Journal of Nursing Management, 2012, 20, 260265

Registered nurse job satisfaction and satisfaction with the

professional practice model
KAREN MC GLYNN D N P , R N , C N A , B C 1, MARY QUINN GRIFFIN
3
4
N E A - B C and JOYCE J. FITZPATRICK P h D , R N , F A A N

PhD, RN

, MOREEN DONAHUE

DNP, RN,

Deputy Chief Nursing Officer, Nassau University Medical Center, East Meadow, NY, 2Assistant Professor, Frances
Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, 3Chief Nurse Executive, Senior
Vice President of Patient Care Services, Danbury Hospital, Danbury, CT and 4Elizabeth Brooks Ford Professor of
Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA

Correspondence
Karen McGlynn
2201 Hempstead Turnpike
East Meadow
NY 11554
USA
E-mail: kmcglynn@numc.edu

M C G L Y N N K . , G R I F F I N M . Q . , D O N A H U E M . & F I T Z P A T R I C K J . J . (2012) Journal of Nursing Management 20, 260265

Registered nurse job satisfaction and satisfaction with the professional
practice model

Aims This paper describes the initial assessment of job satisfaction and satisfaction
with the professional practice environment of registered nurses working on units
where a professional practice model was implemented and the relationship between
these two variables.
Background The nursing shortage has been linked to overall job satisfaction and
specifically to nurses satisfaction with the professional practice environment.
Initiatives to increase retention and recruitment and decrease turnover have been
linked to work satisfaction among nurses.
Methods A descriptive, cross-sectional design was used with participants (N = 101)
from four patient care units; this represented a 55% response rate.
Results The nurses were moderately satisfied with the professional practice environment but had overall low job satisfaction. There was a significant negative
relationship between overall work satisfaction and satisfaction with the professional
practice environment (P < 0.0001).
Conclusions The introduction of the professional practice model may have raised
awareness of the components of job satisfaction that were not being met. Thus, the
nurses may have become more knowledgeable about the potential needs in these
areas.
Implications for nursing management Nurse managers and leaders must recognize
that job satisfaction consists of many dimensions, and each of these dimensions is
important to nurse retention. Implementation of a professional practice model may
heighten awareness of the missing components within a practice environment and
lead to decreased overall satisfaction. A broader understanding of characteristics
associated with increased satisfaction may aid in development of organizational
change necessary to retain and attract nurses.
Keywords: job satisfaction, practice environment, professional practice model,
registered nurse
Accepted for publication: 3 November 2011

260

DOI: 10.1111/j.1365-2834.2011.01351.x
2012 Blackwell Publishing Ltd

RN job satisfaction

Introduction
Job satisfaction reflects a positive affective orientation
toward work and the organization, whereas job dissatisfaction reflects a negative affective orientation
(Taunton 2003). Registered nurse (RN) job satisfaction
and retention are major concerns for nurse administrators, particularly as the demand for RNs continues to
surpass supply. As job satisfaction decreases, the likelihood of nurses leaving their employment settings
increases (Ma et al. 2003).
According to previous research, an important predictor of RN job satisfaction is the professional practice
model (George et al. 2002, Newhouse & Mills 2002,
Mark et al. 2003, Hall & Doran 2004). The professional practice model is characterized by a greater RN
presence with the patient, which makes preventive and
monitoring action possible, and by greater decisionmaking authority and flexibility for the RN, which
supports rectifying action that is appropriate and efficient (Lake 2002). The importance of nursing practice
models is that these models provide an organizational
framework that offers an opportunity for RNs to become more committed to their practice. Some characteristics of professional nursing practice are autonomy,
shared governance and positive nursephysician relationships (Havens & Aiken 1999).
Professional nursing practice and job satisfaction
have been positively linked in the literature (Newhouse
& Mills 2002, Lynn & Redman 2006). Kalisch et al.
(2010) found that job satisfaction was positively related
to nurses ratings of their teamwork. Further, nurses
have been shown to be more satisfied when they are
valued by the administrative team and given the
opportunity and power to implement key organizational goals (Upenieks 2003). Patrician et al. (2010)
found that unfavourable professional practice environments were significantly related to job dissatisfaction. A
professional nursing practice model is one strategy that
can aid hospitals in maintaining their nursing workforce
and increasing the quality of RN work life through its
positive effect on RN job satisfaction (Mark et al.
2003).

satisfiers motivators and the dissatisfiers hygiene factors, using the term hygiene in the sense that they are
considered maintenance factors (e.g. salary, bonuses
and staffing) that are necessary to avoid dissatisfaction
but that by themselves do not provide satisfaction.
According to the theory, the satisfiers are related to the
nature of the work itself and rewards that flow directly
from performance of that work. The most potent of
these are those characteristics that foster the individuals
needs for self-actualization and self-realization in his
work. These work-related or intrinsic factors are attitude, achievement, recognition, work itself, responsibility and advancement (House & Wigdor 1968).
Hospital administrations often attempt to solve their
RN staffing issues and low satisfaction levels by
addressing hygiene needs. Offering such things as higher
salaries, sign-on bonuses, flexible staffing hours, tuition
reimbursement and increased benefit time will attract
RNs to an institution but not produce long-term satisfaction with the job or retention (Spetz & Given 2003,
Lynn & Redman 2006). Employees are only truly
motivated by being enabled to reach for and satisfy the
factors that Herzberg identified as real motivators
achievement, advancement, recognition, work itself,
responsibility and growth. These motivation factors
that Herzberg has described are the elements of a professional practice model. Literature relevant to job satisfaction indicated that professional practice models,
autonomy and professional status contribute the most
to RN job satisfaction (Simpson 2009). As a professional practice model was recently introduced in our
community hospital, we were interested in assessing the
relationship between nurses overall work satisfaction
and their satisfaction with the practice environment.
Thus, the purpose of this study was to examine the
relationship between (RN job satisfaction and RN satisfaction with the practice environment among those
working on units where a professional practice model
had been implemented. Based on Herzbergs theory it
was expected that there would be a positive relationship
between overall job satisfaction and satisfaction with
the professional practice environment. The primary research question addressed the relationship between
these two measures of work satisfaction.

Theoretical framework
Herzbergs MotivationHygiene Theory (Herzberg
et al. 1959) was used as the framework for this study.
Herzberg found that factors causing job satisfaction
were different from those causing job dissatisfaction.
Herzberg developed the two-factor motivation
hygiene theory to explain these results. He called the
2012 Blackwell Publishing Ltd
Journal of Nursing Management, 2012, 20, 260265

Methods
A descriptive, cross-sectional design was used. The
study was approved by the appropriate Institutional
Review Boards. The study was conducted in a 900-bed
academic medical centre in the northeast USA. Participation in this study was voluntary and anonymous.
261

K. McGlynn et al.

Sample
All full-time and part-time RNs (N = 182) working on
the four units were invited to participate, regardless of
age, sex or ethnicity. Nurse managers, assistant nurse
managers, per diem nurses, private duty nurses and
contract agency nurses were excluded from this study.
The researcher attended staff meetings on each of the
units, explained the study, how the study would be distributed and encouraged participation. The questionnaires were attached to the pay checks of the RNs and
returned to a sealed container placed in the nurses lounge
of each of the patient care units. Although no additional
reminders were sent, a poster was placed on each of the
units describing the study and encouraging participation.

The professional practice model

The professional practice model was developed within
the hospital where this study was done. This Collaborative Care Model (CCM), has seven core values:
professionalism, excellence, leadership, caring, collaboration, safety and honouring the human spirit. The
CCM is a shared governance model of professional
practice where the patient is in the centre and comes
first. Central to the CCM is the Collaborative Care
Council (CCC) on each patient care unit. These shared
governance councils are structured so that all nursing
staff members are encouraged to participate in unit
governance, share best practices, foster autonomy and
empower them to advocate for the patients, their coworkers and themselves. In a study by McElligott et al.
(2010), participants who attended the CCM programme reported significantly increased interpersonal
relationships (P = 0.04).
The CCM was presented to all RNs working on the
study units. The 8-hour program was offered in the
same classroom with the same content and instructors.
Content of the class included the concept of the CCM,
why it is needed, how to get there and how to sustain it.
The instructors of the class continued working with the
RNs as facilitators and consultants to the newly formed
CCCs.

Instruments
Job satisfaction was measured with the Index of Work
Satisfaction, Part B (IWS-Part B), which consists of six
components of satisfaction: pay, professional status,
doctornurse relationship, administration, autonomy,
task requirements and interaction. The IWS-Part B
measures the respondents current level of satisfaction
262

with these components through a Likert-type attitude

scale with the agree/disagree scores ranging from 1 to 7
and a total possible score ranging from 44 to 308
(Stamps et al. 1978). The six component scores are
summed to produce a single overall score, the total
satisfaction score (TSS) with high scores indicating
greater satisfaction (Stamps et al. 1978). The reliability
of the scale has been determined by the use of the
Cronbach a coefficient; reliability for the 44-item tool
was 0.91 (Stamps et al. 1978). In the present study the
total IWS Part B Cronbach a was 0.77. The Cronbachs
a coefficients for each of the subscales were: pay 0.80,
professional status 0.73, autonomy 0.69, organizational
policies 0.74, task requirements 0.76 and interactions
0.71. Validity was estimated using principal component
analysis (Stamps et al. 1978).
Satisfaction with the professional practice environment was measured using The Practice Environment
Scale of the Nursing Work Index (PES-NWI) developed
by Lake (2002). The PES-NWI is a 31-item questionnaire comprising five subscales: nurse participation in
hospital affairs; nursing foundations for quality of care;
nurse manager ability, leadership and support of nurses;
staffing and resource availability; and collegial nurse
physician relations. Reponses for each item on the
Likert scale range from 1 to 4. Overall scores range
from 31 (dissatisfied) to 124 (satisfied). The subscales
and composite scores showed high reliability at both the
individual and hospital levels. In Lakes (2002) research,
individual-level internal consistency was high (a 0.80)
except for the collegial nursephysician relations subscale, in which it was moderate (a = 0.71). The reliability of the hospital-level measures was robust, with
correlations of 0.640.91 (Lake 2002). In the present
study, the total PES-NWI Cronbachs a was 0.85. The
following values were obtained for each of the subscales: RN participation in hospital affairs a = 0.81,
RN foundations for quality care a = 0.81, manager
ability, leadership, support a = 0.82, staffing and resource adequacy a = 0.83 and nursephysician relations
a = 0.81. The discriminant validity of the scale was
supported by the significantly higher mean scores of
nurses in Magnet hospitals compared with those of
nurses in non-Magnet hospitals (Lake 2002). This suggests that the instrument is a sensitive tool for detecting
differences in nursing practice environments measured
at the hospital level (Lake 2002).

Results
The data were collected during a 5-week period. Of the
182 nurses working on the four units where the
2012 Blackwell Publishing Ltd
Journal of Nursing Management, 2012, 20, 260265

RN job satisfaction

professional practice model had been implemented, 101

returned the surveys. This represented a response rate of
55%. Sample characteristics are included in Table 1.
Descriptive statistics indicated that the nursing staff
working on units with a professional practice model
had a mean TSS of 144.16 (SD 21.52). The range of
scores for the TSS was 44308. The range for the TSS
for this study was 87228. A TSS of 144.16 falls in the
second quartile and the 47th percentile, thus indicating
moderately low overall job satisfaction. These results
are included in Table 2.
Participants had a mean PES-NWI composite score
of 2.90 (SD 0.25). The range of scores was 14. A
PES-NWI composite score of 2.90 falls in the third

Table 1
Sample characteristics (N = 101)
Characteristic
Gender
Female
Male
Race/Ethnicity
Caucasian/White
African-American/Black
Hispanic/Latino
Asian
Native American/Alaskan
Pacific Islander
Other
Highest education level
Associate degree
Diploma in nursing
BSN
MSN
Years experience as a nurse
Mean = 12.76
SD = 9.25
Range = 138
Years employed at this hospital
Mean = 12.24
SD = 9.21
Range = 138

94
7

93.07
6.93

61
14
7
14
0
2
3

60.40
13.86
6.93
13.86
0.00
1.98
2.97

36
5
56
4

35.64
4.95
55.45
4.95

Table 2
Registered nurse job satisfaction scores (N = 101): Index of Work
Satisfaction
Variable

Mean

SD

Pay
Professional status
Autonomy
Organizational policies
Task requirements
Interaction
Nursenurse
Nursephysician
Total scale score (TSS)

22.81
17.18
22.50
22.55
26.93
32.18
13.73
18.45
144.16

5.63
4.55
5.30
4.76
5.27
8.15
4.94
5.87
21.52

2012 Blackwell Publishing Ltd

Journal of Nursing Management, 2012, 20, 260265

quartile and the 73rd percentile, indicating moderate

satisfaction with the professional practice environment.
The range of the overall scores for this study was
63102. These results are included in Table 3.
Correlations between the total scores on the two
instruments indicated a statistically significant negative
correlation between job satisfaction and satisfaction
with the practice environment (r = )0.49, P < 0.0001).
Further analysis indicated no statistically significant
relationship between background variables (age, work
experience) and the measures of job satisfaction and
satisfaction with the professional practice environment.

Discussion
The findings of this study indicated that RNs working
on a unit where a professional practice model is in place
had moderately low overall work satisfaction. Using the
same instrument, Ea et al. (2008) reported a moderate
level of satisfaction among foreign-educated nurses
working in the USA. From the perspective of nurse
leaders and nurse managers, it is important to understand the factors, personal, professional and organizational, that are directly related to work satisfaction
among nurses in acute-care settings.
The RNs in the present study were moderately satisfied with their professional practice environment. Although the study hospital was not a Magnet institution,
this moderate level of satisfaction with the professional
practice environment is comparable to the level of satisfaction of the nurses working in Magnet hospitals
studied by Lake (2002). The aspects of the professional
practice environment studied were nursing participation
in hospital affairs, nursing foundations for quality care,
nurse manager ability, leadership and support of nurses,
staffing and resource allocation, and collegial nurse
physician relations (Lake 2002). This moderate level of
satisfaction with the professional practice environment
may be related to the CCM that was introduced on the
units. The RNs on these units are members of all
committees that may have implications for nursing
Table 3
Registered nurse practice environment satisfaction scores (n = 101):
Practice Environment Scale of the Nursing Work Index (PES-NWI)
Variable

Mean

SD

Nurse participation in hospital affairs

Nursing foundations for quality of care
Nurse manager ability, leadership, support
Staffing and resource adequacy
Collegial nursephysician relations
PES-NWI

2.88
3.01
2.97
2.75
2.89
2.90

0.27
0.25
0.35
0.47
0.43
0.25

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K. McGlynn et al.

practice, such as standard/policy/procedure committee,

professional practice committee, pharmacy and therapeutics committee, and the chief nursing officer is a
voting member of the medical board. Study hospital
RNs also participate in the interview process for hiring
nurse managers and assistant nurse managers. This level
of involvement by the study RNs has contributed to
their satisfaction with their practice environment. In
light of the present nursing shortages and predictions of
the number of available nursing positions increasing by
21% (Ingersoll et al. 2002), attention needs to focus on
maximizing the desirability of the work environment to
satisfy RNs. The disparity between the desired and
the perceived work environment contributes to a
disengagement and withdrawal from the profession of
nursing (Ingersoll et al. 2002).
Most surprising was the high negative relationship
between overall job satisfaction and satisfaction with
the professional practice environment. This is in contrast to results of previous studies (George et al. 2002,
Newhouse & Mills 2002, Mark et al. 2003, Hall &
Doran 2004) and thus raises questions for future research regarding the multiple dimensions of nurse satisfaction. The satisfaction of the nurses in this study
with their practice environment is similar to the satisfaction of nurses working in Magnet hospitals (Lake
2002). However, hospitals may experience turbulence
as they restructure organizational components. Organizational restructuring, particularly if nurses are
expected to develop more self-governance, may be
stressful, and changes in work satisfaction may be
associated with this process (Newcomb et al. 2009).

Limitations
A limitation of the study was the fact that the study was
conducted in only one hospital and only 55% of the
eligible nurses participated in the study. The authors
should have also considered the short amount of time
that the professional practice model had been in place
(just 10 months). Adequate time and planning needs to
be allocated for transitioning from one model to another, especially for identifying positive and negative
attitudes toward change within teams as well as key
people to help implement change, and for highlighting
possible areas of conflict (Welford 2006). Another
limitation of the study was the different unit types included: one medical unit, two surgical units and one
critical-care unit. Ingersoll et al. (2002) found that RNs
on medical and surgical units have lower job satisfaction and RNs on obstetric units have higher job satisfaction. While, in this study, there were no significant
264

differences between units, this aspect of research deserves future attention. An additional concern may have
been the use of the measure of the various facets of job
satisfaction rather than a global measure, such as a
single-item question. There has been considerable discourse regarding this specific measurement issue (Weiss
2002). An additional measurement issue was the overlap in content on the two instruments. Even though
there was a strong negative relationship between the
measures, the subscale overlap may have affected the
results. This factor should be considered in future
research. It could be argued that satisfaction with
the professional practice model is a component of job
satisfaction. Further research addressing the various
dimensions of job satisfaction is warranted.

Conclusion
The results of this study indicate moderately low job
satisfaction among RNs working on units where a
professional practice model has been implemented and
moderate satisfaction with their practice environment.
In addition there is a negative correlation between the
two measures of satisfaction.

Implications for nursing management

It is important for nurse managers and leaders to be
tuned into the specific components of job satisfaction
that are important to nurses working on any type of
unit. The results of this study indicate that particular
attention should be paid to professional interactions,
both nursenurse and nursephysician. In light of the
present nursing shortages and predictions of the number
of available nursing positions increasing by 21% (Ingersoll et al. 2002), attention needs to focus on maximizing the desirability of the work environment to
satisfy RNs. The disparity between the desired and the
perceived work environment contributes to a disengagement and withdrawal from the profession of nursing (Ingersoll et al. 2002). A broader understanding of
nurses desired practice environments, and those characteristics that presently are associated with increased
satisfaction, may aid in development of organizational
change necessary to retain and attract nurses.
In future studies researchers should consider differences between the desired and perceived practice environments of RNs. A broader understanding of RNs
desired practice environments, and those characteristics
that presently are associated with increased satisfaction,
will aid in the development of the organizational change
necessary to retain and attract RNs. This crucial
2012 Blackwell Publishing Ltd
Journal of Nursing Management, 2012, 20, 260265

RN job satisfaction

information will allow hospital nursing leadership to

facilitate a positive practice environment and satisfied
RNs. It is also important to implement longitudinal
studies to track the range of factors that might influence
overall work satisfaction and satisfaction with the
professional practice environment.

Source of funding
There was no source of funding.

Ethical approval
IRB Case Western Reserve University, Cleveland, Ohio;
IRB NSLIJ Health System, Manhasset, NY.

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