Table 1.

Summary of literature on the personal system

Sub-system	Authors, year (site)	Design	Sample	Interventions	Outcomes	Critique
Personal	Sparks Coburn & Hall, 2014 (USA)	Descriptive, comparative	223 American nurses	Online survey to identify quality of work life (QWL), psychological empowerment (PE) and job satisfaction (JS) between four generations of nurses	Baby boomers have significantly more years of experience, perceptions of PE and JS than Generation X and Millennial nurses	Participant self-selection. Possible falsification of responses and identity. Exclusion of non-USA respondents. Online recruitment only. Generational responses not reflective of national population
Personal	Kovner, et al., 2006 (USA)	Cross-sectional	1,538 American nurses working in metropolitan areas	Survey randomly mailed to examine factors that influence work satisfaction in metropolitan areas	Nurses who are Caucasian, self-perceived as healthy, working in nursing education, career oriented and have paid time off, are more satisfied	54% of the variance in satisfaction is explained by: supervisor support, work-group cohesion, variety of work, autonomy, organizational constraint, promotional opportunities, work and family conflict, and distributive justice
Personal	Moore & Dienemann, 2014 (USA)	Mixed-method	238 male nurses	Online survey to examine if JS differs between men who choose nursing as their first choice of career, as a convenience, or as a second career	No significant differences in JS found between entry paths. Second career nurses are more likely to work in specialty practice and aspire to work in advanced practice than first career nurses	Participant self-selection. Possible falsification of responses and identity. Participants with BScN or graduate degree 25% greater than national average. Participant average 10+ years of experience
Personal	Rochlen, Good & Carver 2009 (USA)	Descriptive	174 American male nurses	Online questionnaire to examine gender role conflict, social support, gender-related work barriers, and work and life satisfaction of male nurses	Participants are overall well adjusted and content with their roles and lives. Career and life satisfaction is predicted by perceptions of gender-related work barriers, conflict between work and family, social support from significant others, confidence in job skills, and comfort in physical and emotional expression with other men	Participant self-selection. Possible falsification of responses and identity. Overwhelming response from Caucasian nurses (79%) and part-time employees (84%). SAJS and GRWB scales have not yet been evaluated. Causality of variables and direction is not determined
Personal	Wilson, et al., 2008 (Canada)	Descriptive, cross-sectional	6,541 Ontario nurses	Mailed survey to Ontario nurses employed at acute-care hospitals to examine generational differences in JS	Baby boomers are significantly more satisfied with overall JS than Generation X and Y nurses as well as with pay and benefits, scheduling, and praise and recognition satisfaction (P-value <0.001)	Focused participant group limits generalizability
Cognitive	Aiken, et al., 2008 (USA)	Mixed-method	10,184 Pennsylvanian nurses and 232,342 surgical patients from Pennsylvanian hospitals	Questionnaires mailed to nurses and patient outcome data collected from selected acute-care Pennsylvanian hospitals to measure care environment outcomes including nurse JS, burnout, intent to leave, reports of quality of care, mortality, and failure to rescue in patients	Hospitals with better care environments reported more positive JS, fewer concerns with quality of care, and significantly lower risks of death and failure to rescue	Data collected from 1999. Focused participant group limits generalizability. Failures to rescue values are estimated. Causality and direction is not determined
Cognitive	Bratt & Felzer, 2011 (USA)	Repeated measures	468 newly licensed nurses employed in acute, Wisconsin hospitals	Nurses complete questionnaires at hospital at beginning of employment, 6 months, and 12 months after employment to examine their perceptions of their professional practice competence and work environment	JS is significantly lowest at 6 months and highest at 12 months. Job stress is lowest at 12 months. Organizational commitment is highest at baseline. Quality of nursing performance significantly increases with each measurement point	Study was non-experimental; therefore no control group was used to compare results. Focused participant group, and prominence of Caucasian females, limits generalizability. Completion at workplace, and in some cases, mandatory study participation enforced by workplace threatens internal validity. Use of same questionnaire at each measurement point may have created bias
Cognitive	Brown, et al., 2013 (USA)	Longitudinal, cohort	47 certified nursing assistants (CNAs) employed at an Ohio long-term care facility	CNAs participate in advanced training program and surveyed with results compared to facility data to determine if program increases job satisfaction and in turn, impact turnover rates and clinical outcomes	Overall, JS improved slightly during study period. Turnover rates significantly decreased between pre-and post-intervention periods. Resident UTIs significantly decreased	Low response rate limit reliability. Inconsistent JS scores with national average. Short observation period (2 months)
Cognitive	Lerner, 2011 (USA)	Descriptive	556 nursing assistants (NAs) from 12 Maryland nursing facilities	Existing data-set of survey results from sample used to explore factors found to influence JS	Years of experience and performance of restorative care is positively associated with JS. Self-esteem is negatively associated with JS	Parent study exclude NAs employed less than 6 months, limit generalizability. 30% refusal to participate rate also limits generalizability. Cross-sectional nature of parent study does not determine causality
Cognitive	Meyer, Raffle & Ware, 2014 (USA)	Longitudinal, ex post facto	123 CNAs employed in American LTC settings	Survey CNAs at 6 months and 1 year post-training to identify retention and turnover issues	At 1 year post-training, 53.7% were working in LTC, 30.9% worked in LTC and left, and 15.4% never worked in LTC. 58.3% of CNAs working at 6 months but not at 1 year report pay as a problematic issue to worsen over time, and 50% report lack respect/recognition as an issue	Small sample size and high attrition rate (~66% drop-out before 1 year) limit generalizability. Young and rural sample also limit generalizability
Affective	Kalisch, Tschanen & Lee, 2011 (USA)	Descriptive	3,135 nurses and 939 NAs from 10 Midwestern hospitals	Nurses were surveyed to explore the impact of missed nursing care on JS	Nurses who perceive less missed nursing care are more satisfied with their current position and occupation. Perceptions of staffing adequacy also significantly predict satisfaction	Sample limited to small hospitals. Measure of missed nursing care is based on perceptions, which is subjective to reporter bias
Affective	Mason, et al., 2014 (USA)	Non-experimental, descriptive, correlational	26 experienced, surgical ICU trauma nurses from selected hospital	Nurses complete survey to examine the effect of compassion satisfaction, compassion fatigue, moral distress, and level of nursing education on critical care nurses’ work engagement. In addition, nurses were also asked to describe sources of moral distress and self-care strategies for coping with stress	58% scored average compassion fatigue while 42% scored low. 38% scored average secondary traumatic distress while 62% scored low. On average, moral distress situations were elevated and work engagement was low. As work engagement increased, compassion satisfaction significantly increased and burnout significantly decreased. Sources of moral distress reported were role conflict with management/rules, death and suffering, dealing with violence in the ICU, dealing with family, powerlessness, physical distress, and medical vs. nursing values. Sources of coping reported were caring, helping families, long-time interdependent relationships of colleagues, and satisfaction in trauma nursing	Purposive, small convenience sample limit generalizability (power sample of 59 not achieved)
Affective	Moneke & Umeh, 2014 (USA)	Non-experimental, quantitative	204 critical care nurses employed in various ICUs across New York City healthcare organizations	Nurses complete online survey, by which they were invited to participate via email, to examine the relationship between critical-care nurses’ commitment to their organization and their overall JS	There is a significant correlation between organizational commitment and JS (r = 0.66, P = 0.00). No significant association is found between JS and demographic variables (gender, age, experience, education; F(5, 87) = 0.605, P = 0.69; ethnicity, specialty, shift; P > 0.05)	Sample limited to one American hospital. Small, purposive sample
Affective	Morrison & Korol, 2014 (Canada)	Grounded theory	9 nurses working in the maritime district for a minimum of 5 years	Nurses participate in open-ended interviews to compare nurses’ caring expectations with their caregiving experiences	Concepts of monitoring and patient advocacy are key components of reported satisfaction or alienation. Discrepancies between management care expectations and nurses' perceptions of care provision are found. Level of nursing education is related to nurses' confidence in applying skills	Use of convenience sample. Under-representation of male nurse (1 male participant). Over-representation of experienced nurses (average experience of 15 years); nurses who have high compassion fatigue would leave job. Nurses with high JS are more likely to participate in such research. Retrospective nature of questions affects accuracy and bias
Social Relationships	Brewer, et al., 2006 (USA)	Cross-sectional	25,471 female nurses working in urban USA	Secondary data from the National Sample Survey of Registered Nurses 2000 (NSSRN), the InterStudy Competitive Edge Part III Regional Market Analysis 2001, and the Area Resource File 2002 was combined to produce sample to analyze factors that are related to female nurses working or not working, and working full or part time	Age of 55 and older, other family income, and prior work experience in health care are negatively related to working as a nurse. Wage, age, children, minority status, student status, employment status, and other income negatively influences full-time work. Previous health care work has a positive effect on whether married nurses work. Married nurses who are more dissatisfied are less likely to work full time. A greater number of market-level factors influence full/part-time work than working/not working behavior	Findings not compared to rural and male nurses. Data was collected from 2000–2002 sector of nurses.
Social Relationships	Ozkara, 2014 (USA)	Concept analysis	Articles selected from 1990 to present on the concept of nurse happiness	Articles were analyzed to examine and clarify the concept of nurse happiness	Attributes of nurses’ happiness are organized into three groups: personal factors, work characteristics, and work environment. Personal factors include age, gender, marital status, race, culture, educational level, and working experience	Articles from 1990 are included in analysis
Social Relationships	Tellez, 2012 (USA)	Longitudinal	10,449–13,849 female nurses less than 65 years old working in California	Results from mailed survey at four points of time (1997, 2004, 2006, 2008) were analyzed to evaluate the effect of the nurse-to-patient ratios law on JS and to compare the results of nurse who are satisfied against those who are not	Overall JS increased significantly over time, suggesting law was associated with improved satisfaction. Satisfied nurses were more likely to have a balanced and financially secure life that included a partner, children living at home, higher hourly wages, and higher income from sources other than job. RNs working in direct patient care positions remained dissatisfied in larger proportions than nurses in other positions	Survey did not directly ask effect of law on JS. Large span of time also present other variables to influence increasing JS. Sample limited to female nurses