Analysis Of Job Satisfaction Of Professional Nurses In Public And Private Sectors

Project and Seminar Material for Nursing (Science)

Abstract

This study investigated the job satisfaction of professional nurses in public and private health sectors in Anambra State. A survey design was employed and a study population of 5903 comprising all professional nurses in private and public hospitals was used. Proportionate stratified random sampling technique was used in selecting a sample of 375 nurses for the study. Instrument for data collection was a structured questionnaire. Data collected were analyzed using mean and standard deviation statistical tool to answer the four research questions and t-test statistical tool was used to test the four hypotheses.

Findings showed that nurses in public hospitals were satisfied from job security unlike nurses in private hospitals. Nurses in public and private hospitals were satisfied from job control/ responsibilities. Also, it was found that opportunity for advancement guarantees job satisfaction to nurses in public and private hospitals. Based on the findings, it was recommended that hospital management should create a work environment that is free from dissatisfiers in order that nurses would carry out their duties effectively towards the actualization of organization’s goal. Few relevant areas that the present study did not cover were suggested for further investigation.

Chapter One

Introduction

Background To The Study

Output in terms of performance in any given organization is a function of many variables which job satisfaction is one of them. Job satisfaction which is equally understood and sometimes referred to as “work satisfaction” has been variously defined in the literature. Job satisfaction is the extent to which an employee expresses a positive orientation towards a job. It also describes how content an individual is with his or her job. Job satisfaction has also been defined as a pleasurable emotional state resulting from the appraisal of one’s job, an affective reaction to one’s job and an attitude towards one’s job (Chimanikire, Mutandwa, Gadzirayi, Muzondo, & Mutandwa, 2007; Thompson & Phua, 2012).

Job satisfaction is a worker’s sense of achievement and success on the job. It is generally perceived to be directly linked to productivity as well as to personal well-being. Job satisfaction implies doing a job one enjoys, doing it well and being rewarded for one’s efforts. Job satisfaction further implies enthusiasm and happiness with one’s work. Job satisfaction is the key ingredient that leads to recognition, income, promotion, and the achievement of other goals that lead to a feeling of fulfilment (Kaliski, 2007).

Job satisfaction has continued to be a major area of interest in the study of industrial and organizational psychology because of the presumed and common-sense linkages between satisfaction and other mainstream concepts.

like leadership, performance, reward system and group process (Poole & Warner, 2000). Furthermore, job satisfaction has been an interesting construct for researchers in understanding employee behaviours and attitudes (Zurn, Dolea & Stillwell, 2005). Despite the number of studies that dealt on different aspects of job satisfaction, Boles, Wood and Johnson (2008), stated that more studies are needed on job satisfaction because of several reasons. According to them satisfaction with the job is directly related to organizational commitment, behaviours and actions. To this end therefore job satisfaction among professional nurses should be of great importance and concern to any health organization, sector or nation given the pivotal role that nurses play in determining the efficiency, effectiveness and sustainability of health care delivery system. It is therefore imperative to understand what motivates nurses and the extent to which the organization and other contextual variables, add up to achieve satisfactory performance output in the overall health care delivery system. This is necessary going by the fact that job satisfaction is an essential part of ensuring high quality care and performance output (Lambert, Hogan & Barton, 2001; Mount, Ilies & Johnson, 2006). Job satisfaction does not necessarily concern the professional nurses only, but cuts across the entire system – patients and patients’ relations, hospital management as well as health sector, health organizations, and indeed the entire nation. The inaction or inability of any organization to achieve a reasonable level of job satisfaction among her workforce will lead to dissatisfaction.

Job dissatisfaction generally, has been frequently cited as the primary reason for low/poor quality output, non-commitment, low productivity and high rate of staff turnover among others. Dissatisfied nurses not only give poor quality, less efficient care, there is also evidence of a positive correlation between professional nurse satisfaction and patient satisfaction and outcomes (Tzeng, 2002; Tsang, 2002, Takase, Maude & Manias, 2005). Nurses who were not satisfied at work were also found to distance themselves from their patients and their nursing chores, resulting in sub-optimal quality of care (Demorouti, Bekker, Nachreiner & Schaufeli, 2002).

The growing importance attached to studying job satisfaction especially among the professional nurses in recent times is not far-fetched. For instance, there is a growing need to strengthen health system in Nigeria to help meet the Millennium Development Goals (MDGs). It is widely believed that a key constraint to achieving the MDGs is the absence of a properly trained and motivated work force of which nurses are part and parcel, and improving the health workers working conditions is critical for health system performance (FMOH, 2007). In addition, the HIV/AIDS epidemic is compounding the problem by creating a stressful environment for health workers through increased workload, exposure to infection and reduced morale.

The organization of the health care system in Nigeria is pluralistic and complex. It includes a wide range of providers, comprising the public health institutions and a large and equally growing private sector, made up of private-for-profit and private-for-non-profit providers, e.g. Non-Governmental Organizations (NGOs), Religious, Spiritual and Traditional Care Providers. This situation is equally the same in all the 36 States of the

Federation including Anambra State. Anambra State health care system consists of public sector health institutions that serve both the indigent and the affluent in the society, and the private health providers that specifically cater for the segment of the population that can afford their services.

Outside public health institutions, the private sector hospitals, maternity homes and clinics provide about 80 percent health services to Nigerians (Federal Ministry of Health, 2007). Despite these remarkable contributions of the private sector to the overall health care need of the country, the sector are not very well supported (Kwahar & Ukeh, 2012). Evidence from the literature, however, shows that the sector lags behind in training and refresher courses (Larbi, 2004). With the exemptions of few non-governmental and mission hospitals, most private sector hospitals are privately owned and run by the physicians (doctors) who oversee the management of the hospitals on one man basis. Most of the job satisfaction variables such as opportunity for advancement, recognition, job security, working conditions, interpersonal relationship, etc. are not regulated and policy driven in private sector as obtained in public health sector. This situation, therefore, makes a critical evaluation of job satisfaction variables in the sectors worthwhile considering the rate of nurses’ turnover in both sectors.

Statement of the Problem

It is believed that the satisfied employee can provide good service while a low level of employee job satisfaction can result to difficulties in increasing service quality. To ensure the achievement of firm goals, organisations create atmosphere of commitment and cooperation for its employees through policies that facilitate employee satisfaction. However, Kwahar and Ukeh (2012) found that there has been a general lack of satisfaction with jobs in Nigeria. Evidence from Ruggiero (2005) suggests that there is widespread lack of job satisfaction among nurses. Coupled with a critical shortage of registered nurses, this situation threatens the provision of safe healthcare. One way of ensuring optimum satisfaction of nurses in the health sector for maximum performance is to appraise the overall working conditions, job security, interpersonal relationship, recognition, advancement, etc of nurses. This requirement as suggested here is presumed on the premise that output in terms of performance in any organization is a function of many variables of which job satisfaction is inclusive.

Evidence from the literature shows that absence of job satisfaction leads to increased stress and frustration which result in physical, emotional and behavioural problems, lower productivity and abandonment of nursing profession (Kendrick, 2000; Robertson, Birch & Cooper, 2012), high turnover of nurses and increased rates of absenteeism (Larabee, 2003; Siu, 2002), as well as migration to other countries especially United States of America and United Kingdom, in search of better remuneration. These, nonetheless, are not healthy for the development of the health sector. Hence, these unabating penchant and unhidden desires of many professional nurses to either move from private sector to public sector, or move from both sectors to outside the country for whatever reasons call for an in-depth empirical study. This researcher therefore speculates that these unhidden desires and unabating penchant for the (intra and extra) movements might be because of the desire for better or improved job satisfaction. However, the unavailability of recent and empirical inter-sectoral research studies on professional nurses’ movements in Nigeria create a serious gap in the literature. It is against these backdrops that this study is being carried out to analyse the job satisfaction of professional nurses in public and private hospitals in Anambra State, Nigeria.

Purpose of the Study

The main purpose of this study was to compare the job satisfaction of professional nurses in public and private health sectors in Anambra State.

The study is also set to achieve the following specific purposes:

To determine the level of satisfaction nurses derive from job security in public and private hospitals.
To determine how recognition of nurses’ performances in public and private hospitals provide job satisfaction.
To identify the extent to which opportunity for advancement guarantees job satisfaction to nurses in public and private hospitals
To ascertain the level of satisfaction nurses derive from job control/responsibilities in public and private hospitals.

Research Questions

Based on the objectives, the following research questions are posed:

What level of satisfaction do nurses derive from job security in public and private hospitals?
How does recognition of nurses in public and private hospitals provide job satisfaction?
To what extent does opportunity for advancement guarantees job satisfaction to nurses in public and private hospitals?
What level of satisfaction do nurses derive from job control in public and private hospitals?

Research Hypotheses

The following Null hypotheses were formulated to guide the study.

There is no significant difference in satisfaction from job security between nurses in the public and private hospitals
There is no significant difference in satisfaction from recognition between nurses in public and private hospitals
Opportunity for advancement does not significantly guarantee job satisfaction between nurses in public and private hospitals
Job control does not have significant effect on job satisfaction between nurses in public and private hospitals

Significance of the Study

The relevance and benefits of this study cut across different strata of the stakeholders and participants in the health sector. It provides health sector managers some useful insights on the factors that would be addressed to achieve professional nurses’ job satisfaction towards delivering effective and efficient health care to the publics. Consequently, government, organizations and non-governmental organizations that operate in the nation’s health sector through this study know where and what to contribute towards improving health care delivery. Again, the study’s findings would guide the nurses in taking informed decisions that would guarantee their job satisfaction and fulfillment. Finally, the study would guide health managers in handling health related issues as they concerned the nurses and industrial crisis within the health sector. The society also will benefit from the study because, when nurses are satisfied with their job, they will render quality services to the society.

Scope of the Study

This study is delimited to professional nurses’ job satisfaction in both public and private health sectors of Anambra State. As a comparative study, the job satisfaction variables considered in this study were; job security, opportunity for advancement, recognition and job control.

Operational Definition of Terms

Job satisfaction:

This is the degree of positive affective orientation an individual has toward a job.

Job satisfaction variables in this study refer to:

Job security:

The nature and state of contractual agreement that guarantee steady or permanent employment, e.g. assurance of financial assistance, benefits and welfare in case of accident and disability arising from the job.

Status recognition:

Refer to involvement in decision making, verbal or written award or commendation due to high performance as sources of inspiration and motivation.

Professional development opportunities: Refer to encouraging and sponsoring the nurses to national, regional, and international conferences, seminars, workshops and training that will boost their professional standing and status.

Ranking of job satisfaction variables:

Refer to assignment of numbers from 1-7 to represent different values along the continuum in the scaling of job satisfaction variables.

Public health institutions:

Publicly owned hospitals that depend on government subventions for its operations and are not strictly out to make profits, State teaching hospitals, medical centres, model health centres, general hospitals, etc.

Private health institutions:

Privately owned hospitals that depend on the owner(s) for its financing and are strictly out to make profits. Mission hospitals, individually owned private hospitals, clinics, maternity homes.

Private health workers:

This refers to nurses working private health institution.

Public health workers:

This refers to nurses working in public health institution.

Chapter Five

Discussion of Findings, Conclusions and Recommendations

This chapter presented the discussion of findings on data presented in chapter four and inferences drawn therein, conclusion, implications of the study, limitations of the study, recommendation and suggestion for further study.

Discussion of Findings

Discussion was based on the research questions and the tested Null hypotheses. The findings of this study were also compared with empirical studies done previously by other researchers.

Nurses’ Satisfaction from Job Security

The result of the study indicated that nurses in the public hospitals were satisfied with job security while nurses in the private hospitals were not. This finding is supported by Rao & Malik (2012) who found that more number of government hospital nurses have job security as such they are more satisfied with their job whereas most of the private hospital nurses do not have security with their job as such they seemed to be less satisfied. Chimanikire et al., (2007) also supported that even though most employees indicate that their jobs were relatively secure, most of them expressed overall lack of satisfaction.

Nurses’ Satisfaction from Recognition

Result showed that nurses in the public hospitals were satisfied with recognition while nurses in the private hospitals were not satisfied with recognition. To this end, Barker & Guzman (2012) supported that the use of recognition is a very effective tool to assist facilities in the promotion of job satisfaction and nurse retention. Barker & Guzman also observed that many nurses do not feel their work is rewarded or appreciated while some do. Lephalala, (2006) also agreed that recognition was low in private hospitals as nurses’ opinions were undervalued by medical staff (mostly the medical doctors). Danish & Usman (2010) reported that there was a significant relationship between recognition and work motivation and satisfaction.

Nurses’ Satisfaction from Opportunity for Advancement

From findings nurses in the public hospitals were satisfied with the opportunity for advancement whereas nurses in the private hospitals were not satisfied with opportunity for advancement in their career. Rao & Malik (2012) agreed that growth opportunities are available more in government hospitals thus nurses from this sector are more satisfied than their counterparts from the private hospitals. Lephalala (2008) also found that advancement opportunities were portrayed in the nurses’ perception as being in a dead-end in private hospitals. Chimanikire et al., (2007) observed that some employees felt that the current environment does not promote personal growth and academic advancement. While, Hill (2011) supported that employees are more satisfied with their current job if they see a path available to move up the ranks in the company and be given more responsibility and along with it higher compensation.

Nurses’ Satisfaction from Job Control/Responsibilities

Results revealed that nurses in both public and private hospitals derive satisfaction from job control. This was supported by Waskiewicz (1999) who noted that if the characteristics of the job are enhanced, job satisfaction is increased. Archna, (2012) and Judge and Bono (2011) also noted that job responsibility/control results in job satisfaction

Difference in Satisfaction from Job Security between Nurses in Public and Private Hospitals

The Null hypothesis showed that there is a significant difference in satisfaction from job security between nurses in the public and private hospitals. This view was supported by Rao and Malik (2012) who stated that job security is more in government nurses (82%) whereas in the private sector nurses’ job security level was low as 72% of nurses were not satisfied.

Difference in Satisfaction from Recognition between Nurses in Public and Private Hospitals

The Null hypothesis showed that there was a significant difference in satisfaction from recognition between nurses in public and private hospitals. Abushaikha and Saca-Hazboun (2009) agreed also that there is disparity between government and private healthcare sector in recognition of nurses’ performance.

Opportunity for Advancement and Job Satisfaction

The Null hypothesis indicated that opportunity for advancement significantly guarantees job satisfaction between nurses in public and private hospitals. According to Robertson, Birch and Cooper (2012) there has been a relationship found between perceived opportunity for advancement and job satisfaction. Abushaikha and Saca-Hazboun (2009) supported this view by observing that lack of advancement opportunities and supportive hospital policies contribute to job dissatisfaction.

Effect of Job Control on Job Satisfaction

The Null hypothesis showed that job control does not have significant effect on job satisfaction between nurses in public and private hospitals. This finding is in line with Shimazu et al., (2004) who observed that job satisfaction does not depend on job control and Robertson, Birch and Cooper (2012) who noted that there is no positive relationship between variety of job responsibilities and job satisfaction.

In this study, nurses in public health care settings were more satisfied with their job than private nurses. This could be attributed to structural and functional differences between public and private hospitals. It was based on the fact that government hospitals offer better facilities, more incentives and superior service conditions to nurses compared with private hospitals, which usually have limited financial and human resources to offer to employees. The disparity between government and private health care settings continues to be an issue of debate and warrants more in-depth investigation.

Conclusion

From the findings of this study, it was obvious that job satisfaction was high among nurses in public hospitals than nurses in private hospitals. The study equally shows that government guarantees job security to its employees more than private individuals. Finally, nurses in both public and private hospitals were satisfied with job control in their career.

Implications of the Study

The findings of the study have far reaching implication for stakeholders in the health sector. Nurses in private hospitals as the study reveals are less satisfied with their jobs. Consequently, since low level satisfaction leads to absenteeism, labour turnover and negative publicity of the organization, management of private hospitals would be faced with these vices because an unsatisfied worker can prove to be a liability to the organization just as Igbal (2012) submits that a higher job satisfaction is associated with increased productivity, lower absenteeism, and lower employee turnover. Conclusively therefore, happy and satisfied worker is always a productive worker and this to a reasonable extent was the case in public hospitals but not so in the privately owned hospitals in Anambra State.

Limitations of the Study

This study had some limitations that must be acknowledged though they did not affect the final outcome and results. Firstly, the distribution of the questionnaire was a hectic task because of the spatial geographical location of the hospitals. This almost affected the distribution and collection of the copies of questionnaire on-the-spot.

Secondly, the study employed the survey method of generating information from the respondents through questionnaires relied on subjective or qualitative responses which were somehow difficult to quantitatively validate.

Recommendations

Based on the findings of this study, the following recommendations were proffered:

Management should encourage employees to take responsibility for their own job satisfaction by developing an environment that allows them the scope to perform well. In this environment, employees need to accept that responsibility and take steps to build on their own satisfaction.
Because career opportunities and further training afford professional nurses the prospect of further developing themselves, and growing within the ranks of their career. Health managers in both sectors should provide nurses with the enabling facilities to actualize their desires in this respect.
Effective strategies for motivation and retention of professional nurses in both sectors should be centered on creating a stimulating, challenging and friendly working environment by health managers.
Health managers should recognize the needs of nurses and work towards improving them to address the cases of increasing migration of nurses from private sector to public sector and from both sectors to outside the country.
Management of private hospitals should strive to create enabling environment similar to what is obtained in public hospital in terms of job security to discourage staff turnover.

Contribution to knowledge

This study highlighted the obvious disparity on the level of job satisfaction of professional nurses working in the public and private health sectors of Anambra State. Giving the pivotal roles nurses’ play in the effective and efficient health care delivery in Anambra State, it therefore becomes imperative for health managers especially those in private sector to address holistically the four core variable identified in this study namely: job security, performance recognition, opportunity for advancement and job control as antidotes to professional nurses job satisfaction and retention. Furthermore, improving the private sectors working environment to be congruent with the aspirations, expectations and values system of professional nurses is more likely to increase satisfaction of nurses working in this sector. This consequently will have positive and endearing effects on both professional nurses and Anambra State health sector.

Suggestion for further studies

Job satisfaction no doubt represents one of the most complex areas facing managers under human resources management. Despite thousands of papers and researches conducted on job satisfaction all over the world, the area is still in exhaustive. While the changing work environment portends new research interest, the need to revisit past research finding in line with the modern trends became obvious hence making it necessary for further and more studies on job satisfaction. On this note therefore, the researcher suggested for further studies in the following areas;

Comparative study of job satisfaction variables among professional nurses and other health workers e.g. Pharmacist, Laboratory Scientists, Doctors, etc.
Gender issues, female dominance and job satisfaction in Nursing Profession and career.
Job satisfaction levels of professional nurses based on their area of specialization and practice, among others.

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