RESEARCH ARTICLES

Job satisfaction of intensive nursing staff of a teaching hospital

Gelena Lucinéia Gomes da Silva Versa^I; Laura Misue Matsuda^II

ABSTRACT: Descriptive and analytic study, conducted in October, 2010. It aims both at determining Index of Work Satisfaction (IWS) of adult intensive care unit nursing staff and at assessing the influence of socio demographic characteristics of that team on job satisfaction. The IWS questionnaire was applied to 27 (82%) intensive care professionals from a university hospital in northwestern Paraná, Brazil. Data were treated by descriptive analysis. An 11.01 IWS was identified among nursing technicians and an 8.62 IWS among nurses. Outstanding profile characteristics were as follows: female; from 20 to 29 years old; married; with children; dual employment; low remuneration; working in critical unit for longer time aa well as holding a position as a nurse together occurred on lower levels of job satisfaction. Conclusions show staff’s dissatisfaction at work resulted from lack of profession reassurance, interaction difficulties, and low remuneration.

Keywords: Job satisfaction; occupational health; nursing; intensive care units. 

INTRODUCTION

Economic, political and social changes have provoked many technological innovations, and as a result, working methods have been an object of research, especially those related to adaptations in the work environment, in order to achieve workers' satisfaction^III. Work satisfaction, especially in the field of life sciences, has gained great importance, as it reflects on personal life and healthcare services¹.

In regards of the concept of work satisfaction, it is defined as "[...] a positive affective state resulting from the appraisal of employment or employment-related experiences [...]"^2:9. Therefore, it is possible to say that work satisfaction depends on various factors, from the kind of work to each individual's experiences. In nursing, work is characterized by an excessive amount of activities and by direct contact with stressful situations³, which can interfere negatively in the workers' health and work satisfaction.

Regarding nursing workplaces, intensive care units (ICUs) are characterized as hostile environments for these workers' health, due to critical care demands and frequent emergency situations, suffering and pain4, which are circumstances that favor the emergence of diseases and dissatisfaction.

LITERATURE REVIEW

In view of the situation presented above, the development of this study is explained by the fact that investigations related to work satisfaction of intensive care nursing staff can provide new data that allow managers and staff to improve working conditions and consequently care given in ICUs.

In order to guide this investigation, the following questions were addressed: What is the level of satisfaction of intensive care nursing professionals? Do sociodemographic features interfere in work satisfaction of adult intensive care nursing staff?

To answer these questions, the development of this study was proposed, and its objectives were: to determine the Index of Work Satisfaction (IWS) of the nursing staff of an adult intensive care unit; and to assess the influence of the staff sociodemographic characteristics on work satisfaction.

Concerning the occupational risks in ICU, it is worth mentioning physical characteristics of risks to occupational health, which are typical of these units, such as a refrigerated and closed environment, with noise and artificial light⁴, which can result in health problems and job dissatisfaction.

Regarding world scientific output on work satisfaction in nursing, according to some review studies^5,6, there is a serious lack of studies on the topic, especially regarding work satisfaction of intensive care nursing staff, despite the increase of such publications in the 1990s⁷.

As for the level of satisfaction of ICU nursing professionals, some studies indicate that they are dissatisfied with their job due to the characteristics of the work itself, such as providing care for seriously injured people, having a very heavy workload and working in a hermetic environment^7,8.

METHODOLOGY

This is a quantitative, cross-sectional and descriptive study, carried out in an adult ICU of a teaching hospital in northwest Paraná, in October 2010. The referred ICU has eight beds and cares for patients, aged 14 or over, with different sorts of pathology and who come from the Brazilian Unified Health System (SUS, as per its acronym in Portuguese).

The sample was made of 27 professionals (82%) of the nursing staff, of which 10 were nurses and 17 were nursing technicians (NT), who met the following inclusion criteria: having worked for at least 6 months in the adult ICU; being an employee of the institution (hired through a public examination) and working with direct care for patients.

Data were collected by means of scheduled interviews, with the application of the IWS (Index of Work Satisfaction)⁸, which was translated into Portuguese and validated for Brazil in 1999².

The IWS consists of two parts: part I containing 15 sociodemographic features and part II including the assessment features for work satisfaction, which were divided into two subitems - A and B8.

In subitem A, there were 15 combinations of 6 IWS components (autonomy, interaction, professional situation, job requirements, organizational rules and salary). In this subitem, based on paired comparisons, the respondent had to rate the importance of each component for work satisfaction, by indicating one option for each combination².

Subitem B was a Likert scale, made of 44 items and answering options from 1 to 7. In this rating, the closer the answer was to 1, the more the respondent agreed with the statement, whereas the closer the answer was to 7, the more the respondent disagreed with the statement.

After data collection, the information was compiled on a Microsoft Excel® database, and then the spreadsheets were exported to Statistica 8.0® software, in order to perform descriptive statistical analyses.

Regarding the achievement of the actual level of work satisfaction (which was the focus of this study), the weighted mean was calculated between subitems A and B from ISW part II. That is, the weighting coefficient (obtained by the calculation of pair-wise comparisons) was multiplied by the mean score of each component (division of the total score of each component by the number of items), which resulted in an adjusted score by component of work satisfaction. Subsequently, the scores of the adjusted components were added and then divided by the number of components (6), resulting in the IWS score, which varied between 0.9 and 37.18.

In order to verify the relationship between the IWS and sociodemographic variables, the IWS was calculated for each sociodemographic variable, and then a descriptive analysis of this relationship was performed.

The development of this study complied with Resolution 196/19969. The research proposal was approved by the Human Research Ethics Committee (COPEP) of the State University of Maringá - Paraná, under protocol no. 461/2010.

RESULTS AND DISCUSSION
 
Intensive care professionals of the studied institution are mostly married young women, as shown in Table 1. Prevalence of female gender in ICU matched the profile of Brazilian nursing, in which there is a predominance of women¹⁰. Regarding their age, a mean of 35.6 years indicates that the staff is relatively young. This feature was actually expected, as the place requires young and agile professionals to meet the requirements of an intense work routine⁴.

As for the IWS, we observe that certain sociodemographic features were associated with lower scores in the IWS, which were: female gender; the youngest age group (20 to 29); married; with children; dual employment; income between 1 and 3 minimum wages; working in ICU for more than 4 years; position as a nurse, as presented in Table 1.

Regarding the gender of the nursing staff, international publications indicate that women have higher levels of work satisfaction than men^5,6. However, a study found in the Brazilian literature obtained statistically significant results of work satisfaction associated with gender (p=0.030): men had higher levels of work satisfaction than women¹¹, confirming the information of the present study, in which male nursing professionals also had higher levels in the IWS.

The lower scores in the IWS for women may be associated with the accumulation of duties and responsibilities at work and within the family, which results in physical and mental weariness11 and are very common in the Brazilian society, where women have been greatly responsible for the education of children and the organization of the household¹². Worthy of note that the highest score among men in the IWS is not representative enough to make inferences about intensive nursing as a whole, as the sample of male professionals was small, with only 5 workers (8.46%).

The features married and with children did not favor work satisfaction of the studied staff, as married professionals with children had lower scores in the IWS, as shown in Table 1. It is important to note that these variables are perceived as stress factors resulting from the accumulation of duties and responsibilities, once these features can have a negative effect on work satisfaction¹³.

Married professionals with children reconcile work, family responsibilities and household duties. This situation favors the occurrence of physical and mental weariness, such as depression, fatigue and work dissatisfaction^13,14. By contrast, other studies pointed out that these variables can act as emotional support for the worker¹⁰. In that sense, the family situation married with children can have both positive and negative impacts on workers' well-being and satisfaction with their jobs.

As for working time, professionals who have worked for more than 4 years in ICUs had lower rates in the IWS, according to Table 1. This demonstrates that this feature can have an effect on work satisfaction. The period of work in ICUs is proportional to exposure to physical, biological, ergonomic, psychosocial and chemical risk factors⁴, thus, the longer the working time in a critical environment, the greater the risks of health problems and high levels of work dissatisfaction.

Regarding age group, professionals who were between 20 and 29 had lower scores in the IWS - 8.88 - as shown in Table 1. In addition, there was a progressive increase in satisfaction with salary as age advanced.

According to a study carried out in China, the older the professional, the greater their satisfaction, as it increases proportionally over time with their improved financial situation⁷. In this study, despite knowing that age alone does not ensure higher wages, the fact that it was carried out in a public institution - where there is a career and salary plan - the variables age and salary could have an effect on workers' greater satisfaction.

Low-wage workers (earning between 1 and 3 minimum wages) were less satisfied than those with higher wages; this fact is in line with the literature, which mentions the association of low income with work dissatisfaction¹⁵. In addition to generating dissatisfaction, low wages lead to another aggravating circumstance: many professionals are forced to commit to another employment, and this causes even more dissatisfaction⁸.

In this study, the lowest scores in the IWS were found among people with more than one job. Having two or more employments is considered to be harmful to health and work satisfaction, as professionals are exposed to greater risks of becoming ill, to heavy workloads and high physical and mental wear. Thus, it can have negative effects on workers' social life and leisure^7,8.

As for the general scores of the IWS, nurses had lower scores (8.82) than nursing technicians (11.01).
The nurses' low scores in the IWS are particularly worrying, especially if compared to the results of a previous study carried out in 2002 at the same place as the present study⁸, which found a score of 12.08, showing a 28.64% decrease. The IWS of components of work satisfaction for nurses and nursing technicians obtained in this study and in the one carried out in 2002⁸ are found in Table 2.

Nurses of the present study are more satisfied with the component organizational rules and nursing technicians with interaction, according to Table 2. A greater satisfaction with organizational rules among nurses occurred because 6 of them (60%) reported that they are consulted by the general management about everyday problems and 6 (60%) disagreed with the gap that exists between management and healthcare services. In that sense, great satisfaction with this component occurred as a result of the adoption of a democratic management model, which favored nurses' work and consequently their work satisfaction.

In the previous study⁸, the component organizational rules was ranked fourth by nurses. This score may be associated with the work reality of these professionals, as in 2002 the ICU had only been active for 2 years, and consequently, the unit's rules and routine were still in process of construction and/or adaptation.
Interaction was the component with the highest level of satisfaction among nursing technicians in both studies - from 2002 and 2010. In the current study, 12 professionals (70.5%) reported the existence of teamwork; 9 of them (53%) agreed that the group is friendly/outgoing and 13 (76.4%) stated that colleagues are ready to help each other. Regarding nurses' satisfaction with interaction, a sharp drop is observed between 2002 and 2010, as seen in Table 2.

This decrease in the interaction score may have occurred because the ICU doubled the number of beds in 2003. As a result, changes that took place may have influenced the relationship between professionals, such as: care for patients with more complex and severe illnesses; increase in the staff; and changes in the nursing work process. Another interfering factor in staff interaction concerns the division of duties, which are inherent to the profession and result in personal and professional conflicts¹⁶, caused by the hierarchy between nurses and nursing technicians. As the working environment of ICUs is a stressful place, where duties are complex and the levels of anxiety and tension are high¹⁰, work process of the studied team may have increased even more the difficulties of relationship, as heavy workload and lack of time to rest can have a negative impact on interpersonal relations¹⁷.

It is important to underline that dissatisfaction with work interaction also have an effect on job requirements², which is the fourth component with the highest level of satisfaction among nurses and third among nursing technicians, as presented in Table 2. Moreover, interaction may have influenced satisfaction with job requirements, as an adequate relationship among professionals favors teamwork, especially in critical areas that are characterized by heavy workload and high levels of stress and tension¹⁰.

For the component job requirements, 11 professionals (40.7%) reported not having enough time for giving care. Thus, this score suggests that heavy workload and short time for giving care had a negative effect on work satisfaction. Heavy workload of critical departments are harmful factors for work satisfaction, as overload and difficulty in achieving duties trigger feelings of frustration and work dissatisfaction^2,8.

Another component that is worth mentioning is salary, which had a decrease in satisfaction levels between 2002 and 2010, for both categories of intensive care professionals, as nurses' scores in the IWS went from 16.95 to 9.40 and nursing technicians' from 15.30 to 10.70. The decrease in satisfaction with salary may have been triggered by a low purchasing power caused by the devaluation of wages and by the economic instability of the current capitalist model^11,12, and even by the sharp decrease of the perception of what a good salary is, which is common among workers in the course of time.

Salary is a common issue in the nursing reality and is reported to be one of the main reasons for concern and dissatisfaction among professionals, according to Brazilian and foreign literature^7-8,18. Thus, the approach to this matter needs to be further studied, with different methodologies, and salary equalization with other health professions is also necessary. It is important to note that low pay, besides being a reason for dissatisfaction, affects the worker's own value and perception of their professional status, as capitalist economies tend to value well-paid professions^2,16.

Observing Table 2, it is possible to see that both in the present study and in the previous one⁸, the component professional status was defined as the least satisfying among nurses and nursing technicians. This confirms the results of other studies^5,14,18, in which nursing professionals pointed out low satisfaction with salary, due to the lack of recognition and appreciation of their category. Nursing is still not widely recognized as an important category⁸. Moreover, lack of financial reward, accumulation of work and low expectation of career growth are some of the factors that cause low satisfaction with status^2,5,8 and this can have a negative impact on workers' self-image and self-esteem.

Regarding appreciation and recognition of nursing, it is worth mentioning that professional autonomy is one of the elements that most provides professionalism and prestige². Therefore, nursing has to gain recognition and autonomy through science, efficiency and organization, as well as quality-oriented care practices.

Analysis of the component autonomy shows a decrease among nurses, from 13.3 to 8.67 points, as only 8 workers (29.6%) stated having freedom to make decisions and 5 of them (50%) reported having little control over their work. These data are worrying, considering that little autonomy affects nurses' roles and limits their action, recognition and appreciation.

It should be stressed that autonomy in ICU nursing may be compromised by the current model of critical care, which is focused on the physician’s role, thus restricting the field and actions of nursing². To minimize this situation, some measures can be taken, such as the definition of nurses' role and incentive to continuing education in intensive nursing.

As for the general IWS related to position, the nurse category had a score of 8.62 in the IWS, and nursing technicians a score of 11.01, which indicate low work satisfaction among these professionals, as seen in Table 1.

Low work satisfaction among nurses is in line with results of previous studies, whose scores in the IWS were 9.602, 12.088 and 10.0219. Thus, national literature points to professional dissatisfaction of nurses, even among those who work in different areas.

It is important to highlight that, regarding this low work satisfaction, these workers are responsible for coordinating the activities carried out within the unit, besides being in charge of care for critical patients4. As a result, the high degree of responsibility and workload may have favored the occurrence of low scores in the IWS among these professionals.

The IWS among nursing technicians was 11.01, and when compared to the only Brazilian study that assessed the IWS of this category, which was of 11.338, the variation in these results is not meaningful, which suggests that dissatisfaction remained stable and that it is a recurrent problem.

It is relevant to mention the low number of studies on work satisfaction of nursing technicians, especially because this category does not exist in many countries, and therefore, research on this topic is limited to Brazilian studies, which makes it evident that new studies including this category are necessary and urgent.

CONCLUSIONS

Nurses had 8.62 points in the IWS and nursing technicians 11.01. Thus, the professionals who participated in this study are dissatisfied with work, and the causes are mainly related to the lack of professional recognition and difficulties in interacting, as well as low pay. Regarding sociodemographic characteristics, some of them had low scores in the IWS, namely: female gender, age between 20 and 29 years old; with children; dual employment; married; income between 1 and 3 minimum wages; working in UCI for more than 4 years; position as a nurse.

Lack of recognition and appreciation of nurses by other professions and/or society was the main reason for dissatisfaction among nurses and nursing technicians.

It is important to note, as a methodological limitation, that this study presented facts of an actual Brazilian ICU, so when different realities are studied and analyzed, the singularities of their context must be taken into account and components related to work satisfaction must be reviewed.

The results of this study are expected to foster reflection and discussion among managers and staff in order to improve intensive care nursing, and consequently, workers' satisfaction. We also suggest that further research be done, so as to assess possible impacts of work (dis)satisfaction on workers' health and also on quality of care given in ICUs.

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