CHAPTER ONE

INTRODUCTION

1.0 Introduction

This chapter explains the background of study, statement problem, research objective, general
objectives, and specific objectives, and research questions, scopes of study, content scope,
geographical scope, time scope definition of terms and conceptual framework.

1.1 Background of the Study

Job satisfaction refers to a positive emotional feeling that can be obtained from job experiences,
and it is one of the individualistic elements of happiness derived from the working environment.
Job satisfaction is an essential component of nurses’ lives that can impact patient safety,
efficiency and performance, quality of care, retention and turnover, and commitment to the
organization and the profession. Moreover, it can determine the productivity and efficacy of
human resources (Habtamu et al., 2021).

Job satisfaction has become a critical issue for healthcare organizations in recent years,
particularly in nursing, because of potential labour shortages, their effect on patient care, and the
associated costs. Work satisfaction is a major factor in nurse retention and the delivery of high
quality care, but rapid changes in healthcare services have placed more demands on nurses and
this has increased the need for organisations to consider ways to sustain and improve nurses’ job
satisfaction. To achieve this, they need to understand the factors that affect job satisfaction and
dissatisfaction (Maqbali, 2015).

Nurses constitute major professional group among healthcare workers (Kamal, 2011). In recent
years, providing high-quality health care delivery system is a fundamental challenge (Al-Enezi et
al., 2009). To reach that quality level, reasonable level of nurses’ job satisfaction should be
attained (Maqbali, 2015).

The word “Nurse” originated from the Latin word “Nutrire” but in the late 16th century it
attained its modern meaning which is “person who cares for the infirm”. Historically,
professional nursing started with Florence Nightingale in the 19th century. Nightingale
challenged social norms by becoming a nurse. At that time, the public objected to the idea of
women's nursing but nightingale saw it as an opportunity for women to serve the community.
She believed that patient care can be improved by using education and scientific knowledge. The
nursing profession's evolution accelerated later during the American civil war (Arumugam et al.,
2023)

Professional nursing facilities started in the early 19th century and wars played a significant role
to improve nursing awareness among the people. The evolution of nursing facilities started after
the 19th century and modern-day nursing is different from the time of the Crimean war [5].
Nursing facilities have changed over time specifically in the education and training areas of
nursing. Technology and healthcare awareness are the main factors that help in the evolution of
nursing facilities. Presently nurses have to perform a wide range of work that includes taking
vital symptoms of patients, recording medical histories, and conducting physical examinations
and they also have to work under the instruction of physicians. Nurses are getting proper training
to perform these works and technology helps them to perform these works efficiently
(Arumugam et al., 2023).

During the post-war period nursing witnessed many changes and development towards attaining
a professional status. Many of the ‘housekeeping’ tasks once performed by nurses were taken
away to leave them free to use their nursing skills. More men were encouraged to join the
service. Requirement of registration, recruitment and training enhanced its future development as
a profession. With the rapid advancement in the field of medical science and technology, more
and more complex areas of study and practice have appeared in the field of nursing as well.
Nursing has become complex as it consists of caring functions and administration (Arumugam et
al., 2023).

Nursing services in modern society has to address certain basic issues like improving patient care
standards and providing quality and tertiary care. A nurse’s role is pivotal in providing the health
care delivery system both in the hospitals and the peripheral health centers. Nursing services
today has the overall responsibility for the provisions of quality nursing care for patients and
management of its human, physical, and financial resources (Arumugam et al., 2023).
In ancient times, much of the practice of medicine in India, Egypt, Assyria, and Greece was
inextricably mingled with religious practices. In the Fourth century B.C. the Greek physician
Hippocrates laid the foundation of rational medicine. Even at that time we find no mention of
skilled nursing by specially trained attendants. Treatment was carried out by the physician or his
pupil assistants and the general nursing care of the patient was in the hands of the women of the
household or slaves. It is worth noting that a large proportion of the nursing care of the sick was
continued to be carried out by women of the household throughout the history. Midwives were
frequently mentioned in early days, and midwifery was usually a hereditary family profession.
The ‘man midwife’ and the obstetric physician were innovations of the seventeenth century.
(Clarke, Margaret 1979)

The history of job satisfaction research began in the 1930s. Early definitions described job
satisfaction as a combination of psychological, physiological, and environmental factors that lead
a person to say they are satisfied with their job. One of the biggest influences was the Hawthorne
studies in the 1920s-1930s, which showed that novel changes temporarily increase productivity
due to being observed, not the changes themselves. This provided evidence that factors other
than pay influence job satisfaction. Scientific management also impacted the field by increasing
productivity but leaving workers exhausted and dissatisfied. Maslow's hierarchy of needs theory,
proposing that people seek to satisfy physiological, safety, social, esteem, and self-actualization
needs, provided a foundation for early job satisfaction theories.

Job satisfaction refers to the level of contentment and fulfillment that is experienced by nurses in
their jobs, while nursing workforce competencies refer to the knowledge, skills, and abilities
required for nurses to effectively perform their duties. Nursing workforce competencies are
important because they ensure that nurses have the knowledge and abilities necessary to provide
care that is safe, effective, and centered on the patient. It is necessary to provide competent
nursing care to reduce healthcare costs, improve patient satisfaction, and prevent unfavorable
patient outcomes. Additionally, competent nursing care contributes to the overall quality of the
delivery of healthcare as well as the safety of the patient The nursing workforce’s competencies
and their level of satisfaction in their jobs are both essential components of nursing practice
necessary for delivering high-quality care to patients (Alshammari & Alenezi, 2023).
Nurses’ job satisfaction is related to high performance and retention (Ellenbecker et al 2008,
Grissom 2009), while job dissatisfaction is a major reason for high staff turnover (Coomber and
Barriball 2007, Estryn-Behar et al 2010) and absenteeism (Cohen and Golan 2007, Albion et al
2008). Aiken et al (2012) highlight how satisfaction in the workplace can also improve patient
safety and quality of care (Maqbali, 2015).

Nurses play a crucial role in hospitals. In the profession of nursing, job satisfaction has supreme
importance, since nurses deriving satisfaction from their job will perform better, which
ultimately affects the condition of patients.8 However, nurses who are not satisfied with their
jobs will involve themselves in disputes and high turnover, and their patients will be
dissatisfied.5 Nurses are the most undervalued teams among healthcare staff even though they
are working with admitted patients for the whole time during the patient’s stay in the hospital.
Currently, nurses in Ethiopia seem less satisfied and are leaving their profession and joining non-
nursing fields due to inadequate salaries, shift schedules, and community perceptions of the
nursing profession (Habtamu et al., 2021).

Nurses’ job satisfaction is a multidimensional occurrence affected by many variables (Alnems ,

2005). They can be divided to intrinsic and extrinsic variables. Extrinsic factors include
perceptible aspects of the work, such as benefits and salary, whereas intrinsic factors include
personal and professional progress chances and recognition (Yilmazel, 2013 and Kabeel and
Eisa, 2017). Currently, nurses seem to be less satisfied due to many unidentified factors, and
hence, there is a constant threat of attrition (Ee & El-Masry, 2018).

A shortage of nurses has been a problem for a long time and is expected to continue worldwide.
Nearly half of the World Health Organization (2017) members have reported fewer than three
nurses per 1000 population with 27% reporting to have less than 1 per 1000 population. The
retention of hospital staff nurses has been identified as a key factor to counteract the shortage
(Wang et al., 2012; Zhao, 2013; Sabanciogullari and Dogan, 2015; Masum et al., 2016; Chen et
al., 2016; Zhang et al., 2016a, b). The shortage of nurses reduces the efficiency and quality of
nursing care which adversely affects patient outcomes (Lu et al., 2019).

Wilson et al (2008) explored job satisfaction among different generations of 6,541 Canadian
registered nurses categorized by year of birth. Results showed that baby boomers, born between
1946 and 1964, were more satisfied overall than generation X babies, born between 1965 and
1979, and generation Y babies, born from 1980 onwards. Baby boomers were more satisfied with
scheduling, pay, and benefits. More than one-third of the baby boomers and Generation X nurses
worked in critical care, while half of the Generation Y nurses worked in medical and surgical
units. Nurses of Generation Y started their careers in medical or surgical units to enhance their
knowledge and skills. The levels of satisfaction appeared to decrease in the younger generations
of nurses (Maqbali, 2015)

Gurková et al (2012), meanwhile, found a positive relationship between nurses aged between 36
and 40 and job satisfaction (P>0.01) as well as with nurses with less than five years experience,
while Kanai-Pak et al (2008) suggested that nurses in Japan with less than ten years experience
exhibited job dissatisfaction and a high level of burnout; the latter was measured using the
Emotional Exhaustion Scale of the Maslach Burnout Inventory (Maqbali, 2015).

Globally, In Pakistan, over half of the nurses were satisfied with their jobs, and they received
honor from peers, hospital administration, and doctors. Work overload, job rotation, and
emotional exhaustion from work were predictors of the job satisfaction of nurses.8 Job
dissatisfaction among nurses was highest in the USA (41%) followed by Scotland (38%),
England (36%), Canada (33%), and Germany (17%). Regarding the work climate, when
compared with other countries, the nurses in Germany (61%) reported that they derived greater
satisfaction from the opportunities available for career advancement, whereas nurses in the USA
(57%) and Canada (69%) felt that they derived greater satisfaction from their salaries. A study in
Swiss hospitals indicates supportive leadership, better teamwork, safe residency, and adequate
staff to be positive predictors of nurses’ job satisfaction. A study in South Africa showed benefits
and rewards could be key predictors of nurses’ job satisfaction (Habtamu et al., 2021).

In Hong Kong, a study of 1,271 registered nurses in 10 hospitals (Choi et al 2012) examined the
work environment in terms of job satisfaction and intention to resign and identified five
dimensions: professionalism, management, co-worker relationships, staffing and resources, and
ward practice. Results showed 56% of respondents were satisfied overall and 45% were
dissatisfied, while more than 60% had considered resigning. The findings indicated that the five
dimensions are significant in terms of predicting nurse job satisfaction; however, the study
instrument was newly developed so the validity and reliability of the results are questionable.
The instrument has to be tested in other settings to confirm validity and reliability (Maqbali,
2015).

In Africa, Kenya recognizes that nurses are essential components of the healthcare workforce
who are expected to multitask and accomplish varied roles within and outside the nursing
profession (Abuya, Maina, & Chuma, 2015). Such according to the researchers include
dispensing of drugs as well as taking up doctors’ roles. Although considered critical in offering
crucial services in the health care system, nurses in Kenya operate under an imbalance ratio of
8.3:10,000 as opposed to the WHO-recommended 25:10,000 (Okeyo, 2017; Utriainen & Kynga,
2009). Additionally, they earn low salaries and have limited career development opportunities.
Cumulatively, the prevailing conditions pose a threat of attrition and job dissatisfaction among
nurses within the country. These concerns have precipitated bitter disputes between
representatives of nurses such as the National Nurses Association of Kenya and Kenya National
Union of Nurses with both the central and county governments (Onsarigo, 2014; Wahito, 2013).
Of concern to representatives have been calls for improving nurses’ job conditions including
compensation (Kimanthi & Nyamai, 2017). With the disputes culminating into country-wide
strikes that often paralyzed the entire healthcare system for months on end (Kimanthi & Nyamai,
2017), it has been speculated that nurses' job satisfaction could be at the lowest. However,
empirical data that could specifically illustrate the extent to which such factors could have
impacted nurses’ job satisfaction are non-existent. Tarcan, Hikmet, Schooley, Top, and Tarcan
(2017) lament the lack of empirical data specific to developing countries such as Kenya despite
the existence of several studies carried out on job satisfaction among nurses globally. The study
thus sought to establish the factors influencing job satisfaction among nurses in public hospitals
in Kenya with a specific focus on nurses working in health facilities in Mombasa, Kwale, and
Kilifi counties (Tengah, 2019).

In Egypt, nurses are the backbone of the healthcare system (Kabeel and Eisa, 2017). They play a
vital role in promoting the healthcare program of the country by contributing their own share for
the achievement of the Millennium Development Goals (MDGs) (Francis, 2013). Although the
fact that these are the people who take care of our beloved relatives when they are hospitalized
(Alam and Mohammad, 2010), nursing staffs in most medical institutions are the most
unappreciated staff members (Ee & El-Masry, 2018).

In somalia, Nursing staff had reported low satisfaction with professional development
opportunities, recognition, poor salaries, benefits, doing a lot of improper tasks and having more
work pressure. Based on the findings of the study, interventions should be carried out to increase
level of job satisfaction among nursing staff by reinforcing relevant human resource polices,
improving working conditions and compensations. Hospital manager should balance the benefit
package and internal promotion to increase job satisfaction. The hospital managers should give
emphasis for conducive environment for work, appropriate rewards and recognition for
achievements among nurses. More studies should be conducted on a larger scale especially in a
nationwide to identify factors that enhance job satisfaction for the hospital-based nurses
(Mohamud, B. A. 2024).

1.2 Problem Statement

In the healthcare sector of Mogadishu, the backbone of service delivery lies in the hands of
nurses, who are pivotal in providing continuous patient care. However, the volatile environment,
coupled with socio-economic challenges, poses significant stressors that potentially impact the
job satisfaction of these essential healthcare workers. The problem is that there is a lack of
comprehensive understanding of the factors contributing to job satisfaction among nurses in
Mogadishu, Somalia. This knowledge gap is critical as job satisfaction is directly linked to nurse
retention, patient satisfaction, and overall healthcare quality. The absence of detailed research on
this subject within the context of Mogadishu hinders the development of effective strategies to
improve working conditions and ensure the well-being of nurses. Consequently, this study aims
to investigate Job Satisfaction and associated factors among nurses in Mogadishu, Somalia, and
to assess the level of job satisfaction among nurses working, to identify the key factors that
influence job satisfaction among nurses in Mogadishu, and evaluate the impact of job satisfaction
on nurses in Mogadishu of nurses in Mogadishu’s healthcare institutions.

However, there is no previous or current research about on Job Satisfaction and associated
factors among nurses in Mogadishu, Somalia

1.3 Research objectives

1.3.1 General objective

The main objectives of this study will on Job Satisfaction and associated factors
among nurses in Mogadishu, Somalia
1.3.2 Specific objectives
 To assess the level of job satisfaction among nurses working in Mogadishu, Somalia.
 To identify the key factors that influence job satisfaction among nurses in Mogadishu,
 To evaluate the impact of job satisfaction on nurses in Mogadishu
1.4 Research questions
 What are the level of job satisfaction among nurses working in Mogadishu,
Somalia?
 What are the key factors that influence job satisfaction among nurses in Mogadishu?
 What are the impact of job satisfaction on nurses in Mogadishu?

1.5 Scopes of the study

1.5.1 Content scope
This study will focus on Job Satisfaction and associated factors among nurses
in Mogadishu, Somalia
1.5.2 Geographical scope
This study will be conducted in Mogadishu Hospital, Mogadishu Somalia.

1.5.3 Time scope

The study will be time period between APRIL in 2024 to July in 2024

1.6 Significance of the study

This study will be useful for:

 Local community.

 NGOs both national and international.

 The international community operating and financing in the field health

because it makes them fully aware of the existing health problems in the country
 in general and Job Satisfaction and associated factors among nurses in particular
so as to consider in the upcoming national health planning.
 In additionally this study will help ministry of health and other health programmers.

 This study will also useful for other researchers.

1.7 Operational Key Terms

Job Satisfaction: refers to a positive emotional feeling that can be obtained from job
experiences, and it is one of the individualistic elements of happiness derived from the
working environment (Habtamu et al., 2021).

Nurse: Nursing encompasses autonomous and collaborative care of individuals of all ages,
families, groups and communities, sick or well and in all settings (Currie & Carr ‐Hill,
2012).

1.8 Conceptual framework

IV DV

Job Satifaction

Nurse
Level Of Job Satisfaction

Key Factors That Influence Job

Satisfaction

Impact Of Job Satisfaction

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