Job Satisfaction Among Saudi Nurses: Recruitment and Retention

Background and Problem Statement

Organizations in the public and private sectors rely for their success and performance on technical, financial, and human resources. Each resource plays an important role in implementing strategy and provides certain types of benefits. Human resources represent the most critical asset that organizations draw upon in their attempt to reach their objectives. It is therefore important to focus on employees' job satisfaction, as it is a key factor affecting productivity, costs, and organizational practices.

This area is of particular importance to the Saudi Arabian nursing field because of its direct implications for the quality of health care. It should represent a focal concern of governmental practices as well as those of hospital managers. Extensive research in the field provides important information on assessing Saudi Arabian nurses' job satisfaction and its impact on recruitment and retention, though findings across studies sometimes differ, pointing to the need for further substantiation.

In Saudi Arabia, nursing care is delivered mainly by expatriate nurses, who contribute approximately 70% of the nursing workforce in Ministry of Health hospitals — a figure that rises to 96% in the private sector (Almalki et al., 2011). Recently, however, the Saudi government has deployed efforts to retain nurses as part of a broader strategy to increase the proportion of Saudi nationals in the nursing profession. Every year, hundreds of Saudi nurses graduate from nursing schools and join the workforce in primary health care centers, secondary hospitals, and tertiary hospitals across the country. Yet meeting the demands of nursing care has remained a persistent challenge for the Saudi government. There is also evidence of high nursing job turnover among Saudi nurses (Gieter et al., 2011). Literature suggests that job dissatisfaction is one recurrent factor — among numerous others — contributing to the intention to leave the nursing profession, and it has been shown to negatively impact both recruitment and retention of Saudi nurses (Currie and Hill, 2012). In the Saudi context, relatively little has been revealed in the literature about this issue, which leaves substantial room to better understand the problem and suggest appropriate solutions.

This study assesses job satisfaction among Saudi nurses and its impact on recruitment and retention.

The study pursues three primary objectives:

1. To identify factors contributing to Saudi nurses' job dissatisfaction.

2. To assess nurses' satisfaction at an overall level and regarding different aspects of their work.

3. To develop strategies intended to enhance the number of Saudi nurses in the healthcare workforce and minimize the rate of Saudi nurse turnover.

1. Are Saudi nurses satisfied with their nursing career?

2. Does the level of job satisfaction indicate the intent to leave the nursing career among Saudi nurses?

The study aims to investigate job satisfaction levels among Saudi Arabian nurses in three hospitals. Although the research questions, hypotheses, and questionnaire are designed in accordance with previous research, the sample cannot be considered representative of the entire population of nurses in Saudi Arabia. Therefore, the study's limitations — determined by its sample size — mean it is best suited to reinforcing or challenging findings from existing studies and addressing less-studied issues that influence the relationship between nurses' job satisfaction and hospital managers' recruitment and retention practices.

The limited sample size does not allow for extrapolation at the national level. The study's significance lies in its attempt to investigate areas less addressed by previous research and to provide information for further national-level research on the impact of certain recruitment and retention practices on Saudi Arabian nurses' job satisfaction levels. In other words, the study intends to validate or invalidate certain hypotheses that can provide important information in analyzing how nurses' job satisfaction levels can be improved and how improvements can support efficient recruitment and retention processes.

Defining Job Satisfaction

Nursing turnover has been an ongoing concern to healthcare professionals over the past few decades. Researchers have made sincere efforts to uncover the factors underlying its persistence. One major consequence of sustained nursing turnover across all levels of healthcare is the global nursing shortage (Laureen et al., 2012; Sara et al., 2011). As nursing turnover refers to the actual physical departure from the nursing profession and/or healthcare organization, efforts have been made to investigate its predictors so that policymakers and administrators can develop evidence-based solutions. The intention to leave the nursing profession has been a major focus around which studies addressing nursing turnover have revolved.

In a cross-sectional descriptive study conducted at King Faisal University Hospital in Al Khobar, Saudi Arabia, Zaghloul et al. (2008) described staff nurses' job satisfaction in relation to their intention to leave. They identified reasons for staff nurses' intention to stay in nursing — in addition to salary — as hospital policies, yearly bonuses, fairness of performance appraisal, and opportunities for achievement recognition. In another cross-sectional study drawing on 1,636 registered nurses working in hospitals, Genevieve and Denis (2010) studied nurses' burnout through the lens of the balance between job demands (e.g., workload, work stress, and work–family interference) and available resources (e.g., support from colleagues and supervisors, recognition, competence, decision-making authority). They concluded that when job demands exceed accessible resources, nurses are more likely to consider leaving the profession.

Job satisfaction has been defined as an overall feeling about the job or as a related set of attitudes about various aspects or facets of the job (Hong Lu et al., 2012). It has been identified as a recurrent predictor of nurse intention to leave the profession (Sara et al., 2011). A recent systematic review by Hong Lu et al. (2012) emphasized the need for more research to better understand the many factors relating to the job satisfaction of hospital nurses. Among those factors, nursing working conditions emerged as a major area requiring improvement. Roelen et al. (2013) reported an association between higher rates of sickness absence and lower job satisfaction and highlighted the need for more robust instruments to measure nurse job satisfaction. Additionally, Judy (2010) explored the correlation between job satisfaction and workload — expressed in terms of increased feelings of workload stress — and recommended that hospital administrators take steps to reduce nurses' workload.

To understand job satisfaction, how it can be assessed, and its implications for personnel recruitment and retention, it is important to consider several influential definitions. Hoppock (1935) defines job satisfaction as the combination of psychological, physiological, and environmental factors that lead employees to consider themselves satisfied with their job. In other words, job satisfaction is affected by a series of internal and external factors.

Spector (1997) defines job satisfaction as employees' liking or disliking of different aspects of their jobs, such as the workplace environment, relationships with peers and superiors, pay scale, nature of work, and schedule. Under this approach, employees may be satisfied with some aspects of their job while being dissatisfied with others. Vroom (1964) offers another perspective, defining job satisfaction as affective orientations on the part of the individual toward the roles he or she is expected to play at work.

Davis et al. (1985) propose a theory that describes job satisfaction as the combination of positive and negative feelings employees express about their work. What this theory adds to others is an explicit focus on the relationship between job satisfaction and the degree to which employees' expectations are met by their job.

Kaliski (2007) develops a theory that treats job satisfaction as an intrinsic value, representing employees' sense of achievement. Although influenced by internal factors, job satisfaction is also acknowledged externally through recognition, pay scale, promotions, and similar rewards, and is considered to have a direct influence on productivity. Statt (2004) similarly associates job satisfaction with employees' level of contentment regarding the rewards they receive at work. Most definitions — including that advanced by Armstrong (2006) — focus on employees' positive and negative feelings toward different aspects of their job.

Each of these definitions can be applied to assessing Saudi Arabian nurses' job satisfaction. In this context, the research identifies the degree to which Saudi Arabian nurses rate their overall job satisfaction as well as satisfaction with specific aspects of their work. The general dimension provides an overall picture of how nurses feel about their job, while specific dimensions reveal areas where nurses are satisfied — indicating the organization is managing them appropriately — and areas where nurses are dissatisfied, allowing organizations to identify factors requiring improvement. The main areas expected to require attention are: the nature of nurses' work, compensation and benefits, attitudes toward superiors, relationships with coworkers, and promotion opportunities.

Job Satisfaction, Recruitment, and Retention

The importance of job satisfaction can be examined both in terms of its direct effects on employee productivity and in terms of organizational efforts to retain existing personnel and recruit new ones. Reduced levels of job satisfaction have been linked to lack of employee loyalty, increased absenteeism, reduced productivity, tardiness, strikes, high employee turnover, and negative workplace behavior. Organizations where employees report low job satisfaction face difficulties retaining key staff. Employees dissatisfied with their working conditions often leave in search of organizations perceived to offer more rewarding conditions. Job satisfaction therefore exerts a significant influence on employee retention.

The link between job satisfaction and employee loyalty has been documented by research including the study by Vanderberg and Lance (1992), in which 100 employees were monitored to determine how their job satisfaction levels influenced their loyalty to their employer. The research demonstrated that higher job satisfaction is reflected in higher employee loyalty.

The same study addressed the effects of low job satisfaction and observed that job satisfaction is inversely related to employee absenteeism: when job satisfaction is high, absenteeism is low, and vice versa. Specialists note, however, that increasing job satisfaction may not necessarily reduce absenteeism on its own, though low job satisfaction is considered a direct contributor to high absenteeism. This is a matter of concern for healthcare providers in Saudi Arabia, as nurses' absenteeism can generate significant problems — including elevated costs — for any healthcare organization.