Ebere Omeje

ONYEYILI, ADAORA NGOZI

PG/MSC/07/47001

ANALYSIS OF JOB SATISFACTION OF PROFESSIONAL NURSES IN PUBLIC AND PRIVATE SECTORS IN

ANAMBRA STATE, NIGERIA

FACULTY OF HEALTH SCIENCES

DEPARTMENT OF NURSING SCIENCES

Ebere Omeje Digitally Signed by

DN : CN = Webmaster’s name

O= University of Nigeri

OU = Innovation Centre

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ONYEYILI, ADAORA NGOZI

PG/MSC/07/47001

ANALYSIS OF JOB SATISFACTION OF PROFESSIONAL NURSES IN PUBLIC AND PRIVATE SECTORS IN

ANAMBRA STATE, NIGERIA

FACULTY OF HEALTH SCIENCES

DEPARTMENT OF NURSING SCIENCES

Digitally Signed by: Content manager’s Name

Webmaster’s name

O= University of Nigeria, Nsukka

OU = Innovation Centre

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ANALYSIS OF JOB SATISFACTION OF PROFESSIONAL

NURSES IN PUBLIC AND PRIVATE SECTORS

IN ANAMBRA STATE, NIGERIA

ONYEYILI, ADAORA NGOZI

PG/MSC/07/47001

DEPARTMENT OF NURSING SCIENCES

FACULTY OF HEALTH SCIENCES

UNIVERSITY OF NIGERIA, ENUGU CAMPUS

JULY, 2014

TITLE PAGE

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ANALYSIS OF JOB SATISFACTION OF PROFESSIONAL

NURSES IN PUBLIC AND PRIVATE SECTORS

IN ANAMBRA STATE, NIGERIA

ONYEYILI, ADAORA NGOZI

PG/MSC/07/47001

A DISSERTATION SUBMITTED TO THE DEPARTMENT OF

NURSING SCIENCES, FACULTY OF HEALTH SCIENCES,

UNIVERSITY OF NIGERIA, ENUGU CAMPUS

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE

AWARD OF MASTER OF SCIENCE (M.Sc.) IN NURSING SCIENCES

SUPERVISOR:

DR. (MRS.) I. L. OKORONKWO

JULY, 2014

APPROVAL PAGE

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This project has been approved by the Department of Nursing Sciences.

_________________________ ______________________

Dr. (Mrs) I. L. Okoronkwo Dr. (Mrs) Uche Okolie Supervisor Head of Department

Prof. Pauline O. Ezenduka External Examiner

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CERTIFICATION

Onyeyili, Adaora Ngozi, a postgraduate student in the department of

Nursing Sciences has satisfactorily completed the requirement for the award

of Master of Science (M.Sc.) in Nursing. The work embodied in this project

report is original and has not been submitted in part or full for any other

degree of this or any other University.

_______________________ ______________________

Onyeyili, Adaora Ngozi Dr. (Mrs) I. L. Okoronkwo Student Supervisor

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DEDICATION

To God Almighty, the giver of wisdom, knowledge and understanding.

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ACKNOWLEDGEMENTS

With great joy and gratitude I thank God Almighty for keeping me alive and

seeing me through these years till the completion of my study. To you my

God be all the glory.

Many people too numerous to mention here contributed immensely towards

the success of this programme. Suffice me to first and foremost

acknowledge and convey my inexhaustible gratitude to my erudite

supervisor Dr. (Mrs) Ijeoma Okoronkwo whom I look up to as my mentor

for her constructive critiques at different stages of the writing. Her motherly

motivation, encouragement and unhindered accessibility anytime and

anywhere made smooth the road for successful completion of this research.

Indeed, Doctor ... ma, you are an epitome of academic excellence.

My special thanks go to my amiable, hardworking and indefatigable Head of

Department, Dr. (Mrs) Uche Okolie who was delivered to us from Heaven to

see that our programme in the Department was accelerated for speedy

completion. To all my wonderful lecturers in the Department of Nursing

Sciences, especially core lecturers in my area of specialization; Nursing

Administration and Management – Dr. Nwaneri, Dr. Okoronkwo, Dr.

Chinwuba, Prof. Okafor and Dr. Ehiemere, I say God’s continuous

protection and divine upliftment. Without all of you, this programme would

not have been a success. To the readers in my post-field proposal, Dr.

Chinwuba and Dr. Okolie who made very useful corrections and

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contributions that made the work to come out better, I say may God continue

to bless you all.

My heartfelt gratitude goes to my dearly beloved cousin Dr. Shed Chinwuba

Moguluwa who has been my pillar throughout the period of this programme.

He committed time, money, advice and provided the needed comfort and

supports that reduced the stress and burden of my academic workload. To

my precious children, Nelly, Iyke, Og and Enkay and my husband, Prof. Sir

Pat. Onyeyili who demonstrated great love, endurance and magnificent

support to see that this programme was a success; I say a big thank you. I

love you all. To my mum, brothers, and sisters I remain appreciative. My

appreciation goes to my great in-laws for their love and support.

To my precious friends, classmates, professional colleagues, and

administrative staff of Nursing Sciences Department, University of Nigeria

Enugu Campus who shared knowledge with me, prayed fervently for my

success and guided me in one way or the other, I say a very big thank you.

To my industrious, hardworking and dedicated typist/computer operator

Mrs. Ngozi Edeh who worked round the clock, I say only God can reward

and pay you for the sacrifices.

Finally in memory of my father Chief Godson Iloanusi (Ukwa I) whose

tutelage and initial training prepared the ground for whatever I am today, I

say continue to rest in the bossom of the Lord until the resurrection day. I

personally accept responsibility for any lapses in this work.

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TABLE OF CONTENTS

Page

Title Page …. …. …. i

Approval Page …. …. …. ii

Certification …. …. …. iii

Dedication …. …. …. iv

Acknowledgements …. …. …. v

Table of Contents …. …. …. vii

List of Tables …. …. …. xi

Abstract …. …. …. xii

CHAPTER ONE: INTRODUCTION

Background to the Study …. …. …. 1

Statement of the Problem …. …. …. 4

Purpose of the Study …. …. …. 6

Research Questions …. …. …. 6

Research Hypotheses …. …. …. 7

Significance of the Study …. …. …. 7

Scope of the Study …. …. …. 8

Operational Definition of Terms …. …. …. 8

CHAPTER TWO: LITERATURE REVIEW

Introduction …. …. …. 10

Overview of Nigeria’s Health System …. …. …. 10

Component Issues in the Nigeria Health System …. …. 13

Conceptual Issues on Job Satisfaction and Motivation …. 21

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Theoretical Review on Job Satisfaction …. …. 29

Maslow’s Hierarchy of Needs Theory …. …. 29

Frederick Herzberg’s two Factor Theory …. …. 31

Edwin Locke’s Range of Affect Theory …. …. 32

Timothy Judge’s core Self-Evaluation Model …. …. 32

Conceptual Framework on Nurses’ Job Satisfaction …. 33

Empirical Studies on Professional Nurses’ Job Satisfaction …. 35

Summary of the Literature Review …. 41

CHAPTER THREE: RESEARCH METHOD

Research Design …. …. …. 43

Area of Study …. …. …. 43

Population of the Study …. …. …. 44

Sampling Procedure …. …. …. 45

Instrument for Data Collection …. …. …. 45

Validity of Instruments …. …. …. 46

Reliability of Instruments …. …. …. 46

Ethical Consideration …. …. …. 46

Procedure for Data Collection …. …. …. 47

Method of Data Analysis …. …. …. 47

CHAPTER FOUR: DATA PRESENTATION AND ANALYSIS

Presentation of Results …. …. …. 48

Research Question One …. …. …. 49

Research Question Two …. …. …. 50

Research Question Three …. …. …. 51

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Research Question Four …. …. …. 52

Hypotheses Testing …. …. …. 53

Hypothesis One …. …. …. 53

Hypothesis Two …. …. …. 53

Hypothesis Three …. …. …. 54

Hypothesis Four …. …. …. 55

CHAPTER FIVE: DISCUSSION OF FINDINGS, CONCLUSIONS

AND RECOMMENDATIONS

Discussion of Findings …. …. …. 56

Nurses’ Satisfaction from Job Security …. …. 56

Nurses’ Satisfaction from Recognition …. …. 57

Nurses’ Satisfaction from Opportunity for Advancement …. 57

Nurses’ Satisfaction from Job Control/Responsibilities …. 58

Difference in satisfaction from job security between nurses

in Public and Private Hospitals …. …. …. 58

Difference in satisfaction from recognition between nurses

in Public and Private Hospitals …. …. …. 58

Opportunity for Advancement and Job Satisfaction …. 58

Effect of Job Control on Job Satisfaction …. …. 59

Conclusion …. …. 59

Implications of the Study …. …. 60

Limitations of the Study …. …. 60

Recommendations …. …. 61

Contribution to knowledge …. …. 62

Suggestion for further studies …. …. 62

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References …. …. 64

Appendices …. …. 73

Appendix A …. …. 74

Appendix B …. …. 75

Appendix C …. …. 79

Ethical Approval Letter …. …. 84

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List of Tables

Table 1: Study Sample …. 47

Table 2: Sex and Age Distribution …. 51

Table 3: Mean Analysis of Satisfaction Derived from Job Security 51

Table 4: Mean Analysis of Satisfaction Derived from Job Security 52

Table 5: Mean Analysis of Satisfaction Derived from

Opportunity for Advancement 53

Table 6: Mean Analysis of Satisfaction Derived from Job Control 54

Table 7: t-test Analysis of Nurses’ Response on Satisfaction

with Job Security 55

Table 8: t-test Analysis of Nurses’ Response on Satisfaction

with Recognition 56

Table 9: t-test Analysis of Nurses’ Response on Satisfaction with

Opportunity for Advancement 56

Table 10: t-test Analysis of Nurses’ Response on Satisfaction

Job Control 57

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ABSTRACT This study investigated the job satisfaction of professional nurses in public and private health sectors in Anambra State. A survey design was employed and a study population of 5903 comprising all professional nurses in private and public hospitals was used. Proportionate stratified random sampling technique was used in selecting a sample of 375 nurses for the study. Instrument for data collection was a structured questionnaire. Data collected were analyzed using mean and standard deviation statistical tool to answer the four research questions and t-test statistical tool was used to test the four hypotheses. Findings showed that nurses in public hospitals were satisfied from job security unlike nurses in private hospitals. Nurses in public and private hospitals were satisfied from job control/ responsibilities. Also, it was found that opportunity for advancement guarantees job satisfaction to nurses in public and private hospitals. Based on the findings, it was recommended that hospital management should create a work environment that is free from dissatisfiers in order that nurses would carry out their duties effectively towards the actualization of organization’s goal. Few relevant areas that the present study did not cover were suggested for further investigation.

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CHAPTER ONE

INTRODUCTION

Background to the Study

Output in terms of performance in any given organization is a function of

many variables which job satisfaction is one of them. Job satisfaction which

is equally understood and sometimes referred to as “work satisfaction” has

been variously defined in the literature. Job satisfaction is the extent to

which an employee expresses a positive orientation towards a job. It also

describes how content an individual is with his or her job. Job satisfaction

has also been defined as a pleasurable emotional state resulting from the

appraisal of one’s job, an affective reaction to one’s job and an attitude

towards one’s job (Chimanikire, Mutandwa, Gadzirayi, Muzondo, &

Mutandwa, 2007; Thompson & Phua, 2012). Job satisfaction is a worker’s

sense of achievement and success on the job. It is generally perceived to be

directly linked to productivity as well as to personal well-being. Job

satisfaction implies doing a job one enjoys, doing it well and being rewarded

for one’s efforts. Job satisfaction further implies enthusiasm and happiness

with one’s work. Job satisfaction is the key ingredient that leads to

recognition, income, promotion, and the achievement of other goals that lead

to a feeling of fulfilment (Kaliski, 2007).

Job satisfaction has continued to be a major area of interest in the study of

industrial and organizational psychology because of the presumed and

common-sense linkages between satisfaction and other mainstream concepts

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like leadership, performance, reward system and group process (Poole &

Warner, 2000). Furthermore, job satisfaction has been an interesting

construct for researchers in understanding employee behaviours and

attitudes (Zurn, Dolea & Stillwell, 2005). Despite the number of studies that

dealt on different aspects of job satisfaction, Boles, Wood and Johnson

(2008), stated that more studies are needed on job satisfaction because of

several reasons. According to them satisfaction with the job is directly

related to organizational commitment, behaviours and actions. To this end

therefore job satisfaction among professional nurses should be of great

importance and concern to any health organization, sector or nation given

the pivotal role that nurses play in determining the efficiency, effectiveness

and sustainability of health care delivery system. It is therefore imperative to

understand what motivates nurses and the extent to which the organization

and other contextual variables, add up to achieve satisfactory performance

output in the overall health care delivery system. This is necessary going by

the fact that job satisfaction is an essential part of ensuring high quality care

and performance output (Lambert, Hogan & Barton, 2001; Mount, Ilies &

Johnson, 2006). Job satisfaction does not necessarily concern the

professional nurses only, but cuts across the entire system – patients and

patients’ relations, hospital management as well as health sector, health

organizations, and indeed the entire nation. The inaction or inability of any

organization to achieve a reasonable level of job satisfaction among her

workforce will lead to dissatisfaction.

Job dissatisfaction generally, has been frequently cited as the primary reason

for low/poor quality output, non-commitment, low productivity and high rate

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of staff turnover among others. Dissatisfied nurses not only give poor

quality, less efficient care, there is also evidence of a positive correlation

between professional nurse satisfaction and patient satisfaction and

outcomes (Tzeng, 2002; Tsang, 2002, Takase, Maude & Manias, 2005).

Nurses who were not satisfied at work were also found to distance

themselves from their patients and their nursing chores, resulting in sub-

optimal quality of care (Demorouti, Bekker, Nachreiner & Schaufeli, 2002).

The growing importance attached to studying job satisfaction especially

among the professional nurses in recent times is not far-fetched. For

instance, there is a growing need to strengthen health system in Nigeria to

help meet the Millennium Development Goals (MDGs). It is widely believed

that a key constraint to achieving the MDGs is the absence of a properly

trained and motivated work force of which nurses are part and parcel, and

improving the health workers working conditions is critical for health

system performance (FMOH, 2007). In addition, the HIV/AIDS epidemic is

compounding the problem by creating a stressful environment for health

workers through increased workload, exposure to infection and reduced

morale.

The organization of the health care system in Nigeria is pluralistic and

complex. It includes a wide range of providers, comprising the public health

institutions and a large and equally growing private sector, made up of

private-for-profit and private-for-non-profit providers, e.g. Non-

Governmental Organizations (NGOs), Religious, Spiritual and Traditional

Care Providers. This situation is equally the same in all the 36 States of the

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Federation including Anambra State. Anambra State health care system

consists of public sector health institutions that serve both the indigent and

the affluent in the society, and the private health providers that specifically

cater for the segment of the population that can afford their services.

Outside public health institutions, the private sector hospitals, maternity

homes and clinics provide about 80 percent health services to Nigerians

(Federal Ministry of Health, 2007). Despite these remarkable contributions

of the private sector to the overall health care need of the country, the sector

are not very well supported (Kwahar & Ukeh, 2012). Evidence from the

literature, however, shows that the sector lags behind in training and

refresher courses (Larbi, 2004). With the exemptions of few non-

governmental and mission hospitals, most private sector hospitals are

privately owned and run by the physicians (doctors) who oversee the

management of the hospitals on one man basis. Most of the job satisfaction

variables such as opportunity for advancement, recognition, job security,

working conditions, interpersonal relationship, etc. are not regulated and

policy driven in private sector as obtained in public health sector. This

situation, therefore, makes a critical evaluation of job satisfaction variables

in the sectors worthwhile considering the rate of nurses’ turnover in both

sectors.

Statement of the Problem

It is believed that the satisfied employee can provide good service while a

low level of employee job satisfaction can result to difficulties in increasing

service quality. To ensure the achievement of firm goals, organisations

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create atmosphere of commitment and cooperation for its employees through

policies that facilitate employee satisfaction. However, Kwahar and Ukeh

(2012) found that there has been a general lack of satisfaction with jobs in

Nigeria. Evidence from Ruggiero (2005) suggests that there is widespread

lack of job satisfaction among nurses. Coupled with a critical shortage of

registered nurses, this situation threatens the provision of safe healthcare.

One way of ensuring optimum satisfaction of nurses in the health sector for

maximum performance is to appraise the overall working conditions, job

security, interpersonal relationship, recognition, advancement, etc of nurses.

This requirement as suggested here is presumed on the premise that output

in terms of performance in any organization is a function of many variables

of which job satisfaction is inclusive.

Evidence from the literature shows that absence of job satisfaction leads to

increased stress and frustration which result in physical, emotional and

behavioural problems, lower productivity and abandonment of nursing

profession (Kendrick, 2000; Robertson, Birch & Cooper, 2012), high

turnover of nurses and increased rates of absenteeism (Larabee, 2003; Siu,

2002), as well as migration to other countries especially United States of

America and United Kingdom, in search of better remuneration. These,

nonetheless, are not healthy for the development of the health sector. Hence,

these unabating penchant and unhidden desires of many professional nurses

to either move from private sector to public sector, or move from both

sectors to outside the country for whatever reasons call for an in-depth

empirical study. This researcher therefore speculates that these unhidden

desires and unabating penchant for the (intra and extra) movements might be

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because of the desire for better or improved job satisfaction. However, the

unavailability of recent and empirical inter-sectoral research studies on

professional nurses’ movements in Nigeria create a serious gap in the

literature. It is against these backdrops that this study is being carried out to

analyse the job satisfaction of professional nurses in public and private

hospitals in Anambra State, Nigeria.

Purpose of the Study

The main purpose of this study was to compare the job satisfaction of

professional nurses in public and private health sectors in Anambra State.

The study is also set to achieve the following specific purposes:

1. To determine the level of satisfaction nurses derive from job security

in public and private hospitals.

2. To determine how recognition of nurses’ performances in public and

private hospitals provide job satisfaction.

3. To identify the extent to which opportunity for advancement

guarantees job satisfaction to nurses in public and private hospitals

4. To ascertain the level of satisfaction nurses derive from job

control/responsibilities in public and private hospitals.

Research Questions

Based on the objectives, the following research questions are posed:

1. What level of satisfaction do nurses derive from job security in public

and private hospitals?

2. How does recognition of nurses in public and private hospitals

provide job satisfaction?

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3. To what extent does opportunity for advancement guarantees job

satisfaction to nurses in public and private hospitals?

4. What level of satisfaction do nurses derive from job control in public

and private hospitals?

Research Hypotheses

The following Null hypotheses were formulated to guide the study.

1. There is no significant difference in satisfaction from job security

between nurses in the public and private hospitals

2. There is no significant difference in satisfaction from recognition

between nurses in public and private hospitals

3. Opportunity for advancement does not significantly guarantee job

satisfaction between nurses in public and private hospitals

4. Job control does not have significant effect on job satisfaction

between nurses in public and private hospitals

Significance of the Study

The relevance and benefits of this study cut across different strata of the

stakeholders and participants in the health sector. It provides health sector

managers some useful insights on the factors that would be addressed to

achieve professional nurses’ job satisfaction towards delivering effective and

efficient health care to the publics. Consequently, government,

organizations and non-governmental organizations that operate in the

nation’s health sector through this study know where and what to contribute

towards improving health care delivery. Again, the study’s findings would

guide the nurses in taking informed decisions that would guarantee their job

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satisfaction and fulfillment. Finally, the study would guide health managers

in handling health related issues as they concerned the nurses and industrial

crisis within the health sector. The society also will benefit from the study

because, when nurses are satisfied with their job, they will render quality

services to the society.

Scope of the Study

This study is delimited to professional nurses’ job satisfaction in both public

and private health sectors of Anambra State. As a comparative study, the

job satisfaction variables considered in this study were; job security,

opportunity for advancement, recognition and job control.

Operational Definition of Terms

Job satisfaction: This is the degree of positive affective orientation an

individual has toward a job.

Job satisfaction variables in this study refer to:

• Job security: the nature and state of contractual agreement that

guarantee steady or permanent employment, e.g. assurance of

financial assistance, benefits and welfare in case of accident and

disability arising from the job.

• Status recognition: Refer to involvement in decision making, verbal

or written award or commendation due to high performance as sources

of inspiration and motivation.

• Professional development opportunities: Refer to encouraging and

sponsoring the nurses to national, regional, and international

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conferences, seminars, workshops and training that will boost their

professional standing and status.

• Ranking of job satisfaction variables: Refer to assignment of

numbers from 1-7 to represent different values along the continuum in

the scaling of job satisfaction variables.

• Public health institutions: Publicly owned hospitals that depend on

government subventions for its operations and are not strictly out to

make profits, State teaching hospitals, medical centres, model health

centres, general hospitals, etc.

• Private health institutions: Privately owned hospitals that depend on

the owner(s) for its financing and are strictly out to make profits.

Mission hospitals, individually owned private hospitals, clinics,

maternity homes.

• Private health workers: This refers to nurses working private health

institution.

• Public health workers: This refers to nurses working in public health

institution.

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CHAPTER TWO

LITERATURE REVIEW

Introduction

This chapter generally, reviewed materials on job satisfaction as a prelude

towards gaining both conceptual and theoretical insight and knowledge that

formed the bedrock of the present study. To this end therefore, the study

presents the review of related literature under the following headings:

Overview of the Nigeria health care system, Theoretical review on job

satisfaction, Conceptual framework on nurses’ job satisfaction, Empirical

studies on professional nurses’ job satisfaction and Summary of literature

review.

Overview of Nigeria’s Health System

The Nigerian health care sector is broad and comprises of public, private for-

profit, Non-Governmental Organizations (NGOs), Community-Based

Organizations (CBOs), Faith-Based Organizations (FBOs), and traditional

health care providers. The health care sector is very heterogeneous, and

includes unregistered and registered providers ranging from traditional birth

attendants and individual medicine sellers to sophisticated hospitals. Thirty-

eight percent of all registered facilities in the Federal Ministry of Health

(FMOH) facilities database are privately owned, of which about 75% are

primary care and 25% are secondary care facilities (WHO, 2008). Private

facilities account for one-third of primary care facilities and could be a

potentially important partner in expanding coverage of key health services.

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Nigeria is a federation with three tiers of government – Federal, State, and

Local. While the federal government develops policies that are relevant

across all three levels, responsibility for health service provision in the

public sector reflects the three-tier structure. According to the Department

of Health Planning, Research and Statistics of the Federal Ministry of Health

(FMOH), (2006) there were over 20,000 registered health facilities in the

public sector across these three tiers in Nigeria in 2007. The levels of care

in the public sector according to Nigeria Health System Assessment (NHSA)

report in 2008 are as follows:

• Tertiary: Tertiary facilities form the highest level of health care in

the country and include specialist and teaching hospitals and federal

medical centers. These facilities have special expertise and full-

fledged technological capacity that enable them to serve as referral

centers for patients from the primary and secondary levels and act as

resource centers for knowledge generation and diffusion. Each state

has at least one tertiary facility. The responsibility for tertiary care

and training falls under the mandate of the federal government.

• Secondary: Secondary care facilities include general hospitals,

which provide general medical and laboratory services as well as

specialized health services such as surgery, pediatrics, obstetrics and

gynecology. General hospitals are typically staffed by medical

officers (who are physicians), nurses, midwives, laboratory and

pharmacy specialists, and Community Health Officers (CHOs). The

facilities serve as referral centers for primary health care facilities.

Each district, local government (LGA), or zone is expected to have at

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least one secondary-level facility. State governments are responsible

for this level of care.

• Primary: Facilities at this level form communities’ entry point into

the health care system. They include health centers and clinics,

dispensaries, and health posts which typically provide general

preventive, curative, promotive, and pre-referral care. Primary

facilities are typically staffed by nurses, CHOs, Community Health

Extension Workers (CHEWs), junior CHEWs, and environmental

health officers. It is the expectation and practice that LGAs finance

and manage primary health care under the supervisory oversight of the

state government.

Unlike the public health sector that is run by the three tier of government,

private health sector as the name depicts is dominated by individuals,

groups, and organizations that establish and manage health facilities as

private entrepreneurs. The private sector also plays a large role in the

provision of health care across the country. It has a wide range of providers

including physician practices, maternity homes, clinics, and hospitals.

Private for-profit health facilities have proliferated since the mid-1980s and

together with the FBO facilities, are reported to provide 80% of health

services to Nigerians (FMOH, 2007; Larbi, 2004).

This report nevertheless compares with the figures obtained in the study’s

area of coverage - Anambra State where information from Anambra State

Ministry of Health showed 38 public health institutions as against 1,304

privately owned hospitals under private health sector. The private for-profit

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facilities provide mostly curative services, while the faith-based facilities

provide a wider range of preventive and health promotion services. There

are also traditional medicine practitioners and informal medicine vendors.

While the private sector makes an appreciable contribution to health care in

Nigeria, the sector is not very well regulated and supported. For example,

private sector health care workers have fewer opportunities for training and

refresher trainings than those in the public sector. Availability of policies,

guidelines, and manuals is also weak in the private sector. Insights into the

Nigerian health system are further given by looking into the main issues

within the nation’s health system below.

Component Issues in the Nigeria Health System

Job satisfaction no doubt is dependent on some variables and issues. These

variables and issues can be aggregated from individual workers at micro

level of the society to the macro level of components in the health system.

Review of these variables which include human capital, health sector

financing, health service delivery, and health sector management provides a

brief background of the variables used in this study.

Human Capital

Nigeria has one of the largest supplies of human capital also known as

Human Resources for Health (HRH) in Africa, comparable only to Egypt

and South Africa. Figures provided by the Federal Ministry of Health of

Nigeria indicate that, there are about 39,210 doctors and 124,629 nurses

registered in the country as of 2006, which translates into 30 doctors and 100

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nurses per 100,000 people. These figures are significantly higher than the

sub-Saharan African average of 15 doctors and 72 nurses per 100,000 people

(World Development Report, 2007).

Despite the large supply of HRH, there are great disparities in health status

and access to health care among different population groups in Nigeria.

Like most countries, urban areas typically have more health workers than

rural areas. Accordingly, health indicators in rural areas are worse than in

urban areas. For example, 26% of women in rural areas deliver with a

doctor, nurse, or midwife compared with 59% of women in urban areas

(NDHS, 2003). There are also wide variations in health indicators and

access to care between the country’s six geo-political zones, with indicators

generally being worse in the north than in the south.

The government is the primary provider and financier of health training.

Nigeria has nursing training schools in all 36 states (with some states having

as many as five schools). These institutions produce approximately 3,700

nurses per year, of which an estimated 25% begin their careers in the public

sector.

Despite the number of nurses that are produced every year, information from

the Federal Ministry of Health shows that the annual turnover rate (the

number of nurses leaving the profession) for nurses and midwives is higher

than the annual production rate (World Development Report, 2007).

According to FMOH, the overall annual turnover of nurses and midwives

was 1.4 percent. The top three reasons for this high turnover are resignation

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(46%), termination (23%) and retirement (16%). Those that left the services

through resignation included the higher percentage of nurses that sought

greener pasture elsewhere. It is in view of these that job security of nurses is

included as one of the variables to be studied. However, other variables that

affect job satisfaction such as financing of health facilities are discussed.

Health Sector Financing

The structure of the Nigerian health system and mechanisms for its financing

draw their origins from the colonial medical system. During colonial times,

services were designed principally for public servants with preventive health

care, mainly in the form of hygiene and sanitation, provided to the general

population. Financing for public sector service delivery was derived largely

from the government budgets. Curative care was largely undertaken and

funded by the missionaries, who established FBO service delivery units,

many of them outside the capital and in areas that were not readily served by

public sector services. Over the years in the public sector, different tiers of

government were implicitly charged with the different health care delivery

roles described above: the Federal government for tertiary care, State

governments for secondary care, and local governments for primary care

services as depicted in figure 1 below:

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Figure 1: Government funding flows to the Health System in Nigeria

Source: Adapted from the Federal Ministry of Health (MOH) and World Bank, 2006

The findings of Nigeria’s first National Health Accounts (NHA), published

in 2006 (WHO, 2008), provided important insights into the sources of health

care financing in Nigeria. According to this report, it showed that household

out-of-pocket expenditures remain the single largest source of health care

financing in Nigeria, providing 65.9% of total health expenditures. This is

followed by the government at 26.2% (federal 12.4%, state 7.4%, and local

government 6.4%), firms at 6.1% and development partners at 1.8% (WHO

Statistical Information System, 2006).

As part of efforts to strengthen the national health system, a national health

policy has been developed and adopted by the Federal Executive Council.

The key thrusts of the policy are to expand financial options for health care

and strengthen the contribution of the private sector and pre-payment based

approaches for financing (Dare, 2008). It also seeks to engage communities

and households in community-based schemes for the financing of primary

care services. Public-private partnerships (PPPs) are also presented as

strategic approaches for the expansion of health financing options at all

operational levels.

Federation Account

Federal Government tertiary health services

parastatals and vertical programs

secondary health services

primary health services

State Government

Local Government Authorities

17

Private sector health financing comes primarily from the individuals, groups

and organizations that establish private hospitals. However, they participate

in sharing the 65.9 percent of household out-of-pocket expenditure on health

care services. Since government is the highest spender in any economy, it

means that public health sector would have more money at its disposal to

cater for the staff welfare unlike the private sector where heavy and stiff

competition determines who gets what. The extent to which management

can sponsor staff training and education is determined by available finance.

This no doubt, informed the basis upon which opportunity for advancement

was included as one of the variables to be examined. Nevertheless, the

extent and nature of service delivery at both sectors are important

considerations to nurses’ job satisfaction.

Health Service Delivery

Provision of priority health services (both general and HIV/AIDS-related) is

done through public and private facilities. It is important to note that

significant inequities are evident in service coverage by zone, rural-urban

location, and socioeconomic status across many of these indicators. For

instance the use of maternal and reproductive health services is relatively

limited. According to the 2003 NDHS, approximately 37% of women did

not receive any Antenatal Care (ANC) and there were sharp rural-urban,

regional, and wealth inequities among those who did receive this care. ANC

coverage has not shown much improvement since the 1990s. Between 1998

and 2003, only 35% of births were attended by a skilled attendant (NDHS,

2003).

18

As stated earlier, the private sector in Nigeria is very heterogeneous, and

includes unregistered and registered providers ranging from traditional birth

attendants and individual medicine sellers to sophisticated hospitals. Thirty-

eight percent of all registered facilities in the FMOH health facilities

database are privately owned, of which about 75% are primary care and 25%

are secondary care facilities (NHSA, 2008). Private facilities account for

one-third of primary care facilities and could be a potentially important

partner in expanding coverage of key health services.

Estimates suggest that a little over 50% of all registered private facilities are

for-profit (Federal Ministry of Health, 2007). In the non-profit sector, FBOs

are important service providers. To illustrate, the Christian Health

Association of Nigeria (CHAN), an umbrella organization, reports about

3,500 facilities. Although comprehensive data on the composition of the

private health sector in Nigeria are difficult to find, there is some evidence

which suggests that “for-profit” private facilities in the formal sector tend to

be small in size and have a greater presence in urban and semi-urban areas.

Based on the limited information available, no clear patterns are evident in

infrastructure or diagnostic capacity of private providers. Quality

monitoring of private health sector providers by the government is limited.

While State Ministries of Health (SMOHs) issue licenses to ensure that

facilities comply with regulations, enforcement activities are limited.

Professional associations do not actively assure quality, although Nurses and

Midwives Council of Nigeria (N&MCN) do have committees on ethics and

discipline.

19

Recent research highlights that the private sector is used not only by the

urban wealthy, but also by rural populations and by the poor. In fact, as

mentioned earlier, nearly 80% of the population utilizes some form of

private sector provider (FMOH, 2007; Larbi, 2004) and over 50% of the

population uses for-profit private providers (WHO, 2008). However, as is

the case in most of the developing world, the poor are more likely to use

informal sector providers who also provide lower-quality services. No

trained or professional nurse would like to provide low quality health care

services which are mostly associated with private hospitals. This may

inform the reasons while majority of the professional nurses prefer to work

in public health institutions where there are better facilities for quality health

services delivery.

Job satisfaction could be a factor of adequate facilities for qualitative health

care services which relatively abound mainly on public health institutions

and some big private hospitals in the country. Quality service delivery will

result in adequate and functional equipment and working materials as well as

work environment and conditions which all constitute the major variables of

the study. However, good governance and management in the health sector

plays important and vital roles in workers job satisfaction. This,

nonetheless, is examined here.

Health Sector Management

Over the last two decades, management in the health sector has been very

challenging because of the complexity of the sector and the country’s

complicated federal administrative structure. Accordingly

20

“In the three-tier federal administrative structure each tier is notionally autonomous over the management of its resources. Nevertheless, the relationship between them has not been without friction in the health sector. Constitutionally, health is on the concurrent legislative list, which allows the federal, state, and local governments to assume varying and potentially overlapping responsibilities for policy making, regulation, and provision. But the constitution’s silence on the precise division of roles and responsibilities across the tiers makes for considerable ambiguity in the management of the health system” (NHSA, 2008).

In line with the Revised National Health Policy (FMOH, 2004), the federal

government sets overall policy direction and standards and ensure quality

and training. In addition, it implements nationwide sector programs such as

immunization and also oversees dozens of federally funded tertiary health

facilities across the country. The 36 states and the FCT undertake policy

making and regulation as well as financial responsibility for the personnel

and running costs and capital investment of their tertiary, secondary, and

primary care departments and facilities. The 774 LGAs are responsible for

primary health care delivery under the guidance and supervision of federal

and state departments of primary health care. Alongside these public actors

is an array of private voluntary and for-profit providers that operate at all

levels of care and, together with the traditional care sector, are responsible

for an estimated 80% of all services provided in the country (FMOH, 2007;

Larbi, 2004).

At both the federal and sub-national levels, the management responsibilities

are further shared between the three branches of government, where the

21

executive takes responsibility for policy formulation and implementation,

the legislature provides oversight, representation, and laws, and the judiciary

protects voice and ensures accountability. The weakness of checks and

balances within government naturally puts the spotlight on the roles of civil

society organizations (CSOs), including professional organizations,

specialized health NGOs and the media, in projecting and protecting

citizens’ voices and ensuring the responsiveness of services and the

accountability of providers and policymakers.

Sound health sector management at both public and private levels is

necessary for effective and efficient health care service delivery. People

would be highly satisfied working in organized and well managed

institutions where policies and procedures dictate the state of affairs. This,

however, manifests in organizational structure which lends great support to

interpersonal relationship and team work. So far, the study has x-rayed the

Nigeria’s health system by examining some core issues that affect

performance and productivity.

Conceptual Issues on Job Satisfaction and Motivation

A number of studies, mostly in the industrialized world have sought to

examine the variables that constitute job satisfaction as well as those factors

that could lead to dissatisfaction in a workplace. It was Herzberg’s two

factor theory that gave rise to most of the classical and some modern studies

on job satisfaction. Lawrence, Harvey and James (2006) asserted that

certain common job conditions must be at an acceptable standard to each

individual employee before job satisfaction can be guaranteed. According to

22

them, raising these factors above the standard level does not create great job

enthusiasm; however, allowing them to deteriorate below the acceptable

standard yields dissatisfaction. These variables are salary, good supervision,

fringe benefits, job security, interpersonal relations, physical working

conditions, fair company policies, and administrative practices. Barrick,

Stewart and Piotrowski (2002) in their study measured six factors which

contributed to job satisfaction. These are:

• The way an individual reacts to unpleasant situations

• The facility with which he adjusts himself to other people.

• His relative status in the social and economic group with which he

identifies himself.

• The nature of the work in relation to this abilities, interactions and

relationships with other workers.

• Job security, and

• Loyalty.

Lim and Ployhard (2004) in their study of job satisfaction discovered that

sex, age, education, skill and income affect a person’s level of satisfaction

while Lepine and Dyne (2001) and Wright, Cropanzano & Bonett (2007)

asserted that employee performance is determined by three things namely:

motivation, which is the desire to do the job; ability, which is the power or

strength to do the job and the work environment which involves the tools,

materials and information needed to do the job. Discussing on five-factor

models of personality and job satisfaction, Judge, Heller and Mount (2002)

theorise that job satisfaction is a composite of several factors, each of which

23

influence the degree and level of satisfaction. They gave the following

factors;

• The nature of the job – is it routine or challenging? Can you measure

your accomplishment?

• The pay – Does it provide security and incentive? Is the amount paid

competitive with relative jobs and companies?

• Opportunities for advancement.

• The nature of cooperation with other workers.

• The nature of supervision and supervisors – How closely are you

supervised? How well do the supervisors communicate with you?

• The nature of training – This includes both induction and continuation

training.

• The physical environment of the job – Is it in a pleasant location? Are

living conditions pleasant in the community?

• The nature of nurses/patients relations.

• The social prestige or status of the nursing profession vis-à-vis other

professionals in the health institution.

Mosley, Megginson and Pietri (1989) in their classic book highlighted that

supervisor’s attitude and approach to supervision affect satisfaction. They

said that high rate of dissatisfaction occurs where workers lose their sense of

achievements because of the dictatorial attitudes of supervisors. They

equally submitted that workers with higher income were more satisfied than

those with lower income. However, Hurtz & Donovan (2000) and Schultz

& Schultz (2010) grouped the factors in order of importance as determinants

of job satisfaction. According to them, pay and the nature of work itself are

24

the most important source of job satisfaction, promotional opportunities and

supervision are moderately important sources of job satisfaction, and the

work group and working conditions are relatively minor source of job

satisfaction.

It is evident from the above job satisfaction studies that different variables

apply to different environments and conditions. This, notwithstanding, there

are variables discovered from these studies that are pertinent and relevant to

both our environment and the two sectors of the health institution which the

present study would try to unveil. Such variables as salary or payment, job

security, work and working conditions, opportunities for advancement,

working facilities among others are important variables which the present

study sets out to investigate.

Job Motivation Strategies

Motivation is a basic psychological process. Motivating is the management

process of influencing behaviour based on the knowledge of what makes

people thick (Benson & Dundis, 2003). They assert that motivation is the

process that arouses, energizes, directs and sustains behaviour and

performance. That is, it is the process of stimulating people to action and to

achieve a desired task. One way of stimulating people is to employ effective

motivation, which makes workers more satisfied with and committed to their

jobs. Money is not the only motivator. There are other incentives which can

also serve as motivators. They defined motivation as a, process that starts

with physiological deficiency or need that activates behaviour or a drive that

is aimed at a goal. Managers and management researchers have long

25

believed that organizational goals are unattainable without the enduring

commitment of members of the organizations.

Motivation is a human psychological characteristic that contributes to a

person’s degree of commitment (Kaliski, 2007; Armstrong, 2006). It

includes the factors that cause, channel and sustain human behaviour in a

particular committed direction. Armstrong (2006) goes on to say that there

are basic assumptions of motivation practices by managers which can be

understood first, that motivation is commonly assumed to be a good thing.

One cannot feel very good about oneself if one is not motivated. Second,

motivation is one of several factors that go into a person’s performance (e.g.

as a nurse). Factors such as ability, resources and conditions under which

one performs are also important. Third, managers and researchers alike

assume that motivation is in short supply and in need of periodic

replenishment. Fourth, motivation is an indispensable tool for managers. If

managers know what directs the people working for them, they can tailor job

assignments and rewards to what makes these people “thick”. Motivation

can also be conceived of as whatever it takes to encourage workers to

perform by fulfilling or appealing to their needs. Olajide (2000), says it is

goal-directed and therefore cannot be outside the goals of any organization

whether public, private profit or non-profit.

Strategies for Motivating Workers

Aziri (2008) accords due recognition to the need of workers saying that “the

ultimate test of organizational success is its ability to create values sufficient

to compensate for the burdens imposed upon resources contributed “Bernard

26

looks at workers, in particular Liberians, in an organized endeavour, putting

in time and efforts for personal, economic and non-economic satisfaction. In

this era of nurses migrating to look for greener pastures, organizations must

be careful to meet their needs; otherwise they will discover they are losing

their talented and creative professionals to other countries or organizations

who are ready and willing to meet their needs and demands. The question

here is what strategies can be used to motivate professional nurses. The

following are strategies:

Job Control

Job control can be over any aspect of work, including location, scheduling,

and how tasks are done. Evidence is growing that enhanced control at work

can be an important element in employees’ health and well-being. Control

over one’s work (deadlines, outputs etc) has a strong impact on job

satisfaction, affecting both an individual’s self esteem, as well as their ability

to achieve work goals. Employees with low control can become frustrated

and feel under appreciated. Low job control is recognized as another

important source of stress (Igbal, 2012).

Impact of Job Satisfaction and Job Control on Recognition

Danish and Usman (2010) assert that rewards and recognition programs

keep high spirits among employees, boosts up their morale and create a

linkage between performance and motivation of the employees. The basic

purpose of recognition and reward program is to define a system to pay and

communicate it to the employees so that they can link their reward to their

performance which ultimately leads to employee’s job satisfaction. When

27

we recognize and acknowledge the employees in terms of their

identification, their working capacity and performance is very high.

Recognition today is highest need according to some experts, whereas a

reward which includes all the monetary and compensative benefits cannot be

the sole motivator for employees’ motivation program (Christen, Iyer &

Soberman (2006). Rewards play a vital role in determining the significant

performance in job and it is positively associated with the process of

motivation. There are two factors which determine how much a reward is

attractive, first is the amount of reward which is given and the second is the

weight an individual gives to a certain reward. Good managers recognize

people by doing things that acknowledge their accomplishments and they

reward people by giving them something tangible. Fair chances of

promotion according to employee’s ability and skills make employee more

loyal to their work and become a source of pertinent workability for the

employee.

Advancement Opportunity

How a worker views the opportunity for advancement is important to how

satisfied the worker is with the job. Vroom (1982) explained that job

satisfaction is directly related to the extent that jobs provide individuals with

rewarding outcomes. If a worker believes that achievement of organizational

goals will lead to such personal rewards as promotion, then whether or not

these rewards occur is likely to affect the worker's job satisfaction.

Promotional opportunity is important to job satisfaction because employees

who perceive few opportunities for advancement have negative attitudes

toward their work and their organizations (George & Jones, 2008).

28

Job Security

Job security is the probability that an individual will keep his or her job; a

job with a high level of job security is such that a person with the job would

have a small chance of becoming unemployed. Job security is dependent on

economy, prevailing business conditions, and the individual's personal skills.

It has been found that people have more job security in times of economic

expansion and less in times of a recession. Unemployment rate is a good

indicator of job security and the state of the economy and is tracked by

economists, government officials, and banks. Typically, government jobs

and jobs in education, healthcare and law enforcement are considered very

secure while private sector jobs are generally believed to offer lower job

security and it usually varies by industry, location, occupation and other

factors. Personal factors such as education, work experience, job functional

area, work industry, work location, etc., play an important role in

determining the need for an individual's services, and impacts their personal

job security. Since job security depends on having the necessary skills and

experience that are in demand by employers, which in turn depend on the

prevailing economic condition and business environment, individuals whose

services are in demand by employers will tend to enjoy higher job security

(Uchitelle & Leonhardt, 2006).

Sweney & Mcfarlin (2005) examined agency-influenced work and

employment conditions, and assess their impact on social worker’s job

satisfaction. According to them some motivation issues such as recognition,

responsibilities, advancement opportunity, job security, physical

surroundings and safety affect job satisfaction. Again, certain environmental

29

and motivation factors are predictors of job satisfaction. In the same vein,

Rue & Byars (2003) assert that financial incentives will get people to do

more of what they are doing. Wegge, Sehmidt, Parkes & Van Dick (2007)

investigated motivational and managerial styles in the private and public

sector. Their results indicated that there was a little difference between the

motivational needs of public and private sector employees, managers and

non-managers.

Theoretical Review on Job Satisfaction

Since a person’s job satisfaction involves an overall attainment of both

intrinsic and extrinsic factors, our theoretical framework on job satisfaction

were based on some classical motivation theories. A lot of theories have

been put forward to best explain job satisfaction. Some of these theories

were discussed below:

Maslow’s Hierarchy of Needs Theory

The most famous classification of needs is the one formulated by Maslow in

1954. He suggested that there are five major need categories which apply to

people in general, starting from the fundamental physiological needs and

leading through a hierarchy of safety, social and esteem needs to the need

for self-fulfilment, the highest need of all. Maslow’s hierarchy is as follows:

1. Physiological – the need for oxygen, food, water and sex.

2. Safety – the need for protection against danger and the deprivation of

physiological needs.

3. Social – the need for love, affection and acceptance as belonging to a

group.

30

4. Esteem – the need to have a stable, firmly based, high evaluation of

oneself (self-esteem) and to have the respect of others (prestige).

These needs may be classified into two subsidiary sets: first, the desire

for achievement, for adequacy, for confidence in the face of the world,

and for independence and freedom, and, second, the desire for

reputation or status defined as respect or esteem from other people,

and manifested by recognition, attention, importance, or appreciation.

5. Self-fulfilment (self-actualization) – the need to develop

potentialities and skills, to become what one believes one is capable of

becoming.

Maslow’s theory of motivation states that when a lower need is satisfied, the

next highest becomes dominant and the individual’s attention is turned to

satisfying this higher need. The need for self-fulfilment, however, can never

be satisfied. Maslow stated that ‘man is a wanting animal’; only an

unsatisfied need can necessitate behaviour and the dominant need is the

prime motivator of behaviour. Psychological development takes place as

people move up the hierarchy of needs, but this is not necessarily a

straightforward progression. The lower needs still exist, even if temporarily

dormant as motivators, and individuals constantly return to previously

satisfied needs.

Human needs as stated by Maslow are insatiable and start from the lowest up

to the higher order needs. Some of these needs especially the lower needs

may have been satisfied at the level of professional nurses meanwhile needs

like security, social, self esteem, self actualization deserve attention. Nurses

require security in their job, and it is only when they are assured of job

31

security that they will be more relax to do their job without fear. Again, their

social life is another aspect and has to do with interpersonal relationship in

the organization. The environmental friendliness is important in creating a

conducive working atmosphere. Nurses need to be recognized and

commended when they have done well. They also need to be allowed to

make certain decisions that are pertinent to their job. This will help to boost

their self esteem and so will like to do more in future. Also, it is important to

create an environment that will encourage advancement in the career. This is

because, some of these nurses are no longer motivated by their salaries but

feel more fulfilled as they advance in their career.

Frederick Herzberg’s two Factor Theory

Frederick Herzberg’s two factor theory also known as motivator hygiene

theory attempts to explain satisfaction and motivation in the workplace.

This theory states that satisfaction and dissatisfaction are driven by different

factors – motivation and hygiene factors, respectively. An employee’s

motivation to work is continually related to job satisfaction of a subordinate.

Motivation can be seen as an inner force that drives individuals to attain

personal and organization goals (Mount, Ilies & Johnson, 2006). Motivating

factors are those aspects of the job that make people want to perform, and

provide people with satisfaction, for example achievement in work,

recognition, promotion opportunities. These motivating factors are

considered to be intrinsic to the job, or the work carried out. Hygiene

factors include aspects of the working environment such as pay, company

policies, supervisory practices, and other working conditions (Rode, 2004)

32

Edwin Locke’s Range of Affect Theory

Locke (1976), range of affect theory is arguably the most famous job

satisfaction model. The main premise of this theory is that satisfaction is

determined by a discrepancy between what one wants in a job and what one

has in a job. Further, the theory states that how much one values a given

facet of work, e.g. the degree of autonomy in a position moderates how

satisfied/dissatisfied one becomes when expectations are/aren’t met. When

a person values a particular facet of a job, his satisfaction is more greatly

impacted both positively when expectations are met and negatively when

expectations are not met, compared to one who doesn’t value that facet. To

illustrate, if Employee A values autonomy in the workplace and Employee B

is indifferent about autonomy, the Employee A would be more satisfied in a

position that offers a high degree of autonomy and less satisfied in a position

with little or no autonomy compared to Employee B. This theory also states

that too much of a particular facet will produce stronger feelings of

dissatisfaction the more a worker values that facet.

Timothy Judge’s Core Self-Evaluation Model

A significant model that narrowed the scope of the dispositional theory was

the core self-evaluations model, proposed by Timothy A. Judge in 1998. It

is a very general theory that suggests that people have innate dispositions

that cause them to have tendencies toward a certain level of satisfaction,

regardless of one’s job. This approach became a notable explanation of job

satisfaction in light of evidence that job satisfaction tends to be stable over

time and across careers and jobs. Research also indicates that identical twins

have similar levels of job satisfaction (Mount, Ilies & Johnson, 2006).

33

According to Judge (2001), there are four core self-evaluations that

determine one’s disposition towards job satisfaction: self-esteem, general

self-efficacy, locus of control, and neuroticism. This model states that

higher levels of self-esteem that is the value one places on his/her self and

general self efficacy – the belief in one’s own competence, lead to higher

work satisfaction. Having an internal locus of control, that is, believing one

has control over his/her own life, as opposed to outside forces having control

leads to higher job satisfaction. Finally, lower levels of neuroticism lead to

higher job satisfaction.

Conceptual Framework on Nurses’ Job Satisfaction

The study adopted Justin (2008) job satisfaction model for retention since

the purpose was to examine the level of job satisfaction of professional

nurses in both public and private health sectors with a view to determining if

the job satisfaction variables that motivate nurses in public health sector to

either stay or move out of the sector are same with their counterparts in

private sector as depicted in figure 3 below:

34

Figure 3: Job satisfaction model for retention.

Adapted from Justin, Fields (2008) Job satisfaction model for retention of workers, Journal of

Managerial Psychology, 22(3) Page 126

The model shows factors leading to satisfaction and dissatisfaction. People

leave organizations when they are not satisfied, and their dissatisfaction

could occur on many levels. Moreover, one’s level of satisfaction is

dependent on some other factors such as sex, age, education and years of

service among others. Our adoption of this model is based on its relevance

to the health sector’s environment of the study. Unlike in advanced

countries, and some developing countries pilot survey showed that many

professional nurses in public health sector of Anambra State still search for

greener pastures outside the country while their counterparts in private

sector nurse the ambition of either moving to public sector or securing a

more lucrative job elsewhere. This situation, no doubt, is based on the

individuals’ perception of and attachment to both extrinsic and intrinsic

Job Satisfaction Model

Employee Dissatisfaction

Employee Satisfaction

Fulfilment Commitment Engagement

Factors leading to satisfaction:

Good leadership practices

Good manager relationship

Recognition

Advancement

Personal growth

Feedback and support

Clear direction and objectives

Factors leading to dissatisfaction:

Poor pay

Poor compensation

Poor work conditions

Lack of promotions

Poor benefits offering

Lack of job security

35

factors as contained in the above model. Our adoption of this model is

therefore, a precursor of the assumption that while public sector professional

nurses job satisfaction variables are mainly intrinsic: their counterparts in

private sector are mostly extrinsic. This assumption is made because of the

prevailing health system environment of the country in general and Anambra

State in particular.

Government at whatever level – Federal, State and Local command more

financial resources to guarantee the extrinsic factors of salary, fringe benefit,

bonuses, etc for the public health workers, unlike the private hospitals. With

this situation on ground, nurses at the public health sector may not be

motivated or highly satisfied with these factors as their colleagues in private

hospitals. However, they will be challenged and motivated to higher level of

satisfaction when the intrinsic factors of recognition, advancement and

personal growth are guaranteed.

Empirical Studies on Professional Nurses Job Satisfaction

Studies on nurses’ job satisfaction abound in the literature. While some

studies examined job satisfaction among registered nurses, many make no

distinction between certified and non-certified registered nurses in reporting

study findings (Ellenbecker & Byleckie, 2005; Forsyth & McKenzie, 2006;

Hsu & Kernohan, 2006). Taking cognizance of our unique and peculiar

environment and society where many fraudulent practices occur in the health

care system, where quacks, untrained and non-registered nurses get

employment as nurses, mostly in private health care sector, we would

36

therefore examine, only those studies that reported on professional nurses

job satisfaction being the focus of the study.

In their comparative analysis of job satisfaction among public and private

sector professionals, - Barrows and Wesson, (2008) employed Hackman and

Oldham’s Job Characteristics Model to determine whether or not there is a

meaningful difference between the public and private sector professionals in

terms of job satisfaction. Using fifteen different job satisfaction variables

which include nature of the work, pay, benefits and opportunity for

promotion, training, degree of burnout and working condition among others,

this study identified huge differences and nearly identical levels of

satisfaction with the variables. For example, while both sector respondents

expressed the same level of satisfaction with the nature of the work they do

and their feelings of burnout, there were vast differences in terms of pay and

benefits. Without taking the variables one after the other, their overall

findings are indicative of systematic unhappiness with the work environment

on the part of the public sector respondents in comparison to the private

sector respondents. However, respondents from the two sectors were

equally satisfied with the actual work that they perform. That is, the

differences are not in satisfaction with job content, but rather a difference in

satisfaction with the environment in which the respondents’ work is

performed. This study, therefore, has generated much insight into the

environmental factors relating to job satisfaction levels of public and private

sector professional nurses.

37

Certification is the formal recognition of specialized knowledge, skills and

experience demonstrated by the achievement of standards identified by a

nursing specialty to promote optimal health outcomes (Barker & Guzman,

2012). It was based on this professionalism that Gulick, Halper & Namey

(2008) undertook a qualitative study of job satisfaction of multiple sclerosis

certified nurses in United States of America. Their study was based on the

premise that despite the fact that certification may benefit the individual

nurse, area of specialty practice, nursing profession, institution and

community, nurse certification also adds an advantage over non-certified

nurses in recruitment and job retention (Woods, 2002; Stromborg, Neebuhr

& Prevost, 2005). According to them, many factors, both internal and

external to the professional nurse influence job satisfaction.

Several studies conducted in primary and acute care settings reported that

the amount of autonomy, acceptance and recognition by others, and the

degree of collaboration between nurses and the health care team directly

influences job satisfaction (Schmalenberg & Kramer, 2008; Kovner, Brewer,

Wu, Cheng & Suzuki, 2006). Again, it was discovered from their study that

personal satisfaction and professional pride contribute immensely to job

satisfaction, so also the respect and recognition arising from interaction with

co-workers. Finally, a realistic workload and sufficient staff and time to

provide case management and documentation are essential for professional

practice and job satisfaction (Flynn & Dietrick, 2003; Ellenbecker, Boylan

& Samia (2006).

38

The environment in which a person lives and works plays a vital role in

determining the person’s attitudinal changes and behaviours. This was the

focus of Manojlovich (2005) study on linking the practice environment to

nurses’ job satisfaction through communication. Improving the practice

environment for nurses might be a strategy to promote job satisfaction

(Manojlovich & Laschinger, 2002), and the practice environment might have

a stronger relationship to job satisfaction than to personal variables such as

age, experience and length of service in an organization, Saari & Judge

(2004). Using a sample of 500 hospital nurses throughout Michigan and

employing the Nursing Role Effectiveness Model (NREM), the researchers

asserted that factors in the practice environment contributed both directly to

nursing job satisfaction and also indirectly through nursing – physician

communication.

Study findings showed that a practice environment favourable to nurses

improved both nurses perception of their communications with physicians

and their job satisfaction. We can argue from this study, based on our own

context that nurses – physician communications in public health institutions

are bound to generate job satisfaction since the two relate as co-workers

being employed by the government, unlike in the private hospitals, where

the physicians (doctors) are usually the boss, being the employer of the

nurses working with them. Communication at this level definitely cannot be

said to be horizontal rather, it would be vertical because the physician would

be communicating to the nurse as a boss, thereby hampering the satisfaction

that would have emanated from ideal nurse – physician communication.

39

In their empirical study on job satisfaction among nurses in Iraq, Sherin Al-

Doski & Aziz (2010) carried out a descriptive inference research of 200 staff

nurses selected from four general hospitals in Erbil City, Iraq. Their

findings show that, overall nurses were dissatisfied with work, pay and

promotions. Nurses in this study were most dissatisfied with salary and lack

of prospects for promotion in line with the findings of (Hallin & Danielson,

2007; Armstrong-Stassen & Cameron, 2005; Johnston, 2008). Again, the

study shows that personal characteristics have important influences on

nurses’ job perception which indirectly affect their job satisfaction (Piko,

2006). In a similar study on the level of job satisfaction and intent to leave

among Malaysian nurses, Alam & Mohammad (2010), sampled 153 nursing

staff in public sector hospitals. They categorized job satisfaction into six

multidimensional facets namely; satisfaction with supervisor, satisfaction

with variety – challenging but not routine, satisfaction with closure –

opportunity from start to finish, satisfaction with compensation, satisfaction

with co-workers, and satisfaction with management and human resources

policies.

Findings showed that shortages can be a symptom of low job satisfaction,

poor management and lack of organizational support (Zum, Dolea &

Stillwell, 2005). Shortages result in heavy workload, which is a precursor to

job stress and burnout, which have also been linked to low job satisfaction.

Nurses’ job satisfaction is an elusive concept, which is defined within its

extrinsic and intrinsic values (Cowin, 2002). Extrinsic values encompass the

tangible aspects of the job including wages or salaries, benefits and bonuses,

whereas intrinsic values include status, recognition, personal and

40

professional development opportunities, and other similar factors (Firth,

Mellor, Moore & Loquet, 2004). Findings of this study suggested that the

nursing staff were moderately satisfied with their job in all the six facets of

job satisfaction mentioned above, therefore, they exhibit a perceived lower

level of their intention to leave the hospital and the job.

Lastly, in his study, work satisfaction of professional nurses in South Africa,

Pillay (2009) did a comparative analysis of the public and private sectors.

Employing a total of 569 professional nurses in a cross sectional survey

conducted throughout South Africa, the study recorded a number of thought

provoking findings. Private-sector nurses were generally satisfied, while

public-sector nurses were generally dissatisfied. Public-sector nurses were

most dissatisfied with their pay, the workload and the resources available to

them. They were satisfied only with the social context of the work. Private-

sector nurses were dissatisfied only with their pay and career development

opportunities. This study highlighted the overall dissatisfaction among

South African nurses and confirmed the disparity between the levels of job

satisfaction between the public and private sectors. Based on our postulation

that the nations health system environment, nurses extrinsic and intrinsic

values, and the nurses’ perception of nursing job play great roles in

determining the level of job satisfaction among professional nurses in public

and private sectors, we would therefore adopt South African study as our

reference case study.

41

Summary of the Literature Review

The review of related literature started with a brief overview of the Nigeria’s

health system which comprised of public and private health sectors. It

equally reviewed the main issues in the health system such as human

resources, financing, service delivery and health sector management. With

the nursing training schools in all the 36 states whereby some states have as

many as five schools; these institutions produce approximately 3,700 nurses

per year, of which an estimated 25 percent begin their careers in the public

sector while the remaining 75 percent seek employment with the private

sector.

The theoretical review on job satisfaction was undertaken. This was based

on four classical motivation theories namely, Maslow’s hierarchy of needs

theory, Frederick Herzberg’s two factors theory, Edwin Locke’s range of

affect theory and Timothy Judge’s core self evaluation model. All the

reviewed theories discussed various job motivation factors that helped in this

study.

The literature further reviews the conceptual framework for job satisfaction

relying heavily on the works of Hinshaw, Smeltzer & Attwood (1987) and

Price & Mueller (1986). It examined the influence of organizational and

environmental factors from these two models on the professional nurses’

satisfaction and the nurses’ voluntary decision to stay or leave their jobs. In

consideration of the purpose of this study, Justin (2008) Job satisfaction

model which captured the variables to be examined were adopted for the

study.

42

Lastly, an attempt was made to develop a framework for designing

professional nurses’ job satisfaction model by looking at the factors that lead

to satisfaction and dissatisfaction respectively. More insights were thrown

to the study by reviewing some empirical studies on professional nurses’ job

satisfaction. Findings from these studies showed that most of the job

satisfaction variables were dependent on the working environment,

organizational structure and the professional nurses’ personal intrinsic and

extrinsic factors based on education, numbers of years of working,

experience, training, personality, life values, and perception among others.

However, since most of these studies were conducted in developed

countries, there is an urgent need to carry out similar studies in developing

countries. This need is germane when one considers the differences in

human and environmental factors among the nations of the world. Again,

some of the nurses job satisfaction variables studied in these developed

countries are not universally applicable. This, nonetheless, constitute a gap

which the present study attempted to fill.

43

CHAPTER THREE

RESEARCH METHOD

This chapter presented the research design, area of study, population of the

study, sample and sampling technique, instrument for data collection,

validity and reliability of the study, ethical consideration, procedure for data

collection and method of data analysis.

Research Design

This is a cross-sectional comparative study that sought to gain insight into

the job satisfaction of professional nurses that work in both public and

private health sectors of Anambra State. Comparison, as a fundamental

research strategy helped us in this study to identify the basic job satisfaction

variables of professional nurses in both health sectors of Anambra State.

However, Survey research method was adopted for the study.

Area of Study

The study was conducted in Anambra State, South East of Nigeria. The

State which has boundaries with Enugu, Abia, Imo, Delta and Kogi States

has twenty one (21) local government areas. It has one Federal teaching

hospital, good number of State hospitals, privately owned and Mission

hospitals. The Federal teaching hospital is located at the commercial/

industrial town of Nnewi, while the State, Private and Mission hospitals are

scattered within the twenty one (21) local government areas of the State.

44

Professional nurses working in these hospitals were drawn from the civil

servants that constitute the population.

Population of the Study

The population of the study was the professional nurses working in both

Public and Private Health sectors of Anambra State. According to the data

collected from Anambra State Ministry of Health Awka, there were 1,258

and 4,645 professional nurses working in Public and Private health sectors

of Anambra State respectively. This therefore, gives a population of 5903

professional nurses at the time of the study. A sample size of 375 subjects

was determined using the sample determination formula for a known

population figure as developed by Yamane (1964) as follows;

n = N

1 + N (e2)

where;

n = the sample size

N = the target population size (5,903)

e = the level of precision (+ 5 percent)

1 = constant value.

Substituting

n = 5,903

1 + 5903 (0.05)2

n = 375

45

Sampling Procedure

Proportionate stratified random sampling was used to select samples. Nurses

were stratified in terms of public and private hospitals thereafter; their

relative sizes and proportions were assigned and used in determining sample

from each stratum. Each proportion is the population percentage of each

stratum to the parent population. Thus,

Table 1: Study Sample

Hospitals N Proportions N

Public 1258 .21 79

Private 4645 .79 296

Total 5903 1.00 375

Sources: Anambra State Ministry of Health, 2011, Field Survey 2012

Instrument for Data Collection

The instrument for data collection was a self designed questionnaire. The

questionnaire contained 20 items which centers on the research questions.

Items 1 - 5 were structured to elicit responses on level of satisfaction from

job security. Items 6 – 10 provided responses on level of satisfaction from

working conditions. Items 11 – 15 elicited responses on satisfaction from

opportunity for advancement while items 16 – 20 provided responses on

satisfaction from interpersonal relationship. Items 1 – 10 and 16 – 20 were

placed on a four point rating scale of Very Satisfied, Moderately Satisfied,

Fairly Satisfied and Not Satisfied while items 11 – 15 were placed on a four

point scale of Very High Extent, High Extent, Low Extent and Very Low

Extent.

46

Validity of Instruments: The face and content validity of the instrument

was done by the researcher’s supervisor and other experts from Department

of Management, University of Nigeria Enugu Campus and Department of

Psychology, Nnamdi Azikiwe University, Awka. Their corrections were

effected accordingly.

Reliability of Instruments: In order to establish the highest degree of

reliability of the instrument, a pilot survey was carried out. Thirty (30)

copies of questionnaires were administered to professional nurses working in

both public and private hospitals in Enugu State. For measuring the internal

consistency, Cronbach’s alpha coefficient test was applied using the SPSS

software to ensure reliability on an alpha level of 0.05. The analysis gave

alpha co-efficient values of .971 for satisfaction from job security; .970 for

satisfaction from recognition; .948 for extent of satisfaction from

advancement opportunity and .969 for satisfaction from job

control/responsibilities. An overall Alpha co-efficient of .988 was obtained

and this was high enough to justify their use as reliable instruments for data

collection (See Appendix B).

Ethical Consideration

Ethical issues considered in this study included the rights of the respondents,

the right of the institutions and the scientific honesty on the part of the

researcher. Ethical approval was obtained from Nnamdi Azikiwe University

Teaching Hospital, Nnewi to conduct the study (see appendix). Informal

consent was obtained from the respondents who were willing to participate

in the study after explaining the purpose of the study. They were assured of

47

confidentiality and anonymity. In order to maintain the quality of the

research, the researcher employed an honest conduct and objective reporting

in the study.

Procedure for Data Collection

With a letter of introduction from the department, and the ethical approval,

the researcher obtained administrative permit from heads of the various

hospitals to collect data. The researcher trained nursing students on

community experience posting on the purpose of the study and how to

administer the instrument. Copies of questionnaire were distributed and

collected on the spot. The researcher and the trained research assistants

administered copies of the questionnaire to the respondents. Data collection

lasted for a period of three months.

Method of Data Analysis

Data were presented in Tables. Statistical Package for Social Science (SPSS)

software was used to analyze data. Mean scores and Standard Deviation

were used to answer the research questions. t-test statistical technique was

used to test hypotheses 1, 2, 3, and 4. The hypotheses were tested at .05

level of significance.

48

CHAPTER FOUR

PRESENTATION OF RESULTS

This chapter discussed the presentation, analysis and interpretation of data

from the study. A total of 375 copies of questionnaire were administered out

of which 358 representing 95.47 percent copies were completed and

returned. However among the returned questionnaire, eight (8) were

wrongly filled and was subsequently rejected for the analysis. The

researcher was therefore left with 350 (93.33 percent) questionnaires for the

analysis which was adequate and enough representative of the population of

the study (Eboh, 2009).

Data were presented according to the research questions and hypotheses as

follows:

The Demographic Data of the Respondents

Although the demographic data of the respondents did not have direct

relationship with the key variables that were studied, however, female nurses

between the ages of 25 years to 55 years constitute the majority as depicted

in the Table below:

49

Table 2: Sex and Age Distribution

Age Range (Yrs)

Sex

Total Public Private Male Female Male Female Male Female

25 – 34 4 14 2 85 6 99

35 – 44 2 28 0 123 2 151

45 – 55 0 26 0 66 0 92

Total 6 68 2 274 8 342

Source: Field Survey, 2012

From the above Table, out of the total number of 350 correctly filled

questionnaire used for the analysis, an insignificant number of 8 or (2.29

percent) were male nurses while a whopping number of 342 or (97.71

percent) were female nurses. This, no doubt shows the dominance of

females in the nursing profession in both public and private health sectors of

Anambra State.

Research Question 1

What level of satisfaction do nurses derive from job security in public and

private hospitals in Anambra State?

Table 3: Mean Analysis of Satisfaction Derived from Job Security

S/N Items Public = 74 Private = 276 Public and Private = 350 Mean Remark Mean Remark Mean Remark

1 Financial state of the hospital 3.32 SA 2.18 NS 2.75 SA

2 Management of the hospital 2.72 SA 2.35 NS 2.53 SA

3 Acquisition of necessary skills and competencies 3.15 SA 1.93 NS 2.54 SA

4 Stable economic status of the hospital 2.30 SA 1.70 NS 2.00 SA

5 Ownership status of the hospital 3.84 SA 1.70 NS 2.77 SA

Overall 3.07 1.97 2.52 SA

Source: Field Survey, 2012 n=350, Criterion Mean = 2.5. (≥ 2.5 Satisfied (SA), ≤ 2.5 Not Satisfied (NS)

n = 350

50

Table 3 shows that nurses in public hospital were satisfied with the financial

state of the hospital (3.32), management of the hospital (2.72), acquisition of

skills and competencies (3.15), ownership status (3.84) but were not satisfied

with the economic status (2.30). Their counterparts in private hospitals were

not satisfied with items 1 – 5 with mean less than 2.5. Meanwhile, an

overall mean of 2.52 indicate that nurses are satisfied with job security.

Research Question 2

How does recognition of performance of nurses in public and private

hospitals provide job satisfaction?

Table 4: Mean Analysis of Satisfaction Derived from Job Security

S/N Items Public = 74 Private = 276 Public and Private

= 350

Mean Remark Mean Remark Mean Remark

1 Reward for good performance 3.19 SA 2.45 NS 2.68 SA

2 Respect from nursing colleagues 3.09 SA 2.69 SA 2.89 SA

3 Respect from doctors 2.85 SA 2.17 NS 2.51 SA

4 Respect from family members 3.15 SA 2.76 SA 3.11 SA

5 Respect from patients 2.84 SA 2.34 NS 2.41 NS

Overall 3.08 SA 2.48 NS 2.72 SA

Source: Field Survey, 2012 n=350, Criterion Mean = 2.5. (≥ 2.5 Satisfied (SA), ≤ 2.5 Not Satisfied (NS)

In Table 4 nurses in public hospitals achieved satisfaction from reward for

good performance (3.19), respect from nursing colleagues (3.09), respect

from doctors (2.89), respect from patients (3.15), and respect from family

members (2.84). In private hospitals, nurses were not satisfied with reward

for good performance (2.45), respect from doctors (2.17), and respect from

51

patients (2.34) but satisfied with respect from nursing colleagues (2.69) and

respect from family members (2.76). An overall mean score of 2.72 for

public and private hospitals shows that nurses are satisfied with recognition

in public and private hospitals.

Research Question 3

To what extent does opportunity for advancement guarantees job satisfaction

to nurses in public and private hospitals?

Table 5: Mean Analysis of Satisfaction Derived from Opportunity

for Advancement

S/N Items Public = 74 Private =276 Public and Private

= 350

Mean Remark Mean Remark Mean Remark

1 Present rank in the hospital 3.05 HE 2.99 HE 3.02 HE

2 Opportunity for promotion 2.86 HE 2.36 LE 2.61 HE

3 Management sponsor of employees’ education 2.64 HE 2.12 LE 2.38 LE

4 More responsibility and higher compensation 3.27 HE 2.43 LE 2.85 HE

5 Training and development scheme 3.05 HE 1.78 LE 2.44 LE

Overall 2.97 HE 2.34 LE 2.66 HE

Source: Field Survey, 2012

n=350, Criterion Mean = 2.5. (≥ 2.5 High Extent (HE), ≤ 2.5 Low Extent (LE)

Data in Table 5 reveal that nurses in public hospitals were satisfied with

items 1–5 to a high extent with mean above 2.5 while nurses in private

hospitals were satisfied with their present rank to a high extent (2.99) but

were satisfied with items 2 – 5 to a low extent with mean scores below 2.5.

52

However, an overall mean score of 2.66 shows that nurses are satisfied with

opportunity for advancement to a high extent.

Research Question 4

What extent of satisfaction do nurses derive from job control in public and

private hospitals?

Table 6: Mean Analysis of Satisfaction Derived from Job Control

S/N Items Public = 74 Private = 276 Public and Private

= 350

Mean Remark Mean Remark Mean Remark

1 Opportunity to make decision 3.20 SA 3.00 SA 3.10 SA

2 Responsibility and autonomy 3.17 SA 2.87 SA 3.02 SA

3 Work loads 2.76 SA 2.67 SA 2.72 NS

4 Managing subordinates 2.73 SA 2.66 SA 2.70 SA

5 Co-operation from others 2.61 SA 2.63 SA 2.62 NS

Overall 2.89 SA 2.77 NS 2.83 SA

Source: Field Survey, 2012

n=350, Criterion Mean = 2.5. (≥ 2.5 Satisfied (SA), ≤ 2.5 Not Satisfied (NS)

Results presented in Table 6 shows that nurses in public hospitals (2.89) and

private hospitals (2.77) were both satisfied with opportunity to make

decision, responsibility and autonomy, work loads, managing subordinates

and co-operation from others. This was reflected in mean scores above 2.5

for all the items in 1 – 5. The result also revealed that nurses in public and

private hospitals derive job satisfaction from job control as reflected in

overall mean of 2.83.

53

Hypotheses Testing

Null Hypothesis 1: There is no significant difference in satisfaction from

job security between nurses in the public and private hospitals.

Table 7: t-test Analysis of Nurses’ Response on Satisfaction from Job

Security

n x SD df t Sig (2-tailed) Decision

Public 74 3.06 0.79

348 10.16 .000 S

Private 276 1.97 0.93

S = Significant

The analysis presented in Table 7 reveals a calculated t value of 10.16

significant at .000 (2-tailed). Since the significant level of .05 is greater than

.000 (2-tailed), the test is significant. Therefore, the Null hypothesis is not

accepted which implies that there is a significant difference in satisfaction

from job security between nurses in the public and private hospitals.

Null Hypothesis 2: There is no significant difference in satisfaction from

recognition between nurses in public and private hospitals.

54

Table 8: t-test Analysis of Nurses’ Response on Satisfaction from

Recognition

n x SD df t Sig (2-tailed) Decision

Public 74 3.02 0.92

348 4.91 .000 S

Private 276 2.42 1.03

S = Significant

Table 8 shows a calculated t value of 4.91 significant at .000 (2-tailed). The

test is significant since .05 level of significant is greater than .000 (2-tailed).

Therefore, the null hypothesis is not accepted, hence it was concluded that

there is a significant difference in satisfaction with recognition between

nurses in public and private hospitals.

Null Hypothesis 3: Opportunity for advancement does not significantly

guarantee job satisfaction between nurses in public and private hospitals.

Table 9: t-test Analysis of Nurses’ Response on Satisfaction from

Opportunity for Advancement

n x SD df t Sig (2-tailed) Decision

Public 74 2.99 0.84

348 5.72 .000 S

Private 276 2.34 0.97

S = Significant

55

The analysis on Table 9 shows a calculated t value of 5.72 significant at

.000(2-tailed). Since .000(2-tailed) is less than significant level of .05, the

test is significant. The null hypothesis therefore is not accepted, hence, we

conclude that opportunity for advancement significantly guarantees job

satisfaction between nurses in public and private hospitals.

Null Hypothesis 4: Job control does not have significant effect on job

satisfaction between nurses in public and private hospitals.

Table 10: t-test Analysis of Nurses’ Response on Satisfaction from Job

Control

n x SD df t Sig (2-tailed) Decision

Public 74 2.90 0.85

348 .700 .484 NS

Private 276 2.80 1.13

NS = Not Significant

The analysis presented in Table 10 reveals a calculated t value of .700

significant at .484 (2-tailed). Since the probability level of 0.05 is lesser than

.484(2-tailed), the test is not significant. Hence the null hypothesis is not

rejected. This implies that job control have significant effect on job

satisfaction between nurses in public and private hospitals.

56

CHAPTER FIVE

DISCUSSION OF FINDINGS, CONCLUSIONS AND

RECOMMENDATIONS

This chapter presented the discussion of findings on data presented in

chapter four and inferences drawn therein, conclusion, implications of the

study, limitations of the study, recommendation and suggestion for further

study.

Discussion of Findings

Discussion was based on the research questions and the tested Null

hypotheses. The findings of this study were also compared with empirical

studies done previously by other researchers.

Nurses’ Satisfaction from Job Security

The result of the study indicated that nurses in the public hospitals were

satisfied with job security while nurses in the private hospitals were not.

This finding is supported by Rao & Malik (2012) who found that more

number of government hospital nurses have job security as such they are

more satisfied with their job whereas most of the private hospital nurses do

not have security with their job as such they seemed to be less satisfied.

Chimanikire et al., (2007) also supported that even though most employees

indicate that their jobs were relatively secure, most of them expressed

overall lack of satisfaction.

57

Nurses’ Satisfaction from Recognition

Result showed that nurses in the public hospitals were satisfied with

recognition while nurses in the private hospitals were not satisfied with

recognition. To this end, Barker & Guzman (2012) supported that the use of

recognition is a very effective tool to assist facilities in the promotion of job

satisfaction and nurse retention. Barker & Guzman also observed that many

nurses do not feel their work is rewarded or appreciated while some do.

Lephalala, (2006) also agreed that recognition was low in private hospitals

as nurses’ opinions were undervalued by medical staff (mostly the medical

doctors). Danish & Usman (2010) reported that there was a significant

relationship between recognition and work motivation and satisfaction.

Nurses’ Satisfaction from Opportunity for Advancement

From findings nurses in the public hospitals were satisfied with the

opportunity for advancement whereas nurses in the private hospitals were

not satisfied with opportunity for advancement in their career. Rao & Malik

(2012) agreed that growth opportunities are available more in government

hospitals thus nurses from this sector are more satisfied than their

counterparts from the private hospitals. Lephalala (2008) also found that

advancement opportunities were portrayed in the nurses’ perception as being

in a dead-end in private hospitals. Chimanikire et al., (2007) observed that

some employees felt that the current environment does not promote personal

growth and academic advancement. While, Hill (2011) supported that

employees are more satisfied with their current job if they see a path

available to move up the ranks in the company and be given more

responsibility and along with it higher compensation.

58

Nurses’ Satisfaction from Job Control/Responsibilities

Results revealed that nurses in both public and private hospitals derive

satisfaction from job control. This was supported by Waskiewicz (1999)

who noted that if the characteristics of the job are enhanced, job satisfaction

is increased. Archna, (2012) and Judge and Bono (2011) also noted that job

responsibility/control results in job satisfaction

Difference in Satisfaction from Job Security between Nurses in Public

and Private Hospitals

The Null hypothesis showed that there is a significant difference in

satisfaction from job security between nurses in the public and private

hospitals. This view was supported by Rao and Malik (2012) who stated that

job security is more in government nurses (82%) whereas in the private

sector nurses’ job security level was low as 72% of nurses were not satisfied.

Difference in Satisfaction from Recognition between Nurses in Public

and Private Hospitals

The Null hypothesis showed that there was a significant difference in

satisfaction from recognition between nurses in public and private hospitals.

Abushaikha and Saca-Hazboun (2009) agreed also that there is disparity

between government and private healthcare sector in recognition of nurses’

performance.

Opportunity for Advancement and Job Satisfaction

The Null hypothesis indicated that opportunity for advancement

significantly guarantees job satisfaction between nurses in public and private

59

hospitals. According to Robertson, Birch and Cooper (2012) there has been a

relationship found between perceived opportunity for advancement and job

satisfaction. Abushaikha and Saca-Hazboun (2009) supported this view by

observing that lack of advancement opportunities and supportive hospital

policies contribute to job dissatisfaction.

Effect of Job Control on Job Satisfaction

The Null hypothesis showed that job control does not have significant effect

on job satisfaction between nurses in public and private hospitals. This

finding is in line with Shimazu et al., (2004) who observed that job

satisfaction does not depend on job control and Robertson, Birch and Cooper

(2012) who noted that there is no positive relationship between variety of

job responsibilities and job satisfaction.

In this study, nurses in public health care settings were more satisfied with

their job than private nurses. This could be attributed to structural and

functional differences between public and private hospitals. It was based on

the fact that government hospitals offer better facilities, more incentives and

superior service conditions to nurses compared with private hospitals, which

usually have limited financial and human resources to offer to employees.

The disparity between government and private health care settings continues

to be an issue of debate and warrants more in-depth investigation.

Conclusion

From the findings of this study, it was obvious that job satisfaction was high

among nurses in public hospitals than nurses in private hospitals. The study

60

equally shows that government guarantees job security to its employees

more than private individuals. Finally, nurses in both public and private

hospitals were satisfied with job control in their career.

Implications of the Study

The findings of the study have far reaching implication for stakeholders in

the health sector. Nurses in private hospitals as the study reveals are less

satisfied with their jobs. Consequently, since low level satisfaction leads to

absenteeism, labour turnover and negative publicity of the organization,

management of private hospitals would be faced with these vices because an

unsatisfied worker can prove to be a liability to the organization just as Igbal

(2012) submits that a higher job satisfaction is associated with increased

productivity, lower absenteeism, and lower employee turnover.

Conclusively therefore, happy and satisfied worker is always a productive

worker and this to a reasonable extent was the case in public hospitals but

not so in the privately owned hospitals in Anambra State.

Limitations of the Study

This study had some limitations that must be acknowledged though they did

not affect the final outcome and results. Firstly, the distribution of the

questionnaire was a hectic task because of the spatial geographical location

of the hospitals. This almost affected the distribution and collection of the

copies of questionnaire on-the-spot.

Secondly, the study employed the survey method of generating information

from the respondents through questionnaires relied on subjective or

61

qualitative responses which were somehow difficult to quantitatively

validate.

Recommendations

Based on the findings of this study, the following recommendations were

proffered:

1. Management should encourage employees to take responsibility for

their own job satisfaction by developing an environment that allows

them the scope to perform well. In this environment, employees need

to accept that responsibility and take steps to build on their own

satisfaction.

2. Because career opportunities and further training afford professional

nurses the prospect of further developing themselves, and growing

within the ranks of their career. Health managers in both sectors

should provide nurses with the enabling facilities to actualize their

desires in this respect.

3. Effective strategies for motivation and retention of professional nurses

in both sectors should be centered on creating a stimulating,

challenging and friendly working environment by health managers.

4. Health managers should recognize the needs of nurses and work

towards improving them to address the cases of increasing migration

of nurses from private sector to public sector and from both sectors to

outside the country.

5. Management of private hospitals should strive to create enabling

environment similar to what is obtained in public hospital in terms of

job security to discourage staff turnover.

62

Contribution to knowledge

This study highlighted the obvious disparity on the level of job satisfaction

of professional nurses working in the public and private health sectors of

Anambra State. Giving the pivotal roles nurses’ play in the effective and

efficient health care delivery in Anambra State, it therefore becomes

imperative for health managers especially those in private sector to address

holistically the four core variable identified in this study namely: job

security, performance recognition, opportunity for advancement and job

control as antidotes to professional nurses job satisfaction and retention.

Furthermore, improving the private sectors working environment to be

congruent with the aspirations, expectations and values system of

professional nurses is more likely to increase satisfaction of nurses working

in this sector. This consequently will have positive and endearing effects on

both professional nurses and Anambra State health sector.

Suggestion for further studies

Job satisfaction no doubt represents one of the most complex areas facing

managers under human resources management. Despite thousands of papers

and researches conducted on job satisfaction all over the world, the area is

still inexhaustive. While the changing work environment portends new

research interest, the need to revisit past research finding in line with the

modern trends became obvious hence making it necessary for further and

more studies on job satisfaction. On this note therefore, the researcher

suggested for further studies in the following areas;

63

1. Comparative study of job satisfaction variables among professional

nurses and other health workers e.g. Pharmacist, Laboratory

Scientists, Doctors, etc.

2. Gender issues, female dominance and job satisfaction in Nursing

Profession and career.

3. Job satisfaction levels of professional nurses based on their area of

specialization and practice, among others.

64

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73

Appendix A

Introductory Letter

Department of Nursing Sciences,

Faculty of Health Sciences and

Technology,

University of Nigeria,

Enugu Campus.

Dear Respondent,

I am a post graduate student of Department of Nursing Sciences, University

of Nigeria, Enugu Campus. I am conducting an academic research on

“Analysis of Job Satisfaction of Professional Nurses in Public and Private

Sectors in Anambra State, Nigeria”. You have been selected among those

whose opinions would form the database for extracting the necessary

information for the analysis. To this end therefore, your valued assistance

and cooperation in filling the attached questionnaire are highly solicited.

Kindly note that this project is purely an academic exercise, therefore, all the

information volunteered will be treated with utmost confidentiality and trust.

Thanking you for your immense contributions and cooperation in this

regards.

Yours truly,

Onyeyili, Adaora Ngozi

74

QUESTIONNAIRE

Kindly indicate your opinion by ticking (√) in the appropriate column. Hospital Ownership: (a) Public (b) Private

Indicate your opinion regarding the level of satisfaction derived from job security

S/n Items Very

Satisfied

Moderately

Satisfied

Fairly

Satisfied

Not

Satisfied

1 Financial state of the hospital

2 Management of the hospital

3 Acquisition of necessary skills and competencies

4 Stable economic status of the hospital

5 Ownership status of the hospital

Indicate your level of satisfaction regarding recognition in your hospital

S/n Items Very

Satisfied

Moderately

Satisfied

Fairly

Satisfied

Not

Satisfied

6 Reward for good performance

7 Respect from nursing colleagues

8 Respect from doctors

9 Respect from family members

10 Respect from patients

Indicate the extent to which opportunity for advancement in your hospital guarantees job

satisfaction to you

S/n Items Very

High

Extent

High

Extent

Low

Extent

Very

Low

Extent

11 Present rank in the hospital

12 Opportunity for promotion

13 Management sponsor of employees’ further education

14 More responsibility and higher compensation

15 Training and development scheme

Indicate your opinion to the level of satisfaction you derive from job control/responsibilities in

your hospital

S/n Items Very

Satisfied

Moderately

Satisfied

Fairly

Satisfied

Not

Satisfied

16 Opportunity to make decision

17 Responsibility and autonomy

18 Work loads

19 Managing subordinates

20 Co-operation from others

75

Appendix B Reliability [DataSet0] C:\Users\CHRIS\Documents\ Reliability fo r Nurse.sav

Scale: ALL VARIABLES

Case Processing Summary

N %

Cases Valid

Excluded(a)

Total

a Listwise deletion based on all variables in the procedure.

Reliability Statistics Inter-Item Correlation Matrix

Item Statistics RELIABILITY /VARIABLES=Item6 Item7 Item8 Item9 Item10 /SCALE('ALL VARIABLES') ALL/MODEL=ALPHA /STATISTICS=DESCRIPTIVE CORR .

Reliability [DataSet0] C:\Users\CHRIS\Documents Reliability for Nurse.sav

Scale: ALL VARIABLES Reliability Statistics

Case Processing Summary

N %

Cases Valid

Excluded(a)

Total

a Listwise deletion based on all variables in the procedure.

Cronbach's Alpha

Cronbach's Alpha Based on Standardized Items N of Items

Mean Std. Deviation N

Item1

Item2

Item3

Item4

Item5

Item1 Item2 Item3 Item4 Item5

Item1 1.000 .773 .814 .844 .829 Item2 .773 1.000 .895 .929 .933 Item3 .814 .895 1.000 .874 .905 Item4 .844 .929 .874 1.000 .933 Item5

.829 .933 .905 .933 1.000

Cronbach's Alpha

Cronbach's Alpha Based on Standardized Items N of Items

.970 .972 5

76 Item Statistics Inter-Item Correlation Matrix

Mean Std. Deviation N

Item6 2.2000 1.12648 30 Item7 2.0000 .98261 30 Item8 2.2333 1.04000 30 Item9 1.8667 .93710 30 Item10 2.2000 .84690 30

RELIABILITY /VARIABLES=Item11 Item12 Item13 Item14 Item15 /SCALE('ALL VARIABLES') ALL/MODEL=ALPHA /STATISTICS=DESCRIPTIVE CORR .

Reliability [DataSet0] C:\Users\CHRIS\Documents\ Reliability fo r Nurse.sav

Scale: ALL VARIABLES Case Processing Summary Reliability Statistics

N %

Cases Valid 30 100.0 Excluded(a) 0 .0 Total 30 100.0

a Listwise deletion based on all variables in the procedure. Item Statistics Inter-Item Correlation Matrix

Mean Std. Deviation N

Item11 2.5333 1.50249 30 Item12 2.1667 1.08543 30

Item13 1.9667 .88992 30 Item14 1.9333 .98027 30 Item15

RELIABILITY /VARIABLES=Item16 Item17 Item18 Item19 Item20 /SCALE('ALL VARIABLES') ALL/MODEL=ALPHA /STATISTICS=DESCRIPTIVE CORR .

Item6 Item7 Item8 Item9 Item10

Item6 1.000 .935 .871 .908 .860

Item7 .935 1.000 .810 .936 .829

Item8 .871 .810 1.000 .882 .846

Item9 .908 .936 .882 1.000 .860

Item10 .860 .829 .846 .860 1.000

Cronbach's Alpha

Cronbach's Alpha Based on Standardized Items N of Items

.948 .966 5

Item11 Item12 Item13 Item14 Item15

Item11 1.000 .874 .684 .704 .737 Item12 .874 1.000 .898 .918 .900 Item13 .684 .898 1.000 .946 .906 Item14 .704 .918 .946 1.000 .939 Item15

77

Reliability [DataSet0] C:\Users\CHRIS\Documents\ Reliability fo r Nurse.sav

Scale: ALL VARIABLES Reliability Statistics Case Processing Summary

N %

Cases Valid 30 100.0 Excluded(a) 0 .0 Total 30 100.0

a Listwise deletion based on all variables in the procedure.

Item Statistics Inter-Item Correlation Matrix

Mean Std. Deviation N

Item16 2.9667 1.03335 30 Item17 3.1667 .91287 30 Item18 2.8333 1.05318 30 Item19 3.4000 .67466 30 Item20 3.1000 .80301 30

RELIABILITY /VARIABLES=Item1 Item2 Item3 Item4 Item5 Item6 It em7 Item8 Item9 Item10 Item11 Item12 Item13 Item14 Item15 Item16 Item17 Item18 Item19 Item20 /SCALE('ALL VARIABLES') ALL/MODEL=ALPHA /STATISTICS=DESCRIPTIVE CORR .

Reliability [DataSet0] C:\Users\CHRIS\Documents\ Reliability fo r Nurse.sav

Scale: ALL VARIABLES

Case Processing Summary Reliability Statistics

N %

Cases Valid 30 100.0 Excluded(a)

0 .0

Total 30 100.0

a Listwise deletion based on all variables in the procedure.

Cronbach's Alpha

Cronbach's Alpha Based on Standardized Items N of Items

.969 .974 5

Item16 Item17 Item18 Item19 Item20

Item16 1.000 .920 .914 .861 .918 Item17 .920 1.000 .891 .840 .917 Item18 .914 .891 1.000 .874 .877 Item19 .861 .840 .874 1.000 .815 Item20 .918 .917 .877 .815 1.000

Cronbach's Alpha

Cronbach's Alpha Based

on Standardized

Items N of Items

.988 .990 20

78 Item Statistics

Mean Std. Deviation N

Item1 2.1667 1.11675 30 Item2 2.1667 1.08543 30 Item3 1.9333 1.11211 30 Item4 2.2667 1.04826 30 Item5 2.4000 1.19193 30 Item6 2.2000 1.12648 30 Item7 2.0000 .98261 30 Item8 2.2333 1.04000 30 Item9 1.8667 .93710 30 Item10 2.2000 .84690 30 Item11 2.5333 1.50249 30 Item12 2.1667 1.08543 30 Item13 1.9667 .88992 30 Item14 1.9333 .98027 30 Item15 1.8000 .84690 30 Item16 2.9667 1.03335 30 Item17 3.1667 .91287 30 Item18 2.8333 1.05318 30 Item19 3.4000 .67466 30 Item20 3.1000 .80301 30

79

Appendix C

T-Test [DataSet1] C:\Users\CHRIS\Documents\Ada for Nurse a nd Hospital.sav

Group Statistics

Hospital N Mean

Std.

Deviation

Std. Error

Mean

Item1 Public 74 3.3243 .86179 .10018

Private 276 2.1848 1.09806 .06610

Item2 Public 74 2.7162 .98649 .11468

Private 276 2.3478 1.04900 .06314

Item3 Public 74 3.1486 .94626 .11000

Private 276 1.9312 .99397 .05983

Item4 Public 74 2.2973 1.09457 .12724

Private 276 1.6957 .84946 .05113

Item5 Public 74 3.8378 .37112 .04314

Private 276 1.6993 .86137 .05185

Item6 Public 74 3.1892 .90168 .10482

Private 276 2.2464 1.08082 .06506

Item7 Public 74 3.0946 .89395 .10392

Private 276 2.6920 1.03892 .06254

Item8 Public 74 2.8514 1.05574 .12273

Private 276 2.1667 1.05887 .06374

Item9 Public 74 3.1486 .94626 .11000

Private 276 2.7572 1.06299 .06398

Item10 Public 74 2.8378 .95124 .11058

Private 276 2.2355 1.06462 .06408

Item11 Public 74 3.0541 .85835 .09978

Private 276 2.9928 .93027 .05600

Item12 Public 74 2.8649 .94106 .10940

Private 276 2.3587 1.08123 .06508

Item13 Public 74 2.6351 1.01461 .11795

Private 276 2.1232 1.05108 .06327

Item14 Public 74 3.2703 .70802 .08231

Private 276 2.4312 1.10485 .06650

Item15 Public 74 3.1081 .86907 .10103

Private 276 1.7790 .92543 .05570

Item16 Public 74 3.2027 .64063 .07447

Private 276 3.0000 .94580 .05693

Item17 Public 74 3.2162 .74522 .08663

Private 276 2.8370 1.00483 .06048

Item18 Public 74 2.7568 .99051 .11514

Private 276 2.6703 1.04620 .06297

Item19 Public 74 2.7297 1.06369 .12365

Private 276 2.6630 1.08152 .06510

Item20 Public 74 2.6081 1.03126 .11988

Private 276 2.8478 2.90430 .17482

80

Independent Samples Test

Levene's Test for

Equality of Variances t-test for Equality of Means

F Sig. T df Sig. (2-tailed)

Mean

Difference

Std. Error

Difference

95% Confidence Interval

of the Difference

Lower Upper Lower Upper Lower Upper Lower Upper Lower

Item1 Equal variances

assumed 8.187 .004 8.268 348 .000 1.13954 .13783 .86845 1.41063

Equal variances

not assumed 9.495 143.180 .000 1.13954 .12002 .90230 1.37678

Item2 Equal variances

assumed 1.644 .201 2.716 348 .007 .36839 .13565 .10160 .63518

Equal variances

not assumed 2.814 121.020 .006 .36839 .13091 .10922 .62756

Item3 Equal variances

assumed .151 .698 9.450 348 .000 1.21749 .12883 .96410 1.47088

Equal variances

not assumed 9.723 119.797 .000 1.21749 .12522 .96956 1.46542

Item4 Equal variances

assumed 16.726 .000 5.071 348 .000 .60165 .11865 .36828 .83501

Equal variances

not assumed 4.387 97.803 .000 .60165 .13713 .32951 .87378

Item5 Equal variances

assumed 58.766 .000 20.828 348 .000 2.13856 .10268 1.93662 2.34051

Equal variances

not assumed 31.706 280.716 .000 2.13856 .06745 2.00579 2.27133

Item6 Equal variances

assumed 12.046 .001 6.887 348 .000 .94281 .13690 .67355 1.21207

Equal variances

not assumed 7.642 134.768 .000 .94281 .12337 .69883 1.18680

Item7 Equal variances

assumed 10.163 .002 3.044 348 .003 .40257 .13225 .14246 .66267

Equal variances

not assumed 3.319 130.887 .001 .40257 .12128 .16263 .64250

Item8 Equal variances

assumed .194 .660 4.943 348 .000 .68468 .13853 .41223 .95714

Equal variances

not assumed 4.951 115.458 .000 .68468 .13829 .41077 .95860

Item9 Equal variances

assumed 5.677 .018 2.876 348 .004 .39140 .13609 .12374 .65906

Equal variances

not assumed 3.076 126.899 .003 .39140 .12726 .13958 .64322

Item10 Equal variances

assumed 8.017 .005 4.416 348 .000 .60233 .13639 .33408 .87058

Equal variances

not assumed 4.713 126.480 .000 .60233 .12781 .34942 .85525

Item11 Equal variances

assumed .118 .731 .511 348 .609 .06130 .11987 -.17445 .29705

Equal variances

not assumed .536 122.982 .593 .06130 .11442 -.16519 .28779

Item12 Equal variances

assumed 9.593 .002 3.671 348 .000 .50617 .13789 .23496 .77738

Equal variances

not assumed 3.976 129.512 .000 .50617 .12729 .25433 .75801

Item13 Equal variances

assumed .006 .941 3.748 348 .000 .51195 .13661 .24327 .78062

Equal variances

not assumed 3.825 118.450 .000 .51195 .13384 .24691 .77698

Item14 Equal variances

assumed 38.118 .000 6.197 348 .000 .83911 .13540 .57281 1.10541

Equal variances

not assumed 7.930 179.165 .000 .83911 .10582 .63030 1.04792

81

Item15 Equal variances

assumed 1.594 .208 11.110 348 .000 1.32912 .11964 1.09382 1.56442

Equal variances

not assumed 11.521 121.162 .000 1.32912 .11537 1.10073 1.55752

Item16 Equal variances

assumed 5.277 .022 1.739 348 .083 .20270 .11657 -.02657 .43198

Equal variances

not assumed 2.162 168.022 .032 .20270 .09374 .01764 .38776

Item17 Equal variances

assumed 12.987 .000 3.030 348 .003 .37926 .12518 .13306 .62546

Equal variances

not assumed 3.590 151.932 .000 .37926 .10566 .17052 .58800

Item18 Equal variances

assumed 1.492 .223 .638 348 .524 .08647 .13546 -.17995 .35289

Equal variances

not assumed .659 120.343 .511 .08647 .13124 -.17337 .34631

Item19 Equal variances

assumed .483 .488 .473 348 .637 .06669 .14109 -.21081 .34419

Equal variances

not assumed .477 116.697 .634 .06669 .13974 -.21007 .34344

Item20 Equal variances

assumed .169 .681 -.698 348 .486 -.23972 .34358 -.91548 .43604

Equal variances

not assumed -1.131 324.296 .259 -.23972 .21197 -.65674 .17730

82

T-Test [DataSet1] C:\Users\CHRIS\Documents\Ada for Nurse a nd Hospital.sav

Group Statistics

Hospital N Mean Std. Deviation Std. Error

Mean

ResearchQuestion1 Public 74 3.0649 .79112 .09197 Private 276 1.9717 .92932 .05594

Independent Samples Test

Levene's Test for

Equality of Variances t-test for Equality of Means

F Sig. T df

Sig. (2-

tailed)

Mean

Difference

Std. Error

Difference

95% Confidence

Interval of the

Difference

Lower Upper Lower Upper Lower Upper Lower Upper Lower

Research Question

1

Equal variances

assumed 4.019 .046 9.257 348 .000 1.09313 .11809 .86087 1.32538

Equal variances

not assumed 10.155 132.204 .000 1.09313 .10764 .88020 1.30605

T-Test

[DataSet1] C:\Users\CHRIS\Documents\Ada for Nurse a nd Hospital.sav

Group Statistics

Hospital N Mean Std. Deviation Std. Error

Mean

ResearchQuestion2 Public 74 3.0243 .91559 .10644 Private 276 2.4196 1.02835 .06190

Independent Samples Test

Levene's Test for

Equality of Variances t-test for Equality of Means

F Sig. T df

Sig. (2-

tailed)

Mean

Difference

Std. Error

Difference

95% Confidence

Interval of the

Difference

Lower Upper Lower Upper Lower Upper Lower Upper Lower

Research

Question

2

Equal variances

assumed 4.835 .029 4.593 348 .000 .60476 .13166 .34581 .86371

Equal variances

not assumed 4.912 126.879 .000 .60476 .12313 .36111 .84841

83

T-Test [DataSet1] C:\Users\CHRIS\Documents\Ada for Nurse a nd Hospital.sav

Group Statistics

Hospital N Mean Std. Deviation Std. Error

Mean

ResearchQuestion3 Public 74 2.9865 .83835 .09746 Private 276 2.3370 .97067 .05843

Independent Samples Test

Levene's Test for

Equality of

Variances t-test for Equality of Means

F Sig. T df

Sig. (2-

tailed)

Mean

Differen

ce

Std.

Error

Differen

ce

95% Confidence

Interval of the

Difference

Lower Upper Lower Upper Lower Upper Lower Upper Lower

Research

Question3

Equal

variances

assumed

6.323 .012 5.254 348 .000 .64953 .12364 .40636 .89270

Equal

variances not

assumed

5.716 130.434 .000 .64953 .11363 .42474 .87432

T-Test [DataSet1] C:\Users\CHRIS\Documents\Ada for Nurse a nd Hospital.sav

Group Statistics

Hospital N Mean Std. Deviation Std. Error

Mean

ResearchQuestion4 Public 74 2.9027 .85383 .09926 Private 276 2.8036 1.13425 .06827

Independent Samples Test

Levene's Test for Equality of Variances t-test for Equality of Means

F Sig. T df Sig. (2-tailed)

Mean Difference

Std. Error Difference

95% Confidence Interval of the

Difference

Lower Upper Lower Upper Lower Upper Lower Upper Lower

ResearchQuestion4

Equal variances assumed

3.289 .071 .700 348 .484 .09908 .14157 -.17937 .37753

Equal variances not assumed

.822 149.535 .412 .09908 .12047 -.13896 .33712

84