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Factors Affecting Job Satisfaction in the Registered Nurse

Jennifer L. Kettle RN
University of North Carolina, Charlotte, NC


This author, using literature review, investigates several aspects of job satisfaction, and the impact of said factors on turnover rates in health care settings. Reviewed were research articles on each of the following factors contributing: job satisfaction, productivity, burnout, turnover rates, and, empowerment.


Job satisfaction in staff nurses should be of great concern to any organization. Nurses hold the majority of positions in most health care settings, and replacement of an licensed personnel is costly and time consuming. As a newly graduated nurse, I have had limited time but ample exposure to varying degrees of job satisfaction. What makes some so happy with their chosen profession, and others so unhappy? Aside from a change of career, is there a solution? With the current nursing shortage, and the anticipation of worsening conditions, I set out to investigate the sources of dissatisfaction in the health care setting. I reviewed several scholarly sources and withdrew pertinent information. Following the discussion of literature findings is a summary including suggestions for further research.

Job Satisfaction

In the article written by Fletcher, job satisfactions as well as dissatisfactions were investigated. Questionnaires were mailed to 5,192 registered nurses (RNs), 1,780 of which were returned and scored using several evaluation methods (Fletcher, 2001). Researchers looked at job satisfaction, patient satisfaction and safety, extrinsic work values, role of the immediate supervisor, and intent to stay in nursing.

Job satisfaction was evaluated on several levels: Profits, Job performance, Intrinsic work values, and, Patient care issues. Profits referred not to personal financial gain, but to the organization’s profits. Many nurses responded feeling "devalued in their job" (Fletcher, 2001), and resentful of "the perceived placing of profits over patients…" (Fletcher, 2001). Job Performance was not only applied to themselves, but attitudes and performance of coworkers on a horizontal and vertical plane were also considered. Many held expectations of fellow employees to a high standard and "…were frequently disappointed" (Fletcher, 2001). Not surprisingly, many of the intrinsic work values of nurses responses were derived from "…patient care activities or making a difference in the life of a patient" (Fletcher, 2001). When considering patient care issues, many respondents voiced concern over the idea that patient care lacked due to organizational changes in staffing and assignment.

Patient satisfaction and safety was considered and found to be a great source of dissatisfaction to most respondents. Nurses felt guilt over not being able to offer the bedside "…nursing care of 25 to 30 years ago" (Fletcher, 2001). Also found as a source of dissatisfaction, was poorly trained unlicensed assistive personnel (UAP). Most felt that this type of employee were "mostly undependable" and "resentful of high paid nurses not doing what they perceive to be work" (Fletcher, 2001).

Extrinsic work values such as, job security, salary, fringe benefits, and work schedules, are also considered to be important in job satisfaction. Restrictions in scheduling and limited availability of time off promote frustration and dissatisfaction.


In the article written by D. K. McNeese-Smith, issues of productivity and nonproductivity were investigated. The purpose of this study was to consider "staff nurse views of their productivity and nonproductivity, and factors that increase or decrease their productivity" (McNeese-Smith, 2001). McNeese-Smith used semi-structured interviews to gather data about, and factors influencing productivity. Recruited from six different nursing units, 30 staff nurses were used, in an attempt to accurately represent nurses as a whole. The researchers found that productivity was based on two categories; quantity, and quality of their work. A third category considered, was personal factors that "influence their quantity and quality of work" (McNeese-Smith, 2001).

The quantity of work accomplished was a key factor in having felt productive in their days work. Common themes of respondents were "finishing all tasks", "being efficient", "staying late", and "doing extra around the unit"( McNeese-Smith, 2001), done without monetary compensation.

The quality of work was found to be based on several aspects of nursing care. Respondents felt that outcomes of teaching and caring for individuals proved to be rewarding and contributed to productivity of work. Many felt that an offering of suggestions to improve the nursing unit contributed to work quality, as well as the day-to-day process of nursing care (McNeese, 2001).

Nonproductivity was discussed in "…relation to two major categories: organizational factors and personal factors" (McNeese-Smith, 2001). Organization was dependent on feelings of "being overloaded", reaction to "difficult patients" and "lack of teamwork" (McNeese-Smith, 2001). Most nurses felt lack of organization, usually based on the above, contributed significantly to feeling of nonproductivity.

Personal factors such as personal problems, and lack of physical or mental readiness to work also contributed to nonproductivity. According to most respondents, personal factors made just as much, if not more of an influence on coworkers’ productivity levels. Staff nurses consumed with personal inabilities are seen as a distraction to others (McNeese, 2001).

The findings of this research suggest that nurses understand the factors pertinent to productivity and lack thereof. And given the appropriate settings, including quality and quantity of patient care, can improve productivity in the nursing field.


In the article written by K. E. Shrader, et al, research was conducted with the purpose of examining the relationship between work satisfaction, stress, age, cohesion, work schedule and anticipated turnover. The study used a cross-sectional design in which 241 staff nurses and five nurses managers from 12 nursing units completed a questionnaire.

The basis of the research was the following four questions: "What is the relationship between job stress, group cohesion, and stability of the schedule and anticipated turnover?", "Which factors are predictive of anticipated turnover?", "What factors predict anticipated turnover for nurses of different age groups?", and,
"Is there a relationship between anticipated turnover and actual turnover?" (Shrader, et al, 2001).

Based on the data reviewed for the first question, "What is the relationship between job stress, group cohesion, and stability of the schedule and anticipated turnover?", researchers found that nurses experience moderate levels of job stress, but cohesion is above average for all nursing units (Shrader, et al, 2001). Shrader, et al, also found the more job stress, lower the cohesion, lower the work satisfaction, the higher the anticipated turnover. The higher the work satisfaction, the higher group cohesion, and, the lower the anticipated turnover. Lastly, The more stable the schedule, the less work stress, the lower anticipated turnover, the higher group cohesion, and, the higher the work satisfaction (Shrader, et al, 2001).

Question two, "Which factors are predictive of anticipated turnover" revealed to researchers that "work satisfaction, weekend overtime, job stress, and group cohesion were all predictors of the anticipated turnover rate" (Shrader, et al, 2001).

The "…factors [that} predict anticipated turnover for nurses of different age groups", question number three, showed factors differed for each group. Aged 20 to 30-year old nurses reported that work satisfaction and job stress were significant. For ages 31 to 40, work satisfaction was the most popular decisive factor. Nurses age 41 to 50, reported that work satisfaction and group cohesion were the primary predictors. For nurses aged 51-years and more, there were no significant predictors (Shrader, et al, 2001).

Lastly, question 4, which read "Is there a relationship between anticipated turnover and actual turnover" required specific turnover numbers from each unit based on the previous fiscal year. This showed a positive correlation between anticipated turnover and actual turnover (Shrader, et al, 2001).

Nurse managers as well as individual staff nurses should use these findings to make improvements where they can easily be made. Scheduling is a great source of stress and can solved with flexibility. It is important for "…nurse managers to be more creative about engaging and retaining their nurse workforce" (Shrader, et al, 2001).


Burnout is defined as "A syndrome of emotional exhaustion and cynicism that occurs frequently among individuals who do "people work" of some kind" (Toscano, 1998). The research conducted by P. Toscano and M. Ponterdolph attempted to investigate any correlations that might exist between the personality trait of hardiness and the syndrome of burnout. The researchers used a questionnaire of 100 nurses. Though "this study did not indicate a correlation between personality hardiness and burnout", (Toscano, 1998), it helped to identify factors that do exist. The authors made several suggestions regarding prevention of burnout, such as: improved environment, additional personal time, compensation for certification requirements, age analysis (does burnout affect ages differently?), and stress management (Toscano, 1998) Burnout is a significant contributor to job satisfaction, and needs to be decreased in order to improve job satisfaction.


In the article written by H. K. Spence Laschinger and D. Sullivan Havens, the authors discuss testing of the Kanter’s theory of organizational power. (Kanter, 1993). Based on Kanter’s work, empowerment is defined as "…conditions [that] are created that enhance persons’ ability and motivation to develop and make the most constructive use of their talents and experience" (Spence Laschinger, 1997). The authors used 150 nurses and the questionnaire method of investigation, and the variables studies were: opportunity, information, support, resources, overall empowerment, formal power, informal power, job tension, work effectiveness, and achievement orientation.

The authors found a strong negative correlation between perceptions of job tension and occupational mental health, suggesting that "lack of access to empowering work structures such as opportunity, information, resources and support is likely to lead to frustration" (Spence Laschinger, 1997). The strongest correlation with job tension was access to resources followed by access to support (Spence Laschinger, 1997).

Opportunity for growth and movement as well as access challenge and an increase in knowledge and skill was found to be key in motivation towards empowerment (Spence Laschinger, 1997). Lack of opportunity in any form, contributes to negative occupational stress, and limits improvement from within.


In conclusion, there are many factors that contribute to dissatisfaction in the work place. Many variables within each factor make achieving satisfaction for every individual a very difficult task. Recognition of frustrations, such as turnover, lack of internal empowerment, burnout, and, elimination of external sources of stress can decrease dissatisfaction in the health care setting.

Issues concerning job satisfaction, potential for burnout, as well as effect of burnout on patients, expanded knowledge and better understanding of productivity, and, sources of empowerment for RNs in the health care setting should continue to be investigated. Improved job satisfaction results in less turnover, better quality patient care, less physical and mental injuries to health care staff, and betterment of entire organization.


Fletcher, C. E. (2001, June). Hospital RN’s job satisfactions and dissatisfactions. 
Journal of Nursing Administration, 31(6), 324-31.

Kanter, R. M. Men and Women of the Corporation, Second ed. New York: Basic Books, 1993.

McNeese-Smith, D. (2001, February). Staff nurse views of their productivity and nonproductivity. Heath Care Management Review, 26(2), 7-19.

Shader, K., Broome, M. E., Broome, C. D., West, M. E., & Nash, M. (2001, April). Factors influencing satisfaction and anticipated turnover for nurses in an academic medical center. Journal of Nursing Administration, 31(4), 210-6.

Spence Lashinger, H. K., Sullivan Havens, D. (1997, June). The effect of workplace empowerment of staff nurses’ occupational mental health and work effectiveness. Journal of Nursing Administration, 27(6), 42-50.

Toscano, P., & Ponterdolph, M. (1998, August). The personality to buffer burnout. Nursing Management, 29(8), 32L, 32N, 32R.

Spence Lashinger, H. K., Sullivan Havens, D. (1997, June). The effect of workplace empowerment of staff nurses’ occupational mental health and work effectiveness. Journal of Nursing Administration, 27(6), 42-50.

Toscano, P., & Ponterdolph, M. (1998, August). The personality to buffer burnout. Nursing Management, 29(8), 32L, 32N, 32R.


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