Research participants’ profile
Out of 327 nursing faculties, who were sent questionnaire, 171 (52.3%) were included in final analysis. The average age was 36.8±7.0 years (range 26 to 57 years). Only 2.9% were male faculties. Majority of the faculty had Master of Nursing (MN) degree (55.6%), followed by Master of Science in Nursing (MSN, 40.9%) and Doctorate in Nursing (PhD, 3.5%).
The percentages of nursing faculties employed in private colleges and public colleges were 60.8% and 39.2% respectively. Overall 58.5% faculties were permanent (tenured) however there was huge disparities in tenure status among private colleges (45.2%) and public colleges (79.1%). Exactly two thirds of the faculties (66.7%) worked at Lecturer or lower position followed by 18.7% as Associate Professor or higher level and 14.6% as Assistant Professor. 38.0% of faculty had specialization in adult health (adult health nursing, medical-surgical nursing, critical care nursing and general nursing), followed by women's health (maternal health and women’s health; 26.9%) and child health (pediatrics and children's health; 17.5%). Only 10.5% and 7.0% were specialized in psychiatric and mental health and community health respectively.
Job satisfaction score
Slightly over one third (36.8%) of the graduate nursing faculties were satisfied with their job. Dissatisfaction about their current job was observed only in 14.6% faculties and majority (48.5%) had ambivalent feeling towards their job. Among the nine job satisfaction domains, highest job satisfaction was observed in coworkers (81.3%), followed by the nature of job (71.3%), communication (70.8%) and supervision (63.2%). Most dissatisfaction was towards lack of promotion (56.1%), contingency rewards (44.4%), operating condition (44.4%), pay (40.9%) and fringe benefits (35.1%). Only two domains, pay and supervision, have acceptable reliability score (Cronbach’s alpha >=0.70). Hence, individual domain scores are not analyzed further and the satisfaction categories are presented for informational purpose. (Table 1)
Our primary objective of this study was to explore factors associated with overall job satisfaction among the graduate nursing faculty. Since majority of the respondents were ambivalent with few respondents expressively dissatisfied, we grouped these two categories as not-satisfied opposite to the respondents who were satisfied. This would allow us to run a multiple logistic regression model with a binary dependent variable (satisfied vs not-satisfied).
Sociodemographic characteristics of graduate nursing faculties by job satisfaction
The details of sociodemographic and organizational characteristics of the faculties are shown in Table 2.
Organizations related characteristics of nursing faculties by job satisfaction
Majority of the nursing faculties (60.8%) were from private organizations and 39.2% from the public institutions. While public institutions usually offer provident fund, grade and promotional opportunities for their employees, private institutions are also catching up with providing these benefits to both their tenured and non-tenured employees. For example, 76.6% faculties responded positively about grade opportunity and 63.7% reported having provident fund benefits even though the overall employment in public colleges was 39.2% and tenure (permanent) rate was only 58.5%.
A grade in Nepalese context is a periodic increment in the basic salary of employees after they completed certain years at service. In other word, it can be defined as steps within the same grade level in the USA. On the other hand, a provident fund is a pension fund scheme for employees of both the public and private sectors in Nepal. This fund is managed by a government institution which invests the money to generate profit for the depositors. Under this scheme, eligible employees contribute 10% of their basic salary and employer equally matches the fund. This scheme operates similar to a 401(K) savings plan in the USA.
Healthcare benefits was reported by 74.3%. Healthcare benefits in Nepalese context is employer provided welfare scheme that provides limited medical care within their network for employee and their dependents. Immediate family members including spouse and children plus parents of both spouses are usually covered by this benefit.
Majority of respondents reported the availability and easy access to textbooks (74.9%), reference books (66.1%), nursing and medical journals (57.3%) and internet facilities (83.6%). (Table 3)
Characteristics associated with job satisfaction
The descriptive results showed that some of the variables have stronger association with job satisfaction than others. In order to evaluate the effect of each of those factors while simultaneously controlling for other factors, a multiple logistic regression model was used in next step. All variables with an effect size greater than 0.15 (see the correlation coefficient or Cramer’s V statistics in Table 2 and 3 above) were included in the initial model. Univariate logistic regression (not shown in these tables) also suggested the selection of these variables. All variables that were selected based on the high correlation with job satisfaction were further evaluated for possible collinearity and strong association among each other. Cramer’s V test statistics were used to check for each pair of categorical variables. A cutoff point of 0.50 was established for unusually high correlation at which point two variables were probably measuring the same concept.
Being permanent had strong correlation with provident fund (0.70) and grade (0.54). In Nepalese context, whether it is a public or private institution, a permanent employment (tenured status) usually requires the employer to provide both provident fund and grade (0.59) but employers can extend these benefits to non-permanent employees at any time. Since majority of the faculty worked in private sector colleges, an employer matched provident fund may have greater value towards their saving for the future. Therefore, only provident fund benefit was chosen to enter the model. Similarly, strong association was detected between current position and level of primary teaching responsibility (0.57) and total compensation above median (0.52). However, effect size between master’s program and total compensation was much lower (0.37) and both primary responsible program and total compensation were entered in the model without current position. Adequate textbook and reference book were also strongly related (0.64) and only adequate reference book which had higher correlation with outcome was selected.
(Figure 2 about here)
Table 4 shows the results from multiple logistic regression model where the job satisfaction is the function of many variables. The area under curve of the receiver operating curve showed very strong discriminatory power (AUC = 0.855) of the model. It means that the logistic regression model can accurately classify the predicted outcome as satisfied or not-satisfied for every possible pair of observations for 85.5% of the pairs. The likelihood ratio test (p<0.0001) and Hosmer and Lemeshow goodness of fit statistics (p=0.609) also indicate that the model is well behaved. However, majority of the individual variables included in the model do not have statistically significant coefficient and have a very wide odds ratio interval.
The researchers would like to point out that involvement in decision making (higher job satisfaction with higher involvement levels) and adequate reference books came out to be the only strongly significant variables (p<0.05) in the model. Faculties who were involved in departmental decision-making processes ‘sometimes’ and ‘often or always’ were 3.6 and 4.83 times more likely to be satisfied respectively than those who were never or rarely involved. It is interesting to note that the lowest job satisfaction (Table 1) was in the domain “operating conditions”. It suggests that job satisfaction is high when faculties are included in the decision-making process and they feel part of the ‘system’. Similarly, their job satisfaction is higher (OR=2.92, p=0.050) reference books were adequately available for themselves and the student.
Although the adjusted odds ratios were not significant at 5% level of significance and 95% confidence interval, there were positive indicators of job satisfaction with various factors identified during the descriptive analysis. The nursing faculties were more likely to be satisfied with availability of medical or nursing journals (OR=2.32, p=0.090) and internet access (OR=3.92, p=0.100). They were 64% more likely to be satisfied (OR=1.64, p=0.378) when they were involved in setting questions for the final exams, which is often regarded a greater respect to the faculty in Nepal. They were more likely to be satisfied with their job when they did not have evening clinical (OR=3.30, p=0.069), could start their AM clinical 8 am or later instead of earlier in the morning (OR=1.54, p=0.352), had weekly work load of less than 42 hours (OR=1.98, p=0.198), had annual teaching load less than 125 hours (OR=2.41, p=0.082) and were provided with more than 5 days of professional development opportunities (OR=2.34, p=0.072).