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Nurse job satisfaction and retention: Comparing public to private hospitals in

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Journal of Nursing Management, 2005, 13, 40–50

Nurse job satisfaction and retention: comparing public

to private hospitals in Jordan

MAJD TAWFEEQ MRAYYAN PhD, RN

Assistant Professor, The Hashemite University, Faculty of Nursing, Zarqa, Jordan

Correspondence M R A Y Y A N M . T . (2005) Journal of Nursing Management 13, 40–50

Majd Tawfeeq Mrayyan Nurse job satisfaction and retention: comparing public with private hospitals in
The Hashemite University Jordan
Faculty of Nursing
PO Box 150459 Aims To identify variables of Jordanian nursesÕ job satisfaction and retention.
Zarga 13115 Comparisons were performed between three public and two private hospitals.
Jordan Background There has been little research on nurse job satisfaction and retention in
E-mail: mmrayyan@hu.edu.jo Jordan. Interest in nurse retention is renewed with each cycle of nursing shortage.
Methods A descriptive design using surveys guided this study through convenience
sample of 438 nurses. Data were analysed using descriptive and inferential statistics.
Results Nurses reported that they were Ômoderately satisfiedÕ in their jobs with
ÔneutralÕ opinion about their retention. Nurses who work in private hospitals were
more satisfied and intended to retain their jobs more than nurses in public hospitals.
Conclusion Nurse job satisfaction and retention are related concepts; nurses who
are satisfied in their jobs are likely to retain these jobs.
Keywords: job satisfaction, Jordan, nurse, retention

Accepted for publication: 4 December 2003

emphasis on retention. Nurse job satisfaction and

Introduction
Nurse job satisfaction and retention are complex issuethat
have been studied in social and nursing sciences. Many
studies used the term intent to stay to explore the concept
of nurse retention (Edwards 2002, Schmidt 2002, Arm-
strong-Stassen & Cameron 2003). The phenomena of
interest are multidimensional; influenced by many factors
including workersÕ value systems and work environments
in which they work. Globally, many changes have influ-
enced health care systems, significant among these is the
nursing shortage (Baker et al. 2000, Curtin 2000, Arm-
strong-Stassen & Cameron 2003). Minimizing turnover is
a priority for nurse administrators who are concerned
about the survival of their health care organizations,
particularly with the current escalating nursing shortage.
Nowadays, the nursing shortage is epidemic in nat-
ure. However, many health care organizations continue
to focus on nursesÕ recruitment but without enough
retention strategies are areas that have not been studied
extensively enough. Hospitals have to assess why nurses
are dissatisfied and leaving their jobs (Romano 2002).
Overwork, stress and non-supportive work environ-
ments are the common causes of nurse job dissatisfac-
tion and turnover (Shapiro 2001). The researcher stated
that hospitals have deflected shortages by offering
higher wages or increasing recruitment. As the nursing
shortage continues to intensify, most nurses report that
they are now working longer hours but earning less
than they did in the past few years (Bauer 2001).
Nursing turnover rates have increased over the years,
accompanied by a decline in nursing school graduates
since 1996 (AHA & The Lewin Group 2001). Nurse
dissatisfaction and turnover result from many factors
such as lack of autonomy. Dissatisfied nurses are likely
to leave their jobs (Price & Mueller 1986, Mueller &
Price 1990, Alexander et al. 1998, Cowin 2002).

40 ª 2005 Blackwell Publishing Ltd


In the past, nursing shortages have been cyclic. As
demand increased, nursing education responded by
increasing enrolment through aggressive recruitment
efforts, while hospitals striving to create supportive
work environment such as provide improved compen-
sation packages (Tanner & Bellack 2001, Tieman
2001).
The health care system in Jordan is composed of 27
public hospitals, 56 private hospitals, two large uni-
versity-affiliated teaching hospitals, 10 military hospi-
tals, and few centres that are directed by The United
Nations Relief and Works Agency (UNRWA). This
health care system is characterized by centralization
and lack of competition for patients except in private
hospitals. Excluding the private sector, health care is
provided for people almost free or at nominal charges.
The purpose of this research is to describe Jordanian
nursesÕ job satisfaction and retention. Specific ques-
tions are: (1) What are the differences in demograph-
ics, job satisfaction, and retention of nurses in public
and private hospitals? (2) What factors influence job
satisfaction and retention of Jordanian nurses? and (3)
What is the relationship between nurse job satisfaction
and retention?
Significance of the study
The knowledge about factors that contribute to job
dissatisfaction and turnover has grown in the last two
decades. In the 1980s, many studies investigated nurse
job satisfaction and retention. However, for nearly a
decade (1990s), few studies focused on nurse retention.
As a result of the current international nurse shortage,
there is renewed interest in nurse retention. Most nur-
sing studies about job satisfaction and retention were
conducted in a single type of hospital. Few studies were
conducted to estimate the difference between public and
private sectors; but these studies were not nursing-
related (Paine et al. 1966, Rainey 1979, Solomon 1987,
Schneider & Vaught 1993). In nursing, comparative
studies were mainly performed between critical and
non-critical care units (Bowler & Mallik 1998, Boyle
et al. 1999), teaching vs. non-teaching hospital (Pola-
nczyk et al. 2002, Derlet 2003), or a particular type of
units such as psychiatric units in two psychiatric settings
(Happell et al. 2003). Hospitals are usually compared
according to their performance (Griffith et al. 2002). In
Jordan, this is the second nursing study linking job
satisfaction to retention (the first study was conducted
by Suliman & Abu Gharbieh 1996). In another study
(Al-Ma’aitah et al. 1996) investigated Jordanian nursesÕ
job satisfaction, but did not link it to other variables as
ª 2005 Blackwell Publishing Ltd, Journal of Nursing Management, 13, 40–50
Nurse job satisfaction and retention
retention. The results of current study will provide
baseline information for managerial interventions that
are needed to be initiated in the future.
Literature review
NursesÕ roles become complicated and overlapped.
Thus, innovative interventions that would influence
nurse job satisfaction and retention are required.
Although not studied in Jordan, internationally, many
researchers linked between job satisfaction and retent-
ion (Price & Mueller 1981, Irvine & Evans 1995,
Alexander et al. 1998, Cowin 2002).
Nurse job satisfaction
In the 1980s and 1990s, many researchers have been
addressed nurse job satisfaction. The understanding of
nurse job satisfaction and its contributing variables are
important for any health care organization to exist and
prosper. Job satisfaction is defined as the degree to
which employees enjoy their jobs (McCloskey &
McCain 1987). Nurse job satisfaction is a multi-
dimensional phenomenon that is influenced by many
variables. Autonomy has been identified as the strongest
predictor of nurse job satisfaction, which in turn reflects
positively on nurse retention (Boyle et al. 1999, Chab-
oyer et al. 1999, 2001, O’Rouke et al. 2000, Upenieks
2000, Finn 2001).
Sengin (2003) supported Hinshaw and Atwood
(1984), who are in a comprehensive literature review
identified variables that influence nurse job satisfaction.
These factors included: (1) demographic variables:
education, experience, and position in the hierarchy; (2)
job characteristics: autonomy, tasks repetitiveness, and
salaries; and (3) organizational environment factors:
degree of professionalization, type of unit, and nursing
care delivery model. Recent research identified new
variables that influence nurse job satisfaction such as
environment and job settings (Shaver & Lacey 2003).
Non-supportive work environments increase nursesÕ
stress and job dissatisfaction (Sims 2003), which neg-
atively influence nurse retention.
There was one Jordanian study assessing nurse job
satisfaction and retention (Suliman & Abu Gharbieh
1996). The researchers identified factors that influence
Jordanian nursesÕ job dissatisfaction and estimated the
magnitude of anticipated withdrawal from practice
(number of nurses that leave their jobs/year). The results
indicted that Jordanian nurses were dissatisfied with
many work variables such as payment, career oppor-
tunities, nursing and hospital administratorsÕ support,
41
M.T. Mrayyan
transportation, and child care facilities. The withdrawal
rate of Registered Nurses (RNs) was 18.4%.
Nurse retention
With each nursing shortage, the focus on nurse
retention is renewed but not sustained. Cyclical fluc-
tuation of nurse turnover is a complex problem (Boyle
et al. 1999). The primary reasons for focusing on nurse
retention are concerns about the quality of patient care
and the high cost of recruiting and orienting new staff.
Many models and strategies have been suggested to
explain and enhance nurse retention (Hinshaw et al.
1987, Riggs & Rantz 2001). Salary compression,
where base wages are tightly clustered together with
little variability is a common problem in nursing
(Greipp 2003). A salary scale that is adaptable with
increased life requirements is suggested as an
important strategy to enhance nurse retention. Other
predictors of nurse retention include but are not lim-
ited to nurse job satisfaction, supervision, work
environment, organization and context-specific, perso-
nal factors such as experience, education, and age
(Al-Ma’aitah et al. 1996, Krueger et al. 2002, Stra-
chota et al. 2003).
Job dissatisfaction has been identified as a predictor
of burnout and turnover among nurses (Kalliath &
Morris 2002). Nurse dissatisfaction and turnover rates
are stressful with reported levels as follows: 41 and
22.7% consecutively in the USA, 32.9 and 16.6% in
Canada, 36.1 and 38.9% in England, 37.7 and 30.3%
in Scotland, and 17.4 and 16.7% in Germany (Aiken
et al. 2001). In the United States, hospital nursesÕ job
satisfaction is reported to be lower than the average for
other workers (Aiken et al. 2001). In Jordan, the turn-
over rate was reported to be 18.4% (Suliman & Abu
Gharbieh 1996); however, there are not any recent
reported statistics about such trend.
Turnover indices are usually used to study nurse
retention. Turnover is defined as the number of resig-
nation or termination divided by the average of direct
and indirect care of registered nurses full-time equival-
ent (FTE) positions for the same year, which estimated
to be 21.3% in 2000 (The HSM Group 2002). Nurse
turnover has been linked to dissatisfaction (Hinshaw
et al. 1987, Alexander et al. 1998, Tai et al. 1998,
Larrabee et al. 2003), low salaries (Jones 1996), few
years on the job and insufficient time to perform job
tasks (Davidson et al. 1997), job possibilities elsewhere
and supervisor behaviour (Tai et al. 1998), and some
demographic characteristics as being male and unmar-
ried (Jones 1996).
42
Nurse job satisfaction and retention are interrelated
concepts that have to be monitored on regular basis
especially in the current rapidly changing health care
environment.
Methodology
Design
A descriptive design using survey methods was the
framework for the study. A descriptive design is the
most appropriate to study such topic in health care
systems that have few resources (Brink & Wood 1998),
in which satisfying basic human needs comes first. Data
were collected in the Fall of 2003, during a 4 weeks
period.
Study instrument
The first part of the study instrument asked questions
on nursesÕ demographics. These include: gender, marital
status, shift worked, time commitment, level of educa-
tion, age, years of experience in nursing and in current
area of work, type of units or wards, unit/ward’s
average daily census, unit/ward’s organizational struc-
ture, model of nursing care delivery, unit/ward’s decis-
ion-making style, hospital’s financial situation, and
dominant changes that influence the hospital.
Instruments used to assess the main variables, job
satisfaction and retention, have reported high psycho-
metric measures. Reliability and validity have been
established for all tools by their original researchers
(Huber et al. 2000). In this study, nurse job satisfaction
was defined as the degree of positive affection employee
feels about his/her employment (Price & Mueller 1986).
Operationally, nurse job satisfaction was measured
using the Mueller/McCloskey Satisfaction Scale
(MMSS) (Mueller & McCloskey 1990) as follows:
nurse job satisfaction: extrinsic rewards, scheduling,
family/work balance, co-workers, interaction, profes-
sional opportunities, praise/recognition, and control/
responsibility. The MMSS is a 5-point Likert scale rated
as: 1 ¼ very dissatisfied; 2 ¼ moderately dissatisfied;
3 ¼ neither satisfied nor dissatisfied; 4 ¼ moderately
satisfied and 5 ¼ very satisfied. The MMSS has a
Cronbach’s alpha ranged from 0.52 to 0.84 for each
subscale. In term of construct validity, the cutoff for
item loading on factor was 0.40. In the current study, a
Cronbach’s alpha of the nurse job satisfaction subscales
ranged from 0.65 to 0.94.
Nurse retention was defined conceptually as the per-
centage of nurses who stay in their jobs during a period
ª 2005 Blackwell Publishing Ltd, Journal of Nursing Management, 13, 40–50

of a year (Hofmann 1981). In Jordan, there is absence
of job records that could be used to measure nurse
retention. Therefore, nurse retention was defined
operationally as nursesÕ intent to stay in their present
jobs throughout the rest of their careers. Nurse retent-
ion was measured by McCain’s Behavioral Commit-
ment Scale (McCloskey & McCain 1987). McCain’s
Behavioral Commitment Scale consisted of 38-items;
McCain extracted 5-items from this scale to measure
nurse intent to stay (McCloskey 1990). McCain’s
Behavioral Commitment Scale is a 5-point scale rated
as: 1 ¼ strongly disagree, 2 ¼ disagree, 3 ¼ neutral,
4 ¼ agree and 5 ¼ strongly agree. McCain’s Intent to
Stay Scale is also a 5-point scale rated as: 1 ¼ strongly
disagree, 2 ¼ disagree, 3 ¼ neutral, 4 ¼ agree and
5 ¼ strongly agree. In McCloskey (1990), the Cron-
bach’s alpha of nurse retention scale was 0.90 while in
the current study was 0.91.
Subjects
This study was conducted in three public and two pri-
vate hospitals, chosen non-randomly from the total
number of Jordanian hospitals. These hospitals were
located in the Capital and a large district; those were
chosen based on their bed capacity (>300 beds) and
similarity of work environments. Five hundred and fifty
questionnaires were distributed. A convenience sample
of 438 nurses was recruited; 124 of the nurses were
from public hospitals and 314 from private hospitals.
Nurses participated on a voluntary basis. Nurses were
sent an invitation letter that included a brief description
of the study’s purpose along with the questionnaire and
demographic form. Nurses were provided with enve-
lopes that they could seal themselves to protect the
information of the returned questionnaires. Nurses
were asked to deposit the completed questionnaires in
the nursing office mailbox. The response rate of this
study was 79.6%.
Statistical analysis
Data were analysed using SPSS software version 10
(SPSS Inc. 2000) at 0.05 alpha levels. The demographics
of the sample were treated as categorical variables, thus
chi-square was used to test the differences between
nurses and hospitalsÕ demographics (Agresti & Finlay
1999). Other items of the nurse job satisfaction and
retention were treated as continuous variables. The
t-tests were thus used to measure the differences
between public and private hospitals in regard to nurse
job satisfaction and retention (Agresti & Finlay 1999).
ª 2005 Blackwell Publishing Ltd, Journal of Nursing Management, 13, 40–50
Nurse job satisfaction and retention
Descriptive statistics (mean values, SD, and fre-
quencies) were presented for sample’s variables. As the
instruments are rated on a 5-point scale, any item
having a mean value of above 3 was considered a factor
that enhances nurse job satisfaction and retention. Total
scores for nurse job satisfaction and retention were
calculated for each scale by adding the items and divi-
ding them by the number of items for each scale; total
scores would decrease type 1 error.
The association between nurse job satisfaction and
retention was estimated based on the Pearson Product-
Moment Correlation. An additional analysis was per-
formed using multiple regressions to determine whether
the demographic variables are predictive of nurse job
satisfaction and retention.
It was possible to compare between two types of
hospitals with unequal sample sizes as a result of the
absence of large differences between variablesÕ SD.
Ethical consideration
The university that funded the research approved its
methodology. Approvals for collecting the data were
obtained from hospitalsÕ administrators and nurses
before conducting the study. The anonymity of partic-
ipants and confidentiality of their responses were
ensured by using numerical codes for questionnaires,
and destroying the data at the end of the study.
Results
Descriptive statistics
To answer research question 1, the demographics of the
sample were compared between public and private
hospitals (Table 1). There were some significant differ-
ences between both groups in term of marital status
(P < 0.001): majority of nurses who work in public
hospitals were single (n ¼ 89, 71.7%) vs. (n ¼ 152,
49.2%) in private hospitals; shift worked (P < 0.001):
majority of nurses in public hospitals worked day or
rotating shifts [45.5% (n ¼ 55) and 46.2% (n ¼ 56)
consecutively] vs. [27.7% (n ¼ 85) and 67.8%
(n ¼ 208)] in private hospitals; time commitment
(P ¼ 0.031): public hospitals use part-time nurses more
than private hospitals [15.5% (n ¼ 17) vs. 8.3%
(n ¼ 24)]; nurses in public hospitals were younger
[65.3% (n ¼ 81) of nurses were under 25 years old]
than those in private hospitals [36.3% (n ¼ 113),
P < 0.001]. Nurses in private hospitals were more
experienced in their jobs than those in public hospitals
[44.6%, (n ¼ 140) vs. 21.5%, (n ¼ 26), have 5 years
43
M.T. Mrayyan

Table 1
Public hospitals Private hospitals
Significant differences of sample's
(N ¼ 124)* (N ¼ 314)*
demographics in public and private
Variables N* (%) N* (%) Chi-square  Significance hospitals

Marital status
Single 89 (71.7) 152 (49.2) 19.64, 2 d.f. <0.001
Married 35 (28.3) 149 (48.2)
Separated/divorced and widowed – 8 (2.6)
Shift worked
Day 55 (45.5) 85 (27.7) 17.82, 3 d.f. <0.001
Evening 2 (1.7) 5 (1.6)
Night 8 (6.6) 9 (2.9)
Rotating 56 (46.2) 208 (67.8)
Time commitment
Full-time 93 (84.5) 264 (91.7) 4.36, 1 d.f. 0.031
Part-time 17 (15.5) 24 (8.3)
Age (year)
<25 81 (65.3) 113 (36.3) 33.46, 3 d.f. <0.001
25–34 38 (30.7) 155 (49.8)
35–44 5 (4.0) 37 (12.0)
45–54 – 6 (1.9)
Years of experience in nursing
<1 30 (24.8) 43 (13.7) 27.55, 4 d.f. <0.001
1–2 44 (36.40) 66 (21.0)
3–4 21 (17.3) 65 (20.7)
5–9 16 (13.2) 76 (24.2)
10 or more 10 (80.3) 64 (20.4)
Years of experience in the current area of work
<1 37 (30.8) 55 (17.9) 39.79, 4 d.f. <0.001
1–2 59 (49.3) 88 (28.6)
3–4 10 (8.3) 65 (21.1)
5–9 10 (8.3) 61 (19.8)
10 or more 4 (3.3) 39 (12.6)
Hospital's financial situation
Strong 19 (16.2) 125 (40.6) 29.21, 3 d.f. <0.001
Moderate 61 (52.1) 137 (44.5)
Poor 16 (13.7) 15 (4.9)
Unclear 21 (18.0) 31 (10.0)

*The totals for some categories do not equal (public hospitals, n ¼ 124 or private hospitals, n ¼ 314)
due to missing data.
 
Asymptomatic significant (2-sided).

and more of experience] (P < 0.001) and in their cur-
rent areas of work [32.4% (n ¼ 100) vs. 11.6%
(n ¼ 14), have 5 years and more of experience]
(P < 0.001). The financial situations of hospitals were
different (P < 0.001); while 40.6% (n ¼ 125) of private
hospitals were reported to have strong financial situa-
tions, 16.2% (n ¼ 19) of public hospitals have the same
situation.
In assessing job satisfaction and retention, the sample
mean for total nurse job satisfaction was 2.98 Ômoder-
ately satisfiedÕ (Table 2). Nurses in private hospitals
were more satisfied (X ¼ 3.04) than nurses in public
hospitals (X ¼ 2.85) (P ¼ 0.003). The mean for total
nurse retention for the sample was 2.94 ÔneutralÕ. Nur-
ses in private hospitals intended to retain their jobs
(X ¼ 3.01) longer than nurses in public hospitals
(X ¼ 2.77) (P ¼ 0.005).
To answer questions 1 and 2, mean values and SD
were calculated for each item of nurse job satisfaction in
each type of hospitals. The t-tests were used to compare
between public and private hospitals. Findings indicate
that nurses who work in public and private hospitals
were different in most items of nurse job satisfaction
scale (Table 3).These differences were advantageous for
nurses who work in private hospitals as follows,
external rewards: vacation (P ¼ 0.012), and benefit
package (P < 0.001); scheduling: opportunity to work
straight days (single shift) (P ¼ 0.003), flexibility in
scheduling work hours (P < 0.001), compensation for
working weekends (P ¼ 0.046), and hours of work
(P < 0.001); family/work balance: maternity leave and
child care facilities (P < 0.001) and opportunities to
work part-time (P ¼ 0.006); interaction opportunities:
opportunities for social contact with colleagues after

44 ª 2005 Blackwell Publishing Ltd, Journal of Nursing Management, 13, 40–50

 Nurse job satisfaction and retention

Table 2
Whole sample Public hospitals Private hospitals
Comparison of total scores of nurse
(N ¼ 438) (N ¼ 124) (N ¼ 314)
job satisfaction and retention between
public and private hospitals Total scores X (SD) X (SD) X (SD) t-Test* Significance 

Nurse job satisfaction 2.98 (0.600) 2.85 (0.595) 3.04 (0.595) )2.98 0.003
Nurse retention 2.94 (0.820) 2.77 (0.769) 3.01 (0.831) )2.83 0.005

*Equal variances are not assumed.

 
Significance (2-tailed).
Both scales are on a rating of 1–5.

Table 3
Comparison of variables that influence nurse job satisfaction between public and private hospitals

Public hospitals Private hospitals

(N ¼ 124) (N ¼ 314)

Variables of nurse job satisfaction X (SD) X (SD) t-Test* Significance 

External rewards
Salary 3.09 (1.03) 2.80 (1.14) 2.61 0.009
Vacation 2.54 (1.10) 2.92 (1.98) )2.52 0.012
Benefit package (insurance, retirement) 2.20 (1.14) 2.64 (1.12) )3.58 <0.001
Scheduling
Weekends off per month 3.11 (1.31) 2.99 (1.20) 0.839 0.402
Flexibility in scheduling your weekends off 2.99 (1.11) 3.11 (1.22) )1.00 0.316
Opportunity to work straight days (single shift) 2.82 (1.27) 3.25 (1.29) )3.04 0.003
Flexibility in scheduling your hours 2.72 (1.08) 3.18 (1.06) )3.96 <0.001
Compensation for working weekends 2.70 (1.00) 2.93 (1.15) )2.00 0.046
Hours that you work 2.28 (1.23) 3.21 (1.14) )7.24 <0.001
Family/work balance
Opportunity for part-time work 2.49 (1.16) 2.84 (1.18) )2.79 0.006
Maternity leave time 2.48 (1.19) 3.03 (1.12) )3.88 <0.001
Child care facilities 1.94 (1.15) 2.59 (1.10) )4.67 <0.001
Coworkers
The physicians you work with 3.86 (2.71) 3.28 (1.01) 1.34 0.181
Nursing peers 3.76 (0.976) 3.55 (0.970) 2.06 0.041
Interaction opportunities
The delivery of care method used (e.g. functional, team, primary) 3.16 (0.985) 3.38 (0.991) )2.00 0.056
Opportunities for social contact at work 2.94 (1.06) 3.01 (1.09) )0.607 0.545
Opportunities to interact professionally with other disciplines 2.84 (1.00) 3.03 (0.976) )1.76 0.079
Opportunities for social contact with your colleagues after work 2.61 (1.11) 3.12 (2.01) )3.32 0.001
Professional opportunities
Opportunities to belong to ward and institutional committees 3.20 (1.12) 3.09 (1.09) 0.902 0.368
Opportunities to interact with faculty of the College of Nursing 2.59 (1.18) 2.72 (1.11) )1.02 0.309
Opportunities to participate in nursing research 2.30 (1.20) 2.55 (2.00) )1.56 0.118
Opportunities to write and publish 2.19 (1.13) 2.45 (1.09) )2.13 0.034
Praise/recognition
Immediate supervisor 3.40 (1.55) 3.37 (1.05) 0.329 0.742
Recognition of your work from peers 3.17 (0.949) 3.08 (1.01) 0.904 0.367
Recognition for your work from superiors 2.75 (0.970) 2.99 (1.07) )2.14 0.033
Amount of encouragement and positive feedback 2.75 (1.15) 2.75 (1.10) 0.013 0.989
Control/responsibility
Your control over work 3.51 (1.10) 3.50 (0.983) 0.109 0.913
Your amount of responsibility 3.45 (1.11) 3.39 (0.988) 0.477 0.634
Control over what goes in your work setting 3.00 (0.964) 3.29 (1.01) )2.77 0.006
Your participation in organizational decision making 2.73 (1.24) 2.99 (1.12) )2.02 0.044
Opportunities for career advancement 2.72 (0.955) 2.78 (1.07) )0.608 0.544

*Equal variances are not assumed.

 
Significance (2-tailed).

work (P ¼ 0.001); professional opportunities: oppor- supervisor (P ¼ 0.033); control/responsibility: control

tunities to write and publish research (P ¼ 0.034); over what goes in work settings (P ¼ 0.006), and par-
praise and recognition: recognition of work from ticipation in organizational decision making

ª 2005 Blackwell Publishing Ltd, Journal of Nursing Management, 13, 40–50 45

M.T. Mrayyan

Table 4
Comparison of variables that influence nurse retention between public and private hospitals

Public hospitals Private hospitals

(N ¼ 124) (N ¼ 314)

Variables of nurse retention X (SD) X (SD) t-Test* Significance 

Plan to keep this job for at least 2 or 3 years 3.01 (1.29) 3.23 (1.18) )1.59 0.113
Plan to work at my present job as long as possible 2.90 (1.29) 3.11 (1.17) )1.60 0.111
Under no circumstances would nurses leave their present job 2.67 (1.19) 2.80 (1.08) )1.02 0.304
Even if this job does not meet all nursesÕ expectations, they will not quit 2.62 (1.24) 2.96 (1.10) )2.59 0.010
Nurses will probably spend the rest of their career in this job 2.60 (1.07) 2.94 (1.12) )2.92 0.004

*Equal variances are not assumed.

 
Significance (2-tailed).

Table 5
Whole sample Public hospitals Private hospitals
Correlations of total scores of nurse
(N ¼ 438) (N ¼ 124) (N ¼ 314)
job satisfaction and retention
Total score of nurse job satisfaction* 0.503  0.141  0.130 
Total score of nurse retention

*Correlated with.
 
Correlation is significant at 0.01 level (1-tailed).

(P ¼ 0.044). However, nurses in public hospitals were Table 6

more satisfied than nurses in private hospitals in term of
external rewards: salary (P ¼ 0.009); and co-workers:
nursing peers (P ¼ 0.041).
Mean values and SD were calculated for each item of
nurse retention in each type of hospitals. Using t-tests,
there were significant differences between hospitals in
term of nurse retention in the public and private hos-
pitals (Table 4). Nurses in private hospitals intended to
retain their jobs longer than nurses in public hospitals
with respect to all 5-items on the scale. On a 5-point
Likert scale, the two highest mean values for nurses in
private hospitals were for the items: Ôplan to keep this
job for at least 2 or 3 yearsÕ (X ¼ 3.01) and Ôplan to
work at my present job as long as possibleÕ (X ¼ 2.90).
Correlation of nurse job satisfaction and retention
To answer question 3, the total score for nurse job
satisfaction was correlated with the total score of nurse
retention for the whole sample (r ¼ 0.503), public
hospitals (r ¼ 0.141) and private hospitals (r ¼ 0.130)
(Table 5).
Regression of sample’s demographics on total
score of nurse job satisfaction
For the whole sample, the total score for nurse job
satisfaction was regressed on samplesÕ demographics to
predict if these demographics would predict nurse job
satisfaction (Table 6). Several significant regression
Significant regression coefficients of sample's demographics with the
total scores of job satisfaction for the whole sample (N ¼ 438)
Regression
Demographics coefficient
Years of experience in nursing 0.287 
Years of experience in the current area of work 0.251 
Hospital's financial situation )0.152*
Level of education )0.143*
Shift worked )0.116*
Age 0.105 
Dominant changes that affect the hospital )0.102*
*Correlation is significant at 0.05 level (2-tailed).
 
Correlation is significant at 0.01 level (2-tailed).
coefficients were found, the strongest and positive are:
years of experience in nursing (r ¼ 0.287), years of
experience in the current area of work (r ¼ 0.251), and
age, while the strongest and negative are: hospital’s
financial situation (r ¼ )0.152), level of education
(r ¼ )0.143), shift worked (r ¼ )0.116), and dominant
changes that affect the hospital (r ¼ )0.102).
Regressions of sample’s demographics and total
score of nurse retention
For the whole sample, the total score for nurse retention
was regressed on samplesÕ demographics to predict if
these demographics would predict nurse retention
(Table 7). Significant regression coefficients were found
between the total score of nurse retention and: shift
worked (r ¼ )0.318), marital status (r ¼ 0.234), years

46 ª 2005 Blackwell Publishing Ltd, Journal of Nursing Management, 13, 40–50


Table 7
Significant regression coefficients of sample's demographics with the
total scores of nurse retention for the whole sample (N ¼ 438)
Demographics
Marital status
Shift worked
Years of experience in the current area of work
Years of experience in nursing
Level of education
Age
*Correlation is significant at 0.01 level (2-tailed).
of experience in the current areas of work (r ¼ 0.193),
years of experience in nursing (r ¼ 0.185), level of
education (r ¼ )0.165) and age (r ¼ 0.138).
Discussion
Nurses in private hospitals report higher rates of job
satisfaction and higher intentions to retain their jobs
than nurses in public hospitals; these results are sup-
ported in the literature (Paine et al. 1966, Rainey 1979,
Solomon 1987). Nurses in private hospitals also tended
to be married, working full-time and were more
experienced in nursing and current area of work than
nurses in public hospitals. Nurse job satisfaction was
found to correlate significantly and positively with
nurse retention which is evidenced in other studies
(Price & Mueller 1981, Irvine & Evans 1995, Alex-
ander et al. 1998, Cowin 2002).
As evidenced by other studies, nurse education has a
positive impact on nurse satisfaction and retention
(Ndiwane 1999, Janney et al. 2001), which is also true
with age and experience (Blegen 1993, Ndiwane
1999). Aiken et al. (2003) reported that surgical
patients experienced lower mortality and failure-
to-rescue rates when the higher proportions of nurses
were educated at the baccalaureate level or higher.
However, regressions of this study indicated the neg-
ative influence of nurse education on nurse job satis-
faction and retention. Such result could be explained
that highly educated nurses have higher expectations
such as working in highly supportive work environ-
ment with adequate and equal professional opportun-
ities. If such environment is not available they intend
to leave their job searing for better chances. Marital
status (being single), shift worked (rotating or day),
years of experience in nursing and current area of
work, and age are other predictive factors of Jordanian
nursesÕ job satisfaction and retention. In the literature,
nurses who work permanent night shift reported to
ª 2005 Blackwell Publishing Ltd, Journal of Nursing Management, 13, 40–50
Nurse job satisfaction and retention
have lower levels of commitment to nursing which in
turn influence nurse job satisfaction and retention
(Brooks & Swailes 2002). Twelve hour shift when
Regression compared with 8-h shift were found to improve nurse
coefficient
retention (Hoffman & Scott 2003). However, nothing
0.234* is known about the influence of 12-h shift on nurse job
)0.318* satisfaction. Ndiwane (1999) and Blegen (1993) found
0.193*
0.185* that age and experience had a positive influence on
)0.165* nurse job satisfaction, which may apply to nurse
0.138* retention. In Jordan, salaries are not meeting the daily
requirements of professionals and their families.
Insufficient salaries would lead to nurse dissatisfaction
and turnover (Fletcher 2001, Greipp 2003). Career
ladders, which offer an opportunity for salary,
increased based on indicators such as education,
experience, job performance and research participation
(Blegen 1993, Fletcher 2001, Greipp 2003) are limited
in the Jordanian hospitals. Transformational and
visionary leaders with participative leadership style are
reported to influence nursesÕ motivation (McClure
et al. 1983). The results of current study have impli-
cations for practice and research.
Implications for practice
There were significant differences between public and
private hospitals. There is a need to focus on inter-
ventions that would enhance nurse job satisfaction
and retention. These interventions include increase
external reward especially the benefit package,
decrease worked hours, and compensate nurses for
working weekends. Also, child care facilities should be
available in work settings; more time has to be
available to interact with their colleagues after work
(social interaction); nurses should be supported with
library time and Internet access to write, publish and
participate in nursing research; more encouragement
and feedback have to be given for nurses to promote
their satisfaction; more career advancement oppor-
tunities have to be available for nurses in all settings.
Positive perceptions of career development opportun-
ities were a stronger predictor of commitment to
nursing (Brooks & Swailes 2002). As a retention
strategy, opportunities for career advancement should
be expanded and linked to a widening pay scale and
clear job description, especially in current nationwide
nursing shortage. Career ladder programmes should
be explored for their applicability to the Jordanian
health care settings.
The differences between Jordanian public and pri-
vate hospitals can be partially explained by the pre-
sence of more restrict rules in public hospitals,
47
M.T. Mrayyan
especially if these hospitals are university-affiliated.
Having worked as a staff nurse in a university-
affiliated hospital, I can attest to these hospitals being
dominated by physicians, with their decisions prior-
itized over nursesÕ decisions. This would influence the
communication styles and conflict management strat-
egies of these professional groups. Moreover, Jorda-
nian nurses play multiple roles in their practice
settings, which contribute to unclear job description
and stress. Role stress has been found to result in job
dissatisfaction (Hoffman & Scott 2003). Differences
between nursesÕ experience in public and private hos-
pitals may be related to the fact that nurses who retire
from public hospitals frequently work in private hos-
pitals to support their families.
Nurse manager must act with supportive leadership
styles to enhance the practice environment, which will
contribute to higher job satisfaction and nurse
retention rates. Many of the suggestions provided
above are within the mandate of nurses. Managers at
all levels, and particular chief nurse executives, can
work together, with their hospital administrators and
nurses to strengthen the environment and improve
patient care.
Implications for research
Further research is needed to study variables of nurse
job satisfaction and retention which include but are not
limited to job position, experience, autonomy, com-
mitment, salary, stress and geographical areas. Nurse
retention rates need to be calculated based on job
records, rather than using a scale. The nurse retention
tool needs to be expanded to cover a wider range of
variables that may affect nurse retention. As there are
27 public and 56 private hospitals in Jordan, a larger
sample of both types of hospitals has to be obtained in
further research. Nurse satisfaction and retention have
to be assessed on various work shifts; in this study low
samples were obtained from nurses working night and
evening shifts. Thus, randomized sampling technique is
required in future research.
Because of the lack of nursing studies that focused on
nurse job satisfaction and retention in Jordan, longi-
tudinal studies have to be conducted. This study was
conducted in the Capital and another large district;
future studies have to cover other districts in Jordan.
Specific and detailed definitions of study’s demograph-
ics are needed, for example, the financial situation of
the hospital should be assessed based on figures rather
than categories. Since experience is an important mile-
stone in nurse job satisfaction, job satisfaction scores
48
have to be calculated in relation to nursesÕ years of
experience in nursing and in current area of work sep-
arately.
An in-depth study of public hospitals using focus
groups would provide valuable data on factors contri-
buting to job satisfaction and retention. In addition, as
nurse leadership is so strongly linked to nursing job
satisfaction, a study of nurse managers and their lead-
ership styles would also add to our understanding of
nursing in Jordan. Further nursing researches have to be
conducted about the influence of time commitment,
marital status, age, gender, shift, organizational struc-
ture, average daily census, style of decision making,
model of nursing care, hospitalsÕ financial situation and
dominant changes affect the hospitals on nurse job
satisfaction and retention. The culture of advancement
by seniority is a common issue in Jordanian practice
settings. A research has to consider the establishment of
professional advancement programmes based on edu-
cation and experience. These programmes will promote
nursesÕ interaction with faculty members at the College
of Nursing and research participation. The data provi-
ded in this study could form the basis for future studies.
This study can be considered as a milestone for Jorda-
nian policy-makers.
Summary and conclusion
This study provides evidence about the relationship
between nurse job satisfaction and retention. A des-
criptive design using survey methods was used in this
study. A convenience sample was obtained from public
and private hospitals. Nurses reported their job satis-
faction to be at a moderate level and nurses were
ÔneutralÕ in reporting their retention. Nurses who work
in private hospitals report higher levels of job satisfac-
tion and reported higher intention to stay at their jobs
than nurses in public hospitals. The findings emphasize
the importance of promoting and maintaining positive
work milieu, which is an essential step in enhancing
nurse job satisfaction and retention for any health care
organization. Nurse managers must act with supportive
professional leadership to enhance the practice envi-
ronment.
Acknowledgements
The researcher would like to thank the Hashemite University
for funding this research. Also, the researcher would like to
thank Prof. Sonia Acorn from the Faculty of Nursing, Uni-
versity of British Columbia for her insight and editing this
manuscript.
ª 2005 Blackwell Publishing Ltd, Journal of Nursing Management, 13, 40–50

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