Sri Lankan Journal of Management

Volume 13, Nos. 3 & 4, July-December, 2008

Keys to Job Satisfaction of Nursing Officers in Government

Hospitals
Sathasivam Sridharan
Uditha Liyanage
Shirani Champika Wickramasinghe

Abstract

Staff-perceived quality of care is influenced by staff job satisfaction.

Employee perceptions of the working environment have a positive
impact on customer-perceived service quality in health care service.
Such impact is particularly important in government hospitals, where
patients have a long-term relationship with staff, and could be
vulnerable to poor quality of care. In any type of hospital, nursing
personnel constitute the largest proportion of the hospital staff. For
this reason alone, priority for the study of nurses could be justified.
It is important to find out whether the environment of an organization
(Central Ministry and Provincial Ministry hospitals) plays an
important role in determining the job satisfaction of Nursing Officers.

This is a hospital-based descriptive, cross-sectional study carried

out in selected hospitals in the Western Province. All four Central
Ministry Hospitals with medical wards were selected for the study.
Four hospitals under the Provincial Ministry of Health were selected
randomly. The main study unit was a female Nursing Officer working
in a medical ward of a selected hospital in the Western Province.
Accordingly, a sample of 170 Nursing Officers was selected from
Central Ministry and Provincial Ministry hospitals. . The data was
collected using a self-administered questionnaire, that was adopted
from an instrument developed by Traynor & Wade, to measure Job
Satisfaction of Nursing Officers in the United Kingdom.

Dr. Sathasivam Sridharan is Registrar, (Medical Administration), at the Castle Street Hospital for
Women (Teaching), Colombo 08.
Dr. Uditha Liyanage is Director, Postgraduate Institute of Management (PIM). He is also a leading
consultant and developer of managers, and sits on the boards of a number of leading companies.
Dr. (Mrs) Shirani Champika Wickramasinghe is Director / International Health at the Ministry of
Healthcare and Nutrition, Colombo 10.

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The study illustrates that there is a significant difference in the job

satisfaction of Nursing Officers between Central Ministry hospitals
and Provincial Ministry hospitals. Job satisfaction of Nursing
Officers working in Central Ministry Hospitals has a higher mean
score (3.53± 0.59) than those working in Provincial Ministry
Hospitals (3.31± 0.64). This study identified workload, professional
support, training received, and working conditions as the main
factors that influence job satisfaction among Nursing Officers. Of
these, professional support influenced job satisfaction most, while
this study revealed that opportunities for career development had
no influence on their job satisfaction.

It is evident from the study that the independent variables considered

in this study explained approximately forty percent of job satisfaction.
Therefore, it is necessary to further research those other factors
that influence job satisfaction. Recommendations are made
according to the findings of the study in order to enhance the job
satisfaction level of Nursing Officers in government hospitals.

1. Introduction

The Sri Lankan health care system is experiencing major changes, notably in its levels
of quality and safety in health care systems, within its limited resources. In the recently
held WHO's South East Asian Summit, the Organization stated that Sri Lanka has set
an example for all other regions with its excellence in the departments of hospital
administration, medical services, and patient care (Daily News, 03/09/2007).

Quality systems and quality awards - generic ones or designed specifically for health
care systems - increasingly address continuous human resources development and
the availability of highly motivated and quality-oriented staff as a precondition for the
quality systems of an organization to be certified, recognized or awarded. Due to the
anticipated significant impact of human resources management on the quality of services,
and its increasing coverage in formalized quality systems, it is essential that a healthcare
establishment pays attention to the quality of human resources in the early stages of
the development of a quality system. Giving attention to the creation of job satisfaction
for staff is then a fundamental component of human resources management.

All activities of a hospital are carried out by the staff, and the standard of service,
patient care, etc. are dependent on employee satisfaction levels. It is vital that people
participate effectively, both as individuals and as team members, with respect to
performance and rapid adaptation to change; and hospital physicians and other staff

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 Keys to Job Satisfaction of Nursing Officers

possess valuable knowledge about the performance of their organization and

opportunities for improvement.

Job satisfaction represents the degree to which nurses like or enjoy their jobs, which is
an essential issue for both employees and employers. It leads to less job turnover,
increased staff productivity, and greater patient satisfaction. Nursing and hospital
administrators need to focus on ways to increase job satisfaction, and thus improve
the performance, and thereby raise the level of quality of patient care. Job satisfaction
is an important factor in increasing the level of work performance and career
aspirations. It is noted in the literature that there is a high correlation between job
satisfaction, commitment and better performance (Culphan et al, 2002). There is a
strong relationship between emotional exhaustion, staff conflict and job dissatisfaction
(Piko, 2006).

2. Purpose of the Study

The importance of Human Resource Management (HRM) to the success or failure

of health system performance has, until recently, largely been overlooked. Health
sector reform in many countries in the 1990s focused mainly on structural change,
cost containment, the introduction of market mechanisms, and consumer choice, but
little direct attempt has been made to address human resource aspects (Buchan, 2004).

Human resource management in health would have to function in a sector with some
unique characteristics. The workforce is large, diverse, and comprising separate
occupations often represented by powerful professional associations as well as trade
unions. Some personnel have sector-specific skills, while others could readily move
from the health sector to employment in other sectors. The main avowed commitment
of those with sector-specific skills and qualifications (physicians, nurses, etc.), are
towards their profession and patients (ibid et al, 2004).

The Chief Nursing Officer, Calgary Health Region of Canada, says that “nurses play
an important role in the health care system, and we know that it is important to maintain
a positive and rewarding work environment for nurses and all health care workers.
Job satisfaction studies are an excellent tool to help nurses and management achieve
this goal. It supports the region's efforts to retain and attract nurses and to provide the
best possible care for the community (Calgary Health Region, 2005)”. This statement
can be applied anywhere, and in the Sri Lankan context, too.

Many researchers have demonstrated strong positive correlations between job

satisfaction of medical staff and patient satisfaction, and the service levels in such
health care settings (Leiter et al 1998).

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Consequently, by creating an environment that promotes job satisfaction, a health care

manager can develop employees who are motivated, productive and fulfilled. This in
turn will contribute to higher quality patient care and patient satisfaction (Kaldenberg,
1999). The Nursing Officers are usually in the wards for 24 hours in a day on a shift
basis. This means they are the category of health care workers who are with the
patients most of the time. They function as the bridge between Medical Officers and
patients, too. Therefore, job satisfaction of Nursing Officers is a highly important
factor contributing to patient satisfaction. This is, indeed, critical to the process of
attracting external customers through internal customers.

In any type of hospital, nursing personnel constitute the largest proportion of the hospital
staff. For this reason alone, priority for the study of nurses could be justified
(Nanayakkara 1988). This study intends to find out the job satisfaction levels of Nursing
Officers in Central Ministry and Provincial Ministry hospitals. The study attempts to
discover the factors affecting job satisfaction of Nursing Officers. Through this study,
inhibitors as well as boosters of job satisfaction will be highlighted.

In Sri Lanka, there are many studies done on patient satisfaction but may be only a
few studies on job satisfaction of hospital employees.

3. Research Objectives

General objective

To assess the effect of selected variables on job satisfaction of Nursing Officers in

Central and Provincial Ministry hospitals, using a conceptualized model.
Specific objectives

1. To compare the job satisfaction of Nursing Officers in hospitals of the Central

Ministry and Provincial Ministry; and

2. To conceptualize a model that describes job satisfaction of Nursing Officers.

4. Overview of Central Ministry Hospitals and Provincial Ministry Hospitals

The health services of the Government function under a Cabinet Minister. With the
implementation of the Provincial Councils Act in 1989, health services were devolved.
This resulted in the Ministry of Health at the national level and separate Provincial
Ministries of Health in the eight provinces.

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The Central Ministry of Health is primarily responsible for the protection and promotion
of people's health. Its key functions are setting guidelines, providing medical and
paramedical education, management of teaching hospitals, tertiary care hospitals and
specialized institutions, and bulk purchase of medical requisites.

The eight Provincial Directors of Health Services (PDHS) are totally responsible for
the management of hospitals (District General, Base and District Hospitals, Peripheral
Units, Rural Hospitals and Maternity Homes), and outpatient facilities such as Central
Dispensaries and Visiting Stations. During 2003, there were twenty-six Deputy
Provincial Directors of Health Services (DPDHS) to assist the eight Provincial
Directors of Health Services (Annual Health Bulletin, 2003).

The Central Ministry and Provincial Ministry hospitals are curative care institutions,
even though there is a difference in the administration, size and the range of facilities
provided. It is observed that there are advantages and disadvantages in both forms of
hospitals. Some of these are:

• Personal files are maintained at the institutional level in Central Ministry Hospitals,
while in Provincial Ministry Hospitals personal files are maintained at the DPDHS
office that may be located far away from the hospital. Therefore, increments
and promotions are done at the right time in Central Ministry Hospitals, in contrast
with Provincial Ministry hospitals. Also, in most of the Central Ministry hospitals
overtime payment and allowances are paid punctually; in these hospitals
departmental loans, too, can be obtained quickly.

• In Provincial Ministry hospitals, the employees, especially the Nursing Officers,

commute from home. Therefore, they may be able to spend more time with
their families;

• Supplies and repairs of instruments are quicker in Central Ministry Hospitals

than in Provincial Ministry hospitals. This is mainly due to quick decision making
directly in the Central Ministry hospitals, whereas in Provincial Ministry hospitals
decisions are made away from the institutions; and

• The procedure of condemning items is easy in Provincial Ministry Hospitals in

comparison with Central Ministry hospitals, especially those Central Ministry
hospitals located far away from Colombo (Karandagoda, 2007).

Therefore, it is important to find out whether the environment of an organization

(Central Ministry and Provincial Ministry hospitals) plays an important role in
determining the job satisfaction of Nursing Officers.

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5. Literature Review

Job satisfaction is an integral component of organizational climate, of which an important

element is managing employee relationships. The assessment of employee attitudes
such as job satisfaction has become a common activity in organizations in which
management is concerned with the physical and psychological well-being of the people.
Satisfaction results when a job fulfils or facilitates the attainment of individual values
and standards. Dissatisfaction occurs when the job is seen as blocking such attainment.
This attitude has received extensive attention from researchers and practitioners
alike, because it was at one time, believed to be the cause of improved job performance.
Recent research questions negate such a relationship and suggest a more complicated
interaction between satisfaction, commitment, turnover and productivity. Now, because
of the managers concern for creating both a humane and high performance workplace,
researchers continue to search for definite answers about the causes and consequences
of job satisfaction. For example, recent research suggests that employee involvement
in information processing, decision making and problem solving have only a small,
although statistically significant, effect on job satisfaction (Gordon, 2000).

Job satisfaction is good not only for employees but for employers too; as job satisfaction
increases productivity and decreases staff turnover. Satisfied employees tend to be
more productive, creative and committed to their employers.

Why Job Satisfaction is Important?

Rao (1996) stated several reasons for the importance of job satisfaction:

• Job satisfaction has certain relations with the mental health of the people. When
an employee finds less satisfaction in his work, he may suffer from personality
problems. Both scientific studies and casual observations provide ample evidence
that is important for psychological adjustments, and the happiness of an individual;

• Job satisfaction has some degree of positive correlation with the physical health
of the individual;

• It spreads goodwill in relation to the organization;

• Individuals can live with the organization; and

• It reduces absenteeism and turnover.

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6. Determinants of Job Satisfaction

Workload

The content of work itself is a major source of satisfaction. For example, research
related to the job characteristics approach to job design shows that feedback from the
job itself and autonomy are two of the major job-related motivational factors. Recent
research has found that such job characteristics and job complexity mediate the
relationship between personality and job satisfaction, and if the creative requirements
of employees' jobs are met, then they tend to be satisfied (Luthans, 2002).

The amount of work to be performed is a significant stressor for many workers. Both
overload and under-load can generate psychological (and physical) strain. In 1908,
Yerkes and Dodson proposed their now well-known Yerkes-Dodson Law, which states
that there is an inverted U relationship between the amount of work required of a
person and his or her health and performance. Each individual, therefore, has an
optimal band of workload. Substantial deviations above or below this optimal band are
likely to induce strain (Cooper et al 2001).

Professional support

Collaboration between health professionals is an integral part of nursing practice.

Collaboration is a process which stresses joint involvement in the decision-making
process to meet the goals of patient needs related to wellness and illness (Henneman
et al, 1995). In creating an optimal working relationship, physicians and nursing
practitioners (NPs) need to have a clear understanding of the nursing practitioner's
role. Sellards and Mills (1995) stated: "Unclear boundaries between nursing Practitioners
(NPs) and physicians may cause tension." The scope of practice of NPs includes a
broad spectrum of direct interventions with clients, including health assessment, risk
appraisal, health education and counselling, diagnosis and management of acute minor
illness and injuries, and management of chronic conditions. The roles of the health
team members are not to be viewed as substitutive, but collaborative. A meaningful
and open working relationship rests on the ability of nursing practitioners, physicians,
and other health team members to appreciate the uniqueness of their and each other's
roles to provide the best care for the patients (Carroll & Fay, 1997).

Training received

Effective organizations seek to create alignment between the needs, wants, and
expectations of their customers; the organization's strategies, goals, and objectives;
and the day-to-day activities of their employees. Part of creating alignment is ensuring
that employees have the appropriate education and training that enables them to perform

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their job requirements, at a level that supports the customer's ultimate needs, wants,
and expectations. A part of this education and training should include information
about how quality, cost, schedule, and profit expectations for their job affect customer
satisfaction. Effective employees understand the impact their job has on each of these
concepts. They are involved in the decisions that affect their jobs (Summers, 2005).

Remuneration

Wages and salaries are recognized to be a significant but cognitively complex and
multi-dimensional factor in job satisfaction. Money not only helps people attain their
basic needs; it is also instrumental in providing upper-level need satisfaction. Employees
often see pay as a reflection of how management views their contribution to the
organization. Fringe benefits are also important, but they are not as influential. One
reason undoubtedly is that most employees do not even know how much they are
receiving in benefits. Moreover, most tend to undervalue these benefits because they
do not realize their significant monetary value. However, research indicates that if
employees are allowed some flexibility in choosing the type of benefits they prefer
within a total package, called a flexible or cafeteria benefits plan, there is a significant
increase in both benefits - satisfaction and overall job satisfaction (Luthans, 2002).

Career development

Career development is one category of potential stressors that includes job insecurity,
perceived under-promotion or over-promotion within the organization, and a general
sense of lack of achievement of one's goals and ambitions. For many employees, the
linear career development path is no longer a feasible, or perhaps even desired, option.
There is a growing body of evidence that a perceived lack of promotion opportunities
and lack of progress in one's career represent primary sources of job dissatisfaction,
and hence may function as major stressors for many people.

There is also substantial evidence that despite changes in societal attitudes concerning
equal employment opportunities, women and minority groups still encounter
organizational barriers to their career development, which inevitably will lead to higher
levels of psychological strain for these groups of employees. (Cooper et al, 2001)

Working condition

Working conditions have a modest effect on job satisfaction. If the working conditions
are good (clean, attractive surroundings, for instance), personnel will find it easier to
carry out their jobs. If the working conditions are poor (hot, noisy surroundings, for
example), personnel will find it more difficult to get things done. In other words, the
effect of working conditions on job satisfaction is similar to that of the work group. If

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things are good, there may or may not be a job satisfaction problem. Most people do
not give working conditions a great deal of thought unless they are extremely bad.
Additionally, when there are complaints about working conditions, these are sometimes
really nothing more than manifestations of other problems (Luthans, 2002). Employees
are concerned with their work environment for both personal comfort and for facilitating
doing a good job. They prefer physical surroundings that are safe, comfortable, clean,
and have a minimum degree of distractions (Robbins, 2003).

Conceptualization

Although there are many factors affecting job satisfaction, for the purpose of this
study, some of the key areas which may be most relevant are considered. Fredrick
Herzberg's Dual-Factor theory of job satisfaction and motivation provided the idea for
the conceptual framework for this research study. Herzberg's theory categorizes affects
in the work places as either extrinsic factors - such as salary and supervision - or
intrinsic factors - such as achievement and autonomy that influence job satisfaction.
The key concepts were developed through the literature review. Further, two focus
group discussions and brain storming sessions were held to validate these concepts.
After the focus group discussions, the variables not appropriate to the Sri Lankan
context were removed, while the variables relevant to the Sri Lankan context were
included for the study.

With the knowledge gained from the literature review and information from the focus
group discussions, the following concepts were identified for the study:

• Socio-demographic characteristics;
• Job satisfaction;
• Workload;
• Professional support;
• Career development;
• Training received;
• Remuneration; and
• Working conditions

This study will determine whether any moderating factors affect job satisfaction. The
conceptual framework is shown in the following Figure.

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Figure 1: Conceptual Framework

Factors affecting
Job Satisfaction

Workload

Professional
• Central Ministry
Hospitals
Remuneration
Moderating
Factor • Provincial Ministry
Career Hospitals

Training Received
Job Patient
Satisfaction Satisfaction
Working Condition

Scope of study

Hypothesis

H1 - Nursing Officers working in Central Ministry hospitals are more satisfied than
Nursing Officers working in Provincial Ministry hospitals.

7. Methodology

Of the nine provinces in Sri Lanka, hospitals of the Western Province were selected
as the study setting, because of the easy access to the principal investigator.

Only those hospitals that have medical wards with consultant coverage were selected.
Usually medical wards are more overcrowded and have a high turnover rate than
other wards irrespective of the type of hospital. To avoid any bias related to the
specialty concerned only the medical wards are selected for this study. There are
four Central Ministry hospitals and seven Provincial Ministry hospitals with specialist
medical care located in the Western Province. Of these seven Provincial Ministry
hospitals, four were randomly selected. As only five percent of the nurses were male
nurses in government hospitals in Sri Lanka, it was decided to select only female
Nursing Officers as the study population.

Appropriate formula and Epi Info are used to calculate the sample size. It was found
out that 74 Nursing Officers from the Central Government hospitals and 74 Nursing
Officers from the Provincial Ministry hospitals need to be studied. An allowance of
15% was added for non-respondents. The final sample was 85 Nursing Officers selected

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from each category of hospitals. A population proportionate to the size method was
used to select nurses from each hospital.

The data was collected using a self-administered questionnaire. The questionnaire

consisted of two parts:

1. Section on socio-economic characteristics.

This part comprised seven questions on socio-economic characteristics. The
information collected was on age, gender, marital status, number of children,
service period in the department, and the current hospital.

2 Section on attitude of the employee to certain selected aspects of the job.

This part consisted of 34 questions, mainly focused on the attitude of the employee
on certain selected aspects of the job. The responses to these questions were
assessed on a Likert Scale that has five ratings, i.e., very dissatisfied, dissatisfied,
neither dissatisfied nor satisfied, satisfied, and very satisfied. Some questions
were directed towards a positive reply, while others were towards a negative
reply. There were twenty-four positive and ten negative questions.

The Principal Investigator checked the data collected before it was fed into the computer
for analysis. The data was checked for missing and unused values. The data entry
was carried out in MS-Access. Before the analysis the computer base was screened
for possible data entry errors. An analysis of the data was carried out manually as
well as with the aid of computers. The software package used for this study was MS-
Excel, MS-Access and SPSS / PC+.

Ethical Issues

There were no anticipated risks or direct benefits for the participants in this study. The
participants shared personal and confidential information with the researcher. They
were given the assurance that their identities would not be revealed and also that the
data would not be processed in terms of individuals, but as groups. Appropriate
ethical approval was obtained from the Faculty of Medicine, University of Colombo,
and the relevant authorities.

Analysis and Findings

A test-retest was carried out to find the reliability over time. A paired ‘t’ test was used
to find out whether each variable in the questionnaire was reliable. It is considered
that if the 'p' value is more than 0.05, then the variable in the questionnaire is reliable.
Test-Retest Reliability revealed that the significance level for paired sample correlation
and paired samples test is more than 0.05 for all the variables. Therefore, the

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questionnaire is reliable over time. In this study Cronbach's D coefficient is 0.86, and
therefore, this questionnaire can be regarded as reliable.

Description of the Sample

Of the total calculated sample size (n = 170), only 164 participated in the study (dropout
rate - 4.12%). The difference between the calculated sample size and the actual
sample size was due to various reasons. Days off, leave, absence and hospitalized for
treatment are a few of them. The following Table shows the demographic characteristics
of the sample that participated in the study.

Table 3: Selected Demographic Characteristics between Central Ministry and Provincial

Ministry Hospitals
Type of Hospital
Central Ministry Provincial Ministry
Age Hospital Hospital

< 36 years (n = 95) 53 (63.86%) 42 (52.5%)

36 - 45 years (n = 43) 19 (22.89%) 24 (30.0%)
> 45 years (n = 25) 11 (13.25%) 14 (17.5%)

Marital Status

Unmarried (n = 47) 27 (32.53%) 20 (25.0%)

Married (n = 115) 55 (66.27%) 60 (75.0%)
Widow(er) (n = 1) 1 (1.2%) 0 (0.0%)

Number of Years in the Department

< 5 years (n = 46) 21 (25.3%) 25 (31.25%)

5 - 8 yrs. (n = 42) 27 (32.53%) 15 (18.75%)
9 - 12 Yrs. (n = 17) 10 (12.05%) 7 (8.75%)
13 - 16 Yrs (n = 25) 7 (8.43%) 18 (22.5%)
17 - 20 Yrs. (n = 11) 6 (7.23%) 5 (6.25%)
> 20 years (n = 22) 12 (14.46%) 10 (12.5%)

Number of Years in the Present Hospital

< 5 years (n = 69) 26 (31.33%) 43 (53.75%)

5 - 8 years. (n = 47) 25 (30.12%) 22 (27.5%)
9 - 12 years. (n = 14) 10 (12.05%) 4 (5.0%)
13 - 16 years (n = 18) 12 (14.46%) 6 (7.5%)
> 16 years (n = 15) 10 (12.04 %) 5 (6.25 %)

Total 83 (100%) 80 (100%)

Source: Survey data

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The Chi Square test indicated that of these demographic characteristics, probably
there is a significant association between the service period of the Nursing Officers in
the hospital where the study was carried out, and the type of hospital (Central and
Provincial Ministry hospital).

8. Job satisfaction in Government Hospitals in the Western Province

The job satisfaction level of Nursing Officers in four Central Ministry hospitals and
four Provincial Ministry hospitals were measured. Table 4 gives the overall picture of
the job satisfaction in Central Ministry and Provincial Ministry hospitals.

Table 4: Level of Job Satisfaction at Central Ministry Hospitals and Provincial Ministry
Hospitals

Type of Hospital Mean

Central Ministry Hospitals (n = 83) 3.53± 0.59

Provincial Ministry Hospitals (n = 80) 3.31± 0.64

Total (n = 163) 3.42±0.63

Source: Survey data

The mean score of job satisfaction was 3.42 for selected government hospitals. The
Nursing Officers working in Central Ministry hospitals have a mean score of 3.53;
this indicates a higher satisfaction level as compared with the Nursing Officers working
in Provincial Ministry hospitals (where mean job satisfaction score is 3.31).

To verify the relationship of job satisfaction between the Nursing Officers of the two
types of hospitals, ANOVA was used. The F score was 4.966, and the probable
significance value for one-way ANOVA was 0.027, which is less than the five percent
significant level. Therefore, we reject the null hypothesis stating that there is no
difference in job satisfaction between Nursing Officers in Central Ministry hospitals
and those in Provincial Ministry hospitals.

The results show that there is a possibility of a difference in job satisfaction between
Nursing Officers working in Central Ministry hospitals and Provincial Ministry hospitals.
When job satisfaction was compared with the mean value the Nursing Officers in
Central Ministry hospitals were found to be more satisfied than the Nursing Officers
in Provincial Ministry hospitals.

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9. Relationship between Job satisfaction and Independent variables

Job satisfaction in Central Ministry hospitals and Provincial Ministry hospitals was
analyzed using Pearson's correlation coefficient, simple linear regression and multiple
regression analysis. Many studies on job satisfaction had used Pearson's correlation
coefficient to find out the relationship between job satisfaction and other independent
variables (Adams, 2000, Chu, 2003).

Table 5: Correlation Coefficient in Central Ministry and Provincial Ministry Hospitals

Workload Professional Training Remuneration Career Working

Support Received Development Condition

Central Ministry Hospitals

Pearson Job
correlation Satisfaction 0.189 0.532 0.395 0.274 0.172 0.370

Significance Job
(1-tailed) Satisfaction 0.043 0.001 0.001 0.006 0.061 0.001

Provincial Ministry Hospitals

Pearson Job
correlation Satisfaction 0.416 0.479 0.234 0.292 0.123 0.358

Significance Job
(1-tailed) Satisfaction 0.001 0.001 0.018 0.004 0.138 0.001

Source: Survey data

Table 5 indicates that in Central Ministry hospitals, the probable significance value for
job satisfaction and professional support is 0.001, which indicates that the correlation
is significant, and the value of the Pearson correlation is (0.532) high. Therefore, we
can conclude that there is linear relationship between job satisfaction and professional
support. Although other dependent variables have a low probability significance value
(< 0.05), the value of Pearson's correlation between the dependent variables and job
satisfaction is low. Further, the probable significance value for job satisfaction and
career development is > 0.05 (0.061), indicating that there is no significant correlation
between them.

In Provincial Ministry hospitals, the significance level of correlation between job

satisfaction and independent variables is less than 0.05 except for career development
(where the significance level is 0.138). Professional support and workload have a

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high Pearson correlation. Therefore, we can conclude that there is a linear relationship
between job satisfaction and professional support as well as workload. Further, the
probable significance value for job satisfaction and career development is 0.123 (>
0.05), indicating that there is no significant correlation between them.

It reveals that professional support is the most important factor in determining job
satisfaction in both Central and Provincial Ministry hospitals. Workload has contributed
little to job satisfaction in Central Ministry hospitals, whereas in Provincial Ministry
hospitals it was the second most important factor in determining job satisfaction. Career
development has contributed the least to job satisfaction in both types of hospitals, and
it is not significant too.

The analysis is carried out further using simple linear regression. The value of R2
between job satisfaction and factors affecting job satisfaction using simple linear
regression is given in the following table:

Table 5.28: R2 between Job Satisfaction and Factors affecting Job Satisfaction using
Simple Linear Regression

Type of Variables Wor k Professional Training Remun- Career Wo rking

Hospital load Support Received eration Development Condition

Central Job
Ministry Satisfaction 0.04 0.28 0.16 0.08 0.03 0.14
Hospital

Provincial Job
Ministry Satisfaction 0.17 0.23 0.05 0.09 0.02 0.13
Hospital

Source: Survey data

R Square is the coefficient of determination, interpreted as the percentage of variance

in Y that can be explained by X. For example, an "R Square" of 0.04 (workload in
Central Ministry hospitals) in the above Table indicates that only four percent of the
variance in job satisfaction can be explained by the workload in Central Ministry
hospitals, which is 17 percent in Provincial Ministry hospitals. Likewise, assumptions
can be made for the variance in job satisfaction that can be explained by the other
independent variables too.

According to simple linear regression, professional support, training received and

working conditions were found to be important determinants of job satisfaction in
Central Ministry hospitals and professional support, workload and working conditions
were found to be important determinants of job satisfaction in Provincial Ministry
hospitals.

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The analysis was further carried out using Multiple Linear Regression. Table 5.14
summarizes the multiple regression model for job satisfaction of Nursing Officers
working in Central Ministry and Provincial Ministry hospitals.

Table 5.14: Multiple Regression Model Summary (Central Ministry Hospitals)

R R2 Adjusted R2 Standard Error of

the Estimate

Central Ministry Hospitals

0.618 0.382 0.333 0.4818

Provincial Ministry Hospitals

0.580 0.337 0.282 0.546

Source: Survey data

Since R2 = 0.382 in Provincial Ministry hospitals, this indicates that 38.2% of the
variables can be explained by this multiple regression model, whereas it is 33.7% in
Provincial Ministry hospitals. It indicates that some other important variables should
be included in this model.

However, R Square tends to somewhat over-estimate the success of the model when
applied to the real world. Therefore, an Adjusted R Square value is calculated which
takes into account the number of variables in the model and the number of observations
(participants) our model is based on. This Adjusted R Square value gives the most
useful measure of the success of our model (Brace, 2006). This study has an adjusted
R Square value of 0.333 according to which we can say that our model has accounted
for 33.3% of the variance in the dependent variable in the Central Ministry hospitals
and 28.2% in Provincial Ministry hospitals.

A multiple regression model for Central and Provincial Ministry hospitals was also
developed.

y = D + E1 x1 + E2 x2 +E3x3+E4x4 + E5x5 + E6x6 + H

Where y is job satisfaction

x is independent variable

E is the regression coefficients (or E coefficients) representing the independent

contributions of each independent variable to the prediction of the dependent variable.

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The Beta value is a measure of how strongly each independent variable influences the
dependent variable. Beta is measured in units of standard deviation (Brace, 2006).

H is error

The Multiple Regression Model for Central Ministry hospitals is:

y = 1.098 - 0.135 (Work load) + 0.388 (Professional support)

+ 0.290 (Training received) + 5.004E-02 (Remuneration)
+ 3.298E-02 (Career development) + 0.191 (Working condition) + H

To identify the probable significance level of the multiple regression, ANOVA was
used. The F score was 7.8255 and the probable significance value for one way ANOVA
was 0.001, which is less than the five percent significant level. Therefore, the fitness
of the model can be correct.

The Multiple Regression Model for Provincial Ministry hospitals is:

y = 1.035 + 0.366 (Workload) + 0.290 (Professional support)

- 0.114 (Training received) + 0.135 (Remuneration)
- 0.0712 (Career development) + 0.194 (Working condition)

To identify the probable significance level of the multiple regression, ANOVA was
used. The F score was 6.183 and the probable significance value for one way ANOVA
was 0.001, which is less than the five percent significant level. Therefore, the fitness
of the model can be correct.

10. Discussion

Job satisfaction of Nursing Officers working in Central Ministry hospitals has a higher
mean score (3.53± 0.59) than those working in Provincial Ministry hospitals (3.31±
0.64). The ANOVA test illustrates that this difference is significant. Considering that
the basic socio-demographic characteristics are similar in both groups, Nursing Officers
working in Central Ministry hospitals show a higher degree of job satisfaction. The six
independent variables that are selected in this study had influenced job satisfaction
differently in Central Ministry and Provincial Ministry hospitals.

The present study was compared with the studies on job satisfaction in other countries.
Some counties show a higher job satisfaction for nurses while others do not. From
this study, it is evident that the job satisfaction level of Nursing Officers in Provincial
Ministry hospitals (3.31± 0.64) is somewhat similar to the job satisfaction of Nursing

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Officers in Taiwan, where their mean score for job satisfaction on a 5-point scale was
3.32, and 0.28 being the standard deviation (Tzeng et al, 2002). The Nursing Officers
of Jordan and South Korea have a job satisfaction level less than Nursing Officers
working in Provincial Ministry hospitals in the Western Province of Sri Lanka. In a
study done in Jordanian public hospitals, the nurses were moderately satisfied with a
mean equal to 2.85 on a 5 point Likert scale (Mrayyan, 2005). Song et al (1998)
showed that the level of work satisfaction among Korean hospital nurses (n = 225) is
moderate or average (mean=3.06, range = 1-5). Job satisfaction of Nursing Officers
working in government hospitals in the Western Province (3.42±0.63) is almost similar
to that of Nursing Officers in Hong Kong. In Hong Kong, nurses were more dissatisfied
than satisfied, as indicated by the total scale mean of 3.46 in a 5-point range (Lee,
1998). The average job satisfaction score for nurses in Turkey was 3.8±0.5 (Bodur,
2002).Their job satisfaction is higher than that of the Nursing Officers working in
Central Ministry hospitals in the Western Province, Sri Lanka.

11. Job satisfaction and workload

In Central Ministry hospitals, the correlation between job satisfaction and workload
was 0.18, with 0.04 being the significance level between them. Of all independent
variables, only career development had a lesser correlation than the workload in Central
Ministry hospitals while other independent variables had a higher correlation with job
satisfaction.

In contrast, the Provincial Ministry hospitals had a correlation of 0.41 between job
satisfaction and workload, while 0.001 was the significance level. That is, workload
has contributed to job satisfaction more in the Provincial Ministry hospitals. These
findings were supported by the simple linear regression, too. Workload explains only
four percent of variance in job satisfaction in the Central Ministry hospitals, whereas
it is 17% in Provincial Ministry hospitals.

Workload reflects the way work is organized and led in the wards, but is probably
better explained by external factors such as population health status and hospital
capacities in each hospital's catchment area, the referral patterns of the local doctors,
and the emergency admittance profile of each unit. (Krogstad et al, 2005).

Workload has higher linear correlation in Provincial Ministry hospitals than in the Central
Ministry hospitals. Since the Central Ministry hospitals are tertiary care centres, all
the patients with complications are treated in these institutions. More attention is needed
to care these patients. Further, at weekends usually there are more transfers from the
Base Hospitals to the Central Ministry hospitals (Weerasinghe, 2005). In addition, the
catchment area of the Teaching Hospitals is larger when compared with the Provincial

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 Keys to Job Satisfaction of Nursing Officers

Ministry hospitals. Due to these reasons, workload is higher in the Central Ministry
hospitals. This may be the reason for weak correlation between workload and job
satisfaction in the Central Ministry hospitals.

The Provincial Ministry hospitals have only one or two medical wards. These hospitals
are not Teaching Hospitals. However, of the four Central Ministry hospitals where
this study was conducted, three hospitals (excepting the General Hospital, Kalutara)
have more than two medical wards. In addition, these three hospitals are Teaching
Hospitals. In Teaching Hospitals, usually a Nursing Officer has to spend more time
due to two or more ward rounds and prolonged ward rounds. Apart from this, these
tertiary care hospitals have more in-ward investigation and therapeutic procedures
when compared with the Provincial Ministry hospitals. These aspects also increase
the workload of Nursing Officers working in the Central Ministry hospitals.

12. Job satisfaction and professional support

The correlation between job satisfaction and professional support is 0.53 (significance
level - 0.001) in the Central Ministry hospitals and 0.479 (significance level - 0.001) in
Provincial Ministry hospitals. In the Central Ministry hospitals 28% percent of variance
in job satisfaction can be explained in terms of professional support, whereas it is
23% in the Provincial Ministry hospitals. In both hospitals, professional support had
the highest correlation coefficient out of all the independent variables.

Aiken et al (2001) found variation in nurse - job - satisfaction between hospitals related
to staffing and professional support. The present study discloses that the mean of
professional support in the Provincial Ministry (3.09±0.55) is lower than in the Central
Ministry hospitals (3.25±0.59). This may be one of the causes for lower job satisfaction
of Nursing Officers in the Provincial Ministry hospitals than in the Central Ministry
hospitals.

Other studies related to job satisfaction and professional support were also reviewed.
Nurses were moderately (mean - 3.4 on a 5-point Likert scale) satisfied with co-
workers such as immediate supervisors and nursing peers, physicians, and the delivery
care system in a study done in Jordan (Mrayyan, 2006). Nurses in Turkey had a mean
of 3.6 ± 1.1 for the way co-workers get along with each other (Bodur, 2002). In
Western Australia, professional support had a mean score of 3.669 with a standard
deviation of 0.934 in a staff satisfaction survey of nursing homes. This was the highest
mean score among all the other satisfaction components, such as personal job
satisfaction, workload, and team spirit (Chou, S C et al, 2003), whereas in the present
study the mean score of professional support is less than in the studies described
above.

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In both the Central and Provincial Ministry hospitals too professional support had a
higher correlation with job satisfaction when compared with the other independent
variables. The largest coefficient involved was in the case of the professional support,
suggesting that the more people are jointly involved with the other categories of staff
in the decision-making process, the more likely they are to be satisfied with their job in
both types of hospitals. Thus, the present study suggests that professional support can
play a central role in driving all other aspects of staff satisfaction. From this it can be
noted that Belongings Needs of Maslow's hierarchy of needs dominates the Nursing
Officers in the Western Province of Sri Lanka.

13. Job Satisfaction and training received

In the Central Ministry hospitals, the correlation between job satisfaction and training
received was 0.395, with 0.001 being the significance level between them, whereas in
the Provincial Ministry hospitals, the correlation was 0.234 with 0.018 being the
significance level between them. In the Central Ministry hospitals, 16% of variance in
job satisfaction can be explained by the training received, while in the Provincial Ministry
hospitals it is only five percent.

Training received has a higher linear correlation in the Central Ministry hospitals but,
this relationship is weak in the Provincial Ministry hospitals. This may be due to less
opportunity for the Nursing Officers working in the Provincial Ministry hospitals to
attend training programmes. Further, in this study, three Central Ministry hospitals
selected were Teaching Hospitals. Usually, in Teaching Hospitals, there are more
training sessions and on the job training than in the other hospitals.

Overseas studies were also reviewed. Owings (1999) found that among Family Nursing
Practitioners in the United States Air Force, 20 to 25% cited dissatisfaction with funding
and availability of time for them to attend training programmes. In Western Australia,
training had a mean score of 3.303 with a standard deviation of 0.941 in a staff
satisfaction survey in nursing homes (Chou, S C et al, 2003). In the present study,
training had a mean score of 3.25±0.57 in the Central Ministry hospitals and 3.21±0.57
in the Provincial Ministry hospitals.

In a study done in the West Coast of the USA, the correlation between training and
job satisfaction was -0.317 (Cavanagh, 1992), whereas in this study the correlation
between job satisfaction and training is positive as seen in the Central Ministry hospitals
(0.395) and the Provincial Ministry hospitals (0.234).

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14. Job satisfaction and remuneration

The correlation between job satisfaction and remuneration was 0.27 with 0.006 being
the significance level between them in the Central Ministry hospitals, and it was 0.292
with 0.004 being the significance level between them in the Provincial Ministry hospitals.
In the Central Ministry hospitals eight percent of variance in job satisfaction can be
explained in terms of remuneration, whereas it is only nine percent in the Provincial
Ministry hospitals. It is noted that in the Central Ministry hospitals, job satisfaction had
a higher correlation with professional support, training received and working conditions,
than with remuneration. In Provincial Ministry hospitals, workload, professional support
and working conditions had a higher correlation with job satisfaction than with
remuneration. From these findings, it is evident that remuneration is not the main
factor related to job satisfaction. This may be due to increments being mainly based
on seniority and not on performance. Further, Nursing Officers are aware that the
salary will be paid on time. There may be delay in getting overtime payments and
allowances, but they will definitely be paid.

There is currently a shortage of Nursing Officers in Sri Lanka. To cover this shortage,
extra duties are assigned to the Nursing Officers, and payment is made for overtime
worked. In-depth interviews with Nursing Officers reveal that most of the Nursing
Officers do not enjoy their extra duty. They prefer their family commitments to the
extra duty payment.

A study in Australia reveals that with regard to remuneration, it was apparent that
nurses report dissatisfaction with pay rates. It further says that length of employment
can influence nurses' perceptions of the adequacy of remuneration. This finding is
important as it was the newly employed nurses who were most dissatisfied (Hegney
et al, 2006). In Taiwan, pay does not have a significant correlation with job satisfaction
(Chu et al, 2003).

Numerous reports suggest that many nurses feel that they are underpaid (California
Health Care Foundation, 2001). Compensation and benefits were identified as one of
five challenges that hospitals must meet in their efforts to improve the workplace
partnership. Canadian researchers provide evidence that while there is a correlation
between job satisfaction and economic factors, the correlation was weak. (Andrews,
2005). In a Canadian study of pay satisfaction mean scores on a 1-7 point scale was
3.45 in the year 2000 and 3.13 two years later. In the years 2000 and 2002, pay ranked
second in the Nurses' Job Satisfaction criteria (Best, 2006).

Cavanagh (1992) found that the fact that salary was only weakly associated with job
satisfaction fuels the debate about this variable. Many conflicting findings have been
reported in the literature. Froebe et al (1983) and Munro (1983) found that pay was

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not a highly regarded feature of work. A study carried out in Ireland reveals that pay
had contributed least to job satisfaction (Curtis, 2007). In the present study too,
remuneration is weakly associated with job satisfaction. It is evident from the literature
that pay is an important factor in job satisfaction. Yet, research findings have
demonstrated small correlations between pay and job satisfaction (Curtis, 2007;
Gruneberg (1979).They suggest: 'Money seems to be so central to our thinking in
relation to our jobs that it leads one to be suspicious about research findings, which
report money as being of relatively low importance. The reason for the difference
between actual and reported importance of money might well be due to people distorting
their replies to questionnaires. It may well be for example that many individuals do not
think it 'proper' to admit that their main motivation for working is financial, rather than
for the intrinsic interest of the job itself.'

This viewpoint may well explain why pay contributed least to respondents' current
level of job satisfaction. This may be true in this study too.

15. Job Satisfaction and career development

In this study, the correlation between job satisfaction and career development is not
significant in Central and Provincial Ministry hospitals. In Central Ministry hospitals,
three percent of variance in job satisfaction can be explained in terms of career
development, whereas in Provincial Ministry hospitals it is only two percent.

The results indicate that the value of the Pearson correlation is not significant when
types of hospital were analyzed. This is mainly because in Sri Lanka, Nursing Officers
have little chance of career development, especially in their early period of service.
Further, nursing is a female dominant profession. In their personal life, the Nursing
Officer, have to play different roles such as daughter, wife, and mother. According to
Sri Lankan culture, the home is mainly managed by the housewife. These factors too
hinder the career development of Nursing Officers.

A study was carried out to find the Satisfaction with Nursing Care and Work (SNCW)
in the Melbourne metropolitan area among psychiatric nurses (n = 78) from mainstream
health services. Professional growth had a mean score of 2.3 with a standard deviation
of 0.98 (Happell, 2003). In a study done at Los Angeles, the prospects for promotion
and career development were found to be linked with nurses' job satisfaction, with
0.148 being the path coefficient (Cavanagh, 1992). Positive perceptions of career
development opportunities were a stronger predictor of commitment to nursing and
job satisfaction (Brooks et al 2002). It is not so in this study. Therefore, career
development of Nursing Officers needs more attention in the government hospitals in
Western Province.

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 Keys to Job Satisfaction of Nursing Officers

16. Job Satisfaction and working condition

In Central Ministry hospitals, the correlation between job satisfaction and working
conditions was 0.37 with 0.001 being the significance level between them, while in
Provincial Ministry hospitals, it was 0.358 with 0.001 being the significance level between
them. With regard to correlation between job satisfaction and working condition there
is not much difference between Central Ministry hospitals (0.37) and Provincial Ministry
hospitals (0.358). In Central Ministry hospitals 14% of variance in job satisfaction can
be explained in terms of working conditions, whereas it is 13 percent in Provincial
Ministry hospitals.

In both types of hospitals, working conditions have a closer correlation with job
satisfaction than does remuneration. This indicates that, of external rewards, Nursing
Officers value non-monetary motivation more than monetary motivation.

17. Refined Conceptual Framework of Job Satisfaction for Nursing Officers

Working in Government Hospitals of Western Province after the Study

Before the study was carried out, the type of hospital was considered as the moderating
factor. There were six independent variables selected for this study. Of these
independent variables, using Pearson's correlation coefficient, it was found that the
correlation between job satisfaction and career development was not significant in
both the Central Ministry hospitals and Provincial Ministry hospitals. Therefore, career
development was removed from the original conceptual framework.

There was a significant difference in the job satisfaction between the Central Ministry
hospitals and Provincial Ministry hospitals. With these findings, the conceptual
framework of the study is refined. Figure 2 shows the refined conceptual framework
of the study.

Figure 2: Refined conceptual framework on job satisfaction of Nursing Officers in Western

Province Hospitals of Sri Lanka
Factors affecting
Job Satisfaction Type of Hospital
Workload
• Central Ministry
Professional Hospitals Moderating
Factor
Remuneration • Provincial Ministry
Hospitals
Training Received
Job Patient
Satisfaction Satisfaction
Working Condition

Scope of study

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18. Limitations

Even though the study was carried out systematically after reviewing the literature on
job satisfaction among nurses, there are a few limitations identified. Some of them
are that this study was conducted only in medical wards in the hospitals of the Western
Province. Smaller hospitals such as District Hospitals, Periphery Units and Rural
Hospitals were not included in this study. In the comparison of findings with those of
other studies, researchers often use a variety of instruments to measure the variables
they are investigating. This diversity presents a significant problem for researchers in
that they may find it difficult to compare their findings with those of previous research
findings. This is partly true in this study too.

19. Conclusions and Recommendations

From the study it is clear that professional support plays an important role in determining
the job satisfaction of Nursing Officers. Further, career development has not influenced
job satisfaction. This needs attention. The majority of studies in other parts of the
world reveals that career development had played a significant role in determining job
satisfaction in their countries. According to this study, career development had not
influenced job satisfaction when compared with the other variables. Therefore, more
importance must be given to the career development of Nursing Officers by the policy
makers and senior managers. Further, it is recommended that there is a need for
further studies between job satisfaction and career development.

There was a significant difference in job satisfaction between Central Ministry hospitals
and Provincial Ministry hospitals. In Provincial Ministry hospitals training has contributed
less to job satisfaction. Therefore, it is necessary to organize regular in-service training
programmes that provide equal opportunities for staff to update their practice, skills,
and knowledge. Further, it is necessary to establish a resource centre, that will provide
education and training materials such as textbooks, journals and videos, which the
staff can access, and which will encourage self-initiated learning.

This study showed that professional support plays an important role in determining job
satisfaction. Therefore, it is necessary to arrange regular staff meetings that allow
staff at all levels to discuss concerns and difficult issues, exchange information and
ideas, and support each other to solve encountered problems. This can be carried out
by establishing Work Improvement Teams (WIT) in all the units.

Working conditions contributed more than remuneration in determining job satisfaction

of Nursing Officers. Therefore, improving working conditions is important. Importance
should be given to provide proper rest rooms, toilets, clean canteens and library facilities.

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 Keys to Job Satisfaction of Nursing Officers

The present study was carried out only in the medical wards. Therefore, this type of
research should be extended to Nursing Officers working in other specialties in future.
To be comprehensive it is essential to study the job satisfaction of other categories of
staff as well.

20. Acknowledgment

This research on job satisfaction was possible due to all the committed staff in health
care organizations, who have influenced our life, and to whom we owe much gratitude.
Gratitude is first expressed to Prof. Gunapala Nanayakkara, founder Director,
Postgraduate Institute of Management. It is his commitment and vision for the
profession of management that have inspired the new generation of Sri Lankan
managers to pursue quality of life as well as work with dual commitment. We appreciate
the support given by the heads of the institutions, matrons and nursing staff of the
hospitals where the pilot study and the final study were conducted. Their assistance
to collect data was considerable.

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