ASIA METROPOLITAN UNIVERSITY
FACTORS CONTRIBUTING TO JOB SATISFACTION AMONG NURSES AT
HARGEISA GROUP HOSPITAL (HGH) IN HARGEISA, SOMALILAND.
JAWERIA ABDIRASHID FARAH
MASTER OF SCIENCE IN HEALTHCARE MANAGEMENT
MHCMF2018010015
Thesis in partial fulfilment of the requirement for
Master of Science in Healthcare Management.
Faculty of Allied Health Sciences,
Asia Metropolitan University, Malaysia
June 2019
i
ABSTRACT
BACKGROUND: Job satisfaction is a critical factor in health care. This research was conducted
to assess the level and to determine and factors contributing to job satisfaction among nurses at
Hargeisa Group Hospital by using Herzberg’s job motivators and hygiene factors.
OBJECTIVES: To determine the factors contributing to job satisfaction among nurses in
Hargeisa group hospital in Hargeisa, Somaliland.
METHOD: A cross sectional study was conducted among 207 nurses of Hargeisa Group Hospital
in Hargeisa, Somaliland. Cluster random sampling method was employed for this study. A
pretested structured questionnaire was used to collected data from the hospital. Data was analysed
using SPSS version 25.
RESULTS: SPSS statistical technique one-way ANOVA and independent t-test were used in the
analysis and the result showed that more than half of the nurses at Hargeisa Group Hospital (HGH)
57.1% were dissatisfied with their job, while the rest 42.9% nurses were satisfied with their current
job. Several factors had hugs effect such as salary, current position and level of education.
However, gender, age group and background experience did not show any significance difference.
CONCUSIONS: More than half of the nurses at the Hargeisa Group Hospital (HGH) were
dissatisfied with their job, and that the job satisfaction level was somehow derived from co-worker
relationships, job independence, supervisor’s independence, improved working conditions, job
authority, security, and responsibility. Nurses earning more salary are more likely to be satisfied
than nurses get lower monthly income and Nurses with a diploma or no certificates are more likely
to be satisfied compared to nurses with Bachelor’s degrees or Post-graduate. It was clear that the
current position was playing a great role in job satisfaction, where Nurse Managers were more
satisfied compared to staff nurses. For the recommendation, Special attention should be given to
less earning nurses, well-educated nurses and Staff Nurses, since most of them fall in this cluster
and they are a workforce. The chance of losing them is very high if no efforts are done.
KEYWORDS: Job satisfaction, nurses, Hargeisa group hospital, hygiene, motivation factors.
ii
ACKNOWLEDGEMENTS
First of all, I would like to give glory to the almighty Allah who makes all things possible. My
sincere thanks and profound gratitude to my Supervisors for her guidance, her excellent feedback,
kindly support, encouragement and belief in me PROF DR RAJA LEXSHIMI RAJA GOPAL
her expertise and assistance made the research both interesting and enjoyable. I would like to thank
the following individuals and groups for being there for assisting, and encouraging me throughout
the long process of my master studies: Faculty of Science in Healthcare Management, Asia
Metropolitan University, DR. YASIN ARAB ABDI, Manager of Hargeisa Group Hospital (HGH)
DR. ALI HASSAN Nursing Department Hargeisa Group Hospital for their collaborations on this
project.
Finally, yet importantly, I thank my family especially my father and mother who have supported
me for their guidance, trust and their solid advice, for their love, confidence, prayers, and for each
sacrifice, as they give it all, without thinking twice and all their financial supports. And I would
like to thank to my truly Cousin Sead Ahmed who really encourage and support me kind, cooperation, who helped me out of their willingness to assist. I thank all of you because you made
this possible. May God’s blessings be with you all, Amen.
iii
Name of Candidate
: …………………………………………………………………..
Signature of the Candidate
: …………………………………………………………………..
Date
iv
DEDICATION
This project is committed to my past, current, and future patients. I have a strong desire of as long
as them and their families with the best quality and safe nursing care. I hope this project in quality
improvement enhances the care many patients receive, and promotes future development in
nursing care.
v
Table of Contents
ABSTRACT ................................................................................................................................... ii
ACKNOWLEDGEMENTS ........................................................................................................ iii
DEDICATION............................................................................................................................... v
LIST OF TABLES ........................................................................................................................ x
LIST OF FIGURES ..................................................................................................................... xi
LIST OF ABBREVIATION....................................................................................................... xii
CHAPTER ONE INTRODUCTION ........................................................................................ 13
1.2 Background of the study ..................................................................................................... 13
1.3 Problem statement .............................................................................................................. 16
1.4 Research Objectives and Questions ................................................................................... 17
1.4.1 General objectives ........................................................................................................ 17
1.4.2 Specific objectives ........................................................................................................ 17
1.4.3 Research questions ....................................................................................................... 17
1.5 Research hypothesis ........................................................................................................... 18
1.6 Limitation of the study ....................................................................................................... 18
1.7 Significance of the study .................................................................................................... 18
1.8 Operational Definition........................................................................................................ 19
1.9 Summary ............................................................................................................................ 21
CHAPTER TWO LITERATURE REVIEW ........................................................................... 22
2.1 Introduction ......................................................................................................................... 22
2.2 Job satisfaction among Nurses ........................................................................................... 23
2.2.1 Individual’s Characteristics .............................................................................................. 25
2.2.2 Incentive (Motivational) and (Hygiene) Factors ............................................................ 26
2.3 Evolution of nursing profession ...................................................................................... 28
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2.3.1 Legal aspects and future of nursing.................................................................................. 29
2.3.2 The Role of a Nurse ......................................................................................................... 30
2.3.2 Nursing commitment in relationship to satisfaction ........................................................ 31
2.4 Factors affecting job satisfaction........................................................................................ 32
2.4.1 Extrinsic Factors ........................................................................................................... 32
2.4.2 Intrinsic Factors ............................................................................................................ 35
2.5 Concepual framework: ........................................................................................................ 37
2.6 Summary ............................................................................................................................. 38
CHAPTER THREE METHODOLOGY .................................................................................. 39
3.1 Introduction ......................................................................................................................... 39
3.2 Research design ................................................................................................................... 39
3.3 Research setting................................................................................................................... 39
3.4 Population and sampling ..................................................................................................... 41
3.4.1 Population ..................................................................................................................... 41
3.4.2 Sampling ....................................................................................................................... 41
3.4.3 Sample size ................................................................................................................... 42
3.5 Inclusion and Exclusion Criteria ........................................................................................ 43
3.5.1 Inclusion criteria ........................................................................................................... 43
3.5.2 Exclusion criteria ......................................................................................................... 43
3.6 Variables............................................................................................................................. 43
3.7 Research instruments.......................................................................................................... 43
3.8 Reliability ............................................................................................................................ 45
3.8.1 Reliability Test ............................................................................................................. 45
3.9 Data collection method....................................................................................................... 46
3.9.1 Flow chart of the data collection .................................................................................. 47
vii
3.10 Data Analysis ................................................................................................................... 48
3.11 Ethical issues: .................................................................................................................... 49
3.12 Pilot study......................................................................................................................... 49
3.13 Summary ........................................................................................................................... 49
CHAPTER FOUR RESULTS ................................................................................................... 50
4.1 Introduction ....................................................................................................................... 50
4.2 Data Analysis .................................................................................................................... 50
4.3 Demographic and Description of Research Findings ........................................................ 50
4.4 Level of job satisfaction among nurses in Hargeisa Group Hospital ................................ 54
4.4.1 Overall job satisfaction level ....................................................................................... 54
4.4.2 Factors contributing of job satisfaction with hygiene factors ....................................... 56
4.4.3 Factors that contributing of job satisfaction with the Motivation Factors .................... 58
4.6 Study of relationship between Demographic Characteristics of nurses in job Satisfaction 61
4.6.1 Gender .......................................................................................................................... 61
4.6.2 Age group ..................................................................................................................... 61
4.6.3 Salary ........................................................................................................................... 62
4.6.4 Level of Education....................................................................................................... 62
4.6.6 Experience .................................................................................................................... 62
4.6.5 Position ......................................................................................................................... 62
4.7 Summary ............................................................................................................................. 64
CHAPTER FIVE DISCUSSION ............................................................................................... 65
5.1 Introduction ........................................................................................................................ 65
5.2 Level of Job Satisfaction among Nurses in Hargeisa Group Hospital ................................ 65
5.2.1 Satisfaction on Job Satisfaction .................................................................................... 65
5.3 Factors that contributing to job satisfaction ........................................................................ 66
viii
5.4 Relationship between Demographic Characteristics and Job Satisfaction.......................... 67
5.4.1 Gender .......................................................................................................................... 67
5.4.2 Age group ..................................................................................................................... 67
5.4.3 Salary ............................................................................................................................ 69
5.4.4 Level of Education........................................................................................................ 69
5.4.5 Working Experience ..................................................................................................... 70
5.4.6 Current Position ............................................................................................................ 71
CHAPTER SIX CONCLUSION AND RECOMMENDATION ............................................ 65
6.1 Conclusion........................................................................................................................... 72
6.2 Recommendation ................................................................................................................. 73
REFERENCE .............................................................................................................................. 75
APPENDIX .................................................................................................................................. 81
APPENDIX A BUDGET ............................................................................................................ 83
APPENDIX B GANTT CHART............................................................................................... 84
APPENDIX C1 CONSENT FORM .......................................................................................... 85
APPENDIX C2 QUESTIONNAIRE ......................................................................................... 85
APPENDIX C3 EMAIL ............................................................................................................. 90
APPENDIX D REQUEST LATTER ........................................................................................ 91
APPENDIX E ETHICAL APPROVAL.................................................................................... 92
APPENDIX F APPROVAL LETTER ...................................................................................... 93
APPENDIX G SOMALILAND MAP ....................................................................................... 94
APPENDIX H SPSS TEMPLATE ............................................................................................ 95
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LIST OF TABLES
Table 2.1 Reliability Test ……………………………………………………………………….46
Table 3.1 Technique of the data analysis …………….……………………………...…………. 48
Table 4.1 Demographic characteristics of the participants………………………………………52
Table4.2 Hygiene Factors ……………………………………………………………………….57
Table 4.3 Motivation Factors ……………………………………………………………….…...60
Table 4.4 Job satisfaction Score and demographic Variables……………………………….…...63
x
LIST OF FIGURES
Figure 2.1 Conceptual framework ………………………………………………………... 37
Figure 2.2 System of Administration…...……………………………………………….... 54
Figure 3.1 Flow Chart ……………………………………………………………………. 55
Figure 4.1 Working hours per week ……………………………………………………… 40
Figure 4.2 Level of job satisfaction………………………………………………………...47
xi
LIST OF ABBREVIATION
ANOVA: Analysis of variance
HGH: Hargeisa group hospital
NHS: National Health Service
RM: Ringgit
SD: Standard deviation
SPSS: Statistical package for the social sciences
WHO: World Health Organization
SL: Somaliland shillings
US: United States
xii
CHAPTER ONE
INTRODUCTION
1.2
Background of the study
Nurses constitute a fundamental and a major part of health professional staffs in any hospital.
They are considered as main factor of the healthcare professionals who facilitate upgrading and
developing the healthcare service. Furthermore, they have a critical role in the patient care and
medical management. Nowadays, any health care system is being evaluated according to the
quality of services for the patients.
Dr. Ozin (2016) one of the famous cardiologist has answered a question about the importance
of nurses as there is a general misunderstanding survived that the vocation of nursing limited
around basic personal needed and cleaning beds. I had relish saying that people today are more
literate about the consequential role which nurses play in the healthcare sector. Nurses are
responsible in introduce and regulate a timetable of your treatment. If you’re a patient, nurses
are your greatest advocate. Because they spend more time with you, nurses can
comprehensively moderate your development. Nurses provide precious emotional and
sentimental support. They understand the sequences and complications of an illness. They can
advise the patient and their relatives through everything from comprehension a disease to
coping with death.
Nurse shortage is a World-wide problem of health organizations to a large extend this problem
is obviously existed in pacific and Asian countries, every country facing this dilemma has to
distinguish the related causes and to suggest policies which motivate workers and attract them
to remain in health organization (Henderson and Tulloch, 2008). The WHO announced that
more than 60% of nurses all over the world work in urban regions, that explains a critical
disparity of nursing distribution in the rural regions (Roberge, 2012).
13
Nursing turnover is a disturbing issue for human resources managers and health care
administrative (Leineweber 2016). Employees who obtain appreciation, esteem and respect
usually perform their work and duty to the maximum effort, and stay faithful for their
organizations( Irshad and Afridi, 2007).Turnover sometime guides the organization to review
the current strategies regarding work motivation, it is considered a normal path form of
workers' career, but excess in turnover rate affects in employee certainty toward their
organizations to offer them an appropriate care and satisfaction (Lephalala, 2009). The
organization does not only forfeit the worker by leaving the job, but it loses his knowledge,
current project and faithful client whom dealing with him (Irshad and Afridi, 2007).
The world health organization (WHO) emphasizes on the importance of health human
resources in development of health care workers and in evolution of health care services
(Roberge, 2012). Most of successful organisations have a similar policies which aim to esteem
and regard the workers, also to keep and retain them in the workplace (Irshad and Afridi, 2007)
both aims are valuable in competition among the organizations. There are some integrated
issues that share in the persistent shortage of health care professionals, such as absence of health
system resources, incompetent human resource management, and unpleasant work
environment (Weller, 2008). Results from previous researches stated that applications of
human resources in different aspects of organizational management such as work environment,
development and leadership play a significant improvement in employees' maintenance and
quality of work (Irshad and Afridi, 2007).
Considerate of nurse retention is a remarkable matter to assess a health care service competence
and maintenance (Roberge, 2012). Retaining workers is a fundamental objectives for any
organization, Irshad and Afridi (2007) have mentioned that hiring a new employees needs
further expenses for training and education, these extra budgets for each worker are
approximately equal up to double his annual salary. Job satisfaction is a fundamental key to
keep the work force in any organization, on the other hand job dissatisfaction upsurges turnover
rate and may have further impacts such as burnout (Lephalala, 2009).
14
Many of researches results from Asia and pacific region established that wages and benefits
such as working condition, training and competent management are playing a significant role
in workers' decision toward their career, however factors that may affect in this decision have
not been assessed or estimated to a large degree (Henderso and Tulloch, 200 8). studies have
been conducted in different countries on the implementations of financial and non-financial
incentives in healthcare management, these studies stated that it is not enough to apply financial
incentives alone to prompt your workers (Weller, 2008) .
Silverman (2004) has highlighted the difference between the meaning of rewards and
recognition, rewards is related to something given for a perfect work as a recompense or
remuneration, on the hand, recognition is the matter of an acknowledgement or gratitude for
something achieved, both have disparate effects on workers' motivation and failure in
distinguish between them is a critical, and leads to inadequate motivation and promotion of
employees. Hospitals and health care managers have adapted various incentives that applied
financial and non-financial methods which are generally concerned to certain health care
professionals and their performance (Weller, 2008).
15
1.3
Problem statement
Nursing is no longer the first choice profession. In the 1970s and earlier, a large number of
Malaysian young women go overseas to countries like England and Australia to be trained as
nurses as opportunities to be trained as nurses in Malaysia was limited (Utusan, 2004).
Nowadays, even though there are abundant opportunities available in Malaysia, nursing is no
longer popular as it used to be. The shortage is of nurses a worldwide phenomenon and
Malaysia is no exception. The shortage in Malaysia is made acute with trained nurses going
overseas where they can earn much more and especially in Saudi Arabia where the income is
not taxable. In his speech for the International Nurses Day 2007, the Malaysian Prime Minister
appealed to trained Malaysian nurses to serve in the country rather than abroad (Bernama,
2007).
One of the factors of attrition of nurses from private hospitals is due to economic reasons
mainly to work in Saudi Arabia. Two of the three private hospitals that participated in this
study reported that out of the 176 registered nurses that left the two hospitals over the past three
years, 85 (48%) left for Saudi Arabia to work. As for nurses from the public sector, generally
the attrition is much lower, most probably to better job security in the public sector.
Understanding the factors that nurses are satisfied and dissatisfied will enable interventional
measures be taken to improve the working conditions. Whereas such understanding will not
improve the retention rate, it will improve the nurses’ work performance leading to better
quality care to the patient (Newman, Maylor, and Chansarkar, 2002).
Therefore, this study determines the level of satisfaction among nurses in Hargeisa Group
hospital and the reasons that cause which they are satisfied or dissatisfied.
16
1.4
Research Objectives and Questions
1.4.1
General objectives
To determine the factors contributing to job satisfaction among nurses in Hargeisa group
hospital.
1.4.2. Specific objectives
1. To determine the level of job satisfaction among nurses in Hargeisa group hospital.
2. To identify the factors that contributing to job satisfaction of nurses
3. To determine the relationship between demographic data of nurses such as age, level
profession education, year of experience with job satisfaction.
1.4.3
Research questions
1. What is the level of job satisfaction of nurses in Hargeisa group hospital in the various factors
of job satisfaction?
2. Does the educational level (certificate versus diploma and/or higher) impact nurses’ job
satisfaction?
3. Are there differences in job satisfaction level between nurses in different unit Types/work
groups?
4 Do demographic factors like age and years of experience affect nurse’s job satisfaction?
17
1.5
Research hypothesis
1. There is significant difference in level of job satisfaction among nurses in Hargeisa group
hospital.
2. There is a significant relationship between demographic data of nurses such as age, level
profession education, year of experience with job satisfaction.
1.6
Limitation of the study
The study is focus on just Hargeisa group hospital (HGH). There are few existing studies which
have been investigated on relations between incentives and nursing job satisfaction in HGH,
that limits resources of information and comparisons about this topic. The study has inquired
and explored only few selected incentives. Event out the researcher has chosen the most
significant rewards for nursing profession. The practical constraints such like unavailability of
enough time to explore further information need to be considered.
1.7
Significance of the study
It would give a clue about the role of incentives in nursing job satisfaction. In addition to the
few existed researchers, this study would add some knowledge about the rewarding system in
Hargeisa group Hospital. It may show any limitations or perfections in the selected hospital
regarding a motivation of their nurses. It may encourage further researchers to broaden this
study to include other incentives and cover more hospitals. It may promote some hospital
managers to apply or improve a good rewarding system as a part of their human resource
strategies. It could highlight the subsequent impact on the career decision regarding stay or
leave the workplace, according to satisfaction level.
18
1.8
Operational Definition
All definition in this part are collected from two sources (P.Robbins, 2015) and (Mondy, 2014).
Attitude: evaluations employee makes about objects, people, or events.
Autonomy: the degree to which a job provides substantial freedom and discretion to the
individual in scheduling the work and in determining the procedures to be used in carrying it
out.
Benefits (indirect financial compensation): all financial rewards that are not included in
direct financial compensation.
Burnout: incapacitating condition in which individuals lose a sense of the basic purpose and
fulfilment of their work.
Career path: a flexible line of movement through which a person may travel during his or her
life.
Compensation: total of all rewards provided employees in return for their services.
Development: learning that goes beyond today's job and has a more long-term focus.
Direct financial compensation: pay that a person receives in the form of wages, salary,
commissions, and bonuses.
Equity theory: motivation theory that people assess their performance and attitudes by
comparing both their contribution to work and the benefits they drive from it to the
contributions and benefits of comparison others whom they select- and who in reality may or
may not be like them.
Flexible benefits: a benefit plan that allows each employee to put together a benefits package
individually tailored to his or her own needs or situation.
Hierarchy of needs: Abraham Maslow's hierarchy of five needs: physiological, safety, social,
esteem, and self-actualization- in which, as each need is substantially satisfied, the next need
becomes dominant.
Higher-order needs: needs that are satisfied internally, such as social, esteem, and selfactualization needs.
19
Human resource management: utilization of individuals to achieve organizational objectives.
Human resource manager: individual who normally acts in an advisory or staff capacity,
working with other managers to help them deal with human resource matters?
Hygiene factors: factors such as company policy and administration, supervision, and salarythat when adequate in a job, placate workers. When these factors are adequate, people will not
be satisfied.
Job: group of tasks that must be performed for an organization to achieve its goals.
Job satisfaction: a positive feeling about one's job resulting from an evaluation of its
characteristics. in other word Job satisfaction is a multi-faceted concept. It is an attitude which
can be categorized into five groups of factors that is individual factors, social factors, cultural
factors, organizational factors, and environmental factors (Mullins, 2005). The work itself is
part of organizational factors. Work satisfaction is part of the broader concept of job
satisfaction. Job satisfaction can be described as the extent to which employees like their jobs
(Stamps, 1997). According to Herzberg’s two-factor theory of motivation and job satisfaction,
there are two sets of factors that is extrinsic factors (hygiene) and intrinsic factors (motivation).
Manager: an individual who achieves goals through other people.
McClelland's theory of needs: a theory that states achievement, power, and affiliation are
three important needs that help explain motivation.
Motivation: the process that account for individual's intensity, direction and persistence of
effort toward attaining a goal.
Non-financial compensation: satisfaction that a person receives from the job itself or from
the psychological and/or physical environment in which the person works.
Organization: a consciously coordinated social unit composed of two or more people, which
functions on a relatively continuous basis to achieve a common goal or set of goals.
Position: collection of tasks and responsibilities performed by one person.
Reward power: compliance achieved based on the ability to distribute rewards that others
view as valuable.
Self-determination theory: a theory of motivation that is concerned with beneficial effects of
intrinsic motivation and the harmful effects of extrinsic motivation.
20
Two factor theories: a theory that relates intrinsic factors to job satisfaction and associates
extrinsic factors with dissatisfaction also called motivation-hygiene theory.
1.9
Summary
In the consummation, the result of this study should be basis for factors conrtibuting to job
safistafaction among nurses Hargeisa group hospital. Then problems regarding the research
topic were discussed. Research questions and research objectives were formulated based on
the problems that were idientified. Moreover the significance of the study operational definition
are incorprated in this chapter. The next chapter will dicuss about literture review for the study
.
21
CHAPTER TWO
LITERATURE REVIEW
2.1
Introduction
The World Health organization report in 2006 shows that nursing can be characterized
as a mobile profession. It shows that majority of the nurses especially women migrate
in search of better working conditions and salary, career mobility, better quality of life, personal
safety, sometimes for adventure or for professional development. An approximated amount of
30,000 African nurses are currently employed in seven OECD countries. However, there are
barriers that limit the migration of nurses and these same factors may affect the foreign nurses
that had already moved and acquired jobs in foreign countries. These factors include;
adapting to new clinical skills, process of requalification, need to learn a new language,
cultural differences and cost of physical transfer. (Kingman 2007, 1281‑1294.)
The prevalence of global shortage of nurses and high turnover among nurses has become a
major problem in the society today in both developed and developing countries.
It affects the efficiency and the effectiveness of the health services being offered
and also consumes a lot of time and resource trying to replace the workers who have
left. In regard to this, the question of job satisfaction sets in. Nursing is a demanding
profession, whereby the nurse is responsible of promoting health in the society, maintaining
health, taking care of patients and the family and a duty to ensure a healthy environment.
Nursing in a very important part of the health care system. Nurses are present in hospital,
rehabilitation centres, nursing homes, outpatient centres, clinics, schools and homes (While
and Barriball 2004, 211‑227.)
22
In any job setting, employees work plays an important role for organizational achievements.
Thus, it is very important for management to recognize employees’ work and provide
them with an opportunity to grow and to look after their well-being. It is true that work has
predominantly occupied most of employees’ time than any other single activities, and
it also provides an economic well-being. Therefore, job satisfaction is one of the most
important areas of research for many researchers. (Alam and Mohammad 2009.)
2.2
Job satisfaction among Nurses
A study (Peters 2010) which conducted in two indian states (Andhra Pradesh and Uttar
Pradesh) and included 1916 health care employers in public and private hospitals, it aimed at
finding the relation between job satisfaction and motivation factors according to importance
and presence of these motivatores. According to the characterstics of health workers most of
the respondents in both states and both sectors are working in public hospitals , male doctors
and their ages between 30- 45 years.
The variables were divided into four categories wich are job content and work environment,
extrinsic benefits, autonomy and transperancy. All were rated as their importance for perfect
job and presence in the current job, workers rated many of the motivation factors as more
important than income, such as good relationship with co workers (96%), training opportunities
(92%), tools to use skills (92%), and income just was rated with (76%), that suuported previous
studies conducted in africa and showed that good financial incentives alone such as salaries
would not improve the motivation of health care workers.
Specifically, public sector employers valued supervisor recognition and employment benefits
more important than private sector workers did, furthermore there were a wide distinction in
presence of these factors within the current job between public and private hospitals in which
the second have higher present of presence of these motivators.
23
Lambrou et al. (2010) has conducted a study in a Cyprus public hospital to adress the relation
between motivatores and job satisfaction of health professionals. Both medical and nursing
staffs were included in this survey (Doctors =67, Nurses=219). Four groups of motivators (job
attributes, remuneration, co-workers and achievements) were tested against demographic and
work variables (gender, age, and years of experience, sector and managerial position). Among
all motivatores, achievements as intrinsic factor was ranked the first by doctores and nurses,
followed by remuneration, co-workers and finally job attributes.
Selvarajah (2015) has conducted a study at one private hospital in Kajan , Selengorto evaluate
the relation between rewards and nursing job satisfaction in that hospital, the study included
102 nurses from total number 112 nurses with response rate about 91%. Demographic data
analysis showed that most nureses were femal (91,2%) and males only represented (8,8%) of
total number, the greatest age group was between 21 to 30 and represented (73,5%), also
showed (80%) of all respondents have been working between one to six years at this hospital.
The main conclusions of this research were there is a positive link between incentives and job
satisfaction of nurses, also non-financial incentives have a more significant connection with
job satisfaction compared with financial incentives, it gives an idea that the greatest number of
respondents convinced that non-financial incentives such as recognition, good work
environment and career development have an important role inan attraction to work beside
financial issues. Another secondary findings for this study are 90.3% of nurses declared that
job satisfaction would raise job performance, 58.6% agreed that job satisfaction could promot
nurses to work at an unusual times and 53.8% stated that work would be done perfectly in
prsence of job satisfaction.
In the research we will try to concern about the limitations of this study by expanding the study
to hargeisa group hospital in somaliland. this is directly leading to increase the sample size to
cover all nurses in hospital, further more we will focus on selected incentives which are
srongely related to nursing profession.
24
Job satisfaction is the extent to which people like (satisfaction) or dislike (dissatisfaction) their
jobs. From literature discussed below it can be appreciated that job satisfaction has various
sources.These
include
individual’s
characteristics,
intrinsic
characteristicsextrinsic
characteristics. Individual social-demographic characteristics include age, gender, level of
education marital status and professional working experience.
Intrinsic characteristics include those factors related to the job such as authority, policy,
procedures, security, recognition, responsibility, supervision and variety. Extrinsic
characteristics are those provided by external forces. These include the following; ability of
utilization, achievement, compensation, coworker’s relation, independence, activity, moral
value, social status, working condition, advancement and social service.
2.2.1 Individual’s Characteristics
a) Age
The relationship between age and job satisfaction is variably reported. Some studies show that
older people are more satisfied than the younger ones (Mottaz, 1998; Bohloko, 1999; Neezam,
2005; Al-Juhani, 2006) while other studies report the opposite (Shaha, 2001). Studies
conducted in South Africa and Kuwait among health professionals revealed that nurses above
age forty were significantly more satisfied on their job than their younger colleagues (Neezam,
2005; Shaha, 2001).
In contrary, a study conducted in Taiwan showed that there was no linear relationship between
age and nurses’ job satisfaction (Kuo, and Chen, 2004). Few other studies have shown that
older workers were more satisfied with their jobs than younger ones (Mottaz, 1998; Bohloko,
1999), However Benton and Halloran concluded that young workers were more satisfied with
their job than older ones (Benton, 1991).
25
b) Gender
Generally females have been found to be more satisfied compared to males in their jobs,
(Hodson, 1989; Chambers, 1989). However, others have shown that gender has no impact
(Dervaney and Chen, 2003).
c) Marital Status and Job Satisfaction
Kuo and Jamal, reported that married employees experienced higher levels of job satisfaction
in comparison to that of single employees (Kuo, 2004; Jamal and Baba, 1992). However
Neezam Luddy has found that there was no significant relationship between marital status and
job satisfaction amongst employees working at a Public health institution in the western Cape
Town (Neezam 2005).
d) Work experience
Working experience has been found to be significantly correlated with job satisfaction in some
studies (Oshagbemi, 2003; Al-Ahmad, 2002). However Green found no such correlation
(Green, 2000). Additionally Al-Ahmad also reported no significant association between job
satisfaction and gender, age, income, marital 11 status and the level of education. Kreitner et
al. (1999), Shaha (2001), and Oshagbemi, (2003) have found that job satisfaction was
significantly correlated with increased professional working experience.
2.2.2
Incentive (Motivational) and (Hygiene) Factors
A lot of studies on motivational and hygiene factors and the way they relate to job satisfaction
have been conducted, with some supporting the link, while others being not in favor.
26
In one study done by Pietersen, (2005) it was found that all participants were dissatisfied by
extrinsic factors, but some showed satisfaction with intrinsic factors like job it self promotion
at working place and patience care. Another study showed that 86% of factors related to job
satisfaction were motivators, and that hygiene factors were 72% of all the factors that
contributed to dissatisfaction about their work, (Abushaikha and Sac 2009). Studies testing
Herzberg’s two-factor theory show that in line with Herzberg's predictions, factors associated
with intrinsic satisfaction do play a more important part in increasing job satisfaction (Nate and
Santhat (2008). While from a study 12 done in Ghana the author agreed that intrinsic factors
are related to job satisfaction and extrinsic factors to dissatisfaction, he argued that more
emphasis should be on the hygiene factors since it appears to motivate the Ghanaian workers
better (DarteyBaah and Amoako, 2011).
About the hygiene factors results have exposed that there was a important connotation between
hygiene factors (salary and working conditions) and job satisfaction (Rubin, 2009). Apart from
working conditions and salary recognition, utilization of skill, technical aspects of supervision
and job advancement were found to be significantly related to job satisfaction in a study done
in Saudi Arabia (AlAhmad, 2002). However, in another study it was found that there was no
significant association between other aspects, such as policy and administration, supervision
and interpersonal relationship with job satisfaction (Nate and Santhat, 2008).
One national study conducted in China revealed that intrinsic job characteristics were found to
be as important as extrinsic job characteristics on nurses’ job satisfaction (Trevor, 2008). In
contrast, in Indonesia hygiene factors were significantly associated with nurses’ job
satisfaction, whereas motivation factors were not significantly associated with job satisfaction
(Rubin, 2009). Pay and promotion opportunities were strongly correlated with job satisfaction
in a study done among nurses of Khyber teaching hospital, Peshawar (Usman, and Ahmad
2010), whereas professional opportunity, work load and appreciation reward showed
dissatisfaction among nurses in another study (Al Juhani, 2006).
27
2.3 Evolution of nursing profession
From the beginning of time, nursing has existed in the basic form and with time it has grown
and changed from the informal act of caring to a complex scientific based profession guided
by legislations. Nursing has seen significant changes over time so as to keep up the frequently
changing needs of the society. The factors affecting the changes in the nursing care
involve; the change in population make up, economy, consumer demands, and change in
technology. Due to these factors, the nursing education given over time has established, the
practice setting and also the roles and responsibilities have changed significantly.
Nursing is a profession that is developing day in day out and it is important to note that it
is nowhere near its maturity. (Introduction to nursing profession 2010.)
Florence Nightingale founded modern nursing and she developed the first formal
training program that mainly dwelt on the role of the nurse as preventing and
curing of diseases through sanitary techniques. Despite those early times, Florence Nightingale
used evidence-based principles to guide the nursing practice and she initiated major
reforms in hygiene and sanitary practice. In the United States, nursing evolved
during the wartimes as in Nightingales era. Dorothy Dix was not a nurse but
she was credited for coming up with the Nursing Corps in the states army. In
addition, Clara Barton founded the American Red Cross. Its main responsibility was to take
care of the health needs of soldiers in the civil war. (Introduction to nursing profession 2010.)
28
2.3.1 Legal aspects and future of nursing
Currently the nursing profession is guided by rules and regulations. Each country possesses its
own legislations that govern the nursing profession, its practice, scope, method, criteria and
kind of education to be offered to the nurses. For one to practice nursing as a career, they
need to possess a license that is given to them by the body in charge after they graduate. Each
country has its own body in charge. In Finland, the National Authority for Medico
legal Affairs is responsible and one has to submit an application to them. It is important to
note that the requirements vary from one state to another. According to the European
Union. there are five directives that must be put into consideration on training, degree
certificates and right to professional practice as a physician, midwife, nurse or dentist. A
language skill certificate may also be required but not always. For those who are not members
of the EU or the EEA states, they are required to show sufficient language skills in Finland.
(Markkanen and Tammisto 2005.)
Nursing and health care has seen tremendous changes over the years. The health care
personnel’s and consumers are now more educated and informed and are currently taking part
in making health decisions. In relation to this, the nursing roles and responsibilities have grown
beyond the direct patient care. Nursing has become a respected and independent profession,
which has improved greatly due to the development of technology. However, it is also
experiences a lot of challenges and the health costs are raising. There is also inequality in access
to the health care facilities and shortage of the nursing staff that is leading to less quality care
offered. Despite the challenges, the profession will evolve more and the nurses will
always play a major and active role in society. (Introduction to nursing profession 2010.)
29
2.3.2 The Role of a Nurse
Nurses are the most underrated people in the society despite them playing a major role of
providing health services, which are very essential, and taking care of people when they are
hospitalized. In the nursing job, job satisfaction is very important so as to ensure the health
services provided are sufficient, efficient and of high quality. (Alam and Mohammad 2009.)
It is important to note that the nurses have a lot of duties and responsibilities to take care of
and
their roles are constantly changing. Recently they are accountable for even larger and
wider health care responsibilities. In our current society, diseases such as diabetes, obesity and
other illnesses are on the rise.
This requires for the development of more complex health care systems and the nurses all
over the world are rising to the occasion and are getting empowered through advanced nursing
education. In our fast growing world the nurses, other than caring for the sick, they have
taken
other responsibilities such as giving TED talks, coming up
with
mobile medical
applications, taking part in creating and addressing health policies, doing and publishing
scientific research, working with other health professionals such as social workers, oncologists
and others to ensure provision of quality nursing care. Despite the continuous evolvement
of
the
hospital
structures, technological
gadgets
and
the
political challenges, the
profession does not change much. The nurse is still the major caregiver and act as a advocate
for the sick and the vulnerable members of the society. (Tiffin 2012.)
However, for a nurse to be able to take full accountability for her duties and responsibilities,
she must possess and practice certain skills. A nurse should have very good communication
skills, be a good listener and should possess both mental and physical endurance. Above that
the nurse should be kind and compassionate, be ready and willing to provide a healing touch,
should be flexible and open to new changes, should always be alert and observant, and
motivated. Finally, and most important the nurse should be culturally sensitive so as
to be able to deal with people from different cultures. It is essential to remember
that some of these qualities such as motivation are greatly influenced by job satisfaction.
(Jirage 2013.)
30
2.3.2 Nursing commitment in relationship to satisfaction
In a situation where a nurse is not satisfied with their work, this means that the nurse is not
committed to her job These two terms are closely related and go hand in hand since the factors
influencing job satisfaction are similar to those affecting nursing commitment. In that
case
nursing commitment
to a registered nurse according to Zwol (2009) involves
establishing, maintaining and improving the quality of health care in nursing either
individually or collectively. It is an act of committing to a charge or trust act of referring a
matter to a legislative committee, it is an agreement or a pledge to do something in
the future or the state of being obligated or being emotional. (Zwol 2009.)
Commitment puts into to consideration the past and the present and is directed
towards the future. Nursing commitment goes hand in hand with the quality of nursing care
provided. For commitment to move from nursing care to caring nursing it requires
accountability creativity and attitude. Accountability involves telling the patient your name,
the role you play and your expectations from the patient. Creativity involves taking care of
patient’s needs. Ensuring that they are met at the right time and the patient is satisfied despite
limited resources. Attitude comes about in that despite being tired, overwhelmed and burned
out the nurse have to do their duties well. (Henderson 2010)
31
2.4
Factors affecting job satisfaction
2.4.1 Extrinsic Factors
Extrinsic factors are hygiene or maintenance factors which if absent, cause dissatisfaction. The
presence of extrinsic factors is not satisfaction but no dissatisfaction (Mullins, 2005). Extrinsic
factors, according to Herzberg (1959) are salary, job security, working conditions, level and
quality of supervision, company policy and administration, and interpersonal relations
(Mullins, 2005). Extrinsic factors that affect nurses’ job satisfaction are interaction,
organizational policies and pay (Stamps, 1997).
Extrinsic factors are external factors that affect job satisfaction. These includes relationship
with co-workers, physician and the boss, salary, working environment, organization and
administration
policies, supervision, discrimination and harassment, stress and work related
tension.
1. Relationship with Colleagues/Co-Workers: When working with others, their personal
characteristics may influence one’s job satisfaction level. If one has dedicated colleague
workforce, he/she may also perform better and enjoy the job as compared to working with
colleagues who have biased attitudes and personality issues. Overall contribution from
colleagues may determine the level of satisfaction one has on their job. (Kabir 2011.).
2. Relationship with physicians: Collaboration between the nurses and the physicians
is very important in patient outcomes and therefore a good relationship should
be enhanced through good communication skills and appreciating each other’s
contribution to the care. Unbearable behaviour and language from the physicians can
contribute to the nurse’s job dissatisfaction and resigning from the job. (Rosentein 2002.).
32
3. Salary: Employees are satisfied when their salary is in accordance with the amount of input
they put. If the workers’ perception of their salary is not good, then it would lead to lack
of motivation and dissatisfaction comes in. Through increasing the employee’s salary
annually even if it is with small percentage is one strategy to motivate the workers.
Organizations should try to reduce the gap between the salaries for the workers
with other highly paying organizations. (Shief 2008.)
4. Working environment: The environment is very important aspect that contributes
to turnover among workers and thus it should be conducive and well kept. The environment
should be safe to work in, lean, good sanitation and should have break room. Also enough
instruments required should be available round the clock. Communication should be
with respect and appreciating and giving each other room to equally contribute to the
work. (Lephalala June 2006)
5. Organization and administration policies: reasonable policies should be made and
should be easy to understand. The main principles should be understood and
clear to all. These principles keep the workers focused. Lack of focus may lead to
lack of achievement thus causing dissatisfaction. (Lephalala 2006).
6. Supervision: Those in charge should respect the workers and should treat all workers
equally, distribute responsibilities equally and solve problems that may arise within
the work place. Poor leadership contributes greatly to the high turnover of nurses. (Kabir
2011.).
7. Discrimination
and
harassment: According
to
Shields
and
Wheatley
Price
(2002), after the introduction of National Health Service (NHS) 50 years ago racial
discrimination allegations are one of their major features. A research showed
that black nurses have over a long period persisted systematic racism at the work places.
This impacts negatively on job satisfaction and makes one want to leave their career for
another.
33
The research showed that most of the nurses faced discrimination in terms of job
promotions and the access and availability to further training opportunities. The nurses
said they experienced the discrimination and harassment from their colleagues, patients and
their families. (Likupe 2006.)
8. Stress and work related tension: According to a study that was done by Bratt, Broome,
Kelber and Lostocco (2002), stress and work place tension are the major causes
of lack of job satisfaction. It is important for the nursing managers to be able
to manage these two things at the work place. The relationship between coworkers should be established. The person in charge should be able to identify how her
employees work as a team. It is also crucial to note if there is good collaboration and
cooperation among nurses and the other members of the team. If not, ways and means to
facilitate togetherness should be established and implemented. (Gullatte and Jirasakhiran
2005) In relation to this, Sengin (2003) came up with ten factors that attributed and
promoted job satisfaction at the work place.
One is good collaboration within nurses, supervisors and other professionals in
health care and good inter communication skills, second is practice of autonomy
where one is given the independence to practice their profession, thirdly is the
organisational structure and culture which mostly deals with the administration
and management and then there is the opportunity for specialization in the nurses
profession. On the other hand, there is the act of fairness where equality
should be practiced, nurses should be provided with further opportunities for learning and
developing their skills, the working conditions and physical environment should be
conducive in terms of schedules, resources, salaries, benefits and workload. Above that
there should be variety of work and task responsibilities should be allocated according
to ones skills and finally recognition, respect and status should be allocated to the
nurses by the society at large. (Gullatte and Jirasakhiran 2005.)
34
2.4.2 Intrinsic Factors
The intrinsic factors motivate individuals to superior effort and performance. The Intrinsic
factors can also be described as growth factors. They affect the feelings of satisfaction. The
intrinsic factors according to Herzberg (1959) are sense of achievement, recognition,
responsibility, nature of the work, and personal growth and advancement (Mullins, 2005).
Intrinsic factors that motivate a nurse are task requirements, autonomy and professional status
(Stamps, 1997).
Intrinsic factors are motivating factors that bring about satisfaction through fulfilling
individual needs for personal
the
growth and meaning and relate directly to the
individual’s job and facilitate the level of job satisfaction. (Syptak et al 1999.)
1. Work Schedule and workload: a job should be meaningful to every individual by
knowing every effort they make is helpful to the organization. A balance between work
and leisure time should be kept. Work schedules should allow the workers to
have enough free time for attending other personal activities and family. Workload
comes about due to lack of planning the schedules properly. An organization or a hospital
should make sure that they employ more workers to reduce the work load of
the workers at the moment and find replacement for those who have left. (Maniram
2007.)
2. Achievement: The health care organizations and employers should set clear achievable
goals and easy to understand standards. Feedback should regularly be given about
the work done and the achievements this makes the employees feel that they have
been doing something all along by knowing that they have achieved something.
Poor feedback may lead to dissatisfaction among nurses because they may feel that they
do much and achieving less or nothing. Nurses should continuously be educated and
provided with enough up to date information because the less the knowledge
leads to lack of motivation to continue working due to the changes that continuously
occur in the health care field through the development of technology and new
strategies of working. (Irum, Ahm and Sultana 2012.)
35
3. Recognition: Workers always like it when their achievements on the job are recognized.
Employers should sincerely recognize every achievement from the smallest to
the greatest from their workers. For example you can give them something as
a sign of appreciation and showing that their input is not in vain and the organization is
happy with the work done. Lack of recognition may contribute to dissatisfaction.
4. Responsibility: Proper and equal distribution of responsibility is very important.
This motivates the workers to do their job well by feeling that they own their work and no
one is imposing anything on them. It is important to recognize the talent of every
worker
and
giving
responsibility
according
to what an individual can do best.
(Lephalala 2006.).
5. Advancement: Reward employees by promoting them to another level if their
achievements and dedication to the work are deserving and support them if they
want to pursue further education to make them more valuable to the work and have
a more professional fulfilment (Maniram 2007). Communication in every organization
communication is a very vital aspect in collaboration working in order to deliver the
targeted outcomes. The means and sources of communication should be very good.
Poor communication create a lot of confusion at the work place and by the
end of the day the achievement is not as expected, thus in the long run it leads to
dissatisfaction among the workers. (Sammons 2009).
6. Language barrier: The mastery of occupation’s professional language as well as the
community’s national language in the event of performing your duties is key to
one’s overall satisfaction and efficiency. Challenges in language or communication play
an important role especially for foreigners when it comes to their overall satisfaction.
Innate desire of the job: When a person enjoys the job he does, chances are they will still
be satisfied of the job should there be unexpected adversities in carrying out the
job. For instance, when one loves a job you may do it for less pay, long hours or in
non-­‐‑conducive environments without being unsatisfied. (Lephalala 2006.)
36
7. Culture: The
differences
in
cultural
background
may
affect
certain
job
performance aspects like punctuality, level of involvement in terms of speech, distance
and time taken to perform certain tasks in relation to the host’s culture. For
job satisfaction, one has to adapt themselves to the community’s culture so as to
perform as expected and if the stress on this factor is excessive then job satisfaction
levels may drop. (Sammons 2009.)
2.5 Concepual framework:
The Concepual framework is structure that explains the difference of independent variables
(IV) which are training opportunities, salaries, autonomy, and recognition, these IV will be
tested in presence of individual and organizational variables as Moderating variables to find
the relation with job nursing satisfaction which represents the dependent variable (DV).
Socio- demographic
factors: Incentives
Age
Training
Gender
Recognition
Job satisfaction
Education
Salary
Job related factors: Autonomy
Unit
Position
Experience
Figure 2.1 Conceptual framework
37
2.6
Summary
In conclutions, the literature review and concepual framework constructed based on the
variables of the study. The next chapter was deliberated about the methology.
38
CHAPTER THREE
METHODOLOGY
3.1
Introduction
This chapter discussed most important parts in the study including research design, setting of
the study, population and sample, instruments and data collection procedure study. In addition
to that it also shows ethical issues of research as well as displaying dependent and independent
variable and the last one contribution of the research.
3.2
Research design
This was quantitative study where cross sectional design was being adopted. This design was
suitable to determine the factor contributing to job satisfaction among nurses in Hargeisa group
hospital. Researcher was going to use this design to identify the factors that leady to job
satisfaction among nurses.
3.3
Research setting
This study aimed to determine the factors contributing to job satisfaction among nurses in
Hargeisa group hospital in Hargeisa, Somaliland. The questionnaire was used to collect the
data from study population Hargeisa Group Hospital (HGH).
39
This study was being conduct based on questionnaire archive from the nurses in Hargeisa group
hospital. Hargeisa is the capital city of Somaliland. Somaliland is a self-declared republic that
broke away from Somalia in 1991 and whose independence remains unrecognized by the world
that is bordered Gulf of Aden to the north; Somalia to the East; the Federal Republic of Ethiopia
to the South and the west; and the Republic of Djibouti to the North West.
Hargeisa Group Hospital (HGH) was the largest public hospital in Somaliland with large
national referral from the rest of the country and the private health sector. The Hospital is
complex consists of several buildings each containing a single ward and five wards structure
of in component each ward 20-30 beds, with an overall capacity of approximately 400 beds
(including mental health and payment wards).
System of Administration and Department in Hospital
The system of administration in Hargeisa Group Hospital which was Organized organizational
system.
Director
administration
Human resources
Different
wards
Doctor’s
Finance
Staff of hospital
Including nurses
Casher
Logistical
Figure 3.1: System of Administration in Hargeisa
40
In general, The Hospital has different department such as gynaecologic and obstetric ward,
medical (male and female wad), paediatric (nutrition, neonatology and medical), surgery
(orthopaedic and general surgery), psychiatric (male and female), theatre, emergency and
pharmacy, laboratory investigation, blood bank, x-ray and ultrasound ECG, payment, dental,
offices and meeting hall. The Hospital faced severe constraints in many areas, as the only public
health facility providing general secondary level health care services, the hospital serves a
population that was estimated to be over a per day 150-200. The number of nurses who are
working in hospital were 447 and also there were a very limited number of qualified staff,
doctors and nurses to cope for the capacity of the hospital and the level of salary was inadequate
while training, coordination, management and supervision of staff was almost non-existent or
very limited.
3.4
Population and sampling
3.4.1
Population
The population of nurses in Hargeisa group hospital was obtained for this study. It consists of
local and international nurse’s population of 447 in total.
3.4.2
Sampling
The sampling method was used in this study was purposive sampling. This method was easiest,
inexpensive, require less time to acquire. To reduce sample bias there were four settings of the
data collection inclusion and exclusion criteria for respondents and the question was distributed
at various days and time. Respondents answered the questionnaire in provided rules that was
calmed and quieted to reduce environmental bias.
41
3.4.3
Sample size
This was used the formula developed by Krejcie and Morgan (1970) was used to calculate the
estimated sample size. The formula and calculation for the sample size was showed as below:
x2NP(1−P)
S =(𝑑(𝑁−1)+𝑋2 𝑃(1−𝑃)
S = sample size that are required
X2 = the table valve of Chi-square for one degree of freedom at the desired confidence level
N = the population size
P = the population proportion (assumed to be 0.50 since this would provide the maximum
sample size)
D= the degree of accuracy expressed as a proportion (0.50)
S = (3.841)(447)(0.50)(1- 0.50)
(0.05) (0.05) (447-1) + (3.841) (0.5) (1- 0.5)
S=
429.23175
(1.115) + (0.96025)
S=
429.23175
2.07525
S= 206.833755
S = 207 Nurses
42
3.5
Inclusion and Exclusion Criteria
3.5.1
Inclusion criteria
In this research the inclusion criteria were been as follow:
1) All the nurses of that selected hospital.
3.5.2 Exclusion criteria
1) The nurses those who were on leaves due to medical leave, vacation or other reasons
2) The nurses who are on night shift.
3.6 Variables
Variables were divided into two main according to the correlation between exposure and
outcome, dependent and independent variable, the main dependent variable is the study job
satisfaction where independent variables are socio-demographic characteristics variables ( age,
gender, and educational level ) training, and recognition salary autonomy.
3.7
Research instruments
The instrument for the study was a questionnaire. The instrument adopted for the study follows
the procedure used by Lee cheng poh“ Nurses Job satisfaction in Malaysian Private Hospitals
in 2008”. There were two types of questionnaire was used to achieve the objectives. The
questionnaires compromised of two section. Section A: demographic data, Section B: what
they feeling nurses about their Job Satisfaction. All the sections of study instrument are
described respectively as below:43
Section A: - Demographic data
This demographic data characteristic consisted of eight items to collected from the respondents.
The items were gender, age, marital, level of education, salary, current positions, work hours,
and work experience.
Section B: Your feelings about Job Satisfaction
Instructions:
There are 15 statements about job satisfaction, and each statement has five alternatives with
five-point scale ranging: -
1 = Very Dissatisfied
2 = Dissatisfied
3= Neutral
4= Satisfied
5 =Very
Satisfied
To Read each item carefully and for each question and circle one number that best expresses
your feelings. If you feel that your job gives you more than you expected, choose “very
satisfied.” If you feel that your job gives you what you expected, choose “satisfied.” If you
can’t make up your mind whether or not the job gives you what you expected, choose “neutral
“(neither satisfied nor dissatisfied) If you feel that your job gives you less than you expected,
choose “dissatisfied.” If you feel that your job gives you much less than you expected, choose
“very dissatisfied.” Be frank and honest: Give a true picture of your feelings about your present
job.
44
3.8
Reliability
On one hand, the validity of the instruments, which were questionnaire, and measure. Validity
of the instrument means the ability of an instrument to measure what it will intend to measure.
In this study, the validity of the instruments was measured by a section of experts through an
assessment of select items in the instruments that would ensure that the instrument was measure
to the expectations. After identifying the vague and ambiguous questions, corrections were
made and a final instrument was prepared. On the other hand, the reliability of an instrument
was measured. Reliability of the instrument means the consistence of the instrument in picking
the needed information
3.8.1 Reliability Test
The reliability test is a method for checking a scale’s internal consistency. In this study
Cronbach’s alpha is being used as the indicator to check the degree of consistency. The value
of Cronbach’s alpha for all variables should be above 0.7. In this research, it was found that
Cronbach’s alpha is 0.9. Nunnaly and Bernstein (1994) state that for newly constructed scales
the minimum Cronbach’s Alpha value to be considered acceptable is 0.70. Therefore, the
current value is considered as a strong indicator of reliability. However, for the items “The
praise I get for doing a good job” and “The chance for advancement of the job” have great
effect on Cronbach’s alpha if deleted.
45
Table 3.1: Reliability test, Cronbach’s Alpha Values
Items
Cronbach's
Alpha if Item
Deleted
How Much are you satisfied with your job
.906
The way hospital is put in to practice
.906
How I feel about My pay (salary) and the amount work i do
.908
Hygiene factor working conditions such as cleanliness of the work place,
.908
healthy environmental condition, enough tools and supplies. This thing
encourages me to work
How I feel about the way my co-workers get along with each other
.908
Being able to do things that i don’t go against my conscience
.909
How I feel the chance to do things for other people
.907
How I feel about the chance to do something that makes use of my abilities
.910
How I feel about the chance to do different things from time to time
.909
The way my job provides for steady employment
.909
The chance to tell people what I do
.910
The praise i get for doing a good job
.911
The freedom to use my own judgment
.908
The chance for advancement of the job
.911
The feeling of accomplishment I get from the Job
.910
Total
3.9
0.914
Data collection method
Researcher identified eligible respondents to inclusion and exclusion criteria. The respondents
who were eligible, researcher were approached and a brief explanation after given to
respondents for their understanding about the research. The respondent was being asked to sign
consent form if they agree to participate.
The respondents were asked to answer and complete the questionnaire. They were given 30-40
minutes to complete the questionnaire. The questionnaire was collected immediately once the
respondents completed the answer. If the respondent was not eligible, do not agree to
participate and do not completely provide the data, they will be excluded from the study.
46
3.9.1 Flow chart of the data collection
Identify eligible respondents in nurses of Hargeisa Group Hospital
Respondents are eligible
Respondents who are not eligible, do
not agree to participate and do not
completely provide the data
Brief explanation will be given to
respondents for their understanding.
Respondents will ask to sign a consent
form if they agree to participate.
Respondents will be asking to be
answer and complete it.
30-40 minutes to complete the
questionnaire
Collect the questionnaire
Analysis data
Figure 3.1: Flow Chart
47
3.10
Data Analysis
Upon completion of the field cross sectional study, data was transferred in to computer for
statistical analysis (SPSS version 25).
3.10.1 Technique of the data analysis
Table 3.2 Technique of the data analysis
Research Objectives
Types of Data
Method of Analysis
To determine the factors
Age (continuous data)
Mean and standard deviation
contributing to job satisfaction
Gender
frequency and percentage
among the nurses
Level Education
One-way ANOVA
Salary
Position
Experience
To identify the level of job
staff nurse
Mean and standard deviation
satisfaction among the nurses
Head of nurse
frequency and percentage
Nursing
manager
(Supervisor,
Deputy and Chief Nursing)
Other, please indicate (Nursing
Education and quality Control
Nurses)
Identify the relationship between
Age (continuous data)
Independent test
demographic factors and job
Gender
ANOVA
satisfaction
Level Education
Salary
Position
Experience
48
3.11
Ethical issues:
Permission was obtained from the responsible managers in hospital before starting the survey,
I must explain for participants the aim and the benefits of the study, also I have to clarify any
ambiguous point for them and assure of privacy of the collected information and the final
results. Regarding data collection, I always refer to sources of data in this proposal or in the
final project. I was stated both positive and negative results without omitting or hiding any
information in the final report.
3.12
Pilot study
Pilot study was being carried out to identify any potential problems before carrying out the
larger-scale. The reason to perform pilot study is to evaluate feasibility whether the research
protocol was workable and followed and appropriateness of the instruments used. The number
of the respondents for the pilot study will be counted 10 % of the sample size (Connelly 2008).
Pilot study will be carried out to 21 nurses who fulfil all the criteria. The researcher was giving
briefed explanation to the respondents before answering the questionnaires. The results were
not including in the actual study.
3. 13 Summary
In this chapter, methodology for the study is discussed. Sample size of nurses in HGH workers
with total number of was required to complete this survey. The data was analyzed with SPSS
version 23 and the result was presented in bar chart, histogram charts and par chart with
interpretation.
49
CHAPTER FOUR
RESULTS
4.1 Introduction
This chapter present the results and analysis from questionnaire distributed. This part started
with descriptive analysis as well as, the variable involved in the research to get the general
information and overview of the observed samples. Concluding the conceptual framework also
provided guide to study.
4.2 Data Analysis
Statistical package for social science (SPSS) Version 25 was used to aggregate and analyse the
data presented in this chapter. The presentation of this data is in line with aim of the study
which was factors contributing of job satisfaction among nurses’ in Hargeisa Group Hospital
(HGH) in Hargeisa, Somaliland.
4.3 Demographic and Description of Research Findings
Socio-Demographic characteristics of the respondents consisted of nine items to collect from
respondent. The items were gender, age, marital, level of education, salary, current position,
work hours, and work experience.
Overall 207 of this study included nurses at Hargeisa Group Hospital (HGH), 89 (43%) males,
and 118 (57%) females. In terms to their age, 96 (46.4%) were younger than 25 years old, 82
(39.6%) were in between 25 – 30 years old, while 29 (29%) were older than 31 years old and
above. When asked member’s marital status, 111 (53.6%) were single, while 81 (39.1%) were
married and remaining 15 (7.2%) stated that they were either divorced or widowed.
50
About nurses’ monthly salary,137 (66.2%) had income of ranging between 477,000 – 954,000
Somaliland Shillings (SLsh) which was equivalent to RM 200 – RM 400, while 43 (20.8%)
earned salary between 1431,000 – 1908,000 SLsh equivalent to RM 600 – RM 800 and the
remaining 27 (13%) got a monthly income of 4770,000 – 9540,000 SLsh which was equitant
RM 2000 –RM 4000. Finally, according to this study’s objectives and the possibility of nurses’
educational background was found 99 (48%) diploma, 80 (39%) either Bachelor’s degree or
Post Graduate degree holders and remaining 24 (14%)has health occupations. According to the
member’s number of children depend on them, 128 (61.8%) replied none, while 65 (31.4%)
pointed 1 – 5 child/children depend on them, where, 13 (6.3%) stated 6 -10 children were
dependent and remaining 1 (0.5%) indicated more than 10 children.
According to research findings, the participants were asked their current positions, majority of
the members 69.1% (n = 143) staff nurses, 12% (n = 25) head of the nurses, 12.6% (n = 25)
were nurse managers and lastly it was observed some minority group 6.3% (n = 13) members
representing none of the above mentioned three categories.
The above mentioned data are presented in the Table 4.1
51
Table 4.1 Demographic characteristics of the participants (N = 207 nurses)
Respondent Percentage
Variables
(N 207)
(100%)
Mean
SD
1.57
0.496
1.68
0.708
1.54
0.629
1.74
0.717
1.47
0.716
1.45
0.636
1.56
0.937
Gender
-
Male
89
43
-
Female
118
57
-
Less than 25 years
96
46.4
-
25 – 30 years
82
39.6
-
31 years and above
29
14.0
Age
Marital status
-
Single
111
53.6
-
Married
81
39.1
-
Divorced / widow
15
7.2
Education level
-
Diploma
99
48
-
Bachelor’s and post graduate degree
80
39
-
Health occupation
24
14
Salary per month
-
SLSH47,700 – SLSH954,000
137
66.2
-
SLSH143,100 – SLSH198,000
43
20.8
-
SLSH4770,000 – SLSH9540,000
27
13.0
Children dependent on you
-
None
128
61.8
-
1 – 5 children
65
31.4
-
6 – 10 children
13
6.3
-
10 children and above
1
0.5
Current position
-
Staff Nurse
143
69.1%
-
Head of the Nurse
25
12.0%
-
Nurse Managers
26
12.6%
-
None
13
6.3%
52
From the total of 207 participants, about 163(78.7%) works less than 50 hours per week, where
the remaining 44 (21.3%) spend 50 and more hours per week working figure 4.2. When asked
their experience and “how long have they been working in this hospital”, 118 (57%) answered
that they have worked less than 5 years, were 60 (29%) of the staff stated 5 – 10 of working
experience in this hospital, where the remaining 29 (14%) have been working at Hargeisa
Group Hospital more than 10 years.
53
Figure 4.1 How long you worked in the Hospital?
4.4
Level of job satisfaction among nurses in Hargeisa Group Hospital
4.4.1
Overall job satisfaction level
One of the main hypothesis of this research is to find out the satisfaction among nurses, the
participants were asked their level of satisfaction on their current job. To do so the level of job
satisfaction was categorized into two groups namely “satisfied and dissatisfied” by their mean
scores. The results showed that there is great difference between the groups in which 89
(42.9%) replied they were satisfied with their job, while the rest 118 (57.1%) were dissatisfied
with their current job. (Figure 4.2)
54
Figure 4.2 Level of job satisfaction
According to the above mentioned results, it was clear that there is more dissatisfaction among
nurses at Hargeisa Group Hospital by referring this questionnaire. More than half of the
participants replied with very dissatisfied at their current job, therefore, Hargeisa Group
Hospital’s results showed very dissatisfied among nurses.
55
4.4.2 Factors contributing of job satisfaction with hygiene factors
To find out factors contributing job satisfaction among nurses, it is essential to look out
different aspects, here, in this section Hygiene and motivation factors were being focused as
shown in Table 4.3. Firstly, “working conditions such as, cleanliness of the work place, healthy
environmental conditions, enough tools and supplies”. 21.3% (n = 44) of the participants
indicated very dissatisfied with the hygiene condition of the hospital, where, majority 27.5%
(n = 57) members were common on dissatisfied, 15.5% (n =32) were stating neutral, while,
18.4% (n = 38) were satisfied this factor and the remaining 17.4% (n = 36) pointed they were
very dissatisfied.
Secondly, the participants were asked “the way my co-workers get along with each other”
therefore, more than quarter of the staff 32.4% (n = 67) expressed that they were dissatisfied,
where, 16.9% (n = 35) pointed very dissatisfied, 13.5% (n = 28) were stated neutral, while
19.3% (n = 40) were satisfied and the other 17.9% (n = 37) were very satisfied.
Only 8.7% (n = 18) nurses were very satisfied with the item “being able to do things that do
not go against my ethics”, where, 21.7% (n = 45) were satisfied, and 19.8% (n = 41) indicated
neutral, while the majority of the group 28.0% (n = 58) were dissatisfied and the remaining
21.7% (n = 45) were very dissatisfied on this item.
56
Table 4.2 Hygiene Factors (N= 207)
Items
Very
Dissatisfied
Neutral
Satisfied
Very
Dissatisfied
N(%)
N(%)
N(%)
Satisfied
N(%)
1
Mean
SD
2.93*
1.29
N(%)
How I feel about My pay (salary) and the amount work I do
28 (13.5)
63 (30.4)
43 (20.8)
42 (20.3)
31 (15.0)
Working conditions such as cleanliness of the work place,
44 (21.3)
57 (27.5)
32 (15.5)
38 (18.4)
36 (17.4)
2.83** 1.41
35 (16.9)
67 (32.4)
28 (13.5)
40 (19.3)
37 (17.9)
2.89*
healthy environmental condition, enough tools and supplies. This
thing encourages me to work.
2
The way my co-workers get along with each other.
1.38
`
3
Being able to do things that do not go against my conscience
45 (21.7)
58 (28.0)
41 (19.8)
45 (21.7)
18 (8.7)
2.68** 1.27
4
The chance to do things for other people
45 (21.7)
56 (27.1)
33 (15.9)
45 (21.7)
28 (13.5)
2.78** 1.36
5
The chance to do something that makes use of my abilities.
35 (16.9)
53 (25.6)
47 (22.7)
43 (20.8)
29 (14)
Average
1= Very Dissatisfied
2= Dissatisfied 3= Neutral
2.89*
1.30
2.833
1.34
4= satisfied 5 = Very satisfied
*Mean > 2.83 = “Satisfied” while ** Mean < 2.83 = “Dissatisfied”
57
4.4.3 Factors that contributing of job satisfaction with the Motivation Factors
About 56 participants (27.1%) were dissatisfied that the item “the chance to do things for other
people”, where, another 45 of them (21.7%) were very dissatisfied, 33 (15.9%) were uncertain,
while 45 (21.7%) were satisfied and the left over 28 (13.5%) indicating very dissatisfied. The
fouth item “the chance to do something that makes use of my abilities” were asked the
participants, again, the majority 25.6% (n = 53) were dissatisfied, where, 16.9% (n = 35) felt
very dissatisfied and 22.7% (n = 47) were uncertain, while, 20.8% (n = 43) were stating
satisfied and 14.0% (n = 29) were very dissatisfied. Again, the majority 26.1% (n = 54)
expressed dissatisfaction the factor “the chance to do different things from time to time”,
where, 19.3% (n = 40) were very dissatisfied and 15.5% (n = 32) were neutral, while, 23.2%
(n = 48) were delighted and satisfied followed by 15.5% (n = 32) very dissatisfied.
In terms of “the way my job provides for steady employment”, thirty 30% (n = 62) members
felt dissatisfied, where 16.4% (n = 34) were very dissatisfied, and 15.9% (n = 33) were
expressed neutral, while, 24.2% (n = 50) were satisfied with the current way that the job
provides for steady employment and the remaining 13.5% (n = 28) were very satisfied.
When asked the participants “the praise they get for doing a great job”, 26.6% (n = 55) were
answered dissatisfied, where, 15.0% (n = 31) pointed very dissatisfied, 17.4% (n = 36) stated
neutral, while 25.1% (n = 52) indicated very satisfied and last group 15.9% (n = 33) mentioned
very satisfied.
Unlike previous items, “the praise they get for doing a good job” nearly quarter of the
participants 24.6% (n = 51) replied satisfied, where, 14% (n = 29) were very satisfied, while,
23.2% (n = 48) mentioned dissatisfied, another 16.4% (n = 34) felt very dissatisfied and the
remaining 21.7% (n = 45) were uncertain and neutral. On another question “the freedom to use
your own judgement” more than one-fourth 26.6% (n = 55) replied dissatisfied, where, more
than one-fifth 21.7% (n = 45) felt very dissatisfied, on the other hand, less than one-fifth 17.9%
(n = 37) and 18.4% (n = 38) stated satisfied and very satisfied respectively, while 15.5% (n =
32) pointed neutral.
58
Again the dissatisfied reply was dominated on item “the chance for advancement on this job”
with 29.0% (n = 60), where, 15% (n = 31) indicated very dissatisfied, on the positive side,
19.8% (n = 41) participants expressed satisfied and 16.9% (n = 35) pointed very dissatisfied
while, the rest 19.3% (n = 40) stated neutral.
59
The last item of the motivational factors in this research to find out issues related factors contributing job satisfaction among nurses at Hargeisa
Group Hospital (HGH) is “the feeling of accomplishment they get from the job factors”, one-fourth 25.1% (n = 52) members answered dissatisfied,
where, 18.8% (n = 39) were common very dissatisfied on this item, while, 15.5% (n = 32) were stating neutral, 19.3% (n = 40) mentioned satisfied,
where, the remaining one-fifth, 21.3% (n = 44) stated very satisfied.
Table 4.3 Motivation Factors (n= 207)
Items
Very
Dissatisfied
Neutral
Satisfied
Very
Dissatisfied
N (%)
N (%)
N (%)
Satisfied
N (%)
Mean
SD
N (%)
1
The chance to do different things from time to time.
40 (19.3)
54 (26.1)
32 (15.5)
48 (23.2)
32 (15.5)
2.89**
1.38
2
The way my job provides for steady employment.
34 (16.4)
62 (30)
33 (15.9)
50 (24.2)
28 (13.5)
2.88**
1.32
3
The chance to tell people what to do.
31 (15.0)
55 (26.6)
36 (17.4)
52 (25.1)
33 (15.9)
3.00*
1.33
4
The praise I get for doing a good job
34 (16.4)
48 (23.2)
45 (21.7)
51 (24.6)
29 (14)
2.97*
1.31
5
The freedom to use my own judgment
45 (21.7)
55 (26.6)
32 (15.5)
37 (17.9)
38 (18.4)
2.85**
1.43
6
The chance for advancement on this job.
31 (15.0)
60 (29.0)
40 (19.3)
41 (19.8)
35 (16.9)
2.95*
1.33
7
The feeling of accomplishment I get from the job.
39 (18.8)
52 (25.1)
32 (15.5)
40 (19.3)
44 (21.3)
2.99*
1.44
2.93
1.36
Average
1= Very Dissatisfied
2= Dissatisfied 3= Neutral
4= satisfied 5 = Very satisfied
*Mean > 2.93 = “Satisfied” while ** Mean < 2.93 = “Dissatisfied”
60
4.6 Study of relationship between Demographic Characteristics of nurses in job
Satisfaction
Table 4.4 is showing the results of the Independent-Sample t-test and Analysis of Variance
(ANOVA) as well as the mean and standard deviation of the variables.
4.6.1 Gender
The results of SPSS independent-sample t-test showed that male nurses scored higher mean
(SD) score 2.87 (1.59) compared to female mean (SD) score of 2.67 (1.46) on satisfaction
However, the results were no statistically significant difference, indicating that p > 0.05. (Table
4.4)
4.6.2 Age group
Since the age group is more than two population means, therefore, Analysis of Variance
(ANOVA) is being used. The mean (SD) of job satisfaction score for the age group less than
25 years, 25 -30, and 31 and above were 2.81 (1.503), 2.96 (1.475) and 3.10 (1.665)
respectively (Table 4.4). The results showed that the participants aged more than 31 years old
had higher overall mean through all factors compared to other two age groups, where the group
25 – 30 years old had greater mean and standard deviation than group age >25. On the other
hand, all factors were common on one thing, P-value > α; which means the differences between
the means are not statistically significant at this age group factor.
61
4.6.3 Salary
Analysis of one-way ANOVA, showed that the salary satisfaction had significantly higher
score on the amount of monthly income. The group “4770, 000 – 9549, 000” pointed greater
mean and standard deviation 3.70 (SD =1.463) compared to “1431, 000 – 1908,000 and
477,000 – 954,000” 2.26 (1.432) and 2.41 (1.438) respectively.
This group has showed great effect on satisfaction. Moreover, the results were statistically
significant since P < 0.05. Table 4.4 shows the analysis of variance of salary satisfaction.
4.6.4 Level of Education
The results of One-way ANOVA showed that health occupation had higher score on
satisfaction mean (SD) score of the background education categories of Diploma,
Bachelor’s/Masters and Health occupants were 2.25(1.405), 3.09 (1.442) and 3.19 (1,665)
respectively. The results presented statistically significant difference of population variances,
since p = 0.05 < α = 0.05. As shown in Table 4.4.
4.6.6 Experience
The results of One-way ANOVA showed that the mean (SD) job satisfaction of working
experience categories of less than 5, (5 – 10 years) and more than 10 years were; 2.61 (1.491),
2.92 (1.488) and 3.00 (1.669). These means were no statistically significant different across the
working experience categories p>0.05. Table 4.4
4.6.5 Position
The results of One-way ANOVA showed that Nurse Managers had higher score on satisfaction
mean (SD) score of the current position categories of stuff nurse, head nurse, nurse managers
and some minor group of others were 2.64 (1.517), 2.52 (1.229), 2.65 (1.599) and 2.62 (1.387)
respectively. The results presented statistically significant difference of population variances,
since p = 0.013 < α = 0.05. As shown in Table 4.4.
62
Table 4.4 Job Satisfaction Score and Demographic Variables (N=207)
Variables
Category
Freq.
Mean
SD
P-value
Gender
Male
89
2.87
1.59
0.36
Female
118
2.67
1.46
<25
96
2.81
1.503
25 -30
82
2.96
1.475
31 +
29
3.10
1.665
477k - 954k
137
2.41
1.438
1431k – 1908k
43
3.26
1.432
4770k – 9540k
27
3.70
1.463
Diploma
99
2.25
1.405
Bachelors/Master
80
3.09
1.442
Health Occ.
24
3.19
1.665
Age
Salary
Education
0.374
0.000*
0.001*
Mean (SD) score of the background education categories of Health
occupants statistically different from Bachelor’s/Masters and Diploma
Experience
< 5 years
118
2.61
1.491
5 – 10 years
60
2.92
1.488
10 + Years
29
3.00
1.669
0.286
Mean (SD) of working experience categories of more than 10 years was
statistically different from less than 5 years and (5 – 10 years)
Current
Nurse Staff
143
2.64
1.517
Position
Head Nurse
25
2.52
1.229
Nurse Manager
26
3.65
1.599
Others
13
2.62
1.387
0.013*
The Mean (SD) of Nurse Managers was statistically different from Staff
Nurse and Head Nurses.
The mean difference is statistically significant at P value < 0.05*
63
4.7
Summary
In conclusion, the chapter has reported several statistical and related analysis. In particular, the
descriptive statistics, frequencies, pie charts, histograms, followed by t-test and one-way
ANOVA to find out job satisfaction among nurses at Hargeisa Group Hospital. several factors
had huge effect such as Salary, current position and level of education. However, gender, age
group and background experience did not show any significance difference. Detailed
discussion was addressed in the next chapter.
64
CHAPTER 5
DISCUSSION
5.1
Introduction
This study about factors affecting job satisfaction among nurses at Hargeisa Group Hospital
(HGH), intended to find out the satisfaction level of this hospital. A questionnaire was
distributed; 207 participants were replied. This chapter contains a discussion of key findings
concerning research question and objectives in which first section mainly focus the satisfaction
level of the hospital, where the last section explores the strategic management of job
satisfaction and recommends strategies for further improvements of job satisfaction among
nurses keeping in mind using both hygiene and motivation factors and finally the conclusion.
5.2 Level of Job Satisfaction among Nurses in Hargeisa Group Hospital
5.2.1 Satisfaction on Job Satisfaction
This study assessed the levels and different factors affecting nurses’ job satisfaction using
motivation and hygiene at Hargeisa Group Hospital (HGH). It is realized that higher
productivity and performance of hospital cannot be acknowledged without the participation of
satisfied nurses. The research has been revealed that 42.86% nurses replied “satisfied” with
their job. On the other hand, 57.14% of the nurses were “dissatisfied” with their job. This
finding is similar to a study conducted by Leshabari in 2008 stating that more than half of
Doctors and nurses were dissatisfied with their job, another study done by Mbeya found that
77% of health care workers were dissatisfied with their job. (Leshabari, 2008; Bushigazi,
2009). In addition, a study by Bodur (2002), and Rain et, al. (2009) found that 60% of the
nurses were dissatisfied with their job.
65
Similarly, a study done in Saudi Arabia stated that 67.1% of the nurses were dissatisfied (AlJuhani and Kishke 2006). However, the finding is comparable to a research from Ethiopia
whereby it has revealed that 53.8% of the nurses were satisfied with their job (Yami et al 2011).
The disappointing level of dissatisfaction found in this study is probably due to the fact that the
Somaliland government is dealing to separate from Somalia, therefore, it is undergoing huge
socio-economic changes such us cost of living is highly increasing day by day to the majority
of workers. Additionally, because of economic needs the government is unable to provide the
necessary working facilities, which resulted the majority to replied dissatisfaction among
nurses at Hargeisa Group Hospital (HGH).
5.3 Factors that contributing to job satisfaction
The study findings were in totally inconsistent with Herzberg’s two factor Theory of job
satisfaction because majority of the nurses identified that both hygiene (extrinsic) factors
(salary, co-workers, chance to something that makes use of my abilities) and motivation
(intrinsic) factors (The chance to tell people what to do, praise they get, chance for
advancement and the feeling of accomplishment) are important factors contributing nurse’s job
satisfaction.
In this study a number of hygiene (extrinsic) factors under study have been found to be below
the average mean for satisfaction (2.833). These included “working condition”, “Being able to
do things that don’t go against my conscience”, as well as “The chance to do things for other
people”. It can therefore be advised that these items with below average scores need to be
improved so as to increase the job satisfaction of nurses. On the other hand, motivational
(extrinsic) factors that had below average score (2.93) included “The chance to do different
things from time to time”, “The way my job provides for steady employment”, and “The
freedom to use my own judgment”. These also require special attention in order to increase job
satisfaction. Indeed, a study done in Saudi Arabia revealed significant association between
recognition, utilization of skill, technical aspect of supervision and job advancement with job
satisfaction (Al-Ahmad 2002).
66
Overall, it is being that study has found that mean scores of items in both intrinsic and extrinsic
domains were crucial for job satisfaction. Similarly, a study from China discovered the same
that intrinsic factors were found to be as important as extrinsic factors on nurses’ job
satisfaction (Trevor et al 2008) although there is another study that showed motivation factors
playing a bigger role than hygiene factors in determining job satisfaction (Nate and Santha,
2008).
5.4 Relationship between Demographic Characteristics and Job Satisfaction
5.4.1 Gender
Demographic characteristics found to frequently impact job satisfaction were the level of
education, length of work experience, age, gender and marital status, salary and current
position. It is quite possible that some of these personal characteristics predispose some
individuals to be satisfied or dissatisfied with their jobs irrespective of the actual work
environment. However, in this study the factors affecting job satisfaction has found out that the
socio-demographic characteristics that were statistically significant to be salary, level of
education and current position. On the other hand, age, gender, and working experience did not
show statistically significant in this study but in contrast this results were contradicting with
other studies conducted by Greenberg (2003) believed that older people tend to be generally
more satisfied with their jobs than younger people.
5.4.2 Age group
According to Stephen (2005), satisfaction tends to increase continually among professionals as
they age, although it falls among non-professionals during middle age, rising again in the later
years. Moreover, as workers become older, they are less likely to resign their jobs, as they have
fewer alternative job opportunities. In addition, compared to younger employees, older workers
are less likely to resign because long tenure tends to provide them with higher wage rates,
longer paid vacations and benefits (Stephen, 2005).
67
Shah, Enezi, Chowdhury, and Otabi (2003) conducted a Cross Sectional study to explore the
determinants of job satisfaction among nurses in Kuwait. The findings of the study revealed
that the older nurses and nurses working in the Medical and Surgical department or ICU were
found to be more satisfied with their job. These findings are inconsistent with the current study
that identified that younger nurses, between the age of 20-30 years n= 60 (49.5%) were
moderately satisfied with their job. It also identified that nurses who were younger and had
experience between 1-5 years were more satisfied as compared to the older and experienced
nurses.
Wieck et al. (2010) reported that in the United States younger nurses were less satisfied than
those over the age of 40. One third of the nurses who participated in the study planned to leave
their job within two years of the survey date; over two thirds expected to leave within five
years. Sixty-one per cent of this group stated that they planned to leave their current jobs within
ten years. Similarly, Toa et al. (2012) indicated that in China older nurses were more satisfied
with their jobs, and with each additional year of age, a nurse’s job satisfaction improved about
0.06. Higher levels of satisfaction have also been linked to working longer in a specific unit or
hospital (Bjørk, Samdal, Hansen, Tørstad, 2007) which may also be related to the age of the
nurse and years of experience of nursing. Significantly, Moneke and Umeh (2013) and Penz et
al. (2008) concluded that age did not predict job satisfaction.
On the other hand, other researchers found that gender also received a great deal of attention
in job satisfaction however our results showed opposite. In comparison, several studies have
reported no significant difference between gender and job satisfaction (Kinanee, 2009; Meade,
Brown, and Trevan-Hawke, 2005). Other studies have found that gender affects job satisfaction
with the data indicating either males or females to be generally more satisfied with their job
(Clark, 1997). Hsiu-Yueh (2010) used a cross sectional survey to examine predictors of
occupational burnout among registered nurses in Taiwan. Hsiu-Yueh et al. (2010) found that
the turnover rate for male nurses in Taiwan was twice that of female nurses. The nursing
profession has long been recognised as a female profession.
68
5.4.3 Salary
With regard to salary, this study has found that salary showed significant different to job
satisfaction, therefore, nurses who has got highest paid were more likely to be satisfied
compared to low paid nurses. Since it was mentioned earlier that there was an economic
hardship, salary played great role on job satisfaction. Salary is defined as the money an
individual receives as payment from the organisation they work for. Money not only helps
people attain their basic needs but is also instrumental in providing upper-level need
satisfaction (Luthans, 2002). It would be reasonable to think that pay is an important indicator
of job satisfaction. Research evidence which relates the importance of nurse salary to job
satisfaction and retention has produced inconsistent results (O’Brien-Pallas, Duffield, and
Hayes, 2006). The relationship between pay and job satisfaction has been widely investigated,
with previous studies reporting pay and benefits as factors that positively relate to nurses’ job
satisfaction (Coomber and Barriball, 2007;Cowin, 2002; Daehlen, 2008; Mocharab and
Madarshahian, 2006; Williamsa, McDaniela, and Nguyena, 2006).
Study done by Shief (2008) stated that the employees are more satisfied when their salary is in
accordance with the amount of input they put. If the workers’ perception of their salary is not
good, then it would lead to lack of motivation and dissatisfaction comes in. Through increasing
the employee’s salary annually even if is with small percentage is one strategy to motivate the
workers. Organisations should try to reduce the gap between the salaries for the workers with
other highly paying organizations.
5.4.4 Level of Education
Nursing education is one of the most frequently examined biographical variables in studies
investigating job satisfaction. Results of this study showed that education has significant
difference with job satisfaction. Nurses with no degree or just have diploma were satisfied than
the nurses having Bachelor’s degree or Post-graduate certificates. Similarly, some studies have
found a positive association between nurses’ educational levels and job satisfaction (AlHussami, 2008; Mogharab , 2006; Monjamed , 2004; Rambur , 2005).
69
Another study from Kuwait by Shah, Enezi, Chowdhury, and Otabi, (2003) Stated that Diploma
holder nurses had showed a higher level of job satisfaction. The possible reason for these
findings could be that they were being giving a higher salary, having both the Diplomas, as
compared to the nurses who had only Diploma in Nursing. While on the other hand, others
have reported a negative association (Robinson, Murrells, and Clinton, 2006). A study by Liu.
(2011) examined how job satisfaction levels impacted nurses’ intention to leave their current
job. The results indicate that level of education (bachelors versus master’s degrees) influences
the likelihood that a nurse will experience levels of dissatisfaction.
In contrast, unlike our study numerous studies have found that there was no statistically
significant difference between nurses with diplomas and those with Bachelor’s degrees in
Overall job satisfaction score (AL-Dossary, Vail, and Macfarlane, 2012; Dunn 2005; Tao,
Zhang, Hu, and Zhang, 2012; Wang, Tao, Ellen becker, and Liu, 2012). Another from Kuwait
pointed that nurses having a Diploma in Nursing and Midwifery with Matric qualification were
found to have a moderate level of satisfaction as compared to those holding Diploma in nursing
only. (Shah, Enezi, Chowdhury, and Otabi, 2003).
5.4.5 Working Experience
Additionally, more years of working experience have been found to be associated with job
satisfaction in this study. In this study it was found that working experience has not significant
difference on job satisfaction. Together with a research by others (Oshagbemi 2003; and Shaha
et al. 2001). Wang et al. (2012) reported that in a study among 560 nurses working in four
hospitals in China, there was no statistically significant association between employment years
of working experience with total job satisfaction.
However, there is a reported study that has found the opposite. Ma et al. (2003) studied factors
influencing nurse job satisfaction in South Carolina hospitals. The results of the cross-sectional
study showed that experienced nurses with more than two years of experience had lower levels
of job satisfaction than new graduates with less than two years of experience. Hu and Liu
(2004) conducted a study among 403 nurses employed at hospitals in 16 provinces in China.
The findings indicated that nurses with more years of experience, higher professional titles,
and more opportunities to attend further education programmes were more likely to have a
70
higher level of job satisfaction than others. These findings were found to be inconsistent with
the previous findings of Shah, Enezi, Chowdhury, and Otabi (2003) and Khaliq et al (2011)
who reported that nurses with more clinical experience were more satisfied with their job then
the less experienced nurses in Kuwait and Pakistan, respectively
5.4.6 Current Position
Again, current position of the nurse had showed it has statistically significant difference on job
satisfaction. Nurse Managers were found to be more satisfied with their job compared to Staff
Nurses. The findings are in line with those of Curtise et al. (2007) and (Cowin, 2002), who
conducted a study to determine the level of job satisfaction among nurses in the Ireland. The
result of this study showed that professional status, interaction and autonomy made the greatest
contribution to nurse job satisfaction.
71
CHAPTER 6
CONCLUSION AND RECOMMENDATION
6.1 Conclusion
This study determine job satisfaction among nurses at Hargeisa Group Hospital (HGH) was
carried out to find out the satisfaction level of the nurses with the help of using Herzberg’s job
satisfaction motivators and hygiene factors. A set questionnaire was distributed to the nurses
to see the real situation among nurses. Independent t-test and one-way ANOVA (SPSS package
version 25) were used to interpret the results.
Based on the results from the present study, the following conclusions were forwarded:
a) More than half of the nurses at the Hargeisa Group Hospital (HGH) are dissatisfied
with their job, and that the job satisfaction level is somehow derived from co-worker
relationships, job independence, supervisor’s independence, improved working
conditions, job authority, security and responsibility.
b) Nurses earning more salary are more likely to be satisfied than nurses get lower monthly
income.
c) Nurses with having diploma or no certificates are more likely to be satisfied compared
nurses having Bachelor’s degree or Post-graduate.
d) It was clear that current position was playing great role on job satisfaction, where Nurse
Managers were more satisfied compared to staff nurses.
72
6.2
Recommendation
The recommendations basing on the findings are as follows:
Recommendations for nursing management
1. In order to increase nurses job satisfaction managers can use both hygienic and
motivation factors. In comparing the two of them, it was observed that motivational
factors appeared to be more important.
2. Special attention should be given to less earning nurses, well-educated nurses and Staff
Nurses, since most of them fall in this group and they are a work force. The chance of
losing them is very high if no efforts are done. The following could be helpful:
i.
Conducting regular supervision and providing immediate sound feedback.
ii.
Preparing building capacity and training sessions for health occupants / diploma
holding nurses with their Bachelor’s degree holder counterparts
iii.
Paying a special attention to job satisfaction predictors.
iv.
Creating fundraising projects to increase monthly income of less earning nurses
to motivate them.
v.
Assigning duties to less educated nurses in the company of well-educated
nurses.
vi.
Creating promotions for nurses to improve higher titles after they gain
experiences.
3. Since among all of the motivational factors, the ones that stood out as important were
authority, security and responsibility, it follows that appropriate mechanisms should be
developed and put in to practice by all level managers to effect the above-mentioned
factors. The following could be helpful:

Managers should provide freedom for nurses to decide on nursing matters by
their own experience and judgment.

Measures to ensure job security should be maintained place such as employment
on permanent terms
73
4. Qualitative research should be conducted to get an in-depth information about factors
influencing job satisfaction in a provincial hospital.
5. Impact of nurses’ working conditions on patient satisfaction should be researched to
take corrective measures based on scientific research.
In general, this study may be helpful in reducing job satisfaction among nurses at Hargeisa
Group Hospital (HGH). The outcomes got from the results were applied and followed as
the above mentioned recommendations and improvements, it is obvious that satisfaction
level will approach to 100% within short period of time.
74
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80
APPENDIX
81
APPENDIX A BUDGET
APPENDIX B GANTT CHART
APPPENDIX C1 CONSENT FORM
APPENDIX C2 QUESTIONNAIRES
APPENDIX C3 EMAIL
APPENDIX D REQUEST LATTER
APPENDIX E ETHICAL APPROVAL
APPENDIX F APPROVAL LATTER
APPENDIX G SOMALILAND MAP
APPENDIX H SPSS TEMPLATE
82
APPENDIX A BUDGET
Questionnaires
Token of the appreciation
A-4 paper
Faber Cost sell pen for respondents 0.10 Rm
Per paper 0.10 (photocopy)
1 pen Rm 1.70
152 papers x 0.10 = Rm 15.20
207 respondents’ x Rm 1.70 = Rm Rm 15.20 + Rm 351.90 =
351.90 Rm
Total
10 pen x1.70 = 17 Rm
Rm 367.10
83
APPENDIX B GANTT CHART
2018
RESEARCH
2019
ACTIVITIES
AU
SEP
G
T
OCT
NO
V
DEC
JAN
FEB
MARC
H
APRIL
MAY
JUNE
TOPIC SELECTION
LITERATURE
REVIEW
LOCATION
AND
RESEACH SAMPLE
DEVELOP
QUESTIONNAIRE
SUBMIT
RESEARCH
PROPOSAL
ETHIC APPROVAL
DATA
COLLECTION
DATA ANALYSIS
DOCUMENTATION
OF
RESEARCH
REPORT
RESEARCH
REPORT
SUBMISSION
84
APPENDIX C 1 CONSENT FORM
ASIA METROPOLOTAN UNIVERSITY CONSENT FORM
FACTORS CONTRIBUTING TO JOB SATISFACTION AMONG NURSES AT
HARGEISA GROUP HOSPITAL (HGH) IN HARGEISA, SOMALILAND.
I confirm that I have read/ been briefed regarding the procedures for the above study and have
had the opportunity to ask questions.
I understand that my participation in this study is voluntary and that I am free to withdraw at
the anytime, without giving reason.
I agree to take part of the above study
Name of the participant
Jaweria Abdirashid Farah
Data
Data
Signature
Signature
85
APPENDIX C2: Questionnaire (English Version)
Nurses Job Satisfaction Survey
This questionnaire has two parts: Part one is about your personal information, part two is about
overall job satisfaction. Each part has its own instructions. Please read each item carefully and
give your honest response to each item. If you overlook any item without giving response, it
will invalidate the study. So, please check that you have given your response to all items.
Section A: Socio-demographic information
Please respond to the questions below by ticking one appropriate circle
1. Gender
( ) Male
( ) Female
2. Age ( ) less than 25 years
( ) 25- 30 years
( ) 35 and above
3. Marital status
( ) Single
( ) Married
( ) Divorced or Widowed
86
4. Educational level
( ) Diploma
( ) Bachelor’s degree and Post-graduate degrees
( ) Health Occupation collage
5. What is your salary range per month?
( ) SLSH 477,000 – SLSH 954,000
( ) SLSH 1431,000- SLSH 1908,000
( ) SLSH 4770,000 – SLSH 9540,000
6. Please indicate how many dependent children do you have
____________________________
7. What is your current position?
( ) staff nurse
( ) Head of nurse
( ) Nursing manager (Supervisor, Deputy and Chief Nursing)
( ) Other, please indicate (Nursing Education and quality Control Nurses)
8. How many hours do you work?
( ) Less than 50 hours
( ) 50 hours and more
87
9. How long have you worked in this hospital?
( ) Less than 5 years.
( ) 5-10 years
( ) More than 10 years
Section B: Your feelings About Job Satisfaction
Instructions:
There are 15 statements about job satisfaction, and each statement has five alternatives with
five-point scale ranging: -
1 = Very Dissatisfied
2 = Dissatisfied
3= Neutral
4= Satisfied
5 =Very
Satisfied
Read each item carefully and for each question, please circle one number that best expresses
your feelings. If you feel that your job gives you more than you expected, choose “very
satisfied.” If you feel that your job gives you what you expected, choose “satisfied.” If you
can’t make up your mind whether or not the job gives you what you expected, choose “neutral
“(neither satisfied nor dissatisfied) If you feel that your job gives you less than you expected,
choose “dissatisfied.” If you feel that your job gives you much less than you expected, choose
“very dissatisfied.” Be frank and honest: Give a true picture of your feelings about your present
job
88
Nu
On my current job, this is how I feel about Very
mbe
dissatisfie
r
d
how much are you satisfied with your job
Dissatisfie Neutral Satisfie
Very
d
d
satisfied
1
2
3
4
5
1)
Hygiene factor and (Motivation) factors
2)
The way hospital is put in to practice
1
2
3
4
5
3)
My pay (salary) and the amount work I do
1
2
3
4
5
4)
Working conditions such as cleanliness of 1
2
3
4
5
2
3
4
5
2
3
4
5
the work place, healthy environmental
condition, enough tools and supplies. This
thing encourages me to work.
5)
The way my co-workers get along with each 1
other.
6)
Being able to do things that do not go against 1
my conscience
7)
The chance to do things for other people
1
2
3
4
5
8)
The chance to do something that makes use 1
2
3
4
5
2
3
4
5
2
3
4
5
of my abilities.
9)
The chance to do different things from time 1
to time.
10)
The way my job provides for steady 1
employment.
11)
The chance to tell people what to do.
1
2
3
4
5
12)
The praise I get for doing a good job
1
2
3
4
5
13)
The freedom to use my own judgment
1
2
3
4
5
14)
The chance for advancement on this job.
1
2
3
4
5
15)
The feeling of accomplishment I get from 1
2
3
4
5
the job.
89
APPENDIX C3 EMAIL
90
APPENDIX D REQUEST LATTER
91
APPENDIX E ETHICAL APPROVAL
92
APPENDIX F APPROVAL LETTER
93
APPENDIX G SOMALILAND MAP
94
APPENDIX H SPSS TEMPLATE
95
96