Content uploaded by Syed Billah
Author content
All content in this area was uploaded by Syed Billah on Dec 11, 2020
Content may be subject to copyright.
Unique expatriate factors associated with job
dissatisfaction among nurses
S.M.B. Billah
1
PhD,N.Saquib
2
PhD,M.S.Zaghloul
3
MBBS,A.M.Rajab
3
MBBS,
S.M.T. Aljundi
3
MBBS,A.Almazrou
4
FRCPC &J.Saquib
1
PhD
1Assistant Professor, College of Medicine, Sulaiman Al Rajhi University, Bukayriah, Saudi Arabia, 2Associate Professor, College of Medicine, Sulaiman Al Rajhi
University, Bukayriah, Saudi Arabia, 3Research Fellow, College of Medicine, Sulaiman Al Rajhi University, Bukayriah, Saudi Arabia, 4Professor, College of
Medicine, Sulaiman Al Rajhi University, Bukayriah, Saudi Arabia
BILLAH S.M.B., SAQUIB N., ZAGHLOUL M.S., RAJAB A.M., ALJUNDI S.M.T., ALMAZROU A.& SAQUIB J.. (2020) Unique
expatriate factors associated with job dissatisfaction among nurses. Int. Nurs. Rev. 00,1–7
Aim: To assess whether expatriate-specific factors were associated with nurses’ overall job dissatisfaction after controlling for known factors.
Background: Current evidence about job dissatisfaction among nurses in Saudi Arabia is not specific to expatriate nurses. Specific
aspects such as job insecurity, fear of litigation, and language barriers have not been assessed in the context of job dissatisfaction.
Introduction: The majority of nurses in the Arab Gulf countries are expatriate. The motive for employment here is purely financial
because there is no path to permanent residency.
Methods: This was a cross-sectional electronic survey of 977 expatriate nurses in Al-Qassim, Saudi Arabia. The survey included
questions on demography, job dissatisfaction (overall and related to salary, workload, and teamwork), job characteristics, job duration
as an expatriate, communication issues with patients and doctors, fear of litigation, and job insecurity. We used a hierarchical logistic
regression to evaluate whether unique factors were associated with overall job dissatisfaction either as a group, or individually.
Results: The mean age of the nurses was 32 years, and 19% reported overall job dissatisfaction. The unique expatriate factors as a
group contributed significantly to the model. Job insecurity, patient communication problems, and shorter job duration were
significantly associated with higher overall job dissatisfaction.
Conclusions: Job insecurity, job duration, and patient communication were significant correlates of overall job dissatisfaction among
expatriate nurses.
Implications for nursing policy: A longer job contract and organizational initiatives to help new expatriate nurses acculturate will
likely decrease feelings of job insecurity and increase job satisfaction.
Keywords: Communication, Expatriate, Job Dissatisfaction, Job Insecurity, Nurses, Saudi Arabia
Background
Dissatisfaction with a job negatively affects employee perfor-
mance (Wang et al. 2017). This is consequential for nurses
because their performance makes a difference in the lives and
well-being of patients. Retention of quality nurses has posed a
problem in the healthcare sector of many countries due to
shortages of trained nurses and high job turnover (Halcomb
& Bird 2020). As a result, job satisfaction among nurses has
been a much-studied topic (Fernet et al. 2017). Factors such
as a better salary, a congenial work environment, a supportive
hospital system, good co-worker interaction, organizational
motivation, and professional and educational opportunities
have been found to promote job satisfaction (Ohman et al.
*Correspondence address: Syed Muhammad Baqui Billah, Research Unit, College
of Medicine, Sulaiman AlRajhi University, P.O. Box 777, Zip code 51941,
Bukayriah, Al-Qassim, Saudi Arabia; Tel: 00966538602502; Email: s.bil-
lah@sr.edu.sa.
Funding: This work was supported by Qassim University (Buraydah,
Saudi Arabia), represented by the Deanship of Scientific Research, [grant
number 1536-med-2016-1-12-S] during the academic year 1437 AH/2016
AD. It had no role in the study design, the collection, analysis, interpreta-
tion of data, the writing of the report, or in the decision to submit the
article for publication.
Conflicts of interest: No conflict of interest has been declared by the
authors.
1
©2020 International Council of Nurses
Original Article
2017). On the other hand, low autonomy, long working
hours, heavy workloads, and a lack of support from peers or
supervisors were found to be associated with job dissatisfac-
tion (Han et al. 2015).
An understanding of these factors comes from studies of
nurses working in their home countries. It is likely that expa-
triate nurses face an additional set of challenges associated
with the immigration process, including longing for their
home country, family, friends, and relatives, difficulty in ori-
enting to the host culture, communication barriers due to
language differences, facing discrimination and marginaliza-
tion in some cases, and lack of opportunities for professional
development (Pung & Goh 2017; Wang & Jing 2018). Nurses
who report more of these challenges also report lower job sat-
isfaction (Pung et al. 2017).
The majority of nurses in the Arab Gulf countries are expa-
triate; for example, they constitute 63% of all registered
nurses in Saudi Arabia (Alghamdi et al. 2018). Unlike some
other regions of the world (e.g., Europe and North America),
where nurses migrate for a whole host of reasons, the impetus
for expatriate nurses to seek employment in the Gulf region
is purely financial as there is no path to permanent residency.
Nurses may intend to work in Saudi Arabia for various
lengths of time, but the duration of the job contract is always
one year, which may cause a feeling of job insecurity. Addi-
tionally, though the risk of litigation is ever present for all
healthcare workers, for expatriate nurses in the Gulf region,
litigation has additional consequences. Besides expensive fines
for negligence, they are not allowed to leave the country until
the end of a legal dispute.
The work environment in the Saudi health sector is multi-
national; the diverse physicians and nurses have differing lan-
guages, cultures, and professional training, which makes
teamwork more challenging and complex. Existent studies
from Saudi Arabia have shown that factors such as work
environment, salary, teamwork, fringe benefits, and commu-
nication skills affect job satisfaction (Ibrahim et al. 2016),
which mirrors findings from other countries. However, these
studies do not give a comprehensive picture of the factors
associated with job dissatisfaction among expatriate nurses
because they were conducted at a single institution, had small
sample sizes, or had unstratified (native vs. expatriate) data.
They also do not identify the factors that are amenable to
solutions by hospital and nursing administrators.
With these limitations in mind, we conducted a cross-sec-
tional survey among the expatriate nurses working in the gov-
ernmental hospitals and primary healthcare centers across the
Al-Qassim province of Saudi Arabia. We assessed their overall
job satisfaction along with their satisfaction with salary, work-
load, and teamwork. In addition, we collected information on
factors that may be unique to expatriate nurses and might
well be associated with their overall job satisfaction, such as
job duration as an expatriate, communication problems with
Arabic-speaking patients, difficulty in understanding tasks
from doctors, fear of litigation, and job insecurity.
We previously published findings from this survey on expa-
triate mental health (Saquib et al., 2019a; Saquib et al., 2019b;
Zaghloul et al. 2019). We showed that some of the aforemen-
tioned unique factors (e.g., job insecurity, fear of litigation)
were strong and independent correlates of the nurses’ mental
health (Saquib et al., 2019a). However, we did not test
whether these factors are associated with their job dissatisfac-
tion. Such associations, if present, have international implica-
tions as expatriate nurses elsewhere in the world may face
similar challenges.
The objectives of this current study were to assess whether
expatriate-specific factors, either as a group or individually,
were associated with overall job dissatisfaction after control-
ling for covariates. We hypothesized that these factors would
explain a portion of the variance of overall job dissatisfaction
among expatriate nurses above and beyond the known and
studied factors such as long working hours, night shifts, sal-
ary, and workload.
Methods
Research design
We used a cross-sectional study design to assess the overall
job dissatisfaction among the expatriate nurses and to identify
its significant correlates. We used the Strengthening the
Reporting of Observational studies in Epidemiology
(STROBE) checklist as a guideline.
Sample and setting
We collaborated with the General Directorate of the Ministry
of Health, Al-Qassim region for the study and collected data
between January and June of 2017. Hospital/primary health
center administrators sent all government nurses (2800) our
invitation to anonymously participate in the Google Forms
electronic survey. Being employed as a government nurse was
the only inclusion criteria. The response rate was 61.5%
(n=1078) after 17 refused to participate (opted ‘no’ to
informed consent). Sixty-two records had missing values on
key variables out of 1061 who gave informed consent and
filled out the survey. Out of the remaining 999, we excluded
22 Saudi nurses, leaving 977 expatriate nurses in the analysis.
©2020 International Council of Nurses
2 S. M. B. Billah et al.
Measurements
Outcome
With a single-item question, we asked the nurses to rate their
overall job satisfaction on a 5-point Likert scale (very dissatis-
fied, dissatisfied, uncertain, satisfied, and very satisfied). The
single item is valid and reliable based on evidence from individ-
ualaswellasmeta-analyticstudies (Cicolini et al. 2014; Dolbier
et al. 2005). Because the focus of this paper was to determine
correlates of overall job dissatisfaction and not its gradation
(i.e., very dissatisfied versus dissatisfied), we made the job dis-
satisfaction variable binary by combining very dissatisfied and
dissatisfied into ‘yes’ and the remaining options into ‘no’.
Covariates
We selected variables based on our literature review (Al-Har-
oon & Al-Qahtani 2020; Al-Takroni et al., 2016; Ibrahim
et al. 2016) and then grouped them into three blocks. The
first and second blocks included variables that were common
to nurses in general. First-block variables included age in
years, monthly income in Saudi Riyals (<5000 5000–7000,
and >7000), service type (outpatient, emergency, and in-pa-
tient), night shifts per month (none, 1–4, 5–8, and 9–13),
and average work hours per day (≤8, 9–10, ≥11). Second-
block variables included Likert scale ratings of satisfaction
with salary, workload, and teamwork. The responses were
made into binary variables using the same method as the
overall job dissatisfaction. We combined these three binary
variables into one summary variable that had three levels
(none, one, or two or more areas of dissatisfaction). The
third block had covariates unique to expatriate nurses: job
duration in Saudi Arabia (<5, 5–10, or >10 years), communi-
cation problems with Arabic-speaking patients (yes or no),
not understanding tasks from doctors (yes or no), fear of liti-
gation (yes or no), and job insecurity (yes or no). The latter
four variables were collected on a 4-point Likert scale (never,
sometimes, usually, and always), but we made them binary
(never and sometimes =‘no’; usually and always =‘yes’).
Ethical consideration
We conducted this study after obtaining approval from the
Qassim Ethics Research Committee (QERC), Saudi Arabia
(approval number 45-78-1240). We included an informed
consent in the survey link. Participation was entirely volun-
tary, and data confidentially was ensured.
Data analysis
For this analysis, we did not consider three variables. Age was
highly correlated with job duration in Saudi Arabia.
Therefore, we chose the latter as it is more relevant to the
research question. Gender was not evaluated as 99.6% of the
participants were women. Ethnicity was not related to the
overall job dissatisfaction.
We compared and contrasted overall job dissatisfaction
(yes or no) by the covariates. We tabulated the mean and
standard deviation for the continuous variable and the fre-
quencies for the categorical variables. We used a t-test for the
former and chi-square tests for the latter. We used a hierar-
chical logistic regression to assess whether the covariates that
were unique to expatriate nurses (third block) contributed to
the model variance beyond the variance explained by covari-
ates that were common to all nurses (first and second blocks).
We reported the chi-square value, degrees of freedom, and
the P-value for each step and the overall model. Additionally,
we reported the variance explained (Cox & Snell R
2
) by each
model. Since all three blocks of variables contributed signifi-
cantly to the model, we used them all for inclusion in the
final model. For the final model, we reported the odds ratios
(OR) as the measure of association along with their 95% con-
fidence interval and P-value. We analyzed the data in SPSS
(version 25) and used a 2-sided test with an alpha of 0.05. A
post hoc power analysis showed that our study had, respec-
tively, 97%, 83%, and 51% power to detect a prevalence odds
ratio of 2.0, 1.75, and 1.5 for job dissatisfaction, assuming a
95% two-sided confidence interval and a sample size of 977.
Results
The mean age of expatriate nurses was 32.1 years (standard
deviation 7.2, range 24–62); almost all were female (99.4%);
the majority were from India/Pakistan (60.3%), followed by
The Philippines/Indonesia (37.9%), and the remaining 1.8%
were from neighboring Arabic countries (e.g., Syria, Egypt,
and Yemen) (Data are not shown).
A total of 19.1% of the nurses reported overall job dissatisfac-
tion. The dissatisfied nurses were more likely to have reported a
low monthly salary (<5000 SAR, 53.5% vs. 39.5%), higher num-
ber (9–13) of night shifts per month (57.8% vs. 44.6%), longer
working hours per day (≥11, 19.3% vs. 14.2%), two or more
areas of dissatisfaction related to salary, workload, or teamwork
(65.2% vs. 11.8%), and shorter job duration (<5years)inSaudi
Arabia (67.9% vs. 49.0%) than nurses who did not report dissat-
isfaction with their job (P-values <0.05) (Table 1).
The dissatisfied nurses were also more likely to have
reported communications problems with patients (36.9% vs.
25.1%) and doctors (23.5% vs. 13.9%), fear of litigation
(24.6% vs. 17.0%), and job insecurity (37.4% vs. 15.7%) than
nurses who did not report dissatisfaction (P-values <0.05)
(Table 1).
©2020 International Council of Nurses
Expatriate nurse job dissatisfaction 3
The hierarchical model building showed that all three
blocks explained significant variance in the model of overall
job dissatisfaction (Table 2). Monthly salary, service type,
number of night shifts per month, and average daily working
hours, together (block 1), explained only 5% of the variance.
The inclusion of dissatisfaction with salary, workload, or
teamwork (block 2) more fully explained the variance (26%).
It was explained even further (29%) by the addition of job
duration in Saudi Arabia, communication problems with Ara-
bic patients, not understanding tasks from doctors, fear of lit-
igation, and job insecurity (block 3).
Of the covariates unique to expatriate nurses (block 3),
only job duration in Saudi Arabia and job insecurity had a
significant association, and communication problems with
Arabic patients had a borderline association with overall job
dissatisfaction after the model was controlled for both block 1
and block 2 variables. For example, those with a job duration
of <5 years were 3.3 times more likely to be dissatisfied with
their job compared to those with ≥10 years. Similarly, nurses
who were insecure about their job were 3 times more likely
to be dissatisfied than those who were not insecure (Table 3).
Table 1 Comparison of nurse characteristics by overall job dissatisfac-
tion among expatriate nurses in Al-Qassim, Saudi Arabia (n=977)
NOverall Job Dissatisfaction P-value
No
(n=790)
%
Yes
(n=187)
%
Age in years
<30 483 46.3 62.6 <0.001
30 40 340 36.2 28.9
>40 154 17.5 8.6
Monthly salary (Saudi Riyal)
<5000 412 39.5 53.5 <0.001
5000–7000 441 45.8 42.2
>7000 124 14.7 4.3
Service type
Outpatient 68 6.8 7.5 0.73
Emergency 222 22.3 24.6
Inpatient 681 70.9 67.9
# Night shifts per month
9–13 460 44.6 57.8 0.009
5–8 215 22.5 19.8
1–4 36 3.8 3.2
None 266 29.1 19.3
Average working hours per day
≥11 148 14.2 19.3 0.002
9–10 524 52.2 59.9
≤8 305 33.7 20.9
Dissatisfaction with salary, workload, or teamwork
Two or more 215 11.8 65.2 0.001
One 282 29.0 28.3
None 480 59.2 6.4
Job duration in Saudi Arabia (years)
<5 514 49.0 67.9 0.001
5–9 262 27.6 23.5
≥10 (ref) 201 23.4 8.6
Communication problem with Arabic patients
Yes 267 25.1 36.9 0.001
No (ref) 710 74.9 63.1
Not understanding tasks from doctors
Yes 154 13.9 23.5 0.001
No (ref) 823 86.1 76.5
Fear of litigation
Yes 180 17.0 24.6 0.015
No (ref) 797 83.0 75.4
Job insecurity
Yes 194 15.7 37.4 0.001
No (ref) 783 84.3 62.6
Table 2 Model building for the hierarchical logistic regression of job
dissatisfaction among expatriate nurses in Al-Qassim, Saudi Arabia
(n=977)
Model 1 Model 2 Model 3
Block 1:
Monthly salary
Service type
# Night shifts per month
Average working hours per day
v
2
=48.8
df =9
P<0.001
Block 2:
Dissatisfaction with salary,
workload, or teamwork
v
2
=246.9
df =2
P<0.001
Block 3:
Job duration in Saudi Arabia
(years)
Communication problem with
Arabic patients
Not understanding tasks from
doctors
Fear of litigation
Job insecurity
v
2
=42.8
df =6
P<0.001
Overall Model:
Chi-square (v
2
) 48.8 295.7 338.5
df 9 11 17
P-value <0.001 <0.001 <0.001
Cox & Snell R
2
0.05 0.26 0.29
©2020 International Council of Nurses
4 S. M. B. Billah et al.
Among the block 1 covariates, only service type remained
significant in the adjusted model. Nurses who worked in out-
patient departments were 3.4 times more likely to report job
dissatisfaction than those who worked in in-patient depart-
ments. Of all the covariates, dissatisfaction with salary, work-
load, or teamwork exhibited the strongest association with
overall job dissatisfaction. Nurses who were dissatisfied with
one area and two or more areas were 8 and 55 times more
likely, respectively, to report overall job dissatisfaction than
those with no area of dissatisfaction (Table S1).
Discussion
The salient findings of our study are 1) dissatisfaction with
salary, workload, or teamwork was the strongest correlate of
overall job dissatisfaction, and the likelihood of overall job
dissatisfaction increased incrementally across the number of
areas of dissatisfaction, 2) the unique expatriate factors as a
group contributed significantly to the model of overall job
dissatisfaction, and 3) specifically, job duration as an expatri-
ate, communication problems with patients, and job insecu-
rity were significantly associated with overall job
dissatisfaction.
The weak effect size, albeit significant, suggests that lan-
guage barriers may not be as large a problem for expatriate
nurses as we expected. One explanation is that expatriate
nurses receive language training at the beginning of their ser-
vice. Another potential explanation is that the hospital staff
overall do not use a single language exclusively but are choos-
ing the easiest language for each situation despite the fact that
English is the ‘official’ language of communication. For exam-
ple, an Indian nurse may speak in English with her Filipino
colleague and in Arabic with her patients. This fluidity in lan-
guage may explain the weak association between communica-
tion and overall job dissatisfaction. However, the importance
of effective communication cannot be overlooked as it may
impact other outcomes, such as patient care and safety (Meu-
ter et al. 2015).
Job insecurity, which is associated with temporary job con-
tracts (Balz 2017), also has a moderately strong association
with overall job dissatisfaction. This finding is in line with a
Korean study that showed those with higher job insecurity
have higher job dissatisfaction (Nam et al. 2016). In Saudi
Arabia, the expatriate job contracts are typically for one year,
and nurses are no exception. Although the job contracts usu-
ally get renewed annually, it is subject to job performance
evaluation and budgetary adjustments. It is reasonable for
expatriate nurses to feel vulnerable about their job security
given the short contract duration and given the recent gov-
ernment policies to encourage Saudi nationals to enter the
nursing profession.
Shorter job duration (<5 years) in Saudi Arabia was signifi-
cantly associated with more overall job dissatisfaction. Expa-
triate nurses struggle to adapt to the new environment,
culture, and norms in the initial years, which may result in
higher job dissatisfaction (Helbing et al. 2017). There is evi-
dence that novelty—challenges faced by an immigrant in the
early years of migration—is associated with higher job dissat-
isfaction (Pung et al. 2017). Some of the effect of the shorter
job duration may be due to the age of the expatriate nurses.
Age was excluded from the model because of its strong corre-
lation with job duration.
Our findings that the service type and dissatisfaction with
salary, teamwork, and workload were significantly associated
with overall job dissatisfaction confirm the findings of earlier
studies that identified them as significant correlates among
nurses (Al-Haroon & Al-Qahtani 2020; Al-Takroni et al.,
2016; Ibrahim et al. 2016; Lu et al. 2019). Having a greater
role in decision making, less team conflict, and more collabo-
ration was found to be associated with job satisfaction (Fleury
et al. 2017).
Limitations
Our study had several limitations. We did not collect data on
a few of the known correlates of job dissatisfaction, such as
Table 3 Adjusted logistic regression of job dissatisfaction among expa-
triate nurses in Al-Qassim, Saudi Arabia (n=977)
NOR 95% CI P-value
Job duration in Saudi Arabia (years)
<5 514 3.3 1.53, 7.08 0.002
5–9 262 2.1 1.00, 4.44 0.05
≥10 (ref) 201 1.0
Communication problem with Arabic patients
Yes 267 1.6 1.00, 2.46 0.05
No (ref) 710 1.0
Not understanding tasks from doctors
Yes 154 1.5 0.88, 2.45 0.14
No (ref) 823 1.0
Fear of litigation
Yes 180 0.6 0.37, 1.05 0.08
No (ref) 797 1.0
Job insecurity
Yes 194 3.1 1.89, 5.02 <0.001
No (ref) 783 1.0
Model adjusted for age, income, service type, # night shifts, avg. working
hours/day, and dissatisfaction summary score.
©2020 International Council of Nurses
Expatriate nurse job dissatisfaction 5
turnover intention, organizational commitment, and burnout,
which were identified in earlier studies (Fernet et al. 2017; De
Simone et al. 2018). The cross-sectional study design pre-
vented us from examining the temporality of the associations.
Our sampling strategy was non-random because the survey
was administered online, and participation was voluntary.
Also, the sample included nurses employed in governmental
hospitals/clinics only, not in the private hospitals/clinics.
Implications for nursing policy and management
Nurses are an integral part of the healthcare system. Their
viewpoints, professional challenges, and satisfaction in the
workplace should be considered when formulating healthcare
policies (Lewinski & Simmons 2018). Nurses are in a unique
position to manage and improve coordination across health-
care departments as well as propose new health policies
(Arabi et al. 2014). Improving nurses’ job satisfaction ulti-
mately increases quality of care, improves patient health, and
protects patient safety (Wang et al. 2017; Yilkal Fentie et al.
2018).
A few of our findings have international implications. The
fixed one-year expatriate job contract with no permanent
immigration potential in Gulf countries in general, and in
Saudi Arabia in particular, results in job insecurity and lower
job satisfaction for expatriate nurses. This finding is applica-
ble to any other country where similar conditions prevail.
Health ministries could consider linking expatriate nurses’ job
performance to the duration of their job contracts, meaning
those who perform well could be offered longer contracts
(e.g., 3 to 5 years instead of one year) (Balz 2017). This might
be a win–win for both parties. The institutions will likely
decrease their staff turnover without any added cost, and the
nurses will have more job security and satisfaction.
Apart from policy revision regarding job contracts, hospital
and nursing administrations in Saudi Arabia should pay par-
ticular attention to those nurses who are relatively new to the
country. Educating them on the host culture and providing
them with culture-specific tips to accommodate patients’
expectations might prove beneficial. Other initiatives that can
be undertaken at the organizational level to promote nurses’
job satisfaction include 1) stimulating a sense of ownership of
the organization among employees, 2) investing in the devel-
opment of employee competency, and 3) promoting working
collaborations between nurses and physicians (Galletta et al.
2016; Hariyati & Safril 2018; Tosun & Ulusoy 2017).
Acknowledgements
The authors thank Ms. Erin Strotheide for her editorial con-
tributions to this manuscript.
Author contributions
Study design: NS, JS
Data analysis: JS, NS
Study supervision: JS
Manuscript writing: NS, JS, SB, MZ, AR, SA, & AA
References
Alghamdi, M.G., Topp, R. & AlYami, M.S. (2018) The effect of gender
on transformational leadership and job satisfaction among Saudi
nurses. Journal of Advanced Nursing,74 (1), 119–127.
Al-Haroon, H.I. & Al-Qahtani, M.F. (2020) The demographic predictors
of job satisfaction among the nurses of a major public hospital in KSA.
Journal of Taibah University Medical Sciences,15 (1), 32–38.
Al-Takroni, H., Al-Hindi, A., Joshva, K. & Al-Harbi, A. (2016) Job satis-
faction among nurses in Al-Qassim hospitals and primary health care
centers, Saudi Arabia. International Journal of Advanced Nursing Stud-
ies,7(1), 34–38.
Arabi, A., Rafii, F., Cheraghi, M.A. & Ghiyasvandian, S. (2014) Nurses’
policy influence: a concept analysis. Iranian Journal of Nursing and
Midwifery Research,19 (3), 315–322.
Balz, A. (2017) Cross-national variations in the security gap: perceived
job insecurity among temporary and permanent employees and
employment protection legislation. European Sociological Review,33
(5), 675–692.
Cicolini, G., Comparcini, D. & Simonetti, V. (2014) Workplace empower-
ment and nurses’ job satisfaction: a systematic literature review. Journal
of Nursing Management,22 (7), 855–871.
Dolbier, C.L., et al. (2005) Reliability and validity of a single-item mea-
sure of job satisfaction. American Journal of Health Promotion,19 (3),
194–198.
Fernet, C., Trepanier, S.G., Demers, M. & Austin, S. (2017) Motiva-
tional pathways of occupational and organizational turnover intention
among newly registered nurses in Canada. Nursing Outlook,65 (4),
444–454.
Fleury, M.J., Grenier, G. & Bamvita, J.M. (2017) A comparative study
of job satisfaction among nurses, psychologists/psychotherapists and
social workers working in Quebec mental health teams. BMC Nursing,
16, 62.
Galletta, M., et al. (2016) The effect of nurse-physician collaboration on
job satisfaction, team commitment, and turnover intention in nurses.
Research in Nursing and Health,39 (5), 375–385.
Halcomb, E. & Bird, S. (2020) Job satisfaction and career intention of
Australian general practice nurses: a cross-sectional survey. Journal of
Nursing Scholarship,52 (3), 270–280.
Han, K., Trinkoff, A.M. & Gurses, A.P. (2015) Work-related factors, job
satisfaction and intent to leave the current job among United States
nurses. Journal of Clinical Nursing,24 (21–22), 3224–3232.
Hariyati, R.T.S. & Safril, S. (2018) The relationship between nurses’ job
satisfaction and continuing professional development. Enfermer
ıa
Cl
ınica,28 (Suppl. 1), 144–148.
©2020 International Council of Nurses
6 S. M. B. Billah et al.
Helbing, E., Teems, M. & Moultric, D. (2017) An investigation of job sat-
isfaction among nurses in the emergency department. The ABNF Journal,
Fall, pp 103–108.
Ibrahim, N.K., et al. (2016) Quality of life, job satisfaction and their
related factors among nurses working in King Abdulaziz University
Hospital, Jeddah, Saudi Arabia. Contemporary Nurse,52 (4), 486–
498.
Lewinski, A.A. & Simmons, L.A. (2018) Nurse knowledge and engage-
ment in health policy making: findings from a pilot study. Journal of
Continuing Education in Nursing,49 (9), 407–415.
Lu, H., Zhao, Y. & While, A. (2019) Job satisfaction among hospital
nurses: a literature review. International Journal of Nursing Studies,94,
21–31.
Meuter, R.F., et al. (2015) Overcoming language barriers in healthcare: a
protocol for investigating safe and effective communication when
patients or clinicians use a second language. BMC Health Services
Research,15, 371.
Nam, S.J., et al. (2016) Job stress and job satisfaction among health-care
workers of endoscopy units in Korea. Clinical Endoscopy,49 (3), 266–
272.
Ohman, A., Keisu, B.I. & Enberg, B. (2017) Team social cohesion, profes-
sionalism, and patient-centeredness: gendered care work, with special
reference to elderly care - a mixed methods study. BMC Health Services
Research,17 (1), 381.
Pung, L.X. & Goh, Y.S. (2017) Challenges faced by international nurses
when migrating: an integrative literature review. International Nursing
Review,64 (1), 146–165.
Pung, L.X., Shorey, S. & Goh, Y.S. (2017) Job satisfaction, demands of
immigration among international nursing staff working in the long-term
care setting: a cross-sectional study. Applied Nursing Research,36,42–49.
Saquib, J., et al. (2019) Job insecurity, fear of litigation, and mental
health among expatriate nurses. Archives of Environmental & Occupa-
tional Health,75 (3), 144–151.
Saquib, N., et al. (2019) Association of cumulative job dissatisfaction with
depression, anxiety, and stress among expatriate nurses in Saudi Ara-
bia. Journal of Nursing Management,27 (4), 740–748.
De Simone, S., Planta, A. & Cicotto, G. (2018) The role of job satisfac-
tion, work engagement, self-efficacy and agentic capacities on nurses’
turnover intention and patient satisfaction. Applied Nursing Research,
39, 130–140.
Tosun, N. & Ulusoy, H. (2017) The relationship of organizational com-
mitment, job satisfaction and burnout on physicians and nurses? Jour-
nal of Economics and Management,28 (2), 90–111.
Wang, H., et al. (2017) Job satisfaction among health-care staff in town-
ship health centers in rural China: results from a latent class analysis.
International Journal of Environmental Research and Public Health,14
(10), 1101.
Wang, Z. & Jing, X. (2018) Job satisfaction among immigrant workers: a
review of determinants. Social Indicators Research,139, 381–401.
Yilkal Fentie, D., Enyew Ashagrie, H. & Getinet Kasahun, H. (2018) Job
satisfaction and associated factors among anesthetists working in
Amhara National Regional State, Northwest Ethiopia, May 2017: a
multicenter cross-sectional study. Anesthesiology Research and Practice,
2018, 6489674.
Zaghloul, M.S., Saquib, J., AlMazrou, A. & Saquib, N. (2019) Mental
health status of expatriate nurses in northcentral Saudi Arabia. Journal
of Immigrant and Minority Health,21 (6), 1233–1240.
Supporting information
Additional Supporting Information may be found in the
online version of this article:
Table S1 Adjusted logistic regression of job dissatisfaction
among expatriate nurses in Al-Qassim, Saudi Arabia (n=977).
©2020 International Council of Nurses
Expatriate nurse job dissatisfaction 7