Title: Job satisfaction of full-time professional nurses employed in hemodialysis treatment facilities
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Permanent Link: http://ufdc.ufl.edu/UF00099107/00001
 Material Information
Title: Job satisfaction of full-time professional nurses employed in hemodialysis treatment facilities
Physical Description: viii, 112 leaves : ; 28 cm.
Language: English
Creator: Mulkerne, Donald J. D
Copyright Date: 1980
Subject: Job satisfaction   ( lcsh )
Nurses -- Florida   ( lcsh )
Hemodialysis -- Nursing   ( lcsh )
Counselor Education thesis Ph. D
Dissertations, Academic -- Counselor Education -- UF
Genre: bibliography   ( marcgt )
non-fiction   ( marcgt )
Statement of Responsibility: by Donald J.D. Mulkerne, Jr.
Thesis: Thesis (Ph. D.)--University of Florida, 1980.
Bibliography: Bibliography: leaves 90-94.
General Note: Typescript.
General Note: Vita.
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Bibliographic ID: UF00099107
Volume ID: VID00001
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: alephbibnum - 000100262
oclc - 07336882
notis - AAL5723


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The author wishes to express his sincere appreciation to all

those who have helped make this study possible. In particular,

the author wishes to thank Dr. Ellen Amatea for her continuous

guidance and support as chairperson of his doctoral committee.
Sincere thanks also go to Dr. Robert 0. Stripling for his advice

and professional assistance throughout the author's doctoral

program. The other members of the doctoral committee, Dr. Robert

Soar, Dr. Max Parker, Dr. Elizabeth Altmaier, and Dr. Gordon C.
Finlayson, are also thanked for their counsel and support. Thanks

are also extended to Dr. Carolyn Tucker and Dr. Robert Zi.11er,

whose enthusiasm and interest are deeply appreciated, to the

Standards Task Force Committee of Network 19, whose assistance in

the study is gratefully acknowledged, and to the persons who so

willingly participated in the study.

Although too numerous to mention here, appreciation is extended

to the many professional colleagues and personal friends who have

offered encouragement to the author throughout his doctoral program.

Love and appreciation are given to the author's parents who

have always provided the model, support, and encouragement for the

author in his endeavors. Their contributions to the author's

personal and professional development are immeasurable.

Most importantly, love and appreciation are given to the



. .. .. ... . i

ABSTRACT . . . . . . . .

Statement of the Problem .
Analysis of the Problem .
Definition of Terms . .
Delimitation of the Problem
Rationale . . . . .
Purpose of the Study . .
Organization of the Study .

. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .
. . . . . . . .


Introduction ... .. .... .. ..

. .

Studies Using the Job Descriptive Index . . .
Studies Using the Occupational Satisfaction of Hospital
Nurses Scales (OSHNS) . . . . . . .
Other Studies of Job Satisfaction Among Nurses . . .


RESEARCH METHODOLOGY . . . . . . . . .

Overview . . . . . . . . . . . .
Hypotheses . . . . . . . . . . . .
Data Collection Procedures and Selection of Subjects
Job Descriptive Index (JDI) . . . . . . . .
The Occupational Satisfaction of Hospital Nurses Scales
(OSHNS) . . . . . . . . . . . . .
Analysis of Data . . . . . . . . . .
Limitations of the Study . . . . . . . .


RESULTS . . . . . . . . . . . . . 40

Introduction . . . . . . . . . . . . 40
Data Collection Procedures and Return Rate . . . . 40
Demographic Description of Subject Sample . . . . 42
Hypotheses . . . . . . . . . . . . 44
Results of Summary Questionnaire (SQ) . . . . . 59
Summary of Findings . . . . . . . . . . 69



Discussion . . . . . . . . . . . . 79
Total Job Satisfaction Scores . . . . . . . 80
Summary Questionnaire . . . . . . . . . 85
Implications . . . . . . . . . . . . 87
Conclusions . . . . . . . . . . . . 88
Recommendations . . . . . . . . . . . 88

REFERENCES . . . . . . . . . . . . 90



C JOB DESCRIPTIVE INDEX . . . . . . . 100



F POSTCARD . . . . . . . . . . 108


H COVER LETTER . . . . . . . . . 110

BIOGRAPHICAL SKETCH . . . . . . . . . . 111

Abstract of Dissertation Presented to the Graduate
Council of the University of Florida in
Partial Fulfillment of the Requirements for the
Degree of Doctor of Philosophy


Donald J. D. Mulkerne Jr.
December, 1980
Chairperson: Ellen Amatea
Major Department: Counselor Education

The purpose of this study was to determine the current status
of occupational satisfaction among nurses employed in hemodialysis
treatment facilities in the State of Florida. The participants for
this study consisted of 150 registered and 22 licensed practical nurses

employed in 28 public and private facilities across the state. The
Job Descriptive Index, the Occupational Satisfaction of Hospital
Nurses Scales, the Demographic Information Questionnaire, and the
Summary Questionnaire were used as research tools.
Four major hypotheses, stated in terms of the JDI, OSHNS, DIQ,
and SQ, were addressed in this study. Each hypotheses was based on

the perceptions of the nurse participants, and was tested at the .05
level of significance.
One significant difference was noted in the hypothesis that
there would be no significant relationship between the subject's

degree of job satisfaction and specific demographic variables, in
that Black participants scored significantly lower in total satis-

faction on the OSHNS than Oriental or White subjects. Differences

were also noted on the Work subscale of the JDI and the Pay subscale

of the OSHNS by type of facility. The data tend to support the con-

clusion that significant differences in the perceived affective responses

to work exist among certain ethnic groups.

The differences found in age, marital status, number of dependents,

education, shift, nursing credential, sex, number of nurses, patients,
and doctors, and experience appeared to be minor, with the major

differences in the areas of ethnic origin, type of facility where

employed, most liked and least liked aspects of dialysis nursing,
sources of stress, useful skills, skills lacking but useful, aspects

of work to change, and utility of a counselor in the dialysis setting.

The following recommendations were made based on the data

1. Studies comparing male and female dialysis nurses' affective

responses to work, educational, and demographic backgrounds, perceptions
of the work environment, and behaviors should be conducted in other states.

2. Further studies examining recruitment, employment, and advance-

ment of minority group practices in the field of dialysis nursing

should be conducted.

3. Current preservice educational programs preparing individuals

for roles in the field of nursing, and inservice programs addressing

professional burnout among nurses should be reviewed.
4. Further studies towards validating the use of occupational

satisfaction instruments with dialysis nurses, addressing the quality

of patient-nurse, physician-nurse, and nurse-nurse interaction,
routineness of tasks, and professional autonomy, should be conducted.

5. Counselors and counselor educators should explore the

medical setting, particularly dialysis facilities, for future profes-

sional growth and interaction.


A person with a chronic illness, aside from possessing a health

problem, poses a challenge to the health professionals involved with

the patient's care. Quite often an atmosphere of disappointment,
dissatisfaction, and lack of motivation may become instilled, due

to the physical incapacity of the patient and the inability of the
staff to improve the patient's condition. Other psychological,
social, sociological, personality, and economic needs may affect

adversely the motivation, performance, and satisfaction of the health
care staff. Praise, recognition, security, sense of accomplishment,

opportunities for decision-making inputs, social contact, and other
variables interplay in the nursing staff's ability to function and
the degree to which satisfaction and enjoyment are derived from
work. These consequences may affect adversely, not only the staff,
but may impact negatively upon delivery of health services.

Worker satisfaction studies-have focused predominantly on
factory employees and other forms of manual labor (Smith, 1969).

Employee work satisfaction during the first quarter of the century
was, in most cases, related to productivity levels, a presumption

ignoring intrinsic and extrinsic needs of the person. The "humanis-
tic" perspective of the 1930s shifted this focus to some degree;


however, the rationale for examining the work satisfaction has been
that the satisfied worker is a more productive worker. Job satis-

faction studies typically have attempted to establish relationships
between satisfaction and productivity, absenteeism, job attrition,
or some environmental conditions related to employee needs.
Job satisfaction research has not neglected the health profes-

sions, although most studies have emphasized productivity or turn-
over among health professionals and paraprofessionals (Wright, 1957).
Other studies have utilized personality assessments and job satisfac-
tion along personality dimensions (Imparato, 1972). Studies of job

satisfaction among health professionals generally have examined

hospital staff nurses and other medical personnel. Slavit, Stamps,
Piedmont, and Haase (1977) examined general staff shift nurses' work
satisfaction, and Pablo (1976) investigated nursing and non-nursing

job satisfaction in an extended care unit for cardiac Datients.
With the growth of outpatient hemodialysis centers in the United
States during the past 20 years, a new type of nursing specialist

has emerged, the dialysis nurse. The development of dialysis nursing,
as a specialization, is only now receiving attention in medical
literature (Leonard, 1980, Santipietro, 1975). As federal support

for outpatient hemodialysis grows, more nursing personnel will be
needed to assume positions in dialysis centers. An examination of
factors determining job satisfaction of dialysis nurses will be useful,
both in generating information to improve existing nursing conditions
in dialysis centers and in increasing the awareness of both student

and graduate nurses towards this area of chronic care.

Statement of the Problem

What is the current status of job satisfaction among full-time

professional nurses employed in outpatient and inpatient hemodialysis
centers in the State of Florida? This study was designed to survey

a population of dialysis nurses in Florida to ascertain the degree
to which they are satisfied with their work. Factors related to job

satisfaction included the scope of nursing services provided,

autonomy, opportunities for decision-making input, supervision,

pay, interaction with coworkers, promotions, and doctor-nurse rela-
tionships. Demographic information regarding the nurses was also

collected. This information included the age, sex, number of dependents,

marital status, race of the subject, the type of facility, unit size,

nurse/patient ratios, number of physicians, and operational procedures

(Appendix A).

Analysis of the Problem

The problem involved the following components related to job

(1) Were there differences in job satisfaction among dialysis
nurses employed in limited care outpatient dialysis centers as com-

pared with nurses employed in self-care dialysis facilities?
(2) Were there differences in job satisfaction among male and
female dialysis nurses?

(3) Were there differences in job satisfaction among dialysis
nurses holding bachelors degrees in nursing, non-degree registered

nurses, and licensed practical nurses?

(4) Did a significant relationship exist between job satis-
faction and the number of years experience in dialysis nursing?

(5) Was there a significant relationship between the marital
status of the dialysis nurse and job satisfaction?

(6) Were there differences in job satisfaction among dialysis
nurses who are black, white, or belong to other ethnic groups?

(7) Was there a significant relationship between age and job
satisfaction among dialysis nurses?

(8) Was there a significant relationship between job satisfac-
tion and the dialysis nurse/patient ratio in a dialysis center?

(9) Did the type of dialysis facility in any way influence the
job satisfaction of the nursing staff?

Definition of Terms

The research problem employed certain words and terms with the
following specific meanings:

Professional Nursing: The "performance" for compensation of
acts requiring substantial judgment and specialized skills based on
knowledge and application of scientific principles learned in an

approved school of professional nursing (State of Ohio Revised Code,
1968). The titles "registered nurse" and "licensed practical nurse"
may be used, in Florida, only by those who have met all legal require-
ments for the practice of nursing. The sample included persons of
three different educational levels: (1) a bachelor of science in

nursing degree (B.S.N.), (2) a three-year certificate from a hospital
school of nursing degree (A.S.), and (3) a school of practical nursing


Job Satisfaction: Vroom (1964) defined job satisfaction as

the affective orientation toward work roles an individual occupies.
Positive attitudes towards the job are conceptually equivalent to

job satisfaction (p. 99). For the purposes of this study, job
satisfaction was operationally defined as the subject's score on the
Cornell Job Descriptive Index and the Occupational Satisfaction of

Hospital Nurses Scale.
Hemodialysis: The use of an artificial kidney machine to maintain
the chemical balance of the body's blood. Persons who have experienced

partial or complete kidney failure due to disease or injury receive
hemodialysis treatments.
Hemodialysis Treatment Facility: Three types will be utilized in
this study: (1) limited care facilities where patients who are not
trained professional staff; (2) self-care units, an outpatient

facility where a properly trained patient can dialyze himself with
little or no professional supervision; and (3) private and public

hospitals that provide services to persons on home dialysis treatments.

Delimitation of the Problem

The research problem was concerned only with the relationship

between job satisfaction and certain demographic and environmental
conditions across a group of professional nurses employed in hemo-

dialysis treatment facilities in the State of Florida. It was not
concerned with the relationship between the previously described
variables and individual treatment facilities. Consequently, the
research problem did not constitute an evaluation of specific

individuals or facilities. Furthermore, the research problem was

concerned neither with either specific nursing or administrative

practices, nor was intended as an evaluation of such practices.


According to Super (1942) job satisfaction depends upon the
individual's opportunity to find adequate outlets for abilities,

interests, personality traits, and values. Hoppock (1935) stresses

the importance of the status given to the worker by the job, in the

sense of group membership and prestige. Contemporary research on the

job satisfaction of health professionals has examined several of
these facets, but typically regarding how they relate to job per-

formance, or to other types of observable output.

The nursing profession encompasses many areas of specialization.
Nursing students and persons considering entering the nursing profes-
sion are in need of information regarding areas of specialization to

assist their decision-making processes regarding choosing an area of

specialization. Nurses currently employed but wishing to change
nursing areas are also in need of information regarding other areas

of specialization.
Hemodialysis and dialysis nursing is a relatively new area of
medical specialization, having become accepted practices within the

past 20 years. Although several researchers have examined the adjust-
ment and well-being of dialysis patients (Abram, 1968; Levy, 1975),
a review of standard references sources, including Dissertation

Abstracts International and Index Medicus revealed that no research

examining the satisfaction of dialysis nurses has been reported in

the literature.

If low degrees of job satisfaction are found to exist among

dialysis nurses, effective ways of changing attitudes may be sought
and incorporated in preservice nurse training programs and inservice

training for professional nurses. This study also provides informa-

tion regarding specific psychological factors in several other areas:

(1) what dialysis nurses perceive as causes of job-related stress;

(2) what dialysis nurses consider to be appropriate job skills, other
than those skills they already possess; (3) what aspects of work

dialysis nurses would change to make their jobs more satisfying; (4)

dialysis nurses' evaluation of the usefulness and necessity of counsel

ing services in the dialysis setting; and (5) the five most important
factors affecting the nurses' liking and disliking their jobs. This

information, obtained through the Summary Questionnaire (Appendix B);

will provide the basis for counselor educators to further examine the

psychological dynamics of working with chronically ill persons,
incorporating the data into inservice training programs for profes-

sional nurses, providing consultation in dialysis settings, and

training graduate students in counselor education to be effective

in understanding the nature of dialysis nursing and developing skills

to seek employment in the medical setting, a need which is documented

as an outcome of the study.

Purpose of the Study

The purpose of this research study was to investigate the
status of job satisfaction of full-time professional nurses employed
in hemodialysis treatment facilities in the State of Florida.

Currently there are 62 licensed hemodialysis units in the state,

employing over 250 nurses. This survey attempted to measure the

degree to which these specialized nurses are satisfied with their
work, and related demographic variables and environmental conditions
of the treatment facilities which may influence the occupational

satisfaction of the nurses.

Occupational satisfaction for a population of full-time profes-
sional nurses employed in hemodialysis treatment facilities in the
State of Florida was measured through the Cornell Job Descriptive

Index (Appendix C), the Occupational Satisfaction of Hospital Nurses

Scale (Appendix D), and the Summary Questionnaire (Appendix B).

Information compiled from the Demographic Information Questionnaire

(Appendix A) was utilized to determine what conclusions and interpre-
tations may be drawn regarding the influence of these factors on the

nurses' job satisfaction.

Organization of the Study

The remainder of this study is organized into four chapters.

The second chapter includes a review of the literature relating to
the theoretical foundations of occupational satisfaction and research
on the job satisfaction of nurses. The third chapter presents the


research methodology, including the design of the research methods,

subject selection, data collection, and statistical treatment of the
data. The fifth chapter includes a discussion of the results,

implications of the findings, and directions for future research.



Attempts to understand and learn more about kidney disease date
back over 200 years to the work of Cotunnius who associated pulmonary
edema with coagulable substances in the urine (Robson, 1967). It

was not until 50 years later, however, that urea was to be synthesized,
leading to extensive, but crude research into abnormal substances
found in the urine of deathly ill persons (Parsons & Jones, 1978).

Experiments by Thomas Graham in 1840 in intravenous fluid therapy lead
to the discovery of the principles of diffusion through semi-permeable
membranes (Parsons & Jones, 1978). Graham coined the phrase "dialysis"

(from the Greek dia, through, and 1ulin, to loosen) to describe the

process. The "Graham Hoop Dialyzer" became the focus of research
that would later lead, in 1912, to animal experimentation in hemo-

dialysis by Abel, Rowntree, and Turner (Parsons & Jones, 1978). How-
ever, 40 years elapsed before hemodialysis became well established
for managing patients with reversible types of renal failure. The

picture changed drastically in 1960 with the development of the Scribner
Shunt. This medical breakthrough made possible the long-term

management of patients with irreversible types of renal failure,

solving the problem of repeated vascular access necessitated by the

hemodialysis treatment procedure (Parsons & Jones, 1978). Later, in

the 1960's the shunt was replaced by the arterio-venous fistula

(Brescia et al., 1966). The fistula is a surgical graft of the main
radial artery and cephalic vein in the arm of the dialysis patient.

Once grafted, the vein grows in diameter and thickness, much like the

artery, and is easily accessible for venipuncture attachment of the

dialysis lines.
Other aspects of hemodialysis have changed as well. Originally,
when dialysis became available to kidney patients, treatment would last

10 to 12 hours or more, depending upon the type of dialyzer and the

patient's condition. New technology in artificial kidneys, especially
in the modern hollow-fiber type commonly used today, has reduced safe

treatment times to four to six hours, and has drastically changed the
working conditions as well as the roles and functions of the persons

providing treatment. As the popularity of hemodialysis treatment has

grown among the medical profession, and a rapid expansion of medical
facilities providing treatment occurred, the dialysis nurse specialist

has emerged as a new type of professional.

The annual turnover rate for nurses is estimated at 35 to 60 per-
cent (McCloskey, 1974), and the costs for replacing a nurse range up

to $2,000 depending on the type of position and geographic location

(Strilaeff, 1978, Tirney & Wright, 1975). These figures do not account
for the hidden costs of replacement such as orientation, disruption
of routines, and impact on the remaining staff. Costs for replacing

a nephrology or dialysis nurse are probably at the high end of the

industry estimates, as the technical aspects of the position demand
skills not generally used in the nursing profession.

Theories of Job Satisfaction

Job satisfaction and worker morale have been of great interest

to personnel specialists since the early 1900's. As vocational

psychologists became aware of the economic importance of employee
turnover in industry, they sought to improve the worker's lot and

engender more satisfied personnel. Research studies investigating
the roles of lighting, performance, and fatigue on worker satisfac-

tion have shown that the intangible conditions are more important than

the material factors (Super, 1942).

Emphasis on the physical work conditions, performance outputs,
and worker fatigue continued until the 1930's with the much heralded

Hawthorne studies (Mayo, 1960). The outcomes of this research are

many, with a major conclusion being that the worker's attitudes or
feelings about the work situation had a greater influence on his or
her subjective reaction to the job than various interventions attempt-

ing to improve performance. The work of Homans (1950) and others

implemented a new trend in the research of job satisfaction, often
referred to as the humanistic or human relations approach. The focus

of this approach involved the interpersonal relationships among the

employees, supervisors, and immediate work group as being significantly
important in determining work satisfaction.
The human relations approach was modified by the work of Herzberg,

Mausner, and Snyderman (1959), and Herzberg (1966), who investigated

both the structure of the work and the opportunities for personal

growth. By enriching the job through enlargement of tasks and

providing for increased personal growth among workers, it was hoped
that an increase in job satisfaction would occur.

Other prominent theorists have speculated as to the nature and
causes of job satisfaction. One of the more eminent theories con-

cerning the dynamics of job satisfaction was Maslow's (1954) hierarchy

of needs. Jobs fulfilling more of Maslow's higher order needs would

mean greater job satisfaction for the employee. Blai (1964), using

Maslow's conceptual framework, identified variety of duties, security,

and self-actualization as being the most influential job satisfies

in a study of 470 federal employees in 29 different occupations.

Vroom (1964) postulated that job satisfaction constituted the

relative valence of the job for its incumbent, and that satisfaction

would be inversely related to voluntary attrition and employee

absenteeism. The Valence Force Theory (Vroom, 1964) seems somewhat

related to Herzberg's model (Herzberg et al., 1959) which postulated
that two variables, called satisfies and dissatisfiers, effected

job satisfaction through the influence on intrinsic events such as

recognition, and extrinsic events, such as supervision. In this model,
both the content and context of the work are considered important
determiners of satisfaction with work. In the study of Herzberg et al.

(1959)ofover 11,000 workers, security was identified as the most
important job factor. However, ordering of factors related to job
satisfaction varied by class and occupation of the workers. Blum and

Naylor (1968) found, consistent with Herzberg's concept, that a

worker would not be satisfied if he or she did not get along with

the work group. This intrinsic need for approval and acceptance,

and other intrinsic needs, such as personal fulfillment, are necessary

for job satisfaction (Schaeffer, 1953).
Wanous and Lawler (1972) have identified three divergent theoreti-

cal foundations for job satisfaction: fulfillment, equity, and desires

or values. Need fulfillment frameworks have been discussed previously
in the works of Blai (1964) and others who based their research on
the hierarchy of needs developed by Maslow (1954). Equity, or the

discrepancy between need of importance and fulfillment, was the basis

of Jeswald's (1972) study of 1,600 clinical laboratory personnel. He

determined the rank ordering of need deficiency of technicians, super-
visors, and aides to be self-actualization, esteem, autonomy,

security, and social, as discussed by Maslow (1954).

Zytowski (1970), Herzberg et al. (1959), Super (1942), Vroom

(1964), and Gerstenfeld and Whitt (1970) based their work on the
attainment of goals, or values model of job satisfaction. The concept
of work values has been summarized by Zytowski (1970) as a set of
concepts mediating between the individual's affective domain and

external objects which provide similar satisfaction.

Job Satisfaction Among Nurses

Numerous studies have been conducted over the years investigating

job satisfaction among health professionals, including nurses
(Godfrey, 1978a, 1978b, 1978c; Gross & Brown, 1967, McCloskey, 1947;
Nahm, 1940; Wright, 1957). An exhaustive review of every study is not

suited to the purpose of this literature review; however, a synopsis

of the research efforts will be presented.

Research studies relating to job satisfaction of nurses date back

to pre-World War II (Nahm, 1949), and such studies have become increas-

ingly prevalent in the health professions literature. The reason for
the numerous studies appears to be related to the problems of "burnout"

and turnover among nurses (McMinn, 1979; Tirney & Wright, 1975).

These two factors seem to be a chronic problem for hospital adminis-

trators relating to the cost of replacing a nurse, and the impact on

the delivery of services to patients (Seybolt, Pavett, & Walker, 1978;
Strilaeff, 1978; Wright, 1957).

Historically, studies in job satisfaction among nurses have been
of two types: (1) assessment of a strategy to improve nurses job

satisfaction through redesign of their work (Kelly & Lambert, 1978);

(2) analysis of factors influencing job satisfaction for a given group
of nurses (Maryo & Laskey, 1959; Pickens, 1957, Smith, 1976). There

are several similarities between these two categories of studies.

First, the subject sample is usually general staff nurses, both

Registered Nurses (RN's) and Licensed Practical Nurses (LPN's),

employed in a hospital setting (Longest, 1974; Slavitt et al., 1978).
Only one study reviewed (Pablo, 1976) focused on nursing specialists,
rather than the general population of nurses. This dearth of knowledge

about nurses specializing in a particular area of patient care may be
due to difficult accessibility to the nursing specialist population,
or the relatively small numbers of nurses who work in only one area

of special care.

Another similarity among these studies is in the data collec-

tion and subject selection techniques. Each study reviewed employed

a job satisfaction questionnaire as the primary means of data collec-
tion. Most studies utilized commercially available instruments such

as the Job Descriptive Index (JDI). Several studies (Stamps et al.,

1978; Wagner, Loesch, & Anderson, 1977) utilized instruments developed

by the investigators to ascertain job satisfaction among nurses.

Subjects selected for these studies typically have been volunteers
out of a target population of nurses employed in a hospital or other

medical facility. The use of volunteers represents the largest source
of bias across all studies reviewed. The effects of subject-role

playing and differences in motivation existing between volunteers and
non-volunteers constitutes a source of bias in survey research. One

study (Godfrey, 1978a) on job satisfaction of nurses resulted in over
17,000.responses to a survey published in a nursing journal. However,
lack of scientific control of the sample limits the credibility and

generalization of this study to other settings and populations.

Studies Using the Job Descriptive Index

Several studies examining the job satisfaction of nurses have
utilized the JDI as the primary dependent measure (Smith et al., 1969).

Boyd (1976) conducted a study that was designed to investigate the
extent to which educational level functioned as a prediction of nurses'

job satisfaction. Three hundred and one registered nurses, 103 of
whom had bachelor's degrees, were administered the JDI and the Job
Factor Questionnaire. Three experimental hypotheses were tested:

(1) increased educational preparation would increase job satisfaction
on the motivation factor scale; (2) increased educational prepara-

tion would increase job satisfaction on the hygiene factor scale;

and (3) increased educational preparation would increase the job
satisfaction score on the JDI. A sub-hypothesis that there would

be a significant association between the JFQ and JDI was also tested.

Correlational analysis, involving linear and stepwise linear multiple

regression, were used with educational level as a predictor for job
satisfaction scores. Results of the data analysis revealed several
findings. First, when educational level was used as a predictor for

increased job satisfaction, there was not a significant relationship

to the motivation factors of the JFQ. However, educational level
correlated significantly with the JFQ hygiene factors. Educational

level as a predictor was not correlated successfully with the JDI,

but when the JFQ motivation and hygiene factors were used as predictors,
there was a significant correlation. Examining the results indicates

that employing educational level as a predictor of increased job

satisfaction was of greatest value in correlating with the JFQ hygiene

factors. Also, there was not a significant difference between

subjects when job satisfaction was measured by the JFQ motivation
factors and the JDI, so hypotheses one and three were rejected.

Boyd's study indicated that when higher educational level increased
job satisfaction, the change in satisfaction is attributable to job
factors within the work environment. An implication of this study

is that there may be a discrepancy between the job satisfaction

expectancy of nurses and nurse educators.

A study by Brief, Aldag, and Jacox (1978) examined the impact

of task characteristics on the affective and behavioral responses of

nurses aides to their work. Seventy-seven nurses aides completed the

Job Diagnostic Survey and the JDI, as well as an index of tension

constructed by the investigators. The purpose of the study was to
examine the relationship between five task characteristics (skill

variety, task identity, task significance, autonomy, and feedback)

and job satisfaction and performance. The investigators hypothesized
that the subject's perception of each task characteristic would be

positively related to job satisfaction and performance, and negatively
related to tension and turnover.

Results of the study indicated that there was a significant
correlation between task characteristic perceptions and actual task

behavior. A six month follow-up revealed that 15 of the 77 original

subjects had resigned their jobs, and that 11 of these 15 had scores

significantly lower than the remaining sample. The investigators
conclude that jobs can be enriched by encouraging employees to engage

in task behaviors shown to increase job satisfaction, such as con-

tinuing education.
In a study by Smith (1976), an attempt was made to identify

important determiners of nurses' job satisfaction in small rural
hospitals (populations less than 20,000 people). The purpose of this
study was to examine determiners of job satisfaction for nurses, to
see which could be positively influenced by hospital management

personnel. A total of 186 nurses out of 330 at six different

hospitals (75-150 bed) volunteered to participate in the study.

Thirty of the 186 nurses were randomly selected for a validity group.
Each subject was interviewed and completed the JDI and a Questionnaire

to Explain Job Satisfaction (QEJS) developed by the investigator.

Variables were extracted from the QEJS and tested to determine their
effect on the dependent variable, total JDI scale scores. A stepwise

regression analysis identified 37 significant variables arranged into
seven general categories from the total of 147 items. These included

fringe benefits, compensation, likes and dislikes, reasons for a nurs-
ing career, terminating present job, unions, and personal factors.

The predicted ability of the regression equation was verified using
the validity sample (N=30). Of the 30 nurses, 23 were properly
identified as either more satisfied or less satisfied.
Conclusions of this study are in two areas. First, the JDI is

capable of identifying factors incluencing job satisfaction of nurses.
This finding lends validity to the use of the JDI in assessing job

satisfaction of other nursing populations. Secondly, many of the

significant variables affecting job satisfaction are within the
influence of hospital administrators who can increase job satisfaction

and perhaps tenure of their nursing staff.

Studies Using the Occupational Satisfaction
of Hospital Nurses Scales (OSHNS)

Slavitt, Stamps, Peidmont, and Haase (1978) conducted a three-year
research study that investigated the concept of occupational satis-
faction of health professionals. The purpose of their research was to

develop a method of measuring a level of occupational satisfaction
and to examine factors defining job satisfaction important to health

professionals. Two articles (Slavitt et al., 1978, Stamps et al.,

1978) present a summary of the results of the three-year project.
Data from the three separate administrations of the job satisfaction

questionnaire were collapsed for the purposes of these reports.
The investigators administered a pilot instrument, an Index of
Work Satisfaction (IWS), to 786 nurses in two different hospitals.

An 83 percent return rate resulted from the first hospital while a

62 percent return rate came from the second administration. The
survey consisted of two parts, the first section measuring the relative

importance of the various aspects or components of job satisfaction for
the respondent through the use of a paired-comparisons method. These

components consisted of 15 pairs of items, or every possible combina-
tion of the six areas (autonomy, job status, pay, task requirements,

interaction, and organizational requirements). Each respondent was

asked to pick which one of each pair was more important a contributor

to job satisfaction. The six components were rank-ordered in terms of
relative importance. The second section measured the respondent's

current level of satisfaction through a seven-point Likert-type

attitude scale. Weighting coefficients were devised to multiply the

average component score, thereby producing weighted component scores.
These six weighted component scores were summed to produce a single

score, an Index of Work Satisfaction, that reflected both the

importance of the individual components and actual satisfaction.

Data from this survey were comprised of rankings of the levels

of importance of the satisfaction components (paired comparisons),

scores on the components to measure current levels of satisfaction

(attitude scale), and the IWS. Results indicated across the groups
of nurses that autonomy was ranked as most important as a contributor

to job satisfaction. The remainder of the components in descending
order were job status, pay, task requirements, interaction, and

organizational requirements.
Based upon the results of the first two administrations, the

authors addressed the three central problems of reliability, validity,

and scoring. A factor analysis, utilizing principal component analysis

with a Varimax rotation, was completed on the responses from the

second administration of the questionnaire where 62 percent of the

nurses responded. The factor analysis produced 19 factors that

accounted for 59 percent of the variance among the items. As successive

factors produced less variance, only the initial 19 that related to

different aspects of job satisfaction which had already been identified

were chosen. On the basis of the amount of explained variance, seven

factor categories were defined. These included pay, autonomy, task

requirements, administration, interaction/social contact, professional
status, and doctor-nurse relationships.
Internal reliability of the scale was evaluated by use of

Cronbach's coefficient alpha. Reliability for the 72-item original

scales was .93; and for the 48-question form chosen by the factor

analysis, .91. Based on the high reliability and brevity of the
instrument, the investigators decided upon the shorter 48-item

questionnaire. Intrascale reliabilities range from .70 for the
autonomy factor to .85 for the pay factor. It appears from this
information that each of the 48 questions measures job satisfaction
and that each item within the subscale measures that particular

aspect of job satisfaction.

Other Studies of Job Satisfaction Among Nurses

Numerous studies have investigated job satisfaction among nurses

employing a variety of instruments and populations to determine the
status of occupational satisfaction for these health professionals.
An early study by Pickens (1957) attempted to develop a job satisfac-
tion instrument for nursing personnel. The investigator constructed

a questionnaire after interviewing 15 public health nurses. The

questionnaire consisted of four statements adapted from Hoppock's
Job Satisfaction Scale (Hoppock, 1935) and five statements developed

by the author. Under each statement was a scale that measured the
subject's feelings ranging from very positive to very negative. One
hundred thirty-nine surveys were sent to public health nurses, result-

ing in 126 (90.7 percent) returns. Analysis of the data yielded mean
scale scores of x=15.5 out of a possible score of 20, indicating high
overall job satisfaction. One hundred nineteen (B6 percent) subjects

reported satisfaction with their work hours, and 121 (95.8 percent)
stated that they were satisfied with the security afforded by their

job. However, only 48 (38 percent) stated that they were satisfied
with the advancement opportunities in public health nursing, and 15

(11.8 percent) thought the salary was adequate. The clerical duties

of public health nursing were deemed satisfactory by only 13 (10

percent). No relationship between educational background and
satisfaction was found, a finding that has been challenged by other

investigators (Boyd, 1976, Godfrey, 1978b).

Maryo and Laskey (1959) attempted to identify the likes and
dislikes of nurses as they pertained to job satisfaction. A total

of 57 nurses were mailed a survey inquiring which three things the

nurses liked most about work and which three things were liked least.
The subjects were also to state what changes they would institute and

what was necessary to improve existing work conditions. Twenty-seven
nurses (63 percent) responded to the questionnaire within a two-week

deadline set by the investigators. Examination of the returns revealed
four positive aspects of nursing that were identified consistently by

the respondents. These positive aspects are in order of importance:

(1) the cooperative nature of the nurses' interpersonal relationships,

(2) pleasant work conditions, (3) the personally rewarding nature of
their work, and (4) the benefits and salary. Three dislikes were

determined to negatively affect job satisfaction: (1) shortage of

nursing staff, (2) lack of trust and communication between the nursing

staff and hospital administration, and (3) the poorly defined task

expectations. Referring to Maslow's model (1954), a conclusion of
this study is that fulfillment of higher-order needs contributed to
satisfaction among the nurses surveyed and lack of higher-order need

fulfillment adversely affected satisfaction. Nichols (1971) conducted
a study investigating the relationship between job satisfaction and
turnover among Army nurses. One hundred eighty-one Army nurses with

four months of duty remaining were contacted by mail. Each subject

was asked to state his or her intentions regarding staying in or

leaving the Army. Information regarding the subject's educational

training, sex, marital status, and number of dependents was also
collected. Four scales measuring perceived ease of movement occupa-

tionally, importance of work, satisfaction with nursing, and available

alternatives in civilian life were included on the questionnaire.

One hundred-thirty eight (76 percent) persons who completed the

survey stated that they intended to leave the Army nursing corps, 30

(17 percent) stated that they would stay, and 13 (7 percent) were
undecided about their choice. Ninety-five (69 percent) of the

respondents held diplomas from hospital schools of nursing and 43

(31 percent) had degrees from a college or university school of
nursing. The age range among respondents was 22 to 31 years, but 75

(54 percent) were over 24. One hundred nine (79 percent) of the subjects
were female and the remaining 21 percent of the sample were males.

Further analysis indicated that 83 (60 percent) of those deciding to
remain in the Army were women and the percentage of males choosing to

remain was twice that of the percentage of males in the population.

Sixty percent of the male nurses were married, as were 33 percent of
the women, yet only 23 percent of the persons remaining in the Army
were married. Twenty-seven percent of the persons staying reported

having one or more dependents, while 46 percent of the persons leaving

had dependents. It appears from this study that males tended to stay
in the Army nursing corps more than women, and that the sex of the

subject was of greater importance than number of dependents in terms
of making the decision to stay or leave.

The questions pertaining to real and perceived job satisfaction
revealed that the persons staying, regardless of sex or marital

status, were more satisfied with Army nursing. As might also be

expected, those leaving perceived the greater satisfaction would
exist in civilian life.
A study by Bullough (1974) sought to investigate the impact of
a new role, the nurse practitioner, on job satisfaction. Using a

sample of 73 subjects, two hypotheses were tested: (1) would nurses
derive increased satisfaction of intrinsic needs in an extended role

as compared with a traditional nursing role; and (2) would the increase
in intrinsic rewards be important enough to increase the overall

feelings of job satisfaction? Seventeen full-time nurse practitioner
students, 18 employed nurse practitioners, and 38 registered nurses

completed an instrument developed by the researcher. The instrument
consisted of an 11-item semantic differential and a seven-item scale

related to intrinsic, extrinsic, and general job satisfaction.
Results of the study indicated that 14 (82 percent) of the students

reported high extrinsic satisfaction as compared with 12 (67 percent)
of the employed group, and 16 (42 percent) of the registered nurse

group. Six (35 percent) of the students stated they were very
satisfied with the extended nursing role, compared to four (22 percent)
of the employed group. Thirteen (76 percent) of the students stated

they would select the same job, but only eight (44 percent) of the

employed group said they would choose the same job again. These
results indicate the employed group was less satisfied with the
extended role to start, perhaps due to some discrepancy between the

responsibilities and rewards of the extended role.

Everly and Falcione (1976) surveyed 144 nurses in four

metropolitan hospitals to determine the dimensions underlying

perceived job satisfaction. An instrument was constructed con-
sisting of 18 items arranged in a Likert format to represent

various aspects of the working environment, adequacy of equipment,

good work conditions, recognition, relations with coworkers,

policies, security, supervision, hospital reputation, respect for
suggestions, work enjoyment, advancement, pay, help, benefits, educa-
tional opportunities, recognition of service, supervisory relation-

ships, and use of skills. The collected data were submitted to a

principal component factor solution with a Varimax rotation of the
factor matrix. Analysis revealed that four factors related to satis-

faction accounted for 58.8 percent of the variance: (1) relationship

orientation, (2) internal work rewards, (3) external work rewards,

and (4) administrative policies. This study suggested that nurses

perceive job satisfaction in more complex terms than the traditional
intrinsic/extrinsic dichotomy model, with intrinsic factors being of

greater importance. Results also show that nurse's interpersonal
relationships are of increasing importance, accounting for 24 percent

of the total variance. Job satisfaction perhaps needs to be defined

beyond the traditional view and more credibility given the variety
of factors that interplay in determining job satisfaction.
An attempt was made to apply Herzberg's Two Factor theory of

job satisfaction to a specific occupational group in a specific
setting in a study by U11rich (1978). Forty nurses in a private

general hospital were interviewed using a format based on Herzberg's

good-bad job experience method, modified to limit discussion to

the present job. U11rich's hypothesis, contrary to Herzberg, was
that increased turnover results as much from dissatisfaction with

intrinsic job factors as with extrinsic factors. Transcripts of

the interviews were broken into three factors: (1) elements, the

source of good-bad experiences; (2) affects, the subjective feelings

of satisfaction-dissatisfaction; and (3) effects, the behavioral or

attitudinal change resulting from the affects. Results of the study

noted supervisory failure and responsibility as greater sources of

dissatisfaction and resulting more often in turnover or other nega-

tive effects and contradicted Herzberg.

Another study applying Herzberg's theory of job satisfaction to

the nursing population was conducted by Longest (1974). The investi-

gator undertook to show how registered nurses employed in hospitals

perceive the effect of Herzberg's ten factors on the nurse's job
satisfaction. Out of a sample of 237 nurses, 195 (82 percent)

responded to a questionnaire asking the nurse to rate, in order of

importance, the ten factors as determinants of job satisfaction.
Results of this survey indicated that the perception of the registered

nurses did not support Herzberg's findings, with a Spearman rank-order

correlation coefficient of .16. The greatest disagreement between the

two rankings occurred with the factors of interpersonal relations,

recognition, and advancement. The same questionnaire was then
administered to 28 directors of schools of nursing, of whom 24

responded. When the rankings by the directors of nursing schools
were compared to the Herzberg ranking, there was a correlation

coefficient of .47. However, when the director's rankings were

compared to the nurse's rankings, a correlation coefficient of .31
was obtained. An important conclusion drawn from this study is that

there exists a discrepancy between what nurses in the field and the

persons responsible for nursing training perceive as important
factors in job satisfaction. Nursing educators may be preparing

students with one set of expectations about what will be satisfying

in the work when, in fact, other factors may be more important.

This disparity may be related to the problem of turnover among nurses,

as low satisfaction with the work of the nurse forces the nurse to

seek satisfaction in other settings.

Seybolt, Pavett, and Walker (1978) addressed the turnover problem
in their study of 242 nurses in a large urban hospital. This study

was an attempt to identify determinants of job satisfaction so that

ways of managing the turnover problem could be developed. A question-
naire was constructed after interviewing 25 nurses for 30 minutes

each. The issues related to satisfaction that were identified through

the interview process were then incorporated into the survey.

Results of the administration of the survey contain information

regarding the demographic characteristics and specific aspects
related to job satisfaction and dissatisfaction. The educational

characteristics of the group were that 194 (80 percent)were R.N.'s

and the remainder were L.P.N.'s. One hundred thirty one (54 percent)

nurses were under 27 years of age, 102 (42 percent) were single, and

114 (47 percent) were married. Two hundred twelve of the subjects
were followed for one year, after which time 89 had resigned (42

percent). Levels of satisfaction of those who left after one
year were significantly lower (ps .05) in four out of 12 areas:

(1) subject's overall satisfaction, (2) satisfaction with super-
vision, (3) satisfaction with opportunities to use abilities, and

(4) satisfaction with freedom from stress. Those nurses who left
were significantly younger (p < .05) and had been employed at the

hospital for a shorter period of time (p < .05) than nurses who stayed.
No difference in mobility across educational levels was found, as there

were no significant differences between R.N.'s and L.P.N.'s on the

mobility dimension. Of the four mobility facets--education, tenure,

age, and marital status--two facets discriminated between the two

groups. Regarding the rated ability of each group, supervisors rated
the nurses who stayed higher in ability, but not at a significant level

statistically. No difference was found between the two groups in role

perception, perhaps indicating that the nurses who left had higher

expectations of satisfaction. This finding is consistent with Longest's
(1974) results. Other significant outcomes of this study were that the
nurses who resigned were lower in overall motivation to perform well

(p < .005) and valued high performance less (p < .004). A possible
conclusion drawn from these data is that the nurses who resigned ex-

perienced a higher degree of unmet personal and professional growth
needs. Also, there may have been a sentiment among these nurses that

there was no practical relationship between the rewards for job per-
formance and the nurse's unmet growth needs, a factor often cited as a

symptom of professional "burnout."

Brief (1976) proposes that hospitals are the culprit in the
nursing turnover problem, contending that hospitals do not utilize
nurses to the fullest, provide challenging tasks, or attempt to
meet personal growth needs of the nursing staff. He disagrees
with the argument that turnover and job dissatisfaction is related
to low nursing salaries, and contends instead that turnover is a
combination of lack of professional autonomy, clear task identity,

opportunity to develop and implement new skills, and inadequate feed-
back regarding work performance. Tirney and Wright (1975) also noted

the nontrivial nature of the turnover problem. Citing industry
estimates from 1973, they estimated the cost of replacing one registered

nurse at $1,000, not including intangible costs such as disruption of
routines. The authors stated that current turnover figures represent

the weakness of the initial interview and exit interview method of

personnel management, in that information gathered during the exit
interview is not utilized in hospital inservice training or other
activities designed to increase staff tenure. Tirney and Wright
advocated a behavioral approach to dealing with the turnover problem
through an employee-centered evaluation technique that potentially would

help attack the real causes of turnover among nursing personnel.
Godfrey (1978a, 1978b, 1978c) sheds additional light on the
factors perceived by nurses as important to satisfaction and tenure.
Over 17,000 nurses responded to a questionnaire published in a
nursing journal, which investigated the various components of the

respondents work that enhanced or affected adversely the nurse's
job satisfaction. Although 91 percent of the responses rated nursing

favorably as an occupation, as educational level increased, the

percentage of favorable responses decreased. Ninety-seven percent
of the nursing students, 94 percent of the L.P.N.'s, and 92 percent

of the R.N.'s rated the profession highly; yet 88 percent of nurses

with master's degrees and only 50 percent of nurses holding Ph.D.'s

rated nursing favorably. Seventy-five percent of the respondents

stated that they enjoy work "most of the time," but 70 percent felt

that they were ignored in the decision-making process, and 57 percent

rated their morale as being "poor" or "fair." Among nurses respond-

ing, 41 percent stated that nursing affected adversely their psycho-

logical well being and 31 percent stated that nursing was occasionally

negatively affecting them. Adequacy of staff was only experienced

by 18 percent of the nurses while the remainder felt that their setting
was "somewhat" or "badly" understaffed. Twenty-five percent of the

nurses felt they did not have the authority to do their work as it

should be done, and 35 percent of the nurses felt a minimal sense of


The summary to Godfrey's series of reports (1978a, 1978b, 1978c)

presents a profile of the hypothetical satisfied nurse. This person,
according to the author, would be a nurse who works in a setting with

adequate staffing, spends the majority of time on direct patient care,
has interesting and challenging work, is autonomous, rates team spirit

as high, trusts a supervisor, receives feedback and recognition for

service, supports the administration, gets a response to complaints

and suggestions, and derives a strong sense of personal accomplishment

from work. Reviewing the significant outcomes of this study, it would

appear that few nurses fit the ideal.

This review of the literature of the study of job satisfaction

among nurses indicates the need for additional research in job
satisfaction, particularly among a specialized population such as

dialysis nurses. Several factors that tend to enhance job satisfac-
tion, such as interpersonal relationships, the sense of helping others,
the interesting and challenging nature of the work itself, and a

feeling of prestige have been shown to be consistent for general staff
nurses. Factors resulting in a sense of dissatisfaction, such as lack

of administrative support, poor supervision, lack of autonomy in

decision-making, and staffing shortages also appear consistently in

the literature. Several studies dealing with attempts to increase job

satisfaction through redesign of the work, expansion of the role of the

nurse, and other interventions have been presented. A discussion of the

problems of burnout and turnover among nurses has presented the complex
nature of this concern, although efforts to curb the exodus of nurses

have been relatively unsuccessful. Despite the wealth of information

regarding the general nursing population, few data exist concerning
nursing specialists. A systematic inquiry into the current status of

job satisfaction and the factors influencing non-satisfaction among

one group of specialists, dialysis nurses, needs to be collected in
order to verify if the determinants of satisfaction for the general
nurse population hold for nursing specialists. This information

will build a data base so that vocational counselors, nursing educators,
and others involved in preparing or guiding students will have reliable

information about job satisfaction for nurses.



The purpose of this study was to determine the current status
of occupational satisfaction among nurses employed in hemodialysis
treatment facilities in the State of Florida. This study included
nurses from both public and private hospitals and dialysis treatment
Job satisfaction was investigated through a descriptive research

design (Campbell & Stanely, 1963; Kerlinger, 1973). The subjects
were administered the Cornell Job Descriptive Index (JDI) (Appendix C),
the Occupational Satisfaction of Hospital Nurses Scale (OSHNS)

(Appendix D), and the Summary Questionnaire (SQ) (Appendix B). Subjects
also completed the Demographic Information Questionnaire (DIQ)

(Appendix A) describing the work setting.


Four experimental hypotheses were tested. Criterion for statisti-
cal significance was set at the .05 level of confidence:

(1) There will be no statistically significant differences
between male and female hemodialysis nurses' scores on the JDI and
the OSHNS.

(2) There will be no statistically significant relationship
between the subject's degree of job satisfaction and the selected

demographic variables: age, ethnic origin, marital status, number
of dependents, nursing degree, nursing credential, or nursing

(3) There will be no statistically significant relationship
between the subjects' degree of job satisfaction and the selected

environmental variables: number of nurses on staff, number of

patients, number of doctors on staff, type of facility, or shift.

(4) There will be no statistically significant relationship
between the subjects' degree of job satisfaction and the subjects'

feelings toward peers and administrators, doctor-nurse relationships,

perceived effectiveness of a counselor, advancement opportunities, or

perceived professional status.

Data Collection Procedures and Selection of Subjects

All subjects met two criteria: (1) they have met the State of
Florida standards for the practice of professional nursing (either a

registered nurse or a licensed practical nurse) and (2) they are
employed on a full-time basis in either a licensed public or private
hemodialysis treatment facility in the State of Florida.

A list of accredited dialysis facilities in the state was pro-

vided by the End-Stage Renal Disease Network 19 office in Tampa,

Florida. An appropriate individual at each facility, such as the

administrator, was mailed a letter soliciting interest in participating

in the study (see Appendix E). This person was asked to return an

enclosed postcard (Appendix F) indicating: (1) the facility's

decision whether to participate, (2) the number of employed nurses,

and (3) the name, address, and phone number of a contact person.
All facilities agreeing to participate were mailed an appropriate

number of copies of the JDI, OSHNS, SQ, and the DIQ for completion

by each full-time nurse employee. A self-addressed, stamped mailing
envelope in which to return the completed questionnaires was included.

Although a return rate total of 75 percent of the nurses for all

participating facilities was desirable, for the purposes of this study,
a 40 percent return rate was deemed acceptable. The study received

the endorsement of two local nephrologists, as well as the Network 19

Standards Task Force. These endorsements enhanced the study's
credibility, perhaps increasing the number of responses.
All nurses who volunteered to participate in the study were instructed

to return the completed packet of instruments to the designated contact

person at his or her facility within 24 hours. The contact person was
to return the completed packets to the investigator within one week.

Those persons not responding within the one week interval were

telephoned by the investigator and reminded to return the packets.
Both male and female nurses were included as subjects. Although

the nursing profession is currently comprised predominantly of females,

it was desirous to include males as subjects, since an increasing

number of males enter the nursing profession each year, and they have
similar needs as females for information regarding areas of specializa-

The entire sample was composed of adults, with an age range of
20 to 65. Controlling for age was not indicated for the purpose of

this study, as a broad range is desirable to insure a variety of work

attitudes. The sample included blacks, whites, and persons of other

ethnic groups. As ethnic origin may be related to job satisfaction,

a variety of ethnic backgrounds were solicited. The subject sample

also included persons who were married, divorced, separated, widowed,

and single. Since marital status was being considered as a possible

factor in job satisfaction, a variety of marital status was preferred.

As educational level and nursing degree also were being considered

factors in job satisfaction, subjects with a diversity of training

experiences provided useful information, and should not affect
adversely the generalizability of the results.

Job Descriptive Index (JDI)

This scale, developed by Smith (1969) of Cornell University, is

a paper-and-pencil instrument which assesses level of satisfaction
derived from work and work-related aspects of coworkers, pay, promo-

tion, and supervision. The survey consists of five subscales

comprising a total of 72 items which are listed as adjectives. The
five scales measure satisfaction with work, pay, promotions,

supervision, and coworkers.
The instrument utilizes a forced choice fonnat with responses of

"Yes", "?", or "No". The subjects are asked to read the list of

adjective-items for each scale and place a "Y", "?", or "N" next to

each, indicating their choice. To score, the number of "Yes", "?",
and "No" responses for each subscale are summed, then each subscale

score is added to yield a total scale score.

The internal consistency coefficients of the JDI, corrected by

the Spearman-Brown formula, were reported to be in the .80s for a

sample of 80 male electronic workers (Locke & Schneider, 1963).
Hulin and Smith (1963) reported that the five JDI scales had split-
half reliabilities of .80 to .88. Scale ordering effects upon JDI
scores resulted in negative findings, suggesting that it makes no
difference which scale is presented first in administering the JDI

(Crites, 1969). Schneider and Dachler (1978) found that the JDI

possesses acceptable stability over pre-post analyses with coefficients
of approximately .57. They also stated that the five scales maintain
their relative independence over time. Smith, Smith, and Rollo (1974)

reported that the JDI was able to discriminate between three groups of
subjects in mean scores for scale items. The JDI is preferable to
most other measures of job satisfaction because of its "sophisticated

conceptualization" and the strong discriminant and convergent validity

(Crites, 1969, p. 490). Crates also states that the JDI had broad

applicability with generally more consistent scales than most inven-
tories (p. 490).

The Occupational Satisfaction of Hospital Nurses Scales (OSHNS)

This instrument was developed by Stamps, Piedmont, Slavitt, and

Haase at the University of Massachusetts and the Mt. Auburn Hospital

(1978). The concept of occupational satisfaction, as applied to
various professions within the health field, was investigated during
a three-year research project. The authors identified six components

of occupational satisfaction: pay, autonomy, task requirements,

organization requirements, interaction, and job prestige. The
instrument measures the relative importance of various aspects

(or components) of job satisfaction to the respondent through the
use of the paired comparisons technique. Seven components of job

satisfaction: (1) pay, (2) job status, (3) interacting, (4) autonomy,

(5) task requirements, (6) organization requirements, and (7)
doctor-nurse relationships have been incorporated into 48 statements

arranged in pairs. Each respondent is asked to mark "agree,"

"disagree," or "uncertain" next to each of 48 statements. Scale

scores are computed for each component following the summing of re-

sponses for each component. As each component is treated as a

separate dimension of satisfaction, each yields a separate score
and a total score may be computed for the entire scale by summing

each component score.

The authors utilized a factor analysis to assess the face validity

of the instrument. The principal component analysis with a varimax

rotation produced seven factors which accounted for 59 percent of the

variance among items, with 48 of the original 60 items being chosen

for inclusion in the revised form (Stamps et al., 1978).

Cronbach's coefficient alpha was used to determine the

internal consistency of the instrument. Reliability for the

48-item test is reported at .91 (Stamps et al., 1978). Intra

subscale reliabilities for each component range from .70 for the

Autonomy component to .85 for the Pay component (Stamps et al.,

1978). Factors with more items tend to have higher scores, but
all fall within acceptable ranges. Normative data for the OSHNS

are based on administration of the instrument to 696 nurses in

hospital settings and 42 physicians in group practice. Data
collection was completed over a three-year period, 1972 to 1974.

Analysis of Data

The responses from each instrument were totaled for each

subject and group means calculated. Hypotheses 2, 3, and 4 were
tested by analysis of variance (ANOVA) and correlational analysis

to determine significant relationships between job satisfaction

scores and the stated demographic variables. The .05 confidence

level of significance was selected for all tests. For hypotheses

one the t-test was calculated to assess the significant differences
between males' and females' scores on the JDI and OSHNS.

Limitations of the Study

This study did not employ either a control or comparison group;

therefore, generalizability is limited to the respondent sample.

Also, all subjects were volunteers. Kerlinger (1973) has stated
that such self-selection in survey research of this type presents

methodological problems regarding the external validity of the

results. Volunteers may, by the nature of their willingness to partici-

pate, bias their responses in a perceived socially desirable fashion.

Responses to the research instruments and the results of the study
should be viewed with this caution.



This chapter presents the results for this study in accordance
with the procedures outlined in Chapter III. The purpose of this

study was to determine the current status of occupational satis-
faction among nurses employed in hemodialysis treatment facilities
in the State of Florida. Nurses from both public and private

hospitals and dialysis treatment centers were included as subjects
for the study.

Job satisfaction was investigated through a descriptive research

design (Campbell & Stanley, 1963; Kerlinger, 1973). The subjects
completed the Job Descriptive Index (JDI), the Occupational
Satisfaction of Hospital Nurses Scales (OSHNS), the Summary

Questionnaire (SQ), and the Demographic Information Questionnaire

Data Collection Procedures and Return Rate

A list of accredited hemodialysis treatment facilities in the
State of Florida was provided by the Florida End-Stage Renal Disease

Network 19 office in Tampa, Florida. During June, 1980, a total

of 62 facilities were contacted by a letter (Appendix E) seeking

participation in the study. A self-addressed, stamped postcard

(Appendix F) was included for the person at each facility to
indicate their participation in the study, the name, address, and

phone number of the contact person, and the total number of full-
time nurses employed at the facility. Of the 62 facilities con-
tacted, 35 (56.5 percent) returned postcards indicating their

willingness to participate in the study. Follow-up phone calls

were placed to the remaining 27 facilities to ascertain whether or

not those centers would participate. Three of the facilities were

no longer in operation, and the remaining 24 indicated that they

would not participate either due to administrative policy against

research conducted from outside their center, staff shortages

restricting the nurses' time to complete the instruments, an

existing overabundance of "paperwork" already placed on staff, or
lack of interest in the research. Other reasons cited were their

unit employed only a few nurses, they were preparing for a Medicare/

Medicaid inspection, or staff was taking vacation time reducing the

number of nurses available.
The 35 treatment centers agreeing to participate were sent a
total of 340 packets of surveys, based on the number of nurses

supplied by each facility. A total of 172 (69.4 percent) nurses
returned the completed instruments from 28 facilities (80 percent;

N = 248). The seven units not returning packets were contacted by

phone. The contact person at each unit stated that they withdrew

their participation because (1) the nurses chose not to complete the
surveys, (2) the administrator changed his/her mind after reviewing

the surveys, or (3) the staff felt that they were overworked and did
not have time to complete them. Response rate per facility can be

found in Table 1.

Demographic Description of Subject Sample

Information regarding the age, ethnic origin, sex, marital
status, number of dependents, education, nursing credential, total

experience in nursing, dialysis experience, time in current position,
type of facility where employed, shift, number of patients, number of
nurses, number of physicians, and number of direct patients was
obtained from the 172 subjects. A copy of the Demographic Information

Questionnaire (DIQ) can be found in Appendix A.
The majority of the subjects were females (N=169, 96.5 percent)
between the ages of 26 and 30 (N=63, 36.6 percent). The age range

was from 22 to 60 years. The subjects were predominantly married,

with 102 (59.3 percent) subjects indicating this status. However,
96 of the subjects (55.8 percent) indicated they had no dependents,
and 33.7 percent (N=58) stated they had one or two dependents,

perhaps signifying a trend towards smaller families. Seventy-eight
percent of the subjects (N=134) were Caucasians. Subjects were
evenly divided by education, with 70 percent (N=119) having either
an Associate of Science degree, or a certificate from a three-year

hospital school of nursing. One hundred fifty subjects were
registered nurses (87 percent), 72 subjects (41.9 percent) have

Table 1

Facility Number Number of Nurses Number Responding Percent



between six and ten years of nursing experience, yet 95 subjects

(55.2 percent) have less than two years experience in dialysis
nursing, and 46.5 percent (N=80) have been at their current job for

one year or less. This indicates a trend on the oart of nurses to
move into dialysis nursing as a specialty area from other types of
nursing. The subjects in the study were employed in several different

types of facilities, with 81 subjects (47.1 percent) employed in
limited care outpatient dialysis units. The staff sizes varied con-

siderably, yet 47 percent (N=81) of the subjects worked in a facility

employing up to ten nurses. The number of patients per facility
varied widely, with 16 percent of the units treating between 30 and

40 patients, and 16 percent treating 90 or more patients. The nurse-

patient ratio was reported by 135 subjects (79.7 percent) as between
one and five patients per nurse. The majority of subjects, 149

(87.3 percent), work a morning shift. A tabular presentation of the

complete data can be found in Table 2.


Hypothesis One: There will be no statistically significant
differences between male and female hemodialysis nurses' scores on

the JDI and OSHNS. A t-test was performed on the subjects scores on
the JDI and OSHNS. No significant differences were found on either

instrument when controlled for sex, so hypothesis one was retained.

These results should be viewed cautiously however due to the small
number of males (N=6) participating in the study. A tabulation of

results is presented in Table 3.

Table 2





















Educational Training
Degree N Percent
B.S. 30 17.4

A.S. 61 35.5
Certificate 59 34.3
L.P.N. 22 12.2

Ethnic Origin
Black 16
Oriental 8

Hispanic 9
White 134
Other 5

Nursing Credential



Table 2 Continued

MartalStaus N





Total Nursing Experience
Years N Percent

0-5 53 30.8

6-10 72 41.9

11-15 25 14.5

16-20 13 7.5
21-25 5 2.9

26-30 3 1.7

31-35 0 0.0

36-40 1 .6









Nursing Experience
N Percent

95 55.2

43 25.0

21 12.2

7 4.0

1 .6

4 2.3

2 1.3


0- .5









at Current Job

N Percent

41 23.8

39 22.7

11 6.4

22 12.8
6 3.5

16 9.3
13 7.5
11 6.4

3 1.8
4 2.3

4 2.3

2 1.3

Shift Schedule

Table 2 Continued

Number of Patients/Nurses per Facility
N Patients N Nurses Percent
1-10 17 9.9
10-20 17 9.9
20-30 23 13.4
30-40 28 16.3
40-50 25 14.6
50-60 7 4.0
60-70 13 7.5
70-80 7 4.0
80-90 7 4.0
90+ 28 16.3

Number of Nurses
Number Percent
1-5 4.0
6-10 43.1
10-15 16.3
15-20 20.4
20-25 1.8
25-30 1.3
35-40 2.3

Number of Physicians/Nurses
N Physicians N Nurses
I 17 .
2 50
3 32
4 19
5 8
6 8
7 0
8 7
9 30

per Facility


Table 2 Continued

Employment by Facility
Type N Percent
Hospital/inpatient 8 4.7
Hospital/outpatient 18 10.5
Limited care outpatient 81 47.1
Self-care outpatient 4 2.3
One or more of above 61 35.5






























Variable Group* Mean

WORK 1 40.2303
2 39.8333
SUPERVIS 1 35.4970
2 37.1667
PAY 1 14.4848
2 14.5000
PROMOTN 1 15.5939
2 17.1667
COWORKS 1 33.7515
2 32.6667
JOB TOTL 1 139.5455
2 141.3333

*Group 1 = Female (N=165)
Group 2 = Male (N= 6)

Table 3

Hypothesis One

Pooled Variance Estimate
t Degrees of 2-Tail
Value Freedom Prob.

0.17 169 0.866

-0.80 169 0.426

-0.01 169 0.990

-1.33 169 0.186

0.54 169 0.587

-0.27 169 0.790

Separate Variance
t Degrees of
Value Freedom

0.21 5.61

-1.27 6.05

-0.01 5.49

-1,75 5.68

1.34 8.17

-0.54 6.84










Variable Group*





















Table 3 Continued

Pooled Variance Estimate
t Degrees of 2-Tail
Value Freedom Prob.

-0,47 169 0.641

-0.66 169 0.507

0.03 169 0.973

-0.67 169 0.501

Separate Variance
t Degrees of
Value Freedom

-0.47 5.38

-0.73 5.46




























Hypothesis 2: There will be no statistically significant rela-
tionship between the subjects' degree of job satisfaction and the

selected demographic variables: age, ethnic origin, marital status,
number of dependents, nursing degree, nursing credential, or nursing

experience. Analysis of variance was used as the statistical tool to

compute these findings for the JDI and OSHNS. This technique is based
on the following assumptions: (1) observations are drawn from normally

distributed populations, (2) observations represent random samples from

populations, (3) variances of populations are equal, and (4) one
observation is independent of another observation (Kirk, 1968). Main

effects, explained (between) group variance, residual (within) group

variance, and significance of findings are reported in table form (see

Table 4). Turkey's test for honestly significant differences was used,

where appropriate, to make all pairwise comparisons among means.

Hypothesis two was tested at the .05 level of significance and a
main effect (significance of p=0.01) was found for total satisfaction
on the OSHNS for ethnic origin (p=0.05). Turkey's HSD procedure on

the means for the total satisfaction score of the 05HNS indicates that

Black subjects GE = 86.0) scored significantly lower (ps .05) than

did Oriental subjects GE = 96.75) and White subjects 07 = 91.99), but

not significantly lower than subjects of Hispanic origin DE = 90.67).
No significant interaction was found for total satisfaction on the JDI.

Analysis of variance for the subscales of the OSHNS and JDI was also

performed. A main effect was found on the Autonomy subscale of the
OSHNS (F=0.019) for the ethnic origin variable (F=0.009) indicating
that Black subjects are less satisfied GE = 6.15) with their autonomy


Source Sum of Squares D.F. Mean Square F Signif. of F

Table 4

Hypothesis Two

Main Effects
Ethnic Origin
Marital Status
Nursing Experience







Source Sum of Squares D.F. Mean Square F Signif. of F

Main Effects 3600.102 11 327.282 1.231 0.271
Ethnic Origin 1891.011 3 630.337 2.371 0.073
Marital Status 1074.738 3 358.246 1.348 0.261
Education 529.654 3 176.551 0.664 0.575

Shift 410.390 2 205.195 0.756 0.471

Age 169.032 1 169.032 0.594 0.402
Dependents 105.654 1 105.654 0.389 0.534
Credential 65.369 2 32.685 0.123 0.884
Nursing Experience 1.919 1 1.919 0.007 0.932

Explained 3602.023 12 300.168 1.129 0.341
Residual 40138.953 161 265.821
Total 43740.977 173 268.349

Table 4 Continued

Satisfaction Total Scores (JDI)

Autonomy Subscale of OSHNS

Source Sum of Squares D.F. Mean Square F Signif. of F

Between 54.9854 3 14.3282 4.795 0.0032

Within 611.5171 160 3.822

Total 666.5015 163

Table 4 Continued

Group Count Mean Standard Deviation Standard Error

Table 4 Continued












Fixed Effects
Random Effects

Cochran's C-Max = 0.3596

Bartlett Box F = 2.294
Max Variance/Min Variance = 2.450

Tukey HSD Ranges = 3.68

Tukey Value = 1.382

P =0.065

1 3 4 2

Source Sum of Squares D.F. Mean Square F Signif. of F

Main Effect 107.040 10 10.704 2.017 0.035

Ethnic Origin 43.522 3 14.507 2.734 0.046

One-Way Analysis of Variance

Source Sum of Squares D.F. Mean Square F Signif. of F

Between 27.908 3 9.303 1.678 0.1739

Within 887.032 160 5.544

Total 914.940 163

Table 4 Continued

Pay Subscale of OSHNS

Group Count Mean Standard Deviation Standard Error

Table 4 Continued








Fixed Effects
Random Effects

Cochran's C-Max = 0.332
Bartlett Box F = 1.001
Max Variance/Min Variance =

Tukey HSD Ranges = 3.68
Tukey Value = 1.665

P = 027

1 2 3 4

at work than either Oriental subjects (x = 8.87) or White subjects

DE = 8.19). Also, analysis of variance for the Pay Subscale of the
OSHNS was performed and a main effect was found (F=.035) for the

Ethnic Origin variable (F=.045). However, a one-way analysis of
variance of the Pay Subscale for ethnic origin reduced the level of

significance to .17, implying that the main effect found was a chance
occurrence. Lending support to this interpretation is the point that

the sample size for ethnic origin was not normally distributed among

the four groups, hence violating a basic underlying assumption

pertinent to the ANOVA procedure. Because of the significant
difference in total satisfaction scores for the OSHNS based on ethnic

origin, Hypothesis two was rejected. A summary presentation of this
data can be found in Table 4.

Hypothesis Three: There will be no statistically significant
relationship between the subjects' degree of job satisfaction and the
selected environmental variables: number of nurses per facility,
number of patients/nurses, number of physicians per facility, shift,

or type of facility. Hypothesis three was tested at the .05 level
of significance and no interaction was found. However, a main effect

was found on the Work Scale of the JDI for type of facility (F=0.0159)

indicating that subjects employed in limited care outpatient dialysis
facilities scored significantly higher and are more satisfied with

the nature of their work OE = 40.96) than subjects employed in

hospital outpatient units [x = 37.22). Also, a difference was found
for the Pay Scale of the OSHNS (F=0.028) by type of facility, and

Turkey's HSD procedure (HSD = 3.69) suggests that subjects employed

in hospital outpatient dialysis units were more satisfied with their

pay (x = 17.33) than subjects employed in self-care types of
facilities (x = 13.5). A summary presentation can be found in

Tables 5, 6, and 7. Because no significant differences were found

for the total satisfaction scores and the stated variables, Hypothesis

three was retained.

Hypothesis Four: There will be no statistically significant
relationship between the subjects' degree of job satisfaction and the

subjects' feelings towards peers and administrators, doctor-nurse
relationships, perceived usefulness of a counselor in the dialysis

setting, advancement opportunities, or professional status.

Hypothesis four was tested at the .05 level of significance and no
relationship was found between the degree of job satisfaction, total

scores on the OSHNS and JDI, and the selected variables. Based upon

these results, Hypothesis four was supported. A tabulation of these

results can be found in Table 8.

Results of Summary Questionnaire (SQ)

The SQ was the final instrument included in the survey packets

completed by the research subjects. A copy of the SQ can be found in

Appendix B. The first item asked the subject to list in order of

importance the five aspects of dialysis nursing that they like the
most. One hundred sixty-four subjects (96.3 percent) responded to

this question, listing in order (1) their work schedule, (2) the
various tasks of dialysis nursing, (3) their coworkers, (4) their

pay, and (5) the dialysis patients. Reviewing responses by

Table 5
Tabulation of Results: Hypothesis Three

Correlation Coefficients OSHNS

Satisfaction Total Score with Number of Patients
Correlation (R) = -0.026

Standard Error of Estimate = 7.847
R2 = 0.00072

Intercept (A) = 92.014

Significance = 0.364

Slope (B) = -0.00712
Satisfaction Total Score with Number of Nurses

Correlation (R) = 0.0512
Standard Error of Estimate = 7.839
R2 = 0.003
Intercept (A) = 90.891

Significance = 0.253
Slope (B) = 0.065
Satisfaction Total Score with Your Patients (number)
Correlation (R) = -0.011

Standard Error of Estimate = 7.849
R2 = 0.0001
Intercept (A) = 91.735

Significance = 0.443
Slope (R) = -0.008

Table 5 Continued

Satisfaction Total Score with Number of Physicians
Correlation (R) = -0.009

Standard Error of Estimate = 7.849
R2 = 0.0001

Intercept (A) = 91.776

Significance = 0.454

Slope (B) = -0.025

Correlation Coefficients JDI

Job Total Scores with Number of Patients

Correlation (R) = 0.049

Standard Error of Estimate = 16.88

R2 = 0.003

Intercept (A) = 137.863

Significance = 0.259

Slope (B) = 0.028
Job Total Scores with Number of Nurses

) = 0.041
of Estimate =

Correlation (R

Standard Error
R2 = 0.002

Intercept (A)


Slope (B) =




Table 5 Continued

Job Total Scores with Your Patients
Correlation (R) = 0.032
Standard Error of Estimate =
R2 = 0.001

Intercept (A) = 138.842

Significance = 0.339
Slope (B) = 0.047
Job Total Scores with Number of Phy

Correlation (R) = 0.050

Standard Error of Estimate =
R2 = 0.003

Intercept (A) = 137.971

Significance = 0.256

Slope (B) = 0.305


Correlational Analysis
of 05HNS by Age Total Satisfaction

= -0.007 Correlation (R)
= 115.35 Standard Error
= 0.0001 R2
= 413.895 Intercept (A)
= 0.465 Significance

= -0.099 Slope (B)

Total Satisfaction
Correlation (R)
Standard Error
Intercept (A)


Slope (B)

of JDI by Age
= -0.112
= 114.628
= 0.013

= 511.061
= 0.072
= 0.764

Source D.F. Sum of Squares Mean Squares F Ratio F Prob.

Between Groups 3 1020.126 340.042 2.372 0.0744

Within Groups 107 15337.694 143.343

Total 110 16357.820

Tukey's HSD = 3.69 > .05

Actual HSD = 8.466

Satisfaction Total Scores by Facility OSHNS

Source D.F. Sum of Squares Mean Squares F Ratio F Prob.

Between Groups 3 243.742 81.247 1.173 0.324

Within Groups 107 7409.882 69.251

Total 110 7653.621

Tukey's HSD < .05 = 3.69

Observed HSD = 5.884

Table 5 Continued

Job Total b aiiy

Source D.F. Sum of Squares Mean Squares F Ratio F Prob.

Table 6

Between Group

Turkey's HSD
Observed HSD

s 3

< .05 = 3.69

= 3.285



3.601 006



(2) Hospital Outpatient
(4) Self-Care Outpatient

(3) Limited Care Outpatient
(1) Hospital Inpatient

(3 different from 2, but not 4 or 1)

2 4 3

Source D.F. Sum of Squares Mean Squares F Ratio F Prob.

Table 7

Between Groups 3

Within Groups 107

Total 110

Turkey's HSD < .05
Observed HSD = 1.745



3.151 008





Self-Care Outpatient

Hospital Inpatient
Limited Care Outpatient

Hospital Outpatient

4 1 3 2

(2 was different from 4, but not 1 or 3)

Table 8

Total Score on the OSHNS by:

(1) Coworkers

(2) Administration

(3) Doctor-Nurse Relationships

(4) Usefulness of Counselor

(5) Promotions

(6) Professional Status

(7) Total Scores on the JDI

Total Score on the JDI by:

(1) Coworkers

(2) Administration

(3) Doctor-Nurse Relationships

(4) Usefulness of a Counselor

(5) Promotions

(6) Professional Status

(7) Total Score on the OSHNS

= 0.06

= 0.65

= 0.48

= -0.06

= 0.19

= 0.23

= 0.16

= 0.04

= 0.13

= 0.09

= 0.27

= 0.61

= 0.09

= 0.16

credential indicates a somewhat different picture, however.

Registered nurses (N=141) listed their preferences in order as their
schedule, the task requirements, coworkers, patients, and pay.

Licensed practical nurses (N=22) ranked, in order, their schedule,

pay, the task requirements, coworkers, and the work environment.
The second item asked subjects to list, in order of importance,

the five aspects of dialysis nursing liked least. One hundred

fifty four subjects (90 percent) rank-ordered their least liked

components as: (1) pay, (2) work schedule, (3) the administration
of the facility, (4) the dialysis patients, and (5) the work environ-

ment. It is interesting to note, however, that ratings varied by

ethnic origin, marital status, education, credential, and faciltiy,

with dissatisfaction with salary and benefits heading the list for

Whites, R.N.'s, married subjects, L.P.N.'s, and subjects employed in

limited care and hospital outpatient facilities. Single nurses and

graduates of hospital nursing schools rated their work schedule and
time off as their least liked job aspect. Subjects with Bachelor's

degrees employed in hospital inpatient or self-care outpatient
facilities ranked the administration's practices and policies as the

least liked aspect, and included boredom, supervision, complaining

patients, staff shortages, medical risks such as exposure to hepatitis,
and coworkers among their least liked things about work.

Item three inquired as to what the subjects considered to be the
five most important skills needed for dialysis nursing. One hundred

fifty-nine (92.4 percent) subjects responded, ranking interpersonal
skills as most important, followed by medical knowledge concerning

renal failure and body chemistries, basic nursing care skills, good

venipuncture technique, and psychological skills such as empathy and
basic counseling ability. The interpersonal skills category included

such items as ability to communicate and express oneself, having a

pleasant attitude, patience with patients, a caring nature, and an
interest in helping others. Regardless of education, all subjects

ranked interpersonal skills as most important. Subjects holding

Bachelor's degrees followed interpersonal skills with behavioral

observation skills, mechanical ability, psychological skills and

medical knowledge, and venipuncture technique. Three of the four
education categories included psychological skills such as basic

counseling, understanding the psychological effects of dialysis, and

dealing with stress, as one of the five most important skills.

Question four asked the subjects to identify what five skills

they are lacking but would be useful in their work. Learning to cope
with the death of patients was ranked first, followed by increased

education in medical aspects of dialysis and renal failure, training

in modifying the work environment, mechanical skills for working with

equipment, and interpersonal skills to enhance the doctor-nurse rela-
tionships. Also mentioned in this question, although not skills, was
an increase in professional status and pay, with 54 percent and 40

percent of the 119 subjects responding listing these categories.
One hundred twenty subjects ranked an increase in professional
status, pay and benefits increases, work schedule and vacation times,

a reduction in clerical work, and less involvement in social service
tasks as the five aspects of work they would change to make dialysis

nursing more satisfying.

The five aspects of dialysis nursing that cause stress were

ranked by 118 subjects. Low professional status was rated as most

stressful, followed in order by inadequate social service support,

boredom, low pay, and work schedules.

The last question on the SQ asked the subjects to rate how useful

the services of a psychologist or counselor help in dialysis nursing

if such services were available to both patients and staff. One

hundred sixty-four of the 172 subjects responded to this question,

with 102 (62.2 percent) subjects rating such support as "very useful,"

31 (18.9 percent) rating "somewhat useful," 20 (12.2 percent) stating

they were "not sure," 7 (4.3 percent) as "limited usefulness," and

4 (2.4 percent) as "not useful." Thirty-seven subjects indicated that

psychological services were currently available, with 35 stating that
such services were "very useful." Frequency and percent for the SQ

are presented in tabular form in Table 9.

Summary of Findings

Data from the Job Descriptive Index, the Occupational Satisfaction
of Hospital Nurses Scales, the Demographic Information Sheet, and

Summary Questionnaire were analyzed. Total scores and sub-scale

scores were examined with the significance level set at .05. These

data were analyzed based on the perceptions of nurses employed full-
time in hemodialysis treatment centers. Summary tables and additional

analyses of these data were presented, as well as a narrative descrip-
tion of the demographic characteristics, and summary questions.



Table 9

I. Five Things Liked Most About Job
Ranking N
1. Schedule 147
2. Task Requirements 118
3. Coworkers 87
4. Pay 53
5. Patients 51

Totals: N = 164 96.3%

By Credential
Registered Nurses
1. Schedule
2. Task Requirements




N = 141 87.
Totals: N = 22



5. Pay
Licensed Practical Nurses
1. Schedule
2. Pay
3. Task Requirements

Table 9 Continued

II. Five Things Liked Least About Job
Ranking N
1. Pay 67
2. Schedule 66
3. Administration 48
4. Patients 46
5. Environment 38

Totals: N = 154 89.5%

By Ethnic Origin
Blacks Totals: N = 10
1. Environment
2. Doctor-Nurse Relations
3. Schedule



Whites Totals:
1. Pay
2. Schedule
3. Administration
4. Patients
5. Tasks

N = 123 91.8%


Table 9 Continued

By Marital Status

Single N = 52 34%
Ranking N %

1. Schedule 21 40.4

2. Patients 18 34.6

3. Administration 16 30.8

4. Pay 14 26.9

5. Task Requirements 12 23.1

Environment 12 23.1
Married N = 93 60%

Ranking N %

1. Pay 52 55.9

2. Schedule 40 43.0
3. Patients 28 30.1

4. Administration 26 27.9

5. Task Requirements 21 22.6

Environment 21 22.6

By Education
B.S. N = 26 16.9%

Ranking N_ %
1. Administration 14 33.8

2. Boredom 7 26.9
3. Supervision 6 23.1

4. Environment 5 19.2
5. Patients 5 19.2



Table 9 Continued

N =56





= 17



1. Pay

2. Schedule
3. Environment
4. Patients
5. Administration
Certificate N = 55

1. Schedule

2. Pay
3. Tasks
4. Administratio
5. Coworkers
Practical Nursing
1. Pay
2. Patients


By Nursing Credential
Registered Nurse N
1. Pay
2. Schedule
3. Administration
4. Patients
5. Environment
Licensed Practical Nurse
1. Pay
2. Patients
3. Doctor-Nurse

9 Continued

= 135


N = 8 118%


By Facility
Hospital Inpatient
1. Administration
2. Staff Shortages
3. Schedule
4. Environment
5. Pay

N = 8


Table 9 Continued

Hospital Outpatient N = 16 16.0%
Ranking N %

1. Pay 7 43.8

2. Patients 5 31.3

3. Schedule 5 31.3



Limited Care Outpatient N = 72 72.0%

Ranking N %

1. Pay 35 48.6

2. Schedule 28 38.9

3. Patients 26 36.1

4. Administration 25 34.7

5. Supervision 16 22.2

Self-Care Outpatient N = 4 4.0%

Ranking N %

1. Administration 4 100.0

2. Task Requirements 2 50.0

3. Coworkers 2 50.0

4. Medical Risks 2 50.0


Table 9 Continued

III. Fv otIpratSil o o


1. Interpersonal Skills

2. Medical Knowledge

3. Nursing Skills

4. Venipuncture

5. Psychological Skills

By Education
Bachelor of Science

1. Interpersonal Skills

2. Observation Skills

3. Nursing Skills

Mechanical Skills

Psychological Skills
4. Medical Knowledge

5. Venipuncture

Hospital Certificate
1. Interpersonal Skills
2. Nursing Skills

3. Medical Knowledge
4. Psychological Skills

5. Venipuncture






Associate of Science

Interpersonal Skills

Medical Knowledge

Observation Skills

Mechanical Skills

Graduate School of
Practical Nursing

Interpersonal Skills

Medical Knowledge

Mechanical Skills

Psychological Skills

Table 9 Continued

IV. Fv klsLcigBtUeu



Dealing with Patient Death
Medical Knowledge
Modify Environment
Mechanical Skills
Doctor-Nurse Relationships

(Professional Status)



V. Five Things to Change for More Satisfa
Totals: N = 120
1. Professional Status
2. Pay
3. Schedule
4. Clerical Work
5. Social Service Work
VI. Five Things That Cause Stress on the
Totals: N = 118



3. Brdm

Table 9 Continued

VII. How useful would the services of a psychologist or counselor
help in your job if these services were available to you and/or
your patients?
Totals: N = 164 95.5%
Ranking N %

Very Useful 102 62.2
Somewhat Useful 31 18.9
Not Sure 20 12.2
Limited Usefulness 7 4.3
Not Useful 4 2.4



Four major hypotheses, stated in terms of the Job Descriptive
Index, the Occupational Satisfaction of Hospital Nurses Scales, the

Demographic Information Sheet, and the Summary Questionnaire, were
addressed in this study. Three hundred forty participants were

queried. The total number of participants responding was 172, 150
of which were registered nurses, and 22 of which were licensed

practical nurses. All 172 participants responded to the JDI, SW,
and OSHNS based on their perceptions of their like or dislike of
different aspects of work, as well as their most important possessed
skills, important skills lacking, aspects of work where change was

desired, perceived stressors, and perceived efficacy of psychological
or counseling services in the dialysis setting. A return rate of
69.4 percent was achieved from participating dialysis facilities,
which has been shown to be acceptable (Ary, Jacobs, & Razavich,

The majority of responses (50 percent) were returned from
facilities with populations between six and ten nurses. Some

responses (14.3 percent) were returned from facilities employing

between one and five nurses. Responses (25 percent) were also

returned from units with between 11 and 15 nurses. Two units (7.1

percent) with between 16 and 20 nurses also participated in the

study. Information regarding the representativeness of this sample
was not available, however, there is no data suggesting that the

sample was not representative of dialysis units in Florida.

Total Job Satisfaction Scores

The hypothesis that there would be no significant differences

between male and female hemodialysis nurses' scores on the JDI and

OSHNS was retained. Although the literature reviewed (Nichols, 1971)

stated that males tended to stay in nursing longer than females and

were more satisfied, no differences were discovered in the present

study. The primary reason for this result may be the small number
of male participants (N=6). Information about the number of male

dialysis nurses was not available prior to the study, and the small
number of male participants rendered statistical analysis of sex

differences invalid. However, rather than state that no differences

exist between male and female dialysis nurses, it is salient to

state that differences were not demonstrated by this study.

The second hypothesis addressed the relationship between specific

demographic variables and total job satisfaction scores. A main
effect was found on the total satisfaction score of the OSHNS for

ethnic origin. Turkey's HSD procedure indicated that participants

of Hispanic origin scored significantly lower in total job satis-

faction than subjects of Black, Oriental, or White origin. However,
the small number of Hispanic subjects (N=9) may have affected these

results, minimizing the significance of this finding. The analysis

of variance procedure assumes a normally distributed sample and this
assumption was violated by having an unbalanced sample, generaliza-

tions regarding the occupational satisfaction of Hispanic dialysis
nurses are unwise. No significant interactions were found for the
total satisfaction score of the JDI.

Analysis of variance was performed on the subscales of both the
OSHNS and JDI. A main effect was found on the Autonomy subscale of
the OSHNS for ethnic origin indicating that White and Hispanic

subjects scored significantly higher on this scale than Black subjects

A possible interpretation of this outcome is that Whites and Hispanics
in this study have higher educational levels than Blacks, and may be

given more decision-making responsibility. A main effect was also
found on the Pay subscale of the OSHNS for ethnic origin. However,
a one-way analysis of variance was performed, the results indicating

that the main effect was not significant at the .05 significance
level. A reasonable interpretation of this result is that the

original main effect was a chance occurrence statistically, and that
a more scrutinizing analysis bore out the truer probability.
The third hypothesis examined the relationship between total job
satisfaction scores and certain environmental variables. Although no

significant interaction was found for total scores of the JDI or
OSHNS, main effects were found on two subscales. A main effect for

type of facility was found in the Work subscale of the JDI, indicating
that nurses employed in limited care outpatient facilities are more
satisfied with their work-related tasks than nurses employed in

hospital outpatient units. One possible interpretation of this result
is that there exists a difference in the nature of dialysis nursing

between hospitals and limited care outpatient facilities. Hospitals

being a more diverse medical facility have greater patient, and

perhaps staff turnover, a factor shown to reduce satisfaction with
work. Limited care outpatient facilities provide only dialysis

related medical services and are operated in a more business-like

fashion, with staff having set schedules for work and days off from

treatment, stable patient caseloads, necessary equipment and support

services on-premises, a smaller, centralized administration, and a

lack of competition among specialty areas for priority funding or

staffing. Hospital outpatient units usually handle hepatitus positive

patients, increasing the medical risk to staff, and transient patients
from other centers who may only dialyze once or twice at the hospital

unit. Transient patients present a particular problem to dialysis

staff as unfamiliarity with the patient's dialysis history requires

the nurse to monitor their treatment more intently than a patient

whose treatment history is familiar. Nurses working in limited

care facilities have a set number of patients for whom they are

primarily responsible, a clear hierarchy of supervisors, and
administrators with greater accessibility than a nurse employed

in a hospital who may have several supervisors and administrators
who are concerned with not just dialysis but other specialized

medical services. Finally, nurses employed in a hospital setting

may have been assigned to outpatient dialysis due to manpower needs,

opposed to a nurse employed in a limited care facility who chose to
work in dialysis.

A main effect was found for the Pay subscale of the OSHNS by

type of facility. Analysis of the results demonstrates that nurses

employed in hospital outpatient units are more satisfied with their

pay and benefits than nurses employed in self-care units. However,
the small number of subjects employed in both areas limits the

generalizability of this outcome. Whether real pay differences
exist between the two groups is not known, although one would expect

that differences, if any, would be slight. Rather it seems that the

lower rating by the self-care nurses is more a reflection of the pay

not being equal to the tasks involved. Self-care facilities in

Florida appear to be few in number with only four nurses reporting

it as their place of employment. Self-care units provide services

for patients who have received training and are primarily responsible
for their own dialysis. Some patients dialyze at home with a partner's
assistance and come to the facility for supplies and check-ups. Other

patients use the equipment of the self-care unit rather than dialyze
at home, and utilize the nurse as their assistant. Many self-care

patients also are employed and structure their dialysis around their
working hours, often in the evenings and week-ends which requires the

self-care nurse to be on call perhaps 24 hours a day, seven days a

week. Although this kind of schedule may provide flexibility,

planning activities can be difficult and are often interrupted.
Possibly then it is these aspects of the work, the unpredictableness
of hours and the medical and mechanical expertise required, that are

being reflected on the low pay scale ratings of the self-care nurses.

The fourth hypothesis addressed the relationship between total
scores on the dependent measures and subject's attitudes concerning

coworkers and administrators, the quality of the professional

relationship between physicians and nurses, the perceived value

of a counselor in the dialysis setting, the perceived professional

stature of nursing, and the opportunities for professional advancement

in dialysis nursing. Only moderate correlations were identified for
Administration (.65) and Promotions (.61), and essentially no correla-

tion existed between the two dependent measures, the OSHNS and JDI.

Two possible explanations may account for the lack of significance
of these results. First, there may not exist a relationship between

job satisfaction of dialysis nurses and these variables. However,
these findings are inconsistent with previous research on job satis-

faction. Blum and Naylor (1968) found that feelings toward coworkers

was a factor in job satisfaction. Stamps, Piedmont, Slavitt, and

Haase (1978) identified professional status and social contact as

significant determiners of positive affective responses towards work.
Godfrey (1978a, 1978b, 1978c) identified team spirit, administrative

support, and opportunity for advancement among the characteristics of
satisfied nurses. Unless dialysis nurses are a separate professional

entity, such extreme differences between observed and expected attitudes
would not be anticipated.

A second possible explanation, and perhaps the salient of the

two, is that the dependent measures utilized in the study, the JDI
and the OSHNS, were not sensitive to the dynamics of occupational
satisfaction of the sample population and, therefore, were unable to

measure attitudes belonging to the subject sample. Although the JDI

has been traditionally an efficacious means of assessing occupational
satisfaction, and has been utilized in several studies of nurses'

occupational satisfaction (Boyd, 1976; Brief et al., 1978; Smith,
1976), only one main effect on one subscale was identified and no
correlations between total scores and the demographic or Summary

Questionnaire items were established.
The OSHNS was specifically designed to assess positive affective

responses to work among nursing professionals and was chosen for use
in the present study for that reason. Developed following consider-

able item analysis, pilot testing, and refining, the OSHNS appeared
to be a promising tool for measuring the degree of satisfaction

derived from nursing. Despite the promising appearance and statistical

support for using the instrument, results of the present study raise
questions regarding further empirical use with dialysis nurses.

Summary questionnaire
Results of the SQ were discussed in Chapter IV, yet further

explanation and interpretation of the data appears necessary. Several
points of interest relating to the appropriateness of counseling and

psychological services in the dialysis setting exist. Thirty-one
percent of the subjects responding to the SQ selected their patients
as one of the five most-liked aspects of dialysis care, yet an almost

equal number (29.9 percent) stated that the patients were a least-
liked aspect of dialysis care. McMinn (1979) and Dickerson (1980)

have addressed the issue of burnout among dialysis professionals and
cite an apathetic, depersonalized attitude towards patients as a

major indicator of burnout. A review of Table 9 also points to

patients as a least-liked work aspect among single, married, R.N.'s,
L.P.N.'s, all educational levels, and for nurses employed in the

two largest types of facilities. It would seem then that dialysis

nurses are faced with a considerable burnout factor. Perhaps a

recognition of the burnout issue by dialysis nurses is reflected by

the participants of the present study choosing interpersonal skills,
such as assertiveness training or other communications education, and

psychological skills such as peer counseling, psychological aspects
of chronic illness, and death education, as one of the important

skills for the job.

Another indication of burnout among the subject sample is found

in job-related stress factors. An experienced decreased professional
status perceived by 40 percent of the subjects is indicative of

burnout, as one experiences professional recognition waning the

incentive to perform at a peak level subsides as well. Another
indication of burnout is seen when examining the most-liked aspects

of dialysis nursing. Ninety percent (N=147) of the subjects rated

their work and vacation schedule as the most liked aspect of the job.

The challenging nature of the tasks involved placed second, perhaps

implying that although dialysis nurses enjoy the tasks involved with
the job, the hours they must perform them and the time the nurses
can leave the tasks behind is primarily important.
Finally, when asked to rate how useful the services of a psycholo-

gist or counselor would help patients and/or staff in the dialysis
setting, 81 percent of the participants responded that such services

would be "somewhat" or "very" useful. This recognition by the

study participants of the value and need for counseling and

psychological services lends support to the interpretation that
dialysis nurses are experiencing burnout which may impact negatively
on their job satisfaction. Also, counselor educators need to become

more actively involved in the medical profession, by understanding

the psychological problems of chronic-care professionals and extending
their skills, experience, and knowledge of treatment of related

problems to this professional domain.


The findings of this study would lend support to the following

1. Job satisfaction, as measured by the OSHNS, was found to be

significantly related to the ethnic origin of the nurse.
2. Autonomy, or decision-making ability, as measured by the

OSHNS, was found to be significantly related to the ethnic origin
of those whose perceptions were surveyed.
3. Positive affective responses to the general nature of

dialysis nursing and the financial rewards may significantly relate
to the type of facility where those surveyed are employed.
4. Burnout, anda loss of concern for the people with whom and
for whom one is working, is experienced by dialysis nurses and effects

the degree to which they are satisfied with nursing.


Male and female dialysis nurses in the State of Florida were

surveyed on four instruments; the JDI, the OSHNS, the DIQ, and the

SQ. The data from these instruments tend to support the conclusion
that significant differences in perceived occupational satisfaction

and autonomy on the basis of ethnic origin, work characteristics

and pay, on the basis of dialysis facility type, exist. These data
lead to the support of three of the four stated hypotheses.

Significant differences were found on the Total Satisfaction Score
and Autonomy subscale of the OSHNS on the basis of ethnic origin

and the Work and Pay subscales based on type of employing facility.

Differences found concerning the DIQ and SQ information were

found in all areas. Differences in age, marital status, number of

dependents, education, shift, nursing credential, sex, number of
nurses, patients, and doctors, and experience appeared to be minor

with the major differences in the areas of ethnic origin and type of

facility where employed. One cannot conclude from this study that

significant differences exist based on sex of the nurse, or demographic
variables. Nor can one conclude from the results that such differences

do not exist.


1. Studies comparing male and female dialysis nurses' affective

responses to work, educational and demographic backgrounds, perceptions
of the work environment, and behaviors, should be conducted in other


2. Further studies examining recruitment, employment, and

advancement of minority group practices in the field of dialysis

nursing should be conducted.

3. Current preserve educational programs preparing indivi-

duals for roles in the field of nursing, and inservice programs

addressing professional burnout among nurses should be reviewed.

4. Further studies towards validating the use of occupational

satisfaction instruments with dialysis nurses, addressing the quality

of patient-nurse, physician-nurse, and nurse-nurse interaction,
routineness of tasks, and professional autonomy, should be conducted.

5. Counselors and counselor educators should explore the

medical setting, particularly dialysis facilities, for future profes-

sional growth and interaction.


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