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AN INDEPENDENT VOICE FOR NURSING
Job Satisfaction in Nursing: A Concept Analysis Gustavo A. Castaneda, RN, BN, and Judith M. Scanlan, RN, PhD Gustavo A. Castaneda, RN, BN, is Graduate Student, Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada; and Judith M. Scanlan, RN, PhD, is Associate Professor, Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada. Keywords Administration, concept analysis, professional issue Correspondence Gustavo A. Castaneda, RN, BN, Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada E-mail: [email protected]
TOPIC. Concept analysis and job satisfaction in nursing. PURPOSE. In this article, Walker and Avant’s concept analysis method-
ology is used to examine and clarify the phenomenon of job satisfaction in nursing. SOURCES. Published literature. CONCLUSION. A review of the published nursing literature suggests that job satisfaction is an affective reaction to a job that results from the incumbent’s comparison of actual outcomes with those that are desired, expected, and deserved. In health care, specifically nursing in a hospital setting, job satisfaction can be measured and identified. Job satisfaction is compromised of three attributes: autonomy, interpersonal relationships, and patient care.
A concept is often described as a label, expressed as a word or phrase, that summarizes the essence of a phenomenon (Fawcett, 2012). A concept may be relatively abstract or concrete. In nursing, a growing body of literature has emerged that is used by researchers to synthesize and understand the knowledge called concept analysis (Fawcett, 2012; Rodgers & Knafl, 2000; Walker & Avant, 2011). A concept analysis is always done with a purpose in mind. Newly created concepts assist in identifying previously unrecognized or poorly understood events. Furthermore, the main advantage of a concept analysis is that it renders precise theoretical as well as operational definitions for use in theory and research (Walker & Avant, 2011). In this paper, Walker and Avant’s (2011) concept analysis framework is used to examine and clarify the phenomenon of job satisfaction. Walker and Avant’s method is an appropriate guide to decipher the meaning of job satisfaction in nursing within a hospital setting. Their eight-step process of concept analysis are selecting the concept for analysis, determining the aim of analysis, identifying all uses of the concept, 130 © 2014 Wiley Periodicals, Inc. Nursing Forum Volume 49, No. 2, April-June 2014
determining the defining attributes, constructing a model case, constructing additional cases, identifying the antecedents and consequences of the concept, and defining the empirical referents for the concept. Walker and Avant’s framework is the most frequently used method for concept analysis in recent nursing literature (Walker & Avant, 2011). Walker and Avant (2011) assert that concept selection should reflect a topic or area of interest. Job dissatisfaction is a common topic of conversation among nurses and prompted the interest in exploring this concept further. Job satisfaction is a complex phenomenon that is described as an intrinsic feeling, with individual meaning, and impacts multiple aspects within a given work environment. Job satisfaction influences productivity, performance, absenteeism, retention, recruitment, organizational commitment, patient satisfaction, and patient care (Lu, While, & Barriball, 2007; Utriainen & Kyngas, 2009). Job satisfaction is one of the most widely discussed and studied constructs in disciplines such as psychology, human resource management, organizational management, economics, and health care. For the purpose of this
G. A. Castaneda and J. M. Scanlan paper, the focus will be on health care, with a particular interest on nursing job satisfaction in a hospital setting.
Aim of Analysis Job satisfaction is a concept that has been in the literature for more than 100 years. Frederick Taylor (1911) marked the beginning of a movement concerned with work measurement, which inspired future research about job satisfaction (Weir, 1976). Over the last two decades, there has been a growing awareness of job satisfaction within international nursing research and practice. Nonetheless, the concept remains unclear. Therefore, a concept analysis will enhance the understanding of the meaning of job satisfaction within the nursing profession. The purposes of this paper are to conduct a concept analysis, examine the current use of the concept of job satisfaction as it relates to nurses in a hospital setting, and identify a definition of job satisfaction in nursing. There are gaps in the literature regarding the concept of job satisfaction, and a need to clarify the concept as it differs among psychology, business, and nursing practice. The attributes emerging from the nursing literature examine the congruence between the definition of the concept of job satisfaction and the way the concept has been operationalized. Enhancing the current literature on job satisfaction of nurses working in hospitals will facilitate better understanding on why nurses may not be satisfied with their jobs.
Data Sources The Cumulative Index of Nursing and Allied Health Literature, ProQuest, PubMed, Business Source Complete, and PsycINFO were accessed, and articles from the English-language literature published from 1980 through 2011 were obtained. No concept analyses of job satisfaction in nursing were found. Key words included job satisfaction, nursing satisfaction, nursing staff-hospital, and nurses’ attitudes. English-language dictionaries were also used to further define the concept. Inclusion of articles in the review was based on relevancy of content regarding background, definition, use, defining attributes, and consequences of job satisfaction. Articles that did not make reference to job satisfaction were excluded.
Job Satisfaction in Nursing Background Job satisfaction remains a complex concept illustrated by the multiple variables that have been studied in relation to this phenomenon. These variables include, but are not limited to, patient satisfaction, burnout, intent to stay, salary, stress, work environment, leadership, education, organizational commitment, empowerment, and turnover (Coomber & Barriball, 2007; Garon & Ringl, 2004; Larrabee et al., 2003; Raup, 2008). Job satisfaction is investigated as an important value in healthcare organizations on the assumption that increasing job satisfaction will improve nursing productivity and patient outcomes (Guleryuz, Guney, Aydin, & Asan, 2008; Kelly, McHugh, & Aiken, 2011). There have been three recent systematic literature reviews regarding job satisfaction among nurses in a hospital setting (Hayes, Bonner, & Pryor, 2010; Lu, While, & Barriball, 2005; Utriainen & Kyngas, 2009). Hayes et al. (2010) sought to identify the factors that contribute to nurse job satisfaction based on intrapersonal (within the nurse), interpersonal (between the nurse and colleagues), and extrapersonal (those external to the nurse) factors. Their review posits that job satisfaction in nursing is multifaceted, complex, and highly subjective. Manojlovich and Laschinger (2002), and Chan, Leong, Luk, Yeung, and Van (2010), emphasized the importance of taking personality variables into consideration during the process of evaluating job satisfaction. Utriainen and Kyngas (2009) were guided by two questions: What factors influence nurses’ job satisfaction and what evokes job satisfaction among nurses working in hospitals? A critical appraisal of 21 studies found two themes to be most significant to nurses’ job satisfaction: interpersonal relationships and patient care. Lu et al.’s (2005) systematic literature review on nurse job satisfaction found that interactions among patients, coworkers, and managers were important, as well as workload, remuneration and promotion, autonomy and leadership style, and organizational policies. A meta-analysis of studies of nurses’ job satisfaction conducted by Zangaro and Soeken (2007) examined 31 studies representing a total of 14,567 subjects who found that job stress had the strongest negative correlation with job satisfaction, with a strong emphasis on stress from supervision, work, and environment. Nurse–physician collaboration had the strongest positive correlation with job satisfaction and resulted from 131
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Job Satisfaction in Nursing interactions within the nurses’ work environment and with patients. Autonomy had a moderately positive correlation with job satisfaction and consisted of perceived autonomy. Literature supporting characteristics such as workplace relationships (Kelly et al., 2011; Zangaro & Johantgen, 2009), care delivered (Dunn, Wilson, & Esterman, 2005; Kelly et al., 2011; McGlynn, Griffin, Donahue, & Fitzpatrick, 2012), and the ability to carry out nursing-related tasks (Coomber & Barriball, 2007; Curtis, 2007; Hayes et al., 2010) were also found to impact nurse job satisfaction. There has not been a concept analysis about job satisfaction in nursing despite the high prevalence of job dissatisfaction in the nursing literature. Therefore, it is important to investigate and identify the factors that affect nurses’ job satisfaction to improve nursing knowledge about this topic. Uses of the Concept of Job Satisfaction According to The Ultimate Business Dictionary (2003), job satisfaction is defined as the sense of fulfillment and pride felt by people who enjoy their work and do it well. An absence of job satisfaction can lead to poor motivation, stress, absenteeism, and high labor turnover. The Concise Dictionary of Business Management (1999) defines job satisfaction as “the extent to which a worker is content with the rewards s/he gets out of his or her job, particularly in terms of intrinsic motivation” (Statt, 1999, p. 86). Shim (2006) asserts that job satisfaction is defined as an attitude that reflects the extent to which an individual is gratified by or fulfilled in his or her work. Furthermore, Shim states that extensive research conducted on job satisfaction indicates that personal factors, such as an individual’s needs and aspirations, determine this attitude, as well as group and organizational factors, such as working conditions, work policies, compensation, and relationships with coworkers and supervisors. In business, the study of job satisfaction is central to organizational behavioral scientists. Companies want to know why their employees are or are not satisfied since many people spend a third or more of their waking hours at work (Jernigan, Beggs, & Kohut, 2002). Satisfaction levels can provide a rich picture of the mood of employees, which management can use as a guide to improving reward, benefit, and motivational conditions (Malonis, 2000). The Encyclopedia of Management (2009) uses the word morale in the same context as job satisfaction. In this context, job 132 © 2014 Wiley Periodicals, Inc. Nursing Forum Volume 49, No. 2, April-June 2014
G. A. Castaneda and J. M. Scanlan satisfaction is defined as how employees actually feel about themselves as workers, their work, their managers, their work environment, and their overall work life. Job satisfaction incorporates all the mental and emotional feelings, beliefs, and attitudes that individuals and groups hold regarding their job. Consideration of employee morale or job satisfaction was a major emphasis of the behavioral school of management that started with the famous Hawthorne experiments in the late 1930s (Weir, 1976). The behavioral school claimed that employee morale influenced employee productivity. Frederick Herzberg conducted research in the 1950s and 1960s indicating that employees’ satisfaction and motivation were influenced more by how they felt about their work, rather than the specific attributes of their job, including pay and workplace surroundings (Weir, 1976). According to Sutherland and Canwell (2004) and Lee, Magnini, and Kim (2011), job satisfaction refers to the attitude that employees have about the work they carry out, and the level of satisfaction which correlates with the degree of involvement people have within the organization. Further, in order for employees to be satisfied, they must be in a job that suits their personality and expertise, be paid fairly, have appropriate resources, adequate working conditions, and a supportive manager. In economics, job satisfaction is a good predictor of labor market behavior, particularly employee departures (Hamermesh, 2001). Hamermesh (2001) stated that job satisfaction indicates the overall desirability of a job, whereas Stride, Wall, and Catley (2007) stated that job satisfaction contains four domains: extrinsic (pay) and three intrinsic (sense of achievement, respect from supervisors or line managers, and influence over the job). Several job satisfaction definitions now exist in health care. According to Stamps (1997), job satisfaction is defined as the extent to which employees like their jobs. Stahl (2004) defined job satisfaction as the feelings people have about their jobs. Adams and Bond (2000) described job satisfaction as the degree of positive affect toward a job or its components. These feelings exist among nursing staff and physicians, who are the two groups of hospital employees most involved in the delivery of patient care (Stahl, 2004). For the purpose of this paper, the focus will be on the profession of nursing, specifically nurses working in hospitals. In the current nursing literature, the most commonly cited reason that nurses give for leaving nursing is job dissatisfaction (Ma, Lee, Yang, & Chang,
Job Satisfaction in Nursing
G. A. Castaneda and J. M. Scanlan 2009; Gieter, Hofmans, & Pepermans, 2011; Wang, Tao, Ellenbecker, & Liu, 2012). Job satisfaction, according to Hayes et al. (2010), could be conceptualized and labeled as intrapersonal, interpersonal, or extrapersonal factors. Intrapersonal factors included age, education, and experience, while interpersonal factors included autonomy, coworker interactions, relationships with staff and patients, task requirements, and supervisory support. Extrapersonal factors included organizational structure, salary, workload, and promotion opportunities. Job dissatisfaction can be expressed in a number of different ways depending on the situation (and possible alternatives): absenteeism, quitting, and specific on-the-job behaviors (Lu et al., 2005; Zangaro & Soeken, 2007). Furthermore, Hayes et al. (2010) and Manojlovich and Laschinger (2002) state that job satisfaction must be considered in terms of the interrelationship of a number of variables. These variables include the subjective and objective characteristics of the job, individual abilities and experiences, alternatives available in the organization and larger community, individual values, and the environment in which the nurses work. All these factors influence job satisfaction, performance, and productivity. Defining Attributes of Job Satisfaction Attributes are characteristics that frequently appear in the literature and help define the concept of interest. Defining the attributes is considered by Walker and Avant (2011) to be the heart of concept analysis. According to the results from the literature review on job satisfaction, and contextual definitions of job satisfaction in nursing, three attributes are most significant to nurses’ job satisfaction in a hospital setting: autonomy (Hayes et al., 2010; Zangaro & Soeken, 2007), interpersonal relationships (Utriainen & Kyngas, 2009; Zangaro & Soeken, 2007), and patient care (Utriainen & Kyngas, 2009; Zangaro & Soeken, 2007). Autonomy Autonomy has been studied for many years and is ranked as one of the most significant factors contributing to nurses’ job satisfaction (Hayes et al., 2010; Zangaro & Soeken, 2007). Finn (2001) described the lack of autonomy inhibiting job satisfaction as “nursing wastage” (p. 350). Nursing wastage results in
increased turnover (Lynn, Morgan, & Moore, 2009; Zangaro & Johantgen, 2009) and decreased efficiency in clinical settings (Larrabee et al., 2010), and undermines high-quality patient care (Aiken, Clarke, & Sloane, 2002; Ma et al., 2009). Autonomy and job satisfaction have been shown to be positively related (Aiken et al., 2002; Zangaro & Soeken, 2007). The clinical autonomy of staff nurses is related to many factors, including scope of practice, interprofessional teamwork, support from management and coworkers, mutual trust between physicians and nurses, and education. These structural and process factors are all prerequisites to achieving autonomous nursing practice (Chen & Johantgen, 2010). Interpersonal Relationships Interpersonal relationships between nurses and various communal factors are of major importance for nurses’ job satisfaction. Several studies (Dunn et al., 2005; McGillis, Doran, & Pink, 2008; McLennan, 2005; Meraviglia et al., 2009) indicated the relationship between nurses, and the interpersonal relationships among other nurses, doctors, and interprofessional members, to be one of the best predictors of job satisfaction. According to Utriainen and Kyngas (2009), and Chang, Ma, Chiu, Lin, and Lee (2009), job satisfaction is most strongly predicted by social and professional relationships in the workplace. McLennan (2005) described nurses’ interaction with other people as the greatest source of job satisfaction in nursing. Newman and Maylor (2002) contend that nurses were of the opinion that coworkers and patient care were the best predictors of their job satisfaction at work. Dunn et al. (2005) found relationships with other members of the nursing staff to be an important factor in creating job satisfaction. Relationships between nurses, collaboration with medical staff (Utriainen & Kyngas, 2009), and communication between nurses and physicians (Chen & Johantgen, 2010; Manojlovich, 2005) are key to nursing job satisfaction. Harmony between nurses and togetherness (DiMeglio et al., 2005), nurse-to-nurse interactions (McLennan, 2005), and collaboration and good communication (Hayes et al., 2010) are predictors of nurses’ job satisfaction. Patient Care Patient care is related to increased job satisfaction, and includes the following aspects: good relationships 133
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Job Satisfaction in Nursing with patients (Cortese, 2007; Dunn et al., 2005), a felt experience and deep human connection of providing good care (Gurkova, Cap, Ziakova, & Duriskova, 2012; Newman & Maylor, 2002), receipt of personal praise from patients and their families (Gurkova et al., 2012), and the joy of seeing patients get better and go home (Ma et al., 2009). Constructed Cases Constructed cases illuminate the concept and support the analysis by describing the concept’s presence in a model case, the absence of a concept in a contrary case, and the difference between the concept and a closely associated concept in a borderline and related case (Walker & Avant, 2011). Model Case According to Walker and Avant (2011), a model case contains all critical attributes of the concept and provides an example of the concept. The following is a model exemplar of job satisfaction. Rebecca, a new graduate nurse begins to work on a medical unit in a hospital. Rebecca’s excitement comes from knowing that she will be able to attend interprofessional rounds that are attended by physicians, nurses, and other team members in the development of care plans for the patients for whom she cares. After the treatment plan is discussed and developed by the team, Rebecca implements the care plan by herself for the patients she has been assigned to that day.
G. A. Castaneda and J. M. Scanlan some instances contrary to the concept and assist in making better judgment about the attributes and/or characteristics of the concept. The cases include the borderline, related, and contrary. Borderline Case A borderline case is an example that contains most, but not all, of the defining attributes of the concept. The inconsistency of the borderline case in comparison to the model case assists in clarifying the characteristics of the concept (Walker & Avant, 2011). Tracey, a new registered nurse on a cardiology ward is asked to educate a patient about reversible risk factors that commonly lead to heart attacks. Since this is her first time performing this task, she requires assistance from another nurse to help her with this task. Tracey asks Edith, who is also a registered nurse on the ward, to come with her and help her carry out this task. Edith agrees, and they both teach the patient together. This borderline case contains two of the three components of job satisfaction: interpersonal relationship and patient care. However, this case lacks autonomy as Tracey requires Edith’s assistance in educating the patient about reversible risk factors. Tracey is not able to take control of this task and make a decision by herself about the best way to carry out this patient education. Related Case
This model case contains all three attributes of job satisfaction: interpersonal collaboration, autonomy, and patient care. In this case, the novice nurse is able to attend interprofessional rounds to discuss her patients’ care plans, an example of interpersonal collaboration with doctors, nurses, and other team members to develop a plan of care for her patients. Autonomy is displayed as the new nurse takes the plan of care and makes a decision to implement independently. Patient care is displayed by providing care to each patient to whom she is assigned that day. Identity Additional Cases Walker and Avant (2011) state that additional cases are similar to the concept but not the same, and in 134 © 2014 Wiley Periodicals, Inc. Nursing Forum Volume 49, No. 2, April-June 2014
Related cases are instances that are related to the concept being studied but do not contain all the defining attributes (Walker & Avant, 2011). Carole is a registered nurse with 30 years of experience works in the emergency department and is called to a meeting with management to discuss a treatment plan for a patient who has been there for 96 hr on a ventilator. During this meeting, Carole speaks on behalf of the other nurses in the unit. She talks about how this case is affecting the morale of the unit and a plan needs to be developed to transition this patient to a unit that has experience with a ventilated patient. During the meeting, management identifies a place and provides Carole with
G. A. Castaneda and J. M. Scanlan coffee certificates to improve morale in the unit. Also, Thomas, the director of the department, announces that he will be more visible to answer concerns about this case. Carole is satisfied and goes back to tell the patient and family the news, and provides the two nurses looking after this patient with coffee gift cards. Just as Carole is done handing out the gift cards, Thomas enters the unit and asks the nurses if they have any questions. This case does not exhibit all defining attributes of job satisfaction. However, this case provides an example of other related concepts that are prevalent in the literature about job satisfaction but do not contain all the defining attributes. The concept of morale is described as a concept that is interchangeable with job satisfaction and has similar attributes with regard to how employees feel about their job within the environment in which they work (Encyclopedia of Management, 2009; Sutherland & Canwell, 2004). Another concept that is frequently described in the job satisfaction literature is support. Support can come from a supervisor, manager, coworker, or other team member regarding the work of an employee and provides affirmation about work performed (Brunetto, Farr-Wharton, & Shacklock, 2010; Han & Jekel, 2011). The concept of compensation or reward is prevalent in the business literature and is a fundamental concept in nursing according to Zarea, Negarandeh, Dehghan-Nayeri, and Rezaei-Adaryani (2009), and Melo, Barbosa, and Souza (2011).
Contrary Case According to Walker and Avant (2011), a contrary case is a clear example of what the concept is not. Jackie, a politician and the wife of a patient, is present during patient rounds in the intensive care unit and provides suggestions about possible causes for her husband’s disease process. She listens to her husband’s proposed care plan for the day and takes it upon herself to implement the daily care plan for her husband. Clearly, this is a contrary case, an example of missing attributes of the concept (Walker & Avant, 2011). Jackie’s behavior is not an example of nurses’ job satisfaction. Although Jackie may feel satisfied,
Job Satisfaction in Nursing the nurses were not involved in the care of Jackie’s husband.
Identify Antecedents and Consequences Antecedents, as described by Walker and Avant (2011), are events or incidents that occur prior to the concept. The two most common antecedents in the reviewed literature are personal/individual characteristics and work environments (Hayes et al., 2010; Utriainen & Kyngas, 2009). Both antecedents have been shown to influence job satisfaction. Personal/ individual characteristics, such as age, education, family structure, and living in an urban or rural setting, have an effect on job satisfaction as these focus on the individual nurse rather than nursing in general (Chang, Li, Wu, & Wang, 2010; Manojlovich & Spence Laschinger, 2002; Sheward, Hunt, Hagen, MacLeod, & Ball, 2005; Wilson, Squires, Widger, Cranle, & Tourangeau, 2008). Work environment has been researched over time across many countries, organizations, and different types of jobs. Results from this research show that when employees are asked to evaluate different aspects of their job, such as supervision, pay, promotion opportunities, training, and organizational structure, the nature of the work itself emerged as the most important job facet (Abushaikha & Saca-Hazboun, 2009; Bjork, Samdal, Hansen, Torstad, & Hamilton, 2007; Curtis, 2007; Melo et al., 2011; Zangaro & Johantgen, 2009). Consequences, according to Walker and Avant (2011), are events or incidents that occur as a result of the concept and are also known to be outcomes of the concept. These events can be described in the categories of work, family, and individual, and are a result of job satisfaction or dissatisfaction. At work, when an employee is satisfied, his or her absenteeism is less (Kelly et al., 2011; Tourigny, Baba, & Wang, 2010), has a decreased intent to quit (Coomber & Barriball, 2007; Djukic, 2011; Hayes et al., 2010), and is more involved within his or her unit and/or organization (Ahmad & Nelson, 2010). Satisfaction at work has been shown to have positive affects with a nurse’s personal life satisfaction and vice versa (Golbasi, Kelleci, & Dogan, 2008). Furthermore, evidence indicates that job satisfaction is strongly and consistently related to subjective well-being (Murrells, Clinton, & Robinson, 2005), improved physical health, and less burnout at work (Abushaikha & Saca-Hazboun, 2009). 135
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Job Satisfaction in Nursing Define Empirical Referents Empirical referents are classes or categories of actual phenomena that, by their existence or presence, demonstrate the occurrence of the concept (Walker & Avant, 2011). Historically, job satisfaction has been measured with interviews or questionnaires administered to the job incumbents in question. Although interviews are used in some cases, most research typically is conducted using questionnaires (Spector, 1997; Utriainen & Kyngas, 2009). Six of the most common job satisfaction scales are the Job Satisfaction Survey by Spector (1985), the Job Descriptive Index by Smith, Kendall, and Hulin (1969), the Minnesota Satisfaction Questionnaire by Weiss, Dawis, England, and Lofqueist (1967), the Job Diagnostic Survey by Hackman and Oldham (1975), the Nursing Work Index-Revised by Aiken and Patrician (2000), and the Maslach Burnout Inventory by Maslach and Jackson (1981) (Fairbrother, Jones, & Rivas, 2009–2010; Spector, 1997). Each has been validated and considered reliable as they have all been used in research studies in health care. In nursing, the McCloskey/Mueller Satisfaction Scale (MMSS) (1990) is one of the most commonly used tools to measure nurses’ attitudes toward their jobs, and is used to identify job satisfaction in a variety of clinical and geographical settings (Tourangeau, McGillis, Doran, & Petch, 2006; VanSanne, Sluiter, Verbeek, & Frings-Dresen, 2003). This instrument consists of 31 descriptors that measure eight aspects of nurse job satisfaction (Tourangeau et al., 2006). The MMSS factors capture the attributes of job satisfaction of nurses in a hospital setting and have demonstrated to be drivers of nursing satisfaction in the past (Aiken & Patrician, 2000; Sorensen, Seebeck, Scherb, Specht, & Loes, 2009; Tourangeau et al., 2006; VanSanne et al., 2003).
Conclusion Thousands of scholarly articles on job satisfaction have been published. Despite the volume of articles, enough questions remain to establish an agenda for more research about job satisfaction in nursing. The answer to these questions has two dimensions. One is the variety and complexity of how different nurses perceive job satisfaction, its components, and its correlates. The other is the confusion and contradiction that exist in the literature related to job satisfaction in 136 © 2014 Wiley Periodicals, Inc. Nursing Forum Volume 49, No. 2, April-June 2014
G. A. Castaneda and J. M. Scanlan nursing. Minimal advancement has been made in defining job satisfaction from a nursing point of view. This concept analysis clarifies the concept of job satisfaction in relation to nurses working in a hospital setting. Although a review of published literature suggests that the constitutive definitions of the construct vary somewhat from one article to the next, there appears to be general agreement that job satisfaction is an affective (i.e., emotional) reaction to a job that results from the incumbent’s comparison of actual outcomes with those that are desired, expected, and deserved. In health care, specifically nursing in a hospital setting, job satisfaction can be measured and identified. Job satisfaction is comprised of three attributes. The three defining attributes of job satisfaction—autonomy, interpersonal relationships, and patient care—can be tested by the MMSS. Future research should focus on the role of cognition and affect in job satisfaction of nurses as there is more to be learned about how cognition and affect are intertwined and related to nursing job satisfaction. Rather than focusing on measurement properties (tasks), a look at more substantive issues in cognitive processing should be the goal, as behavioral implications of these events might provide a different perspective of job satisfaction in nursing.
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Job Satisfaction in Nursing characteristics to nursing job satisfaction. Journal of Nursing Administration, 32(11), 586–595. Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Organized Behavior, 2(2), 99–113. McGillis, H. L., Doran, D., & Pink, L. (2008). Outcomes of interventions to improve hospital nursing work environments. Journal of Nursing Administration, 38(1), 40–46. McGlynn, K., Griffin, M. Q., Donahue, M., & Fitzpatrick, J. J. (2012). Registered nurse job satisfaction and satisfaction with the professional practice model. Journal of Nursing Management, 20(2), 260–265. McLennan, M. (2005). Nurses’ views on work enabling factors. Journal of Nursing Administration, 35, 311–318. Melo, M. B., Barbosa, M. A., & Souza, P. R. (2011). Job satisfaction of nursing staff: Integrative review. Revista Latino-Americana de Enfermagem, 19(4), 1047–1055. Meraviglia, M., Grober, S. J., Tabone, B., Wainwright, M., Shelton, S., Miner, H., & Jordan, C. (2009). Creating a positive work environment: Implementation of the nurse-friendly hospital criteria. Journal of Nursing Administration, 39(2), 64–70. Murrells, T., Clinton, M., & Robinson, S. (2005). Job satisfaction in nursing: Validation of a new instrument for the UK. Journal of Nursing Management, 13(4), 296–311. Newman, K., & Maylor, U. (2002). Empirical evidence for the nurse satisfaction, quality of care and patient satisfaction chain. International Journal of Health Care Quality Assurance, 15, 80–88. Raup, G. H. (2008). The impact of ED nurse manager leadership style on staff nurse turnover and patient satisfaction in academic health center hospitals. Journal of Emergency Nursing, 34(5), 403–409. Rodgers, B. L., & Knafl, K. A. (2000). Concept development in nursing (2nd ed.). Philadelphia: Saunders. Sheward, L., Hunt, J., Hagen, S., MacLeod, M., & Ball, J. (2005). The relationship between UK hospital nurse staff and emotional exhaustion and job dissatisfaction. Journal of Nursing Management, 13(1), 51–60. Shim, J. K. (2006). Dictionary of business terms. Mason, OH: Thomson Publishing. Smith, P. C., Kendall, L. M., & Hulin, C. L. (1969). Measurement of satisfaction in work and retirement. Chicago: Rand McNally. Sorensen, E. E., Seebeck, E. D., Scherb, C. A., Specht, J. P., & Loes, J. L. (2009). The relationship between RN job satisfaction and accountability. Western Journal of Nursing Research, 31(7), 872–888. Spector, P. E. (1985). Measurement of human service staff satisfaction: Development of the job satisfaction survey. American Journal of Community Psychology, 13(6), 693–713. Spector, P. (1997). Job satisfaction: Applications, assessment, causes, and consequences. Thousand Oaks, CA: Sage Publications. Stahl, M. J. (Ed.). (2004). Encyclopedia of health care management. Thousand Oaks, CA: Sage Publications.
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G. A. Castaneda and J. M. Scanlan Stamps, P. L. (1997). Nurses and work satisfaction: An index for measurement (2nd ed.). Ann Arbor, MI: Health Administration Press. Statt, D. A. (1999). Concise dictionary of business management (2nd ed.). New York: Routledge. Stride, C., Wall, T. D., & Catley, N. (2007). Measures of job satisfaction, organizational commitment, mental health and jobrelated well-being (2nd ed.). Chichester, UK: John Wiley & Sons Ltd. Sutherland, J., & Canwell, D. (2004). Key concepts in business practice. New York: Palgrave Macmillan. Tourigny, L., Baba, V. V., & Wang, X. (2010). Burnout and depression among nurses in Japan and China: The moderating effects of job satisfaction and absence. International Journal of Human Resource Management, 21(15), 2741–2761. Tourangeau, A. E., McGillis, H., Doran, D. M., & Petch, T. (2006). Measurement of nurse job satisfaction using the McCloskey/Mueller Satisfaction Scale. Nursing Research, 55(2), 128–136. Ultimate business dictionary. (2003). Cambridge, MA: Perseus Publishing. Utriainen, K., & Kyngas, H. (2009). Hospital nurses’ job satisfaction: A literature review. Journal of Nursing Management, 17(8), 1002–1010. VanSanne, N., Sluiter, J. K., Verbeek, J. H. A. M., & Frings-Dresen, M. H. W. (2003). Reliability and validity of instruments measuring job satisfaction: A systematic review. Occupational Medicine, 53, 191–200. Walker, L., & Avant, K. (2011). Concept analysis. In L. Walker & K. Avant (Eds.), Strategies for theory construction in nursing (5th ed., pp. 157–179). Upper Saddle River, NJ: Pearson Education. Wang, L., Tao, H., Ellenbecker, C. H., & Liu, X. (2012). Job satisfaction, occupational commitment and intent to stay among Chinese nurses: A cross-sectional questionnaire survey. Journal of Advanced Nursing, 68(3), 539–549. Weir, M. (1976). Job satisfaction. Glasgow: William Collins Sons & Co. Weiss, D. J., Davis, R. V., England, G. W., & Lofquist, L. H. (1967). Manual for the Minnesota Satisfaction Questionnaire. Minneapolis: University of Minnesota. Wilson, B., Squires, M., Widger, K., Cranley, L., & Tourangeau, A. (2008). Job satisfaction among a multigenerational nursing workforce. Journal of Nursing Management, 16(6), 716–723. Zangaro, G. A., & Johantgen, M. (2009). Registered nurses’ job satisfaction in navy hospitals. Military Medicine, 174(1), 76–81. Zangaro, G. A., & Soeken, K. L. (2007). A meta-analysis of studies of nurses’ job satisfaction. Research in Nursing and Health, 30, 445–458. Zarea, K., Negarandeh, R., Dehghan-Nayeri, N., & Rezaei-Adaryani, M. (2009). Staffing shortages and job satisfaction in Iran: Issues and challenges. Nursing and Health Sciences, 11, 326–331.
AN INDEPENDENT VOICE FOR NURSING
Job Satisfaction in Nursing: A Concept Analysis Gustavo A. Castaneda, RN, BN, and Judith M. Scanlan, RN, PhD Gustavo A. Castaneda, RN, BN, is Graduate Student, Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada; and Judith M. Scanlan, RN, PhD, is Associate Professor, Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada. Keywords Administration, concept analysis, professional issue Correspondence Gustavo A. Castaneda, RN, BN, Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada E-mail: [email protected]
TOPIC. Concept analysis and job satisfaction in nursing. PURPOSE. In this article, Walker and Avant’s concept analysis method-
ology is used to examine and clarify the phenomenon of job satisfaction in nursing. SOURCES. Published literature. CONCLUSION. A review of the published nursing literature suggests that job satisfaction is an affective reaction to a job that results from the incumbent’s comparison of actual outcomes with those that are desired, expected, and deserved. In health care, specifically nursing in a hospital setting, job satisfaction can be measured and identified. Job satisfaction is compromised of three attributes: autonomy, interpersonal relationships, and patient care.
A concept is often described as a label, expressed as a word or phrase, that summarizes the essence of a phenomenon (Fawcett, 2012). A concept may be relatively abstract or concrete. In nursing, a growing body of literature has emerged that is used by researchers to synthesize and understand the knowledge called concept analysis (Fawcett, 2012; Rodgers & Knafl, 2000; Walker & Avant, 2011). A concept analysis is always done with a purpose in mind. Newly created concepts assist in identifying previously unrecognized or poorly understood events. Furthermore, the main advantage of a concept analysis is that it renders precise theoretical as well as operational definitions for use in theory and research (Walker & Avant, 2011). In this paper, Walker and Avant’s (2011) concept analysis framework is used to examine and clarify the phenomenon of job satisfaction. Walker and Avant’s method is an appropriate guide to decipher the meaning of job satisfaction in nursing within a hospital setting. Their eight-step process of concept analysis are selecting the concept for analysis, determining the aim of analysis, identifying all uses of the concept, 130 © 2014 Wiley Periodicals, Inc. Nursing Forum Volume 49, No. 2, April-June 2014
determining the defining attributes, constructing a model case, constructing additional cases, identifying the antecedents and consequences of the concept, and defining the empirical referents for the concept. Walker and Avant’s framework is the most frequently used method for concept analysis in recent nursing literature (Walker & Avant, 2011). Walker and Avant (2011) assert that concept selection should reflect a topic or area of interest. Job dissatisfaction is a common topic of conversation among nurses and prompted the interest in exploring this concept further. Job satisfaction is a complex phenomenon that is described as an intrinsic feeling, with individual meaning, and impacts multiple aspects within a given work environment. Job satisfaction influences productivity, performance, absenteeism, retention, recruitment, organizational commitment, patient satisfaction, and patient care (Lu, While, & Barriball, 2007; Utriainen & Kyngas, 2009). Job satisfaction is one of the most widely discussed and studied constructs in disciplines such as psychology, human resource management, organizational management, economics, and health care. For the purpose of this
G. A. Castaneda and J. M. Scanlan paper, the focus will be on health care, with a particular interest on nursing job satisfaction in a hospital setting.
Aim of Analysis Job satisfaction is a concept that has been in the literature for more than 100 years. Frederick Taylor (1911) marked the beginning of a movement concerned with work measurement, which inspired future research about job satisfaction (Weir, 1976). Over the last two decades, there has been a growing awareness of job satisfaction within international nursing research and practice. Nonetheless, the concept remains unclear. Therefore, a concept analysis will enhance the understanding of the meaning of job satisfaction within the nursing profession. The purposes of this paper are to conduct a concept analysis, examine the current use of the concept of job satisfaction as it relates to nurses in a hospital setting, and identify a definition of job satisfaction in nursing. There are gaps in the literature regarding the concept of job satisfaction, and a need to clarify the concept as it differs among psychology, business, and nursing practice. The attributes emerging from the nursing literature examine the congruence between the definition of the concept of job satisfaction and the way the concept has been operationalized. Enhancing the current literature on job satisfaction of nurses working in hospitals will facilitate better understanding on why nurses may not be satisfied with their jobs.
Data Sources The Cumulative Index of Nursing and Allied Health Literature, ProQuest, PubMed, Business Source Complete, and PsycINFO were accessed, and articles from the English-language literature published from 1980 through 2011 were obtained. No concept analyses of job satisfaction in nursing were found. Key words included job satisfaction, nursing satisfaction, nursing staff-hospital, and nurses’ attitudes. English-language dictionaries were also used to further define the concept. Inclusion of articles in the review was based on relevancy of content regarding background, definition, use, defining attributes, and consequences of job satisfaction. Articles that did not make reference to job satisfaction were excluded.
Job Satisfaction in Nursing Background Job satisfaction remains a complex concept illustrated by the multiple variables that have been studied in relation to this phenomenon. These variables include, but are not limited to, patient satisfaction, burnout, intent to stay, salary, stress, work environment, leadership, education, organizational commitment, empowerment, and turnover (Coomber & Barriball, 2007; Garon & Ringl, 2004; Larrabee et al., 2003; Raup, 2008). Job satisfaction is investigated as an important value in healthcare organizations on the assumption that increasing job satisfaction will improve nursing productivity and patient outcomes (Guleryuz, Guney, Aydin, & Asan, 2008; Kelly, McHugh, & Aiken, 2011). There have been three recent systematic literature reviews regarding job satisfaction among nurses in a hospital setting (Hayes, Bonner, & Pryor, 2010; Lu, While, & Barriball, 2005; Utriainen & Kyngas, 2009). Hayes et al. (2010) sought to identify the factors that contribute to nurse job satisfaction based on intrapersonal (within the nurse), interpersonal (between the nurse and colleagues), and extrapersonal (those external to the nurse) factors. Their review posits that job satisfaction in nursing is multifaceted, complex, and highly subjective. Manojlovich and Laschinger (2002), and Chan, Leong, Luk, Yeung, and Van (2010), emphasized the importance of taking personality variables into consideration during the process of evaluating job satisfaction. Utriainen and Kyngas (2009) were guided by two questions: What factors influence nurses’ job satisfaction and what evokes job satisfaction among nurses working in hospitals? A critical appraisal of 21 studies found two themes to be most significant to nurses’ job satisfaction: interpersonal relationships and patient care. Lu et al.’s (2005) systematic literature review on nurse job satisfaction found that interactions among patients, coworkers, and managers were important, as well as workload, remuneration and promotion, autonomy and leadership style, and organizational policies. A meta-analysis of studies of nurses’ job satisfaction conducted by Zangaro and Soeken (2007) examined 31 studies representing a total of 14,567 subjects who found that job stress had the strongest negative correlation with job satisfaction, with a strong emphasis on stress from supervision, work, and environment. Nurse–physician collaboration had the strongest positive correlation with job satisfaction and resulted from 131
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Job Satisfaction in Nursing interactions within the nurses’ work environment and with patients. Autonomy had a moderately positive correlation with job satisfaction and consisted of perceived autonomy. Literature supporting characteristics such as workplace relationships (Kelly et al., 2011; Zangaro & Johantgen, 2009), care delivered (Dunn, Wilson, & Esterman, 2005; Kelly et al., 2011; McGlynn, Griffin, Donahue, & Fitzpatrick, 2012), and the ability to carry out nursing-related tasks (Coomber & Barriball, 2007; Curtis, 2007; Hayes et al., 2010) were also found to impact nurse job satisfaction. There has not been a concept analysis about job satisfaction in nursing despite the high prevalence of job dissatisfaction in the nursing literature. Therefore, it is important to investigate and identify the factors that affect nurses’ job satisfaction to improve nursing knowledge about this topic. Uses of the Concept of Job Satisfaction According to The Ultimate Business Dictionary (2003), job satisfaction is defined as the sense of fulfillment and pride felt by people who enjoy their work and do it well. An absence of job satisfaction can lead to poor motivation, stress, absenteeism, and high labor turnover. The Concise Dictionary of Business Management (1999) defines job satisfaction as “the extent to which a worker is content with the rewards s/he gets out of his or her job, particularly in terms of intrinsic motivation” (Statt, 1999, p. 86). Shim (2006) asserts that job satisfaction is defined as an attitude that reflects the extent to which an individual is gratified by or fulfilled in his or her work. Furthermore, Shim states that extensive research conducted on job satisfaction indicates that personal factors, such as an individual’s needs and aspirations, determine this attitude, as well as group and organizational factors, such as working conditions, work policies, compensation, and relationships with coworkers and supervisors. In business, the study of job satisfaction is central to organizational behavioral scientists. Companies want to know why their employees are or are not satisfied since many people spend a third or more of their waking hours at work (Jernigan, Beggs, & Kohut, 2002). Satisfaction levels can provide a rich picture of the mood of employees, which management can use as a guide to improving reward, benefit, and motivational conditions (Malonis, 2000). The Encyclopedia of Management (2009) uses the word morale in the same context as job satisfaction. In this context, job 132 © 2014 Wiley Periodicals, Inc. Nursing Forum Volume 49, No. 2, April-June 2014
G. A. Castaneda and J. M. Scanlan satisfaction is defined as how employees actually feel about themselves as workers, their work, their managers, their work environment, and their overall work life. Job satisfaction incorporates all the mental and emotional feelings, beliefs, and attitudes that individuals and groups hold regarding their job. Consideration of employee morale or job satisfaction was a major emphasis of the behavioral school of management that started with the famous Hawthorne experiments in the late 1930s (Weir, 1976). The behavioral school claimed that employee morale influenced employee productivity. Frederick Herzberg conducted research in the 1950s and 1960s indicating that employees’ satisfaction and motivation were influenced more by how they felt about their work, rather than the specific attributes of their job, including pay and workplace surroundings (Weir, 1976). According to Sutherland and Canwell (2004) and Lee, Magnini, and Kim (2011), job satisfaction refers to the attitude that employees have about the work they carry out, and the level of satisfaction which correlates with the degree of involvement people have within the organization. Further, in order for employees to be satisfied, they must be in a job that suits their personality and expertise, be paid fairly, have appropriate resources, adequate working conditions, and a supportive manager. In economics, job satisfaction is a good predictor of labor market behavior, particularly employee departures (Hamermesh, 2001). Hamermesh (2001) stated that job satisfaction indicates the overall desirability of a job, whereas Stride, Wall, and Catley (2007) stated that job satisfaction contains four domains: extrinsic (pay) and three intrinsic (sense of achievement, respect from supervisors or line managers, and influence over the job). Several job satisfaction definitions now exist in health care. According to Stamps (1997), job satisfaction is defined as the extent to which employees like their jobs. Stahl (2004) defined job satisfaction as the feelings people have about their jobs. Adams and Bond (2000) described job satisfaction as the degree of positive affect toward a job or its components. These feelings exist among nursing staff and physicians, who are the two groups of hospital employees most involved in the delivery of patient care (Stahl, 2004). For the purpose of this paper, the focus will be on the profession of nursing, specifically nurses working in hospitals. In the current nursing literature, the most commonly cited reason that nurses give for leaving nursing is job dissatisfaction (Ma, Lee, Yang, & Chang,
Job Satisfaction in Nursing
G. A. Castaneda and J. M. Scanlan 2009; Gieter, Hofmans, & Pepermans, 2011; Wang, Tao, Ellenbecker, & Liu, 2012). Job satisfaction, according to Hayes et al. (2010), could be conceptualized and labeled as intrapersonal, interpersonal, or extrapersonal factors. Intrapersonal factors included age, education, and experience, while interpersonal factors included autonomy, coworker interactions, relationships with staff and patients, task requirements, and supervisory support. Extrapersonal factors included organizational structure, salary, workload, and promotion opportunities. Job dissatisfaction can be expressed in a number of different ways depending on the situation (and possible alternatives): absenteeism, quitting, and specific on-the-job behaviors (Lu et al., 2005; Zangaro & Soeken, 2007). Furthermore, Hayes et al. (2010) and Manojlovich and Laschinger (2002) state that job satisfaction must be considered in terms of the interrelationship of a number of variables. These variables include the subjective and objective characteristics of the job, individual abilities and experiences, alternatives available in the organization and larger community, individual values, and the environment in which the nurses work. All these factors influence job satisfaction, performance, and productivity. Defining Attributes of Job Satisfaction Attributes are characteristics that frequently appear in the literature and help define the concept of interest. Defining the attributes is considered by Walker and Avant (2011) to be the heart of concept analysis. According to the results from the literature review on job satisfaction, and contextual definitions of job satisfaction in nursing, three attributes are most significant to nurses’ job satisfaction in a hospital setting: autonomy (Hayes et al., 2010; Zangaro & Soeken, 2007), interpersonal relationships (Utriainen & Kyngas, 2009; Zangaro & Soeken, 2007), and patient care (Utriainen & Kyngas, 2009; Zangaro & Soeken, 2007). Autonomy Autonomy has been studied for many years and is ranked as one of the most significant factors contributing to nurses’ job satisfaction (Hayes et al., 2010; Zangaro & Soeken, 2007). Finn (2001) described the lack of autonomy inhibiting job satisfaction as “nursing wastage” (p. 350). Nursing wastage results in
increased turnover (Lynn, Morgan, & Moore, 2009; Zangaro & Johantgen, 2009) and decreased efficiency in clinical settings (Larrabee et al., 2010), and undermines high-quality patient care (Aiken, Clarke, & Sloane, 2002; Ma et al., 2009). Autonomy and job satisfaction have been shown to be positively related (Aiken et al., 2002; Zangaro & Soeken, 2007). The clinical autonomy of staff nurses is related to many factors, including scope of practice, interprofessional teamwork, support from management and coworkers, mutual trust between physicians and nurses, and education. These structural and process factors are all prerequisites to achieving autonomous nursing practice (Chen & Johantgen, 2010). Interpersonal Relationships Interpersonal relationships between nurses and various communal factors are of major importance for nurses’ job satisfaction. Several studies (Dunn et al., 2005; McGillis, Doran, & Pink, 2008; McLennan, 2005; Meraviglia et al., 2009) indicated the relationship between nurses, and the interpersonal relationships among other nurses, doctors, and interprofessional members, to be one of the best predictors of job satisfaction. According to Utriainen and Kyngas (2009), and Chang, Ma, Chiu, Lin, and Lee (2009), job satisfaction is most strongly predicted by social and professional relationships in the workplace. McLennan (2005) described nurses’ interaction with other people as the greatest source of job satisfaction in nursing. Newman and Maylor (2002) contend that nurses were of the opinion that coworkers and patient care were the best predictors of their job satisfaction at work. Dunn et al. (2005) found relationships with other members of the nursing staff to be an important factor in creating job satisfaction. Relationships between nurses, collaboration with medical staff (Utriainen & Kyngas, 2009), and communication between nurses and physicians (Chen & Johantgen, 2010; Manojlovich, 2005) are key to nursing job satisfaction. Harmony between nurses and togetherness (DiMeglio et al., 2005), nurse-to-nurse interactions (McLennan, 2005), and collaboration and good communication (Hayes et al., 2010) are predictors of nurses’ job satisfaction. Patient Care Patient care is related to increased job satisfaction, and includes the following aspects: good relationships 133
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Job Satisfaction in Nursing with patients (Cortese, 2007; Dunn et al., 2005), a felt experience and deep human connection of providing good care (Gurkova, Cap, Ziakova, & Duriskova, 2012; Newman & Maylor, 2002), receipt of personal praise from patients and their families (Gurkova et al., 2012), and the joy of seeing patients get better and go home (Ma et al., 2009). Constructed Cases Constructed cases illuminate the concept and support the analysis by describing the concept’s presence in a model case, the absence of a concept in a contrary case, and the difference between the concept and a closely associated concept in a borderline and related case (Walker & Avant, 2011). Model Case According to Walker and Avant (2011), a model case contains all critical attributes of the concept and provides an example of the concept. The following is a model exemplar of job satisfaction. Rebecca, a new graduate nurse begins to work on a medical unit in a hospital. Rebecca’s excitement comes from knowing that she will be able to attend interprofessional rounds that are attended by physicians, nurses, and other team members in the development of care plans for the patients for whom she cares. After the treatment plan is discussed and developed by the team, Rebecca implements the care plan by herself for the patients she has been assigned to that day.
G. A. Castaneda and J. M. Scanlan some instances contrary to the concept and assist in making better judgment about the attributes and/or characteristics of the concept. The cases include the borderline, related, and contrary. Borderline Case A borderline case is an example that contains most, but not all, of the defining attributes of the concept. The inconsistency of the borderline case in comparison to the model case assists in clarifying the characteristics of the concept (Walker & Avant, 2011). Tracey, a new registered nurse on a cardiology ward is asked to educate a patient about reversible risk factors that commonly lead to heart attacks. Since this is her first time performing this task, she requires assistance from another nurse to help her with this task. Tracey asks Edith, who is also a registered nurse on the ward, to come with her and help her carry out this task. Edith agrees, and they both teach the patient together. This borderline case contains two of the three components of job satisfaction: interpersonal relationship and patient care. However, this case lacks autonomy as Tracey requires Edith’s assistance in educating the patient about reversible risk factors. Tracey is not able to take control of this task and make a decision by herself about the best way to carry out this patient education. Related Case
This model case contains all three attributes of job satisfaction: interpersonal collaboration, autonomy, and patient care. In this case, the novice nurse is able to attend interprofessional rounds to discuss her patients’ care plans, an example of interpersonal collaboration with doctors, nurses, and other team members to develop a plan of care for her patients. Autonomy is displayed as the new nurse takes the plan of care and makes a decision to implement independently. Patient care is displayed by providing care to each patient to whom she is assigned that day. Identity Additional Cases Walker and Avant (2011) state that additional cases are similar to the concept but not the same, and in 134 © 2014 Wiley Periodicals, Inc. Nursing Forum Volume 49, No. 2, April-June 2014
Related cases are instances that are related to the concept being studied but do not contain all the defining attributes (Walker & Avant, 2011). Carole is a registered nurse with 30 years of experience works in the emergency department and is called to a meeting with management to discuss a treatment plan for a patient who has been there for 96 hr on a ventilator. During this meeting, Carole speaks on behalf of the other nurses in the unit. She talks about how this case is affecting the morale of the unit and a plan needs to be developed to transition this patient to a unit that has experience with a ventilated patient. During the meeting, management identifies a place and provides Carole with
G. A. Castaneda and J. M. Scanlan coffee certificates to improve morale in the unit. Also, Thomas, the director of the department, announces that he will be more visible to answer concerns about this case. Carole is satisfied and goes back to tell the patient and family the news, and provides the two nurses looking after this patient with coffee gift cards. Just as Carole is done handing out the gift cards, Thomas enters the unit and asks the nurses if they have any questions. This case does not exhibit all defining attributes of job satisfaction. However, this case provides an example of other related concepts that are prevalent in the literature about job satisfaction but do not contain all the defining attributes. The concept of morale is described as a concept that is interchangeable with job satisfaction and has similar attributes with regard to how employees feel about their job within the environment in which they work (Encyclopedia of Management, 2009; Sutherland & Canwell, 2004). Another concept that is frequently described in the job satisfaction literature is support. Support can come from a supervisor, manager, coworker, or other team member regarding the work of an employee and provides affirmation about work performed (Brunetto, Farr-Wharton, & Shacklock, 2010; Han & Jekel, 2011). The concept of compensation or reward is prevalent in the business literature and is a fundamental concept in nursing according to Zarea, Negarandeh, Dehghan-Nayeri, and Rezaei-Adaryani (2009), and Melo, Barbosa, and Souza (2011).
Contrary Case According to Walker and Avant (2011), a contrary case is a clear example of what the concept is not. Jackie, a politician and the wife of a patient, is present during patient rounds in the intensive care unit and provides suggestions about possible causes for her husband’s disease process. She listens to her husband’s proposed care plan for the day and takes it upon herself to implement the daily care plan for her husband. Clearly, this is a contrary case, an example of missing attributes of the concept (Walker & Avant, 2011). Jackie’s behavior is not an example of nurses’ job satisfaction. Although Jackie may feel satisfied,
Job Satisfaction in Nursing the nurses were not involved in the care of Jackie’s husband.
Identify Antecedents and Consequences Antecedents, as described by Walker and Avant (2011), are events or incidents that occur prior to the concept. The two most common antecedents in the reviewed literature are personal/individual characteristics and work environments (Hayes et al., 2010; Utriainen & Kyngas, 2009). Both antecedents have been shown to influence job satisfaction. Personal/ individual characteristics, such as age, education, family structure, and living in an urban or rural setting, have an effect on job satisfaction as these focus on the individual nurse rather than nursing in general (Chang, Li, Wu, & Wang, 2010; Manojlovich & Spence Laschinger, 2002; Sheward, Hunt, Hagen, MacLeod, & Ball, 2005; Wilson, Squires, Widger, Cranle, & Tourangeau, 2008). Work environment has been researched over time across many countries, organizations, and different types of jobs. Results from this research show that when employees are asked to evaluate different aspects of their job, such as supervision, pay, promotion opportunities, training, and organizational structure, the nature of the work itself emerged as the most important job facet (Abushaikha & Saca-Hazboun, 2009; Bjork, Samdal, Hansen, Torstad, & Hamilton, 2007; Curtis, 2007; Melo et al., 2011; Zangaro & Johantgen, 2009). Consequences, according to Walker and Avant (2011), are events or incidents that occur as a result of the concept and are also known to be outcomes of the concept. These events can be described in the categories of work, family, and individual, and are a result of job satisfaction or dissatisfaction. At work, when an employee is satisfied, his or her absenteeism is less (Kelly et al., 2011; Tourigny, Baba, & Wang, 2010), has a decreased intent to quit (Coomber & Barriball, 2007; Djukic, 2011; Hayes et al., 2010), and is more involved within his or her unit and/or organization (Ahmad & Nelson, 2010). Satisfaction at work has been shown to have positive affects with a nurse’s personal life satisfaction and vice versa (Golbasi, Kelleci, & Dogan, 2008). Furthermore, evidence indicates that job satisfaction is strongly and consistently related to subjective well-being (Murrells, Clinton, & Robinson, 2005), improved physical health, and less burnout at work (Abushaikha & Saca-Hazboun, 2009). 135
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Job Satisfaction in Nursing Define Empirical Referents Empirical referents are classes or categories of actual phenomena that, by their existence or presence, demonstrate the occurrence of the concept (Walker & Avant, 2011). Historically, job satisfaction has been measured with interviews or questionnaires administered to the job incumbents in question. Although interviews are used in some cases, most research typically is conducted using questionnaires (Spector, 1997; Utriainen & Kyngas, 2009). Six of the most common job satisfaction scales are the Job Satisfaction Survey by Spector (1985), the Job Descriptive Index by Smith, Kendall, and Hulin (1969), the Minnesota Satisfaction Questionnaire by Weiss, Dawis, England, and Lofqueist (1967), the Job Diagnostic Survey by Hackman and Oldham (1975), the Nursing Work Index-Revised by Aiken and Patrician (2000), and the Maslach Burnout Inventory by Maslach and Jackson (1981) (Fairbrother, Jones, & Rivas, 2009–2010; Spector, 1997). Each has been validated and considered reliable as they have all been used in research studies in health care. In nursing, the McCloskey/Mueller Satisfaction Scale (MMSS) (1990) is one of the most commonly used tools to measure nurses’ attitudes toward their jobs, and is used to identify job satisfaction in a variety of clinical and geographical settings (Tourangeau, McGillis, Doran, & Petch, 2006; VanSanne, Sluiter, Verbeek, & Frings-Dresen, 2003). This instrument consists of 31 descriptors that measure eight aspects of nurse job satisfaction (Tourangeau et al., 2006). The MMSS factors capture the attributes of job satisfaction of nurses in a hospital setting and have demonstrated to be drivers of nursing satisfaction in the past (Aiken & Patrician, 2000; Sorensen, Seebeck, Scherb, Specht, & Loes, 2009; Tourangeau et al., 2006; VanSanne et al., 2003).
Conclusion Thousands of scholarly articles on job satisfaction have been published. Despite the volume of articles, enough questions remain to establish an agenda for more research about job satisfaction in nursing. The answer to these questions has two dimensions. One is the variety and complexity of how different nurses perceive job satisfaction, its components, and its correlates. The other is the confusion and contradiction that exist in the literature related to job satisfaction in 136 © 2014 Wiley Periodicals, Inc. Nursing Forum Volume 49, No. 2, April-June 2014
G. A. Castaneda and J. M. Scanlan nursing. Minimal advancement has been made in defining job satisfaction from a nursing point of view. This concept analysis clarifies the concept of job satisfaction in relation to nurses working in a hospital setting. Although a review of published literature suggests that the constitutive definitions of the construct vary somewhat from one article to the next, there appears to be general agreement that job satisfaction is an affective (i.e., emotional) reaction to a job that results from the incumbent’s comparison of actual outcomes with those that are desired, expected, and deserved. In health care, specifically nursing in a hospital setting, job satisfaction can be measured and identified. Job satisfaction is comprised of three attributes. The three defining attributes of job satisfaction—autonomy, interpersonal relationships, and patient care—can be tested by the MMSS. Future research should focus on the role of cognition and affect in job satisfaction of nurses as there is more to be learned about how cognition and affect are intertwined and related to nursing job satisfaction. Rather than focusing on measurement properties (tasks), a look at more substantive issues in cognitive processing should be the goal, as behavioral implications of these events might provide a different perspective of job satisfaction in nursing.
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