Development of a scale measuring the job satisfaction of Japanese hospital nurses

bs_bs_banner Japan Journal of Nursing Science (2014) 11, 160 170 doi:10.1111/jjns.12017 ORIGINAL ARTICLE Development of a scale measuring the job satisfaction of Japanese hospital nurses Makiko MUYA 1, Kimiko KATSUYAMA 2, Fusako OZAKI 3 and Hifumi AOYAMA 1 1 School of Nursing, Osaka Prefecture University, Osaka, 2 School of Medicine, College of Nursing, Yokohama City University, Yokohama and 3 School of Nursing, Saku University, Nagano, Japan Abstract Aim: This study attempts to develop a scale measuring job satisfaction in Japanese hospital nurses. Methods: The authors developed items for a new scale measuring job satisfaction and determined the scale s internal and external validity. Based on this analysis, the authors then modified the scale after conducting two surveys. In Survey 1, the scale was tested on 600 nurses from two hospitals and items were selected based on item and factor analyses. In Survey 2, items were further refined based on responses from 800 nurses from four hospitals. Using these responses, the authors determined the reliability and validity of the scale. Results: A 37 item job satisfaction scale was developed through examination of internal and external validity and based on the results of item analysis. Through factor analysis, four factors positive emotions toward work, appropriate support from superiors, perceived significance in the workplace, and pleasant working environment and 28 items were extracted. The cumulative contribution rate was 43.9%. Cronbach s alpha coefficient was 0.91. The correlations found between sense of satisfaction with work, burnout, and self-esteem supported the scale s concurrent and construct validity. Conclusion: The authors were successful in developing a scale measuring hospital nurses job satisfaction. The surveys conducted using this scale identified factors associated with work achievement and capability development, including positive emotions toward work and perceived significance in the workplace, neither of which have been covered by existing scales. Key words: job satisfaction, nurses, scale development. INTRODUCTION Job satisfaction in nurses is associated with their retention (Cowin, 2002) and turnover rates (Applebaum, Fowler, Fiedler, Osinubi, & Robson, 2010), and is one indicator for evaluating the quality of medical care a hospital provides. In the 1970s, aiming to reduce turnover rates, researchers in the USA developed the Reward/ Satisfaction Scale (McCloskey, 1974), Index of Work Correspondence: Makiko Muya, School of Nursing, Osaka Prefecture University, 3-7-30 Habikino, Habikino, Osaka 583-8555, Japan. Email: muyamaki@nursing.osakafu-u.ac.jp Received 18 May 2012; accepted 20 December 2012. Satisfaction (IWS; Stamps, Piedmont, Slavitt, & Haase, 1978), and several other scales to measure job satisfaction. Using their original scale, Stamps et al. (1978) conducted a job satisfaction survey involving hospital nurses, and found that scores for professional status and nurse nurse interaction were high, as were those for pay and task requirements. Following this, a meta-analysis revealed that job satisfaction was negatively correlated with stress, and positively correlated with organizational commitment, autonomy, and approval (Blegen, 1993). In addition, studies have revealed an association between job satisfaction and phenomena distinctive to the modern age, such as stress (Applebaum et al., 2010), organizational commitment (Ahmad & Oranye, 2010), self-esteem (Chang, Li, Wu,

Japan Journal of Nursing Science (2014) 11, 160 170 Nurse Satisfaction Scale: Development & Wang, 2010), and autonomy (Zangaro & Soeken, 2007). Measures of job satisfaction have thus helped researchers understand and improve nurses satisfaction with work. In the USA, in the 30 years following the development of the IWS, changes in the healthcare environment and improvement in nurses autonomy have influenced their satisfaction with their work. Thus, the IWS was revised by Stamps in 1997 (Stamps, 1997). The revised scale consists of six factors and 44 items, with fewer payrelated items and more items associated with autonomy as a professional. Similarly, in Japan, an increasing number of studies on job satisfaction in nurses have been conducted to reduce turnover among, and increase the retention of, nursing staff. In surveys assessing job satisfaction in Japanese nurses, the Japanese version of the IWS, translated by Ozaki and Tadamasa (1988), is the most widely used measure. After the reliability and validity of the Japanese version of the IWS was confirmed, Muya, Katsuyama, Ozaki, and Aoyama (2011) investigated job satisfaction in mid-career Japanese nurses, finding results consistent with those of Stamps et al. (1978). However, a factor analysis of the job satisfaction scale identified 12 factors, with a cumulative contribution rate of 56.4%. Five factors were extracted with eigenvalues of 1.0 or more, according to scree plotting criteria, which suggested that factors for explaining job satisfaction had changed since the study by Stamps et al. (1978). In Japan, since the 1970s, when the first scale for measuring job satisfaction was developed, there have been significant changes in nursing environments, for example, increases in the number of specialized and certified nurses, and the promotion of inter-professional health care with nutrition support and infection control teams. A recent survey showed that aspiring nurses most frequently cited a well-developed education and training system as their reason for seeking a career in nursing (Japanese Nursing Association, 2009), and, in another study, reported that they were seeking a career as a specialist in a specific field (Asano, 2002). However, as medical care becomes more sophisticated, nurses have been required to provide care of a higher quality and work for longer hours under poorer working conditions. This has led to problems such as an increase in turnover rate and burnout (Izugami, 2007). These issues are assumed to influence the quality of nursing care and procedures, and existing job satisfaction scales only partially describe the aspects of job satisfaction in nurses. Thus, the authors conducted qualitative and inductive analyses to better define the concepts associated with job satisfaction in this population. On the basis of the authors analyses, they focused on aspects such as work achievements and capability development, rather than factors related to nursing care tasks and management, as in the IWS (Muya, Katsuyama, Ozaki, & Aoyama, 2011). The present authors developed a set of questionnaire items based on insights from qualitative studies and a published work review, and then carefully selected items to comprise a preliminary version of the authors questionnaire. In examining the validity of this intended scale, the authors included burnout as a measure, as it is a concept reported to show strong correlation with job satisfaction and self-esteem (degree of self-respect and personal value). Thus, the aim of this study was to develop a scale measuring job satisfaction in Japanese hospital nurses. METHODS Four steps were followed in developing the job satisfaction scale: (i) development of items; (ii) examination of their internal and external validity; (iii) careful selection of relevant items; and (iv) examination of overall reliability and validity. Development of the items for measuring job satisfaction Job satisfaction has been found to consist of six concepts: (i) positive emotions toward work ; (ii) autonomy as a professional ; (iii) confirmation of work achievements ; (iv) support from superiors ; (v) connections with others ; and (vi) pleasant working environment (Muya et al., 2011). The items included in the scale assessing these concepts were decided as follows: First, 78 descriptions were selected based on these subcategories from a study by Muya et al. (2011). Additionally, the authors conducted a published work review, using the key words scale for job satisfaction, job motivation, self-realization, and work environment to search CINAHL, PubMed, Medline, and databases in the field of management studies. Ten items were identified from this, and thus, a total of 88 items were utilized. The concepts were defined as follows: 1 Positive emotion toward work, which refers to finding the responsibilities related to being a nurse meaningful and rewarding. 2 Autonomy as a professional, which refers to feeling free to decide one s own course of action. 161

M. Muya et al. Japan Journal of Nursing Science (2014) 11, 160 170 3 Confirmation of work achievements, which refers to gaining successful experience through nursing and having a sense of achievement. 4 Support from superiors, which means recognizing the support from a superior in terms of their management, professional development, and emotional development, which enhances the individual nurse s own growth and development. 5 Perceived significance in the workplace, which refers to receiving diverse evaluations from colleagues, other professionals, doctors, and patients on the practice of nursing care. 6 Pleasant working environment, which refers to having appropriate shift patterns and amount of work, holiday entitlement, and pay that is appropriate for the job. Examination of internal and external validity Internal validity was examined as follows: three nurses working at hospitals (a nurse specialized in supporting nursing practice and two nurses in charge of overall nursing care), four academics specialized in nursing management and nurse education, and a doctoral student majoring in nursing management, scrutinized the appropriateness of the concepts and items. The scale items were rated on a 5 point Likert scale, from 1 ( definitely no ) to 5 ( definitely yes ). The authors used Kuroda s (2006) method of evaluating appropriateness, determining the correspondence between concepts and items by calculating the degree of conformity between two groups. After inappropriate items (such as those regarding personal relationships at the workplace and work tasks) were corrected or removed, 79 items remained. The authors then assessed external validity as follows: seven hospital nurses and five graduate school of nursing students checked for appropriateness of expression and redundancy; subsequently, 54 items remained. Selection of items To ensure careful selection of items and to determine their reliability and validity, the authors carried out two surveys. In Survey 1, the authors carried out a careful selection of questionnaire items from the above 54 items. In Survey 2, the authors engaged in further selection and determined the scale s reliability and validity. Participants In total, six hospitals with more than 500 beds and with different funding bodies were extracted from the hospital directory for the Kinki region in Japan. Survey 1 was administered to two hospitals and Survey 2 was carried out in four hospitals. Survey 1 was administered to a total of 600 nurses from the two hospitals. The questionnaire was administered to nurses engaged in nursing practice and not those in management positions. The questionnaire was posted only to hospitals that had given consent to the verbal requests the authors had made to hospital managers. The questionnaire was distributed to nurses with varying degrees of nursing experience. To collect the questionnaire, the authors asked each respondent to post his/her questionnaire individually and considered the return of the questionnaire as consent to participate in the survey. Survey 2 was administered to a total of 800 nurses from the four hospitals, thus increasing the number of respondents. As in Survey 1, the questionnaire was administered to practicing nurses only. The same method as in Survey 1 was adopted to collect responses. Survey content Survey 1 included questions based on the job satisfaction scale the authors had developed and respondents demographics (age, length of clinical experience, sex, marital status, educational background, and department in the hospital). Survey 2 used the same questions as in Survey 1, in addition to a job stress questionnaire, and burnout and self-esteem scales. These are detailed as follows: Job satisfaction. Items were taken from the Japanese version (Haratani, 1998) of the job stress questionnaire (Hurrell & Mclaney, 1988) by the National Institute for Occupational Safety and Health (NIOSH). Job satisfaction in the job stress questionnaire is a subscale comprising four items that measure the satisfaction the respondent feels toward the work in which he/she is engaged. Items 1 3 use 3 point scales and item four, a 4 point scale, with higher scores reflecting higher job satisfaction. Self-esteem. The authors used the Japanese translation by Yamamoto, Matsui, and Yamanari (1982) of the Rosenberg Self-Esteem Scale (Rosenberg, 1965). This is a 10 item scale that evaluates self-respect and value for oneself. Answers are made using a 5 point Likert scale, with higher scores reflecting stronger self-esteem. Burnout. This scale was developed by Tao and Kubo (1992). It consists of three factors and 17 items (five items under emotional exhaustion, six under depersonalization, and six under diminished personal 162

Japan Journal of Nursing Science (2014) 11, 160 170 Nurse Satisfaction Scale: Development accomplishment ) and employs a 5 point Likert scale. Higher scores reflect more serious burnout symptoms. Statistical analysis Survey 1 Using SPSS ver. 17.0 J for Windows (SPSS, Chicago, IL, USA), the authors conducted item (item total correlation, item item correlation) and factor (principal factor method with promax rotation) analyses. The survey took place between October and December 2009. Survey 2 Item and factor analyses were performed again with data from a larger sample to further refine the selection of items. Then, the reliability and validity were determined as follows: Reliability. Cronbach s alpha coefficient was calculated for the overall scale and each factor. Validity. For construct validity, the four items from the job satisfaction scale in the NIOSH job stress questionnaire were used in this analysis. Pearson s product moment correlation coefficient was calculated between scores on the authors draft of the job satisfaction scale and the NIOSH job stress questionnaire. Then, the total scores on the job satisfaction scale were compared between the groups of nurses who had received high and low scores on the NIOSH job stress questionnaire by using Student s t-test. For criterion-related validity (concurrent validity), Pearson s product moment correlation coefficients were calculated between scores on the job satisfaction scale and the burnout and self-esteem scales. Survey 2 took place between July and September 2010. Ethical considerations The present study was conducted with the approval of the research ethics committee of each of the authors universities. The questionnaire surveys were completed anonymously. Participants provided informed consent after receiving explanations about the purpose and significance of the study, privacy protection, data handling, and how the research results would be reported. RESULTS The demographics of the respondents in Surveys 1 and 2 are shown in Table 1. The number of questionnaires returned in Survey 1 was 264 (response rate, 44.0%). The mean age was 33.1 years, and the mean length of clinical experience was 8.6 years. The number of questionnaires returned in Survey 2 was 412 (response rate, 51.5%), the mean age of respondents was 29.2 years, and the mean length of clinical experience was 7.4 years. In Survey 1, in terms of educational background, most nurses (n = 168, 63.6%) had completed 3 year nursing schools, while 33 (12.5%) had completed 2 year colleges. In Survey 2, in terms of educational background, most nurses (n = 321, 77.9%) had completed 3 year nursing schools, as in Survey 1, while 33 (8.0%) had completed colleges. In terms of departments for Survey 1, most nurses (n = 97, 36.7%) worked in internal medicine, followed by 80 (30.3%) in surgery, and 44 (16.7%) in pediatrics. In terms of departments for Survey 2, most nurses (n = 179, 43.5%) worked in surgery, followed by 145 (35.2%) in internal medicine, and 24 (5.8%) in obstetrics. Selection of items Survey 1 The correlation coefficients between the 54 items ranged 0.01 0.58; thus, no item needed to be excluded. The Item Total (I-T) correlation analysis revealed correlation coefficients of 0.3 or smaller for seven items, which the authors excluded. Following this, a principal component analysis was conducted, and 12 factors with eigenvalues of 1 or higher were extracted. The cumulative contribution rate of these factors was 62.4%, and five factors for analysis were selected by taking into account changes in the eigenvalues attributed to the scree plot and the authors interpretation of those eigenvalues. The authors then repeatedly conducted factor analyses (principal factor method with promax rotation) to remove items with factor loadings of less than 0.35, and the authors excluded items with multiple large factor loadings. Ultimately, five factors and 37 items were selected, with a cumulative contribution rate of 42.9%. Survey 2 Using the results of Survey 2, the authors carried out item analyses with the larger sample. The correlation coefficients between the 37 items ranged 0.01 0.61; thus, no item needed to be excluded. An I-T correlation analysis was conducted, and six items with correlation coefficients of 0.3 or smaller were excluded. The authors then conducted a principal component analysis, extracting five factors with eigenvalues of 1 or higher and a cumulative contribution rate of 54.29%. As the authors 163

M. Muya et al. Japan Journal of Nursing Science (2014) 11, 160 170 Table 1 Characteristics of the nurses Survey 1, N = 264 Survey 2, N = 412 Age, years, mean ( SD) 33.1 ( 8.6) 29.2 ( 6.2) Range of age, years 21 56 21 53 Length of clinical experience, years, mean ( SD) 8.6 ( 7.8) 7.4 ( 5.9) N (%) N (%) Sex Male 7 (2.7) 12 (2.9) Female 257 (97.4) 398 (96.6) Marital status Single 86 (32.6) 95 (23.1) Married 176 (66.7) 312 (75.7) Educational background Three year nursing schools 168 (63.6) 321 (77.9) Colleges 19 (7.2) 33 (8.0) Three-year colleges 15 (5.7) 22 (5.3) Two year nursing schools 15 (5.7) 13 (3.2) Two year colleges 33 (12.5) 3 (0.7) Graduate schools 3 (1.1) 0 (0.0) Others 3 (1.1) 11 (2.7) Department Surgery 80 (30.3) 179 (43.5) Internal medicine 97 (36.7) 145 (35.2) Obstetrics 14 (5.3) 24 (5.8) Pediatrics 44 (16.7) 23 (5.6) Intensive care unit 25 (9.5) 23 (5.6) Operating rooms 4 (1.5) 9 (2.2) SD, standard deviation. considered four factors appropriate, rather than five, and taking into account changes in eigenvalues attributed to the scree plot and the authors interpretation of those eigenvalues, the authors conducted factor analyses (principal factor method with promax rotation) with four factors. Factor analyses were repeatedly conducted to remove items with factor loadings of less than 0.35, and the authors excluded items with multiple large factor loadings. Ultimately, four factors and 28 items were selected, with a cumulative contribution rate of 43.88% (Table 2). The first factor, consisting of nine items, included the factors theoretically developed by Muya et al. (2011): autonomy as a professional and confirmation of work achievements. Autonomy as a professional, or rather, clearly defined challenges associated with work, leads to positive emotions. Confirmation of work achievements, including involvement in patients recovery process, can also be regarded as being related to positive emotions. Therefore, the first factor was named positive emotions towards work. The second factor consisted of six items related to support from superiors, which were consistent with the factors theoretically developed by Muya et al. (2011). As these items included educational and emotional support focusing on nurses progress and development, the second factor was renamed appropriate support from superiors. The third factor, consisting of eight items, was related to the approval of colleagues, other professionals, and patients, as well as nurses realization of their own significant role in the workplace, through their accomplishments. The third factor was named perceived significance in the workplace. Finally, the fourth factor, consisting of five items, was also in line with the theoretically developed factors and related to the working environment, such as requests regarding time off and work life balance. Thus, the fourth factor was named pleasant working environment. In summary, the authors scale consisted of 28 items and four factors: (i) positive emotions toward work ; (ii) appropriate support from superiors ; (iii) perceived significance in the workplace ; and (iv) pleasant working environment. 164

Japan Journal of Nursing Science (2014) 11, 160 170 Nurse Satisfaction Scale: Development Table 2 Factor analysis of the Job Satisfaction Scale (principal factor method: promax rotation) Factors (factor loading) Factor Factor 1: positive emotions toward work (nine items) Factor 2: appropriate support from superiors (six items) Factor 3: perceived significance in the workplace (eight items) Factor 4: pleasant working environment (five items) Items 1 2 3 4 Commonality Q.01: I am proud of my current job. 0.62-0.05 0.13-0.20 0.38 Q.02: Provision of nursing care is what I like to do. 0.41-0.05 0.21 0.12 0.37 Q.03: I find my work challenging. 0.84-0.13-0.04 0.09 0.64 Q.04: I clearly understand my problems and 0.35 0.14 0.13-0.01 0.26 challenges in work. Q.05: Working in this hospital helps me improve. 0.57 0.25-0.11 0.09 0.50 Q.06: I find my job interesting. 0.78 0.06-0.08 0.07 0.64 Q.07: I cannot find any meaning in my work. 0.60-0.12 0.10-0.13 0.33 Q.08: Helping patients recover motivates me to 0.51-0.08 0.10 0.04 0.31 work as a nurse. Q.09: There are nurses in my workplace who serve as good examples. 0.46 0.36-0.27-0.01 0.34 Q.10: The nursing supervisor in my workplace often -0.15 0.73-0.05 0.19 0.60 talks to nurses to praise and thank them. Q.11: When a problem occurs in my workplace, the 0.03 0.92-0.07-0.14 0.70 nursing supervisor properly addresses it. Q.12: The nursing supervisor helps me make 0.11 0.82-0.04-0.06 0.67 progress and improve by providing advice. Q.13: I can consult the nursing supervisor frankly. -0.09 0.59 0.34 0.03 0.57 Q.14: The nursing supervisor in my workplace -0.13 0.81 0.09-0.05 0.58 provides nursing staff with detailed explanations of work policies and goals. Q.15: The nursing supervisor evaluates me fairly. -0.03 0.48 0.01 0.11 0.29 Q.16: While providing nursing care, I always think 0.28 0.09 0.36-0.06 0.34 of ideas to improve it. Q.17: I can express my opinions at conferences. -0.12-0.07 0.69-0.01 0.37 Q.18: My suggestions are reflected in the workplace. 0.00 0.06 0.65 0.18 0.62 Q.19: I play my role in the workplace. 0.24 0.02 0.55 0.03 0.56 Q.20: I can consult with other professionals on -0.01 0.03 0.46 0.21 0.37 patient care. Q.21: I cannot assert my opinions to physicians. 0.11-0.04 0.50-0.22 0.24 Q.22: I sometimes receive praise and recognition 0.23 0.09 0.35-0.09 0.26 from colleagues. Q.23: I feel trusted by patients and their families. 0.33-0.02 0.39-0.08 0.35 Q.24: Our hospital allows nurses to work flexibly, 0.07 0.20-0.02 0.51 0.46 taking into consideration individual circumstances. Q.25: I can balance work with my private life. 0.25-0.06 0.08 0.46 0.40 Q.26: An appropriate number of personnel are -0.04 0.03-0.03 0.65 0.41 deployed in the hospital I work for. Q.27: I receive a sufficient salary for my work. -0.13 0.00-0.10 0.65 0.33 Q.28: Requests concerning days off are accepted in 0.00-0.09 0.01 0.69 0.42 my workplace. Square sum of loadings after rotation 7.97 2.27 1.18 0.86 Contribution rate (%) 28.47 8.12 4.22 3.07 Cumulative contribution rate (%) 28.47 36.59 40.81 43.88 Correlations between factors Factor 1 1.00 Factor 2 0.47 1.00 Factor 3 0.55 0.39 1.00 Factor 4 0.44 0.57 0.49 1.00 165

M. Muya et al. Japan Journal of Nursing Science (2014) 11, 160 170 Reliability and validity of the job satisfaction scale Reliability Cronbach s alpha coefficient for the overall scale, including 28 items, was 0.91, with 0.83 for the first factor, 0.87 for the second, 0.81 for the third, and 0.75 for the fourth. Validity The results of the construct validity are shown in Tables 3 and 4. There was a significant positive correlation between scores on the current job satisfaction scale and scores on the NIOSH job stress questionnaire (NIOSH job satisfaction). A moderate correlation (r = 0.41, P < 0.01) was found between scores on all items of the job satisfaction scale and NIOSH job satisfaction, and a strong correlation (r = 0.54, P < 0.01) was found between scores for the first factor of the job satisfaction scale and NIOSH job satisfaction. However, there were weak correlations between scores for the second factor of the job satisfaction scale and NIOSH job satisfaction (r = 0.11, P < 0.05), and between scores for the fourth factor of the job satisfaction scale and NIOSH job satisfaction (r = 0.23, P < 0.01). Respondents who scored 4 8 (first quartile or 25%) and 10 13 (fourth quartile or 75%) points on NIOSH job satisfaction were categorized into low Table 3 The Job Satisfaction Scale, and comparisons between NIOSH Job Satisfaction Scale the high and low groups NIOSH job satisfaction High group (n = 147), Low group (n = 97), mean SD mean SD Factor A B Total score 88.15 11.94 ** 75.44 10.43 Factor 1: positive emotions toward work 31.65 4.10 ** 25.39 4.47 Factor 2: appropriate support from superiors 18.32 4.49 * 16.98 3.75 Factor 3: perceived significance in the workplace 24.36 3.85 ** 21.02 3.74 Factor 4: pleasant working environment 13.95 3.09 ** 12.37 2.87 **P < 0.01, *P < 0.05. NIOSH, National Institute for Occupational Safety and Health; SD, standard deviation. Table 4 Correlations between score of the Job Satisfaction Scale, and Burnout Scale, Self-esteem Scale, NIOSH Job Satisfaction Scale Total score Emotional exhaustion Burnout Depersonalization Personal accomplishment Self-esteem NIOSH job satisfaction Factor r P r P r P r P r P r P Total score -0.56 <0.01-0.35 <0.01-0.40 <0.01-0.58 <0.01 0.34 <0.01 0.41 <0.01 Factor 1: positive -0.64 <0.01-0.37 <0.01-0.51 <0.01-0.63 <0.01 0.34 <0.01 0.54 <0.01 emotions toward work Factor 2: -0.24 <0.01-0.12 <0.05-0.12 <0.05-0.34 <0.01 0.04 n.s 0.11 <0.05 appropriate support from superiors Factor 3: perceived -0.49 <0.01-0.32 <0.01-0.33 <0.01-0.52 <0.01 0.45 <0.01 0.33 <0.01 significance in the workplace Factor 4: pleasant -0.33 <0.01-0.30 <0.01-0.21 <0.01-0.28 <0.01 0.16 <0.01 0.23 <0.01 working environment NIOSH, National Institute for Occupational Safety and Health; n.s., not significant. 166

Japan Journal of Nursing Science (2014) 11, 160 170 Nurse Satisfaction Scale: Development and high groups, respectively, and the mean scores on the current job satisfaction scale were compared between the two groups. The mean score for the high group (88.15 11.94 points) was significantly higher than that in the low group (75.44 10.43 points; P < 0.01). The results of the concurrent validity are shown in Table 4. The authors found a significant negative correlation between scores on the job satisfaction scale and the burnout scale. Strong negative correlations were found between scores for all items (r =-0.56) and the first factor (r =-0.64) of the job satisfaction scale and the burnout scale (P < 0.01). A weak negative correlation was found between scores on the second factor of the job satisfaction scale and the emotional exhaustion factor of the burnout scale (r =-0.12, P < 0.05), while the other factors of the job satisfaction scale showed only moderate negative correlations with emotional exhaustion (r =-0.30 to -0.37, P < 0.01). While there was a strong negative correlation between scores on the first factor of the job satisfaction scale and the depersonalization factor of the burnout scale (r =-0.51, P < 0.01), the second factor of the job satisfaction scale and depersonalization showed a weak correlation (r =-0.12, P < 0.05). There were strong negative correlations between the scores for individual sense of achievement factor of the burnout scale and all items (r =-0.58, P < 0.01), the first factor (r =-0.63, P < 0.01), and the third factor of the job satisfaction scale (r =-0.52, P < 0.01). In addition, there were moderate positive correlations between all items, the first factor, and the third factor of the job satisfaction scale and the self-esteem scale (r = 0.34 0.45, P < 0.01). The authors also found a weak positive correlation between scores on the second factor of the job satisfaction scale and the self-esteem scale (r = 0.04, P > 0.05). DISCUSSION Eighty-eight items were constructed according to previous qualitative research (Muya et al., 2011) and a published work review. These were then revised in light of their internal validity, and after a further selection of items through an initial questionnaire survey, the authors arrived at a scale consisting of four factors and 28 items. Following this, the authors administered the scale to 412 nurses working in four hospitals, and from the results the reliability and validity were further reviewed. Reliability and validity of the job satisfaction scale Cronbach s alpha coefficient, a widely used indication of internal consistency, was 0.7 or higher for both the whole and subordinate scales. Burns and Grove (2005) reported that a reliability coefficient of 0.70 or higher supports internal consistency. Therefore, the internal consistency has been established for each item of this job satisfaction scale. The authors calculated the reliability coefficients between the self-esteem, burnout, and job satisfaction scales, and because the authors found marked correlations, the concurrent validity for this scale was established. There was a moderate negative correlation between the job satisfaction and burnout scales, and a lower than moderate positive correlation between the job satisfaction and self-esteem scales. At the factor level, no correlation was noted between self-esteem and the second factor ( appropriate support from superiors ). As self-esteem represents an individual s degree of self-respect and personal valuation, it may be difficult for it to be concurrently valid with appropriate support from superiors. This could be a future challenge, requiring review of external criteria. The scale s construct validity was also established: a moderate correlation was noted between scores on the job satisfaction scale and the job satisfaction subscale of the NIOSH job stress questionnaire, indicating that those who were satisfied with their work received markedly higher scores on the job satisfaction scale. Characteristics of the factors of the job satisfaction scale Factor 1: positive emotions toward work The first factor included items on how rewarding nurses found their work and their accomplishments in nursing practice. Given the items comprising this factor, the authors suggest that capacity development and degree of job achievement are strongly related to job satisfaction. Existing scales for measuring job satisfaction contain job-related factors, such as professional status in the IWS (Stamps et al., 1978) and the work itself in the Job Descriptive Index (Smith, Kendall, & Hulin, 1969). They focus on individuals general emotions toward their professional status. In this study, the factor comprised content acquired specifically through nursing practice, and thus, the authors concluded that an important aspect of job satisfaction is making the most of one s professional abilities. 167

M. Muya et al. Japan Journal of Nursing Science (2014) 11, 160 170 Factor 2: appropriate support from superiors Correlations between job satisfaction and support from superiors, such as the superior s acknowledgment and good communication, have been reported in previous studies (Cummings et al., 2008, McGillis et al., 2005). The scale the authors developed included those aspects of support, along with the superior s leadership and guidance in solving various clinical problems, all of which have been found to assist in nurses growth and development. Existing job satisfaction scales have labeled support from superiors as nursing management, as in the IWS (Stamps et al., 1978) or praise and approval, as in the McCloskey/Mueller Satisfaction Scale (MMSS) (Mueller & McCloskey, 1990). The MMSS factor represents the degree of acknowledgment provided by the superior (Mueller & McCloskey, 1990), while the IWS factor mainly describes aspects of the organization s management system such as standard work procedures and the degree to which nurses can participate in decision-making. However, respondents of the present study sought support from their superiors in ways that would assist their growth and development. They were working at large hospitals with 500 or more beds, which possess adequate management systems for their nursing departments. In addition, the nursing education systems are well developed and based on criteria for continuous education (Japanese Nursing Association, 2000) in order to encourage staff development. Nevertheless, it has been reported that nurses do not necessarily achieve a sense of development, as seen when they are confronted with the limitations of their skills in nursing practice (Muya et al., 2011). It is therefore important for superiors to provide appropriate support to give nurses a strong sense of growth and development. Factor 3: perceived significance in the workplace In this study, the authors extracted a third factor consisting of two concepts: (i) the individual s effective use of social skills, such as being able to speak effectively in meetings; and (ii) how they fulfill their role as caregivers and are acknowledged by others at work, such as being relied on by patients and their families and connecting with colleagues. Comparing the factor extracted in this study and those from existing job satisfaction scales, the authors found that the IWS (Stamps et al., 1978) has three factors corresponding to the authors third factor autonomy as a professional which represents an individual s work-related autonomy, including their ability to take the initiative and be free from constraints, mutual influence among nurses, and the doctor nurse relationship. In addition, in the MMSS (Mueller & McCloskey, 1990), the corresponding factors are colleagues and praise and approval, both of which are independent factors. This is a recent concept; it refers to team health care, which involves not only medical staff but also patients, has been promoted in clinical settings (Ministry of Health, Labor and Welfare, 2008). Within these services, nurses require approval from other professionals in the same team in addition to fulfilling their roles as caregivers. Thus, the authors argue that such circumstances have integrated utilizing one s capacity, fulfilling one s role, and maintaining relationships with coworkers into one factor. Factor 4: pleasant working environment The final factor comprises items about worker-friendly working conditions, including the ability to secure time off according to one s needs and establishing good work life balance. In existing job satisfaction scales, analogous factors include pay and nursing work of the IWS (Stamps et al., 1978) and physical reward, scheduling, and work life balance of the MMSS (Mueller & McCloskey, 1990). These represent the degree of security at work and in the work environment. The present authors study, however, points to a work environment that enables appropriate execution of the work itself, rather than uniform working conditions. The minimum adequate working conditions were guaranteed in the hospitals in which the surveys took place. It was also clear that many nurses were in need of downtime, during which they could relax and take time away from the often stressful and busy nursing environment. Additionally, another aspect of the work environment unique to this study was the allocation of staff in proportion to the amount of work. Improper staff allocation has been found to be related to mortality rate amongst patients, medical accidents, and nurses burnout and dissatisfaction with their work (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002). In order for nurses to make the most of their abilities as professionals, it is necessary for them to be within a pleasant work environment with working conditions that are not uniform but tailored to individual needs, and adequate staff allocation. Significance of the scale measuring job satisfaction Conventional job satisfaction scales such as the IWS and MMSS were developed between 1970 and 1980 for 168

Japan Journal of Nursing Science (2014) 11, 160 170 Nurse Satisfaction Scale: Development nurses in the USA to prevent turnover and promote retention. Since then, research into job satisfaction using the IWS scale has been undertaken in order to prevent nurses from leaving their jobs and to encourage retention. However, Nakagawa and Hayashi (2004) have pointed out some problems in administering the IWS in Japan, such as questions and items inappropriate for nursing practice. To address this, the present authors study focused on Japanese nurses and its findings clarify the actual situation faced by these nurses, using a scale developed based on qualitative inductive analyses. The scale the authors developed for this study consists of four factors and 28 items, suggesting that it is suited for clinical nursing practice. Overall, this scale contains more items that reflect concrete nursing practices than items reflecting general emotions toward work. That the first factor was found to contribute most in the factor analysis confirms that the scale is centered on job achievement and staff development in nursing practice. The next step in this research is to introduce this job satisfaction scale centered on job achievement and staff development as one of the evaluation indicators for clinical educational programs. The authors must also clarify the relationship between the will to continue practice and the authors job satisfaction scale, to find ways of encouraging aspiring nurses to continue practicing, by examining the concrete measures that lead to job satisfaction in nursing practice. Limitations and future challenges Although there were some differences between the factors and the structure of the theoretically developed concepts, the factors were consistent with the definition of job satisfaction. The scale developed in this study focused on Japanese nurses, and therefore, it has limited use abroad. In addition, because the surveys took place at a limited number of hospitals (four hospitals with 500 beds), the findings are not easily generalizable. It is therefore necessary to keep modifying the scale to improve its applicability and accuracy by testing it at facilities of different sizes and on randomly selected samples. CONCLUSION The authors constructed a scale to measure the job satisfaction specifically that related to work achievement and capability development of nurses working in hospitals. This scale consists of 28 items and four factors: (i) positive emotions toward work ; (ii) appropriate support from superiors ; (iii) perceived significance in the workplace ; and (iv) pleasant working environment. The present study confirmed that the scale has adequate reliability and validity. ACKNOWLEDGMENT This study was supported by a grant from the Ministry of Education, Science, Culture and Sports, Japan (no. 23890183). REFERENCES Ahmad, N. & Oranye, N. O. (2010). Empowerment job satisfaction and organizational commitment:a comparative analysis of nurses working in Malaysia and England. Journal of Nursing Management, 18, 582 591. Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J. & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. The Journal of the American Medical Association, 288, 1987 1993. Applebaum, D., Fowler, S., Fiedler, N., Osinubi, O. & Robson, M. (2010). The impact of environmental factors on nursing stress, job satisfaction, and turnover intention. The Journal of Nursing Administration, 40, 323 327. Asano, Y. (2002). Nurses career orientation and related factors. The Japanese Journal of Nursing Research, 25, 45 56 (in Japanese). Blegen, M. A. (1993). Nurses job satisfaction: a meta-analysis of related variables. Nursing Research, 42, 36 41. Burns, N. & Grove, S. K. (2005). The practice of nursing research : conduct, critique, and utilization. 5th edition. The concepts of measurement. Chapter 15. pp. 374 386. Philadelphia, USA: Elsevier Saunders. Chang, Y. H., Li, H. H., Wu, C. M. & Wang, P. C. (2010). The influence of personality traits on nurses job satisfaction in Taiwan. International Nursing Review, 57, 478 484. Cowin, L. (2002). The effects of nurses job satisfaction on retention. The Journal of Nursing Administration, 32, 283 291. Cummings, G. G., Olson, K., Hayduk, L., Bakker, D., Fitch, M., Green, E. et al. (2008). The relationship between nursing leadership and nurse job satisfaction in Canadian oncology work environments. Journal of Nursing Management, 16, 508 518. Hall, L. M. G., McGilton, K. S., Krejci, J., Pringle, D., Johnston, E. et al. (2005). Enhancing the quality of supportive supervisory behavior in long-term care facilities. The Journal of Nursing Administration, 35, 181 187. Haratani, T. (1998). NIOSH job stress questionnaire the 8th. Journal of Occupational Health, 40, A31 A32 (in Japanese). 169

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