The Impact of Nurses Recognition, and Empowerment Related to Nurses Job Satisfaction at KFSH-D ()
1. Introduction
According to WHO (2018), it has been estimated, globally, there are about 7.2 million shortages of nurses. In Saudi Arabia the ratio of 55.2 nurses per 10,000 individuals representing the population of Saudi Arabia (MOH, 2018) [1] 184.565 registered nurses are currently working in both agencies including private and government sectors. Though the government promotes nursing profession, Saudi Arabia remains low compared to France (93/10,000), United Kingdom (95/10,000), and Canada (105/10,000) (The World Bank, 1019) [2] . Important need in assessing job satisfaction among nurses plays an important role dealing with patient health care. Apart from that, job satisfaction does not only explain how individual feel about their scope of services, thus various components are included such as job conditions, policies, clearer communication, and recognition. Therefore, in related towards improvement and sustainability of nursing profession, recruitment and retention plays a major role in dealing with career satisfaction among nurses [2] . The need to understand and evaluate job satisfaction may allow administrators to predict nurses’ intentions weather to leave or stay in their profession. Team spirit and cooperation are key elements in providing continues quality of care and establishment of optimistic attitude.
Recent studies reflect effective recognition may foster job satisfaction. The AACN contributes healthy working environment by adopting evidence-based approach. These standards are interdependent aspect of a healthy work environment that fosters job satisfaction. The following standard is developing a proficient communication skill, which involves skillful communication.
Saudi Vision 2030 contributes a series of developing healthcare services to enhance community health status. The demand for nurses will be tripled by year 2030. This shows that 150,000 nurses’ positions must be filled before 2030. To meet these needs, approximately 10,000 newly graduate nurses should be employed each year. Policies and regulations along with ensuring best quality of care being delivered to their patients [3] [4] . With extensive growth in healthcare system in Saudi Arabia; yet little intention of job comfort was highlighted in nursing field.
1.1. Aim
The aim of the studies is to analyze the importance of nurses’ recognition, and empowerment towards nurses’ job satisfaction at KFSH-D.
1.2. Objective
1) The importance of nurses’ empowerment towards job satisfaction.
2) To examine the relationship between nurses’ recognition and nursing job satisfaction.
1.3. Research Question
1) What is the impact of nursing structural empowerment towards nurses’ job satisfaction?
2) What is the relationship between nurses’ recognition and nursing job satisfaction?
1.4. Hypothesis
H1. There is significant impact on the importance of nursing empowerment related to job satisfaction.
H2. There is significant impact on the relationship between nurses’ recognition and job satisfaction.
2. Literature Review
Nursing shortage is increasing because nurses are leaving the profession, particularly because of difficult working conditions (Buerhaus et al. 2000, 2006) [5] [6] and unsatisfying workplaces. The factors causing this desertion could be: a high nurse turnover (Hauck et al. 2011) [7] , heavy workloads and lack of development opportunities (Laschinger et al. 2009a) [8] .
Globally there are mounting concerns about nurses’ job satisfaction because of its pivotal role in nurse turnover and the quality of care of patients. Job satisfaction of hospital nurses is closely related to work environment, structural empowerment, organizational commitment, professional commitment, job stress, patient satisfaction, patient-nurse ratios, social capital, evidence-based practice, and ethnic background (Lu et al., 2019) [9] , rewards and recognition (Ahmed et al. 2014) [10] .
According to Alsufyani et al. (2020) [3] [4] , the Saudi government is in the face of achieving the “Gold Standard” in the nursing profession. Hence, it collaborates towards achieving the Vision of Saudi 2030 by contributing the services in healthcare premise which could enhance the health status in the community. Studies done by Alsufyani et al. (2020) [3] [4] , mentioned the demand for nurses will be tripled by year 2030 and shows that 150,000 nurses’ positions must be filled before 2030. However, with an extensive growth in healthcare system in Saudi Arabia but the job dissatisfaction was highlighted in nursing field (Alsufyani et al., 2020) [3] [4] .
Job satisfaction is defined as the positive feeling or attitude about various aspects of the job (Lu et al. 2019) [9] . Nurses’ job satisfaction is referring to the level to which people feel that they can have an influence on the workplace. Higher levels of nurse satisfaction have been positively linked to improved quality of care and patient outcomes (Adams and Bond, 2000) [11] and retention of staff (Newman et al. 2001) [12] .
2.1. Significance of the Study
Structural empowerment and nursing recognition plays an impact towards nursing job satisfaction. For example, when nurses have the accessibility of resources to gather information needed, supports from their supervisors, it will give satisfaction level and feeling of empowered. Thus, the satisfaction adheres from the nurses, it will encourage them to provide quality input of care.
A study conducted by (Dahinten et al., 2016) [13] on staff nurses’ workplace empowerment and job satisfaction found that structural empowerment was the strongest independent predictor of job satisfaction. Also the study concludes that nurses’ job satisfaction is most influenced by their access to organizational empowerment structures. So, nurse leaders should use a variety of empowerment strategies that are important to nurses’ job satisfaction and potentially to the quality of patient care and nurse turnover.
Kanter (1977) [14] defined an empowering work environment as a workplace in which employees have access to the four empowerment structures. The first structure is information, referring to the data, technical knowledge and expertise that are necessary effectively to fulfil someone’s professional requirements (Laschinger & Havens 1996) [15] . The second is resources, referring to material, money, time, requirement, and equipment needed to accomplish the organizational goals. The third is support, referring to feedback, leadership and guidance received from superiors, peer, and subordinates. The last is opportunities referring to autonomy, self-determination, a feeling of challenge and the opportunity to learn and grow.
A systematic review and meta-analysis to explore the relationship between structural empowerment and organizational commitment found that structural empowerment is strongly correlated to organizational commitment and thus job satisfaction (Fragkos et al., 2020) [16] .
Results of a systematic review about workplace empowerment and nurses’ job satisfaction indicate a positive correlation between structural and empowerment and job satisfaction and other organizational outcomes. Structural empowerment was a stronger predictor of job satisfaction and organizational commitment (Cecolini et al. 2014) [17] .
A study to examine what extent structural empowerment and global empowerment predict job satisfaction found that all dimensions of structural empowerment (access to opportunities, information, resources, and support) were positively and significantly, (level of significance 95%) related to job satisfaction. The study recommends Managers should try to provide opportunities for increasing empowerment levels and job satisfaction in nursing staff (de Almeida et al., 2017) [18] .
On the other hand, meaningful recognition for nurses is considered a powerful tool to enhance nurses’ sense of self efficacy especially facing an emotional challenge that may affect their wellbeing. According to Sherwood et al. (2017) [19] recognition and appreciation in healthy working environment contributes to high level of satisfaction among nurses. Hence, the American Association of Critical-Care (AACN), in their framework, standard of recognition, has a greater impact in promoting a healthy work-environment. The AACN contributes healthy working environment by adopting evidence-based approach (Sherwood et al. 2017) [19] . These standards are interdependent aspect of a healthy work environment that foster job satisfaction and nurses’ retention.
Meaningful recognition program should be widely adopted and applied for the nurses and all health care teams in different health care settings especially in such a stressful period due to the COVID-19 pandemic. Nurse and medical members (White Army) as called by social media, should receive recognition from health care managers, governmental systems, stakeholders, and different social media for their contributions and efforts to face negative experiences of the COVID-19 pandemic which has a great impact on providing them with power, purposefulness, and determination to comprehend and manage such stressful situations and feel that it was worthy. Additionally, such appreciation enabled them to trust their capabilities in caring for different patients during that troubled time. A descriptive study (Ernst et al., 2004) [20] on factors that describes nursing satisfaction predict relationship among nurses’ job satisfaction, organizational work satisfaction, and recognition. The study found that older nurses were more satisfied with recognition they received than their younger counterparts. The findings of this study support the need to focus on programs to improve institutional nursing recognition for all levels to improve nursing satisfaction. Moreover, career advancement and promotion stimulate nurses to be satisfied at work, leading to better quality of service delivered to patients and attendees in the hospital. This is because promotion usually comes with a high salary and reward increase (Akinwale et al., 2020) [21] .
Similar levels of burnout, secondary traumatic stress, compassion satisfaction, overall satisfaction, and intent to leave were reported by nurses in hospitals with and without meaningful recognition programs. Meaningful recognition was a significant predictor of decreased burnout and increased compassion. The same study concludes that In addition to acknowledging and valuing nurses’ contributions to care, meaningful recognition could reduce burnout and boost compassion satisfaction.
A study to examine the magnitude and determinants of job satisfaction in nurses working in Ministry of Health hospitals Riyadh identified recognition as one of the most important determinants of job satisfaction (Al-Ahmadi, 2002) [22] .
2.2. Recognition at KFSH-D
Since KFSH-D is magnet accredited hospital, it allows nurses to recognize nursing excellence in other nurses. ANCC proclaims that a growing body of research indicates that Magnet hospitals have higher percentages of satisfied RNs, lower RN turnover and vacancy, improved clinical outcomes and improved patient satisfaction. So, this review could be useful for guiding leaders’ strategies to develop and maintain an empowering work environment and recognition program that enhances job satisfaction. This could lead to nurse retention and positive organizational and patient outcomes.
3. Methodology
3.1. Research Design
This study takes the form of a quantitative research methodology, and descriptive-analytical technique. The descriptive-analytical research, the goal is to obtain complete and accurate information, the research design must make enough provision for protection against bias and must maximize reliability based on analyzes in order to make a critical evaluation of the material. Also, the method utilized in descriptive research is survey methods of all kinds, including comparative and correlational methods. A questionnaire was used to gather data from registered nurses employed at King Fahad Specialist Hospital-Dammam (KFSH-D) about the structural empowerment and nurses’ recognition program impact on their job satisfaction. Following the collection of data, the descriptive statistic was used to describe the personal characteristics of the respondents, while inferential statistics were used to determine the statistical relationship existing between independent variable job satisfaction and the structural empowerment and nurses’ recognition program among the registered nurses at KFSH-D as dependent variables.
3.2. Population and Sampling
At King Fahad Specialist Hospital, Dammam, 1099 nurses are distributed in many settings around the hospital to fulfil the variance and different specialties needed from direct patient care up to the managerial level. 578 registered nurses working in seventeen inpatient units but not limited to medical, surgical, pediatric, oncology, intensive care unit and rehabilitation. The other 420 registered nurses covering outpatient and procedural areas were excluded from the study.
The illegible sample is 234 registered nurses who work more than six months at King Fahad Specialist Hospital, Dammam who must be sufficient time to become familiar with current workplace environment. Therefore, the total eligible population for this study is registered nurses who have been selected from the seventeen inpatient units and will be asked to fill up an online questionnaire survey that may take up to 10 minutes its completion
3.3. Sample Size
Based on the following formula for calculating sample size s = X2 NP (1 − P) ÷ d2 (N − 1) + X2 P (1 − P). The sample size is 234 registered nurses who are working in seventeen inpatient units at KFSH out of 578 registered nurses as a total number.
3.4. Inclusion Criteria
The inclusion criteria for the research include all registered nurses who are working at the inpatient unit at KFSH as well as nurses who have more than six months of working experience at KFSH-D.
3.5. Exclusion Criteria
The exclusion criteria that the researcher would not include for their studies, nurses have less than six months of working experience. Besides that, nurses who are on annual leave, maternity leave, on educational leave would be excluded. Apart from that, nurses who are assigned in the outpatient department will also be excluded from the studies. Besides that, all administrative managerial levels will also be excluded from the studies.
4. Result
A total of 8 males and 92 females (100 out of 234 nurses) completed and returned the questionnaires (42.7 percent response rate). All those nurses were working in the Adult Hematology Unit, Adult ICU, General Pediatric Unit, Medical Oncology Unit, Medical Unit, Neuroscience Unit, Palliative Unit, Nuclear Unit, Rehabilitation Unit, Step Down (SDU), Surgical Units, Transplant Units, VIP Unit respectively. Of the participants’ age (64%) were aged (30 - 39 years), followed by (20%) were aged (40 - 49 years), only (8%) were aged (20 - 29 years) and the same percentages were aged (50 years and more). Regarding their years of experience, the majority of respondents (56%) had (6 years and more) of experience, then (17%, 14%, and 13%) of respondents had (2 - <4 years), (6 months - <2 years), and (4 - <6 years) of experience respectively. As far as their qualification; (86%) of them had a bachelor’s degree in nursing while (8%) had a post-graduate and only (6%) of the respondents had diplomas in nursing. Of the 100 respondents who indicated their nationality, the majority of them (82%) were non-Saudi and (18%) were Saudi nationality. The characteristics of participating nurses are shown in (Table 1).
4.1. Relationship between Structural Empowerment and Job Satisfaction
A positive relationship existed between structural empowerment and job satisfaction; pearson product-moment coefficients of correlation were computed because both scores are normally distributed. A preliminary analysis indicated a statistically significant moderately strong positive correlation between overall structural empowerment and job satisfaction (r = 0.614; p < 0.001; n = 100) indicating that structural empowerment increases as job satisfaction increases (Table 2).
4.2. Relationship between Each Subscale of Structural Empowerment and Job Satisfaction
A positive relationship existed between structural empowerment (Information, support, resources, work/setting job, activities opportunity, and each kind of opportunity) and job satisfaction, Pearson product-moment coefficients of correlation were computed because both scores are normally distributed. A preliminary analysis indicated a statistically significant moderately strong positive correlation between structural empowerment subscales and job satisfaction (r = 0.442**; p < 0.001; n = 100), (r = 0.501**; p < 0.001; n = 100), (r = 0.443**; p < 0.001; n = 100), (r = 0.584**; p < 0.001; n = 100), (r = 0.436**; p < 0.001; n = 100), (r = 0.599**; p < 0.001; n = 100) respectively, indicating that structural empowerment subscales (Information, support, resources, work/setting job, activities opportunity, and each kind opportunity) respectively increases as job satisfaction increases.
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Table 1. Frequency and percentage distribution of studied participants’ characteristics (n = 100).
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Table 2. Correlation between Structural Empowerment (SE) and job satisfaction among nursing staff (n = 100).
No relationship existed between structural empowerment (Opportunity) and job satisfaction, (r = 0.139; p > 0.05; n = 100) (Table 2).
4.3. Relationship between Recognition and Job Satisfaction
A positive relationship existed between recognition and job satisfaction; Pearson product-moment coefficients of correlation were computed because both scores are normally distributed. A preliminary analysis indicated a statistically significant moderately strong positive correlation between overall recognition and job satisfaction (r = 0.659; p < 0.001; n = 100) indicating that recognition increases as job satisfaction increases (Table 3).
4.4. Relationship between Each Subscale of Recognition and Job Satisfaction
A positive relationship existed between recognition (competent performance, outstanding performance, and achievements) and job satisfaction; pearson product-moment coefficients of correlation were computed because both scores are normally distributed. A preliminary analysis indicated a statistically significant moderately strong positive correlation between recognition subscales and job satisfaction (r = 0.644**; p < 0.001; n = 100), (r = 0.542**; p < 0.001; n = 100), and (r = 0.539**; p < 0.001; n = 100) respectively, indicating that recognition subscales (competent performance, outstanding performance, and achievements) respectively increases as job satisfaction increases (Table 3).
5. Discussion
In the current studies, the researcher is focusing on the role of empowerment and recognition related to nursing job satisfaction. The main findings indication relates to recognition and empowerment in the organization that promotes a greater impact on nurses staying and being satisfied with their daily work routine. However, though there is a great significance between empowerment and
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Table 3. Correlation between Recognition and job satisfaction among nursing staff (n = 100).
nurses’ satisfaction, opportunities have a great manifestation to be analyzed in the future. The studies analysis shows there is not any relationship between opportunity and empowerment among nurses. From the literature review, empowerment and recognition give an important role in minimizing turnover in any healthcare organization, nurses are reflected as the strength of healthcare, and they are the front line in delivering patient care. Therefore, the quality of the nursing profession determines the service performance in allied healthcare.
As per the findings, nurses are satisfied with the work setting, information tools, resources, and activities being provided at KFSH-D. Thus, the correlation between empowerment and job satisfaction gives a significant impact on nurses’ stay and contributes to the organization promptly.
Empowerment gives a structural impact on the professional working environment. Based on Kanter’s Theory of Organizational Empowerment (1977) [14] , explains the concept of workplace behavior, opportunities, and environment is associated with a degree of power that an individual has towards the organization. Hence, according to the studies conducted by García-Sierra & Fernández-Castro, (2018) [23] and Li et al., (2018) [24] has even mentioned, it shapes work empowerment with having sufficient access to information, support, resources, and opportunities. Therefore, certain opportunities and power support from an organization give a different behavior and outcome from an individual. Apart from empowerment, extrinsic job characteristics play a crucial role. According to the American Association of Critical Care Nurses (AACN, 2016) [25] has indicated, recognition is a vital component to promote a healthy working environment among nurses. Decades of research on human needs, organizational behavior, and professional development have shown that recognition is not only important but also necessary for the success of individuals and corporations. Thus, recognition is one of the criteria that gives a significant impact on nurses’ job satisfaction. According to Maslow’s Hierarchy, encouragement and recognition are assets to keep the staff from continuing to an organization. Sherwood et al. (2018) [19] , has also stated, recognition, appreciation, and improving staff welfare are important to adopt a healthy working lifestyle. From the data analysis, competent performance, outstanding performance, and achievements have a great impact on job satisfaction among nurses. According to studies conducted by Kelly LA et al. (2017) [26] meaningful recognition was a significant predictor of decreased burnout and increased compassion satisfaction.
Meaningful recognition mainly provided by transformational leadership, and it is highly rated for an employee’s well-being. However, reported recognition should be genuine and directly linked to the staff of the organization (AACN, 2016) [25] . This is crucially important as it gives distinctive praise and gratitude from others. This goes beyond a simple thank you; meaningful recognition signifies how the staff makes a difference from others. For instant, The DAISY award is a significant meaningful recognition tool for leadership to recognize their members in a unique way, apart from many other tools of recognition that exist (Clavelle et al., 2019) [27] .
Therefore, empowerment and recognition are a key source component that keeps nurses motivated, to do more and gives a high level of satisfaction with their role in the organization.
6. Recommendation
There are a few recommendations that intended to be seen by the researcher after the completion of the projects. The researcher only focuses on the medical-surgical unit, thus, the data collected, and information gathered were limited. Therefore, future studies, are recommended to focus on every dimension and category level of units to explore further the impact of recognition and empowerment related to their work satisfaction.
In addition, perhaps the researcher could include monitoring of turnover rates in each unit as it gives an in-depth outcome of the studies. Thus, the team will integrate with the NDNQI survey to give a meaningful outcome of this project with an additional domain such as leadership roles in respective units.
Apart from that, when looking into job satisfaction and empowerment, to be more specific, the researcher could investigate another dimension by comparing age, and clinical working experience which may provide a depth of understanding of the contribution perception of structural empowerment. To provide a better understanding of structural empowerment, a qualitative design will help to elaborate the significance of empowerment at workplace and staff intend to stay.
7. Conclusion
The findings of the studies reveal that nurses are satisfied with their job with the recognition and empowering working environment. Further efforts need to be looked into especially focusing on opportunities that are vague and perhaps specification could help further in the studies. However, as the studies show, recognition and empowerment are assets to make nurses stay and increase their level of job satisfaction and task assignments. However, further research is needed, to focus on different perspectives, the rewarding expectation as well as involving other units to make evaluate the extent of the studies.
8. Statement of Ethics
Institutional Review Board (IRB) approval obtained from King Fahad Specialist Hospital-Dammam, all studied (IRB approval number NED0329). Informed Consent taken from the participant before the studies being conducted. The unit managers will identify potential subjects. You may refuse to participate and shell not be loss of benefits. Use the information provided by you in this questionnaire for research purpose. Your participation will be strictly confidential. Participant was informing that they are allow to withdraw themselves at any point during the studies. Confidentiality of participants and data maintained.
9. Data Availability Statement
All data generated or analyzed during this study are included in this article and its supplementary material files. Further enquiries may be directed to the corresponding author Ms. Reem ALAhmari