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International Journal of Nursing Studies 42 (2005) 211–227

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Job satisfaction among nurses: a literature review

Hong Lu, Alison E. While, K. Louise Barriball
Florence Nightingale School of Nursing and Midwifery, King’s College London, James Clerk Maxwell Building,
57 Waterloo Road, London SE1 8WA, England, UK
Received 13 May 2004; received in revised form 15 August 2004; accepted 7 September 2004

Abstract

The current nursing shortage and high turnover is of great concern in many countries because of its impact upon the
efficiency and effectiveness of any health-care delivery system. Recruitment and retention of nurses are persistent
problems associated with job satisfaction. This paper analyses the growing literature relating to job satisfaction among
nurses and concludes that more research is required to understand the relative importance of the many identified factors
to job satisfaction. It is argued that the absence of a robust causal model incorporating organizational, professional and
personal variables is undermining the development of interventions to improve nurse retention.
r 2004 Elsevier Ltd. All rights reserved.

Keywords: Job satisfaction; Nurse shortage; Nurse retention; Nurse turnover; Intention to quit

1. Introduction 2. The definition of job satisfaction

The widespread nursing shortage and nurses’ high
turnover has become a global issue (Kingma, 2001)
which is of increasing importance to both the developed
and developing countries (Cavanagh, 1990; Blegen,
1993; Hancock, 1998; Lee, 1998; Aiken et al., 2001;
Fang, 2001; Lu et al., 2002). In light of this, concern
about recruitment and retention of nursing staff is
increasing in a number of countries (Lundh, 1999).
While numerous factors have been linked to nurses’
turnover, job satisfaction is the most frequently cited
(Cavanagh and Coffin, 1992; Blegen, 1993; Irvine and
Evans, 1995), and therefore merits attention. This review
examines the extensive empirical literature regarding
nurses’ job satisfaction and its associated factors.
Corresponding author.
E-mail address: hong.lu@kcl.ac.uk (H. Lu).
Job satisfaction is a topic of wide interest to both
people who work in organizations and people who study
them. It is a most frequently studied variable in
organizational behaviour research, and also a central
variable in both research and theory of organizational
phenomena ranging from job design to supervision
(Spector, 1997). The traditional model of job satisfac-
tion focuses on all the feelings that an individual has
about his/her job. However, what makes a job satisfying
or dissatisfying does not depend only on the nature of
the job, but also on the expectations that individuals
have of what their job should provide.
The work of Maslow (1954) is seminal and suggested
that human needs form a five-level hierarchy ranging
from physiological needs, safety, belongingness and
love, esteem to self-actualization. Based on Maslow’s
theory, job satisfaction has been approached by some
researchers from the perspective of need fulfillment
(Kuhlen, 1963; Worf, 1970; Conrad et al., 1985).

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 ARTICLE IN PRESS
212 H. Lu et al. / International Journal of Nursing Studies 42 (2005) 211–227
However, this approach has become less popular with
increasing emphasis on cognitive processes rather than
on underlying needs so that the attitudinal perspective
has become predominant in the study of job satisfaction
(Spector, 1997).
In contrast to the traditional view, Herzberg and
Mausner (1959) formulated the two-factor theory of job
satisfaction and postulated that satisfaction and dis-
satisfaction were two separate, and sometimes even
unrelated phenomena. Intrinsic factors which they
named ‘motivators’ (i.e. factors intrinsic to the nature
and experience of doing work) were found to be job
‘satisfiers’ and included: achievement, recognition, work
itself and responsibility. Extrinsic factors which they
named ‘hygiene’ factors were found to be job ‘dissatis-
fiers’ and included: company policy, administration,
supervision, salary, interpersonal relations and working
conditions. Herzberg and Mausner’s Motivation-Hy-
giene theory has dominated the study of the nature of
job satisfaction, and formed a basis for the development
of job satisfaction assessment (Table 1).
Thus job satisfaction is the affective orientation that
an employee has towards his or her work (Price, 2001).
It can be considered as a global feeling about the job or
as a related constellation of attitudes about various
aspects or facets of the job. The global approach is used
when the overall attitude is of interest while the facet
approach is used to explore which parts of the job
produce satisfaction or dissatisfaction. Based on the
review of the most popular job satisfaction instruments,
Spector (1997) summarized the following facets of job
satisfaction: appreciation, communication, co-workers,
fringe benefits, job conditions, nature of the work itself,
the nature of the organization itself, an organization’s
policies and procedures, pay, personal growth, promo-
Table 1
Definition of job satisfaction
Definition
The individual matching of personal needs to the perceived
potential of the occupation for satisfying those needs (Kuhlen,
1963)
Need fulfillment, that is, whether or not the job met the
employee’s physical and psychological needs for the things
within the work situation (Worf, 1970)
A match between what individuals perceive they need and
what rewards they perceive they receive from their jobs (Conrad
et al., 1985)
A function of satisfaction with the various elements of the job
(Herzberg and Mausner, 1959)
All the feelings that an individual has about his job (Gruneberg,
1976)
The affective orientation that an employee has towards his or
her work (Price, 2001)
tion opportunities, recognition, security and super-
vision.
3. Identification of the literature
The literature relating to job satisfaction and nurses
was identified through electronic databases. The electro-
nic databases used to obtain the relevant literature were:
CINAHL (1982–2004), Medline (1966–2004), PsycIN-
FO (1974–2004) and British Nursing Index (1985–2004).
Some databases in Chinese such as China Medical
Academic Conference (1985–2004) and China Academic
Journal (1985–2004) were also used. To maximize the
amount of relevant literature, key phrases and similar
phrases were utilized in the subject search in combina-
tion with nurses following guidelines for searching
OVID interface. This identified 1189 published research
papers from all the databases searched. The abstracts or
full texts of the papers were reviewed prior to their
inclusion in the literature review. One thousand and
eighty-eight papers were deemed not relevant and 47
papers were of poor quality (research method including
data analysis unclear). Additionally, the reference lists of
the selected papers were examined to identify earlier
seminal sources.
4. Sources of nurses’ job satisfaction
Given that job satisfaction has been found to be
related to performance within the work setting
(Landeweerd and Boumans, 1988), it is not surprising
that the concept of job satisfaction has attracted much
attention. Researchers have attempted to identify the
Related theory
Maslow’s human needs theory (Maslow, 1954)
Herzberg and Mausner’s motivation-hygiene theory (Herzberg
and Mausner, 1959)
Focus on cognitive process (Spector, 1997)
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H. Lu et al. / International Journal of Nursing Studies 42 (2005) 211–227
various components of job satisfaction, measure the
relative importance of each component of job satisfac-
tion and examine what effect these components have on
workers’ productivity (Burnard et al., 1999). A range of
findings derived from quantitative studies as well as
qualitative studies has been reported in the literature on
sources of job satisfaction among nurses.
Aiken et al. (2001) found job dissatisfaction among
nurses was highest in the United States (41%) followed
by Scotland (38%), England (36%), Canada (33%) and
Germany (17%). One third of nurses in England and
Scotland and more than one fifth in the United States
planned on leaving their job within 12 months of data
collection. More striking, however, was that 27–54% of
nurses under 30 years of age planned on leaving within
12 months of data collection in all countries. Regarding
the work climate, only about one third of nurses in
Canada and Scotland felt that they participated in
developing their own work schedules in comparison with
more than half in the other three countries. When
compared with other countries, the nurses in Germany
(61%) reported that they were more satisfied with the
opportunities for advancement while the nurses in the
United States (57%) and Canada (69%) felt more
satisfied with their salaries.
Similarly, Adamson et al. (1995) found that British
nurses perceived themselves to be more dissatisfied than
Australian nurses (po0:001). The British nurses per-
ceived their professional status to be lower (po0:01),
their relationship with hospital administrators to be
poorer (po0:01), and their working conditions to be less
adequate than Australian nurses (po0:01). They also
reported more conflict between the idealized perspective
of work gained during training and actual work practice
(po0:01), and were less satisfied with their professional
organization (po0:01). The British nurses were also
more concerned about the lack of communication
between nurses and doctors (po0:01) and reported
being less respected by other allied health professionals,
hospital administrators and doctors (po0:01). However,
there was no overall significant difference between the
Australian and British nurses regarding perceived level
of autonomy of the medical profession (p40:01).
Different measurements regarding nurses’ job satis-
faction show various sources of satisfaction. The
findings derived from different studies using the same
scales are more valuable in providing comparative
information, particularly some cross-culture data. For
example, the Adams et al.’s (1995) Ward Organizational
Features Scales were used in a set of studies to collect
information from nurses about their perceptions of the
various aspects of ward life and the impact which they
had on care organization (Tovey and Adams, 1999;
Adams and Bond, 2000). The tool comprised six sets of
measures comprising 14 sub-scales rated on a 4-point
Likert scale (1=strong disagree/very bad/very difficult,
213
4=strongly agree/very good influence/very easy): phy-
sical environment of the ward, professional nursing
practice, professional working relationships, ward lea-
dership, nurses’ influence and job satisfaction. The
test–retest reliabilities of the scales were good with a
correlation coefficient of 0.7 or above (Adams et al.,
1995).
Utilizing this questionnaire, Tovey and Adams (1999)
found that key sources of nurses’ dissatisfaction
included working relationships, particularly those with
management, lack of staff, professional concerns about
poor standards of care and external work pressure.
Adams and Bond (2000) found that most nurses
positively rated aspects of ward services, facilities and
layout (mean43, respectively). The highest correlations
were found between job satisfaction and cohesion of the
ward nursing team (r ¼ 0:51; po0:001), staff organiza-
tion (r ¼ 0:46; po0:001), the level of professional
practice achieved within the ward (r ¼ 0:46; po0:001)
and collaboration with medical staff (r ¼ 0:41;
po0:001). Furthermore, the most important contribu-
tors to nurses’ job satisfaction were the degree of
cohesion existing among ward nurses (R2 ¼ 0:26), the
degree of collaboration with medical staff (R2 ¼ 0:20)
and perception of staff organization (R2 ¼ 0:20).
Nolan et al.’s (1995) Job Satisfaction Questionnaire
was also utilized in a series of studies in the different
countries to assess nurses’ job satisfaction and morale
(Nolan et al., 1995, 1998; Lundh, 1999). It comprises 16
items addressing aspects of the work environment,
perceptions of change in the last 12 months and overall
satisfaction and morale. Responses are rated on a 5-
point Likert scale (‘strongly agree/increased a lot’ to
‘strongly disagree/ decreased a lot’).
Nolan et al. (1995) found that level of job satisfaction
had remained stable and two factors were dominant in
nurses’ understanding of satisfaction and morale,
namely: the perceived ability to deliver good patient
care and good collegiate relationships with co-workers.
Together, these accounted for more than 50% of all the
additional positive comments received. Nolan et al.
(1998) further found that the vast majority of respon-
dents (85%) considered that their work was interesting,
and this was one of the most significant factors
influencing job satisfaction. Regarding job satisfaction
and morale, 35% of respondents considered that their
job satisfaction had decreased in the last year and 69%
felt that overall morale had fallen.
Similarly, Lundh’s (1999) study showed that over
90% of respondents saw their work as interesting and
most respondents also thought that they received respect
from their superiors (68%). Conversely, however, 55%
of respondents reported that leadership within the
organization was not seen to be particularly democratic
with limited opportunities to influence the decisions
of managers. In addition, nearly three quarters of
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214 H. Lu et al. / International Journal of Nursing Studies 42 (2005) 211–227
respondents reported that their levels of stress had
increased over the last 12 months, while important
aspects of their job satisfaction, such as satisfaction with
pay and satisfaction with overall working conditions
had fallen.
In addition to providing a general outline of reported
job satisfaction, Price (2002) explored key areas of job
satisfaction using the Mueller and McCloskey’s
(1990a, b) Satisfaction Scale. It is a 5-point Likert scale
(5=very satisfied, 1=very dissatisfied) comprising 31
items on eight dimensions: extrinsic rewards, scheduling,
balance of family and work, co-workers, interaction
opportunities, professional opportunities, praise and
recognition, control and responsibility. The global
scale’s correlation coefficient was reported as 0.89 and
the validity ranged from 0.53 to 0.75, with the scale
correlating positively with several established satisfac-
tion scales. The results demonstrated that over half of
the respondents (58%) were generally satisfied with their
job. They identified that highest satisfaction was related
to co-workers and extrinsic rewards (mean=3.8 and 3.5,
respectively) and that most dissatisfaction was with the
amount of control and responsibility they had and with
professional opportunities (mean=2.7 and 2.6, respec-
tively). The individual items on this scale with which
nurses were most satisfied were identified as annual
leave, nursing peers and hours worked (79%, 78% and
Table 2
Sources of nurses’ job satisfaction
Sources of job satisfaction
Working conditions
Interaction
Relationships with patients
Relationships with co-workers
Relationships with managers
Work itself
Workload; scheduling; challenging work; routinization; task
requirements (abilities, skills etc)
Remuneration (pay, salary)
Self-growth and promotion
Professional training; opportunities of advancement; job
promotion; personal achievement
Praise and recognition
Control and responsibility
Autonomy; decision-making
Job security
Leadership styles and organizational policies
76% of respondents scored 4 or 5, respectively), and for
dissatisfaction compensation for working weekends and
control over work conditions and childcare facilities
(55%, 55% and 46% of respondents scored 1 or 2,
respectively). Using the same scale, Wang (2002) found
that Chinese nurses were more dissatisfied than satisfied
(mean=2.51) and were mostly dissatisfied with pay
(mean=1.85) and job promotion (mean=1.97).
From another point of view, Lee’s (1998) cross-
sectional survey examined the level of job satisfaction
regarding six job components (autonomy, professional
status, pay, interaction, task requirements and organiza-
tional policies) using the Index of Work Satisfaction
(Stamps and Piedmonte, 1986). The first part addresses
the relative importance of each of the six job compo-
nents, using 15 sets of paired comparison statements.
The second part is a 44-item Likert scale that requires
subjects to respond to one of seven choices from
‘strongly disagree’ to ‘strongly agree’ to measure current
levels of satisfaction regarding each of the six compo-
nents. The results showed that nurses were dissatisfied
more than satisfied (mean=3.46) and reported most
satisfaction with professional status (mean=4.17) and
most dissatisfaction with task requirements
(mean=2.81). The level of need for autonomy was
below the mid-score of the sub-scale with no significant
relationship (r ¼ 0:11; p40:1) between their satisfaction
Key empirical sources
Adamson et al. (1995), Nolan et al. (1995), Tovey and Adams
(1999), Adams and Bond (2000), Tzeng (2002a, b)
Adamson et al. (1995), Nolan et al. (1995), Lee (1998), Tovey
and Adams (1999), Adams and Bond (2000), Aiken et al. (2001),
Price (2002), Tzeng (2002a, b), Wang (2002)
Nolan et al. (1995, 1998), Lee (1998), Lundh, (1999), Tovey and
Adams (1999), Adams and Bond (2000), Price (2002), Tzeng
(2002a, b), Wang (2002)
Adamson et al. (1995), Nolan et al. (1995), Lee (1998), Aiken et
al. (2001), Price (2002), Tzeng (2002a, b), Wang (2002)
Nolan et al. (1995), Lee (1998), Aiken et al. (2001), Price (2002),
Tzeng (2002a, b), Wang (2002)
Nolan et al. (1995), Lundh (1999), Aiken et al. (2001), Price
(2002), Wang (2002)
Nolan et al. (1995, 1998), Lee (1998), Price (2002), Wang (2002)
Nolan et al. (1995, 1998)
Lee (1998), Tzeng (2002a, b)
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H. Lu et al. / International Journal of Nursing Studies 42 (2005) 211–227
with job autonomy and their individual need for
autonomy.
Tzeng (2002a, b) has also noted that expectation and
reality may be a source of nurses’ dissatisfaction. The
Nurses’ Job Satisfaction and the Perceived Importance
Questionnaire was specially designed for the study and
included 92 items, comprising of 8 job satisfaction scales
and 8 importance indicators (indirect working environ-
ment, direct working environment, salary and promo-
tion, self-growth, challenging work, interaction with
patients, leadership style and working atmosphere).
Responses were given on a 5-point Likert scale ranging
from 1 (least satisfied) to 5 (most satisfied) for job
satisfaction items and from 1 (least important) to 5
(most important) for importance items. Pearson correla-
tion analyses revealed that, except for the scale of
indirect working environment, all the scales were
statistically and significantly correlated to their corre-
sponding scales (pp0:05). The nurse sample identified
factors such as indirect working environment (a
hospital’s policies, benefits, leisure activities, housing,
parking, and vacation policy), salary and promotion as
very important but strongly dissatisfying (Table 2).
In conclusion, job satisfaction of nurses is an
important concept as levels of job satisfaction may
impact upon the global nursing workforce. Although the
reported studies differed regarding levels of job satisfac-
tion among nurses, the literature reveals that the sources
of job satisfaction are relatively similar, e.g., physical
working conditions, relationships with fellow workers
and managers, pay, promotion, job security, responsi-
bility, the recognition from managers and hours of
work. Furthermore, it seems that nurses who had
received tertiary education felt less satisfied with their
jobs than those who had not received tertiary education
(Table 3).
5. Effects of job satisfaction of nurses on absenteeism,
burnout, turnover and intention to quit
Absenteeism is an important problem for health-care
providers because it is costly and related to preventable
job stress (Matrunola, 1996). The impact of job
satisfaction upon nursing absenteeism, burnout and
nurses’ intention to quit and turnover has been explored
in a number of research studies, however, the findings
are equivocal.
Siu’s (2002) study of nurses in Hong Kong found that
involvement (the degree of commitment displayed
towards employees by the organization) (b ¼ 0:42;
po0:05), job satisfaction (b ¼ 0:21; po0:05), psycho-
logical distress (b ¼ 0:20; po0:01) and age (b ¼ 0:20;
po0:01) were significant predictors of absenteeism for
sample 1; and organization (the interaction between the
worker and the organization) (b ¼ 0:70; po0:01),
215
involvement (b ¼ 0:51; po0:05) and occupational type
(b ¼ 0:33; po0:001) were significant predictors of
absenteeism for sample 2. The inconsistent findings
may be explained by the relatively small sample sizes, the
unmatched gender ratios, the unmatched occupational
type, the relatively low response rate in sample 2 (57%)
and the use of self-report sickness-absence. Such
inconclusive results suggest that further research in this
area should be replicated among other Chinese nurses.
Conversely, Matrunola’s (1996) found study of English
nurses that there was no relationship between job
satisfaction and absenteeism. In the light of the small
sample size, the generalization of the findings needs to
be treated with caution.
Lee et al.’s (2003) South Korean study showed that
the most frequently mentioned reasons for nurses’
intending to leave their jobs were work overload,
rotating shifts and conflict in interpersonal relationships.
A total of 24%, 15% and 35% of variance regarding
depersionalization, emotional exhaustion and personal
accomplishment, respectively, was explained by the
individual characteristics, job stress and personal
resources. It was particularly noteworthy that nurses
who experienced higher job stress showed lower
cognitive empathy and empowerment, and worked on
night shifts at tertiary hospitals were more likely to
experience burnout.
Regarding the effect of job satisfaction on nurse
turnover, there are some similar findings in the different
studies. Cavanagh (1990) found that US public hospital
nurse turnover could be predicted using kinship
responsibility, promotion, salary and instrumental com-
munication (R2 ¼ 0:37; po0:05). Cavanagh and Coffin
(1992) further found job satisfaction and participation at
work to be important variables in the turnover process.
There were four variables significantly related to intent
to stay (po0:05): job satisfaction (r ¼ 0:338), kinship
responsibilities (r ¼ 0:123), pay (r ¼ 0:086) and oppor-
tunity (r ¼ 0:072). However, these findings do not
conclusively support the Price and Mueller’s (1981)
model of nursing turnover.
Gauci Borda and Norman (1997a) found a significant
positive relationship between job satisfaction and intent
to stay (rs ¼ 0:48; po0:005) and negative relationships
between job satisfaction and frequency of 1 day absence
and short-term absence (lasting 3 days or less)
(rs ¼ 0:14; po0:05; respectively) among Maltese
nurses.
Yin and Yang’s (2002) meta-analysis also found that
the strongest individual and organizational factors
related to nurse turnover were job satisfaction
(rxy ¼ 0:23; po0:05), autonomy (rxy ¼ 0:23;
po0:05), advancement opportunity (rxy ¼ 0:22;
po0:05), job stress (rxy ¼ 0:21; po0:05), pay
(rxy ¼ 0:20; po0:05), group cohesion (rxy ¼ 0:19;
po0:05), marital status (rxy ¼ 0:14; po0:05) and
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Table 3
Summary of included studies regarding sources of nurses’ job satisfaction

Code study Location Sample and response rate Instruments Key findings Comments

Adams and Bond England 834 nurses of clinical grade C and Adams et al’s The most important contributors to
(2000) above; a response rate of 57% (1995) ward nurses’ job satisfaction were the
organizational degree of cohesion (R2=0.20) and
features scales perception of staff organization
(R2=0.20)

H. Lu et al. / International Journal of Nursing Studies 42 (2005) 211–227

Adamson et al. Australia, 133 Australian nurses (83% Specially British nurses were more dissatisfied Medical dominance is a barrier to
(1995) England response rate) and 108 British designed scales: than Australian nurses (po0.001) both Australian and British nurses’
nurses (78% response rate) Nurses’ workplace satisfaction
dissatisfaction
scale
Medical The British nurses perceived their
autonomy scale professional status to be lower, their

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Medical relationship with hospital
authority scale administrators to be poorer and
their working conditions to be less
adequate than Australian nurses.
Aiken et al. US, Canada, 43,329 nurses working in adult Nurses’ working Job dissatisfaction among nurses The core problems in nurses’ work
(2001) England, acute hospital; a response rate of perceptions was highest in US design and workforce management
Scotland, 42–53% questionnaire hold much in common
Germany (specially
designed)
Maslach and The nurses in Germany were more
Jackson’s (1986) satisfied with the opportunities for
burnout advancement while the nurses in the
inventory US and Canada (69%) felt more
satisfied with their salaries
Lee (1998) Hong Kong 190 nurses; response rates of Stamps and Nurses more dissatisfied than
45–83% Piedmonte’s satisfied
(1986) index of
work satisfaction
Edward’s (1959) No significant relationship between
personal satisfaction with job autonomy and
preference individual need for autonomy
schedule (EPPS)
Lundh (1999) Sweden 439 nurses, 83 laboratory Nolan et al.’s Nurses’ levels of stress had
technologists, 31 midwives and 72 (1995) job increased
managers; an overall response rate satisfaction Satisfaction with pay and overall
of 59% questionnaire working conditions had fallen
Nolan et al. Wales 676 nurses, midwives and health Nolan et al.’s Job satisfaction had remained
(1995) visitors; a response rate of 41% (1995) Job stable
satisfaction Falling confidence in the future of
questionnaire the NHS
Nolan et al. Sheffield 518 nurses; a response rate of 35% Nolan et al.’s About 35% of respondents
(1998) (1995) job considered that their job
satisfaction satisfaction had decreased in the
questionnaire last year and 69% felt that overall
morale had fallen

H. Lu et al. / International Journal of Nursing Studies 42 (2005) 211–227

Price (2002) England 141 E-grade nurses in a large Mueller and Over half of the respondents (58%) Caution is needed in generalizing
teaching hospital; a response rate of McCloskey’s were generally satisfied with their the results due to the sample bias
82% (1990a, b) job with only one grade of nurses
satisfaction scale Highest satisfaction was related to working in acute wards represented
co-workers and extrinsic rewards
and most dissatisfaction was with
the amount of control and

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responsibility they had and with
professional opportunities
Tovey and England 265 nurses Adams et al.’s Key sources of dissatisfaction:
Adams (1999) (1995) ward working relationships, lack of staff,
organizational professional concerns about poor
features scales standards of care and external work
pressure
Tzeng (2002b) Taiwan 786 nurses; a response rate of 76% Tzeng’s (2002b) Indirect working environment,
nurses’ job salary and promotion were very
satisfaction and important but strongly dissatisfying
the perceived
important
questionnaire
Wang (2002) Mainland China 191 nurses; a response rate of 100% Mueller and Nurses were more dissatisfied than
McCloskey’s satisfied and mostly dissatisfied with
(1990a, b) pay and job promotion
satisfaction scale

217
 218
Table 4
Summary of included studies regarding effects of nurses’ job satisfaction

Code study Location Sample and response rate Instruments Key findings Comments

Cavanagh (1990) US 232 hospital nurses; an overall Price and The combination of the variables
response rate of 38.5% Mueller’s (1981) accounted for 36.8% (po0.05) of
turnover scale the explained variance in turnover

H. Lu et al. / International Journal of Nursing Studies 42 (2005) 211–227

rate
Cavanagh and US 221 nurses; a response rate of 80.5% Price and Factors related to intention to stay: The Price and Mueller’s (1981)
Coffin (1992) in a public hospital and 19.5% in a Mueller’s (1981) job satisfaction, kinship model of nursing turnover was not
private hospital turnover scale responsibilities, pay and conclusively support
opportunity
Job satisfaction was a key

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determinant in the turnover process
Gauci Borda and Malta 171 nurses; a response rate of 67% Lyons’ (1971) A significant positive relationship The model of absence and turnover
Norman (1997a) global between job satisfaction and (Gauci Borda and Norman, 1997b)
satisfaction scale intention to stay (r ¼ 0:48; was not totally supported
Mueller and po0:005) and negative relationships
McCloskey’s between job satisfaction and
(1990a, b) frequency of 1 day/short-term
satisfaction scale absence (r ¼ 0:14; po0:05;
Redfern’s (1981) respectively)
propensity to
leave index
Lee et al. (2003) South Korea 178 nurses; a response rate of 81% Maslach and A total of 24%, 15% and 35% of
Jackson’s (1981) variance in depersionalization,
burnout emotional exhaustion and personal
inventory accomplishment, respectively, were
Mehrabian’s explained by the predictor variables
(1994) emotional
empathy scale
Barrett-Lennard’s
(1978) empathy
scale, etc.
Lu et al. (2002) Taiwan 21,971 nurses; a response rate of Specially designed Job satisfaction was positively Further research needs to explore
86.2% scales: correlated with professional the effect of organizational
professional commitment and negatively commitment regarding any
commitment scale correlatively correlated with interrelationships
intention to leave the organization
and profession
 Job satisfaction About 38.4% of nurses had the
scale intention to leave the organization
and 30.4% intending to leave the
profession because of lack of job
satisfaction
Intention to quit
scale
Matrunola (1996) England 34 nurses working within an elderly Matrunola’s There was no significant Due to the small sample size,
care unit; a response rate of 68% (1996) job relationship between job generalization of these findings
satisfaction satisfaction and absenteeism needs to be treated with caution

H. Lu et al. / International Journal of Nursing Studies 42 (2005) 211–227

questionnaire
Maslach and
Jackson’s (1981)
burnout
inventory
Beck et al.’s
(1974)

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hopelessness scale
Siu (2002) Hong Kong 144 nurses (sample 1) and 114 Siu and Cooper’s Job satisfaction was a significant Further research in this area should
(sample 2); response rates of 100% (1998) predictor of absenteeism in sample be replicated among other Chinese
and 57%, respectively psychological 1; while no similar result was found nurses
distress scale in sample 2
Tzeng (2002a) Taiwan 648 nurses; a response rate of 82% General job satisfaction was
significant predictor of nurses’
intention to quit
Wu et al. (2000) Mainland China 382 nurses; a response rate of 92.5% Job stress scale There was a positive and significant Further research is needed to
(specially relationship between job stress and confirm the findings
designed) intention to quit (r ¼ 0:46; po0:05)
Yin and Yang Taiwan (meta- 129 studies relating to nursing The strongest factors related to It suggests to group studies using
(2002) analysis) turnover from 1978–1998 nurse turnover were job satisfaction, the same measures for satisfaction
autonomy, opportunities for and the related variables
promotion, job stress, pay group
cohesion, marital status and
educational level

219
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220 H. Lu et al. / International Journal of Nursing Studies 42 (2005) 211–227
educational level (rxy ¼ 0:09; po0:05). Similarly, Wu et
al. (2000) reported a positive and significant relationship
between job stress and intention to quit among Main-
land Chinese nurses (r ¼ 0:46; po0:05). Using the
multiple regression, Tzeng (2002a) reported that institu-
tion (privately owned local hospital), age of the youngest
child, level of education (e.g., diploma and associate
degree), salary and promotion, general job satisfaction
and general job happiness were significant predictors of
Taiwanese nurses’ intention to quit (the Nagelkerke
Pseudo R2 ¼ 0:410).
The influence of job satisfaction on intention to leave
the nursing profession was examined in Lu et al.’s (2002)
study of Taiwanese nurses. It’s findings indicated that
job satisfaction was positively correlated with profes-
sional commitment (r ¼ 0:386; po0:01) and negatively
correlated with intention to leave the organization and
profession (r ¼ 0:480; r ¼ 0:370; respectively,
po0:01). In the discriminant analysis, 38.4% of the
nurses could be classified as having the intention to leave
the organization and 30.4% as intending to leave the
profession because of lack of job satisfaction.
In summary, most published research from various
countries indicates that job satisfaction is a significant
predictor of nursing absenteeism, burnout, turnover and
intention to quit; however, there have been some
inconsistent findings (Table 4).
6. Related factors to job satisfaction of nurses
Job satisfaction is a complex phenomenon, as
evidenced by the many related factors identified in the
studies already discussed. The identification of these
factors and exploration of their effects on job satisfac-
tion has the potential to refine the theoretical models of
nurses’ job satisfaction and aid the development of
management interventions (Blegen, 1993). Blegen’s
(1993) meta-analysis found that job satisfaction was
most strongly associated with stress (r ¼ 0:61) and
organizational commitment (r ¼ 0:53). Seven variables
had correlations between 0.20 and 0.50: communication
with supervisor, autonomy, recognition, routinization,
communication with peers, fairness and locus of control;
and four variables had very weak correlations: age
(r ¼ 0:13), years of experience (r ¼ 0:09), education
(r ¼ 0:07) and professionalism (r ¼ 0:06).
A causal model of job satisfaction has been tested in
Chu et al.’s (2003) study of Taiwanese nurses and Seo et
al.’s (2004) study of South Korean nurses, respectively.
In this model 11 independent variables included: job
involvement, positive affectivity, negative affectivity,
autonomy, distributive justice, procedural justice, job
stress (role ambiguity, role conflict, workload and
resource inadequacy), pay, promotional chances, routi-
nization and social support. Chu et al. (2003) found
that, with the exception of pay (p40:05), all of the
independent variables were significantly related to job
satisfaction (po0:05). Seven of the exogenous variables
were the major determinants of job satisfaction accord-
ing to Pearson’s correlation coefficients: positive affec-
tivity (r ¼ 0:452), routinization (r ¼ 0:441), resource
inadequacy (r ¼ 0:341), negative affectivity
(r ¼ 0:333), role ambiguity (r ¼ 0:327), supervisor
support (r ¼ 0:325) and co-worker support (r ¼ 0:309).
The regression results indicated that six of the exogen-
ous variables hypothesized to impact upon job satisfac-
tion were significant: routinization (b ¼ 0:286;
po0:001), positive affectivity (b ¼ 0:266; po0:001),
involvement (b ¼ 0:147; po0:01), negative affectivity
(b ¼ 0:118; po0:05), co-worker support (b ¼ 0:118;
po0:05) and role ambiguity (b ¼ 0:018; po0:05). The
exogenous variables in this model explained 45% of the
association of variance in job satisfaction.
Seo et al. (2004) also found a reasonable fit between
the causal model and the data (CFI=0.904,
IFI=0.907). When considering all of the independent
variables (Model 1), seven variables had statistically
significant net effects on job satisfaction (po0:05):
positive affectivity, supervisory support, pay, routiniza-
tion, negative affectivity, workload and job opportunity
(b ¼ 0:286; b ¼ 0:11; b ¼ 0:095; b ¼ 0:250; b ¼
0:213; b ¼ 0:211; b ¼ 0:105; respectively). Model
1 explained about 53% of the variance in satisfaction,
but when the psychological variables (positive and
negative affectivity) were not included (Model 2), job
opportunity was no longer significant (p40:05). Pay and
supervisor support positively impacted upon job satis-
faction (b ¼ 0:185; b ¼ 0:164; respectively) while routi-
nization and workload negatively impacted upon it
(b ¼ 0:347; b ¼ 0:24; respectively). Model 2 ex-
plained 40% of the variance in satisfaction.
Interestingly, Packard and Motowidlo (1987) found
that stress and job satisfaction in the US were not
directly related and that stress, primarily acting through
depression, was associated with lower levels of job
performance. Job satisfaction correlated with depression
(r ¼ 0:55; po0:01), hostility (r ¼ 0:41; po0:01),
subjective stress (r ¼ 0:27; po0:01), frequency of
stressful events (r ¼ 0:22; po0:01), intensity of stress-
ful events (r ¼ 0:18; po0:05) and anxiety (r ¼ 0:16;
po0:05). However, multiple regression analysis showed
depression had a strong effect on job satisfaction
(b ¼ 0:53; po0:01) and hostility (b ¼ 0:23; po0:01)
and fear of negative evaluation (b ¼ 0:20; po0:01) had
weaker direct effects, but others showed no significant
impacts upon job satisfaction (p40:05).
Organizational commitment refers to identification
with and loyalty to the organization and its goals (Blau
and Boal, 1987) which Mowday et al. (1979) defined as
the relative strength of an individual’s identification with
and involvement in a particular organization. In
 ARTICLE IN PRESS
H. Lu et al. / International Journal of Nursing Studies 42 (2005) 211–227
particular, commitment is characterized by three factors:
a strong belief in and an acceptance of the organization’s
goals and values; a willingness to exert considerable
effort on behalf of the organization; and a strong desire
to maintain membership in the organization. It has been
found that organizational commitment is positively
related to job satisfaction of hospital nurses (Blegen,
1993; Al-Aameri, 2000). Knoop (1995) found that
organizational commitment was related to overall job
satisfaction (r ¼ 0:64; po0:001), satisfaction with work
(r ¼ 0:58; po0:001), promotion opportunity (r ¼ 0:55;
po0:001), supervision (r ¼ 0:54; po0:001), co-workers
(r ¼ 0:30; po0:001) and pay (r ¼ 0:22; po0:01) among
Canadian nurses. Furthermore, the regression analysis
revealed that organizational commitment explained
41% of the variance in job satisfaction.
Professional commitment is a person’s involvement,
pledge, promise or resolution towards his/her profession
(Fang, 2001). It has an incremental effect on a
professional’s intention to leave the organization (Blau
and Lunz, 1998). Therefore, enhancing professional
commitment in nursing has the potential to produce
benefits for both the individual and their organization
(Cohen, 1998; Cohen, 1999). Furthermore, professional
commitment is positively related to the job satisfaction
of nurses (Lu et al., 2000; Jones, 2000). For example,
Fang’s (2001) study of Singaporean nurses demon-
strated that job satisfaction was significantly and
positively related to organizational commitment
(r ¼ 0:571; po0:01), professional commitment
(r ¼ 0:347; po0:01) and supervisor satisfaction
(r ¼ 0:155; po0:05) and negatively related to job stress
(r ¼ 0:545; po0:01), turnover cognition (r ¼ 0:415;
Table 5
Related factors to job satisfaction of nurses
Related factors
Substantial to very strong relationship with job satisfaction
(correlation coefficient40.5)
Job stress; organizational commitment; depression; cohesion
of the ward nursing team
Moderate to substantial relationship with job satisfaction
(correlation coefficient 0.2–0.5)
Affectivity; role ambiguity; professional commitment;
routinization; supervisor/co-worker support; collaboration with
medical staff; job performance; job involvement; hostility staff
organization; autonomy; recognition; fairness; locus of control;
communication with supervisor/peers
Slight relationship with job satisfaction (correlation
coefficiento0.2)
Role conflict; job involvement; age; year of experience;
educational level; professionalism; anxiety; supervisor
satisfaction
221
po0:01) and intention to quit (r ¼ 0:283; po0:01).
About 41% of the variance in turnover cognition was
explained by the mentioned antecedents; however, the
contributions of job stress, organizational commitment
and professional commitment to job satisfaction were
not identified.
In addition, the nurses’ roles within their work
situations and its effect on job satisfaction are also of
primary concern with role conflict and ambiguity being
the main sources of job stress (Hingley and Cooper,
1986). Role conflict is defined in terms of the dimensions
of congruency-incongruency or compatibility-incompat-
ibility in the requirements of the role, where congruency
of compatibility is judged relative to a set of standards
or conditions which impinge upon role performance.
Role ambiguity is the predictability of the outcome or
responses to one’s behaviour and the existence or clarity
of behavioural requirements, often in terms of inputs
from the environment, which would serve to guide
behaviour and provide knowledge that the behaviour is
appropriate (Rizzo et al., 1970). Role conflict and
ambiguity are significantly related to job stress, organi-
zational commitment, job satisfaction and intentions to
leave the nursing profession (Rosse and Rosse, 1981).
Dailey (1990) found that tension discharge rate, role
ambiguity and role conflict were significant predictors of
experienced stress symptoms (b ¼ 0:24; 0.15, 0.08,
respectively) among US nurses. Together, the three
produced an overall multiple R2 value of 0.47
(po0:001). On the other hand, the most significant
predictor of intention to quit was experienced job-
induced stress symptoms (b ¼ 0:36), followed by tension
discharge rate (b ¼ 0:22). Role ambiguity (b ¼ 0:13) and
Key empirical sources
Packard and Motowidlo (1987), Blegen (1993), Knoop (1995),
Adams and Bond (2000), Fang (2001)
Packard and Motowidlo (1987), Blegen (1993), Knoop (1995),
Adams and Bond (2000), Fang (2001), Chu et al. (2003)
Packard and Motowidlo (1987), Blegen (1993), Fang (2001),
Lu et al. (2002), Chu et al. (2003)
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222 H. Lu et al. / International Journal of Nursing Studies 42 (2005) 211–227
Table 6
Predictors of job satisfaction among nurses
Predictors
Depression
Organizational commitment
Cohesion existing among ward nurses; collaboration of medical
staff; perceptions of professional practice; team building skills
of the ward managers
Organizational commitment; job stress; supervisor satisfaction
Psychological distress; occupational type (psychiatric/general);
the physical conditions in the work area
Routinization; affectivity; job involvement; co-worker support;
educational level
role conflict (b ¼ 0:04) were also significant predictors of
intention to quit. The regression model explained 75%
of the variance in intention to quit (po0:001).
However, Mitchell’s (1994) US study found that there
was not a significant linear association between a nurse’s
job satisfaction and the correlation between work role
values and actual work roles (p40:05). This may be
attributed to several factors. Firstly, the mean correla-
tion (r ¼ 0:58) between work roles and work role values
was weak and non-significant (p40:05) and secondly,
the scores of job satisfaction did not have a normal
distribution, with 54% of respondents having a high
level of satisfaction. Furthermore, the roles as used in
the questionnaire for this study were not tested for
validity and reliability. Therefore, further explanation of
the relationship between personal work role values and
actual work roles is needed in relation to nurses’
expressed job satisfaction (Tables 5 and 6).
In summary, much research has revealed that job
satisfaction of hospital nurses is closely related to job
stress, role conflict and ambiguity, organizational
commitment and professional commitment (Table 7).
7. Conclusion
Most member states of the WHO have reported nurse
resource difficulties (Kingma, 2001). Developed coun-
tries are faced with the double challenge of having an
ageing nurse workforce and increasing demand for
nursing care from an ageing population (Buchan, 2001).
International migration of nurses has increased as
nurses pursue opportunities for improved pay and
opportunities in the wake of global liberalization of
trade spurred on by developed countries increasing their
international recruitment to meet their health-care
workforce needs and in so doing creating a ‘skills drain’
in many developing countries (Kingma, 2001). This
increased mobility of the nursing workforce means that
Key empirical sources
Packard and Motowidlo (1987)
Knoop (1995)
Adams and Bond (2000)
Fang (2001)
Siu (2002)
Chu et al. (2003)
factors which contribute to nurses’ turnover merit
attention. Job satisfaction among nurses has been
identified as a key factor in nurses’ turnover with the
empirical literature suggesting that it is related to a
number of organizational, professional and personal
variables.
While the literature indicates common issues across
the world, it is possible that different issues have greater
significance in different countries due to the social
context of the different labour markets. Further, the
literature suggests that nurses are experiencing increas-
ing levels of work-related stress over time and increased
levels of work-related stress are associated with lower
levels of satisfaction with reward packages and working
conditions. Current workforce shortages are likely to
place greater demands upon nurses which might be
expected to increase their work-related stress and may
reduce the quality of workplace relationships which has
emerged as an important source of job satisfaction and
contributes to organizational commitment. The lower
levels of job satisfaction among nurses with tertiary
education are noteworthy as such nurses probably
represent the most well-educated element of the nursing
workforce and the future leadership of the profession.
Also noteworthy is the lower job satisfaction of those
who had unfulfilled expectations regarding nursing work
which suggests that some nurses retain an idealized view
of nursing despite most initial nurse education including
extended periods of clinical practice to prevent reality
shock on entry into the workforce.
The current worldwide shortage of nurses highlights
the importance of understanding the impact and
interrelationships of the identified variables if health-
care organizations are to implement interventions to
improve the retention of their nursing workforce.
Although several models of job satisfaction have been
postulated, these models require further testing espe-
cially regarding the relative contribution of different
factors. The literature suggests that the current models
 ARTICLE IN PRESS
H. Lu et al. / International Journal of Nursing Studies 42 (2005) 211–227 223

Table 7
Summary of included studies regarding related factors to job satisfaction of nurses

Code study Location Sample and Instruments Key findings Comments

response rate

Blegen (1993) (Meta- 48 Job satisfaction was most

analysis) quantitative strongly associated with
studies stress (r ¼ 0:61) and
organizational commitment
(r ¼ 0:53)
Chu et al. Taiwan 308 nurses; a The items from Price and Six variables had significant Impact of work unit on job
(2003) response rate Mueller (1986b), Watson et impact job satisfaction: satisfaction should be
of 75% al. (1987), Cyphert (1990); routinization, positive considered
Kim et al. (1996) and Price affectivity, involvement,
(2001) negative affectivity, co-
worker support and role
ambiguity, which explained
45% of the variance in
satisfaction
Dailey (1990) US 116 nurses; a Rose et al.’s (1978) Tension The regression model
response rate Discharge Rate Scale explained 75% of the
of 38.7% Rizzo et al.’s (1970) Role variance in intention to quit
Conflict and Ambiguity
Scale
Symptoms of Stress Index

Fang (2001) Singapore 180 nurses; a Mowday et al.’s (1979) Job satisfaction was The contributions of job
response rate Organizational significantly and positively stress, organizational
of 90% Commitment Scale related to organizational commitment and
Fang’s (2001) Professional commitment, professional professional commitment to
Commitment Scale commitment and negatively satisfaction were not
Fang’s (2001) Nursing related to job stress identified
Turnover Scale
Knoop (1995) Canada 171 nurse Mowday et al.’s (1979) Organizational commitment The impact of professional
educators and organizational Commitment was related to overall job commitment upon job
nurses; a Questionnaire satisfaction (r ¼ 0:64; satisfaction should be taken
response rate Kanungo’s (1982) Graphic po0:001) and explained into account
of 70% Job Involvement 41% of the variance in job
Iris and Barrett’s (1972) Job satisfaction
Satisfaction Scale, etc.
Mitchell US 201 nurses; a Weiss et al.’s (1967) There was not significant Further explanation of the
(1994) response rate Minnesota Satisfaction linear association between a non-relationship is needed
of 33% Questionnaire nurse’s job satisfaction and
Benner’s (1984) Work Role the correlation between
Scale work role values and actual
work roles (p40:05)

Packard and US 206 nurses; a Price and Mueller’s (1981) Job satisfaction correlated The model of job
Motowidlo response rate Job Satisfaction Scale with depression, hostility, satisfaction was reasonable
(1987) of 56% Others from Motowidlo et subjective stress, frequency but incomplete
al. (1986) of stressful events, intensity
of stressful events and
anxiety
Seo et al. South 353 nurses; a The items from Kahn et al. There was a reasonable fit The model could be used in
(2004) Korea response rate (1964), Rizzo et al. (1970), between the causal model Korean work organizations
of 65.4% House (1981), Breaugh and the data
(1985), Watson and Tellegen All of the variables
(1985), etc. explained 53% of the
variance in satisfaction
 ARTICLE IN PRESS
224 H. Lu et al. / International Journal of Nursing Studies 42 (2005) 211–227
of job satisfaction need to be modified as they omit some
important predictors of job satisfaction such as role
perception. The lack of a comprehensive model of job
satisfaction in nursing is a major shortcoming and
without which effective management interventions
cannot be developed or tested.
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