Lack of Job Satisfaction among Nurses

Nurse of a medical ward working in territory care hospital reached to the human resource department to give her resignation. This a real clinical experience which I have encounter during my work experience. Upon asking the reason of resignation it reveals that her nurse manager has a bias attitude towards her staff. There was hardly any appreciation by the nurse manager and inequality in behavior at work. She has no concern with their professional growth due to heavy work load. Nurse was looking for the appraisal because of her low salary package as it may provide her some relief in form of increment but at the time of appraisal she gave her the evaluation by saying that most of the time you cannot manage intravenous fluid as it was her general observation and not noticed personally. To respond her answer nurse was not allowed to give her opinion and asked to keep nurse comment part unfilled .Recently three nurses resigned from the area and only two nurses on the evening shift were available. Because of attitude of the manger nurses were not having cooperative behavior among them.

Nurse of a medical ward working in territory care hospital reached to the human resource department to give her resignation. This a real clinical experience which I have encounter during my work experience. Upon asking the reason of resignation it reveals that her nurse manager has a bias attitude towards her staff. There was hardly any appreciation by the nurse manager and inequality in behavior at work. She has no concern with their professional growth due to heavy work load. Nurse was looking for the appraisal because of her low salary package as it may provide her some relief in form of increment but at the time of appraisal she gave her the evaluation by saying that most of the time you cannot manage intravenous fluid as it was her general observation and not noticed personally. To respond her answer nurse was not allowed to give her opinion and asked to keep nurse comment part unfilled .Recently three nurses resigned from the area and only two nurses on the evening shift were available. Because of attitude of the manger nurses were not having cooperative behavior among them.
When the chances for growth and promotion come most of the time she used her preference and had discrepancy on overall rating system. These were the potential issues to dissatisfy her and all these disappointed factors positioned the nurse to give up. This also left negative image of a nurse manager on the remaining staff. All of these aspects have a major influence on the performance and cause adverse effect not only on nurse but also on organization.
These kinds of working environment hinder motivation level and the capability of the nurses in professional growth. Therefore the job dissatisfaction decreases the efficiency and effectiveness of health care delivery system. Nursing manager can provide social support to enhance the level of job satisfaction which allows nurses to cope with their stressor and improve the turnover rate.

Describe
Management of human resources has a substantial role in order to enhance the employee performance. Human resources allocation is pivotal in a functioning healthcare system to deliver the standardized services. Employees are the most significant resources of healthcare organizations depend on its workforce job satisfaction. A study conducted by Bonenberger [1] findings suggest that the "Effective human resource management practices at district level influence health worker motivation and job satisfaction, thereby reducing the likelihood for turnover". Effective management is crucial to improve the nature of working relationship of employee with their employing organization.
Nurses have a major role to achieve the organization goal and a core part of health care setting. Shortage of nurses is common globally and considers being the most significant barrier to improve the performance of health care system. It is a major concern all over the world since has a great influence on health care organization. Retention of health care worker is critical in any health care setting to improve the outcome. Job satisfaction has multi dimensional facets which influences on the employee retention and their work productivity.
Job satisfaction is one of the potential aspects to distinguish between the actual performances with the anticipated results. It plays a key role for specify the interest of a person and ensuring the gratification. In order to determine the level of contentment and commitment it is essential to comprehend the importance of work satisfaction. The term job satisfaction is defined by Asegid [2]. "Job satisfaction describes how content an individual is with his or her job" Thus it is an emotional state rise by the response of one's own job situation and it is also a serious concern for the evaluation purpose. The most used research definition of job satisfaction is by Locke who defined it as "a pleasurable or positive emotional state resulting from the appraisal of one's job or job experiences.

Analyze
Motivation and satisfaction are the two major prospects for an individual and each may expect to reach the highest level of satisfaction during their course of work experience .While having this idea I choose Frederick Herzberg's two-factor theory. It endeavors to describe the satisfaction and dissatisfaction that are resulted from motivation and hygiene factors. According to Herzberg's theory motivational factors presume to be an internal power that pursue individual to accomplish individual and organization goal. They are the aspects of the job which drive the individual to perform and leave people with satisfaction. Hygiene factors are those who do not motivate them but as far as satisfaction is concern so they can decrease the motivational level if they are not there.

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First I will describe the motivator factor related to my scenario. In above scenario nurse was de-motivated because nurse manager was having bias attitude toward their staff as well as and not interested to provide them the opportunities for promotion. A study conducted at Khyber Teaching Hospital, Raza [3] shows that nurses were dissatisfy due to the lack of promotion opportunities and low salary. Nurses were unsatisfied because of slow procession and unfair means used to avail the Promotion opportunities although they are eligible and meeting the criteria. Therefore it seems that job satisfaction is highly effected by these factors and found a strong linkage among them. Employee seems to be less interested because they have no opportunity for growth. They want to expand their abilities in order to function well for their career advancement. In above mention scenario at the time of appraisal nurse receive comment based on general observation which is not directly observed by nurse manger which influence on her performance. Employee satisfaction is more prone to destruction situation when an employee does not get attention; achievement and recognition in their work place. Organizations tend to be more concerns about their productivity rather than the employee apprehensions. Management attitude towards their employee resulted in a feeling of being neglected. Lack of recognition is a barrier for an employee to reach their potential outcomes which leads to frustration. Hardly have they been appreciated by their senior management.
Some institutions have performance appraisals system to appraise them but they did not do in a proper way which put them on risk instead of being motivated. As a result when employee does not have the insight of motivation and positive future results then automatically their performance were not up to the mark. Consequently, recognition and achievement are the most predisposed factor in keeping high morale and self-esteem. According to Farsi [4] study findings shows that employees are less satisfied in terms of work content and neglecting aspects of recognition while they feel secure by having sufficient promotional opportunities and salaries. Therefore the achievement, recognition and nature of work are the potential behavioral attitude which they intent to facilitate the job satisfaction of the employees. It would eventually contribute to the job satisfaction that could help to ensure the success of organization.
According to Herzberg's theory postulates that extrinsic (hygiene) factors avoid individual from unpleasant situations that produce discomfort and enable individuals to satisfy their needs and helping them to meet their personal developmental necessities. Poor hygiene factors lead to increase the employee's levels of dissatisfaction. Herzberg's theory specifies that if the hygiene factors are addressed in a proper manner so these motivators will help to promote job satisfaction and Productivity. Extrinsic factors are that hygiene factor which does not enhance an employee's level of job satisfaction but can decrease the level of job satisfaction so the term used as a maintenance factor.
Environmental events are considered to be the one of major maintenance factors and exposure to certain conditions lowers the satisfaction level. Reflecting back to the scenario nurse was unable to work in collegial condition because of uncertainty of the group dynamics. Group cohesion is seems to be important and crucial for the individual to integrate their work in a reciprocal way. In an organization, group becomes the part an individual and withdrawal of it can mislead the self-concept and harms the perception of satisfaction. Asegid [2] done a study to evaluate the factor influencing on job satisfaction and intension for turnover by using job satisfaction scale and subscale which consist of 32 question and were titled as leadership relationship subscale, promotion subscale, autonomy subscale, working environment and group cohesion subscale, professional training subscale, benefit and salary subscale, recognition at work subscale, and perceived alternative employment opportunities. Findings rated on the Likert scale suggested that working environment and group cohesion subscale were the only important prognosticators for the intentions to turnover while the other were significant determinant for job satisfaction.
Thus the working environment enables the individual to feel supportive and have mutual positive attitude towards one another. It improves the performance and boosts the commitment level toward their work so they can accomplish their task collectively which will ultimately assist the individual to achieve the goal. In above scenario nurse feel that minimal salary is provided by the institution is not compensating her hard work and efforts. Economical constraint and challenge faced by the employee lead to dissatisfaction because it acts like a basic stimulus to satisfy their needs. Employee frustration is more likely to be provoked when they found the organization are reluctant to provide them with the elementary need and they were more prone to discontent. Employee intent to leave the institutions because their salary package are not as good as comparing with other people who doing the similar work. "Compared between the main stressors of nurses in 5 private and 5 public hospitals in India, Salary and other incentives, job security ranked the highest stressors in the private hospitals while in the public hospitals: unstable time scheduling, long working hours in addition to the formal relations with seniors were the major nurses' stressors" [5].
Employees working in private sector were less satisfied because of their salaries whereas public sector employees were found moderately satisfied. Hence the performance of the employee ultimately gets effected and looking for other opportunities. It shows it is drive for many employees as it has the connection between money and performance which motivates employees to be more productive. Job satisfaction rate were predominantly get shorter when negative feelings arouse about the job condition. Nurse had to carry out a lot of work due to shortage of staff and heavy work load which ultimately result in burnout situation.
According to Hamid [6] carry out a qualitative study at tertiary care hospitals in Pakistan public and private sector and finding suggested that public sector nurses were overburdened because of the shortage of nurses, limited resources availability, lack of promotion and pay structure opportunities whereas in the private sector nurses bear the workload burden as to utilize this prospect for the abroad employment and they also considered the strict supervision and higher accountability as a stressor. Nurses of the

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public and private division both feel overburden but causes were different according to the sector context.
Multiple stressors attached with the heavy work load situation and it may cause burden on remaining employees. Most of the unwanted work which is not related to the direct care of patient is the leading cause of dissatisfaction. This kind of stressor can cause the job strain and have negatively effect on the physical and psychological well-being on the person. The extreme strain can indicate the detrimental effect not only on individual but also on the working environment and result into negative outcome such as low job satisfaction.

Strategies to resolve the organizational problem/issue
After thorough review of the above scenario certain Problems have been identified and multidimensional strategies can be done to overcome the challenges. First strategy to deal with the problem is using supportive management style by the nurse manger to enhance the performance of employee as it is evident by a study done Tackenberg [7] and it finding suggest that manager used participative leadership style which reveal via open communication, respect and recognition thus it increase the employees job satisfaction. Therefore, manager need to adopt the participative leadership style as the behavior of manager has a major influence on shaping the commitment and satisfaction level. However manger can resume various other management styles also according to context and situation.
Another issue which is highlighted in the scenario was poor working environment. Work environment is one of the potential factors that could enhance the job satisfaction and reduce the turnover rate. Positive work environment plays a comprehensive role in order to promote healthy work. Liu et al. [8] study on the work environments of hospital nurses in China. "The findings of this study indicated that nurses in nearly 40% of the surveyed units rated their work environments as poor, and nurses were dissatisfied with their job and suffered from high burnout. The study also found that better work environments were associated with positive nurse outcomes" .Further more study also suggest that working environment can be improve by participating in management and decision making level.
Another study support it as conclude by Abdullah et al. [9] study that nurse manager should provide such opportunities to the nurses so they can participate in the policy making level and policy maker need to consider the professional developmental need for the employee growth. Poor salary packages with low fringe benefit also hinder the job satisfaction. As Hamid [6] study identified that the private sector attracts nurses from the public sector as they offering better pay and better working conditions. Salary should be similar for people who performing their work in similar profession and it should be determined through comparing it with the market pay rates. It should include a well compensation package that will help to attract and seek better employees. Amoako [10] study identified that human resource management practice for the better salary and benefit has a strong relationship to attract the employee and their satisfaction level.
Next issue highlighted in this scenario is heavy work load and nurses were dealing with problems while doing additional task which frustrate them. Strategy to deal with this problem team comprised of well balance way in term of experience and quantity as well which will help the team to work efficiently. A study done by Hamid [6] shows that "The presence of a well-trained health workforce is vital, and that certain aspects of its organization are key, including numbers (available quantity), skill mix (health team balance), and distribution (urban/rural).
Job related stressor are the common indicator of emotional exhaustion and result into high turnover rate. Jasperse [11] study identified that "Ongoing education, mentoring, post-graduate study, role extension, clinical supervision and psychosocial support would increase job satisfaction and help alleviate occupational stressors for New Zealand oncology workers [12]". In that way organization can address and provide support the employee to reduce their stressor via engaging them in order to enhance their motivation and work condition.

Conclusion
To sum up that job satisfaction has a potential effect on organization and on individual. Organizations are more concern about the availability and accessibility of human resource to provide quality care. Manageable factors play an important role in persuading job satisfaction and increase the capability to produce the quality work. Moreover nurse manger can facilitate the developmental needs and enabling the employees through exploring the career growth possibilities within the organization. They can drives the individuals to see different aspects of the job that enable people to perform efficiently and also encourage them to attain personal and organization goals.
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