There has been a stigma attached to the profession of nursing as it is always considered an inferior profession. This field has been dishonored for it is always regarded a feminine line of work which is one of the leading causes of this stigmatization. Nurses face number of issues such as rejection in society and workplace violence including sexual harassment, bullying and threats. These acts of violence are not only confined to workplace but also in different settings. These concerns can result in low self- esteem and self- efficacy lesser sense of satisfaction on job and poor competence level. Still this area secures a strong position in medical and psychiatry fields, there has been multiple researches conducted on the issues mentioned above.
The American Nurses Association explain nursing as, “the safety, promotion, and optimization of health and abilities, avoidance of illness and injury, improvement of suffering through the identification and cure of human reaction, and advocacy in the care of individuals, families, communities and populations.”
Like many other countries in Pakistan nurses face continuous challenges in there nursing profession. Basically these challenges are related with multiple factors that consist of the low status and illustration of the profession (Buchan, 2001; Goodin, 2003; International Council for Nurses, 2003). In Pakistan the actual number of nurses is unidentified, and the predictable numbers usually vary from truth. According to the World Health Organization (2004) statistics, Pakistan has 4.6 nursing and midwifery personnel and 6.9 physicians per 10,000 population. Though with varieties, the nurse to-understanding proportion in healing facilities is as low as 1:60. There is a deficiency of 1 million medical caretakers in the nation (Dawn Review, 2003). Nursing in Pakistan involved in three units; that is, general nursing, midwifery, and public health nursing. The prevalent method of nursing education, regardless of whether in the general population or the private segment, is described by three years of recognition when all is said in done nursing; while a couple of schools have as of late offered a four-year Bachelor of Science in Nursing (BScN) degree. Achieving a diploma in maternity care and in addition general wellbeing nursing requires one year of practice. For post-essential nursing training, five nursing institutes in the country show propelled certificates in instructing and ward organization, other than different clinical specializations. Two institutes in the country offer a post-RN BScN degree, and one university likewise offers a Master of Science in Nursing degree (Upvall, Karmaliani, Pirani, Gul, & Khalid, 2004).
The large portion of nursing schools in the country are worked under the umbrella of the hospital organization. Several schools have a separate principal for the school, but they informed to the hospital administrator. Following the apprenticeship system of training, students gain experience mainly within hospital settings and are paid a monthly stipend for their services in the hospital. Most of the hospitals in Pakistan do not have enough qualified staff; hence, it is not unusual to find nursing students working on their own without any supervision, especially during the evening and night shifts. All three units of nursing staff are regulated by the Pakistan Nursing Council as registered nurses (RNs), registered midwifes (RMs), and LHVs. Nurses are typically restricted to hospital settings, whereas LHVs and midwives are deployed in the public settings for maternal and child care. Usually, LHVs and midwives are paid less than nurses, but they are more sovereign in their practice and well respected. Like doctors, LHVs and midwives can have a private practice and can earn more money than nurses. Nurses with relevant post-basic qualifications may be promoted to various levels of administrative and teaching positions in the hospitals and nursing schools. Although nurses are paid better salaries than teachers yet nursing is considered less attractive because of the challenging work conditions (Morgan & French, 1993).
Career self-efficacy is normally characterized as judgments of individual adequacy in connection to the extensive variety of conduct engaged with profession decision and alteration (Lent &Hackett, 1987). As a rule, there are two lines of request under the umbrella of career self-efficacy: one manages the substance of profession determination (e.g., self-viability to have an effective vocation in a particular region); alternate manages the procedure of career selection (e.g., self-efficacy to examine diverse word related area. Career decision process refers to those behavioral spaces that are vital to the decision and execution of any profession zone, for example, self-efficacy for profession basic leadership and self-efficacy for consolidating home and career (Stickel and Bonnet, 1991).
Self-efficacy is ordinarily characterized as having a confidence in one’s capacity to succeed. One fondles to the test of troublesome assignments and is consequently inherently motivated by them (Bandura, 1993; Zeldin, Britner,; Pajares, 2008). Unfortunately, numerous enrolled nurses don’t feel enabled and positive about connection to their training (Aiken, Clarke, Sloane, Sochalski,& Silber,2002; Jacobs, Fontana, Hildalgo, Matarese,& Chinn, 2005; McKenna, Smith, Poole,&Coverdale, 2003; Peter, Macfarlane,& O’Brien-Pallas, 2004; Roche, Diers, Duffield,; CatlingPaul, 2010). By and by, patterns and issues, for example, a nursing not have, perplexity over extent of training skills and steady loss from nursing instruction and nursing practice add to pressure and turmoil in the nursing professional (Benner, 2010; Beurhaus, 2008; Corpus Sanchez International Consultancy, 2007; Maddalena,; Crupi,2008). A high level of new graduates leave their first position inside the first or two years (Bowles, 2005). A current overview of new graduates in Nova Scotia reports that as of now 67% arrangement to leave their present position (College of Registered Nurses of Nova Scotia CRNNS, 2011).
A competency is an expected level of performance that integrates knowledge, skills, abilities, and judgment (ANA, 2013). Professional competence is a major idea in nursing, which has an immediate association with quality change of patient care. Locsin (1998) exhibited two implications of competence. To start with, competence is compared to execution, and second, competence can be viewed as a nature of an individual (Locsin, 1998). Girot (1993) likened competency with both execution (the capacity to perform nursing undertakings) and a “psychological build” the combination of intellectual, full of feeling, and psychomotor aptitudes.
Nolan (1998) concurred that competency is a person’s real execution, though competence portrays the limit of people to play out the elements of their job. Assessment Strategies, Inc. (2012) defined competencies as being “generally written as behavior statements that reflect the knowledge, skills, abilities, attitudes and judgment required for effective performance in the profession at the level being tested”. The Canadian Nurses Association (2000) defined continuing competency as the “ongoing ability of a nurse to integrate and apply the knowledge, skills, judgement and personal attributes required to practise safely and ethically in a designated role and setting” (Canadian Nurses Association, 2000).
Nurses are responsible for long lasting learning, intelligent practice and incorporating learning into nursing practice (Canadian Nurses Association, 2000). They are answerable of “guaranteeing that their abilities are significant and breakthrough on a proceeding with premise in connection to the clients they serve; searching out quality training encounters important to their territory of training; and supporting each other in illustrating, creating and looking after competence” (Canadian Nurses Association, 2000). Nurses are answerable for “working with employers to guarantee that their workplaces sustain continuing competence; and meeting the necessities of their regulatory body for continuing competence” (Canadian Nurses Association, 2000). Each administrative body has norms to secure people in general, propel hone, give a reference to settling concerns identified with training, affirm instruction programs, create rules, help with lawful choices, give open data, and guarantee nursing competency (Saskatchewan Registered Nurses Association, 2006). Professional measures depict the competence level of care in each period of the nursing procedure. They reflect a coveted and achievable level of execution against which a medical attendant’s genuine execution can be analyzed. The primary reason for proficient measures is to coordinate and keep up safe and clinically equipped nursing practice (Davis,2014).
Social acceptance means that other people signal that they wish to include you in their groups and relationships (Leary, 2010). The image and status of nursing and role are a worldwide dilemma that nurses face. Image is defined as the “character of a thing or individual as supposed by public” Kalisch and Kalisch defined nursing image as “the sum of the beliefs, thoughts, and impressions that people have of nurses and nursing”. Observed evidence from the industrial and rising countries suggests that a low or poor image is a permanent problem for the profession of nursing. The different reasons for the poor image of nursing consist of the incapability of the general public to recognize the role of nurses, a lack of recognition from other health professionals, low salaries, an insecure work environment, and the negative depiction of nurses in the media; for example, as handmaidens to physicians, or sex objects. On the other hand media plays crucial role in influence people perception of nursing but also instigate a poor self-concept among nurses. The environment of nursing work, which involves the presentation of unskilled tasks and intimate contact with the human body, has also been identified as one of the factors that influences nursing image negatively around the world (Gul, 2007, Hemsley-Brown ; Foskett, 1999; Lawler, 1991).
Research suggests that the private health region is generally well structured and has enhanced working conditions although with reduced job safety. The health workers within public health sector face issues which mostly relate to job satisfaction. Paul Spector describes job satisfaction as “the extent to which people like (satisfaction) or dislike (dissatisfaction) their jobs” (Spector, 1997). Job satisfaction rely on various factors, efficiency and output of the human resources is one of the most important among them. Human resource in any organization is the most important quality and it works as an engine to provide a sustainable service delivery (Hafeez, Khan, Bile, Jooma ; Sheikh,2009).
An person’s recognition in the association assumes a fundamental part in work fulfillment (Anton,2009). In healthcare setting doctors’ approval plays a immense role in their performance and satisfaction among their patients. In the same way nurse’s job satisfaction in their jobs determines whether their roles are fulfilled towards service delivery for their clients of various communities (Haas et al, 2000).Better presentation has been straightforwardly related with it. Job satisfaction has also been inversely linked with absence, turnover in an organization, and level of stress as well as eventual exhaustion (McManus, Keeling & Paice 2004). Job dissatisfaction was strongly associated with organizational factors and poor working conditions, social aspects of the job were found to be a important factor in job satisfaction as well (Kekana , du & Wyk, 2007). Evidence exists that there is a close alliance between job satisfaction of health care professionals and the overall quality of health service (Bodur, 2002). Productivity and quality of work in any organization depends on the job satisfaction of nursing staff. This complex fact of approach towards one’s job has an impact not only on encouragement, but also on career, health and relation with peers. While many studies have been done to address the subject of level of job satisfaction among nursing staff, however very few have been conducted in Pakistan, especially in the recent past. Elsewhere poor salaries, poor working conditions, no fringe benefits, job insecurity, nepotism, political influences, lack of training opportunities and improper career development structure are the notable factors which hinder the qualified nurses to join public sector(Bresi et al. 2007). The already employed nursing staff also seems to be less satisfied due to many unidentified factors and hence there is a constant threat of attrition among nursing professionals in public sector organizations in Pakistan. We aimed to assess the level of and determine the factors influencing job satisfaction amongst nursing staff working in tertiary care health settings.
The content theories supports what motivates inhabitants at work that is, identifying the desires, drives and incentive and their prioritization by the individual to get pleasure and thus perform effectively (Luthans, 2005).
Maslow’s Theory of Motivation/Satisfaction (1943)
Maslow’s hierarchy of needs is “the most widely mentioned theory of motivation and satisfaction (Weihrich & Koontz, 1999).” This theory mainly based on humanistic psychology and the clinical experiences, Abraham Maslow postulated that an individual’s motivational needs could be given in a hierarchy. Once a given level of needs is fulfilled, it no longer helps to motivate. Therefore, next higher level of need has to be activated in sort to motivate and in that way satisfy the individual (Luthans, 2005).
Maslow (1943) recognized five levels in his need hierarchy:
1. Physical needs: (food, clothing, shelter, sex)
2. Safety needs: (physical protection)
3. Social: (opportunities to develop close associations with other persons)
4. Esteem/Achievement needs: (prestige received from others), and
5. Self-Actualization: (opportunities for self-fulfillment and accomplishment through personal growth) (Maslow, 1943).
Also individual need satisfaction is predisposed both by the significance attached to a variety of needs and the quantity to which each individual recognize that diverse aspects of his or her life should, and actually do, fulfill these needs (Karimi, 2007).
Herzberg’s Two-Factor Theory (1959)
Herzberg work on motivation theory. He did a motivational study on about 200 accountant and applied scientist working by firms in Pittsburgh, Pennsylvania. He used the critical confrontation method of data collection with two questions: a. when did you feel particularly good about your job – what turned you on? And b. when did you feel exceptionally bad about your job – what turned you off? (Luthans, 2005).
Arranging these revealed great and terrible sentiments, Herzberg reasoned that activity satisfiers (helpers) are identified with work content and that activity dissatisfiers (Hygiene factors) are united to work setting. Sparks identify with the activity substance like Achievement, Recognition, Work itself, Responsibility and Advancement. They cleanliness factors don’t propel/satisfy? rather „prevent disappointment. These components identify with the setting of the activity, for example, Company strategy, Administration, Supervision, Salary, Interpersonal relations, Supervisor, and Working conditions (Herzberg et al., 1959).
Theory of Needs Achievement Theory (David McClelland, 1961)
McCelelland and Associates contended that a few people have a convincing drive to succeed. They are taking a stab at individual accomplishment as opposed to the prizes of achievement as such. they want to improve or more effectively than it has been done before so they favor testing work these are high achievers (Shajahan and Shajahan, 2004).
Hypothesis underscores on the accomplishment thought processes in this manner, otherwise called accomplishment hypothesis. However demonstrate incorporates three interrelated needs or thought processes:
1. Accomplishment: The drive to exceed expectations, to accomplish in connection to resource of benchmarks, to endeavor to succeed.
2. Power: The need to influence others to carry on in a way that they would not have carried on something else (Shajahan and Shajahan, 2004). It alludes to the want to have an effect, to be persuasive, and to control others (Robbins, 2005).
3. Association: The want for cordial and close relational connections (Shajahan and Shajahan, 2004). Individuals with high alliance favor agreeable circumstances as opposed to aggressive ones (Robbins, 2005).
Differentiating to content theories, process theories are additionally concerned with how the motivation happens. The idea of expectancy from cognitive theory plays main role in the process theories of job-satisfaction (Luthans, 2005:246). As a result process theories seek to explain how the needs and goals are fulfilled and accepted cognitively (Perry et al., 2006).
Equity Theory (J. Stacy Adams, 1963)
Equity theory says that employees weigh what they put into a job circumstances (input) against what they get from it (outcome) and then contrast their input-outcome ratio with the input-outcome ratio of relevant others. If they perceive their ratio to be equal to that of the significant others with whom they compare themselves, a state of equity is said to exist (Robbins, 2005). The first of these equality perceptions – distributive justice – has been broadly studied over the past few decades under the more eagerly identifiable name of equity theory (Yusof & Shamsuri, 2006). Continuing through the motivation cycle suggests that high performance leads to the receipt of rewards, both intrinsic and extrinsic, which leads to increased employee satisfaction when such rewards are valued by the employee and perceived as equitable (Perry et al., 2006).
Goal-Setting Theory ( Edwin Locke, 1968)
In late 1960s, Edwin Locke contended that expectations communicated as objectives can be a noteworthy wellspring of work motivation and fulfillment (Shajahan and Shajahan, 2004). Some particular objectives prompt expanded execution. For instance, troublesome objectives, when acknowledged, result in higher execution than simple objectives and that criticism prompts higher execution than no input. Essentially, specific hard goals create a more elevated amount of yield than generalized goals of do your best. Besides, individuals will improve the situation when they get input on how well they are declaring toward their goals since criticism recognizes inconsistencies between what they have done and what they need to do. Studies testing goal- setting hypothesis have exhibited the prevalence of particular, testing goal with input, as motivating powers (Robbins, 2005).
The goal-setting theory is the only most researched and leading theory of employee motivation in the field, for example, researchers have applied goal-setting theory to studies of more than 40,000 participants’ performance on well over 100 different tasks in eight countries in both lab and field settings (Perry et al., 2006).
Goal theory proposes that difficult goals require focus on the problem, increase sense of goal importance, and encourage persisting and working harder to achieve the goals. Goal theory can be combined with cognitive theories to better understand the phenomena, for example, cognitive tool of self-efficacy is the perception of the difficulty of a goal and ability to achieve the goal. Greater self-efficacy is positively related to employees? perception that they are successfully contributing to meaningful work and therefore foster enhanced work motivation (Moynihan ; Pandey, 2007).
Job Characteristics Theory (Hachman ; Oldham, 1975-76)
Hackman and Oldham’s (1980) unique formulation of job characteristics theory argue that the results of job restore were predisposed by numerous moderators. Remarkable among these moderators are differences in the degree to which various individuals or employees desire personal or psychological development. (Perry et al., 2006). Job characteristics are part of the individual employee’s job and chores that shape how the individual perceives his or her particular role in the association. The clarity of tasks leads to greater job satisfaction (Moynihan ; Pandey, 2007).
The literature has been reviewed to support the current study.
Adeniran, Smith, Bhattacharya and XU (2013) used cross-sectional design to investigate difference in levels of mentorship function and self-efficacy as well as the differences in participation in professional development and career advancement between internationally educated nurses (IEN) and US- educated nurses (UEN). It was a web based survey with IEN (n=145) and UEN (n=55). The results showed IENs and UENs reported equivalent levels of self-efficacy. An explanation for the similarity in self-efficacy levels is the group’s professional nursing experiences. Regarding the nurses participating in this study, self-efficacy could have been enhanced by different sources
McConville and Lane (2005) assessed how on –line video clips enhance self-efficacy in dealing with difficult situations among nursing students. Self-report questionnaires were used to assess the effectiveness of video clip material. Level 1 (n = 145) nursing students completed a self-efficacy measure that examined confidence to deal with situations such as breaking news of death, working with children, people with disability and aggressive behavior at the start and the end of the module. Results indicated that student’s self-efficacy increased noticeably over the course of the module. Differences between increases in self-efficacy attributed to watching videos or attending lectures were marginal. Findings suggest that using video clips that show students effectively coping with adverse situations provide an effective teaching approach for enhancing self-efficacy.
Ammentorp, Sabroe, Kofoed and Mainz (2007) conducted a research to determine how training in communication skills affected the medical doctors’ and nurses’ self-efficacy on randomized trial. Clinicians in the intervention group received a 5 day communication course and the control group received no intervention. The impact of the intervention was evaluated by observing changes in doctors’ and nurses’ self-efficacy through means of questionnaires measuring the effect of communication courses on. The results depicted that clinicians who took part in the communication course improved their self-efficacy for specific communication tasks with up to 37%. It was concluded that communication skills training can improve clinicians’ evaluation of his or her ability to perform a specific communication task—measured as self-efficacy.
As in Netherlands, the distinction between Bachelor degree and diploma nursing educational levels remains unclear. Gloudemans, Schalk and Reynaert, (2012)
investigated whether Bachelor degree nurses have higher critical thinking skills than diploma nurses do and whether a positive relationship between higher critical thinking skills and self-efficacy beliefs exists or not. Questionnaire data were used of a sample of 95 registered mental health staff nurses (62 diploma nurses and 33 Bachelor degree nurses). First, ANOVA was performed to test whether the two groups were comparable with respect to elements of work experience. Second, t-tests were conducted to compare the two groups of nurses on self-efficacy, perceived performance and critical thinking outcomes. Third, relationships between the study variables were investigated. Finally, structural equation modelling using AMOS was applied to test the relationships.
The findings revealed that Bachelor degree nurses were better critical thinkers than diploma nurses (pb0.01). Years in function turned out to be positively related to self-efficacy beliefs (pb0.01). There was non-significant relation between the level of education and self-efficacy beliefs. The study concluded that the results of this study support career development and facilitate more efficient positioning of nursing levels.
Unkuri et al., (2013) directed Self-assessed level of competence of graduating nursing students and factors related to it by a cross-sectional study design. The data were collected using an on-line survey (the Nurse Competence Scale) in 2011 and administered to 302 graduating nursing students in Finland practicing in their final clinical placement in university hospitals. The sample contained 154 students (response rate 51%). The data were analyzed statistically. The self-assessed overall competence was on good level (66.7, VAS 0-100). The competence was highest in helping role and in diagnostic functions, being slightly lower in therapeutic interventions and work role. Pedagogical atmosphere during the final clinical placement had a statistically significantly positive correlation with the overall level of competence.
The transition from a nursing student to a professional nurse has turned out to be both challenging and stressful (Clare and van Loon, 2003; Mooney, 2007). The term “reality shock” by Kramer (1974) describes the transition from student to qualified nurse by three phases, as well as the conflict between the qualification expectations and the actual reality of work.
According to previous studies, 13% to 30% of new nurses have changed jobs after the first year (Bowles and Candela, 2005; Kovner et al.,2007), and this trend is in evidence throughout Europe (Flinkman et al., 2008; Aiken et al., 2012). The awareness of nurse responsibility differs between students and graduated nurses (Wangensteen et al.
Han et al., (2017) conducted a qualitative and phenomenographic study in Taiwan inspected workplace violence (WPV) against emergency nurses with a question: what are the qualitatively different ways in which nurses in Taiwan experience WPV in the emergency department (ED)? Thirty ED nurses who identified as experienced with WPV were interviewed, and the data was evaluated through phenomenographic analysis. In findings, four categories of description emerged. WPV was seen as a continuing nightmare, a part of daily life, and a direct threat, and it had a negative impact on nurses’ passion for emergency care. Nurses’ physical, psychological, social, personal, and professional levels were adversely affected by WPV.
Morken, Johansen, & Alsaker, (2015) conducted a survey showed that more than 50% of emergency department (ED) nurses have experienced some form of WPV in any single week (Kelley, 2014). It has been reported that 90% of nurses have experienced verbal abuse, and 30% have been exposed to physical violence. In fact, violence related injuries set up the second-largest category of occupational injuries, and 16% of violence-related injuries can be attributed to individual situations.
Zhang et al., (2017) executed a similar cross-sectional and multi-center research in seven geographical regions of China on a sample of 4125 nurses. The questionnaire included demographic information, the Workplace Violent Incident Questionnaire, the Jefferson Scale of Empathy-Health Professionals, and the Practice Environment Scale of Nursing Work Index. Workplace violence was measured in terms of physical violence, verbal or psychological violence, sexual harassment, and organized healthcare disturbances. A logistic regression analysis revealed that nurses who have less experience, work a rotating roster, work in emergency rooms and pediatrics departments, have low empathy levels, and who work in poor nursing environments have greater odds of experiencing violence.
Clinical nurses reportedly face workplace violence more often than do other occupations (US Department of Justice, 2011); one literature review of the overall violence exposure rates of nurses found a rate of 57.3%, ranging from 24.7% to 88.9% in the last 12 months (Spector et al., 2014). Furthermore, the exact prevalence of workplace violence varies by country and department; for instance, in the US, UK, and Ethiopia, the prevalence rates of workplace violence against nurses were 3.9% (US Department of Justice, 2011), 36% (National Health Service, 2014), and 29.9% (Fute et al., 2015), respectively.
Howerton and Sussman (2017) found occupational disappointment, peer support, lack of preparation by mandatory violence prevention classes, and unrealistic patient expectations were the main experiences of participant nurses. The sample consisted of 28 registered nurses across the state of California and the study used in-depth interviews using Glaserian grounded-theory methodology.
A study by Patridge and Affleck (2017) showed that nurses were more likely to have been physically assaulted in the last six months among other emergency department workers and were less likely to feel safe. Nurses were better than medical staff at reporting instances of occupational violence although overall reporting across all roles was low.
Gates et al. (2011) found a weak correlation between the number of assaults and verbal abuse experienced by ED staff and their self-rated feelings of safety, but neither of those studies found any significant differences between doctors and nurses in terms of their feelings of safety, or in the number of assaults they experienced.
On the other hand, Kansagra et al. (2008) found that ED nurses were five times less likely than doctors to say they felt safe “most of the time” or “always”, although the number of physical assaults experienced by ED staff did not their predict perceptions of safety. Only a minority of ED nurses in those studies felt unsafe, but a more recent survey of ED nurses at two Australian hospitals found that 90% had been physically assaulted in the last year, all had been verbally abused, and more than half felt “very” or “moderately” unsafe (Hyland, Watts and Fry, 2016).
Another study regarding social acceptance was executed in South Korea to determine the workplace violence and job outcomes of newly licensed nurses. An online survey was conducted of newly licensed registered nurses who had obtained their license in 2012 or 2013 in South Korea and had been working for 5-12 months after first being
employed. The sample consisted of 312 nurses working in hospitals or clinics. The Copenhagen Psychosocial Questionnaire II was used to measure violence and nurse job outcomes.. The study found Verbal abuse was most prevalent (59.6%), followed by threats of violence (36.9%), physical violence (27.6%), bullying (25.6%), and sexual harassment (22.4%). Approximately three quarters of the nurses had experienced at least one type of violence. The main perpetrators were patients and nurse colleagues, although the distribution of perpetrators varied depending on the type of violence. Bullying had a significant relationship with all four job outcomes (job satisfaction, burnout, commitment to the workplace, and intent to leave), while verbal abuse was associated with all job outcomes except for intent to leave. Violence perpetrated by nurse colleagues had a significant relationship with all four job outcomes, while violence by physicians had a significant inverse relationship with job satisfaction (Chang and Cho, 2016).
Violence in hospitals can be perpetrated by patients or their families, or by colleagues. Violence perpetrated in the workplace by peers is known as horizontal violence, lateral violence, or relational aggression (Vessey, Demarco, Difazio, 2010, and Dumont et al., 2012). Physicians were also found to be the most common source of sexual harassment toward nurses in Turkey (Celick and Celick, 2007).
Xue (2014) examined racial and ethnic minority nurses’ job satisfaction in the U.S. A retrospective cross-sectional analysis was conducted using the 2008 National Sample Survey of Registered Nurses. The sample includes registered nurses who were primarily employed in nursing in the U.S. Job satisfaction was measured by a single survey item. Racial and ethnic minority status was defined as self-identified membership in a group other than White non-Hispanic, including Hispanic and non-Hispanic Black, Asian, Native Hawaiian/Pacific Islander, American Indian/Alaska Native, and Multiracial. Multinomial logistic regression was performed to compare job satisfaction across racial and ethnic groups while adjusting for individual and job-related characteristics. The majority of nurses were satisfied with their job. The nurse group that had the highest proportion of being satisfied with their job was Native Hawaiian/Pacific Islander (88.8%), followed by White (81.6%), Asian (81%), Hispanic (78.9%), Black (76%), Multiracial (75.7%), and American Indian/Alaska Native (74.3%). Adjusting for individual and job related characteristics, evidence indicated the potential for lower job satisfaction among Black, American Indian/Alaska Native, and Multiracial nurses compared to White nurses. Asian nurses reported the highest levels of neutral (versus dissatisfaction) compared to White nurses. There was no evidence indicating a clear difference in job satisfaction between Hispanic, Native Hawaiian/Pacific Islander, and White nurses.
In another study examining job satisfaction in a sample of 112 nurses in critical care units in a large nonprofit healthcare organization in New York City, race and ethnicity was not associated with job satisfaction (Moneke and Umeh, 2013).
Jaradat et al. (2016) explored Workplace aggression, psychological distress, and job satisfaction among Palestinian nurses through a cross-sectional method. 372 nurses eligible for the study, 343were included (response rate of 92.2%). The sample comprised
62% females and 38% males. The participants responded to questions about their socio-demographic status, workplace aggression (WHO questionnaires), psychological distress (General Health Questionnaire, GHQ-30), and job satisfaction (Generic Job Satisfaction Scale). Ninety-three (27.1%) of the respondents reported exposure to workplace aggression of any kind. Seventeen (5%) reported exposure to physical aggression, 83 (24.2%) reported exposure to verbal aggression, and 25 (7.3%) reported exposure to bullying. The patients and the patients’ relatives were the main sources of physical and verbal aggression, whereas colleagues were the main source of bullying. Males reported a higher prevalence of bullying than females. Younger nurses reported a higher prevalence of exposure to physical aggression, verbal aggression and bullying. Verbal aggression was associated with more psychological distress. Bullying was associated with lower job satisfaction.
AbuAlRub & AL Khawaldeh, (2014) studied Jordanian nurses and physicians, reported that approximately 15% of the participants were exposed to physical aggression. The majority of the study participants were very dissatisfied with the administrations way of dealing with incidents.
Evidence shows that work stress contributes to higher burnout levels among nurses and is associated with lower job satisfaction (Graham, Davies, Woodend, Simpson, & Mantha, 2011).
In a research done by Khamisa et al., (2016), addressed that whether personal stress is a more significant predictor of burnout, job satisfaction and general health than work stress. Of the 1200 nurses randomly selected to participate in the study, 895 agreed to complete six questionnaires over 3 weeks. Data was analysed using hierarchical multiple linear regression. Findings revealed that personal stress is a better predictor of burnout and general health than job satisfaction, which is better predicted by work stress.
Other studies among Pakistani and South African nurses found that personal stress significantly predicts job satisfaction (Makola et al., 2015; Zulfiqar, Khan, & Afaq, 2013).
Gandhi et al., (2014) carried a research in India to assess and correlate the level of somatic symptoms, perceived stress and perceived job satisfaction among the subjects. The authors used a descriptive correlation design to invite 150 nurses of both genders working for more than one year with psychiatric patients. The Scale for Assessment of Somatic Symptoms (Chaturvedi et al., 1987) and a Visual Analogue Scale (VAS) for stress and job satisfaction perception were used to collect data. The nurses (128) reported mainly pain related (4.87 _ 2.97) somatic symptoms. Somatic symptoms positively correlated (r = 0.302) with stress perception and negatively correlated (r = _0.231) with perceived job satisfaction, while perceived stress and perceived job satisfaction were negatively correlated (r = _0.460, p = 0.000).
A descriptive study with Iranian nurses and patients’ family members
(Zali et al., 2017) on family presence during resuscitation was examined data was collected from the random sample of 178 nurses and 136 family members in four hospitals located in Iran. A 27-item questionnaire was used to collect data on attitudes towards FPDR, and descriptive and correlational analyses were conducted. Of family members, particularly the women, 57.2% (n = 78) felt it is their right to experience FPDR and that it has many advantages for the family; including the ability to see that everything was done and worry less. However, 62.5% (n = 111) of the nurses disagreed with an adult implementation of FPDR. Nurses perceived FPDR to have many disadvantages. Family members becoming distressed and interfering with the patient which may prolong the resuscitation effort. Nurses with prior education on FPDR were more willing to implement it.
A Pakistani research was conducted by Gul (2008) to explore the image of nursing from nurses’ and non-nurses’ perspective in Pakistan to identify factors that impact on the desirability of entering into the nursing profession. A descriptive, correlational, and comparative design was employed. A convenient sample of 487 subjects of doctors, nurses, patients, and members of the public comprised the study. Data were obtained through the use of a structured questionnaires. Measure of central tendency, Chi-square and ANOVA were used to analyze the data. Results revealed that the negative characteristics of the nursing profession outweigh its positive characteristics creating low image of nurses. The low socio-economic status of nurses, unsafe work environment, lack of respect from doctors, and the very nature of nurse’s work create a dichotomy in society’s attitude towards the nursing profession. Although 90% of the respondents considered “nursing a noble profession” and 92% thought that “hospitals cannot function without nurses,” less than 30% of the respondents considered nursing a suitable profession for their daughters or sisters. Results also indicated that the nursing shortage and the image of the profession present a reciprocal relationship. People’s perception of nursing is strongly influenced by nurses’ availability and the quality of nursing care that people receive.