Job Satisfaction and Commitment among Registered Nurses Employed in Selected Private Hospitals in Malaysia

Lee Ming Ming1, Aini Ahmad2, Annamma Kunjukunju2*, Nurul Fariza2, Salida Johari2, Puziah Yusof2

1KPJ Sri Manjung Specialist Hospital, Lot 14777 & 14778, Jalan Lumut, 32000 Sitiawan, Perak, Malaysia

2KPJ Healthcare University Lot PT 17010, Persiaran Seriemas Utama, Kota Seriemas, 71800 Nilai, Negeri Sembilan, Malaysia

*Corresponding Author’s Email: ann@kpjuc.edu.my

ABSTRACT

Background: Job satisfaction and professional commitment are job-related attitudes that have garnered widespread attention from researchers worldwide. Such interest stems from the finding that committed and satisfied employees are typically high performers who contribute substantially to organizational productivity. This study assessed the relationship between job satisfaction and professional commitment among registered nurses in selected private hospitals in Perak, Malaysia. Methods: A quantitative cross-sectional descriptive design and a convenient sampling method were used for data collection. The questionnaire employed in the study comprised three components. An anonymous self-administered questionnaire consisting of multiple-choice questions and the Likert Scale was distributed to 150 eligible registered nurses working in several private hospitals in Perak. Descriptive statistics were then used to analyze the data collected. An independent t-test or one-way ANOVA was used to investigate the relationship between demographic factors, job satisfaction, and commitment. Results: The findings show registered nurses had moderate job satisfaction. The implementation of the corporate policy had thehighest satisfaction recorded (4/5). The other 19 items recorded a score of 3.01-3.83 on a 5-point Likert scale, signifying that job satisfaction was moderate among nurses. Contrarily, job commitment had a higher rating, with 4/6 items rated >4/5. There was no statistically significant correlation between demographic factors and job satisfaction. Nevertheless, the Pearson correlation indicated a weak yet significant connection between job commitment and job satisfaction (r=0.361) among nurses, reaching significance at the 0.001 level. Conclusion: The findings of this study suggest registered nurses exhibited moderate job satisfaction and commitment towards their work and the organization. Increasing career advancement and promotion and using innovative approaches in nursing care are the main factors in improving nurses' job satisfaction. Organizations must provide more career opportunities and involve nurses in evidence-based nursing practice to improve job satisfaction.

Keywords: Job Commitment; Job Satisfaction; Nurse Retention; Nurses Turnover; Registered Nurse

INTRODUCTION

Amidst the current turbulent healthcare environment, organizations have become acutely aware of nurses' pivotal role in determining healthcare systems’ efficiency, effectiveness, and sustainability (Kieft et al., 2014). Employee satisfaction is the key to determining the success of any organization, given its direct effects on individual and organizational performance (Ćulibrk et al., 2018). Nurses are central healthcare team members, so job satisfaction is crucial in delivering high-quality services (Chung et al., 2020). Job satisfaction relates to a person’s expectations of their job and whether the job fulfills these expectations (Polat & Iskender, 2018). It is the degree to which a person enjoys their work and their overall attitude towards their job, whether favorable or unfavorable. Higher levels of job satisfaction among nurses have been positively correlated to better patient outcomes and care quality in the healthcare setting (Karaca & Durna, 2019). There is a significant correlation between the respondents’ job satisfaction and job retention (Ali & Bangcola, 2022). Job stress is the emotional evaluation of the gap between work demands and one's capabilities, with the potential for positive effects like increased motivation and alertness among the nurses (Manurung & Zuriati, 2020). Maintaining optimal levels of job satisfaction among nurses is, therefore, quintessential. Other factors are associated with job performance and outcomes: workplace environment and leadership, positive attitude and efficacy, contentment and dedication, and other psychological and social aspects (Kundi et al., 2021). Identifying and addressing gaps in leadership knowledge is crucial as a future goal to have a positive impact on nurse job satisfaction and subsequently improve healthcare quality indicators (Ariani et al., 2022). Organizational commitment, or a worker's loyalty to the company, is another critical determinant of performance (Aminuddin, Basari, & Shamsudin, 2020).

According to several studies (Bit-Lian,Woei-Ling & Shuhaimi, 2022; Ćulibrk et al., 2018; Kieft et al., 2014), job discontent leads to negative impacts such as the intention to leave the job. The correlation between professional commitment and job satisfaction also underscores the need for strategic actions by organizations to boost employees' commitment and job satisfaction, which, in turn, raises the standard of healthcare services provided (Rodríguez- Fernández, Herrera & de las Heras-Rosas, 2021). Job burnout can be identified as the cause of job discontent, which translates into job desertion and frequent job switching (Bit-Lian, Woei- Ling & Shuhaimi, 2022). Conversely, high professional devotion increases employees’ inclination to participate in activities that benefit their company (Semachew et al., 2017), similarly highlighting the impact of professional commitment (Kim et al., 2023).

Factors such as work overload, unclear job descriptions, staff problems, shift coverage, low pay, and limited promotion opportunities have been frequently linked to the increased susceptibility of nurses to experience job dissatisfaction and diminished commitment (Bit- Lian, Woei-Ling & Shuhaimi, 2022). While nurses reported overall satisfaction with their nursing practice, they expressed dissatisfaction in other aspects, such as their involvement in decision-making, recognition and reward, and limited career advancement opportunities (Bit- Lian, Woei-Ling & Shuhaimi, 2022; Singh, Chakradhar & Joshi, 2021). Ee, E (2018) reported that 62% of the study’s respondents experienced job dissatisfaction, primarily poor communication with colleagues. Organizational justice was also found to be another component of job satisfaction (Wei et al., 2023; Elkholy, Elshall, & Higazee, 2020). The study reported low organizational justice and job satisfaction among registered nurses. Considering existing nursing shortages, local private hospital administrators must prioritize the retention of domestically trained professional nurses due to the utmost value of their skills and knowledge. The potentially detrimental effects of the burgeoning nursing shortage, particularly on patient safety, necessitate using retention strategies to retain and attract employees. Maintaining a work-life balance is among the finest strategies for raising employee satisfaction and organizational commitment. A study suggested that employee training, along with employee competence, has an indirect impact on organizational commitment via its influence on job satisfaction, and it also indicates that employee job satisfaction plays a role in enhancing managerial competence, highlighting the effectiveness of employee training in helping organizations attain their objectives (Riyanto et al., 2023). To retain nurses, healthcare organizations must establish effective policy solutions. This study determined the commitment and job satisfaction levels among state-registered nurses in a private facility in Perak, Malaysia.

METHODOLOGY

Design and Sampling

This cross-sectional study was conducted across three private hospitals in Perak, specifically in Ipoh, Taiping, and Sri Manjung. The study population (n=150) included registered nurses holding valid Malaysian Nursing Board (MAB) annual practicing licenses with more than six months of work experience. Respondent recruitment was conducted using a convenient sampling method. While the initial study population was 150 nurses (n=150), based on Krejcie and Morgan's (1970) table (Bukhari, 2020), the final sample size for this study was 108 nurses.

Study Tools

A descriptive research design was used for this investigation. Section A comprised seven questions capturing socio-demographic data. Section B utilized the Minnesota Satisfaction Questionnaire, which had 20 items, to gauge the nurses’ job satisfaction levels (Tosun & Ulusoy, 2017; Abdullah & Nusari, 2019). Respondents were asked to rate their level of job satisfaction using a 5-point Likert scale, with the scale's alpha coefficients ranging between 0.87 and 0.95. Section C, on the other hand, assessed the nurses’ "loyalty to their profession" using the Professional Commitment Questionnaire (Lachman & Aranya, 1986). Six statements about various job elements were included in the test. Respondents were asked to rate their satisfaction regarding a particular aspect of work on a 5-point Likert scale. Strong internal consistency was found across the three components, as proven by Cronbach’s Alpha value of 0.718. Datawas gathered using a Google form due to the COVID-19 epidemic, and respondents were contacted via WhatsApp. The study's objectives, informed consent requirements, and respondent privacy and confidentiality criteria were delineated in the Google form. Data analysis was conducted using the SPSS Software. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were included in the analysis. The Pearson correlation method examined the association between job commitment and nurse satisfaction.

Ethical Consideration

Ethical clearance for this study was obtained from the Research Management Committee (RMC) of KPJ Healthcare University, Malaysia with reference number KPJUC/RMC/SON/EC/2021/377) on 1st October 2021.

RESULTS

The sample consisted of 147 female (98%) and three male nurses (2%) aged 31 to 40 years (60.7%), a majority of whom possess a diploma in nursing (n=150, 89.3%) and job experience between 5 to 10 years (34.7%). The results are shown in Table 1.

Table 1: Analysis of Demographic Characteristics of the Sample (n=150)

Job Satisfaction among Registered Nurses

Table 2 shows the responses to the 20 items on the job satisfaction scale, which were rated using a 5-point Likert scale (1=Very Dissatisfied, 2=Dissatisfied, 3=neither, 4=Satisfied, and 5=Very Satisfied). The mean and standard deviation (SD) assessed registered nurses' job satisfaction. A score of 4 or higher demonstrates contentment, whereas a score of 3 or lower suggests a lack of strong sentiments regarding the question. The average score across all 20 questions was higher than 3/5, as shown in Table 1, signifying a consensus regarding job satisfaction in the respondents' current settings and organizations. A mean of 3.62 (SD 0.742) indicates that registered nurses generally have high levels of job satisfaction. Most respondents (S12, 4/5) agreed that corporate policies are followed. The ‘ability to direct others’ recorded the second-highest mean score (S10, 3.85/5) for work satisfaction. The ability to work independently (S2) and "the praise I get for doing a good job" (S19) both received scores of 3.83/5, indicating that they are both important factors in nurses' overall job satisfaction.

Table 2: Job Satisfaction among Registered Nurses

Job Commitment among Registered Nurses

Table 3 displays the respondent's responses to the six items on the job commitment scale. The respondents used a five-point Likert scale (1=strongly disagree, 2=slightly disagree, 3= uncertain, 4 = slightly agree, and 5 = strongly agree) to describe their dedication to their current positions. A score of 3 or higher suggests a commitment to the current position, whereas a score of 3 or lower indicates that the respondent did not harbor strong thoughts about the question. Overall, registered nurses possess a high level of commitment (M 3.99/5, SD=0.56).

The statement "I am proud to tell others that I am part of this profession" received the highest score (C3, 4.23/5), whereas concern for the future of the nursing profession received the second-highest grade (C4, 4.2/5).

Table 3: Job Commitment among Registered Nurses

Correlation between Job Satisfaction and Job Commitment

The correlation between job commitment and job satisfaction is shown in Table 4. The link between the two variables was examined using the Pearson correlation. As seen in Table 4, there is a low positive correlation between the total nurses' (n=150) "job satisfaction and commitment" (r=0.361), which is significant at the 0.001 level.

Table 4: The Relationship between Job Commitment and Job Satisfaction

Relationship between Selected Demographic Variables and Job Satisfaction

Using one-way ANOVA, Table 5 displays the correlation between job satisfaction and several demographic factors. A p-value of 0.05 or lower is regarded as significant. According to the study's findings, there is no correlation between registered nurses' socio-demographic characteristics and job satisfaction in the sample of private hospitals in Perak, Malaysia. This is proven by the >0.05 p-value for age, education level, work experience, marital status, and job position.

Table 5: Relationship between Selected Demographic Variables and Job Satisfaction

Relationship between Selected Demographic Variables and Job Commitment

Table 5 shows the relationship between job commitment and selected demographic variables using a one-way ANOVA. A p-value of <0.05 is considered significant. The study’s findings reveal a p-value of >0.05 for age, educational level, working experience, marital status, and job position; therefore, there is no statistically significant relationship between the socio- demographic variables and the job commitment of registered nurses in selected private hospitals in Perak, Malaysia.

Table 6: Relationship between Selected Demographic Variables and Job Commitment

DISCUSSION

The primary objective of this research was to identify the levels of job satisfaction and commitment among registered nurses at a private hospital in Perak. The study also aimed to explore the relationship between job satisfaction and commitment.

The first objective was to identify the extent to which registered nurses are satisfied with their jobs. The findings highlighted a moderate to high level of job satisfaction among them, which aligns with pre-existing studies that quoted a high level of job satisfaction (Bit-Lian, Woei- Ling & Shuhaimi, 2022; Roe et al., 2013). In the present study setting, the management team ensures the implementation of relevant policies and systems and prioritizes remuneration and staff welfare. The findings act as a benchmark for policymakers and those responsible for implementation to pinpoint areas for enhancing nurse job satisfaction (Ali & Bangcola 2022). The continuous professional development of nurses is also accorded high precedence. Such factors may affect the job satisfaction level of registered nurses, reflected in their performance as nurses are critical mediators in organizational relationships. However, several studies reported contradictory findings where registered nurses expressed poor job satisfaction (Bit- Lian, Woei-Ling & Shuhaimi, 2022; Al‐Hamdan, & Bani Issa, 2022; Panhwar et al., 2019;Tosun & Ulusoy, 2017). The dissatisfaction stems from a heavy workload, inflexible working hours, role conflicts, low income, routine tasks and functional dependence, a lack of sufficient resources, and the profession's low social status (Khai-Lee, Woan-Ching, & Bit-Lian, 2020). Further causes include staff shortages, long working hours, and the lack of opportunities for promotion (Alah et al., 2021). Given the importance of staff welfare in retaining nurses, the human resources team’s support, practices, and effortsto foster a positive working environment are crucial for job satisfaction among registered nurses.

One factor that may affect the staff nurses' satisfaction is their workload. In the settings of this study, the nurse-patient ratio is 1-4:6 in the general wards, the ICU ventilated patient is 1:1, and the non-ventilated patient is1:2. The current staffing is in alignment with the Ministry of Health, Malaysia requirements (Mary Beth & Yaacob, 2017). Thus, in the study context, nurses and staff ratio is unrelated to job satisfaction and commitment. The hospitals also follow the team nursing patient care model. Nursing encourages collaborative patient care and improves patient care quality (Doud et al., 2020).

The second objective of this study was to determine the level of commitment among registered nurses in private hospitals located in Perak. The findings indicated a medium-high level of job commitment among registered nurses (M=3.99, SD=0.56). Overall, the nurses possess a moderate organizational commitment level consistent with similar studies in the past (Aminuddin, Basari & Shamsudin, 2020; Bit-Lian, Woei-Ling & Shuhaimi, 2022; Panhwar et al., 2019). The results of this study highlighted the need for private hospitals in Perak to ensure an adequate allocation of nursing staff. The primary cause behind the mounting pressure on nurses is the insufficient workforce, which leads to intensified workplace burnout among staff nurses. Thus, properly allocating nurses in private hospitals is imperative for improving service efficiency, creating a safe environment, and delivering effective patient care.

Conversely, reducing pressure in the workplace increases employee satisfaction (Momennasab, Ghanbari, & Rivaz, 2021). In private hospitals, pay scale is a significant determinant of staff commitment to their duties. Low pay scales and high work pressure increase workplace burnout, so employees seek opportunities at other hospitals or healthcare institutes for better compensation. To retain staff, private hospitals should offercompetitive pay per market norms. Additional incentives, such as night shift incentives, can enhance employee satisfaction. Offering comprehensive benefits such as insurance and perks is also crucial to meeting the needs of the nursing staff (Reiling, Hughes & Murphy, 2008).

Furthermore, a positive workplace environment and supportive policies are instrumental in satisfying the needs of employees. The study finds that staff tend to be more content when working in a positive work environment where their concerns are addressed promptly by the management hierarchy. According to Porter-O’Grady (2020), allowing and prioritizing the participation of nursing staff in the policy development and decision-making process can guarantee employees’ job satisfaction. By encompassing the needs and concerns of staff, internal governance can be more holistically developed.

The following objective was to ascertain if there exists any connection between job commitment and job satisfaction for registered nurses. The current study exhibits evidence of a tenuous positive link between job commitment and job satisfaction. According to previous research (Kalliath, & Morris, 2002; Kieft et al., 2014; Kundi et al., 2021), professional dedication appeared to mitigate the effects of burnout on job satisfaction, thus rendering commitment a key factor in predicting job satisfaction among nurses.

The final aim of the study was to examine how demographic factors affected the link between commitment and job satisfaction among registered nurses. To analyze this, an independent t- test and one-way ANOVA have been employed. The results revealed that only job satisfaction concerning education exhibited a statistically meaningful link, given that the p-value was less than 0.05 (p-value 0.05). This suggests no correlation exists between education and job satisfaction among registered nurses working at a private hospital in Perak. However, other demographic factors, including gender, age, working experience, job position, and marital status, had no discernible impact or relationship with the job satisfaction of registered nurses. The study's revelation that most demographic factors exhibited no statistical correlation with work satisfaction was consistent with a prior study, which similarly found that nurses’ professional dedication and satisfaction should not be subjected to the influence of demographic factors (Ali et al., 2019).

CONCLUSION

In summary, registered nurses in the study exhibit moderate job satisfaction and commitment. A low positive correlation was found between job satisfaction and commitment, indicating that increased job satisfaction corresponds with increased job commitment. However, no significant relationship was found between age, educational level, working experience, marital status, and job position of the registered nurses. To further enhance nurses’ job satisfaction and commitment, the human resource management of the private hospitals in Perak must persist in their efforts to guarantee job stability, a good pay scale, a good workplace environment, and other aspects to meet nurses’ needs and expectations, like career advancement. Such initiatives are essential when considering the immense value of nurses’ performance in determining a hospital’s quality-of-service delivery.

Conflict of Interest

The authors declare that they have no conflict of interests.

ACKNOWLEDGEMENT

The researcher would like to thank all the registered nurses in this research project. The researcher is also extremely thankful to the author, who graciously permitted the use of the questionnaire.

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