Archives of Psychiatric Nursing 29 (2015) 213–216
Contents lists available at ScienceDirect
Archives of Psychiatric Nursing journal homepage: www.elsevier.com/locate/apnu
Job Satisfaction and Intent to Leave Among Psychiatric Nurses: Closed Versus Open Wards Alexander Baum a, Ilya Kagan b,c,⁎ a b c
Geha Mental Health Center, Clalit Health Services, Helsinki 1, Petah Tikwa, Israel Rabin Medical Center, Clalit Health Services, Petah Tikwa, Israel Nursing Department, Steyer School of Health Professions, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
a b s t r a c t Purpose: The aim of this study was to investigate: (a) the association between socio-demographic variables, job satisfaction and intent to leave among hospital psychiatric nurses, and (b) the differences in the above between psychiatric nurses working on closed and open wards. Procedures: After receiving ethical approval, a convenience sample of 52 (70% of total nursing staff) was drawn from psychiatric nurses in a large Israeli psychiatric hospital (95% response rate). The sample completed anonymously a self-administered structured questionnaire. Main findings: A negative correlation was found between job satisfaction and intent to leave and between age, all categories of seniority, and intent to leave. Closed-ward nurses reported a higher intent to leave psychiatric nursing. Nurses under 35 reported a significantly higher intent to leave psychiatric nursing than nurses over 35. Job satisfaction was significantly higher among full-time nurses than part-time. Principal conclusions: Psychiatric hospitals need to pay attention to all factors associated with workers' readiness to leave. Given the widespread shortage of nurses, it is especially important that they address the relatively low job satisfaction of both younger and part-time nurses, and the particular stresses that closed-ward nurses work under. © 2015 Elsevier Inc. All rights reserved.
Job satisfaction is a key factor in human resources management in nursing, and in a nurse's decision to leave a workplace or stay. Satisfied workers perform better, have lower absenteeism and display higher motivation and organizational commitment. Israel has been experiencing in recent years a general shortage of nurses, and of psychiatric nurses in particular, which, if not amended, is likely to impinge on patient care. According to Herzberg (1968) job satisfaction is a positive attitude that a worker has for their place of work and which expresses itself in their desire to remain working there. Tett and Meyr (1993) define it as an emotional attachment, and Price (2001) as an emotional orientation, to one's work, while Spector (1997) terms it the extent to which a worker is happy or unhappy with their work. FACTORS INFLUENCING JOB SATISFACTION AMONG NURSES The published literature divides these factors into the environmental (organizational) and the personal. The former is associated with conditions at the workplace and organizational processes while the latter Contribution of the authors: IK—supervision, design, writing, data analysis; AB—literature review, data collection, writing. ⁎ Corresponding Author: Dr. Ilya Kagan, Ph.D., Nursing Department, Steyer School of Health Professions, Tel Aviv University, Ramat Aviv, Tel Aviv, 69978, Israel. Tel.: +972 3 6405338; fax: +972 3 9409496. E-mail addresses: [email protected] (A. Baum), [email protected] (I. Kagan). http://dx.doi.org/10.1016/j.apnu.2015.03.004 0883-9417/© 2015 Elsevier Inc. All rights reserved.
relates to the individual worker's character traits and other personal variables (Irvine & Evans, 1995: Baron & Byrne, 1997). A worker's age, for instance, correlates positively with higher job satisfaction (Avigdor, 2010; Hwang et al., 2009). Brinder (1993) and Bjork, Samdal, Hansen, Torstad, and Hamilton (2007) add the contribution of workplace seniority and level of education to job satisfaction. However, there have also appeared contrary findings. Bar (2003), for instance, found no association between age and job satisfaction. Nor did Friedman (2004) find an association with seniority. Yitzhaki (2006), studying Israeli nurses, even found the opposite association, namely that nurses with more than 9 years' seniority reported less job satisfaction than less experienced nurses. Gender differences also complicate the picture. Avigdor (2010) found women, overall, reporting higher levels of job satisfaction than men, a phenomenon which Gasser, Flint, and Tan (2000) explain by women having lower reward expectations from their employment than men. Additional sources of individual job satisfaction among hospital nurses such as ethnicity, individual morale, motivation and others, are mentioned and analyzed in the Lu et al. literature review (2011). As for the systemic–organizational factors in job satisfaction, Laschinger, Finegan, Shamian, and Almost (2001) for example, report that workload and workplace stress drag job satisfaction down while sending up rates of absenteeism, burn-out and workers' leaving. BarCohen, Rotem-Ficker, and Adami (2000) found that support from and good communications with bosses correlated positively with job satisfaction, which Cortese, Colombo, and Ghisliyri (2010) confirm. In their
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A. Baum, I. Kagan / Archives of Psychiatric Nursing 29 (2015) 213–216
study of general hospital nurses Adams and Bond (2000) concluded that a sense of solidarity and togetherness among nurses contributed both to better working relations and to job satisfaction. Lu, While, and Barriball (2005) confirm that good working relations raise job satisfaction, and add that external rewards also do so. Further organizational sources of job satisfaction are ward climate, organizational culture, level of professional practice, good relationships and cooperation with colleagues, and more (Lu, Barriball, Zhang, Alison, & While, 2012). In addition to the variation in job satisfaction at the personal or local level, international differences have been noted too. Aiken et al. (2001), for instance, found significant differences in job satisfaction between nurses in United States, Scotland, England, Canada and Germany.
MATERIALS AND METHODS In this cross-sectional quantitative design study, a convenience sample of 52 nurses was drawn from psychiatric nurses working on closed and open wards in a large psychiatric hospital in central Israel. The 52 represented some 70% of the hospital's total nursing staff. Ninety-two percent of the sample were registered nurses, the remainder practical nurses. Fifty-eight percent of the sample had an academic B.A. or M.A. degree in nursing. Men and women were represented more or less evenly and the nurses ranged in age from 25 to 65, with a mean age of 45 (SD = 10.91). Nurses working on closed wards were on average younger than those on open wards (M = 39 vs. M = 49 respectively). Fifty-six percent of the sample were born in Israel, 40% in the former Soviet Union and 4% in North Africa.
JOB SATISFACTION AMONG PSYCHIATRIC NURSES Roche and Duffield (2010) compared the job satisfaction of psychiatric nurses with that of general hospital nurses. While the former reported better doctor–nurse working relations the latter felt more involved in the running of the hospital, that the hospital offered them more leadership potential and a wider range of personal development options. Happell, Martin, and Pinikahana (2003) compared psychiatric nurses working on regular wards with those on forensic secure wards and were surprised that it was the latter, whose work is thought to be more stressful, hazardous and unpredictable, who reported higher job satisfaction levels. A literature review by Kagan and Guy (2004) which compared psychiatric nurses in hospitals with those in community care, concluded similarly that although the community care nurses faced the higher workloads and stress levels it was they who displayed the more job satisfaction. The present authors have located no studies comparing psychiatric nurses on open and closed hospital wards.
THE TENDENCY TO LEAVE The tendency of nurses to leave general hospitals has been widely researched. For, example, Aiken et al. (2001) in their study in five countries report that a third of nurses in England and Scotland and more than a fifth in the United States planned to leave their job and that, across the whole international sample, 27–54% of nurses under 30 years of age planned to leave within 12 months of data collection (Aiken et al., 2001). This tendency has been connected to different variables but a central variable is nurses' job satisfaction. Irvine and Evans (1995) argue that job satisfaction plays a large role in a worker's decision to stay or go and that the higher is job satisfaction the less likely is a worker to leave. Correspondingly, say Crampton and Wagner (1994), low job satisfaction is associated with high worker turnover. Numerous studies from many countries confirm this (e.g. Letvak & Buck, 2008; Zurmehly, Martin, & Fitzpatrick, 2009). As for the sociodemographic factors acting on workers' tendency to leave, researchers have found a negative correlation between the age and level of schooling of general hospital nurses and their intent to leave (Bjork et al. 2007; Zurmehly et al., 2009). Larrabee et al. (2003) found that nurses with less than 5 years' seniority reported a higher intent to leave than nurses with higher seniority. In sum, this brief review of the published literature shows that while job satisfaction is clearly a strong influence on worker turnover the precise nature of this association among psychiatric nurses, and in particular whether it operates differently among nurses on open and closed wards has been little researched. In light of the above, this study is aimed to: (a) Investigate the association between the socio-demographic variables of psychiatric nurses, their job satisfaction and intent to leave the nursing profession itself and psychiatric nursing. (b) To investigate the differences in the above between psychiatric nurses working on closed and open hospital wards.
TOOLS The sample completed a self-administered structured questionnaire which comprised the following sections: (1) Personal data: age, gender, religion and extent of religious practice, marital status, country of birth, generic and post-basic nurse training, type of ward currently employed on, job description, seniority (a) in nursing, (b) in hospital nursing, (c) in the current ward, and (d) in the current job; full or part-time working. (2) Job satisfaction: The Toren, Kerzman, and Kagan (2010) was used. This instrument comprises nine statements that respondents have to state their level of agreement/disagreement with on a five-point Likert scale from ‘Totally disagree’ to ‘Very much agree’. Sample statements are: ‘I am happy in my work as a nurse’; ‘I would recommend my children to take up the same sort of nursing as me’; ‘I feel that my work is meaningful and important’; ‘I am satisfied with the level of my wages’. The internal validity of the instrument was measured by its authors at Cronbach alpha = 0.81. (3) Intent to leave: This concept was measured by the responses to two statements: ‘There is a chance that I shall leave my current sphere of nursing in the next two years’ and ‘There is a chance I shall leave nursing in the next two years’. Respondents expressed their agreement/disagreement as above.
RESEARCH PROCEDURE Data collection began after the hospital's nursing management and its ethical (Helsinki) committee had given the study their approval. All potential respondents were explained the aims of the study and their rights as respondents to confidentiality and anonymity, that participation was completely voluntary, and that the data would be used for research purposes only. The researchers distributed the instruments personally to each respondent and the response rate was 95%. The data were analyzed by SPSS version 21. RESULTS Overall, the level of job satisfaction reported was quite high, a mean of 3.8 out of a maximum 5. Sixty-six percent of respondents reported high or very high satisfaction and no more than 4% reported low job satisfaction. A quite strong negative correlation emerged between job satisfaction and intent to leave, both psychiatric nursing (r = − .38, p b .001) and the nursing profession itself (r = −.33, p b .05). Quite strong negative correlations were found between age and all categories of seniority on the one hand, and on the other, intent to leave nursing itself and psychiatric nursing in particular (see Table 1). No other sociodemographic variable was found to correlate significantly with job satisfaction.
A. Baum, I. Kagan / Archives of Psychiatric Nursing 29 (2015) 213–216 Table 1 Pearson Correlations Between Socio-Demographic Variables and Intent to Leave Psychiatric Nursing and the Nursing Profession (N = 52).
Variable
Intent to leave the nursing profession
Intent to leave psychiatric nursing
−.31⁎ −.37⁎⁎ −.34⁎ −.40⁎⁎ −.30⁎
−.53⁎⁎ −.58⁎⁎ −.52⁎⁎ −.54⁎⁎ .45⁎⁎
Age Seniority in nursing Seniority on ward Seniority in hospital Seniority in current job ⁎ p b .05. ⁎⁎ p b .01.
COMPARING NURSES ON OPEN WARDS WITH NURSES ON CLOSED WARDS No significant differences were found between the two groups on job satisfaction. However, closed-ward nurses did report a higher intent to leave psychiatric nursing (t = 3.05, p b .005). It should also be recalled that open-ward nurses were significantly older than closedward nurses (M = 49 vs. M = 39 respectively) (t = 4.77, p b .001). Dividing the sample into two age groups, under and over 35, the younger group reported a significantly higher intent to leave psychiatric nursing (t = 3.35, p b .01) but no similar difference was found with respect to leaving the nursing profession as a whole. Comparing full- and part-time workers, job satisfaction was significantly higher among the full-time workers (t = 2.05, p b .05). Part-time workers also reported a higher intent to leave, both psychiatric nursing (t = 3.37, p b .01) and the nursing profession (t = 2.10, p b .05). No differences were found by gender or ethnicity (country of birth) either on job satisfaction or on intent to leave. LINEAR REGRESSION ANALYSIS Entering the socio-demographic variables as the independent variables in this analysis, it was found that four variables—extent of working hours, country of birth, extent of religious practice, and gender—made statistically significant contributions to explaining the variance in the dependent variable, job satisfaction, and that the regression model overall explained 29% of the variance in job satisfaction (R 2 = .29, p b .05). To see how much the sociodemographic variables explained workers' intention to leave, these variables plus job satisfaction were entered into a second linear regression analysis, where intent to leave was the dependent variable. Job satisfaction made a statistically significant contribution to the explanation of both intent to leave psychiatric nursing (t = 2.5, beta = .31, B = .36, p b .05) and intent to leave the nursing profession (t = 2.03, beta = .31, B = .27, p b .05).
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to deal with the predictors of a tendency to leave, and the differences in this strategy between closed and open wards. In addition, it is important to enhance the factors that promote and strengthen the tendency to stay in a job, such as higher group cohesion, a more stable work schedule, less work-related stress (Shader, Broome, Broome, West, & Nash, 2001; Sourdif, 2004), more autonomy, professional opportunities and occupational commitment (Engeda, Birhanu, & Alene, 2014; Wang, Tao, Ellenbecker, & Liu, 2012). Another finding confirms one made by many earlier studies (e.g. Coomber & Barriball, 2007; Letvak & Buck, 2008; Willer & Goldberg, 2005) in that it found and measured a strong negative correlation between job satisfaction and intent to leave. Also, a linear regression analysis found job satisfaction to be a significant predictor of intent to leave, both psychiatric nursing and the profession of nursing itself. In the present study two groups, part-time nurses and younger nurses, expressed a higher intent to leave than other nurses. With regard to the younger nurses, the explanation may be that younger nurses have before them a wide variety of job opportunities. Alternatively, the high levels of burnout found by Kagan and Guy (2004) may provide the explanation. A third possibility is that younger people are in general more ready to change sphere and place of work than older workers: Hendel and Kagan (2011) for instance, found that nurses under the age of 35 were significantly more willing to emigrate to find work than older nurses. As for the part-time nurses, the explanation for their lower job satisfaction and higher intent to leave may lie in the fact that they tend to be employed on evening and night shifts and so are less involved in daily staff life and relationships on the ward. An additional possible explanation is that they work part-time precisely because they like the work of a psychiatric nurse less. With respect to the negative correlation the present study found between age and seniority (both in psychiatric nursing and on the respondent's current ward) on the one hand and intent to leave on the other, this also confirms earlier studies and is unsurprising. Staff with greater seniority will naturally tend to be older (Bjork et al., 2007; Hellman, 1997; Zurmehly et al., 2009). To conclude, the findings of the present study make it clear that in their ongoing efforts to improve staff retention rates, the managements of psychiatric hospitals need to pay attention to all the factors associated with a greater readiness to leave and that, given the widespread shortage of nurses, it is especially important that they address the relatively low job satisfaction of both younger and part-time nurses, as well as the particular stresses that closed-ward nurses work under. It would be useful if future research into staff retention in psychiatric hospitals (a) investigated further the factors which increase the tendency to leave and (b) investigated this tendency not at the declarative level of intent but at the actual level of why nurses who have left their work did so.
DISCUSSION References The particular contribution of the present study to the exploration of the association between nurses' job satisfaction and their intention to leave their job is twofold, firstly in investigating the association among psychiatric nurses and secondly in comparing psychiatric nurses working on open and closed hospital wards. Starting with this innovatory aspect, the authors found that nurses working on closed wards reported a higher intent to leave than those working on open wards. Two possible explanations offer themselves. One is that the nurses on closed wards were younger on average than the open-ward nurses and younger workers, on the whole, display more readiness to change jobs than older staff—see below. A second possible explanation is that closed-ward working tends to be more stressful and emotionally burdensome than open-ward work (Laschinger et al., 2001; Ogresta, Rusac, & Zorec, 2008). These findings emphasize the importance of taking measures not only to recruit but also to retain nurses and part of the managerial retention strategy has
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Cortese, C. G., Colombo, L., & Ghisliyri, C. (2010). Determinants of nurse's job satisfaction: The role of work–family conflict, job demand, emotional charge and social support. Journal of Nursing Management, 18, 35–43. Crampton, S. M., & Wagner, J. A. (1994). Percept–percept inflation in micro organizational research: An investigation of prevalence and effect. Journal of Applied Psychology, 79, 67–76. Engeda, E. H., Birhanu, A. M., & Alene, K. A. (2014). Intent to stay in the nursing profession and associated factors among nurses working in Amhara Regional State Referral Hospitals, Ethiopia. BMC Nursing, 25, 13–24, http://dx.doi.org/10.1186/1472-6955-13-24. Friedman, A. (2004). The effect of seniority and age on global work satisfaction. A metaanalysis. Israel: Tel Aviv University (Masters dissertation, in Hebrew). Gasser, M., Flint, N., & Tan, R. (2000). Reward expectations: The influence of race, gender type of job. Journal of Business and Psychology, 15(2), 321–329. Happell, B., Martin, T., & Pinikahana, J. (2003). Burnout and job satisfaction: A comparative study of psychiatric nurses from forensic and a mainstream mental health service. International Journal of Mental Health Nursing, 12, 39–47. Hellman, C. M. (1997). Job satisfaction and intent to leave. The Journal of Social Psychology, 137, 677–689. Hendel, T., & Kagan, I. (2011). Professional image and intention to emigrate among Israeli nurses and nursing students. Nurse Education Today, 31, 259–262. Herzberg, F. (1968). One more time: How to motivate employees? Harvard Business Review, 1, 53–62. Hwang, J. -I., Lou, F., Han, S. S., Cao, F., Kim, W. O., & Li, P. (2009). Professionalism: The major factor influencing job satisfaction among Korean and Chinese nurses. International Nursing Review, 56, 313–318. Irvine, D., & Evans, M. (1995). Job satisfaction and turnover among nurses: Integrating research findings across studies. Nursing Research, 44(4), 246–253. Kagan, A., & Guy, D. (2004). Burn-out and workplace satisfaction in mental health nursing: Hospital vs. community care. Public Health Nursing Magazine, 5, 42–46 (in Hebrew). Larrabee, J. H., Janney, M. A., Ostrow, C. L., Withrow, M. L., Hobbs, G. R., & Burant, C. (2003). Predicting registered nurse job satisfaction and intent to leave. Journal of Nursing Administration, 33, 271–283. Laschinger, H., Finegan, J., Shamian, J., & Almost, J. (2001). Testing Karasek's demand–control model in restructured health care settings: Effect of job strain on staff nurses quality of work life. Journal of Nursing Administration, 31, 233–243. Letvak, S., & Buck, R. (2008). Factors influencing work productivity and intent to stay in nursing. Nursing Economic$, 26(3), 159–165.
Lu, K. H., Barriball, L., Zhang, X., Alison, E., & While, A. E. (2012). Job satisfaction among hospital nurses revisited: A systematic review. International Journal of Nursing Studies, 49(8), 1017–1038. Lu, H., While, A. E., & Barriball, K. L. (2005). Job satisfaction among nurses: A literature review. International Journal of Nursing Studies, 42, 211–227. Ogresta, J., Rusac, S., & Zorec, L. (2008). Relation between burnout syndrome and job satisfaction among mental health workers. Croatian Medical Journal, 49, 364–374. Price, J. L. (2001). Reflections on the determinants of voluntary turnover. International Journal of Manpower, 22(7), 600–624. Roche, M. A., & Duffield, C. M. (2010). A comparison of the nursing practice environment in mental health and medical-surgical settings. Journal of Nursing Scholarship, 42(2), 195–206. Shader, K., Broome, M. E., Broome, C. D., West, M. E., & Nash, M. (2001). Factors influencing satisfaction and anticipated turnover for nurses in an academic medical center. Journal of Nursing Administration, 31(4), 210–216. Sourdif, J. (2004). Predictors of nurses' intent to stay at work in a university health center. Nursing Health & Science, 6(1), 59–68. Spector, P. E. (1997). Job satisfaction: Application, assessment, causes, and consequences. Thousand Oaks, CA: Sage Publications. Tett, R. P., & Meyr, J. P. (1993). Job satisfaction, organizational commitment, turnover intention, and turnover: Path analyses based on meta-analytic finding. Personnel Psychology, 46(2), 259–293. Toren, O., Kerzman, H., & Kagan, I. (2010). The difference between professional image and job satisfaction of nurses who studied in a post-basic education program and nurses with generic education: A questionnaire survey. Journal of Professional Nursing, 27(1), 28–34. Wang, L., Tao, H., Ellenbecker, C. H., & Liu, X. (2012). Job satisfaction, occupational commitment and intent to stay among Chinese nurses: A cross-sectional questionnaire survey. Journal of Advanced Nursing, 68(3), 539–549, http://dx.doi.org/10.1111/j. 1365-2648.2011.05755.x. Willer, S., & Goldberg, A. (2005). Work satisfaction, choice of occupation, mental burnout, nurses and switching occupation. Guf Yeda, 1. (pp. 72–79) (in Hebrew). Yitzhaki, M. (2006). The emotional expectations laid on nurses: A qualitative study of how nurses cope and comply with expectations. Israel: Tel Aviv University (Doctoral dissertation, in Hebrew). Zurmehly, J., Martin, P. A., & Fitzpatrick, J. J. (2009). Registered nurse empowerment and intent to leave current position and/or profession. Journal of Nursing Management, 17, 383–391.
Contents lists available at ScienceDirect
Archives of Psychiatric Nursing journal homepage: www.elsevier.com/locate/apnu
Job Satisfaction and Intent to Leave Among Psychiatric Nurses: Closed Versus Open Wards Alexander Baum a, Ilya Kagan b,c,⁎ a b c
Geha Mental Health Center, Clalit Health Services, Helsinki 1, Petah Tikwa, Israel Rabin Medical Center, Clalit Health Services, Petah Tikwa, Israel Nursing Department, Steyer School of Health Professions, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
a b s t r a c t Purpose: The aim of this study was to investigate: (a) the association between socio-demographic variables, job satisfaction and intent to leave among hospital psychiatric nurses, and (b) the differences in the above between psychiatric nurses working on closed and open wards. Procedures: After receiving ethical approval, a convenience sample of 52 (70% of total nursing staff) was drawn from psychiatric nurses in a large Israeli psychiatric hospital (95% response rate). The sample completed anonymously a self-administered structured questionnaire. Main findings: A negative correlation was found between job satisfaction and intent to leave and between age, all categories of seniority, and intent to leave. Closed-ward nurses reported a higher intent to leave psychiatric nursing. Nurses under 35 reported a significantly higher intent to leave psychiatric nursing than nurses over 35. Job satisfaction was significantly higher among full-time nurses than part-time. Principal conclusions: Psychiatric hospitals need to pay attention to all factors associated with workers' readiness to leave. Given the widespread shortage of nurses, it is especially important that they address the relatively low job satisfaction of both younger and part-time nurses, and the particular stresses that closed-ward nurses work under. © 2015 Elsevier Inc. All rights reserved.
Job satisfaction is a key factor in human resources management in nursing, and in a nurse's decision to leave a workplace or stay. Satisfied workers perform better, have lower absenteeism and display higher motivation and organizational commitment. Israel has been experiencing in recent years a general shortage of nurses, and of psychiatric nurses in particular, which, if not amended, is likely to impinge on patient care. According to Herzberg (1968) job satisfaction is a positive attitude that a worker has for their place of work and which expresses itself in their desire to remain working there. Tett and Meyr (1993) define it as an emotional attachment, and Price (2001) as an emotional orientation, to one's work, while Spector (1997) terms it the extent to which a worker is happy or unhappy with their work. FACTORS INFLUENCING JOB SATISFACTION AMONG NURSES The published literature divides these factors into the environmental (organizational) and the personal. The former is associated with conditions at the workplace and organizational processes while the latter Contribution of the authors: IK—supervision, design, writing, data analysis; AB—literature review, data collection, writing. ⁎ Corresponding Author: Dr. Ilya Kagan, Ph.D., Nursing Department, Steyer School of Health Professions, Tel Aviv University, Ramat Aviv, Tel Aviv, 69978, Israel. Tel.: +972 3 6405338; fax: +972 3 9409496. E-mail addresses: [email protected] (A. Baum), [email protected] (I. Kagan). http://dx.doi.org/10.1016/j.apnu.2015.03.004 0883-9417/© 2015 Elsevier Inc. All rights reserved.
relates to the individual worker's character traits and other personal variables (Irvine & Evans, 1995: Baron & Byrne, 1997). A worker's age, for instance, correlates positively with higher job satisfaction (Avigdor, 2010; Hwang et al., 2009). Brinder (1993) and Bjork, Samdal, Hansen, Torstad, and Hamilton (2007) add the contribution of workplace seniority and level of education to job satisfaction. However, there have also appeared contrary findings. Bar (2003), for instance, found no association between age and job satisfaction. Nor did Friedman (2004) find an association with seniority. Yitzhaki (2006), studying Israeli nurses, even found the opposite association, namely that nurses with more than 9 years' seniority reported less job satisfaction than less experienced nurses. Gender differences also complicate the picture. Avigdor (2010) found women, overall, reporting higher levels of job satisfaction than men, a phenomenon which Gasser, Flint, and Tan (2000) explain by women having lower reward expectations from their employment than men. Additional sources of individual job satisfaction among hospital nurses such as ethnicity, individual morale, motivation and others, are mentioned and analyzed in the Lu et al. literature review (2011). As for the systemic–organizational factors in job satisfaction, Laschinger, Finegan, Shamian, and Almost (2001) for example, report that workload and workplace stress drag job satisfaction down while sending up rates of absenteeism, burn-out and workers' leaving. BarCohen, Rotem-Ficker, and Adami (2000) found that support from and good communications with bosses correlated positively with job satisfaction, which Cortese, Colombo, and Ghisliyri (2010) confirm. In their
214
A. Baum, I. Kagan / Archives of Psychiatric Nursing 29 (2015) 213–216
study of general hospital nurses Adams and Bond (2000) concluded that a sense of solidarity and togetherness among nurses contributed both to better working relations and to job satisfaction. Lu, While, and Barriball (2005) confirm that good working relations raise job satisfaction, and add that external rewards also do so. Further organizational sources of job satisfaction are ward climate, organizational culture, level of professional practice, good relationships and cooperation with colleagues, and more (Lu, Barriball, Zhang, Alison, & While, 2012). In addition to the variation in job satisfaction at the personal or local level, international differences have been noted too. Aiken et al. (2001), for instance, found significant differences in job satisfaction between nurses in United States, Scotland, England, Canada and Germany.
MATERIALS AND METHODS In this cross-sectional quantitative design study, a convenience sample of 52 nurses was drawn from psychiatric nurses working on closed and open wards in a large psychiatric hospital in central Israel. The 52 represented some 70% of the hospital's total nursing staff. Ninety-two percent of the sample were registered nurses, the remainder practical nurses. Fifty-eight percent of the sample had an academic B.A. or M.A. degree in nursing. Men and women were represented more or less evenly and the nurses ranged in age from 25 to 65, with a mean age of 45 (SD = 10.91). Nurses working on closed wards were on average younger than those on open wards (M = 39 vs. M = 49 respectively). Fifty-six percent of the sample were born in Israel, 40% in the former Soviet Union and 4% in North Africa.
JOB SATISFACTION AMONG PSYCHIATRIC NURSES Roche and Duffield (2010) compared the job satisfaction of psychiatric nurses with that of general hospital nurses. While the former reported better doctor–nurse working relations the latter felt more involved in the running of the hospital, that the hospital offered them more leadership potential and a wider range of personal development options. Happell, Martin, and Pinikahana (2003) compared psychiatric nurses working on regular wards with those on forensic secure wards and were surprised that it was the latter, whose work is thought to be more stressful, hazardous and unpredictable, who reported higher job satisfaction levels. A literature review by Kagan and Guy (2004) which compared psychiatric nurses in hospitals with those in community care, concluded similarly that although the community care nurses faced the higher workloads and stress levels it was they who displayed the more job satisfaction. The present authors have located no studies comparing psychiatric nurses on open and closed hospital wards.
THE TENDENCY TO LEAVE The tendency of nurses to leave general hospitals has been widely researched. For, example, Aiken et al. (2001) in their study in five countries report that a third of nurses in England and Scotland and more than a fifth in the United States planned to leave their job and that, across the whole international sample, 27–54% of nurses under 30 years of age planned to leave within 12 months of data collection (Aiken et al., 2001). This tendency has been connected to different variables but a central variable is nurses' job satisfaction. Irvine and Evans (1995) argue that job satisfaction plays a large role in a worker's decision to stay or go and that the higher is job satisfaction the less likely is a worker to leave. Correspondingly, say Crampton and Wagner (1994), low job satisfaction is associated with high worker turnover. Numerous studies from many countries confirm this (e.g. Letvak & Buck, 2008; Zurmehly, Martin, & Fitzpatrick, 2009). As for the sociodemographic factors acting on workers' tendency to leave, researchers have found a negative correlation between the age and level of schooling of general hospital nurses and their intent to leave (Bjork et al. 2007; Zurmehly et al., 2009). Larrabee et al. (2003) found that nurses with less than 5 years' seniority reported a higher intent to leave than nurses with higher seniority. In sum, this brief review of the published literature shows that while job satisfaction is clearly a strong influence on worker turnover the precise nature of this association among psychiatric nurses, and in particular whether it operates differently among nurses on open and closed wards has been little researched. In light of the above, this study is aimed to: (a) Investigate the association between the socio-demographic variables of psychiatric nurses, their job satisfaction and intent to leave the nursing profession itself and psychiatric nursing. (b) To investigate the differences in the above between psychiatric nurses working on closed and open hospital wards.
TOOLS The sample completed a self-administered structured questionnaire which comprised the following sections: (1) Personal data: age, gender, religion and extent of religious practice, marital status, country of birth, generic and post-basic nurse training, type of ward currently employed on, job description, seniority (a) in nursing, (b) in hospital nursing, (c) in the current ward, and (d) in the current job; full or part-time working. (2) Job satisfaction: The Toren, Kerzman, and Kagan (2010) was used. This instrument comprises nine statements that respondents have to state their level of agreement/disagreement with on a five-point Likert scale from ‘Totally disagree’ to ‘Very much agree’. Sample statements are: ‘I am happy in my work as a nurse’; ‘I would recommend my children to take up the same sort of nursing as me’; ‘I feel that my work is meaningful and important’; ‘I am satisfied with the level of my wages’. The internal validity of the instrument was measured by its authors at Cronbach alpha = 0.81. (3) Intent to leave: This concept was measured by the responses to two statements: ‘There is a chance that I shall leave my current sphere of nursing in the next two years’ and ‘There is a chance I shall leave nursing in the next two years’. Respondents expressed their agreement/disagreement as above.
RESEARCH PROCEDURE Data collection began after the hospital's nursing management and its ethical (Helsinki) committee had given the study their approval. All potential respondents were explained the aims of the study and their rights as respondents to confidentiality and anonymity, that participation was completely voluntary, and that the data would be used for research purposes only. The researchers distributed the instruments personally to each respondent and the response rate was 95%. The data were analyzed by SPSS version 21. RESULTS Overall, the level of job satisfaction reported was quite high, a mean of 3.8 out of a maximum 5. Sixty-six percent of respondents reported high or very high satisfaction and no more than 4% reported low job satisfaction. A quite strong negative correlation emerged between job satisfaction and intent to leave, both psychiatric nursing (r = − .38, p b .001) and the nursing profession itself (r = −.33, p b .05). Quite strong negative correlations were found between age and all categories of seniority on the one hand, and on the other, intent to leave nursing itself and psychiatric nursing in particular (see Table 1). No other sociodemographic variable was found to correlate significantly with job satisfaction.
A. Baum, I. Kagan / Archives of Psychiatric Nursing 29 (2015) 213–216 Table 1 Pearson Correlations Between Socio-Demographic Variables and Intent to Leave Psychiatric Nursing and the Nursing Profession (N = 52).
Variable
Intent to leave the nursing profession
Intent to leave psychiatric nursing
−.31⁎ −.37⁎⁎ −.34⁎ −.40⁎⁎ −.30⁎
−.53⁎⁎ −.58⁎⁎ −.52⁎⁎ −.54⁎⁎ .45⁎⁎
Age Seniority in nursing Seniority on ward Seniority in hospital Seniority in current job ⁎ p b .05. ⁎⁎ p b .01.
COMPARING NURSES ON OPEN WARDS WITH NURSES ON CLOSED WARDS No significant differences were found between the two groups on job satisfaction. However, closed-ward nurses did report a higher intent to leave psychiatric nursing (t = 3.05, p b .005). It should also be recalled that open-ward nurses were significantly older than closedward nurses (M = 49 vs. M = 39 respectively) (t = 4.77, p b .001). Dividing the sample into two age groups, under and over 35, the younger group reported a significantly higher intent to leave psychiatric nursing (t = 3.35, p b .01) but no similar difference was found with respect to leaving the nursing profession as a whole. Comparing full- and part-time workers, job satisfaction was significantly higher among the full-time workers (t = 2.05, p b .05). Part-time workers also reported a higher intent to leave, both psychiatric nursing (t = 3.37, p b .01) and the nursing profession (t = 2.10, p b .05). No differences were found by gender or ethnicity (country of birth) either on job satisfaction or on intent to leave. LINEAR REGRESSION ANALYSIS Entering the socio-demographic variables as the independent variables in this analysis, it was found that four variables—extent of working hours, country of birth, extent of religious practice, and gender—made statistically significant contributions to explaining the variance in the dependent variable, job satisfaction, and that the regression model overall explained 29% of the variance in job satisfaction (R 2 = .29, p b .05). To see how much the sociodemographic variables explained workers' intention to leave, these variables plus job satisfaction were entered into a second linear regression analysis, where intent to leave was the dependent variable. Job satisfaction made a statistically significant contribution to the explanation of both intent to leave psychiatric nursing (t = 2.5, beta = .31, B = .36, p b .05) and intent to leave the nursing profession (t = 2.03, beta = .31, B = .27, p b .05).
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to deal with the predictors of a tendency to leave, and the differences in this strategy between closed and open wards. In addition, it is important to enhance the factors that promote and strengthen the tendency to stay in a job, such as higher group cohesion, a more stable work schedule, less work-related stress (Shader, Broome, Broome, West, & Nash, 2001; Sourdif, 2004), more autonomy, professional opportunities and occupational commitment (Engeda, Birhanu, & Alene, 2014; Wang, Tao, Ellenbecker, & Liu, 2012). Another finding confirms one made by many earlier studies (e.g. Coomber & Barriball, 2007; Letvak & Buck, 2008; Willer & Goldberg, 2005) in that it found and measured a strong negative correlation between job satisfaction and intent to leave. Also, a linear regression analysis found job satisfaction to be a significant predictor of intent to leave, both psychiatric nursing and the profession of nursing itself. In the present study two groups, part-time nurses and younger nurses, expressed a higher intent to leave than other nurses. With regard to the younger nurses, the explanation may be that younger nurses have before them a wide variety of job opportunities. Alternatively, the high levels of burnout found by Kagan and Guy (2004) may provide the explanation. A third possibility is that younger people are in general more ready to change sphere and place of work than older workers: Hendel and Kagan (2011) for instance, found that nurses under the age of 35 were significantly more willing to emigrate to find work than older nurses. As for the part-time nurses, the explanation for their lower job satisfaction and higher intent to leave may lie in the fact that they tend to be employed on evening and night shifts and so are less involved in daily staff life and relationships on the ward. An additional possible explanation is that they work part-time precisely because they like the work of a psychiatric nurse less. With respect to the negative correlation the present study found between age and seniority (both in psychiatric nursing and on the respondent's current ward) on the one hand and intent to leave on the other, this also confirms earlier studies and is unsurprising. Staff with greater seniority will naturally tend to be older (Bjork et al., 2007; Hellman, 1997; Zurmehly et al., 2009). To conclude, the findings of the present study make it clear that in their ongoing efforts to improve staff retention rates, the managements of psychiatric hospitals need to pay attention to all the factors associated with a greater readiness to leave and that, given the widespread shortage of nurses, it is especially important that they address the relatively low job satisfaction of both younger and part-time nurses, as well as the particular stresses that closed-ward nurses work under. It would be useful if future research into staff retention in psychiatric hospitals (a) investigated further the factors which increase the tendency to leave and (b) investigated this tendency not at the declarative level of intent but at the actual level of why nurses who have left their work did so.
DISCUSSION References The particular contribution of the present study to the exploration of the association between nurses' job satisfaction and their intention to leave their job is twofold, firstly in investigating the association among psychiatric nurses and secondly in comparing psychiatric nurses working on open and closed hospital wards. Starting with this innovatory aspect, the authors found that nurses working on closed wards reported a higher intent to leave than those working on open wards. Two possible explanations offer themselves. One is that the nurses on closed wards were younger on average than the open-ward nurses and younger workers, on the whole, display more readiness to change jobs than older staff—see below. A second possible explanation is that closed-ward working tends to be more stressful and emotionally burdensome than open-ward work (Laschinger et al., 2001; Ogresta, Rusac, & Zorec, 2008). These findings emphasize the importance of taking measures not only to recruit but also to retain nurses and part of the managerial retention strategy has
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