Effect of head nurse empowerment program on staff nurses' job satisfaction at two educational hospitals in Rasht, Iran

Abstract

Background:

Job satisfaction of nurses is an important concept in nursing profession because it influences nursing care. Head nurses play a crucial role in the job satisfaction of nurse staffs. The current study, therefore, aimed to investigate the effect of Head Nurse Empowerment Program (HNEP) on job satisfaction of nurses.

Materials and Methods:

This quasi-experimental study was conducted at two educational hospitals in Rasht, Iran. Of 160 staff nurses who were working in eight medical-surgical wards and two Intensive Care Units, 60 were recruited using simple random sampling method. The samples were randomly assigned to control and experimental groups. The HNEP was applied to promote the management skills among nurses, which included technical, communicational, perceptional, and diagnostic skills. The data were collected using nurses' job satisfaction questionnaire and analyzed using the Mann–Whitney and Wilcoxon Singed Ranks tests. P < 0.05 was set as the significance level.

Results:

There was a significant difference in the job satisfaction of nurse staff within the experimental group on comparing pre- and post-HNEP phases [78 (65.50) vs. 78 (65.50); P < 0.001]. The job satisfaction also differed between the control and experimental groups [60 (82.25) vs. 128.5 (51.75); P < 0.001]. However, no significant difference [62 (78.75) vs. 60 (82.25); P = 0.129] was found within the control group. The number of satisfied nurse staffs increased in the experimental group from approximately 25% to 76% after HNEP.

Conclusions:

The HNEP can be used as a promoting tool in the nursing profession. Increasing head nurses' management skills can result in job satisfaction among the staff nurses.

INTRODUCTION

Nurses are the largest human resource group in the healthcare system. They should be managed in a way that leads to job satisfaction (JS) and high quality care.[1] JS is a global feeling or attitude toward various aspects of a job[2] and is an affective orientation toward work that an employee perceives.[3] The traditional model of JS emphasizes on all the feelings that people have about their job.[4] However, people's satisfaction or dissatisfaction depends on the nature and expectations of that job.[5]

JS, particularly in nursing, is an influential factor[6] and a critical challenge for healthcare organizations.[7] JS has been found to positively attribute to the professional commitment and negatively correlates with job burnouts. Lack of JS leads to approximately 30–40% of nurses intending to leave the organization and the profession.[8] The other important factors on JS are interpersonal relationships between nurses and patient care, work planning, intrinsic motivation, workload, unit size, and leadership.[9] Nursing authorities have a critical role in promoting JS among staff nurses.[10] Of the nurse managers, head nurses directly deal with nursing staff in performing day-to-day operations and nursing care. They also establish unit policies and coordinate the staff nurses' duties. Head nurses must be concerned about organizational and nurse staff's needs simultaneously to solve the problems that may arise in the hospital wards or units. As the effectiveness of head nurses influences the organization's productivity and staff satisfaction, their management skills have to be promoted.[11] Head Nurse Empowerment Program (HNEP) as an in-service education program strengthens the management knowledge and skills, especially interpersonal relationships, the capacity to deliver high-quality patient care,[7] and self-confidence,[11] in head nurses and, consequently, improves nurse staff's JS. This study aimed to evaluate the effect of HNEP on nurse staff's JS.

MATERIALS AND METHODS

This quasi-experimental study was conducted at two educational hospitals in Rasht, Iran. The hospitals were randomly selected as the experimental and control groups. Four medical-surgical wards and an Intensive Unit Care (ICU) were randomly chosen from each hospital. The study population consisted of all the nurses who had a Bachelor of Nursing degree with at least 6 months job experience in the hospitals and were voluntarily willing to participate in the study. Of 160 nurse staffs who were working in the given hospitals, 60 were randomized. Each group of the study sample consisted of 30 staff nurses.

Data were collected from March to May 2011 using Nurses' Job Satisfaction Questionnaire, which is a valid and reliable instrument. Cronbach's alpha coefficient of the instrument was 0.96. The instrument consisted of 40 items which covered 12 dimensions, including virtuality, job shifts, salary, job mistakes, responsiveness, organization, facilities, individual skills, nurse–physician relationship, public relations, relationship between job and family, and meta-professional. The instrument was scored based on a five-point Likert-type scale (5 = absolutely satisfied, 1 = absolutely dissatisfied). The JS was categorized into five levels as absolutely dissatisfied (1–40), dissatisfied (41–80), neither dissatisfied nor satisfied (81–120), satisfied (121–160), and absolutely satisfied (161–200). Besides, six questions were on the demographic data of the participants, including age, gender, job experience, shift status, employment status, and education status.

The study was conducted between two groups of nurse staffs in two phases. First, a pre-test was carried out to find out the satisfaction of nurse staffs. The educational needs of the head nurses in terms of managerial skills were evaluated through observing their performances, self-reporting, and nurse staff's satisfaction. The HNEP, designed to increase the efficacy of head nurses in managerial skills and, consequently, the JS of nurse staffs, was conducted in 15 sessions and followed up for 3 months. In the second phase, a post-test was performed to evaluate the satisfaction of nurse staffs after the HNEP.

The data were analyzed using SPSS version 16. The normality distributions of JS were evaluated using the Shapiro–Wilk test. As the normality of distributions was violated, the non-parametric Mann–Whitney U test was conducted to compare the JS between the control and experimental groups. The Wilcoxon Signed Ranks test was also used to evaluate the changes within the groups separately pre- and post-experiment. P < 0.05 was set as the significance level.

Ethical considerations

Ethical approval was obtained from the Tarbiat Modares University before conducting the study. The hospitals' authorities also permitted to conduct the study. The collected data were anonymous and the participants were allowed to withdraw from the study anytime they wanted. The consent form was achieved through a cover letter.

RESULTS

Table 1 shows the demographic data of the study population. All the participants were bachelors in nursing. Females, having a job experience or more than 5 years, being causal employees, and having rotation shifts were predominant in both control and experimental groups. There was no significant difference in demographic information between the control and experimental groups.

Table 1.

Frequency or mean (SD) of demographic information of experimental and control groups

The Shapiro–Wilk test showed that the distribution of JS in both groups in pre- and post-experimental phases was non-normal (all P < 0.001). Table 2 shows that most of the nurses in the control group were dissatisfied and absolutely dissatisfied in the pre-experimental phase. Besides, the majority of them remained dissatisfied and absolutely dissatisfied in the post-experimental phase. Job dissatisfaction in the experimental group decreased after the intervention.

Table 2.

Frequency of nurses’ job satisfaction in control and experimental groups before and after HNEP

Table 3 shows no significant difference in JS between the control and experimental groups in pre-experimental phase. However, a significant difference was found in the JS of nurses between the control and experimental groups after HNEP (P < 0.001). In addition, the median of JS was not significant in pre- and post-experimental phases. Besides, there was a significant difference in the JS scores between the control and experimental groups after HNEP (P < 0.001).

Table 3.

Comparison of nurses’ job satisfaction before and after HNEP in control and experimental groups

DISCUSSION

The current study aimed to evaluate the effect of HNEP on the JS of nurse staffs. Most of the participants were young females. The majority of nurses were dissatisfied with their job. In this study, many factors were found to result in job dissatisfaction for the employees, such as workload, low salary, non-fixed contract job, and perhaps having unskilled managers. The average score of JS of nurse staffs in the experimental group increased after conducting HNEP, which shows that having effective managerial skills and applying them can promote nurse staff's satisfaction. The results of the current study were in line with those of Zaeimipur.[12] Longeson's study[13] results also indicated the effect of nursing management on the personnel. The results showed a firm relationship between the nurses' performance, quality, and nurses' JS. This indicates that when the performance and skills of head nurses increased, the nurse staffs' JS improved as well. The results indicate that despite the fact that many problems are encountered by the nurse staff in their job, the head nurse managerial skills highly influence the satisfaction of the nurse staffs and perhaps achieving the goal of organization in caring the clients. The head nurses are the first-line managers in the nursing profession and are responsible for executive tasks of nursing staffs. Although it should be noted that all the nursing managers play a vital role in organizing and providing nursing care, the head nurses play the key role in the hospital wards, and their skill and knowledge improve the quality of healthcare services.[14] The results of the current study show that the empowerment program improved the managerial skills of head nurses, which consequently improved the nurse staffs' JS. Sullivan et al. 's[15] study showed that acquiring the crucial skills such as leadership and human resources management is essential for the head nurses to fulfill their job, and these skills are required for nurses' JS. In addition, organizational commitments[16] and organizational trust[17] in nurse staffs increase when they are satisfied with their own job.

CONCLUSION

In addition to many factors that contributed to JS among nurse staffs, the head nurses' management skills play a crucial role. The authorities of healthcare systems, especially the head nurses, should enhance their knowledge about management. Regarding the results of the current study, execution of the HNEP in clinical settings can improve the nurse staffs' JS. Nurses' JS can lead to higher organizational commitment and lower rate of the nurse burnout.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.