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Research into Work Life Experiences

Nurses’ job satisfaction and attitudes towards

people living with HIV/AIDS in Russia
L. Hamama1 PhD, E. Tartakovsky2 PhD, K. Eroshina3 MD, E. Patrakov4
PhD, A. Golubkova5 MD, J. Bogushevich5 MD & L. Shardina5 MD
1 Senior lecturer, Social worker, 2 Senior lecturer, Psychologist, Tel Aviv University, Tel Aviv, Israel, 3 Manager of the Global
Fund Project, Open Health Institute, Moscow, 4 Psychologist, Head of the Social Security Department of Ural Federal
University, Ekaterinburg, 5 Physicians, Urals State Medical Academy, Ekaterinburg, Russia

& SHARDINA L. (2014) Nurses’ job satisfaction and attitudes towards people living with HIV/AIDS in
Russia. International Nursing Review 61, 131–139

Background: Previous studies internationally have highlighted that working with people living with
HIV/AIDS may lead to nurses’ stress and burnout. However, this topic has not been well explored in Russia, a
country with an exponential growth in HIV/AIDS.
Aim: This study focused on nurses’ job satisfaction and their attitudes towards people living with HIV/AIDS
in centres where nurses regularly treat such patients, and in a general hospital where nurses rarely treat such
Method: We distributed three self-report questionnaires: demographics, job satisfaction and attitudes towards
people living with HIV/AIDS to nurses working in six HIV/AIDS centres and the largest general hospital in
Ekaterinburg, Russia. Sixty-nine nurses from the HIV/AIDS centres and 66 from the general hospital (about
90% of those approached) completed these.
Results: Nurses who regularly treated people with HIV/AIDS were significantly younger and a greater number
held master degrees than those who rarely treated such patients. No significant differences between the two
settings emerged for job satisfaction but what did emerge were differences in nurses’ attitudes: nurses in
HIV/AIDS centres reported less avoidance than nurses in the general hospital. Regarding empathetic attitudes,
no significant differences emerged, but empathetic attitudes contributed to the explained variance of job
Conclusion: Although our sample was small, the associations found between avoidant attitudes and job
satisfaction highlight the need for stigma-reduction strategies and increased disease knowledge. Healthcare
managers should consider attitudes towards people living with HIV/AIDS as an important factor in ensuring
adequate care for them and initiate education programmes for nurses, especially programmes dealing with
HIV/AIDS in general hospitals.

Correspondence address: Dr Liat Hamama, Bob Shapell School of Social Work, Tel Aviv University, Ramat Aviv 69970, Israel; Tel: +972-3-9305551; Fax: +972-3-9305551;

Funding: This study was funded in part by a Sara Peleg grant from the School of Social Work at Tel Aviv University (grant no.34030000).
Conflict of interest: No conflict of interest has been declared by the authors.

© 2013 International Council of Nurses 131

132 L. Hamama et al.

Implications for nursing and health policy: Support and supervision can be used as a strategy, for
empowering nurses to meet the challenges of working with HIV/AIDS patients.

Keywords: Attitudes, HIV/AIDS, Job Satisfaction, Nursing, Russia

Introduction hospitalized, patients are diagnosed and they are usually then
Nurses have always been at the forefront of the HIV epidemic; referred to a centre for the continuation of treatment. There-
they are on the frontline of HIV prevention, care and advocacy fore, medical staff in general hospitals are often unaware that
(Li et al. 2007; Qu et al. 2010). Working with people living with they are treating PLWHA and receive very little training and
HIV/AIDS (PLWHA) may lead to nurses’ stress, burnout and experience in dealing with PLWHA (Pankratov & Peresypkina
even dropout, especially when physical contact with HIV/AIDS 2012).
patients elicits misunderstandings and avoidance among nurses’ The present study is the first of its kind to examine the con-
social connections and families (Bride 2007). Although this has nection between job satisfaction and nurses’ attitudes towards
been well studied in the West, this phenomenon has not been PLWHA in these two settings.
studied in Russia.
In the current study, we aimed to assess the associations
between Russian nurses’ job satisfaction and attitudes towards Job satisfaction
PLWHA, in order to inform healthcare policy and identify Job satisfaction is a multidimensional construct consisting of
training and supervision needs. Specifically, the present study elements essential to the personal fulfilment from one’s job
highlighted the similarities and differences regarding job satis- (Shader et al. 2001). It pertains to how employees feel about
faction and attitudes towards PLWHA among Russian nurses their work environment and about diverse aspects of their
working in two settings that vary in exposure to PLWHA: spe- employment (Spector 1997; Thompson & Phua 2012). As such,
cialized HIV/AIDS centres where nurses regularly treat PLWHA job satisfaction is conceived as a reaction to role stressors and as
vs. general hospitals where nurses rarely treat PLWHA. a predictor of occupational mental health (Sheward et al. 2005;
HIV/AIDS continues to be a major public health issue in Tourigny et al. 2010).
Russia (UNAIDS/WHO 2010). The Russian Federation is Low job satisfaction in nurses has been found to result in
experiencing an exponential growth in HIV incidence, as burnout, high turnover, physical and psychological disturb-
reflected in an increase in reported cases of new HIV diag- ances, higher stress levels and low levels of patient care (Chang
noses, from less than 40 000 in 2006 to over 60 000 in 2011 et al. 2010; Mrayyan 2009; Murrells et al. 2008).
(UNAIDS 2012). In Russia, each large city (population over Job satisfaction has been studied especially among nurses
200 000) has its own HIV/AIDS centre. These centres provide working in HIV/AIDS services (Chirwa et al. 2009; Delobelle
HIV diagnostics, treatment of opportunistic infections, psy- et al. 2009). These studies conducted in African countries found
chosocial consulting for patients and their families, and infor- that perceived HIV stigma was the strongest predictor of job
mation dissemination on these issues to mass media and dissatisfaction (Chirwa et al. 2009) and that the work itself was
educational systems (Ekaterinburg Regional Center for associated with job satisfaction (Delobelle et al. 2009).
Prophylactics and Treatment of HIV/AIDS 2008). Nurses and The importance of job satisfaction in the nursing profession
other staff working in HIV/AIDS centres are well informed has been linked to positive patient outcomes as rated by
about HIV/AIDS, receive specialized training, have close inten- healthcare providers (Aiken et al. 2002) and to a higher quality
sive contacts with PLWHA and their families, and accrue sub- of care as perceived by patients (Murrells et al. 2005). Nurses’
stantial experience in treating these patients (Pankratov & personal characteristics, attitudes and behaviours are factors
Peresypkina 2012). that may influence their job satisfaction (Hayes et al. 2010;
On the other hand, general hospitals in Russia rarely treat Utriainen & Kyngas 2009). Moreover, according to a literature
HIV/AIDS patients. Most PLWHA who are treated in general search that was conducted by Hayes et al. (2010), factors associ-
hospitals either do not know their diagnosis or for some other ated with nurses’ job satisfaction can be grouped into
reason do not wish to be treated in HIV/AIDS centres. Once intrapersonal, interpersonal (between the nurse and colleagues

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Job satisfaction among nurses in Russia 133

or patients) and extrapersonal. In the current study, we focused treated PLWHA (working in HIV/AIDS centres) and nurses
on the intrapersonal factor, using the attitudes variable. who rarely treated PLWHA (working in general hospitals) in
Russia. We predicted that Russian nurses working in HIV/AIDS
Attitudes towards PLWHA centres would reveal lower job satisfaction than those working
Attitude is an internal state generally believed to reflect three in general hospitals due to the uniquely stressful characteristics
different components: the cognitive component linked to a of caring primarily for PLWHA in the centres: stigma, discrimi-
person’s beliefs or thinking, the affective component linked to nation and overexposure to suffering (Ijumba 2003). We also
a person’s values, and the behavioural component linked to a predicted that Russian nurses working in HIV/AIDS centres
person’s actions (Smith & Mackie 2007). Thus, attitudes can would reveal lower avoidance attitudes and higher empathetic
significantly affect a person’s choices regarding personal behav- attitudes than those working in general hospitals, in line with
iour, and in the case of nurses, may have an important impact Allport’s (1954) social psychological theory positing that inter-
on the quality of patient care (Smith & Mathews 2007). group contact reduces intergroup prejudice, which in turn may
Previous studies showed that higher empathy and compas- affect attitudes. Thus, nurses with more frequent exposure to
sion among nurses working with PLWHA in particular were PLWHA should reveal more positive (empathetic) attitudes and
associated with lower feelings of psychological distress (e.g. fewer negative ones (avoidant), but also lower job satisfaction.
Delobelle et al. 2009; Smit 2005). On the other hand, several In sum, the following hypotheses were tested:
studies (Li et al. 2007; Tyer-Viola 2007) have documented nega- 1 Nurses who regularly treat PLWHA (in the centres) will
tive attitudes towards HIV/AIDS patients shared by many report lower job satisfaction than nurses who rarely treat
healthcare professionals for a number of reasons, including but PLWHA (in the hospital).
not limited to the fear of contracting the disease, a dislike of 2 Nurses who regularly treat PLWHA will report less avoidant
working with terminally ill patients, perceptions of personal attitudes and more empathetic attitudes than nurses who rarely
risk, an unwillingness to work with certain patient populations treat PLWHA.
(e.g. intravenous drug users, homosexuals) and concern over 3 Avoidant attitudes will associate with low job satisfaction and
being professionally stigmatized. empathetic attitudes will associate with high job satisfaction.
Furthermore, researchers assume that increased contact with
PLWH helps healthcare providers increase their knowledge Method
about HIV transmission and their empathy towards their
patients (Pettigrew & Tropp 2006). These findings are consistent Design
with Allport’s social psychological theory of intergroup contact This study used a cross-sectional, quantitative research design.
(Allport 1954), which argues that prolonged contact with an
out-group weakens prejudices and leads to a more positive atti- Sample
tude towards the group. The intergroup contact is consequently The research questionnaires were distributed to the nurses who
understood as both a cognitive process of obtaining more worked regularly with PLWHA in six HIV/AIDS centres in
objective knowledge about the out-group and a behavioural Ekaterinburg, during the centres’ training seminars at a time
process of changing attitudes towards the out-group (Pettigrew when 76 nurses participated in the training seminars (168
and Tropp 2006). With regard to nurses, Chirwa et al. (2009) nurses employed in all centres, groups of 21–35 nurses in each
found that the perception of stigma related to HIV influences centre). The nurses were informed of the purpose of the study
their job satisfaction significantly. and were assured that the study was confidential and voluntary.
Notably, these variables were examined among nurses in After completing the questionnaires, the nurses sealed them in
South Africa (Chirwa et al. 2009; Delobelle et al. 2009, 2011; an envelope and handed them to the researchers personally or
Smit 2005), in Belize (Andrewin & Chien 2008) and in Finland through the administrative assistant.
(Suominen et al. 2010). However, to the best of the authors’ The comparison sample of nurses who did not work regularly
knowledge, Russian HIV/AIDS nurses have not been well with PLWHA was recruited from the largest general hospital in
studied regarding their attitudes towards PLWHA in centres and Ekaterinburg, which runs the largest nursing school in the
hospital settings. region (Sverdlovsk Regional Medical College 2012). In this hos-
pital, 371 nurses are employed. The research questionnaires
Hypotheses were distributed to these hospital nurses during three randomly
This study investigated the possible differences between job sat- selected sessions of a conference held in the hospital to provide
isfaction and attitudes towards PLWHA of nurses who regularly the latest practical nursing information and teach skills for

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134 L. Hamama et al.

working with PLWHA. Seventy-five nurses participated in these patients with HIV/AIDS: avoidance (14 items, e.g. ‘Patients who
selected sessions (groups of 21–29 nurses in each). The hosp- are HIV positive should not be put in rooms with other
ital’s nurses were randomly assigned to the sessions; therefore, patients’) and empathy (7 items, e.g. ‘Patients with AIDS should
the sample obtained was a random representation of the nurses be treated with the same respect as any other patient’). Partici-
working in the hospital. pants rated their attitudes towards PLWHA on a 6-point Likert-
type scale ranging from strongly disagree (1) to strongly agree
Ethical considerations (6), where higher scores indicated more avoidance attitudes
The nurses were informed of the purpose of the study and towards PLWHA. Internal consistency (Cronbach’s alpha) was
were assured that the study was confidential and voluntary. 0.88. (Internal consistencies for the two settings were as follows:
They completed the questionnaires anonymously and returned avoidance: regularly treated HIV/AIDS = 0.87, rarely treated
them to the researchers in sealed envelopes with a signed, HIV/AIDS = 0.82; empathy: regularly treated HIV/AIDS = 0.76,
informed consent form. The study was approved by the Ethical rarely treated HIV/AIDS = 0.80).
Commission in the general hospital and the HIV centres in
Ekaterinburg and supervised by Tel Aviv University Research
Ethics Committee. Data analysis
To examine the differences between the two groups (nurses who
Data collection
regularly treated PLWHA and nurses who rarely treated
PLWHA) in job satisfaction and in attitudes towards PLWHA
Participants completed three self-report questionnaires. All
(avoidance, empathy), we conducted univariate one-way multi-
questionnaires used in the present study were translated from
variate analysis of variance (MANOVAs). In our analyses, we
English to Russian and back to English by two bilingual transla-
controlled for the two demographic variables that differed
tors. Internal consistency of all the scales in the present study
between the two settings – age and education.
was similar to that obtained in previous studies applying
English-language scales (for job satisfaction, see: Taber & Taylor
1990; for attitudes towards PLWHA, see: Froman & Owen
About 90% of the nurses who were approached in both settings
agreed to participate in the study (in the HIV/AIDS centres –
Demographic questionnaire
69; in the general hospital – 66). Participants comprised 135
This self-report related to demographic details of age, sex,
female nurses in Russia, 69 of whom regularly treated PLWHA
family status, religiosity, health, education, professional experi-
in HIV/AIDS centres, and 66 of whom worked in a general hos-
ence and experience in treating PLWHA.
pital and rarely treated PLWHA. Mean age overall was
41.3 years (SD = 9.88), but the nurses who regularly treated
Job satisfaction PLWHA were significantly younger (M = 39.58, SD = 8.61) than
Hackman & Oldham’s (1975) 15-item Job Diagnostic Survey the nurses who rarely treated PLWHA (M = 43.15, SD = 10.81),
measured workers’ satisfaction with various aspects of their jobs t = 2.13, P < 0.05. Nurses had a mean of 19.65 years of profes-
(e.g. skill variety, task identity, task significance, autonomy). sional experience (SD = 10.00), which did not differ signifi-
Previous applications of the Russian version of this scale, in cantly between the two groups.
Russia and other countries of the former Soviet Union, con- In terms of other demographic variables (see Table 1), only in
firmed its validity and reliability (see Bondarenko 2010). Par- education did a significant difference emerge between the two
ticipants rated their job satisfaction along a 7-point Likert-type groups, χ2 = 4.51, P < 0.05. In both groups, the majority of
scale ranging from not at all satisfied (1) to completely satisfied nurses held a bachelor’s degree (∼80% of the nurses who treated
(7), with higher scores indicating higher job satisfaction. Inter- PLWHA and ∼92% of the nurses who rarely treated PLWHA),
nal consistency (Cronbach’s alpha) was 0.87. (Internal consist- although approximately 20% of the nurses who treated PLWHA
encies for the two settings were as follows: regularly treated held a master’s degree, whereas only 8% of those in the general
HIV/AIDS = 0.88; rarely treated HIV/AIDS = 0.87). hospitals did. No significant differences were found between the
groups with regard to marital status, religiosity or health.
Attitudes towards PLWHA Validating the hypothesis that nurses working in general hos-
The 21-item AIDS Attitude Scale questionnaire (Froman et al. pitals rarely treated PLWHA, only five hospital nurses reported
1992) was used to assess two aspects of attitudes towards seeing, at the most, two HIV/AIDS patients during the previous

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Job satisfaction among nurses in Russia 135

Table 1 Demographic characteristics for nurses in the two settings

Variable Regularly treated HIV/AIDS Rarely treated HIV/AIDS χ2

– centres (n = 69) – hospitals (n = 66)

n % n %

Marital status Single 30 43.5 20 30.3 0.11

Married 39 56.5 46 69.7
Education BA 55 79.7 61 92.4 4.51*
MA 14 20.3 5 7.6
Religiosity Religious 63 92.3 55 90.2 0.54
Not religious 6 7.7 11 9.8
Health† Healthy 62 91.2 58 92.1 0.85
Not healthy 7 8.8 8 7.9
Total 69 100.0 66 100.0

*P < 0.05.
†There are missing values for health.

Table 2 Means, standard deviations and F and eta squared values for job satisfaction and attitudes in the nurses’ two settings

Variables Regularly treated HIV/AIDS Rarely treated HIV/AIDS F† η2

– centres (n = 69) – hospitals (n = 66)


Job satisfaction 3.60 0.68 3.50 0.70 0.64 0.00

Attitudes towards PLWHA
Empathy 3.72 0.73 3.54 0.76 1.90 0.01
Avoidance 2.17 0.94 3.41 0.81 62.41*** 0.33

***P < 0.001.

†For job satisfaction: F (2, 126); for attitudes: F (3, 124).
PLWHA, people living with HIV/AIDS.

week. In contrast, for those working in the HIV/AIDS centres, treated PLWHA and nurses who rarely treated PLWHA. Means,
the mean number of HIV-infected patients seen during the pre- standard deviations and F values for each measure are presented
vious week was 33.6. in Table 2.
Significant differences emerged between the groups only
regarding avoidance attitudes towards PLWHA, F (3, 124) = Correlations between the variables
62.41, P < 0.001, η2 = 0.33, where the nurses working in HIV/ Pearson’s analyses were conducted to examine correlations
AIDS centres revealed significantly lower avoidance towards between the demographic variables (age, sex, family status,
PLWHA than their counterparts in the general hospitals. religiosity, health, education, professional experience and
Empathy did not significantly differ between the groups. Like- experience in treating PLWHA) and the study variables. No
wise, the MANOVA comparing the two groups’ rates of job sat- demographic variables were found to be linked to the study
isfaction yielded no significant difference between the two variables.
settings, F (2, 126) = 0.40, P > 0.05. That is to say, job satisfac- Pearson’s analyses were conducted to examine correlations
tion did not significantly differ between nurses who regularly among the study variables. Job satisfaction showed a positive

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136 L. Hamama et al.

Table 3 Hierarchical regression coefficients (β) to explain differences in AIDS centres vs. nurses who worked in general hospitals and
job satisfaction (N = 135) rarely treated PLWHA in Russia.
Our findings did not confirm our first hypothesis, which pre-
Predictors B SE B β R2 ΔR2 dicted differences in job satisfaction between nurses who
worked in specialized HIV/AIDS centres and nurses who
Step 1 0.00 worked in general hospitals and rarely treated PLWHA. To the
Group 0.08 0.12 0.06 best of our knowledge, no research has yet been conducted to
Step 2 0.16***
examine the differences between nurses who work in these two
Group −0.23 0.14 −0.17
Empathy 0.17 0.08 0.18*
settings in relation to job satisfaction. Perhaps the current lack
Avoidance −0.23 0.08 −0.36** of differences in job satisfaction between the groups can be
related to the methodology of the study, that is, a small sample
*P < 0.05; **P < 0.01; ***P < 0.001.
size and differences in the characteristics associated with the
work environment rather than the differences associated with
whether or not nurses regularly treated PLWHA (in line with
the fact that only 16% of the variance in job satisfaction was
correlation with empathetic attitudes towards PLWHA
explained by attitudes). As mentioned previously, nurses’ job
(r = 0.28, P < 0.001) and a negative correlation with avoidant
satisfaction is multifaceted, complex and highly subjective
attitudes towards PLWHA (r = −0.32, P < 0.001). In other
(Hayes et al. 2010). Another explanation can be related to
words, nurses with higher empathy towards PLWHA and
Hobfoll’s (1989) conservation of resources model. This model
with lower avoidant towards PLWHA, reported higher job
assumes that people consciously and unconsciously utilize the
amount and quality of resources at their disposal. In a stressful
We next conducted a hierarchical regression analysis with job
situation, when a specific resource is threatened, people will
satisfaction as the dependent variable. The first step assessed the
‘compensate’ by utilizing a different resource. According to this
group (PLWHA-treating nurses vs. general nurses). The second
model, it seems that nurses from both groups may be efficient at
step assessed the contribution of the two attitude subscales
utilizing their motivation and their intrinsic rewards to help
(avoidance, empathy). As seen in Table 3, these variables
their patients (HIV/AIDS and non-HIV/AIDS). Moreover,
explained 16% of the variance in job satisfaction. The group
nurses are expected to give quality care to patients regardless of
(PLWHA-treating nurses vs. general nurses), entered in the first
diagnosis; they are expected to feel ethically bound to act indis-
step, yielded no significant contribution. However, nurses’ atti-
criminately towards all patients (Smit 2005).
tudes towards PLWHA, entered in the second step, added 16%
The second hypothesis, related to nurses’ attitudes towards
to the explanation of the variance. A significant contribution
PLWHA, did confirm our expectations. Nurses working in HIV/
was made by the attitudes of empathy and avoidance to explain
AIDS centres reported less avoidant attitudes towards PLWHA
job satisfaction: nurses with more empathetic and less avoidant
than their peers working in general hospitals who experienced
attitudes reported higher job satisfaction.
less frequent exposure to PLWHA. Nevertheless, no significant
To examine the differences between the two settings (nurses
difference emerged regarding empathetic attitudes; thus, the
working in HIV/AIDS centres and nurses working in general
second hypothesis was only partially confirmed.
hospitals) on these correlations, Pearson’s analyses were con-
A probable explanation for the less avoidant attitudes
ducted separately. Significant differences emerged between the
among nurses in the specialized HIV/AIDS centres may be that
two settings: among nurses working in HIV/AIDS centres, job
their personal contact with PLWHA and their AIDS-specific
satisfaction correlated significantly and positively with empa-
training acted to dispel misinformation and decrease stigma
thetic attitudes (r = 0.36, P < 0.001), and correlated significantly
(Brems et al. 2010). In contrast, nurses who work in general
and negatively with avoidant attitudes (r = −0.34, P < 0.001). In
hospitals rarely have contact with PLWHA and may experience
contrast, the nurses working in general hospitals revealed no
deficiencies in AIDS-specific training, resulting in insufficient
significant correlations between job satisfaction and attitudes
and inadequate knowledge regarding HIV/AIDS care, leading
(avoidance, empathy).
to avoidant and negative attitudes towards PLWHA (Smit
2005). Further study, including more detailed qualitative and
Discussion quantitative reports about nurses’ interactions with PLWHA in
The current study is innovative regarding the comparison both settings, specifically in the Russian context, is needed to
between two settings: nurses who worked in dedicated HIV/ validate this speculation, which coincides with Allport’s social

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Job satisfaction among nurses in Russia 137

psychological theory of intergroup contact (Allport 1954). In a victims is likely to be marginal if the reduction plan focuses
meta-analytic test of intergroup contact theory, Pettigrew & solely on educating healthcare professionals about false beliefs.
Tropp (2006) found that intergroup contact typically reduces They found it necessary to change general dispositions for
intergroup prejudice. Thus, nurses who work in general hospi- prejudice, a much more difficult task. Thus, healthcare manag-
tals and rarely treat PLWHA may be flooded with anxiety over ers should augment education programmes for nurses, espe-
their safety practices and fears of occupational contagion, cially programmes dealing with HIV/AIDS in general hospitals.
which may evoke avoidant attitudes towards PLWHA. They must consider attitudes towards PLWHA as an important
Regarding the third hypothesis, the correlation between lower factor in ensuring adequate care for PLWHA. Moreover, nurses
job satisfaction and nurses’ greater avoidance towards PLWHA and healthcare professionals who work with HIV/AIDS patients
was confirmed only among nurses who worked in HIV/AIDS should be encouraged to stay current on changing issues relat-
centres. As mentioned above, direct contact with PLWHA may ing to HIV/AIDS, and to understand that the disease process
produce anxiety over safety practices and fears of occupational has already helped to start a social reconstruction of HIV as a
contagion, which may be very stressful for AIDS caregivers chronic illness (Qu et al. 2010). From these changes, both an
(Gueritault-Chalvin et al. 2000). Further study is needed to vali- oppressed client population and the nurses who have an obliga-
date this speculation and to also consider as a whole the infor- tion to provide the best care possible are likely to benefit. Thus,
mation about job satisfaction for nurses in Russia. these changes might contribute to enhancing the job satisfac-
tion of nurses and other healthcare professionals.
Study limitations Given the fact that nursing is a highly stressful profession
This study had several limitations that should be noted. First, with severe concern regarding retention issues (Curtis 2007),
literature is scarce on the cultural aspects that may influence the results of this study may assist in developing practical
study variables; therefore, special care should be taken in the organizational strategies to increase workers’ job satisfaction.
future to examine the possible effects of such cultural issues and Further research should investigate the similarities and differ-
to untangle the specifics of the healthcare system, specifically ences between these two settings with respect to physical, social
the HIV/AIDS system, in the Russian Federation. and organizational work–environment characteristics.
Second, it was a convenience sample and the sample size Furthermore, the results of this study have theoretical impli-
restricted usage of structural equation modelling; therefore, we cations. The study expanded knowledge about attitudes towards
could not conduct an assessment of generalizability. Third, the PLWHA among nurses in two different health settings and their
study was of a cross-sectional nature, which allowed us to estab- associations with job satisfaction. It also extended intergroup
lish associations but not causal relationships. contact theory to Russian nurses who work in specialized HIV/
Fourth, the present self-report survey responses were subject AIDS centres vs. nurses who worked in general hospitals and
to common method variance bias. Nurses’ job satisfaction is rarely treated PLWHA.
multifaceted, complex and highly subjective (Hayes et al. 2010). Nurses and heath providers are part of the general society,
Therefore, researchers would do well to collect complementary and their perceptions and attitudes towards HIV/AIDS are
objective data on the actual work environment, to confirm expected to be influenced by societal norms and attitudes.
current outcomes. In addition, the current quantitative design If AIDS were viewed as a normal disease in society, the health
should be complemented in the future by qualitative methods providers could feel more comfortable when they treat
that give voice to the unique perspectives on job satisfaction AIDS patients. Thus, HIV education might be a necessary
among nurses. That is to say, interpersonal (between the nurse intervention component to maintain a healthy psychological
and colleagues or patients) and extrapersonal (those external to state among nurses and health providers and to increase their
the nurse; Hayes et al. 2010; Utriainen & Kyngas 2009). productivity.

Implications Implications for health and nursing policy

The associations found between avoidant attitudes and job sat- From a health policy perspective, the Russian political system is
isfaction highlight the need for stigma-reduction strategies and shaped by its Soviet institutional legacy. That is to say, the state
increased disease knowledge. Stigma and discrimination repre- still plays a large part in Russian health, education and the
sent not only human rights violations, but also violations of the economy. Private health facilities exist, but the vast majority of
ethical principles on which the healthcare system is based Russians continue to receive health care through the state
(Brems et al. 2010). A recent study by Collani et al. (2010) system (Pankratov & Peresypkina 2012; Wallander 2005).
showed that a reduction in the stigmatization faced by AIDS Hence, to be able to meet the challenges of their profession and

© 2013 International Council of Nurses

138 L. Hamama et al.

work with HIV/AIDS patients, nurses need to perceive them- Chang, Y.H., Li, H., Wu, C.M. & Wang, P.C. (2010) The influence of per-
selves as being empowered. Support and supervision can be sonality traits on nurses’ job satisfaction in Taiwan. International Nursing
used as a strategy for commitment and involvement when pro- Review, 57, 478–484.
Chirwa, M.L., et al. (2009) HIV stigma and nurse job satisfaction in five
viding care for people with HIV/AIDS (McGlynn et al. 2012).
African countries. Journal of the Association of Nurses in AIDS Care, 20,
Because of the lack of research focusing on nurses’ experi-
14–21. doi: 10.1016/j.jana.2008.10.001.
ences of HIV/AIDS-related job satisfaction and attitudes in
Collani, G.V., Grumm, M. & Streicher, K. (2010) An investigation of the
Russia, similar studies should be conducted at other hospitals determinants of stigmatization and prejudice toward people living
and HIV/AIDS centres to ascertain whether the findings can be with HIV/AIDS. Journal of Applied Social Psychology, 40 (7),
replicated. The greater understanding gained by such studies 1747–1766.
could inform social policies and programmes dealing with HIV/ Curtis, E.A. (2007) Job satisfaction: a survey of nurses in the Republic of
AIDS-related care in Russia. Ireland. International Nursing Review, 54 (1), 92–99.
Delobelle, P., et al. (2009) HIV/AIDS knowledge, attitudes, practices and
Acknowledgements perceptions of rural nurses in South Africa. Journal of Advanced Nursing,
We wish to thank all nurses who participated and collaborated 65 (5), 1061–1073. doi: 10.1111/j.1365-2648.2009.04973.x.
Delobelle, P., et al. (2011) Job satisfaction and turnover intent of primary
in this study whose contribution enabled the production of this
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Author contributions Ekaterinburg Regional Center for Prophylactics and Treatment of HIV/
Liat Hamama: study conception, data analysis, drafting of AIDS (2008) Service Center. Available at:
manuscript, critical revisions for important intellectual content; index.php?page=about&pid=4 (accessed 1 May 2013).
Eugene Tartakovsky: study design, data analysis, drafting of Froman, R.D. & Owen, S.V. (1997) Further validation of the AIDS Attitude
manuscript, critical revisions for important intellectual content; Scale. Research in Nursing & Health, 20 (2), 161–167. doi: 10.1002/
Ksenia Eroshina: study design, drafting of manuscript, adminis- (SICI)1098-240X(199704)20:2<161:AID-NUR8>3.0.CO;2-I.
trative support; Eduard Patrakov: study design, data collection, Froman, R.D., Owen, S.T. & Daisy, C. (1992) Development of a measure of
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