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Understanding the Mediating Role of Symptoms of Stress on the Perceived Access to Training and Job Satisfaction Relationship

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The purpose of this study is to examine the mediating role of symptoms of stress on the relationship between perceived access to training and job satisfaction. The changing nature of work (i.e. workplace and job complexity) has implications for stress and job satisfaction outcomes. Concerns about stress and job satisfaction levels and their link to performance have created interest in training interventions to improve the adequacy of knowledge and skills. A cross-sectional questionnaire survey of 1396 nurses was collected from three large teaching hospitals. The positive relationship between employees’ perceived access to training and job satisfaction is increased by the partial mediation of symptoms of stress. Based on the evidence of this study, we recommend human resource personnel and managers focus on training as a factor enhancing job satisfaction and mitigating stress.
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Perceived Access to Training and Job Satisfaction Page 1 of 37
UNDERSTANDING THE MEDIATING ROLE OF SYMPTOMS OF STRESS ON
THE PERCEIVED ACCESS TO TRAINING AND JOB SATISFACTION
RELATIONSHIP
James Chowhan PhD a, Isik U. Zeytinoglu PhD b,
Margaret Denton PhD c, and Jennifer Plenderleith M.A. d
Working Paper
December 2013
a Adjunct Professor, DeGroote School of Business, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada, L8S
4M4, Canada, chowhan@mcmaster.ca, (Corresponding Author).
b Professor, DeGroote School of Business, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada, L8S 4M4,
Canada, zeytino@mcmaster.ca
c Professor, Department of Health, Aging & Society, Department of Sociology, and Gilbrea Centre for Studies in Aging, McMaster
University, 1280 Main Street West, Hamilton, Ontario, Canada, L8S 4M4, Canada, mdenton@mcmaster.ca
d Research Coordinator, Gilbrea Centre for Studies in Aging, McMaster University, 1280 Main Street West, Hamilton, Ontario,
Canada, L8S 4M4, Canada, jplend@mcmaster.ca
Acknowledgements
We thank research project team members, S. Davies and A. Higgins for their assistance at
various stages of this research.
Perceived Access to Training and Job Satisfaction Page 2 of 37
Understanding the Mediating Role of Symptoms of Stress
on the Perceived Access to Training and Job Satisfaction Relationship
Abstract
The purpose of this study is to examine the mediating role of symptoms of stress on the
relationship between perceived access to training and job satisfaction. The changing
nature of work (i.e. workplace and job complexity) has implications for stress and job
satisfaction outcomes. Concerns about stress and job satisfaction levels and their link to
performance have created interest in training interventions to improve the adequacy of
knowledge and skills. A cross-sectional questionnaire survey of 1396 nurses was
collected from three large teaching hospitals. The positive relationship between
employees’ perceived access to training and job satisfaction is increased by the partial
mediation of symptoms of stress. Based on the evidence of this study, we recommend
human resource personnel and managers focus on training as a factor enhancing job
satisfaction and mitigating stress.
Keywords: Perceived access to training, Job satisfaction, Symptoms of stress, Nurses
Perceived Access to Training and Job Satisfaction Page 3 of 37
Understanding the Mediating Role of Symptoms of Stress
on the Perceived Access to Training and Job Satisfaction Relationship
Introduction
The increasing pace of globalization and technological innovation are generally
leading to greater workplace and job complexity, and these are a source of stress for
employees (Cappelli et al., 1997, 2000). The negative effects of stress on employee
outcomes, such as reduced employee performance (i.e. reduced productivity and quality
of output) and lower job satisfaction have an established relationship (Jamal, 1985,
Tetrick and Larocco, 1987). However, the interventions that can be taken to mitigate the
potential harmful effects are less well established. Interventions, such as training, have
been suggested (Cooper and Cartwright, 1994, Schabracq and Cooper, 2000, Sullivan and
Bhagat, 1992), however, no study has comprehensively explored the path between
training, stress, and job satisfaction. Employers in their pursuit of improving their
workers’ job satisfaction levels often focus on levers within the workplace directly under
their control, we suggest that the provision of training is an important practice to
consider. Some studies have explored the relationship between training and job
satisfaction and found a positive relationship (Georgellis and Lange, 2007, Jones et al.,
2009, Schmidt, 2007). Nonetheless, the mediating factors affecting the training and job
satisfaction relationship are not entirely understood, and in particular, the role of stress as
a mediator.
When studying stress and job satisfaction, consideration of workplace context and
specific job context have been advocated for as a way to aid in a better understanding of
Perceived Access to Training and Job Satisfaction Page 4 of 37
the theoretical relationships (Fairbrother and Warn, 2003, Sparks and Cooper, 1999).
The current study adopts this suggestion by focusing on one particular occupation group--
nurses. Further, in addition to the human resource management and training and
development literatures, the current study draws on the nursing literature to support the
development of a conceptual framework that is more situation specific, both in terms of
the workplace and job contexts.
The importance of training in keeping nurses’ knowledge and skills up to date is
continuing to gaining awareness. In particular, the positive relationship between training
and improvements in patient care is explored in the following literature reviews (Griscti
and Jacono, 2006, Unruh, 2008, West et al., 2009). The link between training and
performance is particularly important in the field of health care where up-to-date clinical
procedures are essential for providing quality patient care (Chassin et al., 1998).
Recently, evidence has been found for a link between both professional development and
the availability of information provided to nurses and their satisfaction with the care
provided to patients (Roulin et al., 2012), and for a link between competency satisfaction
and job performance satisfaction (Tzeng, 2004).
Job satisfaction is important because of its positive and moderate association with
employee job performance (Judge et al., 2001). In the context of nurses, job satisfaction
is important because job performance includes patient care (Tzeng et al., 2002, Tzeng
and Ketefian, 2002). The need to maintain a high standard of care for patients creates
the potential for on-going stress because deficiencies in knowledge and skill due to a lack
of training can have serious consequences for patients (Ericsson, 2004, McKeon et al.,
2006, Paige, 2010). Adverse events for patients have been linked to increasing stress
Perceived Access to Training and Job Satisfaction Page 5 of 37
levels among health care workers (Day et al., 2009, Wrenn et al., 2010). Thus, it is
important to understand factors that can help mitigate stress and improve job satisfaction.
This relationship is important for nurses but it also applies generally for all employees;
however, research has tended to focus on higher stress occupations (Fairbrother and
Warn, 2003, Sparks and Cooper, 1999).
The effects of perceived access to training on job satisfaction and the possible
mediating effect of stress on this relationship has not been explored in the training and
development, human resource management, or nursing literatures. The objective of this
study is to examine the association between employees' perceived access to training and
job satisfaction, and whether or not stress mediates the perceived access to training and
job satisfaction relationship.
This topic is important for both managers and human resource managers because
training enables employees to maintain and enhance their knowledge and skills within a
workplace that is becoming increasingly complex. This is particularly the case in the
nursing profession; thus, training is imperative for nurses to adequately perform the tasks
of their jobs. Nurses deal with sick and potentially vulnerable individuals who need care,
and the patients look upon nurses to receive the good quality care they need. Nurses
know that the knowledge they gain through training is essential for patient care and any
deficiencies in their training may have serious consequences for patients' health. Thus, a
perceived lack of access to training can affect their stress levels contributing to lowered
job satisfaction. Exploring these relationships within the situational-context of the nursing
occupation contributes to knowledge by identifying the nuances of these relationships
within a particular workplace and job specific context. Findings from our study can assist
Perceived Access to Training and Job Satisfaction Page 6 of 37
managers and human resource managers by informing and contributing to human
resource policy development in organizations. Findings can also inform decision-makers
at national and intergovernmental organizations on the importance of access to training
for employees’ stress and job satisfaction. More generally, the findings can inform the
decisions of managers whose employees operate in similar situational contexts and
environments as nurses and that may have similar stress levels.
Conceptual model
Job satisfaction is often thought of as an attitudinal concept that captures how
people feel about their job and aspects of their job (Spector, 1997). Spector identifies
workload, job control, perspective of roles, job stress, pay, work schedules, and support
as common job characteristic and environmental factors that affect job satisfaction.
Many of these factors are among the most frequently identified factors associated with
nurses’ job satisfaction, including stress, supervisor and co-worker support, and control
over their job (Blegen, 1993). Recent studies focusing on nurses' job satisfaction have
included many additional factors (i.e. workload, shifts and scheduling, job demands,
professional training, and remuneration) that have contributed to greater understanding of
the key relationships (Lu et al., 2012, Meeusen et al., 2011, Zeytinoglu et al., 2007).
The present study builds on this growing literature by developing a conceptual
model for understanding the relationship between perceived access to training, symptoms
of stress, and job satisfaction--with symptoms of stress examined as a mediator. Further,
we include the key antecedents of job satisfaction identified in the human resource
management and nursing literatures to allow for alternate explanations in the analyses.
Perceived Access to Training and Job Satisfaction Page 7 of 37
We suggest that training is essential for employees, and in particular nurses, to
adequately perform their duties. As a regular part of their tasks and work, nurses care for
individuals, by providing services that range from health promotion to caring for those
with illness, disease, or disability. Families and patients expect good quality care from
nurses when they need it. Nurses know that the skills and expertise they acquire through
training is vital for patient care. The importance of training for performance is well
established in the human resource management literature (Dysvik and Kuvaas, 2008,
Jones et al., 2009, Salas and Cannon-Bowers, 2001). Further, nurses understand that any
gaps in their training may have grave consequences for patients. Thus, we argue that a
perceived lack of access to training can affect nurses' stress levels, and that higher stress
levels are contributors to lowered job satisfaction. The conceptual model of the
interrelationships between these factors is schematically presented in Figure 1. In the
remainder of this section some key concepts are defined, then support from the literature
for each of the key relationships are presented.
<Insert Figure 1 about here>
Definitions
We focus on the concept of perceived access to training because unlike traditional
conceptualizations of training in the human resource literature--that focus on objective
measures of incident (whether training was received) or intensity (number of courses,
number of hours, number of days of training, or number of years (Cooke et al., 2011,
Georgellis and Lange, 2007, Jones et al., 2009, Trevor, 2001), for example)--the
Perceived Access to Training and Job Satisfaction Page 8 of 37
perceived access to training scale measures perceived employer-support and employee
need for training and avoids implicitly assuming these exist because training was
observed. In one study that looks at perceived access to training, Bartlett (2001, 339)
identifies two main elements: 1) employees' belief that they have access to needed job-
related knowledge and skills training, and 2) employees' perception that there are limited
organizational constraints on employee participation in training. We contribute to the
training and development sub-field of the human resource management literature by
adopting Bartlett's definition and these two elements for our study. Further, we argue that
these are critical elements of training that have not been addressed sufficiently in earlier
studies.
Many studies, when investigating stress, do not clearly distinguish the dimensions
of stress. For the current study, we make a distinction between sources of stress and
types of stress (such as symptoms of stress) (Denton et al., 2002), and focus on symptoms
of stress conceptually and empirically (definitions for the main variables of interest are
discussed in more detail in the methods section below). Thus, in the current study, the
focus is not on job stressors (i.e. an event or workplace condition that requires an
adaptive response, such as workload, job control, job insecurity, pay, and work
schedules--although we control for these relevant variables in the analysis), but on the
response to stressors (i.e. job strain) and specifically physical and psychological
reactions, which we refer to as symptoms of stress (Denton et al., 2002, Fairbrother and
Warn, 2003, Jex and Bliese, 1999, Spector, 1997).
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Key relationships
The empirical relationship between objective measures of training and job
satisfaction shows that employer-sponsored training has a significant positive relationship
with job satisfaction (Georgellis and Lange, 2007, Jones et al., 2009). This relationship is
not only robust in the human resource management literature, which tends to use national
samples in these types of analyses, but it persists in the nursing literature (Chen et al.,
2007, Ramirez et al., 1996). There is one study in the human resource development
literature, that the authors are aware of, that finds a positive significant correlation
between perceived access to training and job satisfaction (Bartlett, 2001); however, this
relationship was not explored in a multivariate analyses. A related vein of human
resource training and development literature looks at perceived access to training's
positive effect on employee outcomes including commitment, intrinsic motivation, task
performance, organizational citizenship, and turnover intention (Bartlett, 2001, Bulut and
Culha, 2010, Dysvik and Kuvaas, 2008). This literature suggests that employee beliefs
about the employment relationship and real or perceived entitlements contribute to
shaping reciprocal attitudes and behaviors; and that perceived access to training has
significant moderate positive correlations with employee outcomes (Bartlett, 2001, Bulut
and Culha, 2010, Dysvik and Kuvaas, 2008). These consistent findings across the
various measures of training, and in particular for perceived access to training, leads to
the expectation that perceived access to training will be positively associated with job
satisfaction. In our analyses below, we first establish this well-known association
between perceived access to training and job satisfaction before continuing with the test
for mediation.
Perceived Access to Training and Job Satisfaction Page 10 of 37
The beneficial effect of training on stress has received some attention over the last
two decades (Cooper and Cartwright, 1994). In particular, a decline in the emphasis by
employers on workplace learning and the availability of training opportunities puts
increasing stress on employees to “manage their own development and careers” (Cappelli
et al., 1997, 10). The shift away from an internal labour market focus has made it
increasingly difficult for employees to maintain skill levels (Cappelli et al., 1997).
Frameworks looking at occupational stress interventions have included career
development and training as an important intervention to build knowledge, skill, and
occupational competence (Cooper and Cartwright, 1994, Sullivan and Bhagat, 1992).
One study that the authors are aware of has looked at the perceived access to training and
stress relationship; specifically, Teo and Waters (2002) look at the relationship between
human resource practices (including the opportunity for training and development) on
both vocational strain and interpersonal strain. These authors found that, other than stress
management intervention practices, the opportunity for training was a main significant
and substantial contributor to reduce both vocational and interpersonal strain (Teo and
Waters, 2002, 219).
With regard to health care personnel, some studies identify a link between
insufficient or perceived inadequacy of training and stress (Graham et al., 1996, Ramirez
et al., 1996), and also highlight the need for training to mitigate these risks (Graham et
al., 1996). A meta-analysis by Ruotsalainen et al. (2008) looked at the effectiveness of
interventions on symptoms of stress and found that stress management interventions such
as developing knowledge and skills can have positive effects for nurses. These findings,
taken together, suggest that when training focuses on job knowledge and skills it has an
Perceived Access to Training and Job Satisfaction Page 11 of 37
integral role to play in helping to reduce stress levels. Applying this knowledge, we
argue that any gaps in knowledge and skills can affect perceived performance
contributing to employee stress, and when employees perceive they have access to
training that can assist them, in adequately performing their tasks they will be less
stressed. Similarly, but with respect to nurses, competency gaps can affect perceived
patient care contributing to nurses’ stress; however, we argue that when nurses perceive
they have access to training that enables them to adequately provide patient care, they
will be less stressed. In our study, we also establish the well-known association between
training and stress, focusing on perceived access to training and symptoms of stress.
The negative relationship between psychological and physical symptoms of stress
and job satisfaction has been robust in the human resource management literature (Jex
and Bliese, 1999, Judge et al., 2012, Sullivan and Bhagat, 1992); however, the
relationship is not always significant in all job and environmental contexts (Judge et al.,
2012, Siu and Cooper, 1998). Thus, the literature supports the negative relationship
between stress and job satisfaction, but it suggests an importance in investigating the
significance of the relationship across different job and workplace contexts. Different
occupations and environments may have salient features that potentially lead to differing
stressors and symptoms of stress outcomes (Fairbrother and Warn, 2003, Sparks and
Cooper, 1999).
Empirical research that focuses on nurses has also shown a significant negative
relationship between stress and job satisfaction (Lu et al., 2012, Ramirez et al., 1996,
Tetrick and Larocco, 1987). For example, Zeytinoglu et al. (2005) find that as symptoms
of stress increase job satisfaction decreases for nurses. Further, a study by Chen et al.
Perceived Access to Training and Job Satisfaction Page 12 of 37
(2007) looking at nurse specialists found that role stress accounted for the majority of the
variation in job satisfaction. It is important to note that Chen et al. (2007) also included
nurse specialist training in their analyses and found that training is a substantial positive
contributor to job satisfaction.
Considering the research on the relationship between training and stress
(discussed above) and stress and job satisfaction, the combination of these results suggest
that perceived access to training (i.e. belief that they have access to needed job-related
training and limited organizational restrictions on training participation) can diminish
symptoms of stress and that lower stress levels contribute to higher job satisfaction leads
to the following hypothesis:
Hypothesis 1: Symptoms of stress mediates the relationship between perceived access to
training and job satisfaction for nurses.
Method
Data and survey participant characteristics
The survey sample was drawn from three large teaching hospitals in Southern
Ontario. All nurses employed at the hospitals were included in the study target
population. After an initial pilot questionnaire was tested, the survey was sent by mail to
2,684 nurses in the participating hospitals. The total response rate was 52% (individual
hospital response rates ranged from 40 to 59%) with a final sample size of 1,396. This
response rate is consistent with the 50% median response rate found for nurses between
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1996 to 2005 (Cook et al., 2009). The survey was conducted between April 2002 and
July 2002. For key demographic characteristics, such as age, gender, and occupation (i.e.
percentage of registered nurses and registered practical nurses), our data are substantially
similar to comparisons between 2003 and 2012 for Ontario
(College of Nurses of Ontario, 2012).
Variables and measurement
Mean and standard deviation estimates are presented in Table 1 for all variables
included in the path analysis regressions (and ranges are provided for all scale variables),
these variables are discussed below. Correlation estimates are presented in Table 2 for
only the scale variables. All items for all scales were measured on a five point Likert
scale; for example, 1=strongly disagree, 2=disagree, 3=neither agree nor disagree, 4=
agree, and 5=strongly agree. For the measurement model underlying Figure 1,
confirmatory factor analysis was conducted using all of the items for the scales used in
the path analysis. All factor loadings were significant (p < 0.01) and the model exhibited
an acceptable fit, detailed results are available upon request from the first author. With
regard to scale reliability Cronbach’s alphas are presented below (see Table 2). Further,
to test for common method variance (CMV) we added a first-order factor to the
measurement model underlying Figure 1this is equivalent to the single-method-factor
approach (Podsakoff et al., 2003). For the CMV latent factor, none of the factor loadings
for all items (for all scales included in the model) were significant. This is an indication
that CMV is not likely a concern (additional details are available upon request).
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Job Satisfaction. Spector's 1985 Job Satisfaction Survey (JSS) (Spector, 1997,
75-76) was adapted for the dependent variable job satisfaction measure. The questions
assess nine facets of job satisfaction including pay, benefits, contingent rewards,
promotion opportunities, immediate supervisor, rules and procedures, co-workers, type of
work, and communication within the organization. The overall job satisfaction scale
includes all 36 items summed. The overall job satisfaction scale had a Cronbach's alpha
of .89 indicating a high reliability (and mean = 110.3, standard deviation = 15.3, and a
range from 36 to 180 indicating a moderate level of satisfaction).
Perceived access to training. Perceived access to training was measured with
items developed by Zeytinoglu, Denton, Davies, Higgins, Blythe, and Baumann (2002).
Exploratory factor analysis, using an iterated principal factors extraction method, resulted
in one single factor being revealed that consists of eight items. The variance of the factor
(i.e. eigenvalue) was 2.64 with the next highest factor’s eigenvalue being 0.53. The
single factor accounted for 86% of the variance. The items used are as follows: "a) my
schedule prevents me from taking courses/furthering my education, b) access to
education varies across units in this hospital, c) support for education is subject to
favouritism, d) support for education is inequitable, f) there is a lack of funding for
education in my unit, g) there is a lack of funding for education in this hospital, h) there is
not sufficient training for new technologies and procedures, and i) I don’t feel I am
adequately trained in some technologies and procedures" (Zeytinoglu et al., 2002, 20).
These items all had acceptably high factor loadings. The item “e) I would like to further
my education” is not included because of its low communality below a 0.2 threshold in
the exploratory factor analysis. A low communality implies the item does not
Perceived Access to Training and Job Satisfaction Page 15 of 37
substantially contribute to explaining the variability of the factor and as such the item is
dropped. The perceived access to training scale can be described as a measure of an
employees` perception of employer-support and employee need for training. The
retrospective nature of this variable also provides some support for its use in a mediation
model. The perceived access to training scale has a Cronbach's alpha of .77 indicating an
adequate internal consistency reliability, and the mean was 22.0 (std. dev. = 4.7 and range
8 to 40) indicating moderate feelings with regard to levels of training access.
Symptoms of stress. Stress measures vary from focusing on sources of stress
(stressors such as work intensification, workload, feeling overloaded, dealing with
suffering, having managerial responsibilities, and feeling poorly managed and resourced)
(Graham et al., 1996, Muhonen and Torkelson, 2004, Zeytinoglu et al., 2007), role stress
(including dimensions such as role conflict, ambiguity, overload, incompetence, over-
qualification, and incongruity) (Chen et al., 2007, Tetrick and Larocco, 1987) to overall
measures of stress ("overall how stressful do you find your work?") (Grunfeld et al.,
2000, 169, Ramirez et al., 1996, 726). The present study focuses on symptoms of stress,
and we clearly delineate the dimensions of stress by separately measuring the dimensions
of sources and types of stress (i.e. we include workload, job control, and job insecurity in
the models, see details below).
The symptoms of stress scale is a 14-item symptom measure based on previous
work by Denton, Zeytinoglu, Webb, and Lian (2002). Many of the items used are similar
to other psychological and physical stress measures in the literature (Jex and Bliese,
1999). Items were used to collect reflections to each statement about how often they felt
in the past month: (1) exhausted at the end of the day, (2) headaches or migraines, (3)
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unable to sleep through the night, (4) felt like crying, (5) lack of energy on the job, (6)
burnt out, (7) felt like yelling at people, (8) felt like there is nothing more to give, (9)
difficulty concentrating, (10) angry, (11) helpless, (12) not in control of my life, (13)
irritable and tense, and (14) dizzy (Denton et al., 2002). Because these items are
retrospective over the past month their use in a cause and effect mediation model has
some support. The aggregate symptoms of stress scale had a Cronbach's alpha of .87
indicating high internal reliability and a mean of 32.4 (std. dev. = 7.9 and range from 14
to 70) indicating moderate levels of stress symptoms being felt by nurses.
Control variables. In addition to demographic variables, control variables
related to the employee's job and employment relationships have been included in the
analysis to account for alternative explanations of job satisfaction outcomes identified in
the literature (Armstrong-Stassen et al., 2001, Lu et al., 2012, Lu et al., 2005, Nabirye et
al., 2011). Six items measuring work demands were used to create a workload scale
(alpha = .85), see Denton, Zeytinoglu, Davies, and Lian for details (2002, 337). A seven
item job insecurity scale (alpha = .88) was adopted from Zeytinoglu et al. (2007, 210).
For brevity items from previously validated scales are not listed here and their source has
been referenced.
Exploratory factor analysis was used to develop a job control scale for inclusion
in the path analysis regression. A series of eight items covering job decision latitude and
discretion were included in the exploration, detailed output are available from the first
author upon request. The following five items, with communalities greater than 0.2 and
acceptable loadings, were used to derive the job control scale: "I have freedom to decide
how I do my job, I have a lot to say about what happens on the job, I am free from
Perceived Access to Training and Job Satisfaction Page 17 of 37
conflicting demands that others make, I have flexibility in scheduling my job activities,
and I have a voice in the organizational decisions that affect my work" (Zeytinoglu et al.,
2002, 13). The Cronbach’s alpha for the job control scale indicates an acceptable
reliability (alpha = .70). Workload and job control are included in the path analysis
regression to account for the long established relationship with symptoms of mental strain
(i.e. psychological strain including exhaustion and depression) and subsequent job
satisfaction (Karasek, 1979, Schmidt and Diestel, 2011, Tetrick and Larocco, 1987).
Finally, organizational support, supervisory support, and peer support were also
included (alphas equal to .74, .94, .80, respectively). Organizational support has six
items, supervisory support has six items and peer support has four items. These variables
are discussed in more detail in Zeytinoglu et al. (2007). Organizational, supervisory, and
peer support have been identified as having moderate positive correlations with job
satisfaction in the literature (Blegen, 1993, Utriainen and Kyngas, 2009).
Several variables measuring employment characteristics are included: type of
employment, nursing position, and importance of income. There were three types of
employment status measured full-time, part-time, and casual. Full-time employment
status is coded full-time (59%) equal to one and zero otherwise; and part-time (33%) and
casual employees (8%) are combined to comprise the reference group. The prefer
different employment status variable is coded as equal to one if nurses preferred a
different employment status than the one they are currently in and zero otherwise. Nurses
were asked to indicate their primary position in nursing at the hospital (options included
Staff Registered Practical Nurse (RPN), Instructor/Educator/Professor,
Office/Occupational Health Nurse, Staff Registered Nurse (RN), Manager/Assistant
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Manager, Clinical Nurse Specialist, Nurse Practitioner, and Other). The variable Staff RN
was coded as equal to one if the nurse’s primary position was as a Staff Registered Nurse
and zero otherwise--84% were Staff RNs. The tenure in occupation variable is the
number of years in the nursing profession. The average tenure was 18 years (SD = 10.3).
Age is not included in the analysis to avoid collinearity with tenure; however, the average
age is 42 years (SD = 9.5). Nurses were asked to rate the importance of income to the
family's economic well-being (income importance to family), 59% rated their income as
very important on the scale “1 = not at all important to 5 = very important”, very
important responses were coded as equal to one and all other responses were coded as
zero. Additional demographic control variables include gender (female), education, and
marital status. For the education variable, University degree (22%) is coded as equal to
one if the nurse had completed a Bachelor's degree, post-graduate degree MA, or PhD
and all other levels of education were coded as zero. Gender is coded as female equal to
one and male equal to zero. Most of the survey participants (96%) were female. With
regard to marital status, 72% were married or living with a partner, coded as equal to one
if the nurse was married or living with a partner and zero otherwise. Missing values were
imputed for all variables included in the analysis and as a result the final sample used in
the analysis was n=1396.
Statistical analysis
All scale variables were standardized (z-scores) for the path analysis regression,
with the exception of tenure in occupation measured in years, so that all multivariate
analysis generally uses only standardized continuous variables or binary variables.
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Standardizing scale variables aids in the interpretability of the output. For example, the
regression coefficients represent the amount the standardized dependent variable will
change in units of its own standard deviation with respect to a one standard deviation
change in the standardized independent variable. This is very useful because the results
can be understood in the context of the distribution of the variables of interest (i.e. units
of standard deviation). In contrast, unstandardized results are difficult to interpret given
scales’ ranges vary and no context for comparison across scales exists in unstandardized
measures for a one unit change.
Descriptive statistics, correlations, and path analysis regression (using maximum
likelihood) techniques were used to examine associations between variables. Stata 13
was used for all analyses. With regard to the path analysis regression, the equivalent of
Baron and Kenny’s (1986) three-stage regression analysis was used to test for mediation:
(1) the independent variable needs to affect the mediator when the mediator is regressed
on the independent variable (Model 1), (2) the independent variable needs to also affect
the dependent variable (Model 2), and (3) in a fully specified regression the mediator
needs to affect the dependent variable and the independent variable’s effect should be less
(Model 3), where “less”, in the case of strong mediation, implies a non-significant zero
parameter estimate (Baron and Kenny, 1986, Edwards and Lambert, 2007). This
technique for assessing mediation is used in the stress management literature (Miles and
Perrewe, 2011, Villanueva and Djurkovic, 2009). If all of the above models have
significant relationships then it can be said that the linkages of the mediational model
have been confirmed. Adjusted R-squared was used to show the additional variance
explained while moving toward the full mediation model. It is important to note that the
Perceived Access to Training and Job Satisfaction Page 20 of 37
mediation relationship being empirically tested is not causal, but rather the modelled
paths suggest associations. Our cross-section data do not enable a proper test of cause
and effect.
Results
Mean and standard deviation estimates for all variables used in the analyses are
presented in Table 1. For each of the scale variables, the Cronbach’s alpha reliability
estimate is above the commonly accepted 0.70 threshold, see Table 2. For the
correlations, all relationships are in the expected direction. It is important to note that the
correlation relationships necessary for mediation are present. The correlation between
perceived access to training and symptoms of stress is r = -0.31 (p<0.01). Further the
correlations between job satisfaction and symptoms of stress and job satisfaction and
perceived access to training are r = -0.49 (p<0.01) and r = 0.54 (p<0.01), respectively.
<Insert Tables 1 and 2 about here>
Table 3 presents the path analysis regression models for all the steps of the
mediation analysis. The continuous variable coefficients are in standard deviation units,
so a one standard deviation change, in for example Model 1's perceived access to training
variable decreases stress by .08 standard deviations. Presenting the results as
standardized coefficients aids the interpretation of the results for the continuous variables
because observed changes can be understood within the context of a variable’s
distribution. Model 1 presents the first step of the mediation test of perceived access to
Perceived Access to Training and Job Satisfaction Page 21 of 37
training on stress. Models 2 and 3 test the second and third steps of the mediation (i.e.
that perceived access to training is related to job satisfaction, and that symptoms of stress
is related to job satisfaction while the relationship with perceived access to training is
diminished). F-tests indicate that all models are significant at the 1% level of
significance. Further, the mediation models (2 to 3) show that a significant incremental
amount of variance is explained from the addition of the mediator variable symptoms of
stress--the adjusted R-squared increased about 2% from R2 = 0.638 (F = 164.8, p<0.001)
to R2 = 0.654 (F = 166.1, p<0.001).
<Insert Table 3 about here>
Model 2 shows strong support that perceived access to training positively affects
job satisfaction. Perceived access to training has one of the largest positive effects (B =
0.15, p < 0.001) preceded by organizational support (B = 0.23, p < 0.001) and
supervisory support (B = 0.28, p < 0.001), and staff RN (B = 0.23, p < 0.001). Tenure in
nursing occupation also had a substantive positive significant effect. For example, for
every one year increase in occupation tenure the job satisfaction coefficient increased by
.01 standard deviations (or .1 for every ten years). Workload and job insecurity have
significant negative effects on job satisfaction.
The analysis in Model 1 shows perceived access to training is significantly and
negatively related to symptoms of stress (B = -0.08, p < 0.01). Job control,
organizational support, peer support and occupational tenure also had significant negative
associations with symptoms of stress, whereas workload, job insecurity, having full-time
Perceived Access to Training and Job Satisfaction Page 22 of 37
employment, and preferring different employment status were all positively and
significantly related to symptoms of stress.
Model 3, shows the third stage in the mediation test, both the mediator symptoms
of stress (B = -0.15, p < 0.001) and the independent variable perceived access to training
(B = 0.14, p < 0.001) have substantial significant effects on job satisfaction. The positive
effect of perceived access to training is partially mediated by the negative effect of stress
in that the perceived access to training effect is smaller. Thus, there is support for
Hypothesis 1. Further, the indirect effect, the product of the effects of perceived access
to training on stress (path a, in model 1, B=-.08, p<0.01) and the effect of symptoms of
stress on job satisfaction (path b in model 3, B=-.15, p<0.01) is B = 0.012 and significant
at the 1% level. (Both the Sobel z-value test (z-value = a*b/SQRT(b2*sa2 + a2*sb2)) and
the Baron and Kenny (1986) modified Sobel test equation, which is equivalent to the
Aroian test (z-value = a*b/SQRT(b2*sa2 + a2*sb2 + sa2*sb2)) are used to calculate the
standard errors, where the z test statistics are 2.75 and 2.73, respectively, and where a and
b are path coefficients and sa and sb are their standard errors.) This indicates that
perceived access to training has a positive effect on job satisfaction via reduced
symptoms of stress--accounting for 8% of the total effect (i.e. 8% = 0.012/0.15, where the
total effect equals the direct plus the indirect effects, 0.14+0.012=0.15). The magnitude
of this mediation relationship can be described as relatively weak. This implies
symptoms of stress is not a dominant mediator, and that there may be multiple factors
mediating the perceived access to training and job satisfaction relationship.
Perceived Access to Training and Job Satisfaction Page 23 of 37
Discussion
The findings for mediation indicated that symptoms of stress is a mediator, though
weak, accounting for only 8% of the total relationship between perceived access to
training and job satisfaction. This suggests that most of the benefits from higher
perceived access to training on job satisfaction come from the direct association rather
than indirect relationship through symptoms of stress. The level of variance explained by
our models is at the higher end of the range of models looking at a similar set of variables
(Bartlett, 2001, Bulut and Culha, 2010, Engstrom et al., 2011, Lu et al., 2005).
We contribute to the literature by showing the partial mediating role of symptoms
of stress in the relationship between perceived access to training and job satisfaction,
while controlling for alternative explanations. Our findings extend previous studies that
only looked at components of the comprehensive model we present. In particular,
previous studies have found that training is negatively related to stress (Malihe, 2011,
Ruotsalainen et al., 2008) and perceived access to training is positively related to job
satisfaction (Bartlett, 2001, Chen et al., 2007, Gazioglu and Tansel, 2006); and symptoms
of stress is negatively associated with job satisfaction (Denton et al., 2002, Zeytinoglu et
al., 2005). Further, with regard to our conceptualizations of training and stress, we argue
that our emphasis on perceived access to training and symptoms of stress focus on
dimensions (of training and stress respectively) that have not been given adequate
attention in the human resource management literature. When studying stress, we believe
it is important to clearly delineate and separate the dimensions of stress being explored.
For training, we argue that the use of a measure of perceived access to training, which
Perceived Access to Training and Job Satisfaction Page 24 of 37
encompasses employer-support and employee need, includes two critical elements of
training that have not been addressed sufficiently in previous studies.
Similar to Teo and Waters' (2002) findings, our results suggest that among the
possible human resource practices employers can choose from, access to training and
development have an important role to play in contributing to employee outcomes. Thus,
in addition to being concerned with human resource practices that contribute to workload,
job control, job insecurity, and support for employees, managers need to be concerned
with the access of training and development for all workers. From a strategic human
resource management perspective, access to training can be seen as a workplace practice
that reduces stress and increases job satisfaction. Training opportunities enable
employees to adjust to changes, including not just the learning of tasks and skills in their
current job, but also learning that focuses on broadening the employee's view of the
organization (i.e. cross-training and development) (Traut et al., 2000, 348).
In the context of health personnel, our results suggest that hospital administrators
and nurse managers need to be concerned with nurses’ access to training and
development because it can reduce stress and increase job satisfaction. By prioritizing
and promoting access to training, nurse managers can attain training outcomes that
include nurses receiving appropriate training and development, and being able to
maintain and update their skills and knowledge. Training is one of the key levers
available to hospital administrators and nurse managers to improve upon the state of
current outcomes. Training opportunities enable nurses to adjust to changes in evidence-
based practice and clinical procedures. Thus, when nurses have the knowledge and skills
to be able to adequately perform the tasks of their jobs (i.e. dealing with sick patients in
Perceived Access to Training and Job Satisfaction Page 25 of 37
need of care), they are more likely to be able to provide a high level of patient care free
from deficiencies and lacking serious consequences for patients.
With regard to organization level effects, if the improvements in reduced
symptoms of stress and higher job satisfaction at the individual level can be generalized
to the unit or organization level then training may contribute to managing stress levels
and improving job satisfaction across the organization. In other words, in the context of
health personnel, hospital level outcomes can be improved through the demonstration of
(additional) hospital management support and enabling nurses to satisfy their training
needs. The benefits of training should not be overlooked or underappreciated.
Limitations and future research directions
The current study is not without limitations. With regard to generalizability, the
sample only focused on three large hospitals, so the degree to which the nurses in these
hospitals are representative of the nursing occupation, or the health care industry more
generally, impacts the generalizability of the results. Beyond nursing as an occupation,
Sparks and Cooper's (1999) finding of similar magnitude correlations between mental
and physical health and occupational stressors (such as workload, pay, hours of work,
control, support, and opportunities for personal development) across a variety of
occupations (from civil servants, manual workers, telecommunications engineers to
nursing staff) indicates that these findings may extent to other occupations.
The relationships found in the current study cannot be considered causal. The use
of data from a single time period (i.e. a cross-sectional research design and not a
Perceived Access to Training and Job Satisfaction Page 26 of 37
longitudinal design) implies the data will not be able to assess directional causality
between the identified relationships.
With regard to future research, a focus on other mediators is possible. Our results
indicate that addressing issues of workload and organizational support may be potential
alternative interventions. However, workload and organizational support may also be
potential mediators of the perceived access to training and job satisfaction relationship.
For example, workload is moderately correlated with perceived access to training.
Management’s support for training and addressing employees’ skill needs may be key
elements that enable employees to better manage the demands of their jobs. By creating
a better understanding of technologies and procedures, productivity efficiencies are more
likely to emerge leading to reduced workload demands. Thus, given the partial mediating
role of stress, a focus on other mediators of the training and job satisfaction relationship,
such as workload, may prove valuable. Further, given the partial mediation results
presented above, the evidence suggests that the role of training should be considered
additive to the possible actions that could be taken by managers.
Conclusion
Access to training is one way for managers to reduce employees’ stress and increase job
satisfaction--through skill maintenance and enrichment. These interventions also address
issues of skill gaps among employees and skill obsolescence, and the need for employees
to update or acquire new knowledge and skills to be effective at their tasks and duties.
These types of interventions are critical to indicating support for and access to training
that encourages job satisfaction. Understanding the utility or effectiveness of varying
Perceived Access to Training and Job Satisfaction Page 27 of 37
human resource practices and interventions on mitigating stress is critical for managers
with limited resources to devote to reducing or controlling the effects of stress.
Perceived Access to Training and Job Satisfaction Page 28 of 37
Figure 1. The conceptual model of the associations between perceived access to training,
symptoms of stress, and job satisfaction.
Perceived Access to Training and Job Satisfaction Page 29 of 37
TABLES
Table 1
Descriptive Statistics of All Variables:
Means (Standard Deviations) or Percentages a
Variables
Mean
Standard
Deviation
Dependent variable
Job satisfaction (range 36-180)
110.3
15.33
Independent variable
Perceived access to training (range 8-40)
22.0
4.74
Control variables
Workload (range 6-30)
20.6
4.44
Job control (range 5-25)
14.4
3.24
Job insecurity (range 7-35)
15.5
4.96
Organizational support (range 6-30)
16.5
3.83
Supervisory support (range 6-30)
19.1
5.55
Peer support (range 4-20)
15.5
2.49
Full-time employment (%)
59.2
Prefer different employment status (%)
21.1
Staff RN (%)
83.8
Tenure in occupation (years)
18.2
Income importance to family (%)
59.2
University (%)
22.1
Gender (female) (%)
96.3
Married or living with a partner (%)
71.5
Mediation variable
Symptoms of stress (range 14-70)
32.4
7.93
a n= 1396, the means and standard deviations are all reported in their original metric.
Perceived Access to Training and Job Satisfaction Page 30 of 37
Table 2
Reliability and Correlation Estimates of Scale Variables a
1
2
3
4
5
6
7
8
9
1
Job satisfaction
0.89
2
Perceived access to training
0.54
0.77
3
Symptoms of stress
-0.49
-0.31
0.87
4
Workload
-0.47
-0.27
0.41
0.85
5
Job control
0.52
0.34
-0.31
-0.30
0.70
6
Job insecurity
-0.20
-0.17
0.13
0.00
-0.07
0.88
7
Organizational support
0.65
0.58
-0.38
-0.32
0.52
-0.20
0.74
8
Supervisory support
0.60
0.39
-0.25
-0.18
0.42
-0.11
0.53
0.94
9
Peer support
0.31
0.18
-0.19
-0.14
0.25
-0.18
0.22
0.26
0.80
a n= 1396, the diagonal reports each scale's Cronbach's alpha to aid in the assessment of reliability (in italics). All
variables are continuous. Correlations whose absolute values are greater than .03 are significant at the 0.05 level (2-
tailed).
Perceived Access to Training and Job Satisfaction Page 31 of 37
Table 3
Perceived Access to Training and Control Factors Associated with Job Satisfaction, with
Symptoms of Stress as a Mediator a
Symptoms of
Stress
Job Satisfaction
Job Satisfaction with
stress included
Dependent Variable
B
S.E.
B
S.E.
B
S.E.
Constant
-0.19
0.152
-0.43
***
0.107
-0.46
***
0.105
Independent variable
Perceived access to training
-0.08
**
0.029
0.15
***
0.020
0.14
***
0.020
Control variables
Workload
0.29
***
0.025
-0.24
***
0.018
-0.19
***
0.018
Job control
-0.08
**
0.028
0.13
***
0.020
0.11
***
0.019
Job insecurity
0.07
**
0.024
-0.05
**
0.017
-0.04
*
0.017
Organizational support
-0.15
***
0.033
0.23
***
0.024
0.21
***
0.023
Supervisory support
-0.03
0.028
0.28
***
0.020
0.28
***
0.019
Peer support
-0.06
*
0.024
0.09
***
0.017
0.08
***
0.017
Full-time employment
0.18
***
0.049
-0.03
0.034
0.00
0.034
Prefer different employment status
0.15
**
0.057
-0.07
0.040
-0.05
0.039
Staff RN
-0.02
0.065
0.23
***
0.046
0.23
***
0.045
Tenure in occupation (years)
-0.01
***
0.002
0.01
***
0.002
0.01
***
0.002
Income importance to family
0.08
0.049
-0.06
0.035
-0.05
0.034
University
-0.01
0.056
0.01
0.039
0.01
0.039
Gender (female)
0.18
0.122
0.15
0.086
0.17
*
0.084
Married or living with a partner
-0.01
0.053
0.04
0.037
0.04
0.036
Mediation variable
Symptoms of Stress
--
--
--
--
-0.15
***
0.019
F
36.0
***
164.8
***
166.1
***
Adjusted R-Square
0.274
0.638
0.654
a n= 1396, standardized regression coefficients are presented for all continuous variables because the z-score standardized variables are used
in the analysis, except tenure in occupation.
* p < .05, ** p < .01, *** p < .001.
Perceived Access to Training and Job Satisfaction Page 32 of 37
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