Nursing Research: Job Satisfaction

Job satisfaction is the degree to which individuals like their jobs. As a general attitudinal construct, job satisfaction reflects a positive affective orientation toward work and the organization, whereas job dissatisfaction reflects a negative affective orientation. Job satisfaction has been studied extensively in nursing, psychology,
sociology, management, and organizational development. Most commonly, researchers have studied job satisfaction as a dependent variable in assessing the impact of organizational changes and innovations, or as an intervening variable with multi-staged models of employee turnover, retention, or absenteeism.

nursing satisfaction

Currently, nurses’ job satisfaction is being studied as a part of the organizational context, in conjunction with variables such as nurse staffing, autonomy, control over nursing practice, burnout, and emotional exhaustion to determine effects on outcomes such as patient satisfaction, quality of care, adverse events, morbidity, mortality, length of stay, and costs. Registered nurse (RN) staff in acute care hospitals has been the population of greatest interest in studies of nurses’ job satisfaction. Less is known about job satisfaction among RNs who work in other settings or about licensed practical/vocational nurses in any setting. In early studies of organizations, workers’ liking or disliking their jobs usually was labeled morale. Midway through the 20th century, researchers began to develop both general and dimension-specific measures of satisfaction-dissatisfaction. General or global measures estimate an individual’s overall feelings about the job. In dimension-specific measures, subconstructs distinguish satisfaction about specific facets of the job, such as the work or task, pay and benefits, administration, and, for nurses, dimensions such as professional status, nurse-physician relationships, and quality of care. As work on job satisfaction continued, debate arose about whether job satisfaction and dissatisfaction were opposite ends of a single continuum or were two separate constructs. Although job satisfaction currently is reported most often
in the research literature, the one-or-two constructs issue has not been resolved. The terms are used inconsistently and sometimes inter-changeably. Amore recent concern is the possibility that positive and negative affectivity, which are mood-dispositional personality traits, contaminate effects of determinants (e.g., autonomy, stress, burnout) on strain related variables such as job satisfaction. Ina meta-analysis of affective underpinnings of job perceptions, Thoresen, Kaplan, Barsky,Warren, and de Chermont (2003) found that both positive and negative affect uniquely contributed to the prediction of job satisfaction, organizational commitment, emotional exhaustion, and personal accomplishment.
Commonly used measures of job satisfaction have been influenced by or adapted from instruments developed in the organizational research field. Subsets of the Brayfield and Rothe (1951) items have been used frequently as general measures of job satisfaction. Prominent in the measurement of dimension-specific job satisfaction among nurses are the Index of Work Satisfaction (IWS) (Stamps, 1997), the McCloskey-Mueller Satisfaction Scale (MMSS) (Mueller & McCloskey, 1990), and the Nursing Work Index (NWI)/Revised Nursing Work Index (NWI-R) (Aiken & Patrician, 2000; Kramer & Hafner,1989). These measures all estimate job satisfaction at the individual level. Recently, Taunton et al. (in press) adapted the Stamps IWS for use in the National Database o fNursing Quality Indicators (NDNQI). The adaptation included changing the wording of items to a unit-level referent so that satisfaction data could be aggregated to the unit level and analyzed with other unit-level indicators (e.g., nursing care hours per patient day, nurse staffing mix, pressure ulcers, patient falls, and patient satisfaction) as part of the American Nurses Association Safety and Quality initiative. Researchers choose measures of job satisfaction based on the nature of the study and the response burden for subjects. For instance, a short, general job satisfaction measure would impose less subject burden in a multisite study that includes multiple measures of organizational and clinical variables or when assessing the overall relationship of job satisfaction to behavior. In contrast, researchers focused on the impact of a specific nursing practice innovation in one setting might be interested in nurse satisfaction about professional status, nurse-physician relationships, quality of care, or other dimension-specific facets. Also, as more researchers study job satisfaction as part of the unit organizational context, it will be important to use a measure that is reliable and valid at the aggregated unit or hospital level, such as the NDNQI-Adapted IWS (Taunton et al., inpress).
Researchers (Blegan, 1993; Irvine & Ev-ans, 1995) conducting meta-analyses of accumulated nursing job satisfaction research have found that autonomy, stress, commitment to the organization, and intent to stay in the job demonstrate the strongest, most consistent correlations with job satisfaction; autonomy and stress usually are antecedents of job satisfaction, whereas commitment and intent to stay are outcomes. Other variables with more moderate correlations are communication with supervisor, recognition, routinization, communication with peers, fairness, and locus of control. In general, variables measuring job characteristics (e.g., routinization, autonomy) and work environment (e.g., leadership, stress) have stronger relationships than economic (e.g., pay, opportunity elsewhere) or individual difference (e.g., age, experience, organizational tenure) variables.
More recently, researchers of the organizational context for nursing have found higher nurse-to-patient ratios are associated with lower job satisfaction and higher emotional exhaustion, as well as higher patient risk adjusted mortality and failure-to-rescue (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002).

A high priority for current and future research is examining the relationship between nurses’ job satisfaction and outcomes of care, such as quality of care, patient satisfaction, adverse events (e.g., falls, pressure ulcers, failure-to-rescue, infections), mortality, and the like. These relationships need to be studied not only in acute care settings, but also in the community, in home care, and in long-term care facilities—which will allow improvement of outcomes across all health care settings. Issues that still need more elucidation are first, the degree to which nurses’ positive and negative affectivity confound relationships between job satisfaction and variables such as autonomy, job stress, burnout, and emotional exhaustion. Second, the association between patient positive and negative affectivity and patient satisfaction with nursing care is not clear. Here again, associations between nurse satisfaction and patient satisfaction could be confounded by underlying affectivity. Last, the unresolved issue about whether job satisfaction and dissatisfaction are separate constructs warrants further attention. Nurses’ satisfaction and dissatisfaction may associate differently with outcomes of care.