SCHOOL OF NURSING COLLEGEG OF HEALTH SCIENCES …
Transcript of SCHOOL OF NURSING COLLEGEG OF HEALTH SCIENCES …
SCHOOL OF NURSING
COLLEGEG OF HEALTH SCIENCES
UNIVERSITY OF GHANA, LEGON
FACTORS INFLUENCING JOB SATISFACTION AMONG NURSES IN
AHMADU BELLO UNIVERSITY TEACHING HOSPITAL (ABUTH), ZARIA,
KADUNA STATE, NIGERIA.
BY
OYIBO SAIDU SILAS
(10553049)
A DISSERTATION SUBMITTED TO THE SCHOOL OF NURSING,
UNIVERSITY OF GHANA, LEGON IN PARTIAL FULFILLMENT OF THE
REQUIREMENT FOR THE AWARD OF MASTER OF SCIENCE IN NURSING
DEGREE.
JULY, 2015
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DECLARATION
This is to certify that this dissertation is the result of research undertaken by Oyibo Saidu Silas
towards the award of the Master of Science in nursing degree in the School of Nursing, University
of Ghana
OYIBO SAIDU SILAS ……….……………….. ..…………………
(STUDENT) SIGNATURE DATE
DR, ADELAIDE M. ANSAH OFEI ……….……………….. ..…………………
(SUPERVISOR) SIGNATURE DATE
MRS. ADZO KWASHIE ……….……………….. ..…………………
(SUPERVISOR) SIGNATURE DATE
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ABSTRACT
Job satisfaction has been a recurring problem amongst nurses in Nigeria. As such, unfavorable
working conditions are compounding problems of shortage and anticipated turnover among the
Nigerian nursing workforce. Competent and skilled nurses are emigrating in search of better
remunerations, better standards of living, gaining experiences, and upgrading qualifications. The
resilient nurses practicing in Nigeria regardless of unfavourable conditions are exposed to work
related stresses. The purpose of the study was to assess factors influencing job satisfaction among
nurses in Ahmadu Bello University Teaching Hospital (ABUTH), Kaduna State, Nigeria. A
quantitative descriptive cross-sectional design was used. Disproportionate stratified random
sampling technique was used to select a sample of 360 participants from a population of 695 nurses
with a response rate of 304 (84%). Revised Nursing Work Index (NWI- R) was adopted as the
data collection tool. Data was analyzed using descriptive and inferential statistics. The major
causes of job dissatisfaction among the participants were poor salary, working conditions and
staffing. ABUTH management should improve upon nurses’ remuneration, create healthy
practicing environment and improve their staffing of nurses to retain the practicing nurses and
attract younger generation into the profession
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DEDICATION
This thesis is dedicated to God Almighty for his love, mercy and guidance over my life. I also
dedicate this work to Elder and Deaconess Yusuf Francis and my lovely wife Mrs. Ruth One Oyibo
in appreciation of her encouragement and for funding my studies in Ghana.
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ACKNOWLEDGEMENT
My profound gratitude and appreciation goes to the Almighty God for his guidance, love and
mercies over my life and for the courage to rise above obscurity and challenges of poor family
background to undertaking this tasking but bearable MSc. Nursing Programme.
I fervently acknowledge my project supervisors Dr. (Mrs) Adelaide M. Ansah Ofei and Mrs. Adzo
Kwashie for their useful criticisms and guidance from the beginning to the end of this research
study. I cannot thank you enough for your prompt responses, presence and availability, anytime I
came knocking even without scheduled appointments. You both made my research work an easy
burden to bear. Mr. Barry Baide Afoi, thank you for your guidance and support.
Many thanks to my lovely wife for taking the burden of sponsoring me for this programme and for
caring for our two children throughout the period I was away. I also want to thank the Dean school
of nursing, Prof. Donkor and all faculty members of the school. I appreciate all your mentorship
roles in my studies. All the non-teaching staff especially Aunty Regina, the two Ivy’s I will miss
you. My M.Phil. /MSc. classmates thank you too.
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Table of Contents DECLARATION ............................................................................................................................. i
ABSTRACT .................................................................................................................................... ii
DEDICATION ............................................................................................................................... iii
ACKNOWLEDGEMENT ............................................................................................................. iv
LIST OF TABLES ....................................................................................................................... viii
LIST OF FIGURES ....................................................................................................................... ix
CHAPTER ONE ............................................................................................................................. 1
INTRODUCTION .......................................................................................................................... 1
1.0 Background of the study .................................................................................................. 1
1.2 Problem Statement ........................................................................................................... 4
1.3 Purpose of the study ......................................................................................................... 6
1.4 Objectives of the Study .................................................................................................... 6
1.5 Research Hypotheses........................................................................................................ 6
1.6 Research Questions .......................................................................................................... 7
1.7 Significance of the Study ................................................................................................. 7
1.8 Operational Definition...................................................................................................... 8
1.9 Organization of the Study ................................................................................................ 8
CHAPTER TWO .......................................................................................................................... 10
LITERATURE REVIEW ............................................................................................................. 10
2.0 Introduction .................................................................................................................... 10
2.1 Theoretical Framework .................................................................................................. 10
2.4 Relationship between Socio-demographic Characteristics and Job Satisfaction ........... 28
2.5 Summary of the Literature Review ................................................................................ 34
CHAPTER FOUR ......................................................................................................................... 46
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DATA ANALYSIS, PRESENTATION AND INTERPRETATION .......................................... 46
4.0 Introduction ........................................................................................................................ 46
4.1 Socio-demographic Characteristics of Respondents ...................................................... 46
4.2 Nurses’ Satisfaction with Intrinsic Factors .................................................................... 47
4.2.1 Nurses’ Opportunities for Advancement. ............................................................... 48
4.2.2 Nurses’ Satisfaction with work itself. ..................................................................... 48
4.2.3 Nurses’ Satisfaction with the level of Recognition in their Workplace.................. 49
4.2.4 Nurses’ Satisfaction with the level of Responsibility on the Job............................ 50
4.2.5 Nurses’ Satisfaction with their level of Achievement on the Job ........................... 51
4.3 Influence of Intrinsic Factors on Job Satisfaction ...................................................... 53
4.5 Nurses’ Satisfaction with Extrinsic factors .................................................................... 57
4.5.1 Nurses’ Satisfaction with the Level of Interpersonal Relations in their Workplace.
58
4.5.2 Nurses’ Satisfaction with Salary ............................................................................. 58
4.5.3 Nurses’ Satisfaction with Policies and Administration .......................................... 59
4.5.4 Nurses’ Satisfaction with Quality of Supervision ................................................... 61
4.5.5 Nurses’ Satisfaction with Working Conditions ...................................................... 62
4.6 Influence of Extrinsic Factors on Job Satisfaction ......................................................... 64
4.7 Relationship between Socio-Demographic Factors and Job Satisfaction ...................... 70
CHAPTER FIVE .......................................................................................................................... 72
DISCUSSION OF FINDINGS ..................................................................................................... 72
5.0. Introduction .................................................................................................................... 72
5.1 Demographic Characteristics of Participants ................................................................. 72
5.2 Influence of Intrinsic Factors on Job Satisfaction .......................................................... 73
5.3 Influence of Extrinsic Factors on Job Satisfaction. ........................................................ 76
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5.4 Relationship between Job Satisfaction and Socio-demographic Characteristics ........... 81
5.6 Summary of Discussion ................................................................................................. 85
CHAPTER SIX .............................................................................. Error! Bookmark not defined.
SUMMARY, IMPLICATIONS, LIMITATIONS, CONCLUSION, AND
RECOMMENDATIONS ............................................................... Error! Bookmark not defined.
6.0 Introduction ..................................................................... Error! Bookmark not defined.
6.1. Summary of the Study ..................................................... Error! Bookmark not defined.
6.2 Implications ..................................................................... Error! Bookmark not defined.
6.2.1 Hospital Management .............................................. Error! Bookmark not defined.
6.2.2 Nursing Practice ....................................................... Error! Bookmark not defined.
6.2.3 Further Nursing Research ........................................ Error! Bookmark not defined.
6.3 Limitations of the Study .................................................. Error! Bookmark not defined.
6.4 Conclusion ....................................................................... Error! Bookmark not defined.
6.5 Recommendations ........................................................... Error! Bookmark not defined.
6.51 Ministry for Health ...................................................... Error! Bookmark not defined.
6.5.2 Nursing and Midwifery Council of Nigeria (NMCN)Error! Bookmark not
defined.
6.5.3 Hospital Management .............................................. Error! Bookmark not defined.
REFERENCES ............................................................................................................................. 95
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LIST OF TABLES
Table 4.1: Demographic Characteristics of Respondents ................................................... 46
Table 4.2: Work itself ......................................................................................................... 48
Table 4.3: Responsibilities .................................................................................................. 51
Table 4.4: Recognition ....................................................................................................... 50
Table 4.5: Influence of Advancement on Job satisfaction .................................................. 53
Table 4.6: Influence of Work itself on Job satisfaction ...................................................... 54
Table 4.7: Influence of Possibility for growth/promotion on Job satisfaction ................... 55
Table 4.8: Influence of Responsibilities on Job satisfaction ............................................... 56
Table 4.9: Influence of recognition on Job satisfaction ...................................................... 57
Table 4.10: Influence of Achievement on Job satisfaction . Error! Bookmark not defined.
Table 4.11: Interpersonal relations ..................................................................................... 58
Table 4.12: Policy and Administration ............................................................................... 60
Table 4.13: Working conditions ......................................................................................... 63
Table 4.14: Influence of Interpersonal Relations on Job satisfaction ................................. 64
Table 4.15: Influence of salary on Job satisfaction ............................................................. 65
Table 4.16: Influence of Administration on Job Satisfaction ............................................. 66
Table 4.17: Influence of Policy on Job satisfaction ............................................................ 67
Table 4.18: Influence of supervision on Job satisfaction .................................................... 68
Table 4.19: Influence of working conditions on Job satisfaction ....................................... 69
Table 4.20: Association between Gender, Age Marital status and highest education and Job
satisfaction .......................................................................................................... 70
Table 4.21: Association between Current position, weekly working hours, years in hospital, years
in nursing department/unit and Job satisfaction ................................................. 72
Table 4.22: Anticipated Nurse Turnover. ........................... Error! Bookmark not defined.
Table 4.23: Regression analysis – Anticipated Nurses’ Turnover on Job satisfaction Error!
Bookmark not defined.
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LIST OF FIGURES
Figure 2.1: Conceptual Framework for the study ............... Error! Bookmark not defined.
Figure 4.1: Bar chart showing nurses opportunity to serve on hospital and nursing committees.
............................................................................................................................ 47
Figure 4.2: Advancement ................................................... Error! Bookmark not defined.
Figure 4.3: Career development/clinical ladder opportunityError! Bookmark not defined.
Figure 4.4: Active in-service/continuing education programmes for nursesError! Bookmark not
defined.
Figure 4.5: Enough time and opportunity to discuss patient care problems with other nurses
............................................................................................................................ 52
Figure 4.6: Nurse Manager back up nursing staff decision making, even if there is conflict with
physician ............................................................. Error! Bookmark not defined.
Figure 4.7: Satisfactory Salary ............................................................................................ 59
Figure 4.8: A supervisory staff that is supportive of nurses ............................................... 61
Figure 4.9: A Chief nursing officer is highly visible to nurses ........................................... 62
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CHAPTER ONE
INTRODUCTION
1.0 Background of the study
Nursing profession is the largest health care workforce in the healthcare system having more direct
contact with patients. Nurses are therefore major determinant of overall quality of hospital care
and patients’ outcome. To enable provision of standard care, nurses must be provided with an ideal
professional practice environment where their job satisfaction is guaranteed. Nurses however, are
faced with job dissatisfaction thereby threatening the effectiveness and efficiency of the nursing
workforce (de Francisco, Meguid & Campbell, 2015). Job satisfaction is described as the major
determinant of having good staff retention in the nursing workforce (Wang, Tao, Ellenbecker, &
Liu, 2012).
In an ideal setting, employees’ welfare and satisfaction are imperative in attaining the
organizational mission and vision. For instance, nurses are the safety net, ever present with their
patient at the bedside, caring and detecting medication errors, addressing patients’ real need.
Nurses are the first point of contact to clients in any healthcare facilities. Job satisfaction in the
nursing workforce is therefore vital to quality care provision (Abualrub, El-Jardali, Jamal & Al-
Rub, 2015; Alenius, Tishelman, Runesdotter, & Lindqvist, 2013; Saleh, Darawad, & Al‐Hussami,
2015). Job satisfaction thus, is the most important aspect of nurses’ lives which has positive
influence on their morale, productivity, quality of care, patients’ safety, and retention (Ezeonwu,
2011; Aiken, et al., 2012).
Job satisfaction is the product of employee’s attitude to his/her job and job processes. Employee’s
job satisfaction entails an outcome of job demands meeting employee’s expectations. It is “a
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pleasurable or positive emotional state resulting from the appraisal of one’s job or job experiences”
(Locke, 1969, p. 28). Job satisfaction is a consequence of people’s opinion and feeling about their
job arising from intricately interwoven factors regarding the work itself and the work process. It
is a function of the extent to which one values certain facets of work, such as the degree of
autonomy, company policy, management style, promotion, pay, recognition, relationship among
co-workers, work itself and working conditions. These are broadly grouped into extrinsic/hygiene
and intrinsic/motivation factors by Herzberg (Herzberg, 1968; Asegid, Belachew, & Yimam,
2014).
Decline in job satisfaction is one of the major cause of shortage in nursing workforce globally. In
the United States, Australia and Canada, poor job satisfaction has led to nurses quitting their
organization and/or nursing profession leading to shortage in the nursing workforce (Bellasch,
2015). There is a projection of about 500,000 shortage of nurses by the year 2025 in the United
State of America while that of Canada is anticipated to rise to 60,000 by 2022 (Buchan, O'May &
Dussault, 2013; Trautman, 2015). Likewise, nurses from Germany, France, Poland, Italy,
Netherlands, Belgium, Slovakia and China reported having poor job satisfaction and frustration
with the nursing profession due to excessive work load coupled with poor recognition and
remuneration (Li, Bruyneel, Sermeus, Van den Heede, Aiken & Lesaffre, 2013). Thus, Bellasch
(2015) acknowledged that until adequate measures are taken to address decline in job satisfaction
among nurses and halt the current high rate of nurse turnover, this shortage will continue to
negatively impact the quality of healthcare systems across the globe.
The challenge of decline in job satisfaction among nurses and its associated consequences such as
poor patient outcome, high turnover and attrition has become a global issue (Aiken et al., 2012).
Indeed, the situation is more serious among the low and middle income nations such as Sub-
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Saharan Africa of which Nigeria is one (Dolamo & Olubiyi, 2013). This health workforce crises
accounts for the reason most African countries failed in meeting up with the Millennium
Development Goals (MDGs) (Gupta, Bush, Dorsey, Moore, van der Hoof, & Farmer, 2015; De
Francisco, Meguid, & Campbell, 2015). Additionally, retention problems in the nursing workforce
in sub-Saharan Africa accounts for some of the reasons behind the high maternal and child
mortality rate, poor response and ineffective management of infectious diseases and outbreak of
epidemics (Sun & Larson, 2015). It is however, anticipated that when nurses are satisfied with
their job, they would remain on their job and be committed to their organisation.
Nigerian healthcare system is under-resourced and overstretched owing to the rapid growing
population, poor policy implementation and security challenges. This is further compounded with
poor management of human resources for health such as mal-distribution of the nursing workforce
and poor welfare packages (Green, 2016; Agboghoroma & Gharoro, 2015). Thus, the push and
pull factors associated with global market forces such as poor working conditions, unattractive
benefits and poor salary are forcing well trained and most competent Nigerian nurses to emigrate
to high income nations in search of better remuneration and satisfactory working conditions. These
are deepening the shortage in nursing workforce especially in terms of skill in Nigeria (Walani,
2015).
Nursing practice is more challenging in Nigeria, especially in the rural areas and the northern part
of Nigeria plagued with terrorism (Innocent, Uche, & Uche, 2014; Adegoke, Atiyaye, Abubakar,
Auta & Aboda, 2015). Nurses practicing in such areas are usually mandated by situation and
empathy to go beyond their professional jurisdiction in patients’ care especially in the advent of
epidemic outbreaks, such as Ebola, Lassa fever and meningitis as well as bomb-blasts. Nurses are
thereby exposed to uncountable occupational-related stresses ranging from excessive workload,
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dealing with death and dying patients (Green, 2016; Mosadeghrad, 2013). Most studies carried out
on job satisfaction among nurses in other states of Nigeria reported decline in their job satisfaction
due to poor salary, inadequate and sub-standard medical equipment and drugs, lack of opportunity
for advancement and low self-esteem arising from being under-valued by their employers (Nwafor,
Immanel & Obi-Nwosu, 2015; Edoho, Bamidele, Neji & Frank, 2015; Adegoke et al., 2015).
Without a stable nursing workforce, quality of care will continue to be compromised as nurses
would demonstrate lack of commitment and competence to their work when they are not satisfied
with their job. Having a satisfied nursing workforce in ABUTH which is the only tertiary
healthcare facility in Kaduna State is therefore imperative. Anecdotal evidence though, shows a
decline in job satisfaction among ABUTH nurses due to frequent industrial strikes, emigration and
high nursing staff turnover.
To the best knowledge of the researcher, no study was found on job satisfaction among ABUTH
nurses at the time of this study. In addition, other studies on job satisfaction among Nigerian nurses
were conducted in other parts of Nigeria which have different cultural background and working
conditions in contrast to ABUTH. The researcher therefore aimed at exploring factors influencing
job satisfaction among ABUTH nurses. The findings will contribute to the existing knowledge on
job satisfaction and will further enlighten the management of ABUTH on how to enhance job
satisfaction among nurses so as to generally promote quality healthcare delivery.
1.2 Problem Statement
Nigeria is naturally endowed with both human and natural resources. Unfortunately, despite these
leverages, the responsiveness of Nigerian’ healthcare system is inadequate. The Nigerian
healthcare milieu is increasingly becoming volatile with unpleasant scenarios such as decreased
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job satisfaction, incessant industrial strike actions among nurses, and deficient healthcare services.
This has been observed to be the cause of massive exodus of Nigerians to access medical care
abroad and poor health indicators such as increased rate of maternal and child mortality (Agbedia,
2012; Obansa & Orimisan, 2013; Green, 2016).
The healthcare system in Nigeria is faced with many challenges including unfair distribution of
nursing workforce, increasing “brain drain” culminating into shortage of skilled and competent
nursing workforce. Furthermore, poor human resources planning, mismanagement practices and
structures, unsatisfactory working conditions, political crises, and terrorism among others are
genuine challenges confronting the Nigerian healthcare system (Welcome, 2016; Obansa &
Oriminsa, 2013).
Ogbolu, Johantgen, Zhu and Johnson (2015), described the nursing workforce as being deficient
both in material and human resources which contributes to the inability of nurse leaders to achieve
a healthy, adequate and stable nursing workforce. The frequent industrial strike actions among
Nigerian healthcare workforce has resulted in unquantifiable losses, ranging from loss of lives,
deformities and untold hardships among Nigerians especially the masses who cannot afford
seeking care in private healthcare facilities or access medical care abroad due to financial
incapability.
ABUTH has had its fair share of industrial strikes and upheavals among nurses due to job
dissatisfaction. For instance, this year nurses in ABUTH participated in the general nurses’ strike
in Nigeria. Nurses agitated against poor remuneration and lack of recognition among their peers
especially, the promotion of nurses to executive positions. Thus, for two weeks, nurses stayed
away from work while their leaders dialogue with government to resolve the impasse. ABUTH
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though, has initiated some strategies to enhance job satisfaction among nurses, such as granting
nurses study leave, a lot have to be done to build trust between management and nurses.
Additionally, partnership must be developed with stakeholders to mobilize resources to nurture
and retain competent, confident and committed nursing workforce to effectively harness the
material and human resources that will demystify these challenges. There must be adequate
knowledge of the various variables either discouraging or encouraging job satisfaction among
nurses. This study would therefore, explore the different variables influencing job satisfaction
among nurses in ABUTH.
1.3 Purpose of the study
The purpose of this study is to describe the factors influencing job satisfaction among nurses in
ABUTH.
1.4 Objectives of the Study
Specific objectives of the research are:
1. To explore the influence of extrinsic factors (working conditions, salary, supervision,
interpersonal relations and policy and administration) on job satisfaction
2. To explore the influence of intrinsic factors (work itself, achievement, recognition,
responsibility and advancement) on job satisfaction.
3. To establish relationship between socio-demographic characteristics (marital status,
gender, age and educational status) and job satisfaction.
1.5 Research Hypotheses
1. H1 - Extrinsic factors will influence nurses’ job satisfaction
2. H1 - Intrinsic factors will influence nurses’ job satisfaction
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3. H1 - Nurses’ socio – demographic factors will influence their level of job satisfaction
1.6 Research Questions
1. What are the extrinsic factors that influence nurses’ job satisfaction?
2. What are the intrinsic factors that are influencing nurses’ job satisfaction?
3. How do nurses’ socio-demographic characteristics influence their job satisfaction?
1.7 Significance of the Study
The findings of the study when communicated to nurse leaders and management of ABUTH,
would equipped them with adequate information to enable deal successfully with challenges of job
dissatisfaction among nurses. It will also be relevant to the nursing profession by providing more
insight that could herald policies that will ensure maximum support for nurses in their practice
settings thereby leading to more stable and productive nursing workforce. The findings may also
reveal other areas that would need further studies on variables associated with job satisfaction
among nurses. The findings will also contribute to the existing knowledge on job satisfaction
among nurses.
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1.8 Operational Definition
Variable Conceptual definition Operational definition
Job satisfaction It is “a pleasurable or positive
emotional state resulting from
the appraisal of one’s job or
job experiences” (Locke,
1969, p. 28)
An outcome of job demands
meeting employees’
expectation.
Factors Webster’s Concise Edition
Dictionary and Thesaurus
(2002, P. 118) defines factors
as “any circumstances that
contribute towards a result.”
Attributes or phenomena
which have an impact on
another variable.
Intrinsic factors ‘Intrinsic/ motivators relate
directly to the person’s job
and can enhance his/her level
of job satisfaction (Lephalala,
2009, P. 30).
These are internally
generated motivational
variables directly related to
the job content.
Extrinsic factors “Extrinsic/hygiene needs do
not relate to a person’s work
but to conditions surrounding
a job” (Lephalala, 2009, P.
28).
These are externally
generated variables directly
related to the job
surrounding/context which
prevent employees’ job
dissatisfaction.
Nurses Professionals formally trained
to care for anyone with self-
care deficit.
Professionals licensed by the
Nursing and Midwifery
Council of Nigeria to practice
nursing in Nigeria.
1.9 Organization of the Study
The study is made up of six (6) chapters. The First Chapter is the introduction which discusses the
background to the study and the significance. Explanations of the research problems, aims and
objectives of the research, definition of concepts are also included. Chapter two presents the
literature review which looks at: theoretical framework, influence of extrinsic factors on job
satisfaction, influence of intrinsic factors on job satisfaction and relationship between socio-
demographic characteristics and job satisfaction and conceptual framework of the study. Chapter
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three presents information on the philosophical assumptions underpinning the study and the
technique employed. The research setting, population of the study, the inclusion and exclusion
criteria, sample size, sampling technique, and tool employed for data collection, method of data
collection, and information on the pre-test of the instrument, the data management process, and
the ethical considerations were discussed. The chapter four presents analysis and interpretation of
the data while chapter five presents discussion of result. The last chapter (six) discusses the
summary of the findings, limitation of the study, conclusions and recommendations.
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CHAPTER TWO
LITERATURE REVIEW
2.0 Introduction
This chapter reviews relevant and related literature about the phenomena of motivation and job
satisfaction. The databases used in the review of literature includes Google scholar, Science direct,
Willey online, Sage Journals, Health source, Elsevier, CINHAL, EBSCO and MEDLINE. The key
concepts used for the literature search included job satisfaction, nurses, turnover, attrition,
retention, satisfaction and dissatisfaction, intrinsic and extrinsic factors, socio–demographic
factors and healthcare workforce. The literature review is discussed under the theoretical
framework, influence of extrinsic factors on job satisfaction, influence of intrinsic factors on job
satisfaction, relationship between socio-demographic characteristics and job satisfaction.
2.1 Theoretical Framework
The concept of motivation is an issue crucial to both employers and employees. Effective and
efficient management of motivational issues in any organization evidently leads to the
sustainability of the entity. Motivation is a very delicate issue to employees and according to
Blader, (2007) motivation is the intention targeted at a specific goal which results to goal-directed
behaviours.
The theoretical framework adopted for this study is Herzberg’s two factor theory of motivation.
Herzberg’s two factor theory was developed out of a burden to find answers to the challenges of
motivation of employees dated back 1950s. Herzberg’s theory consists of intrinsic/motivation
factors and extrinsic/hygiene factors, which he believed, cannot be measured on the same
continuum. Herzberg described factors responsible for employees’ job satisfaction as intrinsic
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factors, which he believed are internally generated motivational variables directly related to the
job content. These include work itself, responsibility, advancement, recognition, and achievement.
The factors responsible for employees’ job dissatisfaction were described as extrinsic factors,
which he believed are externally generated variables directly related to the job surrounding. These
include supervision, working conditions, company policy and administration, salary, and
interpersonal relationships.
Herzberg opined that the opposite of satisfaction is no satisfaction while opposite of dissatisfaction
is no dissatisfaction. Herzberg also argued that while the absence of extrinsic factors could cause
dissatisfaction, the presence does not amount to job satisfaction by employees (Hertzberg, 1968).
That is, while extrinsic factors influence job dissatisfaction, intrinsic factors influence job
satisfaction. Herzberg advanced his argument that intrinsic factors supersede extrinsic factors
because they are the major determinants of employees’ motivation and overall job satisfaction.
The employer must therefore provide extrinsic factors before providing factors that motivate
employees thereby regarding extrinsic factors as a launch pad for establishing a platform for
employees’ motivation as shown in Figure 2.1.
Figure 2.1: Herzberg’s Two Factor Theory of Motivation.
Dissatisfaction and
Demotivation
Not Dissatisfied but
not Motivated
Positive Satisfaction
and Motivation
Extrinsic/Hygiene Factors Intrinsic/Motivational Factors
Working conditions
Supervision
Company policy and
administration
Interpersonal relations
Salary
Work itself
Recognition
Advancement
Achievement
Responsibility
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Consequently, when the extrinsic factors are absent or insufficient, employees would be
dissatisfied and demotivated either with or without the presence of intrinsic factors. On the other
hand, when extrinsic factors are present and adequate, employees will not have job dissatisfaction
but will still remain unmotivated. Herzberg therefore posited that it is at this stage onward that
employees can be satisfied and motivated by the presence of intrinsic factors.
Some scholars have criticized Herzberg’s theory. The theory has been critiqued for its failure to
measure the correlation between job satisfaction and performance (Armstrong, 2006).
Furthermore, Herzberg viewed humans as being mechanical instead of being dynamic by explicitly
and rigidly stipulating factors that influence employees’ job satisfaction. The implication is that
these factors are fixed and do not evolve. He further advocated complete provisions of extrinsic
factors before anticipating employees’ job satisfaction, which is practicably unrealistic in practice
(Vroom, 1966; House & Wigdor, 1967; Diener & Biswas – Diener, 2011).
Herzberg’s two factor theory however still remains valid for understanding factors influencing
employees’ job satisfaction even in Africa as reported by some literature of African origin (Dartey-
Baah & Amoako, 2011; Akanbi, 2011; Worlu & Chidozie, 2012; Edoho et al., 2015; Adegoke et
al., 2015). Edoho et al. (2015) studied job satisfaction among Nigerian nurses using Herzberg’s
two-factor theory and found it relevant to understanding factors influencing job satisfaction. The
researcher therefore adopted Herzberg’s theory because it has been proven to be effective in
studying job satisfaction among nurses both in Nigeria and beyond.
In this study, nurses were asked to rate their level of satisfaction with their intrinsic and extrinsic
factors. Nurses’ job satisfaction was based on their level of satisfaction with their intrinsic and
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extrinsic factors. The researcher in addition, established relationships between socio-demographic
characteristics such as age, gender, marital status educational status and job satisfaction.
2.2 Influence of Extrinsic Factors on Job Satisfaction
Extrinsic factors are externally generated variables directly related to the job surrounding whose
presence do not amount to job satisfaction but are however capable of preventing job
dissatisfaction (Akanbi, 2011; Herzberg, 1968). These factors are salary, allowance, supervision,
working conditions, interpersonal relationships, company policy and administration. These factors
are very important to nurses because they provide the nurses with an enabling environment and
good frame of mind where their skills and competence would be maximally utilised.
Nurses are very passionate about their salary, and become dissatisfied when their pay is inadequate
and living conditions become unbearable. Several studies have postulated that, the major tool for
preventing employees’ job dissatisfaction is better remuneration like allowances, better pay, proper
and better conditions of service and among others (Asuquo, Imaledo, Thomp-Onyekwelu, Abara,
& Agugua, 2016; Worlu & Chidozie, 2012). When employees perceive their remuneration to be
adequate in commensuration with their responsibilities, it increases their level of job satisfaction
and commitment to their organisation (Kaplan & Brown, 2009). Good pay enables employees to
meet up with their financial obligations such as family responsibilities and better standard of living
leading to increase in their level of job satisfaction.
In a study on job satisfaction and retention of midwives in rural Nigeria, using mix method
approach, Adegoke et al. (2015) reported that, midwives in the northern part of Nigeria are
dissatisfied with their jobs due to poor salary. The participants were dissatisfied with their poor
standard of living especially in the rural areas where social amenities are in their worse state. This
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could be attributed to the fact that in a developing nation like Nigeria, there is usually dearth of
social amenities and infrastructures in the rural areas. Nurses and Midwives practicing in such
areas usually have to cope with many unfavourable circumstances such as having to transport their
children over long distances where they can have access to good education, dealing with frequent
power outages, security for themselves and their families as well as access to quality healthcare
services when the nurses themselves fall sick. All these put extra burden on their finances thereby
affecting their level of satisfaction with their jobs.
In a cross-sectional study to assess level of job satisfaction among South African nurses, Khunou
and Davhana-Maselesele (2016) established that good salary has significant positive impacts on
nurses’ job satisfaction. The South African nurses reported dissatisfaction with poor salary and
therefore indicated a desire to migrate to high-income countries in search of better remuneration
and conditions of service. Clearly, good salary appears to be appealing and gratifying to
employees. It accounts for the major motivating factor behind employees’ passion to work as well
as a pursuit for advancement and promotion. In order to safe guard the morale and enthusiasm of
employees for maximum performance, their salary should be commensurate with their skill and
job demand (Worlu & Chidozie, 2012).
When employees perceive their salaries to be adequate and commensurate with their level of
competency, job demands and prevailing pay standards, they find their job more attractive and
fulfilling which invariably leads to increase in their level of job satisfaction and productivity
regardless of the presence of other unfavourable conditions (Dartey-Baah & Amoako, 2011).
Oriarewo, Agbim and Owutuamor (2013) in a study among bankers in Nigeria explored job
rewards as correlates of job satisfaction. The authors reported bankers citing good salary as a major
factor influencing their job satisfaction. Nigerian bankers are usually accorded respect by the
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society due to their good salary. Other studies equally established positive relationship between
good salary and job satisfaction among nurses (Wang & Liesveld, 2015; Dignani et al., 2013;
Yang, Yu & Wang, 2013).
Working conditions (extrinsic factors) consist of two broader dimensions such as work itself and
context (Raziq & Maulabakhsh, 2015). The authors indicate that work itself include all the
different characteristics of the job, tasks and activities, sense of achievement from the work, and
the context refers to the physical and social working environments respectively. Studies have
shown that the physical and social working conditions influence job satisfaction and that when
these are ignored in organizations, the employees’ performance is adversely affected (Raziq &
Maulabakhsh, 2015). Consequently, healthy working conditions are indispensable to achieving
employees’ job satisfaction. Also, physical and social working environments are fundamental
requirements for achieving adequate staffing, effective and efficient nursing care and positive
patient outcomes which in turn influence job satisfaction (Hayes, Douglas and Bonner 2015; Aiken
et al., 2011; Hu et al., 2015).
In a study by Waqas, Bashir, Sattar, Abdullah, Hussain, Anjum and Arshad (2014), conducted
among 148 Pakistan employees from different disciplines, findings indicated that good working
conditions was positively associated with job satisfaction. This implies that the working conditions
such as adequate space, lighting, quality and adequate equipment, good staffing, ideal workload
must be adequately catered for in order to ensure that employees are satisfied with their jobs as
expressed by the findings of Waqas et al. (2014). Healthy working conditions would provide
employees with favourable workplace where their potentials can be maximised.
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Similarly, Asuquo et al. (2016) in a descriptive cross-sectional study assessed job satisfaction
among nurses in Port-Harcourt Teaching Hospital, Nigeria. Poor working conditions were rated
highest as cause of job dissatisfaction among the participants. Employees would be comfortable
and satisfied with their job when they perceived their working conditions attractive and would be
more apt to learn to adapt to the organisational culture (Sarode & Shirsath, 2014). Similar findings
were reported by another study among Nigerian nurses by Ogbolu et al. (2015), in which the nurses
expressed dissatisfaction with their working conditions and rated patient safety as poor in their
settings. The nurses reported frustration with having to battle with gross shortage of staff,
excessive workload and scarcity of resources. To address the problems of decline in job
satisfaction, deterioration of quality care, nurses must be provided with adequate material and
human resources to enable them carry out their professional duties effectively and efficiently.
Aiken et al. (2011) conducted a survey involving 98,116 professional nurses in 1406 different
hospitals across nine European countries between 1999 and 2009. They reported high level of
burnout among nurses in all the countries except Germany. Poor working conditions were
evidenced in most of the hospitals across the countries. They however, reported hospitals with
good practice environment having decreased burnout, increased job satisfaction, decreased
turnover and good patient outcome. They advocated quality work environment as formidable
measures to achieving and sustaining efficient nursing workforce globally. Their study has high
creditability for generalization considering the large sample size drawn from different hospitals
across nine countries with rigorous scientific procedures employed in the conduct of the study.
Nurses are satisfied with their job when provided with good working conditions and would be
equipped to render quality care.
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Additionally, Ganzo and Toren (2014) assessed the Israeli nursing practice environment
characteristics and job satisfaction and established a strong positive association between the
practice environment and job satisfaction of nurses. They reported appropriate staffing and
resources as the most vital but often neglected characteristics of nursing practice environment and
working conditions. Adequate staffing and resources are effective solutions to workplace related
stresses. Quality and sufficient and ergonomically designed working tools are formidable in
creating and sustaining employees’ motivation and enhancing their productivity (Ganzo &Toren,
2014). Other literature similarly established strong positive relationship between healthy working
conditions and job satisfaction among nurses (Lu, Barriball, Zhang and Alison, 2012; Leineweber
et al., 2016; Hu, Luk and Smith, 2015). Furthermore, nurses are satisfied with their job when they
are able to realise their objectives of patient’s care. However, they can only utilise their skill and
competence when given the right resources and tools to work with.
Human behaviours are intricately complex and unique and good interpersonal relations remain the
only common denominator for harnessing this diversity and uniqueness of human behaviours for
healthy and productive co-existence among employees (Polis et al., 2015). Good interpersonal
relation is a proven tool in creating and sustaining strong positive group cohesion, trusts,
confidence, socialization, teamwork and healthy practice environments, which are vital to
employees’ job satisfaction (Ulrich et al., 2014). Good interpersonal relations encourage
transparency and cultivation of confidence among employees (Kailsch & Lee, 2013). Moreover,
job satisfaction and organisational commitment is usually high in a friendly atmosphere because
there is singleness of purpose and focus. Every effort would be geared towards achieving the
organisational goal because the system is devoid of sabotage.
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Yang et al. (2012) in a cross-sectional survey assessed level of job satisfaction among Chinese
nurses. Their study proved good interpersonal relations to enhance job satisfaction and teamwork
among nurses. Similarly, Al-Dossary, Vail and Macfarlane (2012) in a quantitative study assessed
the level of job satisfaction and explored factors that influence job satisfaction among Saudi
Arabian nurses. The result of their study proved that interpersonal relations influence nurses’ job
satisfaction. The participants were satisfied with their interpersonal relations and happy with their
work environment. When there is good interpersonal relations, there would not be room to
entertain misunderstanding among nurses because good interpersonal relations encourages open
communication through which nurses could easily resolve their differences. Dignani and Toccaceli
(2013) similarly, in a survey on factors influencing job satisfaction among Italian nurses recounted
interpersonal relations being positively correlated with nurses’ job satisfaction. Other studies
reported similar findings (Mosadegrad 2013; Kim, Han, Kwak, & Kim; 2015; Liu et al., 2016).
Policy and administration are formally documented guidelines aimed at streamlining activities and
interest for achieving the objectives of the organization. It is imperative for healthcare facilities to
frequently review their organizational policies while taking into cognizance the current prevailing
circumstances. Hayes, Bonner & Douglas (2013) explored the level of job satisfaction among
Australian and New Zealand nurses working in a haemodialysis unit. A cross-sectional design was
adopted to recruit 417 nurses through online survey. While the result proved that level of job
satisfaction between Australia and New Zealand was similar, Australian nurses rated the impacts
of company policies and administration on their job satisfaction higher than New Zealand nurses.
Decision-making is an aspect of administrative and policy issues in organizations. Al-Hamdan,
Bawadi, Redman and Al-Nawafleh (2016) in a study among Jordanian nurses reported nurses
having job dissatisfaction, which was attributed to their non-involvement in decision-making. The
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authors cited nurses’ displeasure with the non-existence of formally stipulated policies in their
organisation. On the other hand, nurses would find their work environment more friendly,
accommodating and satisfied with their job when they are involved in the hospital administration
and day-to-day decision-making especially in matters relating to their services.
According to Emmarex and Owuze (2015), clarity, transparency and uniformity are indispensable
characteristics of effective organizational policy and administration. When employees are aware
of the rules and regulations operational in their organizations, role conflicts, occupational stresses,
destructive and unethical behaviours, which are inimical to their job satisfaction, would be reduced
to their barest minimum. In another study by Edoho et al. (2015) to determine level of job
satisfaction among nurses in Calabar, Cross River State, Nigeria, revealed that good policies and
administration are positively associated with nurses’ job satisfaction. Similar findings have been
reported by Mosadegrad (2013). Khunou and Davhana-Maselesele (2016), and Wang and Liesveld
(2015). These findings suggest that in formulating organisational policies, employees’ input should
be sought and acknowledged. Moreover, involving employees in policy formulation would
eliminate the chances of employees’ misrepresentation of the organisation’s interest and also give
employees a sense of belongingness and achievement, which would enhance their job satisfaction.
Employees’ job satisfaction is created and sustained with the presence and effort of unit
supervisors who are passionate, friendly, and accommodative (Locke, 1976). Al-Dossary, Vail and
Macfarlane (2012) in a quantitative study assessed the level of job satisfaction and explored factors
that influence job satisfaction among Saudi Arabian nurses. The result of their study indicated that
the nurses were satisfied with the quality of supervision of their work. The study involved only
one teaching hospital in Saudi Arabia limiting the generalizability of the result.
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Nurses fare better in an atmosphere where their effort is acknowledged and appreciated and are
convinced of equal treatment (Abualrub et al., 2015). It takes a supportive and competent
supervisor to create a healthy work environment where employees’ interest and organisational goal
are harnessed and sustained. A study among Jordanian nurses by Abualrub et al. (2015) established
strong positive association between supportive supervisor and employees’ job satisfaction. This
suggests that nurses with high levels of supervisory support indicated high levels of job
satisfaction. Therefore, nurse managers (supervisors) at all levels must ensure that the wellbeing
of their subordinates are given adequate and prompt attention because employees would cultivate
sense of belonging and loyalty when they perceive their supervisors interested in their wellbeing
(Wang & Liesveld 2015). This is likely to lead to job satisfaction among the employees.
In another study conducted in Canada by Nowrouzi et al. (2015), participants advanced poor
management as being detrimental to staff support and positive group cohesion. Lack of unity and
distrust would ensue in the workplace when employees perceive their superior displaying
preferential treatment among their colleagues. Good supervision entails that every employee is
given equal treatment as the need arises. Furthermore, acknowledgment of staff’s outstanding
performance and promotion or opportunity for training would only influence employees’ job
satisfaction positively when it is strictly based on merit and not favour or sentiment.
Good supervision is also largely dependent on role modelling and availability. Studies have shown
that nurses’ morale is usually sustained even in adverse situations when their supervisors are
always within their reach and offering them necessary support. For instance, Adegoke et al. (2015)
in a study to assess the factors influencing job satisfaction of midwives in rural Nigeria reported
that midwives have job dissatisfaction due to unavailability of supervisors and lack of support for
their welfare. When the workplace is uncoordinated due to poor supervision, the environment
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becomes unhealthy for employees to function maximally, which could lead to job dissatisfaction
manifesting in burnout, depression and frequent absenteeism among employees.
According to Van Bogaert et al. (2014) in a study among nurses in Dutch speaking part of Belgium,
the participants cited good supervision as central to effective team building, involvement of nurses
in decision making, overall job satisfaction, quality nursing care and positive patient outcome.
Good supervision is indispensable to creating and sustaining a healthy nursing practice
environment. Correspondingly, Gok, Karatuna and Karanca (2015) reported good supervision as
major determinant of creating and sustaining higher level of job satisfaction among nurses.
2.3 Intrinsic Factors on Job Satisfaction.
Intrinsic factors are internally generated motivational variables directly related to the job content
(Akanbi, 2011). Intrinsic factors are directly associated with employee’s job and can influence
employee’s job satisfaction (Herzberg, 1968). Intrinsic factors are: job advancement, work itself,
responsibilities, recognition and achievement. They are intrinsic within the work itself and
associated with the actual content of the job.
According to Herzberg (1968), job must be interesting and varied for employees to derive positive
satisfaction from doing it. Thus, work itself entails mentally challenging tasks, but still interesting
enough to give the employees a sense of success and satisfaction (Locke, 1976). Other components
of work itself include the work environment; workload, staffing and skill mix which are reported
having strong association with job satisfaction among Chinese nurses (Duffield et al., 2011).
Adequate human and material resources are strong positive predicator of employees’ job
satisfaction. Hospital environment should be pleasant, wards and office should be spacious and
well lit. Improvising of equipment should be reduced to the barest minimum. Furthermore,
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equipment provided must be ergonomically designed and suitable for their purpose so as to
enhance nurses’ performance and job satisfaction.
Work itself must be favourable for nurses to measure up to their professional demand. Nurses from
Germany, France, Poland, Italy, Netherlands, Belgium, Slovakia and China reported having poor
job satisfaction and frustration with nursing profession due to excessive workload (Li et al., 2013).
Similarly, Wang, Tao, Ellenbecker and Liu (2012) in a cross-sectional study among Chinese nurses
reported that ideal workload and job enrichment were associated with increased job satisfaction
among the nurses. An ideal workload is attainable only through adequate staffing while staffing is
said to be adequate when there is a rational allocation of patients / clients’ care to nurse(s) (Duffield
et al., 2011). Adequate staffing and job enrichment are therefore imperative to nurses’ job
satisfaction.
Work itself is attractive in the presence of adequate staffing without subjecting nurses to excessive
workload and burnout, which leads to job dissatisfaction. There is empirical evidence linking
adequate staffing and ideal workload to patient positive outcomes and nurses’ job satisfaction
(Trinkoff et al., 2011; Aiken, Sloane, Bruyneel, Van den Heede, Griffiths, Busse, & McHugh.,
2014). For instance, when few nurses are left to care for many patients regardless the severity of
the disease condition, quality of care is usually compromised leading to poor patient outcomes
(Tao, Ellenbecker, Wang & Li, 2015). This could lead to burnout and job dissatisfaction among
nurses.
When employees are assigned to challenging tasks that are commensurate with their training and
experience, a successful completion of such tasks would increase their sense of achievement and
job satisfaction (Mosadegrad, 2013). Allowing nurses to practice at the level of their expertise and
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making decisions about patients’ care increase their motivation and thus their level of job
satisfaction. More so, professional autonomy is central to cultivation of passion for excellence and
professional development among nurses (Azim, Haque & Chowdhury, 2013). It is observed that
having autonomy over nursing practice increases nurses’ self-esteem, job satisfaction and desire
to be more ethically inclined in anticipation to project and uphold good professional image.
Graham, Davies, Wood, Simpson and Manta (2011), conducted a survey involving 18, 676 nurses
and reported that participants rated autonomy above all other variables as impacting on job
satisfaction followed by workload. From their study, that autonomy is one of the most powerful
predictors of job satisfaction among nurses. The recognition accorded professional autonomy by
nurses may be attributed to the fact that being aware that you are responsible for the outcome of
your decisions and actions automatically instils in one the consciousness and discipline to be
ethically inclined and law abiding.
Advancement and recognition are vital to nurses’ job satisfaction when accompanied with change
in task allocation and overall job description. It is observed that underutilisation of employees’
knowledge and competence usually results in their job dissatisfaction. Underutilisation of nurses’
skill and competence was reported to have negative influence on nurses’ job satisfaction
(Bruyneel, Aiken, Lesaffre, Van den Heede, & Sermeus, 2013).
Advancement opportunities are very critical to employees’ job satisfaction and commitment to the
organizational goals. Recognizing and rewarding the dedicated and competent employees with
non-monetary reward like opportunity for training and promotion would equally give employees
higher level of job satisfaction and impetus to strive harder in achieving the organizational goals
(Mustapha & Zakaria, 2013). Advancement is measured in various ways such as promotion,
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increase in remuneration and autonomy (Masum et al., 2016). It is usually one of the major
motivating factors behind employee’s acceptance of responsibilities and it equally affects all facets
of employee’s life (Luthan, 1998). Advancement affords the employees means for personal
growth, development and increase in societal status and improvement in standard of living. In a
cross sectional survey to examine the variables influencing job satisfaction among healthcare
workers in the Philippines, opportunity for training and development were reported as the most
important sources of satisfaction among the participants (Fabiene & Kachchhap, 2016).
One of the major ways to align the interest of the organisation with that of employees is having a
well-structured pattern of opportunities for training and job promotion for all employees
documented and implemented accordingly (Ugwa & Ugwa, 2014). Another study conducted to
assess nurses’ working conditions and quality of care in 12 Europeans countries reported different
levels of job satisfaction among the countries. One of the factors associated with decrease in job
satisfaction in most of the countries was opportunity for advancement (Aiken et al., 2013)
Additionally, it is observed that employees usually feel ill-treated when denied opportunities for
training and promotion when due. It would therefore save the organisation from a lot of stress
handling conflicts and disloyalty in the workplace by having laydown rules guiding the benefits
available for their employees.
Rouleau, Fournier, Philibert, Mbengue, and Dumont (2012) examined the professional lives and
job satisfaction of midwives in Senegal and reported that more than half of the participants (55%)
have emotional exhaustion and job dissatisfaction which was positively correlated with lack of
opportunity for advancement and professional training. Nurses’ professional aspiration and self-
fulfilment can only be achieved via advancement in their professional career. Similar findings
were reported by other studies conducted among Nigerian nurses (Oyetunde & Ayeni, 2014;
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Edoho et al., 2015; Ugwa & Ugwa, 2014). This could also be responsible for decline in job
satisfaction and deterioration in quality care commonly observed in the Nigerian health care
system.
It is observed that employees measure the prospect of their work with opportunity for
advancement. Employees therefore would remain with the organization when they become aware
of the policy for promotion. Such awareness and the expectation for advancement while in service
keeps employee motivated and committed to the organisational goals. A study conducted in
Mexico to assess the life of nursing faculty members in association with their job satisfaction
recounted opportunities for professional advancement as a major source of job satisfaction (Wang
& Liesveld, 2015). Similar findings were reported by other literature (Zahaj et al., 2016; Ali &
Wajidi, 2013; Masum et al., 2016; Khunou et al., 2016). This could be attributed to the fact that
advancement comes with different packages and benefits, which nurses enjoy. Moreover, it is
through advancement that employees can ascend the ladder of managerial position and being in a
managerial position is in itself an achievement.
Recognition is the positive acknowledgement of employees’ exceptional performance or
achievement, which have significant bearing on employees’ overall level of job satisfaction
(Tessema, Ready & Embaye, 2013). Recognition is observed to have a catalyst-like influence on
the potential of employees. This is because employees’ passion and commitment seems to be on
the increase in the workplace where culture of recognition is held in high esteem. Consequently,
employees’ job satisfaction and performance will be on perpetual decline in the absence of
appropriate feedback and acknowledgement of positive achievement.
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Khunou, and Davhana-Maselesele (2016) assessed the level of job satisfaction and anticipated
turnover among professional nurses and enrolled nursing assistants in South Africa. Findings
revealed that the participants were having poor job satisfaction due to lack of recognition and
appreciation for job well done. When employees are appreciated for job well done, it serves as
source of positive feedback to them thereby increasing their level of confidence, job satisfaction
and desire to be more productive. Similarly, Franek, Mohelska, Bachmann and Sokolova (2014)
in cross-sectional studies involving 1776 participants drawn from different organizations cited
recognition as having the capacity to cushion other unpleasant scenarios emerging from the work
environment and work related processes. Franek et al. (2014) also emphasized that higher
education does not often result in higher job satisfaction but only becomes beneficial in influencing
level of job satisfaction when accompanied with recognition.
Miyata, Arai and Suga (2013), in a survey across 10 hospitals involving 1425 nurses in Japan
explored the perception of nurses on the recognition behaviours of their nurse manager and
established its relationship to the nurse sense of coherence (SOC). Their findings cited recognition
of nurses’ achievement as potential factor that could enhance nurse SOC leading to reduced
burnout and increased job satisfaction. The more recognition employee receives for positive effort,
the more the passion to strive better and harder for achievement to earn more recognition. Other
empirical literature reported similar findings (Adogoke et al., 2015; Khunou, & Davhana-
Maselesele, 2016). Indeed, in nursing, recognition of efforts by nurse managers enhances
competence building and commitment to work. Young nurses are always looking forward for their
in-charges/ nurse managers to acknowledge their efforts using all sorts of ways especially by just
showing appreciation, patting their back and even smiling. Invariably, these signify positive
acknowledgment of employees’ effort, which has positive impact on their level of job satisfaction.
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Furthermore, on the part of achievement, nurses become more satisfied when their patient care
objectives are met as delegated by their superior. When nurses are involved in decision-making
and are also given job description with role differentiation in accordance with their educational
achievement, it raises their self-esteem and level of job satisfaction (Brunel, Li, Aiken, Lesaffre,
Van den Heede and Sermeus (2013). On the other hand, nurses were reported having frustration
from not achieving their goal of caring due to much time spent on routine tasks below their skills
and training (Velickovic et al., 2014). This may be due to the fact that employees’ potential are
observed to be maximally utilized when they perceived their placement on duty is fair and in line
with their training and talent.
Bahalkani, Kumar, Lakho, Mahar and Majeed (2011) reported gross job dissatisfaction among
Pakistan nurses due to lack of involvement of nurses in decision making, and under-achievement
as a result of doing more of improper and non-nursing task and poor career structure. Similar
findings have been reported by Adegoke et al. (2015) and Hoonakker et al. (2013) which indicates
clearly that involvement of employees in decision-making at all levels by employers serve as a
strong motivator to work leading to job satisfaction. Obviously, employees will feel more satisfied
embracing the job that brings out the best in them. Such jobs are the jobs that require employees’
assertiveness, experience and training. Having role differentiation for employees in accordance
with their training, skill and competence makes them feel satisfied with their achievement.
Prompt acknowledgement and recognition of employees’ performance either with monetary and
non-monetary rewards are also observed to contribute to employees’ sense of achievement. In a
study among nurses from Aminu Kano Teaching Hospital, Nigeria. Ugwa and Ugwa (2014)
assessed nurses’ level of job satisfaction and its correlate and compared the levels of job
satisfaction between senior and junior nurses. The authors cited delay in promotion as having more
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detrimental effects on nurses’ job satisfaction in contrast to workload and salary. The authors
attributed this to the fact that promotion equally comes with change in job description and
increment in remuneration, which also lead to nurses’ job satisfaction. Nurses would remain
passionate and committed to their professional mandate as long as they are provided with mentally
challenging but attractive work. However, their job satisfaction can only be sustained when the
opportunities to realising their personal goals are realistic.
2.4 Relationship between Socio-demographic Characteristics and Job
Satisfaction
Studies have shown that nurses’ job satisfaction is highly associated with their socio-demographic
characteristics. The most frequently studied socio-demographic factors in relation to job
satisfaction are age, experience, educational status, gender and marital status. (Ghazzawi, 2011;
Reid, Hurst and Anderson, 2013; Alshmemri, 2014; Kaddourah et al., 2013; Lu, Barriball, Zhang,
& While, 2012). In a cross-sectional survey to examine factors influencing job satisfaction among
nurses, Lu et al. (2012) reported job satisfaction as a multidimensional construct influenced by
different variables such as marital status, age, work experience, gender and educational status.
However, several other findings on the relationships between nurses’ socio-demographic factors
and job satisfaction are divergent (Choi et al., 2013, Hayes et al., 2010, Kaddourah et al., 2013;
Lu et al., 2012). That is, while some studies reported socio-demographic characteristics
influencing job satisfaction, others equally reported no association as presented in the subsequent
paragraphs.
Marital status from the sociological perspective is believed to provide couples with enormous
sense of fulfilment and accomplishment, which invariably provide enabling environment for life
satisfaction. Moreover, marriage itself is a desirable societal status, which is usually accorded
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respect in many societies. Therefore, being married in such societies is in itself a source of
satisfaction. Simon (2014) studied the significance of marital status for emotional well-being and
job satisfaction and revealed that marital status was positively associated with more access to
psychological resources and social support and higher level of job satisfaction. This means that
married employees are able to access more support from their partners, which makes them able to
cope with other stressors and hence more satisfied with their jobs. In addition, other studies have
also indicated that, responsibilities that accompany marriage seems to make employees more
determined and resilient to face the brunt of work related stresses and as such, may have higher
job satisfaction than unmarried employees. These studies also establish strong positive association
between job satisfaction and marital status (Liu et al., 2012; Kim et al., 2015; Reid et al., 2013;
Gholami, Aghamiri, & Mohamadian, 2013).
On the contrary, Adeoye, Akoma and Binuyo (2014) studied the influence of marital status on job
satisfaction among Nigerian workers and reported unmarried employees having more job
satisfaction than their married counterparts. It was argued that married employees are more
encumbered with diverse responsibilities, which could serve as source of distraction impeding
their work commitment and job satisfaction. Again, when a married employee works in a more
demanding organization such as the military, bank, it may result in work life imbalance leading to
poor copping mechanism at work, which could manifest in poor job satisfaction. On the other
hand, single employees mostly do not experience such external distractions and could therefore be
more organized, focused and committed to their job demands manifesting in higher job
satisfaction.
Panisoara and Serban (2013) were of contrary opinion. Panisoara and Serban (2013) asserted that
marital status has no association with employees’ level of job satisfaction. Tao et al. (2012) and
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Wang and Liesveld (2015) also reported weak positive association between marital status and job
satisfaction. These may be due to socialization and difference in socio-cultural beliefs and
practices especially where extended family system is practiced. In such environments, both
married and unmarried employees are equally saddled with responsibilities of catering for
dependants. As such, everybody equally strives to develop positive coping strategies against
workplace related stressors in order to remain employed so that the employees still are capable of
maintaining their social responsibilities and status.
Issues related to gender often indicate that women are believed to be more prone to higher rate of
depressive disorder than men, which is a demerit for job satisfaction (Saunders, Davis, Williams,
& Williams, 2004). On the other hand, men are also known to be more resilient and assertive than
women which could position them for better coping mechanisms with life and work related
challenges. In a cross-sectional study involving 102 nurses and 89 doctors working in a federal
medical centre in Ekiti State, Nigeria, Olatunji and Mokuolu (2014) reported significant positive
correlation among socio-demographic characteristics and job satisfaction. Both male nurses and
male doctors reported having higher level of job satisfaction than their female colleagues. Males
are often expected to be providers for their families or other dependants. Thus, having a steady
source of income to provide for one’s family is a source of prestige and respect. Males are also
believed to have higher social responsibilities than women (Kim, 2015; Heidarian et al., 2015;
Franek et al., 2014). This could explain their determination and resilience in keeping their jobs in
anticipation to maintain their social status.
Carrilo et al. (2013) conducted a study on job satisfaction among healthcare workers in relation to
the role of age and gender and found women having higher job satisfaction than men. Reid et al.
(2013) also examined the impacts of socio-demographics characteristics on job satisfaction among
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2000 Australian registered nurses. They reported that female nurses rather have higher job
satisfaction than their male counterparts. Alshmemri (2014), in his findings among Saudi Arabian
nurses also established that Saudi Arabian female nurses were more satisfied with their job than
their male colleagues which is explained by the fact that modernization and socialization have
brought emancipation and freedom to compete with men in all life’s endeavours. This freedom
may have accounted for their source of satisfaction above their male counterparts regardless of
work related challenges.
Other studies provide divergent views on the influence of gender on job satisfaction. For instance,
Ayelew, et al. (2015) in a cross-sectional survey among Ethiopian nurses reported that gender has
no association with job satisfaction. Similarly, Cahill (2011), also studying job satisfaction among
nurses in different clinical settings in the United States of America reported gender having no
statistically significant correlation with job satisfaction. This difference may be due to influence
of western culture, which does not attach importance to differences in gender but rather advocates
gender equality. Consequently, self-esteem and the enabling environment are usually adequate for
both sexes to compete favourably.
On the influence of age on job satisfaction, the findings are also conflicting. While some accepted
positive relationship, others accepted negative relationship (Ghazzawi, 2011). However,
Generational diversity in the nursing workforce is believed to be a major determinant of differences
in age and job satisfaction. According to Hendricks and Cope (2013) generational cohorts in the
nursing workplace include the Veterans (1925 – 1945), Baby Boomers (1946 – 1964), Generation
X (1965 – 1980), and the Millennial Generation (1980 – 2000). Given that the resilience and
perceptions of these generational cohorts are different, so are their job expectations and coping
mechanisms. According to Hendrick (2013), the generational cohorts in the nursing profession
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differ in terms of commitment, communication and compensation. Most of the relational frictions
at workplaces are predicated upon inabilities of nurse leaders and supervisors to efficiently
recognize and harness diversities in beliefs and perceptions among these generational cohorts. All
these influence job satisfaction.
Further study on the relationship between age and job satisfaction by Carrilo, Salano, Martizez –-
Roche and Gomez-Garcia (2013), was conducted among healthcare workers. In relation to the role
of age on employees’ job satisfaction, a statistically significant correlation between age and job
satisfaction was identified. The most satisfied groups were the youngest and the oldest. The
explanations given for these findings are that the younger generation has access to modern
technology which gives them easy access to relevant information to work with to boost their job
satisfaction. On the other hand, the older generation might have had adequate experience from
years of practice, which might have made them develop more positive adaptive strategies to cope
with unfavourable working conditions to sustain job satisfaction.
However, in another study by Kozuchova, Magerciakova and Vargova (2015), no statistically
significant correlation was found between age and job satisfaction, which was attributed to
difference in socio-cultural background. Advancement in technology has made available relevant
information for self-development by all irrespective of one’s age. This leads to increase in skills
and competence and corresponding increase in job satisfactions.
Education has been cited as one of the factors influencing job satisfaction in the nursing profession.
Adeoye, Akoma, & Binuyo, (2014) explored the impacts of educational background on job
satisfaction among Nigerian workers and established strong positive association between job
satisfaction and educational background. Some reasons for this observation are attributed to the
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fact that some Nigerians esteem higher qualification at expense of skill and competence. Again,
those with higher educational background are usually employed in higher positions, which comes
with more opportunities such as higher wage, training and advancement leading to job satisfaction.
It is also worthy to note that their study involved several workers from different disciplines which
may not share the same view with the nursing workforce.
A study conducted on postgraduate nurse practitioner education about impact on job satisfaction
found nurses with postgraduate education having higher level of job satisfaction compared to those
without postgraduate education (Bush, 2015). Higher levels of education usually produce more
knowledge and skill necessary for more competence and better performance at work. Invariably,
nurses with higher educational background are usually accorded higher recognition in their
workplace and also have more employment opportunities as they can both work either in the
clinical setting or in the nursing training institutions. Consequently, having the opportunity to work
in their desired setting and mostly in the managerial position afford them more self-esteem and job
satisfaction.
However, other literature found no statistically significant relationship between educational status
and job satisfaction (Franek et al., 2014; Mehrdad et al., 2013). This could be attributed to the fact
that those with higher educational background are usually saddled with more responsibilities at
work and also have higher expectations from work. Indisputably, the authorities usually blame
them when things go wrong in the workplace, which could lead to frustration, burnout and job
dissatisfaction. Furthermore, when their expectations are not met, it equally leads to job
dissatisfaction.
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2.5 Summary of the Literature Review
Relevant literature reviewed above investigated nurses’ job satisfaction in examining the influence
of intrinsic, extrinsic and socio-demographic factors on job satisfaction. Extrinsic and intrinsic
factors were established as factors influencing employees’ job satisfaction. Some of the literature
however established that both extrinsic and intrinsic factors could be measured on the same
continuum, which differed from Herzberg’s assertion. For instance, salary was often cited having
impact both on employees’ job satisfaction and job dissatisfaction. In addition, the findings of
most of the studies on the influence of socio-demographic characteristics on job satisfaction were
divergent.
To the best knowledge of the researcher, there was no study that addressed job satisfaction among
nurses in ABUTH. This study therefore aimed at exploring factors that influence job satisfaction
among nurses.
Review of empirical literature on nurses’ job satisfaction was carried out in this chapter. Also,
discussed include the theoretical framework for the study. The next chapter will discuss the
research design, research setting, population of the study, sample size and sampling technique, tool
employed for the data collection, data management process, and the ethical consideration.
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CHAPTER THREE
RESEARCH METHODOLOGY
3.0 Introduction
The previous chapter reviewed relevant literature relating to the study. This chapter presents
information on the research design and techniques chosen to answer the research questions. The
research setting, population of the study, the inclusion and exclusion criteria, sample size, sampling
technique, research instrument, method of data collection, pre-test of the research instrument, the
data management process, and the ethical considerations have all been described.
3.1 Research Design
Research design is “a blueprint for action” (Brink, 1998:100). A cross sectional quantitative
method was employed because much is already known about job satisfaction among nurses both
in Nigeria and beyond. The researcher therefore did not intend to provide in-depth knowledge on
job satisfaction but rather aimed at quantifying the attitudes, behaviours and opinions of ABUTH
nurses on the impact of intrinsic, extrinsic and socio-demographic factors (individual
characteristics) on their job satisfaction. The method was therefore deemed suitable to enable the
researcher generate both statistical and numerical information large enough for generalisation
through the use of questionnaire. Furthermore, cross-sectional survey was adopted because it is
the most accurate design to examine the attributes of an individual, group, and situation and to
measure the occurrence of phenomena as well as summarizing the data through statistical tools
(Grove, Burns, & Gray, 2014).
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3.2 Research Setting
The research setting was Ahmadu Bello University Teaching Hospital (ABUTH). Ahmadu Bello
University is a public owned University located in Samaru - Zaria, Kaduna State, Nigeria. ABUTH
started as Institute of Health in 1967. The objectives of setting up the institution are to provide a
broad range of tertiary services to meet the health needs of people from the catchment area and the
country at large, provide technical support to primary and secondary health facilities within its
area of operation, provide facilities for the training of different cadres of health workers and
conduct relevant research into prevalent health and health related problems. ABUTH is reputed
for excellence in oncology management and psychiatric conditions. It is a hub of referral to many
primary and secondary healthcare facilities within and outside Kaduna State, Nigeria.
The hospital has a 547-bed capacity with 39 departments including pharmaceutical services,
anaesthesia, ophthalmology, dental surgery, physiotherapy, haematology and blood transfusion,
medical microbiology, pathology, radiology, paediatrics, community medicine, operating theatre,
administration, nursing services, medicine, obstetrics and gynaecology, medical records,
radiotherapy, and oncology. The hospital has 695 nurses spread across 26 departments. The
nursing department is headed by the assistant director of nursing services. The 26 departments are
managed at unit level by ward managers and deputy managers who are mostly of the rank of Chief
Nursing Officers (CNOs).
3. 3 Target Population
The target population is “the entire aggregation of respondents that meet the designated set of
criteria” (Burns & Grove 1997, p. 236). The target population was the entire professional nurses
working in ABUTH. The participants were drawn from the various department of the hospital.
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3.3.1 Inclusion Criteria
The inclusion criteria are the characteristics the researcher desire (Rees, 1997). Professional nurses
licensed by the Nursing and Midwifery Council of Nigeria and who have worked in ABUTH for
more than six months were recruited into the study. Thus, nurses who were more knowledgeable
about ABUTH nursing practice environment were recruited.
3. 3.2 Exclusion Criteria
Exclusion criteria are defined as the, “characteristics, which a participant may possess, that could
adversely affect the accuracy of the results” (Rees, 1997). Professional nurses who have not
worked up to six months in ABUTH were excluded from the study. Student nurses on training
were also excluded.
3.4 The Sampling Size
The scientific process of recruiting a segment of a population which possesses the comprehensive
attribute of the entire anticipated population of interest is termed as sampling while the specific
number of the participants recruited is the sampling size for the study (Siyasinghe &
Sooriyarachchi, 2011).
A sample of 360 professional nurses in ABUTH was recruited using the technique of prevalence:
n = z2 p q/ d2
z = standard normal deviation = 1.96 at 95% confidence interval.
P = 30.3% (prevalence rate of job satisfaction from one of the previous studies by Ofili et
al. (2004)).
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q = 1- p = 1 – 30.3% = 0.697,
d = 5% (error margin).
n = 1.962 × 0.303× 0.697/0. 0025 = 325
10% of 325 was then added to the value in anticipation for any error and/or loss of any
questionnaire. That is: 10/100 × 325 = 32.5. This value was further rounded up to 360. The sample
size for the study was therefore 360.
3.5 Sampling Technique
Sampling technique is the precise and systematic gathering of information relevant to the research
purpose or specific objectives and questions (Grove, Burns, & Gray, 2014). ABUTH as a tertiary
healthcare institution has 26 departments where nurses function and in order to give nurses
working in each department equal representation, proportionate stratified random sampling
technique was employed. The researcher was able to group the nurses into strata based on their
departments and thereby increase the accuracy in the estimation of sample. It also enabled the
researcher to eliminate researcher’s bias in recruitment of participants thereby giving every
participant equal chance of being selected.
The researcher represented each department as a stratum from which 6 departments were
handpicked at random to participate in the study by having their names written in a piece of paper,
squeezed and put together on a table while a nurse on duty was asked to pick 6 papers at random.
The departments picked included medical, surgical, emergency, obstetrics and gynaecology, out-
patient department and oncology. The participants for the study were therefore randomly selected
from these strata as represented in Table 3.1.
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Table 3.1: Selection of Respondents.
Department Number of Nurses Percentage Number of Respondents
Medical 70 16 58
Surgical 65 15 54
Emergency 106 24 86
Obstetrics & Gynaecology 68 15 54
Oncology 64 14 50
Out-patient department 70 16 58
TOTAL 360 100% 360
3.6 Research Instrument
Research instruments commonly employed in quantitative study include self-reporting tools,
observation, biophysical measures and questionnaires (Polit & Hungler, 1994). Job satisfaction is
an extensively studied subject among researchers. The researcher therefore found it more reliable
and less time consuming to adopt a validated questionnaire which has been used across similar
settings and with good validity. Revised Nursing Work Index (NWI – R) on a four Linkert scale
with options for eliciting nurses’ response on it graded as ‘1’ for strongly agree, ‘2’ for agree, ‘3’
for disagree and ‘4’ for strongly disagree was therefore adopted. Nursing Work Index
questionnaire was originally developed by Kramer and Hafner (1989) and revised by Aiken and
Patrician (2000) with a reliability coefficient of .69. Revised Nursing Work Index (NWI – R) is
widely reputed for its efficiency and effectiveness in measuring nurses’ professional practice
environment (Balsanelli, & Cunha, 2015; Ogbolu, Johantgen, Zhu, & Johnson, 2015).
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In this study, however, socio-demographics characteristics were added to the NWI – R to make it
more contextual. The Cronbach alpha for the modified questionnaire was .66. The final survey
instrument employed in the survey consists of four sections: Section A is made up of demographic
characteristics and consists of 9 questions, Section B is the description of factors which either their
absence or presence can influence nurses’ level of job satisfaction (motivation / intrinsic factors)
and comprised of 20 questions, and Section C is also made up of 26 questions and consists of the
description of factors which either their absence or presence can influence nurses’ level of job
dissatisfaction (hygiene / extrinsic factors). The total number of questions for the final research
instrument was 70, that is, additional 13 questions were added to the original NWI – R (57 + 13 =
70) document.
3.7 Pilot Testing
Pilot study is usually done involving a minute number of participants to re-examine the efficiency
and effectiveness of the research instrument in fulfilling its intended purpose of use. The outcome
is used to either modify or change the instrument (Kulnik et al., 2014). The pilot study was
conducted among 20 professional nurses from the University of Abuja Teaching Hospital, Federal
Capital Territory, Nigeria. The participants of the pilot study were closely monitored for feedback
on any ambiguity noticed in the questionnaire. 20 minutes was used in completing the
questionnaire. All the questions elicited adequate response from the participants and all their
observations were noted and addressed prior to the main study.
3.8 Data Collection
Prior to data collection, ethical clearance was obtained from NOGUCHI Memorial Institute of
Medical Research, University of Ghana. An introductory letter was also obtained from the School
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of Nursing, University of Ghana and submitted to ABUTH Health Research Ethics Committee for
institutional approval which was granted. Permission was also sought from the nursing
administration for the study using the introductory letter from the School of Nursing, UG and the
institutional permission.
General information about the research was given to the nurses to enable them make informed
decisions. Selection of participants from the departments was done by writing ‘YES’ and ‘NO’ on
pieces of papers, squeezed and put inside a bowl. Nurses who met the stipulated inclusion criteria
and accepted to participate in the study were given adequate information about the study to elicit
informed consent. Participants were assured that information gathered from them would not be
shared with anyone but would be used for academic purposes. Nurses were then requested to pick
a piece of paper each from the bowl. Nurses who picked papers bearing ‘YES’ were selected and
given a questionnaire to complete. This process was used throughout all the three shifts run by the
nurses in ABUTH to recruit participants. The recruitment process lasted for two weeks (8th April,
2016 – 22nd April, 2016). A total of 360 professional nurses from ABUTH participated in this
study. Two research assistants were recruited and trained to assist the researcher in the distribution
and collation of the questionnaires. The researcher and research assistants ensured that the
questionnaires were adequately completed before collection.
3.9 Validity
Validity determines whether the research instrument truly measures that which it was intended to
measure or how truthful the research results are. In other words, does the research instrument allow
you to hit the bull’s eye of your research object?” (Joppe, 2000). In this investigation, the
researcher minimized the occurrence of threat to validity of the survey by employing proportionate
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stratified random sampling technique in recruiting participants and adopting a globally
acknowledged proficient research instrument (NWI – R) for data collection. External validity was
addressed by selecting appropriate statistical tools and programme package for the analysis of data.
Descriptive statistical tools such as the frequency value, mean and standard deviation were equally
employed. Content validity was achieved through extensive and rigorous review of most recent
and relevant literature. The entire variables were adequately captured by NWI – R questionnaire.
The adopted questionnaire (NWI – R) was also presented to the supervisor who also acknowledged
its proficiency in measuring the nurses’ experiences about job satisfaction. Furthermore, the
questionnaire was pretested among 20 nurses from another teaching hospital. Their inputs were
used to ensure that the instrument remained valid and fit for its purpose.
3.10 Reliability
According to Sarmah et al. (2012, p. 9), “reliability means consistency whereby trustworthiness
and stability in results are observed from a reliable instrument if it is administered on the same
group of individuals time to time provided the trait to be measured does not itself change in the
meantime’’. The researcher reviewed relevant and most recent literature. Furthermore, the
questionnaire was pretested among 20 nurses from another teaching hospital who were not
included in the main study. Their inputs were used to ensure that the instrument remain reliable
and fit for its purpose. After the pilot study, a statistician was consulted for the analysis of the
instrument’s reliability. A confirmatory analysis of reliability was therefore executed on the data
generated from the pilot study via Cronbach’s Alpha (α) (Cronbach, 1957). The Cronbach’s Alpha
of the items captured in the NWI – R yielded 0.649, depicting good reliability.
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3.11 Data Management.
Data management denotes the scientific and rigorous systematic processes of squeezing and
synthesizing out comprehensive, communicative, valid and reliable information on research
findings and validation of hypothesis (Joppe, 2000). According to Brink (1996) data management
comprises categorizing, ordering, manipulating and summarizing the data and describing them in
meaningful terms. The quality of data was established by creating criteria for database structure
prior to computation and analysis, data cleaning, data coding and data analysis.
Data cleaning: The data was closely assessed against any occurrence of outliers, inconsistencies
and overstated patterns of response. In the course of this, 20 questionnaires were discovered not
properly filled. These were excluded from the analysis.
Data coding: The data was coded into compatible format for computer entry and statistical tools’
application. The steps taken in coding process include data reduction through disintegrating similar
and related values into few and precise headings. This was then accompanied by data exploration
which enabled the researcher to ensure that the value of the entire responses was within acceptable
range.
Descriptive statistics employed include the frequencies, measures of central tendency (mean) and
measures of dispersion (standard deviation). The frequency tables were utilized to collate data
values in ascending order in relation to their degree while reflecting their occurring frequencies
thereby giving a vivid representation of the data. While the mean was used to give the average
value of the data generated which was further compared with parametric statistical tools. In
addition, the standard deviation was employed to examine the spread or dispersion of the generated
data within the mean.
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Inferential statistics utilized include correlation and Chi-square. Correlation was used to establish
relationship between nurses’ socio-demographic factors and their job satisfaction. While Chi-
square was employed to test hypothesis. The higher the value of Chi-square, the negligent the
significance level of association between the variables.
3.12 Ethical Considerations
“Research ethics involve requirements on daily work, the protection of dignity of subjects and the
publication of the information in the research” (Marianna, 2011, p. 2). Ethical clearance was
obtained from Noguchi Institute for Medical Research (NMIMR), College of Health Sciences,
University of Ghana (NMIMR-IRB CP 08/15-16). Institutional approval was obtained from the
Health Research Committee for ABUTH (ABUTH/HREC/T13/2016).
Respect for persons as autonomous individual was ensured in this study by explaining the research
procedure in detail to the participants which enabled them make informed consent. Furthermore,
the participants were duly informed that they reserved the right to participate and also withdraw at
any point without any form of coercion. The privacy of the participants was held in high esteem
by informing the participants not to write their names on the questionnaire. In addition, designated
points were unanimously chosen for the submission of completed questionnaires to ensure the
enforcement of anonymity and confidentiality. The data collection was therefore void of the
possibility of tracing the participants’ identity through personal responses by allowing participants
to return completed questionnaires to any designated place closer to them at their convenient time
to avoid third party involvement.
Anxiety on the implication of filling the questionnaire was allayed by assuring the participants that
the information gathered from them will be used solely for research purpose and will only be
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accessible to the principal investigator and his supervisor who will secure them in a locked and
secured cabinet in the supervisor’s office. While the information would be finally destroyed after
five (5) years of the study. The participants were therefore assured that completing the
questionnaire will have no negative consequences on the security of their job in any way as no one
from their institution will have access to the raw data generated.
3.13 Summary
This chapter presented the procedures employed in carrying out the study. The research settings,
target population, inclusion and exclusion criteria, sampling size, sampling technique, research
instrument, pilot study, validity and reliability, data management and ethical considerations were
therefore described.
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CHAPTER FOUR
DATA ANALYSIS, PRESENTATION AND INTERPRETATION
4.0 Introduction
This section presents the analysis and interpretation of the results based on the research questions.
Out of a total of 360 questionnaires distributed, 30 were not returned while 20 were also not
properly completed and were therefore excluded from the analysis. This brought the response rate
for the study to 84%. Descriptive statistics were used in presenting the results such as bar charts,
frequency tables and percentages. Inferential statistics such as chi-square, and correlation were
used in testing hypothesis 1, 2, and 3 respectively.
4.1 Socio-demographic Characteristics of Respondents
Socio-demographic factors are observed to influence job satisfaction among nurses. Nurses’ socio-
demographic characteristics such as age, gender, marital status and educational status were
therefore explored in this study to assess their relationship with job satisfaction among nurses.
Out of 304 respondents, 34.9% were males and 66.1% were females. Out of 304 respondents
33.6% were age between 31 – 41 years while 12.8% were aged between 53 – 63 years. The mean
age of the respondents was 39±10.97 years. Out of 304 respondents, 27.3% were diploma holders,
40.8% had post basic diploma, 30.6% were degree holders and only 1.3% had master’s degree
respectively. Detail is presented in Table 4.1.
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Table 4.1: Demographic Characteristics of Respondents Gender Frequency [Percent (%)]
Male 106(34.9)
Female 198(65.1)
Total 304(100)
Age range at last birthday
20 to 30 years 85(28.0)
31 to 41 years 102(33.6)
42 to 52 years 78(25.7)
53 to 63 years 39(12.8)
Total (Mean age (�̅�) = 39±10.97 years) 304(100)
Marital status
Single 74(24.3)
Married 226(74.3)
Divorced 1(0.3)
Widow 3(1.0)
Total 304(100)
Educational status
Diploma (RN/RM) 83(27.3)
Post basic diploma 124(40.8)
Bachelor's degree
93(30.6)
Master’s degree
Total
4(1.3)
304(100) Source: Field Survey, 2016.
4.2 Nurses’ Satisfaction with Intrinsic Factors
Intrinsic factors are internally generated motivational variables which are directly related to the
job content. These are non-monetary rewards which nurses expect to benefit in the process of doing
the job. Intrinsic factors considered in this study included work itself, recognition, responsibility,
achievement and advancement. Descriptive statistic was used to describe nurses’ satisfaction with
their intrinsic job factors.
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4.2.1 Nurses’ Satisfaction with Opportunities for Advancement.
Two questions were asked to elicit nurses’ opinion on their satisfaction with opportunities for
advancement in their work place. Out of 304 respondents, 63% agreed that they have career
development/clinical opportunity while 36.8% were of contrary opinion. 66.4% agreed having
opportunity for active in-service/continuing education programs for nurses, 33.6% disagreed.
Detail in Table 4.2.
Table 4.2 Opportunities for advancement
Field data, 2016.
4.2.2 Nurses’ Satisfaction with Work itself.
Work itself is associated with the actual content of the job. Job must be interesting and varied for
employees to derive positive satisfaction from doing it. A total of eight questions were asked to
elicit nurses’ opinion on their satisfaction with work itself. Seven out of these eight questions
elicited positive response from the nurses. Out of 304 respondents, 56% agreed having nurses who
are involved in the internal governance while 43.4% disagreed. In addition, out of 304 respondents,
46% of the respondents agreed having enough registered nurses while 54% did not agree having
enough registered nurses on duty to provide quality patient care. Details presented in Table 4.3.
Advancement Strongly
Agree
Agree Disagree Strongly
Disagree
Total
Career
development/clinical
ladder opportunity
(49)16.1% (143)47% (77)25.3% (11.5)11.5% 100%
Active in-
service/continuing
education
programmes for
nurses
(111)36.5% (91)29.9% (68)22.4% (34)11.2% 100%
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Table 4.3: Nurses’ Satisfaction with Work Itself
Work itself Strongly
Agree
Agree Disagree Strongly
Disagree
Total
Working with experienced
nurses who know the hospital
132(43.4) 139(45.7) 23(7.6) 10(3.3) 304(100)
Total patient care as the nursing
delivery system
84(27.6) 126(41.4) 78(25.7) 16(5.3) 304(100)
Team nursing as the nursing
delivery system
64(21.1) 197(64.8) 24(7.9) 19(6.3) 304(100)
Working with nurses who are
clinically competent
122(40.1) 132(43.4) 29(9.5) 21(6.9) 304(100)
Nurses actively participate in
developing their work schedules
(i.e. days on duty and say off-
duty)
87(28.6) 173(56.9) 28(9.2) 16(5.3) 304(100)
Clinical nurses’ specialists who
provide patient care consultation
86(28.3) 118(38.8) 65(21.4) 35(11.5) 304(100)
Nurses are involved in the
internal governance
50(16.4) 122(40.1) 98(32.2) 34(11.2) 304(100)
Enough registered nurses on
duty to provide quality patient
care
67(22.0) 73(24.0) 75(24.7) 89(29.3) 304(100)
Source: Field Survey, 2016.
4.2.3 Nurses’ Satisfaction with Recognition.
Recognition is the acknowledgment of employees’ outstanding performance or contribution by
his/her superiors. Four (4) questions were asked to elicit nurses’ opinion on the level of recognition
usually accorded them by their superiors. Majority of the respondents agreed that they were
satisfied with all the four questions under recognition. For instance, out of 304 respondents, 67.1%
accepted that their contributions to patient care are acknowledged publicly whereas 32.9%
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disagreed. While 54.6% agreed having recognition for job well-done, 44.4% disagreed. Details
presented in Table 4.4.
Table 4.2: Recognition
Recognition Strongly
Agree
Agree Disagree Strongly
Disagree
Total
The contributions that nurses
make to patient care are publicly
acknowledged
54(17.8) 150(49.3) 78(25.7) 22(7.2) 304(100)
Support for new and innovative
ideas about patient care
64(21.1) 200(65.8) 27(8.9) 13(4.3) 304(100)
Praise and recognition for a job
well done
38(12.5) 128(42.1) 101(33.2) 37(12.2) 304(100)
Nursing staff are supported in
pursuing a degree in nursing
60(19.7) 116(38.2) 82(27.0) 46(15.1) 304(100)
Source: Field Survey, 2016.
4.2.4 Nurses’ Satisfaction with the level of Responsibility on the Job
Responsibility describes the amount of nursing related tasks that nurses do and their authority over
nursing care. Six questions were asked to elicit nurses’ satisfaction with the level of responsibility
in their workplace. Out of 304 respondents, 59.6% agreed that patient assignments foster
continuity of care while 40.5% disagreed. In addition, while 62.2% agreed having opportunity to
participate in controlling cost, 37.8% disagreed having the opportunity to control cost. Less than
half of the participants (47.4%) agreed that physicians give high quality care while 52.6%
disagreed. Details presented in Table 4.5.
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Table 4.5: Nurses’ Responsibilities on the Job
Responsibilities Strongly
Agree
Agree Disagree Strongly
Disagree
Total
Patient assignments foster
continuity of care (the same
nurse care for the patient from
one day to the next)
58(19.1) 123(40.5) 89(29.3) 34(11.2) 304(100)
Nurses actively participate in
efforts to control cost
35(11.5) 154(50.7) 83(27.3) 32(10.5) 304(100)
Freedom to make important
patient care and work decisions'
60(19.7) 126(41.4) 73(24.0) 45(14.8) 304(100)
A nurse manager who is a good
manager and leader
130(42.8) 105(34.5) 31(10.2) 38(12.5) 304(100)
Physicians give high quality
care
27(8.9) 117(38.5) 80(26.3) 80(26.3) 304(100)
Not being placed in a position of
having to do things that are
against my nursing judgment
58(19.1) 123(40.5) 81(26.6) 42(13.8) 304(100)
Source: Field Survey, 2016.
4.2.5 Nurses’ Satisfaction with Achievement on the Job
Two questions were asked to prompt nurses’ satisfaction with their level of achievement on the
job. Out of 304 respondents, 54.6% agreed that the have opportunity to discuss patient care
problems with other nurses. While 55.6% acknowledged having the back up of nurse manager in
decision making, even when there is conflict with physician, 44.4% however disagreed having the
back up of their nurse managers in decision making.
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Field data, 2016.
Figure 4.1: Adequate time and Opportunity to Discuss Patient Care Problems.
Source: Field data, 2016
Figure 4.2: Nurse Manager’s Support for Decision making
8.90%
45.70%
34.90%
10.90%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
50.00%
Strongly Agree Agree Disagree Strongly Disagree
Freq
uen
cy
Responses
16.80%
38.8…
28.90%
15.50%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
Strongly Agree Agree Disagree Strongly Disagree
Freq
uen
cy
Responses
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4.3 Influence of Intrinsic Factors on Job Satisfaction
Chi-square analysis was performed to test if intrinsic factors influence nurses’ job satisfaction
Table 4.6: Influence of Advancement on Job satisfaction
There are opportunities for advancement * Have job satisfaction in the current organization
Strongly
Agree Agree Disagree
Strongly
Disagree
There are
opportunities for
advancement
Strongly
Agree 10(3.3%) 22(7.2%) 30(9.9%) 42(13.8%) 104(34.2%)
Agree 8(2.6%) 27(8.9%) 93(30.6%) 26(8.6%) 154(50.7%)
Disagree
2(0.7%) 10(3.3%) 20(6.6%) 1(0.3%) 33(10.9%)
Strongly
Disagree 0(0.0%) 1(0.3%) 11(3.6%) 1(0.3%) 13(4.3%)
Total
20(6.6%) 60(19.7%) 154(50.7%) 70(23.0%) 304(100.0%)
Source: Field data, 2016.
Df = 9, Chi-square (X2) = 45.523, Significance level= 0.05, Critical value =16.919, P value= 0.000
The calculated chi-square (X2) value is greater than the critical/table value and the P value is less
than 0.05 at the degree of freedom (df) = 9. Therefore, alternate hypothesis (H1) which states that
intrinsic factors (advancement) will influence nurses’ job satisfaction is accepted. This implies that
intrinsic factor (advancement) influence nurses’ job satisfaction in ABUTH.
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Table 4.7: Influence of Work itself on Job Satisfaction
Working with experienced nurses who know the hospital * Have job satisfaction in the current
organization
Total
Strongly
Agree Agree Disagree
Strongly
Disagree
Working with
experienced
nurses who know
the hospital
Strongly
Agree 6(2.0%) 28(9.2%) 54(17.8%) 44(14.5%) 132(43.4%)
Agree 13(4.3%) 21(6.9%) 81(26.6%) 24(7.9%) 139(45.7%)
Disagree 1(0.3%) 10(3.3%) 10(3.3%) 2(0.7%) 23(7.6%)
Strongly
Disagree 0(0.0%) 1(0.3%) 9(3.0%) 0(0.0%) 10(3.3%)
Total 20(6.6%) 60(19.7%) 154(50.7%) 70(23.0%) 304(100.0%)
Source: Field data, 2016.
Df = 9, Chi-square (X2) = 45.523, Significance level= 0.05, Critical value =16.919, P value= 0.000
The calculated chi-square (X2) value is greater than the critical/table value and the P value is less
than 0.05 at the degree of freedom (df) = 9. Therefore, alternate hypothesis (H1) which states that
intrinsic factor (work itself) will influence nurses’ job satisfaction is accepted. This implies that
intrinsic factor (work itself) influence nurses’ job satisfaction in ABUTH.
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Table 4.8: Influence of Achievement on Job Satisfaction
Enough time and opportunity to discuss patient care problems with other nurses * Have job
satisfaction in the current organization
Total
Strongly
Agree Agree Disagree
Strongly
Disagree
Strongly
Agree 4(1.3%) 7(2.3%) 15(4.9%) 23(7.6%) 49(16.1%)
Agree 9(3.0%) 30(9.9%) 69(22.7%) 35(11.5%) 143(47%)
Disagree 6(2.0%) 13(4.3%) 49(16.1%) 9(3.0%) 77(25.3%)
Strongly
Disagree 1(0.3%) 10(3.3%) 21(6.9%) 3(1.0%) 35(11.5%)
Total 20(6.6%) 60(19.7%) 154(50.7%) 70(23.0%) 304(100.0%)
Source: Field data, 2016.
Df = 9, Chi-square (X2) = 30.625, Significance level= 0.05, Critical value =16.919, P value= 0.000
The calculated chi-square (X2) value is greater than the critical/table value and the P value is less
than 0.05 at the degree of freedom (df) = 9. Therefore, alternate hypothesis (H1) which states that
intrinsic factor (achievement) will influence nurses’ job satisfaction is accepted. This implies that
intrinsic factor (achievement) influence nurses’ job satisfaction in ABUTH.
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Table 4.9: Influence of Responsibilities on Job Satisfaction
Patient assignments foster continuity of care (the same nurse care for the patient from one day to
the next) * Have job satisfaction in the current organization
Total
Strongly
Agree Agree Disagree
Strongly
Disagree
Patient
assignments foster
continuity of care
(the same nurse
care for the patient
from one day to
the next)
Strongly
Agree 5(1.6%) 18(5.9%) 13(4.3%) 22(7.2%) 58(19.1%)
Agree 6(2.0%) 23(7.6%) 72(23.7%) 22(7.2%) 123(19.1%)
Disagree 7(2.3%) 14(4.6%) 52(17.1%) 16(5.3%) 89(29.3%)
Strongly
Disagree 2(0.7%) 5(1.6%) 17(5.6%) 10(3.3%) 34(11.2%)
Total 20(6.6%) 60(19.7%) 154(50.7%) 70(23.0%) 304(100.0%)
Source: Field data, 2016.
Df = 9, Chi-square (X2) = 26.433, Significance level= 0.05, Critical value =16.919, P value= 0.002
The calculated chi-square (X2) value is greater than the critical/table value and the P value is less
than 0.05 at the degree of freedom (df) = 9. Therefore, alternate hypothesis (H1) which states that
intrinsic factor (responsibilities) will influence nurses’ job satisfaction is accepted. This implies
that intrinsic factor (responsibilities) influence nurses’ job satisfaction in ABUTH.
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Table 4.10: Influence of Recognition on Job Satisfaction
The contributions that nurses make to patient care are publicly acknowledged * Have job
satisfaction in the current organization
Total
Strongly
Agree Agree Disagree
Strongly
Disagree
The contributions
that nurses make
to patient care are
publicly
acknowledged
Strongly
Agree 7(2.3%) 11(3.6%) 16(5.3%) 20(6.6%) 58(17.8%)
Agree 7(2.3%) 23(7.6%) 89(29.3%) 31(10.2%) 150(49.3%)
Disagree 6(2.0%) 21(6.9%) 36(11.8%) 15(4.9%) 78(25.7%)
Strongly
Disagree 0(0.0%) 5(1.6%) 13(4.3%) 4(1.3%) 22(7.2%)
Total 20(6.6%) 60(19.7%) 154(50.7%) 70(23.0%) 304(100.0%)
Source: Field data, 2016.
Df = 9, Chi-square (X2) = 22.640, Significance level= 0.05, Critical value =16.919, P value= 0.007
The calculated chi-square (X2) value is greater than the critical/table value and the P-value is less
than 0.05 at the degree of freedom (df) = 9. Therefore, alternate hypothesis (H1) which states that
intrinsic factor (recognition) will influence nurses’ job satisfaction is accepted. This implies that
intrinsic factor (recognition) influence nurses’ job satisfaction in ABUTH.
4.5 Nurses’ Satisfaction with Extrinsic Factors
Extrinsic factors are externally generated variables which relate to the job surrounding or context;
they are related to tangible factors in the job environment which prevent employees from job
dissatisfaction. Extrinsic factors considered in this study include working conditions, supervision,
salary, interpersonal relationship and policy and administration.
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4.5.1 Nurses’ Satisfaction Interpersonal Relations
Interpersonal relations in the nursing practice environment describe work and socially associated
interactions that occur in the workplace. Four questions were asked to prompt nurses’ response on
their satisfaction with the level of interpersonal relations in their workplace. Out of 304
respondents, 58.9% agreed that there is collaboration between nurses and physicians whereas
41.2% disagreed. Similarly, 50.6% of the nurses agreed that there is teamwork between nurses and
doctors while 49.4% were of contrary opinion. Details presented in Table 4.11.
Table 4.11: Interpersonal Relations
Strongly
Agree
Agree Disagree Strongly
Disagree
Total
Physicians and nurses have good
working relationship
51(16.8) 124(40.8) 106(34.9) 23(7.6) 304(100)
Good relationship with other
departments such as
housekeeping and dietary
38(12.5) 210(69.1) 36(11.8) 20(6.6) 304(100)
Collaboration (joint practice)
between nurses and physicians
30(9.9) 149(49.0) 61(20.1) 64(21.1) 304(100)
Much team work between
nurses and doctors
35(11.5) 119(39.1) 82(27.0) 68(22.4) 304(100)
Source: Field Survey, 2016.
4.5.2 Nurses’ Satisfaction with Salary
One question was asked to elicit nurses’ response on satisfaction with salary. Out of 304
respondents, 28.7% agreed that they have satisfactory salary. However, 71.4% disagreed that they
have satisfactory salary. Detail is presented in Figure 4.3.
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Source: Field data, 2016.
Figure 4.3: Nurses’ Satisfaction with Salary
4.5.3 Nurses’ Satisfaction with Policies and Administration
Company policies and administration are the formal ways which procedures and orders are carried
out in an organization. Nineteen questions were asked to prompt nurses’ response on satisfaction
with policies and administration of their organization. Out of 304 respondents, 7.2% strongly
agreed that they had an administration that listens and responds to employees’ concern, while
19.1% of the respondents agreed. However, 31.3% of the respondents disagreed, while 42.4%
strongly disagreed. Out of 304 respondents, 8.9% strongly agreed that they had a preceptor
programme for newly hired registered nurses, while 48% agreed. However, 25% of the
respondents disagreed, while 17.4% strongly disagreed. Out of 304 respondents, 13.5% strongly
agreed that each nursing unit determines its own policies and procedure, 37.2% agreed. However,
37.8% of the respondents disagreed, while 11.5% strongly disagreed. Details are provided in Table
4.12.
6.30%
22.40%
45.70%
25.70%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
50.00%
Strongly Agree Agree Disagree Strongly Disagree
Freq
uen
cy
Responses
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Table 4.3: Policy and Administration
Strongly
Agree
Agree Disagree Strongly
Disagree
Total
An administration that listens and
respond to employee concerns
22(7.2) 58(19.1) 95(31.3) 129(42.4) 304(100)
A preceptor programme for newly hired
registered nurses
27(8.9) 147(48.4) 76(25.0) 53(17.4) 304(100)
Primary nursing as the nursing delivery
system
31(10.2) 169(55.6) 70(23.0) 34(11.2) 304(100)
Nursing care is based on nursing rather
than a medical model
109(35.9) 95(31.3) 63(20.7) 37(12.2) 304(100)
Standardized policies procedures and
ways of doing things
64(21.1) 126(41.4) 82(27.0) 32(10.5) 304(100)
Each nursing unit determines its own
policies and procedure
41(31.5) 113(37.2) 115(37.8) 35(11.5) 304(100)
An active quality assurance programme 61(20.1) 89(29.3) 99(32.6) 55(18.1) 304(100)
Written up-to-date nursing care plans
for all patients
62(20.4) 123(40.5) 89(29.3) 30(9.9) 304(100)
A good orientation programme for
newly employed nurses
88(28.9) 82(27.0) 110(36.2) 24(7.9) 304(100)
Nursing care plans are verbally
transmitted from nurse to nurse
41(13.5) 72(23.7) 140(46.1) 51(16.8) 304(100)
Flexible or modified work schedule are
available
42(13.8) 156(51.3) 81(26.60 25(8.20 304(100)
There is use of nursing diagnoses 66(21.7) 156(51.3) 51(16.8) 31(10.2) 304(100)
Nurse managers consult with staff on
daily problems and procedures
68(22.4) 114(37.5) 83(27.3) 39(12.8) 304(100)
Regular, permanent assigned staff
nurses never have to float to another
unit
37(12.2) 95(31.3) 113(37.2) 59(19.4) 304(100)
A clear philosophy of nursing pervades
the patient care environment
50(16.4) 98(32.20 127(41.8) 29(9.5) 304(100)
Opportunity for staff nurses to
participate in policy decisions
25(8.2) 105(34.5) 119(39.1) 55(18.1) 304(100)
High standards of nursing care are
expected by the administration
114(37.5) 116(38.2) 46(15.1) 28(9.2) 304(100)
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The nursing staff participates in
selecting new equipment
30(9.9) 75(24.7) 122(40.1) 77(25.3) 304(100)
Chief nursing executive is equal in
power and authority to other top-level
executives
27(8.90 114(37.5) 116(38.2) 47(15.5) 304(100)
Source: Field Survey, 2016.
4.5.4 Nurses’ Satisfaction with Quality of Supervision
Two questions were asked to elicit nurses’ response on satisfaction with the quality of their
supervision. Out of 304 respondents, 77.7% agreed that they have supervisory staff that is
supportive of nurses while 22.4% disagreed. In addition, 84.5% of the nurses acknowledged having
Chief Nursing Officer that is highly visible to them whereas 15.5% disagreed. Details presented
in Figure 4.4 and 4.5.
Source: Field survey, 2016
Figure 4.4: Supportive Supervision
30.30%
47.40%
18.80%
3.60%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
50.00%
Strongly Agree Agree Disagree Strongly Disagree
Freq
uen
cy
Responses
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Source: Field data, 2016.
Figure 4.5: Highly Visible Chief Nursing Officers
4.5.5 Nurses’ Satisfaction with Working Conditions
Working conditions involve the physical setting of the job such as amount and quality of
environment, space, ventilation and temperature. Seven questions were asked to elicit nurses’
response on satisfaction with their working conditions. Out of 304 respondents, 67.5% agreed that
there is usage of medical oriented record while 32.6% disagreed. While 35.2% agreed that there is
adequate support services, 64.8% were of contrary opinion. About staffing, out of 304 respondents
27% agreed that there is enough staff to get the work done whereas 73% disagreed. While on work
environment, out of 304 respondents, 24.7% of the respondents agreed that their work environment
is attractive, 75.3% disagreed. Detail presented in Table 4.13.
27.60%
56.90%
7.60% 7.90%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
Strongly Agree Agree Disagree Strongly Disagree
Freq
uen
cy
Responses
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Table 4.4: Nurses’ Satisfaction with Working Conditions
Working conditions Strongly
Agree
Agree Disagree Strongly
Disagree
Total
There is use of medical oriented
record
37(12.2) 168(55.3) 44(14.5) 55(18.1) 304(100)
Nurses control their own
practice
52(17.1) 173(56.9) 57(18.8) 22(7.2) 304(100)
Floating so that staffing is
equalized among units
45(14.8) 144(47.4) 92(30.3) 23(7.6) 304(100)
Opportunity to work in highly
specialized unit
57(18.8) 131(43.1) 85(28.0) 31(10.2) 304(100)
Adequate support services allow
me to spend time with my
patients
50(16.4) 57(18.8) 111(36.5) 86(28.3) 304(100)
Enough staff to get the work
done
37(12.2) 45(14.8) 79(26.0) 143(47.0) 304(100)
The work environment is
pleasant, attractive and
comfortable
26(8.6) 49(16.1) 112(36.8) 117(38.5) 304(100)
Source: Field Survey, 2016.
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4.6 Influence of Extrinsic Factors on Job Satisfaction
Chi-square analysis was performed to test if extrinsic factors influence nurses’ job satisfaction in
ABUTH.
Table 4.5: Influence of Interpersonal Relations on Job satisfaction
Physicians and nurses have good working relationship * Have job satisfaction in the current
organization
Total
Strongly
Agree Agree Disagree
Strongly
Disagree
Physicians and
nurses have good
working
relationship
Strongly
Agree 4(1.3%) 17(5.6%) 16(5.3%) 14(4.6%) 51(16.8%)
Agree 5(1.6%) 16(5.3%) 71(23.4%) 32(10.5%) 124(40.8%)
Disagree 5(1.6%) 25(8.2%) 55(18.1%) 21(6.9%) 106(34.9%)
Strongly
Disagree 2(0.7%) 2(0.7%) 12(3.9%) 3(1.0%) 23(7.6%)
Total 20(6.6%) 60(19.7%) 154(50.7%) 70(23.0%) 304(100.0%)
Source: Field data, 2016.
Df = 9, Chi-square (X2) = 32.3130, Significance level= 0.05, Critical value =16.919, P value= 0.000
The calculated chi-square (X2) value is greater than the critical/table value and the P-value is less
than 0.05 at the degree of freedom (df) = 9. Therefore, alternate hypothesis (H1) which states that
extrinsic factors (interpersonal relationship) will influence nurses’ job satisfaction is accepted.
This implies that extrinsic factors (interpersonal relationship) influenced nurses’ job satisfaction
in ABUTH.
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Table 4.6: Influence of Salary on Job Satisfaction
A satisfactory salary * Have job satisfaction in the current organization
Total
Strongly
Agree Agree Disagree
Strongly
Disagree
A satisfactory
salary
Strongly
Agree 0(0.0%) 1(0.3%) 11(3.6%) 7(2.3%) 19(6.3%)
Agree 5(1.6%) 17(5.6%) 27(8.9%) 19(6.3%) 68(22.4%)
Disagree 11(3.6%) 31(10.2%) 73(24.0%) 24(7.9%) 139(45.7%)
Strongly
Disagree 4(1.3%) 11(3.6%) 43(14.1%) 20(6.6%) 78(25.7%)
Total 20(6.6%) 60(19.7%) 154(50.7%) 70(23.0%) 304(100.0%)
Source: Field data, 2016.
Df = 9, Chi-square (X2) = 19.359, Significance level= 0.05, Critical value =16.919, P value= 0.047
The calculated chi-square (X2) value is greater than the critical/table value and the P-value is less
than 0.05 at the degree of freedom (df) = 9. Therefore, alternate hypothesis (H1) which states that
extrinsic factor (a satisfactory salary) will influence nurses’ job satisfaction is accepted. This
implies that extrinsic factor (a satisfactory salary) influence nurses’ job satisfaction in ABUTH.
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Table 4.7: Influence of Administration on Job Satisfaction
An administration that listens and respond to employee concerns * Have job satisfaction in the
current organization
Total
Strongly
Agree Agree Disagree
Strongly
Disagree
An administration
that listens and
respond to
employee
concerns
Strongly
Agree 0(0.0%) 5(1.6%) 9(3.0%) 7(2.3%) 22(7.2%)
Agree 4(1.3%) 10(3.3%) 24(7.9%) 20(6.6%) 58(19.1%)
Disagree 6(2.0%) 19(6.3%) 43(14.1%) 27(8.9%) 95(31.3%)
Strongly
Disagree 9(3.0%) 26(8.6%) 78(25.7%) 16(5.3%) 129(42.4%)
Total 20(6.6%) 60(19.7%) 154(50.7%) 70(23.0%) 304(100.0%)
Source: Field data, 2016.
Df = 9, Chi-square (X2) = 18.447, Significance level= 0.05, Critical value =16.919, P value= 0.008
The calculated chi-square (X2) value is greater than the critical/table value and the P-value is less
than 0.05 at the degree of freedom (df) = 9. Therefore, alternate hypothesis (H1) which states that
extrinsic factor (administration) will influence nurses’ job satisfaction is accepted. This implies
that presence or absence of extrinsic factor (administration) will influence nurses’ job satisfaction
in ABUTH.
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Table 4.8: Influence of Policy on Job Satisfaction
Each nursing unit determines its own policies and procedure * Have job satisfaction in the current
organization
Total
Strongly
Agree Agree Disagree
Strongly
Disagree
Each nursing unit
determines its own
policies and
procedure
Strongly
Agree 4(1.3%) 11(3.6%) 15(4.9%) 11(3.6%) 41(13.5%)
Agree 5(1.6%) 25(8.2%) 58(19.1%) 25(8.2%) 113(37.2%)
Disagree 8(2.6%) 19(6.3%) 60(19.7%) 28(9.2%) 115(37.8%)
Strongly
Disagree 3(1.0%) 5(1.6%) 21(6.9%) 6(2.0%) 35(11.5%)
Total 20(6.6%) 60(19.7%) 154(50.7%) 70(23.0%) 304(100.0%)
Source: Field data, 2016
Df = 9, Chi-square (X2) = 27.301, Significance level= 0.05, Critical value =16.919, P value= 0.002
The calculated chi-square (X2) value is greater than the critical/table value and the P-value is less
than 0.05 at the degree of freedom (df) = 9. Therefore, alternate hypothesis (H1) which states that
extrinsic factor (policy) will influence nurses’ job satisfaction is accepted. This implies that
extrinsic factor (policy) influence nurses’ job satisfaction in ABUTH.
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Table 4.9: Influence of Supervision on Job Satisfaction
A supervisory staff that is supportive of nurses * Have job satisfaction in the current organization
Total
Strongly
Agree Agree Disagree
Strongly
Disagree
Each nursing unit
determines its own
policies and
procedure
Strongly
Agree 8(2.6%) 24(7.9%) 40(13.2%) 20(6.6%) 92(30.3%)
Agree 6(2.0%) 23(7.6%) 77(25.3%) 38(12.5%) 144(37.2%)
Disagree 5(1.6%) 11(3.6%) 30(9.9%) 11(3.6%) 57(18.8%)
Strongly
Disagree 1(0.3%) 2(0.7%) 7(2.3%) 1(0.3%) 11(3.6%)
Total 20(6.6%) 60(19.7%) 154(50.7%) 70(23.0%) 304(100.0%)
Source: Field data, 2016
Df = 9, Chi-square (X2) =18.971, Significance level= 0.05, Critical value =16.919, P value= 0.040
The calculated chi-square (X2) value is greater than the critical/table value and the P-value is less
than 0.05 at the degree of freedom (df) = 9. Therefore, alternate hypothesis (H1) which states that
extrinsic factors (supervision) will influence nurses’ job satisfaction is accepted. This implies that
extrinsic factor (supervision) influence nurses’ job satisfaction in ABUTH.
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Table 4.10: Influence of Working Conditions on Job Satisfaction
Adequate support services allow me to spend time with my patients * Have job satisfaction in the
current organization
Have job satisfaction in the current organization
Total
Strongly
Agree Agree Disagree
Strongly
Disagree
Adequate support
services allow me
to spend time with
my patients
Strongly
Agree 2(0.7%) 10(3.3%) 19(6.3%) 19(6.3%) 50(16.4%)
Agree 6(2.0%) 6(2.0%) 20(6.6%) 25(8.2%) 57(18.8%)
Disagree 7(2.3%) 21(6.9%) 61(20.1%) 22(7.2%) 111(36.5%)
Strongly
Disagree 5(1.6%) 23(7.6%) 54(17.8%) 4(1.3%) 86(28.3%)
Total 20(6.6%) 60(19.7%) 154(50.7%) 70(23.0%) 304(100.0%)
Source: Field data, 2016
Df = 9, Chi-square (X2) = 42.505, Significance level= 0.05, Critical value =16.919, P value= 0.000
The calculated chi-square (X2) value is greater than the critical/table value and the P-value is less
than 0.05 at the degree of freedom (df) = 9. Therefore, alternate hypothesis (H1) which states that
extrinsic factor (working conditions) will influence nurses’ job satisfaction is accepted. This
implies that extrinsic factor (working conditions) influence nurses’ job satisfaction in ABUTH.
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4.7 Relationship between Socio-Demographic Factors and Job Satisfaction
The socio-demographic characteristics examined in this study include age, gender, marital status
and educational status. Correlation was employed to establish the relationship between socio-
demographic characteristics and job satisfaction.
Table 4.11: Relationship between Socio-demographic Characteristics and Job Satisfaction
Have job
satisfaction in
the current
organization Gender Age
Marital
status
Highest
education
Have job satisfaction in
the current organization
Pearson
Correlation 1 .063 .100 .069 -.080
Sig. (2-
tailed) .273 .082 .233 .165
Gender Pearson
Correlation .063 1 .220** .221** -.068
Sig. (2-
tailed) .273 .000 .000 .234
Age Pearson
Correlation .100 .220** 1 .525** .082
Sig. (2-
tailed) .082 .000 .000 .154
Marital status Pearson
Correlation .069 .221** .525** 1 .135*
Sig. (2-
tailed) .233 .000 .000 .018
Highest education Pearson
Correlation -.080 -.068 .082 .135* 1
Sig. (2-
tailed) .165 .234 .154 .018
Source: Field data, 2016
**. Correlation is significant at the 0.01 level (2-tailed).
*. Correlation is significant at the 0.05 level (2-tailed).
c. Listwise N=304
There is a weak positive correlation between Job satisfaction and gender, which is not statistically
significant (r = -0.063, p=0.273>0.05).
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There is a weak positive correlation between Job satisfaction and age, which is not statistically
significant (r = 0.100, p=0.082>0.05). There is a weak positive correlation between Job satisfaction
and marital status, which is not statistically significant (r = 0.069, p=0.233>0.05). There is a weak
negative correlation between Job satisfaction and educational status, which is not statistically
significant (r = -0.080, p=0.165>0.05).
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CHAPTER FIVE
DISCUSSION OF FINDINGS
5.0. Introduction
This chapter presents the discussion of the major findings of the study. The purpose of this study
was to assess the factors influencing job satisfaction among nurses in ABUTH. The discussion is
presented based on the objectives of the study which were:
1. To explore the influence of extrinsic factors on job satisfaction.
2. To explore the influence of intrinsic factors on job satisfaction.
3. To establish relationship between job satisfaction and socio-demographic
characteristics.
5.1 Demographic Characteristics of Participants
A total of 360 professional nurses were recruited through disproportionate random sampling
technique for the study. The mean age of respondents was 39+_97. Majority of the respondents
(66.1%) were females while 34.9% were males. The majority of respondents being women could
be attributed to the fact that nursing is usually seen as women profession. Majority of the nurses
(74.3%) were married whereas 24.3% were single. On educational status, 27.3% were diploma
holders, 40.8% had post basic diploma, and 30.6% had their first degree in nursing while 1.3% had
master degree.
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5.2 Influence of Intrinsic Factors on Job Satisfaction
Findings from the study showed that intrinsic factors influence job satisfaction among ABUTH
nurses which agreed with Herzberg’s (1968) assertion that intrinsic factors are responsible for
employees’ job satisfaction. ABUTH nurses were satisfied with their intrinsic factors.
Findings from the study showed that advancement influence job satisfaction among ABUTH
nurses. Majority of ABUTH nurses were satisfied with the two components of opportunities for
advancement. While 63% of the nurses agreed that they have career development/clinical
opportunity, 66.4% also agreed having opportunity for active in-service/continuing education
programs for nurses. This study agreed with the findings of Edoho et al. (2015), Ugwa and Ugwa
(2014) and Fabiene and Kachchhap (2016) who reported advancement as vital to nurses’ job
satisfaction. ABUTH nurses’ satisfaction with advancement could be credited to the fact that
ABUTH as a teaching hospital serves as a training and research centre to Ahmadu Bello University
(ABU) and therefore have close relationship with teaching hospital. ABUTH is also closely located
to ABU. Nurses in ABUTH are therefore benefitting from the close relationship between ABUTH
and ABU and with their proximity; enrol easily for further studies and training at ABU.
Advancement in life is constant and imperative. Every individual would like to develop and grow
in the area of work to enable self-actualization. It is therefore important to ensure that work
relativities enable growth and advancement.
The study also established work itself having influence on job satisfaction among ABUTH nurses.
Out of the eight components under work itself, ABUTH nurses were satisfied with seven but
nevertheless dissatisfied with not having enough registered nurses on duty to provide quality
patient care. Consequently, ABUTH nurses were dissatisfied with poor staffing. This finding is
congruent with the study of Duffield et al. (2011) who recounted nurses having job dissatisfaction
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due to poor staffing, skill mixes and excessive workload. Similarly, nurses from Germany, France,
Poland, Italy, Netherlands, Belgium, Slovakia and China have reported poor job satisfaction and
frustration with the nursing profession due to poor staffing and excessive workload (Li et al.,
2013). According to Aiken et al. (2012), improving staffing would yield more positive outcomes
in patient care than any other investment the organization can embark upon.
ABUTH nurses’ dissatisfaction with staffing may be attributed to the fact that ABUTH as the only
major tertiary health facility in the state is usually crowded with clients from within and outside
the state. Nurses in ABUTH therefore usually have overflow of patients to care for. When there is
poor staffing, opportunities for transfer to other department and change of job description in
accordance to one’s level of training and experience would not exist. This will invariably lead to
boredom and monotony consequently leading to job dissatisfaction (Tao et al., 2015).
The study also established responsibility influencing job satisfaction among ABUTH nurses. In
the current study, a good percentage (61.1%) of the nurses agreed having freedom to make decision
concerning their patient care while 38.8% disagreed. Furthermore, while 62.2% accepted having
involvement in cost controlling, 37.8% were however of contrary opinion. Nurses in ABUTH were
satisfied with their responsibility. This finding is consistent with the study of Ugwa and Ugwa
(2014) who reported nurses having satisfaction with responsibility. The satisfaction of ABUTH
nurses in the current study may be attributed to the fact that ABUTH as a tertiary healthcare
institution manage different disease conditions which usually demand the experience and
knowledge of the nurses. The study of Azim et al. (2013) further supported the finding of the
current study when he reported that when nurses are allowed to practice at the level of their training
and competency as well as making decisions about patients’ care, it increase their motivation and
raise their level of job satisfaction. The finding of this study however differed from the finding of
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Edoho et al. (2015) who reported nurses having dissatisfaction with the level of their responsibility
on the job.
Recognition of outstanding performance will encourage nurses to remain committed to their
organisation while striving to earn more recognitions. Healthcare organisations through prompt
acknowledgment of nurses’ contribution can therefore create a positive organisational climate for
quality nursing care and positive patient outcomes. The current study established that recognition
influence job satisfaction among ABUTH nurses. While some of the participants (17.8%) were
highly satisfied with the level of the acknowledgement of their contributions to patients’ care,
49.3% were moderately satisfied. Similarly, 54.6% of the nurses reported being satisfied with
praise and recognition. Similarly, Tessema, Ready and Embaye (2013) reported recognition as
having positive impacts on employees’ morale and job satisfaction which further supported the
finding of this study. Obviously, praise and recognition are essential to the development of staff.
Thus, the more satisfied employees are with praise and recognition, the happier and productive
they would be.
The finding of this study however differed from the study of Khunou et al. (2016) who reported
South African nurses having dissatisfaction with their level of recognition. Recognition instil sense
of accomplishment and the desire to strive for more achievement among employees. While good
remuneration is gratifying, it cannot buy happiness. Happy employees are healthy employees while
healthy employees are satisfied and productive (Tao et al., 2015). More so, satisfaction with
recognition enhances the cultivation of confidence since employees are aware of the expectations
and standards expected from their employers from previous praise and recognition given by their
supervisors over job well-done (Cleary et al., 2013).
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The finding of this study also revealed that achievement influence job satisfaction among nurses
in ABUTH. The nurses were satisfied with achievement. This finding however differed from the
findings of Velickovic et al. (2014) and Buhalkani et al. (2011) who reported nurses having job
dissatisfaction with achievement. The satisfaction of ABUTH nurses may be attributed to good
supervision as reported by the nurses.
Employees’ pursuance of achieving organizational goals are in anticipation of achieving their own
personal goals. Therefore, a symbiotic kind of relationship between organizational goals and
employees’ goal will positively influence employees’ job satisfaction. Furthermore, Feelings of
achievement provides happiness and satisfaction in employees. Such feelings are strong antidotes
to workplace related stresses upon which employees’ job satisfaction is predicated.
5.3 Influence of Extrinsic Factors on Job Satisfaction.
Extrinsic factors are externally generated variables directly related to the job surrounding and are
responsible for prevention of job dissatisfaction (Herzberg, 1968). Extrinsic factors considered in
this study included interpersonal relations, salary, policy and administration, supervision and
working conditions.
The findings of this study revealed extrinsic factors influencing job satisfaction among nurses in
ABUTH as opposed to Herzberg’s assertion (1968). Herzberg advanced that extrinsic factors do
not provide job satisfaction but prevent job dissatisfaction. ABUTH nurses equally require
extrinsic factors to be motivated. The findings of this study are consistent with a study among
Nigerian employees which reported that extrinsic factors equally influence job satisfaction (Worlu
& Chidozie, 2012). The study of Dartey-Baah and Amoako (2011) among Ghanaian workers
further supported the findings of this study when they reported extrinsic factors equally serving as
motivators among Ghanaian workers. African employees are faced with unemployment and
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economic hardship and would therefore be more satisfied with whatever would directly improve
their standard of living (Dartey-Baah & Amoako, 2011). The current study also confirmed the
assertion of Edoho et al. (2015) which established that extrinsic factors are equally needed to
motivate Nigerian nurses.
Satisfaction of staff is very relevant in the nursing profession since satisfied staff enhance quality
service delivery and are less likely to come up with many errors in their work. Satisfaction also
brings about commitment and confidence among nurses. It is therefore important to ensure that
nurses are satisfied with their work. The result of this study revealed that ABUTH nurses were
satisfied with their interpersonal relations. The finding of this study is congruent with the study of
Dignani and Toccaceli (2013) who reported nurses having job satisfaction arising from good
interpersonal relations among their co-workers. Yang et al. (2012) equally proved good
interpersonal relations to enhance job satisfaction and team work among nurses which further
supported the findings of current study. Good interpersonal relations encourage open
communication through which nurses could easily resolve their differences thereby stay happy and
satisfied on their job.
Policies are standing plans used in formal organizations to encourage equity, fairness and
collaboration of staff. Frequently reviewed policies take account of current changes in the
environment to relatively enhance job satisfaction. Adequate policies are therefore needed to
enhance workplace climate. The current study revealed that ABUTH nurses were moderately
satisfied with the policies and administrations of their organisation. Out of the nineteen questions
under policies and administrations, ABUTH nurses were satisfied with twelve while dissatisfied
with seven. A higher percentage (62.5%) of nurses in ABUTH are satisfied with standardized
policies and procedures established by their employer while 37.5% disagreed. Similarly, 73% of
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the participants were satisfied with the use of nursing diagnosis in ABUTH. On the other, 57% of
the participants disagreed having the opportunity for staff nurses to participate in policy decisions.
A higher percentage (65.4%) of the participants were equally dissatisfied with not being involved
in selection of new equipment. ABUTH nurses were not satisfied with all the components of their
policy and administration. They were mostly dissatisfied with their level of involvement in
decision making. Nurses’ dissatisfaction with their hospital policy and administration could be as
a result of non-differentiation in nurses’ job description by ABUTH management regardless of
difference in nurses’ educational level.
The result of this study supported the finding of Al-Hamdan et al. (2016) who reported that nurses
were dissatisfied with policy and administration due to non-involvement in decision making. The
findings of Philips et al. (2015) further supported the current study when they cited clearly
documented policies, role clarity, knowledge of organizational culture and appropriate feedback
mechanism as vital to nurses’ organizational commitment and overall job satisfaction. Nurses are
appreciative of clarity, transparency and uniformity of organizational policies and administration.
When employees are aware of rules and regulations operational in their organizations, role
conflicts, and occupational stresses, destructive and unethical behaviours would be reduced to their
barest minimum thereby providing an enabling environment for employees’ job satisfaction. It is
therefore imperative for healthcare facilities to frequently review their organizational policies
while taking into cognizance the current prevailing circumstances (Khunou et al., 2016; Aiken et
al., 2015).
Supervision is important in coordinating the nurses’ practice environment. The result of this study
revealed that ABUTH nurses were satisfied with supervision. This study was in agreement with
Van Bogaert et al. (2014) who stated that nurses from Belgium had satisfaction with the quality of
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their supervision. Nurses’ satisfaction with supervision in the current study could be due to the fact
that ABUTH nurses usually explore the advantage of the close relationship between their
organisation and Ahmadu Bello University (ABU) to enrol for further training even in
management courses. This might have positive impacts on the competency and effectiveness of
their supervisions. Another study among Saudi Arabian nurses by Al-Dossary, Vail, and
Macfarlane (2012) also established that the nurses were satisfied with their supervision further
supporting the present study.
The current study however differed from the findings of Adegoke et al. (2015) who reported
Midwives having job dissatisfaction due to poor supervision arising from unavailability and lack
of support. Nurses are encouraged and resilient in carrying out their professional mandate when
they have the support of their supervisors (Kellerman, 2012).
Working conditions include adequate resources, workload, space, security, amount of noise and
among others. Nurses need healthy working conditions to carry out their duties effectively and
efficiently. The result of this study revealed that ABUTH nurses’ satisfaction with their working
conditions was relatively low. Nurses in ABUTH were dissatisfied with their work environment,
poor staffing and organisational support. Most studies on job satisfaction among nurses in other
parts of Nigeria reported similar findings (Adegoke et al., 2015; Olakunde, 2012; Ogbolu et al.,
2015). Another study among nurses from European countries reported nurses having
dissatisfaction with their working environment (Aikent et al., 2011) further supporting the current
study.
The findings of McGlynn et al. (2012) and Masum et al. (2016) however differed from the current
study when the reported that participants in their studies were satisfied with their working
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conditions. The dissatisfaction of ABUTH nurses with many components of their working
conditions may be attributed to inadequate human and material resources resulting from the
teeming clients accessing care being that ABUTH is the major tertiary healthcare facility in
Kaduna State. Nurses require good working conditions to practice effectively. On the other hand,
when nurses are faced with excessive workload, poor staffing and inadequate resources, their
professional skills would be impaired leading to poor job satisfaction (Ganzo & Toren, 2014).
Social standing in any African society is largely determined by how wealthy you are financially
and how you are able to assist with family obligations. Thus, salary levels are very relevant to job
satisfaction. It is no wonder that nurses in ABUTH were dissatisfied with their salary. Specifically,
most of the nurses (71.4%) reported their salary as inadequate. The outcome of the present study
is in line with the finding of Khunou and Davhana-Maselesele (2016) who reported that South
African nurses were dissatisfied with their salary. The outcome of this study is also in agreement
with the finding of Adegoke et al. (2015) who reported that Nigerian midwives were dissatisfied
with their salary. Similar finding was reported by Worlu and Chidozie (2012) who reported that
salary had strong positive influence on job satisfaction among Nigerian workers.
On the contrary, nurses from private hospitals in Turkey rated salary as the least factor influencing
their job satisfaction (Masum et al., 2016). This could be attributed to the fact that the participants
were recruited from only private health institutions which may have a more structured and
satisfactorily salary compared to public institutions. Nurses’ organisational commitment would be
sustained when they perceive their salary to be fair. Hospital management should therefore ensure
that nurses’ salaries are adequate and should be reviewed periodically.
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5.4 Relationship between Job Satisfaction and Socio-demographic
Characteristics
The socio-demographic characteristics (individual characteristics) considered were age, gender,
marital status and educational status. Findings on relationship between job satisfaction and age,
gender, and marital status using correlational analysis yielded weak positive correlations which
were not statistically significant. Thus, association between age, gender and marital status was not
strong enough to predict job satisfaction among ABUTH nurses. In addition, the association
between educational status and job satisfaction yielded weak negative correlation which was not
statistically significant. Therefore, educational status does not equally predict job satisfaction
among nurses in ABUTH.
Nurses in ABUTH reported satisfaction with most of their intrinsic factors such as achievement,
responsibilities, recognition and advancement. The participants also reported being satisfied with
some of the extrinsic factors such as interpersonal relations, supervision and policies and
administration. This could account for higher level of motivation which in turn has the ability to
cushion unpleasant work related stressors thereby empowering nurses to overcome differences in
socio-demographic characteristics such as age, gender and marital status.
Furthermore, nurses in ABUTH have higher educational status with 40.8% having post basic
diplomas and 30.6% having degree in nursing. Such educational status could have positively
influenced their cultural perspectives and orientation on differences in age, marital status and
gender. Advance in technology has also deposited information at the disposal of nurses which
could leverage them to easily bridge the gap between the differences in their educational status.
The finding of this study is congruent with the study of Panisoara and Serban (2013) who reported
marital status having positive weak association with employees’ job satisfaction. Study from
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Mexico (Tao et al., 2012) and China (Wang et al., 2012) equally lend credence to the finding of
the current study when they reported positive weak association between marital status, age, gender
and job satisfaction. Furthermore, weak positive association between marital status and job
satisfaction among ABUTH nurses maybe attributed to influence of socialisation which has
changed the societal perspectives especially in regard to responsibility. Nowadays, both men and
women share the responsibility of fending for their family. Therefore, women are equally resilient
in protecting their job.
However, the findings of another study in Nigeria involving workers from different professions
reported unmarried employees having higher job satisfaction in contrast to married employees
(Adeoye et al., 2014). The authors cited economic hardship being responsible for decline in job
satisfaction among married employees. Indisputably, in the face of economic hardship, married
employees with higher responsibilities would feel the economic hardship than unmarried
employees.
On gender, the correlational analysis yielded weak positive correlation which was not statistically
significant. Therefore, gender cannot be said to predict job satisfaction among ABUTH nurses.
The findings of Ayelew et al. (2015) was consistent with the current study. Ayelew et al. reported
gender not been statistically associated with job satisfaction among Ethiopian nurses. Another
study in the USA also lends credence to the current findings (Cahill, 2011). Cahill equally reported
gender not having significant relationship with job satisfaction among nurses. The weak positive
relationship between gender and job satisfaction in the current study could be due to influence of
civilisation which does not attach importance to difference in gender but rather advocates gender
equality. Consequently, self-esteem and the enabling environment is usually adequate for both
sexes to compete favourably. Furthermore, the Northern part of Nigeria are predominantly
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Muslims who do not permit women to go out and socialise. Consequently, women who are allowed
the opportunity to work are usually seen as privileged, leading to increase in their self-esteem and
confidence to compete favourably at the workplace.
The current study differed from the findings of Olatunji and Mokuolu (2014) who reported that
both male nurses and doctors have higher level of job satisfaction than their female colleagues.
Contrary to the above, Alshmemri (2014) acknowledged that Saudi Arabian female nurses have
higher job satisfaction than their male counterparts. Cultural practices seem to account for the
difference in influence of gender on job satisfaction.
The result of this study equally yielded weak positive correlation between age and job satisfaction
which was not statistically significant. Age therefore does not predict job satisfaction among
ABUTH nurses. This is in agreement with Kozuchova et al. (2015), who reported no statistically
significant correlation between age and job satisfaction. This could be due to technological
advancement. Advancement in technology has made available relevant information for self-
development leading to increase in skills and competence and corresponding increase in job
satisfaction regardless of age. Moneke and Umeh (2013) also established weak positive correlation
between age and job satisfaction, further supporting the findings of the present study.
The current study contrasted the findings of Carrilo et al. (2013) who reported statistically
significant correlation between age and job satisfaction. However, the most satisfied group were
the youngest and the oldest. This could be due to the fact that the younger generation belong to the
computer age where information is at their fingertips thereby giving them easy access to needed
information that could boost their job satisfaction. On the other hand, the older generation might
have had adequate experience from years of practice which might have made them develop more
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positive adaptive strategies to cope with unfavourable working conditions to sustain job
satisfaction. Gellasch (2015), Toa et la. (2012) and Heidarian et al. (2015) also established positive
relationship between age and job satisfaction.
Education is very crucial in nursing as the healthcare milieu is increasingly becoming complex
due to change in epidemiological pattern and advancement in technology. Nurses therefore need
to be adequately prepared in order to continue to maintain their relevance in the healthcare system.
Furthermore, education is observed to be one of the factors influencing job satisfaction among
nurses. The current study nevertheless established a weak negative correlation between
educational status and job satisfaction which was not statistically significant. Franek et al. (2014)
and Mehrdad et al. (2013) also acknowledged that educational status has no statistical significant
relationship with job satisfaction. However, the weak negative correlation between educational
status and job satisfaction in the current study could be due to non-recognition of differences in
nurses’ qualification by ABUTH management. Indisputably, education would influence job
satisfaction only when it is accompanied with higher privileges.
The present study differed from the findings of Adeoye et al. (2014) who established significant
positive association between educational status and job satisfaction. However, their study involved
workers from different professions which may not have problem of non-recognition of differences
in educational qualifications. Acquiring additional educational qualification require both time and
money. Unarguably, nurses who take the pain to go for further training will expect to be rewarded
by promotion and change of job description. But when the management fail to do so, invariably,
it would lead to poor job satisfaction.
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5.6 Summary of Discussion
The study revealed influence of intrinsic factors and extrinsic factors on job satisfaction as well as
association between socio-demographic characteristics and job satisfaction. Nurses in ABUTH
were moderately satisfied with their intrinsic factors. The participants were equally satisfied with
their supervision, interpersonal relations but were dissatisfied with some components of their
organizational policy and administration such as non-involvement in decision making. The nurses
were also dissatisfied with salary, working conditions and staffing. On the other hand, association
between age, gender and marital status yielded weak positive correlation which was not
statistically significant while the association between educational status and job satisfaction
yielded a weak negative correlation which was not also statistically significant.
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CHAPTER SIX
SUMMARY, IMPLICATIONS, LIMITATIONS, CONCLUSION, AND
RECOMMENDATIONS
6.0 Introduction
The chapter provides a summary of the study with conclusion and recommendations drawn from
the findings. The chapter in addition, suggests areas for further studies as derived from the outcome
of the study.
6.1. Summary of the Study
The nursing workforce is the major pillar of the Nigerian health system. The Nigerian nursing
workforce however, is increasingly becoming fragile and inadequate in meeting the health needs
of Nigerians. The Nigerian nursing workforce is consequently characterized with incessant
industrial actions in a bid to have their plights addressed by the government. Failure of the
government to adequately address these challenges has led to excessive migration of highly trained
and competent nurses to developed countries in search of better working conditions and standard
of living. This study therefore sought to investigate the practicing conditions (intrinsic and
extrinsic factors) of nurses in ABUTH and how these conditions are impacting on their job
satisfaction. Consequently, the research was guided by the following objectives:
1. To explore the influence of extrinsic factors on job satisfaction
2. To explore the influence of intrinsic factors on job satisfaction
3. To establish the relationship between job satisfaction and socio-demographic characteristics
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Herzberg’s two factor theory was adopted as the theoretical frame work. Literature was reviewed
thematically under extrinsic factors, intrinsic factors and socio-demographic characteristics
influencing job satisfaction.
The study was done quantitatively using descriptive cross-sectional design at ABUTH.
Proportionate stratified random sampling technique was adopted to recruit 360 professional nurses
from 6 departments of ABUTH. Revised Nursing Work Index (NWI – R) questionnaire was used
for the data collection. The instrument (NWI – R) was pretested among 20 professional nurses
from University of Abuja Teaching Hospital, Nigeria. Ethical clearance was obtained from
NOGUCHI (NMIMR-IRB CPN 080/15-16) and institutional clearance from ABUTH Ethical
Clearance Committee (ABUTH/HREC/T13/2016). Data generated were collated, cleaned, coded
and analysed using descriptive and inferential statistics.
The purpose of the study was to assess the factors influencing job satisfaction among nurses in
ABUTH. The study revealed that the mean age of respondents was 39±10.97. While 34.9 of the
respondents were males, 66.1% were females. Nurses were satisfied with almost all the facets of
their intrinsic factors. They were satisfied with achievement, advancement, responsibilities and
recognition but were however dissatisfied with work itself. Nurses were partially satisfied with the
extrinsic factors. The nurses were satisfied with the competence and support from their
supervisors, interpersonal relations but were partly dissatisfied with some components of their
organisational policies and administration such as non-involvement in decision making. The
nurses were also dissatisfied with their working conditions and salary. The nurses nevertheless,
had mixed opinion on the assessment of their intrinsic and extrinsic factors. Thus, nurses in
ABUTH could be motivated by both intrinsic and extrinsic factors.
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Evidence from the study equally revealed that nurses’ socio-demographic characteristics do not
predict job satisfaction among nurses. This could be attributed to their satisfaction with intrinsic
factors as motivated and satisfied employees are resilient and productive.
6.2 Implications
From the findings of this study, the following implications were outlined for hospital management,
nursing practice and nursing research.
6.2.1 Hospital Management
The findings of this study revealed that nurses were satisfied with most of their intrinsic and
partially satisfied with their extrinsic factors. Nevertheless, while majority of the nurses reported
being satisfied, others were not satisfied. There is need for the hospital management to employ an
individualistic management approach to promote satisfaction among nurses. The individual
approach will also enlighten management about the challenges confronting individual nurses. This
would eschew incidence of rivalry, witch-hunting and lack of teamwork which can lead to sabotage
and compromised quality care.
Hospital management should also hold regular meetings and seminars to educate and acquaint both
staff on hospital policies and appropriate ways of channelling complaints. There must be equity
and justice in the management of personnel so as to discourage outburst of grievances between
nurses and management. This is paramount because until nurses are satisfied with their job, they
cannot be poised to maximise their potentials. Furthermore, for hospital management to have a
stable nursing workforce, they must enable conditions that promote positive workplace climate.
Developing a positive workplace climate and a learning organization in the hospital naturally
would foster job satisfaction among nurses.
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6.2.2 Nursing Practice
Quality nursing care is determined by having adequate numbers and quality nursing workforce.
Having adequate numbers and quality nursing workforce however, depends on committed,
competent and confident nurses which is classically ensured by their job satisfaction. Nurses would
therefore, continually demand for better working conditions that promote job satisfaction from
management. Unfortunately, in their attempt to rationalize with management for better options
estranged nurse leaders from management which ultimately affects nursing services. This study is
expected to contribute towards improvement of quality nursing care by shedding more light on
how to have motivated nursing workforce. This is vital because satisfied nurses are productive and
ethically inclined. Therefore, nurses’ job satisfaction would lead to good nurse retention, quality
nursing care and positive patient outcomes.
6.2.3 Further Nursing Research
Although majority of nurses were satisfied with their intrinsic factors, few were dissatisfied.
Similar result was obtained from their satisfaction with extrinsic factors while the association
between their socio-demographic factors and job satisfaction were not statistically significant.
There is therefore need for further research about why nurses have divergent views on satisfaction
with factors that influence their job satisfaction.
6.3 Limitations of the Study
Structured questionnaire was used for the study which may have limited the information
respondents want to provide if not captured in the questionnaire. Secondly, there could be
respondents’ bias from the nurses who may not want to give the actual response of the situation of
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the hospital. Due to time constraint, the study could not also involve other hospitals in Kaduna
State.
6.4 Conclusion
Nursing as the single largest component of the Nigerian healthcare workforce plays an
indispensable role in the overall stability and quality of the national health system. Ensuring that
nurses are satisfied with their job therefore is necessary to having a reliable health system that is
responsive to the health needs of the people. This study therefore assessed factors influencing job
satisfaction among nurses in ABUTH using Herzberg’s theory which delineates a relationship
between intrinsic and extrinsic factors.
The result of this study revealed that nurses were moderately satisfied with their jobs. Inadequate
salary, non-involvement in decision making, poor working conditions and staffing were the major
sources of job dissatisfaction among nurses in ABUTH. The practice of “one stroke fitting for all
employees” has proofed to be highly ineffective in the present nursing practice environment as
evidenced by mixed opinion of nurses on their satisfaction with their intrinsic and extrinsic factors.
In addition, no statistically significant relationships were established between nurses’ socio-
demographic characteristics and job satisfaction. Furthermore, nurses in ABUTH were motivated
by both intrinsic and extrinsic factors. Therefore, ensuring job satisfaction among nurses is an
enigma which demands a multifaceted approach that cannot be left to chance. There is need to
constantly engage nurse leaders and nurses to deliberate on factors that enhance job satisfaction.
Managers should be trained periodically on leadership and management concepts so as to augment
their effectiveness and efficiency in human resource management.
6.5 Recommendations
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Based on the findings of this study, the researcher made the followings recommendations for
Ministry of Health, Nursing and Midwifery Council of Nigeria (NMCN), and the Hospital
Management.
6.51 Ministry for Health
The Ministry for Health should:
1. Develop a policy on the ideal nurse-patient ratio in order to ensure that all hospitals comply
with standard staffing. This could be rightly achieved by keeping abreast with what is obtainable
in the international communities on nurse staffing. In addition, for nurse-patient ratio to be ideal,
nurses’ training, competence and the severity of patient’s condition must be put into cognizance.
2. Have formally structured service entry points for nurses based on their educational level.
3. Have structured career progression for nurses. That is, opportunities for training and
criteria for promotion should be formal, well-structured and implemented without sentiment and
favoritism.
4. Improve on nurses’ remuneration as well as conditions of service. Nurses’ conditions of
service should be made attractive with benefits such as vacation allowance, standard
accommodation, maternity leave and allowance, bonuses for festivities, etc.
6.5.2 Nursing and Midwifery Council of Nigeria (NMCN)
Nursing and Midwifery Council of Nigeria should:
1. Liaise with the Ministry of Health both at the Federal, State and Local government levels
to ensure formulation of policies that will represent the interest of the Nigerian nursing workforce.
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This could be rightly achieved through adequate consultation with nurses to know their plights and
demands and lobby the appropriate authorities to ensure that nurses’ demand and welfare are given
due consideration and provided for.
2. Visit healthcare organizations periodically to ensure that they are complying with the
standard of practice such as accepted nurse-patient ratio, service entry point, etc. The NMCN
should constitute a unit that will be saddled with the sole responsibilities of visiting healthcare
institutions at all levels to assess their level of compliance with the constituted standard and ethics
of nursing profession.
3. Ensure that nurses’ complaints are acknowledged and channeled to the appropriate bodies
for immediate action so as to ensure a satisfied nursing workforce. This is achievable through one-
on-one consultations with nurses to know their level of job satisfaction and factors impeding their
professional practice.
6.5.3 Hospital Management
1. The practice of “one stroke fitting for all employees” from different generational age cohorts,
socio-demographic background and educational status does no longer prove effective in today’s
divers and complex healthcare milieu. There is therefore need for the hospital management and
nurse leaders in ABUTH to have individualized strategies for addressing employees’ job needs
based on their differences. Therefore, nurse managers/leaders in ABUTH should always be
accessible to their subordinates and constantly listen to their suggestions, complaints and demands
while taking into cognisance their differences. This could be brought about by providing
suggestion boxes for nurses in strategic locations in their work environment and holding regular
and organised staff meetings.
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2. Hospital management should keep vivid record of nurses’ performance and poised to recognize,
commend, reward both in kind and cash such as bonuses, and promotion for job well-done, ethical
conduct and excellence.
3. Hospital management should as a matter of urgency improve upon staffing of nurses. Hospital
management having determined through adequate consultations the size of staff needed for
efficient nursing care, employment should be done promptly and accordingly. They should also be
at alert to replace staff in the advent of resignation, retirement, transfer or death so as to circumvent
further staff shortage.
4. Management should focus on nurses’ job enrichment by providing them with stimulating and
interesting work that challenge and motivate them. Nurses should equally be given autonomy over
nursing practice.
5. Hospital management should be explicit and transparent on their policies and administrations.
Nurses should be given job description with clearly delineated jurisdiction while taking into
cognizance their competency, experience, and educational training.
6. Good organizational culture should be created and sustained through regular staff meetings,
orientation, seminars and workshops to socialize and educate employees on professional and
ethical practices.
7. Nurses’ opinion should be respected by other professionals. Nurses professional practice
judgement should not be relegated on the bases of sentiments.
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8. Management should improve nurses’ remunerations while taking into cognizance their
experience, number of years in service and educational achievements. Salary should also be paid
regularly and promptly.
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