Job satisfaction of nurses with master of nursing degrees in Poland: quantitative and qualitative analysis

The MNPJSS was developed in the USA [13] and includes 44 statements referring to different aspects of work. Responses are given in a 6-point Likert scale (1 – the lowest level of satisfaction, 6 – the highest level of satisfaction). Adaptation of the MNPJSS instrument to the Polish setting began by obtaining consent to use the MNPJSS in the present study (consent was provided by De Anna Cox, MN, APRN, FNP-BC, College of Nursing, University of South Carolina, Columbia, SC, USA). The original English version of the MNPJSS questionnaire was translated into Polish. Then, after establishing the final version of the translation, a back-translation to English was applied. Any remaining concerns were settled by group discussion amongst 3 masters of nursing. To test the usability of the MISENER questionnaire under Polish conditions, a pilot study was carried out in 2013 concerning the satisfaction and dissatisfaction of nurses with master’s level education employed at medical institutions. The pilot study involved 272 participants with Masters of Nursing degrees employed at 9 hospitals in central and northeast Poland [14, 15].

The original survey questionnaire included 14 questions concerning the workplace, position, specialisation, family and financial situation, age, sex, and working experience. There were also two open-ended questions which allowed the respondents to extemporise: (1) What makes the nursing job satisfying for you? (2) What makes the nursing job dissatisfying for you?

To improve the validity [16] of the results obtained in the Misener scale, we used the respondents’ answers to two open-ended questions from the original survey questionnaire: (1) What makes the nursing job satisfying for you? (2) What makes the nursing job dissatisfying for you?

Reliability coefficients of the scores were estimated using Cronbach’s alpha coefficient, which assesses internal consistency reliability [17]. The Cronbach’s alpha coefficient for the scale was 0.96.

All written responses to the two open-ended questions were fully entered into a computer database, but separated based on whether the respondents were satisfied or dissatisfied. Comments to the open questions were studied by content analysis [18]. Because the respondents referred to many aspects at the same time, their responses were divided into components (units). Then, using the technique of content analysis and preserving the division into satisfaction (internal) factors and dissatisfaction (external) factors, they were attributed to factor groups identified and named in accordance with Herzberg’s theory [19].

The vast majority of the 686 respondents were women (97.5% vs. 2.5% men). The study sample was diverse in terms of age. The largest proportion of respondents ranged in age from 41 to 50 years (41.1%). More than half of the respondents had nursing experience of 21–30 years (35.6%) or 11–20 years (23.6%). Nearly three-fourths (71%) did not have any specialisation. The respondents were employed at different types of hospitals. The highest number worked at clinical hospitals (36%). Two-thirds worked as divisional nurses (66.6%). One quarter was a senior charge nurse or a coordinating nurse (25.7%). Relatively few respondents held higher managerial positions (4.7%). A minority (3.1%) of the participants had other positions, such as epidemiology nurse or endoscopy nurse (Table 1).

The distribution of the aggregate scale of professional satisfaction in the whole study sample is presented in Fig. 1. The mean value is approximately 168 points, the lowest, 58, and the highest, 260.

Table 2 shows the mean ratings by study participants of all aspects of work, from best to worst. The participants gave the highest ratings to their relationships with direct superiors and other nurses, as well as their social contacts at work. They were also satisfied with the vacation entitlement, the complexity of health problems encountered at work, and the resulting challenges which gave them a sense of professional fulfilment. The lowest ratings were given to the pension scheme and factors connected with remuneration (including cash bonuses, compensation for extra services, and the distribution of awards). Dissatisfaction also resulted from scientific development issues (including the level of engagement in research and insufficient time or financial support for continuing education, time off to serve on professional committees), as well as the status of the nursing profession in the community (i.e. perceived as undervalued).

The factor that significantly affected the level of professional satisfaction was the position held at work. Participants with managerial positions rated their work satisfaction 10 points higher than senior charge nurses, and senior charge nurses reported having an almost 10-point higher work satisfaction rating compared to divisional nurses. A highly statistically significant relationship was found between the position and the level of professional satisfaction (p < 0.001) (Table 3).

The responses to the open-ended questions were divided into factors based on Herzberg’s theory. Among the 686 respondents, 484 (70.6%) answered the question concerning professional satisfaction, and 421 (61.4%) answered the question concerning the reasons for lack of satisfaction with the job. The respondents’ answers referred to many aspects of work. Therefore, the responses were divided into 1732 units, including 864 factors causing satisfaction (49.9%) and 868 factors causing dissatisfaction (50.1%).

The following categories were identified as external factors: remuneration, working conditions, interpersonal and social relationships, company policy, and professional status. In this group of factors, most answers referred to dissatisfaction (40.7%), for example:

“Very low pay! Especially in comparison with the responsibility connected with the nurse's job”;

“Little respect from patients, their families, and the medical circle Although we gain new skills and improve our qualifications, we cannot use them in our work”.

Internal factors were categorised as follows: accomplishments, development and promotion, the content of work, responsibilities, and recognition. In this group, in contrast to the preceding one, most answers referred to satisfaction (43.3%) (Table 4), for example:

“I find fulfillment in this profession and I'm happy to be able to participate in the process of fighting for the primary human values: life and health”;

“I'm happy when I see a child getting better”;

“I work in a team where the atmosphere is really good”.

The results of our study may indicate an important direction of activity for managers, who should be interested in keeping professional medical personnel – masters of nursing – in Poland. The increasing lack of interest in the nursing profession as a career choice, resulting from, amongst other concerns, low remuneration, is a major issue in many countries [28]. Research carried out in 10 European countries shows that about 9% of nurses (from 5% to 17% in different countries) are thinking about leaving the job [29]. Our study results suggest that managers should strengthen those areas that contribute to employees’ higher satisfaction, particularly interpersonal relationships, by commendation and recognition of work effects.