Pakistan Journal of Public Health, 2016 ( December )

Pak J Public Health Vol. 6, No. 4, 2016 Original Article

JOB SATISFACTION AMONG NURSES IN PUBLIC AND PRIVATE HOSPITALS OF RAWALPINDI

AND ISLAMABAD

Saman Waqar1, Saima Hamid2

1
PhD Fellow, Health Services Academy, Islamabad.2Associates Professor, Health Services Academy, Islamabad.
1
Corresponding Author: PhD Fellow, Health Services Academy, Islamabad. Email: saman.naqvi@yahoo.com

Abstract
Background: Job satisfaction is an important factor for retention of health workers within organization. Multiple
factors have influenced the job satisfaction among nurses working in the public sector hospitals of Pakistan. This
study was conducted to quantify and compare the levels of job satisfaction among nurses of tertiary care public and
private hospitals.
Methods: A cross sectional comparative study was conducted in one Public and one Private hospital in Rawalpindi
and Islamabad over the period of 6 months. The study included all nurses registered with Pakistan Nursing Council
(PNC). Sampling was done by first acquiring the list of all the hospitals from Rawalpindi and Islamabad, 2 hospitals
were then selected. Afterwards, the list of all the registered nurses was taken; sample size was determined by
applying inclusion / exclusion criteria and by simple random technique by computer generated method. Data was
analyzed by using SSS.
Results: Results showed that working conditions were more comfortable and working relations with male
coworkers were friendlier in private hospital as compared to public hospitals. Satisfaction with the competence of
senior nurses, and administrative support in service problems was also more in private hospital. Majority of public
hospital nurses were satisfied with their profession because of manageable duty hours, pay and other benefits
provided and administrative support in their domestic problems. On the other hand private hospital nurses were
more satisfied with positive feedback of their performance, professional growth, and promotion system.
Conclusion: There is a dire need to improve the conditions regarding working schedule, working environment and
management support of nursing staff of hospitals in Pakistan.
Key words: Job satisfaction, nurses, nursing experience, sociocultural aspects.

Introduction: major factors leading to dissatisfaction of nursing work

Introduction: Nurse means to treat with care1. WHO has force. By addressing these issues, satisfaction of
defined a nurse as a person who has basic qualification nursing staff can be improved and will attract more
in nursing education and practices nursing in their area competent people in this profession (5). The aim of this
(1). A qualified nurse offers nursing care for promotion of study is to address the problems faced by nurses so a
health and illness prevention (2). They form a significant timely action can be taken for their solution.
connection between the patient and the doctor by Methodology: Study was conducted in public and
providing the healthcare and reducing the private tertiary care hospital of Rawalpindi and
communication gap between the patient and the doctor Islamabad over a period of 6 months. The study design
(3). For the health system to work appropriately, nurses was comparative cross-sectional and intended to
have to be motivated, which is directly associated with quantify the proportion of nurses satisfied with their job
their job satisfaction (4). Job satisfaction is an enjoyable and to compare this proportion between the public and
emotional condition resulting from appraisal of one's job private sector. The hypothesis thus formulated was
experience (5). Features influencing job satisfaction are tested at Alpha = 0.05 (significance level), the power of
type of job, salary, promotion, management, and the study was kept at 80%. The anticipated population
working circumstances (6). A well-organized proportion for the public sector nurses was set at 0.50
organization usually sees a worker as a main source of whereas the same was kept at 0.65 for the private sector
quality and productivity (7). In Pakistan, work overload is (8). A difference of 15% was expected in the satisfaction
causing dissatisfaction among nurses resulting in poor level of public and private hospitals. Minimum sample
quality of patient care and poor performing health size for the study was calculated using sample size
system. In addition, professional, financial calculation software by WHO and for each group of
insufficiencies as well as attitude of colleagues are the nurses was 76 (9). Simple Random Sampling from

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 Pakistan Journal of Public Health, 2016 ( December )

among the two major public and private sector tertiary There were 43 matriculated, 57 FA/FSc, 49 BA/BSc and
care hospitals of Rawalpindi and Islamabad was done. 3 MA/MPhil nurses. 138 were married and 14 were
All the nurses of the selected public and private tertiary unmarried (Figure 1). Range of number of service years
care hospitals who were registered with PNC were was between 1 and 33 with a mean of 13. Salary of the
included in the study. Nurses who were either not nurses was between 9000 and 44000 with a median of
registered or had an expired registration were excluded 17000. Chi square was applied to see the proportion of
from the study and so were Paramedics, other allied nurses satisfied in their work schedule, working
health care professionals and nurses with a job environment and management support.it is important to
experience (in present) position of 1 year or less. Two note that a greater proportion of public sector nurses
major tertiary care hospitals were selected for the were more satisfied (89.5%) as compared to private
conduct of the study, one each from the Public and the sector (75%), x2(1, n=152) =5.449, p=0.001 (Figure 2).
Private sector. Selection of these hospitals from all of As far as the satisfaction with promotion system is
the hospitals of the twin cities was made, based on an concerned, proportion of nurses in private sector
assumption that these two would be the best (78.9%) were more satisfied as compared to public
representative of the targeted population. Upon the sector (60%), x2(1, n=152) =6.110, p=0.022. Results of
grant of organizational consent, lists of all the employed administrative support in service problems showed that
nursing personnel were obtained. A sampling frame was private sector nurses were more satisfied (98.7%) as
created and adequate sample size was calculated. The compare to public sector nurses (85.5%), x2(1, n=152)
sampling frame consisted of 1154 individuals; a list of =9.048, p=0.007. Regarding managing kids with the job,
152 random numbers was generated using computer proportion of public sector nurses were more satisfied
software Microsoft Excel 2003. These 152 individuals (100%) as compared to private sector nurses (88.2%),
were all included in the sample. Out of 152 respondents, x2(1) = 8.621, p<0.05 (Table 1).
76 respondents were from public hospitals and 76 from a
private hospital.
Never bothered by extra work
Each independent respondent was approached and a
formal written consent was obtained after having
adequately explained the objectives and the rationale
for the study. A structured questionnaire was Working schedule managable
administered with first section containing demographic
Night du es managable Private
variables like age, marital status, number of service
Public
years, qualification. The questionnaire was prepared
keeping in mind all the possible factors affecting job
satisfaction of nurses. It mainly covered 3 basic areas of Work managable with kids

working environment, working schedule and

Sa sfied with Rota ons
management support affecting job satisfaction of
nurses. All the questions in the questionnaire were 0 20 40 60 80 100
closed ended and their responses were based on Likert
scale, 9 which was modified for certain questions
depending on the desired targeted information. These
responses were coded and their coding was used for Figure:1 Percentages of the responses regarding
data entry and generating a satisfaction scores for every working schedule of the respondents in Public and
individual. Certain other questions which had Private hospitals
dichotomous responses did not contribute to the
satisfaction score. The questionnaire was administered
and filled by the primary researcher alone. It was
developed in English however at the time of interviewing
the respondents; their queries were explained in Urdu as
well. The order of responses to the questions
contributing to the final satisfaction score was
meticulously looked into; ensuring that positive
response to every question scores the highest in each
category. SPSS-15 software was used to analyze the
data.
Results:
There were 144 females and 8 male respondents.
Minimum age of the respondents was 20 and maximum
was 50 with a mean age of 36. There were 108 staff
nurses, 41 head nurses and 3 nursing superintendents.

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 Pakistan Journal of Public Health, 2016 ( December )

Figure:2 Percentages of
the job satisfaction
regarding management
support in Public and
Private hospitals

Table:1 Frequencies and percentages of the nursing deficiency, retention of nursing staff is extremely
responses regarding working environment in Public critical to healthcare industry. Management of the
and Private Hospitals hospitals must be equipped with the information needed
S.N Variables Public Private Total
to help in creating a place of work that will draw new
nurses and retain old ones. Nurses often work in
N % N % N %
substandard conditions with insufficient staffing and
1. Working conditions 56 73.3 66 86.8 122 80.3
deficiency of necessary supplies. These things, among
comfortable others, may lead to job dissatisfaction and pushes
2. satisfied with 48 63.2 53 69.7 101 66.4
nurses to find employment somewhere else, frequently
accommodation facilities outside the field of nursing. This study is an effort to
3. Satisfied with the friendly 76 100 74 97.4 150 98.7 compare the levels of job satisfaction among nurses of
working relation public and private institutions. Satisfaction level was
4. Satisfied with attitude of 68 89.5 73 96.1 141 92.8 high in age group between 34-46 years, mainly because
male coworkers of adjustment to the job and more job prospects; similar
5. Satisfied with the respect 62 81.6 65 85.5 127 83.6 results were found in the study in Grafton Base
given by the community Hospital12 where young age group was less satisfied
6. Satisfied with skill utilization 76 100 76 100 152 100 due to low career opportunities. Another study showed
that younger nurses and better educated respondents
7. Not getting bored with the 75 98.7 74 97.4 149 98.5 were more satisfied with their jobs (1). Head nurses and
same routine
nursing superintendents reported higher satisfaction
8. Job providing feeling of 70 92.1 70 92.1 140 92.1 because of higher pay, more autonomy and experience.
accomplishment
Similar results were shown in a study at Sidama (5).
9. Profession is a major 76 100 74 97.4 150 98.7 Respondents were mostly married (127), some reported
contributor in improving
health difficulty in managing domestic affairs with their jobs and
10. Would choose the same 65 85.5 64 84.2 129 84.9
this was very similar to the study conducted in Regional
profession again Public Hospital Heti (12). Skill utilization in Private and
Public hospitals was same which was were very
dissimilar to the study carried out in Islamabad where
Discussion: nurses in the private hospitals were more satisfied with
The notion of job satisfaction among nurses is of their skill utilization1. Similar results were found in the
exceptionally important. Satisfied nurses more likely study carried out in Abbottabad13 where nurses were
stay in field of nursing and in the organization in which mostly dissatisfied with poor skill utilization and low
they are satisfied. Taking into account the considerable salaries. In contrast a study in Cyprus showed that skills

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 Pakistan Journal of Public Health, 2016 ( December )

utilization was the least satisfactory element (4). (1). Private hospital nurses were praised and
Working conditions were comparatively better in private encouraged more after doing a good job as also seen in
hospitals which were similar to the study conducted in study conducted in Islamabad1 and Cyprus (4).
Islamabad.1 and at Heti hospital.12 Also study at Similarly, nurses at Sidama (5) and Abbottabad (13) had
Abbottabad showed that poor working conditions were a constant sense of being undervalued and not being
among the top dissatisfying factors (13). Nurses in acknowledged resulting in demotivation and
private hospital were more satisfied with training dissatisfaction. Private hospital nurses were less
courses compared to public hospitals, similar to studies satisfied with their pay as compared to public hospital.
conducted in Islamabad (1) where the educational Study at Rawalpindi also showed that respondents with
opportunities were more in the private hospitals and better salary packages had more satisfaction levels
study in Sidama (5) where most of the respondents were (10). In contrast, the study at Sidama showed that pay
satisfied with their jobs because of in-service education was not among the top factors for job satisfaction (5),
and training. Nurses at Abbottabad were highly and nurses in Regional Public Hospital Haiti were
dissatisfied with their educational and developmental satisfied with even lesser pay as they had more job
opportunities (13). Private hospital had more promotion security as compared to private hospitals (12). Study
opportunities as compared to public hospitals. Similarly, conducted in Saudi Arabia showed that nurses who
study conducted in Regional Public Hospital Haiti worked near their villages were more satisfied. Working
showed that one of the most dissatisfying factors was schedule and managing kids at home was more in
poor promotion possibilities. Respondents in private private hospitals as compared to public hospitals.11 In
hospital were more satisfied with rotational duties and this study, nurses in public hospitals were more satisfied
flexible working schedule as compared to public with the working schedule (94.7%) and grooming of kids
hospitals. Study conducted in Heti had similar result (90.8%) as compared to private hospitals ((85.5%) and
where nurses working on night duties had a constant (78.9%) respectively. Attitude of male coworkers and
sense of being undervalued and less acknowledged respect given by the community was much better in
(12). However some showed higher level of job private hospital as compared to public hospital, similarly
satisfaction working on night rotation as they could a study at Islamabad showed that no respect was shown
continue their academic studies. Similarly study in Saudi by the patients, relatives and the doctors in the public
Arabian hospital also revealed that nurses preferred one hospitals (1). A study at Cyprus (4) and Rawalpindi (10)
shift duty because of social and family obligations and showed that social respect is one of the top job
nurses whose shifts changed frequently had adaptation satisfaction factors. When asked whether they would
problems (11). More help and support was provided by choose the same profession again, most of the nurses in
the administration to the nurses in private as compared public as well as private hospital gave a positive answer.
to public hospital. Similar results were found in the study CONCLUSION: This study analyzed job satisfaction
conducted in Sidama where non supportive among nurses of public and private hospitals. The
administration is one of the main causes of results of the study revealed that in some aspects,
dissatisfaction.5 Study at Abbottabad showed that the nurses in the private setup had more job satisfaction as
nurses were not involved in decision making13 and were compared to nurses of public sector while in others, the
dissatisfied. Similarly study at Cyprus showed that one case was vice versa. As nursing deficiency continues to
of the highest motivators in job is appreciation and worsen, job satisfaction of nurses is of fundamental
administrative support (4). Private hospital nurses were importance. Nursing administrators should start
satisfied more regarding feedback of their performance considering the needs of their employees in any
as compared to public hospital. A study conducted at organization and should do everything within their
Heti showed that lack of appreciation and incentives power to meet those requirements. Results of this study
lead to demotivation and dissatisfaction among nursing should be used to develop policies that could help in
staff.12 Study at Islamabad (1) and Cyprus (4) and at improving the conditions leading to nurse's job
tertiary care hospital Rawalpindi (10) also showed satisfaction, better patient satisfaction, a decrease in
similar results where work recognition was among the turnover of registered nurses and increased profit for the
highest motivating factors. Dispute resolution due to organization. First limitation of the study is the cross
involvement of senior nurses was much better in public sectional design. Long term follow up studies are
hospital as compared to private hospital. Similar results needed to explore the relationship between nurses' job
were found in a study carried out in Tertiary Care satisfaction and practice places and due to the limited
hospitals in Islamabad where supportive management time period, the study was conducted only in two
and helpful seniors led to job satisfaction (1). Regarding hospitals.
the attitude and competence of senior nurses,
respondents in private hospital were much satisfied as
compared to public hospitals, results were similar in a
study conducted on nurses in Islamabad where private
hospital showed better satisfaction with senior's attitude

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 Pakistan Journal of Public Health, 2016 ( December )

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