Exploring the Relationship Between Job Satisfaction and Job Retention among Registered Nurses Under the Nurse Deployment Program in Southern Philippines

Norhanie Aba Ali, Ashley A. Bangcola*

College of Health Sciences, Mindanao State University, Marawi City 9700, Philippines

*Corresponding Author’s Email: ashley.bangcola@msumain.edu.ph

ABSTRACT

Background: This study explores the relationship between job satisfaction and job retention among registered nurses working under the Nurse Deployment Program (NDP) in Southern Philippines.

Methods: The design employed in the study is descriptive-correlational to measure the nurses' perceptions of organizational job satisfaction and the link between job satisfaction and job retention using a survey questionnaire developed by Traynor and Wade (1993). A total of 139 registered nurses were selected using the random sampling method from the hospitals, rural health units, birthing homes, and barangay health stations in the municipalities of Lanao del Sur, Philippines. The data was analyzed through frequency and percentage distribution and Spearman Rho Correlation using manual computation and SPSS. Nurse retention was calculated by dividing the average number of registered nurses during a period of 6 months by the job turnover rates on the units.

Results: The findings revealed that the respondents were 'satisfied' with the overall indicators on the job satisfaction scale. With a Spearman Rho Correlation value of 0.003 and a p-value of 0.016, the data suggests that there is a significant correlation between the respondents’ job satisfaction and job retention in the Nurse Deployment Project.

Conclusion: This research illuminates the factors that may influence nurse retention, improve nurse job satisfaction, and promote healthy workplaces. It can serve as a standard or foundation for policymakers and implementers in identifying areas for improvement in boosting job satisfaction among nurses.

Keywords: Job Satisfaction; Nurses; Job Retention; Nurse Deployment Program

INTRODUCTION

Nurse retention is critical in today's health-care industry. Maintaining a healthy rate of job retention in healthcare organizations ensures high-quality patient outcomes and lower costs for hospitals. Based on the comprehensive literature review, job satisfaction (employee satisfaction) is one of the most important factors that affect organizational success, and it is crucial to pay close attention to it to avoid negative impacts on the overall performance of an organization (Lu, While & Barriball, 2005). This is especially true in the healthcare setting, where the performance of the nurse can adversely affect the quality of care given to patients.

However, gaps in the literature show that research on the relationships between nurse job satisfaction and employment retention in various geographic areas is yet to be clarified. According to several studies, job satisfaction of nurses may influence nurse retention (Baernholdt & Mark, 2009). Nurses’ job satisfaction has been frequently used as a predictor of retention and has been previously directly linked to high turnover rates (Baernholdt & Mark, 2009). The Philippines is a job-scarce country. Poor working conditions drive Filipino nurses to seek employment abroad, resulting in a shortage of highly skilled nurses, which creates severe problems for the Filipino health system.

The Philippine scenario is such that it is a victim of brain drain in regard to its health sector. According to Lorenzo et al., 2005, immigration was viewed as negatively impacting nursing in the Philippines because it depletes the pool of skilled and experienced health workers, putting the quality of services in the health-care system at risk. However, some sectors perceive that the Philippines has more than enough nurses, which cannot be accommodated because there were never enough job opportunities (Fitzpatrick, 2008). In the Philippines, jobs are made available not because of the need for them but because there are enough resources to keep the workers in the workforce. For instance, the Nurse Deployment Project (NDP) by the Department of Health (DOH) is a project that intends to improve health systems in the Philippines and support the country in attaining Universal Health Care or "Kalusugang Pangkalahatan" (Harby, 2013). It also aims to provide job opportunities to the country’s growing number of unemployed nurses. But while this may be true, nurses employed under the NDP may also leave their jobs after gaining more experience for a better opportunity elsewhere. This situation in the status quo may increase nursing turnover and deplete our resources for highly skilled nurses in the Philippines. High rates of nursing turnover are found to be costly for both healthcare organizations and patients. As a result, healthcare systems around the world have focused heavily on retaining nurses in the field for decades. The challenge in today's modern Philippine society is to close the knowledge gap about job satisfaction, which has been recognized in independent studies as a factor that influences retention and turnover, as well as the quality of nursing care that influences patient care outcomes (Locke, 1976). Nursing leaders must have a wide range of tools at their disposal in order to help the current nursing workforce achieve greater job satisfaction and healthier working conditions. Improvements in our daily work environment are required for high-quality patient outcomes.

METHODOLOGY

Study Design

This research utilized descriptive-correlational research design, for which data was collected through descriptive survey questionnaires. A descriptive design was utilized to describe the respondents’ job satisfaction. On the other hand, correlation research seeks to identify whether and to what extent two or more quantitative variables are related (Van Saane et al., 2003). The correlation technique was deemed appropriate for this study in determining the existence of significant relationships between the variables as a basis for rejecting or accepting the hypothesis drawn for this study. The degree of relationships was expressed in terms of the correlation of coefficient.

Participants

A sample of one hundred thirty-nine (139) registered nurses employed full time as community health nurses in the Rural Health Units, Birthing Homes, Hospitals and Barangay Health Stations in different municipalities in Lanao del Sur participated. The primary data for this research was collected through surveys of eligible participants who were drawn through random sampling from a list of all registered nurses employed in the 2015 Nurse Deployment Project in Lanao del Sur (Dakis, 2013).

Instrument

The research instrument is a four-part questionnaire that was adapted based on job satisfaction research and a literature review of job satisfaction and nurse retention. To measure the nurses’ perceptions of satisfaction in their work, the researcher utilized the Measure of Job Satisfaction (MJS) developed by Traynor and Wade (1993). This instrument has demonstrated evidence of adequate validity and reliability (Healy & McKay, 1999). Additionally, to assess the validity of the research instrument, a panel of experts was requested to evaluate the content validity of the research instrument.

Data Collection

The 139 eligible participants were contacted personally or by phone and email with the focus of having a variation among the types of facilities and with consideration to urban-rural differences. The questionnaires were used in their original form but included demographic factors such as age, sex, civil status, education level, current professional certifications, length of clinical experience before NDP employment, hours of duty, and length of service in the NDP, area of assignment, and monthly. The survey instrument included a cover letter and a consent form describing the purpose, risks, and benefits of participating in the study. The respondents were also guaranteed that anonymity was going to be maintained by assuring that the researcher and the statistician were the only two persons viewing the data collected.

Data Analysis

Descriptive statistics and reliability estimates were computed for all study variables. Spearman Rho Correlation was conducted to examine the hypotheses using the Statistical Package for Social Sciences (SPSS) version 16.0. The use of Software SPSS is the most widely used program for quantitative data analysis in the social sciences. For in-depth statistical treatment of the data, the following methods were used:

Frequency and Percentage Distribution were used to determine the response distribution of the profile of the respondents in terms of age, sex, civil status, education level, current professional certifications, length of clinical experience before NDP employment, hours of duty, length of service in the NDP, area of assignment, and monthly income.

The formula for frequency and percentage distribution is as follows:

Where:

Mean was used to describe the respondents’ job satisfaction. The mean (or average) of a set of data values is the sum of all the data values divided by the number of data values. That is:

Ranking was used to determine the respondents’ job satisfaction based on the statements given by them. After which, the respondents’ responses were counted in frequencies and percentages and ranked from the highest count to the lowest.

Spearman Rho Correlation was used to find a possible correlation and significant relationship between the personal characteristics of the respondents and the respondents’ satisfaction, as a basis to reject or retain the alternative hypothesis. Spearman Rho Correlation was used due to the level of measurement used in the variables’ scale, which is ordinal.

The Spearman Rho Correlation’s formula is as follows:

Where: n = the number of paired ranks

d = the difference between the paired ranks

The level of significance is set at .05, which entails a .95 or 95% level of confidence that there is a significant relationship between the correlated variables. A negative (-) correlation points to an inverse relationship direction between the independent and dependent variables.

Based on the ordinal responses of the respondents, as the respondents’ response direction for the independent variable goes down, there is a tendency that the respondents’ response direction for the dependent variable goes up. A positive (+) correlation points to a parallel relationship direction between the independent and dependent variables.

Ethical Consideration

All procedures conducted in this study were in accordance with the ethical standards of the author's institution. To ensure that this research study was conducted in full compliance with research ethical norms, an application for full ethical approval was made to the Research Ethics Committee of Mindanao State University, which was subsequently approved on May 13, 2019 with record number 182/2019-13.

RESULTS

The results revealed that Job satisfaction is influenced by various factors. This research is focused on the seven (7) domains of Job Satisfaction postulated by Traynor and Wade (2013) as measures of job satisfaction among the nurses employed in the Nurse Deployment Project (NDP). These domains include Personal Satisfaction, Workload Satisfaction, Professional Support Satisfaction, Training Satisfaction, Pay Satisfaction, Prospects Satisfaction, and Satisfaction in the Standards of Care.

Table 1: Mean and Descriptive Rating, Summary of the Respondents’ Overall Job Satisfaction

Scaling: 1-1.8 = Very Satisfied 2.61-3.40 = Neither Satisfied or Disatisfied 1.81-2.60 = Satisfied 3.41-4.20 = Dissatisfied

4.21-5.0 = Very Dissatisfied

Table 1 revealed that sample respondents were "satisfied" in terms of standards of care, workload, professional support, and personal satisfaction, with a mean of 2.05, 2.25, 2.30, and 2.38 respectively.

On the other hand, the respondents were "dissatisfied" with their pay or salary with a mean of 3.56 and they were "neither satisfied nor dissatisfied" in terms of prospects and training with a mean of 2.65 and 2.75. Collectively, findings revealed an overall "satisfied" job satisfaction among NDP nurses.

In the context of personal job satisfaction, results show a "satisfied" (Weighted Mean: 2.38) personal job satisfaction. It means that NDP nurses are personally satisfied by a feeling of worthwhile accomplishments, personal growth and development, a varied and interesting role in the job, independent exercise of thought and action, the extent of use of skills, and having a challenging job. Similarly, NDP nurses are "satisfied" (weighted mean: 2.25) in the context of workload. Workload may mean available time to get through work, time spent on administration, staffing levels, hours of work, accomplishment at home after work, or the availability of time spent on patient or client care.

Interestingly, in terms of standards of care, respondents were generally "satisfied" (weighted mean: 2.05). They expressed that they were "satisfied" with the standards of care, quality of work, and the way care is given to patients or clients. This could mean a reliable competence and reflection of NDP nurses’ commitment, responsibility, and performance towards promoting a standardized nursing profession. The data also revealed that NDP nurses were "satisfied" (weighted mean: 2.305) with their job in terms of professional support. Sample respondents of NDP nurses expressed that they were satisfied with the professional support for their job because they felt being part of the team, having opportunities to discuss their own concerns, having enough support and guidance, fair treatment of their boss, having available support for their job, contact with colleagues, and quality of supervision at work. However, findings show that they were "neither satisfied nor dissatisfied" (weighted mean: 2.75) in the context of training as an indicator of job satisfaction. Though there could be missed opportunities to advance careers, the majority of the respondents were sceptical about the support for training, like the availability of funds and the opportunity to attend courses. This could be due to the contractual basis of employment among NDP nurses, where contract expiry (24 months) was projected as a turnover, which could be costly for both the health organisation and the patient outcome [4]. This seems to be consistent with the results in the context of Prospect as an indicator of job satisfaction, which shows "neither satisfied nor dissatisfied" (weighted mean: 2.65). Career choice and current job satisfaction among newly licenced or neophyte nurses may seem to be gloomy, primarily those employed on a contractual basis, with a few notable exceptions, like those who have secured work with regular pay or salary in a work setting.

Among all the indicators, the results revealed that the respondents were generally "dissatisfied" in terms of pay or salary (weighted mean: 3.56). The result is not surprising considering that the amount of pay most of the respondents were receiving was less than 20,000 pesos, which is far lower compared to Salary Grade 15 (P24,887.00) that they were supposed to be receiving as mandated by Republic Act No. 9173 otherwise known as the Nursing Act of 2002. Based on the Two-Factor Theory by Herzberg, pay or salary is an extrinsic source of motivation and satisfaction for employees (Stamm, 2005). Therefore, if the mindset of nurses is conditioned to the expectancy of Salary Grade 15 as entry-level but they end up receiving Grade 11 or less in the NDP, then it is quite understandable why the level of dissatisfaction among nurses in the program is high. On the other hand, since the salary levels in the NDP is dictated by governmental budgetary constraints, nurses entering the program must be informed accordingly so that the dissonance between expectation and reality is minimized.

Table 2: Frequency and Percentage, Respondents’ Job Retention

Source: Integrated Provincial Health Office (IPHO)

The job retention of NDP was measured by dividing job turnover rates by the average number of registered nurses on the units for the same period or year. People who quit their jobs, retired, moved to another unit, or were fired or let go by the Nurses Deployment Project in Lanao del Sur were counted.

Table 2 above shows the sample respondents’ (NDP nurses) job retention based on the summed number of resignations, transfers, and terminations from the year 2014 to 2015 in a quarterly scheme. Based on the data gathered from IPHO (Fitzpatrick, 2008), there was almost one fourth, 54, or 21.2%, out of 254 total number of NDP nurses in the year 2014, and 36, or 12.9% out of 278 total NDP nurses in the year 2015 job turnover. This means that there is 70% to 80 % job retention among NDP nurses in the province of Lanao del Sur. Conversely, the data revealed that there is a 20% to 30% turnover of NDP nurses in Lanao del Sur indicating that nurses are still leaving their jobs without finishing their contract of service. This high nursing turnover can be costly for both the health care organization and patient outcomes due to training, hiring, and maintaining employees.

Table 3: Relationship, Respondents Job Satisfaction and Job Retention

Finally, Table 3 shows that there is a significant relationship between the respondents’ job satisfaction and job retention in the Nurse Deployment Project. With a Spearman Rho Correlation value of 0.003 and a p-value of 0.016, which is lower than the value 0.05 alpha level of significance, job satisfaction is positively correlated with the job retention of NDP nurses. The positive correlation between these variables entails a parallel relationship, which could also be interpreted to mean that as the respondents’ satisfaction in their job increases, job retention also increases, and vice-versa. Job satisfaction is a sum of various factors, whether material or psychological, that make the job enjoyable and rewarding to the worker.

DISCUSSION

As outlined in the findings, if nurses are generally satisfied with various measures of satisfaction while working in the NDP, the chances are they will renew their contracts in the NDP after expiry. Accordingly, around 70-80% of nurses in the NDP continue working in the program.

According to Rosales, Leodoro & Rosales (2013), being personally satisfied in a workplace is parallel to quality health. Previous literature postulated the significant relationship between workload and job satisfaction, in which nurses with an adequate workload are more satisfied and deliver efficient and effective quality output (Adams & Bond, 2000).

Personal job satisfaction represents a person’s evaluation of his/her job and work context. As exemplified by Franek (2010), it’s an individual’s pleasurable emotional state resulting from an affective reaction to one’s job, an appraisal of one’s job, and an attitude towards one job. This agrees with Locke (1976) as he argued that job satisfaction has dispositional characteristics, which are personal features of an individual. These personal features of job satisfaction are strongly linked to job retention in various work settings. Countries like Australia and America have been focusing on workload in healthcare settings, particularly among nurses as front-liners, because it directly affects performance in providing care (Duffield & LeBlanc, 2009).

The results show that the respondents were neutral regarding their prospects and training. This implies that much can still be done on the part of employers to make training relevant to our nurses, as this is an integral part of evolving professional proficiency. According to the American Nurses Association and National Staff Development Organization, any healthcare profession, particularly nurses, should have active participation in learning activities that assist in developing and maintaining continuous competence, professional practice, and support achievement of their goals. In any work setting, training is essential in creating and developing competitive skills to mobilize the organization and promote an effective and efficient quality outcome. Healthcare providers need crucial training to equip them with special skills necessary in the promotion of health outcomes that consequently entail continuous investment in the organization. According to Tamayo et al., (2015), replacement of trained staff nurses negatively affects quality of care.

On the other hand, there is satisfaction in terms of standards of care, workload, professional support, and personal satisfaction, but "neither satisfied nor dissatisfied" in terms of prospects and training and dissatisfied with their pay. Career options and current job satisfaction among newly licenced or neophyte nurses may appear bleak, especially for those employed on a contract basis, but there are a few notable exceptions, such as those who have secured work with regular pay or salary in a work setting. According to an AMN Healthcare, Inc., survey of registered nurses in California, RNs are generally satisfied with their career choice but less so with their current job.

In terms of salary, research has shown that salary satisfaction can be a factor in overall job satisfaction, which can contribute to a healthy work environment. According to Trosvik et al., (2012), healthy work environments enhance nurse satisfaction, commitment to the organization, and improve the quality of care. So, nursing leaders need new information about the connections between the components of a healthy work environment, nurse satisfaction, and nurse retention. This will help them design a nursing workplace that helps patients get the best care possible.

Collectively, the findings reveal that the respondents are generally satisfied with their job. However, this does not necessarily mean having high satisfaction with their job, but rather the mean score can be said to be just average. In other words, much can still be done to improve the job satisfaction of the respondents, with the overall goal of increasing their length of service, improving retention rates, as well as maximizing their potential while also contributing to their self-development.

The study's findings clearly demonstrate how job satisfaction can increase nurses' job retention. Therefore, job satisfaction as a factor contributes to the overall retention of nurses in the NDP. With the ongoing health care reforms in the Philippines, there is an urgent need for policy makers to consider factors related to job satisfaction to improve nursing personnel's employment status and retention in the workforce

CONCLUSION

This study investigated job satisfaction as a determinant of job retention among registered nurses working in the Nurse Deployment Program (NDP) in Lanao del Sur. The findings show that the job satisfaction of nurses in the NDP influences their decision to stay and continue working in the NDP. Retention efforts should have a major emphasis on the work environment. The findings of the study support the notion of a link between the need for positive workplace management initiatives. Furthermore, the findings of this study help nurse leaders better understand how a healthy work environment can improve nurses' job satisfaction and overall retention in complex health-care systems.

This study would seem to support the general tendency of people to stay at work longer if a combination of work environment and personal satisfaction factors rate high in their satisfaction range. The result of the study also implies that a healthy working environment is not indispensable to job satisfaction.

A satisfied nurse is a happy nurse. This state of well-being can translate into better care of patients and more enthusiasm in the performance of duties. Good performance in the workplace would naturally lead management to want such nurses to stay on the job. Hence, the positive correlation between job satisfaction and job retention.

Conflict of Interests

The authors have no financial, intellectual passion, political, religious, and institutional affiliations that might lead to a conflict of interest in making this paper.

ACKNOWLEDGEMENT

The authors express genuine and heartfelt gratitude to all participants for their time and cooperation in participating in this study.

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