Determinants of Nurses Job Satisfaction and Quality of Nursing Care among Nurses in Private Hospital

Determinants of Nurses Job Satisfaction and Quality of Nursing Care among Nurses in Private Hospital Setting

Introduction Nurses are thought to play an important role in the healthcare system. This is why they are aptly referred to as the "heart" of the healthcare system. Being a nurse is one of the most difficult jobs in the world, requiring a great deal of dedication and commitment (1). Nurses' unique role on the health care team involves an ongoing assessment of the patients' health status and response to their care plan. They even spend most of their time directly with the patient, providing around-the-clock observations and care. Nurses are the front liners in implementing the physician's orders, such as giving medications or changing dressings, and assessing the client's responses to the treatment plan. The nurse is also responsible for evaluating the safety of the medical plan of care before implementing it. Moreover, nurses decide what actions to take based on their assessment. Through this ongoing assessment, nurses can focus on helping patients meet their physical, emotional, cognitive, social, and spiritual needs (3). The notion of “happy nurse, happy patients” supports the idea of a correlation between nurse satisfaction and patient outcomes. Working in a healthcare setting is demanding because of the system's complexity. It requires nurses to deal with the unique needs of each patient and family under their care and the need to maintain close communication with a variety of healthcare professionals who have different characters and personalities, which adds to workplace stress. The negative effects of job stress are not limited to the workplace; they can also be seen outside of the workplace (4). Nurses were most satisfied with certain aspects of their jobs, according to an ANA satisfaction survey from 2005. Interactions with other nurses, professional status, and career development opportunities were the aspects that received the highest level of satisfaction. Nurses' job satisfaction is linked to their ability to connect with coworkers and patients. A variety of factors influences professional job satisfaction. Enhancing relationships with other nurses through team building and mentoring programs that connect novice nurses with nursing expert clinicians is one part of the solution to increasing nursing job satisfaction. Understanding the importance of employee satisfaction and how to improve employee satisfaction is critical to providing high-quality healthcare with positive outcomes (5). Nursing job satisfaction is an essential component to retaining nurses and resolving the nursing shortage. For practicing nurses, meeting human needs through caring, empathetic, and respectful interactions revealed the lived meaning of quality nursing care (6). In Saudi Arabian context, courtesy and respect was found to be the most important parameter of quality care which indicates a strong cultural norm of care and family values within the quality care concept. Patients’ satisfaction with nursing care has been reported as the most important predictor of overall satisfaction with hospital care and an essential goal of any healthcare organization (7). Patient evaluation of care is critical in order to provide opportunities for improvement, such as strategic framing of health plans that sometimes go above and beyond patient expectations, and benchmarking. Measuring quality of care is identified as an important quality outcome indicator to measure the success of the services delivery system (8). The study's locale is a private healthcare facility. It has had a constant turnover of staff, mostly expatriate nurses for the past year impacting the institution's services. Hiring, staffing, and retaining the most experienced nurses appears to be a persistent problem at the facility, prompting the researcher to delve deeper into the issue to determine its root causes and provide a clearer understanding on the factors that predict job satisfaction. Similarly, the goal of this research is to assess the hospital's nursing care quality for its patients. The results of this research will be used to identify areas for improvement in order to revitalize its service quality. Aside from that, this study would support the hospital's commitment to providing highquality care to its patients while also taking into account the welfare of its nursing staff. Materials and Methods Design A descriptive research design was used to achieve the study's goal. Using this design,

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the researcher was able to find out the predictors and extent of nurses' job satisfaction and patients' satisfaction with the quality of nursing care. Respondents The participants in this study were nurses and admitted patients. Staff nurses must be able to complete the ninety-day probationary period and have passed all of the initial competencies required of them to independently assume their role to be considered for the study. This study recruited the participation of 49 nurses from various in-patient wards and intensive care units. To obtain an adequate number, universal sampling was used, which yielded a response rate of seventy percent (70%). For patient respondents', eligibility criteria include admission to the hospital unit for at least two days so patients can visibly rate the quality of nursing care they have received. A total of twenty-nine (29) patients were included as patient respondents following the inclusion criteria. Research Tools The University of Iowa College of Nursing provided the instrument used in this study to assess the respondents' job satisfaction. They've agreed to let the researchers use the McCloskey/Mueller Satisfaction Scale. The scale was created to determine the level of satisfaction among hospital nurses. The scale has 31 items capturing eight domains of satisfaction: satisfaction with extrinsic rewards, scheduling, family/work balance, co-workers, interaction, professional opportunities, praise/recognition, and control/ responsibility. Each item was rated using a five-point Likert scale where 5 indicates the highest level of satisfaction. For each subscale, scores are summed and divided by the number of items to attain a mean. An overall means for the global scale can be attained as a general measure of nursing satisfaction (Mueller & McCloskey, 1990). The subscales include three items (1-3) from satisfaction with intrinsic rewards, six items (4,5,6,8,9,10) from satisfaction with scheduling, three items (7,11,12) from satisfaction with co-workers, four items (1619) from satisfaction with interaction opportunities, four items (20,21,27,28) from professional opportunities satisfaction, four items (13,24,25,26) from parties and recognition satisfaction and lastly five items (22,23,29,30,31) control and responsibility satisfaction. The Cronbach's alpha for the McCloskey/Mueller Satisfaction Scale subscales ranged from 0.71 to 0.87, which indicated stronger internal consistency (20). To measure the patient satisfaction with regards to nursing care the Patient Satisfaction with Nursing Care Quality tool (PSNCQQ) was used (1). This was downloaded from the internet, which is composed of 21 questions. Each item is rated using a 5-point Likert scale ranging from Excellent, Very Good, Good, Fair or Poor. This questionnaire was translated into Arabic so that the respondent will understand the content and answer the question appropriately. Proofreading was done to ensure that translated sentences were accurate. The reliability of this tool was tested and previous studies suggested a high Cronbach α reliability coefficient ranging from .90 to .94 (2). Data Analysis SPSS software was used to analyze the data. Frequencies, means, standard deviations, and percentages were among the descriptive statistics used in the study. In terms of parametric tests, the ANOVA test was used to investigate the influence of respondents' demographics on the expected outcome (job satisfaction). This was also used to see how the demographics of the patients influenced the quality of nursing care they received. For the mean satisfaction ratings, the SPSS data was used for faster computation of the results. For interpretation of the resulting mean ratings, the following range of interpretation was used. Table 1: Likert Scale Used to Interpret Results Scale Range Interpretation 4.21 – 5.00 Very Satisfied/ Excellent 3.41 - 4.20 Moderately Satisfied /Very Good 2.61 - 3.40 Neither Satisfied nor Dissatisfied /Good 1.81 – 2.60 Moderately Dissatisfied /Fair 1.00 – 1.80 Very Dissatisfied /Poor Abella JL Ethical Consideration The institutional approval for the conduct of this study was sought after the hospital administration. In this study, the rights of the research participants are protected. The participants were given informed consent so that they could fully comprehend the scope of the study and decide whether or not to participate. The instrument was translated into Arabic to better understand the study's context, so patient respondents can get a better understanding of what the research is about. The consent form also stated that they would be guaranteed confidentiality and anonymity, and that they would be free to refuse to participate in the study. The consent form was signed by all participants to confirm that they were aware of the project's scope. To assuage their fears and help them decide whether or not to participate in this study, nurses were assured that confidentiality and anonymity would be maintained. Results Demographic Characteristics of the Respondents The respondents of this study cover (89.8%, n=44) staff nurses and (10.2%, n=5) head nurses. Majority of them are between 26-30 years old (63.3%) and 21-25 years old (20.4%); mostly have spent one year to three years of service in the hospital; renders a maximum of twelve hours of duty everyday (42.9%) four hours of which was rendered as overtime. Their monthly salary is between 2000 SR-3000 SR and the majority were Filipinos (85.7%). no significant difference in the quality of nursing care provided to patients, according

Discussions

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This study evidently illustrates the migration of nurses towards a quest to earn a better living, professional achievement, advancement, to experience other cultures and expand their professional experience. The study shows that a great majority of Filipino nurses filled up the nursing position from staff nurse to the highest echelon in the nursing service position within the locale of the study. Countries in the Middle East have the most number of job opportunities for Filipino nurses. A lot of medical institutions in the Arab countries highly regard the knowledge and ability of every registered Filipino nurse, which is why most of the foreign nurses there are from the Philippines. Another reason is that, most Filipino OFW (Overseas Filipino Workers) Nurses consider the Philippines as a jobscarce environment and, even for these jobs in the health care sector, poor working conditions often motivate nurses to seek employment overseas. The country has also become dependent on labor migration to ease the tight domestic labor market. National opinion has generally focused on the improved quality of life for individual migrants and their families, and on the benefits of remittances to the nation (9). Filipino nurses have proven their worth working in diverse cultures. Nurses abroad are confident in giving care and are fully aware of the cultural background and culture specific health care that can affect nursing care. Filipino nurses are confident in giving care to patients from diverse cultures (10). This study has proven that the quality of nursing care provided mostly by Filipino nurses and nurses from different nationalities were totally excellent. Using the PSNCQQ questionnaires it clearly confirms that nurses were able to ensure patient comfort by addressing all their needs and displays a reassuring attitude towards the patients despite their age, gender, nationality and their number of days of stay in the hospital. For the Saudi family, considerable cultural clashes may arise when Saudi patient are hospitalized and receive care from healthcare professionals who do not understand Islamic principles and Saudi cultural beliefs and values. The healthcare workforce in Saudi Arabia is a unique multicultural workforce that is mix of Saudi and significant other nationalities (11). It could be inferred from the major findings of this study that nurses were also able to display flexibility towards meeting the needs of the patients. Clearly it only implies that nurses broadly understand culturally competent care from a Saudi perspective. Unique value system among nurses like courtesy, respect, kindness and friendliness towards the patients were among the most sought characteristics which made the nursing profession exceptional.

The results of this study found moderate satisfaction among the nurse respondents with regards to co-workers, praise and recognition, interaction opportunities, and professional opportunities. The rewarding benefits of having close friendly relations among your coworkers (nurses, physician) and actively interacting with them brings meaningful benefits to the nurses’ job satisfaction. Because through this interaction it would bring a positive work environment that fosters acceptance, recognition, and positive encouragement thereby creating a feeling of belongingness and satisfaction. Because working with people from culturally and linguistically diverse backgrounds may lead to desolation and dissatisfaction. It is a great thing that the respondents maintain workplace friendship because this facilitates increased communication, respect, securities, and trust among employees (12). According to the findings of this study, respondents are neither satisfied nor dissatisfied with control and responsibility, balance of family and work, extrinsic benefits and scheduling. Several research works suggest that career development practices in the workplace help companies attract and retain high performing employees (13-15). Research conducted by the Career Innovation Group

(16) found that employees are more likely to stay if offered the opportunity to develop. But due to the current nursing understaffing problem of the hospital this hinders the total achievement of the training and development plan among nursing staff because instead of participating during in house activities nurses instead spend time carrying out their nursing task. This also leads to low satisfaction rate with regards to scheduling because it is quite evident that nurses were deprived of day off and are likely to spend more than eight hours of hospital duty per day. Due to the higher vacancy rate nurses have a higher workload which leads them to be neither satisfied nor dissatisfied with their work and may leave readily afterwards thereby increasing the turnover rate of nursing in the hospital.

Pay satisfaction is of primary concern to both employers and employees. For employees, pay is of obvious importance in terms of satisfying their economic needs. It is important that they are satisfied with their overall pay as this may impact their attitudes and behavior (17). However, findings suggest that nurses’ quality of nursing care is not altered even though there is low extrinsic satisfaction rate. Meaning, nurses unceasingly provide high quality nursing care among patients admitted at the hospital as evident by an excellent rating of nursing quality survey that was included in this study. Nevertheless, salary and other employee benefit packages should be thoroughly examined to continuously provide fair compensation among the nursing personnel.

On the other hand, statistical tests show a significant difference in the nurse job satisfaction as to their nationality, monthly income and highest educational attainment. Surprisingly, this study found that local Saudi nurses are less satisfied compared to their expatriate counterparts. The difference in their satisfaction could be attributed to their physical working condition, the hospital ward where they are stationed, cost of living in Saudi Arabia and the expatriates’ home country and currency value. A study

conducted by (18) revealed

that satisfaction

with pay, job characteristics, promotion opportunities, co-workers, and supervisors

were associated with the nationality of the manager. Moreover, the respondents of this

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study expressed a higher level of satisfaction with pay, job characteristics, promotion opportunities, coworkers and supervisors than their expatriate counterparts.

Consequently, highest educational attainment yields a significant difference in relation to the respondents’ job satisfaction. Expatriates, mostly Filipino nurses, occupy the majority of the nursing position and staffing in the hospital. The Philippines has been hailed as the largest exporter of Nurses to foreign countries. Filipino nurses can be found everywhere around the world in the big cities of the United States and Ireland, in urbanized centers of Europe and Asia, in the far corners of Africa and South America, in remote desert clinics and state of the art hospitals in the Middle East. The educational system for nurses in the Philippines mandates English as the medium of instruction. Moreover, the training of nurses features apprenticeship, laboratory work, experiments, residency and communitybased projects, all lectures and school work being done in English. Nursing programs in the Philippines have been certified to be equivalent to the education standards in the U.S (19). The significant difference disclosed by this study is attributed strongly to the educational attainment of the expatriate nurses compared to the degrees attained by the local health care provider and other nurses from different nationalities. Both expatriate and local Saudi health workers had a co-equal professional obligation in clinical practice, regardless of educational preparation, but not in terms of pay. Clear distinctions when it comes to job responsibilities based on educational attainment should be crafted and pursued within the local setting so it may differentiate the delineation of nurses with advanced education and healthcare professionals with limited education preparation.

Conclusions

In terms of the eight (8) satisfaction domains identified in this study, nurses are neither satisfied nor dissatisfied. Nurses' job satisfaction is influenced by their nationality, highest educational attainment, and monthly income. Despite nurses' dissatisfaction with their jobs, the quality of nursing care remains excellent, implying that they continue to provide safe, timely, efficient, effective, and patient-centered care regardless of their patients' age, gender, nationality, or length of hospital stay. In this sense, job satisfaction has no bearing on nursing quality care, but further research is needed to confirm this assumption.

Recommendations

Since this study has some limitations, it is recommended that future study focuses on determining the factors that affect the low job satisfaction rate of Saudi nurses. A study might be undertaken to see if there is a difference in nurse job satisfaction and nursing care quality between private and government hospital nurses. And lastly, correlate the factor of job satisfaction to the quality of nursing care and identify what are the most essential aspects of nursing care are for the majority of patients.

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