Occupational Satisfaction of Public Hospital Nurses in India: A Qualitative Explorative Study

Abstract

AIM:

This study aimed to explore occupational satisfaction experienced by nurses working in a public hospital.

METHOD:

Qualitative approach was used to explore experiences toward occupational satisfaction among 16 nurses working in different units of a selected public hospital in Tamil Nadu, South India. A semi-structured interview guide facilitated the individual in-depth face-to-face interviews, which were audio-recorded and transcribed verbatim. Thematic approach was used for data analysis and data management was performed using NVIVO-12 software.

RESULTS:

The two major themes that emerged as nurses’ experiences on occupational satisfaction were “Quality patient care rendering and responses” and “Professional opportunities and responsibility.” The sub-themes under quality patient care rendering and responses were patient care environment, team dynamics, leadership, and patient’s health status. The sub-themes under professional opportunities and responsibility were pay and promotion, professional growth, and recognition.

CONCLUSION:

The findings help us understand the various facilitating and hindering challenges nurses face in occupational satisfaction. It also emphasizes the organization’s focus on modifiable factors in the working environment, enhancing satisfaction, and helping the nurses work more effectively and efficiently to deliver quality nursing care. Nursing administration in every healthcare setting should focus on strategies to improve nurses’ professional development.

Introduction

Job satisfaction is a significant factor in the satisfaction and retention of workers and enhancement of their morality. The principles of work satisfaction and job satisfaction assessment were introduced by Frank Taylor through research that started in 1911 (Ugwa & Charity, 2016). However, in 1971, in the USA (Ogiwara & Araki, 2006), a job satisfaction test was carried out between healthcare workers employed in medical laboratories. Studies on various categories of healthcare workers were performed in various parts of the world. The satisfaction of the job was defined in various ways. Generally speaking, several authors designed job satisfaction as the level of contentment the workers feel toward their job (BasuMallick, 2021). The highly satisfied employees were more productive and creative and stayed for long periods within the working organization. Within nursing, job satisfaction assessment can help identify health service issues and plan potential solutions to improve workplace quality and care delivery quality. Furthermore, job satisfaction has been shown to have a significant effect on patient satisfaction (Lu et al., 2019). Although nurses’ work satisfaction and connection to the psychological well-being of nurses and patients are significant, little attention has been paid to the natural qualities of this complex concept in nursing.

Worldwide study results on the satisfaction of nursing staff varied from country to country. The employment satisfaction rate of nurses in India was rated low with less scores in professional support and personal satisfaction domains (Purohit et al., 2021). Although job satisfaction levels vary globally, there are major trends in job discontent, triggered by various factors influencing the hospital’s working atmosphere, facilities, and organizational patterns. The analysis of job satisfaction determinants is based on sociodemographic, emotions, nature of work, and environmental variables (Lu et al., 2019). Influencing factor of nursing satisfaction is demographic variables such as education, marital status, working experience, jobs, and place or settlement (Yasin et al., 2020). Also correlated with job satisfaction were emotional variables, including work beliefs, work engagement, organization and professional dedication, behavioral disconnect, positive or negative affectivity, psychological stress, and job motivation (Tengah et al., 2019). The emotional outcomes or emotions of the work performed in the hospital setting were these factors. Job characteristics of nursing that are decisive for job’s satisfaction include staffing, repetitive duties, autonomy, expectations for work, workloads, and organizational structure (Piotrowski et al., 2022; Sharma et al., 2021). Other studies have identified the context for working environment variables such as teamwork and effective communication, professional growth, social or organizational support, boss or colleagues, institutional empowerment, psychological empowerment, and work satisfaction transformative leadership (Leong et al., 2022; Salahat & Al-Hamdan, 2022). In addition, previous studies in India show that, due to the additional burden of family and child-breeding, married nurses are more stressed than unmarried nurses (Sharma et al., 2021). Another research study showed that scores on the Satisfaction Index remain higher in areas such as availability of professional support and the climate (Sharma et al., 2020). They play a crucial role in supporting both the hospital and the community health initiative in the nation.

Indian healthcare delivery system has been divided into three healthcare tiers, namely, primary, secondary, or tertiary care. Primary medical services involve community-based care, i.e., sub-center and primary health center. The Community Health Center and District Hospital offer secondary healthcare. Tertiary medical treatment requires care in tertiary care clinics, such as the government- and private-sector teaching and non-teaching super specialty hospital (Modi, 2014). The trained nursing staff is essential to facilitate, maintain, and support the world’s healthcare system. However, in many places in India, it is hardly possible to properly acknowledge nurses’ value and their happiness in the workplace. There was not much research and much less literature found in India that affected job satisfaction among nurses. Although there is a great deal of evidence for healthcare providers’ satisfaction in developed countries, India’s subject was lacking. Therefore, this research investigated nurses’ experience with job satisfaction in a selected tertiary care public hospital in India.

Research Question

1. How do nurses are satisfied with their occupation.

Methods

How do nurses are satisfied with their occupation. Study design

This study was a qualitative exploratory study.

Sample

The present study was conducted among nurses working at tertiary care public teaching hospital in Kanyakumari district of Tamil Nadu, South India. It is a multi-specialty hospital, providing 24-hour care throughout the year to outpatients and inpatients and emergency services. This tertiary care teaching hospital was selected as the setting due to tertiary care facility covering the health needs of all people of the district (Kanyakumari) and availability of subjects working in all areas including wards, intensive care units, out-patient departments, and operation theaters of that setting could express their experiences toward job satisfaction. Besides, the researcher was from same district and comfortable with the regional language (Tamil) the study participants speak.

The study included 16 registered nurses with at least 2 years of experience and permanently working in various departments, including the intensive care unit and outpatient department. The list of nurses employed in different units was collected, and the relationship was formed through telephone contact and face-to-face interaction for their willingness to participate in the interview. Out of 20 nurses approached, 4 declined to participate because of their busy schedule. After explaining the study’s purpose, those who agreed to participate and gave informed written consent were included. Recruitment continued until data saturation was reached (Barrett et al., 2018). After the 16th interview, no new themes emerged from the participants’ experiences, and hence, the sample recruitment had come to an end with 16 participants.

Data Collection

Design was adopted for the present study to explore the nurse’s experience with job satisfaction (Mayan, 2016). Using purposive sampling technique, participants were recruited in the study (Black, 2010). The data were collected among the nurses between December 2019 and January 2020. Data were obtained through in-depth interviews (IDIs). The IDIs were carried out in each hospital department’s restroom as per the participants’ convenient time. The first author, who was a native of study’s settings, interviewed all local language participants. We did not conduct any repeat IDI.

After receiving written consent, the socio-demographic characteristics of the participants were collected. The participants were aware of the audio recording of the interview session, and confidentiality was ensured. The face-to-face interview was conducted using open-ended questions, which lasted 30–minutes.

The in-depth interview guide contained the following questions:

• How would you describe your experience working in this hospital?

• Explain your everyday work. What are the factors that improve your work satisfaction?

• What are the factors restrictive to promoting your satisfaction in work?

• What else would you like to add about your job satisfaction?

As the participants spoke about how much they were pleased with their work, the researcher asked questions to help the participants explain who, what, how, where, and why the factors that affect their job satisfaction in their workplace. Once the data were saturated and no further new information was added from the participants, the interview was discontinued.

Statistical Analysis

The digitally recorded interviews were initially transcribed verbatim and then translated into the English language. The data were subjected to thematic analysis (Guest et al., 2011). The first author performed the coding process, and confirmation on the codes, themes, and sub-themes was done by the second author, who was well experienced in qualitative research methods. Both researchers were from the field of nursing. Data were systematically studied, and the transcripts were read and re-read several times, which gave an overall idea about the researcher’s content. Initial codes were then generated and allocated to relevant sentences and paragraphs, which helped identify the concepts. Later, the concepts were grouped into themes. The themes were reviewed and named with definitions. The themes were primarily descriptive and represented a broad scope to allow for variation. Instead of imposing a preselected theoretical grid on the data, this method ensured that the coding frame elements reflected the language of nurse’s experience on factors associated with job satisfaction in their work setting. QSR NVIVO software version 12 was used for data management (Azeem et al., 2012).

Validity

Lincoln and Guba have refined the concept of trustworthiness of the data by introducing the four criteria which are as follows: credibility, transferability, dependability, and confirmability (Lincoln & Guba, 1985). Credibility was ensured by including study participants of varied characteristics in age, education, marital status, working area, and experience. The authors were from diverse educational backgrounds, with all having academic teaching and research experience, which enriched the study’s findings, which helped in data triangulation. During analysis, field notes, audiotaping of interviews, and auditing of transcripts contributed to enhancing the data’s dependability. The researchers’ condensation of interviews and exploration for similarities and differences in nurses’ experiences was done independently, thus motivating and demotivating factors on job satisfaction among nurses were finalized. We used consolidated criteria for reporting qualitative study guidelines for our study (Tong et al., 2007).

Ethical Considerations

Ethical permission was obtained from the hospital’s Institutional Ethics committee, and the study protocol was reviewed by Kanyakumari Government Medical College and Hospital ethics committee (Ref.No.50/ME2/2017, dated December 20, 2017), and informed written consent was obtained from each participant before initiating the interview. Permission to conduct the study was obtained from hospital authorities.

Results

Participant’s Characteristics

The average age of the nurses who participated in the study was 30.7 ± 5 years, and half of them were female, and most of them were married. Around 70% had taken the baccalaureate program as their professional qualification with 6.7 ± 3 years of clinical experience. One-third of them were employed in intensive care units, while 30% were in wards and the remaining was engaged in outpatient department and operation theater.

Two major themes emerged from this study: “Quality patient care rendering and responses” and “Professional opportunities and responsibility.”

Theme 1: Quality Patient Care Rendering and Responses

Under this theme, the key categories mentioned were patient care environment including resources and workload, team dynamics, leadership, and patient status.

Patient care environment including resources and workload: Nurses stated resource scarcity in terms of material and workforce as a demotivating factor for their job satisfaction. Due to the manpower shortage of ward attendants, nurses were pushed to perform non-nursing tasks to accomplish patient care and ward management. Moreover, they stated that non-nursing tasks had stolen their time, which was supposed to be spent on quality nursing care for the patients and ultimately burden them with the workload. Another participant added that occasionally, material shortage at the workplace made them use the available resources in the ward for patient care, which affected their job satisfaction.

I experienced a lack of manpower, including attendant in my ward, and I will often be forced to do the non-nursing activity, which is irrelevant/deviated from my nursing activity. It led to waste of time, and I feel dissatisfied. (Participant No. 16)

Bed occupancy status keeps increasing, but manpower status remains the same makes me feel stressed and dissatisfied. (Participant No. 6)

Nurses expressed that as they strived to provide quality care, due to workload, increased nurse–patient ratio and inadequate time led to difficulty in accomplishing patient care and ward-related work. In addition to it, workload also induced stress for them which they were dissatisfied.

When my workload is high, I could not be able to deliver quality nursing care to the patients, and it had induced stress for me to complete the task which makes me feel dissatisfied at work and I was pushed to a situation where I cannot neglect any care for the patients at the same time quality also matters. (Participant No. 10)

Team dynamics: Teamwork was perceived as a vital factor that helped nurses execute their workplace tasks without conflict among health team members. In the present study, team dynamics was varied from unit to unit. In a medical unit, nurses reported that they felt satisfied with the co-worker’s relationship as they were supporting each other and felt comfortable receiving emotional support from their colleagues in a stressful situation. However, from another unit, a nurse stated that the professional conduct was lacking and not that much appreciable among the nursing fraternity, which ultimately led to conflict and misunderstanding at the workplace led to dissatisfaction.

I am happy and satisfied with my colleagues where I can share my issues and able to get help in a stressful situation in the ward. (Participant No. 04)

There is no teamwork in my ward, where conflict exists between senior and junior nursing staff because this patient care is affected. I feel dissatisfied, and this is not professional conduct to behave between nurses. (Participant No. 07)

Leadership authority: Nurses reported that they had felt less freedom or space to decide on patient care in the workplace; they also have to depend on seniors or doctors and wait to continue nursing care-related activities, which led to dissatisfaction with their job. The senior nurse had a poor experience with their nursing superiors in which they were dissatisfied with ward managerial task.

Only staff-related issues I could take the decision in my ward, but not related to patient care...Sometimes my suggestions have not listened, I feel low at that moment. (Participant No. 01)

Related toward improvement and staff needs if I give request, it will be delayed, sometimes I feel like powerless as an in-charge or senior nurse. (Participant No. 02)

Patient status: Nurses opined that they were satisfied with the care provided to the patients as they were getting well from their sickness, alleviated pain and sufferings, rate of recovery, and prognosis due to the nursing care and interventions. Moreover, it motivated nurses to perform much more for the patient’s wellness.

I feel satisfied when I see patients got admitted in sick stage and they get discharged in stable condition. (Participant No. 12)

When I take care of premies (preterm babies) in new-born care unit and see the prognosis, positive changes in them I feel satisfied. (Participant No. 16)

Theme 2: Professional Opportunities and Responsibility

Within this theme, the main categories mentioned were pay and promotion, professional growth, and recognition and experience.

Pay and promotion: Nurses had reported that they were well satisfied with the organization’s pay due to the public setting in which the pay was three times high compared with the private setting. However, at the same time, they also mentioned they were not satisfied with their due allowances and delayed promotion.

I am satisfied that the pay I received was better compared with another institute, but no eligible allowances were provided for us. Promotions were delayed … this will affect our subsequent promotion. (Participant No. 06)

Professional growth: While asking about job satisfaction in terms of professional development, the nurses expressed that they were satisfied with participating in conferences and workshops, which helped them update their knowledge and clinical skill in inpatient care. They also included a strict policy for their higher studies for which they were not satisfied.

Strict policies related to higher studies made me feel dissatisfied, but participating in conference or workshop in and out of my institute was encouraged, which helped me update my clinical knowledge and skill. (Participant No. 12)

Recognition and experience: Nurses shared from working unit to unit that the recognition and appreciation had varied. Nurses also expressed that they were satisfied and that their work had been recognized by their colleagues, seniors, and other health team members. Simultaneously, few nurses working in other units added that they were unhappy with superiors and doctors’ criticism. They were satisfied with their work experience, which helped them plan their task at the workplace.

My work has been recognized by colleagues, in-charge, and other health team members. I am satisfied to hear their appreciation, which rewards me as an encouragement. (Participant No. 05)

Sometimes, I feel awful to hear the words of Nursing supervisor and Doctors for not recognizing the work of us. (Participant No. 02)

Discussion

The study’s finding helps to explain the various experiences that encourage and impede the nurse’s satisfaction. In this study, quality patient care was affected by the patient care environment with resource availability, workload, team dynamics, leadership, and patient health status, all of which were correlated with job satisfaction of the nurse. Job satisfaction for nurses is often influenced by their compensation, professional development opportunities, job recognition expectations, and experience. The result also stressed that modifiable factors could allow nurses to work more efficiently and effectively to provide quality nursing care in the work atmosphere and organization.

Nurse health workers from Bangladesh perceived their work environments, especially workload to be an essential contributing factor to their job dissatisfaction (Saha et al., 2020). A study from United Kingdom addressed that non-availability of supplies and equipment at work areas for rendering patient care was determined by nurses’ job dissatisfaction (Senek et al., 2020). Low job satisfaction also impacted the caring behavior of nurses and hence, the domains including supervision, work nature, communication, and contingency rewards to be considered for better job satisfaction among nurses (Putra et al., 2021). Nursing workforce shortage hurts job performance and job satisfaction. The shortage of nurses burdens them with the workload and pushes them to perform non-nursing tasks, leading to a lack of time in completing the nursing task (Saha et al., 2020). Moreover, it can lead to job stress among nurses. Also, nurses’ stress would decrease job satisfaction, which affects their performance of quality patient care.

Leadership role affected the nurse’s job satisfaction perceived in the present study. Nurses who had leaders with transformational leadership styles were well satisfied, emphasizing that nurses’ working environment can be positively changed due to appropriate leadership styles. A study from Greek specified that the role of the head nurse was found to be of paramount importance in reducing stress and enhancing job satisfaction among nurses (Specchia et al., 2021). So an effort should be made by the administration to develop leadership qualities among nursing professionals.

Team dynamics were another critical factor for job satisfaction, and it varied from department to department. Reviews found that the antecedents in environmental variables for nurse’s job satisfaction include collaboration and good communication, professional development, social or organizational support, supervisor or peer support, structural empowerment, psychological empowerment, and transformational leadership (Costello et al., 2021; Ngo et al., 2022).

It was found that professional opportunities include pay, promotion, professional growth, recognition, and experience gained from the work environment and organization influenced nurse’s job satisfaction in the present study. Generally, in a public setting, the turnover rate may be less due to pay and allowances even though in the workplace. There was a positive relationship exist between pay, benefits, and job satisfaction. Opportunity for promotion also had a significant impact on job satisfaction (Broetje et al., 2020). A study conducted in United States of America found critical thinking and decision-making among nurses were affected by poor career development opportunities, and nurses were less satisfied (Yarbrough et al., 2017). Another study from Ethiopia found turnover and job dissatisfaction resulted from a lack of advanced academic education and professional advancement (Gebregziabher et al., 2020).

In the present study, nurses expressed recognition of their work and their experience influenced job satisfaction. This finding is consistent with nurses’ job satisfaction in Pakistan that their salary, workload, getting recognition from others (fulfillment), equipment as an essential element in their job, and leadership were associated factors for job satisfaction (Kousar, 2018). Mutual understandings, recognition at work, and professional commitment showed a significant and positive relationship with overall job satisfaction among Ethiopian nurses (Semachew et al., 2017).

The present study has policy implications in nursing administration. Nursing administration can plan strategies that promote healthy organizational cultures that provide quality nursing care and high job satisfaction among nurses. Nurse managers are suggested to pay more attention to professional nurses on empowerment and focus on modifiable factors for better work environment.

Study Limitations

This study was limited to nurses working in the public hospital setting. The results may not be generalized to nurses working in private and community healthcare settings. Few subjects were unwilling to disclose the truth due to fear of hospital authorities. The study’s strength includes nurses working from most of the various department units, and the qualitative approach helped to understand the in-depth nurse’s job satisfaction.

Conclusion and Recommendations

For the organization’s success, satisfied employees play a vital role. Hence, healthcare organizations should be vigilant enough on ensuring employee’s job satisfaction. On an annual basis, monitoring employee’s job satisfaction and its associated factors help the organization rectify the demotivating factors. The shift in attitude change among the nursing supervisor toward positive relationship with nurses enhances job satisfaction.