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Table 2 Summary table

From: Job satisfaction and career intentions of registered nurses in primary health care: an integrative review

Reference Aim Country Sample Methods Findings
Almalki et al. [42] Examine the relationship between quality of work life (QWL) and turnover intention Saudi Arabia 508 PHC nurses
(87% response)
Brooks Quality of Nursing Work Life
Anticipated Turnover Scale
• 67.3% female. 44% aged between 20 and 29 years.
• Mean time in current PHC organisation 6.6 years and mean 6.1 years in current position.
• Brooks’ scale can range from 42 to 252. Participants scored from 45 to 218 (mean 139.45), indicating they were dissatisfied with work life.
• 40% respondents indicated a desire to leave their current PHC workplace.
• Turnover was significantly related to quality of work life, explaining 26% of variance (p < 0.001).
• Quality of work life and demographics explained 32.1% of variance (p < 0.001).
• In the final model, work context (p < 0.001), duration in positional (p < 0.05), payment per month (p < 0.05), and gender (p < 0.05) were statistically significant.
Armstrong-Stassen [26] Compare work-related concerns, job satisfaction, and factors influencing retention Canada 1044 PHC nurses
(52% response)
Survey • 98% female. Mean age 44 years
• Employed in the position and agency for a mean of 8 years.
• 4/5 highest ranked concerns were the same across the 3 settings, namely; inadequate staffing, increasingly complex needs of clients, working with vulnerable families with many problems, and dealing with difficult clients.
• There were significant differences for 15 of the 17 work-related concerns between nurses from the 3 settings (p < 0.001).
• Community Care Access Centre nurses expressed greatest concern about the emotional effects of the job. HCNs reported significantly greater concern over working conditions and safety issues. PHNs reported significantly greater concern about poor facilities.
• There was a significant difference between the three groups for 6 of the 7 job satisfaction items (p < 0.001).
• 3 /5 highest ranked retention items were identical across the three settings, although the ranking order varied.
Best and Thurston [33] Test standardised job satisfaction tool Canada PHC Nurses
Pre: n = 44 (60% response).
Post: n = 43 (49% response)
Index of Worklife Satisfaction (IWS)
• Most important components of job satisfaction were autonomy then pay.
• Participants most satisfied with professional status.
• Satisfaction with professional status and interaction significantly increased over the study (p < 0.01).
• Aspects of work life giving the most satisfaction were quality client care / making a difference. Other factors identified included; autonomy/independence, colleague relationships, and opportunities for health teaching, respect/recognition, and client appreciation.
• An open-ended question asking about what respondents would change identified administrative concerns, the need for more educational opportunities, more time for client care, more respect/recognition, and more opportunity for independence/autonomy.
Betkus and MacLeod [43] Examine job and community satisfaction; how these relate to retention Canada 124 PHC nurses in rural and small urban communities (76% response) Survey
Piedmonte’s Work Satisfaction Index (WSI)
• 99% female. Mean age 43 years, 67% aged over 40 years.
• 60% were first licensed ≥20 years ago, 50% had worked 5 years or longer in PHC nursing, and 49% were in PPT positions
• Overall, most were satisfied. Most satisfied with professional status, professional interactions, and autonomy. Least satisfied with salary.
• PHC nurses had varied perceptions of the organisational environment.
• Nil correlation between age and job satisfaction (p > 0.05).
• 52% indicated intent to stay in position for 5 years or more;
• No correlation between job satisfaction and retention.
• 52% intended to stay in their job for ≥5 years. 28% planned to leave within 2 years – this was 43% of those aged ≤35 yrs.
• Factors impacting on decisions to stay were age, retirement, family circumstances and the economy.
• Job satisfaction and community satisfaction were correlated (p < 0.001).
Campbell, et al. [34] Impact of organisational structure on job satisfaction USA 192 PHC nurses (55% response) Survey
Alexander Structure Instrument (ASI)
McCloskey / Mueller Satisfaction Survey (MMSS)
• 96.9% female. 40.5% aged between 41 and 50 years.
• 85.9% worked full-time, 48% had worked in nursing ≥20 years, and 40% had been employed in their department < 5 years.
• The more that supervisors and subordinates work together concerning tasks and decisions and the more that individuals are involved in decision making and task definition, the higher job satisfaction.
• Increased vertical participation and horizontal decision-making opportunities equate to higher job satisfaction.
• Full-time staff reported higher levels of vertical participation compared to part-time staff (p < 0.002).
• ‘Formalization’ (i.e. standardised policy, practices and position responsibilities) was not significantly related to job satisfaction.
• Significant differences found between position classifications for total ASI score (p = 0.000), and vertical and horizontal participation subscales (p = 0.000).
• Global job satisfaction scores ranged from 75 to 144 (Mean 113.04; SD = 6.32). As 94 is the lowest score that indicates satisfaction, most participants were satisfied.
• No significant differences for job satisfaction were associated with current position or primary work assignment.
• Educational preparation made a difference to job satisfaction with MSN prepared nurses (8.5%) scoring highest on MMSS.
• To make the job more satisfying 27% indicated “better pay”, 19% wanted increased management feedback and staff recognition, 15% indicated a desire to have more input and decision-making opportunity in their jobs, and 4% sought to increase role clarity.
• 98% of participants planned to remain working in their health department.
• Enjoyment of what they do, autonomy, flexibility, scheduling, benefits, and low stress were reported as intention to remain working.
Cameron, et al. [35] Nurse satisfaction and retention in hospital and community settings Canada 644 Community nurses
(54% response)
Survey • Most participants female (97.5%), Mean age of 45.07 years and 60% work full-time
• Community nurses were significantly more likely than hospital nurses to report greater cohesiveness in the work place and a higher degree of support from supervisors related to feedback and recognition.
• Community nurses were significantly more likely than hospital nurses to report higher autonomy and greater satisfaction with work demands.
• Hospital nurses were significantly more likely than community nurses to be satisfied with remuneration.
Curtis & Glacken [37] Level of and factors affecting job satisfaction Ireland 351 PHC nurses (35.1% response) Survey
• 35% aged 36–45 years. 34.5% practiced as PHN 1-to-5 years
• 53.3% hadn’t worked as part of a primary care team previously.
• IWS score of 12.62 (range 0.5–39.7) suggests a low level of job satisfaction.
• Variables considered most important to their job satisfaction were: autonomy, interaction and pay. Task requirements were rated as least important to their job satisfaction.
• Statistically significant differences in IWS scores noted for 3 age groups (p < 0.05): < 35 years, 35–45 years, and 45 years (p = 0.000).
• The > 45 years age group were significantly more satisfied than younger colleagues.
• There was no significant difference in job satisfaction between the < 35 years group and the 35–45 years group (p = 0.574).
• Those employed as PHNs for > 10 years had a significantly higher job satisfaction compared to those with < 5 years (p = 0.001) and 6–10 years experience (p = 0.006). There was no significant difference between participants with < 5 years and 6–10 years experience (p = 0.995).
• There was no statistically significant difference between job satisfaction and educational background (p = 0.478), rurality of practice (p = 0.137) or if participants were members of a constituted primary care team (p = 0.16).
Cole, et al. [36] Difference in job satisfaction between nurse managers and nurses Canada 88 PHC nurses (20 managers and 68 staff nurses) (56% response) Survey
Stember’s model of job satisfaction
• 94% female, 75% worked full-time and 75% had flexibility in work schedules.
• Job experience: Managers’ 20–42 yrs. (mean 29.7 yrs); Staff nurses 1–50 yrs. (mean 21.6 yrs).
• Both managers and staff reported high job satisfaction – a mean > 3 for each subscale.
• There was no significant differences between managers and staff nurses on the total job satisfaction scores (p = 0.530).
• Managers were significantly less satisfied than staff nurses in both the ‘influence’(participation in decision making) (p = 0.026) and ‘interpersonal relationship’ (p = 0.008) subscales.
• The comparison of education levels and job satisfaction was inconclusive.
Delobelle et al. [2] Examine the relationship between job satisfaction, turnover intent and demographic variables South Africa 143 Rural PHC nurses
(82% response)
Survey & focus group
• 87% female, 58% were aged > 40 yrs.
• 83% had been working in the unit for 10 years or less.
• 51% of participants considered turnover within 2 years.
• Job satisfaction was reportedly moderate (Mean = 3.2; SD 0.5).
• Higher mean scores were attained for work itself and co-workers, and lower scores for pay and work conditions.
• There was a significant difference in job satisfaction amongst professional ranks - NA and ENs were more satisfied than RNs (p < 0.001)
• Job satisfaction negatively correlated with unit tenure (p < 0.05), professional rank (p < 0.01) and turnover intent (p < 0.01).
• There was no significant difference between job satisfaction and age, education or years of nursing.
• Turnover intent was statistically significantly explained by job satisfaction, age and education (p < 0.001).
• Younger and more highly educated nurses are more likely to show turnover intent.
• Nurses who reported more satisfaction with supervision were nearly 40% less likely to consider a job change.
• The most satisfying aspects of job were the nature of work itself, staff and patient relationships, adequate staffing and resources.
• The least satisfying aspects of the job were; work conditions (including lack of space), adequate staffing, lack of equipment and supplies, inadequate security, high workload, and the time spent doing non-nursing activities. Participants were also dissatisfied with their pay and benefits, lack of training and promotion, and lack of recognition and support from supervisors.
• When asked what factors would help in their work respondents identified work conditions and equipment (88%), improved pay (69%), additional training (60%) and more staffing (49%).
Doran et al. [38] Relationship between employment, job satisfaction and perceived job security Canada 700 HCNs (479 RNs, 211 RPNs, and 9 APNs)
(49.0% response)
Nursing Job Satisfaction Scale
• 98% female, mean age 45 years, mean 8.2 years of community experience, 30% full-time.
• A mean score of 3.84 (SD = 0.54) demonstrated that participants were moderately satisfied with work enjoyment.
• Of the items measuring work enjoyment, participants were least satisfied with the conditions of the job (1.69) and balance between work and leisure (2.14). A mean score of 2.62 (SD = 1.28) indicated a low level of satisfaction with job security.
• There were significant differences in nurses’ work enjoyment between agencies (p < 0.05).
• Older nurses rated work enjoyment higher than younger nurses.
• There were significant differences in participants’ satisfaction with time for care among agencies (p < 0.05).
• Participants who had been employed by the same agency for a longer period were less satisfied with time for care than those who had been employed by the same agency for a shorter period.
• Participants paid on an hourly basis were more satisfied with their time for care than those paid on a per-visit basis.
• Participants who were employed on a casual basis perceived less job security than those employed full-time.
Flynn and Deatrick [27] Identify attributes important to professional practice and job satisfaction USA 58 HCNs Focus groups • 91% female, Mean age 44.7 years, and had worked in HC 7 years or longer (50%).
• Continuing education opportunities were identified by all to enhance retention.
• There were 6 major categories and 8 sub-categories identified to positively influence and support job satisfaction and retention if present or working towards;
– ‘An extensive, preceptor-based orientation’
– ‘An organised and supportive office environment’ including; Real-time phone support, Interdisciplinary coordination and follow-up and Adequate and efficient clerical assistance
– ‘Reasonable working conditions’ including Realistic workload, Adequate staffing and Scheduled days off
– ‘Accessible field security’
– ‘Competent and supportive management’, including; Competent nursing supervisors and Supportive administrative practices
– ‘Patient-centred mission and values’
Graham et al. [39] Examine relationship between autonomy, control-over-practice, workload and job satisfaction Canada 271 PHC nurses (79.7% response) Survey • Mean age 42.5 years, 52% permanent full-time, 50% worked in PHC for < 7 years.
• 53.5% reported being very satisfied with their jobs.
• Control-over practice (p = 0.01) and workload (p < 0.01) were reliable predictors for job satisfaction.
• As workload increased job satisfaction decreased.
• Increases in control over practice scores were related to increased job satisfaction.
• Interaction between autonomy and workload was a significant predictor for job satisfaction (p < 0.01).
• The interaction between age and workload was a significant predictor for job satisfaction (p < 0.01).
Junious, et al. [28] Explore job satisfaction and changes needed to boost levels of job satisfaction USA 71 School Nurses (78.9% response) Focus Groups • All female, 55% worked in an elementary school, 84% had ≥3 years’ experience.
• 83% of participants reported being satisfied with their job.
• 17% were dissatisfied with their job, primarily related to poor remuneration and lack of trust / support from administration.
• Four major themes arose: (a) benefits, (b) resources, (c) autonomy, and (d) coping
• Theme 1 Benefits. Issues related to job satisfaction included things such as creativity, freedom, growth, power, work standards, and ethics. Participants were very satisfied with job flexibility and paid holidays.
• Theme 2 Resources. Resources, such as salary and supplies, were areas where participants were least satisfied with their jobs. Participants also wanted to be appreciated, valued, and compensated fairly for job performance.
• Theme 3 Autonomy. Autonomy was considered the ability to act independently within one’s scope of professional practice. When autonomy was not expressed, “isolation” emerged as the divergent theme. Over half of the participants stated that working with outside agencies increased satisfaction (53%).
• Strategies that could be implemented to increase satisfaction included; career or pay scale differentiating qualifications (52%), increased professional development (32%), supervision by another nurse rather than nonnurse (24%), and a designated budget / supplies (17%).
• Factors that negatively impacted on job satisfaction were; uncooperative staff and parents (61%), constant interruptions (48%), and the expectation that they would use their personal vehicle for work (13%).
Lorenz & Guiradello [19] Relationship between burnout, satisfaction at work, quality of work and the intention to quit Brazil 168 PHC nurses (58.5% response) Survey
Nursing Work Index-Revised
Maslach Burnout Inventory
• 88.4% female, Mean age 36.3 years, 6.6 years’ experience in primary care; employed 4.9 years at current job.
• Satisfaction measure on Likert scale. 62.6% considered that they were satisfied at work. 34.9% were dissatisfied.
• Satisfaction at work was significantly related to organisational support (p < 0.01) and control over the practice environment (p < 0.01).
• The intention to quit their job was significantly related to autonomy (p < 0.01)
O’Donnell, et al. [41] Degree of professional support felt by PHC nurses and their career intentions Scotland 200 PHC nurses
(61% response)
Survey • All female, 49% aged 40–49 years and 29% were aged > 50 years. Employed as PHC nurse for a mean of 10 years (Range 0.5–24.0 years).
• 15.5% intended to leave general practice in the next 5 years.
• There was a significant association between age and intention to leave employment (p = 0.001), with 60% of those intending to leave aged ≥50 years, although 40% were aged under 50 years.
• Isolated nurses are less likely to intend staying in practice nursing (p = 0.009).
• 52.3% felt isolated at least sometimes, 43.7% reported feeling isolated sometimes, and 31% of nurses worked alone.
• 77.3% of isolated nurses intended to continue working for the coming 5 years compared to 91.4% of non-isolated nurses.
• Factors contributing to feelings isolation are generally located in the work environment.
• Training and qualifications being used to the full and a productive appraisal both significantly reduce feelings of isolation, as did the intention to continue working in the future.
Royer [32] Perceptions of work and workplace to identify factors affecting tenure intent USA 478 C/PHC nurses (76% response) Survey
TCM Work Commitment Survey
• 73% clinical nurses, 11.6% were in management/administrative positions and 22% supervisors
• 70.5% of respondents were middle aged or nearing or at retirement age
• 1/3 were either thinking about leaving, looking into leaving, or planning to leave the job in 1 year
• Of the 70% of respondents aged > 45 years, 1/3 were planning to leave within 1 year.
• 46% of those aged 35–45 years were looking into leaving, and almost 40% of those aged 56–65 were thinking about leaving.
• Respondents aged 35–45 years are 4.3 times more likely to be looking into leaving compared with those nurses who are older.
• Respondents who have the least tenure (1–36 months) are 0.35 times less likely to be planning to leave < 1 year than those with greater tenure.
• Respondents who have increasing attachment (affective commitment) to the job are also 1.7 times more likely to be looking into leaving and three times more likely to be planning to leave within 1 year than those who are committed in other ways.
• Respondents who hold obligatory or loyalty commitment (normative) to the job are 1.4 times more likely to be planning to leave within 1 year than those who are committed by attachment or cost.
Storey et al. [29] Impact of age on retention England 485 PHC nurses (61% response) Survey • 78% respondents were aged between 40 and 59 years. 47% worked full-time.
• 178 district nurses, 114 health visitors, 56 school nurses, and 137 practice nurses
• 61% indicated that their role lived up to expectations. There was no significant difference across professional groups.
• Older nurses are more likely to report that their role lived up to expectations opposed to younger ones (p = 0.001).
• There was no difference in happiness in their current role between those aged under and over 50 years.
• Older nurses were more likely to report being happy working in nursing than those < 50 years (p = 0.006).
• Stress and job satisfaction were identified as key factors contributing to respondents views of working as a nurse.
• School nurses were significantly less happy than other groups in their current role (p = 0.006).
• Sources of unhappiness were identified as excessive workload, low morale, disillusionment, high administrative workload, perceived lack of support and staff shortages.
• In terms of job satisfaction, ‘relationships with other people at work’ (62%), ‘the actual job itself’ (60%),’ the level of job security in your present job’ (55%) were highest scored.
• There was a statistically significant difference between those aged under and over 50 years on nine items related to job satisfaction.
• There was a statistically significant difference between those aged under and over 50 years on nine items related to factors encouraging them to stay.
• Highest scored scales of dissatisfaction related to salary relative to experience (27%), change management’ (21%), and organisational communications (18%).
• Enhanced pay is a factor encouraging retention (p = 0.044) for those with degree-level qualifications.
• Significant potential causes of nurses leaving were high administrative workloads, problems in combining work and family commitments (p > 0.001), and lack of workplace support (p = 0.029).
Stuart et al. [30] Workload management, job satisfaction and challenges Scotland 31 district nurses Focus groups & interviews • Most job satisfaction is derived from the ‘hands-on nature’ of patient care using clinical knowledge and skills.
• Nurses liked the ‘personal nature’ of caring for patients in this setting and the formation of ongoing and sometimes intergenerational relationships.
• Job dissatisfaction arises with overwhelming workloads, increased time pressure and policy change that negatively affects patient care and feeling devalued.
• Nurses are dissatisfied as administrative tasks are taking them away from patient care.
Tourangeau [31] Factors affecting intention to remain employed Canada 50 PHC nurses Focus groups • 6 categories were found to influence nurse intention to remain employed:
 I. Job characteristics: variation in clientele and wide use of nursing skills, autonomous nature of work, decision authority;
 II. Work structures: continuity of care, appropriateness of client expectations, and flexibility in scheduling work hours, workload and use of technology.
 III. Relationships and communication: clients and families, physicians nursing colleagues, supervisors, CCAC case managers;
 IV. Work environment: professional practice environment: orientation, education and training; physical work environment: travel demands, access to resources and personal safety;
 V. Nurse responses to work: work-life balance, meaningfulness of work.
 VI. Employment conditions: employment status, union status, pay and benefits, unpaid work, work-related expenses, and income stability;
• Job satisfaction was not a reported concept affecting intention to remain employed.
Tullai-McGuinness [40] Predictors of job satisfaction USA 201 PHC nurses (42.5% response) Survey
Nurse Work Index-Revised
Global Appraisal of Autonomous Practice
• Mean age 45 years. Mean experience 17.8 years, with a mean of 8.3 years HC experience. 75% employed fulltime.
• Almost 77% of HC nurses were satisfied (ratings > 60).
• Diploma nurses had lower satisfaction (69.25%), compared to baccalaureate (74.43%) and associate degree (75.21%) nurses (p > 0.05).
• There was an inverse relationship between years worked as a home healthcare nurse and satisfaction (p < 0.01).
• Controlling for years of experience significant predictors of satisfaction were control over practice decisions and practice setting decisions.