1

Chapter -1

1. TITLE: Job Satisfaction among Nurses Working in Public Sector Hospital of Multan.

2. INTRODUCTION:

The widespread nursing shortage and nurses’ high turnover has become a global

issue (Kingma,2001).which is increasing day by day both in developed and developing

countries (Cavanagh,1990).So, concern about recruitment and retention of nursing staff is

getting attention of Health Care (Profession Lund,1999).While numerous factors have

been linked to nurses’ turnover, job satisfaction is the most frequently cited

(Cavanagh,1992).Pakistan has a major shortfall of human resource for health. Research

suggests that the private health sector is generally well organized and has better working

conditions with reduced job security. The health workers within public health sector face

issues which mostly relate to job satisfaction. Job satisfaction depends upon many

factors, efficiency and productivity of the human resources is one of the most important

among them. Human resource in any institution is the most valuable asset and it works as

an engine to provide a sustainable service delivery Hafeez A, Khan Z,et al (2009).An

individual’s perception in the organization plays a vital role in job satisfaction Anton

(2009).

In healthcare setting doctors’ satisfaction plays a great role in their performance

and satisfaction among their patients. Similarly nurse’s job satisfaction in their jobs

determines whether their roles are fulfilled towards service delivery for their clients of

various communities Haas JS (2000).Job dissatisfaction was strongly associated with

organizational factors and poor working conditions, social aspects of the job were found
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to be a important factor in job satisfaction as well Kekana HP Curationis (2007). In

Pakistan, the nursing profession has been experiencing a workforce shortage in recent

years, making nurses a precious resource. The substantial shortage of nurses is mainly

due to their emigration to developed countries in search of better pay and job prospects.

The work-life issues threatening retention of nurses is of serious concern for health

administrators. The Joint Learning Initiative Report in 2004 and the World Health Report

in 2006 have listed Pakistan as one of the 57 countries with critical workforce

deficiencies MA: Harvard University Press; 2004. Although there are 109 nursing

schools and colleges in the country, shortage of nurses is still a problem of national

concern with over 44,000 registered nurses in Pakistan. With a comparatively high nurse

to population ratio ie, 1:3,043, the 965 largely urban-based hospitals are facing a shortage

of this vital cadre of the health system.

This dearth of the nurses becomes obvious in light of the reversed doctor to nurse

ratio of 2.7:1 in the country Nishtar S(2013). The nursing shortage results in a “brain

drain” of this vital source from low income countries. A range of factors has been shown

to contribute to the shortage of nurses, including poor job satisfaction Aiken LH (2001).

Findings from studies in Pakistan reveal that the most dissatisfying factors at work and

within the work setting are high workload, the stress associated with that high workload,

biased nursing management, lack of appreciation or monetary incentives, and a rigid

attitude on the part of nursing management. The most satisfying factors were working

with an internationally reputable organization, getting positive feedback from patients,

and the availability of necessary materials and equipment Khowaja K (2005). Findings

from studies in Pakistan reveal that the most dissatisfying factors at work and within the
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work setting are high workload, the stress associated with that high workload, biased

nursing management, lack of appreciation or monetary incentives, and a rigid attitude on

the part of nursing management. The most satisfying factors were working with an

internationally reputable organization, getting positive feedback from patients, and the

availability of necessary materials and equipment Bahalkani HA (2011). The literature

identifies several factors influencing levels of job satisfaction among nurses. Positive

interpersonal relationships (loyalty, trust, sharing of common values) and quality of care

have been associated with higher levels of job satisfaction. When nurses perceive patient

care as being central to their work, their job satisfaction improves. Clearly defined roles

and responsibilities, a balanced workload, and reward for effort are also related to higher

levels of job satisfaction.

Literature suggested that job satisfaction levels among nurses are limited, so the aim of

this study to determine prevalence of job satisfaction.

3. Objective(s)

The objectives of this study are,

1:To determine the prevalence of job satisfaction among nurses working in Nishtar

hospital Multan.

2:To determine the relationship between socio-demographic factors and the level of job

satisfaction.
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4-Significance of the Study

The purpose of this study is to identify factors that affect job satisfaction and

therefore provide relevant information that can assist the hospital management in the

formulation of sound policies aimed at increasing job satisfaction and retention among

the nursing staff at public sector Hospital.The findings from this study will be useful to

other Public and Private Health Institutions in promoting Job Satisfaction and

formulating strategies aimed at retention of qualified staff.The findings from this study

will contribute to knowledge in the area of job satisfaction.

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Chapter 2

5-LITERATURE REVIEW

There is voluminous literature on job satisfaction. The literature available

indicates that job satisfaction is key to high or low performance. Further, they also agree

that employees have different needs and therefore managers must recognize this as a fact

as they rethink on how well to motivate their employees. Some of the factors that

determine employee satisfaction are company and administrative policies, supervision,

remuneration, interpersonal relations, working conditions, work itself, achievement,

recognition, responsibility and advancement.

One of the major contributors to the study of job satisfaction was Herzberg. He

claimed that factors leading to job satisfaction are separate and distinct from factors

leading to job dissatisfaction. These growth or motivator factors are a feeling of

achievement from a job, recognition for doing a good job, having a meaningful piece of

work, gaining increased responsibility and opportunities for advancement. These factors

are intrinsic to a particular job and are related to productivity. Dissatisfaction - avoidance

or hygiene factors are extrinsic to the job and include company policy and administration,

supervision, interpersonal relationships, working conditions and salary. Improving these

conditions alone if they are poor, would not result in satisfaction.

They still can be influential, however in affecting attitudes towards work if they

are not at a minimally acceptable level. Herzberg’s work has provided the theoretical

basis for numerous works on job satisfaction in nursing and allied health, and most scales

assessing job satisfaction are based on this conceptual framework (Dessler C,

2005).There is an old adage that says “you get what you pay for”. This is true when it
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comes to employees. While remuneration alone is not a sufficient condition for high

satisfaction, it is a necessary condition for the same.

The nursing occupation is physically demanding as the handling of heavy loads is

often involved (moving, repositioning and lifting patients), and also due to the

movements and postures that are expected in many work situations. Irvine and Evans

(1995) also outlined the importance of work characteristics (routine, autonomy and

feedback), characteristics of how the work role is defined (role conflict and role

ambiguity) and characteristics of the work environment (leadership, stress, advancement

opportunities and participation) in relation to nurses’ job satisfaction.Schrader and others

(2001) conducted a research to examine the relationship between work satisfaction,

stress, age, cohesion, work schedule and anticipated turnover. They used a cross-sectional

design in which 240 nurses and five nurse managers from 12 nursing units completed a

questionnaire. Based on the data reviewed, the researchers found that nurses experience

moderate levels of job stress, but cohesion was above average for all nursing units

(Shrader et al. 2001).

However, they found that the more the job stress, the lower the cohesion, the

lower the work satisfaction the higher the anticipated turnover. The higher the work

satisfaction, the higher the group cohesion and the lower the anticipated turnover. The more

stable the schedule, the lower the work stress, the lower the anticipated turnover, the higher

group cohesion and the higher the work satisfaction (Shrader, et al 2001).Generally,

individual employees strive to do a good job as long as they are placed in positions that use

their talents and where goals are clearly defined and achievable.
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Indeed the broad role of a manager is to provide necessary direction, guidance and

support in clarifying goal path and removing any obstacles which may hinder attainment of

the goal. Individuals should also receive regular and timely feedback on how they are doing

and should feel they are being adequately challenged in their jobs.Their success will not

necessarily have to be high. Employees also want to be rewarded for their achievement

through advancement or grant of bonus.Recognition of good performance is an important

aspect that raises job satisfaction and boosts one’s morale. Indeed, Coughlin (2000)

reported that nurses ranked peer recognition high in a study conducted amongst staff

nurses.

The study identified that the behaviour that directly influences job satisfaction of

nurses was giving them timely recognition and appreciation for their good performance.

Similarly, McNeese (1997) noted that nurses reported that job satisfaction was most

influenced when a manager gave recognition, praise and thanks.Inadequate staffing in most

organizations leads to overloading of existing capacity. Nonaccomplishment of tasks is

effectively likely to lead to frustration and stress leading to burnout. Burnout is a

phenomenon closely associated with job stress brought about by heavy workload. Toscano

(1998) and Ponterdolph conducted a research to investigate any correlation that might exist

between the personality trait of hardiness and burnout, (A syndrome of emotional

exhaustion and cynicism that occurs frequently among individuals who do ‘people work’

of‘some kind).

The researchers administered a questionnaire to 100 nurses. Khowaja et al (2005)

noted that workload was a major contributor to job dissatisfaction. The nurses felt that
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because of the shortage of staff, absenteeism, performing non-nursing tasks such as feeding

and removing linen from washrooms increased their workload

Chapter-3

Material and Methods.

Study Design: A cross sectional descriptive study design will be adopted.

Study Settings: This study will be conducted in a Public Teaching Hospital of

Multan, Nishtar Hospital Multan.

Sample technique: Nurses will be selected by simple random sampling.

Sampling population

-----------------------------------------------

Sampling Size Calculation:

Formula:

Z 2 * (p) * (1-p)
ss =
c2

Where:

Z = Z value (e.g. 1.96 for 95% confidence level)

p = percentage picking a choice, expressed as decimal
(.5 used for sample size needed)
c = confidence interval, expressed as decimal
(e.g., .04 = ±4)
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Nishtar Hospital will purposively select for the study. The sample size will be

drawn by systematic random sampling techniques from the Nurses present at time

of survey in Nishtar Hospital in different ward

10a. Inclusion Criteria:

All Nurses working in different wards from more than 2 years, will be included in

this study.

Age above 22 years.

Females, passed Diploma in General Nursing And Midwifery.

Having Experience more than 02 years.

Exclusion Criteria:

Physically disabled Nurses will be excluded,

Not willing to participate

11- Data collection procedure:

A structured questionnaire will be used for collection of data. The

questionnaire has been adopted by the researcher under the guidance of advisor.

Investigator will collect data himself. The proposal will be checked by the

institutional review board. The clinical where the study is to be carried out,

permission will be taken from their concerned authorities. Purpose of the study
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will be explained to the participants. Confidentiality will be maintained of all the

information’s. Formal consent will be taken from the participants. The

participants will be allowed to withdraw from the study if they do not want to

participate. The participants will be explained the procedure. After 20 minutes the

questionnaire will be returned to the investigator. Incomplete questionnaires will

be excluded from the study.

Ethical Consideration

We will ensuring quality and integrity of our research.

We will seek informed consent.

We will respect the confidentiality and anonymity of our research respondents.

We will ensure that our participants will participate in your study voluntarily.

We will avoid harm to our participants.

Chapter-5

12-Implications:

Conclusion
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Quality of health care delivered to the patients can be improved not only by

strengthening the interpersonal relationship of nurses but also by facilitation of their

capacity. In a study from tertiary care hospital of Multan, most nurses were found to be

satisfied with their organizations Nizami A 2006. However, key subject of dissatisfaction

has not been raised. The income at that time might have been sufficient to meet the daily

requirements of life and researchers did to scrutinize this aspect in context of their job

satisfaction.

Nurses in tertiary care hospitals always seem to be overburdened and they are not paid in

accordance with their strained job. That is why most leave the government set up in

search of better salary package. Utriainen K, Kyngas H 2009. A study from Kuwait

showed that the nurses working in five general hospitals of Kuwait were dissatisfied with

professional opportunities and extrinsic rewards but expressed their satisfaction with duty

schedule, respect and recognition Al-Enezi N 2009.

In another study, more men left the nursing profession than women for better

salary packages and more convenient working hours Rajapaksa S 2009.In this study,

65.71% and 80% nurses were satisfied with attitude of male and female patients

respectively. Probably these results are due to the fact that males constitute the

dominating members of our society. Males in our set up must be well mannered so that

nurses do not have any inferiority complex pertaining to their profession. Nurses pay

special attention to the patients day and night and must also be appreciated by their

supervisors and seniors for their hectic duty. Attitude of patients’ attendants was

satisfactory in the opinion of only 47.14% nurses. Only 12.86% nurses were found to be

highly satisfied with their job while 37.14% expressed their least satisfaction with
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nursing profession. Their degrees of satisfaction are manipulated after analyzing various

variables of job satisfaction that have been mentioned in the questionnaire (Annexure I).

A study of nurses working in public and private hospitals of Rawalpindi and

Islamabad, 80.4% were found to be satisfied with their career as nurse Another Shaikh

MA 2004. study revealed that job satisfaction and retention among nurses can be

promoted by incorporation of social support Abu AL Rub RF 2009..The need for

improvement of work environment for nurses and provision of more educational

opportunities have been highly emphasized to accentuate the job satisfaction among

nurses and decline their turnover rates Baernholdt M 2009.

Annexure I
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Questionnaire

Hospital ________________ Date: ____________

SECTION-A

1. Name (optional) ___________________________

2. Age ______________

3. Gender ____________

4. Marital status ________________

5. No. of children (if any) ________________

6. Resident of: Rural Urban

SECTION-B

7. Place of posting: ward-5, ward-7, Labour Room.

8. Department ______________________

9. Student Nurse Staff Nurse

10. Working hours _______________

11. Salary ________________

12. Is your salary enough for your expenditures? Yes No

13. Working environment: Good Satisfactory Bad

14. Part time job: Yes No

15. State, if any __________________

16. Attitude of Doctors: Co-operative Non-cooperative

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17. Attitude of fellow nurses: Co-operative Non-cooperative

18. Attitude of Paramedical staff: Co-operative Non-cooperative

19. Attitude of Patients: Males Co-operative Non-cooperative

Females Co-operative Non-cooperative

20. Attitude of Attendants: Co-operative Non-cooperative

SECTION-D

21. Boarder Non-boarder

22. No. of occupants in one room __________________________

23. Condition of Mess: Good Satisfactory Bad

24. Laundry service: Provided Not provided

25. Water Supply: Filtered not filtered

26. Ventilation: Adequate Inadequate

27. Condition of toilets: Good Satisfactory Bad

28. Entertainment facilities, state __________________________________

29. General hygienic conditions of the hostel: Good Bad

30. If Non-boarder:

A- Place of residence _______________________

B- Living with Husband Parents Private hostel

C- Transport facilities provided not provided

D- Traveling expenses ___________________________________

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SECTION-E

Teaching / Training of Nurses

31. Are the teachers trained? Yes No

32. Do you get enough time for rest? Yes No

33. Do you get enough holidays? Yes No

34. Is the job tiring for you? Yes No

Any Suggestions:

_________________________________________________________________

________________________________________________________
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