Factors influencing job satisfaction amongst nurses in Hail Region, Kingdom of Saudi Arabia: A cross-sectional study

Article history: Received 20 September 2019 Received in revised form 10 December 2019 Accepted 15 December 2019 With the present landscape in the healthcare organizations, job satisfaction in the nursing sector must be put into scrutiny as more and more nurses quit due to organizational issues. This study aims to factor-in the sociodemographic information of the nurses working in the Hail region, Kingdom of Saudi Arabia, which can influence their job satisfaction. Specifically, it aims to determine the job satisfaction level of nurses and significant differences in their socio-demographic information. The researcher employed a quantitative cross-sectional design to investigate the job satisfaction of nurses in the Hail region, Kingdom of Saudi Arabia. The researcher utilized the MSQ "short form," which has 20 of the 100 original items. Data gathering was conducted from January to April 2019. Statistically, the weighted mean was used to determine the level of job satisfaction, F-test (one-way ANOVA) and t-test were also employed. This research has obtained ethical approval from the Ethics review board of the University of Hail (H-2016-059). The nurse respondents were satisfied in their present job (M=3.50; SD=1.15). Significant differences have been found in regards to civil status (p=0.01), nationality (p=0.01), age (p=0.03), salary range (p=0.01), and total years of experience (0.01). Factors influencing job satisfaction of nurses in the Hail region, Kingdom of Saudi Arabia such as civil status, nationality, age, salary, and the total years of experiences are vital in planning the strategies to address the turnover. Policymakers can utilize these factors to increase the motivation of these nurses, thereby improving patient outcomes.


Introduction
*Job satisfaction is about the behavior and feelings of the employees about their work (Liu et al., 2012). However, satisfaction depends on the job landscape and expectations of the employees as it depends on what job can provide to them (Ramoo et al., 2013). In the nursing sector, job satisfaction is with utmost consideration in an organization, as this implies the quality of care and excellent patient outcomes. Although there are influences affecting job satisfaction and that it can contribute more to motivation. According to Price (2001), employees are more motivated and satisfied should there be infrastructure to the health facility, finances, development of their career, continued learning, and presence of resources, acknowledgment, and interpersonal relations with the management.
Moreover, sociodemographic like salary, support of the manager, and the nurse-patient relationship (Coomber and Barriball, 2007) are deemed to influence job satisfaction and motivation. In other words, these factors, once considered, can produce better results in job performance. However, with the present background in healthcare organizations, job satisfaction in the nursing sector must scrutinize as more and more nurses quit due to organizational issues.
Previous studies have explored the issues on job satisfaction in the international arena (Cahill, 2011;McGlynn et al., 2003) however, this has not been fully developed as regards other disciplines (Moumtzoglou, 2010;Murrells et al., 2009). Moreover, job satisfaction study results may not be applicable in all settings like in Saudi Arabia. Job satisfaction was explored in Saudi Arabia in general (Alshmemri, 2014;Alotaibi et al., 2016;Mari et al., 2018;Alasmari and Douglas, 2012), but, no study has found focusing on a specific context such as in the Hail region. The Kingdom of Saudi Arabia, in particular, is dominated by expatriate nurses from different countries, which may lead to different factors influencing job satisfaction. In other words, job satisfaction of expatriate nurses may differ from that of nurses from the host country. In a study reported by Al-Momani (2008), the rate of nurses leaving the job in the Middle East is at 18.4% in 1996, and it rises to more than 21% in 2008. In light of this concern, employees need to consider what factors increase nurses' job satisfaction and influence them to stay. As such, the work environment is identified as a critical component of nursing job satisfaction, which then influences the quality of care and patient outcomes (Bawafaa et al., 2015;Galletta et al., 2016;Rudman et al., 2014).
Significantly, findings of this study may be utilized as a framework for the hospital authorities in the Hail region to make a policy that may influence the job satisfaction of nurses. This puts an interest in improving employee productivity and efficiency through the satisfaction they receive from their job attributes. As such, addressing the identified factors to job satisfaction of the nurses in a specific context may further advance their enthusiasm to carry out their job functions. This study aims to factor-in the socio-demographic information of the nurses working in the Hail region that can influence their job satisfaction. Specifically, it aims to determine the job satisfaction level of nurses the significant difference in their socio-demographic elements.

Study design
The researcher employed a quantitative crosssectional design to investigate the job satisfaction of nurses in the Hail region, Kingdom of Saudi Arabia.

Setting and sample
The respondents of the study were the nurses of the hospitals of the Hail region, Kingdom of Saudi Arabia. The said nurses were from the major private and government hospitals within the city of Hail. Convenience sampling was used. The researcher observed the inclusion criteria. Such as the nurses should have been (1) in the job or position for at least a year (2) present during the conduct of the study for them to clarify their responses, (3) and willing to participate.

Instrument
The researcher utilized the MSQ "short form," which has 20 of the 100 original items (Ahmadi and Alireza, 2007). The 20 MSQ-short version items are rated on a 5-point Likert scale; 1) "very dissatisfied with this aspect of my job"; 2) "dissatisfied with this aspect of my job"; 3) "can't decide if I'm satisfied or dissatisfied with this aspect of my job"; 4) "satisfied with this aspect of my job" and 5) "very satisfied with this aspect of my job"). Item responses are summed or averaged to create a total score-the lower the score, the lower the level of job satisfaction. The reliability of the instrument was tested using Cronbach's alpha and was noted at 0.90, showing a high level of reliability.

Data collection procedure
Before data gathering, approval of the Ethics Review Board of the University of Hail was obtained (H-2016-058). A cover letter was provided to the nurses, which included a brief description of the study, the significance of the study, rights of the participants such as the right to withdraw, anonymity, and confidentiality. Data gathering was conducted from January to April 2019.

Data analysis
All data were processed through SPSS Version 21. The demographic profile was treated using frequency count and percentage. Weighted mean was used to determine the level of job satisfaction. To examine the difference between job satisfaction across respondents' profile, the F-test (one-way ANOVA) and t-test for gender were employed. Table 1 presents the level of satisfaction of the nurse respondents in the Hail region, Kingdom of Saudi Arabia. Accordingly, the 218 nurse respondents were satisfied in their present job (M=3.50; SD= 1.15). Meanwhile, the statement "The chance to try my own methods of doing the job" got the highest mean with 3.72(SD=1.24).

Results
T-test was performed to determine the significant difference in the demographic information (sex and civil status) of the respondents with their level of satisfaction. Regarding sex, there is no significant difference in the job satisfaction of male (M=3.66 SD=1.25) and female (M=3.49, SD=1.15) and t (216) =0.46, p=0.65. As regards civil status, there is a significant difference in the job satisfaction of single (M=3.66 SD=1.23) and married (M=3.19, SD=1.08) and t (216)=2.86, p=0.01. Table 2 shows the difference between job satisfactions across the respondent's profile.
One-way ANOVA was conducted to see if there is a difference in the demographic information of the nurse respondents with their level of satisfaction. As regards nationality, it was revealed that there is a significant difference between job satisfaction and nationality of the respondents at the p<0.05 level for the eight nationalities [F (7, 210)=13.98, p=0.01]. Regarding age, it was revealed that there is a significant difference between job satisfaction and the age of the respondents at the p<0.05 level for the seven age groups [F (6, 211)=2.31, p=0.03]. On the other hand, a significant difference found between job satisfaction and salary range of the respondents at the p<0.05 level for the five salary ranges [F (4, 213)=13.98, p=0.01]. Meanwhile, there is no significant difference between job satisfaction and the position of the respondents at the p<0.05 level for the three nursing positions [F (2, 215)=0.79, p =0.45]. Another non-significant difference found between job satisfaction and years of experience in the current job of the respondents at the p<0.05 level for the four range of experience [F (3, 214)=0.88, p=0.46]. As to total years of experience, a significant difference was found at the p<0.05 level for the four range of total experience [F 32, 214)=7.59, p=0.01]. On the other hand, there is no significant difference between job satisfaction and the number of children of the respondents at the p<0.05 level for the five groups of the number of children [F (4, 213)=1.27, p=0.28].

Discussion
This study aims to determine the factor influencing the job satisfaction of nurses working in the Hail region in particular. Nurses in this present study are satisfied with their job performance, which means that various aspects of their present job are being met. This present finding is in agreement with the previous research of Junious et al. (2004) and Rad and Yarmohammadian (2006) explaining that nurses are satisfied with their job. It is important to note that positive job satisfaction contributes to a better work environment, increase patient satisfaction, and improve quality of care. According to Nikic et al. (2008), the satisfaction on the job of the healthcare employees is a vital parameter that impacts their output so with their quality work.
The significant difference in job satisfaction amongst nurses as to civil status implies that single (not married) has a higher job satisfaction than the married once. Obviously, the responsibility of marriage has an impact on work and personal life (Pasay-an et al., 2014). The single nurses (not married) deal with their work more concentrated efforts, thus focusing on the job itself, unlike those married ones which attention could either focus on the family matter than their job. The result of this present study disagrees with Olatunji and Mokuolu (2014), in which they reported that single participants invariably had a higher level of job stress than their married counterparts.
The significant difference between job satisfaction and nationality of the respondents showed that expat nurses are more satisfied than Saudi nurses. Similar scenario seen on the global scale, more nurses specifically coming from Asian countries occupies a big bulk in the nursing workforce of a more developed country. These nurses are trained, and most of them worked in their own countries. However, one of the primary reasons for leaving their families behind and working overseas is the economic crisis that their countries are facing. Expatriate nurses are easily satisfied with their job basically because their point of comparison on their current job is far worst in terms of workload, salary, and technological advancements. Previous studies (Al-Ahmadi, 2002;Adams and Bond, 2000) are somehow inconsistent with the present findings. Most of these studies imply that demographic data such as nationality does not affect job satisfaction. However, a recent study conducted in Riyadh, Saudi Arabia, found that although nationality is insignificant in terms of job satisfaction, it plays a significant role in the commitment of nurses. (Al-Aameri, 2000).
Of note, there is a significant difference between job satisfaction and the age of the respondents. The level of job satisfaction of the respondents varies when grouped according to age. The oldest age group has the highest mean level of job satisfaction, while the youngest age group has the lowest mean job satisfaction. Maturity may be a critical factor that influenced the result of the present study. Older individuals tend to be more matured and quickly get satisfaction compared to the younger generation.
The needs and expectations of the mature person are less and easy being met. However, most studies suggest that age is not a strong determinant of job satisfaction among nurses (Al-Takroni et al., 2018). The job satisfaction and salary range of the respondents vary when grouped according to salary, nurses having a high salary appeared to be satisfied with their job. This means that, like any other employment, the income can be accounted for as motivation or source of satisfaction on the job. The salary may be a reflection of one's experience and position. Nurses gain more income as they develop their experience, and those who are given a position typically receive more. Recent studies on nurse's job satisfaction generated similar findings. (Masum et al., 2016;Top and Gider, 2013;Han and Jekel, 2011) The level of job satisfaction varies when grouped according to total years of experience as a nurse, it can be seen that when the total years of experience increase the level of satisfaction increases. This means that less experienced nurses, usually the younger ones are not contented with their present workload, salary, work environment, and most have a higher set of expectations. Their frustrations are the reason why in most studies (Beecroft et al., 2008;Delobelle et al., 2011;Masum et al., 2016), fresh graduates have higher chances of quitting their jobs. The most experienced nurses are more likely mature, better paid, and might have experienced worse conditions in the past, making it easier for them to accept the difficulties of their present job. These findings are similar/congruent to the past studies of Kavanaugh et al. (2006).

Conclusion
While the studies on job satisfaction of nurses generated the same results, it is vital to consider the context in particular. Factors influencing job satisfaction of nurses in the Hail region, Kingdom of Saudi Arabia with the likes of civil status, nationality, age, salary, and the total years of experiences are vital in planning the strategies to intervene in the turnover. Policymakers can utilize these factors to increase the motivation of these nurses, thereby improving patient outcomes.