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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.
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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. 00,17
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 50007000,
and >7000), service type (outpatient, emergency, and in-pa-
tient), night shifts per month (none, 14, 58, and 913),
and average work hours per day (8, 910, 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, 510, 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 2462); 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 (913) 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
50007000 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
913 460 44.6 57.8 0.009
58 215 22.5 19.8
14 36 3.8 3.2
None 266 29.1 19.3
Average working hours per day
11 148 14.2 19.3 0.002
910 524 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
59 262 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 noveltychallenges faced by an immigrant in the
early years of migrationis 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
59 262 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 winwin 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
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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
... For instance, it was identified that many expatriate nurses initially come to Saudi Arabia even though the working and living conditions are poor, only to gain enough work experience, so that they can later move to the developed countries such as the US and the UK, where they can experience better work-life conditions (13). Therefore, there are various factors that affect both Saudi and non-Saudi nurses in relation to the quality of work-life and their satisfaction levels (14,15). ...
... The previous studies (18,19) have identified that work-related issues such as lack of managerial effort to improve the work environment of nurses, seeking perfectionism, support from the ward manager, salary, the relationship at work with other nurses, communication, relationship with team members, and the fairness of shift work between nurses can significantly affect the loyalty and job performance of nurses in Saudi Arabian hospitals. Communication between nurses and between nurses and patients plays an important role in improving the quality of work life, and communication issues were identified to be significantly correlated with the nurses' dissatisfaction (15). Lower satisfaction levels among the nurses may lead to decreased organization loyalty, while higher satisfaction levels may lead to increased job performance (16), whereas, improved job performance is positively correlated with organizational commitment (17). ...
... Third part of the questionnaire includes 18 items, measured on a 7-point Likert scale ((SD = 0) strongly disagree; (MD = 1) moderately disagree; (LD = 2) slightly disagree; (O = 3) neither disagree nor agree; (LA = 4) slightly agree; (MA = 5) moderately agree; (SA = 6) strongly agree) related to organizational commitment adapted from OCQ. These are further categorized into affective commitment (items 1-6), continuance commitment (items 7-12), and normative commitment (items [13][14][15][16][17][18]. ...
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Purpose The purpose of this study is to analyze the relationship between quality of work-life on the organizational loyalty and job performance in Saudi Arabia. Methods This study used a cross-sectional design for collecting the data related to the nurses' quality of work-life, organizational loyalty, and job performance from nursing staff in Saudi Arabian hospitals. Three questionnaires were used in this study, which includes Quality of Work Life Scale (QWLS), Organizational Commitment Questionnaire (OCQ), and Individual Work Performance Questionnaire (IWPQ). An online version of the survey questionnaire was generated using the Google survey, to which a link is generated for collecting data. At the end of the survey, 243 responses were received. After removing the incomplete responses, 209 responses were considered for the data analysis. The statistical techniques including t-tests and Pearson's correlation were used in the data analysis. Results Nurse managers reflected good quality of life, and high loyalty toward their employers, and also reflected good job performance levels. However, staff nurses reflected poor quality of work-life, organizational loyalty, and job performance. Training and development had strong positive correlation with continuance commitment (r = 0.628, p < 0.01). Job satisfaction and job security held strong positive correlation with task performance (r = 0.601, p < 0.01) and contextual performance (r = 0.601, p < 0.01). Conclusion Quality of work-life, organization loyalty, and job performance are positively correlated, and poor quality of work-life can negatively impact job performance and organizational loyalty of nurses.
... 14 Therefore, not only the barriers to the expatriates but also the job dissatisfaction and turnover are few other issues affecting the nursing sector in Saudi Arabia. 15,16 As a result, there is a need to realize and establish strong and effective leadership in the nursing sector in order to handle the challenges and issues and enabling organizational commitment and increasing retention rates, 17 for better managing challenges such as the Covid-19 pandemic. Various studies 15,18,19 have analyzed nursing retention and linked it with job dissatisfaction, intention to leave, cultural differences, etc., but there is considerably little research focusing on the impact of leadership styles on increasing organizational commitment and retention rates. ...
... Items 1-12 focus on transformational leadership styles, which are further categorized into idealized influence (items 1-3), inspirational motivation (items 4-6), intellectual simulation (items 7-9), and individual consideration (items 10-12). Items 13-18 are related to transactional leadership styles, which are categorized into contingent reward (items 13-15) and management by exception (items [16][17][18]. Items 19-21 are related to laissez-faire leadership style. The questionnaire (MLQ) was translated to Arabic, and a pilot study was conducted with 21 participants, achieving Cronbach's alpha of 0.76 indicating good internal reliability and consistency. ...
... 36 The third part of the questionnaire includes 18 questions, measured on a 7-point Likert scale ((SD = 0) strongly disagree; (MD = 1) moderately disagree; (LD = 2) slightly disagree; (O = 3) neither disagree nor agree; (LA = 4) slightly agree; (MA = 5) moderately agree; (SA = 6) strongly agree) related to organizational commitment adapted from OCQ. These are further categorized into affective commitment (items 1-6), continuance commitment (items 7-12), and normative commitment (items [13][14][15][16][17][18]. The questionnaire (OCQ) was translated to Arabic, and a pilot study was conducted with 21 participants, achieving Cronbach's alpha of 0.77 indicating good internal reliability and consistency. ...
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Purpose The purpose of this paper is to examine how nurse managers’ leadership styles, work engagement, and nurses’ organizational commitment are related in Saudi Arabia. Methods This study used a cross-sectional design using an online survey instrument targeted at nurse managers and nurses working in Saudi Arabian hospitals. Multi-factor leadership questionnaire (MLQ), organizational commitment questionnaire (OCQ), and Utrecht Work Engagement Scale (UWES) were used in the Questionnaire. The survey link is forwarded to HR administrators of 71 hospitals, which includes public, private, and public–private partnership hospitals. The survey link was active from 27th November 2021 to 18th December 2021, and at the end of the survey, 394 responses were received. After removing the incomplete responses, 390 participant responses are considered for data analysis. t-tests and correlation analysis are used to analyze the data. Results Among the participants, 84.4% of the participants were nurses and 15.6% were nurse managers. Significant difference (p < 0.05) of opinions is observed among nurse managers in relation to transformational and transactional leadership styles and engagement. Transformational and transactional leaderships are positively correlated with organizational commitment and nurses’ engagement. Conclusion Differences in leadership style perceptions among nurses and nurse managers reflected issues in nursing management, which have to be addressed in light of rapid infrastructural changes owing to Saudi vision 2030.
... Other than role conflict and role ambiguity, role overload and organizational constraints are additional job stressors that could provoke an employee's job dissatisfaction. Prior studies (Billah et al., 2021;Chiu et al., 2015;De Clercq et al., 2019;Penney & Spector, 2005) discovered that role overload and organizational constraints could induce employees' negative emotions because employees perceive threats in their surrounding conditions. At work, employees' completion of various tasks is mostly threatened by demanding work conditions such as an overload of duties and limited organizational resources. ...
... Consequently, university staff face growing workloads that become too difficult or too stressful to manage. Chou and Robert (2008) found that employees with heavy workloads experience low levels of job satisfaction, especially when they do not have enough resources to perform their jobs (Billah et al., 2021;Ferguson & Cheek, 2011;Liu et al., 2010;Okeke & Mtyuda, 2017;Zhang et al., 2020). The lack of resources in the university context refers to inadequate information, outdated tools, poor equipment, and unavailable support from colleagues that create challenges in completing one's job successfully. ...
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The employee behavior literature is very much dominated by studies on “good” or “positive” behaviors, but relatively little has been researched on the negative attitudes and behaviors of people within the workplace, in particular, job dissatisfaction and counterproductive work behavior (CWB). Therefore, the present study is intended to (1) investigate the influence of job stressors (i.e., role overload, role conflict, role ambiguity, and organizational constraints) on job dissatisfaction among university staff and (2) examine the influence of job dissatisfaction on university staff’s CWB. Data was gathered through 266 questionnaires and tested using partial least squares structural equation modeling. The results revealed that organizational constraints, role overload, and role ambiguity are significant stressors that increase job dissatisfaction, which in turn, increase CWB. Thus, the findings highlight the vital role of specific job stressors (i.e., role overload, role ambiguity, and organizational constraints) in causing job dissatisfaction and CWB among university staff. The findings contribute to the stressor-emotion model and Herzberg’s motivation-hygiene theory. Theoretical and practical implications are discussed.
... This finding concurred with an earlier local study which showed nurses who reported job dissatisfaction were more likely to have shorter job duration (<5 years) than nurses who did not report dissatisfaction with their job (67.9% vs. 49.0%, respectively) 32 . Also, the high percentage of moderate to high level of job satisfaction in this study could be because of the nurses' age. ...
... Also, the high percentage of moderate to high level of job satisfaction in this study could be because of the nurses' age. Studies have shown that nurse's age is associated with the level of job satisfaction, where most study respondents who were satisfied with their jobs, were in the older age range because people become older and more experienced, their expectations will reduce to practical and real-life levels; as a result, their expectations will be somehow achievable, which can lead to an increase in their job satisfaction [31][32][33] . ...
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Foreign nurses face many challenges at the workplace which may affect their level of job satisfaction. High job satisfaction can ensure the delivery of safe and high-quality health services, while low job satisfaction may result in poor work quality and increases the likelihood of the nurses leaving the service. Therefore, ensuring high level of job satisfaction of the foreign nurses is important, especially in countries which heavily rely on their services, such as Saudi Arabia. This study aimed to determine job satisfaction level among foreign nurses in public hospitals in Hail City, Saudi Arabia, and the contribution of intrinsic and extrinsic motivation factors to their job satisfaction level. A cross-sectional study was conducted among 196 foreign nurses in two large public hospitals in Hail City, Saudi Arabia. Data was collected using anonymous self-administered questionnaire. Descriptive and bivariate analysis were conducted. Most foreign nurses had moderate job satisfaction level. There is significant and positive relationship between three components of intrinsic motivation namely autonomy, mastery, and purpose, and three components of extrinsic motivation which were pay, promotion, and operating conditions, with job satisfaction level. Job satisfaction among foreign nurses in the public hospitals is still not optimal. It is imperative for nursing managers, hospitals directors, and policy makers to focus on the significant intrinsic and extrinsic motivation factors in formulating tailored actions to improve foreign nurses’ job satisfaction.
... Overall, in this study respondents were satisfied with their job and their career. Respondents were satisfied with certain aspects of their job, whereas a third reported feeling dissatisfied, particularly with salary, recognition and appreciation, and educational opportunities; this supports the results of a study carried out in South Africa prior to the pandemic [2][3][4] and internationally [61]. However, COVID-19 negatively correlated with job satisfaction, and also with the immediate supervision of managers. ...
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Background This study explored and described the impact of the COVID-19 pandemic on nurse outcomes in the private sector of South Africa. National research shows that nurses had poor nurse outcomes prior to the pandemic, amidst these issues the COVID-19 pandemic occurred, with nurses having to play a key role in the public health response. International studies have shown that although nurses were willing to serve in this manner, they experienced moderate to high burnout, anxiety, depression, fear and exhaustion. However, this topic has received comparatively little attention in African countries. Methods A cross-sectional survey design was conducted. Multistage sampling was applied in selection of provinces, hospital groups, hospitals, units, and nursing personnel. Valid and reliable tools were used to measure nurse outcomes. Data was collected from April 2021 until January 2022. Results Nurses described having high levels of compassion satisfaction, moderate levels of compassion fatigue, and high levels of burnout. Nurses appeared satisfied with their job and career. Almost a quarter of nurses reported the intention to leave their job, and of those about a fifth indicated that they intended to leave the profession. The nurses who routinely cared for COVID-19 patients had a small statistically significant increase in compassion fatigue, compassion satisfaction, emotional exhaustion and, job turnover intention, and a small statistically significant decrease in job satisfaction. Increased exposure to death and dying showed small correlations with emotional exhaustion and career turnover intentions. Conclusion The results of this study show that nurses were impacted by COVID-19 and death and dying during the pandemic, and that follow-up studies are needed post-pandemic. Implications of study It is important that burnout and compassion fatigue be addressed on an organizational level, as nurse outcomes were already negative prior to the pandemic, and all global evidence points to the worsening of these outcomes post-pandemic. There were many psychological support interventions with proven effectiveness that should be explored and applied for the South African context.
... The same was found in a metanalysis that was based on almost 500 previous studies that explored the factors that lead to job dissatisfaction and also the consequences for the physical and mental health of the employees who experienced job dissatisfaction. The literature highlights that job dissatisfaction is one of the core predictors of health indicators (Billah et al., 2021). The research hypothesizes that job dissatisfaction has a direct relation to distress and physical health issues. ...
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Ethnic minority groups usually face discrimination in the form of prejudice and stereotypes. The self-esteem and psychological well-being of ethnic minority groups are adversely impacted by the prejudice and discrimination behavior of others. The perceived discrimination unfavorably influences the attitude and behavior of ethnic minority groups, which in turn develops resistance to innovation among them. With the support of social exchange theory, this study hypothesized that perceived discrimination positively enhances resistance to innovation and job dissatisfaction for empirical investigation. The current study also proposes that job dissatisfaction positively correlates with resistance to innovation. This study further assumes the mediating role of job dissatisfaction and moderating role of psychological distress forfurther investigation. For empirical investigation, the present study collected the data from 328 Ethnic Minority Students of various Chinese universities through a structured questionnaire method using a convenient sampling technique. This study applied partial least square structural equation modeling (PLS-SEM) for empirical examination using Smart PLS software. The findings confirm that perceived discrimination positively correlates with resistance to innovation and job dissatisfaction, respectively. It is also verified that perceived discrimination positively impacts job dissatisfaction. The results further interpreted that job dissatisfaction mediates the relationship between perceived discrimination and resistance to innovation. Additionally, the findings revealed that psychological distress does not moderate the relationship between perceived discrimination and resistance to innovation; however, psychological distress moderates the relationship between job dissatisfaction and resistance to innovation. The findings serve the organizations by pointing out the role of perceived discrimination on job dissatisfaction. This study also provides valuable theoretical and practical implications.
... Specifically, the factors that have been found within the construct of nurse job satisfaction include relationships with patients (Nelson & Cavanagh, 2018), coworkers (Lu et al. 2019), physicians (Pakpour et al. 2019), and supervisors (Gillet et al. 2018), as well as opportunities for professional growth and development (Galletta et al. 2016). Other factors impacting nurses' job satisfaction include autonomy, resources available, work schedules (Leineweber et al. 2016), workload (Billah et al. 2020), leadership (Leineweber et al. 2016), and the fair allocation of organizational rewards when considering the nurses' education and experience or distributive justice (Zahednezhad et al. 2021). The HES (Nelson 2002(Nelson , 2013 includes the most important influential factors for the construct of nurse job satisfaction (Nelson, 2002). ...
Article
Aim: To evaluate the properties of a reduced-item Healthcare Environment Survey measuring nurses' job satisfaction across eight countries. Background: There is currently no rigorously tested international measure of nurses' job satisfaction that can be used internationally to improve the nurse work environment. Methods: Nursing staff from 11 hospitals in eight countries participated in this study. The original 57-item, 11-facet Healthcare Environment Survey was evaluated for reliability, validity, and measurement invariance: Cronbach's alpha was used to test for reliability; construct, discriminate, and convergent testing were used to test validity; and invariance testing including configural, metric, and scalar tests were used to study measurement invariance between the countries. Results: 2,046 nursing staff completed the survey. Reliability was established for all six subscales and the combined composite score. Both validity and measurement invariance were supported in every test conducted. An excellent model fit was found for the final 19-item, 6-facet Healthcare Environment Survey that explained 82% of the variance of nurses' job satisfaction. Conclusions: Findings suggest the instrument is an efficient measure of nurses' job satisfaction across multiple countries. Longitudinal testing for invariance will be needed to ensure the model remains a good fit. Testing more countries will also verify model fit. Implications for nursing: The instrument can be used to measure nurse job satisfaction globally. Implications for nursing policy: The instrument can be used to assess interventions to improve the social (patient, unit manager, and coworker) and technical (professional rewards, autonomy, and professional growth) aspects of nurse job satisfaction.
... Specifically, the factors that have been found within the construct of nurse job satisfaction include relationships with patients (Nelson & Cavanagh, 2018), coworkers (Lu et al. 2019), physicians (Pakpour et al. 2019), and supervisors (Gillet et al. 2018), as well as opportunities for professional growth and development (Galletta et al. 2016). Other factors impacting nurses' job satisfaction include autonomy, resources available, work schedules (Leineweber et al. 2016), workload (Billah et al. 2020), leadership (Leineweber et al. 2016), and the fair allocation of organizational rewards when considering the nurses' education and experience or distributive justice (Zahednezhad et al. 2021). The HES (Nelson 2002(Nelson , 2013 includes the most important influential factors for the construct of nurse job satisfaction (Nelson, 2002). ...
Chapter
This chapter builds on the research on nurses' experience of work in the United Sates and Jamaica. The eight‐country study reported on in this chapter, like the Jamaican study in Chapter 15, examined how clarity of role and system predicted nurse job satisfaction, but expanded the measurement model to also study the extent to which caring for self and the caring of the unit manager predicted nurse job satisfaction. Using structural equation modeling, the study revealed how these factors relate to one another and how they impact nurse turnover and sick time. This study confirmed the viability of the Profile of Caring as a construct appropriate for seven of the eight countries examined.
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Aims We aimed to (1) determine the prevalence of depression, anxiety, and stress among expatriate nurses in Saudi Arabia, and (2) assess how dissatisfaction with salary, workload, and teamwork, individually and in combination, were associated with those conditions. Background Prevalence estimates for depression, anxiety, and stress among nurses are higher than those in the general population. Available data on the mental health of expatriate nurses is limited. Methods Expatriate nurses (n=977) from governmental hospitals completed an electronic survey on demography, lifestyle, job factors, depression, anxiety, and stress (assessed with DASS‐21 scale). Multinomial logistic regressions were used for analyses. Results Dissatisfaction with workload and teamwork were significantly associated with both mild/moderate and severe depression in adjusted models. Dissatisfaction with workload was significantly associated with both anxiety and stress, but teamwork was not. There was a significant dose‐response relationship between the number of domains of dissatisfaction and depression, anxiety, and stress (p for trend was < 0.001). Conclusions Dissatisfaction with salary, workload, and teamwork are associated with depression, anxiety, and stress in expatriate nurses. Implications for nursing management Hospital and nursing administrators should identify specific aspects related to workload and teamwork and offer solutions to reduce mental health distress among nurses. This article is protected by copyright. All rights reserved.
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Background: Globally there are mounting concerns about nurses' job satisfaction because of its pivotal role in nurse turnover and the quality of care of patients. Objectives: To identify a more comprehensive and extensive knowledge of the job satisfaction of qualified general nurses working in acute care hospitals and its associated factors drawing upon empirical literature published in the last five years. Design: Literature review. Data sources: A comprehensive electronic database search was conducted in PubMed (2012-2017), Web of Science (2012-2017), CINAHL (2012-2017), Embase (2012-2017), PsycINFO (2012-2017) and the Applied Social Sciences Index (2012-2017), CNKI (2012-2017), WanFang (2012-2017), SinoMed (2012-2017) and VIP (2012-2017) to retrieve relevant articles published in both English and Chinese between January 2012 and October 2017. Review methods: Key terms and phrases associated with job satisfaction, occupational stress, professional commitment, role conflict and role ambiguity were utilized in the subject search in combination with nurses following guidelines for searching the OVID interface. The abstracts or full texts of research papers were reviewed prior to their inclusion in the review according to inclusion criteria and quality assessment using the Strobe guidelines. Results: A total of 59 papers were included in this review. The impact of job satisfaction upon sickness absence, turnover intention, as well as the influencing factors of job satisfaction such as working shift and leadership, job performance, organizational commitment, effort and reward style has been identified in a number of research studies yielding equivocal findings. Job satisfaction of hospital nurses is closely related to work environment, structural empowerment, organizational commitment, professional commitment, job stress, patient satisfaction, patient-nurse ratios, social capital, evidence-based practice and ethnic background. Various mediating or moderating pathways have been identified with nurses' job satisfaction being mediated by various factors. Conclusions: It is vital to increase nurses' job satisfaction because this has the potential both to improve patients' perceptions of care quality and ensure an adequate nursing workforce. The indirect relationships and predictors of job satisfaction contribute to a more comprehensive understanding of the complex phenomenon of job satisfaction, which in turn may aid the development of effective strategies to address the nursing shortage and increase the quality of patient care.
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