagree and 7 = strongly agree. Cronbach’s alpha coefficients for this instrument for previous research was .77 to .90 (Agho et al., 1992; Yom et al., 2009) and was .65 in this study. Acculturation refers to the culture learning that occurs when immigrants come in contact with a new group, nation, or culture and was measured by the 12-item Short Acculturation Scale (Marin, Sabogal, Marin, Otero-Sabogal, & Perez-Stable, 1987). The acculturation scale has been widely used in research and highly correlated with respondents’ generation, length of residence in the United States, age at arrival, ethnic self-identification, and with another acculturation index (Marin et al., 1987). For this study, an eight-item shortened version of the scale was used. Cronbach’s alpha coefficients for this scale for previous research was .84 (Ea et al., 2008) and was .72 in this study. Life satisfaction refers to a cognitive–judgmental process as a global assessment of a person’s quality of life and was measured by the five-item Satisfaction with Life Scale (Diener, Emmons, Larsen, & Griffin, 1985), a scale designed

to measure the global cognitive judgments of an individual’s life. A 7-point scale was used, with 1 = strongly disagree and 7 = strongly agree. Cronbach’s alpha coefficients for this scale for previous research was .87 (Pavot & Diener, 1993) and was .89 in this study. Self-esteem is a positive perception of the value of and an attitude toward the self and was measured by the 10-item Rosenberg Self-Esteem Scale (Rosenberg, 1965), a scale designed to measure global self-esteem. A 4-point Likerttype scale was used, with 1 = strongly disagree and 4 = strongly agree. Higher scores indicate higher levels of selfesteem. Cronbach’s alpha coefficient of this scale in the original study was .92 and alpha was .89 in this study. Self-efficacy is the extent one’s belief in one’s own ability to deal effectively with tasks, goals, and challenges and was measured by the 10-item General Self-Efficacy Scale (Jerusalem & Schwarzer, 1992), a scale designed to assess personal competency about coping with a variety of stressful situations. Responses range from 1 = not at all true to 4 = exactly true. Cronbach’s alpha ranged from .76 to .90 and was .89 in this study. Perceived stress refers to the degree to which one perceives aspects of one’s life as uncontrollable, unpredictable, and overloading and was measured by the 10-item Perceived Stress Scale (Cohen & Williamson, 1988), a scale for measuring a perceived stress in response to life situations. Reponses range from 0 = never to 4 = very often. Cronbach’s alpha ranged from .84 to .86 in the original study and was .66 in this study. Perceived organizational support refers to global beliefs concerning the extent to which the organization values employees’ contributions and cares about their well-being and was measured by the eight-item Survey of Perceived Organizational Support (Eisenberger et al., 1986). This scale is the short form with 1 = strongly disagree and 5 = strongly agree. Cronbach’s alpha coefficients ranged from .80 to .97 in the original study and alpha was .71 in this study.

Ethical Issues This study was reviewed by the university institutional review boards. To ensure the confidentiality of the research, all data have been coded and treated only as numbers and no identifiers of subjects have been used. The corresponding author has full control of the data; therefore, if needed, the data can be provided on request.

Statistical Analysis The Statistical Package for the Social Sciences (Version 18) was used to analyze the data. Statistical significance was defined as p ≤ .05. The normality of each variable as well as the summated mean scale of the measurements were assessed by normal plots and detrended normal plots. Prior to analyzing data, skewness and kurtosis were examined for normality (Munro, 2005).

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An et al. According to the aims of this study, the statistical methods used were as follows: (a) descriptive statistics were used to identify the sociodemographic characteristics of the subjects and the measurements, (b) Pearson’s correlation coefficient was used to examine the relationships between the measurements, and (c) hierarchical multiple regression analysis was performed to determine the order that the variables are entered into and removed from the regression equation. The results of the hierarchical multiple regression analyses were satisfied with Durbin–Watson of 1.828 and variance inflation factors of 1.019 to 3.482 (Field, 2013). In the hierarchical regression analysis, the order of independent variables entered is defined by the researcher(s), and the order of the entry is generally based on theoretical or logical evidence obtained from the empirically tested previous studies (Cohen, Cohen, West, & Aiken, 2002; Petrocelli, 2003). In the analysis, the demographic characteristics of the subjects were statistically used as control variables to minimize the bias of estimates of the regression coefficients, which were caused due to specification error (Ko & Seo, 2002; Seo, Ko, & Price, 2004). As Mottaz (1988) mentioned, this may be complemented one of the problems of job satisfaction research, which did not control for demographic variables such as the level of education that can affect job satisfaction potentially. In the analysis, dummy variables for education level and marital status were employed.

Table 1.  Demographic Characteristics of Study Subjects (N = 105). Variables Age, years Education  BSN  MSN   Post master’s  Doctorate   No answer Marital status   Now married  Othersa   No answer Annual household income, $   ≤35,000  35,001-75,000  75001-100,000  100,001-150,000  >150,000   No answer Length of U.S. residency, years Working years in the United States

n (%)

M ± SD

Range

52.3 ± 10.7

27-70

61 (58.1) 20 (19.0) 4 (3.8) 3 (2.9) 17 (16.2)

         

81 (77.1) 19 (18.1) 5 (4.8) 83,758.8 ± 21,308.7

      30,000-154,000

22.3 ± 12.5

            3-44

15.5 ± 13.1

1-42

4 (3.9) 15 (14.3) 35 (33.3) 27 (25.7) 20 (19.0) 4 (3.8)

Note. Missing values were excluded in the analysis. BSN = Bachelor of Science in Nursing; MSN = Master of Science in Nursing. a. Widowed, divorced, separated, or never married.

Results Sociodemographic Characteristics

Table 2.  Descriptive Statistics of the Measurements.

Table 1 presents the sociodemographic characteristics of the study subjects. The sample consisted of 105 immigrant Korean nurses who, at the time of data collection, were currently working or had previously worked in the United States. The majority of the nurses were female (n = 98, 93.3%), ranging in age from 27 to 70 years with a mean age of 52.3 years (SD = 10.7). Seventy-seven percent of the nurses were married with an average annual household income of about $83,758. Fiftyeight percent of the nurses had a BSN (Bachelor of Science in Nursing) as their highest degree in nursing, and 2.9% of nurses had a doctoral degree. The nurses had lived in the United States for an average of 22.3 years (SD = 12.5) and worked as RNs for average of 15.5 years (SD = 13.1).

Variable

Descriptive Statistics of the Measurements Table 2 provides the mean scores of the subjects on each of the measurement used as well as the possible range of scores for each measurement. The mean score of job satisfaction was 5.40 (range = 1-7). The mean score of acculturation was 2.40 (range = 1-5). The mean scores of life satisfaction, selfefficacy, and self-esteem were 4.81, 3.06, and 3.23, respectively (range = 1-7, 1-4, and 1-4). And the mean scores of perceived organizational support and perceived stress were 3.33 and 2.01, respectively (range = 1-5 and 0-4).

Acculturation Life satisfaction Self-efficacy Self-esteem Perceived organizational support Perceived stress Job satisfaction

M

SD

Possible range

2.40 4.81 3.06 3.23 3.33 2.01 5.40

0.52 1.24 0.38 0.44 0.44 0.39 0.85

1-5 1-7 1-4 1-4 1-5 0-4 1-7

Correlations Among the Measurements Table 3 presents correlations coefficients among the measurements. There were highly significant correlations between job satisfaction and life satisfaction (r = .476, p < .001), self-esteem (r = .381, p < .001), self-efficacy (r = .342, p < .001), and perceived organizational support (r = .281, p < .001). Perceived stress and job satisfaction were negatively correlated (r = −.328, p < .001).

Predictive Factors for Job Satisfaction Table 4 reports the findings of the hierarchical multiple regression analysis. Model 1 included age, education level (reference = BSN), marital status (reference = others), annual

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Table 3.  Correlations Coefficients Among the Measurements. Life Perceived Acculturation satisfaction Self-esteem Self-efficacy stress Acculturation Life satisfaction Self-esteem Self-efficacy Perceived stress Perceived organizational support Job satisfaction

1 −.011 .352*** .225** .090 .066 .172

1 .164 .325*** −.251*** .270*** .476***

1 .398*** −.217** .134 .381***

1 −.096 .286*** .342***

Perceived Job organizational support satisfaction

1 −.005 −.328***

            1

1 .281***

*p < .05. **p < .01. ***p < .001.

Table 4.  Results of Hierarchical Multiple Regression Analysis for Job Satisfaction. Model 1 Variable Overall Age Education levela  MSN   Post master’s  Doctorate Marital statusa   Now married Annual income Length of U.S. residency Acculturation Life satisfaction Self-esteem Self-efficacy Perceived stress Perceived organizational support

2

R

2

Model 2

β

sr

−.013

.000

.012 .038 .034

.000 .001 .001

.117 .364 .324

.051 .132 .132 .169

.002 .016 .006 .024

.465 1.231 .737 1.515

.078

2

df

F/t

p

R

96

0.924

.500 .946

.375

β

2

sr

Model 3 2

df

F/t

p

R

96

.445

.054

.001

4.635 0.335

.000 .738

.907 .716 .747

−.052 −.038 −.091

.002 .001 .007

−0.572 −0.420 −1.007

.643 .222 .463 .133

−.124 .058 .044 .000 .412 .362 .039

.012 .003 .001 .000 .141 .084 .001

−1.279 0.620 0.281 −0.002 4.378 3.382 0.372

β

sr2

df

F/t

p

96 .053

.001

5.127 0.348

.000 .729

.569 .676 .317

−.050 −.027 −.125

.002 .001 .013

−0.581 −0.308 −1.425

.562 .759 .158

.204 .537 .779 .999 .000 .001 .701

−.178 .062 .092 .017 .346 .299 .011 −.249 .179

.024 .003 .003 .000 .094 .055 .000 .052 .026

−1.904 0.685 0.620 0.176 3.761 2.874 0.108 −2.803 1.957

.060 .495 .537 .861 .000 .005 .915 .006 .054

Note. BSN = Bachelor of Science in Nursing; MSN = Master of Science in Nursing. a. Reference group: BSN (education level), others (marital status).

income, length of U.S. residency, and acculturation. Model 2, including life satisfaction, self-esteem, and self-efficacy in addition to Model 1, resulted in a significant increment in R2 as much as 29.7% of the variance (F = 13.48, p < .001). In Model 3, the addition of perceived stress and perceived organizational support to Model 2 also resulted in an increment in R2 as 7.0% of the variance (F = 5.274, p < .001) accounting for 44.5% of the variance of job satisfaction. Life satisfaction (β = .346, p < .001) had the most positive effect on job satisfaction in Model 3.

Discussion The Korean nurses in this study had moderate levels of job satisfaction. Xu (2010) found that IENs had lower job satisfaction scores than U.S. nurses. While we did not incorporate the job satisfaction of U.S. educated nurses into our design, the current study’s job satisfaction scores indicate that there must be different employment issues influencing IENs job satisfaction when practicing in the United States (Xu, 2010). The factors examined in this study of immigrant Korean

nurses include acculturation, life satisfaction, self-esteem, perceived stress, and perceived organizational support. The mean acculturation score of the immigrant Korean nurses was lower than that of the studies of acculturation in Filipino nurses who comprise the largest number of foreignborn nurses in the United States (Ea et al., 2008; Ea et al., 2010). The acculturation scale used in this study, which has been widely used in research though, was first applied to immigrant Korean nurses. More research is needed to explore the factors that influence the acculturation of these two diverse groups of nurses. Contrary to the findings of Ea et al. (2008) in a Filipino nurse sample, even though it is difficult to directly compare the results because the instruments used in each study were different, acculturation was not significantly related to job satisfaction in immigrant Korean nurses. It was because, while Ea et al. (2008) measured various aspects of job satisfaction such as pay, autonomy, task requirement, organizational policies, interaction, and professional status, the job satisfaction scale used in this study focused on how much satisfied and happy with their work. The results suggest that

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An et al. acculturation programs for immigrant Korean nurses will be helpful but job satisfaction need not be the main focus of the program. Findings to support the immigrant Korean nurses’ life satisfaction scores were equivocal. The life satisfaction scores reported in this study were lower than those of a sample of 136 U.S.-born nurses (Nemcek, 2007), higher than another U.S.-born sample of 310 nurses (Nemcek & James, 2007) and similar to the findings reported by Pavot and Diener (1993). More study of life satisfaction in immigrant Korean nurses is needed. Life satisfaction was significantly correlated with job satisfaction and this relationship was supported in the literature (Lee, Hwang, Kim, & Daly, 2004). Self-esteem scores in this study were higher than those of another study of Korean nurses (Lee, 2013). The findings suggest that immigrant Korean nurses believe in their ability to do something that is important and valuable to their professional work. It can be understood that if nurses have high self-esteem, they give value to their profession, gain a sense of accomplishment through their jobs, and pursue professional development (Kwon & Yeun, 2007). Self-efficacy scores were higher than those of a study of Korean men and women (Luszczynska & Schwarzer, 2005). Job satisfaction in this study showed a significantly positive relationship with self-efficacy, which was also supported by the literature on the meta-analysis of job satisfaction (Judge & Bono, 2001). This result was also consistent with previous research involving Korean nurses (Choi & Park, 2009; Lee, 2008). It supports the claim that people with high self-efficacy usually face well even with their failure, obtain desirable outcomes, and are satisfied with their jobs (Judge & Bono, 2001). Perceived stress levels were moderate, yet lower than those reported by 197 U.S.-born nurses (Purcells, Kutash, & Cobb, 2011). The findings suggest that while Korean immigrant nurses experience moderate levels of stress, it is less intense than that experienced by U.S.-born nurses. It is important that U.S. hospitals provide stress management programs to their foreign born and U.S.-born nurses. Job satisfaction showed a significantly negative correlation with perceived stress. This result was consistent with a meta-analysis of 48 studies with a total of 15,048 subjects revealing that job satisfaction was most strongly associated with stress (r = −.609; Blegen, 1993). Moderate levels of perceived organizational support were reported by the subjects. These results were similar to those of a sample of 240 nurses working in Taiwan hospitals (Chou, Hecker, & Martin, 2012). The findings suggest that Korean immigrant nurses perceive organizational support from their employers but more study of this variable is needed in larger samples to support these results. Job satisfaction was significantly and positively correlated with perceived organizational support in this study, which was supported by the literature on Korean nurses’ job satisfaction (Kwak, Chung, Xu, & Cho, 2010).

In the regression analysis of this study, life satisfaction, self-esteem, and perceived stress were found to be significant predictors of job satisfaction (F = 5.127, p < .001). This model accounted for 44.5% of the variance of job satisfaction. Life satisfaction showed the most substantial effect on job satisfaction (β = .346, p = .000). To improve the job satisfaction of immigrant Korean nurses working in the United States, an effort to promote their life satisfaction should be developed and implemented. Lyubomirsky et al. (2005) found that a happy, satisfying life can also contribute to success (e.g., employees who were satisfied with life were more successful at work because they were more focused on reaching goals than less satisfied workers). To improve life satisfaction, which involves the overall assessment of an individual’s life, the physical, mental, and financial support of their organization should be followed in addition to an individual’s effort to recognize his or her life as positive. These individual and organizational efforts together can cause synergistic effects on life satisfaction (Nemcek & James, 2007). Acculturation and job satisfaction were not significantly correlated. However, self-esteem and self-efficacy were correlated with acculturation. Therefore, there should be a way to improve acculturation in order to improve self-esteem. As acculturation is related to language and communication, nurse managers in U.S. hospitals should develop an intervention to improve acculturation in their organizations. Program development that includes several hospitals around a region can be an economical approach. Communication is the most frequently reported barrier to workforce transition. Improved communication skills result in improved acculturation, increased satisfaction, and increased contributions in the work environment (Yahes & Dunn, 1996). Finally, to reduce perceived stress in Korean nurses, which also is a determinant of job satisfaction, stress management programs, and their utilization may be helpful. To effectively manage nurses’ stress, research investigating factors influencing nurses’ stress is needed. Generally, nurses experience higher levels of stress than other professionals. Moreover, immigrant nurses have additional stressors such as language barrier, rapid changes in their roles and responsibilities, alienation, and heterogeneity from the differences between personal values and social values until they are fully integrated into their host countries (Ea et al., 2008). The longer an individual is exposed to stressors, the lower his ability to control stressful situations. As a result, nurses will eventually leave their jobs because of job dissatisfaction (Ha et al., 2002). This may negatively affect patient care. Thus, nurse managers have to pay close attention to immigrant Korean nurses, to have a special interest in them, and make an active effort to reduce their stress. Most stress management programs include relaxation training, problem solving, claiming training, and techniques such as cognitive restructuring; therefore, these techniques can be applied to develop programs for immigrant Korean

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nurses. In addition, in terms of acculturation, interventions in accordance with the level of acculturation may be required.

Strengths and Limitations This study has its significance in helping U.S. nurse managers and hospital administrators, first, have an interest in internationally educated nurses, and second, therefore, set a strategic plan to reduce their nurse turnover rate while maintaining quality of care by providing empirical evidence as basic information regarding immigrant Korean nurses’ job satisfaction. This study also is meaningful considering that nurses’ job satisfaction increases organizational commitment, quality of care, and patient outcomes (Ea et al., 2008, Kwak et al., 2010). From the point of view that nurse administrators must support the professional development of foreign-born nurses through mentoring and educational training programs (Itzhaki, Ea, Ehrenfeld, & Fitzpatrick, 2013), it is suggested that strategies for immigrant nurses’ successful adaptation to their working environment are necessary. Limitations of this study are as follows. First, because of its cross-sectional design of the study, the correlations between the predictors and job satisfaction of Korean nurses do not suggest causal relationship. Therefore, longitudinal studies of job and life satisfaction in immigrant Korean nurses would help elucidate the nature of this relationship. Second, the total number of subjects in this study was less than the minimum number of samples suggested. The lack of an updated NYKNA mailing list caused the low response rate. Therefore, future research should extend its geographical study areas to the outside of New York and also should consider another way for collecting data other than mailing survey to obtain sufficient sample size. Third, little research on job satisfaction and related factors employing immigrant Korean nurses was conducted. It caused a lack of in-depth discussion when the findings of this study were compared with that of the studies focusing on Koreans. Therefore, there is a need to conduct more research on the area of interest.

Conclusion Life satisfaction, self-esteem, and perceived stress are significant predictors of job satisfaction. To ensure job satisfaction in immigrant Korean nurses, it is essential for U.S. nurses to gain insight in implementing effective programs for stress management and fostering self-esteem. In addition, further research should be conducted to identify more influencing factors to enhance life satisfaction. It is also suggested that future research should be conducted using longitudinal designs to investigate the changes of immigrant Korean nurses’ job satisfaction over time.

Acknowledgments This article was finally prepared thanks to the generous understanding and endless support of William Holzemer, PhD, RN, FAAN (Dean and Professor at Rutgers College of Nursing). The authors greatly appreciate Weonhi Kang, MSN, RN, NP (former President of The Greater New York Korean Nurses Association) for data collection.

Authors’ Note This study was presented at the 9th International Nursing Conference and the 3rd World Academy of Nursing Science, “Care for Vulnerable Populations: Global Perspectives,” which was held in Seoul, Korea (October 16-18, 2013).

Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by Dean’s Award for Faculty Research at the College of Nursing of Rutgers, The State University of New Jersey, and the National Research Foundation of Korea Grant funded by the Korean Government (NRF-2011-413-G00006).

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