Journal of Advanced Nursing, 2000, 32(3), 536543

Nursing and health care management issues

Hospital nurses' job satisfaction, individual

and organizational characteristics
Ann Adams PhD MSc BA Hons RGN
Research Fellow, European Institute of Health and Medical Sciences,
University of Surrey, Guildford

and Senga Bond PhD FRCN RGN

Professor of Nursing Research, Centre for Health Services Research,
The University, Newcastle upon Tyne, England

Accepted for publication 21 February 2000

ADAMS A. & BOND S. (2000)

Journal of Advanced Nursing 32(3), 536543

Hospital nurses' job satisfaction, individual and organizational characteristics
Using the Ward Organizational Features Scales (WOFS), relationships between
aspects of the organization of acute hospital wards, nurses' personal characteristics and nurses' job satisfaction are examined among a nationally representative sample of 834 nurses in England. The analysis contributes to a
growing body of evidence demonstrating the importance of interpersonal
relationships to nurses' job satisfaction. In particular, the positive contribution
of the cohesiveness of ward nursing staff is highlighted, but the potential for
many current NHS stafng strategies and work environments to undermine the
development of cohesive working relationships is also noted. Other inuential
factors are nurses' relationships with medical staff, perceptions of their
workload and their evaluation of the appropriateness of the system of nursing
being practised. The importance of measuring nurses' subjective assessments of
their work environment is emphasized. A weak association was found between
grade and job satisfaction. Individual nurse characteristics were found not to be
associated with job satisfaction.
Keywords: job satisfaction, ward organization, working relationships, clinical
grade, nurse characteristics, work environment, British NHS, human resource
management, retention, commitment

INTRODUCTION
It has long been recognized in Britain that there is a
consistent relationship between aspects of the organization and management of hospitals, staff responses to these
processes and clinical outcomes of care. The number of
qualied nurses available to provide care in the National
Health Service (NHS) is associated with the effectiveness
Correspondence: Ann Adams, European Institute of Health and Medical
Sciences, Edward Duke of Kent Building, University of Surrey, Guildford
GU2 5TE, England. E-mail: a.adams@surrey.ac.uk

536

and efciency of nursing services (Ministry of Health

1948), while Revans (1964) pointed to the association
between staff morale and length of patient stay. More
recently, other aspects of the organization of hospitals and
individual wards have been associated with the effectiveness of hospital care as measured by patient outcomes.
These include the organization of nursing care and ways
in which hospital restructuring redenes the context for
providerpatient relations and clinical decision making
(Aiken et al. 1994, 1997). In a study of intensive care units
in the United States of America (USA), Knaus et al. (1986)
found that the pattern of communication between nurses
2000 Blackwell Science Ltd

Nursing and health care management issues

and physicians was the most important factor associated
with variation in mortality. This nding may be specic to
a culture where many physicians have patients in a single
ward and to a highly acute care setting where patients
require prompt treatment decisions. At a common-sense
level, however, where organizational environments facilitate good communication between staff, then patients are
likely to benet.
While, arguably, patient outcomes are the best measure
of the effectiveness of hospital care, also important are the
effects of hospitals on the staff they employ. Intractable
and negative staff outcomes associated with working in
hospitals are high levels of stress which undermine
performance and lead to high staff turnover (Packard &
1 Motowidlo 1987, Cavanagh & Cofn 1992, Wheeler &
Riding 1994, Janssen et al. 1999). Recent nurse recruitment and retention problems in Britain have brought this
issue to the forefront of politicians' and health service
managers' minds (Buchan et al. 1998). The United
Kingdom (UK) government's White Paper Working
Together (Department of Health 1999a) is the rst national
policy document to lay down specic requirements for the
development of a range of human resource management
(HRM) policies within the NHS. This is to ensure that the
workforce is properly equipped to prosecute the government's health improvement programme to meet national
targets (Deparment of Health 1998b), and to enhance
management and retention of the human resource. This
aim is also reected in the government's Human Resource
Management Research Initiative (Department of Health
1998c) which seeks to develop an evidence base to
underpin effective staff deployment and management
within the NHS.
This paper focuses on nurses' job satisfaction, an important facet of HRM. It is treated here as an intervening variable
between ward organization on the one hand, and job
performance and staff turnover on the other, and attends
to some of the antecedents of nurses' job satisfaction.

The importance of ward level analysis

Acute sector organizations are amenable to analysis at
different levels. It is possible to characterize the larger unit
of the hospital as a distinct entity embracing categories
such as urban, rural or teaching/non-teaching and characterized by variables such as size and range of clinical
services provided. However, hospitals can also be characterized according to management arrangements such as
degree of centralization or devolution and these are
known to have an impact on nurses' work experiences.
2 Weissman et al. (1980) found that predictors of nurses' job
satisfaction differed between hospitals, and Tovey &
Adams (1999) found differences in staff morale associated
with variation in management styles and HRM practice.
Findings derived from the important series of studies of

Job satisfaction
Magnet hospitals in the USA also pointed to the importance of hospital level differences. Those hospitals deemed
to have high quality nursing which both `magnetically'
attracted and retained staff, were characterized by a at
organizational structure and having a nurse director with a
strong position in the management executive (McClure
et al. 1982).
While hospital level variables are inuential, the ward
as a physical and social organizational unit probably
remains the most signicant unit of analysis when examining determinants of nurses' feelings about their work
and patient outcomes. The smaller clinical units within
the Magnet hospitals had organizational attributes recognized in other studies as being positively associated with
reduced mortality, namely: decentralized decision
making, standardization of nursing procedures, a high
ratio of qualied nurses and good relationships with
medical staff (Aiken et al. 1994).
The importance of the ward as an organizational unit
has also been demonstrated. Ward culture was found to
have a pervasive inuence over patterns of nurses' behaviour and their views of the work environment (Thomas
1992). These patterns are consistent between staff grades
within wards, and are related to the way in which patient
care is provided (Anderson & Choi 1980, Thomas 1992).
Moreover, wards within the same hospital have been
shown to vary on a number of organizational characteristics (Adams et al. 1995). While there are occasions when it
is appropriate to consider the relationship between
hospital as the organizational unit and nurses' job satisfaction, there is also compelling evidence that aggregating
wards to provide a hospital-level analysis masks important between-ward variation.

Job satisfaction
As well as being associated with reduced mortality,
Magnet hospitals are acknowledged as good places for
nurses to work, as evidenced by low turnover rates.
Consistent features of USA Magnet hospitals associated
with job satisfaction were greater professional autonomy,
greater control over the practice environment and the use
of nursing systems that promote accountability and continuity of care. Conversely, in other settings, higher turnover rates and propensity to leave have been associated
with job dissatisfaction (Cavanagh 1990, Irvine & Evans
1995) and stress (Cavanagh & Cofn 1992). There is a need
to understand more about the relationship between
nurses' job satisfaction and aspects of ward organization.
Different groups of job satisfaction theories can be
described as: (i) discrepancy theories, which examine
the extent to which employee needs or wants are satised
within the workplace; (ii) equity theories, which highlight
social comparisons in the evaluation of job rewards; and
(iii) expectancy theories, which focus on employee moti-

2000 Blackwell Science Ltd, Journal of Advanced Nursing, 32(3), 536543

537

A. Adams and S. Bond

vation. Job satisfaction is also conceived as an overall
rating or as the sum of several discrete dimensions of job
characteristics (Stamps & Peidmont 1986, Mueller &
McCloskey 1990, Traynor & Wade 1993). Despite these
differences there is consensus that job satisfaction may be
dened as the degree of positive affect towards a job or its
components. This is determined by characteristics both of
the individual and of the job, and particularly how work is
organized within the corporate work environment.

regard their work (Mackay 1991, Shortell et al. 1994,

Walby et al. 1994). So too are changes to job boundaries
between nurses and doctors, with extensions to nurses'
work having the effect of increasing job satisfaction for
some, while reducing it for others (Adams et al. 1998),
particularly if such work is regarded as inappropriate (Last
et al. 1992), or occurring in the absence of professional
recognition and career development (Furlong & Glover
1998).

Job satisfaction and ward organization

Individual nurse characteristics

Associations have been found between a number of

organizational features and job satisfaction. Blegen's
(1993) meta-analysis of North American studies shows a
strong relationship between stress and job satisfaction.
The importance of stress in human service work is being
increasingly recognized (Williams et al. 1998). In this
context, the way in which nurses perceive work attributes,
or their evaluations of them, may be more important than
objective measures. In this regard the recent high and
increasing levels of reported stress and work intensication among UK nurses (Harvey 1995, McNeese-Smith
1999) is likely to have a bearing on job satisfaction. Stress
is particularly associated with increasing workloads, but
also with methods of work organization which reduce
variability among patients' care needs within specic
settings, so that nurses caring for highly dependent
patients experience little respite in their pace of work.
Skill-mix strategies which transfer new clinical tasks and
areas of responsibility from other health care professionals
onto already busy nurses, while simultaneously replacing
professional nursing colleagues with larger numbers of
health care assistants, are also perceived to give rise to
increased stress and isolation (Adams et al. 1998).
Commitment to the organization, associated with staying,
has a strong relationship with job satisfaction (Blegen
1993). However, rather than being antecedent, commitment is often placed causally after job satisfaction.
Job autonomy, cited as a cause of job satisfaction is
found to be moderately related across a number of
occupational groups, including nurses (Loher et al.
1985). So too is recognition for performance, while routinization of work shows a moderate negative correlation
with job satisfaction. Interpersonal factors comprising
communication with supervisor and with peers are also
moderately correlated (Blegen 1993). Thus while having
autonomy in performing their work impacts on nurses' job
satisfaction, they also require the support of good interpersonal relationships both with manager and colleagues.
Nurses do not work in isolation and, as well as relationships with nursing peers, their relationships with medical
colleagues are important features of the work environment. The quality and quantity of interaction with
medical staff is particularly inuential in how nurses

Individual characteristics such as age, years of experience

and education are found to have lower order, but stable
correlations across studies. They have been shown to
contribute far less to the understanding of nurses' job
satisfaction than perceptions of the ward, quality of
working relationships and content and standards achieved
in work (Blegen 1993). The current study provides an
opportunity to re-examine the relative importance of
individual nurse characteristics and organizational
features arguably individual perceptions of the organization and job are more potent than objective indicators
as predictors of job satisfaction. Consequently relationships between nurses' perceptions of organizational and
structural aspects of the ward which they identied as
important, nurses' personal characteristics and nurses' job
satisfaction are examined.

538

METHODS
The Ward Organizational Features Scales (WOFS) were
developed to enable comparisons of the views of nurses
working in acute hospitals of ward structure and organization, care processes and job satisfaction. WOFS include
six sets of measures comprising 14 sub-scales (Table 1)
presented as Likert-type four-point scales.
Full details of the samples, methods of scale development and the statistical properties of scales are reported in
Adams et al. (1995). Briey, data were collected by means
of a postal survey in 1994 using a self-completion questionnaire sent to a sample of 1499 day nurses of clinical
grade C and above, listed as permanently allocated to 119
acute adult wards randomly selected from 17 hospitals
stratied to include all English health regions. Excluded
were wards in maternity and psychiatric specialities as
well as those treating highly dependent patients such as
intensive and coronary care. With one reminder questionnaire, an overall response rate of 57% was obtained,
providing a nal sample of 834 nurses. The nal sample
was biased towards the south of England (54% vs. 46%),
with a higher response rate (66% vs. 47%). We have no
reason to believe that the high level of non-response
biased the sample in ways that inuenced the results
obtained.

2000 Blackwell Science Ltd, Journal of Advanced Nursing, 32(3), 536543

Nursing and health care management issues

Table 1 Summary of scales
and their statistical
properties

Job satisfaction
No. of
items

Name of scale
I. Physical environment of the ward
Ward facilities
Staff organization
Ward layout
Quality of ward services
II. Professional nursing practice
Professional practice
Hierarchical practice
III. Ward leadership
Team-building skills of ward leader

Cronbach's
alpha

Test-retest Pearson
correlation coefcient

5
5
6
4

079
080
081
068

080
071
075
071

13
6

083
066

077
074

092

090

IV. Professional working relationships

Collaboration with medical staff
Collaboration with other health
care professionals
Cohesion amongst nurses

086

083

7
10

084
091

070
084

V. Nurses' inuence over:

Ward management
Timing of ward and patient events
Financial and human resources

10
9
5

090
085
081

080
071
078

077

077

VI. Job satisfaction

Job satisfaction

Data analysis occurred in three stages. The rst stage

explored relationships between individual nurse characteristics, job satisfaction and other WOFS scores using
analysis of variance. The second stage examined relationships between nurses' job satisfaction and their perceptions of other aspects of the ward organizational
environment by correlating scale scores using the Pearson
correlation coefcient. Finally, in order to asses the
cumulative effects of ward organizational features on
nurses' job satisfaction, multiple regression analysis was
carried out using a stepwise procedure. Job satisfaction
was treated as the dependent variable, and sub-scales of
WOFS the independent variables.

FINDINGS
Job satisfaction and individual nurse
characteristics
Mean item scores according to clinical grade are shown in
Table 2. These demonstrate variations in how positively
nurses rated the different organizational features of their
ward. Most positively rated are aspects of ward services
which include facilities and layout, while the sample as a
whole perceived that they had little control over aspects of
ward management, including when events took place or
inuence over human resources.
Between grade comparisons, using analysis of variance,
show that there are no differences between grades in the

scales measuring perceptions of ward facilities, layout or

services, but differences are obtained on all of the other
sub-scales. Differences are in the direction of more positive views of ward organization and job satisfaction the
higher the grade. The trend to lower scores in the
hierarchical practice scale is because there is an inverse
relationship between scores on this scale and the level of
development of professional practice achieved within
wards.
With regard to job satisfaction, no differences were
found between scale scores according to nurses' age, level
of education or length of ward service, while there was a
signicant difference between nurses of different clinical
grades (P < 0001). However, despite systematic grade
differences in score, these were not large, and little
variance is explained by clinical grade (r2 003). On the
strength of this nding, data used in all subsequent
analyses relate only to nurses of grades C to F. Separate
analysis for ward managers is not presented because a full
set of data is not available, i.e. the team building skills of
ward leaders was not collected from this group. Individual
nurse characteristics were not included in any subsequent
analyses.

Job satisfaction and ward organizational features

Pearson correlation coefcients of job satisfaction scores
and other WOFS scores are presented in Table 3. The

2000 Blackwell Science Ltd, Journal of Advanced Nursing, 32(3), 536543

539

A. Adams and S. Bond

Table 2 Mean scale item scores by clinical grade
Clinical grade

Name of scale
Ward facilities
Staff organization
Ward layout
Quality of ward services
Professional practice
Hierarchical practice
Team-building skills of ward leader
Collaboration with medical staff
Collaboration with other health
care professionals
Cohesion amongst nurses
Inuence over ward management
Inuence over the timing of ward
and patient events
Inuence over human and nancial resources
Job satisfaction

C
(n = 32)

D
(n = 313)

E
(n = 285)

F
(n = 91)

G and above
(n = 113)

ANOVA
P value

R2
value

32
26
35
35
31
28
29
24
30

32
26
33
38
32
27
29
27
30

32
28
33
38
32
25
293
26
31

32
28
32
38
32
23
33
26
31

34
32
34
38
35
20

28
33

<0001

<0001
<0001
<0001
<0001
<0001

003

005
011
004
002
002

27
13
17

27
17
19

29
21
21

30
28
22

33
35
26

<0001
<0001
<0001

005
058
014

10
29

12
29

12
30

18
30

33
33

<0001
<0001

062
003

Name of scale

Correlation
coefcient

Signicance
level

Ward facilities
Staff organization
Ward layout
Quality of ward services
Professional practice
Hierarchical practice
Team-building skills of ward leader
Collaboration with medical staff
Collaboration with other health care professionals
Cohesion amongst nurses
Inuence over ward management
Inuence over the timing of ward and patient events
Inuence over human and nancial resources

031
046
028
018
046
)035
033
041
026
051
025
023
020

P
P
P
P
P
P
P
P
P
P
P
P
P

highest correlations found are between job satisfaction

and cohesion of the ward nursing team (051), staff
organization (046) (which includes items about the relationship between stafng and workload), the level of
professional practice achieved within the ward (046) and
collaboration with medical staff (041).
Table 4 shows the results of including nurses' WOFS
scale scores in a multiple regression analysis using a
stepwise procedure incorporating elements of both
forwards and backwards selection of variables to identify
the most important predictors of job satisfaction.
This analysis (Table 4) shows a similar pattern in results
to those presented in Table 3, that the most important

540

<
<
<
<
<
<
<
<
<
<
<
<
<

Table 3 Correlations
between job satisfaction and
scores for other WOFS scales

0001
0001
0001
0001
0001
0001
0001
0001
0001
0001
0001
0001
0001

Table 4 Results of step-wise regression analysis

Name of scale

Standardized
regression coefcient

Cohesion amongst nurses

Staff organization
Collaboration with medical staff
Hierarchical practice
Professional practice
Ward facilities
Team-building skills of ward leader

026
020
020
)011
011
008
006

R2 = 042.

2000 Blackwell Science Ltd, Journal of Advanced Nursing, 32(3), 536543

Nursing and health care management issues

contributors to nurses' job satisfaction are the degree of
cohesion existing among ward nurses, the degree of
collaboration with medical staff and perceptions of staff
organization, respectively, i.e. the system of nursing
organization used and the perceived appropriateness of
stafng levels to cope with the ward workload. Perceptions of professional practice and the perceived team
building skills of the ward manager remain important, but
have less bearing on job satisfaction.

DISCUSSION
This study has considered the effects of both nurses'
individual characteristics and their perceptions of organizational aspects of the wards in which they work,
including perceptions of their practice and relationships
with nurses and other staff, and how these elements relate
to job satisfaction.
Most salient to nurses were their social and professional
relationships with nursing and other professional colleagues. It is fashionable to talk about multidisciplinary
teamwork and the ward team while much of the literature
is anecdotal and exhortatory (Opie 1997). WOFS do not
assess the extent of team functioning. They address
nurses' views of their relationships with nursing, medical
and other professional colleagues. The scales measuring
nurses' views of cohesion with their ward nursing
colleagues and collaboration with medical staff were
found to be the best predictors of job satisfaction.
However, the scale measuring relationships with therapy
staff was not found to contribute to nurses' job satisfaction
perhaps reecting their lesser signicance to many
nurses' work in general wards.
Ward facilities, services provided by hospital departments which have a bearing on nurses' work and aspects
of the physical environment considered to inuence
patient care, are often omitted from studies of nurses'
job satisfaction. We included these and examined the
effects of nurses' views of staff, the appropriateness of
grade mix and rostering practice for providing patient
care. These elements of ward nursing practice were all
associated with nurses' job satisfaction in a positive
direction, i.e. where they considered sufcient numbers
of skilled staff were rostered and organized appropriately,
nurses' satisfaction was greater.
The quality of the professional service nurses consider
they provide is also predictive of job satisfaction.
Certainly lack of pride in the quality of service and
perceived inability to provide a service at appropriate
standards are reported elsewhere as reasons for job
dissatisfaction, stress and leaving nursing (Mackay
1989). The professional practice scale included a number
of items related to nurses' own professional development
as well as to the involvement of patients and families in
care decisions. These ideas are regarded as `progressive' in

Job satisfaction
nursing literature and recent policy documents (Ersser &
Tutton 1991, NHS Executive 1996, Department of Health
1999a), and evidence of their importance to nurses was
found in views expressed in the qualitative phase of scale
development. The other side of the coin, as shown by its
negative correlation with job satisfaction, is hierarchical
practice. This scale reects a staff that feels they and their
work are devalued by nursing superiors and medical staff.
The team building skills of the ward manager also contributed to staff nurses' job satisfaction, as reported in other
studies (McNeese-Smith 1993, Boumans & Landeweerd
3 1993, Hart & Rotem 1995, Morrison et al. 1997). While this
variable is related to professional practice in how staff are
treated regarding professional development, it also
includes aspects of managing relationships and the atmosphere that prevails in the wards.
Thus from the range of the ward features that nurses
identied as being important to the provision of patient
care, the elements that predict their job satisfaction are the
quality of working relationships, having sufcient staff
with the right mix of skills to cope with their workload,
and to a lesser extent, achieving professional standards of
practice and personal development. Absent from this list
are the extents to which nurses have control over a range
of features of the ward. However, participation in the
aspects of ward management included in the scale was
generally at a very low level among this staff nurse sample.
This points to the need to include items in scales that have
a high degree of salience for the staff grades concerned.
We found signicantly higher scores on this scale among
ward managers. While a correlation with job satisfaction
was found, control over ward events did not predict it.
Individual nurse characteristics, with the exception of
clinical grade, were not found to be associated with job
satisfaction. However, the explanatory relationship
between grade and job satisfaction was weak. These
ndings are broadly in line with those of previous
research, where nurses' experience, tenure and position
in the hierarchy have been found to be signicantly
associated with job satisfaction (Hinshaw & Attwood
1984). However, recent qualitative work (Tovey & Adams
1999) highlighted the increasingly different work experiences of ward managers (G grade) compared with nurses of
lower clinical grades, suggesting that grade differences
may become more marked in future. Ward managers are
frequently dissatised because they feel under pressure to
take on additional work roles for themselves and their
staff, both managerial responsibilities and expanded clinical roles, which causes them to experience role conict.
On the other hand, managers derive greater satisfaction
from team working with other disciplines. Nurses of lower
clinical grades are dissatised with low stafng and
perceived falling standards of care provision, as well as
with local Trust management practice and service-wide
changes in the NHS (Robinson et al. 1999).

2000 Blackwell Science Ltd, Journal of Advanced Nursing, 32(3), 536543

541

A. Adams and S. Bond

Our qualitative work that preceded scale construction
led to the conclusion that nurses are an increasingly
heterogeneous group with regard to job satisfaction and
given the increasing diversication and extension of
nurses' work roles (Adams et al. 1998, Department of
Health 1999b), this trend looks set to continue. While the
ndings presented in this paper demonstrate that clinical
grade explained little variance in nurses' experiences of
job satisfaction in the mid-1990s, it may be that data
collected at the present time would reveal a stronger
relationship between these two variables. The increasing
heterogeneity evident in nurses' work roles needs to be
reected in future empirical work.

CONCLUSION

Acknowledgements

This paper has highlighted the importance of organizational features of acute hospital wards as predictors of
nurses' job satisfaction, over and above the importance
of individual nurse characteristics. It also points to the
importance of exploring subjective perceptions of elements of the physical work environment, work processes
and job design, rather than relying purely on objective
measures. By using scales grounded in nurses' views of
their work, they were able to alert us to the importance
of several new factors likely to impinge on providing
good quality patient care and which affect their job
satisfaction, and which seldom appear in traditional
studies or measures of their work experience. These
include the quality of ward facilities and of services
provided to the ward by other departments, which affect
nurses' ability to do their work. Most importantly,
nurses highlighted their perceptions of the appropriateness of the balance between number of available staff,
skill mix, care organization and rostering practice and
the ward's workload as a major inuence on their job
satisfaction.
Overall, relatively high levels of job satisfaction were
found among staff, at a time of immense change in the
health care system in the UK. In particular, the study
reinforces the importance of the quality of nurses' working
relationships in enhancing job satisfaction. Even in times
of turbulence and objectively high workloads, similar
factors impact on job satisfaction. Our research demonstrates that the cohesiveness of the ward nursing staff is
the most important working relationship for nurses, with
the most signicant impact on their job satisfaction. Yet its
development requires staff stability and a sufcient core of
permanent staff. These conditions are threatened by
recruitment and retention difculties and reliance on
transient staff because of the HRM policies emphasizing
exibility. Recent proposals for continuing to expand
nurses' work roles to make better use of their knowledge
and skills (Department of Health 1999b) are likely to
exacerbate these conditions.

542

In order to break the negative cycle of job dissatisfaction

leading to reduced commitment and turnover, and to solve
recruitment and retention problems, our ndings suggest
that NHS managers need to focus attention on creating
conditions that facilitate intra-professional teamwork
amongst nurses and inter-professional teamwork with
medical colleagues. This requires long-term commitment
to resourcing, workforce planning and achieving strategic
aims such as those set out in Working Together (Department of Health 1999a). Cohesive ward nursing teams
developed with the capacity to support each other while
coping with heavy workloads are needed to yield the
health improvements cherished by our political masters.

We would like to thank all the nurses and managers who so

generously gave their time to assisting us in this study, and
research staff at the Universities of Surrey and Newcastle
who assisted with data collection. The study was supported
by a grant from the Department of Health. The views
expressed are those of the authors and not the funding body.

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