Nurse Practitioners’ Job Satisfaction and

Associated Factors among Nurses working at the

University of Gondar Specialized Hospital: A Cross-
sectional Survey study
Abere Woretaw Azagew (  [email protected] )
University of Gondar College of Medicine and Health Sciences https://orcid.org/0000-0002-6270-5992
Chilot Mekonnen
University of Gondar

Research article

Keywords: Nurse practitioner, Job satisfaction, Northwest Ethiopia

Posted Date: April 17th, 2020

DOI: https://doi.org/10.21203/rs.3.rs-21796/v1

License:   This work is licensed under a Creative Commons Attribution 4.0 International License.
Read Full License

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Abstract
Background Job satisfaction is an important measure of cognitive as well as a behavioral component of
employees’ feelings of comfort in their particular work. It is also the outlook and spirit of certain
professionals towards their work. Nurses’ job satisfaction is a significant predictor of staff retention.
Therefore, this study aimed to assess Nurse Practitioners’ Job Satisfaction and Associated Factors
among Nurses Working at the University of Gondar Specialized Hospital Northwest Ethiopia.

Methods A cross-sectional study design was employed from May 15–20/2019. A total of 416 nurses
participated in the study. A simple random sampling technique was used to select each study participant.
A pretested structured questionnaire was used to collect the data. A Minnesota satisfaction measurement
tool was used to measure nurse practitioners’ job satisfaction. A binary logistic regression analysis was
used. Variables having p-value < 0.05 in a multivariable analysis model were considered as statistically
significant and independently associated with the outcome variable.

Result A total of 416 study participants were used in the study with a response rate of 97.6%. In this
study, 204(50.2%) of nurse practitioners were dissatisfied with their job. Motivational factors such as
professional advancement (AOR = 2.737, 95% CI; 1.109, 6.751), work itself (AOR = 4.250, 95%CI; 1.645,
10.983), recognition at work (AOR = 11.869, 95% CI; 4.238, 33.241), growth at work (AOR = 6.272, 95% CI;
2.278,17.264), and hygienic factors; organizational policy (AOR = 5.623, 95% CI; 2.131, 14.836),
relationship with friends (AOR = 6.112,95% CI; 2.393, 15.612), work-security (AOR = 6.562, 95% CI; 95% CI;
2.374,18.136), relationship with supervisor(AOR = 5.127, 95% CI; 1.796, 14.641), payment (AOR = 5.889,
95% CI; 1.989, 17.438), and working conditions AOR = 3.806, 95% CI; 1.195, 12.123) were the factors
associated with nurses’ job dissatisfaction

Conclusions In this study, one of every two nurses experienced job dissatisfaction. Motivational factors
such as professional advancement, work itself, recognition at work, growth at work, organizational policy,
relationship with friends, work security, relationship with supervisor, payment, and working conditions
were the factors associated with nurses’ job dissatisfaction.

Background
Job satisfaction is an important measure of cognitive as well as a behavioral component of employees’
feelings of comfort in their particular work. It is also the outlook and spirit of certain professionals
towards their work(1, 2). The employee is an essential component in the process of achieving the mission
and vision of the organization. They ought to meet the performance criteria set by the organization to
ensure the quality of care for the larger community where they are employed (3). There are predetermined
standards to meet by the organization for the employees to provide quality care. So that the employee
needs a very safe working environment that allows them to give their best without problems that restrain
them from performing up to the level of their full potential. This, in turn, could be the bridge for job
satisfaction(4, 5).

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In the modern community, organizations are facing many more challenges due to the over changing
nature of the working environment. Among the challenges for health organization is to satisfy its
employees to come up with the ever-changing and evolving environment, to achieve success and remain
in competition to give quality care(6). On the other hand; to increase efficiency, effectiveness, productivity,
and job devotion of the employees, the organization must satisfy the needs of its employees by providing
good working conditions(7, 8).

Each year, there are substantial numbers of health professionals leave the health workforce, either
temporarily or permanently. This could impose a shortage if they are not replaced and compromised the
delivery and quality of health care service(9, 10). There are numerous physiological and psychological
factors for job satisfaction. Monthly payment, kind of supervision, low expectation of benefit, operating
procedures, the nature of workload, coworkers, habit of team spirit or teamwork and communication had
been among the physiological factors for job satisfaction(11, 12). Job satisfaction is a motivational
outcome in the health system research due to its relation to performance and turnover, so it is the concern
for researchers and health service managers(13–15). The satisfaction of nurses on their job could also
depend on nature, expectations of what their job provided them and others, and affective orientation that
they have towards their job. It can be measured globally or in the multi-faceted way, with the former
approach being used when the interest is on overall attitude towards the job employees have, and the
latter when specific job dissatisfaction are evaluated(8). The important facets of job satisfaction
identified are salary, benefits, career development, in-service training, work relationship, working
environment, management, recognition, and supervision(7, 9, 14, 16).

When the nurse practitioners dissatisfied they might preserve their activities and in that the quality and
cost of patient care have been compromised (17). Evidences; showed that job satisfaction is a significant
predictor of staff retention(18, 19). Therefore, the study aimed to assess Nurse Practitioners’ Job
Satisfaction and Associated Factors among Nurses Working at the University of Gondar Specialized
Hospital, Northwest Ethiopia.

Methods
Study design and setting
A cross-sectional study design was employed from May 15–20/2019. The study was conducted among
nurses working in Northwest Amhara region referral hospital; namely the University of Gondar Specialized
Hospital(UoGSH). There were around 590 nurses working in this referral hospital.

Source and Study population

All nurses working in Northwest Amhara region referral hospitals were considered as the source
population whereas those nurses presented in the data collection period were taken as the study
population.

Sample size and Sampling procedure

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The sample size was determined using population proportion formula through the Epi info stat calc
program with the assumption of 95% confidence level, 5% margin of error, and 43.6% of nurse practitioner
job satisfaction (20). Taking these into consideration, the estimated sample size was 378. Considering,
10% non-response rate, the final sample size was 416. The study participants were selected using simple
random sampling technique.

Data collection tools and procedures

A pretested structured questionnaire was used to collect the data. It has two parts. The first part contains
socio-demographic variables and the second is nurse practitioner related questions. A Minnesota
Satisfaction measurement tool was used to measure nurse practitioners’ job satisfaction. It has 20 items.
The question has five-point Likert scale responses which are 1 = very dissatisfied, 2 = dissatisfied, 3 =
neutral, 4 = satisfied and 5 = very satisfied (20). The satisfaction level was measured using the responses
of each study participant. Taking the summed responses participants who scored below the mean were
considered as dissatisfied whereas participants who score above or equal to the mean taken as satisfied
related to their jobs. Furthermore, hygienic and motivational factors measurement tools also used. These
tools have eleven sections. These are achievement, advancement, work itself, recognition, growth,
organization policy, relationship, work security, relationship with supervisor, payment, and working
condition. Each of this sub-sections has questions. The responses are given with five-points Likert scale 1
(strongly disagree), 2 (disagree), 3(neutral), 4(agree), and 5(strongly agree). The Crombach alpha or
reliability test was used. The mean of each subscale was calculated. The agreement level was measured
using the responses of each study participant. Taking the summed responses participants who scored
below the mean were considered as disagreed whereas participants who score above or equal to the
mean taken as agreed related to their jobs. A total of three Midwives for data collection and three health
officers as supervisors were used. The self-administered method of data collection method was used.

Data Processing And Analysis

Data were cleaned, coded, and entered to Epi Info version 7, and exported into SPSS Version 22.
Descriptive statistics such as mean, median, frequency, and percentage were used. Tables and bar-graphs
were used to display the findings. A binary logistic regression analysis was used. All variables were fitted
into the multivariable analysis. Crude odds ratio (COR) with 95% CI for binary logistic regression analysis
and adjusted odds ratio (AOR) with 95% CI was calculated. Variables having p-value < 0.05 in a
multivariable analysis model were considered as statistically significant and independently associated
with the outcome variable. Hosmer’s and Lemeshow goodness of fit test was computed.
Results
Socio-demographic characteristics
A total of 416 study participants were used in the study with the response rate of 97.6%. The mean (SD)
age of the study participants was 36.68 ± 9.4 years. One hundred seventy-six (43.3%) of study

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participants were with the age range of 30–39 years. The above half (51.7%) of study participants were
female. Above two-thirds (70.4%) the study participants were married. The majority (77.3%) of study
participants were degree holders and 81.8% of study participants had paid monthly income of ≥ 4000
Ethiopian Birr (Table 1).

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 Table 1
Socio-demographic characteristics of nurses working
at the University of Gondar Specialized. Northwest
Ethiopia, 2019, (n = 406).

Variables Frequency (n) Percent (%)

Age group in years

20–29 106 26.1

30–39 176 43.3

40–49 75 18.5

≥ 50 49 12.1

Sex

Male 196 48.3

Female 210 51.7

Marital status

Single 106 26.1

Married 286 70.4

Divorce 13 3.2

Windowed 1 0.6

Education status

Diploma 43 10.6

Degree 314 77.3

Master 49 12.1

Religious

Orthodox 274 67.5

Muslim 99 24.4

Protestant 25 6.2

Other 8 2.0

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 Table 1
(continued) - Socio-demographic characteristics of nurses
working at the University of Gondar Specialized.
Northwest Ethiopia, 2019, (n = 406).

Variables Frequency (n) Percent (%)

Working Unit

Outpatient department 56 13.8

Ophthalmic 16 3.9

Fistula 13 3.2

Emergency 23 5.7

Inpatient 55 13.5

Surgical 53 13.1

Orthopedic 46 11.3

Operation room 34 8.4

Recovery 30 7.4

Medical 34 8.4

Trauma 19 4.7

Pediatric ward 27 6.7

Work experience

< 2 years 33 8.1

2–6 years 184 45.3

7–10 years 150 36.9

≥ 10 years 39 9.6

Proportion of Nurse Practitioners Job Satisfaction

In this study, 204[50.2% (95% CI; 45.3, 54.9%)] of nurse practitioners were dissatisfied towards their job
(Fig. 1).

Motivational and Hygienic Factors among Nurse

Practitioner

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Of the study participants; 54.2% disagree with professional advancement, 56.2% disagree with workplace
recognition, 57.9% disagree to growth at work, 57.1% disagree to organizational policy, and 51.7%
disagree with relation with supervisors (Fig. 2).

Bivariable and Multivariable Findings: Factors Associated

with Nurses’ Job Satisfaction
A binary logistic regression model was used to test the presence of a significant association. All
independent variables were fitted to bivariable and multivariable logistic regression analysis. Variables
with a p-value < 0.05 with a 95% confidence level were taken as statistically significant. Adjusting
possible confounders in multivariable analysis; Motivational factors such as professional advancement
(AOR = 2.737, 95% CI; 1.109, 6.751),work itself (AOR = 4.250, 95%CI; 1.645, 10.983), recognition at work
(AOR = 11.869, 95% CI; 4.238, 33.241), growth at work (AOR = 6.272, 95% CI; 2.278,17.264), and hygienic
factors; organizational policy (AOR = 5.623, 95% CI; 2.131, 14.836), relationship with friends (AOR =
6.112,95% CI; 2.393, 15.612), work-security (AOR = 6.562, 95% CI; 95% CI; 2.374,18.136), relationship with
supervisor(AOR = 5.127, 95% CI; 1.796, 14.641), payment (AOR = 5.889, 95% CI; 1.989, 17.438), and
working conditions (AOR = 3.806, 95% CI; 1.195, 12.123) were the factors associated with nurse
practitioners job dissatisfaction (Table 2).

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 Table 2
Factors associated with nurse practitioner job satisfaction working at University of Gondar Specialized
Hospital, Northwest Ethiopia 2019, (n = 406)

Variables Nurses’ Job COR, 95% CI AOR, 95%CI

satisfaction

Dissatisfied Satisfied

Level of Education

Diploma 24 19 1 1

Degree 169 145 0.816(0.431, 1.545) 3.065(0.588, 15.963)

MSc 21 28 1.067(0.469, 2.428) 3.328(0.436, 25.419)

Work experience
( in years)

<2 24 9 1 1

2–6 87 97 2.973(1.311, 6.743) 4.014(0.613, 26.284)

7–11 74 76 2.739(1.194, 6.282) 2.804(0.421, 18.685)

≥ 12 19 20 2.807(1.042, 7.558) 1.814(0.196, 16.747)

Monthly income

2500–3000 9 9 0.913(0.353, 2.358) 1.661(0.127,21.670)

3000–3500 13 5 0.351(0.122, 1.007) 3.509(0.210, 58.594)

3500–4000 25 16 0.584(0.301, 1.135) 0.371(0.056, 2.453)

≥ 4000 157 172 1 1

Achievement

Agree 56 150 1 1

Disagree 148 52 7.624(4.907, 11.843) 2.527(0.971, 6.576)

Advancement

Agree 43 143 1 1

Disagree 161 59 9.075(5.769, 14.274) 2.737(1.109, 6.751)*

Work itself

Agree 47 156 1 1

NB: ** p value < 0.001, * p-value < 0.05

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Variables Nurses’ Job COR, 95% CI AOR, 95%CI
satisfaction

Dissatisfied Satisfied

Disagree 157 46 11.328(7.130, 17.998) 4.250(1.645, 10.983)*

Recognition at
work

Agree 29 149 1 1

Disagree 175 53 16.965(10.262, 28.045) 11.869(4.238, 33.241)**

Growth at work

Agree 32 139 1 1

Disagree 172 63 11.859(7.334, 19.177) 6.272(2.278,17.264)**

NB: ** p value < 0.001, * p-value < 0.05

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 Table 2
(Continued) Factors associated with nurse practitioner job satisfaction working at the University of
Gondar Specialized. Northwest Ethiopia, 2019, (n = 406).

Variables Nurses’ Job COR, 95% CI AOR, 95%CI

satisfaction

Dissatisfied Satisfied

Organizational policy

Agree 34 140 1 1

Disagree 170 62 11.290(7.026, 5.623(2.131,

18.143) 14.836)**

Relationship with
friends

Agree 31 157 1 1

Disagree 173 45 19.470(11.740, 6.112(2.393,

32.292) 15.612)**

Work security

Agree 21 165 1 1

Disagree 153 37 13.378(8.303, 6.562(2.374,18.136)**

21.556)

Relationship with
supervisor

Agree 45 151 1 1

Disagree 159 51 10.461(6.614, 5.127(1.796, 14.641)*

16.548)

Payment

Agree 64 144 1 1

Disagree 140 58 5.431(3.552,8.305) 5.889(1.989, 17.438)*

Working conditions

Agree 75 164 1 1

Disagree 129 38 7.423(4.717, 3.806(1.195, 12.123)*

11.681)

NB: ** p value < 0.001, * p-value < 0.05

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Discussion
In this study, 50.2% (45.3%-54.9%) of nurse practitioners were dissatisfied with their job. Of the study
participants; 54.2% disagree with professional advancement, 56.2% disagree with workplace recognition,
57.9% disagree with growth at work, 57.1% disagree with organizational policy, and 51.7% disagree with
relation with supervisors. The finding of this study is consistent with the study conducted in East Gojjam
Ethiopia 45.8%(21), Gondar Ethiopia 46%(22). On the other hand, the finding of this study is lower than
the study in Bahir Dar Ethiopia 56.4%(20), Harar Ethiopia 55.8%(23), and Mansoura Egypt 61.8%(24). The
difference is due to the variation sample size, data collection period, tool and measurement. On the
contrary, the finding of this study is higher than a study conducted in Ethiopia public health facilities
39.2% (25) Khyber Pakhtunkhwa, Pakistan 17%(26). The discrepancy is due to the former study is multi-
centered in nature, whereas the latter study in Pakistan uses a small sample size and differ in the
measurement tool.

Motivational factors such as professional advancement, work itself, recognition at work, and growth at
work were found the determinant factors of job satisfaction. Nurses who disagree with professional
advancement were nearly 2.74 times more likely to dissatisfy to their job compared to those nurses
agreed with professional advancement. This is supported by a study conducted in Bahir Dar City
administrative advancement is positive reinforcement for nurses’ job satisfaction(20, 25). Career
advancement is an important element for employee satisfaction and retention at work. It is one of a staff
motivator and reduces anticipated turnover(27). Nurses who disagreed with the nurses’ work itself were
4.25 times more likely dissatisfied compared to those nurses agreed with nurses work itself. The nursing
profession needs a long term contact with the patient. It has a heavy workload as a result, most nurse
professionals experience burnout. The nature of the work itself improves the level of satisfaction(25).
Nursing draw on the skills of emotional intelligence to meet the needs of direct patient care and co-
operative with the multidisciplinary team. Nurses engage in emotional work to foster caring relationship
with patients(28). Nurses who had no recognition at work were nearly 11.87 times more likely dissatisfied
compared to those nurses who had recognition at the workplace. This is consistent with the study of
Ethiopia. Recognition for once work is motivation (20, 25). Meaningful recognition contributes to healthy
work environments and is one of the keys to establishing and maintaining healthy work environments for
nurses(29). Nonmonetary recognition practice particularly improves nurses job satisfaction(30). Nurses
who had no professional growth at work were 6.27 times more likely to be dissatisfied compared to those
who had professional growth at work. This is the fact that a limited opportunity for continuous
professional development as well as implementing nurse’s carrier rank affects the nurse job satisfaction.
Lack of promotion is the major source of dissatisfaction. Lack of prospect for promotion is the means for
nurse practitioners’ dissatisfaction(31, 32).

Furthermore, hygienic factors such as organizational policy, relationship with friends, work-security,
relationship with supervisor, payment, and working conditions are found to be the factors associated with
nurses’ job satisfaction. Nurses who disagree with the organizational policy were 5.6 times more likely to
be dissatisfied compared to those nurses who have agreed organizational policy. The organizational
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managerial policy has a direct impact on nurses’ job satisfaction. Lack of knowledge in the
organizational policy is the highly practiced discrimination which intern affected nurse job
satisfaction(33). Nurses who had a poor relationship with their colleagues were nearly 6times morel likely
to be dissatisfied compared to those nurses who had a good relationship with friends. Nursing needs
collaborative care to the health care team. If there is no good relationship between nurse professional
became dissatisfied to their work. Interpersonal conflict between nurses and their colleagues is the main
source of dissatisfaction(32). Nurses who had work-insecurity were 6.56times more likely to be
dissatisfied compared to those nurses who had work security. This is supported by a study conducted in
Pakistan that job security is the main reason for job security(26). Nurses who had no good relationship
with a supervisor were 5times more likely to be dissatisfied compared to those who have a good
relationship with a supervisor. This is supported by the study in Egypt, deprivation supervisor support
affects nurse job satisfaction(24). Nurses who have disagreed with the payment were nearly 6times more
likely to be dissatisfied compared to those who agreed to payment. Payment has a significant influence
on job satisfaction (22, 31, 34). A study in Pakistan, salary is the main reason of satisfaction. Nurses who
have an adequate salary 64% more likely to satisfy their job(26). Nurses who disagreed in working
conditions were nearly 4 times more likely to be dissatisfied compared to those who agreed in working
condition. A good working environment is a predictor of job satisfaction(23). High workload leads to a
stressful environment (33). Some of the factors like working unit and behavioral factors like stress
anxiety were not investigated.

Conclusions
In this study, one of every two nurses experienced job dissatisfaction. Motivational factors such as
professional advancement, work itself, recognition at work, growth at work, and hygienic factors such as;
organizational policy, relationship with friends, work security, relationship with supervisor, payment, and
working conditions were the factors associated with nurses’ job dissatisfaction.

Declarations
Ethics approval and consent to participate

The study was approved by the School of Nursing Research and Ethical review committee on the behalf
of the University of Gondar Research and ethical review board. Written informed consent was obtained
from each study participant. No personal identifiers such as name, ID number, and phone number were
used. The information obtained from each study participants was kept secured, locked, and stored as
electronic dataset.

Consent for publication

Not applicable

Availability of data and materials

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The datasets used and/or analysed during the current study are available from the corresponding author
on reasonable request.

Competing interests
The author declares that they have no competing of interests.
Funding
The authors received no specific funding for this work.
Authors' contributions
AWA wrote the proposal, analyzed the data, and drafted the manuscript. CKM approved the proposal with
revisions, data analysis, and revised subsequent drafts of the manuscript. Both the authors read and
approved the final manuscript.
Acknowledgements
The authors would like to thank the study participants and data collectors for their collaboration during
the data collection. We would also like to thank the University of Gondar for providing ethical clearance.

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Figures

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Figure 1

The proportion of nurse practitioners’ job satisfaction among nurses at the University of Gondar
Specialized Hospital Northwest Ethiopia, 2019, (n=406).

Figure 2

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Hygienic and motivational Sub-scales among nurses working at the University of Gondar Specialized
Hospital, Northwest Ethiopia 2019, (n=406)

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