Atefi, Narges (2014) Comparing job satisfcation among registered nurses in an iranian hospital and a Malaysian hospital / Narges Atefi. PhD thesis, University Malaya.
Abstract
Job satisfaction is a critical factor in health care. Strong empirical evidence supports a causal relationship between job satisfaction, patient safety and quality of care. A sequential explanatory mixed-methodology based on Herzberg’s motivation-hygiene theory was employed to identify the factors which influence job satisfaction among Malaysian and Iranian nurses. Proportionate samples of 416 nurses from one large hospital in Malaysia and 397 nurses from a large hospital in Iran were recruited in the initial quantitative phase. A Modified Index of Work Satisfaction (MIOWS) questionnaire consisting of nine components (autonomy, task requirement, work interaction, professional development, supportive nursing management, decisionmaking, professional status, salary, and work conditions) was used to measure the nurses’ job satisfaction. In order to achieve a deeper understanding, 15 focus group discussions (FGDs) with 118 nurses were also conducted in Iran and Malaysia. The Malaysian nurses had a significantly higher proportion than the Iranian nurses in all the components of MIWOS except for work conditions. Of the nine components of MIOWS, both the Iranian and Malaysian nurses had higher scores than their respective midpoints on three components, namely: autonomy, task requirement and work interaction, although Malaysian nurses also scored higher in terms of professional development, supportive nursing management, decision-making and professional status. The results also indicated that only 87 Iranian nurses (28.7%), compared to 290 Malaysian nurses (88.7%), had an overall job satisfaction score which was above the midpoint score of 201. The overall job satisfaction score was significant different between gender, age, marital status and years of working experience for the Iranian nurses although in addition for Malaysian nurses work units were found significant. iv In multiple analyses, young age, being female and being married were significantly associated with a overall job satisfaction score for the Iranian nurses while work unit namely Malaysian nurses working in surgical and critical care units were more likely to have a lower overall job satisfaction score. The adjusted R2 for the model for the Iranian nurses and Malaysian nurses was 0.14 and 0.05, indicating a 14% and 5% variability respectively. The results of the regression model for the Iranian and Malaysian nurses were highly significant at F (4,299) =13.19, P<0.001 and F (5,322) =4.37, p<0.001 respectively. Purposive sampling was used in the qualitative phase. Three themes were identified from the FGDs, two of which influenced both Iranian and Malaysian nurses’ job satisfaction. These were environment and organization factors. Spiritual feelings were reported by the Iranian nurses, while the Malaysian nurses highlighted their ability to help people as the third factor that influenced their job satisfaction. Similar subthemes were reported by both Iranian and Malaysian nurses with regard to environment factors: team cohesion, benefits and rewards, a lack of clarity over nurses’ responsibilities for working conditions and organizational factors: task requirements, professional status, professional development and a lack of clinical autonomy. These supplemented the quantitative findings, as both Malaysian and Iranian nurses scored lower on salary and work conditions components in the MIOWS but higher on task requirements and autonomy. Efforts to increase clinical autonomy, improved teamwork and communication to promote team cohesions and improved working conditions to ensure a conducive and safe practice environment should be considered when developing strategic planning that could effectively improve nurses’ job satisfaction in Iran and Malaysia. v There is also, a need to ensure that in the future nurses will be provided with clear job description, appropriate rewards and professional development programmes which will help improve their professional status.
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