Effects of job satisfaction on employee turnover: intentions among nurses employed in Jeddah City hospitals in Saudi Arabia
Abstract
The purpose of this study was to identify the facets influencing job satisfaction and intention to quit of nurses employed in Jeddah city, Saudi Arabia
The global nursing shortage and the high turnover rate of nurses has become a world-wide problem in most healthcare system in terms of cost, the ability to care for patients and the quality of service . However, Saudi Arabia is currently facing a significant chronic shortage of nurses and a high level of turnover. a high level of job satisfaction on the part of nurses is an important precaution in terms of reducing their intention to quit . Thus, it is important to understand how job satisfaction influences on nursing turnover . This study identifies the significant relationship between nurses’ job satisfaction , intention to quit in organization.
A sample of 188 nurses working in two hospitals was chosen and a quantitative approach, online administered questionnaire was used to collect data on the nurses’ demographic data, their job-related satisfaction and turnover intentions.
Overall, the results indicated that nurses were satisfied with their job. . Nevertheless, nurses reported a high satisfaction level with co-workers and promotion among the selected facets of job satisfaction. They also reported a low satisfaction level with flexible working, leadership support, work environment, recognition and pay. Demographic characteristics effects on nurses’ job satisfaction and their intention to quit was examined. The study revealed a negative relationship between nurses’ job satisfaction and their intention to leave the current workplace. Moreover, remuneration and flexible working were the most factors that significantly impact on turnover intent.
The major limitation of this study was the sample size. The response rate was satisfactory but more questionnaires should have been distributed so that more varied findings could have been generated.
This study would help nurse management to generate the knowledge regarding the relationship between job satisfaction and intention to quit which will have the potential to increase nurses’ job satisfaction and retention ,and ensure appropriate nursing care that will lead to a better quality healthcare service for patients
Keywords: job satisfaction, shortage of nurses, turnover intention, nurses, Saudi Arabia
Acknowledgements
I would like to thank Allah (my God ) for all Graces that I have got and will get in the future , the Most Gracious, the Most Merciful. All praise be to Allah for the chance and the ability to study at higher level of education, and the inspiration, patience, and strength to accomplish this dissertation .
Additionally, I would also like to thank my parents for their continuous support and help in overcoming the challenge throughout my studies. I will never forget their constant encouragement and enthusiasm to challenge myself and to set the highest goals and confidence to succeed them. In addition, they always wish the best for me and always pray for my success. I want to say to parents that without their support many things would never have been achievable for me.
Finally, I would like to express my deep gratitude to my supervisor Dr. Raffaella Valsecchi, who assisted me , advice, and guidance, all of which had a significant impact on this dissertation.
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I certify that the work presented in the dissertation is my own unless referenced
Signature:
Date: 12.9.2016 0 |
Table of Contents
CHAPTER 1: INTRODUCTION………………………………………………………………………. 6
1.1Introduction………………………………………………………………………………………………………………………… 6
1.2 Significance of the study……………………………………………………………………………………………….. 8
1.3 Contribution of the research………………………………………………………………………………………. 9
1.4 Context of the research………………………………………………………………………………………………….. 9
1.5 Aim and objectives………………………………………………………………………………………………………… 10
1.6 Dissertation Outline…………………………………………………………………………………………………….. 10
1.7 Summary……………………………………………………………………………………………………………………………. 11
Chapter 2 : Literature Review…………………………………………………………………. 12
2.1 Introduction…………………………………………………………………………………………………………………….. 12
2.2 Definitions of Job Satisfaction…………………………………………………………………………………. 12
2.3 Job Satisfaction Theory………………………………………………………………………………………………. 13
2.4 Global Job Satisfaction Among Nurses………………………………………………………………….. 15
2.5 Job Satisfaction Among Nurses in Saudi Arabia………………………………………………… 17
2.6 Factors Related to Nurses’ Job Satisfaction………………………………………………………… 19
2.7 Nurse Turnover Determinants………………………………………………………………………………… 21
2.8 Nurse Turnover in Saudi Arabia……………………………………………………………………………… 23
2.9 Conceptual Model and Hypotheses………………………………………………………………………… 23
2.10 Summary…………………………………………………………………………………………………………………………. 25
Chapter 3: Research Methodology…………………………………………………………… 25
3.1 Research approach……………………………………………………………………………………………………….. 25
3.2 Research strategy………………………………………………………………………………………………………….. 26
3.3 Questionnaire Survey:…………………………………………………………………………………………………. 27
3.3.1 Design:…………………………………………………………………………………………………………………………… 27
3.3.2 Sample:………………………………………………………………………………………………………………………….. 28
3.3.3 Measures:……………………………………………………………………………………………………………………… 28
3.4 Pilot test of the questionnaire…………………………………………………………………………………. 29
3.5 Data Analysis:………………………………………………………………………………………………………………….. 30
3.6 Reliability and Validity……………………………………………………………………………………………….. 30
3.7 Ethical Considerations………………………………………………………………………………………………… 30
3.8 Summary……………………………………………………………………………………………………………………………. 31
CHAPTER 1: INTRODUCTION
This first chapter of the dissertation provides an introduction, followed by an overview of the research background; the research focuses on nurses’ job satisfaction and nursing turnover, specifically in the Saudi context. Furthermore, this chapter presents the value and contribution of the research, and the aims and objectives of the research. Finally, the overall structure of the dissertation is presented.
1.1Introduction
The global nursing shortage and the high turnover rate of nurses has become a world-wide problem in most healthcare sectors. For example, according to the US Bureau of Labor Statistics, the USA may have a shortage of about one million nurses by 2020 (Juraschek et al., 2012). In addition, by the year 2020, the European Commission expects that there will be a shortage of 600,000 nurses in Europe (Hofgastein, 2010). Moreover, data from the Ministry of Health of China (2011) reveals that in the next 5 years it is estimated that by 2020 , China will be facing a shortage of 1,590,000 nurses (Liu et al., 2015). As a result, the turnover of qualified nurses can increase work demands, while inadequate staffing on the organizations that employ the remaining nurses may decrease confidence and create more stress due to an excessive workload. In addition, the capacity to meet patients’ needs and provide a good quality care service will have decreased (Van Bogaert et al., 2010). In financial terms, the turnover of nurses is considered to be very costly due to the need for recruitment and orientation programmes, and staff development and training activities (Hayes et al., 2012). As a result of nurse turnover, extensive resources may be required to recruit, hire, and train nurses to replace those nurses who are leaving .Thus, a high level of job satisfaction on the part of nurses is an important precaution in terms of reducing their intention to quit (Sabanciogullari & Dogan, 2015). In contemporary studies, many researchers have suggested that the quality of patient care and satisfied patients are associated with nurses’ job satisfaction (Flinkman et al., 2010; Hyrkas & Morton, 2013; Meeusen et al., 2011). However, high levels of dissatisfaction among nurses leads to a high rate of nursing turnover (Applebaum et al., 2010; Hayes et al., 2012), which generally is due to increased working hours, work stress, burnout and longer patient waiting lists, and finally, leads to lower patient satisfaction. Previous research into nurses’ job satisfaction has revealed that there is a negative relationship between job satisfaction and nurses’ intentions to leave the workplace in particular, as well as to leave the nursing profession in general (Applebaum et al., 2010; Hayes et al., 2012). Furthermore, work stress has been found to be a main predictor of job satisfaction in that it causes several negative behavioural reactions such as absenteeism and turnover, reduced productivity and reduced motivation, decreased satisfaction and reduced quality of care (Mosadeghrad et al., 2011). Major sources of stress in nursing include factors such as high job demands, long working hours, dealing with patients and their families, conflict with other colleagues and supervisors, and dealing with death and dying people (Lim et al., 2010). Hence, it is essential to understand the factors associated with nurses’ job satisfaction and those relating to job stress that influence nuring turnover. This is necessary to help managers take proper actions. For example, researchers have identified the most important factors that influence nurse job satisfaction including individual characteristics, work requirements and policies, professional level, pay, working conditions and co-worker support (Han & Jekel, 2011). Moreover, Heinen et al. (2013) recognized that characteristics of the work setting, job satisfaction is the most important factors that can influence nurses’ decision making in terms of whether to stay in their job or to leave it. Previous research shows that turnover in nursing is a result of nurses’ job dissatisfaction, that lead ultimately to turnover intentions (Iliopoulou & While, 2010). According to Aiken et al. (2013), work stress is the main cause of nursing job dissatisfaction and turnover intentions in many countries. A previous study showed that job satisfaction is negatively associated with work stress and turnover intentions. For instance, higher job satisfaction significantly decreases job stress and turnover intentions among nurses (Mosadeghrad et al., 2011).
However, Saudi Arabia is currently facing a significant chronic shortage of nurses and a high level of turnover (Al Hosis et al., 2013; Alshmemri, 2014; Almalk et al., 2012; Alsaqri, 2014 and Saleh et al., 2013). To illustrate the shortage of nurses we can see that the ratio of nurses to patients (36 nurses per 10,000 population) (Almalki, 2011) compares with that of Japan (95/10,000), Canada (100/10,000), and the UK (101/10,000)( World Health Organization., 2010). Furthermore, according to Data from the Saudi Ministry of Health (MoH , 2013) it is expected that there will be a nursing deficit of 48,000 nurses by 2020. In Saudi Arabia, part of the problem with regard to the chronic shortage of nurses is considered to be the high dependency on expatriate nurses (Almalki , 2011). Most of expatriates use the Saudi healthcare facilities to obtain training and experience. This helps them to move to developed countries such as the USA, the UK and Canada with marketable skills (Almalki et al., 2012). Other factors that are considered as the main reasons for the nursing shortage in Saudi Arabia include the poor image of nursing , family conflicts due to heavy family-work pressure (high workload, long working hours, irregular shifts, and working over public holidays and weekends), low pay and lack of financial incentives, and lack of support for working mothers (Almalki, 2011). Hence, the country needs to recruit and retain Saudi national nurses. Thus, identifying the level of job satisfaction among nurses could help health managers to provide the Ministry of Health with clear information about the factors that influence job satisfaction among nurses working in the city of Jeddah city, Saudi Arabia.
1.2 Significance of the study
There have been few studies that have explored job satisfaction, or the factors that influence turnover intentions in the Saudi context (Al Hosis et al., 2013; Alshmemri, 2014; Almalki et al., 2012, Alsaqri, 2014; Saleh et al., 2013). Hence, there is real need to conduct research in order to explain the relationship between job satisfaction and turnover intentions, to better understand why nurses intend to leave their jobs and, in particular, nurses working in Jeddah City. Therefore, this research will contribute to the existing literature by addressing this gap and providing recommendations that can help further researchers. It might also may be used to inform strategies to reduce nursing turnover. Otherwise, in a competitive business environment that seeks to attract qualified nurses, the Saudi healthcare organizations may lose skilled nurses to other organizations, either nationally or internationally, that better meet their needs by providing a better working environment. According to Alsaqri (2014), a number of expatriate nurses intended to leave Saudi Arabia at an early stage when they had gained sufficient experience to help them to work in better conditions, such as can be found in developed countries.
1.3 Contribution of the research
This study aims to make a effective contribution to the existing literature on these subjects by shedding new light on the influence of job satisfaction on turnover intentions in the Saudi healthcare context. Firstly, the finding that the conceptal model of turnover intentions built on empirical research also applies to the Saudi healthcare system. Here, the result of an intention to quit can be generalized to the overall system in Saudi Arabia. Secondly, the findings of the present study that explore significant predictors of nurses’ intention to quit regarding the relationship between, job satisfaction and nurses’ intention to leave, may help to develop strategies to attract and retain more nurses, to improve nurses’ work conditions in such a way as to reduce the high turnover rates of nurses in the Saudi healthcare system. Moreover, the regression model developed for this purpose can help to provide insights for future researchers with regard to the enhancement of job satisfaction among nurses, patients and the quality of service in hospitals in the Saudi context.
1.4 Context of the research
Managing nursing turnover has become significant in Saudi healthcare as the higher rate among nurses has become a critical issue. Saudi Arabia places emphasis on increasing economic growth, and improving human resource development, and the quality and quantity of care. Therefore, in order to develop, attract and retain more nurses, the Saudi healthcare system must focus on various human resource management activities to enhance nurses’ job satisfaction, increase the organizational commitment and reduce stress in the work environment. Additionally, an increase in job satisfaction is necessary because the Saudi healthcare system is facing higher competition when it comes to surviving in the contemporary business environment, and market competition that may cause an increase in nurses’ intentions to quit, leading to a higher rate of nursing turnover, particularly among expatriate nurses. Therefore, in order to cope up in a competitive labour market, it is important for Saudi hospitals to offer a competitive environment in order to increase job satisfaction and reduce job stress. This would will lower nurses’ intentions to quit and reduce the rate of nurse turnover.
1.5 Aim and objectives
In a broad perspective, this research aims to identify the job satisfaction and job stress variables which are most influential in increasing nurses’ intentions to quit.
The main purpose of the research paper is:
- To identify job satisfaction factors that are most likely to influence nurses’ intentions to quit and the nurse turnover rate.
- To explain whether or not there is a significant relationship between job satisfaction and turnover intentions.
- To explain the effects of socio-demographic variables (e.g., as gender, age, education level, and nursing experience) on job satisfaction and turnover intention
- To make recommendations based on the identified variable factors that impact on nursing turnover intentions in order to improve the nursing retention rate.
Research questions.
- Is there a significant relationship between job satisfaction and turnover intentions on the part of nurses?
- Which are the most influential factors in terms of job satisfaction with regard to increasing nurses’ intention to leave?
- Is there relationship between nurses’ demographic factors, job satisfaction ,job stress and intention to leave?
1.6 Dissertation Outline
Chapter 1: Introduction
This chapter provides details of the research background, the significance of the study, its contribution. It will also deal with the context of the research, the research aim, the research objectives and the research questions.
Chapter 2: Literature Review
This chapter covers previous studies conducted in this area of research and presents the important literature findings on the relationship between job satisfaction and nursing turnover intentions.
Chapter 3: Research Methodology
This chapter discusses the research design, the research approach, data collection methods, the research sample, reliability, ethical issues and limitations of the study.
Chapter 4: Findings Analysis and Discussion
This chapter will present and discuss the findings of the study after analysing the data using SPSS version 15.0.
Chapter 5: Conclusion
This chapter presents the conclusions, as well as the limitations, of the research. Furthermore, this chapter discusses useful insights in terms of implications for practice, and suggests recommendations for future research.
1.7 Summary
This chapter has provided an introduction, followed by an overview of the research background, and the value and contribution of the research . Furthermore, the aims and objectives of the research, and the overall structure of the dissertation were presented. The next chapter discusses a literature review of previous literature related to nursing job satisfaction and turnover and five hypotheses are presented .
Chapter 2 : Literature Review
2.1 Introduction
This chapter intends to critically review both job satisfaction levels amongst nurses and the turnover levels within the profession. The literature review correspondingly intends to focus on the fair amount of literature available on this topic, aligning the conclusions with the aims and objectives of the present study. It further intends to bring five a cornerstone regarding the conceptual framework with regard to the research objective of the current research.
There are three broad sections in the study. The first of these relates to the definition and related theories of job satisfaction; the section discusses job satisfaction aspects from both a global perspective and within the Saudi context, and the concluding section explains the factors impacting upon the nursing profession and the turnover levels therein.
2.2 Definitions of Job Satisfaction
It is a challenge to explicitly explain job satisfaction, considering both how various studies perceive the concept independently and how individual researchers perceive the concept in their own ways. As noted by Hayes et al. (2010) and Spector (1985, 1997), they defined nurses’ job satisfaction levels in terms of their perceptions of their work schedules and working environments. Locke (1976) considered job satisfaction levels to be related to a pleasurable or a positive emotional state concluded from the periodic appraisal of individual job experiences. In identifying the concept of job satisfaction, multiple work facets need to be considered including aspects related to the levels of work satisfaction, supervision, pay, promotion, and the overall practices followed within the organization. In recent times, Aziri (2011) has explained job satisfaction in terms of the negative and positive attitudes and perceptions that employees have with regards to their professional commitments. Liu et al. (2015) described job satisfaction in terms of the positive responses accrued by the worker in comparison to the value and equity associated with the experience. The corresponding literature evaluates multiple aspects of job satisfaction, expressed in terms of job attitudes, satisfaction levels and employee morale (Hayes et al., 2010). This could be perceived to contribute towards enhanced levels of clarity within the corresponding literature.
2.3 Job Satisfaction Theory
Maslow’s hierarchy of needs is considered to be the pioneering study explaining job satisfaction levels. Presented in the 1940s, it was basically a study explaining humanistic motivational factors, and worked upon aspects of how work environments contributed towards fostering and encouraging personal and professional growth amongst employees (Maslow, 1943). The theory encompasses five goals, expressed in terms of the basic human needs in a hierarchical form. It expounds how individuals strive to reach an initial level, before progressing on to the next. The levels relate to the motivational factors contributing to individual survival, safety, and social and societal acceptance, all of which contribute to transcending satisfaction levels within an individual’s lifetime (Hayes et al., 2012). The lowest need of level is pertains to physiological needs and relates to individualistic concerns of basic survival. Within work environments, physiological needs are considered to contribute significantly in providing a favorable working environment. Thereafter, safety is considered, which includes aspects of job security and pay. The third category relates to a sense of belonging with regard to forming sustainable working relationships with work colleagues, supervisors and associated managers. This would also entail the presence of an environment that encourages teamwork. Self-esteem needs to encompass the fourth level and relates to individual recognition and reward. This, in turn, is followed by self-actualization in terms of attaining a given position, overcoming a challenge, and bringing a sense of achievement (Hayes et al., 2012). Shortcomings in fulfilling lower level needs would adversely impact upon the fulfillment of needs on the higher levels. It is considered that individual job satisfaction is ranked along with management responsibility and prestige, which are reflective of professional achievements (Maslow, 1954). Lambrou et al. (2010) are of the opinion that nurses are more inclined to be motivated in lieu of intrinsic factors and, correspondingly, this is a motivator expressible in terms of individual intensity and drive towards fulfilling a given goal. Subsequently, emotive, cognitive and behavioral aspects were also considered part of the mix. The emotive aspect within job satisfaction paradigms relates to employee perceptions with regards to professional engagements, the levels of anxiety, boredom or excitement; cognitive factors in job satisfaction is relating to engagement, that the work functions are intellectually demanding and challenging. This gives rise to the willingness of the employee to socially engage with co-workers towards completing assigned tasks and responsibilities (Parvin & Kabir, 2011).
Related job satisfaction models include the Herzberg two-factor theory (Herzberg et al., 1959). This considered hygiene factors and related motivators. Within workplace paradigms, the hygiene factor was considered in terms of remuneration, working environment, interpersonal relationships and organizational policies. These factors would normally entail negative perceptions and, in turn, contribute towards higher dissatisfaction levels. While the resolution of hygiene factors could contribute to reducing dissatisfaction levels, it may not necessarily conclude in increased satisfaction levels. Herzberg’s motivation levels would, therefore, include the nature of the work involved, achievement and recognition levels, the responsibility of the position and career (Herzberg et al., 1959).
Herzberg’s theory is considered a major theory describing job satisfaction levels (Lambrou et al., 2010). Various researchers have concluded the dual factor theory to be particularly useful within healthcare establishments (Liu et al., 2015). It has also been widely applied to establish job satisfaction levels within the nursing profession (i.e., Delobelle et al., 2011; Kwak et al., 2010; Toode et al., 2011). Table 1.1 summarizes Herzberg’s two-factor theory:
Table 1.1 Summary of the motivation and hygiene Factors in Herzberg’s Theory
| Motivation Factors | Hygiene Factors
|
| Work itself
Recognition Possibility of growth Achievement Responsibility Advancement |
Supervision
Salary Policies and administration Working conditions Interpersonal relationships
|
While these theories investigate job satisfaction levels in broad terms, then the next section will discuss job satisfaction of nurrses specifically .
2.4 Global Job Satisfaction Among Nurses
Nahm (1940) is probably credited with concluding the pioneering study on job satisfaction levels amongst nurses. He found that supervisory relations, income levels, promotions, working hours, on-the-job interest levels, and familial and social relationships all impacted upon job satisfaction levels (Ravari et al,2012) . From this initial study there has been a multitude of further studies conducted in various locales and countries, which include the United States (Cahill, 2011; McGlynn et al., 2012), Australia and New Zealand (Hayes et al., 2010; Skinner et al., 2012), Malaysia (Lee et al., 2011), Pakistan (Bahalkani et al., 2011), Turkey (Sabanciogullari & Dogan, 2015) and Jordan (Abu Raddaha et al., 2012; Alsaraireh et al., 2014). All of these studies intended to perceive the factors enhancing job satisfaction levels within the nursing profession and all draw similar conclusions, irrespective of the geographical locale of the conducted study.
Studies indicated that nurses within the United States are amongst the least satisfied (Cahill, 2011). Indeed, there are multiple factors contributing to this state of affairs, including demographic factors, and job related and associated geographical factors. The conclusions indicated that the gender of nurses is not necessarily a key factor, although men and women did perceive job satisfaction in different ways. Nevertheless, the number of years on the job did have an impact on the satisfaction levels. McGlynn et al. (2012) considered the job satisfaction levels of nurses by comparing it within an academic medical center in the northeastern United States. The conclusions derived indicated a low level of job satisfaction. Nevertheless, it was found that nurses were moderately satisfied with their working environments. It was also found that there was no specific relationship within satisfaction levels with regards to age, gender or work experience. Instead, factors related to the work environment, job functions and other organizational factors contributed more. Thus, it was concluded that available health care and retirement plans, the amount of work experience, organizational support, lowered levels of work-family conflicts, promotional opportunities, support extended by managers and the level of independence accorded were all determinants in this regard. Although studies conducted within the United States revealed minimal impact on age and the number of years spent in the profession (McGlynn et al., 2012), Jordanian studies concluded that satisfaction levels were somewhat proportional to the age of the professional and the number of years on the job (Abu Raddaha et al., 2012; Alsaraireh et al., 2014). It was also found that women and married nurses had a higher level of job satisfaction, while the opposite was true amongst single male nurses. Nabirye et al. (2011) evaluated job satisfaction levels amongst nurses in four hospitals, all located in Kampala, Uganda. This study found that job satisfaction was a function of age and was significantly influenced by this factor. It was therefore concluded that the age of the nurse was a significant factor in establishing satisfaction levels, with older nurses being generally more satisfied with their functions than their younger counterparts. Considering educational factors, it was found that nurses possessing lower levels of education were more satisfied than individuals with advanced degrees. Correspondingly, Sabanciogullari & Dogan (2015) evaluated some 2,122 nurses in Turkey and concluded that demographic factors related to the likes of gender, age, educational level, marital status, and number of years in the profession all contributed to and impacted upon employee satisfaction levels. Nevertheless, Lu et al. (2012) found that the educational levels of the nurses did not significantly impact upon satisfaction levels amongst nurses.
Bahalkani et al. (2011) conducted studies in the Pakistani context and concluded that almost 86% of those interviewed were unsatisfied with their job functions. Reasons contributing to this dismal state of affairs included factors related to poor work environments, a lack of fringe benefits, barriers to educational and training opportunities, shortcomings in leadership and supervision levels, time constraints, low salary structures and financial benefits. In the Australian context, there was a significantly higher level of satisfaction (Skinner et al., 2012).
Skinner et al. (2012) evaluated satisfaction levels among Australian nurses and midwives by using a descriptive survey methodology with a sample population of some 562 registered nurses and midwives working in aged care and public facilities. The conclusions derived indicated that some 4% of the participants were unsatisfied with their jobs, while an overwhelming majority of some 96% respondents were fairly satisfied with their positions. This indicated that Australian nurses functioned with only a moderate level of stress and were more likely to be satisfied with their positions (Skinner et al., 2012). The conclusions indicated that stress is related to the workplace environment, and how the individual reacted to stress .
Other studies in various countries indicated that older nurses are more satisfied with their functions, and that various intrinsic and extrinsic factors contributed towards satisfaction levels. The related intrinsic factors were related to aspects of the performed work functions, morale, and the level of autonomy offered to nurses (Hayes et al., 2010). In addition, the related extrinsic and various organizational factors that significantly impacted upon job satisfaction levels related to working environments, organizational policies, pay scales and professional status (Hayes et al., 2010). It has been concluded that there is a supposedly close interrelation between job satisfaction levels and stress levels among hospital workers in the United Kingdom, with Lu et al. (2012) conducting studies in the British context, which indicated that the turnover of nurses is a function of their dissatisfaction levels.
2.5 Job Satisfaction Among Nurses in Saudi Arabia
While multiple studies have evaluated job satisfaction levels amongst nurses throughout the world, especially in Western societies, there have not been many studies in this regard within the Kingdom of Saudi Arabia (KSA). It is pertinent to mention that the KSA has a different climate and culture compared to the West. Such studies have measured multiple factors including the quality of life enjoyed by nurses, commitment levels of the workers, recruitment and associated retention barriers, prevailing leadership modes, hospital functionalities, the desire to continue in the job and the overall work environment (Abualrub & Alghamdi, 2012; Al-Ahmadi, 2014; Al-Dossary et al., 2012; Almalki et al., 2012).
Studies conducted over time have provided some information on the satisfaction levels amongst nurses within the KSA (Abualrub et al., 2012, Al-Ahmadi., 2014). Thus, Al-Ahmadi (2014) examined satisfaction levels amongst some 350 Saudi nurses and concluded that satisfaction levels could be considered to be moderate. It was found that major factors contributing to job satisfaction included aspects of recognition, supervision, working conditions and the remunerations provided to the nurses. Abualrub and Alghamdi (2012) evaluated how leadership styles impacted upon satisfaction and retention levels within a population sample of some 308 Saudi nurses. It was concluded that, overall, the Saudi nurses were more or less satisfied with their jobs to a certain extent, while the supervisors tried retaining staff to a moderate extent. Studies by Almalki et al. (2012) found that the respondents were dissatisfied with the quality of their lives. Nevertheless, common complaints observed included inconvenient working hours, shortcomings in various facilities, hindrances to having adequate family time, the inability to frequently travel home to spend time with one’s family, poor staffing, inadequate management and supervision practices, inconsistent professional development options, and poor salary structures. Nevertheless, it was concluded that the majority of nurses were satisfied with their co-workers. The study also found that satisfaction levels were also impacted by the number of years spent on the job. Hence, older and more experienced nurses were observed to be more satisfied in comparison to younger and fresh nurses. It was also found that work life balance significantly impacted upon satisfaction and turnover levels within healthcare organizations.
Al-Dossary et al. (2012) concluded that satisfaction levels were significantly impacted upon by multiple intrinsic factors including salaries, prevailing leadership styles, achievement levels, and peer relationships . Correspondingly, factors contributing to dissatisfaction included aspects of institutional policies, working conditions, pay structures, available fringe benefits, shortcomings in recognizing personal achievements, as well as various personal and relationship factors. It was, nevertheless, concluded that, on the whole, nurses were fairly satisfied with their positions and profession within the KSA (Al-Dossary et al., 2012). Research by Alshmemri (2014) showed that female nurses within public hospitals were less satisfied than their male counterparts. This study also supported the notion of job satisfaction levels within this sector being linked to both the number of years on the job and age. Al-Ahmadi (2014) had indicated earlier that job satisfaction was a function of the number of years spent on the job.
Alasmari and Douglas (2012) argued that there is no major correlation between aspects of the demographic origins of the nurses and their age of experience. Instead, the study focused upon how aspects of workload, degree of professional support and remuneration contributed to incidences of employee turnover. Studies by Alotaibi et al. (2015) demonstrated that shortcomings in educational opportunities contributed to image issues within the nursing profession, along with instances of unmanageable workload and stressful work paradigms; correspondingly, this certainly had an impact upon job satisfaction levels. Further, Alasmari and Douglas (2012) have concluded that satisfaction levels amongst Saudi nurses are affected by their workloads, the extent of professional support available, and remuneration., which should be adequately addressed to ensure that nursing professionals are retained. Saleh et al. (2013) and Alsaqri (2014 ) have argued that satisfaction levels amongst nurses are adversely impacted by high stress levels.
2.6 Factors Related to Nurses’ Job Satisfaction
Considering research conducted on the nursing profession, multiple individual attributes have been found to impact upon employee turnover ratios including gender, age, marital status, and educational levels. In addition, various organizational factors including pay, promotion, fringe benefits, co-worker and supervisor support, and overall work environment also impact upon worker turnover.
Job satisfaction is considered to be both an emotional feeling and a behavioral expression derived from a given task. Aspects of pay, remuneration, recognition, the type of work, employee relations amongst themselves, and probably a host of similar related aspects, impact upon such feelings (Lu et al., 2012). Just as with other professions, the extent of job satisfaction amongst nurses is a driving force in their efforts to change jobs (Applebaum et al., 2010). Researchers have noted that satisfied nurses are less likely to switch jobs (Flinkman et al., 2010). It has been concluded that stress levels, depression and low levels of organizational commitment are likely to adversely affect job satisfaction levels among nurses (Lu et al., 2012). It has also been found that satisfaction levels are somewhat passively impacted upon by various other determinants, including ambiguities in work roles, the extent of on-the-job recognition and appreciation extended, the degree of supervisor support and co-worker cooperation . Furthermore, there was a tenuous relationship between the impact garnered by elements of gender, age, number of years on the job, education level attained, and dealing with strategies. It has also been considered that there is a supposed inconsistent impact on job satisfaction aspects within different countries (Zhu et al., 2012). Therefore, it has been observed that age is a major factor contributing to job satisfaction amongst American and Turkish nurses, but it is of minimal consideration amongst Chinese healthcare professionals (Zhu et al., 2012). Van Bogaert et al. (2010) have concluded that job stress bears a direct relationship with employee satisfaction levels among Belgian nurses, although it did not among American nurses to the same extent.
On consideration of various global studies, it can be reasonably stated that most nurses are simply moderately satisfied with their jobs and professional choices (Asegid et al., 2014; Sabanciogullari & Dogan, 2015). This has been concluded after significant research undertaken in this regard. To illustrate, Aiken et al. (2011) evaluated some 98,110 nurses spread across nine countries and found that job satisfaction levels in the nursing profession peaked in Germany (83%), followed by the United States (78%), New Zealand and Canada (67%), South Korea (64%), the UK (63%), China (54%) and, finally, Japan (40%). Researchers therefore concluded that job satisfaction levels within the nursing profession varied from country to country. It was also found that the factors contributing to job satisfaction varied from country to country (Zhu et al., 2012). It was concluded that 38% of specialized cardiac care nurses within Greece were unhappy with the attitude of their respective supervisors, and some 34% of nurses had issues with their colleagues (Iliopoulou & While, 2010). It was further found that some 34% of the respondents considered their hospital management to be agreeable, with around 81% of the nurses interviewed considering the remuneration aspect to contribute significantly to satisfaction levels. Researchers also evaluated the various factors contributing to dissatisfaction, and found that seemingly unfavorable public perceptions of the nursing profession, low salaries, inadequate social options, communication gaps with management, job security issues and inflexible working hours were major determinants (Aiken et al., 2013). Within associated developed economies such as Malaysia, heavy workloads, repetitive job functions and poor working environments contributed to employee dissatisfaction. Moreover, unresponsive matrons or supervisors, shortcomings in recognizing positive contributions made and internal conflicts were also found to give rise to dissatisfaction (Loo & Beh, 2012).
2.7 Nurse Turnover Determinants
At present, employee turnover within the nursing sector is a major concern and various researchers have consistently undertaken multiple studies towards determining a range of definitions in evaluating this concept (Flinkman et al., 2010). Correspondingly, a few of these studies have indicated that the concept relates to the processes by which employees rotate between various organizations, although the studies do not consider inter-departmental transfers to be included within this paradigm (Hayes et al., 2012). There are dual perspectives on external turnover, expressed in terms of the quantum of people who leave an organization for any number of reasons, and internal turnover measures related to job modifications within the organization (Flinkman et al., 2010). In the process, researchers have identified multiple factors that supposedly motivate an individual to switch jobs in the course of their lifetime. Applebaum et al. (2010) are of the opinion that nurses often switch jobs due to factors such as their workload and stress levels, or simply because of professional burnout. On a similar note, Meeusen et al. (2011) concluded that the emotional and psychological well being of nurses deteriorated over a period of time due to either excessive workload, or the lack of support from colleagues and supervisors. Surveys exploring why healthcare professionals often quit their jobs concluded that the number of years they had spent on their jobs was important considerations towards motivating nurses to leave their positions in search of better prospects (Hayes et al., 2012). It was also found that factors related to the gender of the nurse, their age or educational level were less likely to be contributing factors in the variances observed within job satisfaction levels. Both Leiter et al. (2010) and Delobelle et al. (2011) are of the opinion that managers and supervisors are a more important factor in motivating nurses to leave, in comparison to any other factor.
Multiple research initiatives have shown that demographic characteristics are a direct function of nurse’s turnover levels. Within more recent studies, researchers have identified an inverse relationship between employee turnover and the age of the employee (Torkelson et al., 2011). It is, therefore, observed that female Irish nurses are more likely to take early retirement, often because of the responsibilities associated with their family and excessive workloads, or due to shortcomings in training opportunities (McCarthy, Tyrrell & Lehane, 2007). In observing behavioral trends within South African nurses, Delobelle et al. (2011) argued that the number of years on job impacts turnover levels. Within the Jordanian context, turnover was a function of the age of the individual (Alsaraireh et al., 2014). Tremblay et al. (2011) observed that fresh graduates were highly interested in leaving their current position within their first year of their employment. Flinkman et al. (2010) found that young qualified nurses were liable to leave their positions more rapidly. Nevertheless, Rheaume et al. (2011) revealed that younger nurses were more committed to their organizations and that turnover intention was lower, since they were often happier with their professions and remuneration
Recent initiatives have indicated that turnover levels within the nursing profession are positively associated with levels of education (Delobelle et al., 2011; Stewart et al., 2011). Stewart et al. (2011) also concluded that the extent of education has an inverse relation to nurses’ propensity to continue within a single organization, which is reflected in higher educational levels contributing to more turnover. Flinkman et al. (2010) have argued that higher educational levels correlate to increased organizational commitment. It was also observed that more educated nurses were less liable to quit their positions. Recent studies have concluded that job satisfaction is moderately impacted by either the extent of supervisor or co-worker support, or the recognition extended to the individual (Lu et al., 2012). It was also concluded that elements of pay, fringe benefits and contingent rewards impact upon satisfaction levels, which in turn also affects turnover. Other studies have shown that pay and remuneration are the foremost factors in job satisfaction levels, especially for male nurses (Hayes et al., 2012).
Further, Leiter, et al. (2010) argued that co-worker support impacts upon turnover. Tourangeau and Cranley (2010) also supported this notion and stated that cohesive organizations are more likely to retain nurses. Studies by Aiken et al. (2013), encompassing 12 European countries, concluded that between 2-5 out of 10 nurses intended to leave their positions within a year; from this number, between 2-4 out of 10 nurses intended to seek a job outside of nursing. Hence, some 38% of German nurses intended to leave their job within a year’s time, and half intended to work outside of nursing.
2.8 Nurse Turnover in Saudi Arabia
Within the Saudi context, both Alasmari and Douglas (2012) and Al-Ahmadi (2014) concluded that turnover was impacted upon by multiple demographic variables including age, gender, job satisfaction subscales related to workload, the extent of professional support, remuneration and promotion opportunities. Likewise, Alonazi and Omar (2013) identified a strong correlation between turnover and demographic or organizational factors, including pay or interpersonal relationships. Almalki et al. (2012) concluded that, overall, nurses were not satisfied with their work and 40% intended to leave their current employment. They also found that 83% of nurses in the KSA were unsatisfied due to inflexible working hours, job profiles and working environments; 78% of the nurses were unhappy with their workloads and 65% were unsatisfied with their supervision and performance reviews. Thus, a lack of flexibility in working hours and shifts, job design and working conditions, workloads, salaries and supervision relationships were significantly related to turnover intention in the Saudi context. Finally, Saleh et al. (2013) and Alsaqri (2014) confirmed a positive correlation between stress levels and nurseing turnover.
2.9 Conceptual Model and Hypotheses
The range of the literature review gathered indicates that factors related to stress levels, job satisfaction and demographic factors, etc., all contribute to nursing turnover. It is, correspondingly, interesting to evaluate how these factors impact upon turnover rates. The conceptual framework is considered in lieu of literature reviews elaborating related theories or earlier studies conducted in this regard, as reflected in figure 1.1 The dependent variable is concluded to be the turnover intention, while the independent variables include stress levels, job satisfaction and related demographic factors. The study considers the following framework in analyzing this hypothesis.
Table 2.1: Summary of Hypotheses
| H1 | There is a significant relationship between demographic factors (age, experience) and job satisfaction. |
| H2 | Turnover intent is significantly associated with demographic variables such as age, education and years of nursing. |
| H3 | There is a negative significant relationship between the impact of stress and job satisfaction among staff nurses |
| H4 | There is a positive relationship between job related stress and nurses’ intention to leave their job. |
| H5 | There is a negative relationship between job satisfaction and nurses’ intention to leave their job. |
Figure 1.1: The model is an adaptation of the research framework developed by Suhaime et al, (2011)
2.10 Summary
The aim of this study is to build on the prior research described in this literature review and identify the factors that influence job satisfaction and turnover among nurses working in the Jeddah region of the KSA. This chapter discussed the literature relevant to the present study with a specific interest in literature on job satisfaction and turnover intention among nurses. The chapter started by offering a definition of job satisfaction and presenting theories of the job satisfaction. This review presented a discussion of job satisfaction, both globally and locally in the KSA and identified nursing job satisfaction factors that influence nursing turnover. Further, this section also identified nursing turnover factors in many countries worldwide, and in particular in the KSA. Moreover, on the basis on the discussions, a conceptual framework and five hypotheses have been presented for this research
Chapter 3: Research Methodology
The purpose of section is to explain the methodological approach used with regard to this study. The chapter clarifies the research approach and the design of this study in order to fulfill the research aims and to address the reasons for selecting the particular research method used in this study. Furthermore, the chapter outlines the questionnaire design, the sample size and information regarding the pilot study. This is followed by an elucidation of data analyses, validity and reliability, and a consideration of ethical issues.
3.1 Research approach
According to Bryman & Bell (2015) positivism and interpretivism are the main research philosophies. Before choosing a particular research method, it is very important to understand the basic philosophy of the research process. Positivism refers to “…an epistemological position that advocates the application of the methods of the natural sciences to the study of social reality and beyond” (Bryman & Bell, 2007, p.730). On the other hand, interpretivism is “…an epistemological position that requires the social scientist to grasp the subjective meaning of social action” (Bryman & Bell, 2007, p.728). In addition, deductive and inductive theories are the two main research methods. The first approach, the deductive one, involves the testing of hypotheses based on existing theory. On the other hand, the inductive approach develops theory from the collection and analysis of data as a result of the observation of empirical data (Becker and Burke, 2012). However, this study adopted a deductive/positivist approach as the study began with a review of the existing literature and other studies and theories about job satisfaction and turnover intention. Therefore, given the nature of this research, a positivist approach is the most appropriate method for this study.
3.2 Research strategy
Generally, the literature on research methodologies divides research approaches into two main research strategies – quantitative and qualitative.
Quantitative methods emphasise that social aspects possess objective realities. When using quantitative methods, it is important to identify the variables that are associated with these social aspects, and measures possible relationships. Statistical analysis is then done by converting the numerical data into quantities and numbers. Saunders et al. (2011) state that metric scales can be used to establish quantitative data as data that can be grouped or classified, in order to help the researcher analyse different relationships. Furthermore, the researcher can analyse these phenomena objectively and collect them from a large sample that allows the findings to be generalize to other settings. One limitation of this method is that the data collected can only be used to answer the question of “how many?” and not the question of “why?”. However, this method adopts a systematic appropriate in terms of testing a hypothesis (Creswell, 2013).
On the other hand, qualitative research is based on how the researchers understand, observe and interpret the data rather than dealing with numbers (Creswell, 2013). According to Bryman & Bell (2015) the disadvantages of qualitative research is that it tends to be too impressionistic and subjective, it is difficult to replicate, and the possibility of extending the findings of qualitative analyses to other contexts is restricted. In addition, sometimes it is difficult to determine from qualitative research what the researchers really did and how they succeeded in order to arrive at the study’s conclusion (Lack of Transparency).
In keeping with the main goal of the study, a quantitative approach has been chosen, as the intention was to determine the possible relationship between job satisfaction and intention to leave on the part of nurses. It would have been possible to address the research questions in a qualitative method by gathering information through interviews. However, conducting interviews can be difficult due to them being a time consuming expensive process, and dealing with the issue of confidentially. In a positivist study, a large sample of interviewees is required and this could raise the problem of accessibility to an appropriate sample (Marshall et al., 2013). In this study, a large number of participants were required to examine significant relationship between the variables; consequently interviews might not provide a valid and easy method for the analysis of the required data. In addition, the study also aimed to achieve the objective and structured procedures in order to examine the outcomes rather than gathering data about participant’s beliefs, feelings or perceptions regarding their job satisfaction and their intention to quit. Therefore interviews were not considered to be appropriate for conducting this research.
3.3 Questionnaire Survey:
3.3.1 Design:
The most common instruments used by researchers to collect data are questionnaires. Questionnaires are used to obtain a wealth of data and information from the research participants. They are inexpensive for the researcher to manage, and it is easy to analyze and compare the responses to questionnaires (Bryman & Bell, 2015).
The questionnaire used in this research incorporated three pages. The first page was the participant’s information sheet, which obtains information relevant to the participant such as the nature of the study, details with regard to the researcher, the importance of the participant’s contribution, and some suitable words of thanks. The other two pages contained closed-ended questions, which were divided into three sections: the demographic data section, the job satisfaction section, and the turnover intention section (see Appendix 2). Moreover, the questionnaire was initially created in English. However, the questionnaire was translated into Arabic and the translation was them written under each English question for all the survey items in order to increase the clarity of the questions and to make sure that all the nurses understood what was involved. In order to ease the data collection process, an online survey was used; it was created in Google form’s website and the link was sent to the selected participants. The survey was conducted during the last week of July 2016.
3.3.2 Sample:
Sampling can be defined as the process of choosing a sample from a population (Saunders et al. ,2011).The target participants for this research were registered nurses working in the hospitals located in the Jeddah region in Saudi Arabia. This study used a convenience non-probability sample, and all registered nurses participated voluntarily. A convenience sampling strategy was used since it was inexpensive and provided the ability to meet the criteria for the inclusion of subjects, as well as offering easy accessibility and availability (Saunders et al., 2011). In total, 220 questionnaires were distributed. The response rate to the survey was 85% (188), and all returned questionnaires were useable.
3.3.3 Measures:
A structured questionnaire was developed from the literature associated with earlier studies on nurses’ job satisfaction. The questionnaire was divided into three sections. The first part contained seven items to measure demographic factors. These were gender, age, marital status, and educational qualifications, years of working in nursing and years of working in the current hospital. The second part of questionnaire was used to measure the independent variables regarding job satisfaction. The questions were adopted from the past studies conducted by Aiken et al. (2002). The participants responded to the questions using a rating scale (1 = strongly disagree, 2 = disagree, 3= agree and 4 = strongly agree). Many researchers have used this instrument to study nurses’ job satisfaction, the hospital environment, and organisational climate (Kwak et al., 2010 ; Rochefort, & Clarke, 2010). The questions that were used in this study were based on Herzberg’s motivation-hygiene theory. The main idea of this theory is the distinction between two groups of factors – motivation (or intrinsic factors) and hygiene (or extrinsic factors). Motivation factors included items such as feeling recognized, the work itself, the possibility for growth and development, promotion, advancement in the job and having a sense of achievement. The hygiene factors included items related to satisfaction with interpersonal relations, salary, hospital policies, supervision and working environments (Herzberg, 1966) (see Chapter 2). The final part of the questionnaire contained 2 items to measure turnover intention, the dependent variable. Nurses were requested use a 4-point Likert scale (where, 1= very unlikely to 4 = very likely) in order to express their intention to quit the present workplace due to low job satisfaction and the situation being unusually stressful. Table 3.1 below shows the distribution of the job satisfaction items as they relate to Herzberg’s motivation-hygiene theory.
Table 3.1 Distribution of the job satisfaction questions in relation to Herzberg’s Motivation and Hygiene Theory
|
Number of Items | Question Numbers | ||
| Motivation
|
7 | 9,10,11,12,17,18,19 | ||
| Hygiene | 5 | 8,13,14,15.16 |
3.4 Pilot test of the questionnaire
As suggested by Burns and Grove (2012), the main purpose with regard to doing a pilot test are to determine whether the aim of the study is feasible, and to be able to identify any potential problems with regard to the research design. Additionally, a pilot study can help the researcher to examine the validity and reliability of the data collection process and the research instruments, to give the researcher more experience regarding the research approach and subject, and to identify a representative sample (Saunders et al., 2012). However, in this study, the pilot test was used to examine the instrument in terms of timing, clarity and accuracy. Thus, to clear up any potential confusion and to make sure that all participants understood the survey easily, the questionnaire was translated into Arabic, with the questions in Arabic were written under the questions in English for all questionnaire items. This approach was tested on a small sample consisting of five respondents who were requested to estimate how long it would take to complete the questionnaire. Additionally, the aim was to find out if all items were clearly understood and if the translation of each item into Arabic helped to increase clarify the questions. Based on the results of this pilot test it could be concluded that the survey would take around 5 minutes to respond to and there was no difficult with regard to understanding the questions. All respondents agreed that the Arabic translation helped to increase the clarity of questions being asked. Hence, there were no changes in the content of the questionnaire.
3.5 Data Analysis:
The data collection phase was followed by the analysis and interpretation of the data collected using SPSS 15, which is a statistical analysis software package able to process simple to advanced statistical progressions, as well as numerous other measurements. As per Collis and Hussey (2013), SPSS is the useable and very popular software program commonly used by social science researchers to analyse data, because it permits the user to generate descriptive statistics such as means, regressions, correlations, etc.
3.6 Reliability and Validity
Reliability refers to the degree to which a particular research approach brings about the same or similar findings, even the research is being carried out by other researchers in the future (Collis and Hussey, 2013).
Validity refers to the degree of precision to which the research findings represent the reality of the circumstances under consideration (Collis and Hussey, 2013).
In this study, the reliability of the research is ensured by assuming that all of the participants were honest in their responses, and that they would be most likely to provide the same answers if the research was replicated in the future. The validity of the research was ensured by adopting existing questions which have been used in previous studies.
3.7 Ethical Considerations
Ethical issues and objectivity are the most important aspects to consider in every piece of research. The researchers have to consider the ethical rules for the safety of those who participate in a study and in order to gain a genuine response from them (Bryman and Bell, 2007). The research was conducted based on Brunel University’s ethical guidelines. Moreover, the personal information with regard to the participants was protected, and their names were also removed from the demographic section of the questionnaire. Lastly, there was no misrepresentation of the data, with the original viewpoints being measured and evaluated through the survey instrument.
3.8 Summary
In summary, this chapter discussed the methodological approach used in this study and justified the use of the research method adopted for this study (see Figure 2.1).
Figure 2.1: Summary of research methodology
Chapter 5: Results and Analysis
X.1 Introduction
In this section, the data collected from the questionnaire will be analysed and investigated through the use of Excel and TIBCO Spotfire.
X.2 General information of respondents
A sample of 188 nurses from various hospitals in KSA was selected. A questionnaire survey was then shared with them and the results were collated for further analysis. Some key information about the respondents is provided before the detailed analysis in order to elaborate the demographic profile of the sample which may be useful for the reader.
A significantly large proportion of respondents were female. Care was taken in selecting a representative sample and the stratified sampling technique was employed. The nursing occupation is predominantly chosen by females in KSA. Hence a larger number of female respondents is observed from the figure above.
A large number of nurses present in the sample were between 25 and 35 years of age. This is usually the age when graduates seek out employment after completing their basic education qualifications in nursing. Eventually they start to drop out from the occupation as they age and define other priorities in life.
Since a large proportion of the sample were females between the ages of 25 and 35 years, we would expect most respondents to be married. This is commonplace in KSA where females specifically get married in their twenties.
Almost 95% of the respondents were Saudi nationals as immigrants coming to the KSA do not tend to join this profession.
Most of the nurses in the occupation tend to have studied for a Diploma or a Bachelor’s degree in nursing. This is also represented by the figure above where only a few respondents have undertaken a Masters or Doctorate in nursing.
With regards to the experience of the respondents, we can observe a reasonable spread. This should be useful for assessing factors like job satisfaction, career progression and ultimately turnover intention.
X.3 Descriptive results
The questionnaire was designed to have four options. This was intended to avoid respondents giving neutral responses (i.e. neither agree nor disagree). There is a cultural tendency in KSA to not take a position and not offer personal opinion if there is an option not to. Therefore, the four options have been translated to scores between 1 and 4. The summary of the responses for each factor potentially effecting job satisfaction and turnover intention has been provided below:
| Factor | Total respondents | Minimum | Maximum | Mean | Standard dev. |
| Education level | 188 | 1 | 4 | 1.59 | 0.66 |
| Experience | 188 | 1 | 4 | 2.29 | 0.99 |
| Experience at hospital | 188 | 1 | 4 | 2.34 | 1.12 |
| Salary | 188 | 1 | 4 | 2.09 | 0.89 |
| Promotion path | 188 | 1 | 4 | 2.43 | 0.94 |
| Recognition | 188 | 1 | 4 | 2.28 | 0.99 |
| Self-achievement | 188 | 1 | 4 | 2.76 | 0.90 |
| Development opportunities | 188 | 1 | 4 | 2.19 | 0.99 |
| Leadership support | 188 | 1 | 4 | 2.14 | 0.91 |
| Relation with co-workers | 188 | 1 | 4 | 3.02 | 0.70 |
| Work environment | 188 | 1 | 4 | 2.16 | 0.90 |
| Contribution to decision making | 188 | 1 | 4 | 1.98 | 0.80 |
| Flexible working | 188 | 1 | 4 | 2.11 | 0.79 |
| Staff levels | 188 | 1 | 4 | 1.82 | 0.84 |
| Job stress | 188 | 1 | 4 | 3.03 | 0.86 |
| Job satisfaction | 188 | 1 | 4 | 2.43 | 0.91 |
| Likely to leave hospital due to stress | 188 | 1 | 4 | 3.15 | 0.84 |
| Likely to leave hospital due to low job satisfaction | 188 | 1 | 4 | 3.13 | 0.78 |
X.3.1 Effect of each factor on job satisfaction and employee turnover
A direct correlation analysis was run to understand the extent to which each factor effects job satisfaction and turnover intention. The results have been summarised in the table below and discussed in detail subsequently:
| Factor | Pearson’s coefficient – Job satisfaction | Pearson’s coefficient – Intention to leave |
| Education level | 0.00 | 0.07 |
| Experience | 0.03 | 0.01 |
| Experience at hospital | 0.01 | 0.04 |
| Salary | 0.34 | -0.39 |
| Promotion path | 0.14 | -0.18 |
| Recognition | 0.41 | -0.33 |
| Self-achievement | 0.37 | -0.30 |
| Development opportunities | 0.40 | -0.35 |
| Leadership support | 0.44 | -0.34 |
| Relation with co-workers | 0.23 | -0.19 |
| Work environment | 0.42 | -0.33 |
| Contribution to decision making | 0.40 | -0.30 |
| Flexible working | 0.44 | -0.42 |
| Staff levels | 0.33 | -0.33 |
| Job stress | -0.29 | 0.12 |
| Job satisfaction | 1.00 | -0.28 |
X.3.1.1 Education level
Almost negligible correlation is observed between education level and job satisfaction and the likelihood to leave. A Pearson’s product moment correlation coefficient of 0.07 is observed. This suggests that there is not always an increased chance of highly qualified nurses leaving their hospital due to low job satisfaction. Moreover, a 92% of the respondents had up to a Bachelors qualification which could suggest that high education levels are not always sought by prospective nurses.
X.3.1.2 Experience / Experience at hospital
These factors were not deemed to have significant correlation with likelihood to leave or low job satisfaction. Interestingly, a weak negative correlation (product moment correlation coefficient of -0.04) was observed which suggests reduced likelihood to leave if a nurse has spent a long time with their hospital. Upon further investigation, a certain factor of ‘inertia’ was revealed. This meant that nurses who had spent a long time with their hospital had a tendency to stay as they did not like change and had gotten used to the status quo. Moreover, some felt that their motivation levels gradually diminished as they became older and had children, leading to a hesitation to switch jobs.
X.3.1.3 Salary
As expected from initial interviews, salary has an important part to play in the intention to leave. A Pearson’s product moment correlation coefficient of -0.39 was observed which suggests that increased salary results in lesser nurses leaving the hospital. One of the important factors for females joining the nursing occupation is to financially support their family. Results from our survey are hence in line with this observation.
X.3.1.4 Promotion path
Analysis of the survey data suggests that lacking a clear path for promotion may increase the likelihood for nurses to leave. A Pearson’s product moment correlation coefficient of -0.18 was observed. While this is less strong compared to the coefficient for Salary, it is still an interesting observation. The path for promotion leads to an increase in salary besides other things like increased responsibility and broader management experience. Nurses in KSA are more driven by salary than by other factors associated with promotion which justifies the negative correlation observed.
X.3.1.5 Recognition
Recognition for work appears to have a strong correlation with the intention to leave. A Pearson’s product moment correlation coefficient of -0.33 was observed in this case, suggesting a higher chance of leaving when nurses are not adequately given recognition for their work. Based on the statistical analysis, this factor has as much significance for the intention to leave as Salary.
X.3.1.6 Self-achievement
The aspect of self-actualisation and self-achievement in terms of attaining a given position or overcoming a challenge had moderate negative correlation with intention to leave. A Person’s product moment correlation coefficient of -0.3 was calculated which suggests that nurses in KSA give importance to self-achievement when deciding on whether to stay or leave their hospital.
X.3.1.8 Development opportunities
Development opportunities were investigated to be quite important for nurses in our sample. A Perason’s product moment correlation coefficient of -0.35 was observed which reflects the importance of such opportunities towards the decision of leaving or staying. Further investigation revealed that since nurses tend not to switch jobs if they have spent a long time with their hospital, they expect to develop in their existing roles. However, if such opportunities are consistently inadequately made available, nurses tend to leave.
X.3.1.9 Leadership support
Nurses in the examined sample expected support from leadership in performing their daily roles and responsibilities. The nursing profession is not perceived to be a very respectable occupation and hence nurses appreciate any level of support that comes from the hospital leadership to the extent that it effects their decision to leave or to stay. A Pearson’s product moment correlation coefficient of -0.34 was examined.
X.3.1.10 Relation with co-workers / work environment
Nurses in KSA expect a good relation with their co-workers. This gives them a break from the daily lives and adds a social element to their jobs, making work more enjoyable. A Pearson’s product moment correlation coefficient of -0.19 was observed which suggests a moderate correlation between relation with co-workers are the intention to leave. Moreover, a stronger correlation coefficient of -0.33 was observed between the general work environment and the intention to leave / job satisfaction.
X.3.1.11 Contribution to decision making
There was an expectation from nurses to be involved in decision making. A significant proportion of nurses would spend a large portion of their careers at a single hospital. They develop a sense of association with the hospital and over time expect to be involved in decision making as they consider the hospital as their ‘second home’. A Pearson’s product moment correlation coefficient of -0.3 was calculated.
X.3.1.12 Flexible working
One of the most important factors effecting the intention to leave was flexible working. Since most of the nurses in KSA are females with families and children to look after, flexible working is held very important. It is because of this that the data suggests a strong correlation between flexible working and the intention to leave. A Pearson’s product moment correlation coefficient of -0.42 suggests a strong intention to leave in the absence of flexible working.
X.3.1.13 Staff levels
There is general consensus across nurses working in the KSA that staff levels are low. This puts extra workload on the nurses making their daily jobs harder and more strenuous. A Pearson’s product moment correlation coefficient of -0.33 was calculated which suggests a moderate intention to leave in the case of low staff levels.
X.3.1.14 Job stress
Given that staff levels tend to be low, nurses in KSA are conditioned to work hard. Since a significant proportion of nurses work to make ends meet, there is somewhat an underlying acceptance of job stress. It is due to this reason that a large correlation between job stress and intention to leave was not observed. A Pearson’s product moment correlation coefficient of 0.12 resulted.
X.3.1.15 Job satisfaction
By far the strongest correlation was observed between job satisfaction and the intention to leave. This also supports our hypothesis of low job satisfaction leading to nurses leaving their hospital. A Pearson’s product moment correlation coefficient of -0.7 was observed. Multifarious factors effect job satisfaction which in turn directly impacts the intention to leave.
X.4 Hypothesis testing
X.4.1 Pearson’s Correlation Testing
After assessing various factors which may affect job satisfaction and intention to leave, we will now move on and test the hypotheses formed based on the literature reviewed. We will examine correlation as this technique can be used to establish causal / non-causal relations between two or more variables.
The following criteria for interpretation will be used:
Weak 0 to ±0.1
Moderate ±0.1 to ±0.3
Strong > +0.3 or < -0.3
| Hypotheses | Pearson Correlation | Interpretation |
| H1: there is a significantly relationship between demographic factors (age, experience) and job satisfaction. | 0.1 (age)
0.03 (experience) 0.01 (experience at hospital) |
Weak |
| H2: Turnover intent is significantly associated with the demographic variables such as age, education, and years of nursing. | 0.2 (age)
0.07 (education) 0 (experience) |
Moderate for age, weak otherwise |
| H3: there is a negative relationship between job satisfaction and nurses’ intention to leave their job. | -0.3 | Moderate |
| H4: there is a positive relationship between job related-stress and nurses’ intention to leave their job. | 0.12 | Weak |
| H5: there is a negative significant relationship between the impact of stress and job satisfaction among staff nurses. | -0.3 | Moderate |
X.4.2 Discussion on Hypotheses
We will employ regression analysis to the test the various hypotheses developed after reviewing the underlying literature.
X.4.2.1 Hypothesis 1: there is a significantly relationship between demographic factors (age, experience) and job satisfaction.
Experience in general and at the specific hospital appear to have negligible relation with job satisfaction. However, age does have a moderate relation with job satisfaction of 0.1. A number of reasons could explain this link. Nurses could feel more satisfied as their age increases as they become more experienced. In turn, this could result to better salaries which has a correlation with job satisfaction in KSA. Alternatively, more age results in more experienced nurses who could be given more responsibility and managerial positions by the hospitals which results in job satisfaction. Therefore, it could be argued that a direct causal relation might not exist between age and job satisfaction and could be explained by some intermediate variable. In the regression analysis for job satisfaction against age, the following regression equation was obtained:
Job satisfaction = (0.1205 x age) + 2.1
An R2 value of 0.01 is observed which implies that only 1% of total variation in job satisfaction can be explained by age. Due to the limited correlation observed based on the statistical analysis, this hypothesis can therefore not be accepted.
X.4.2.2 Hypothesis 2: Turnover intent is significantly associated with the demographic variables such as age, education, and years of nursing.
Education and experience does not appear to have a relation with turnover intent based on the low Pearson’s product moment correlation coefficients of 0.07 and 0 respectively. However, age does have a moderate influence on turnover intent (Pearson’s product moment correlation coefficient of 0.2). The regression analysis renders the following equation:
Job satisfaction = (0.22 x age) + 2.53
An R2 value of 0.03 is calculated. This exemplifies that only 3% of the total variation in job satisfaction can be explained by age. At p=0.00 (p<0.05), we cannot accept this hypothesis.
X.4.2.3 Hypothesis 3: there is a negative relationship between job satisfaction and nurses’ intention to leave their job.
This hypothesis could be accepted in the light of the strong negative correlation of -0.3 shown by the statistical analysis. An R2 value of 0.1 was observed which shows that 10% of the variation in turnover intention can be explained by job satisfaction levels. The following regression equation of turnover intention on job satisfaction was simulated:
Turnover intention = (-0.24 x job satisfaction) + 3.71
The Beta and t values of the analysis also suggest that this hypothesis can be accepted.
X.4.2.4 Hypothesis 4: there is a positive relationship between job related-stress and nurses’ intention to leave their job.
A moderate Pearson’s product moment correlation coefficient of 0.12 was observed between job related stress and turnover intention. A weak R2 value of 0.02 was calculated which does not contribute much to explaining the variances in turnover intention. The following regression equation was simulated:
Turnover intention = (0.11 x job stress) + 2.8
As a consequence, this hypothesis cannot be accepted (p=0.06 > p=0.05).
X.4.2.5 Hypothesis 5: there is a negative significant relationship between the impact of stress and job satisfaction among staff nurses.
This hypothesis is supported by the statistical analysis. A Pearson’s product moment correlation coefficient of -0.3 is observed whereas an R2 value of 0.1 was calculated. This explains 10% of the variation in job satisfaction which can be accounted to job stress levels. The following regression equation was simulated:
Job satisfaction = (-0.26 x job stress) + 3.79
Based on the correlation assessment of individual variables in the previous section, a similar observation was made between job stress and job satisfaction which further supports this hypothesis.
Summary
We have observed that some of our hypotheses were accepted after running the detailed statistical analysis. Various factors effected job satisfaction and / or turnover intention to different extents. We will now move on and link these results to the outcomes of existing studies and draw conclusions.
DISCUSSION
Introduction
This section discusses and compares the findings with the outcomes of previous studies from literature review in Chapter 2.
This study was designed to fill the gap in the existing knowledge of nurses’ job satisfaction and turnover intention in KSA. However, according to the results from
Table 7, nurses’ job satisfaction mean score was 2.43 , which is relatively mediocre . Moreover, the standard deviation was 0.91, which implies limited positive responses on job satisfaction were received. Therefore, overall job satisfaction among nurses was found to be moderate. This result is in agreement with previous studies on Saudi context (Al-Ahmadi ,2014 ; Al-Dossary et al. 2012). However, this result is inconsistent with previous studies of Abualrub and Alghamdi (2012); Almalki et al. (2012) , who found that nurses in KSA were dissatisfied their job functions.
Among these factors of job satisfaction, it is revealed that nurses expressed high level of satisfaction with coworkers and promotion. However, flexible working , work environment , recognition , leadership support , development opportunities and pay were reported with low satisfaction; these factors were highly related to nurses’ intention to leave the present workplace . This study is consistent with studies by Almalki et al. (2012) who found that the majority of nurses were satisfied with their co-workers, while they were dissatisfied with inconvenient working hours, inconsistent professional development options, poor salary , leadership support . Moreover, the results of contemporary studies conducted by Al-Dossary et al. (2012); Aiken et al., 2013; Hayes et al., 2010; Bahalkani et al. (2011) supports the present study ; who indicated that working hours , lower pay ,Flexible working , work environment , recognition , leadership support as reasons of dissatisfaction among nurses . Aiken et al., 2013 stated remuneration aspect contribute significantly to dissatisfaction levels among nurses consistent with this study. The most factors effecting the intention to leave and job satisfaction was flexible working , since most of participants are female with families and children responsibility ,flexible working is very important for nurses . This is coordinate with Almalki et al. (2012),who stated that 83% of nurses in the KSA were dissatisfied due to inflexible working hours, and working environment. In addition, the recent study conducted by Leiter et al. (2010) and Delobelle et al. (2011) supported that managers or supervisors have more influence on nurses’ intention to leave their present workplace than coworkers .
It was revealed that personal characteristics of nurses has significantly influenced nurses’ job satisfaction and their intention to leave workplace (Cahill, 2011); Nabirye et al. (2011) ; Sabanciogullari & Dogan (2015); Almalki et al. (2012); Al-Ahmadi (2014) . However, the present study reported that weak correlation between aspects of the demographic factors of the nurses ( age and experience) and nurses’ job satisfaction . The results are in agreement with the study of (McGlynn et al., 2012; , Lu et al. (2012) Alasmari and Douglas (2012) found that factors related to the age of the nurse , their educational level and work experience were less likely to be contributing factors in the variances observed within job satisfaction levels. Hence this hypothesis is not accepted
The present study found demographic factors of the nurses (education and experience) did not have strong relation with turnover intention . However, age did have influence on turnover intent. These result were consistent with prior research Flinkman et al. (2010); Tremblay et al. (2011) ; Torkelson et al., (2011) which found that young qualified nurses were likely to leave their positions more rapidly . Nevertheless, Rheaume et al. (2011) revealed that younger nurses were more committed to their organizations and that turnover intention was lower, since they were often happier with their professions and remuneration. In addition, these results are similar to earlier results of Lu et al. (2012) who indicated that the nurses’ intention to quit is weakly associated with years of job experience and education. In contrast Hayes et al., 2012 ; Delobelle et al. (2011) argued that the number of years on job and levels of education were important considerations towards motivating nurses to leave their positions.
Nurses reported that job satisfaction is positively correlated to their professional experience, for instance ,nurse could feel more satisfied as their age increases as they become more experienced , that supported the past research of Sabanciogullari & Dogan (2015); Al-Ahmadi (2014) ; Almalki et al. (2012). In term of intention to quit, it was found nurses who spent a long time with their hospital had intention to stay. This result supports the past research of Delobelle et al. (2011) .
Lu et al. (2012) ; Hayes et al., 2012 revealed that the nurses’ educational levels did not significantly impact on job satisfaction and intention to quit . The present study reveals the same findings. This study did not get many respondents who were highly qualified so result could be misleading. Moreover, in KSA nurses are not expected to be highly qualified. However, these findings are opposite the results of Delobelle et al., 2011; Stewart et al., 2011,who indicated that higher educational levels contributing to more turnover. Wheras Flinkman et al. (2010) have argued that higher educational levels correlate to increased organizational commitment. It was also observed that more educated nurses were less liable to quit their positions.
Based on the present results, job stress has strong relationship with job satisfaction and intention to leave. For instance, a mean score of 3.15 suggests that nurses were very likely to leave due to job stress . 84% of nurses reported their strong intention to leave due to job stress. This is congruent with the research of (Applebaum et al., 2010; Hayes et al., 2012), who found work stress has been found to be a main causes several negative behavioural such as incresesd turnover, and decreased satisfaction. In addition 77% of nuress reported experience unsual stress that had strong impact on nurses’ job satisfaction in KSA. This results are in line with current study of Saleh et al. (2013) and Alsaqri (2014 ) in Saudi context. They found that satisfaction levels amongst nurses are adversely impacted by high stress levels. Hence, the hypothesis( H3 & H4 ) are accepted.
In addition, this study concluded that there is strong negative relationship between job satisfaction among nurses and intention to quit. The finding is consistent with to pervious studies (Applebaum et al., 2010; Hayes et al., 2012; Mosadeghrad et al., 2011 ) . In addition, 84% of nurses reported their strong intention to quit their existing job place due to low job satisfaction. According to the findings, H5 is accepted
However, there of hypotheses are accepted, and two are rejected. The study expected the hypotheses 1 & 2 to supported but the analysis suggested otherwise. The reason for rejection could be due to the culture in KSA which means females join nursing after getting married to provide support to their partners and leave after a few years to priorities their families. What I can add to justify?????????
In this study, the job satisfaction factors of nurses in KSA were examined to increase their satisfaction and reduce the likelihood to leave in organizations. Thus, the present findings are similar to previous researches conducted in other nations.
Summary
This chapter discussed the findings in Chapter 4 with regard to existing literature review .The next chapter discusses the implications of the findings of this research. Finally, the chapter ends with discussion the limitations of the research, making recommendations for future research and presenting conclusion.
Chapter 5: conclusion & recommendation
5.1 Introduction
This chapter discusses the implications of the findings of this research. Finally, the chapter ends with discussion the limitations of the research, making recommendations for future research and presenting conclusion .
Implications for the nurse managers
Implementation of this study would enhance job satisfaction and decrease intention of nurses to quit in Saudi Arabia, that ultimately may lead to increase healthcare service quality. Nursing managers can help nurses to increases their job satisfaction by practicing co-management models for nurses. For instance, nurses can be encouraged to take part in professional activities such as their contribution in decision making and sense of confidence in nursing practices to increase their sense of loyalty in the organization (Aiken et al., 2013; Flinkman et al , 2010).. Evidently, it is important that nursing managers and employers should inspire and allocate sufficient resources for professional development opportunities for learning and growth of nurses. Consequently, this can help to improve their career and enhance their job satisfaction by taking part in constructive programs and meetings (Aiken et al., 2013; Asegid, Belachew & Yimam, 2014). Retaining the qualified nurses can be challenge in a competitive business environment. Thus, to attract and retain nurses, managers should take opportunities to identify and measure the job satisfaction factors of nurses. Managers have to measure routinely for indications of dissatisfaction by conducting job satisfaction surveys. Sometimes, nurses’ intention to apply for different positions either inside or outside hospitals may be considered as one of the first signs of their job dissatisfaction.
The present study provides a suitable and strategic plan of professional development nurses who work in Saudi Arabia ,so that the possibility of intention to leave from their existing workplace as well as the nursing profession can be reduced. Furthermore, this study provides a guideline for hospital management to identify the most important factors of job satisfaction among nurses. By identifying the most important factors of job satisfaction such salary , promotion, recognition, and work environment management will be able to attract and retain qualified nurses in a competitive business environment .
limitations and recommendations for future research
One limitation of this study was that, the sample size was relatively small and limited to nurses who were mainly from the hospitals in Jeddah city, Saudi Arabia . Due to time constraints, questionnaires were distributed to two hospitals in Jeddah city total 220 nurses and 188 have been completed and returned back. The response rate was satisfactory. However, the findings are applicable to this sample only and cannot be generalized to all registered nurses in Saudi Arabia. Furthermore, this study is not longitudinal in nature. Thus, better results would have been obtained if the study was conducted over a longer period of time to determine how nurses’ job satisfaction influences intention to leave and actual turnover. For future research, a longitudinal study design , a larger and representative random sample of nurses from various region in Saudi hospitals can be investigated. Although the findings of this study are consistent with previous studies, attention have to be paied in drawing any certain conclusions for other countries. Another limitation is the fact the nurses were required to complete the surveys while they were had normal busy duties. This may have influenced how they completed the questionnaire and thus, they may not have given accurate information. The last limitation was that in this study only survey has been used, however, qualitative survey through interviews or focus groups could have been also used to generate more accurate data. However, for further research, using qualitative research approach would be better addressed in which nurses can express their experiences and needs ,and to gauge the thoughts and feelings of the nurses . Hence, it can be obtained deeper and more targeted insights and understanding into the ground level issues that they may be facing than only relying on statistical analysis.
CONCLUSION
Nurses’ job satisfaction is a important issue for ensuring better quality healthcare services. The aim of this research is to identify the important factors of job satisfaction among the nurses who were employed in Jeddah city , Saudi Arabia. Overall, this study found that nurses satisfaction level were relatively mediocre. The findings of this study demonstrated that nurses reported a higher satisfaction level with promotion opportunity, relation with co-workers, work environment, supervisors, salary and flexible working as important factors to low job satisfaction and turnover intention . This indicates that this study is comparable with previous studies in different nations. . According to present research, job satisfaction among nurses is negatively correlated with their intention to leave, which is consistent with the results of contemporary studies. Thus, low satisfaction effect the quality of healthcare services and increase the intention to quit the current workplace.
References
- Abu Raddaha, A.H., Alasad, J., Albikawi, Z.F., Batarseh, K.S., Realat, E.A., Saleh, A.A. and Froelicher, E.S., 2012. Jordanian nurses’ job satisfaction and intention to quit. Leadership in Health Services, 25(3), pp.216-231.
- Abualrub, R.F. and Alghamdi, M.G., 2012. The impact of leadership styles on nurses’ satisfaction and intention to stay among Saudi nurses. Journal of nursing management, 20(5), pp.668-678.
- Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber J. H. 2002. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of the American Medical Association, 288, 1987–1993.
- Aiken, L.H., Sloane, D.M., Bruyneel, L., Van den Heede, K., Sermeus, W. and RN4CAST Consortium, 2013. Nurses’ reports of working conditions and hospital quality of care in 12 countries in Europe. International Journal of Nursing Studies, 50(2), pp.143-153.
- Aiken, L.H., Sloane, D.M., Clarke, S., Poghosyan, L., Cho, E., You, L., Finlayson, M., Kanai-Pak, M. and Aungsuroch, Y., 2011. Importance of work environments on hospital outcomes in nine countries. International Journal for Quality in Health Care, 23(4), pp.357-364.
- Al Hosis, K.F., Mersal, F.A. and Keshk, L.I., 2013. Effects of job stress on health of Saudi nurses working in Ministry of Health hospitals in Qassim region in KSA. Life Science Journal, 10(1), pp.1036-1044.
- Al-Ahmadi, H., 2014. Anticipated nurses’ turnover in public hospitals in Saudi Arabia. The International Journal of Human Resource Management, 25(3), pp.412-433.
- AL-Dossary, R., Vail, J. and Macfarlane, F., 2012. Job satisfaction of nurses in a saudi Arabian university teaching hospital: a cross-sectional study. International nursing review, 59(3), pp.424-430.
- Alasmari, H. & Douglas, C. (2012). Job satisfaction and intention to leave among critical care nurses in Saudi Arabia. Middle East Journal of Nursing, 6(4), 3–12.
- Almalki, M., Fitzgerald, G., & Clark, M. 2011. The nursing profession in Saudi Arabia: An overview. International Nursing Review, 58, 304-11.
- Almalki, M.J., FitzGerald, G. and Clark, M., 2012. Quality of work life among primary health care nurses in the Jazan region, Saudi Arabia: a cross-sectional study. Human resources for health, 10(1), p.1.
- Alotaibi, J., Paliadelis, P.S. and Valenzuela, F.R., 2015. Factors that affect the job satisfaction of Saudi Arabian nurses. Journal of nursing management.
- Alsaqri, S.H., 2014. A Survey of Intention to Leave, Job Stress, Burnout and Job Satisfaction among Nurses Employed in the Ha’il Region’s Hospitals in Saudi Arabia(Doctoral dissertation, RMIT University Melbourne Australia).
- Alsaraireh, F., Quinn Griffin, M.T., Ziehm, S.R. and Fitzpatrick, J.J., 2014. Job satisfaction and turnover intention among Jordanian nurses in psychiatric units. International journal of mental health nursing, 23(5), pp.460-467.
- Alshmemri, M.S., 2014. Job satisfaction of Saudi nurses working in Saudi Arabian public hospitals(Doctoral dissertation, Royal Melbourne Institute of Technology).
- Applebaum, D., Fowler, S., Fiedler, N., Osinubi, O. and Robson, M., 2010. The impact of environmental factors on nursing stress, job satisfaction, and turnover intention. The Journal of nursing administration, 40, p.323.
- Asegid, A., Belachew, T. and Yimam, E., 2014. Factors influencing job satisfaction and anticipated turnover among nurses in sidama zone public health facilities, south Ethiopia. Nursing research and practice, 2014.
- Aziri, B., 2011. Job satisfaction: A literature review. Management research and practice, 3(4), pp.77-86.
- Bahalkani, H.A., Kumar, R., Lakho, A.R., Mahar, B., Mazhar, S.B. and Majeed, A., 2011. Job satisfaction in nurses working in tertiary level health care settings of Islamabad, Pakistan. J Ayub Med Coll Abbottabad, 23(3), pp.130-133.
- Becker, W.S. and Burke, M.J., 2012. The staff ride: An approach to qualitative data generation and analysis. Organizational Research Methods, 15(2), pp.316-335.
- Bryman, A. & Bell, E. 2007. Business Research Methods. 2nd Oxford: Oxford University Press.
- Bryman, A. and Bell, E., 2015. Business research methods. Oxford University Press, USA.
- Cahill, B. A. 2011 . Impact of the state practice environment on nurse practitioner job satisfaction. PhD thesis, Health Sciences Center, University of Illinois at Chicago, IL.
- Chung, C.E. and Kowalski, S., 2012. Job stress, mentoring, psychological empowerment, and job satisfaction among nursing faculty. Journal of Nursing Education, 51(7), pp.381-388.
- Collis, J. and Hussey, R., 2013. Business research: A practical guide for undergraduate and postgraduate students. Palgrave macmillan.
- Creswell, J.W., 2013. Research design: Qualitative, quantitative, and mixed methods approaches. Sage publications.
- Delobelle, P., Rawlinson, J.L., Ntuli, S., Malatsi, I., Decock, R. and Depoorter, A.M., 2011. Job satisfaction and turnover intent of primary healthcare nurses in rural South Africa: a questionnaire survey. Journal of advanced nursing,67(2), pp.371-383.
- Flinkman, M., Leino‐Kilpi, H. and Salanterä, S., 2010. Nurses’ intention to leave the profession: integrative review. Journal of Advanced Nursing, 66(7), pp.1422-1434.
- Grove, S.K., Burns, N. and Gray, J., 2012. The practice of nursing research: Appraisal, synthesis, and generation of evidence. Elsevier Health Sciences.
- Han, G., Jekel, M., 2011. The mediating role of job satisfaction between leader-member exchange and turnover intentions. Journal of Nursing Management 19 (1), 41–49.
- Hayes, B., Bonner, A.N.N. and Pryor, J., 2010. Factors contributing to nurse job satisfaction in the acute hospital setting: a review of recent literature.Journal of Nursing Management, 18(7), pp.804-814.
- Hayes, L.J., O’Brien-Pallas, L., Duffield, C., Shamian, J., Buchan, J., Hughes, F., Laschinger, H.K.S. and North, N., 2012. Nurse turnover: a literature review–an update. International journal of nursing studies, 49(7), pp.887-905.
- Heinen, M.M., van Achterberg, T., Schwendimann, R., Zander, B., Matthews, A., Kózka, M., Ensio, A., Sjetne, I.S., Casbas, T.M., Ball, J. and Schoonhoven, L., 2013. Nurses’ intention to leave their profession: a cross sectional observational study in 10 European countries. International Journal of Nursing Studies, 50(2), pp.174-184.
- Herzberg, F., Mausner, B. & Snyderman, B. 1959 . The motivation to work (2nd ed.). New York, NY: John Wiley.
- Hofgastein, B. 2010. Possible Shortage of Up to Two Million Health Care Workers by 2020 – EU Taking Action to Prevent Impending Crisis in Providing Health Care. Available at:http://www.ehfg.org/681.html (accessed 30 May 2016).
- Hyrkas, K. and Morton, J.L., 2013. International perspectives on retention, stress and burnout. Journal of nursing management, 21(4), pp.603-604.
- Iliopoulou KK, While AE. 2010. Professional autonomy and job satisfaction: survey of critical care nurses in mainland Greece. Journal of Advanced Nursing 66(11):2520_2531.
- Juraschek, S.P., Zhang, X., Ranganathan, V. and Lin, V.W., 2012. United States registered nurse workforce report card and shortage forecast. American Journal of Medical Quality, 27(3), pp.241-249.
- Kuo, H.T., Lin, K.C. and Li, I., 2014. The mediating effects of job satisfaction on turnover intention for long‐term care nurses in Taiwan. Journal of nursing management, 22(2), pp.225-233.
- Kwak, C., Chung, B.Y., Xu, Y. and Eun-Jung, C., 2010. Relationship of job satisfaction with perceived organizational support and quality of care among South Korean nurses: A questionnaire survey. International Journal of Nursing Studies, 47(10), pp.1292-1298.
- Lambrou, P., Kontodimopoulos, N. and Niakas, D., 2010. Motivation and job satisfaction among medical and nursing staff in a Cyprus public general hospital. Human resources for health, 8(1), p.1.
- Lavoie-Tremblay, M., Paquet, M., Marchionni, C. and Drevniok, U., 2011. Turnover intention among new nurses: a generational perspective. Journal for Nurses in Professional Development, 27(1), pp.39-45.
- Lee, S. P., Bunpitcha, C. & Ratanawadee, C. 2011. Factors predicting organizational commitment among nurses in state hospitals, Malaysia. International Medical Journal, 10(2), 21–28.
- Leiter, M.P., Price, S.L. and SPENCE LASCHINGER, H.K., 2010. Generational differences in distress, attitudes and incivility among nurses.Journal of Nursing Management, 18(8), pp.970-980.
- Lim, J., Bogossian, F. and Ahern, K., 2010. Stress and coping in Australian nurses: a systematic review. International nursing review, 57(1), pp.22-31.
- Liu, Y., Aungsuroch, Y. and Yunibhand, J., 2015. Job satisfaction in nursing: a concept analysis study. International nursing review.
- Locke, E.A. 1976. The nature and causes of job satisfaction. In Handbook of Industrial and Organizational Psychology, (Dunnette, M.D., ed.). Rand McNally, Chicago.
- Loo LH, Beh LS. 2012. Job stress and coping mechanism among nursing staff in public health services. International Journal of Academic Research in Business and Social Sciences 2(7):131_176.
- Lu, H., Barriball, K.L., Zhang, X. and While, A.E., 2012. Job satisfaction among hospital nurses revisited: a systematic review. International journal of nursing studies, 49(8), pp.1017-1038.
- Marshall, B., Cardon, P., Poddar, A. and Fontenot, R., 2013. Does sample size matter in qualitative research?: A review of qualitative interviews in IS research. Journal of Computer Information Systems, 54(1), pp.11-22.
- Maslow, A. H. 1954. Motivation and personality. New York: Harper & Row.
- Maslow, A.H. 1943. A theory of human motivation. psychological review, 50(4), 370-396.
- McGlynn, K., Griffin, M. Q., Donahue, M., & Fitzpatrick, J. J. 2012. Registered nurse job satisfaction and satisfaction with the professional practice model. Journal of Nursing Management, 20(2), 260–265.
- Meeusen, V.C., Van Dam, K., Brown-Mahoney, C., Van Zundert, A.A. and Knape, H.T., 2011. Understanding nurse anesthetists’ intention to leave their job: how burnout and job satisfaction mediate the impact of personality and workplace characteristics. Health care management review, 36(2), pp.155-163.
- Ministry of Health .2012 Health statistical yearbook. Riyadh: Ministry of Health.
- Ministry of Health of China , 2011 The Long-Term Development Planning for Medical and Health Personnel (Year 2011–2020). Available at: (accessed 20 May 2016).
- Mosadeghrad, A.M., Ferlie, E. and Rosenberg, D., 2011. A study of relationship between job stress, quality of working life and turnover intention among hospital employees. Health Services Management Research, 24(4), pp.170-181.
- Nabirye, R.C., Brown, K.C., Pryor, E.R. and Maples, E.H., 2011. Occupational stress, job satisfaction and job performance among hospital nurses in Kampala, Uganda. Journal of nursing management, 19(6), pp.760-768.
- Parvin, M.M. and Kabir, M.N., 2011. Factors affecting employee job satisfaction of pharmaceutical sector. Australian Journal of Business and Management Research, 1(9), p.113.
- Raddaha, A., Alasad, J., Albikawi, Z., Batarseh, K., Realat, E., Saleh, A. & Froelicher, E. 2012. Jordanian nurses’ job satisfaction and intention to quit. Leadership in Health Services, 25(3), 216–231.
- Ravari, A., Mirzaei, T., Kazemi, M. and Jamalizadeh, A., 2012. Job satisfaction as a multidimensional concept: A systematic review study.Journal of Occupational Health and Epidemiology, 1(2), pp.95-102.
- Rheaume, A., Clement, L. and LeBel, N., 2011. Understanding intention to leave amongst new graduate Canadian nurses: a repeated cross sectional survey. International Journal of Nursing Studies, 48(4), pp.490-500.
- Rochefort, C.M. and Clarke, S.P., 2010. Nurses’ work environments, care rationing, job outcomes, and quality of care on neonatal units. Journal of advanced nursing, 66(10), pp.2213-2224.
- Rowley, J., 2012. Conducting research interviews. Management Research Review, 35(3/4), pp.260-271.
- Sabanciogullari, S. and Dogan, S., 2015. Relationship between job satisfaction, professional identity and intention to leave the profession among nurses in Turkey. Journal of nursing management, 23(8), pp.1076-1085.
- Saleh, A.., Saleh, M.. & AbuRuz, M.. 2013. The impact of stress on job satisfaction for nurses in King Fahad Specialist Hospital-Dammam-KSA. Journal of American Science, 9(3), 371–377.
- Saunders, M., Lewis, P. and Thornhill, A. (2012) Research Methods for Business Students. 6th edn., Harlow: FT Prentice Hall.
- Saunders, M.N. and Thornhill, A., 2011. Researching sensitively without sensitizing: Using a card sort in a concurrent mixed methods design to research trust and distrust. International Journal of Multiple Research Approaches, 5(3), pp.334-350.
- Skinner, V., Madison, J., & Humphries, J. H. 2012. Job satisfaction of Australian nurses and midwives: A descriptive research study. Australian Journal of Advanced Nursing, 29(4), 19–27.
- Toode, K., Routasalo, P. and Suominen, T., 2011. Work motivation of nurses: A literature review. International Journal of Nursing Studies, 48(2), pp.246-257.
- Torkelson, D.J. and Seed, M.S., 2011. Gender differences in the roles and functions of inpatient psychiatric nurses. Journal of psychosocial nursing and mental health services, 49(3), pp.34-41.
- Tourangeau, A.E., Cummings, G., Cranley, L.A., Ferron, E.M. and Harvey, S., 2010. Determinants of hospital nurse intention to remain employed: broadening our understanding. Journal of advanced nursing, 66(1), pp.22-32.
- Van Bogaert, P., Clarke, S., Roelant, E., Meulemans, H. and Van de Heyning, P., 2010. Impacts of unit‐level nurse practice environment and burnout on nurse‐reported outcomes: a multilevel modelling approach. Journal of clinical nursing, 19(11‐12), pp.1664-1674.
- Global Health Observatory (GHO) [Online]. Geneva: World Health Organization 2010. Available from: http://www.who.int/gho/countries/en/. [ accessed 23 June 2016].
- Zhu XW, You LM, Zheng J, Liu K, Fang JB, Hou SX, Lu MM, Lv AL, Ma WG, Wang HH, Wu ZJ, Zhang LF. 2012. Nurse staffing levels make a difference on patient outcomes: a multisite study in Chinese hospitals. Journal of Nursing Scholarship 44(3):266_273.
