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International Journal of Nursing Studies 44 (2007) 747757 www.elsevier.com/locate/ijnurstu

Job satisfaction in a Norwegian population of nurses: A questionnaire survey

Ida Torunn Bjrka,, Gro Beate Samdalb, Britt Stre Hansenc, Solveig Trstadd, Glenys A. Hamiltona
a

Centre for Shared Decision Making and Nursing Research, Rikshospitalet-Radiumhospitalet National Hospital, 0027 Oslo, Norway b Department of Research and Development, Haukeland University Hospital, Jonas Liesvei 65, 5021 Bergen, Norway c Acute Clinic, ICU, Stavanger University Hospital, Armauer Hansensv. 20, 4068 Stavanger, Norway d Department of Research and Strategy, Asker and Brum Hospital, Sogneprest Munthe Kaas v. 100, 1309 Rud, Norway Received 7 October 2005; received in revised form 4 January 2006; accepted 5 January 2006

Abstract Background: Although job satisfaction is a factor that inuences retention, turnover and quality of nursing care globally, there are few studies exploring these factors in European countries. Objectives: To describe job satisfaction among hospital nurses in Norway, to explore the relationship between nurses job satisfaction and participation in a clinical ladder program and to explore relationships between several variables and intent to stay. A secondary purpose was to investigate the use of a job satisfaction instrument in a different culture than its origin. Design: In a survey, 2095 nurses in four different hospitals answered a questionnaire that included demographic data, intent to stay and a job satisfaction instrument covering the importance of and actual satisfaction with different job factors. Results: Interaction, followed by pay and autonomy were the most important job factors for Norwegian nurses. Actual job satisfaction was similar to nurses in other countries. There was no signicant difference in job satisfaction between participants and non-participants in a clinical ladder. Nurses intending to stay more than a year were signicantly more satised in their job. Further education and 1 day or more scheduled for professional development were factors that were positively related to intent to stay in the hospital. Conclusions: Norwegian nurses views on the importance of different job factors mirrored views of the importance ascribed to working milieu in the Norwegian society. As such, the instrument used seemed sensitive to cultural differences. Nurses actual satisfaction with their job was similar to respondents in many other countries and may imply that structures and content dening nurses working situation are similar in many parts of the world. Participation in a clinical ladder did not increase nurses overall job satisfaction. However, further education and the opportunity for professional development increased nurses intention to stay in the organization. r 2006 Elsevier Ltd. All rights reserved.
Keywords: Job satisfaction; Culture; Intent to stay; Clinical ladder; Professional development

Corresponding author. Tel.: +4797591890; fax: +4723075450.

E-mail address: ida.torunn.bjork@rikshospitalet.no (I.T. Bjrk). 0020-7489/$ - see front matter r 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.ijnurstu.2006.01.002

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What is already known about the topic?

 Nurses job satisfaction is linked to turnover, how 

ever, several studies nd that intent to stay is the intervening variable between them. Varying results are reported concerning the effect of participation in professional development on job satisfaction. There are few reported studies focusing on these issues in Europe, and no large systematic studies have been conducted in Norway.

What this paper adds

ship (Upenieks, 2003), or an organizational environment that promotes empowerment (Kuokkanen et al., 2003). Recognition programs, clinical ladders or clinical advancement programs may be viewed both as an attribute of a specic job and as an organizational feature. The distinction has to be made by the variables chosen for measurement (Stamps, 1997). Although these forms of professional development are recognized as important factors associated with lower turnover and higher levels of job satisfaction (Buchan, 1999b), there are relatively few studies, both recent and in general, that have focused on the relationship between participation in clinical ladders and job satisfaction.

 Actual  

job satisfaction of Norwegian nurses was similar to nurses in other parts of the world and job satisfaction was positively related to intent to stay. The job satisfaction instrument used was sensitive to cultural differences in views on the importance of different job satisfaction factors. Participants in a clinical ladder did not have higher overall job satisfaction than non-participants.

2. Purpose of the study The main purposes of this study were threefold; to describe job satisfaction among hospital nurses in Norway, to explore the relationship between nurses job satisfaction and participation in a clinical ladder program and to explore relationships between several variables and intent to stay. In order to compare the ndings with results from similar studies, a widely used and validated job satisfaction instrument was chosen; Index of Work Satisfaction (IWS) by Stamps (1997). A secondary purpose was also to investigate the use of Stamps (1997) instrument in a different culture than its origin. Reported studies with the IWS have mostly been undertaken in the USA, Canada and Australia. A few studies have also been conducted in Asia. The only country in Europe reporting a study with the IWS is Great Britain (Burnard et al., 1999). The research questions were: What are the levels of importance and actual job satisfaction of Norwegian hospital staff nurses? Is there a relationship between participation in a clinical ladder program and job satisfaction? Does time scheduled for professional development per month affect job satisfaction? Is there a relationship between the following variables and intent to stay:

1. Introduction Recruitment, retention, turnover and development of quality care in nursing are global issues within the health care setting (Aiken et al., 2002). For decades the cyclic nature of nursing shortage and surplus has instigated research with the purpose of nding causes and remedies for solving the problems associated with high turnover and the impact this has on the quality of nursing care (Blegen, 1993; Goodin, 2003). Nurses satisfaction with their job has been viewed as one important factor both inuencing and been inuenced by these issues. Job satisfaction has been studied with many different tools and in many different nurse populations. In the literature job satisfaction is conceptualized as an independent variable affecting behaviour such as retention and turnover among nurses, or as a dependent variable occurring as a result of personal characteristics, different job characteristics or as a response to organizational features in the work setting (Stamps, 1997). Personal characteristics and demographic variables are repeatedly reported as quite low correlates of job satisfaction (Adams and Bond, 2000; Blegen, 1993; Stamps, 1997). The relationship with job characteristics and organizational features is often stronger. Satisfaction as a function of a specic job is related to factors such as stress (Flanagan and Flanagan, 2002; Shader et al., 2001), autonomy (Blegen, 1993) or workload (Best and Thurston, 2004). Satisfaction as a function of the organization may be related to factors such as the variation in work hours (Hoffman and Scott, 2003), management style or leader-

 job satisfaction,  participation in a clinical ladder  educational level  time for professional development
Are there differences in job satisfaction that might be accounted for by culture? 3. Review of the literature 3.1. Job satisfaction, intent to stay and turnover Numerous factors have been linked to turnover, but job satisfaction is the most frequently cited (Lu et al.,

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2005). The range of author nationalities represented in this eld of research underscores a global relevance in the issues of job satisfaction, intent to stay and turnover. Based on an extensive literature review, Price and Mueller (1981) developed an explanatory causal model of turnover and tested it among 1100 nurses. There was no direct association between job satisfaction and turnover. However, intent to stay was the intervening variable that connected these two variables. Job satisfaction was positively associated with intent to stay and intent to stay was in turn positively associated with turnover. Cavanagh and Cofn (1992) explored staff turnover among hospital nurses using the Price and Mueller model (1981). Findings corroborated the propositions about the associations between job satisfaction, intent to stay and turnover. In a meta-analysis Irvine and Evans (1995) found that a small negative relationship existed between job satisfaction and turnover. However, the relationship between job satisfaction and behavioural intentions such as intent to stay and intent to leave as well as the relationship between behavioural intentions and turnover was even stronger. In a more recent meta-analysis by Yin and Yang (2002) the relationship between job satisfaction and turnover was characterized as strong, reported as rxy 0:23, po0:05. Turnover intentions are measured as either intent to stay or intent to leave. Stamps (1997) suggested that since the goal was to keep staff, not lose them, it made sense to measure intent to stay. Several other studies have reported a signicant relationship between job satisfaction and intent to stay (Borda and Norman, 1997), or worded in opposite terms as intent to leave (Lu et al., 2002; Tzeng, 2002). In their model of nurse turnover behaviour Irvine and Evans (1995) also included correlates of job satisfaction; economical, sociological and psychological variables. Sociological variables, among them advancement opportunities, had substantially higher correlations with job satisfaction than the other factors. This matches the results from Schultz (1993) study of the relationship between job satisfaction, turnover and level of advancement in a clinical ladder. The more advanced nurses had lower turnover rates and higher satisfaction rates than nurses in lower levels of the ladder. 3.2. Job satisfaction and participation in clinical ladders In general, organizations with professional development programs such as clinical ladders, recognition programs or clinical advancement programs, are associated with opportunities for advancement and report higher overall degrees of staff satisfaction (Serow et al., 1993). The opportunity for professional growth is

sought after when nurses are looking for jobs (Havens and Aiken, 1999; Aiken et al., 2001). Magnet hospitals promoted professional development that encompassed planned orientation of staff, emphasis on service, continuing education, competency-based clinical ladders and management development (Buchan, 1999a). Nurses in these hospitals reported higher job satisfaction than nurses in other hospitals (Kramer and Schmalenberg, 1991). Modelling the successful Magnet hospitals in the USA, Upenieks (2003) proposed a prevention model to increase job satisfaction and reverse the nursing shortage. Implementation of clinical ladders was one suggested strategy in this model. Since the 1970s clinical ladders have been described as an important factor in attracting and retaining nurses, but there is a paucity of evaluation and research into the outcomes of such programs (Buchan, 1999b). In the late 1980s and beginning 1990s there was some interest in studying the impact of different kinds of professional development on job satisfaction. Overall job satisfaction of nurses within a clinical ladder was reported unchanged (Corley et al., 1994), or to increase with increasing levels of advancement in the ladder, although these ndings were both signicant (Roedel and Nystrom, 1987) and not signicant (Bell, 1993; Schultz, 1993). Clinical ladders have been offered as an on-the-job incentive for nurses and one assumption is that this will lead to improved job satisfaction and ultimately reduce turnover. It follows that exploring differences in job satisfaction between participants and non-participants of clinical ladders is of interest. Both Meador (1994) and Babb (1995) showed that participants had a tendency for higher scores on job satisfaction measures, but the differences were not signicant. Limited or no impact of clinical ladders was also reported (Costa, 1990; Thornhill, 1994). In an equal number of studies it was hypothesized that nurses working in units where clinical ladders were a structural part of the appraisal system would show higher job satisfaction than nurses working in settings without these features. Results vary from no signicant differences between nurses regardless of their unit of employment (Haas, 1986; Krugman and Preheim, 1999), to signicantly more satisfaction with some sub-factors of job satisfaction; autonomy, interaction with colleagues and task requirements (Malik, 1991), to signicant differences in overall satisfaction (Bruce, 1990). The literature search revealed some additional studies not mentioned in Buchans (1999b) evaluation of the benet of clinical ladders. In these studies sample sizes were often rather small and many of the studies were only published as master theses or doctoral dissertations, not in scientic journals. Only Krugman and Preheims study (1999) was found

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in the literature after 1997. In conclusion, this review shows that there still is a lack of research into the correlation of job satisfaction and participation in clinical ladders. The result of the review also supports Buchans assertion that the claims made for the use of clinical ladders [y] are neither proved nor disproved by reviewing the limited research based evidence (1999b, p. 143).

5. Methods 5.1. Design This study used a cross-sectional survey design in which nurses from four hospitals completed questionnaires on one occasion. 5.2. Sample and setting Respondents in the study were nurses in clinical positions employed at least 50% of the time at four hospitals in the western and southern part of Norway. The total population of nurses eligible for inclusion according to these criteria (N 4650) was invited to participate. The overall return rate was 45.5% (N 2095), varying between 39.4% and 54.7% among the four hospitals. These hospitals were chosen on the basis of a longer history of systematic professional development for nurses. All four hospitals had implemented a clinical ladder system at the organizational level before year 2000, offering the same opportunities to participants in nearly every department at all hospitals. The hospitals represented the regional, county and local level and two of the hospitals were university afliated. 5.3. Instrumentation The questionnaire consisted of four sections: demographic and background variables, the IWS (Stamps, 1997), and two other sections. These two sections related to clinical decision-making, 24 items (Lauri et al.1999), and 7 author derived evaluation questions about the clinical ladder program, and will be reported in separate papers since they are not the topic of this paper. The IWS was used to measure job satisfaction. Originally developed in 1972 the instrument was based on a combination of need-fulllment theory and social reference group theory (Stamps and Piedmonte, 1986) and has been through two revision processes (Stamps, 1997). The instrument has been widely used, as indicated by retrieval in February 2005 of 44 studies using the instrument since 1995. The IWS is a two-part multidimensional instrument. Part A measures the importance of six components of job satisfaction; pay, autonomy, task requirements, organizational policies, interaction and professional status. The components are dened at the beginning of the instrument before respondents are presented with 15 forced-choice comparisons of the six components. Pay is the monetary remuneration and fringe benets received for work done. Autonomy is the amount of job-related independence, initiative and freedom, either permitted or required in daily work activities. Task requirements are tasks or activities that must be done as a regular part of the job. Organizational

4. Clinical ladders in Norway The Norwegian Nurses Association in Norway (NNA) instituted a program for professional development in nursing in 1995. The purpose of the program was to give nurses an opportunity to develop professional skills at the bedside, and not have to leave their job for formal education in order to update professional skills. Nurses are accredited on an individual basis through documentation to the NNA and use the title of clinical specialist in nursing. Contrary to reports on other programs of clinical advancement (Buchan, 1999b) the Norwegian program is a national level structure. Overall, content specications and criteria for professional development must be followed, but health institutions are free to develop different strategies and local content within the national structure. The programs are quite extensive and resource demanding and require acceptance as part of the organizational structure of the health institution. In comparison with clinical advancement and clinical ladder programs described in the literature (Buchan, 1999b) the Norwegian program has a strong educational prole. Nurses receive a raise in salary, either after accreditation by the NNA or after each level of the ladder (most ladders have three levels). In order to be accredited as a clinical specialist the applicant must document the following:

 5 years of clinical practice within a specied area of

interest in nursing. The borders of this area can be dened through specied nursing functions, the patients age group, specic needs for treatment or care, or a group of patients or diagnosis. 150 h of course work; general nursing topics and topics that target the area of interest. 120 h of supervision; individual bedside supervision and group supervision. 4000 pages of literature related to course subjects and a specied area of interest in nursing. a professional development project within the chosen area of interest in nursing, documented in a paper based on theory, research and experience from clinical practice.

   

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policies are the management policies and procedures put forward by the hospital and nursing administration of the hospital. Interaction is the opportunity presented for both formal and informal social and professional contact during working hours. Professional status is the overall importance or signicance felt about the job, both in own view and in the view of others. Part B is comprised of 44 Likert-style questions reecting different aspects of the above-mentioned six components of job satisfaction. Respondents rate the questions from 1 to 7 (agree to disagree), revealing their current level of job satisfaction. Previous research has documented the instrument as reliable and valid with Cronbachs a in the range of .82.91 for the overall scale (Stamps, 1997). However, estimates of subscale reliabilities, especially the professional status component, have been less consistent. Stamps 19941995 review of research with IWS revealed as between .29 and .46 for this component (Stamps, 1997). There were two questions in the background survey that were explored. Intent to stay is reported as a better indicator of actual behaviour than intent to leave (Stamps, 1997). One question was developed for this study. Participants were asked if they intended to continue as a nurse at the hospital. They could check one of three alternatives; next year, more than a year and do not know. Respondents were also asked to indicate the amount of time scheduled for professional development per month. Such time can be used for development of standards, quality indicators, trying out new interventions, evaluation of procedures and routines or participation in a clinical ladder. Alternative responses were nothing, less than a day, 1 day and more than a day.

6. Results 6.1. Demographics Mean age of the participants was 37.5 years ranging from 21 to 72. Seven point nine per cent of the nurses were men. More than one-fourth of the nurses were single (28%) and nearly half of the participants had children living at home (46.8%). Approximately one-third of the nurses (32.9%) had graduated within the last 5 years. Average years of nursing experience in the hospital were 8.3 and the nurses had worked an average of 5.5 years in their present unit. Nearly half of the nurses (47.1%) had some kind of continuing education. Twenty-two point seven per cent of the nurses had 1 day or more of their working time per month scheduled for professional development/study time. Seventy-two point six per cent of the nurses planned on continuing at the hospital for more than 1 year, 6.6% planned on staying no more than a year, while 20.8% did not know how long they would stay. Five hundred and forty-one nurses (28.3%) participated/had participated in a clinical ladder program at their hospital. 6.2. What are the levels of importance and actual job satisfaction of Norwegian hospital staff nurses? Paired comparisons of the six job components in part A of the instrument were used to establish the weight coefcients. Ranking of these coefcients indicated the relative importance of each component with a range of .9 as least important to 5.3 as most important. The Component Weighting Coefcients fell into two clusters (N 2095). In this order interaction (3.73), pay (3.56) and autonomy (3.52) were ranked as the three most desirable components while task requirements (2.84), professional status (2.81), and organizational policies (2.14) were much less important among these Norwegian nurses. Part B of the instrument measured the nurses current level of satisfaction with the six job components. Component Mean Scores represent the levels of current satisfaction with the job components. The nurses rated professional status as the most satisfying job component (5.50), very closely followed by interaction (5.48) and autonomy (5.05). There was quite a gap in scores between these three job components and the other three, with task requirements (3.79) as the fourth highest ranked component followed closely by organizational politics (3.77) and pay as the job component with the decidedly lowest score (2.62). The range of the Total Scale Score from part B of the instrument is 44308 with higher scores reecting a higher job satisfaction. In this group of nurses the average Total Scale score was 198.5 (SD 25.62), this gives a Mean Scale Score of 4.51 (SD .58). There were signicant differences in levels of job satisfaction related to age, education and number of years at the hospital and in the unit (Table 1).

5.4. Procedure and data analysis Permission to distribute questionnaires was obtained from department directors. A list of names and workplace of nurses working in clinical positions (50% or more) in the participating units were obtained from the personnel department of each hospital. Each participant received an envelope at work consisting of a cover letter explaining the purpose of the study and ensuring condentiality, the questionnaire and a pre-addressed envelope for return of their response. Informed consent to participate was indicated by return of the questionnaire. The questionnaires were optically scanned and data were entered into the SPSS version 12.0. Data were analysed with descriptive and inferential statistics. Conrmatory factor analysis was performed to compare the construct validity of part B of the IWS with results from previous research.

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Nurses older than the mean age of the sample (37 years) were more satised with their job than those younger than the mean age. Nurses who had nished their education before 1999 were more satised than nurses educated within the last 5 years. Nurses with a masters degree or other continuing education were more satised than those without additional education. Nurses who had worked more than the average number of years at the hospital

(48 years) or in the unit (45 years) were more satised than nurses who had worked a shorter time. There were no signicant differences in level of job satisfaction related to gender or family situation. 6.3. Does time scheduled for professional development per month affect job satisfaction? There was a higher mean Total Scale Score for those who had 1 day or more per month scheduled for professional development (N 412; mean 205.13, t 6:58, p :000) than those who had less than 1 day or none (N 1356; mean 195.77). 6.4. Is there a relationship between participation in a clinical ladder program and job satisfaction?

Table 1 Level of overall job satisfaction according to nurse characteristics Nurse characteristic N Total t scale score 195.89 200.50 198.08 196.97 196.45 198.65 198.94 197.25 199.83 194.74 200.60 195.69 196.59 200.05 196.54 201.38 3.71 p

Younger than mean age (2137) Older than mean age (3872) Women Men Single Married/co-habitation With children Without children Educated before 1999 Educated after 1999 Further education No further education o8 years at hospital 48 years at hospital o5 years in unit 45 years in unit

995 745 1640 150 497 1281 821 957 1147 612 824 950 957 611 976 481

.000

.507 .612 1.63 1.39 4.00 4.04 2.67 3.45 .104 .164 .000 .000 .008 .001

There was a difference between participants and nonparticipants in clinical ladders in relation to what job components they ranked as most important, although the differences in Component Weighting Coefcients were very small. Both groups still ranked interaction as the most important component. Participants in clinical ladders ranked autonomy before pay, while nonparticipants saw pay as more important than autonomy. While both groups still agreed on organizational policies as the factor of least importance the participants in clinical ladders saw professional status more important than task requirements. There was no signicant difference in job satisfaction between participants and non-participants in clinical

Table 2 Job satisfaction in participants and non-participants in clinical ladders as measured by the Total Score Scale and subscales of Index of Work Satisfaction (Stamps, 1997) N Total Scale Score Subscales Professional status Autonomy Pay Task requirements Organizational policies Interaction Nursenurse interaction Nursephysician interaction Participants Non-participants Participants Non-participants Participants Non-participants Participants Non-participants Participants Non-participants Participants Non-participants Participants Non-participants Participants Non-participants Participants Non-participants 474 1320 528 1490 514 1432 527 1483 528 1493 512 1447 522 1467 531 1501 530 1496 Mean 198.79 197.73 38.82 38.35 40.18 40.37 16.23 15.58 22.59 22.67 26.67 26.30 54.74 54.89 30.29 29.87 24.43 24.97 SD 25.84 25.55 5.19 5.34 6.56 6.99 6.89 6.81 6.08 6.30 6.77 6.56 8.60 8.41 3.79 4.18 6.50 6.00 t .77 p .44

1.77 .55 1.88 .27 1.08 .35 2.04 1.79

.08 .58 .06 .78 .28 .73 .03 .07

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ladders as measured by the Total Score Scale of IWS or for each of the six subscales. Signicant differences in job satisfaction did however occur when viewing the results of the subscales of interaction. Higher satisfaction with nursenurse interaction was indicated among clinical ladder participants (Table 2). 6.5. Is there a relationship between job satisfaction, participation in a clinical ladder, educational level, or time for professional development and intent to stay? Nurses intending to stay more than 1 year (N 1214) had a signicantly higher mean Total Scale Score of job satisfaction than nurses who planned to stay less than a year or did not know (N 466). Mean score 201.29 vs. 189.43, t 8:13 and p :000. The calculation of w2 tests gave the following results. Further education was found to be positively related to intent to stay, w2 38:27, p :000. Nurses with 1 day or more scheduled for

professional development were more likely to stay, w2 9:91, p :002. There was no signicant difference between participants and non-participants in clinical ladders in their intention to stay, w2 :58, p :45. 6.6. Are there differences in job satisfaction that might be accounted for by culture? Results of the statistical analysis were examined in order to look for trends in Norwegian nurses responses that were different or similar to nurses responses in other countries. A striking difference was Norwegian nurses ranking of interaction as the most important component of job satisfaction, a component never ranked rst in any other study. Furthermore professional status was consistently ranked lower than in all the other studies (Table 3). Table 3 lists the results from all studies after 1990 that have used part A, ranking of importance, as part of their questionnaire.

Table 3 Comparison of nurses ranking of the importance of job satisfaction components across studies reported between 1992 and 2005 Autonomy rank Pay rank Professional status rank 5a 3 4 4 2 3 Interaction rank 1a 4 2 3 5 4 Task requirements rank 4 5 5 5 4 5 Organizational policies rank

Present study N 2095 Hospital nurses Best and Thurston (2004), N 387 Hospital nurses Cowin (2002), N 528, 332 Several locations Ecklund (1998), N 76 Critical care nurses Flanagan and Flanagan (2002), N 287 Correctional nurses Foley et al. (2004), N 299 School nurses Fung-Kam (1998), N 190 Hospital staff nurses Goodell and Van Ess (1994), N 150 Hospital nurses Hoffman and Scott (2003), N 208 RNs, 75% in hospital Johnston (1991), N 126 Hospital staff nurses Kovner et al. (1994), N 850 Hospital nurses Takase et al. (2002), N 80 RNs in post-registration conversion courses or postgraduate courses Tumulty (1992), N 110 Head nurses in hospitals
a

3 1 1 1 1 2

2 2 3 2 3 1

6 6 6 6 6 6

1 1 3 2

4 2.5 1 1

3 2.5 2 3

2 4 4 4

5 5 5 5

6 6 6 6

3 2 1

1 1 3

2 3 4

4 4 2

5 5 5

6 6 6

Major difference in ranking between present study and earlier studies.

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7. Discussion In general nurses in this study valued interaction, pay and autonomy as the components most important for their job satisfaction. Interaction as the most essential component differs from results in other studies using part A of the IWS during the last 15 years (Best and Thurston, 2004; Cowin, 2002; Ecklund, 1998; Flanagan and Flanagan, 2002; Foley et al., 2004; Fung-Kam, 1998; Goodell and Van Ess, 1994; Hoffman and Scott, 2003; Johnston, 1991; Kovner et al., 1994; Takase et al., 2002; Tumulty, 1992), and reects the importance assigned to the working milieu in the Norwegian society as a whole as well as in the nursing profession. Laws that attach importance to psychosocial well-being (Arbeidsmiljloven, 2005) regulate the working environment in Norway. Solidarity and collaboration with fellow colleagues in an inspiring working milieu has been found to be more important for job satisfaction and motivation to stay in the organization among Norwegian nurses than other work related factors such as pay s, 2001; Cappelen, 2002; Srensen, 2000). The (Brata importance of interaction with colleagues is however consistent with the ndings in the meta-analytic studies by Blegen (1993) and Irvine and Evans (1995). Low ranking of professional status might be seen as a consequence of the importance Norwegian nurses ascribe to their working milieu. One can ask if it is more important to have a good time with your colleagues than to have inuence and status in the professional world. As seen in the summary in Table 3, low importance ascribed to organizational policies is well documented as a global phenomenon among nurses, and not something special for the Norwegian nurse population. It should however still be of concern to the educational and professional institutions in Norway that nurses show so little interest in a factor that in many ways can inuence their working conditions and job satisfaction. Nurses actual satisfaction with their job in this study was similar to respondents in many other countries1 (Cowin, 2002; Flanagan and Flanagan, 2002; FungKam, 1998; Gillies et al., 1996; Hays and DowlingWilliams, 1997; Hoffman and Scott, 2003; Medley and Larochelle, 1995; Tranmer et al., 1995), where professional status gave the greatest satisfaction followed closely by interaction and autonomy as either second or third choice. These ndings support Aiken et al. (2002) contention on globalization in nursing and imply that structures and content that dene nurses working situations are similar in many parts of the world. Also
1 In discussion of actual job satisfaction results of this study are compared only with other studies that use the 1986 or 1997 version of Stamps instrument and include the whole scale. From 1986 the number of items was reduced from 48 to 44.

in this sample two of the most important factors for nurses, interaction and autonomy, were among the three factors that gave nurses the highest actual satisfaction in their job. Older age, further education and longer working time in the institution were demographic factors that corresponded signicantly with higher values of current job satisfaction in this study. The main factor here might be age, since both further education and longer working time in the institution in most cases correspond with increasing age. In earlier research demographic factors showed a rather low relationship with job satisfaction (Blegen, 1993) or mixed results (Stamps, 1997). Many of the later studies with the IWS have not included these nurse characteristics. In those that do, Ingersoll et al. (2002) reported similar results to this study regarding the inuence of age and further education on overall job satisfaction. In other studies the results were mixed (Fung-Kam, 1998; Gillies et al., 1996; Hays and Dowling-Williams, 1997). Participants in clinical ladders were signicantly more satised with current nursenurse interaction than nonparticipants. Apart from this, only small variations in the importance of job satisfaction occurred between participants and non-participants of clinical ladders. These variations might indicate a higher professional prole among clinical ladder participants since both autonomy and professional status were rated higher among participants than non-participants. The opportunity to participate in a systematic professional developmental program does not seem to be necessary in order to keep nurses satised in their job. This nding is consistent with some of the earlier studies that investigated the effect of clinical ladders (Babb, 1995; Costa, 1990; Meador, 1994; Thornhill, 1994). However, nurses with a day or more per month scheduled for professional development did have signicantly higher scores on job satisfaction. Being able to use working time for professional development is a gift in a hectic working day, but results that are benecial for the hospital organization, not only the nursing community are expected in times of downsizing and tight budgets. Although job satisfaction is important to the individual nurse, research has documented that it is intent to stay that is strongly related to turnover (Price and Mueller, 1981; Cavanagh and Cofn, 1992; Irvine and Evans, 1995) and therefore of utmost importance to the organizations that employ nurses. In this study the effect of several variables were explored in relation to intent to stay. Nurses with further education and nurses with a reasonable amount of time scheduled for professional development planned on staying more than 1 year in the hospital. By institutionalizing scheduled time for professional development the organization rewards nurses with initiative and promotes a focus on development of quality in nursing care. This is consistent with earlier research exploring the effect of opportunities for

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I.T. Bjrk et al. / International Journal of Nursing Studies 44 (2007) 747757 Table 4 Factor structure for IWS in present study Factor Original subscales (number of items) Pay (6) Interaction: Nursenurse (5) Interaction: Nursephysician (5) Autonomy (8) Professional status (7) Task requirements (6) Organizational policies (7) 1 6 items 5 items 5 items 2 items 4 items 1 item 4 items 5 items 3 items 1 item 1 item 1 item 1 item 1 item 1 item 3 items 2 3 4 5 6 7 8 9 10 755

professional development on job satisfaction of hospital nurses (Havens and Aiken, 1999; Kramer and Schmalenberg, 1991, Serow et al., 1993). In this study there was no signicant relationship between participation in a clinical ladder and intent to stay. However, nurses who intended to stay for more than 1 year did have a higher mean total score for job satisfaction than nurses who planned to leave within the year or did not know what their future plans were. 7.1. Limitations It should be borne in mind that there are a few issues with the internal consistency of some of the Stamps subscales, thus caution must be used when presenting results where reliability of some scales is an issue. Cronbachs a for the total scale of IWS was .86, which is within the range of the originally reported as (Stamps, 1997). The highest subscale a coefcient was .82 for pay. Professional status only had an a of .44, while the a coefcients for the other subscales ranged from .78 to .66. The low a for professional status mirrors the lack of consistency in this subscale as reported in the literature (Hoffman and Scott, 2003; Stamps, 1997). Conrmatory factor analysis was performed to compare the construct validity of the IWS in this study with previous research. All items from the IWS were entered into the procedure in order to focus on the constitution of the IWS, which has demonstrated some inconsistencies (Ingersoll et al., 2002). In the present study all 44 items loaded on 10 factors that had Eigenvalues above 1. All six items of pay loaded on the rst factor, but included on this factor was also 1 item from Stamps organizational policy subscale (Table 4). In Stamps instrument the 10 items of the Interaction subscale can be divided into a nursenurse interaction scale and nursephysician interaction scale with ve items in each scale. The factor analysis conrmed these subscale items as separate and distinct factors (factor 2 and 7). Otherwise the other factors contained a mixture of items assigned to the original instruments subscales,

some factors only including 2 and 3 items (Table 4). The original items on organizational policies loaded on four different factors while the items on professional status, autonomy and task requirements loaded on three different factors each. A further limitation might be the modest response rate. We know only what 45.5% of the nurses thought, thus we do not know how the other nurses think about job satisfaction. On the other hand this response rate is similar or better than that reported in some of the other studies (Best and Thurston, 2004; Ecklund 1998; Hoffman and Scott, 2003; Ingersoll et al., 2002; Takase et al., 2002).

8. Conclusion Although the conrmatory factor analysis of the IWS showed inconsistencies with earlier factor analysis, the results of this study showed that the instrument correctly caught the underlying importance of interaction in the workplace among Norwegian hospital nurses. The results of this study do not support the thinking that clinical ladders per se will increase nurses job satisfaction or even their intent to stay. It did, however support the notion that nurses who are older, more educated, have a high score on job satisfaction and nurses who have the opportunity for professional development in their job have a higher intention of staying in the organization. This can provide hospitals with a large group of stable and knowledgeable nurses and indicates the importance of aiming at ways to ensure time and recognition for professional development within the nursing group.

References
Adams, A., Bond, S., 2000. Hospital nurses job satisfaction, individual and organizational characteristics. Journal of Advanced Nursing 32, 536543.

ARTICLE IN PRESS
756 I.T. Bjrk et al. / International Journal of Nursing Studies 44 (2007) 747757 Cowin, L., 2002. The effects of nurses job satisfaction on retention: an Australian perspective. Journal of Nursing Administration 32, 283291. Ecklund, M.M., 1998. The relationship of mentoring to job satisfaction of critical care nurses. Journal of the New York State Nurses Association 29 (2), 1315. Flanagan, N.A., Flanagan, T.J., 2002. An analysis of the relationship between job satisfaction and job stress in correctional nurses. Research in Nursing & Health 25, 282294. Foley, M., Lee, J., Wilson, L., Cureton, V.Y., Canham, D., 2004. A multi-factor analysis of job satisfaction among school nurses. Journal of School Nursing 20, 94100. Fung-Kam, L., 1998. Job satisfaction and autonomy of Hong Kong registered nurses. Journal of Advanced Nursing 27, 355363. Gillies, D.A., Foreman, M., Pettengill, M.M., 1996. Satisfaction of nurse managers in long-term care. Journal of Gerontological Nursing 22 (4), 3340. Goodell, T.T., Van Ess, C.H., 1994. Outcomes of nurses job satisfaction. Journal of Nursing Administration 24, 3641. Goodin, H.J., 2003. The nursing shortage in the United States of America: an integrative review of the literature. Journal of Advanced Nursing 43, 335343. Haas, S.A.W., 1986. A survey of staff nurse perceptions of proposed outcomes of clinical ladder performance appraisal systems (job satisfaction, commitment, continuing education, productivity). Doctoral Dissertation, University of Illinois. Havens, D.S., Aiken, L.H., 1999. Shaping systems to promote desired outcomes: the magnet hospital model. Journal of Nursing Administration 29, 1420. Hays, A.M., Dowling-Williams, T., 1997. Perceptions of job satisfaction in a long term care facility: a comparison between a dedicated Alzheimers unit and non-Alzheimers units. American Journal of Alzheimers Disease 12 (1), 3539. Hoffman, A.J., Scott, L.D., 2003. Role stress and career satisfaction among registered nurses by work shift patterns. Journal of Nursing Administration 33 (6), 3742. Ingersoll, G.L., Olsan, T., Drew-Cates, J., DeVinney, B.C., Davies, J., 2002. Nurses job satisfaction, organizational commitment, and career intent. Journal of Nursing Administration 32, 250263. Irvine, D.M., Evans, M.G., 1995. Job satisfaction and turnover among nurses: integrating research ndings across studies. Nursing Research 44, 246253. Johnston, C.L., 1991. Sources of work satisfaction/dissatisfaction for hospital registered nurses. Western Journal of Nursing Research 13, 503513. Kovner, C.T., Hendrickson, G., Knickman, J.R., Finkler, S.A., 1994. Nursing care delivery models and nurse satisfaction. Nursing Administration Quarterly 19, 7485. Kramer, M., Schmalenberg, C., 1991. Job satisfaction and retention: insights for the 90 sPart 2. Nursing 21, 5155. Krugman, M., Preheim, G., 1999. Longitudinal evaluation of professional nursing practice redesign. Journal of Nursing Administration 29 (5), 1020. Kuokkanen, L., Leino-Kilpi, H., Katajisto, J., 2003. Nurse empowerment, job-related satisfaction, and organizational commitment. Journal of Nursing Care Quality 18, 184192. Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J.A., Busse, R., Clarke, H., et al., 2001. Nurses reports on hospital care in ve countries: the ways in which nurses work is structured have left nurses among the least satised workers, and the problem is getting worse. Health Affairs 20 (3), 4353. Aiken, L.H., Clarke, S.P., Sloane, D.M., 2002. Hospital stafng, organization, and quality of care: cross-national ndings. Nursing Outlook 50, 187194. Arbeidsmiljloven, 2005. Lov om arbeidsmiljarbeidstid og stillingsvern nr. 62. Arbeids- og Sosialdepartementet. [Working Environment Law 2005. Law concerning working environment, working hours and occupational protection No. 62. Work- and Social Department.] Norway. Babb, D.J., 1995. Clinical ladder participation and staff nurse job satisfaction. Master Thesis, California State University, Dominguez Hills. Bell, P.L., 1993. Nurses perceptions of the clinical ladders contributions to their levels of job satisfaction and dissatisfaction. Doctoral Dissertation, University of Virginia. Best, M.F.M., Thurston, N.E.M.R., 2004. Measuring nurse job satisfaction. Journal of Nursing Administration 34, 283290. Blegen, M.A., 1993. Nurses job satisfaction: a meta-analysis of related variables. Nursing Research 42 (1), 3641. Borda, R.G., Norman, I.J., 1997. Testing a model of absence and intent to stay in employment: a study of registered nurses in Malta. International Journal of Nursing Studies 34, 375384. s, O., 2001. Jobbtilfredshet pa intensivavdeling. HoveBrata doppgave. [Job satisfaction in the intensive ward. Master Thesis.] The Norwegian University for Science and Technology. Bruce, J.A., 1990. Reward strategies for the retention of professional nurses. Doctoral Dissertation, University of Massachusetts. Buchan, J., 1999a. Still attractive after all these years? Magnet hospitals in a changing health care environment. Journal of Advanced Nursing 30, 100108. Buchan, J., 1999b. Evaluating the benets of a clinical ladder for nursing staff: an international review. International Journal of Nursing Studies 36, 137144. Burnard, P., Morrison, P., Phillips, C., 1999. Job satisfaction amongst nurses in an interim secure forensic unit in Wales. Australian and New Zealand Journal of Mental Health Nursing 8 (1), 918. Cappelen, K., 2002. Ledelsemotivasjon og kompetanse I sykehus. Hovedoppgave. [Leadershipmotivation and competence in hospitals. Master Thesis.] University of Oslo. Cavanagh, S.J., Cofn, D.A., 1992. Staff turnover among hospital nurses. Journal of Advanced Nursing 17, 13691376. Corley, M.C., Farley, B., Geddes, N., Goodloe, L., Green, P., 1994. The clinical ladder. Impact on nurse satisfaction and turnover. Journal of Nursing Administration 24, 4248. Costa, L.A., 1990. The effect of nursing clinical ladder programs on patient care and the role of the nurse. Doctoral Dissertation, The Wright Institute.

ARTICLE IN PRESS
I.T. Bjrk et al. / International Journal of Nursing Studies 44 (2007) 747757 Lauri, S., Salantera, S., Gilje, F.L., Klose, P., 1999. Decision making of psychiatric nurses in Finland, Northern Ireland, and the United States. Journal of Professional Nursing 15, 275280. Lu, H., While, A.E., Barriball, K.L., 2005. Job satisfaction among nurses: a literature review. International Journal of Nursing Studies 42, 211227. Lu, K., Lin, P., Wu, C., Hsieh, Y., Chang, Y., 2002. The relationships among turnover intentions, professional commitment, and job satisfaction of hospital nurses. Journal of Professional Nursing 18, 214219. Malik, D.M., 1991. Career ladders: position enrichment vis-avis tenure. Nursing Management 22 120A, 120D, 120F. Meador, D.R., 1994. Inuence of clinical ladder program on job satisfaction in staff nurses. Kentucky Nurse 43 (3), 3637. Medley, F., Larochelle, D.R., 1995. Transformational leadership and job satisfaction. Nursing Management 26 (9) 64JJ, 64KK, 64LL, 64NN. Price, J.L., Mueller, C.W., 1981. Professional Turnover: The Case of Nurses. Spectrum Publications Inc., New York. Roedel, R.R., Nystrom, P.C., 1987. Clinical ladders and job enrichment. Hospital Topics 65 (2), 2224. Schultz, A.W., 1993. Evaluation of a clinical advancement system. Journal of Nursing Administration 23 (2), 1319. Serow, W.J., Cowart, M.E., Chen, Y., Speake, D.L., 1993. Health care corporatization and the employment conditions of nurses. Nursing Economics 11, 279291. Shader, K., Broome, M.E., Broome, C.D., West, M.E., Nash, M., 2001. Factors inuencing satisfaction and anticipated turnover for nurses in an academic medical center. Journal of Nursing Administration 31, 210216. 757 Stamps, P.L., Piedmonte, E.B., 1986. Nurses and Work Satisfaction: An Index for Measurement. Health Administration Press, Chicago. Stamps, P.L., 1997. Nurses and Work Satisfaction. An Index for Measurement, second ed. Health Administration Press, Chicago. Srensen, B.A., 2000. en dag i Helse-Norge. [one day in Health-Norway.] Report no. 7, Work Research Institute, Oslo. Takase, M., Kershaw, E., Burt, L., 2002. Does public image of nurses matter? Journal of Professional Nursing 18, 196205. Thornhill, S.K., 1994. Hospital clinical career advancement programs: comparing perceptions of nurse participants and nonparticipants. The Health Care Supervisor 13 (1), 1625. Tranmer, J.E., Kisilevsky, B.S., Muir, D.W., 1995. A nursing research utilization strategy for staff nurses in the acute care setting. Journal of Nursing Administration 25 (4), 2129. Tumulty, G., 1992. Head nurse role redesign: improving satisfaction and performance. Journal of Nursing Administration 22 (2), 4148. Tzeng, H., 2002. The inuence of nurses working motivation and job satisfaction on intention to quit: an empirical investigation in Taiwan. International Journal of Nursing Studies 39, 867878. Upenieks, V., 2003. Recruitment and retention strategies: a magnet hospital prevention model. Nursing Economics 21 (1), 713. Yin, J.T., Yang, K.A., 2002. Nursing turnover in Taiwan: a meta-analysis of related factors. International Journal of Nursing Studies 39, 573581.