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JOURNAL OF COMMUNITY HEALTH NURSING, 1985,2 (3) 161-173 Copyright o 1985, Lawrence Erlbaum Associates, Inc.

Job Satisfaction Among Occupational Health Nurses

Karen M. Conrad, RN, MS, MPH University of Illinois at Chicago Health Sciences Center

Kendon J . Conrad, PhD, MSPH Northwestern University and the Veterans Administration

Jane E. Parker, RN, MS University of Illinois at Chicago Health Sciences Center

The purpose of this study was to describe job satisfaction among occupational health nurses. Ninety-seven randomly selected occupational health nurses responded to the Minnesota Satisfaction Questionnaire. These responses were compared with those of a normative group of hospital nurses. Student's t test for independent samples revealed no significant differences between the groups in overall job satisfaction; however, signifi- cant differences emerged for 9 of the 20 subscales. Comparing the groups, occupational health nurses were significantly more satisfied with compensation, creativity, and inde- pendence; hospital nurses were significantly more satisfied with advancement, author- ity, co-workers, responsibility, security, and technical supervision. Examination of the occupational health nurses scores only, revealed that they were least satisfied with ad- vancement, technical supervision, and compensation; they were most satisfied with so- cial service, moral values, and achievement.

Occupational health nursing, a community health nursing specialty, is defined as "the synthesis of public health principles, nursing practice, and occupational safety and health procedures for the purpose of conserving, promoting, and restoring the health of workers" (Babbitz, 1983, p. 24). Even though occupational health nursing has ex-

Requests for reprints should be sent to Karen M. Conrad, RN, MS, MPH, Department of Public Health Nursing, College of Nursing, University of Illinois at Chicago, 845 South Damen Avenue, Chicago, IL 60612.

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isted in the United States since 1895 (Lee, 1978), it has been little studied. In fact, oc- cupational health nurses (OHNs) have never been the sole subjects of any job satisfac- tion study, although they were included among other subjects in two studies (Dono- van, 1980; Godfrey, 1978).

In an effort to begin such documentation, this study addresses the following re- search questions: What is the profile of the occupational health nurse based on selected personal and demographic characteristics?, and Are occupational health nurses more satisfied with their jobs than a normative group of hospital nurses?

BACKGROUND

Job satisfaction has fascinated and bewildered researchers and practitioners (Quinn, Staines, & McCullough, 1974; Sorensen & Baum, 1977). Many studies of job satisfac- tion in the nursing field have been done on hospital staff nurses (Everly & Falcione, 1976; McCloskey, 1974; Seybolt , Pavett, & Walker, 1978; Weisman, Alexander, & Chase, 1981). Few studies have been done on community health nurses (Fletcher, 1957; Nahm, 1940; Stember, 1978) and none has been specifically done on occupa- tional health nurses (OHNs).

Several reasons exist that may explain this inequitable research emphasis. First, hospital staff nurses represent the majority (65%) of all employed nurses (American Nurses' Association, 1981). Second, within a single hospital a large number of nurses are employed and thus, an adequate and convenient sample readily exists for study.

In contrast, occupational health nurses number far fewer than hospital staff nurses. According to Brown (198 l), in 1981 there were only 21,406 occupational health nurses and they were often employed in small groups or even in one-nurse units. Further, there is a minimal turnover among occupational health nurses. This is in contrast to hospital nurses who, until very recently, have had an annual turnover rate as high as 40% (Wolf, 198 1). It is not atypical to find occupational health nurses working for the same company for 15,20, or more years.

Research Rationale

The major reasons for studying job satisfaction of occupational health nurses are as follows:

Economic. Seybolt and Walker (1980) found references in the literature that correlated the dissatisfied employee with increased turnover rates and increased ab- senteeism. Other authors (Brief, 1976; Everly & Falcione, 1976; McCloskey, 1974; White & Maguire, 1973) have reported the same correlation. The costs of both turn- over and absenteeism can be prohibitive to employers. Because occupational health nurses have limited turnover rates, a job satisfaction study of this group may point to

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Job Satisfaction Among Occupational Health Nurses 163

specific factors that account for higher satisfaction. Efforts to promote these same factors for other nursing groups might dramatically shift the absenteeism and turn- over rates.

Humanitarian. Hall, VonEndt, and Parker (1981) maintained that health care providers need to be satisfied if they are to provide optimum care to their patients. In their review of occupational sources of stress, Cooper and Marshall (cited in Grune- berg, 1979) supported the view that stress, which can be caused by job dissatisfaction, is related to both heart disease and decreased mental health. Other authors' (Im- parato, 1972; Salancik & Pfeffer, 1977; Slocum, Susman, & Sheridan, 1972; Wolf, 1981) findings support the need to consider the humanitarian aspects of job satisfac- tion. The job satisfaction of occupational health nurses needs to be addressed because it affects not only their ability to effectively intervene with employees but also the nurses' physical and mental well-being.

Professional. Occupational health nurses can use research findings to demon- strate to their employers what job rewards are lacking but needed in their jobs. Increasing occupational health nurses' awareness of sources of job satisfaction/ dissatisfaction and communicating their employment needs to their employers are two beginning steps that can be used to help create employment situations that foster job satisfaction.

Definition of Job Satisfaction

Job satisfaction is "the pleasurable emotional state resulting from the appraisal of the extent to which the work environment fulfills an individual's requirements" (Lofquist & Dawis, 1969, p. 47). This definition and those of others (Hall et al., 1981; Slocum et al., 1972; Vroom, 1964) generally agree that job satisfaction results from a match or balance between what individuals perceive they need and what rewards they perceive they receive from their jobs.

Job Satisfaction Among Nurses

Studies reviewed on job satisfaction of other types of nurses have often reached dif- ferent conclusions about which job rewards were most related to job satisfaction. There are several possible explanations for these apparent contradictions. Specifi- cally, different study populations were used. Differences also existed in the size of the samples, the sampling methods, the research design, the instruments used, and the operational definitions of the variables.

Despite these variations, it is possible to synthesize the common elements from the studies' findings. First, although the rankings varied, many of the same rewards were repeatedly found to be important in different studies. Furthermore, these rewards can

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be subdivided into two types: intrinsic and extrinsic. Thus, intrinsic rewards (those de- rived from the content of the job, Herzberg, 1966), which nurses found to be impor- tant, included the work itself (Stember, 1978; White & Maguire, 1973); opportunity for professional growth (Seybolt, 1979; Seybolt, Pavett, & Walker, 1978; Seybolt & Walker, 1980; White & Maguire, 1973); autonomy (Slavitt & Stamps, 1979; Weis- man, 1982); and job responsibility (Slavitt & Stamps, 1979).

Likewise, extrinsic rewards (those derived from the work environment, Herzberg, 1966), which nurses found to be important, were interpersonal relationships (Everly & Falcione, 1976; Slavitt & Stamps, 1979); salary (Ginzberg, Patray, Ostow, & Brann, 1982; Slavitt & Stamps, 1979; Wandelt, Pierce, & Weddowson, 1981); and organi- zational policies and practices (Everly & Falcione, 1976; Slavitt & Stamps, 1979). It appeared from the studies reviewed that both intrinsic and extrinsic rewards are im- portant to job satisfaction among nurses.

METHODS

Research Design

This survey employed a cross-sectional, nonequivalent control group design. The oc- cupational health nurses in a midwestern state were surveyed through the use of a mail questionnaire that included the Minnesota Satisfaction Questionnaire (MSQ, Weiss, Dawis, Ensford, & Lofquist, 1967) and a secondary questionnaire developed by the author to collect demographic data about the subjects. The respondents to the MSQ were then compared to a normative group of hospital nurses, which was provided by Vocational Psychology Research at the University of Minnesota.

Subjects

Occupational health nurses who resided in a midwestern state were studied. The sampling frame selected consisted of members of the state association of occupational health nurses, which is an association with about 550 members. From a computer list- ing that included the name and address of each member, a simple random sample of 150 nurses was selected by using a table of random numbers (Mattson, 1981). Mem- bership in the association and current employment in occupational health nursing were the criteria for entry into the study. One hundred ten (73%) of the occupational health nurses who were mailed questionnaires responded. Of these questionnaires, 97 were suitable for analysis.

Instrument

After a review of several job satisfaction instruments (Buros, 1978; Cook, Hep- worth, Wall, & Warr, 1981), the MSQ was selected. The MSQ was developed at the

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Job Satisfaction Among Occupational Health Nurses 165

University of Minnesota and was based on the Theory of Work Adjustment (Lofquist & Dawis, 1969), which assumes that each individual seeks to achieve and maintain correspondence with the environment, with work representing a major portion of a person's environment. Satisfaction, then, is a function of the match between the rein- forcer system of the work place and the employee's needs.

The MSQ is designed to measure satisfaction of the individual's needs encountered at work. This 100-item Likert-type questionnaire has 20 subscales with 5 items in each scale. The scales are: ability utilization, achievement, activity, advancement, author- ity, company policies and practices, compensation, co-workers, creativity, independ- ence, moral values, recognition, responsibility, security, social service, social status, supervision-human relations, supervision-technical, variety, and working conditions (Weiss et al., 1967, p. 2). For an explanation of each scale, consult the Manual for the Minnesota Satisfaction Questionnaire (Weiss et al., 1967).

The MSQ has undergone extensive analysis and has been found to be a valid meas- ure of general job satisfaction useful in differentiating among occupational groups (Weiss et al., 1967). Two measures of reliability were used: internal consistency and stability. Internal consistency was estimated by Hoyt's analysis of variance method. Median Hoyt reliability coefficients ranged from .93 for advancement and recogni- tion to .78 for responsibility. For the present study, the Hoyt reliability coefficients ranged from .95 for social service to .81 for responsibility. Data on the stability of the scores on the 21 MSQ scales were obtained for two-time intervals - 1 week and 1 year. For the 1-week interval, stability coefficients ranged from .66 for co-workers to .91 for working conditions, with a median coefficient of 33. For a 1 year interval, stabil- ity coefficients ranged from .35 for independence to .71 for ability utilization, with a median coefficient of .61.

RESULTS

Profile of the Sample

The profile of the occupational health nurse is depicted in Tables 1 and 2. The occupa- tional health nurse was typically female (96.99'0, Table I), middle-aged (M = 49.49 years, Table 2), married (81.4070, Table I), and had two children living at home (M =

1.76 children, Table 2). Table 2 indicates that the sample of occupational health nurses surveyed has been in

occupational health nursing for over 11 years (M = 1 1.69) and in nursing, in general, for about 26 years (M = 26.01). They have worked at their present job an average of 7.59 years on a full-time basis (M = 38.54 hours per week). Over half of the nurses work in staff positions (55.7%) and over half were employed by a manufacturing company (56.7%). The largest percentage of nurses (42.3%) report administratively to the personal manager. Another 21.6% report to another registered nurse and 16.5% to a physician. Finally, the vast majority of nurses (84.5%) received their basic

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TABLE 1 Characteristics of Occupational Health Nursesas Percentages

Variable Frequency Percent

Marital status

Married

Divorced

Widowed

Never married

Basic nursing education

Diploma

Associate degree

Baccalaureate degree

Most recent nursing education

Diploma

Associate degree

Baccalaureate degree

Master's degree

Doctoral degree

Missing information

Position level

Staff nurse (single-nurse unit)

Staff nurse (multi-nurse unit)

Clinician/practitioner

Supervisor

Corporate director

Consultant

Other

Type of company

Manufacturing

Wholesale trade

Retail trade

Service

Other

supervisor

Registered nurse

MD

Personnel manager

Other

Sex

Female

Male

Missing information

Note. n = 97

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Job Satisfaction Among Occupational Health Nurses 167

TABLE 2 Means and Standard Deviations of Characteristics of Occupational Health Nurse Sample

Variable Mean Standard (Range) Deviation

Age in years

Number of years since becoming a registered nurse

Number of years since becoming an occupational health nurse

Number of years working in present job

Number of hours worked per week

Number of employees working at company

Number of children living at home

Note. n = 97.

nursing education in a diploma school. Several nurses (23.7%) have pursued addi- tional nursing education since their basic preparation.

Comparison Between OHNs and Normative Group on Job Satisfaction

A job satisfaction score, like any test score, takes on more meaning when there is a source of comparison available. This study was able to take advantage of a large nor- mative group of hospital nurses, used in the development of the MSQ. The MSQ was the only job satisfaction instrument reviewed that had normative data available on full-time registered nurses and where the job title, "registered nurse," was specifically defined by utilizing the Dictionary of Occupational Titles. These strengths, in addi- tion to the existence of reliability and validity measures on the instrument, the ease of administration of the instrument, and the fact that the questionnaire results can be computer-analyzed by the University of Minnesota, outweighed the fact that the data on the normative group were collected sometime between 1965 and 1967. Although the present study would have benefitted from a more recently developed normative group, one does not currently exist. This comparison group was judged to be useful because even though changes have occurred, such as the increased practice of primary nursing, improved wages, and advanced technology, the job conditions of many cur- rent hospital nurses are similar to those of the hospital nurses of the late 60s. For ex- ample, working hours, organization hierarchy, and institutional policies, remain sim- ilar. The comparison between occupational health nurses and the normative group of hospital nurses is ideally generalizable to hospital nurses of today who work in condi-

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168 Conrad, Conrad, and Parker

tions similar to those of the late 60s. This study makes a major contribution in that it is the first data on occupational health nurses that can be used by subsequent research- ers for comparative purposes.

The data on the normative group were found in the Manual for the Minnesota Satis- faction Questionnaire and are presented in aggregate form only. Some sample charac- teristics for both groups are presented in Table 3. The mean age for occupational health nurses is considerably older than for the hospital nurses, 49.49 versus 32.83, re- spectively. The mean number of years of professional nursing for occupational health nurses is 26.01 compared to 10.91 for the hospital nurses. Almost three times as many occupational health nurses as hospital nurses received a baccalaureate education. Both groups were predominantly female (96.9% of the occupational health nurses and 100% of the hospital nurses).

Analysis

The scales of satisfaction on the MSQ were compared for both groups by using stu- dent's t test for independent samples with a significance level of .O1 (Table 4). Thep value of .O1 was chosen in order to eliminate the "fishing" problem, which applies when performing multiple tests of significance. Therefore, it was unlikely that any of the significant findings occurred simply by chance. There was not a significant differ- ence between the means in the level of general (overall) satisfaction. The score range for overall job satisfaction was 20-100.

Scales on Which Hospital Nurses Scored Higher

Analysis of 20 subscales demonstrated significant differences between the two groups on 9 subscales with the score range for each MSQ subscale from 5-25. Six job aspects

TABLE 3 Comparison of Occupational Health Nurses and a Normative Group of Full-Time Hospital Nurses

on Selected Background Variables

Variable

Normative Group Occupational of Full- Time Health Nurses Hospital Nurses

(n = 97) (n = 419)

Mean age

Percent female

Percent with diploma education

Percent with baccalaureate education

Mean number of years in professional nursing

32.93a (Missing)

100%

89%

11%

10.91a (Missing)

- -

aEstimated from grouped data. "SD in parentheses.

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Job Satisfaction Among Occupational Health Nurses 169

TABLE 4 Comparison of Occupational Health Nurses and a Normative Group of Full-Time Hospital Nurses

on Minnesota Satisfaction Questionnaire Scores

Variable?

Normative Group Occupational of Full- Time

Health Nurse9 Hospital Nursesb t P M (SO) M (SO)

-- - --

Response rate on MSQ

General satisfaction 74.19 (1 1.59) 75.40 (7.99) 1.2237 n.s.

Ability utilization

Achievement

Activity

Advancement

Authority 17.87 (3.32) 19.06 (2.68) 5.1250 <.01

Company policies and prac- 16.52 (4.60) 16.38 (4.53) 0.2735 n.s. tices

Compensation 16.90 (5.27) 15.14 (4.58) 3.3120 <.01

Co-workers 19.39 (3.14) 20.68 (3.13) 7.0453 <.01

Creativity 18.37 (4.88) 17.71 (3.77) 3.2385 <.01

Independence 20.19 (3.69) 18.95 (3.08) 3.3814 c .01

Moral values 21.11 (3.35) 20.98 (2.40) 0.4431 n.s.

Recognition 17.17 85.12) 17.80 (3.90) 1.3242 n.s.

Responsibility 19.11 (3.57) 19.91 (2.60) 2.5300 <.01

Security 18.97 (4.67) 19.94 (2.65) 2.7518 c .01

Social service 21.71 (3.49) 21.51 (2.90) 0.5373 n.s.

Social status 17.87 (3.32) 19.06 (2.68) 5.1250 c.01

Supervision-human relations 17.27 (5.06) 18.28 (4.65) 1.8953 n.s.

Variety 19.35 (4.14) 18.85 (3.50) 1.2231 n.s.

Working conditions 19.05 (4.54) 19.34 (4.28) 0.5944 n.s.

an = 97. bn = 419.

were more satisfying (i.e., differences were statistically significant) to hospital nurses. Although neither group was very satisfied with the opportunity for advancement (hospital nurses = 15.77, occupational health nurses = 14.07), hospital nurses re- ported more satisfaction than did occupational health nurses. The fact that most oc- cupational health nurses work in one-nurse units where they are the only health pro- fessional employed by the company may explain this finding. Hospital nurses re- ported more authority than did the study group. The authority subscale included such items as "The chance to tell other people what to do." If the occupational health nurse works alone, then there is obviously no one there to supervise.

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170 Conrad, Conrad, and Parker

Hospital nurses were more satisfied with their co-workers than occupational health nurses. This may be partly explained by the fact that in the hospital setting the nurse is surrounded by other nurses and health professionals with whom there may exist some sense of collegiality. This is not the case for occupational health nurses who often work alone and for whom a sense of social isolation often exists.

Responsibility was another satisfaction measure that showed a significant differ- ence between hospital nurses and occupational health nurses. Responsibility included "the freedom to use my own judgement" (Weiss et al., 1967, p. 4). This was a some- what surprising finding because occupational health nurses are often employed in set- tings where there is no direct medical supervision and where they become actively in- volved in developing policy and procedures for the employee health service. Both groups scored over 19 points (maximum = 25), which indicates considerable overall satisfaction by nurses.

Occupational health nurses reported less security about their jobs. With the current economic recession, the availability of nursing jobs has decreased.

Technical supervision was more satisfying to the hospital nurses. This finding seems logical when one considers the fact that most occupational health nurses work alone and do not have a person available full-time at the worksite who is able to provide health-related technical supervision.

Scales on Which OHNs Scored Higher

There were three subscales on which occupational health nurses were significantly more satisfied. Neither group was very satisfied with their compensation (occupa- tional health nurses, 16.90, and hospital nurses, 15.14), but occupational health nurses were significantly more satisfied. Occupational health nurses traditionally have been reported to be among the best paid (U.S. Department of Health and Hu- man Services, 1982). Also, the financial remuneration and benefits for registered nurses in general has improved over the past years, after the hospital nurse survey.

Occupational health nurses were found to be more satisfied with their opportunity for creativity. Because occupational health nurses are frequently employed in situa- tions where they can develop, or at least interpret, an occupational health program for industry, they may have more opportunity to be creative. This does not appear to be as true for the hospital staff nurse. Occupational health nurses were more satisfied with their independence. This included "the chance to work alone on the job."

DISCUSSION

Major Findings

The occupational health nurses in this sample were, basically, veteran employees. They had been in both the nursing profession, in general, and occupational health

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Job Satisfaction Among Occupational Health Nurses 171

nursing, in particular, for a long while. They were usually diploma graduates and worked, most often, for a manufacturing company.

As a whole, they were not any more satisfied with their jobs than a normative group of hospital nurses. However, when the various dimensions of job satisfaction were considered, differences between these groups emerged.

Occupational health nurses were significantly more satisfied with compensation, creativity, and independence. Hospital nurses were significantly more satisfied with advancement, authority, co-workers, responsibility, security, and technical supervi- sion. Most of these differences were expected.

The five least satisfying job rewards for occupational health nurses were advance- ment opportunities, company policies and practices, compensation, technical super- vision, and recognition. The job rewards that occupational health nurses found the most satisfying were social service, moral values, independence, achievement, and ac- tivity. These results provided confirmation that both intrinsic and extrinsic rewards can be sources of both satisfaction and dissatisfaction for occupational health nurses.

lrnplications

This study has implications for three major groups: occupational health nurses, em- ployers, and nurse educators. Due to the recent economic recession there is less job mobility for nurses, including occupational health nurses. Several years ago a dissatis- fied nurse could easily leave one employment setting and readily find employment in another, but this is not the case today. Changing jobs is a less viable solution to job dissatisfaction and nurses need to look within themselves for some strategies to in- crease their job satisfaction. Two areas of need for nurses in this sample were compen- sation and advancement opportunities. Although a nurse in a one-nurse unit may not see much opportunity for vertical mobility, it is possible in some instances to advance in both pay and prestige by providing the employer with evaluation studies which doc- ument nursing interventions that make a difference. Outcome measures may include improved worker productivity, decreased absenteeism rates, and decreased health care costs. Employers need to be educated about the monetary worth of the occupa- tional health nurse. These nurses are able to effect positive health changes among em- ployees and thus ultimately contribute to cost containment.

Nursing educators are the third group for which implications exist. Many schools and colleges of nursing do not include any courses related to occupational health nursing in their curricula. Therefore, when nurses choose to enter this specialty, they have little idea of what the job involves. An unrealistic perception of a job can con- tribute to job dissatisfaction. Community health nursing educators can help close this knowledge gap by offering students some opportunities to learn about occupational health nursing. Implications are also great for nursing educators who provide con- tinuing education because, in reality, this is where most of the occupational health nursing teaching is done.

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Finally, there is a need for further research on the job satisfaction of all community health nursing specialties. This research should, of course, be methodologically sound. That is, it should employ a random selection of subjects, a good sample size, and a comparison group. A possible comparison group would be the occupational health nurses in this sample. It is further recommended that a prospective design be used that follows subjects through time, noting any changes in the need/job rewards balance and subsequent alterations in job satisfaction.

ACKNOWLEDGMENT

The authors wish to acknowledge the assistance of Paul Reichelt, PhD, Fred Kviz, PhD, and Cheryl Cox, PhD of the University of Illinois at Chicago Health Sciences Center, Chicago, Illinois.

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