Job satisfaction is a complex phenomenon that has been studied extensively by social scientists and researchers. It is of interest to managers in a variety of settings, and to the employees who work with them.1 In nursing, registered nurse (RN) job satisfaction and RN retention are a major focus for nurse administrators, particularly as the demand for nurses continues to surpass supply. Researchers have demonstrated significant links between RN job satisfaction and RN retention,2-12 job stress and burnout,13,14 quality of care,15-19 and patient satisfaction.19-21 One job satisfaction researcher identified three reasons why nurse satisfaction should be of interest: job satisfaction is related to turnover, it is a possible determinant of effective job performance and quality care, and it should be viewed as an end in itself.22

Job satisfaction is a multidimensional concept influenced by many variables.23-27 Individual workers bring a variety of needs, values, and perceptions to the work environment, along with differing personality and sociodemographic characteristics that may influence job satisfaction. Researchers have posited that the characteristics of the individual (eg, age,25 locus of control28), and the work organization (eg, communication, policies)24,25,27 mutually constitute job satisfaction.29 The phenomenon of job satisfaction is complex, and while no single factor stands out as the major explanatory variable, the work-related attributes that influence registered nurses' job satisfaction are important to identify and understand. This article discusses work-related attributes that contribute to RN job satisfaction, recognizing that other variables (eg, individual characteristics) may further influence satisfaction.

Attributes That Contribute to Registered Nurse Job Satisfaction

Ten attributes that influence RN job satisfaction were identified based on frequency and consistent appearance in the literature.The attributes include autonomy, interpersonal communication/collaboration, professional practice, administrative/management practices, status/recognition, job/task requirements, opportunity for advancement, working conditions/physical environment, pay, and fairness.

Autonomy

Autonomy is independence within one's practice,30 where the ability to exercise nursing judgment for patient care exists.31 Autonomy, sometimes termed responsibility or accountability, has been widely cited in the literature as one of the most important attributes of nursing job satisfaction.9,10,15,22,25,27,32-36 A meta-analysis of factors that contribute to job satisfaction in samples of workers from many occupations found autonomy to have the strongest relationship to job satisfaction (r = .46), followed by feedback (r = .41), and job variety (r = .38).37 Other researchers found that autonomy and control over practice were significant predictors of work satisfaction and perceived work effectiveness,33 as well as of patients' perceptions of their nursing care.38

Interpersonal Communication/Collaboration

Interpersonal communication/collaboration is the effective communication (formal and informal) and collaboration within the organization with co-workers, managers, and physicians.33 Studies have found that relationships with co-workers and supervisors,12,25-27,33 team work,39 as well as collaboration with physicians in decision-making about patient care16 are important correlates of job satisfaction. While examining the communication between staff and physicians in an intensive care unit (ICU), researchers found higher patient satisfaction and better patient outcomes in environments where collaboration and communication among team members was rated as "good" by those providers.16 In another ICU study, researchers found significantly lower mortality rates in intensive care units where there was better interaction and coordination of the hospital's intensive care unit staff.40

Professional Practice

Professionalism, or the dedication to occupational standards, is important to nurses' job satisfaction.25 Professional practice incorporates nursing research into practice and care delivery by employing an evidence-based practice model. Components of professional practice include professional independence, the opportunity for specialization, and a professional care delivery model most often identified as primary nursing.41 Researchers have found the primary nursing care model to positively influence job satisfaction.42

Administrative/Management Practices

Administrative and management practices refer to the structure of the organization. It includes the centralization or decentralization of authority as well as the clarity and fairness of organizational policies and procedures.25,30 Organizational and management practices consistently have been reported in the literature to influence job satisfaction. Centralization is the concentration of power within an organization.25 Decentralization is the delegation of authority for decision-making to the operational level within the organization, which is often facilitated by participatory management styles.43 Researchers have found nurses to be more satisfied with decentralized and participatory management models30,43,44 and less satisfied with centralized authoritative styles.45 Decentralization has also been linked to an increase in autonomy and to nurse retention.43

Status/Recognition

Status and recognition refers to the value of nursing in the organization as well as how individual nurses perceive their value and the recognition of their accomplishments.25 Recognition for work performance is positively related to job satisfaction,23,25,46-49 while the lack of recognition has been linked to decreased job satisfaction27,48 and decreased nurse retention.12 The institutional recognition of the contribution and value of nurses is a consistent finding in magnet hospital research.49 In terms of the types of recognition, researchers found that informal feedback from the head nurse was important to staff nurses' job satisfaction, second only to monetary rewards.48

Job/Task Requirements

The job or the task requirements are the activities that must be accomplished as regular part of the job.50 Herzberg24 reports that task requirements are critical to job satisfaction, but have little influence on dissatisfaction. Job satisfaction is lower when there is routinization of work and the tasks are repetitive.25, 27 Meaningfulness and variety of work was found by researchers to have a significant influence on job satisfaction.50,51

Opportunity for Advancement/Promotion

Price and Mueller define the opportunity for advancement as the "degree of potential vertical occupational mobility within the organization."^6(p11) Professional opportunities have been found to be an important attribute of RN job satisfaction.46,51 Nurses who perceive they have opportunity for promotions are more satisfied than those who do not have the option.52 To provide an advancement opportunity for hospital-based clinical nurses, many institutions developed career ladders. It is important that clinical ladders provide a broad hierarchy that will recognize the achievement of clinical staff.

Working Conditions/Physical Environment

Working conditions and the physical environment of work encompass work conditions including staffing, workload, shift worked, physical environment, supplies and equipment, work scheduling, and flexibility. Researchers have established a relationship between work environment and job satisfaction and have also found a positive relationship between this attribute and job satisfaction.41 Structural problems with work, such as unreasonable expectations of employers, undesirable hours of work or shifts, and lack of flexibility have been associated negatively with job satisfaction.50,53 The actual type of patient care unit and the labor-intensity has also been found to influence satisfaction levels.54

Pay

Pay is the dollar remuneration and fringe benefits received for work.25 It is consistently included as a job satisfaction attribute. Researchers have found a relationship between RN satisfaction with pay and job satisfaction.25,50,51,55 As a single attribute, adequate pay may not enhance job satisfaction; however, pay perceived as inadequate will certainly produce job dissatisfaction.

Fairness

Fairness or distributive justice is defined as the "perceived fairness of the processes through which decisions are made."56^(p278) It is the relationship between job performance and subsequent rewards and punishment.25 Fairness is not consistently included as a job satisfaction attribute; however, researchers have found a relationship between fairness and job satisfaction.27,57 The inclusion of a fairness variable in job satisfaction studies was supported by a meta-analysis of job satisfaction variables.27

Conclusion

The concept of job satisfaction and understanding the attributes, antecedents and consequences is important for all organizations. However, it has specific implication for the healthcare industry, since lower levels of job satisfaction are reported in the human service industry as compared with other types of organizations.58,59 Job satisfaction among hospital nurses is significantly lower than the average for other workers in the United States.60 The challenges for RN recruitment and retention are apparent, particularly in light of the workforce supply forecasts.61 Developing a thorough knowledge of the attributes that influence RN job satisfaction will assist administrators at all levels of the institution in the formation of strategies to enhance RN job satisfaction.

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