Nurses job satisfaction identified by personal preferences and perceived saturation divergence: a comparative cross-sectional study in Czech hospitals between 2011 and 2021

As the first, our research presents the use of an original method for evaluating job satisfaction by identifying the divergence between preference and saturation of selected factors determining the job satisfaction of nurses in Czech hospitals. By comparing the obtained data, this method enables to compile a clear ranking of the most and least diverging factors.

The results of the study clearly show that salary (together with patient care) is at the top of personal preferences of HNs (see Figs. 1 and 2), but at the same time it is the least saturated factor (see Figs. 3 and 4). This fact is also confirmed by the authors of other studies, e.g. in Greece or in the USA (New Hampshire) [51, 52]. In our research, salary was a factor with the greatest divergency in both evaluated periods. It is interesting that this divergence did not change in Czech Republic, although there has been a significant increase in HNs’ salaries in monitored period.

The second most preferred factor was patient care, but, unlike salary, it was the most saturated factor. The salary and patient care are heterogeneous factors, with an exclusive position among other factors. From the point of view of Herzberg’s theory, it is one satisfactor (salary) and one motivator (patient care). An interesting perspective at the question of salary preference and the importance of patient care in relation to nurses’ job satisfaction is offered by Jezorska [53], who together with nurses’ job satisfaction also focused on the rate of burnout syndrome: the salary factor may seem to be a crucial factor, due to its prioritization of HNs and the perceived insufficient fulfilment, its insufficient saturation alone does not lead to emotional exhaustion. Her research showed connection between burnout syndrome and salary preference over the preference for motivators (such as patient care or team cooperation) that dominated nurses who did not show signs of burnout syndrome. Unlike the salary factor, the insufficient saturation of the factors climate at the workplace, working conditions, cooperation with co-workers or non-monetary recognition of work results has a fundamental influence on the occurrence of burnout syndrome. Non-monetary rewards of work or workplace climate have proven to be more effective in preventing burnout syndrome - than satisfaction with salary.

A similar insight into nurses’ satisfaction can be found in the paper of Roth [54] who dealt with factors that could help reduce nurse turnover in Germany. As in our research, in work of Roth, the satisfaction of nurses is viewed from a double perspective: what the nurses themselves expect from the profession (in Roth´ research, so-called pull factors) and what factors are saturated by employers (in Roth´ research, on the contrary, what factors are absent – so called push factors). In Roth´ research, salary is mentioned as a pull factor, i.e. a factor whose improvement could lead to a decrease in the turnover of nurses, or to decrease their dissatisfaction. Image, prestige of profession (in Roth´ research called professional pride) and recognition of nursing are perceived by German nurses as very important. The research shows that in Germany, unlike in the Czech Republic, the image of the nursing profession is at a low level. Perhaps that is why this issue is more important for German nurses than for Czech nurses, for whom the issue of image is not so important, although Czech society perceives the profession of nurse as the third most prestigious profession. For German nurses, the salary factor itself is closely related to the image and prestige of the nursing profession as such, rather than to the financial income, which may be due, among other things, to the higher standard of living in Germany compared to the Czech Republic.

As for the prestige factor, there has been a significant shift to highly saturated factors between 2011 and 2021. The placement of the nurse profession in third place in the ranking of the most prestigious professions in the Czech Republic from the point of view of the general public [32] could be the reason of this shift. Unfortunately, prestige is a factor that occupies lower ranks in terms of personal preferences of HNs and thus does not have a significant effect on their job satisfaction.

On the contrary, internal relations with other professions as physicians, paramedical staff, etc., occur between the preferred and at the same time saturated factors in both examined periods. As confirmed by the divergence graph, internal relations with other professions are one of the factors that contribute to job satisfaction of nurses. A similar conclusion reached, among others, Zangaro and Soeken [55]. A slight shift over the last ten years can also be seen in internal relations with co-workers. According to research, this factor is perceived by nurses in 2021 as less saturated than it was ten years ago, while a higher degree of preference remains. This increases the divergence of this factor. This shift could have been influenced by the covid situation and the related workload at selected workplaces [56] as well as the significant aging of nurses and their general shortage in the Czech Republic, as mentioned in the Introduction.

The placement of the nurse profession in third place in the ranking of the most prestigious professions in the Czech Republic from the point of view of the general public affected the HNs’ saturation ladder, within which the prestige factor shifted to highly saturated factors. Unfortunately, this is a factor that occupies lower ranks in terms of personal preferences of HNs and thus does not have a significant effect on their job satisfaction. On the contrary, internal relations with other professions as physicians, paramedical staff, etc. (InRe_OP), occur between the preferred and at the same time saturated factors in both examined periods. As confirmed by the divergence graph, internal relations with other professions are one of the factors that contribute to job satisfaction of nurses. Zangaro and Soeken, among others, reached a similar conclusion [55]. A slight shift over the last ten years can also be seen in internal relations with co-workers (InRe_PE). According to research, this factor is perceived by nurses in 2021 as less saturated than it was ten years ago, while a higher degree of preference remains. This increases the divergence of this factor. The question remains whether this shift could have been influenced by the COVID-19 situation and the related workload at selected workplaces [56]. Among the least saturated factors, recognition by the direct superior (Recognition_PS) appears in both periods. The importance of praise and recognition is also emphasized by Ivanova [34] who states that the most important for nurses is praise from the patient or their family, followed by the recognition from those who professionally understand their work. A number of studies confirm the irreplaceable role of management in the process of setting conditions that lead to improved job satisfaction of nurses [45, 57, 58]. It is therefore one of the challenges for management to direct their measures to increase the saturation of those factors that occupy higher ranks in the preferential ranking of HNs.

If we distinguish between intrinsic and extrinsic motivation when looking at motivational factors, then theoretical and practical works agree that extrinsic motivational factors are not as effective as intrinsic factors [38, 59‐61]. But our research shows the opposite: the most important factors from the point of view of HNs are salary and relationships at the workplace. This may be due to the already mentioned long-term salary undervaluation of the nursing profession (the situation has only changed in recent years) and also the still persistent perception of nurses by doctors as a less valuable member of the team. Here, however, we are already encountering the limits of quantitative research, within which reality can be reduced. Undoubtedly, this is an interesting stimulus for further research using the methodology of qualitative research, which would focus on international comparisons and find out the causes of the mentioned discrepancy.

Limitations of the study relate to the possibility of comparison with other research. Researchers often use different methods of data evaluation or techniques, information collection or different instruments to measure job satisfaction. This diversity of instruments used means a problem in comparing the findings of research studies. International comparison of the results of studies that use standardized questionnaires also appears to be difficult, as the cultural or political background of the countries where the research is conducted is different. As another limitation of the work may appear different size of the sample of respondents in the monitored years. Nevertheless, the results are valid at a comparable level of significance. The research set in 2011 was considerably oversized due to the size of the base set. Besides that, the composition of both samples reflects the composition of the basic population of HNs in given years and therefore it can be considered sufficiently representative. A certain limitation of the research could be the specific work environment during the COVID-19 pandemic. This fact must be considered when interpreting the results of the comparison of both periods. Subsequent research comparing the job satisfaction of nurses in the post COVID-19 period appears to be another challenge. This opens up space for a future unique comparison of the situation before COVID-19, during the ongoing pandemic and the period after COVID-19.

The benefit of the present study is a twofold comparison of work process factors: first according to the personal preferences of the HNs and then according to the saturation factors provided by the employer (hospital), as the HNs subjectively perceive it. The EDM method was successfully tested to evaluate the obtained data. Its use is original in the context of other studies researching job satisfaction.