Research Into Job Satisfaction Among Nurses

Nurses in most healthcare facilities have some of the highest levels of direct patient contact of any employees. Nursing force plays an essential role in achieving organizational goals and providing high quality care to the community. Hospitals are important health care and social system where nurses are the cornerstones for their effectiveness and efficiency. Many of the nurses even take on the responsibilities of the medical supervisors or the doctors in command, and this makes them a very important part of the medical system (International Council for Nurses, 200) Devoid of people, organizations can not reach their goals. (Drucker, 1999).

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High nurse turnover can impact negatively on an organization’s capacity to meet patient needs and provide quality care (Gray and Phillips, 1996; Tai et al., 1998; Shields and Ward, 2001). At the nursing unit level, high turnover affects the morale of nurses and the productivity of those who remain to provide care while new staff members are hired and orientated (Cavanagh and Cof¬n, 1992; Sofer, 1995). Jones (1990a, b) de¬ned nursing turnover as the process whereby nursing staff leave or transfer within the hospital setting. This de¬nition Includes intentional and unintentional, as well as internal and external turnovers. Voluntary and involuntary turnovers are not always distinguished in studies because costs are incurred regardless of whether staffs resign or are requested to leave. According to L.J. Hayes et al(2008) turnover is a product of job satisfaction and commitment and can lead to nursing shortage.

Nursing shortage and high rates of nurses’ turnover has become a prevalent global issue (Kingman, 2001). The nursing shortage has a vital effect on healthcare system because of its negative impact on both preventive and curative care. For example, in developing countries, fewer nurses have been available for providing immunizations and prenatal care. Hospitals in many industrialized and developing countries have been forced to close units when nursing staff has not been available (Oulton, 2006,cited in sianze,Malvarez (2008).Shortages can be a symptom of low job satisfaction, poor management and lack of organizational support (Zurn et al., 2005). Shortages are resulting in heavy workload, which is a precursor to job stress, and burnout, which have also been linked to low job satisfaction. Nurses’ job satisfaction is an elusive concept, which is defined within its extrinsic and intrinsic values (Cowin, 2002 cited in Masroor A.M., Fakir M. J 2010). Job satisfaction is an essential element that has strong effects on patient safety, productivity, and performance, quality of care, retention and turnover (Cavanagh and Cof¬n, 1992; Blegen, 1993; Irvine and Evans, 1995, Murrells, T., et al, 2007). Job satisfaction refers to overall positive feelings towards a job. It is defined as, “Pleasurable or positive emotional state resulting from the appraisal of one’s job experiences (Locke, 1976).” What in terms of job satisfaction counts the attitude of an employee towards his job? Attitude is a point of view of an individual towards an object. The object may be anything, such as, an organization, a manager, a colleague or a job. What is important about attitude is that: people make decisions based on their attitudes.

When employees are satisfied with their job, they tend to stay in their job. On the other hand, people who are not satisfied with their job tend to take a decision of quitting their workplace. Workers with positive attitude are likely to be productive and effective in the organization whereas those with negative attitude have poor performance and ultimately less productive (Abu Ajamieh, A. R, 1996). Satisfied employees tend to be more productive, creative, and committed to their industry, and recent studies have shown a direct relation between staff satisfaction and patient satisfaction in health care organizations (Al-Aameri, 2000). The entire employee wants to be satisfied at their job no matter what activities they are engaged in or have the will to carry out. The significance of job satisfaction arises from the fact that the nurses whom job satisfaction is positive are not only pleased and happy within themselves but also affecting the quantitative and qualitative outcomes of the health organization in a positive way. Quite the opposite, the dissatisfied nurses are not peacefully pleasured resulting in poor performance, increased absenteeism, tardiness, burnout, turnover and qualitative and quantitative negative outcomes for the health care system.

Nurses’ shortage and Job satisfaction should be of primary concerns to the health managers because nurses take the responsibility of many positions in the hospital and their turnover would have great impact on the employers and the patients as well. The shortage of nurses has been well recognized and extended to the long-term care services (Fletcher, 2001; Mark, 2002; Mitchell, 2003) Cited in MH 2008. In response population growth, health care organizations are facing problems in finding and keeping skillful nurses (Gohen & Van Nostrand, 1995; Kassner & Bertel, 1998). High nurse turnover and vacancy rates are affecting access to health care (Best & Thurston, 2004) Cited in MH 2008. Continuously hiring new staff is costly and recurrent turnover influence the morality of nurses and vitiates patient care (Sofie, Belzar, & Young, 2003) Cited in MH 2008. The increasing rate of turnover resulted in unfavorable physical and emotional effects on nursing home residents, leading to a greater incidence of falls, medication errors, fear and anxiety, and feelings of hopelessness (Best & Thurston, 2004; Sofie, Belza, & Young, 2003).

Background and significance:

There are five governmental schools of nursing spread overall the United Arab Emirates (UAE). Three of them are called Institutes of Nursing (IONs) governed by the Ministry of Health (MOH). The IONs offer a Diploma degree and cover the Northern Emirates. While the Higher College of Technology and the Institute of Applied Technology which are controlled by the Ministry of Higher Education in both of Abu-Dhabi and Al-Ain graduate nurses holding Bachelors degree of nursing science. The period of study in the IONs is three years. All of the graduates are female Emiratis’ and expatriates and the number of graduates in the northern emirates is relatively higher that of Abu-Dhabi and Al-Ain cities.

Despite all such number of graduates, the UAE like the other countries is in severe shortage of nurses related to high rate of turnover. The UAE is need for 30,000 nurses and midwives, only 23000 are available which means that the shortage is 7000 (Underwood, M, 2010). According to the MOH-secretary of the Nursing and Midwifery Council, low remuneration, low status and limited career development are all factors influencing the shortage. Therefore, the UAE must hire up to 25 to 30 per cent; 7000 nurses to overcome the shortage of nursing staff. Dr. Rifaai (2010), the Head of Federal Nursing Department, referred the shortage of nurses and midwives in the UAE to the perceived low status of the profession. The Emirati nurses account only 4% of the total population (UAE-MOH, cited Underwood, M, 2010) which does not run in parallel with the demographics population of the country.

The serious nursing shortage has prompted the MOH-UAE to start a national study to identify the factors that could lead to a better workplace at the governmental hospitals. This study was in response to a previous pilot study funded by the Ministry of Health called ‘Thinking Magnetism’ which revealed that low wages and Lack of autonomy to make decisions are the primary reason for nurses dissatisfaction (Khaleej Times, 23 November 2009). The outcomes of the study drove the government to start looking carefully after these phenomena particularly when the pilot study, the magnet indicators showed very low scores for ministry hospitals as compared with USA magnet hospitals. The indicators studied: nursing contribution in hospital affairs; nursing foundation of quality of care; ability of nurse manager, leadership; staffing; resources; and nurse-physician relationship. Among the 14 urgent requirements identified, the pilot study recommended: part-time jobs; flexible recruitment; promotion policies, and competitive salaries. Involvement in decision-making and encouragement of a healthy nurse-physician relationship was also suggested. Expatriate nurses working in the government hospitals demanded equal treatment with UAE nationals and placements according to qualifications. Suliman, A.B., (2006), stated in his study that staff’s perceptions of fairness are largely based on comparison. For instance, employee may compare their payment, working hours, and incentives. If the comparison is positive, they are likely to feel positive toward their organization. Conversely, if the result is negative, they will react negatively toward the system and may challenge and oppose it. Consequently, the employees may intent to quit their job.

The finding of this study may help the health care managers and policy makers to develop and institutionalize targeted nurse recruitment and retention strategies by taking into consideration the predictors of nurses’ dissatisfaction and turnover.

The significance of the problem and the absence of related researches and statistical data about the level of nurses’ satisfaction, and the factors that contribute to turnover give the urge to study these phenomena.

Statement of Purpose:

The aim of this research is to :

Explore the relationship between job dissatisfaction and turnover among registered nurses in the governmental hospitals of UAE.

Find relationship between individual/ demographic variables and job satisfaction among the registered nurses in the Governmental hospital in the UAE.

Give the nursing managers in the UAE hospitals clear indicators towards improving the nurse’s job satisfaction, retention and reduction of turnover rates.

Research questions:

This research is intended to answer the following questions:

What is the relation between dissatisfaction factors to turnover?

What is the relationship between demographic variables and job satisfaction?

Literature Review

Theoretical Framework:

Job satisfaction is multi-faceted with many definitions and theoretical frames. According to Spector (1997), Job satisfaction is the most important variable that is frequently studied in organizational behavior research. In addition, the fundamental variable in both research and theory of organizational phenomena were ranging from job design to supervision. Moreover, the traditional model of job satisfaction focuses on all the feelings that an individual has about his/her job. Yet, being satisfied or dissatisfied does not rely on the type of the job only but also on the expectations of the individuals from their job.

In another definition, Job satisfaction is defined as the degree to which employees enjoy their jobs (McCloskey & McCain 1987). Job satisfaction is an enjoyable affecting state resulting from the consideration of one’s job (Locke, 1976 cited in Brief, A. P., & Weiss, H. M. (2001) cited in Wikipedia), an emotional response to one’s job (Cranny, Smith & Stone, 1992 cited in Weiss, H. M. (2002) cited in Wikipedia) and an sentiment towards one’s job (Brief, 1998 cited in Weiss, H. M. (2002) cited in Wikipedia).

Researchers usually relate job satisfaction to motivation. Motivation can be defined as an internal process that activates, guides and maintains behaviour over time (Pintrich 2003; Schunk 2000).There are several theories of motivation .The most important theories are Maslow’s hierarchy of needs, Hertzberg’s dual factor theory, and. Vroom’s expectancy theory. Unfortunately, none of these theories have gained adequate support or shown to be valid as job satisfiers. Nevertheless, they are based on satisfying human needs that address motivation.

Maslow’s theory1954:

Maslow suggested a hierarchy of needs and links these needs to motivation. Maslow divided human needs into three categories, the deficiency needs (physical and psychological well being) , growth needs(knowing, appreciating, and understanding), and self actualization (one’s potential). Maslow pointed out that individuals will not be motivated to the second need until the demands of the first need have been satisfied. Based on Maslow’s theory, job satisfaction has been approached by some researchers from the perception of need ful¬llment (Kuhlen, 1963; Worf, 1970; Conrad et al., 1985). The fulfillment of job related needs lead to increase satisfaction as individual moves up in the hierarchy to the highest level. An individual who reaches the self-realization will continue in his job and becomes more efficient and productive, whereas unfulfilled needs will lead to poor performance; less productivity, work related stress and eventually job dissatisfaction which might result in turnover.

Herzberg Motivation-Hygiene theory (1959):

Herzberg presented a dual – factor theory. He uses the needs satisfaction to explain job satisfaction. He believed that satisfaction and dissatisfaction were separate and unrelated. Intrinsic factors called ‘motivators’ (i.e. related to the nature and experience of performing work) were found to be job ‘satis¬ers’ and included: achievement, recognition, work itself and responsibility and similar to the growth needs of Maslow’s hierarchy. Extrinsic factors called ‘hygiene’ factors were found to be job ‘dissatis¬ers’ and included: organizational policy, administration, supervision, salary, interpersonal relations and working conditions to the deficiency needs of Maslow. However, the distinction between motivators and hygiene was not supported by many researches (Cronin-1977; Everly and Falcione, 1976; Gangadhraiah, et al.1990; Hutto & Davis, 1989; Joiner, Johnson & Crokrean, 1981; Koelbel, 1988; Munro, 1983; Simpson, 1985).

Cavanagh (1992 cited in Burnard et al., 1999) noted that these theories attempt to ‘specify particular needs that must be met or values that must be attained’ (p. 705) if an individual is to be satisfied at work.

Figure 1: (Maslow’s and Herzberg’s Ideas Compared, cited in Tiffany Jordan, undated)

Vroom’s Expectancy Theory of Motivation (1964):

Vroom predicts that effort lead to increased performance (Expectancy), and performance lead to valued rewards (Instrumentality) and then these values are placed on outcomes (Valence), all three are required for positive motivation. If either of these factors were absent, performance will be altered to zero (Suliman, 2001). However several researches have supported the principles of the theory (Campbell & Pritchard, 1976, Hollenback, 1979, Mitchell, 1974). However, questions remain to which extent an employee can increase his/her efforts about the corresponding organizational structure and decision making processes needed to fulfill the expectations of workers.

(Expectancy Theory of Motivation (Undated), cited in Arrod, http://www.arrod.co.uk/archive/concept_vroom.php)

Definitions of Job Satisfaction based on the theories:

Job satisfaction is the affective orientation that an employee has towards his or her work (Price, 2001). Specter (1997) summarized the following facets of job satisfaction: appreciation, communication, co-workers, fringe bene¬ts, job conditions, nature of the work itself, the nature of the organization itself, an organization’s policies and procedures, pay, personal growth, promotion opportunities, recognition, security and supervision.

Dentitions

Related Theory

The individual matching of personal needs to the perceived potential of the occupation for satisfying those needs (Kuhlen, 1963)

Maslow’s human needs theory (Maslow, 1954

Need ful¬llment, that is, whether or not the job met the employee’s physical and psychological needs for the things within the work situation (Worf, 1970)

A match between what individuals perceive they need and what rewards they perceive they receive from their jobs (Conrad et al., 1985)

A function of satisfaction with the different elements of the job (Herzberg 1959)

Herzberg motivation-hygiene theory (Herzberg, 1959)

All the feelings that an individual has about his job (Gruneberg, 1976)

Focus on cognitive process (Spector, 1997)

The affective orientation that an employee has towards his or her work (Price, 2001)

(Table 1, Dentitions of job satisfaction, Hong Lu, While, A., Barriball, K.,(2004)

C. Previous Research Review:

C. Previous Research Review:

Locke (1976) defined job satisfaction as “a pleasurable or positive emotional state resulting from the appraisal of one’s job or job experience.” That is, it is the discrepancy between what an employee values and what the situation provides. Job satisfaction is a complex phenomenon. The current global shortage of nurses places of interest the importance of understanding the effect and interrelationships of the factors that contribute to nurses’ dissatisfaction and consequently turnover so that healthcare organizations may implement strategies that help to retain nurses.

Sources of nurses’ job satisfaction:

Satisfaction has been found to be related to performance within the work environment (Landeweerd and Boumans, 1988, cited in Burnard et al., 1999), so it is not amazing that the notion of job satisfaction has gained much attention. Researchers have attempted to identify the different variables of job satisfaction, measure the significance of each variable and examine what effect these variables have on the productivity of the employee (Burnard et al., 1999). A variety of quantitative and qualititative studies have been done on the sources of job satisfaction among nurses and here are the most important findings:

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Aiken et al. (2001) found in his global study in a sample of 43,329 nurses working in adult acute hospitals that job dissatisfaction among nurses was highest in the United States (41%) followed by Scotland (38%), England (36%), Canada (33%) and Germany (17%). One third of nurses in England and Scotland and more than one ¬fth in the United States have intent to quit their job within 12 months of data collection. More striking, however, was that 27-54% of nurses less than 30 years of age intended to quit within 12 months of data collection in all countries. Opportunities for the development were the reason behind the satisfaction of the nurses in Germany (61%) while salary was the satisfier for the nurses in USA (57%) and Canada (69%).

Similarly, Adamson et al. (1995) found that British nurses were more dissatis¬ed than Australian nurses. He pointed that the poor insight of professional status, insufficient relationship with hospital management system and improper working environment, were found in British more than Australian nurses. Professional organization and work design, con¬‚ict between the newly gained experience during training and the available one. Furthermore, lack of communication between nurses and physicians, feeling of being not respected by other related health professionals, hospital managers and physicians were a concern to the British nurses. Nevertheless, the perception of autonomy by the Australian and British nurses was nearly the same.

Eventually Tovey and Adams (1999) came up with the main sources of nurses’ dissatisfaction: working interactions, mainly those with administration, shortage of staff, professional concerns about poor standards of care and external work pressure. Nolan et al. (1998) found that level of job satisfaction had remained stable. They further found in a sample of 518 nurses that 35% of nurses’ reported reduction in their level of satisfaction and 69% drop in their morality. Price (2002), using the satisfaction scale of Mueller and McCloskey’s (1990a, b) in a sample of 141 nurses found that (58%) were generally satis¬ed with their job. Highest satisfaction was related to co-workers and extrinsic rewards and most dissatisfaction was with the amount of control and responsibility they had and with professional opportunities. Nurses were most satis¬ed with annual leave, nursing peers and hours worked (79%, 78% and 76% of respondents) and dissatisfied with compensation for working weekends and control over work conditions and childcare facilities (55%, 55% and 46% of respondents. Using the same scale, Wang (2002) found that Chinese nurses were mostly dissatis¬ed with pay and job promotion.

Finally, nurses’ job satisfaction is very essential to organizations as levels of job satisfaction would globally impact the nursing workforce. Sources of job satisfaction are relatively similar, e.g., physical working setting, relations with fellow workers and managers, salary, promotion, job security, responsibility, the recognition from managers and working hours.

Effects of job satisfaction of nurses on absenteeism, burnout, turnover and intention to quit:

Researchers have generally found that satisfied employees are more productive and committed to their jobs, whereas dissatisfied ones experience absenteeism, grievances and turnover (Smith 1996, cited in Alamri, 2001).Matrunola, (1996) did not find any significant relationship between job satisfaction and abscentism in a small sample of 34 nurses which makes its generalization difficult. Borda and Norman (1997) noted a signi¬cant positive relationship between job satisfaction and intent to stay and negative relationships between job satisfaction and frequency of 1 day absence and short-term absence. Siu’s (2002) indicates that job satisfaction was an important predictor of abscentism. Job dissatisfaction is consistently linked to high levels of stress, burn-out or mental and physical exhaustion (Blegen et al. 1993, Adams & Bond 2000, Aiken et al. 2002). Keel (1993) cited in Tzeng 2002), indicated that burnout affects mainly nurses, physicians, social workers and teachers. Burnout seems to be caused by stressful working conditions, disproportional-high efforts (time, emotional involvement, and empathy) and dissatisfaction with jobs. For the goals of lowering professional stress and improved satisfaction, social support and improved team cooperation could protect nurses against burnout.

There is a vast body of the literature linking job satisfaction in nursing and turnover.

Job dissatisfaction has been frequently identi¬ed as the reason why nurses leave their jobs (Lum et al., 1998; Tzeng, 2002). Tzeng (2002) has also noted that factors such as indirect working environment (hospital’s policies, bene¬ts, leisure activities, housing, parking, and vacation policy), salary and promotion as very important but strongly dissatisfying and indicated that job satisfaction is a predictor of turnover. A study conducted in the United States revealed that dissatisfied nurses were 65% more likely to have intent to quit compared to their satisfied colleagues (Shields & Ward, 2001 cited in Masroor A.M., Fakir M. J., 2010).

Gray and Philips (1994) Examined turnover rates and relationship to age and length of service in 342,000 employees from nine staff groups in National Health Service (NHS) and explored that annual turnover rate among all NHS staff 13.6%; higher turnover among full-time than part-time; turnover declines with age, are high in ¬rst year of service, remains high in second year before declining. Leveck and Jones (1996) indicated that experience on unit and professional job satisfaction were predictors of staff nurse retention; job stress and clinical service were predictors of quality of care. The variable contributing the most was management style. While Davidson et al (1997) in a sample of 736 hospital nurses cited that intent to leave predicted by perception of little promotion, high routinization, low decision latitude and poor communication. Lum et al (1998) found among 361 RNs in neonatal and pediatric Intensive Care Unit that Job satisfaction has indirect and organizational commitment has direct effect on intent to quit. Boyle et al (1999) recognized that managers’ position power and in¬‚uence over work coordination had direct link to intent to stay. Instrumental communication, autonomy, and group cohesion decreased job stress and thus increased job satisfaction. Job satisfaction was directly linked with intent to stay. Furthermore, Hemingway and smith (1999) discovered that high work pressure was predictive of greater role con¬‚ict and role ambiguity, and of more stress from heavy workload. In addition, poor supervisor support was signi¬cantly related to greater stress from heavy workload, and lack of autonomy was related to higher role ambiguity. Larabee et al (2003) proposed that major predictor of intent to leave was job dissatisfaction, and the major predictor of job satisfaction was psychological empowerment. Predictors of psychological empowerment were hardiness, transformational leadership style, nurse/ physician collaboration, and group cohesion. Strachota et al (2003)identified the following reasons: hours worked; better job opportunity; family; poor pay and bene¬ts; poor staffing; unsupportive management; unacceptable work environment; work stress; no opportunity for advancement. Duffield et al (2004) added the following causes: leaving related to work aspects, structural aspects, professional issues, team support, salary and prestige, employer care, and legal concerns. Turnover has many consequences such as mean cost per RN turnover was $10,198, ranging from $6,886 to $15,152(Jones, 1990b, Waldman et al, 2004)), poor patient satisfaction, risk of infection increased almost 30% and the risk of hospitalization increased more than 80% (Zimmerman et al, 2002). Leiter et al. (1998)cited in Tzeng,2002) concluded that patients, who stayed on wards where nursing staff felt more exhausted or more frequently expressed their intention to quit, were less satis¬ed with their medical care. This study con¬rmed the importance of understanding nurses’ job satisfaction and intention to quit as both concepts, which would contribute to patient outcomes. Moreover, both nurses’ job satisfaction and patient satisfaction have been identi¬ed in the Nursing Report Card for Acute Care (American Nurses Association, 1995) as two of the important nursing quality outcome indicators. Lee et al.’s (2003) showed that the most common reasons for nurses’ turnover were work overload, rotating shifts and con¬‚ict in interpersonal relationships. A total of 24%, 15% and 35% of variance regarding depersonalization, emotional exhaustion and personal accomplishment, respectively, was explained by the individual characteristics, job stress and personal resources were explained by the predictor variables.

Turning to, Cavanagh (1990) indicated that job satisfaction was the determining factor of turnover which could be predicted by kinship responsibility, promotion, pay and influential communication skills. Wu et al (2000), found a positive and significant relation between the job stress and intention to quit. This was also confirmed in Yin and Yang’s (2002) meta-analysis who revealed that the strongest factors for nurse turnover were job satisfaction, autonomy, advancement opportunity, job stress, pay, group cohesion, marital status and educational level.

To sum up, researches from various countries indicate that job satisfaction is a signi¬cant predictor of nursing absenteeism, burnout, turnover and intention to quit the organization and nursing profession.

Related factors to job satisfaction of nurses

Blegen’s (1993) meta-analysis found a strong connection between job satisfaction, stress and organizational commitment. Seven variables had strong correlations: communication with supervisor, autonomy, recognition, routinization, communication with peers, fairness and locus of control; and four variables had very weak correlations: age, years of experience, education and professionalism. A causal model of job satisfaction has been tested in the studies of Chu et al.’s (2003) among 308 Taiwanese nurses and Seo et al.’s (2004) among 353 South Korean nurses, respectively. In this model 11 independent variables included: job involvement, positive affectivity, negative affectivity, autonomy, distributive justice, procedural justice, job stress (role ambiguity, role con¬‚ict, and workload and resource inadequacy, pay, promotional chances, routinization and social support .Moreover, four of twelve structural variables (workload, supervisory support, routinization, and pay) were found to have signi¬cant net effects on satisfaction. Chu et al. (2003) found that six variables had significant impact on job satisfaction: routinization, positive affectivity, involvement, negative affectivity, role ambiguity, supervisor support which explain 45% of the variance in satisfaction. Whereas Seo et al. (2004) found seven variables had statistically signi¬cant effects on job satisfaction: positive affectivity, supervisory support, pay, routinization, negative affectivity, workload and job opportunity and he found reasonable fit between the casual model and data; all the variables explained 53% of the variance.

Interestingly, Packard and Motowidlo (1987) correlated job satisfaction with depression, hostility, subjective stress, frequency of stressful events, intensity of stressful events and anxiety. Knoop (1995) indicated that organizational commitment is positively related to job satisfaction among nurses, satisfaction with work, promotion opportunity, supervision, co-workers and pay among Canadian nurses. Organizational commitment refers to identi¬cation with and loyalty to the organization and its goals (Blau and Boal, 1987) which Mowday et al. (1979). Commitment is characterized by three factors: a strong belief in and an acceptance of the organization’s goals and values; a willingness to exert considerable effort on behalf of the organization; and a strong desire to maintain membership in the organization (Blegen, 1993; Al-Aameri, 2000). Fang, (2001) agreed with the studies of (Blegen, 1993; Al-Aameri, 2000) and cited that job satisfaction was significantly and positively related to organizational commitment, professional commitment, and negatively related to job stress. Organizational commitment has an incremental effect on a professional’s intention to leave the organization (Blau and Lunz, 1998). Enhancing professional commitment in nursing has the potential to produce bene¬ts for both the individual and their organization (Cohen, 1998; Cohen, 1999). Furthermore, professional commitment is positively related to the job satisfaction of nurses (Lu et al., 2000; Jones, 2000).Lu et al., (2002) indicates that professional commitment is more effective in predicting intention to leave the nursing profession than intention to leave the organization at 9.2 %. Lu et al., (2002) added that Job satisfaction was more effective in predicting intent to leave the organization than intention to leave the nursing profession at 8 %. Moreover, role con¬‚ict and ambiguity are signi¬cantly related to job stress, organizational commitment, job satisfaction and intentions to leave the nursing profession (Rosse and Rosse, 1981).Dailey (1990) found that most signi¬cant predictor of intention to quit was experienced job induced stress symptoms. However, Mitchell’s (1994) in United State study found that there was not a signi¬cant linear association between a nurse’s job satisfaction and the correlation between work role values and actual work roles. Yet, the ¬nding that workload has the second largest impact emphasizes the relative importance of job stress in determining levels of nurses’ job satisfaction. This ¬nding is consistent with the results obtained in other empirical studies which have shown that the job stress variables have negative impacts on job satisfaction (Mathieu, 1990, 1991