ABSTRACT
This study investigated the job satisfaction of professional nurses in public
and private health sectors in Anambra State. A survey design was employed
and a study population of 5903 comprising all professional nurses in private
and public hospitals was used. Proportionate stratified random sampling
technique was used in selecting a sample of 375 nurses for the study.
Instrument for data collection was a structured questionnaire. Data collected
were analyzed using mean and standard deviation statistical tool to answer
the four research questions and t-test statistical tool was used to test the four
hypotheses. Findings showed that nurses in public hospitals were satisfied
from job security unlike nurses in private hospitals. Nurses in public and
private hospitals were satisfied from job control/ responsibilities. Also, it
was found that opportunity for advancement guarantees job satisfaction to
nurses in public and private hospitals. Based on the findings, it was
recommended that hospital management should create a work environment
that is free from dissatisfiers in order that nurses would carry out their duties
effectively towards the actualization of organization’s goal. Few relevant
areas that the present study did not cover were suggested for further
investigation.
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CHAPTER ONE
INTRODUCTION
Background to the Study
Output in terms of performance in any given organization is a function of
many variables which job satisfaction is one of them. Job satisfaction which
is equally understood and sometimes referred to as “work satisfaction” has
been variously defined in the literature. Job satisfaction is the extent to
which an employee expresses a positive orientation towards a job. It also
describes how content an individual is with his or her job. Job satisfaction
has also been defined as a pleasurable emotional state resulting from the
appraisal of one’s job, an affective reaction to one’s job and an attitude
towards one’s job (Chimanikire, Mutandwa, Gadzirayi, Muzondo, &
Mutandwa, 2007; Thompson & Phua, 2012). Job satisfaction is a worker’s
sense of achievement and success on the job. It is generally perceived to be
directly linked to productivity as well as to personal well-being. Job
satisfaction implies doing a job one enjoys, doing it well and being rewarded
for one’s efforts. Job satisfaction further implies enthusiasm and happiness
with one’s work. Job satisfaction is the key ingredient that leads to
recognition, income, promotion, and the achievement of other goals that lead
to a feeling of fulfilment (Kaliski, 2007).
Job satisfaction has continued to be a major area of interest in the study of
industrial and organizational psychology because of the presumed and
common-sense linkages between satisfaction and other mainstream concepts
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like leadership, performance, reward system and group process (Poole &
Warner, 2000). Furthermore, job satisfaction has been an interesting
construct for researchers in understanding employee behaviours and
attitudes (Zurn, Dolea & Stillwell, 2005). Despite the number of studies that
dealt on different aspects of job satisfaction, Boles, Wood and Johnson
(2008), stated that more studies are needed on job satisfaction because of
several reasons. According to them satisfaction with the job is directly
related to organizational commitment, behaviours and actions. To this end
therefore job satisfaction among professional nurses should be of great
importance and concern to any health organization, sector or nation given
the pivotal role that nurses play in determining the efficiency, effectiveness
and sustainability of health care delivery system. It is therefore imperative to
understand what motivates nurses and the extent to which the organization
and other contextual variables, add up to achieve satisfactory performance
output in the overall health care delivery system. This is necessary going by
the fact that job satisfaction is an essential part of ensuring high quality care
and performance output (Lambert, Hogan & Barton, 2001; Mount, Ilies &
Johnson, 2006). Job satisfaction does not necessarily concern the
professional nurses only, but cuts across the entire system – patients and
patients’ relations, hospital management as well as health sector, health
organizations, and indeed the entire nation. The inaction or inability of any
organization to achieve a reasonable level of job satisfaction among her
workforce will lead to dissatisfaction.
Job dissatisfaction generally, has been frequently cited as the primary reason
for low/poor quality output, non-commitment, low productivity and high rate
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of staff turnover among others. Dissatisfied nurses not only give poor
quality, less efficient care, there is also evidence of a positive correlation
between professional nurse satisfaction and patient satisfaction and
outcomes (Tzeng, 2002; Tsang, 2002, Takase, Maude & Manias, 2005).
Nurses who were not satisfied at work were also found to distance
themselves from their patients and their nursing chores, resulting in suboptimal
quality of care (Demorouti, Bekker, Nachreiner & Schaufeli, 2002).
The growing importance attached to studying job satisfaction especially
among the professional nurses in recent times is not far-fetched. For
instance, there is a growing need to strengthen health system in Nigeria to
help meet the Millennium Development Goals (MDGs). It is widely believed
that a key constraint to achieving the MDGs is the absence of a properly
trained and motivated work force of which nurses are part and parcel, and
improving the health workers working conditions is critical for health
system performance (FMOH, 2007). In addition, the HIV/AIDS epidemic is
compounding the problem by creating a stressful environment for health
workers through increased workload, exposure to infection and reduced
morale.
The organization of the health care system in Nigeria is pluralistic and
complex. It includes a wide range of providers, comprising the public health
institutions and a large and equally growing private sector, made up of
private-for-profit and private-for-non-profit providers, e.g. Non-
Governmental Organizations (NGOs), Religious, Spiritual and Traditional
Care Providers. This situation is equally the same in all the 36 States of the
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Federation including Anambra State. Anambra State health care system
consists of public sector health institutions that serve both the indigent and
the affluent in the society, and the private health providers that specifically
cater for the segment of the population that can afford their services.
Outside public health institutions, the private sector hospitals, maternity
homes and clinics provide about 80 percent health services to Nigerians
(Federal Ministry of Health, 2007). Despite these remarkable contributions
of the private sector to the overall health care need of the country, the sector
are not very well supported (Kwahar & Ukeh, 2012). Evidence from the
literature, however, shows that the sector lags behind in training and
refresher courses (Larbi, 2004). With the exemptions of few nongovernmental
and mission hospitals, most private sector hospitals are
privately owned and run by the physicians (doctors) who oversee the
management of the hospitals on one man basis. Most of the job satisfaction
variables such as opportunity for advancement, recognition, job security,
working conditions, interpersonal relationship, etc. are not regulated and
policy driven in private sector as obtained in public health sector. This
situation, therefore, makes a critical evaluation of job satisfaction variables
in the sectors worthwhile considering the rate of nurses’ turnover in both
sectors.
Statement of the Problem
It is believed that the satisfied employee can provide good service while a
low level of employee job satisfaction can result to difficulties in increasing
service quality. To ensure the achievement of firm goals, organisations
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create atmosphere of commitment and cooperation for its employees through
policies that facilitate employee satisfaction. However, Kwahar and Ukeh
(2012) found that there has been a general lack of satisfaction with jobs in
Nigeria. Evidence from Ruggiero (2005) suggests that there is widespread
lack of job satisfaction among nurses. Coupled with a critical shortage of
registered nurses, this situation threatens the provision of safe healthcare.
One way of ensuring optimum satisfaction of nurses in the health sector for
maximum performance is to appraise the overall working conditions, job
security, interpersonal relationship, recognition, advancement, etc of nurses.
This requirement as suggested here is presumed on the premise that output
in terms of performance in any organization is a function of many variables
of which job satisfaction is inclusive.
Evidence from the literature shows that absence of job satisfaction leads to
increased stress and frustration which result in physical, emotional and
behavioural problems, lower productivity and abandonment of nursing
profession (Kendrick, 2000; Robertson, Birch & Cooper, 2012), high
turnover of nurses and increased rates of absenteeism (Larabee, 2003; Siu,
2002), as well as migration to other countries especially United States of
America and United Kingdom, in search of better remuneration. These,
nonetheless, are not healthy for the development of the health sector. Hence,
these unabating penchant and unhidden desires of many professional nurses
to either move from private sector to public sector, or move from both
sectors to outside the country for whatever reasons call for an in-depth
empirical study. This researcher therefore speculates that these unhidden
desires and unabating penchant for the (intra and extra) movements might be
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because of the desire for better or improved job satisfaction. However, the
unavailability of recent and empirical inter-sectoral research studies on
professional nurses’ movements in Nigeria create a serious gap in the
literature. It is against these backdrops that this study is being carried out to
analyse the job satisfaction of professional nurses in public and private
hospitals in Anambra State, Nigeria.
Purpose of the Study
The main purpose of this study was to compare the job satisfaction of
professional nurses in public and private health sectors in Anambra State.
The study is also set to achieve the following specific purposes:
1. To determine the level of satisfaction nurses derive from job security
in public and private hospitals.
2. To determine how recognition of nurses’ performances in public and
private hospitals provide job satisfaction.
3. To identify the extent to which opportunity for advancement
guarantees job satisfaction to nurses in public and private hospitals
4. To ascertain the level of satisfaction nurses derive from job
control/responsibilities in public and private hospitals.
Research Questions
Based on the objectives, the following research questions are posed:
1. What level of satisfaction do nurses derive from job security in public
and private hospitals?
2. How does recognition of nurses in public and private hospitals
provide job satisfaction?
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3. To what extent does opportunity for advancement guarantees job
satisfaction to nurses in public and private hospitals?
4. What level of satisfaction do nurses derive from job control in public
and private hospitals?
Research Hypotheses
The following Null hypotheses were formulated to guide the study.
1. There is no significant difference in satisfaction from job security
between nurses in the public and private hospitals
2. There is no significant difference in satisfaction from recognition
between nurses in public and private hospitals
3. Opportunity for advancement does not significantly guarantee job
satisfaction between nurses in public and private hospitals
4. Job control does not have significant effect on job satisfaction
between nurses in public and private hospitals
Significance of the Study
The relevance and benefits of this study cut across different strata of the
stakeholders and participants in the health sector. It provides health sector
managers some useful insights on the factors that would be addressed to
achieve professional nurses’ job satisfaction towards delivering effective and
efficient health care to the publics. Consequently, government,
organizations and non-governmental organizations that operate in the
nation’s health sector through this study know where and what to contribute
towards improving health care delivery. Again, the study’s findings would
guide the nurses in taking informed decisions that would guarantee their job
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satisfaction and fulfillment. Finally, the study would guide health managers
in handling health related issues as they concerned the nurses and industrial
crisis within the health sector. The society also will benefit from the study
because, when nurses are satisfied with their job, they will render quality
services to the society.
Scope of the Study
This study is delimited to professional nurses’ job satisfaction in both public
and private health sectors of Anambra State. As a comparative study, the
job satisfaction variables considered in this study were; job security,
opportunity for advancement, recognition and job control.
Operational Definition of Terms
Job satisfaction: This is the degree of positive affective orientation an
individual has toward a job.
Job satisfaction variables in this study refer to:
· Job security: the nature and state of contractual agreement that
guarantee steady or permanent employment, e.g. assurance of
financial assistance, benefits and welfare in case of accident and
disability arising from the job.
· Status recognition: Refer to involvement in decision making, verbal
or written award or commendation due to high performance as sources
of inspiration and motivation.
· Professional development opportunities: Refer to encouraging and
sponsoring the nurses to national, regional, and international
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conferences, seminars, workshops and training that will boost their
professional standing and status.
· Ranking of job satisfaction variables: Refer to assignment of
numbers from 1-7 to represent different values along the continuum in
the scaling of job satisfaction variables.
· Public health institutions: Publicly owned hospitals that depend on
government subventions for its operations and are not strictly out to
make profits, State teaching hospitals, medical centres, model health
centres, general hospitals, etc.
· Private health institutions: Privately owned hospitals that depend on
the owner(s) for its financing and are strictly out to make profits.
Mission hospitals, individually owned private hospitals, clinics,
maternity homes.
· Private health workers: This refers to nurses working private health
institution.
· Public health workers: This refers to nurses working in public health
institution.