Job satisfaction of nurses with master of nursing degrees in Poland: quantitative and qualitative analysis

Due to variability amongst educational standards and the organisational characteristics of health care systems in different countries, professional nurses are diversified in terms of their education levels. In Poland, as in many other European countries, the nursing education system consists of two stages: a 3-year bachelor’s level course (1st cycle) and a 2-year master’s level course (2nd cycle). The duration of master’s nursing studies is at least 4 semesters; practical classes and traineeships must include at least 1300 h, and the number of European Credit Transfer and Accumulation System (ECTS) points is at least 120 [1]. Advancement to master’s level studies is available for those who have graduated from a 1st cycle nursing course.

Graduates of master’s programmes have specialist knowledge in nursing and other medical sciences. They can solve professional problems (especially those that involve making decisions in difficult situations), establish the standards of professional care and implement them in professional practise, monitor the quality of care, and conduct research. Additionally, they are prepared to organise and supervise nursing care, apply legal regulations in management, determine the assumptions of human resources policy, and plan employment at the medical facility. A master’s-prepared nurse is also qualified to develop and implement health education programmes and select optimum teaching and learning methods [1]. Moreover, a nurse with the Master’s degree may engage in doctoral (3rd cycle) studies.

Medical professionals address problems of quality-management in health care; they influence the hospital’s organisational culture and their colleagues’ behaviours; and they participate in building a positive image of the medical institution, through contacts with patients and their families [2]. Master’s studies help nurses develop the habit of continuous learning, and hence ensure continuous professional development. This is especially important in the nursing profession, with its central focus on caring for people. Nurses with a Master’s degree (hereafter referred to as ‘masters of nursing’) can work at health care institutions, in state or local administration, as teachers of the profession, or as researchers.

The current system of nursing education in Poland has definitely contributed to the increasing number of masters of nursing, and thus to the development of Polish nursing itself, through research into the practise of nursing, comparative studies of nursing experiences in Poland versus other countries, obtaining of higher (e.g. PhD) degrees, and organising of conferences and symposia. Data of the Central Statistical Office [3] show that in 2013, amongst medical professionals working directly with patients in health care centres in Poland, there were 200,587 nurses, of whom 19,920 (9.9%) had Master of Nursing degrees.

Although work satisfaction amongst nurses has been studied by many scholars [4–10], there are still only a few studies concerning the cohort of nurses with Master’s degrees [11, 12]. There is some evidence, however, for positive gains for nurses who undertake postgraduate nursing studies at the master’s level, related to professional and personal qualities which may provide direct benefit to patients [11].

To maximise the knowledge and skills of nursing professionals, it is worth identifying the areas of dissatisfaction of nurses who have Master of Nursing degrees and the factors that contribute to satisfaction with the work they do. Learning about and understanding the issues related to professional satisfaction of this cohort may help develop organisational changes necessary for improved functioning of health care institutions.

The objectives of this work were to evaluate the level of professional satisfaction of nurses with Master of Nursing degrees employed at health care institutions and to ascertain its determinants.

This cross-sectional study was carried out in randomly selected health care institutions in Poland between October 2013 and March 2014. Participation in the research was anonymous and voluntary. The following inclusion criteria were adopted: having the degree of Master of Nursing (or equivalent designation), currently employed as a nurse, and expressing consent to participate in the study. The questionnaires were distributed amongst all available masters of nursing employed in each hospital during the study (a total of 1073 participants). Six hundred eighty-six correctly and fully completed questionnaires were analysed, a response rate of 64%. The Misener Nurse Practitioner Job Satisfaction Survey (MNPJSS) and an original survey questionnaire were used to collect the data.

The consent of the Bioethics Committee of the Medical University of Bialystok was obtained for the study (Resolution no. R-I-002/310/2013).

The findings of this original study show that nurses with Master of Nursing degrees are most satisfied with their relationships with direct superiors and other nurses, and with social contacts at work. Other authors have reported similar findings concerning nurses’ professional satisfaction [4, 5, 20]. This concordance may be explained by the fact that both in our analysis and in the other studies the vast majority of the respondents were women. As Lipińska-Grobelny [21] observed when analysing associations between gender and compatibility with the profession, for women, interpersonal relationships were the main area of satisfaction with work.

Our research results also show that masters of nursing who held managerial or autonomous positions (e.g. epidemiology, surgical or endoscopy nurse) are the most satisfied with their work. It has been reported in the nursing literature that a higher level of independence at work may lead to higher satisfaction when carrying out tasks [22]. This is also supported by a Slovenian study, which showed that nurses in leadership positions were more satisfied with their work in comparison to other nurses [23]. Given that, in our study, most of the respondents were female, our findings are consistent with those of Zalewska [24], who observed that for women, job autonomy is conducive to job satisfaction.

The present study involved qualitative analysis of responses to open-ended questions with respect to Herzberg’s motivational theory [19, 25]. According to Herzberg, job satisfaction is affected by two independent categories of factors, i.e. external hygiene factors, and internal motivational ones. The first group of factors refers to the working environment and is relatively independent of the person who does the job (pay, company policy and administration, interpersonal relationships with superiors and colleagues, working conditions, the status of the job). External factors are the main reason for dissatisfaction with work. Internal factors, in turn, refer to personal experiences of the employee connected with the work performed, such as, for example, recognition of professional achievements, development and promotion opportunities, elements demonstrating the intrinsic value of the work [19, 25].

More respondents (70.6%) answered the first open-ended question, which concerned the sources of satisfaction, than the second question, which concerned the reasons for dissatisfaction (61.4%). However, thorough analysis of the respondents’ statements showed that the number of response units indicating dissatisfaction (50.1%) was similar to that for satisfaction (49.9%). In our study, the factors that lead to professional satisfaction correspond to the internal factors identified by Herzberg [25]. Specifically, the content of work was mentioned by one-fourth of the participants (24.77%) as a factor that promoted satisfaction. The source of dissatisfaction reflected in the responses to the open-ended questions was the level of remuneration for nurses’ work (17.55%) (see Table 4).

Content analysis of the responses to the open-ended questions provided more insight into the opinions of masters of nursing concerning professional satisfaction. Examples of this may be the ample punctuation marks used by the respondents (mostly exclamation marks) and comments emphasising the importance of the answers and the problems described. The value of open-ended questions in surveys is also confirmed by other studies [26].

The questionnaire that asks both closed questions and open-ended questions is an example of how quantitative and qualitative data are combined [27]. Employing a primarily quantitatively driven approach in our study and adding a qualitative component to supplement the quantitative survey allows the exploration of deeper or fuller answers to the research questions in order to extract policy relevant results.

The greatest source of satisfaction for masters of nursing is their relationships with direct superiors and other nurses, and the social contacts at work. The greatest source of dissatisfaction is financial factors such as remuneration, the distribution of financial rewards and benefits, and the pension system. Qualitative analysis of responses to open-ended questions confirmed the assumptions of Herzberg’s theory. Internal factors (e.g. the content of the work) promoted satisfaction, whilst external ones (e.g. remuneration) caused dissatisfaction.