Abstract
Purpose
This study aimed to examine job satisfaction and its associated factors among nurses working in selected hospital settings in Germany, Iran, and Canada.
Methods
A multicenter cross-sectional study was conducted from April 2017 to June 2019 across four tertiary-care teaching hospitals. A total of 521 registered nurses (271 from Iran, 186 from Germany, and 64 from Canada) completed a structured 50-item questionnaire assessing job satisfaction, workplace challenges, and sociodemographic characteristics. The questionnaire was developed based on established frameworks of job satisfaction and refined through expert review. Principal component analysis (PCA) identified eight dimensions of job satisfaction. Given deviations from normality, non-parametric statistical methods were applied alongside robust comparative analyses.
Results
Nurses from the participating hospital in Canada reported the highest levels of overall job satisfaction, followed by those from the hospital in Germany and the hospital in Iran (p < 0.001). Significant differences were observed in interpersonal relationships, leadership, perceived workload, and work–life balance (all p < 0.001). Higher job satisfaction was associated with older age, longer work experience, and fewer weekly working hours. Across all sites, overall job satisfaction showed positive correlations with supportive leadership, effective communication, manageable workload, opportunities for professional development, and work–life balance, and negative correlations with perceived workload and intention to leave. Across all settings, insufficient income and administrative burden were consistently reported as key workplace challenges. While site-specific differences were observed, these findings should be interpreted cautiously due to variations in sample characteristics, response rates, and the absence of formal cross-cultural measurement equivalence testing.
Conclusion
Job satisfaction varied across the participating hospital settings and was consistently associated with organizational and work-related factors, particularly workload, leadership, and work–life balance. The findings suggest that while core determinants of job satisfaction appear broadly similar, their relative influence may differ across organizational contexts. Given the study design and sampling approach, results should not be interpreted as representing national-level differences.
Implications for practice
Efforts to improve nurse job satisfaction should focus on modifiable organizational factors, including leadership practices, workload management, and flexible work arrangements, while taking local workplace conditions into account.
Clinical trial number
Not applicable.
Supplementary Information
The online version contains supplementary material available at https://doi.org/10.1186/s12912-026-04879-3.
Keywords: Nurses [https://www.ncbi.nlm.nih.gov/mesh/68009726], Job satisfaction [https://www.ncbi.nlm.nih.gov/mesh/68007588], Workload [https://www.ncbi.nlm.nih.gov/mesh/68016526], Workplace [https://www.ncbi.nlm.nih.gov/mesh/68017132], Delivery of health care [https://www.ncbi.nlm.nih.gov/mesh/68003695]
Introduction
Nursing is a fundamental component of healthcare systems globally, with nurses playing a vital role in patient care, health promotion, and the operational efficiency of medical institutions. As frontline providers of continuous care, nurses contribute directly to patient safety, care quality, and system performance, making their well-being a critical concern for healthcare organizations. Central to this well-being is job satisfaction, a multifaceted construct commonly defined as a positive emotional response to one’s work, shaped by the perceived alignment between professional expectations and actual work experiences [1, 2].
Job satisfaction among nurses is widely recognized as an important indicator of workforce stability and healthcare quality. A substantial body of evidence demonstrates that higher levels of nurse job satisfaction are associated with improved patient outcomes, enhanced quality of care, increased patient satisfaction, and stronger organizational commitment [3, 4]. Conversely, low job satisfaction has been linked to burnout, absenteeism, reduced engagement, compassion fatigue, and increased intention to leave the profession, thereby contributing to ongoing workforce shortages and placing additional strain on healthcare systems [5–7].
The determinants of nurse job satisfaction are complex and operate across multiple levels. These include individual characteristics (e.g., age, experience), intrinsic factors such as professional autonomy, recognition, and meaning in work, and extrinsic conditions including workload, staffing adequacy, remuneration, and managerial support [2, 8, 9]. In addition, organizational climate, ethical challenges, work–life balance, and interpersonal relationships have consistently been identified as influential factors. While these determinants are broadly observed across healthcare systems, their relative importance and the strength of their associations with job satisfaction may vary depending on organizational and contextual conditions rather than representing entirely distinct sets of factors [10, 11].
Understanding both shared and context-sensitive influences on job satisfaction is essential for developing effective workforce strategies. Previous research has highlighted variations in how these factors manifest across settings. In Iran, studies have reported moderate levels of job satisfaction, often shaped by high workload, limited autonomy, and perceived constraints in organizational support, alongside moral distress related to ethical challenges in clinical practice [8, 10, 12]. Socio-cultural expectations, including gender roles and family responsibilities, may further influence nurses’ experiences of work and satisfaction [13, 14]. At the same time, protective factors such as professional commitment, interpersonal communication, and personal coping resources have been shown to support job satisfaction in this context [15, 16].
In Canada, research has consistently emphasized the role of organizational and psychosocial work environments, with higher job satisfaction linked to supportive leadership, professional autonomy, access to resources, and opportunities for career development [17, 18]. Nevertheless, ongoing challenges -including staffing shortages, increasing patient acuity, and workload pressures- continue to affect nurses’ experiences, particularly in specialized and high-demand care settings [19].
In Germany, studies have documented persistent tensions between employment stability and perceived job quality, with reports of declining satisfaction despite relatively stable labor market conditions [20, 21]. Contributing factors include high workload, staffing constraints, limited decision-making autonomy, and increasing administrative demands, particularly in high-intensity clinical environments [22, 23]. Although organizational interventions such as participatory management and work–life balance initiatives have shown some benefit, structural challenges remain prominent [24, 25].
The COVID-19 pandemic has further intensified pressures on the nursing workforce globally, amplifying stress, burnout, and intention to leave, while also highlighting the importance of organizational support, effective communication, and job satisfaction as protective factors for workforce resilience [26, 27]. These developments emphasize the continued relevance of examining job satisfaction within and across healthcare settings, even when data collection predates the pandemic, as many underlying structural challenges persist.
International literature consistently indicates that nurse job satisfaction is shaped by a dynamic interplay of individual, organizational, and contextual influences. Comparative research can therefore be valuable in identifying common underlying determinants -such as workload, leadership, and autonomy- while also examining how their relative importance may differ across organizational settings [26, 28]. However, such comparisons should be interpreted cautiously, particularly when based on samples drawn from specific institutions rather than nationally representative populations.
Against this background, the present study adopts a multisite perspective, focusing on nurses working in selected hospital settings in Germany, Iran, and Canada. Rather than assuming national-level differences, the study aims to explore how job satisfaction and its associated factors vary across these specific organizational contexts.
Objectives
This study aimed to assess job satisfaction and its associated factors among registered nurses providing direct patient care in selected hospital settings in Germany, Iran, and Canada.
Methods
Study design and setting
This study employed a multicenter cross-sectional design and was conducted from April 2017 to June 2019 across four tertiary-care teaching hospitals located in Germany, Iran, and Canada. To preserve institutional confidentiality, hospital names are not reported. The participating sites included large academic hospitals affiliated with university systems, each providing specialized and general medical services and employing substantial nursing workforces (each exceeding approximately 1,000 nursing staff). These sites were selected based on feasibility and existing institutional collaborations, and were intended to reflect diverse organizational and healthcare system contexts rather than nationally representative samples.
Participants and sampling
Eligible participants were registered nurses actively engaged in direct patient care in inpatient and outpatient units. Exclusion criteria included: (a) nurses in exclusively administrative or managerial roles, (b) temporary or agency staff not integrated into routine staffing structures, (c) staff on extended leave (e.g., maternity, educational, or medical leave), and (d) non-registered nursing personnel, including assistants and trainees.
Sample size estimation was informed by the Krejcie and Morgan table for finite populations, alongside prior workforce studies. Given the estimated number of eligible nurses across the participating institutions (each > 1,000), a target sample of approximately 700 participants was considered sufficient to achieve stable estimates for descriptive and comparative analyses. The planned distribution (300 participants each from Germany and Iran, and 100 from Canada) reflected differences in accessibility and recruitment feasibility rather than proportional sampling.
Participants were recruited using a convenience sampling approach, facilitated through nursing leadership at each site. This approach was chosen due to organizational constraints and the absence of centralized sampling frames. A total of 700 questionnaires were distributed, and 521 complete responses were obtained, corresponding to an overall response rate of 74.4%. Response rates differed across sites: Iran (90.3%), Germany (62.0%), and Canada (64.0%), introducing the potential for non-response bias.
Given differences in recruitment, response rates, and sample characteristics across sites, the resulting samples should be considered non-equivalent. Consequently, comparisons are exploratory and should not be interpreted as reflecting national-level differences.
Data collection procedures
Data were collected using a self-administered questionnaire available in German, Persian, and English. To enhance linguistic and conceptual equivalence, a forward–backward translation procedure was conducted by bilingual nursing experts, with discrepancies resolved through consensus.
In Germany and Iran, paper-based questionnaires were distributed via nursing directors and ward managers, with permission granted for completion during working hours. Completed questionnaires were returned anonymously in sealed envelopes. In Canada, due to logistical constraints, questionnaires were distributed electronically to local coordinators, printed, and completed in paper format before being securely returned via scanned copies.
The duration of data collection varied across sites (Germany: 15 months; Iran: 12 months; Canada: 6 months), reflecting differences in organizational processes and access. Participation was voluntary and anonymous. Standardized written information outlined the study purpose, confidentiality, and the right to withdraw.
To enhance data quality, items were formulated to minimize ambiguity and excessive complexity. Negatively worded items were included and later reverse-coded to reduce acquiescence bias.
Measures
The questionnaire comprised four sections:
Sociodemographic and Occupational Characteristics: This section collected data on age, gender, relationship status, number of children, educational level, work experience, weekly working hours, employment contract type, and shift patterns.
Job Satisfaction Scale: The primary outcome measure was a 50-item job satisfaction instrument developed based on the German Trade Union Confederation (DGB) “Good Work” framework and established constructs from the job satisfaction literature. The instrument was designed to capture both organizational and interpersonal dimensions of nursing work, including leadership, teamwork, workload, and professional development.
Responses were recorded on a 4-point Likert scale (1 = “not true” to 4 = “completely true”), intentionally excluding a neutral midpoint to encourage directional responses. Negatively worded items were reverse-coded prior to analysis.
The decision to develop and adapt this instrument, rather than relying solely on an existing standardized scale, was based on the need to capture context-relevant aspects of nursing work across the participating settings.
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3.
Workplace Problems/Challenges: Participants rated the severity of common workplace challenges (e.g., insufficient staffing, excessive workload, administrative burden, interpersonal conflicts, and inadequate compensation) on a 10-point scale (1 = least problematic, 10 = most problematic). This section aimed to complement the job satisfaction scale by capturing perceived stressors within the work environment.
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4.
Open-Ended Responses: An optional section allowed participants to provide additional comments, enabling the identification of contextual issues not fully captured by structured items.
Content validity was assessed through expert review by five senior nursing professionals across the participating settings, and minor revisions were made accordingly. Due to resource and logistical constraints, a formal pilot study was not conducted, which represents a methodological limitation. Instead, post hoc psychometric evaluation was performed.
Psychometric evaluation
Construct validity of the job satisfaction scale was assessed using principal component analysis (PCA) with varimax rotation. Sampling adequacy was confirmed (Kaiser–Meyer–Olkin = 0.89), and Bartlett’s test of sphericity was significant (p < 0.001), supporting factorability.
Items with low communalities (h² < 0.50) or those negatively affecting internal consistency were removed. The final solution yielded eight components, explaining 68.0% of the total variance.
The components included:
Satisfaction with interpersonal relationships.
Satisfaction with management style.
Satisfaction with workload distribution.
Perceived workload.
Work–life balance.
Overall job satisfaction.
Opportunities for professional advancement.
Intention to leave.
Internal consistency was acceptable to good across all components (Cronbach’s α = 0.74–0.88).
Component scores were calculated by summing item responses within each factor and dividing by the number of items, resulting in standardized mean scores ranging from 1 to 4.
Statistical analysis
Data were analyzed using IBM SPSS Statistics version 24. Descriptive statistics were used to summarize participant characteristics and study variables. Normality assumptions were assessed using Kolmogorov–Smirnov tests and visual inspection. As most variables deviated from normal distribution, non-parametric statistical methods were prioritized. Group comparisons across sites were conducted using the Kruskal–Wallis H test, with post hoc pairwise comparisons where appropriate. For comparisons between two groups, the Mann–Whitney U test was applied. Spearman’s rank correlation coefficient was used to assess associations between job satisfaction components. Descriptive ranking analyses were performed to identify the most frequently reported workplace challenges. All tests were conducted with a significance level of α = 0.05, and missing data were handled using listwise deletion.
Ethical considerations
This study was conducted in accordance with the Declaration of Helsinki and relevant institutional guidelines for research involving human subjects. Ethical approval and institutional permissions were obtained from all participating sites prior to data collection.
For the German site (Klinikum Chemnitz gGmbH), approval was granted by the hospital’s Works Council (Betriebsrat) on June 6, 2018, following review of the study protocol and questionnaire by the Nursing Director (Pflegedirektor). Written confirmation of this approval was provided on June 26, 2018.
For the Iranian site (Imam Hospital, Tehran University of Medical Sciences), ethical approval was granted by the Research Committee of the Nursing Faculty at Tehran University of Medical Sciences (Approval Code: 96/d/250/6220). A letter of support from the University of Applied Sciences Jena, dated July 3, 2017, facilitated the institutional review process.
For the Canadian sites (hospitals in Ontario and Quebec), institutional permission was obtained through direct correspondence with nursing leadership. While the participating Canadian hospitals did not issue formal ethical approval codes, written agreements to participate were secured, and the study procedures were reviewed and approved by the responsible nursing directors and hospital administrators.
Participation was voluntary and anonymous across all sites. Written informed consent was implied through voluntary completion and return of the questionnaire. An information cover letter accompanied each questionnaire, explaining the study purpose, confidentiality protections, the voluntary nature of participation, and the right to withdraw at any time without consequence. No identifying information was collected, and all data were handled securely and used exclusively for research purposes. Data were stored on password-protected computers accessible only to the research team.
Results
Participant characteristics
A total of 521 nurses participated in the study, including 271 from one hospital in Iran (52.0%), 186 from one hospital in Germany (35.7%), and 64 from one hospital in Canada (12.3%). The mean age was 35.7 years (SD = 9.5), ranging from 20 to over 50 years. The sample was predominantly female (81.0%, n = 422). The largest age group was 35–49 years (43.8%).
Regarding education, 52.8% held a bachelor’s degree, while 42.6% had a three-year diploma. Most participants were employed under permanent contracts (80.0%) and reported working more than 31 h per week (89.0%) [Table 1].
Table 1.
Sociodemographic characteristics of participating nurses by country (N = 521)
| Variable | Total N (%) | Iran n (%) | Germany n (%) | Canada n (%) | p value |
|---|---|---|---|---|---|
| Gender | 0.84 | ||||
| Female | 422 (81.0) | 214 (79.0) | 152 (81.7) | 56 (87.5) | |
| Male | 83 (15.9) | 43 (15.9) | 32 (17.2) | 8 (12.5) | |
| Not specified | 16 (3.1) | 14 (5.2) | 2 (1.1) | 0 (0) | |
| Age group | < 0.001 | ||||
| 20–34 years | 218 (41.8) | 150 (55.4) | 60 (32.3) | 8 (12.5) | |
| 35–49 years | 228 (43.8) | 100 (36.9) | 80 (43.0) | 48 (75.0) | |
| ≥ 50 years | 67 (12.9) | 13 (4.8) | 46 (24.7) | 8 (12.5) | |
| Not specified | 8 (1.5) | 8 (3.0) | 0 (0) | 0 (0) | |
| Partnership status | 0.15 | ||||
| Yes | 325 (62.4) | 151 (55.7) | 134 (72.0) | 40 (62.5) | |
| No | 186 (35.7) | 110 (40.6) | 52 (28.0) | 24 (37.5) | |
| Not specified | 10 (1.9) | 10 (3.7) | 0 (0) | 0 (0) | |
| Number of children | < 0.001 | ||||
| None | 247 (47.4) | 165 (60.9) | 58 (31.2) | 24 (37.5) | |
| 1 | 113 (21.7) | 45 (16.6) | 52 (28.0) | 16 (25.0) | |
| 2 | 130 (25.0) | 48 (17.7) | 58 (31.2) | 24 (37.5) | |
| > 2 | 23 (4.4) | 5 (1.8) | 18 (9.7) | 0 (0) | |
| Not specified | 8 (1.5) | 8 (3.0) | 0 (0) | 0 (0) | |
| Education | < 0.001 | ||||
| 3-year diploma | 222 (42.6) | 12 (4.4) | 186 (100.0) | 24 (37.5) | |
| Bachelor’s degree | 275 (52.8) | 235 (86.7) | 0 (0) | 40 (62.5) | |
| Master’s degree | 17 (3.3) | 17 (6.3) | 0 (0) | 0 (0) | |
| Not specified | 7 (1.3) | 7 (2.6) | 0 (0) | 0 (0) | |
| Work experience | < 0.001 | ||||
| < 4 years | 139 (26.7) | 97 (35.8) | 34 (18.3) | 8 (12.5) | |
| 5–9 years | 70 (13.4) | 42 (15.5) | 20 (10.8) | 8 (12.5) | |
| 10–19 years | 157 (30.1) | 79 (29.2) | 46 (24.7) | 32 (50.0) | |
| ≥ 20 years | 144 (27.6) | 42 (15.5) | 86 (46.2) | 16 (25.0) | |
| Not specified | 11 (2.1) | 11 (4.1) | 0 (0) | 0 (0) | |
| Weekly working hours | < 0.001 | ||||
| ≤ 20 h | 20 (3.8) | 0 (0) | 4 (2.2) | 16 (25.0) | |
| 21–30 h | 26 (5.0) | 0 (0) | 26 (14.0) | 0 (0) | |
| 31–40 h | 358 (68.7) | 170 (62.7) | 156 (83.9) | 32 (50.0) | |
| > 41 h | 106 (20.3) | 90 (33.2) | 0 (0) | 16 (25.0) | |
| Not specified | 11 (2.1) | 11 (4.1) | 0 (0) | 0 (0) | |
| Contract type | < 0.001 | ||||
| Temporary | 94 (18.0) | 88 (32.5) | 6 (3.2) | 0 (0) | |
| Permanent | 417 (80.0) | 173 (63.8) | 180 (96.8) | 64 (100.0) | |
| Not specified | 10 (1.9) | 10 (3.7) | 0 (0) | 0 (0) | |
| Shift type | < 0.001 | ||||
| Early shift | 64 (12.3) | 46 (17.0) | 10 (5.4) | 8 (12.5) | |
| Late shift | 2 (0.4) | 2 (0.7) | 0 (0) | 0 (0) | |
| Early/late | 97 (18.6) | 87 (32.1) | 10 (5.4) | 0 (0) | |
| Day/night | 350 (67.2) | 128 (47.2) | 166 (89.2) | 56 (87.5) | |
| Night shift | 6 (1.2) | 6 (2.2) | 0 (0) | 0 (0) | |
| Not specified | 2 (0.4) | 2 (0.7) | 0 (0) | 0 (0) |
Note: p-values were derived using chi-square tests for categorical variables and Kruskal–Wallis tests for continuous or ordinal variables, as appropriate
Comparisons across sites indicated statistically significant differences in most sociodemographic variables (Kruskal–Wallis and chi-square tests, p < 0.05), except for gender (p = 0.84) and partnership status (p = 0.15). Nurses from the Iranian site were generally younger, reported longer working hours, and were more likely to have temporary contracts. In contrast, nurses from the German site more frequently reported longer work experience and diploma-level education, while those from the Canadian site were more likely to work reduced hours.
Given these substantial differences in demographic and employment characteristics, the samples should be interpreted as non-comparable groups, and subsequent analyses are presented descriptively and exploratorily.
Job satisfaction components
Descriptive analyses revealed variation in job satisfaction across the three study sites [Table-Table 2]. Nurses from the Canadian site reported higher median levels of overall job satisfaction, followed by those from the German site, while lower values were observed among nurses from the Iranian site.
Table 2.
Descriptive statistics and kruskal–wallis test results for job satisfaction components by site
| Component | Total Median (IQR) | Iran Median (IQR) | Germany Median (IQR) | Canada Median (IQR) | H (df) | p |
|---|---|---|---|---|---|---|
| ZWB | 17 (6) | 16 (7) | 17 (5) | 20 (3) | 53.74 (2) | < 0.001 |
| FS | 17 (6) | 17 (7) | 18 (5) | 18 (5) | 6.50 (2) | 0.002 |
| AV | 9 (4) | 8 (5) | 9 (3) | 11 (2) | 122.45 (2) | < 0.001 |
| WAB | 16 (5) | 18 (4) | 13 (3) | 17 (4) | 184.70 (2) | < 0.001 |
| WLB | 9 (4) | 8 (4) | 10 (4) | 9 (3) | 24.02 (2) | < 0.001 |
| AAZ | 8 (3) | 7 (4) | 8 (3) | 10 (2) | 68.36 (2) | < 0.001 |
| QM | 8 (3) | 7 (3) | 9 (3) | 8 (3) | 33.44 (2) | < 0.001 |
| JW | 5 (3) | 5 (3) | 4 (2) | 6 (2) | 62.79 (2) | < 0.001 |
Note. Kruskal–Wallis H test used due to non-normal distributions. IQR = interquartile range
Similar patterns were observed for interpersonal relationships, leadership style, and division of work, whereas perceived workload was highest among nurses from the Iranian site. Nurses from the German site reported relatively higher scores for qualification opportunities and work–life balance.
As the distribution of most variables deviated from normality, group comparisons were conducted using the Kruskal–Wallis H test. These analyses indicated statistically significant differences across sites for all job satisfaction components (p < 0.001).
Post hoc pairwise comparisons were conducted using Dunn–Bonferroni tests (results not shown), which generally supported the overall patterns observed in the descriptive statistics.
Effect of sociodemographic factors on overall job satisfaction
Associations between overall job satisfaction and sociodemographic variables were examined using non-parametric tests [Table-Table 3].
Table 3.
Non-parametric test results for overall job satisfaction
| Variable | Test | Statistic | p |
|---|---|---|---|
| Age | Kruskal–Wallis | H (2) = 8.18 | < 0.001 |
| Number of children | Kruskal–Wallis | H (3) = 3.97 | 0.01 |
| Education | Kruskal–Wallis | H (2) = 2.75 | 0.08 |
| Work experience | Kruskal–Wallis | H (3) = 3.42 | 0.02 |
| Weekly working hours | Kruskal–Wallis | H (3) = 8.50 | < 0.001 |
| Shift work | Kruskal–Wallis | H (4) = 1.77 | 0.13 |
| Gender | Mann–Whitney U | U = 15,668 | 0.84 |
| Relationship | Mann–Whitney U | U = 26,442 | 0.15 |
| Contract | Mann–Whitney U | U = 18,307 | 0.64 |
Note. Non-parametric tests applied due to non-normal distributions. Education had three categories: 3-year diploma, bachelor’s degree, and master’s degree (degrees of freedom = 2)
Mann–Whitney U tests indicated no significant differences in job satisfaction by gender (p = 0.84), partnership status (p = 0.15), or contract type (p = 0.64).
Kruskal–Wallis analyses demonstrated statistically significant associations between job satisfaction and age (p < 0.001), number of children (p = 0.01), work experience (p = 0.02), and weekly working hours (p < 0.001). No significant differences were found for education level (H (2) = 2.75, p = 0.08), which included three categories (3-year diploma, bachelor’s degree, and master’s degree), or for shift type (p = 0.13).
Post hoc comparisons indicated that older nurses (≥ 50 years) and those with greater work experience tended to report higher job satisfaction. Additionally, nurses working fewer weekly hours reported higher satisfaction levels.
Exploratory stratified analysis by site
Given the non-comparability of samples and violation of parametric assumptions, interaction analyses were not performed. Instead, descriptive stratified analyses by site are presented [Tables 4 and 5] to illustrate patterns within each setting. These results are exploratory and should not be interpreted as evidence of interaction effects.
Table 4.
Descriptive statistics for AAZ by gender, relationship status, and contract duration across countries
| Variable | Iran (N, M ± SD) | Germany (N, M ± SD) | Canada (N, M ± SD) |
|---|---|---|---|
| Gender | |||
| Female | 211, 7.49 ± 2.63 | 146, 8.21 ± 1.92 | 56, 9.71 ± 0.89 |
| Male | 43, 7.56 ± 2.76 | 26, 8.23 ± 1.81 | 8, 9.00 ± 0.00 |
| Relationship status | |||
| Partnered | 149, 7.40 ± 2.69 | 124, 8.56 ± 1.88 | 40, 9.60 ± 0.81 |
| Not partnered | 109, 7.60 ± 2.58 | 50, 7.56 ± 1.88 | 24, 9.67 ± 0.96 |
| Contract duration | |||
| Temporary | 88, 8.00 ± 2.63 | 6, 9.67 ± 0.52 | – |
| Permanent | 170, 7.19 ± 2.60 | 168, 8.23 ± 1.94 | 64, 9.63 ± 0.86 |
Table 5.
Descriptive Statistics for AAZ by age, number of children, education, work experience, weekly working hours, and shift work across countries
| Variable | Iran (N, M ± SD) | Germany (N, M ± SD) | Canada (N, M ± SD) |
|---|---|---|---|
| Age (years) | |||
| 20–34 | 149, 7.60 ± 2.72 | 52, 8.38 ± 1.88 | 8, 9.00 ± 0.00 |
| 35–49 | 98, 7.12 ± 2.50 | 78, 7.97 ± 1.84 | 48, 9.50 ± 0.77 |
| ≥ 50 | 13, 8.92 ± 1.94 | 44, 8.68 ± 2.08 | 8, 11.00 ± 0.00 |
| Number of children | |||
| 0 | 164, 7.66 ± 2.66 | 52, 8.42 ± 1.94 | 24, 9.00 ± 0.00 |
| 1 | 43, 6.98 ± 2.85 | 48, 7.50 ± 2.04 | 16, 10.00 ± 1.03 |
| 2 | 48, 7.27 ± 2.41 | 56, 8.54 ± 1.63 | 24, 10.00 ± 0.83 |
| ≥ 3 | 5, 8.80 ± 1.48 | 18, 9.11 ± 1.91 | – |
| Educational attainment | |||
| 3-year diploma | 12, 7.25 ± 2.38 | 174, 8.28 ± 1.93 | 24, 9.00 ± 0.00 |
| Bachelor’s | 232, 7.54 ± 2.62 | – | 40, 10.00 ± 0.91 |
| Master’s | 17, 7.12 ± 3.12 | – | – |
| Work experience (years) | |||
| ≤ 4 | 97, 7.82 ± 2.60 | 34, 9.24 ± 1.65 | 8, 9.00 ± 0.00 |
| 5–9 | 41, 7.51 ± 2.93 | 14, 7.57 ± 1.74 | 8, 9.00 ± 0.00 |
| 10–19 | 77, 6.87 ± 2.40 | 44, 7.64 ± 1.66 | 32, 9.50 ± 0.88 |
| ≥ 20 | 42, 7.74 ± 2.67 | 82, 8.34 ± 2.04 | 16, 10.50 ± 0.52 |
| Weekly working hours | |||
| ≤ 20 | – | 4, 8.00 ± 1.16 | 16, 9.00 ± 0.00 |
| 21–30 | – | 26, 8.92 ± 1.81 | – |
| 31–40 | 168, 7.48 ± 2.66 | 144, 8.17 ± 1.95 | 32, 9.25 ± 0.44 |
| ≥ 41 | 89, 7.51 ± 2.63 | – | 16, 11.00 ± 0.00 |
| Shift work status | |||
| Early shift only | 46, 7.80 ± 2.50 | 10, 8.80 ± 1.55 | 8, 11.00 ± 0.00 |
| Late shift only | 2, 9.00 ± 0.00 | – | – |
| Early/late | 85, 7.46 ± 2.59 | 6, 8.33 ± 1.37 | – |
| Day/night | 126, 7.25 ± 2.69 | 158, 8.24 ± 1.97 | 56, 9.43 ± 0.74 |
| Night shift only | 6, 9.00 ± 3.35 | – | – |
Correlations between job satisfaction components
Spearman’s rank correlations confirmed that overall job satisfaction was positively associated with interpersonal relationships, leadership style, division of work, work–life balance, and qualification opportunities (all p < 0.001), and negatively associated with perceived workload and intention to leave [Table-6]. The correlation between division of work and intention to leave was negative but did not reach statistical significance (r = − 0.064, p = 0.153).
Table 6.
Spearman’s correlation matrix for job satisfaction components (N = 418–514)
| Component | ZWB | FS | AV | WAB | WLB | AAZ | QM | JW |
|---|---|---|---|---|---|---|---|---|
| ZWB – Interpersonal relationships | 1.000 | |||||||
| FS – Leadership style | 0.615** | 1.000 | ||||||
| AV – Division of work | 0.445** | 0.424** | 1.000 | |||||
| WAB – Perceived workload | –0.212** | –0.264** | –0.131** | 1.000 | ||||
| WLB – Work–life balance | 0.445** | 0.545** | 0.440** | –0.331** | 1.000 | |||
| AAZ – Overall job satisfaction | 0.464** | 0.374** | 0.374** | –0.177** | 0.401** | 1.000 | ||
| QM – Qualification opportunities | 0.465** | 0.558** | 0.298** | –0.302** | 0.473** | 0.334** | 1.000 | |
| JW – Intention to change jobs | –0.165** | –0.284** | –0.064 | 0.486** | –0.360** | –0.283** | –0.332** | 1.000 |
Note. Spearman’s rank correlations reported. p < 0.01 (two-tailed). The correlation between AV and JW was negative but not statistically significant (p = 0.153). Sample sizes vary across pairs (N = 418–514) due to listwise exclusion of missing data
Exploratory analysis: problem ranking
Nurses rated workplace challenges on a 10-point scale. Across the total sample, “insufficient income” and “excessive paperwork” were consistently ranked as the most prominent concerns (median = 9).
When examined by site, insufficient income was rated highest in the Iranian and Canadian samples, while paperwork burden was most prominent in the German sample. Shift work and multiple responsibilities were also frequently identified as major concerns, particularly in the Iranian and Canadian samples. In contrast, interpersonal conflicts were generally rated as less severe problems.
To enhance interpretability, problems are presented in descending order of median severity in Table 7.
Table 7.
Workplace problems ranked by median severity (sites and total sample)
| Problem | Iran | Germany | Canada | Total |
|---|---|---|---|---|
| Insufficient income | 10 | 5 | 9 | 9 |
| Too much paperwork | 9 | 9 | 9 | 9 |
| Responsibility multiplicity | 9 | 7 | 9 | 8 |
| Inadequate time | 8 | 8 | 7 | 8 |
| Shift work | 9 | 5 | 9 | 7 |
| Doctors’ unfriendly behavior | 5 | 4 | 7 | 5 |
| Patients’ dissatisfaction | 5 | 5 | 7 | 5 |
| Patients’ unfriendly behavior | 5 | 4 | 7 | 5 |
| Colleagues’ unfriendly behavior | 5 | 2 | 5 | 3 |
| Charge nurse unfriendly behavior | 3 | 3 | 6 | 3 |
Note. Ratings based on a 10-point scale (1 = least problematic, 10 = most problematic). Medians reported
Discussion
This multinational, cross-sectional study examined job satisfaction and its associated factors among registered nurses in selected hospital settings in Germany, Iran, and Canada. Given the sampling approach and the non-comparability of the samples, the findings should be interpreted as exploratory and reflective of the specific participating institutions rather than national populations. With that caveat, several patterns emerged that merit discussion.
Overall, nurses from the participating hospital in Canada reported the highest levels of job satisfaction (median = 10, IQR = 2), followed by those from the German site (median = 8, IQR = 3), while lower levels were observed among nurses from the Iranian site (median = 7, IQR = 4). These differences, however, cannot be attributed solely to national context, as the samples differed substantially in age, work experience, contract type, weekly working hours, and response rates. The Canadian sample, for instance, included a higher proportion of nurses working reduced hours (25% working ≤ 20 h per week compared with none in Iran) and a larger percentage of nurses aged 35–49 years (75% versus 36.9% in Iran). These demographic disparities alone could explain much of the observed variation in satisfaction. Therefore, rather than interpreting these differences as “country effects,” we view them as patterns emerging from specific organizational and demographic configurations.
That said, the direction of associations between job satisfaction and key work-related factors was broadly consistent across sites. Higher job satisfaction was associated with supportive leadership, effective communication, manageable workload, opportunities for professional development, and better work–life balance. Conversely, perceived workload and intention to leave showed negative associations with job satisfaction. This consistency suggests that the core determinants of job satisfaction -leadership quality, workload, autonomy, and recognition- may be largely universal, even if their relative influence varies by context [2, 28].
The positive correlation between age and job satisfaction (older nurses reporting higher satisfaction) and between work experience and satisfaction aligns with prior research. This pattern may reflect increased professional competence, better coping strategies, career advancement, or selection effects (less satisfied nurses leaving the profession earlier) [29, 30]. Similarly, the observation that nurses working fewer hours reported higher satisfaction underscores the importance of workload control and work–life balance as determinants of well-being -factors that appear to transcend institutional boundaries [31]. Notably, we found no significant association between job satisfaction and gender or educational attainment, challenging some prior assumptions and suggesting that immediate work environment and organizational culture may be stronger predictors than these individual characteristics [13].
The eight-component structure of our job satisfaction instrument -interpersonal relationships, leadership style, workload distribution, perceived workload, work–life balance, overall satisfaction, qualification opportunities, and intention to leave -aligns with established models in the literature [1, 32]. Strong positive correlations between overall satisfaction and both interpersonal relationships (r = 0.464) and leadership style (r = 0.374) highlight the importance of supportive workplace environments. The robust positive correlation between leadership style and both work–life balance and qualification opportunities suggests that effective nurse managers can directly enhance scheduling flexibility and access to professional development, thereby improving satisfaction and reducing burnout [33, 34]. In contrast, the negative correlation between perceived workload and most satisfaction components indicates that excessive demands remain a primary source of professional dissatisfaction, adversely affecting retention intentions [6, 35].
Across all three sites, “insufficient income” and “excessive paperwork” were consistently ranked as the most severe workplace problems. However, the relative ranking varied: insufficient income was rated highest in the Iranian (median = 10) and Canadian (median = 9) samples, while paperwork burden was most prominent in the German sample (median = 9). These differences may reflect varying economic conditions, compensation structures, and documentation requirements across the three healthcare systems. Notably, interpersonal conflicts were generally rated as less severe, suggesting that workplace relationships may be less problematic than structural and administrative issues.
Several limitations must be acknowledged. First and most importantly, the samples were not equivalent. Response rates differed markedly (Iran 90.3%, Germany 62.0%, Canada 64.0%), and the three samples differed substantially on multiple demographic and employment characteristics strongly linked to job satisfaction, including age, work experience, contract type, and weekly working hours. Consequently, the samples cannot be considered comparable, and the observed differences in job satisfaction cannot be validly attributed to national or cultural factors. At best, this study represents a comparison of three convenience samples from three hospitals.
Second, measurement invariance across languages and cultural contexts was not tested. The instrument was originally developed in German and translated into Persian and English, but without formal invariance testing, score comparability cannot be assumed. The use of a 4-point Likert scale without a neutral option may have increased response bias, and such bias may have differed systematically across sites. Third, a formal pilot study was not conducted due to resource constraints, although post-hoc psychometric evaluation (PCA, Cronbach’s α) supported the instrument’s internal structure. Fourth, the cross-sectional design precludes causal inferences. Fifth, the small Canadian sample (n = 64) limits precision, and the pre-pandemic data collection (2017–2019) means the findings do not reflect COVID-19-related changes, though they may serve as a useful baseline. Finally, convenience sampling and reliance on self-report raise concerns about selection and social desirability biases, though anonymity likely mitigated the latter.
Despite these limitations, the findings offer several implications. For hospital administrators and policymakers, the results reinforce that modifiable organizational factors -particularly workload management, leadership quality, and work–life balance- are consistently associated with nurse job satisfaction. Interventions targeting these areas, such as leadership development programs, workload redistribution, and flexible scheduling, may improve satisfaction regardless of national context. However, such interventions should be tailored to local conditions, as the relative salience of specific problems (e.g., income vs. paperwork) appears to vary.
Future research should prioritize longitudinal designs to examine how job satisfaction evolves over time and in response to organizational changes. Cross-country studies should employ probability sampling, test measurement invariance rigorously, and include pilot testing to ensure instrument equivalence. Qualitative research would also be valuable for exploring the lived experiences behind quantitative scores, particularly regarding the interaction between personal circumstances (e.g., relationship status, caregiving responsibilities) and workplace conditions. Intervention studies evaluating specific strategies -leadership training, workload caps, or financial incentives- are urgently needed to build an evidence base for improving nurse job satisfaction and retention globally.
Conclusion
In this exploratory, multicenter study of nurses from selected hospitals in Germany, Iran, and Canada, job satisfaction varied across sites and was consistently associated with organizational and work-related factors, particularly workload, leadership, and work–life balance. While the core determinants of job satisfaction appeared broadly similar, their relative influence differed across settings. Given the substantial demographic and measurement-related differences between samples, however, the findings should not be interpreted as representing national-level differences. Efforts to improve nurse job satisfaction should focus on modifiable organizational factors while taking local workplace conditions into account.
Supplementary Information
Below is the link to the electronic supplementary material.
Acknowledgements
The authors thank Mr. Konrad Schuhmann (Nursing Director of Chemnitz Hospital), Mrs. Karina Peters (Nursing Supervisor of Chemnitz Hospital), Mrs. Alisa Harthaus geb. Shugaley (Psychologist, M.Sc.), Mrs. Arezou Mirzadeh (RN in Mackenzie Richmond Hill Hospitals in Ontario, Canada), and Mrs. Akram Nazary (RN in Montreal Children’s Hospital, Canada), as well as Dr. Shirin Ferdowsi, Dr. Maryam Soleymanzadeh Ardabili, Mrs. Gabriela Pfeifer, Mrs. Pegah Ahmadi, and Mrs. Diana Chamanara for their cooperation. The authors also thank Dr. Reza Hosseiniara (Assistant Professor, Kashan University of Medical Sciences, Kashan, Iran) for his consultation and help in revising the manuscript and submitting it. The authors additionally acknowledge Dr. Arash Fattahi, MD, MBChB Bsc (hons), formerly of the Geriatrics Department, Northampton General Hospital NHS Trust, UK, for his previous involvement and support. We are also grateful to all nurses who graciously and willingly participated in the survey; without them, this study would not have been possible. In the process of writing this manuscript, the authors employed artificial intelligence to assist with light text editing and grammar checking. Following the use of this tool, the authors thoroughly reviewed, revised, and approved the content and assume complete responsibility for the work.
Author contributions
Firoozeh Behjat, Jörg Schulz, and Simin Ranjbaran conceived and designed the study. Data collection was performed by Firoozeh Behjat, Jörg Heinrich, Simin Ranjbaran, Parastoo Aryamloo, and Narges Ramezanpoor. Masoomeh Dehghan, Jörg Schulz, and Firoozeh Behjat analyzed and interpreted the data. The manuscript was drafted by Firoozeh Behjat and Jörg Schulz. All authors critically reviewed, revised, and approved the final manuscript. All authors are accountable for the work’s integrity and accuracy. All authors critically reviewed, revised, and approved the final manuscript, and they all take responsibility for the integrity of the data and the accuracy of the analysis. The corresponding author attests that all listed authors meet authorship criteria and that no others have been omitted.
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Data availability
The data used in this study are available from the corresponding author on request.
Declarations
Ethics approval and consent to participate
This study was conducted in accordance with the Declaration of Helsinki and relevant institutional guidelines for research involving human subjects. Ethical approval and institutional permissions were obtained from all participating sites prior to data collection. For the German site (Klinikum Chemnitz gGmbH), approval was granted by the hospital’s Works Council (Betriebsrat) on June 6, 2018, following review of the study protocol and questionnaire by the Nursing Director (Pflegedirektor). Written confirmation of this approval was provided on June 26, 2018. For the Iranian site (Imam Hospital, Tehran University of Medical Sciences), ethical approval was granted by the Research Committee of the Nursing Faculty at Tehran University of Medical Sciences (Approval Code: 96/d/250/6220). A letter of support from the University of Applied Sciences Jena, dated July 3, 2017, facilitated the institutional review process. For the Canadian sites (hospitals in Ontario and Quebec), institutional permission was obtained through direct correspondence with nursing leadership. While the participating Canadian hospitals did not issue formal ethical approval codes, written agreements to participate were secured, and the study procedures were reviewed and approved by the responsible nursing directors and hospital administrators. Participation was voluntary and anonymous across all sites. Written informed consent was implied through voluntary completion and return of the questionnaire. An information cover letter accompanied each questionnaire, explaining the study purpose, confidentiality protections, the voluntary nature of participation, and the right to withdraw at any time without consequence. No identifying information was collected, and all data were handled securely and used exclusively for research purposes. Data were stored on password-protected computers accessible only to the research team.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The data used in this study are available from the corresponding author on request.