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 International Journal of Public Administration

ISSN: 0190-0692 (Print) 1532-4265 (Online) Journal homepage: http://www.tandfonline.com/loi/lpad20

Job Satisfaction Among Swedish Mental Health

Nursing Staff: A Cross-Sectional Survey

Christopher Holmberg, Iwona Sobis & Eric Carlström

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 International Journal of Public Administration, 00:1–8, 2015
Copyright Copyright © Taylor & Francis Group, LLC
ISSN: 0190-0692 print/1532-4265 online
DOI: 10.1080/01900692.2015.1018432

Job Satisfaction Among Swedish Mental Health

Nursing Staff: A Cross-Sectional Survey
Christopher Holmberg
Department of Food and Nutrition, and Sport Science, University of Gothenburg,
Gothenburg, Sweden

Iwona Sobis
Downloaded by [University of Gothenburg] at 03:02 04 January 2016

School of Public Administration, University of Gothenburg, Gothenburg, Sweden

Eric Carlström
Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg,
Sweden

There is limited amount of empirical studies concerning job satisfaction in inpatient psychia-
tric care. However, job satisfaction has several implications on public administration and
management. The objective of this study is to identify factors having positive impact on job
satisfaction among Swedish psychiatric nursing staff in an inpatient psychiatric clinic. The
cross-sectional study is based on Herzberg’s motivation-hygiene theory. The survey was
distributed among nursing staff at a psychiatric university hospital clinic in Western
Sweden. Overall, job satisfaction was rated relatively high, and salary was rated the lowest
of all factors investigated. Unlike the premises in Herzberg’s theory, salary showed a positive
correlation with job satisfaction and not only in preventing dissatisfaction. Hospital managers
must be attentive to salary levels and staff turnover. Psychiatric nursing personnel in Sweden
lack competitive salaries, and hospital administrators should encourage nursing staff to
improve relationships between staff and managers and establish good relationships among
colleagues.

Keywords: Job satisfaction, mental health care, nursing personnel, two-factor theory

INTRODUCTION Kontodimopoulos, & Niakas, 2013). Nurse turnover is

From an organizational and management perspective, lack
of work motivation and job satisfaction among nursing staff
can result in high turnover rates (Djukic, 2011) and, in turn,
can negatively affect the ability to recruit competent per-
sonnel (Hayes et al., 2012).
Nurses comprise the largest group of health profes-
sionals among hospital staff, indicating that nursing is a
fundamental component of health care (Gaki,
Correspondence should be addressed to Christopher Holmberg, Department
of Food and Nutrition, and Sport Science, University of Gothenburg,
Gothenburg 40530, Sweden. E-mail: christopher.holmberg@gu.se
expensive and can potentially generate production losses
and organizational inefficiencies due to staffing imbal-
ances (Jones, 2008). Low motivation and lack of job
satisfaction among nurses can result in conflicts at work
and emotional disengagement, which can negatively
affect patient outcomes (Molyneux, 2011). Furthermore,
job satisfaction is an integral component in the health
care industry, since physical and psychological stress
related to absence due to illness is frequent amongst
health care workers (Letvak, 2013; Wall et al., 1997). In
addition, every fifth nurse in Sweden intends to leave the
profession after 5 years of practice (Rudman, Gustavsson,
& Hultell, 2014). The objective of this article is to iden-
tify factors having positive impacts on job satisfaction
 2 HOLMBERG ET AL.
among Swedish mental health care nursing staff in an
inpatient psychiatric clinic.
LITERATURE REVIEW
Psychiatric nursing professionals are confronted with emo-
tionally challenging situations, such as suicide attempts,
anxiety attacks, and in some cases, physical and verbal
assaults (Hamaideh, 2012; Mark & Smith, 2012; Nolan,
Soares, Dallender, Thomsen, & Arnetz, 2001; Privitera,
Weisman, Cerulli, Tu, & Groman, 2005). Arnetz, Arnetz,
and Petterson (1996) found that nurses in psychiatric set-
tings were exposed to an increased risk of violence and
threats, and Hamaideh (2012) showed that nurses in mental
health care experience burnout and job dissatisfaction.
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According to the Swedish Work Environment Authority
(2011), threats and violence are relatively common in psy-
chiatric wards and have been found to be highly stressful to
employees. They also represent complications that might
negatively affect recruitment to psychiatric health care.
The Swedish Public Employment Service (2014) reports a
shortage of nurses in psychiatric and mental health care;
both are the third-most sought-after professions in the
Swedish labor market. Thus, it is crucial to attract and retain
nurses to work in mental health care. Furthermore, this
nursing shortage is not only a Swedish problem but a global
one (Kingma, 2007). According to the World Health
Organization (2007), similar trends regarding nursing
shortages within mental health care have been observed
worldwide.
Job satisfaction can be viewed as a discrepancy between
what a person wants or expects from a job and what that
person actually obtains (Price, 2001). Job satisfaction is
recurrently studied in organizational behaviour research
and constitutes a fundamental factor for the design of
work duties and management (Spector, 1997).
Although there is an ample amount of information con-
cerning job satisfaction among general nursing staff (Aiken,
Sloane, Bruyneel, Van den Heede, & Sermeus, 2013;
Gardulf et al., 2008; Lu, Barriball, Zhang, & While,
2012), information on job satisfaction among mental health
nurses is lacking (Aronson, 2005). Few studies have eval-
uated job satisfaction of nursing staff within psychiatric
clinics (Hanrahan, Aiken, McClaine, & Hanlon, 2010; Van
Bogaert, Clarke, Willems, & Mondelaers, 2013). In addi-
tion, while several studies have investigated job satisfaction
of registered nurses, few have looked at job satisfaction
among nursing assistants (Kalisch & Lee, 2014).
The authors of this study have not found any published
study that focuses explicitly on identifying factors that have a
positive impact on job satisfaction among nursing staff work-
ing in a Swedish psychiatric university hospital setting. This is
significant since studies have indicated that the organizational
setting affects job satisfaction (Ward & Cowman, 2007), as
well as the particular discipline of mental health care (Happell,
Martin, & Pinikahana, 2003). Some Swedish studies have
investigated job satisfaction among nursing staff, focusing
on specific areas such as forensic psychiatric care (Rask &
Levander, 2002), and the effect of clinical supervision on
creativity and sense of coherence among psychiatric nurses
(Berg & Hallberg, 1999).
Mathew, Ram, Bhattacharjee, and Sharma (2013) argue
that when comparing self-esteem, job satisfaction, and burn-
out between general and psychiatric nursing staff, psychia-
tric nurses have a higher level of self-esteem than general
nurses. Hanrahan et al. (2010) uses indicators such as effec-
tive management, nurse–physician relationships, and psy-
chiatric nurse-to-patient staffing ratios when asserting that
psychiatric nurses’ burnout rates are significantly correlated
to inpatient environments. Gaebel et al. (2011) note that
psychiatric and mental health care have been stigmatized
by the public and media. This, together with a low percep-
tion of nurses’ status, helps to explain the critical shortage of
professionals in the field of mental health care (Browne,
Cashin, Graham, & Shaw, 2013). Moreover, Stevens,
Browne, and Graham (2013) conducted a longitudinal
study about the career preferences of undergraduate nursing
students in Australia by measuring their preferences at the
beginning, middle, and end of a bachelor’s degree nursing
program. The results showed that mental health nursing was
one of the least desirable career choices at the start of the
nursing program and remained so following graduation.
Hence, according to Hanrahan et al. (2010), it is not so
surprising that the recruitment of psychiatric nursing staff
constitutes a serious problem.
In Sweden, where data collection for this study started,
mass media have played a major role in forming public
opinion about psychiatric care. Magnusson (2010) showed
that reports about Swedish psychiatry during 1980–2006
focused on violence and misery within mental health care
facilities. Mass media, therefore, proved to be a powerful
force behind the rather negative perception of the mental
health care system in Sweden. Thus, Swedish mental health
care in general and inpatient psychiatric care in particular
have a somewhat stigmatized history (Berlin & Carlstrom,
2013; Björkman, Angelman, & Jönsson, 2008).
The background section reveals several reasons for diffi-
culties in achieving job satisfaction in psychiatric nursing.
However, few studies have identified factors contributing to
job satisfaction. Therefore, in this study, we aim to identify
factors that have a positive impact on job satisfaction among
Swedish mental health nursing personnel working in an
inpatient psychiatric clinic.
Herzberg’s Motivation-Hygiene Theory
This study uses Herzberg’s motivation-hygiene theory. It is
also known as the two-factor or dual-factor theory because it
presents a set of motivation and hygiene factors that have
 JOB SATISFACTION AMONG SWEDISH MENTAL HEALTH NURSING STAFF
impacts on job satisfaction and job dissatisfaction
(Herzberg, Mausner, & Snyderman, 1959).
The theory is frequently used when investigating motiva-
tion related to work. Responsibility refers to the worker’s
control over his or her own job and the authority that the
employee thinks that he/she has. This factor is sensitive to
the discrepancies between a person’s scope of responsibility
and power to influence his or her work situation. Another
motivator is the work itself; this includes the actual require-
ments of the job and whether the work is perceived as
interesting and stimulating or unexciting and mundane.
Recognition is the acknowledgment by others, e.g., collea-
gues and patients, for a job well done or for individual
accomplishments. Growth encompasses the cultivation of
new skills as well as individual development. Lastly,
achievement entails the personal satisfaction of solving pro-
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blems and completing a job well.
The most significant feature of the theory is that, when a
job provides motivators, an employee experiences job satis-
faction, but the same employee does not feel dissatisfaction
when these factors are lacking. On the contrary, hygiene
factors can create dissatisfaction when they are lacking, but
they do not necessarily cause satisfaction if they are present.
Thus, an employee feels satisfaction when the organization
has clear policies and a well-functioning administration,
when he or she has good physical working conditions,
positive relationships with peers and supervisors, and a
good balance between work and life. When the employee
has a satisfactory salary that reflects the scope of his or her
responsibilities and personal achievements, then this person
feels job satisfaction, but when some of these hygiene
factors are lacking, the same person feels dissatisfaction.
Status, i.e., how the job is perceived by others, is an indica-
tion of its importance as a profession in the society and is
also considered an important hygiene factor. See Figure 1
for an illustration of the factors.
Like most models, the two-factor theory has several
limitations. According to Sharp (2008), for example,
Herzberg’s theory has faced criticism. Sharp refers to
empirical studies that have emphasized that individuals do
not behave in similar ways at all workplaces. However,
other scholars, e.g., Sachau (2007) and Bassett‐Jones and
Lloyd (2005), have argued that the two-factor theory still
has explanatory power a half century after it was first
established. It has been used as a theoretical framework in
studies from several disciplines, including public adminis-
tration, health care administration, and nursing. Hence,
Herzberg’s theory was regarded as a promising framework
for this research.
METHODS
This study is a typical case study based on a cross-sectional
survey that allows the identification of factors that have
3
Motivation factors Hygiene Factors
− Responsibility − Salaries, wages and benefits
− Challenging or stimulating work − Company policy and administration
− Recognition − Good inter-personal relations
− Sense of personal achievement − Quality of supervision
− Opportunity for advancement − Status
− Promotion − Job security
− Growth − Working conditions
− Balance between work and life
When in place, these factors result in: When in place, these factors result in:
− High motivation − General satisfaction
− High satisfaction − Prevention of dissatisfaction
− Strong commitment
FIGURE 1 Herzberg’s theory distributed in motivation and hygiene
factors.
positive impacts on job satisfaction among Swedish mental
health care nursing staff in an inpatient psychiatric clinic.
We used explanatory variables that included the two sets of
factors from the motivation-hygiene theory created by
Herzberg and some independent demographic variables sup-
porting the analysis.
The study was conducted at a psychiatric university
hospital clinic located in Western Sweden. The clinic was
chosen because a survey conducted by the hospital’s senior
management in 2011 clearly showed that job satisfaction
among nursing staff at the psychiatric clinic was scored at a
significantly lower level compared to the hospital as a whole
(SU, 2011). The survey’s results caused us to consider the
reasons or factors that could be attributed to the outcomes.
Thus, we created several indices by using validated items
reflecting each factor of the motivation-hygiene theory. The
final survey comprised 69 questions.
The benefit of indices was that they captured nuances by
including several items in each dimension. Instead of simply
asking if a person was satisfied with his or her salary,
several items were used to reflect the question, such as
“Are you content with your salary?” and “Do you believe
your salary reflects your competence?” All indices con-
tained at least one reverse-coded question serving as a
control mechanism that provided information about whether
the respondent paid enough attention when answering the
questions. Each index consisted of several simple questions
 4 HOLMBERG ET AL.
or items. The respondent highlighted the degree to which he
or she agreed with the questions on Likert-type scales with
answers ranging from 1 = strongly disagree to 7 = strongly
agree.
The independent variables consisted of validated items
(Hyrkäs, 2005; Teck-Hong & Waheed, 2011). The depen-
dent variable consisted of one overarching item: “Overall, I
am satisfied with my current work situation.” The intention
was to capture the staff’s general assessment of the per-
ceived work situation. The variables were validated as a
measure of overall job satisfaction (Nagy, 2002; Teck-
Hong & Waheed, 2011; Wanous, Reichers, & Hudy, 1997).
Before distributing the survey, a pilot study was con-
ducted. Five experienced nursing staff at the clinic was
asked to complete a draft survey, which essentially contrib-
uted to improving the survey and its face validity.
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Reliability was controlled by calculating Cronbach’s alpha.
Values between 0.71 and 0.89 were measured at each index,
indicating satisfactory internal reliability (Nunnally, 1978).
The internal reliability was further confirmed by means of a
rotated factorization according to the Kaiser normalization
(Fabrigar, Wegener, MacCallum, & Strahan, 1999; Pett,
Lackey, & Sullivan, 2003). This resulted in identifying
four factors with unsatisfactorily low Cronbach alpha
values. Thus, the factorization did not find any additional
significant logical structure with sufficient internal consis-
tency. Consequently, the instrument was used in its original
form. According to Altman’s (1991) recommendation, a
statistical significance was decided at p < 0.05.
The questionnaire was distributed to the nursing staff
(i.e., registered and assistant nurses) in the general psychia-
tric clinic in 2012. The clinic consisted of four wards, and
the total number of nursing staff was 130. The question-
naires were placed together with a collection box in each
ward’s staff room for 2 weeks. A reminder email was sent
out after 1 week.
In order to find patterns or indications, we first analyzed
the frequency scores and made some statistical comparisons
of a descriptive nature, e.g., we calculated means, standard
deviations, and percentages to see the distribution of data.
Next, we ran independent t-tests to identify potential differ-
ences in the levels of job satisfaction among participants and
across the selected variables. Finally, we conducted correla-
tional analysis by using stepwise multiple regressions.
ETHICAL CONSIDERATIONS
In line with the Swedish Research Council’s ethical guide-
lines on good research practice (2002), respondents were
informed about the study’s purpose, method, confidentiality,
and voluntary nature. The study complied with ethical pro-
cedures according to Swedish law and the Declaration of
Helsinki. Participants fulfilling the inclusion criteria were
identified and included with assistance from senior
managers. The questionnaire included an introductory letter
in which the background of the study was described. It
contained detailed instructions and information stating that
participation was voluntary. Participants were informed that
they were free to withdraw at any time and were assured of
strict confidentiality as well as secure data storage. Swedish
statutes (The Swedish Parliament, 2003) do not require
ethics approval for research that does not involve physical
intrusion affecting adult participants.
RESULTS
Out of 130 registered and assistant nurses employed at the
clinic, 118 nursing personnel completed the survey, result-
ing in a 90.7% response rate. The 118 participants com-
prised 65% (n = 77) women and 35% (n = 41) men. The
participants were between 19 and 66 years of age (M = 36,
SD = 9.5), and 54% had more than 10 years of work
experience in psychiatric care. Their average number of
years working in psychiatric care was 10.4 years with a
range of 41 years (SD = 6.2). The nursing assistants domi-
nated, comprising 58% (n = 68), while 42% (n = 50) were
registered nurses.
In general, the respondents seemed to experience their
overall work situation as satisfactory. The score regarding
the question: “Overall, I am satisfied with my current work
situation” displayed a mean of 5.18, on the 7-point Likert-
type scale. However, a significant difference was observed
(p = .02) between registered nurses (M = 5.32) and nursing
assistants (M = 5.08), indicating that the registered nurses
proved to be more satisfied with their overall work situation.
We did not identify general differences between motiva-
tional and hygiene factors; most items were estimated
around 4 on the Likert-type scale, but we detected some
variations among individual factors. Perception of salary
clearly proved to be the factor with the lowest mean score
(M = 2.42), confirming participants’ dissatisfaction with the
monetary compensation for their work. By contrast, rela-
tions with peers was the factor with the highest mean score
(M = 5.14). The everyday tasks and duties associated with
work, i.e., the work itself, also received a relatively high
score (M = 5.04), indicating that the participants found these
motivating factors stimulating.
The psychosocial work environment, e.g., perception of
working with patients suffering from severe mental illness,
was rated higher (M = 4.97) than the physical work envir-
onment, understood in terms of, e.g., perceptions of vio-
lence (M = 4.54). It is noteworthy that the physical work
environment was scored differently by men (M = 4.92) and
by women (M = 4.38).
Perceptions of being accountable and in charge of one’s
own work, i.e., the feeling of responsibility, received a
relatively high mean score (M = 4.82). Also, the nurses
ascribed a rather high score (M = 4.52) to the work status.
 JOB SATISFACTION AMONG SWEDISH MENTAL HEALTH NURSING STAFF 5

The feeling that one’s work effort was recognized and
acknowledged by supervisors, patients, and colleagues was
rated above 4 (M = 4.36). However, “relations with manage-
ment” was rated lower (M = 3.8), which could indicate that
the experience of recognition was coming predominantly
from colleagues, as “relations with peers” was rated rela-
tively high (M = 5.14.). Achievement and personal satisfac-
tion of carrying out tasks were rated at 4.25.
Besides salary, growth—understood as the possibility of
increasing one’s qualifications or mastering new skills—was
rated relatively low (M = 3.55), which suggests that the
nursing staff lacks satisfaction in this regard. Moreover,
we observed that the registered nurses (M = 3.68) had
fewer reasons to complain than the nursing assistants
(M = 3.36). In Table 1, the comparisons of mean (M) and
standard deviation (SD) for motivational and hygiene fac-
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job satisfaction. Demographic variables also functioned as
confounders.
Since multicollinearity is not always detected in a corre-
lation matrix, we calculated the variance inflation factor
(VIF). This measures the variance of an estimated regres-
sion coefficient and how much it increased because of
collinearity. As shown in Table 2, all VIF values were
acceptably lower than 2 (Miles & Shevlin, 2001). The
multiple regressions indicated that 35% of the variance in
job satisfaction could be explained by the included factors
presented in Table 2.
Four factors from Herzberg’s theory proved to be sig-
nificant for job satisfaction; two motivators, i.e., recognition
and responsibility, correlated with job satisfaction posi-
tively, but also two hygiene factors, i.e., relations with
peers and perception of one’s salary, correlated significantly

tors are presented. with job satisfaction.

We conducted a regression analysis in order to estimate
the relationship between Herzberg’s two-factor theory and
job satisfaction among the respondents. Since the survey DISCUSSION
contained several independent variables, we used a stepwise
regression in order to eliminate nonsignificant variables for The purpose of this study was to identify factors having a
positive impact on job satisfaction among Swedish mental
health care nursing staff in an inpatient psychiatric clinic.
TABLE 1
Comparisons of Mean (M) and Standard Deviation (SD) for Our research results proved somewhat surprising, as they
Motivational and Hygiene Factors were in contrast to previous studies conducted by Hyrkäs
(2005) and Stevens et al. (2013). They argued that psychia-
M SD n
tric care was perceived as non-attractive. The hospital’s
Job satisfaction 5.18 1.13 118 internal survey showed that the psychiatric nursing staff
Motivational factors was suffering from high turnover, which negatively influ-
Responsibility 4.82 1.15 118 enced job satisfaction. From our research, it appears that,
The work itself 5.04 .93 118 generally, the registered and assistant psychiatric nurses at
Recognition 4.36 1.16 117
Growth 3.55 1.13 118
this clinic were satisfied with their job situations (as indi-
Achievement 4.25 1.24 118 cated by the relatively high mean score of 5.18). Unlike the
Hygiene factors in-house survey, our questionnaire yielded a high response
Physical work environment 4.54 1.35 117 rate (90.7%), which indicates a rather reliable measure of
Psychosocial work environment 4.97 1.24 118 overall job satisfaction among the staff members.
Salary 2.42 1.19 118
Relations with peers 5.14 1.24 118
The motivation factors such as relations and recogni-
Relations with management 3.85 1.34 118 tion were rated considerably high (M = 5.14 and
Status 4.52 1.03 118 M = 4.36), which was also an unexpected result. Both
of these factors correlated significantly with job

TABLE 2
Multiple Regression, Factors that Significantly Correlated with Job Satisfaction

R2 = 0.395

Dependent variable: Job satisfaction Adjusted R2 = 0.352

Variable B SE Beta t Significance VIF

Recognition 0.298 0.108 0.359 2.759 0.012* 1.256

Relations with peers 0.263 0.071 0.284 3.704 0.001* 1.653
Salary 0.157 0.061 0.120 2.574 0.019* 0.904
Responsibility 0.109 0.058 0.149 1.879 0.023* 1.758

*p < 0.05.
 6 HOLMBERG ET AL.
satisfaction (B = 0.263 and B = 0.298, respectively).
Surprisingly, the hygiene factor of salary also correlated
with job satisfaction (B = 0.157). Although perception of
salary, according to Herzberg, is not a motivating factor, it
can be a hindrance in accomplishing job satisfaction if it
is perceived as insufficient. Similar to our findings, Sharp
(2008) demonstrated that nursing staff in psychiatry were
primarily motivated by the work itself and by relation-
ships with colleagues, while salary was the factor that
received the lowest scores. By contrast, Hyrkäs (2005)
showed that nursing staff in psychiatric wards understated
motivators as well as hygiene factors. These results do,
however, differ from this study in that the nursing person-
nel in our study were fairly satisfied, with no clear dis-
crepancies between most of the motivating and hygiene
factors.
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In this study, we found a correlation between salary and
job satisfaction. The results indicate dissatisfaction with
salary as a significant factor contributing not only to indif-
ference but also resulting in decreased work motivation.
This is in accordance with studies suggesting that salary is
the most dominant work reward for hospital nurses
(Tourangeau, Cummings, Cranley, Ferron, & Harvey, 2010).
During recent years, poor salaries for nursing personnel
have been given much attention in the public debate in
Sweden. In a study by Sjögren, Fochsen, Josephson, and
Lagerström (2005) examining reasons for leaving nursing
care, it was found that salary was the second most influen-
tial reason for considering leaving the nursing profession.
Debate from nursing staff movements indicates, how-
ever, that hygiene factors, particularly monetary compensa-
tion and working hours, are substandard. Many large
hospitals in Sweden are dealing with lack of staffing and
high personnel turnover (Sellgren, Kajermo, Ekvall, &
Tomson, 2009). Hard-pressed public finances with budget
cuts in health care provide Swedish employers with little
opportunity to offer competitive salaries.
Many nurses leave county councils and regions in favor of
municipalities that are able to offer better pay and more-regular
working hours than hospital clinics. Moreover, many nurses
from West Sweden have made the decision to commute to
Norway, where employers offer higher wages and more-favor-
able working conditions (Hasselhorn, Tackenberg, & Müller,
2003). In 2013, 1300 Swedish registered nurses acquired
Norwegian nursing authorizations, which constitutes one-
third of all the nurses graduating in Sweden during that year.
Data from the Norwegian Registration Authority for Health
Personnel (2013) show that Swedish nurses have been emi-
grating to Norway in comparable numbers since 2005.
One important implication of the research can be a need
to alert central health authorities and senior management of
psychiatric clinics of the findings in order to provide care
that is characterized by stability and decreased staff turn-
over. A cross-sectional study design such as this one permits
associations between factors to be identified only at one
point in time, and it does not allow several causal relation-
ships among factors to be established. Thus, longitudinal
studies are needed to understand the development of job
satisfaction over time. Furthermore, this study is based on a
single hospital clinic with a relatively small sample; more
studies are needed to provide a broad and more-general-
izable picture of Swedish circumstances regarding mental
health nursing staffs’ job satisfaction.
In addition, since there was no opportunity to distribute
the survey during a closed meeting, a certain bias in terms
of who completed each questionnaire cannot be excluded. It
can be assumed that staff with strong opinions and experi-
ences answered the questionnaires to a greater extent than
staff that were less keen. However, the high response rate
(90.7%) indicates that the results are fairly representative of
the studied group.
CONCLUSIONS
In contrast to earlier research, the participants of this study
reported experiencing a relatively high degree of job satisfac-
tion. However, salary, one of the hygiene factors, was per-
ceived as poor and could negatively influence job satisfaction.
Thus, the clinic hospital and its managers should be aware of
the need to improve wages for the psychiatric nursing staff by
offering salaries competitive to other areas in the health care
industry, as well as the need to improve relations between
management and nursing staff. There is apparently a need to
develop an attractive working environment in order to prevent
migration to other regions or countries.
This research has also shown that further research is
necessary. For example, there is a need to address the
difficult question of how to make mental health care nursing
attractive, how to attract psychiatric nurses back into the
labor force, and how to improve professional and workplace
conditions to retain those who are currently employed
(Roberts, Jones, & Lynn, 2004; Sharp, 2008).
ORCID
Christopher Holmberg http://orcid.org/0000-0002-6493-
3817
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