You are on page 1of 11


International Journal of Nursing Studies 44 (2007) 747–757

Job satisfaction in a Norwegian population of nurses: A questionnaire survey
Ida Torunn Bjørka,Ã, Gro Beate Samdalb, Britt Sætre Hansenc, Solveig Tørstadd, Glenys A. Hamiltona

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 Bærum 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 influences 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 significant difference in job satisfaction between participants and non-participants in a clinical ladder. Nurses intending to stay more than a year were significantly more satisfied 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 defining 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

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

E-mail address: (I.T. Bjørk). 0020-7489/$ - see front matter r 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.ijnurstu.2006.01.002

2001). Shader et al. and no large systematic studies have been conducted in Norway. autonomy (Blegen. 2003). / International Journal of Nursing Studies 44 (2007) 747–757 What is already known about the topic?  Nurses’ job satisfaction is linked to turnover. a widely used and validated job satisfaction instrument was chosen. There are few reported studies focusing on these issues in Europe.ARTICLE IN PRESS 748 I. 1997). Introduction Recruitment. different job characteristics or as a response to organizational features in the work setting (Stamps.1. Index of Work Satisfaction (IWS) by Stamps (1997). 1997). Reported studies with the IWS have mostly been undertaken in the USA. 1993. Nurses’ satisfaction with their job has been viewed as one important factor both influencing and been influenced by these issues. Job satisfaction has been studied with many different tools and in many different nurse populations. Varying results are reported concerning the effect of participation in professional development on job satisfaction. Satisfaction as a function of the organization may be related to factors such as the variation in work hours (Hoffman and Scott. A few studies have also been conducted in Asia. 1993) or workload (Best and Thurston. management style or leader-  job satisfaction. Blegen.T. 1999). 1997). Purpose of the study The main purposes of this study were threefold. 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. Goodin. 2003).  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.. both recent and in general.. Although these forms of professional development are recognized as important factors associated with lower turnover and higher levels of job satisfaction (Buchan. Review of the literature 3. Participants in a clinical ladder did not have higher overall job satisfaction than non-participants. The distinction has to be made by the variables chosen for measurement (Stamps. clinical ladders or clinical advancement programs may be viewed both as an attribute of a specific job and as an organizational feature. intent to stay and turnover Numerous factors have been linked to turnover. 2003). Canada and Australia. there are relatively few studies. retention. 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 findings with results from similar studies. A secondary purpose was also to investigate the use of Stamps’ (1997) instrument in a different culture than its origin. 2002. 2. For decades the cyclic nature of nursing shortage and surplus has instigated research with the purpose of finding causes and remedies for solving the problems associated with high turnover and the impact this has on the quality of nursing care (Blegen. What this paper adds ship (Upenieks. In the literature job satisfaction is conceptualized as an independent variable affecting behaviour such as retention and turnover among nurses.. Personal characteristics and demographic variables are repeatedly reported as quite low correlates of job satisfaction (Adams and Bond.  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.. 2004). Stamps. 2003). or as a dependent variable occurring as a result of personal characteristics. how  ever. 1999b). Recognition programs.. several studies find that intent to stay is the intervening variable between them. Job satisfaction. The relationship with job characteristics and organizational features is often stronger. 1993. . 2002). that have focused on the relationship between participation in clinical ladders and job satisfaction. 2000. Bjørk et al. to describe job satisfaction among hospital nurses in Norway. turnover and development of quality care in nursing are global issues within the health care setting (Aiken et al. The job satisfaction instrument used was sensitive to cultural differences in views on the importance of different job satisfaction factors. but job satisfaction is the most frequently cited (Lu et al. or an organizational environment that promotes empowerment (Kuokkanen et al. The only country in Europe reporting a study with the IWS is Great Britain (Burnard et al. Satisfaction as a function of a specific job is related to factors such as stress (Flanagan and Flanagan.

T. 1999). Upenieks (2003) proposed a prevention model to increase job satisfaction and reverse the nursing shortage. There was no direct association between job satisfaction and turnover. recognition programs or clinical advancement programs. It follows that exploring differences in job satisfaction between participants and non-participants of clinical ladders is of interest.ARTICLE IN PRESS I. Both Meador (1994) and Babb (1995) showed that participants had a tendency for higher scores on job satisfaction measures. 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. Turnover intentions are measured as either intent to stay or intent to leave. 1990). 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. not lose them. or worded in opposite terms as intent to leave (Lu et al. Price and Mueller (1981) developed an explanatory causal model of turnover and tested it among 1100 nurses. The literature search revealed some additional studies not mentioned in Buchan’s (1999b) evaluation of the benefit of clinical ladders. had substantially higher correlations with job satisfaction than the other factors. or to increase with increasing levels of advancement in the ladder. po0:05. Cavanagh and Coffin (1992) explored staff turnover among hospital nurses using the Price and Mueller model (1981). organizations with professional development programs such as clinical ladders. intent to stay and turnover. Findings corroborated the propositions about the associations between job satisfaction. Sociological variables. to significant differences in overall satisfaction (Bruce. intent to stay and turnover. Implementation of clinical ladders was one suggested strategy in this model.. 1987) and not significant (Bell. Overall job satisfaction of nurses within a clinical ladder was reported unchanged (Corley et al. Since the 1970s clinical ladders have been described as an important factor in attracting and retaining nurses. In a more recent meta-analysis by Yin and Yang (2002) the relationship between job satisfaction and turnover was characterized as strong. The opportunity for professional growth is sought after when nurses are looking for jobs (Havens and Aiken. although these findings were both significant (Roedel and Nystrom. Magnet hospitals promoted professional development that encompassed planned orientation of staff. 2001). not in scientific journals. Modelling the successful Magnet hospitals in the USA. Bjørk et al. However. Several other studies have reported a significant relationship between job satisfaction and intent to stay (Borda and Norman. In these studies sample sizes were often rather small and many of the studies were only published as master theses or doctoral dissertations. Thornhill. 1990. Based on an extensive literature review.2. 1993). competency-based clinical ladders and management development (Buchan. 1997). interaction with colleagues and task requirements (Malik. 1994). but there is a paucity of evaluation and research into the outcomes of such programs (Buchan.. Job satisfaction and participation in clinical ladders In general. 1994). Limited or no impact of clinical ladders was also reported (Costa. Krugman and Preheim. economical. Only Krugman and Preheim’s study (1999) was found . it made sense to measure intent to stay. are associated with opportunities for advancement and report higher overall degrees of staff satisfaction (Serow et al. 3. among them advancement opportunities. However. 1999a).. emphasis on service. This matches the results from Schultz’ (1993) study of the relationship between job satisfaction. 1991). Nurses in these hospitals reported higher job satisfaction than nurses in other hospitals (Kramer and Schmalenberg. 2002. but the differences were not significant. 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. Stamps (1997) suggested that since the goal was to keep staff. reported as rxy ¼ À0:23.. 2002). 1991). autonomy. continuing education. 1993). sociological and psychological variables. In the late 1980s and beginning 1990s there was some interest in studying the impact of different kinds of professional development on job satisfaction. In a meta-analysis Irvine and Evans (1995) found that a small negative relationship existed between job satisfaction and turnover. 1999. Schultz. intent to stay was the intervening variable that connected these two variables. turnover and level of advancement in a clinical ladder. 1999b). 1993. Aiken et al. In their model of nurse turnover behaviour Irvine and Evans (1995) also included correlates of job satisfaction. / International Journal of Nursing Studies 44 (2007) 747–757 749 2005). Job satisfaction was positively associated with intent to stay and intent to stay was in turn positively associated with turnover. to significantly more satisfaction with some sub-factors of job satisfaction. The more advanced nurses had lower turnover rates and higher satisfaction rates than nurses in lower levels of the ladder. The range of author nationalities represented in this field of research underscores a global relevance in the issues of job satisfaction. Tzeng. Results vary from no significant differences between nurses regardless of their unit of employment (Haas. 1986.

/ International Journal of Nursing Studies 44 (2007) 747–757 in the literature after 1997. varying between 39. The programs are quite extensive and resource demanding and require acceptance as part of the organizational structure of the health institution. the patients’ age group. The hospitals represented the regional. p. Nurses are accredited on an individual basis through documentation to the NNA and use the title of clinical specialist in nursing. Design This study used a cross-sectional survey design in which nurses from four hospitals completed questionnaires on one occasion. 5. The instrument has been widely used. Bjørk et al. The IWS is a two-part multidimensional instrument.4% and 54. individual bedside supervision and group supervision. The result of the review also supports Buchan’s 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. The IWS was used to measure job satisfaction. either after accreditation by the NNA or after each level of the ladder (most ladders have three levels). Task requirements are tasks or activities that must be done as a regular part of the job. 4000 pages of literature related to course subjects and a specified area of interest in nursing.7% among the four hospitals. In conclusion. The total population of nurses eligible for inclusion according to these criteria (N ¼ 4650) was invited to participate. as indicated by retrieval in February 2005 of 44 studies using the instrument since 1995. 24 items (Lauri et al. 5. task requirements. 1999b) the Norwegian program is a national level structure. 150 h of course work. general nursing topics and topics that target the area of interest. 120 h of supervision. the IWS (Stamps. research and experience from clinical practice. a professional development project within the chosen area of interest in nursing. or a group of patients or diagnosis. 1997).1999). The borders of this area can be defined through specified nursing functions. 1999b) the Norwegian program has a strong educational profile. All four hospitals had implemented a clinical ladder system at the organizational level before year 2000.     .T. and will be reported in separate papers since they are not the topic of this paper. Nurses receive a raise in salary. Methods 5. Organizational 4. Autonomy is the amount of job-related independence. In comparison with clinical advancement and clinical ladder programs described in the literature (Buchan. Part A measures the importance of six components of job satisfaction. and 7 author derived evaluation questions about the clinical ladder program. pay. The overall return rate was 45.1.ARTICLE IN PRESS 750 I. Overall. 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. either permitted or required in daily work activities. specific needs for treatment or care.5% (N ¼ 2095). Originally developed in 1972 the instrument was based on a combination of need-fulfillment theory and social reference group theory (Stamps and Piedmonte. 5. Clinical ladders in Norway The Norwegian Nurses Association in Norway (NNA) instituted a program for professional development in nursing in 1995. These hospitals were chosen on the basis of a longer history of systematic professional development for nurses. content specifications and criteria for professional development must be followed. interaction and professional status. Instrumentation The questionnaire consisted of four sections: demographic and background variables. The components are defined at the beginning of the instrument before respondents are presented with 15 forced-choice comparisons of the six components. but health institutions are free to develop different strategies and local content within the national structure. offering the same opportunities to participants in nearly every department at all hospitals. and two other sections.3. 1986) and has been through two revision processes (Stamps. and not have to leave their job for formal education in order to update professional skills. organizational policies. autonomy. Contrary to reports on other programs of clinical advancement (Buchan. county and local level and two of the hospitals were university affiliated. The purpose of the program was to give nurses an opportunity to develop professional skills ‘‘at the bedside’’.2. documented in a paper based on theory. initiative and freedom. These two sections related to clinical decision-making. 143). 1997). this review shows that there still is a lack of research into the correlation of job satisfaction and participation in clinical ladders. Pay is the monetary remuneration and fringe benefits received for work done. In order to be accredited as a clinical specialist the applicant must document the following:  5 years of clinical practice within a specified area of interest in nursing.

Informed consent to participate was indicated by return of the questionnaire.91 for the overall scale (Stamps. Five hundred and forty-one nurses (28. very closely followed by interaction (5. education and number of years at the hospital and in the unit (Table 1). 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.4. Professional status is the overall importance or significance felt about the job. The range of the Total Scale Score from part B of the instrument is 44–308 with higher scores reflecting a higher job satisfaction. Alternative responses were nothing. There were two questions in the background survey that were explored. 1 day and more than a day.3 and the nurses had worked an average of 5. More than one-fourth of the nurses were single (28%) and nearly half of the participants had children living at home (46.56) and autonomy (3. 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. estimates of subscale reliabilities. trying out new interventions. 1997).8% did not know how long they would stay. 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 coefficients.3 as most important. There were significant differences in levels of job satisfaction related to age.84). Approximately one-third of the nurses (32.58).1%) had some kind of continuing education. Bjørk et al. Data were analysed with descriptive and inferential statistics.5 years in their present unit. the questionnaire and a pre-addressed envelope for return of their response.79) as the fourth highest ranked component followed closely by organizational politics (3. The nurses rated professional status as the most satisfying job component (5.9%) had graduated within the last 5 years. Each participant received an envelope at work consisting of a cover letter explaining the purpose of the study and ensuring confidentiality.51 (SD . 6. especially the professional status component. In this order interaction (3. Average years of nursing experience in the hospital were 8. 6.3%) participated/had participated in a clinical ladder program at their hospital.14) were much less important among these Norwegian nurses. Participants were asked if they intended to continue as a nurse at the hospital. both in own view and in the view of others. They could check one of three alternatives. Interaction is the opportunity presented for both formal and informal social and professional contact during working hours.0. quality indicators.29 and .46 for this component (Stamps. The Component Weighting Coefficients fell into two clusters (N ¼ 2095). 6. . Confirmatory factor analysis was performed to compare the construct validity of part B of the IWS with results from previous research. revealing their current level of job satisfaction. Stamps’ 1994–1995 review of research with IWS revealed a’s between . Such time can be used for development of standards.62). and organizational policies (2.62).50).48) and autonomy (5.2.1. 5. less than a day. Intent to stay is reported as a better indicator of actual behaviour than intent to leave (Stamps.81). Results 6.52) were ranked as the three most desirable components while task requirements (2.73). this gives a Mean Scale Score of 4. 1997). However. The questionnaires were optically scanned and data were entered into the SPSS version 12. Ranking of these coefficients indicated the relative importance of each component with a range of .05). / International Journal of Nursing Studies 44 (2007) 747–757 751 policies are the management policies and procedures put forward by the hospital and nursing administration of the hospital. Respondents rate the questions from 1 to 7 (agree to disagree).9 as least important to 5. Part B is comprised of 44 Likert-style questions reflecting different aspects of the above-mentioned six components of job satisfaction. Previous research has documented the instrument as reliable and valid with Cronbach’s a in the range of . professional status (2. while 20.8%). pay (3. Nearly half of the nurses (47. next year. 1997). There was quite a gap in scores between these three job components and the other three. In this group of nurses the average Total Scale score was 198.5 years ranging from 21 to 72. Seventy-two point six per cent of the nurses planned on continuing at the hospital for more than 1 year. Component Mean Scores represent the levels of current satisfaction with the job components. Procedure and data analysis Permission to distribute questionnaires was obtained from department directors.T. with task requirements (3. Seven point nine per cent of the nurses were men. evaluation of procedures and routines or participation in a clinical ladder.5 (SD 25. One question was developed for this study.82–. Respondents were also asked to indicate the amount of time scheduled for professional development per month. Part B of the instrument measured the nurses’ current level of satisfaction with the six job components.ARTICLE IN PRESS I.6% planned on staying no more than a year.77) and pay as the job component with the decidedly lowest score (2. have been less consistent. more than a year and do not know. Demographics Mean age of the participants was 37.

39 4.00 t .13.87 24.08 . / International Journal of Nursing Studies 44 (2007) 747–757 Nurses older than the mean age of the sample (37 years) were more satisfied with their job than those younger than the mean age.74 200. Participants in clinical ladders ranked autonomy before pay.T.77 p .67 3.71 p Younger than mean age (21–37) Older than mean age (38–72) 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 .30 6.50 198.08 . 6.43 24.ARTICLE IN PRESS 752 I.25 199.97 196.78 .89 6.06 . p ¼ :000) than those who had less than 1 day or none (N ¼ 1356.27 1.56 8.55 5.37 16. mean 205.59 22.94 197.55 1.77). Nurses with a master’s degree or other continuing education were more satisfied than those without additional education.99 6.89 200.08 196.30 54.45 .000 .79 4.58 22.07 .50 6.58 .73 . Bjørk et al.00 4. although the differences in Component Weighting Coefficients were very small.79 .97 SD 25. There was no significant 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.77 .77 6.04 2.104 .000 .88 .63 1. There were no significant differences in level of job satisfaction related to gender or family situation.4.3.45 198.79 197.44 1.001 There was a difference between participants and nonparticipants in clinical ladders in relation to what job components they ranked as most important.008 . 1997) N Total Scale Score Subscales Professional status Autonomy Pay Task requirements Organizational policies Interaction Nurse–nurse interaction Nurse–physician 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 198.04 1.05 196. 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 195.54 201. t ¼ 6:58.000 . while nonparticipants saw pay as more important than autonomy.65 198. mean 195.67 26.67 26.35 2.56 6.84 25.89 30.35 40.19 5.60 195.34 6.81 6. Nurses who had worked more than the average number of years at the hospital (48 years) or in the unit (45 years) were more satisfied than nurses who had worked a shorter time.18 40.38 3.59 200.08 6.28 .82 38.73 38.29 29.60 8.69 196.612 1. 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.23 15. 6. 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 ¼ 412.507 .164 .03 .41 3.18 6.83 194. Nurses who had finished their education before 1999 were more satisfied than nurses educated within the last 5 years.74 54. Both groups still ranked interaction as the most important component.

5 1 1 3 2. p ¼ :002. educational level. N ¼ 126 Hospital staff nurses Kovner et al. Bjørk et al. N ¼ 190 Hospital staff nurses Goodell and Van Ess (1994). N ¼ 287 Correctional nurses Foley et al. 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. Furthermore professional status was consistently ranked lower than in all the other studies (Table 3). 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 ¼ 2095 Hospital nurses Best and Thurston (2004). N ¼ 76 Critical care nurses Flanagan and Flanagan (2002). A striking difference was Norwegian nurses’ ranking of interaction as the most important component of job satisfaction. Is there a relationship between job satisfaction.43. Nurses with 1 day or more scheduled for professional development were more likely to stay. participation in a clinical ladder. N ¼ 150 Hospital nurses Hoffman and Scott (2003). N ¼ 208 RNs. N ¼ 387 Hospital nurses Cowin (2002). p ¼ :000. N ¼ 80 RNs in post-registration conversion courses or postgraduate courses Tumulty (1992). There was no significant difference between participants and non-participants in clinical ladders in their intention to stay. w2 ¼ 38:27. . w2 ¼ :58.T. N ¼ 528.ARTICLE IN PRESS I.29 vs. 6.5. Significant differences in job satisfaction did however occur when viewing the results of the subscales of interaction. or time for professional development and intent to stay? Nurses intending to stay more than 1 year (N ¼ 1214) had a significantly higher mean Total Scale Score of job satisfaction than nurses who planned to stay less than a year or did not know (N ¼ 466). w2 ¼ 9:91. Further education was found to be positively related to intent to stay. ranking of importance. p ¼ :45. N ¼ 850 Hospital nurses Takase et al. 75% in hospital Johnston (1991).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 1 3 4 2 6 5 Major difference in ranking between present study and earlier studies. t ¼ 8:13 and p ¼ :000. 332 Several locations Ecklund (1998). a component never ranked first in any other study. (2004).6. / International Journal of Nursing Studies 44 (2007) 747–757 753 ladders as measured by the Total Score Scale of IWS or for each of the six subscales. The calculation of w2 tests gave the following results. (1994). as part of their questionnaire. Higher satisfaction with nurse–nurse interaction was indicated among clinical ladder participants (Table 2). N ¼ 299 School nurses Fung-Kam (1998). 189. (2002). Table 3 lists the results from all studies after 1990 that have used part A. Mean score 201. 6. N ¼ 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.

In those that do.. 1995). Hoffman and Scott. interaction and autonomy. Johnston. Costa. 1998. The opportunity to participate in a systematic professional developmental program does not seem to be necessary in order to keep nurses satisfied in their job. Tranmer et al. Discussion In general nurses in this study valued interaction. Irvine and Evans. 1990. Goodell and Van Ess. were among the three factors that gave nurses the highest actual satisfaction in their job. 1991. Foley et al. Ecklund. 1996. Older age. Cappelen. 1995) and therefore of utmost importance to the organizations that employ nurses. 1994. Although job satisfaction is important to the individual nurse. 1981. Many of the later studies with the IWS have not included these nurse characteristics. One can ask if it is more important to have a good time with your colleagues than to have influence and status in the professional world. 2005) regulate the working environment in Norway. not only the nursing community are expected in times of downsizing and tight budgets. 1992).. In other studies the results were mixed (Fung-Kam. but results that are beneficial for the hospital organization. Gillies et al. Meador. 1994). Being able to use working time for professional development is a gift in a hectic working day. 1998.. Sørensen. and not something special for the Norwegian nurse population. Gillies et al. 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. Hays and Dowling-Williams. 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. 1994. 2001. 2003. 2002. 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 influence their working conditions and job satisfaction.. Nurses’ actual satisfaction with their job in this study was similar to respondents in many other countries1 (Cowin. 1997. 1998. 1992. 1995. This is consistent with earlier research exploring the effect of opportunities for . where professional status gave the greatest satisfaction followed closely by interaction and autonomy as either second or third choice. Fung-Kam.. 1995. and reflects the importance assigned to the working milieu in the Norwegian society as a whole as well as in the nursing profession. However. In this study the effect of several variables were explored in relation to intent to stay. 1996. The main factor here might be age. Hays and DowlingWilliams. Laws that attach importance to psychosocial well-being (Arbeidsmiljøloven. 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. These variations might indicate a higher professional ‘‘profile’’ among clinical ladder participants since both autonomy and professional status were rated higher among participants than non-participants. 1993) or mixed results (Stamps. 2002. This finding is consistent with some of the earlier studies that investigated the effect of clinical ladders (Babb. research has documented that it is intent to stay that is strongly related to turnover (Price and Mueller. Takase et al. nurses with a day or more per month scheduled for professional development did have significantly higher scores on job satisfaction. 1994. Thornhill. By institutionalizing scheduled time for professional development the organization rewards nurses with initiative and promotes a focus on development of quality in nursing care. 2004. further education and longer working time in the institution were demographic factors that corresponded significantly with higher values of current job satisfaction in this study. Tumulty. Participants in clinical ladders were significantly more satisfied with current nurse–nurse interaction than nonparticipants. 2002. From 1986 the number of items was reduced from 48 to 44. 1997). 2002. Low ranking of professional status might be seen as a consequence of the importance Norwegian nurses ascribe to their working milieu. As seen in the summary in Table 3. Cavanagh and Coffin.T. (2002) contention on globalization in nursing and imply that structures and content that define nurses’ working situations are similar in many parts of the world. Ingersoll et al. only small variations in the importance of job satisfaction occurred between participants and non-participants of clinical ladders. Flanagan and Flanagan. 2002. These findings support Aiken et al. Hoffman and Scott. low importance ascribed to organizational policies is well documented as a global phenomenon among nurses. The (Brata importance of interaction with colleagues is however consistent with the findings in the meta-analytic studies by Blegen (1993) and Irvine and Evans (1995). 1997). 1998. 2000). FungKam. Bjørk et al. In earlier research demographic factors showed a rather low relationship with job satisfaction (Blegen. 2003.. Cowin. pay and autonomy as the components most important for their job satisfaction. / International Journal of Nursing Studies 44 (2007) 747–757 7. Apart from this. 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. 2004. since both further education and longer working time in the institution in most cases correspond with increasing age. 2002. Flanagan and Flanagan. Kovner et al. (2002) reported similar results to this study regarding the influence of age and further education on overall job satisfaction.ARTICLE IN PRESS 754 I. Medley and Larochelle. in this sample two of the most important factors for nurses.

1999. which is within the range of the originally reported a’s (Stamps. In Stamps instrument the 10 items of the Interaction subscale can be divided into a nurse–nurse interaction scale and nurse–physician interaction scale with five items in each scale. S.ARTICLE IN PRESS I. 7. It did. 2004. 2002. In the present study all 44 items loaded on 10 factors that had Eigenvalues above 1. autonomy and task requirements loaded on three different factors each. References Adams. Stamps. Hoffman and Scott. 1993). 2002). Bjørk et al. The original items on organizational policies loaded on four different factors while the items on professional status. 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.. Bond.86.82 for pay. All six items of pay loaded on the first factor. more educated. The highest subscale a coefficient was . 2000. Journal of Advanced Nursing 32. Hospital nurses’ job satisfaction. individual and organizational characteristics. Conclusion Although the confirmatory factor analysis of the IWS showed inconsistencies with earlier factor analysis. Takase et al. while the a coefficients for the other subscales ranged from . 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. Confirmatory factor analysis was performed to compare the construct validity of the IWS in this study with previous research. some factors only including 2 and 3 items (Table 4). The low a for professional status mirrors the lack of consistency in this subscale as reported in the literature (Hoffman and Scott..T. 1997). A further limitation might be the modest response rate. 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. Cronbach’s a for the total scale of IWS was . however support the notion that nurses who are older.78 to .1. We know only what 45. Professional status only had an a of . 2002). Ingersoll et al. 1991. The factor analysis confirmed these subscale items as separate and distinct factors (factor 2 and 7). the results of this study showed that the instrument correctly caught the underlying importance of interaction in the workplace among Norwegian hospital nurses. Ecklund 1998.. 2003. On the other hand this response rate is similar or better than that reported in some of the other studies (Best and Thurston. thus we do not know how the other nurses think about job satisfaction.66. 2003. Otherwise the other factors contained a mixture of items assigned to the original instrument’s subscales.44. Kramer and Schmalenberg. 8. However. Serow et al. / International Journal of Nursing Studies 44 (2007) 747–757 Table 4 Factor structure for IWS in present study Factor Original subscales (number of items) Pay (6) Interaction: Nurse–nurse (5) Interaction: Nurse–physician (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. In this study there was no significant relationship between participation in a clinical ladder and intent to stay. 536–543. 1997). 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. 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. A.5% of the nurses thought. but included on this factor was also 1 item from Stamps organizational policy subscale (Table 4). 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.

Perceptions of job satisfaction in a long term care facility: a comparison between a dedicated Alzheimer’s unit and non-Alzheimer’s units. T. 2003. Journal of Gerontological Nursing 22 (4). D. Blegen. Aiken. Havens.. N. Lee. DeVinney..L. 1993. Krugman. Testing a model of absence and intent to stay in employment: a study of registered nurses in Malta.A. University of Illinois.J. Journal of Nursing Care Quality 18.T. Doctoral Dissertation. 1369–1376.. T.T. Impact on nurse satisfaction and turnover.R. Journal of Nursing Administration 24. 1999. and the problem is getting worse. M. 250–263.R. Research in Nursing & Health 25. Geddes. 2002. The effects of nurses’ job satisfaction on retention: an Australian perspective. 1996. Schmalenberg. Kuokkanen.. J. J..A. P..A.. 1994.P. University of Massachusetts. 1998.M.A. L. T. 43–53. Corley. L... 2003. Job satisfaction and turnover among nurses: integrating research findings across studies. N.. Doctoral Dissertation.. Scott. Evaluating the benefits of a clinical ladder for nursing staff: an international review. Journal of Nursing Administration 24. job-related satisfaction. [Job satisfaction in the intensive ward. Goodin. An analysis of the relationship between job satisfaction and job stress in correctional nurses. continuing education. J.L.W. Buchan. V. C. Farley. working hours and occupational protection No. 2004.L.S. Nursing care delivery models and nurse satisfaction.. Sochalski. California State University. Olsan.. 503–513. R. Journal of Advanced Nursing 30. Drew-Cates. Arbeids.M. Role stress and career satisfaction among registered nurses by work shift patterns. Hovedoppgave. Doctoral Dissertation.J. 246–253... 1992. Nurse empowerment. 33–40. Journal of Nursing Administration 29 (5).. International Journal of Nursing Studies 36. Dowling-Williams..G. 187–194.H. Journal of Nursing Administration 32. K.. 1999. Bell. Hays. Clarke. M. G.. Foley. and quality of care: cross-national findings.. I. G. 100–108. Gillies. 1997. M. Coffin. C. Van Ess.. Jobbtilfredshet pa ˚ intensivavdeling....H. Norman.ARTICLE IN PRESS 756 I.J. Journal of the New York State Nurses Association 29 (2). Goodloe. et al. 1999. Costa. Morrison. 355–363.M.. R. 283–291. S. Nurses’ job satisfaction: a meta-analysis of related variables. Foreman. Babb. Irvine.. Ingersoll. L. Fung-Kam. Knickman. L.. Hendrickson. Journal of Advanced Nursing 17.. Bruce.D... 1997. Canham. Best. M.M. Outcomes of nurses’ job satisfaction. 14–20. 1990.. 335–343. 2002. The effect of nursing clinical ladder programs on patient care and the role of the nurse. The clinical ladder.. Journal of Nursing Administration 33 (6). Still attractive after all these years? Magnet hospitals in a changing health care environment.E. Master Thesis. 9–18.A.. 2002. Journal of Advanced Nursing 43. 1991. Johnston.. Law concerning working environment. Buchan. Ledelse—motivasjon og kompetanse I sykehus. Job satisfaction amongst nurses in an interim secure forensic unit in Wales. Clarke. L. M. Western Journal of Nursing Research 13. 1993. L. Sources of work satisfaction/dissatisfaction for hospital registered nurses. S.. Journal of Advanced Nursing 27. Master Thesis.. Doctoral Dissertation. Arbeidsmiljøloven. 1998.M. 375–384. International Journal of Nursing Studies 34. Reward strategies for the retention of professional nurses. Journal of School Nursing 20. / International Journal of Nursing Studies 44 (2007) 747–757 Cowin. A multi-factor analysis of job satisfaction among school nurses. 2002. Journal of Nursing Administration 29. H.C. J. S. Thurston. 1999a. 51–55. The Wright Institute. Health Affairs 20 (3).M. Satisfaction of nurse managers in long-term care. 36–41. 94–100. Busse. [Working Environment Law 2005. M. Finkler. C. J....M. D. Australian and New Zealand Journal of Mental Health Nursing 8 (1). 36–41... Borda. 282–294. M. D.A. Goodell. 1994.H. 2001. J.C. Journal of Nursing Administration 32.. ˚ s. commitment..M...A. A. The nursing shortage in the United States of America: an integrative review of the literature. Nursing Administration Quarterly 19... Leino-Kilpi..] Norway.. 1995. Ecklund. 74–85. J. B. 283–290. 62. H. 1999b.. and organizational commitment.. Flanagan... 13–15. Katajisto.T. C.. 10–20. 1995.Y. Kovner. 1986... Cavanagh. T. and career intent. Lov om arbeidsmiljøarbeidstid og stillingsvern nr. D. Haas. A.J. Green. Phillips. Cappelen. Nurses’ reports on hospital care in five countries: the ways in which nurses’ work is structured have left nurses among the least satisfied workers. 37–42. 42–48. University of Virginia.P. Dominguez Hills. 62.. . L. HoveBrata doppgave.. S.A. 2001.. Clinical ladder participation and staff nurse job satisfaction. Nursing 21. H. Hospital staffing.. [Leadership—motivation and competence in hospitals. G. Nurses’ perceptions of the clinical ladder’s contributions to their levels of job satisfaction and dissatisfaction. 2003. Job satisfaction and autonomy of Hong Kong registered nurses. 1994. Nursing Outlook 50. J. Clarke.. Pettengill. 1991. C. Aiken. 1990.. Nursing Research 42 (1). Master Thesis. 137–144.G.F..og Sosialdepartementet.. Job satisfaction and retention: insights for the 90 s—Part 2. P. 2005.and Social Department..H. Wilson. Nurses’ job satisfaction. Nursing Research 44. 184–192.. Aiken. productivity). D. Shaping systems to promote desired outcomes: the magnet hospital model. The relationship of mentoring to job satisfaction of critical care nurses. Work. M. organization. S. B.. Measuring nurse job satisfaction.. L. J. Evans. L.A. O. Hoffman. Cureton. Staff turnover among hospital nurses. Longitudinal evaluation of professional nursing practice redesign. P. A survey of staff nurse perceptions of proposed outcomes of clinical ladder performance appraisal systems (job satisfaction. Journal of Nursing Administration 34. L..] The Norwegian University for Science and Technology.. Preheim. American Journal of Alzheimer’s Disease 12 (1). D. Burnard. 2004. D..] University of Oslo. Bjørk et al.. organizational commitment. Davies.. P. M.J.. 2002. 35–39. D.. Sloane. N.J. M. Flanagan. Kramer. Sloane.

1981. 210–216. Spectrum Publications Inc.L. second ed.K.. Medley.T. S. Meador. Nystrom. 2002. J. Malik. K.... L. Larochelle. Gilje. 2002.. 1991. Journal of Nursing Administration 22 (2). New York. Roedel. An Index for Measurement. Oslo. Kentucky Nurse 43 (3).. 1999. Tranmer. Health care corporatization and the employment conditions of nurses. F. H. C. Speake. B. International Journal of Nursing Studies 42. Nurses and Work Satisfaction... 1994.. 2002. P. 1987. Factors influencing satisfaction and anticipated turnover for nurses in an academic medical center.] Report no. The Health Care Supervisor 13 (1)..L..E. Chang. 13–19. 7–13.L. Journal of Nursing Administration 25 (4)...E. The influence of nurses’ working motivation and job satisfaction on intention to quit: an empirical investigation in Taiwan. Shader. Job satisfaction among nurses: a literature review. P. Salantera. W. [—one day in Health-Norway. Hsieh. Nursing Management 26 (9) 64JJ. A. Sørensen. 36–37. Health Administration Press. Chen. 867–878.L.. 7. Professional Turnover: The Case of Nurses... A nursing research utilization strategy for staff nurses in the acute care setting. M. Takase. G. Kershaw. Yang. Nursing turnover in Taiwan: a meta-analysis of related factors.W. Schultz.. D. Bjørk et al. .. 1995. Nash. 64KK. Piedmonte. D. Broome..ARTICLE IN PRESS I.M. 214–219...E. International Journal of Nursing Studies 39. Mueller.C. Klose..T.R. West.. J. C. 16–25. Nursing Management 22 120A...D. Stamps. 2002.L. M. C. Health Administration Press. Y. Hospital Topics 65 (2). K. P. 21–29.. J. P. 120D. Decision making of psychiatric nurses in Finland. Thornhill.. Muir. Serow.S. Y. and the United States. Tzeng.R. Head nurse role redesign: improving satisfaction and performance. professional commitment. The relationships among turnover intentions.. 1993. Does public image of nurses matter? Journal of Professional Nursing 18. 41–48. Hospital clinical career advancement programs: comparing perceptions of nurse participants and nonparticipants. Lin. Y.. 279–291. Barriball.. F. Burt.A.W. Lu. / International Journal of Nursing Studies 44 (2007) 747–757 Lauri.. Yin.. Influence of clinical ladder program on job satisfaction in staff nurses. Evaluation of a clinical advancement system. Recruitment and retention strategies: a magnet hospital prevention model. 2005. H. K... Journal of Professional Nursing 15. Work Research Institute. E. Nurses and Work Satisfaction: An Index for Measurement. Upenieks. D.. Tumulty. Chicago. Cowart. P. D.. Price. Journal of Professional Nursing 18. Transformational leadership and job satisfaction. Lu. 22–24.L. E. 1986.. Chicago. M. 196–205. International Journal of Nursing Studies 39. A. M.. 1992.R. 1993..E. 573–581. Journal of Nursing Administration 23 (2). 1994. 64LL. 120F. Broome. 2001. 275–280. B. V. 2003. and job satisfaction of hospital nurses.. S... R. Career ladders: position enrichment vis-avis tenure. Nursing Economics 11. Northern Ireland.A..E.. While. Clinical ladders and job enrichment.. M. D.. Journal of Nursing Administration 31. 211–227. Kisilevsky.B.J. K.W. 1997. 757 Stamps. 1995. Wu. S. 64NN. Nursing Economics 21 (1).. —en dag i Helse-Norge. 2000.