Job Satisfaction Among Hospital Nurses Revisited

International Journal of Nursing Studies 49 (2012) 10171038
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International Journal of Nursing Studies

journal homepage: www.elsevier.com/ijns
Review
Job satisfaction among hospital nurses revisited: A systematic review

Hong Lu a, K. Louise Barriball b, Xian Zhang a, Alison E. While b,*
a
b
Peking University School of Nursing, #38 Xueyuan Road, Hai Dian District, Beijing 100191, PR China
Kings College London, Florence Nightingale School of Nursing and Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, United Kingdom
A R T I C L E I N F O
A B S T R A C T
Article history:
Received 15 July 2011
Received in revised form 9 November 2011
Accepted 15 November 2011
Background: The current nursing shortage and high turnover is of great concern in many
countries because of its impact upon the efciency and effectiveness of any healthcare
delivery system. Recruitment and retention of nurses are persistent problems associated
with job satisfaction.
Objective: To update review paper published in 2005.
Design: This paper analyses 100 papers relating to job satisfaction among hospital nurses
derived from systematic searches of seven databases covering English and Chinese
language publications 19662011 (updating the original paper with 46 additional studies
published 20042011).
Findings: Despite varying levels of job satisfaction across studies, sources and effects of
job satisfaction were similar. Hospital nurse job satisfaction is closely related to
working conditions and the organizational environment, job stress, role conict and
ambiguity, role perception and role content, organizational and professional commitment.
Conclusions: More research is required to understand the relative importance of the many
identied factors relating to job satisfaction of hospital nurses. It is argued that the absence
of a robust causal model reecting moderators or moderator is undermining the
development of interventions to improve nurse retention.
2011 Elsevier Ltd. All rights reserved.
Keywords:
Job satisfaction
Job stress
Professional identication
Role perception
Career
What is already known about the topic?

The widespread nursing shortage and nurses high
turnover has become a global issue.
Job satisfaction among nurses has been identied as a
key factor in nurses recruitment and retention but a
comprehensive understanding of nurses job satisfaction
and its related factors remains elusive.
This is a revised and updated version of Lu, H., While, A.E., Barriball,
K.L., 2005. Job satisfaction among nurses: a literature review. International Journal of Nursing Studies 42 (2), 211227.
* Corresponding author.
E-mail addresses: luhong@bjmu.edu.cn (H. Lu),
louise.barriball@kcl.ac.uk (K.L. Barriball), zhangxian0621@yahoo.cn
(X. Zhang), alison.while@kcl.ac.uk (A.E. While).
0020-7489/$ see front matter 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ijnurstu.2011.11.009
What this paper adds

Empirical evidence relating to nurses job satisfaction
indicates the need for continued improvement in nurses
working lives.
The review identies the sources of nurses job satisfaction, its effect and the related factors affecting nurses job
satisfaction.
The lack of a comprehensive and causal model reecting
moderators or moderator of job satisfaction in nursing is
a major shortcoming, undermining the development of
interventions to improve nurse retention.
1. Introduction
The widespread nursing shortage and nurses high
turnover is a global issue (Kingma, 2007) which is of
H. Lu et al. / International Journal of Nursing Studies 49 (2012) 10171038
1018
increasing importance to both the developed and developing countries (Aiken et al., 2001; Fang, 2001; Lu et al.,
2002; Zangaro and Soeken, 2007). In light of this, concern
about recruitment and retention of nursing staff is
increasing in a number of countries (Kingma, 2007). While
numerous factors have been linked to nurses turnover, job
satisfaction is the most frequently cited (Cavanagh and
Cofn, 1992; Blegen, 1993; Irvine and Evans, 1995), and
therefore merits attention. This review updates a previous
review (Lu et al., 2005) and examines the extensive
empirical literature regarding the job satisfaction of
qualied general nurses working in hospitals and its
associated factors.
2. The denition of job satisfaction
Job satisfaction is a most frequently studied variable in
organizational behaviour research, and also a central
variable in both research and theory of organizational
phenomena ranging from job design to supervision
(Spector, 1997). The traditional model of job satisfaction
focuses on all the feelings that an individual has about his/
her job. However, what makes a job satisfying or
dissatisfying does not depend only on the nature of the
job, but also on the expectations that individuals have of
what their job should provide.
Thus job satisfaction is the affective orientation that an
employee has towards his or her work (Price, 2001). It can
be considered as a global feeling about the job or as a
related constellation of attitudes about various aspects or
facets of the job. The global approach is used when the
overall attitude is of interest while the facet approach is
used to explore which parts of the job produce satisfaction
or dissatisfaction. Based on the review of the most popular
job satisfaction instruments, Spector (1997) summarized
Records
identified
and
screened through database
searching
before
2004
(n =1189)
Full-text papers
excluded (n =1135)
Irrelevance(for
sample/population
reasons) n=1088
Poor quality
(design,
instrument,
statistical analysis)
n=47
Full-text papers assessed

for eligibility (n =54)
the following facets of job satisfaction: appreciation,

communication, co-workers, fringe benets, job conditions, nature of the work itself, the nature of the
organization itself, an organizations policies and procedures, pay, personal growth, promotion opportunities,
recognition, security and supervision.
3. Identication of the literature
The literature relating to job satisfaction and nurses
was identied through electronic databases using the
same method as in the previous review (Lu et al., 2005).
The electronic databases used to obtain the relevant
literature were: CINAHL (19822011), Medline (1966
2011), PsycINFO (19742011) and British Nursing Index
(19852011), the Applied Social Science Index (2004
2011). Chinese databases such as the China Medical
Academic Conference (19852011) and China Academic
Journal (19852011) were also used. To maximize the
amount of relevant literature, key terms and phrases
associated with job satisfaction, occupational stress,
professional commitment, role conict and role ambiguity
were utilized in the subject search in combination with
nurses following guidelines for searching the OVID interface. This identied a total of 2435 published research
papers from all the databases searched. The abstracts or
full texts of the papers were reviewed prior to their
inclusion in the review. Inclusion criteria were: qualied
general nurses working in acute care hospitals. Exclusion
criteria were: student nurses, nurse assistants and
qualied nurses working in specialized care settings in
hospitals, other health care settings or non-adult healthcare. Two thousand and two hundred and fth-four papers
were deemed not relevant and 81 papers were of poor
quality with reference to the Strobe guidelines (Altman
Records identified and

screened through database
searching 2004
(n=1246)
Full-text papers assessed

for eligibility (n = 46)
Papers included in this updated review

(n =100)
Fig. 1. The ow diagram illustrating the selection of publication.
Full-text papers
excluded (n =1178)
Irrelevance (for
sample/population
reasons)
(n=1166)
Poor quality
(design, instrument,
statistical analysis)
(n=34)
et al., 2007). A total of 100 papers were included in this

review (Fig. 1).
4. Job satisfaction and its sources
Job satisfaction has been found to be related to
performance within the work setting (Landeweerd and
Boumans, 1988) and therefore researchers have attempted
to identify the various components of job satisfaction,
measure the relative importance of each component of job
satisfaction and examine what effect these components
have on workers productivity (Burnard et al., 1999). A
range of sources of job satisfaction among nurses have
been reported from quantitative studies as well as
qualitative studies.
Aiken et al. (2001) found job dissatisfaction among
nurses was highest in the United States (41%) followed by
Scotland (38%), England (36%), Canada (33%) and Germany
(17%). One third of nurses in England and Scotland and
more than one fth in the United States planned on leaving
their job within 12 months of data collection. More
striking, however, was that 2754% of nurses under
30 years of age planned on leaving within 12 months of
data collection in all countries. Regarding the work climate,
only about one third of nurses in Canada and Scotland felt
that they participated in developing their own work
schedules in comparison with more than half in the other
three countries. When compared with other countries, the
nurses in Germany (61%) reported that they were more
satised with the opportunities for advancement while the
nurses in the United States (57%) and Canada (69%) felt
more satised with their salaries.
Similarly, Adamson et al. (1995) found that British
nurses perceived themselves to be more dissatised than
Australian nurses (p < 0.001). The British nurses perceived
their professional status to be lower (p < 0.01), their
relationship with hospital administrators to be poorer
(p < 0.01), and their working conditions to be less adequate
than Australian nurses (p < 0.01). They also reported more
conict between the idealized perspective of work gained
during training and actual work practice (p < 0.01), and
were less satised with their professional organization
(p < 0.01). The British nurses were also more concerned
about the lack of communication between nurses and
doctors (p < 0.01) and reported being less respected by
other allied health professionals, hospital administrators
and doctors (p < 0.01). However, there was no overall
signicant difference between the Australian and British
nurses regarding perceived level of autonomy of the
medical profession.
Different measurements regarding nurses job satisfaction show various sources of satisfaction. The ndings
derived from different studies using the same scales are
more valuable in providing comparative information,
particularly some cross-culture data. For example, the
Adams et al.s (1995) Ward Organizational Features Scales
were used in a set of studies to collect information from
nurses about their perceptions of the various aspects of
ward life and the impact which they had on care
organization (Tovey and Adams, 1999; Adams and Bond,
2000). The tool comprised six sets of measures comprising
1019
14 sub-scales rated on a 4-point Likert scale: physical

environment of the ward, professional nursing practice,
professional working relationships, ward leadership,
nurses inuence and job satisfaction. The testretest
reliabilities of the scales were good with a correlation
coefcient of 0.7 or above (Adams et al., 1995).
Utilizing this questionnaire, Tovey and Adams (1999)
found that key sources of nurses dissatisfaction included
working relationships, particularly those with management, lack of staff, professional concerns about poor
standards of care and external work pressure. Adams and
Bond (2000) found that most nurses positively rated
aspects of ward services, facilities and layout (mean > 3,
respectively). The highest correlations were found
between job satisfaction and cohesion of the ward nursing
team (p < 0.001), staff organization (p < 0.001), the level of
professional practice achieved within the ward (p < 0.001)
and collaboration with medical staff (p < 0.001). Furthermore, the most important contributors to nurses job
satisfaction were the degree of cohesion existing among
ward nurses (R2 = 0.26), the degree of collaboration with
medical staff (R2 = 0.20) and perception of staff organization (R2 = 0.20).
Nolan et al.s (1995) Job Satisfaction Questionnaire was
also utilized in a series of studies in the different countries
to assess nurses job satisfaction and morale (Nolan et al.,
1995, 1998; Lundh, 1999). It comprises 16 items addressing aspects of the work environment, perceptions of
change in the last 12 months and overall satisfaction and
morale. Nolan et al. (1995) found that level of job
satisfaction had remained stable and two factors were
dominant in nurses understanding of satisfaction and
morale, namely: the perceived ability to deliver good
patient care and good collegiate relationships with coworkers. Together, these accounted for more than 50% of
all the additional positive comments received. Nolan et al.
(1998) further found that 85% of respondents considered
that their work was interesting, and this was one of the
most signicant factors inuencing job satisfaction.
Regarding job satisfaction and morale, 35% of respondents
considered that their job satisfaction had decreased in the
last year and 69% felt that overall morale had fallen.
Similarly, Lundhs (1999) study showed that over 90% of
respondents saw their work as interesting and most
respondents also thought that they received respect from
their superiors (68%). Conversely, however, 55% of
respondents reported that leadership within the organization was not seen to be particularly democratic with
limited opportunities to inuence the decisions of
managers. In addition, nearly three quarters of respondents reported that their levels of stress had increased over
the last 12 months, while important aspects of their job
satisfaction, such as satisfaction with pay and satisfaction
with overall working conditions had fallen.
In addition to providing a general outline of reported
job satisfaction, Price (2002) explored key areas of job
satisfaction using the Mueller and McCloskey (1990a,b)
Satisfaction Scale which comprises 31 items on eight
dimensions: extrinsic rewards, scheduling, balance of
family and work, co-workers, interaction opportunities,
professional opportunities, praise and recognition, control
1020
and responsibility. The global scales correlation coefcient

was reported as 0.89 and the validity ranged from 0.53 to
0.75, with the scale correlating positively with several
established satisfaction scales. The results demonstrated
that More than half of the respondents (58%) were
generally satised with their jobs and most satised with
co-workers and extrinsic rewards (mean = 3.8 and 3.5,
respectively) and most dissatised with the amount of
control and responsibility that they had and with
professional opportunities (mean = 2.7 and 2.6, respectively). The individual items with which nurses were most
satised were: annual leave, nursing peers and hours
worked (79%, 78% and 76% of respondents scored 4 or 5,
respectively), with most dissatisfaction relating to: compensation for working weekends and control over work
conditions and childcare facilities (55%, 55% and 46% of
respondents scored 1 or 2, respectively). Using the same
scale, Wang (2002) found that Chinese nurses were more
dissatised than satised (mean = 2.51) with most dissatisfaction with pay (mean = 1.85) and job promotion
(mean = 1.97). Similarly, in Zheng and Lius (2010a) study,
the average score of Chinese nurses job satisfaction was
2.70, and their highest satisfaction was related to coworkers, while most dissatisfaction was with pay
(mean = 1.98) and job promotion (mean = 2.32).
From another point of view, Lees (1998) cross-sectional
survey examined the level of job satisfaction regarding six
job components (autonomy, professional status, pay,
interaction, task requirements and organizational policies)
using the Index of Work Satisfaction (Stamps and
Piedmonte, 1986). The results showed that nurses were
dissatised more than satised (mean = 3.46) and reported
most satisfaction with professional status (mean = 4.17)
and most dissatisfaction with task requirements
(mean = 2.81). The level of need for autonomy was below
the mid-score of the sub-scale with no signicant relationship (between their satisfaction with job autonomy and
their individual need for autonomy).
Similarly, Bjork et al. (2007) used this scale to describe
job satisfaction among hospital nurses in Norway and
found that interaction, pay and autonomy were ranked as
the three most desirable components of job satisfaction.
Nurses were most satised with professional status
(mean = 5.50), interaction (mean = 5.48) and autonomy
(mean = 5.05), while most dissatised with pay
(mean = 2.62). Penz et al. (2008) also explored predictors
of job satisfaction among rural acute care registered nurses
using the Index of Work Satisfaction, the Home Community Satisfaction scale (Henderson-Betkus and MacLeod,
2004), together with specially designed individual and
work characteristics scale. Four factors including available
and up-to-date equipment and supplies (17%), greater
satisfaction with scheduling and shifts (7%), lower
psychological job demands (5%), and greater satisfaction
with their home community (4%) explained 33% of the
variance in job satisfaction.
Tzeng (2002a,b) has also noted that expectation and
reality may be sources of nurses dissatisfaction. The
Nurses Job Satisfaction and the Perceived Importance
Questionnaire was specially designed for the study
comprised 8 job satisfaction scales and 8 importance
indicators (indirect working environment, direct working

environment, salary and promotion, self-growth, challenging work, interaction with patients, leadership style and
working atmosphere). Pearson correlation analyses
revealed that, except for the scale of indirect working
environment, all the scales were statistically and signicantly correlated to their corresponding scales
(p 0.05). The nurse sample identied factors such as
indirect working environment (a hospitals policies,
benets, leisure activities, housing, parking and vacation
policy), salary and promotion as very important but
strongly dissatisfying.
Kuhar et al. (2004) developed, tested and implemented
the Meaningful Retention Strategy Inventory (MRSI) in a
multi-hospital system. The MRSI comprises 59 items
reecting 8 common attributes contributing to job
satisfaction: autonomy, communication, administrative,
recognition, working conditions, professional practice,
scheduling/stafng issues and pay/benets and is reported
to have good content validity and reliability. The study
results were used to guide decisions relating to sitespecic retention strategies. De Gieter et al. (2010) also
examined the relationship between psychological reward
and nurses job outcomes and found that satisfaction with
psychological rewards from the head nurse has a
statistically signicant inuence on nurses turnover
intention (p < 0.001) and job satisfaction (p < 0.001)
whereas pay satisfaction was not related.
Qualitative studies have also contributed to our understanding of job satisfaction. Sjogren et al. (2005) found that
working conditions (working schedule, management and
relationships with co-workers), salary and professional
development were the dominant reasons both for leaving
and considering a return. In addition, a focus group
methodology was used by Tourangeau et al. (2010) to
identify nurse reported determinants of intention to
remain employed. Nurse assessments of satisfaction
within eight thematic categories were found to inuence
intentions to remain employed: relationships with coworkers, condition of the work environment, relationship
with and support from ones manager, work rewards,
organizational support and practices, physical and psychological responses to work, patient relationships and
other job content, and external factors (Table 1).
In conclusion, job satisfaction of nurses is an important
concept as levels of job satisfaction may impact upon the
global nursing workforce. Although the reported studies
differed regarding levels of job satisfaction among nurses,
the literature reveals that the sources of job satisfaction are
relatively similar, e.g., physical working conditions,
relationships with fellow workers and managers, stafng
and scheduling, pay, promotion, job security, responsibility, the recognition from managers and hours of work
(Table 2).
5. Effects of job satisfaction of nurses on absenteeism,
burnout, turnover and intention to quit
Absenteeism is an important problem for healthcare
providers because it is costly and related to preventable job
stress (Matrunola, 1996). The impact of job satisfaction
1021
Table 1
Sources of nurses job satisfaction.
Sources of job satisfaction
Key empirical sources
Working conditions
Adamson et al. (1995), Nolan et al. (1995), Tovey and Adams (1999), Adams and Bond (2000),
Tzeng (2002a,b), Kuhar et al. (2004), Penz et al. (2008), Tourangeau et al. (2010)
Adamson et al. (1995), Nolan et al. (1995), Lee (1998), Tovey and Adams (1999),
Adams and Bond (2000), Aiken et al. (2001), Price (2002), Tzeng (2002a,b), Wang (2002),
Kuhar et al. (2004), Sjogren et al. (2005), Tourangeau et al. (2010)
Interaction
Relationships with patients

Relationships with co-workers
Relationships with managers
Work itself
Workload; stafng; scheduling and shifts;

challenging work; routinization; task
requirements (abilities, skills, etc.);
psychological job demands
Remuneration (pay, salary)
Self-growth and promotion
Professional training; opportunities of
advancement; job promotion;
personal achievement
Psychological rewards: praise;
recognition; encouragement
Control and responsibility; autonomy;
decision-making
Job security
Leadership styles; organizational policies
Nolan et al. (1995, 1998), Lee (1998), Lundh (1999), Tovey and Adams (1999),
Adams and Bond (2000), Price (2002), Tzeng (2002a,b), Wang (2002), Kuhar et al. (2004),
Sjogren et al. (2005), Penz et al. (2008)
Adamson et al. (1995), Nolan et al. (1995), Lee (1998), Aiken et al. (2001), Price (2002),
Tzeng (2002a,b), Wang (2002), Kuhar et al. (2004), Sjogren et al. (2005), Tourangeau et al. (2010)
Nolan et al. (1995), Lee (1998), Aiken et al. (2001), Price (2002), Tzeng (2002a,b),
Wang (2002), Kuhar et al. (2004), Sjogren et al. (2005)
Nolan et al. (1995), Lundh (1999), Aiken et al. (2001), Price (2002), Wang (2002),
Kuhar et al. (2004), De Gieter et al. (2010), Tourangeau et al. (2010)
Nolan et al. (1995, 1998), Lee (1998), Price (2002), Wang (2002), Kuhar et al. (2004)
Nolan et al. (1995, 1998)
Lee (1998), Tzeng (2002a,b), Kuhar et al. (2004), Sjogren et al. (2005), Tourangeau et al. (2010)
upon nursing absenteeism, burnout and nurses intention

to quit and turnover has been explored in a number of
research studies yielding equivocal ndings.
Siu (2002), predictors of job satisfaction and absenteeism in two samples of Hong Kong nurses, Journal of
Advanced Nursing 40 (2002) (2), pp. 218229. Full Text via
CrossRef jView Record in Scopusj cited By in Scopus (36)
Sius (2002) study of nurses in Hong Kong found that
involvement (the degree of commitment displayed
towards employees by the organization) (p < 0.05), job
satisfaction (p < 0.05), psychological distress (p < 0.01)
and age (p < 0.01) were signicant predictors of absenteeism for sample 1; and organization (the interaction
between the worker and the organization) (p < 0.01),
involvement (p < 0.05) and occupational type (p < 0.001)
were signicant predictors of absenteeism for sample 2.
The inconsistent ndings may be explained by the
relatively small sample sizes, the unmatched gender
ratios, the unmatched occupational type, the relatively
low response rate in sample 2 (57%) and the use of selfreport sickness-absence. Such inconclusive results suggest that further research in this area should be
replicated among other Chinese nurses. Conversely,
Matrunolas (1996) study of English nurses found that
there was no relationship between job satisfaction and
absenteeism, however, generalization of the ndings
needs to be treated with caution owing to the small
sample.
Lee et al.s (2003) South Korean study showed that the
most frequently mentioned reasons for nurses intending
to leave their jobs were work overload, rotating shifts and
conict in interpersonal relationships. A total of 24%, 15%
and 35% of variance regarding depersonalization, emotional exhaustion and personal accomplishment, respectively, was explained by the individual characteristics, job
stress and personal resources. It was particularly noteworthy that nurses who experienced higher job stress
showed lower cognitive empathy and empowerment, and
worked on night shifts at tertiary hospitals were more
likely to experience burnout.
Regarding the effect of job satisfaction on nurse
turnover, there are some similar ndings across the
different studies. Cavanagh (1990) found that US public
hospital nurse turnover could be predicted using kinship
responsibility, promotion, salary and instrumental communication (p < 0.05). Cavanagh and Cofn (1992) further
found job satisfaction and participation at work to be
important variables in the turnover process with four
variables signicantly related to intent to stay (p < 0.05):
job satisfaction (r = 0.338), kinship responsibilities
(r = 0.123), pay (r = 0.086) and opportunity (r = 0.072).
However, these ndings do not conclusively support the
Price and Muellers (1981) model of nursing turnover.
Gauci Borda and Norman (1997a) found a signicant
positive relationship between job satisfaction and intent to
stay (p < 0.005) and negative relationships between job
satisfaction and frequency of 1 day absence and short-term
absence (lasting 3 days or less) (p < 0.05, respectively)
among Maltese nurses. In a study of Canadian nurses
Sourdif (2004) explored the associations between intent to
stay and various predictors and identied strong linear
relationships between satisfaction at work and satisfaction
with administration (p < 0.01), satisfaction with administration and organizational commitment (p < 0.01), and
1022
Table 2
Summary of included studies regarding sources of nurses job satisfaction.
Sample and response rate
Instruments
Key ndings
Adams and Bond (2000)

England
834 nurses of clinical grade C and

above (57% response rate)
Adamson et al. (1995)

Australia and England
133 Australian nurses

(83% response rate)
108 British nurses
(78% response rate)
Adams et al.s (1995) ward

organizational features
scales
Specially designed scales:
Nurses dissatisfaction
scale, medical autonomy
scale, medical authority
scale
Aiken et al. (2001)

USA, Canada, England,
Scotland and Germany
43,329 nurses
(4253% response rate)
Most important contributors to nurses job satisfaction

were the degree of cohesion (R2 = 0.20) and perception
of staff organization (R2 = 0.20)
British nurses were more dissatised than Australian
nurses (p < 0.001)
British nurses perceived their professional status to be
lower, their relationship with hospital administrators to
be poorer and their working conditions to be less
adequate than Australian nurses
Job dissatisfaction among nurses was highest in USA.
German nurses were more satised with the
opportunities for advancement while US and Canadian
nurses (69%) felt more satised with their salaries
Lee (1998) Hong Kong
136 acute hospital nurses and 54

chronic hospital nurses
(response rates of 45% and 83%
respectively)
Lundh (1999) Sweden
439 nurses, 83 laboratory

technologists, 31 midwives and
72 managers (59% response rate)
676 nurses, midwives and health
visitors (41% response rate)
518 nurses (35% response rate)
Nolan et al. (1995) Wales

Nolan et al. (1998) England
Specially designed nurses

working perceptions
questionnaire, Maslach
and Jacksons (1986)
burnout inventory
Stamps and Piedmontes
(1986) index of work
satisfaction, Edwards
(1959) personal
preference schedule
(EPPS)
Nolan et al.s (1995) Job
satisfaction questionnaire
Nolan et al.s (1995) Job
Nolan et al.s (1995) job
Price (2002) England
141 E-grade nurses in a large

teaching hospital (82% response
rate)
Mueller and McCloskey

(1990a,b) satisfaction
scale
Tovey and Adams (1999) England
20 ward leaders and 110 nurses

of grades CF
Tzeng (2002b) Taiwan
Wang (2002) Mainland China
Adams et al.s (1995) ward

organizational features
scales
Tzengs (2002b) nurses
job satisfaction and the
perceived importance
questionnaire
Mueller and McCloskey
(1990a,b) satisfaction
scale
Comments
Medical dominance is a barrier

to both Australian and British
nurses workplace satisfaction
Similar core problems in nurses

work design and workforce
management
Nurses more dissatised than satised

No signicant relationship between satisfaction with
job autonomy and individual need for autonomy
Nurses levels of stress had increased

Satisfaction with pay and overall working conditions
had fallen
Job satisfaction had remained stable
Falling condence in the future of the NHS
35% considered that their job satisfaction had decreased
in the last year and 69% felt that overall morale had
fallen
58% were generally satised with their job
Highest satisfaction was related to co-workers and
extrinsic rewards and most dissatisfaction was with the
amount of control and responsibility they had and with
professional opportunities
Key sources of dissatisfaction: working relationships,
lack of staff, professional concerns about poor standards
of care and external work pressure
Indirect working environment, salary and promotion
were very important but strongly dissatisfying
Nurses were more dissatised than satised and mostly

dissatised with pay and job promotion
Caution needed re. sample bias

with only one grade of nurses
working in acute wards
represented
Random subset of 130 comments
from the main study (Adams
et al., 1995)
Author(s)
Location
971 staff nurses and 182 nurse

leaders (36% response rate)
Specially designed:
Meaningful Retention
Strategy Inventory (MRSI)
Sjogren et al. (2005) Sweden
288 nurses who had left nursing

care
Two open-ended
questions
Bjork et al. (2007) Norway
2095 nurses working at four

hospital (45.5% response rate)
Stamps (1997) Index of

Work Satisfaction
Penz et al. (2008) Canada
944 rural hospital acute care

nurses
Stamps (1997) Index of

Work Satisfaction, Home
Community Satisfaction
scale (Henderson-Betkus
and MacLeod, 2004).
De Gieter et al. (2010)

Belgium
337 nurses working for a diverse

sample of Belgian hospitals
(response rate not reported)
Psychological Reward
Satisfaction Scale(PReSS)
(De Gieter et al., 2008),
commitment to
occupation questionnaire
(Meyer et al., 1993)
Tourangeau et al. (2010)

Canada
13 focus groups involving 78

nurses working in two Canadian
provinces
MRSI reects 8 common attributes contributing to job

satisfaction: autonomy, communication,
administrative, recognition, working conditions,
professional practice, scheduling/stafng issues, and
pay/benets. Results showed that it has good content
validity and reliability. Results used to guide decisions in
the implementation of site-specic retention strategies
Working conditions (working schedule, management
and relationship with co-workers), salary and
professional development were the dominating reasons
both for leaving and considering a return
Interaction, pay and autonomy were ranked as the three
most desirable components of job satisfaction. Nurses
were most satised with professional status
(mean = 5.50), interaction (mean = 5.48) and autonomy
(mean = 5.05), while most dissatised with pay
(mean = 2.62)
Four factors including available and up-to-date
equipment and supplies (17%), greater satisfaction with
scheduling and shifts (7%), lower psychological job
demands (5%), and greater satisfaction with their home
community (4%) explained 33% of the variance in job
satisfaction
Satisfaction with psychological rewards (compliment
and respect) from the head nurse turned out to be the
only statistically signicant predictor of turnover
intention (R2 = 0.19; b = 0.38, p < 0.001)and job
satisfaction (R2 = 0.24; b = 0.42, p < 0.001)
Nurse assessments of satisfaction within 8 thematic
categories found to inuence intentions to remain
employed: (1) relationships with co-workers, (2)
condition of the work environment, (3) relationship
with and support from ones manager, (4) work rewards,
(5) organizational support and practices, (6) physical
and psychological responses to work, (7) patient
relationships and other job content, and (8) external
factors
Sub-sample of larger study

(Stewart et al., 2005)
Kuhar et al. (2004) USA
1023
1024
Table 3
Summary of included studies regarding effects of nurses job satisfaction.
Sample and response rate
Instruments
Key ndings
232 hospital nurses (38.5%

response rate)
221 nurses (response rates:
80.5% in a public hospital and
19.5% in a private hospital)
Price and Muellers (1981)

turnover scale
turnover scale
Gauci Borda and Norman

(1997a) Malta
Lee et al. (2003)

South Korea
Lu et al. (2002) Taiwan
21,971 nurses (86.2% response

rate)
Lyons (1971) global satisfaction

scale, Mueller and McCloskeys
(1990a,b) satisfaction scale,
Redferns (1981) propensity to
leave index
Maslach and Jacksons (1981)
burnout inventory, Mehrabians
(1994) emotional empathy scale,
Barrett-Lennards (1978)
empathy scale
Specially designed scales:
professional commitment scale,
job satisfaction scale, intention
to quit scale
Combination of the variables accounted for 36.8%

(p < 0.05) of the explained variance in turnover rate
Factors related to intention to stay: job satisfaction,
kinship responsibilities, pay and opportunity
Job satisfaction was a key determinant in the turnover
process
Signicant positive relationship between job
satisfaction and intention to stay (r = 0.48, p < 0.005)
and negative relationships between job satisfaction and
frequency of 1 day/short-term absence (r = 0.14,
p < 0.05, respectively)
A total of 24%, 15% and 35% of variance in
depersonalization, emotional exhaustion and personal
accomplishment respectively explained by the predictor
variables
Matrunola (1996)
England
34 nurses working within an

elderly care unit (68% response
rate)
Siu (2002) Hong Kong
Sample 1: 144 nurses (100%

response rate)
Sample 2: 114 nurses (57%
response rate)
Cavanagh and Cofn

(1992) USA
Tzeng (2002a) Taiwan

Wu et al. (2000) Mainland,
China
382 nurses (92.5% response rate)
Yin and Yang (2002) Taiwan
Meta-analysis of 129 studies

relating to hospital nurses
turnover from 1978 to 1998
Sourdif (2004)
Canada
108 registered nurses (48.9%

response rate)
Matrunolas (1996) job

satisfaction questionnaire,
burnout inventory, Beck et al.s
(1974) hopelessness scale
Siu and Coopers (1998)
psychological distress scale
Job stress scale (specially

designed)
Nurses Intent to Stay

Questionnaire (Taunton et al.,
1997)
2Comments

model of nursing turnover
was not conclusively
supported
Model of absence and
turnover (Gauci Borda and
Norman, 1997b) was not
totally supported
Further research needed

to explore the effect of
organizational
commitment regarding
any interrelationships
Job satisfaction was positively correlated with

professional commitment and negatively correlatively
correlated with intention to leave the organization and
profession
38.4% of nurses had the intention to leave the
organization and 30.4% intending to leave the profession
because of lack of job satisfaction
No signicant relationship between job satisfaction and
absenteeism
Small sample size limits

generalisability
Job satisfaction was a signicant predictor of

absenteeism in sample 1; while no similar result was
found in sample 2
Replication needed
among other Chinese
nurses
General job satisfaction was signicant predictor of

nurses intention to quit
There was a positive and signicant relationship
between job stress and intention to quit (r = 0.46,
p < 0.05)
Strongest factors related to nurse turnover were job
satisfaction, autonomy, opportunities for promotion, job
stress, pay group cohesion, marital status and
educational level
There were strong linear relationships between
satisfaction at work and satisfaction with
administration (r = 0.667; p < 0.01), satisfaction with
administration and organizational commitment
(r = 0.602; p < 0.01), and work group cohesion (r = 0.505;
p < 0.01)
Satisfaction at work (b = 0.268) and satisfaction with
administration (b = 0.284) together explained 25.5% of
the variance of intent to stay
Further research is needed

to conrm the ndings
Indicates need for studies
using the same measures
for satisfaction and the
related variables
Code study
Cavanagh (1990) USA
12 predictors from 4 categories: job satisfaction,

personal characteristics of nurses, work group cohesion
and collaboration, and organizational commitment
explained 34% of variance in nurse intention to remain
employed
Predictive relationships were found between nancial

status, organizational commitment, job and professional
satisfaction, and intent to leave their current position
(R2 = 0.42) and between nancial status, professional
satisfaction, and intention to leave nursing (R2 = 0.45)
194 staff nurses (88%response

rate)
787 registered nurses (33%

response rate)
8456 registered nurses from 75

hospitals in Ontario (65%
response rate)
Lee et al. (2004)

South Korea
Lynn and Redman

(2005) USA
Tourangeau and Cranley

(2006) Canada
Stamps et al. (1978) Index of

Work Satisfaction (IWS),
burnout inventory, Wood et al.
(1969) Life Satisfaction Index Z
(LS-Z)
turnover scale, Mowday et al.
(1979) Organizational
Commitment Questionnaire,
Specially designed Satisfaction in
Nursing Scales (SINS)
burnout inventory, Lake (2002)
Revised Nursing Work Index
(NWI-R), Mueller and
McCloskeys (1990a,b)
satisfaction scale
Work satisfaction with professional status, shift

patterns, personal accomplishment and emotional
exhaustion explain 30% of the variance in life
satisfaction
1025
work group cohesion (p < 0.01). Satisfaction at work

(b = 0.268)
and
satisfaction
with
administration
(b = 0.284) explained together 25.5% of the variance of
intent to stay. Tourangeau and Cranley (2006) further
reported 12 predictors from four categories (job satisfaction, personal characteristics of nurses, work group
cohesion and collaboration, and organizational commitment) explained 34% of variance in Canadian nurses
intention to remain employed. The strongest predictors
were nurse age (p < 0.001), years of employment in the
current hospital (p < 0.001) and overall nurse job satisfaction (p < 0.001).
Yin and Yangs (2002) meta-analysis of 129 studies also
found that the strongest individual and organizational
factors related to nurse turnover were job satisfaction
(p < 0.05), autonomy (p < 0.05), advancement opportunity
(p < 0.05), job stress (p < 0.05), pay (p < 0.05), group
cohesion (p < 0.05), marital status (p < 0.05) and educational level (p < 0.05). Similarly, Wu et al. (2000) reported a
positive and signicant relationship between job stress
and intention to quit among Mainland Chinese nurses
(p < 0.05). Using the multiple regression, Tzeng (2002a)
reported that institution (privately owned local hospital),
age of the youngest child, level of education (e.g., diploma
and associate degree), salary and promotion, general job
satisfaction and general job happiness were signicant
predictors of Taiwanese nurses intention to quit (the
Nagelkerke Pseudo R2 = 0.410).
The inuence of job satisfaction on intention to leave
the nursing profession was examined in Lu et al.s (2002)
study of Taiwanese nurses which reported that job
satisfaction was positively correlated with professional
commitment (p < 0.01) and negatively correlated with
intention to leave the organization and profession
(p < 0.01). In the discriminant analysis, 38.4% of the nurses
could be classied as having the intention to leave their
organization and 30.4% as intending to leave the profession
because of lack of job satisfaction. Lynn and Redman
(2005) further found that nancial status, organizational
commitment, job and professional satisfaction explained
42% of variance in American nurses intention to leave their
current position with nancial status and professional
satisfaction explaining 45% of variance in nurse intention
to leave nursing. Chan et al. (2009) investigated factors
associated with nurses intention to leave their current
employment in Macao with 39.0% indicating an intention
to leave their current employment, with age, work
experience, work place and job satisfaction being signicant risk factors for intention to leave. Nurses who
scored as unsatised on pay and benets were 4.14 times
more likely to have the intention to leave than nurses who
scored as satised (p < 0.001).
Furthermore, Lee et al.s (2004) South Korean study
identied that work outcomes such as job satisfaction and
burnout can affect nurses overall life satisfaction. Specically, work satisfaction with professional status, shift
patterns, emotional exhaustion and personal accomplishment explained 30% of the variance in life satisfaction.
In summary, most published research from various
countries indicates that job satisfaction is a signicant
predictor of nursing absenteeism, burnout, turnover and
1026
intention to quit, however, there have been some

inconsistent ndings (Table 3).
6. Related factors to job satisfaction of nurses
Job satisfaction is a complex phenomenon, as evidenced
by the ndings already discussed. The identication of
these factors and exploration of their effects on job
satisfaction has the potential to rene the theoretical
models of nurses job satisfaction and aid the development
of management interventions. Blegens (1993) metaanalysis of 48 studies found that job satisfaction was
most strongly associated with stress (r = 0.61) and
organizational commitment (r = 0.53). Seven variables
had correlations between 0.20 and 0.50: communication
with supervisor, autonomy, recognition, routinization,
communication with peers, fairness and locus of control;
and four variables had very weak correlations: age
(r = 0.13), years of experience (r = 0.09), education
(r = 0.07) and professionalism (r = 0.06). Zangaro and
Soekens (2007) meta-analysis, which built on Blegens
(1993), also found that job satisfaction was most strongly
correlated with job stress (ES = 0.43), followed by nurse
physician collaboration (ES = 0.37), and autonomy
(ES = 0.30). It is noteworthy that both Blegens (1993)
and Zangaro and Soekens (2007) meta-analyses included
studies across a range of settings which were not
exclusively hospitals.
A causal model of job satisfaction has been tested in Chu
et al.s (2003) study of Taiwanese nurses, Seo et al.s (2004)
study of South Korean nurses and Zheng and Lius (2010b)
study of Chinese nurses. This model included 11 independent variables namely: job involvement, positive affectivity, negative affectivity, autonomy, distributive justice,
procedural justice, job stress (role ambiguity, role conict,
workload and resource inadequacy), pay, promotional
chances, routinization and social support. Chu et al. (2003)
found that, with the exception of pay (p > 0.05), all of the
independent variables were signicantly related to job
satisfaction (p < 0.05). Seven of the exogenous variables
were the major determinants of job satisfaction according
to Pearsons correlation coefcients: positive affectivity
(r = 0.452), routinization (r = 0.441), resource inadequacy
(r = 0.341), negative affectivity (r = 0.333), role ambiguity (r = 0.327), supervisor support (r = 0.325) and coworker support (r = 0.309). The regression results indicated
that six of the exogenous variables hypothesized to impact
upon job satisfaction were signicant: routinization
(b = 0.286, p < 0.001), positive affectivity (b = 0.266,
p < 0.001), involvement (b = 0.147, p < 0.01), negative
affectivity (b = 0.118, p < 0.05), co-worker support
(b = 0.118, p < 0.05) and role ambiguity (b = 0.018,
p < 0.05). The exogenous variables in this model explained
45% of the association of variance in job satisfaction.
Seo et al. (2004) also found a reasonable t between the
causal model and the data (CFI = 0.904, IFI = 0.907). When
considering all of the independent variables (Model 1),
seven variables had statistically signicant net effects on
job satisfaction (p < 0.05): positive affectivity, supervisory
support, pay, routinization, negative affectivity, workload
and job opportunity (b = 0.286, b = 0.11, b = 0.095,
b = 0.250, b = 0.213, b = 0.211, b = 0.105, respectively). Model 1 explained about 53% of the variance in
satisfaction, but when the psychological variables (positive
and negative affectivity) were not included (Model 2), job
opportunity was no longer signicant (p > 0.05). Pay and
supervisor support positively impacted upon job satisfaction (b = 0.185, b = 0.164, respectively) while routinization
and workload negatively impacted upon it (b = 0.347,
b = 0.24, respectively). Model 2 explained 40% of the
variance in satisfaction. When Zheng and Liu (2010b)
partly tested this causal model among Chinese nurses in
Beijing, 13 variables from four categories (job characteristics, working conditions, personal characteristics and
organizational factors) explained 56.2% of the variance in
job satisfaction. Autonomy (b = 0.141), job involvement
(b = 0.259), hospital management and organizational
support (b = 0.189), and person-job t (b = 0.255) were
the four most signicant predictors of job satisfaction.
Many studies have also stressed the relationship
between work conditions, organizational environment
and job satisfaction. Gelsema et al. (2006) conducted a
longitudinal study to explore the impact of work condition
changes on job outcomes among Dutch nurses. The
ndings revealed that changes in job conditions predicted
8%, 11%, 16% and 35% of variance of respectively somatic
complaints, psychological distress, emotional exhaustion
and job satisfaction. More specically, increases in skill
discretion (b = 0.18), decision authority (b = 0.19), social
support supervisor (b = 0.22), reward (b = 0.21) and communication (b = 0.15), are associated with an increase in
job satisfaction over time (p < 0.001), while increases in
work time pressure (b = 0.31) and physical demand
(b = 0.14), result in more emotional exhaustion over time
(p < 0.001).
Laschinger (2004) tested an exploratory model of the
antecedents and consequences of Canadian nurses
perceptions of respect in hospitals and found that nurses
perception of respect were signicantly related to
organizational environment characteristics: interactional
justice (r = 0.72), structural empowerment (r = 0.47) and
global empowerment (r = 0.47). In addition, job stress
resulting from workplace factors, such as lack of recognition (r = 0.38), poor interpersonal working relationships
(r = 0.58), and heavy workload (r = 0.24) were also
signicantly related to respect. Nurses perception of
respect were signicantly correlated with job satisfaction
(r = 0.52) and intentions to leave within the next
12 months (r = 0.24), as well as work effectiveness
indicators. More recently, Laschinger et al. (2011) developed a multi-level model of structural empowerment
examining the effect of nursing unit leadership quality
and structural empowerment on nurses experiences of
burnout and job satisfaction. The ndings revealed that
nurses shared perceptions of leadermember exchange
quality on their units positively inuenced their shared
perceptions of unit structural empowerment (b = 0.25,
p < 0.05) (Level 2), which resulted in signicantly higher
levels of individual nurse job satisfaction (b = 0.30,
p < 0.05) (Level 1). The results were consistent with
Laschingers (2008) earlier study which reported that
structural empowerment had a positive direct effect on
the level of job satisfaction (b = 0.45) and perceived

nursing care quality (b = 0.27). Similar relationships were
also found in Cai and Zhous (2009) study of Chinese
nurses with structural empowerment being positively
(p < 0.01) related to the perceived job satisfaction
(r = 0.56) and turnover intention (r = 0.31).
AbuAlRub et al. (2009) investigated the relationships
between social support from supervisors/co-workers, job
satisfaction and intent to stay among Jordanian hospital
nurses. They found that the correlation between social
support from supervisors and job satisfaction was moderately positive (r = 0.35, p < 0.001), while the correlation
between social support from co-workers and job satisfaction was not signicant. There were also a signicantly
positive relationship (p < 0.001) between intent to stay at
work and social support from both supervisors and coworkers (r = 0.37, r = 0.25, respectively). Similar relationships were also reported by van der Heijden et al. (2010).
Kwak et al. (2010) established a multivariate model to
identify predictors of job satisfaction among South Korean
nurses. This model explained 43% of variance for nurses
job satisfaction. Specically, satisfaction with profession
(OR = 11.93, p < 0.001), opportunity for promotion
(OR = 2.27,
p < 0.05)
and
organizational
support
(OR = 1.04, p < 0.05) had positive effects on job satisfaction,
while negative effects were associated with burnout
(OR = 0.92, p < 0.05). However, pay, work environment,
frequency of shift change and perceived quality of care
were not signicant predictors of job satisfaction in this
model.
Van Bogaert et al. (2010) investigated the impacts of
practice environment factors and burnout on Belgian
nurses job outcomes and found that hospital management
and organizational support, and emotional exhaustion
were two signicant predictors of nurses job satisfaction
(OR = 6.96, OR = 0.89, respectively) while positive ratings
of nursephysician relationships (OR = 1.81) and lower
levels of emotional exhaustion (OR = 0.94) predicted
intention to stay in nursing. Brady-Schwartz (2005) found
that Magnet hospital nurses demonstrated signicantly
higher levels of overall job satisfaction compared to nurses
from non-Magnet facilities (p < 0.001) arising from the
professional opportunities in the work environment
(p < 0.001), control and responsibility (p < 0.001) and
extrinsic rewards (p < 0.001). Chen and Johantgen
(2010) established six structural regression models to
explore the relationship between Magnet Hospital attributes and nurses job satisfaction among 3182 registered
staff nurses from Germany and Belgium. Four Magnet
Forces (management style, autonomy, interdisciplinary
relationships and professional development) were able to
explain the variance of job satisfaction in both individual
and hospital levels, with personnel policies having the
strongest effect (b = 0.96) on nurse-level job satisfaction
and management style (b = 0.84) on hospital level job
satisfaction.
Organizational commitment refers to identication
with and loyalty to the organization and its goals (Blau
and Boal, 1987) which Mowday et al. (1979) dened as the
relative strength of an individuals identication with and
involvement in a particular organization. In particular,
1027
commitment is characterized by three factors: a strong

belief in and an acceptance of the organizations goals and
values; a willingness to exert considerable effort on behalf
of the organization; and a strong desire to maintain
membership in the organization. Organizational commitment has been found to be positively related to the job
satisfaction of hospital nurses (Blegen, 1993; Al-Aameri,
2000). Knoop (1995) found that organizational commitment was related to overall job satisfaction (p < 0.001),
satisfaction with work (p < 0.001), promotion opportunity
(p < 0.001),
supervision
(p < 0.001),
co-workers
(p < 0.001) and pay (p < 0.01) among Canadian nurses.
Furthermore, the regression analysis revealed that organizational commitment explained 41% of the variance in
job satisfaction.
Chang et al. (2007) found that the gap between career
needs and career development programmes made signicant (p < 0.01) contributions to organizational commitment (b = 0.209) and turnover intention (b = 0.183).
Organizational commitment made signicant (p < 0.01)
negative contributions to turnover intention (b = 0.453).
Guleryuz et al. (2008) also found that emotional intelligence was signicantly (p < 0.01) and positively related to
job satisfaction and organizational commitment
(p < 0.01). Job satisfaction was signicantly related to
organizational commitment (p < 0.01) and served as a
mediator between emotional intelligence and organizational commitment.
Professional commitment is a persons involvement,
pledge, promise or resolution towards his/her profession
(Fang, 2001). It has an incremental effect on a professionals intention to leave the organization (Blau and Lunz,
1998). Therefore, enhancing professional commitment in
nursing has the potential to produce benets for both the
individual and their organization (Cohen, 1998, 1999).
Furthermore, professional commitment is positively
related to the job satisfaction of nurses (Lu et al., 2000;
Jones, 2000). For example, Fangs (2001) study of
Singaporean nurses demonstrated that job satisfaction
was signicantly and positively related to organizational
commitment
(p < 0.01),
professional
commitment
(p < 0.01) and supervisor satisfaction (p < 0.05) and
negatively related to job stress (p < 0.01), turnover
cognition (p < 0.01) and intention to quit (p < 0.01). About
41% of the variance in turnover cognition was explained by
the mentioned antecedents, however, the contributions of
job stress, organizational commitment and professional
commitment to job satisfaction were not identied.
Interestingly, Packard and Motowidlo (1987) found that
stress and job satisfaction in the US were not directly
related and that stress, primarily acting through depression, was associated with lower levels of job performance.
Job satisfaction correlated with depression (p < 0.01),
hostility (p < 0.01), subjective stress (p < 0.01), frequency
of stressful events (p < 0.01), intensity of stressful events
(p < 0.05) and anxiety (p < 0.05). Multiple regression
analysis showed that depression had a strong effect on
job satisfaction (p < 0.01) and hostility (p < 0.01) and fear
of negative evaluation (p < 0.01) had weaker direct effects,
but other factors showed no signicant impacts upon job
satisfaction. However, Larrabee et al. (2010) found that
1028
stress resiliency was a predictor of psychological empowerment, situational stress, and job satisfaction. The causal
model identied six signicant predictors, namely: situational stress and personal stress (job stress), psychological
empowerment, necessitating and skill recognition (stress
resiliency), years since RN graduation which together
explained 59% of the variance in job satisfaction (p < 0.05)
with psychological empowerment (b = 0.46) as the strongest predictor.
In addition, the nurses roles within their work
situations and its effect on job satisfaction were also of
primary concern with role conict and ambiguity being the
main sources of job stress (Hingley and Cooper, 1986). Role
conict is dened in terms of the dimensions of
congruency-incongruency or compatibility incompatibility in the requirements of the role, where congruency of
compatibility is judged relative to a set of standards or
conditions which impinge upon role performance. Role
ambiguity is the predictability of the outcome or responses
to ones behaviour and the existence or clarity of
behavioural requirements, often in terms of inputs from
the environment, which would serve to guide behaviour
and provide knowledge that the behaviour is appropriate
(Rizzo et al., 1970). Role conict and ambiguity are
signicantly related to job stress, organizational commitment, job satisfaction and intentions to leave the nursing
profession (Rosse and Rosse, 1981). Role discrepancy also
contributes to nurses intention to quit their jobs. Nurses
intention to quit their jobs also increased when they had a
low desire to engage in nursing roles and when they only
performed a few roles (Takase et al., 2006).
Dailey (1990) found that tension discharge rate, role
ambiguity and role conict were signicant predictors of
experienced stress symptoms (b = 0.24, 0.15, 0.08, respectively) among US nurses. Together, the three produced an
overall multiple R2 value of 0.47 (p < 0.001). On the other
hand, the most signicant predictor of intention to quit
was experienced job-induced stress symptoms (b = 0.36),
followed by tension discharge rate (b = 0.22). Role
ambiguity (b = 0.13) and role conict (b = 0.04) were also
signicant predictors of intention to quit. The regression
model explained 75% of the variance in intention to quit
(p < 0.001). Ho et al.s (2009) study revealed that nurses
job rotation had a positive inuence on job satisfaction
(p < 0.01) and organizational commitment (p < 0.01) while
nurses role stress had a negative inuence on job
satisfaction (r = 0.52, p < 0.01) and organizational commitment (p < 0.01).
Lu et al. (2007a) explored nurses views regarding
different components of their working lives in Mainland
China. The results revealed that 53.7% of the nurses were
satised with their jobs and 15% felt moderate to extreme
occupational stress. The majority of the sample reported a
high level of organizational commitment (63.7%) and
professional commitment (85.9%) and only 5.9% and 10.0%,
respectively reported role conict and role ambiguity often
or very often. Nurses with a Bachelor degree reported a
lower level of professional commitment and greater level
of role conict than those with a diploma or associate
degree (p < 0.05). These ndings suggested that nurses
educational background should be considered as an
important factor in understanding nurses working lives

and may indicate the need for a clinical career ladder for
nursing staff in Mainland China.
Mitchells (1994) US study found that there was not a
signicant linear association between a nurses job
satisfaction and the correlation between work role values
and actual work roles (p > 0.05). This may be attributed to
several factors. Firstly, the mean correlation (r = 0.58)
between work roles and work role values was weak and
non-signicant and secondly, the scores of job satisfaction
did not have a normal distribution with 54% of the
respondents having a high level of satisfaction. Furthermore, the work roles in the study questionnaire were not
tested for validity and reliability. Therefore, further
explanation of the relationship between personal work
role values and actual work roles is needed in relation to
nurses expressed job satisfaction.
Lu et al. (2007b) developed a model of job satisfaction in
Mainland China. About 40% of the variance in job
satisfaction could be explained by the set of independent
variables including organizational commitment, occupational stress, professional commitment, role conict, role
ambiguity, educational level, age and working years
(R2 = 0.396). This model was tested in her another study
(Lu, 2008) where 50.7% of the variance in job satisfaction
could be explained by the set of independent variables
including organizational commitment, professional commitment, occupational stress, role conict and ambiguity.
Organizational commitment (p < 0.001) had the strongest
impact on job satisfaction, followed by occupational stress
(p < 0.001) and role ambiguity (p < 0.001). In addition,
nurses role perception and actual role content inuenced
job satisfaction as well as occupational stress, role conict
and role ambiguity (p < 0.05) (Lu et al., 2008). In general,
the respondents who reported that they should do the
roles itemized were more satised with their job with low
levels of occupational stress, role conict and role
ambiguity (p < 0.05) compared to those who reported
that they sometimes undertook those roles (p < 0.05).
Other factors relating to nurses job satisfaction have
also been explored. Nurse stafng is an important factor
inuencing various job outcomes (Rafferty et al., 2007;
Kanai-Pak et al., 2008). According to Kanai-Pak et al.s
(2008) large cross-sectional survey of 5956 staff nurses in
Japan, 56% of nurses scored high on burnout, 60% were
dissatised with their jobs and 59% ranked quality of care
as only fair or poor. The odds on high burnout, job
dissatisfaction and poor-fair quality of care were twice as
high in hospitals with 50% of inexperienced nurses
compared to those with 20% inexperienced nurses and
40% higher in hospitals where nurses had less satisfactory
relations with physicians. Nurses in poorly staffed
hospitals were 50% more likely to exhibit burnout, twice
as likely to be dissatised and 75% more likely to report
poor or fair quality care than nurses in better staffed
hospitals. Similarly in Rafferty et al.s (2007) study patients
were 26% more likely to die in hospitals where nurses had
the heaviest patient loads. The nurses in the hospitals with
the heaviest workloads were between 71% and 92% more
likely to show negative job outcomes (burnout and job
dissatisfaction) and to rate the quality of care as low and
1029
Table 4
Related factors to job satisfaction of nurses.
Related factors
Substantial to very strong relationship

with job satisfaction (correlation coefcient > 0.5)
Packard and Motowidlo (1987), Blegen (1993), Knoop (1995), Adams

and Bond (2000), Fang (2001), Laschinger (2004), Cai and Zhou (2009),
Chang et al. (2011), Ho et al. (2009), Guleryuz et al. (2008)
Job stress; organizational commitment;

depression; cohesion of the ward nursing
team; structural empowerment; organizational
citizenship behaviours; job rotation; role stress; respect
Moderate to substantial relationship with
job satisfaction (correlation coefcient 0.20.5)
Affectivity; role ambiguity; professional

commitment; routinization; supervisor/co-worker
support; collaboration with medical staff; job
performance; job involvement; hostility staff
organization; autonomy; recognition; fairness;
locus of control; communication with
supervisor/peers; emotional intelligence,
nurse caring, self-esteem
Slight relationship with job satisfaction
(correlation coefcient < 0.2)
Role conict; job involvement; age; year of
experience; educational level; professionalism;
anxiety; supervisor satisfaction; coping strategies
Packard and Motowidlo (1987), Blegen (1993), Knoop (1995), Adams

and Bond (2000), Fang (2001), Chu et al. (2003), Zangaro and Soeken (2007),
Karanikola et al. (2007), Guleryuz et al. (2008), AbuAlRub et al. (2009),
van der Heijden et al. (2010), Burtson and Stichler (2010)
Packard and Motowidlo (1987), Blegen (1993), Fang (2001), Lu et al. (2002),
Chu et al. (2003); Golbasi et al. (2008)
Table 5
Predictors of job satisfaction among nurses.
Predictors
Depression
Organizational commitment
Cohesion existing among ward nurses; collaboration of medical staff; perceptions of professional practice;
team building skills of the ward managers
Organizational commitment; job stress; supervisor satisfaction
Psychological distress; occupational type (psychiatric/general); the physical conditions in the work area
Routinization; affectivity; job involvement; co-worker support; educational level
Skill discretion; decision authority; social support supervisor; reward; communication
Nurse stafng
Packard and Motowidlo (1987)

Knoop (1995)
Adams and Bond (2000)
Organizational commitment; occupational stress; professional commitment; role conict; role ambiguity
Autonomy; feedback; job involvement; management; support from leaders; resource adequacy;
nurse stafng; relationships with co-workers; children; shifts; educational level; person-job t;
work department; patient number; bed utilization
Satisfaction with profession; opportunity for promotion; organizational support; burnout
Situational stress and personal stress (job stress);
psychological empowerment; necessitating and skill recognition(stress resiliency);
years since RN graduation
Management style; autonomy; interdisciplinary relationships; professional development
Ethical climates
Perceptions of leader-member exchange quality; structural empowerment
deteriorating. These studies highlight the importance of

adequate and qualied nursing staff to improve nurses job
satisfaction and quality of nursing care.
In addition, signicant positive correlations were
detected between professional satisfaction and selfesteem (r = 0.2490.313, p < 0.01) in Karanikola et al.s
(2007) study. Goldman and Tabak (2010) found that the
congruence of ethical climates explained 32.1% of the
variance in job satisfaction with caring t (b = 0.38) and
independent t (b = 0.22) being the two signicant
predictors of job satisfaction. Findings from various
Fang (2001)
Siu (2002)
Chu et al. (2003)
Gelsema et al. (2006)
Rafferty et al. (2007),
Kanai-Pak et al. (2008)
Lu et al. (2007b, 2008)
Zheng and Liu (2010b)
Kwak et al. (2010)

Larrabee et al. (2010)
Chen and Johantgen (2010)

Goldman and Tabak (2010)
Laschinger et al. (2011)
studies have indicated that organizational citizenship

behaviours (Chang et al., 2011), nurse caring (Burtson and
Stichler, 2010), coping strategies (Golbasi et al., 2008)
were also related factors to nurses job satisfaction (Tables
4 and 5).
In summary, much research has revealed that job
satisfaction of hospital nurses is closely related to working
conditions and organizational environment, job stress, role
conict and ambiguity, role perception and role content,
organizational commitment and professional commitment
(Table 6).
1030
Table 6
Summary of included studies regarding related factors to job satisfaction of nurses.
Code study
Sample and
response rate
Blegen (1993)
Meta-analysis 48
quantitative
studies from 1977
to 1991
308 nurses (75%
response rate)
Chu et al. (2003)

Taiwan
116 nurses (38.7%

response rate)
Fang (2001) Singapore
180 nurses (90%

response rate)
Knoop (1995) Canada
171 nurse
educators and
nurses (70%
response rate)
201 nurses (33%
response rate)
Mitchell (1994) USA
The items from Price and Mueller (1986b),

Watson et al. (1987), Cyphert (1990), Kim
et al. (1996) and Price (2001)
Rose et al.s (1978) Tension Discharge Rate

Scale, Rizzo et al.s (1970) Role Conict and
Ambiguity Scale, Symptoms of Stress Index
Mowday et al.s (1979) Organizational
Commitment Scale, Fangs (2001) Professional
Commitment Scale, Fangs (2001) Nursing
Turnover Scale
Mowday et al.s (1979) organizational
Commitment Questionnaire, Kanungos
(1982) Graphic Job Involvement, Iris and
Barretts (1972) Job Satisfaction Scale
Weiss et al.s (1967) Minnesota Satisfaction
Questionnaire, Benners (1984) Work Role
Scale
Packard and Motowidlo

(1987) USA
206 nurses (56%

response rate)
Price and Muellers (1981) Job Satisfaction

Scale, Others from Motowidlo et al. (1986)
Seo et al. (2004)

South Korea
353 nurses (65.4%

response rate)
Gelsema et al. (2006)

The Netherlands
Time 1: 807 nurses

(64% response rate)
Time 2: 381 nurses
(61% response rate)
The items from Kahn et al. (1964), Rizzo et al.

(1970), House (1981), Breaugh (1985),
Watson and Tellegen (1985), etc.
The Leiden Quality of Work Life Questionnaire
for nurses (LQWLQ-N; Maes et al., 1999),
validated Dutch client version of the Maslach
Burnout Inventory (Schaufeli and Van
Dierendonck, 1994), validated Dutch version
of the SCL-90 (Arrindel and Ettema, 1986)
Zangaro and Soeken

(2007)
Meta-analysis 31
quantitative
studies published
from 19912003
Key ndings
Comments
Job satisfaction was most strongly associated with

stress (r = 0.61) and organizational commitment
(r = 0.53)
40 general hospital nurse studies; the

other 8 studies involved public health
nurses, nurses from long-term care
facilities and an outpatient clinic
Impact of work unit on job satisfaction
should be considered
6 variables had signicant impact job satisfaction:

routinization, positive affectivity, involvement,
negative affectivity, co-worker support and role
ambiguity, which explained 45% of the variance in
satisfaction
The regression model explained 75% of the variance
in intention to quit
Job satisfaction was signicantly and positively
related to organizational commitment, professional
commitment and negatively related to job stress
Organizational commitment was related to overall
job satisfaction (r = 0.64, p < 0.001) and explained
41% of the variance in job satisfaction
No signicant linear association between a nurses
job satisfaction
Correlation between work role values and actual
work roles (p > 0.05)
Job satisfaction correlated with depression, hostility,
subjective stress, frequency of stressful events,
intensity of stressful events and anxiety
A reasonable t between the causal model and the
data. All of the variables explained 53% of the
variance in satisfaction
Increases in skill discretion (b = 0.18), decision
authority (b = 0.19), social support supervisor
(b = 0.22), reward (b = 0.21) and communication
(b = 0.15), are associated with an increase in job
satisfaction over time (R2 = 0.35), while increases in
work time pressure (b = 0.31) and physical demand
(b = 0.14), result in more emotional exhaustion over
time (R2 = 0.16)
Job satisfaction was most strongly correlated with
job stress (ES = 0.43), followed by nursephysician
collaboration (ES = 0.37), and autonomy (ES = 0.30)
Contributions of job stress, organizational

commitment and professional
commitment to satisfaction were not
identied
Impact of professional commitment upon
job satisfaction should be taken into
account
Further explanation of the nonrelationship is needed
Model of job satisfaction was reasonable

but incomplete
Model could be used in Korean work
organizations
20 studies conducted in hospitals and 10

conducted in specialized units. One study
was conducted in multiple sites (i.e., public
hospitals, private hospitals, nursing
homes, and nursing and community-based
agencies)
Dailey (1990) USA
Instruments
431 nurses (28.7%

response rate)
Blau et al.s (1993) index of work

commitment, Mobley et al. (1978) turnover
intention scale, specially designed: career
needs and career development programmes
questionnaire
Rafferty et al. (2007)

England
3984 nurses (49.4%

response rate)
Emotional Exhaustion Scale of Maslach and

Jacksons (1986) burnout inventory, specially
designed: nurse stafng questionnaire, job
satisfaction and quality of care questionnaire
Kanai-Pak et al. (2008) Japan
5956 nurses
working in 19 acute
care hospitals (84%
response rate)
Emotional Exhaustion Scale of Maslach and

Jacksons (1986) burnout inventory, Nursing
Work Index-Revised (Aiken and Patrician,
2000; Lake, 2002)
Lu et al. (2007b,
2008) China
512 nurses (81%

response rate)
Lu (2008) Beijing, China
258 nurses (97%

response rate)
Job Satisfaction Scale (Warr et al., 1979),

Organizational Commitment Scale (Mowday
et al., 1979), Nurses Occupational Stress Scale
(Hingley and Cooper, 1986), Professional
Identication Scale (Brown et al., 1986), Role
Conict and Ambiguity Scale (Rizzo et al.,
1970), Nurses Role Perception Scale derived
from the Kings Nurse Performance Scale
(Fitzpatrick et al., 1997)
Same scales as above
Golbasi et al.
(2008) Turkey
186 nurses (74.4%

response rate)
Weiss et al. (1967) Minnesota Satisfaction

Questionnaire (MSQ), Siva (1991) Turkish
version of the WCI
Guleryuz et al.
(2008) Turkey
267 nurses (48.5%

response rate)
Wong and Law (2002) Emotional Intelligence

Questionnaire, Mowday et al. (1979)
Organizational Commitment Scale, Hackman
and Oldhams (1975) Job Diagnostic Survey
(JDS)
Gap between career needs and career development

programmes made signicant contributions to
organizational commitment (b = 0.209, p < 0.01)
and turnover intention (b = 0.183, p < 0.01)
Organizational commitment made signicant
negative contributions to turnover
intention(b = 0.453, p < 0.01)
Patients where nurses had the heaviest patient loads
were 26% more likely to die.
Nurses with the heaviest workloads were between
71% and 92% more likely to show negative job
outcomes (burnout and job dissatisfaction) and to
rate the quality of care as low and deteriorating
Odds on high burnout, job dissatisfaction and poorfair quality of care were twice as high in hospitals
with 50% inexperienced nurses than with 20%
inexperienced nurses and 40% higher in hospitals
where nurses had less satisfactory relations with
physicians. Nurses in poorly staffed hospitals were
50% more likely to exhibit burnout, twice as likely to
be dissatised and 75% more likely to report poor or
fair quality care than nurses in better staffed
hospitals
40% of the variance in job satisfaction explained by
the set of independent variables including
organizational commitment, occupational stress,
professional commitment, role conict, role
ambiguity, educational level, age and working years
(R2 = 0.396). Nurses role perception and actual role
content inuenced job satisfaction as well as
occupational stress, role conict and role ambiguity
(p < 0.05)
50.7% of the variance in job satisfaction explained by
the set of independent variables including
organizational commitment, professional
commitment, occupational stress, role conict and
ambiguity. Organizational commitment (b = 0.518,
p < 0.001) had the strongest impact on job
satisfaction, followed by occupational stress
(b = 0.147, p < 0.001) and role ambiguity
(b = 0.103, p < 0.001)
Signicant positive relationship between job
satisfaction and dimensions of Ways of Coping
Inventory self-condent approach (r = 0.181) and
optimistic approach (r = 0.175) and negative
relation between job satisfaction and dimensions of
the helpless approach (r = 0.220)
Emotional intelligence was signicantly and
positively related to job satisfaction (r = 0.236;
p < 0.01) and organizational commitment (r = 0.229;
p < 0.01). Job satisfaction was signicantly related to
organizational commitment (r = 0.667; p < 0.01)
Chang et al. (2007) Taiwan
1031
Sample and
response rate
Instruments
Key ndings
Laschinger (2008)
Ontario, Canada
234 staff nurses

(58.5% response
rate)
Laschinger et al. (2001) Conditions for Work

Effectiveness Questionnaire-II (CWEQ-II),
Lakes (2002) Professional Environment Scale,
Hackman and Oldhams (1975) Job Diagnostic
Survey (JDS)
Laschinger et al. (2011)

Ontario, Canada
3156 staff nurses

from 217 units (40%
response rate)

Effectiveness Questionnaire-II (CWEQ-II),
Maslach and Jacksons (1996) burnout
inventory, Laschinger et al. (2001) Global
Satisfaction Scale
AbuAlRub et al.
(2009) Jordan
288 nurses from

public hospitals
(5080% response
rate) and 195
nurses from private
hospitals (4060%
response rate)
McCloskey and Mueller (1990) Satisfaction

Scale, Sargent & Terry (2000) Social Support
Scale, McCloskey & McCain (1987) Intent to
Stay Scale
Ho et al. (2009) Taiwan
532 nurses working

in two large
hospitals (81.8%
response rate)
Specially designed: Job Rotation scale, Role

Stress scale, Job Satisfaction scale,
Organizational Commitment scale
Cai and Zhou (2009)

Mainland, China
189 staff nurses

(98.4% response
rate)
Goldman and Tabak

(2010) Israel
Van Bogaert et al.
(2010) Belgium
95 graduate nurses
(response rate not
reported)
546 staff nurses
(66% response rate)

Effectiveness Questionnaire (CWEQ-II), Peng
and Liu (2008) Global Job Satisfaction
Questionnaire
Zhang et al. (2005) Chinese version of
Michigan Organizational Assessment
Questionnaire
Specially designed: ethical climate and job
Magnet hospital characteristics mediated the effect

of structural empowerment on job satisfaction and
nurses perceptions of patient care quality. Stafng
adequacy (r1 = 0.23, r2 = 0.29) and structural
empowerment (r1 = 0.45, r2 = 0.27) had positive
direct effect on level of job satisfaction and perceived
nursing care quality
Nurses shared perceptions of leader-member
exchange quality on their units positively inuenced
their shared perceptions of unit structural
empowerment (b = 0.25, p < 0 .05) (Level 2), which
resulted in signicantly higher levels of individual
nurse job satisfaction (b = 0.30, p < 0.05) (Level 1)
Reported means of the job satisfaction scale and
intention to stay at work scale for the nurses of
private hospitals were signicantly higher than
those of the nurses of public hospitals (p < 0.01). The
correlation between social support from supervisors
and job satisfaction was moderately positive
(r = 0.35, p < 0.001), while the correlation between
social support from co-workers and job satisfaction
was insignicant (p > 0.05)
Nurses job rotation had a positive inuence on job
satisfaction (r = 0.51) and organizational
commitment (r = 0.46). Nurses role stress had a
negative inuence on job satisfaction (r = 0.52) and
organizational commitment (r = 0.79)
Structural empowerment positively related to the
perceived job satisfaction (r = 0.56) and turnover
intention (r = 0.31)
van der Heijden et al. (2010)

Europe (8 countries)
17,524 registered
female nurses
Nursing Work Index-Revised (Aiken and

Patrician, 2000), Burnout Inventory Human
Service Survey (MBI-VL) (Maslach & Jackson,
1996; Vlerick, 1996; Van Bogaert et al., 2009)
Job satisfaction scale originated from

Kristensen (2000), specially designed social
support from direct supervisor and close
colleagues questionnaire, one item for
intention to leave the profession
Congruence of ethical climates explained 32.1% of

the variance in job satisfaction, with caring and
independent t as the strongest predictor
Hospital management and organizational support,
emotional exhaustion were 2 signicant predictors
of nurses job satisfaction (OR = 6.96, OR = 0.89,
respectively). Positive ratings of nursephysician
relationships (OR = 1.81) and lower levels of
emotional exhaustion (OR = 0.94) predicted
intention to stay nursing
Social support from direct superiors, and from close
colleagues are signicantly and positively related
with job satisfaction (r1 = 0.260.37, r2 = 0.130.19,
p < 0.001), and negatively with intention to leave the
nursing profession (r1 = 0.11 to 0.22, r2 = 0.07 to
0.15, p < 0.05)
Comments
Code study
1032
Table 6 (Continued )
Part of a large European study on nurses

intention to leave their profession (NEXT,
Nurses Early Exit, Hasselhorn et al., 2003).
464 nurses in 5
acute hospitals
(54.5% response
rate)
496 nurses (89%

response rate)
3182 nurses
working in acute
hospitals (response
rate 55.0% in
Germany; 60.4% in
Belgium)
Larrabee et al.
(2010) USA
Kwak et al. (2010)

South Korea
Chen and Johantgen (2010)

Germany, Belgium
Job satisfaction scale and Magnet Specically

designed Forces questionnaire
1283 nurses (91.6%

response rate)
Zheng and Liu (2010b)
Beijing, China
McCloskey and Mueller Satisfaction Scale

(MMSS) (1990), Hackman and Oldhams
(1975) Job Diagnostic Survey (JDS), PES-NWI
(Lake, 2002)
Price and Muellers (1981) turnover scale, the
Work Quality Index (WQI) (Whitley and
Putzier, 1994), Modied version of Hinshaw
and Atwoods (1985) job stress scale,
Psychological empowerment questionnaire
(Spreitzer, 1995), Thomas et al. (1994) Stress
Resiliency Prole
Korean version of the Pennsylvania Registered
Nurse Survey (PRNS) (Aiken et al., 2002)
13 variables from four categories (job characteristics,

working conditions, personal characteristics and
organizational factors) explained 56.2% of the
variance in job satisfaction
Causal model identied 6 signicant predictors:
situational stress and personal stress(job stress),
psychological empowerment, necessitating and skill
recognition(stress resiliency), years since RN
graduation, together explaining 59% of the variance
in job satisfaction, with psychological empowerment
as the most signicant predictor (b = 0.46).
Model explained 43% of variance for nurses job
satisfaction. Specically, satisfaction with profession
(OR = 11.93, p < 0.001), opportunity for promotion
(OR = 2.27, p < 0.05) and organizational support
(OR = 1.04, p < 0.05) had positive effects on job
satisfaction, while negative effects were associated
with burnout (OR = 0.92, p < 0.05).
Four Magnet Forces (management style, autonomy,
interdisciplinary relationships, and professional
development) were able to explain the variance of
job satisfaction in both individual and hospital levels
Secondary data analysis of European

Nurses Early Exit (NEXT) Study baseline
data (Hasselhorn et al., 2005)
1033
7. Conclusion
Most member states of the WHO have reported nurse
resource difculties (Kingma, 2007). Developed countries
are faced with the double challenge of having an ageing
nurse workforce and increasing demand for nursing care
from an ageing population (Buchan, 2001). International
migration of nurses has increased as nurses pursue
opportunities for improved pay and opportunities in the
wake of the global liberalization of trade spurred on by
developed countries increasing their international recruitment to meet their health-care workforce needs and in so
doing creating a skills drain in many developing countries
(Kingma, 2007). This increased mobility of the nursing
workforce means that factors which contribute to nurses
turnover merit attention. Job satisfaction among nurses
has been identied as a key factor in nurses turnover with
the empirical literature suggesting that it is related to a
number of organizational, professional and personal
variables.
This review was limited to general acute hospital
settings and therefore care needs to be taken regarding its
application to other care settings and other elements of the
qualied nursing workforce such as specialist nurses and
mental health nurses. Nonetheless the literature indicates
common issues across the world although it is possible
that different issues have greater signicance in different
countries due to the social context of the different labour
markets. Further the literature suggests that work related
stress is increasing over time in the wake of healthcare
restructuring and technological change (Zangaro and
Soeken, 2007) with increased levels of work related stress
and associated lower levels of satisfaction with reward
packages and working conditions being consistent across
studies. Current workforce shortages are likely to place
greater demands upon nurses which might be expected to
increase their work related stress and may reduce the
quality of workplace relationships which has emerged as
an important source of job satisfaction and contributes to
organizational commitment. The lower levels of job
satisfaction among nurses with tertiary education are
noteworthy as such nurses probably represent the most
well-educated element of the nursing workforce and the
future leadership of the profession. Also noteworthy is the
lower job satisfaction of those who had unfullled
expectations regarding nursing work which suggests that
some nurses retain an idealized view of nursing despite
most initial nurse education including extended periods of
clinical practice to prevent reality shock on entry into the
workforce.
The current worldwide shortage of nurses highlights
the importance of understanding the impact and interrelationships of the identied variables if healthcare
organizations are to implement interventions to improve
the retention of their nursing workforce. Although several
models of job satisfaction have been postulated, these
models require further testing especially regarding the
relative contribution of different factors especially in the
different contexts of countries. The literature suggests that
the moderators or mediators in these models need to be
identied in further studies thereby providing clearer
1034
causal relationships between the predictors and job

satisfaction. The lack of a comprehensive and causal model
of job satisfaction in nursing is a major shortcoming and
without which effective management interventions cannot be developed or tested.
Conict of interest
There are no conicts of interest.
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International Journal of Nursing Studies 49 (2012) 10171038

Contents lists available at SciVerse ScienceDirect

International Journal of Nursing Studies

Job satisfaction among hospital nurses revisited: A systematic review

What is already known about the topic?

What this paper adds

H. Lu et al. / International Journal of Nursing Studies 49 (2012) 10171038

Full-text papers assessed

the following facets of job satisfaction: appreciation,

Records identified and

Full-text papers assessed

Papers included in this updated review

H. Lu et al. / International Journal of Nursing Studies 49 (2012) 10171038

et al., 2007). A total of 100 papers were included in this

14 sub-scales rated on a 4-point Likert scale: physical

H. Lu et al. / International Journal of Nursing Studies 49 (2012) 10171038

and responsibility. The global scales correlation coefcient

indicators (indirect working environment, direct working

H. Lu et al. / International Journal of Nursing Studies 49 (2012) 10171038

Key empirical sources

Relationships with patients

Workload; stafng; scheduling and shifts;

upon nursing absenteeism, burnout and nurses intention

Adams and Bond (2000)

834 nurses of clinical grade C and

Adamson et al. (1995)

133 Australian nurses

Adams et al.s (1995) ward

Aiken et al. (2001)

Most important contributors to nurses job satisfaction

Lee (1998) Hong Kong

136 acute hospital nurses and 54

Lundh (1999) Sweden

439 nurses, 83 laboratory

Nolan et al. (1995) Wales

Specially designed nurses

Price (2002) England

141 E-grade nurses in a large

Mueller and McCloskey

Tovey and Adams (1999) England

20 ward leaders and 110 nurses

Tzeng (2002b) Taiwan

786 nurses (76% response rate)

Wang (2002) Mainland China

191 nurses (100% response rate)

Adams et al.s (1995) ward

Medical dominance is a barrier

Similar core problems in nurses

Nurses more dissatised than satised

Nurses levels of stress had increased

Nurses were more dissatised than satised and mostly

Caution needed re. sample bias

H. Lu et al. / International Journal of Nursing Studies 49 (2012) 10171038

971 staff nurses and 182 nurse

Sjogren et al. (2005) Sweden

288 nurses who had left nursing

Bjork et al. (2007) Norway

2095 nurses working at four

Stamps (1997) Index of

Penz et al. (2008) Canada

944 rural hospital acute care

Stamps (1997) Index of

De Gieter et al. (2010)

337 nurses working for a diverse