1. Watson, Carol A. PhD, RN

Article Content

Job satisfaction is a key concept that has been studied during the years, but understanding job satisfaction is even more important during an era of work force shortage. Understanding the factors that influence nurses' job satisfaction has always been of interest to nurse executives but has been heightened as nurse executives work to create more satisfying work environments for nurses.


The articles in this issue explore several variables that have an impact on nurses' job satisfaction. Many of those variables are interrelated. Therefore, a model to understand the context of job satisfaction is helpful in organizing one's thoughts.


Workforce Model

The American Organization of Nurse Executives (AONE) developed its Nursing Workforce Model to assist in understanding the complexity of the nursing work force shortage. The model is based on systems theory as defined by Peter Senge. 1,2 Understanding systems and thinking systemically is essential to understanding the complex nature of the nursing shortage. Action in one element of the healthcare system will have an impact on other elements in the system and that impact may be positive or it may be negative. AONE's Nursing Workforce Model provides an organizational framework for understanding the complexity of job satisfaction. The AONE Workforce Model 3 identifies the following six domains:


* Education


* Financing


* Technology


* Delivery systems


* Legislation/regulation


* Work environment



In each domain, both factors and leverage points are identified. The factors are variables not easily controlled or influenced.



The number of students available to enter the nursing profession and the other career options available to those students is not easily controlled in the education domain. The capacity of nursing programs is a variable that the profession controls; however, increasing the capacity of nursing programs creates another major issue (ie, sufficient numbers of qualified faculty to accommodate the increased number of students).


Have educational nursing programs prepared students who understand the complexity and demands of healthcare or will the transition from student to practitioner be too difficult? Will they find their careers satisfying and will they stay in the profession? If they stay, what will attract them to work in clinical and geographic areas of the greatest need, rather than migrate to areas that have sufficient supply of nurses?



The financing domain encompasses the whole complex area of healthcare financing. Both public and private financing of healthcare has become increasingly difficult. With limited financial resources, it is difficult to provide salary and benefits so that nurses feel fairly compensated. It also is difficult to provide positions that are competitive with other employment options for nurses and prospective nurses. Special funding through federal grants and private foundations to study the issues that influence the nurses' job satisfaction has never been more important.



Technology is a domain that has received little attention, especially technology that assists nurses in direct patient care activities. The healthcare profession has depended heavily on nurses to carry out all direct care activities; the number of nurses could increase when patients' needs for care are increased. The ability to add nurses is not only limited but will continue to be limited because of the declining pool of potential nursing students. More research and development must be focused on introducing technology that decreases the burden of a nurse's work and that ensures safe patient environments. This research must focus on technology that truly leverages nurses' time. Not all technology decreases work burden; some add to the complexity of work. Because nurses are the end-users of the technology, they must evaluate emerging technology. This is an important step in the creation of new technological tools.


Delivery Systems

The best way to organize the delivery of care is still a dilemma recognized in the delivery systems domain. The future will bring increasing demand for healthcare services and increasing acuity. The right setting for providing care as well as the appropriate staffing and differentiation of roles for that setting are increasingly important. The capacity to innovate quickly is a major challenge. Evidence-based research in practice is vitally important in introducing changes in care processes, as is involving nurses in designing the care delivery models in which they practice.



The domain of legislation/regulation is critically important. How to appropriately balance regulations to protect the public (while permitting the greatest degree of autonomy for nurses) is an ongoing debate. When is regulation helpful and when does it artificially limit creativity? Administrators must take into account the availability of resources when developing regulations and standards. Practice acts, which are specific to each state, have created artificial barriers, because nursing has become increasingly an interstate activity. The plethora of regulations has made the work of nurses burdensome and has an impact on job satisfaction.


Work Environment

The domain over which nurse executives have the most direct control is the work environment. Leverage points are abundant, but the key is to work with nurses within each environment on goals that are most achievable. Paying equal attention to both capacity and flexibility to meet demand and to try new innovations is the challenge. Rigid structures that lack the capacity to be flexible and innovative stifle the work environment and discourage nurses who see ample opportunities to improve care processes.


Many other elements of the work environment effect job satisfaction. Staffing and scheduling are essential aspects for work to be both satisfying and professional. The increasing diversity of the nursing work force creates new challenges to assure genuine opportunity and access for every nurse. The degree of support from other professionals, ancillary departments, and clerical staff, and how well they interface with nursing produces either a collegial environment or one fraught with tension and discord.


Interpersonal relationships cannot be overlooked. Staff development to maintain a sense of competence and safe work environments to address increasingly complex patient care are essential. New graduate nurses or nurses in new roles often are left without benefit of mentors or training programs to help them become secure and competent. Relationships that are collaborative for the entire interdisciplinary team underpin the positive atmosphere that many nurses seek. Also essential is a leadership infrastructure that supports cohesive teams that work together and that function as partners.



A thorough understanding of one domain neither explains the work force shortage nor identifies what creates job satisfaction for nurses. There is no one simple solution. There is no one leverage point that can move the entire system. These elements work together and share common issues. They respond to actions taken in other domains. The nursing work force shortage and job satisfaction are complex topics. They both can be examined piece by piece, but only if the pieces are reassembled into the entire picture can true understanding emerge. Are there solutions to this complex issue of job satisfaction? Absolutely. There are leverage points that can push the system toward a better state. However, they can be successful only if there is an appreciation of the need for exquisite collaboration among all domains.


Job Satisfaction Research

To understand the elements that have an impact on job satisfaction, nursing research is important. Unless one understands the impact a solution will have on the system, job satisfaction will not be sustained. The articles in this issue provide additional understanding of the complexity of not only job satisfaction but also the larger issue of the work force shortage. Threaded through all of these articles are examination of and commentary on leverage points from the six domains of education, financing, technology, delivery systems, legislation/regulation, and work environment.


Cowin examines how the variables of salary, level of responsibility, experience, professionalism, and autonomy are related to retention, especially for the newly graduated nurse. Foley, et al. provide insight into how a military environment differs from a civilian environment, specifically examining autonomy, control over practice, and nurse-physician relationships. Ingersoll et al. evaluate effective commitment of nurses and job satisfaction, while examining longevity, flexibility of schedules, family-focused time, and other external factors in acute care and long-term care nurses, urban and rural nurses, potential retirees, and ADN and BSN graduates. MacPhee and Scott examine rural nurses' satisfaction with nurse managers. Mark et al. report on the factors that influence perceptions of staffing adequacy (unit size, technology, staff education, availability of support services and increased census). Finally, Seago examines the usefulness of a patient classification system and Stevens discusses the intent and direction of the evidence-based practice movement.


Each of these articles provides additional evidence for not only understanding the complex nature of job satisfaction, but also the complex factors that influence the nursing shortage.




1. Senge P. The Fifth Discipline. New York: Doubleday; 1990. [Context Link]


2. Senge, P. The Fifth Discipline Fieldbook. New York: Doubleday; 1994. [Context Link]


3. American Organization of Nurse Executives. Monograph:The AONE Nursing Workforce Model. Washington, DC; 2001. [Context Link]



The manuscript submission deadline for JONA 's tenth annual research edition of JONA (May 2003) is SEPTEMBER 20, 2002. Manuscripts should be formatted according to JONA 's Information for Authors, with the exception of the abstract which should be structured (see May 2002 issue for format).


FOUR copies of the manuscript should be sent to:


Suzanne P. Smith, EdD, RN, FAAN




4301 32nd Street West, Suite C12


Bradenton, FL 34205-2748