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2006 - Kovner - Factors Associated With Work Satisfaction of Registered Nurses
2006 - Kovner - Factors Associated With Work Satisfaction of Registered Nurses
2006 - Kovner - Factors Associated With Work Satisfaction of Registered Nurses
Purpose: To examine the factors that influence the work satisfaction of a national sample of
registered nurses in metropolitan statistical areas (MSAs).
Design: A cross-sectional mailed survey design was used. The sample consisted of RNs ran-
domly selected from 40 MSAs in 29 states; 1,907 RNs responded (48%). The sample of
1,538 RNs working in nursing was used for analysis.
Methods: The questionnaire included measures of work attitudes and demographic charac-
teristics. The data were analyzed using ordinary least-squares regression.
Findings: More than 40% of the variance in satisfaction was explained by the various work
attitudes: supervisor support, work-group cohesion, variety of work, autonomy, organi-
zational constraint, promotional opportunities, work and family conflict, and distributive
justice. RNs who were White, self-perceived as healthy, and working in nursing educa-
tion were more satisfied. RNs that were more career oriented were more satisfied. Of the
benefits options, only paid time off was related to satisfaction.
Conclusions: Work-related factors were significantly related to RNs’ work satisfaction.
* * *
N
ursing shortages have been widely reported in the model of work satisfaction and voluntary turnover (intent
literature both regionally (Cushman, Ellenbecker, to leave) that combines economic, psychological, and so-
Wilson, McNally, & Williams, 2001) and within ciological theories with empirical findings about the de-
healthcare organizations (Buerhaus, Staiger, & Auerbach, terminants of turnover. They theorized that a variety of
2003; Grumbach, Ash, Seago, Spetz, & Coffman, 2001). work-setting characteristics and attitudes toward work are
Work satisfaction is an important issue for registered nurses associated with satisfaction, resulting in intent to leave jobs.
(RNs) and managers in part because of its reported rela- Some empirical evidence for the model (Agho, Mueller, &
tionship with RN turnover (Davidson, Folcarelli, Crawford, Price, 1993; Davidson, Folcarelli, Crawford, Duprat, &
Duprat, & Clifford, 1997; Francis-Felsen et al., 1996; Clifford, 1997; Gaerter, 1999; Gurney et al., 1997) has been
Gurney, Mueller, & Price, 1997; Ingersoll, Olsan, Drew- presented. A modification of Gurney et al.’s model is shown
Cates, DeVinney, & Davies, 2002; Lake, 1998; Larrabee in the Figure.
et al., 2003; Prevosto, 2001; Shader, Broome, Broome, West, Demographic characteristics have been associated with
& Nash, 2001, which can lead to organizational shortages RN work satisfaction (Blegen & Mueller, 1987; Ingersoll
and absenteeism (Siu, 2002; Song, Daly, Rudy, Douglas, &
Dyer, 1997). Results from studies about determinants of RN Christine Kovner, RN, PhD, Upsilon, Professor, College of Nursing, New
work satisfaction should be of interest to both administra- York University, New York City; Carol Brewer, RN, PhD, Associate Pro-
tors and policy makers. fessor, School of Nursing; Yow-Wu Wu, PhD, Associate Professor, School
of Nursing; Ying Cheng, MA, Doctoral Candidate; all at University at Buf-
falo, Buffalo, NY; Miho Suzuki, RN, MSN, Upsilon, Doctoral Candidate,
Background College of Nursing, New York University, New York City. This manuscript
was supported by the Agency for Healthcare Research and Quality, Grant
R01HS01132002. The authors of this article are responsible for its con-
A substantial body of literature exists about factors as- tents. No statement in this article should be construed as an official position
sociated with RN satisfaction with work (Stamps, 1997). of the Agency for Healthcare Research and Quality. Correspondence to Dr.
Various measures of satisfaction have been used, but many Kovner, College of Nursing, New York University, 246 Greene Street, Room
618E, New York, NY 10003. E-mail: ctk1@nyu.edu
are not based on a theoretical framework. Price (2004) and Accepted for publication August 7, 2005.
Gurney et al. (1997) proposed an integrated theoretical
RN characteristics
Demographic
Health
MSA characteristics
Movement constraints
Figure. Factors contributing to nurses’ job satisfaction. Based on Gurney, Mueller, & Price (1997). Adapted with permission.
et al., 2002; Langemo, Anderson, & Volden, 2002; Lum, Taunton et al., 1997) have been related to work satisfac-
Kervin, Clark, Reid, & Sirola, 1998; Weisman, Alexander, tion.
& Chase, 1980), and studies have indicated both a posi- Work-to-family conflict and family-to-work conflict are
tive relationship between autonomy and satisfaction (Acorn, related concepts that have been negatively related to work
Ratner, & Crawford, 1997; Kramer & Schmalenberg, 2003) outcomes, family outcomes, and employee physical and
as well as contradictory findings (Davidson et al., 1997; mental health (Frone, 2003), but they were not included
Gurney et al., 1997; McNeese-Smith & Crook, 2003). The in Price et al.’s model. Family-to-work conflict (family con-
relationship between variety and work satisfaction is equiv- flicts with work) has been positively related to job dis-
ocal (Gurney et al., 1997; McNeese-Smith & Crook, 2003). satisfaction, work-related absenteeism, tardiness, and poor
Findings are contradictory about the relationship between job performance in various occupations (Bernas & Major,
distributive justice and work satisfaction (Gurney et al., 2000; Frone, Russell, & Cooper, 1992; Frone, Yardley, &
1997; Taunton, Boyle, Woods, Hansen, & Bott, 1997), Markel, 1997) and also among nurses (Decker, 1997). In
workload, organizational constraint, and work satisfaction contrast, work-to-family conflict (work conflicts with fam-
(Adams & Bond, 2000; Davidson et al., 1997; Gurney et al., ily) has been associated with intentions to quit one’s job
1997; Hoffman & Scott, 2003; Shaver & Lacey, 2003), and turnover (Greenhaus, Parasuraman, & Collins, 2001;
supervisor and mentor support, and satisfaction (Decker, Kirchmeyer & Cohen, 1999).
1997; Gurney et al., 1997; Larrabee et al., 2003; McNeese- Although not included in Price et al.’s model, some
Smith & Crook, 2003). evidence exists that metropolitan statistical area (MSA)
Work-group cohesion, also termed integration, relation- characteristics affect nurses’ work participation behavior
ship with coworkers, and peer support (Adams & Bond, (Buerhaus, 1993; Buerhaus & Staiger, 1996, 1997), but not
2000; Decker, 1997; Gurney et al., 1997; Larrabee et al., clear is whether these factors have any effect directly on
2003; Shader et al., 2001) and promotional opportunity work satisfaction. For example, in areas with many inpatient
satisfaction (Gurney et al., 1997; Mills & Blaesing, 2000; days, competition for RNs might be high. This competition
might force employers to improve working conditions, ment in an educational program, and religious beliefs), (b)
which would improve RN work satisfaction. Similarly, MSA characteristics (medical, surgical, and other specialists
in areas with competition among healthcare providers, they per 1,000 population, primary care practitioners per 1,000
might compete in relation to quality or cost. If they compete population, index of competition, percentage of HMO hos-
on quality, they might be satisfactory places to work. How- pital services paid through fee schedules, inpatient days, and
ever, if they compete on cost, they might be unsatisfactory RN-to-population ratios, unemployment rate in 2002, and
places to work. The purpose of the study reported here was MSA, and (c) RN perceptions of the labor market that rep-
to empirically test the revised model shown in the Figure in resented movement constraints (local job opportunity and
a national sample of working RNs to determine the factors outside job opportunity). The fourth group was work set-
associated with RNs’ work satisfaction. ting, which included work attitudes (autonomy, variety, dis-
tributive justice, work group cohesion, supervisory support,
Methods mentor support, work-family conflict, family-work conflict,
promotional opportunity, organizational constraints, quan-
The target population for this study was all registered titative workload, work motivation, career orientation,
nurses (RNs) in metropolitan statistical areas (areas around partner’s career orientation, and satisfaction) and charac-
and including metropolitan areas) in the United States. teristics of the work (annual income, holding more than one
About 78% of RNs live in MSAs (Spratley, Johnson, position for pay, work setting, position, work shift, transfer
Sochalski, Fritz, & Spencer, 2001). The sampling design in- of work unit, change in supervisor, needle sticks, strains and
cluded a two-stage sample of RNs in MSAs. First, MSAs back injury, paid time off benefit, medical insurance bene-
were selected; then RNs were randomly selected from all fit, retirement benefit, tuition reimbursement, importance of
RNs in each MSA. Because of financial constraints for this benefits, and number of benefits). The full list of variables
study, only 40 MSAs were randomly selected from the origi- is shown in Table 1.
nal 51 MSAs used by the Center for Studying Health System Work attitudes were measured with scales used in previous
Change in the Community Tracking Study (CTS) in 2000 research (Carlson & Frone, 2003; Gurney, 1990; Quinn &
(Metcalf, Kemper, Kohn, & Pickreign, 1996). The original Staines, 1979; Spector & Jex, 1998). Satisfaction was mea-
sampling strategy for the CTS was designed to result in a sured with the five-item Quinn and Staines’s facet-free job
nationally representative sample of RNs. RNs were sam- satisfaction scale (Quinn & Staines, 1979), but with slightly
pled from 29 states and the District of Columbia (AL, AR, altered response items. We expanded the number of options
AZ, CA, CO, CT, FL, GA, IL, IN, KY, LA, MA, MD, DC, in several cases, such as from the original three-response op-
MI, MO, NC, NJ, NV, NY, OH, OK, PA, SC, TN, TX, VA, tions (strongly recommend, have doubts about recommend-
WV, and WA). The board of nursing in each area was con- ing, and advise the friend against) to four-response options
tacted to get an updated list of names and addresses for all (strongly recommend, somewhat recommend, somewhat ad-
RNs. From these lists, 4,000 RNs were randomly selected vise against, and strongly advise against). The Cronbach
from the 40 MSAs with equal probabilities of selection. An alpha coefficient was .86. Quinn and Staines reported that
advantage of this method is that the statistical analyses do these indicators of job satisfaction were correlated with less
not require the use of sampling weights. role ambiguity (−.22), depressed mood at work (−.43), and
After the sample of 4,000 RNs was selected, each nurse more facet-specific job satisfaction (.55), indicating evidence
was sent a mailed questionnaire based on a seven-stage pro- of the validity of the scale (Cook, Hepworth, Wall, & Warr,
cedure reported by Dillman (2000), including: (a) an alert 1981). All scales were Likert-type, varying in the number
letter, (b) the first survey, (c) a postcard reminder, (d) a sec- of items from 3 (for work-family conflict) to 10 (for orga-
ond survey, (e) a third survey, (f) a follow-up phone call, nizational constraints). Table 1 shows the definition, mean,
and (g) a fourth survey. Each selected RN received the first standard deviation, actual range, Cronbach alphas, and the
survey with a $1.00 incentive and was eligible for one of number of items for all scales used in the analysis. Reliability
10 prizes of $100 in a drawing. These procedures resulted coefficients for the scales ranged from a low of .70 for va-
in completed questionnaires being obtained from 1,906 of riety to .95 for supervisory support and distributive justice.
the 4,000 sampled RNs. The overall response rate was 48% The one-factor structure of each scale using confirmatory
and ranged across the 40 MSAs from 30% to 51%. Forty- factor analysis was supported in all cases except organiza-
five respondents were eliminated from the analytic sample tional constraint. After removing one item from that scale,
because they had moved to an area for which we could not a one-factor solution was supported.
obtain MSA data, and 324 were eliminated because they Partner’s annual income was logged to normalize the dis-
were not employed in nursing. Thus, the final sample was tribution. As for group two characteristics, all variables re-
1,538 nurses who were working in nursing. lated to MSA except unemployment rate were obtained from
Four types of variables were derived from the model: (a) InterStudy (2001). Unemployment rate was obtained from
RN demographic characteristics and health (age, sex, ethnic- the Bureau of Labor Statistics. Primary care practitioners are
ity, race, marital status, highest degree in nursing, living with physicians who provide primary care such as family prac-
children, years of experience in nursing, advanced certifica- tice physicians. Index of competition is how competitive the
tion, partner’s income, overall health status, current enroll- HMO marketplace is.
Table 1. Definition, Reliability, Number of Items, Mean, Standard Deviation, and Actual Range of Work Attitude Scales (N=1,538)
Definition Alpha Number of items Mean (SD) Actual range
Local job opportunity Likelihood of obtaining jobs in local area as good, worse, or better .88 2 2.95 (1.21) 1.00–5.00
than current jobb
Outside job opportunity Likelihood of obtaining jobs outside local area as good, worse, or .90 2 3.09 (1.15) 1.00–5.00
better than current jobb
Supervisory support Degree to which supervisor supports and encourages employeeb .95 5 3.59 (1.03) 1.00–5.00
Mentor support Degree of adequacy of access to an appropriate experienced .91 6 3.00 (0.88) 1.00–5.00
professional to sponsorship, protectorship and professional
benefactorshipb
Work group cohesion Degree to which employees have friends in the immediate work .90 4 3.81 (0.83) 1.00–5.00
environmentb
Variety Degree to which job performance is repetitiveb .77 4 3.03 (0.71) 1.00–5.00
Quantitative workload Amount of performance required in a jobc .89 5 4.13 (1.16) 1.00–6.00
Autonomy Degree to which employees control their job performanceb .79 4 4.09 (0.73) 1.50–5.00
Organizational constraint Degree to which situations or things interfere with employees’ job .89 10 2.41 (0.92) 1.00–6.00
performancec
Promotional opportunities Degree to which career structures within an organization are .90 5 2.87 (0.92) 1.00–5.00
available to its employeesb
Work-to-family conflict Degree to which an employee’s job interferes with family lifed .94 3 3.13 (1.40) 1.00–6.00
Family-to-work conflict Degree to which an employee’s family life interferes with jobd .89 3 1.73 (0.90) 1.00–6.00
Work motivation Degree to which work is central to an employee’s lifeb .83 4 2.08 (0.74) 1.00–5.00
Distributive justice Degree to which the an employee’s rewards are related to .95 4 2.60 (0.98) 1.00–5.00
performance inputs into the organization b
Job satisfactiona Employee’s general affective reaction to the job without reference to .86 5 −.012 (0.80) −2.14–1.03
any specific job facete
Note. a The standardized score was used for job satisfaction because the number of items varied for each question. b Gurney, Mueller, & Price (1997), c Spector & Jex (1998),
d Frone, Yardley, & Markel (1997), e Quinn & Stains (1979)
Findings Hispanic White RNs. RNs who were in poor or fair health
were less satisfied than were those with very good health,
As shown in Table 2, working RNs were primarily women, but injuries did not influence satisfaction. Of the MSA char-
White, married, and only 14.2% had children under 6 years acteristics, only unemployment rate was significantly related
old living with them. 19.1% had more than one position to satisfaction. Local job opportunity was related to satis-
for pay, 61% worked in hospitals, and a similar percentage faction, but nonlocal job opportunity was not. Of work set-
were in direct care positions. In addition to pay, the RNs had ting variables, the only benefit option related to satisfaction
a variety of noncompensation benefits: 85.2% had medical was not having paid time off (e.g., vacation). RNs working
insurance, 82.6% had retirement benefits, and 83.5% said in nurse education were more satisfied than were those in
these benefits were somewhat to very important to them for hospitals. Less career-oriented RNs were less satisfied than
staying in the current position. At the same time 10.9% had were those who were more career oriented. RNs working as
transferred to another work unit and 34.5% had a change in managers or instructors were less satisfied than were RNs
the immediate supervisor in the last year. Table 3 shows that providing direct care.
the RNs had a mean age of 46.4, 18.8 years of experience, More than 40% of the variance in work satisfaction was
and $49,940 annual income. explained by the various attitude scales. High autonomy,
We used ordinary least squares (OLS) regression to esti- high distributive justice, high group cohesion, high promo-
mate the model, because the dependent variable was contin- tional opportunities, high supervisor support, high variety of
uous and we were testing a linear relationship. As shown in work, low work-to-family conflict, and low organizational
Table 4, the model explains 54% of the variance in work constraint, significantly contributed to satisfaction.
satisfaction, with most of the variation explained by the
work setting variables. Only the significant findings are in-
cluded in the table. No other variables were significantly Discussion
related to job satisfaction. Table 4 also shows the rela-
tionships between the predictor variables and satisfaction. Our sample is similar to the sample of working RNs from
Non-Hispanic Black RNs were less satisfied than were non- the National Sample Survey of Registered Nurses (NSSRN;
Table 2. (continued)
n (%)
Spratley et al., 2001) with the samples respectively, male (5% riety and autonomy) might not be related to a meaningful
vs. 6%), White (85.0% vs. 85.3%), and married (69.5% change in satisfaction. In this study satisfaction scores were
vs. 70.4%) RNs. Although the mean age of the working- standardized so the mean is approximately zero. A score of 1
in-nursing RN sample from the NSSRN was not available, is one standard deviation above the mean. What proportion
our sample (M=46.4) is similar to the mean age of the to- of a standard deviation would be meaningful? If a one unit
tal sample of the NSSRN that was 45.2 (Spratley et al., change in supervisory support is related to a.081 change in
2001). satisfaction, that is unlikely to be meaningful. On the other
One of the issues in a study such as the one described hand a one-unit change in career orientation that results in
here is how meaningful the potential changes in satisfac- a .183 change might be meaningful.
tion are. Although the relationships might be significant, Working as an RN is often physically and emotionally
the cost or effort to make a change (such as increasing va- demanding. RNs with poor or fair health might find this
Table 4. Ordinary Least Squares Regression Analysis of Significant Determinants of Job Satisfaction (N = 1,342)
Significant category for Unstandardized
Construct Variable (Reference Category) categorical variables coefficient R2 R2 change
Constant −.971∗∗
Demographic and Health Race/Ethnicity (Non-Hispanic White) Non-Hispanic Black −.204∗∗ .090 .090∗∗∗
Overall health status (Very good) Poor or Fair −.151∗
MSA market Unemployment rate 2002 −.040∗ .099 .009
Movement constraints Local job opportunity −.042∗ .135 .035∗∗∗
Work setting Supervisory support .081∗∗∗ .541 .407∗∗∗
Work-group cohesion .083∗∗
Work setting (Hospital) Nursing education program .355∗
Position (Direct care) Manager −.113∗
Instructor −.283∗
Variety .106∗∗∗
Autonomy .106∗∗∗
Organizational constraint −.154∗∗∗
Promotional opportunity .091∗∗∗
Work family conflict −.077∗∗∗
Career orientation Less than others −.219∗∗∗
(Same as others) More than others .183∗∗∗
Paid time off benefit Not have it .227∗∗
(Have it but not used it)
Distributive justice .087∗∗∗
∗ p <.05, ∗∗ p <.01, ∗∗∗ p <.001.
support aspects of mentoring. These work setting factors in future research. This study was focused on individuals,
can be influenced by employers. not organizations, and it included little information about
Conflicts between work and family have been reported to the organizations in which the RNs worked. We did not as-
be related to work satisfaction. We defined two concepts: sess organizational size or other characteristics, nor did we
work-to-family conflict (work interferes with family) and include data about the dynamics of the work setting, such
family-to-work conflict (family interferes with work). When as how care was organized.
work interfered with family, the RN work satisfaction was Understanding satisfaction is important because it has
lower; however, when family interfered with work no re- been linked inversely to turnover. Findings from this and
lationship to work satisfaction was found. Work-to-family other studies indicate that organizations can do much to
conflict was related to satisfaction in nonnursing samples increase RN satisfaction with work.
as well. Organizational and personal initiatives to reduce
work-to-family conflict would be particularly appropriate
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