Relationship between Empowerment and Job Satisfaction among Staff Nurses in Minia University Hospital

Introduction

Nursing is a dynamic profession in which nurses are increasingly given greater responsibility and providing more complex nursing care. Nurses face many challenges in the health care system due to ongoing healthcare restructuring and policy reform ^(1). The challenges include fewer available resources, more complex patients, reduced opportunities for education and training, and increased job insecurity and job stress^(2). These difficulties yield negative effects on the health care system such as decreased nurse retention, increased nursing shortage, and increased recruitment costs for healthcare institutions ^(3-4-5). Enhancing nurses’ job satisfaction could be a solution for these adverse effects, especially for the nursing shortage ⁽³⁾.

Empowerment  can be defined as the process of sharing power with employees ,thereby enhancing their confidence in their ability to perform their jobs and their belief that they are influential contributors to the organization^{(6) .}Empowerment  is also considered to be the interrelationship between authority ,resources timely and accurate information and accountability⁽⁷⁾.

There are two complementary perspectives on empowerment at work .The First one is a macro focus on the structural conditions that enable empowerment. The second is a macro focus on the psychological experience of empowerment at work. Structural empowerment focuses on empowering structures, policies and practices. Psychological empowerment focuses on employees' perceptions and reactions to structures, policies and practices in which they are embedded ^{(8) .}

Empowerment is one of the most effective tools for increasing employee productivity and efficient use from capacities and abilities of the individual and group according to Organizational goals ^(9).The process of empowerment increases creativity and initiative of people and individuals committed to work more and increases job satisfaction ^(10).Empowerment improve organization effectiveness and increase the flexibility and dynamism organization and knowledge and skills^(11).

Job satisfaction is one of the most important factors in organizations as it is related to organizational effectiveness ^(12). Job satisfaction in nursing is associated with nurse performance, quality of patient care and increased patient satisfaction ^(13).Therefore, enhancing the job satisfaction of nurses is important in health care. Job satisfaction is a multifaceted concept associated with many factors such as working conditions, organizational support, leadership styles, leader empowering behaviors, structural empowerment and psychological empowerment^(5).

Nursing leaders must create work environments that support the bedside nurse in participatory decision-making. Creation of such work environment solidifies the relationship between empowered work environments and patient outcomes. Nursing leaders should create and sustain an environment that is trusting, improves job satisfaction, and provides a shared governance model for decision making. Nurses want work activities that are challenging, learning opportunities, acquisition of technical knowledge and skills, growth opportunities and autonomy to practice ^(14).

Significance of the study

        Through work in Minia University Hospital, it was found that staff nurses are complaining of powerlessness, lack of independence and job dissatisfaction. There are few studies about the empowerment and job satisfaction at Minia University. In Egypt, studies show that 41% of staff nurses had structural empowerment, while 53% had job satisfaction ⁽¹⁵⁾. Therefore it was felt necessary to study the relationship between empowerment and job satisfaction among staff nurses.

Aim of the study

The aim of the current study is to assess the relationship between empowerment and job satisfaction among staff nurses in Minia university hospital through:

1) Identifying the level of structural and psychological empowerment among staff nurses in Minia university hospital.

2) Determining the level of job satisfaction among staff nurses in Minia university hospital.

3) Finding out the relationship between empowerment and job satisfaction among staff nurses in Minia university hospital.

Research questions:

• What is the level of empowerment among staff nurses?
• What is the level of overall nurses’ job satisfaction?
• Is there a relation between empowerment and job satisfaction among staff nurses?

Subjects and Methods

Research design:

A descriptive correlational research design was used in conducting this study to fulfill the study aim.

Setting:

The study was conducted at Minia university hospital .All units were included in the study in Minia governorate.

Subjects:

The subjects of the study sample consisted of all available staff nurses working in the all units during the period of data collection. Their total number is 300 nurses. The inclusion criteria for this study sample include: full time staff nurses who have a minimum of 1 year’ nursing experience (new nurses may need time to be familiar with the hospital structure and its policy).

Tools of Data collection:

Three tools were used in this study for data collection

Tool І: A self – administration questionnaire sheet

It was used for collecting the data for this study. It consists of two main parts:

Part one: this part concerned with data pertaining socio-demographic characteristics of the study subjects as: age, sex, nursing qualification, educational level, current position, area of work, and years of experience.

Part two: this part consisted of The Condition of Work Effectiveness Questionnaire-II (CWEQ-II). This part aimed to identifying the level of structural empowerment among staff nurses. This tool developed by Laschinger and colleagues (2001)⁽¹⁶⁾ a modification of the original CWEQ. It consists of 19 items. These items were grouped under 6 components of structural empowerment described by Kanter (1993)⁽¹⁷⁾.

Tool ІІ: Psychological Empowerment Scale (PES)

It was used to identifying the level of psychological empowerment among staff nurses. This tool developed by Spreitzer's (1995)(18). It consists of 12 items. These items were grouped under four theoretical dimensions.

Scoring system: responses were scored under five point likert scale ranging from one to five in which 1 = Strongly Disagree, 2= Disagree, 3= To some extent, 4= Agree, and 5= strongly Agree. All dimensions (four dimensions) had a positive scoring. The overall scores of each dimension are calculated by taking the average (total scores divided by the number of items) of the respondent’s score for each dimension and multiplying this by 100 to convert it into percent score.

If the total scores were less than 50% considered as low psychological empowerment. If the total scores ranged from 50 % – 75% considered as moderate psychological empowerment, and if the total scores were 75% or more considered as high psychological empowerment .

Scoring system of total empowerment: by sum two scales (structural empowerment plus psychological empowerment). If the total scores were less than 50% considered as low empowerment. If the total scores ranged from 50 % – 75% considered as moderate empowerment, and if the total scores were 75% or more considered as high empowerment.

Tool ІІІ: Job Satisfaction scale:

It was used to determining the level of job satisfaction among staff nurses. This tool developed by McCloskey and Mueller (1990)(19). It consists of 25-items. These items were grouped into five components.

Scoring system: responses were scored under five point Likert scale ranging from one to five in which 1 = very dissatisfied, 2= dissatisfied, 3= to some extent, 4= satisfied, and 5= very satisfied. All components (five components) had a positive scoring. The overall scores of each component are calculated by taking the average (total scores divided by the number of items) of the respondent’s score for each component and multiplying this by 100 to convert it into percent score.

If the total scores were less than 50% considered as low job satisfaction. If the total scores ranged from 50 % – 75% considered as moderate job satisfaction, and if the total scores were 75% or more considered as high job satisfaction.

Tools Validity and reliability

The tools were submitted to a panel of five experts in in the field of nursing administration at Minia and Ain shams university confirmed its validity. Modifications on the tools were done according to the panel judgment in relation to appropriateness of the content and sequence accuracy of items.

Reliability of the tools (tool І, ІІ, ІІІ) were performed to confirm validity of tool and calculated statistically. The internal consistency measured to identify the extent to which the items of the tool measure the same concept and correlate with each other by Cronbach’s alpha test were .92, .92 and .95 respectively

Pilot study:

A pilot study was carried out after the development of the tools and before starting the actual data collection, on 30 staff nurses. The aim of the pilot study was to test the feasibility of the study, the sequence of items, and finally clarity and applicability of the preliminary tool. It also served to estimate the time required for filling the questionnaire sheets which was 20 minutes. They were included in the main study subjects during the actual collection of data. The process of pilot study took two weeks’(from15/6  to 30/6)  in June 2016.

Ethical consideration:

A written initial approval was obtained from the research ethical committee of the faculty of nursing, Minia University. The researcher introducing herself to the directors and discussed the aim of the study, then met the head nurse of each department, and introducing herself with discussed the aim of the study and determined the suitable time to meet the study participants and collect the data. Nurses were reassured that all information obtained was confidential and would not affect their professional evaluation.

Data collection procedure:

The official approvals were obtained from medical and nursing administration of Minia university hospital. Prior to collection of data,  a formal letter issued from the dean of post graduate studies and research at faculty of Nursing, Minia university, and the approval of ethical committee. Submitted to medical and nursing administrations and the heads of the units for obtaining their permission and help to conduct the study. The letters also listed the data needed for the study. Moreover, a written consent was obtained from each participant. Before the nurses participate in this study, the nature, the aim, methods, and anticipated benefits of the study was explained. The researcher informed the participation is voluntary and they have rights to withdrawal at any time without giving any reasons.

Before distribution the questionnaire, the research met the participants according to the time which determined by head of each department, introducing herself and explained the purpose of the study and the components of the tools to the participants in the study setting. Then, the researcher distributed the data collection sheets to respondents individually in their workplace. The filling time for the questionnaire sheet took about 20 minutes. The researchers checked the completeness of each filled form after the participant filled it. Data collection was done during the morning, afternoon, and night shifts two days / week, June, to November 2016.

Statistical design:

Statistical analysis was done by using Statistical Package for the Social Science (SPSS 20.0). Quality control was done at the stages of coding and data entry. Data were presented by using descriptive statistics in the form of frequencies and percentage for qualitative variables, and mean & standard deviation (SD) for quantitative variable. Correlation coefficient test was also used between empowerment and job satisfaction and statistical significance was considered at p < 0.05.

Results

Table 1:  Personal Characteristics of staff nurses in the study sample (n= 300).

Table 1 shows that, the largest proportion of staff nurses were in the age group 18- < 32 years (58%). The mean of subject’s age was 32.6 ± 9.6 years. Concerning years of experience in current work and current department, more than half of staff nurses (53.0% % 51.0% respectively) had experience less than 11 years.

Table 2: Mean score for the sources of  structural empowerment in the study sample(n = 300)

Table 2 summarized that informal power was the highest empowerment source with mean score 11.5 ± 3.1 while formal power was rated as the last empowering source with mean score 4.5 ± 2.3.

Table 3: Mean scores for the sources of psychological empowerment in the study sample(n= 300)

Table 3  mentioned that, competence power was the highest psychological empowerment source with mean score 10.7 ± 2.3 while impact power was rated as the last psychological empowering source with mean score 5.4 ± 3.2.

Table 4: Mean scores for the level of job satisfaction in the study sample(n = 300)

                Table 4 noticed that, Scheduling and family/ work balance was the highest job satisfaction source with mean score 22.0 ± 6.2 while Professional opportunities was rated as the last job satisfaction source with mean score 2.6 ± 1.2.

Table 5: Relation between empowerment and job satisfaction among study group in the study sample (n = 300).

*highly statistical significance

Table 5 showed that, 96.6% of studied group have low empowerment have low job satisfaction, 63.5% who have moderate empowerment have moderate job satisfaction whereas 13.6% who have high empowerment have high job satisfaction with a highly statistical significance difference between level of empowerment and job satisfaction in which p- value ≤ .000.

Fig. (1): level of structural empowerment among studied nurses

Figure 1 showed the level of structural empowerment among studied nurses. Near to two third of studied nurses (62.7%) have low structural empowerment level. While near to one third of them have moderate structural empowerment (31.7%), and only 5.6% of them have high structural empowerment level.

Fig. (2): level of Psychological empowerment among studied nurses

Figure 2 illustrated level of Psychological empowerment among studied nurses. Near to half of studied nurses (49.7%) had low psychological empowerment level. While more than two third of them have moderate psychological empowerment (36.7%), and only 13.6% of them had high psychological empowerment level.

Fig. (3): level of job satisfaction among studied nurses

                Figure (3) illustrated the level of job satisfaction among studied nurses. It noticed that more than two third of staff nurses have low job satisfaction (68.3%). While, more than one quarter (29.7%) have moderate job satisfaction and only 2% have high job satisfaction.