1.0.

INTRODUCTION

The extensive nursing shortage and nurses’ higher turnover are become a worldwide
problem (Kingma, 2001) which is of growing significance to both the developing and developed
countries. Due to this, concern regarding employment and maintenance of nursing workers is
growing in a number of countries. Though many aspects are related to nurses’ turnover, job
satisfaction is the most commonly cited (Irvine & Evans, 1995), and for that reason, it merits
attention. This review studies the widespread empirical literature concerning nurses’ job
satisfaction and its related factor.

1.1. BACKGROUND

In many medical organizations or private institutions around the world, nurses maybe the
most undervalued employees, although they are the ones who take care of us and our loved
ones in times of sickness (Masroor & Fakir, 2010). In the medical job, nurses are the ones who
have diversified tasks and are required to take up multiple responsibilities at their workplace,
which is the hospital. However, they are still undervalued. In Malaysia the circumstances are no
difference. According to the Malaysian Association of Nurses, until 2009, there are no concrete
plans implemented by the Government of Malaysia to increase the motivation of nurses in
Malaysia (Masroor & Fakir, 2010). Nevertheless, in 2008 the Malaysian Prime Minister,
Abdullah Badawi saw the significance of the contribution from nurses to the country and decided
to increase the allocation in the government’s annual budget for nurses in order to appreciate
their contribution and motivate them (Masroor & Fakir, 2010).

In any industrial setting, human resources play an important role. Human resources are
organizations’ or companies’ valuable assets. Much of organizations’ or companies’ productivity
or profit relies on them. If a company’s human resources are unmotivated or their level of job
satisfaction is low, the company may face serious productivity decline or major loss. Job
satisfaction can be both intrinsic and extrinsic. Several current scholars agree to this. This is
based on the explanation that job satisfaction covers the positive and negative emotions inside
them and also the environment that they are in (Bhuian, 2002; Odon, 1990).
 In Malaysia, there are 39,000 nurses and in the year 2000, the was an average of 1.69
nurses per 1,000 populations located in the low density cluster in the world (Masroor & Fakir,
2010). This demonstrates that Malaysia has the lower nurse density in the area or cluster and is
believed to be suffering from too much nurse migration, poor retention, lower job satisfaction
and high turnover (Casey & Fink, 2004). However, little is known on reasons for Malaysian
nurses quitting their job. Thus, this study reviews the perceived degree of job satisfaction and
intentions to quit amongst Malaysian nurses in relation to job satisfaction. It is highly significant
for management teams to recognize employees’ job contentment and provide them with
opportunities to develop themselves and to feel satisfied with their job performance. Therefore,
one of the most extensively studied domains in the organizational behavior is job satisfaction
(Muse & Stamper, 2007).

2.0. THE DEFINITION OF JOB SATISFACTION

According to Hoppock (1935), job satisfaction is a matter of national concern and

research interest. He explained that job satisfaction includes physiological, psychological and
environmental circumstances that cause an individual to say truthfully ‘I am pleased by my
position (p. 47). Locke (1990), wrote the main review of job satisfaction, and collected 3350
articles and dissertation related to this issue. Vroom and Jago (2007) indicated that the negative
attitudes toward the job corresponded to job dissatisfaction, and positive treatments in the
direction of job were conceptually similar to job satisfaction. Job satisfaction focuses on
employee’s attitudes towards their job. In other words, job satisfaction explains the factors for
individuals to be contented or discontented in their job.

3.0. CAUSES OF LOW JOB SATISFACTION

Job satisfaction is a multifaceted phenomenon. The recognition of this fact and the
investigation done on it provide the possibility for the researcher to refine the hypothetical
models of nurses’ job satisfaction and help to minimize manager’s interferences (Blegen, 1993).
Blegen (1993) explained that job satisfaction is most strongly related with organizational
commitment and stress. Job satisfaction is associated with depression, subjective stress,
hostility; intensity of stressful events, frequency of stressful events and anxiety. Organizational
commitment, or employee loyalty, is the level to which an employee identifies with the
organization and desires to maintain active participation in it. Mowday, Steers and Porter (1979)
concluded that organizational commitment was the intensity of identification an employee
received from their organization.

Based on the study by Masroor & Fakir (2010), it was found that nurses studied were
moderately satisfied with their job. This study was conducted among 153 nurses from the state
of Perlis. This writing will focus on four causes of low job satisfaction which are dissatisfaction
with salary or payment, support by management, poor management and working conditions and
also limited career development.

3.1. UNDERPAID AND UNDERVALUED

This issue emerged from all nurses, many of the nurses reported that money was one of
the main factors that influence their job satisfaction. Some of the female nurses explained that
being able to contribute to their overall household income gave them satisfaction.

When asked about how they feel about the salary and benefits that they currently
received, many of the nurses described that they are satisfied with their basic salaries.
However, they mentioned that what salary nurses received was low relative to the heavy
workload. Nurses were also concerned with the inequity of salary received in relation to the level
of their responsibilities. Many medical and surgical nurses explained that they did not receive
extra salary when working overtime as a result of staff shortages.

Moreover, nurses pursued bachelors and advanced degrees in hopes of a salary

increase. However, the outcome was not what they had anticipated. Many senior nurses
reported that they are satisfied with their basic salary but they are dissatisfied with the increment
every year. They felt there are poor retirement benefits, requiring nurses to continue working
after retirement for monetary needs. Many critical care nurses believed that the hospital should
offer a higher salary, which commensurate with their specialized skill set and the greater
amount of pressure they faced caring for their patients compared to other units. In addition,
insufficient income for all nurses was an issue that was frequently brought up across all the
nurses across Malaysia.
 Furthermore, several studies revealed that nurses were dissatisfied with their rewards,
promotion and benefit. Possible explanation may be Malaysian nurses generally have been
identified as being the most undervalued and underpaid public sector nurses in this region
(Masroor and Fakir, 2010). Critical care nurses believed that they are working with very ill
patients and with highly technical equipment and that they have more stress compared to other
ward nurses, so the hospital should pay extra money for their specialty. The findings are similar
to the results of other studies (Emami and Nasrabadi, 2007, Farsi et al., 2010, Klopper et al.,
2012; Ramoo et al., 2013), which showed that nurses were dissatisfied with their salary and
promotion. Therefore, promotion and salary structure should be reviewed by policy makers to
change necessary proportions; nurses’ salary and benefit should be increased based on their
performance and level of education (Farsi et al., 2010).

3.2. LACK OF SUPPORT BY MANAGEMENT

This issue emerged from the employees that Malaysian nurses had a different view of
support given by their sisters (Head nurse). Some of the medical and surgical nurses reported
that they are not satisfied with the emotional support given by their sisters.

Some medical and surgical nurses reported that their matrons usually did not have
enough time to listen to their problems and suggestions, while some did not even appreciate
nurses’ good performances and gave the least priority to nurses’ problems. Some of the
participants mentioned that they felt a lack of support; this feeling was followed closely by
recurring comments on feeling unappreciated by matrons with comments such as ‘They do not
support nurses.’ However, critical care nurses reported that they were happy and satisfied with
a certain level of support they received from the sisters in their difficult situations.

Few studies shown critical care nurses reported that they were happy and satisfied with
certain levels of support they received from the sisters in their difficult situations. Usually the
critical care nurse functions are under the supervision of the sisters. It has been noted that
employees who feel that they are supported or cared for have not only higher levels of
commitment but are also more satisfied (Shacklock et al., 2014). However, surgical and medical
nurses indicate that there is a lack of support by management. They believed that some of the
supervisors and sisters do not give importance to their nurses. They do not listen to the nurses’
problems and sometimes over exaggerate their own problems. Likewise, Cortese (2007) and
Atefi et al. (2013) also reported that the nonsupportive styles of nurse managers cause the high
level of nurses’ job dissatisfaction.

However, if nursing management is more supportive and respective, it provides high job
satisfaction among nurses. Therefore, it is recommended that nurse managers require more
knowledge to deal with situations that influence nurses’ job satisfaction and should promote
their nurse satisfaction through managerial intervention such as involving nursing staff in policy
making; this is especially true for policies that affect nursing staff directly and encourage nurses
and supervisors to be open in their communications to promote a better workplace.

3.3. POOR MANAGEMENT AND WORKING CONDITIONS

Issue as followed emerged from all nurses, that the majority of the nurses cited
inadequate staffing and workload as the main reasons for their job dissatisfaction.
Heavymworkload was mentioned as a factor contributing to workforce stress and making it
difficult to balance work and life. They described their workload as difficult to effectively manage
within the work hours of each day. Shortage of staff nurses and absenteeism was also reported
as an added pressure during work hours. In addition, nurses described having a great deal of
work to do in a single shift, with too much nursing documentation.

Another major problem cited was lack of time to deliver holistic care, especially with the
growing number of acute care patients demanding more time from nurses. Despite carrying very
heavy ward workloads, nurses reported that they needed to be available to give information to
patients, their family members and even answer telephone calls. This left them little time for
good nursing care. Medical and surgical nurses also reported a wide range of nurse-patient ratio
experiences.
 Shortages of supplies and malfunction or lack of necessary equipment were sources of
dissatisfaction for critical care nurses. They also felt unable to adequately help patients because
of hospital budget cuts and staff shortages, or when they encountered difficulty accessing
appropriate services or faced extensive waiting times for necessary equipment.

Studies revealed that high workload, and not enough staff nurses were major
contributors to job dissatisfaction among nurses. These findings were supported by Atashzadeh
Shorideh et al. (2012) and Khowaja et al. (2005), who also found that high workload was nurses’
main reason for job dissatisfaction and was a major stress factors at work. However, Kovner et
al. (2006) found that high workload was not related to nurses’ dissatisfaction and nurses who
perceived that they had a high workload were no more satisfied or less satisfied than others.
Kovner et al. (2006) reasoned that the difference might be related to the perceived fairness of
the workload rather than actual workload. If all nurses are working hard, that might not affect
their satisfaction. However, when some people have higher workloads, the lack of fairness could
lead to dissatisfaction. The perceived higher workload in this study may be due to the current
nursing shortage faced by the hospital, especially in specialized areas like the critical care
wards, which has led to an increase in the patient-nurse ratio and consequently in nurses’
workloads. It should also be noted that there are no polices on flexible working hours in
Malaysia for public sector nurses (Ramoo et al., 2013). Managers should ensure that adequate
numbers of nurses are on the staff allocation to ensure fairness in workload.M

Malaysian nurses reported that they did not have a clear job description. Similarly,
Atashzadeh Shorideh et al. (2012) and Farsi et al. (2010) reported Iranian nurses were
dissatisfied with unclear job descriptions. Malaysian nurses play multiple roles in their wards
because of unclear job descriptions, thus career ladder programmes should be established,
expanded and explored to establish clear job description to attract, satisfy and nurses return to
the work.

Critical care nurses reported that they were dissatisfied with shortages of supplies and
the lack of necessary equipment. Similarly, Tourangeau et al. (2006) and Klopper et al. (2012)
found that critical care nurses were dissatisfied with shortages of supplies and lack of
equipment. Adequate staffing and resources as a crucial part of a positive practice environment
have been reported by Aiken et al. (2008). Engaging the nurses especially among critical care
nurses in assessment and improvement of work design and organization will help to ensure
appropriate resource allocation for necessary equipment and technical support.

3.4. LIMITED CAREER DEVELOPMENT

Some of the critical care nurses reported that career development was one of the main
factors that influence their job satisfaction. Critical care nurses stated that they should improve
their skills and knowledge to cope with the complex needs of acutely ill patients. They also
reported lower satisfaction when given lack of the chance and opportunity to learn and gain
more knowledge.

Critical care nurses mentioned that career development is one of the factors contributing
to their job satisfaction. Similarly, Al-Enezi et al. (2009) and Ramoo et al. (2013) found that
career development contributed to nurses’ job satisfaction. When opportunities for promotion
and development are absent within a hospital, nurses tend to have lower job satisfaction (Al-
Enezi et al., 2009), while higher nurses satisfaction is observed in hospitals that facilitate
educational opportunities and career development (Ramoo et al. 2013).

Career development indicated the importance of the motivation factors for job
satisfaction for these nurses. The working conditions issue which include aspects of the working
environment such as teamwork, pay and benefit and supportive nursing management as
reported by the nurses in this study suggested that the Herzberg’s two factor (motivation and
hygiene) theory play an important role in understanding the reasons of the nurses’ satisfaction
or dissatisfaction on their jobs. According to Herzberg two factors theory, both motivation and
hygiene factors need to be addressed to ensure job satisfaction (King, 1970).
4.0. SUGGESTIONS

Determinants of job satisfaction consist of promotion opportunities, peer assistance and

supervision. The results of the descriptive analysis found that the promotion opportunities and
assistance of colleagues were at a high level while supervision and job satisfaction were at a
moderate level. Correlation analysis showed that there was a significant positive relationship
between promotion opportunities, peer assistance and supervision with job satisfaction. The
findings of this study can help the hospital in particular, supervisors and the hospital in particular
and the government in general, understand the important factors that influence the job
satisfaction of nurses and in turn improve the job performance of nurses and make work
management more quality and effective.

4.1. JOB PROMOTION

Promotion can be defined as the promotion of rank or position of employees in the

organizational hierarchical system and it can be a reward for good performance, that is, a
positive assessment, however, before a company is promoted to a certain position it ensures
that the person can handle additional responsibilities with screen employees with interviews and
tests and give them training or work experience (Cranny et.al 1992). Promotion also involves
advances in terms of appointments, salaries and benefits, and in some organizations, the type
of employment activity may change a lot (Cranny et.al 1992). Promotion is an appreciation from
the organization to individuals who help them achieve their targeted targets or achieve
something that can raise the name of the company or bring the name of the organization to a
larger market to be known. Individuals will feel valued and the contribution given is comparable
to the benefits earned. (Jahan, 2013). Therefore, the individual will be more enthusiastic and
motivated to do the next task. Generally, promotion is very important in keeping an employee
always happy to work and hence the high rate of job satisfaction (Dunn & Stephens, 1972). The
study by Khamlud (2013) also supports the results of the study of Juliansyah (2013) and Van
Fleet (2010) who added that a fair and honest promotion system encourages employees to
improve their performance. In conclusion, based on the results of the study of Khamlud (2013),
Juliansyah (2013) and Van Fleet (2010) who found that the higher the chance of promotion, the
higher the job satisfaction.
 4.2. GOOD SUPERVISION

Fleishman (2009) defines supervision as the act, process, or occupation of supervision,

in particular, observing and directing critical (such as activities or actions) and supervision is
also the act or function of supervising something or someone. A supervisor is a "supervisor", but
does not always have a formal supervisor degree. Supervisors are usually responsible for the
progress and productivity of their direct reporting in the organization and oversight also often
includes basic management skills (decision making, problem solving, planning, disciplining and
concentrating management), organizing teams, observing needs and formulating new job roles
in groups, hiring employees new, new employee training, employee performance management
(goal setting, observation and feedback) (Locke, 1969). Badeni (2013) adds that satisfaction in
terms of supervision is a reflection of employee excellence, decency and communication.
Behavior that affects job satisfaction is the attitude of supervisors such as considerate, impartial,
fair, fair and so on (Fleishman & Harris, 2009). When the supervisor gives clear guidance or
instructions then the employee will receive and be able to complete the instructions or
assignments given perfectly. Based on previous studies such as Jahan (2013), Badeni (2013)
and Fleishman and Harris, (2009) showed that the higher or better the supervision then the
higher the job satisfaction.

5.0. CONCLUSION

Often the quality of nursing services in Malaysian government hospitals is questioned.

There have been previous studies that relate the quality of work from employees depending on
their level of satisfaction with the organization they serve (Adam, 1965). Job satisfaction is
important not only for nurses but also all employees. Job satisfaction is a level where the
individual feels happy or satisfied with the existing work environment and can be considered as
a result of employee recognition to the extent that the individual can channel abilities, interests
and values to the channels that create satisfaction in his work as well as can play an effective
role, (Khamlud, 2013). Job satisfaction can increase organizational productivity and profitability
by Cranny, Smith & Stone (1992). Job satisfaction can also lead to comfortable or positive
emotions resulting from the assessment of Locke’s job or work experience (1976). When
someone are satisfied with the work they tend to do better. This is because they feel valued and
will contribute more to the organization they serve. Herzberg, Mcusner & Snyderman (1993).
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