|Year : 2020 | Volume
| Issue : 1 | Page : 35-41
Assessment of job satisfaction among nursing officers working at a tertiary care hospital in Northern India
Ajay Sharma1, Vipin Kaushal1, Navin Pandey1, Pankaj Arora1, Arulmani Thiyagarajan2, Sudip Bhattacharya3
1 Department of Hospital Administration, PGIMER, Chandigarh, India
2 School of Public Health, SRM University, Chennai, Tamil Nadu, India
3 Department of Community Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
|Date of Submission||15-Nov-2019|
|Date of Decision||26-Nov-2019|
|Date of Acceptance||20-Jan-2020|
|Date of Web Publication||19-Jun-2020|
Department of Community Medicine, Dehradun, Uttarakhand
Source of Support: None, Conflict of Interest: None
Introduction: Job satisfaction among nurses is an indicator of excellent working environment and management of the institution. The study of job satisfaction has relevance to nursing from economic, humanitarian, and professional perspectives. Aim and Objective: This study aimed to understand the job satisfaction among nursing officers (NOs) at a tertiary care hospital. Methodology: A cross-sectional questionnaire-based study was conducted using the Minnesota Satisfaction Questionnaire short form. Results: The study was conducted in the different areas of tertiary care hospital. The study population comprised NOs employed in tertiary care hospital. Nearly half of the participants were in the age group of 21–30 years. Among the nursing professionals, more than two-third of them were NOs 620 (73.4%), followed by senior NOs, assistant nursing superintendent (NS), deputy NS, and NS with least in count comprising 0.1%. It was found that mostly all of the nursing professionals were either moderately satisfied or highly satisfied with their profession. Discussion: Chi-square test was performed to find the relationship between the job satisfaction and age group factor, which indicated that there was a significant association between the variables (P < 0.01). There was no significant difference was observed in the satisfaction level of intrinsic factors among the nurses. Age, area of posting, and the educational qualification had a significant influence on satisfaction level of nurses. It was also observed that length of service did not have any significant influence on the satisfaction level among the nursing staffs. Conclusion: The study found that most of the nurses were satisfied but some factors were commonly related with dis-satisfaction.
Keywords: Departments, hospital, job satisfaction, nurses
|How to cite this article:|
Sharma A, Kaushal V, Pandey N, Arora P, Thiyagarajan A, Bhattacharya S. Assessment of job satisfaction among nursing officers working at a tertiary care hospital in Northern India. CHRISMED J Health Res 2020;7:35-41
|How to cite this URL:|
Sharma A, Kaushal V, Pandey N, Arora P, Thiyagarajan A, Bhattacharya S. Assessment of job satisfaction among nursing officers working at a tertiary care hospital in Northern India. CHRISMED J Health Res [serial online] 2020 [cited 2020 Jul 16];7:35-41. Available from: http://www.cjhr.org/text.asp?2020/7/1/35/286875
| Introduction|| |
The World Health Organization (WHO) defines job satisfaction as “a pleasurable or positive emotional state resulting from the appraisal of one's job or job experiences.” Job satisfaction can be assessed at the global level or at the individual level.
Multiple factors can influence job satisfaction of a person. These factors may be in the form of the salary, other financial benefits, transparency of promotion within the organization, the working environment, social relationships, and group dynamics. Work account for a massive proportion of waking hours per day for majority of the people, and there is strong evidence that work has a huge impact on people's self-concept and self-esteem.,, Job satisfaction is positively and mutually related to life satisfaction. Job satisfaction is affected by employee's desire to use their skills and abilities. According to organization's perspective, they employ task-specific people to accomplish their goals. The organizations recruit those people who are appropriate for their job requirements and employees are contented with whatever is being offered to them, then win-win situation is produced between the employer and the employee.
In recent years, health has been accorded to be privileged on the global agenda. It is being recognized as a central issue and condition for development, growing poverty and inequity in a globalized world, heightened risk posed by ecological, demographic, and socioeconomic changes and their impact on their public health had defined health as a priority for the state. Consequently, the state has intended to deliver health-care services to meet the needs of the entire population through various health-care systems such as subcenters, primary health centers, community health centers, and hospitals.
Hospital is an agency of health-care delivery system which is manned by different groups of professionals using a variety of equipment and supplies for rendering patient care and expansion of medical knowledge. The WHO defines the hospital as “a fundamental part of a medical and social organization.” The function of the hospital is to provide complete healthcare, both preventive and curative care to the people. The outpatient services should reach out to the family as if in its home environment. It is also a place for biomedical research as well as the training center of health workers. The primary purpose of any health-care facility like the hospital is to provide the best possible patient care. The primary quality of care given and the efficiency with which the facility operates are ultimately a reflection of the performance of human resources. With the different levels of impact, the physicians, the nurses, the administrators, and the other health-care workers shared their talents and efforts to provide patients with the care and treatment they need.
Human resource holds a critical position in the economic development of any country because the real strength of the nation and institution depends on the capabilities of their people. It is true that only dynamic employee can build dynamic organization and organization flourishes through the efforts and competencies of their human resources. In the health-care system, nursing personnel are the leading human resource that constitutes the most significant workforce and plays a vital role. In fact, it is accepted worldwide that nurses are the core functionalities in providing healthcare both in the hospital as well as in the community. Healthcare involves human aspects much more than other components such as modern medical technology and advanced infrastructure. Therefore, nursing care is an essential aspect of healthcare.
While physicians after taking detailed patient history, investigations, and diagnostic procedures plan the treatment, it is the nursing staff that spends maximum time in patient caring. They also look after all their needs throughout the period of their hospitalization.
The reputation of the hospital and the success of patient care are directly dependent on the efficiency of the nursing staff, which includes tender loving care that is given to the patient admitted in the hospital. Hence, its a challenging task for the hospital and nursing administration to ensure and maintain a high quality of nursing. Nursing administration plays a vital role in managing the hospital services. According to Finer, nursing service administration provides a coordinated system of activities which are needed for rendering high level of nursing care to patients and drafting policies for achieving overall goals efficiently.
The science of managing nursing service administration developed with the necessity to manage the nursing resource efficiently and effectively while developing harmonized care in the delivery process. Nursing resources are invaluable to the nation's health. The need for knowledgeable, sophisticated, caring nurses is more significant now that at any time in the history of the profession. There exists a severe problem in retaining a sufficient number of registered nurses in the nation's health-care facilities. The probable cause of the nursing shortage is complex, and the deficit has become more and more pronounced as the increasing number of nurses becomes dissatisfied and leaves nursing.
Many studies revealed that dissatisfied nursing care providers give poor quality, inefficient care, whereas there is a positive correlation between nursing satisfaction, patient satisfaction, and the treatment outcomes. Dissatisfied nurses with their job were also found to distance themselves from their patients and avoid nursing responsibilities, resulting in compromised quality of care. Baxter further emphasized the strong impact of nurse job satisfaction on the quality of care as well as on the nurse–patient relationship. It is evident that a positive correlation is present between job satisfaction and employee health.
It is well known that job satisfaction is an important concept widely studied in organizational psychology and organizational behavior. The workers' productivity, as well as personal satisfaction directly linked to success and personal achievements on their job. When an employee starts enjoying his job which implies he is deriving satisfaction from his job. The employee's efforts are equally rewarded by his employers. Job satisfaction is nothing but happiness and enthusiasm which one gets at his work. It was observed by the Harvard professionals that job satisfaction as the key ingredient which leads to achievement, promotion, perks, and recognition leading to general feelings of fulfillment.
However, many changes have occurred in the health-care system in the last decade which has affected the organizations environment for the nurses and the manner, in which they provide patient care. Advancement in technology in healthcare and more emphasis being given to cost containment have drastically resulted in changes in the structure, organization, and delivery of health-care services. While the traditional roles of the hospital have now have been shifted to community-based settings. Meanwhile, the overall acuity of the patients seen in the hospital setting has significantly increased, but the average length of stay has decreased. This implies that now nurses, particularly those working in the hospital have the most stressful work environment because they are caring for the patients who are more critically ill and requiring intensive care and meticulous efforts from nurses. All of these factors can significantly impact on nurse's satisfaction with their jobs. These elements have the potential to create tremendous stress and ultimately form negative attitudes which may cause dissatisfaction with the posts. Job satisfaction is an important part of the nurse's lives that can significantly affect patient safety, performance, and productivity and quality of care to the patient and commitment to the job as well as organization.
Job satisfaction among nurses is an indicator of the excellent working environment and management of the institution. As far as job dissatisfaction has not been calculated in monitory terms but indirectly. A poor patient outcome such as an increased patient fall rate is an indicator of increased expenses on healthcare. The poor patient outcomes increase the average length of stay, increase in resource utilization, which increases the total cost of the treatment. Health care institutions are following the quality indicators established by organizations such as the American Nurses Association (ANA) and the Joint Commission on Accreditation of Healthcare Organizations as monitoring standards. The ANA has recommended that job satisfaction is quantified and decided as one of the nurse's vulnerable performance markers to imitate nursing's impact to the quality of patient care. Together both the organizations recognized workforce satisfaction as a humanoid resources quality indicator. The study conducted by the WHO in various countries on migration and mobility of nursing staff found that inadequate working condition was the leading factor driving nurse's mobility. Nurses are the best friends of patients' although they get remunerated for the task, the care and concern exhibited by them for the patient are beyond comparison, which cannot be compared with any financial remuneration.
Dissatisfaction frequently leads to burnout among nurses. Burnout associated with stress has been quite frequently documented among nurses and is considered as one of the potential hazards occurring among individuals who do “people work.” Usually, low job satisfaction contributes toward nurses' inefficiency and affects their overall care.
The study of job satisfaction has relevance to nursing from economic, humanitarian, and professional perspectives. In hospitals, the nurse is the most vital resource of the organization. Not only is the high proportion of the total budget expended on nursing personnel in salary and benefits but also profit and service delivery is directly related to the presence, performance, and productivity of the nurse. The efficiency and stability of health-care organization rely on maintaining and improving the quality of work life for nurses. Studying the quality of work life and the improvement of work satisfaction for nurses is of humanitarian value and is a legitimate goal in itself. Research to develop a perfect understanding of the forces that shape job satisfaction in nursing, a predominantly female profession, may help policymakers design policies to make social and economic institution better serve the needs of working women. From a professional perspective, theory-generating research in the area of job satisfaction can contribute to the body of knowledge in nursing and identify areas for further study. Research findings can be used by the nurse to negotiate for changes in working conditions and can be incorporated by nursing administrators into the managerial decision-making to create and maintain employment environments that foster job satisfaction. The research on job satisfaction among the nurses in the public sector tertiary care hospitals with larger sample size is very limited. Therefore, a need exists for operational research in job satisfaction with larger sample size among nurses to further understand this phenomenon in the tertiary care hospital setting.
This study aimed to understand the job satisfaction among nursing staff at a Tertiary Care Hospital, Chandigarh. The study objectives are to assess job satisfaction and factors affecting job satisfaction and dissatisfaction, to compare the level of satisfaction among the nursing staff working in different areas of PGIMER, Chandigarh.
| Methodology|| |
This is a cross-sectional questionnaire-based study. Minnesota Satisfaction Questionnaire (MSQ) a prevalidated and free to use survey questionnaire for staff satisfaction study was used. The satisfaction questionnaire the most commonly used tool in the measurement of job satisfaction. It had been used to measure job satisfaction in a variety of sectors, including healthcare (nursing). The short-form MSQ composed of twenty aspects, each aspect represented with one satisfaction item. The short-form MSQ measures mainly three satisfying factors, i.e., intrinsic, extrinsic, and general. Question numbers 1, 2, 3, 4, 7, 8, 9, 10, 11, 15, 16, 20 measured intrinsic factors, the numbers 5, 6, 12, 13, 14, 19 measured extrinsic factor and the numbers 18 and 19 represented general factors. There were 20 sub-themes within the factors. The questions were related with the following themes given in [Table 1].
The questionnaire was given to the participants in a sealed envelope by a messenger to blind fold the study. The messenger collected the filled questionnaire and handed over the sealed envelope to the principal investigator without mentioning the name of the participant, though he had briefed about the objectives of this operational research to the participants. The responses to each question were in Likert scale from 1 to 5. The collected data were entered in MS Excel sheet and was categorized in different satisfaction levels as: Not satisfied <25%, moderately satisfied 26%–74%, and highly satisfied above 75%. This has been measured through summation score approach, by applying Likert scale.
The study conducted in different areas of a tertiary care hospital. The study population comprised nursing staff employed in a tertiary care hospital. This was a questionnaire-based survey; a convenient sampling technique was used to collect a sample size of 845 nursing staff. The inclusion criterion is the nursing staff of tertiary care hospitals who had completed their probation period. The exclusion criteria are nursing staff those who did not consent to participate and nursing staff with any pending/ongoing disciplinary proceedings. The study was approved from the institution ethics committee where the study originated. Informed written consent was obtained from each participant. The study participants were clearly explained by the messenger (after visiting and distributing the questionnaire to their respected working stations) that this operational research would be carried out to know about the satisfaction level among nursing staffs, the bottlenecks would be identified and it would be rectified as per feasibility.
Summary statistics were used to describe the sociodemographic characteristics of the samples. Analysis of variance (ANOVA) test was used to see the difference between the different groups of staff members in terms of job satisfaction. Chi-square analysis is used to see the relationship between the variables. Statistical analysis was carried out by the Statistical Package for the Social Science Version-16 software (IBM, Chicago, USA).
| Results|| |
The mean age of the respondents was 32 years with standard deviation ± 3.2 years. Nearly half of the participants were in the age group of 21–30 years. Nearly (677) 80% of the respondents were female; supporting the fact that most of the nursing professionals were females across the globe,, in spite of gradual increase in the male nurses in recent years. Among nursing professionals, more than two-third of them were nursing officers (NO) 620 (73.4%), followed by senior NO, assistant NS, deputy NS (DNS), and NS with least in count comprising 0.1% [Table 2] and [Table 3].
[Table 4] shows the distribution of nurses on the basis of overall satisfaction level. It was found that most all the nursing professionals were either moderately satisfied or highly satisfied with their profession.
The study population is divided into eight groups based on their working place. The distribution of staff members is shown in [Table 5] and also ensured that the sample is diverse from all the departments in the hospital.
From the working experience calculated in years, it has been found that nearly two-third of the nursing professionals had <10 years of work experience and almost one-third had work experience in between 11 and 30 years [Table 6].
Chi-square test was performed to find the relationship between the job satisfaction and age group factor, which indicated there was a significant association between the variables (P < 0.01). As the age of the person increases, the job satisfaction also increases [Figure 1].
There is no statistical difference of job satisfaction between genders. The ANOVA test implies that no difference in job satisfaction irrespective of gender difference.
Designation plays a vital role in any organization. Similarly, job satisfaction among different designation of nursing professionals is varied.
Educational qualifications of the respondents were divided into four categories - Diploma, BSc, MSc, and PhD. The Chi-square tests and ANOVA test implies that there was a significant difference found between job satisfaction and their educational qualifications among nursing staff. The Chi-square tests and ANOVA suggested that there was a significant difference between the area of posting and level of job satisfaction among the nursing staff.
Here, we have compared the association between the different factors (intrinsic, extrinsic, and general) with independent variables by using Chi-square tests (age, gender, designation, qualification, and area of posting and length of service). It is evident from the literature that extrinsic factors and general factors are the satisfiers, while intrinsic factors are the motivators [Table 8].
The results show that there was no significant difference in the satisfaction level of intrinsic factors among different genders of nurses. Similarly, gender did not have any significant influence on the satisfaction of extrinsic and general factors. Designation did not have any significant influence on satisfaction level of nurses, while designation had a significant influence on satisfaction of extrinsic and general factors. Qualification did not have any influence on satisfaction level of nurses while it had a significant influence on satisfaction level of extrinsic and general factors [Table 7]. Area of posting had a significant influence on satisfaction level of nurses on intrinsic as well as extrinsic and general factors. Age had a significant influence on satisfaction level of nurses on the satisfaction of intrinsic, extrinsic, and general factors. Length of service did not have a significant influence on satisfaction of intrinsic factors on nurses while extrinsic and general factors had a strong influence on satisfaction level.
| Discussion|| |
Job satisfaction is an important dimension of organizational behavior, which is commonly studied and discussed. It is aimed at both physical and emotional well-being in broad perspective comprising from either of organizational and human resource management perspective. Job satisfaction directly increases the productivity and profitability of organizations. In simple words, persons who are highly satisfied with their jobs are the one who would certainly performs better.
However, many changes have occurred in the health-care system in the last decade which has affected the organizations environment for the nurses and the manner, in which they provide patient care. Advancement in technology in healthcare and more emphasis being given to cost containment have drastically resulted in changes in the structure, organization, and delivery of health-care services. While the traditional roles of the hospital have now have been shifted to community-based settings. Meanwhile, the overall acuity of the patients seen in the hospital setting has significantly increased, but the average length of stay has decreased. This implies that now nurses particularly those working in the hospital have most stressful work environment because they are caring for the patients who are more critically ill and requiring intensive care and meticulous efforts from nurses. All of these factors can significantly impact on nurse's satisfaction with their jobs. These elements have the potential to create tremendous stress and ultimately form negative attitudes which may cause dissatisfaction with the posts. Job satisfaction is an important part of nurse's lives that can significantly affect patient safety, performance, and productivity and quality of care to the patient and commitment to the job as well as organization.
As the organization has the responsibility to create a healthy and congenial atmosphere at the workplace so that its human resources could offer their best for the development of the organization with a sense of belongingness, satisfaction, and growth.
In the current study, majority of the nurses were moderately satisfied or highly satisfied with their job. The findings were comparable to the studies conducted among nurses of Chandigarh and New Delhi. However, the percentage of satisfaction was only 40% in the study conducted at Pune. One reason for this may be the different type of tools used by the researcher in their studies for assessing job satisfaction level. Studies conducted in low, middle countries and developed countries have shown variance in job satisfaction level. While the studies conducted in Pakistan and Sri-Lanka had a satisfaction level of 32% and 43%, respectively. This may be due to the benefits such as perks and treat received. While job satisfaction comprises some common factors, it is also affected by several factors that vary through nurses as well as situations.
Nurses in the higher age brackets were more satisfied with the job as compared to the younger lot. The reason may be gradual acceptance and adaptation to work and organizational environment. In contrast, nurses in younger age groups tend to be little impatient and have more expectations from the job, and when the expectations are not fulfilled, that leads to dissatisfaction from the job and think of leaving the present job. Similar findings were observed in a study conducted by Larrabee et al. in the university medical center in West Virginia. That study revealed that those nurses who had <5 years of experience were more prone to quitting the job than of nurses having a longer tenure. This indirectly reflects that nurses in the younger age group are less satisfied with their job. That may be the reason for high tendency to quit the job. Similar findings were observed in a study conducted by Saini and Singh. It was found that nurses with a higher age group were highly satisfied compared to the nurses in the younger age group.
The present study showed a positive association between lengths of service with the level of satisfaction in the job. Length of service is a significant factor for job satisfaction and persons who are highly satisfied with their jobs have very less chances of leaving the sector or organization where they are posted. Similar findings were observed in a study conducted by Larrabee et al. It was found that nurses with >11 years of service were more satisfied compared to the nurses with <10 years of service.
In terms of area of posting, it was found that the nurses in areas which require 24 × 7 patient care areas such as ER and intensive care unit (ICU) are less satisfied compared to their colleagues deployed in less critical nonemergency areas like outpatient departments, operation theaters and general wards. Similar findings were observed in a study conducted by Saini and Singh. It was found that nurses working in wards were more satisfied compared to the nurses who were working in critical areas such as ICUs and emergency. The reason for dissatisfaction among nurses working in critical areas may be a poor patient outcome, irregular duty ours, stress involved in the job etc.
It was found in the present study that the Nurses holding higher postlike DNS were more satisfied than others. In this study, this may be because nurses holding higher post are mostly involved in administrative work, they have fewer interactions with patients in a day-to-day activities. Similar findings were observed in a study conducted by Adams and Bond the study revealed that higher status in the workplace has a definite role in job satisfaction. More precisely, it was observed that nurses in administrative and supervisory roles were more satisfied than nurses involved in direct patient care. The reason behind this may be that with time, experience, higher designation, and job enrichment they become more satisfied than others, even all motivation theories explain the same thing.
| Conclusion|| |
Nurses are a vital human resource of any hospital. Satisfaction of the nurses is directly related to treatment outcome and patient satisfaction. Increasing satisfaction of the nurse is a sure shot solution in the hands of hospital management to improve the image of their hospitals. The study found that most of the nurses were satisfied but some factors were commonly related with dis-satisfaction. Working in stressful areas of hospitals such as emergency, ICUs led to dissatisfaction among them. Similarly, nurses with higher qualification as compared to the peers were found to be more dissatisfied. Nurses in the early phase of their service were also found to be less satisfied it is an established fact that satisfied nurses provides better patient care. Hospital management can address these factors to increase the satisfaction level of the nurses and in turn efficiency of the hospital. As shown in the study, hospital managements have to undertake steps to find out the dissatisfying factors among their nursing staff and take appropriate steps to address them. In conclusion, hospital management has to take a holistic approach in their endeavor to increase hospital efficiency, treatment outcomes, and patient satisfaction vis-à-vis their nursing personal management.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]