Job satisfaction among nurses working in the private and public sectors: a qualitative study in tertiary care hospitals in Pakistan

Abstract

Background

Many low and middle income countries lack the human resources needed to deliver essential health interventions. A health care system with a limited number of nurses cannot function effectively. Although the recommended nurse to doctor ratio is 4:1, the ratio in Pakistan is reversed, with 2.7 doctors to one nurse.

Methods

A qualitative study using narrative analysis was undertaken in public and private tertiary care hospitals in Pakistan to examine and compare job satisfaction among nurses and understand the factors affecting their work climate. Interactive interviews were conducted with nurses working with inpatients and outpatients.

Results

All of the respondents had joined the profession by choice and were supported by their families in their decision to pursue their career, but now indicated that they were dissatisfied with their jobs. Three types of narratives were identified, namely, “Working in the spirit of serving humanity”, “Working against all odds”, and “Working in a functional system and facing pressures of increased accountability”. Nurses working in a public sector hospital are represented in the first two narrative types, whereas the third represents those working in a private sector hospital. The first narrative represents nurses who were new in the profession and despite hard working conditions were performing their duties. The second narrative represents nurses working in the public sector with limited resources, and the third narrative is a representation of nurses who were working hard and stressed out despite a well functioning system.

Conclusion

The study shows that the presence of a well trained health workforce is vital, and that certain aspects of its organization are key, including numbers (available quantity), skill mix (health team balance), distribution (urban/rural), and working conditions (compensation, nonfinancial incentives, and workplace safety). This study has identified the need to reform policies for retaining the nursing workforce. Simple measures requiring better management practices could substantially improve the working environment and hence retention of nurses.

Keywords:

• job satisfaction
• nurses
• health workforce
• Pakistan

Supplementary material

Field guide for the interview

Introduce yourself and explain the objectives of the research project. Thank the interviewee for consenting to participate in the study and for giving you time. Mention that the interview would last from 45–60 minutes.

Ask for the general information and then start with the interview with the respondent.

Demographic profile

Name

Place of posting

Designation

Experience in years

Age

Education

Religion

Marital status

Number of children

Questions

1. How and why did you take up nursing as a profession?

2. How would you describe your experience of working in this hospital?

3. What do you think are the good things in your working environent? (probe for motivators at work, responsibilities and role of autonomy at work, decision-making) What are the bad things in your working environment? (probe for demotivators at work)

4. What are the benefits of working here? What are the working hours like?

5. What type of compensation do you get, if any, for working over weekends and national holidays? How do you get vacations?

6. What is the attitude of the administration towards your work and other related issues? (compensation for services, incentives both monetary and nonmonetary, professional growth opportunities, rewards for recognition of your work)

7. How do you regard the doctor-nurse interaction in this hospital?

8. What role can/do the doctors and administration play in improving the working conditions for the nurses?

9. What are the issues that need to be addressed to improve the job satisfaction of nurses? Can you make suggestions?

Acknowledgments

The authors appreciate the support extended by the hospital administrators for facilitating interviews with the respondents in this study. The authors would also like to thank all nurses who agreed to participate. This research was supported by a small grant from Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Pakistan.

Author contributions

All authors contributed substantially to the conception and design of the project. SH collected the data, supervised the data collection team and transcribed it. All authors verified the transcripts for any inconsistencies or redundancies. The decision about saturation of the data was based on consensus of all the authors. All authors contributed to analysis and interpretation of data. SH took a lead in drafting the manuscript and revising it based on the the critical feedback from all authors. All authors have read the final draft and have approved it.

Disclosure

The authors declare no competing interests in this work.