|Year : 2014 | Volume
| Issue : 2 | Page : 114-120
A cross-sectional study of job satisfaction and leadership styles among the nurses in Aminu Kano teaching hospital
Emmanuel Ajuluchukwu Ugwa
Department of Obstetrics and Gynaecology, Bayero University, Kano State, Nigeria
|Date of Web Publication||6-Sep-2014|
Dr. Emmanuel Ajuluchukwu Ugwa
Department of Obstetrics and Gynaecology, Bayero University, Kano State
Source of Support: None, Conflict of Interest: None
Background/Objectives: Job satisfaction is the positive emotional state that results from the appraisal of one's job or job experience. Lack of good leadership in healthcare is responsible for employee dissatisfaction and turnover. This study was undertaken to assess the levels of job satisfaction and its association with leadership styles among the nurses in Aminu Kano Teaching Hospital (AKTH); and to compare the levels of job satisfaction between senior and junior nurses. Context/Setting: This study was done at AKTH, Kano, Nigeria. Materials and Methods: This was a cross-sectional study. Ethical clearance and informed consent were obtained. A total of 350 participants responded on a 5-point Likert scale to questions related to their work experiences. The data was analysed using Statistical Package for the Social Sciences (SPSS version 16.0) software. Absolute numbers and simple percentages were used to describe categorical variables. Similarly, quantitative variables were described using the summarizing indices as appropriate. Statistical significance of differences between means was determined using analysis of variance. Significant associations between the measured variables were tested using Chi-square test for qualitative variable and Pearson's coefficient of correlation for quantitative variables. Statistical significance was considered at P < 0.05. Result: The mean ages were 30.26 ± 4.76 and 40.19 ± 5.61 years for junior and senior nurses, respectively. Most of the junior and senior nurses were satisfied with their jobs (87.5% and 92.3% respectively); but the senior nurses were more satisfied compared with their juniors ( P = 0.031). Democratic leadership styles showed significant association with job satisfaction. Conclusion: There are high levels of job satisfaction among nurses in AKTH and this is associated with leadership styles.
Keywords: Job satisfaction, northern Nigeria nurses, tertiary healthcare
|How to cite this article:|
Ugwa EA. A cross-sectional study of job satisfaction and leadership styles among the nurses in Aminu Kano teaching hospital. Niger J Basic Clin Sci 2014;11:114-20
|How to cite this URL:|
Ugwa EA. A cross-sectional study of job satisfaction and leadership styles among the nurses in Aminu Kano teaching hospital. Niger J Basic Clin Sci [serial online] 2014 [cited 2018 Aug 18];11:114-20. Available from: http://www.njbcs.net/text.asp?2014/11/2/114/140363
| Introduction|| |
Job satisfaction has been considered a strong predictor of overall individual well-being,  as well as a good predictor of intentions or decisions of employees to leave a job.  The efficiency of an organisation depends largely on the morale of the employees.  Research suggests that job satisfaction and job performance are positively correlated.  Job satisfaction and morale of medical practitioners is of concern, worldwide. , Satisfied workers usually perform well; they also have a reduced level of absenteeism and voluntary turnover, which is defined as employees who leave an organisation at their own discretion.  Job satisfaction is therefore an issue of substantial importance for both employers and employees. As many studies suggest, employers benefit from satisfied employees, as they are more likely to profit from lower staff turnover and higher productivity, if their employees experience a high level of job satisfaction. Nguyen et al. stated that, "employees should also be happy in their work, given the amount of time they have to devote to it throughout their working lives''.
Multiple researches on various categories of health worker like physicians,  dentists,  nurses,  physiotherapists , and primary health care workers  in different parts of the world have been conducted.
Leadership is a social influence process, in which the leader seeks the voluntary participation of subordinates in an effort to reach organisation goals,  and a process whereby one person exerts social influence over other members of the group. 
Leadership style is an important determinant of employee's job satisfaction. The quality of the leader-employee relationship has a great influence on the employee's self-esteem and job satisfaction.  Employees are more satisfied with leaders who are considerate or supportive than with those who are either indifferent or critical towards subordinates.  Negative leader-employee relations reduce productivity and increase absenteeism and the turnover to the organisation can be quite high.  According to Robbins,  resignation rate with transformational leadership is less than with transactional leadership. Improving the employees' working situations, fulfilling their needs, and helping them perform better are positively related to transformational leadership. 
Although there is no one style of management and leadership consciously used within nursing as a specific method to cope with certain issues that nurses and ward managers are facing; however, what emerges is that predominantly health care has moved away from the traditional autocratic style and towards a combination of transactional and transformational leadership styles. Leaders, who use different methods or have mixed qualities often are said to be better than those who can be applied only to one pattern. 
While there are literature focusing on leadership in nursing and the factors, which affect nurse's job satisfaction, there are very few which explain how certain leadership styles implies positive or negative effect on job satisfaction. This study was undertaken t o assess the level of job satisfaction, performance and leadership styles among nurses in AKTH and to compare the level of job satisfaction and performance under democratic and autocratic leadership with the purpose of making recommendation for improvement to health human resource managers. We started with the hypothesis that leadership styles do not affect job satisfaction among nurses in AKTH.
| Materials and Methods|| |
This was a cross-sectional survey of the senior and junior nurses working at various specialties in AKTH, Kano. Simple random sampling was used; a probability sampling procedure that ensures every sampling unit in the target population has a known, equal, non-zero chance of being selected.
The population of the study was all the nurses in AKTH, who have worked for at least one year. The area of study was Kano, North-west geopolitical region, Nigeria. Aminu Kano Teaching Hospital was established in August 1988 as the teaching hospital for Bayero University Medical School. It was established to serve as a fully functional 500-bedded teaching hospital with state of the art facilities for provision of service, teaching and research to cater for the needs of the local and wider community. Patients from other hospitals and clinics are referred here. It also serves as a referral centre from Bauchi, Katsina and Jigawa states. Training covers Medical Students, Resident Doctors, House Officers, Intern Medical Laboratory Scientists, Pharmacists, Physiotherapists, Medical Imaging Scientists, Optometrists, and Dentists. The hospital also trains Community Health Officers, Health Information Management Officers and Post Basic Nursing training in Accident and Emergency in collaboration with National Orthopaedic Hospital, Dala, Kano State. The hospital currently has 16 clinical departments offering services, conducting trainings and research as well as over 10 support service departments including a diagnostic centre. The Hospital provides various services to the community in the field of health and social services through its clinical and service departments. The concentration of nurses of all specialties and the fact that all the government and private hospitals send referral to this Teaching Hospital makes it useful for this type of study.
Ethical clearance was obtained from Health Research Ethics Committee of AKTH with reference number NHREC/21/08/2008/AKTH/EC/1031
(dated 18 th March 2013). Informed consent was obtained prior to the onset of the survey using consent forms. The survey was anonymous and participation was voluntary. A senior nurse was one above the level of nursing officer, while a junior nurse was one at the level of nursing officer and below. Questionnaires were used to obtain response in a 5-point Likert scale: Strongly agree, agree undecided, disagree and strongly disagree. Their response to each question was scored as follows: 1 = agree; 2 = somewhat agree; 3 = neutral; 4 = somewhat disagree; and 5 = disagree. A lower score was therefore associated with agreement and higher scores with increasing levels of disagreement. Individual questions were grouped by aspect covered into several composite indices and the means of the responses for these composite indices were reported. Each question carried equal weight. For easy analysis, the responses where then categorised as satisfied (comprising agreed and somewhat agree), undecided (neutral) and dissatisfied (comprising somewhat disagree and disagree).
The sample size was calculated using technique of prevalence. Documented prevalence of job satisfaction from a previous similar study was 30.3%. 
n = z 2 P q/d 2
(n = Sample Size, z = Standard Normal Deviation = 1.96 at 95% Confidence Limit, P = Prevalence Rate (satisfaction rate from a similar previous study) 9 = 30.3%, q = 1-P = 1-30.3% = 0.697, d = Error Margin = 5%)
The calculated minimum sample size was 325. Minimum sample size of 10% was added because of attrition. Therefore, the sample size of 350 patients was used for this study. Letters A and B were written on 350 questionnaires shared consecutively and equally among groups A and B. Subsets of the study population (group A) comprising 175 subjects were senior and another subset (group B) comprising 175 subjects were junior nurses.
The sample size was assessed to be adequate after objective calculation and comparison with sample size of the previous similar study. It was found to be efficient, representative, reliable, flexible, cost-effective, and achievable within the specified time of the study.
The source and method of data collection was by administration of questionnaires. The mode of distribution was by hand delivery. The questionnaire was divided into 2 sections: Section A assessed the demography of the respondents. Information sought included socio demographic and work data such as age, area of specialisation, number of working hours per day and length of service, presence of dependents and promotion issues. Section B was made up of 40 questions on job satisfaction and work-related conditions and issues like work conditions, facilities at the work place, nature of work, salary, promotion, professional training, interpersonal relationships and co-workers, intention to leave the profession, performance and leadership styles .
To ensure content validity of the instrument, pre-testing of the questionnaire was done using 20 self-administered questionnaires were distributed to participants to comment on the clarity of the questions.
The data was analysed using Statistical Package for the Social Sciences (SPSS version 16.0) software. Absolute numbers and simple percentages were used to describe categorical variables. Similarly, quantitative variables were described using the measures of central tendency (mean, median) and measures of dispersion (range, standard deviation) as appropriate. Statistical significance of differences between means was determined using analysis of variance (ANOVA). Significant association of job satisfaction and performance with socio-demographic, employment characteristics and leadership styles were tested using Chi-square test for qualitative variable and Pearson's Coefficient of Correlation for quantitative variables. Statistical significance was considered at P < 0.05.
| Results|| |
At the end of the study, 330 questionnaires were correctly filled and returned (160 for junior nurses and 170 for senior nurses) and this gave a complete response rate of 94.3%. Dropout was more among the junior nurses (8.57%) than the senior nurses (2.94%). The reason was that some of the junior nurses were not confident to talk about the leadership styles of their superiors, despite being assured anonymity, because of fears that they may be victimised if the superior had a contrary opinion.
As shown in [Table 1], most of the nurses were in the age range of 31-40 years (56.2% and 62.4%) followed by those who were 20-30 (41.9%) and 41-50 years (28.8%), among the junior and senior nurses, respectively. The mean ages were 30.26 ± 4.76 and 40.19 ± 5.61 years for junior and senior nurses, respectively, and the difference was statistically significant, (P = 0.001). Most of the nurses were of Islamic faith among the junior nurses and senior nurses (73.1% and 58.8%, respectively), followed by those who were Christians (26.9% and 38.2%); most were married (73.8% and 84.1%) among the junior and senior nurses, respectively. The mean number of dependents was higher (5 ± 2) for senior nurses compared to junior nurses (4 ± 2), but the difference was not statistically significant.
[Table 2] shows that majority of junior nurses (42.5%) perceive themselves to be of democratic leadership style compared to senior nurses (51.2%) who perceived themselves to be of autocratic leadership style. Most of the nurses were satisfied with their jobs (juniors - 87.5% and seniors - 92.3%) but the senior nurses were more satisfied compared with their junior nurses (P = 0.031). Majority of the nurses (88.1% and 98.8%) believe that their performance had improved, but this was higher among senior nurses (P = 0.01).
|Table 2: Perception of one's leadership style, job satisfaction, and performance|
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[Table 3] shows that more junior nurses perceive their superiors as autocratic (35%) compared to senior nurses (25.3%). A little over 39% of senior nurses and 30% of junior nurses were undecided as to their superiors' type of leadership style. Only 23% and 23.5% of junior and senior nurses, respectively, judged that the performance of their colleagues especially those they supervised had improved while an outstanding number remained undecided whether performance had improved or not.
As shown in [Table 4], socio-demographic and work information had very weak correlations with job satisfaction and performance. Democratic leadership styles showed a strong positive correlation with job satisfaction. The autocratic leadership showed a very strong positive correlation with performance. Therefore, nurses in AKTH were more satisfied with democratic leadership style but performance was better with autocratic leadership.
|Table 4: Correlations among work, socio - demographic and leadership characteristics with job satisfaction and performance (r=coefficient of correlation)|
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| Discussion|| |
This study demonstrated that most of the nurses were in the age range 31-40 years (56.2% and 62.4%) followed by those who were 20-30 (41.9%) and 41-50 years (28.8%) among the junior and senior nurses, respectively. The present study compares with another study which demonstrated that approximately in half of nurses of their ages were between 20-<25 years; meanwhile, in very few of them their ages were at 40-≤45 years.  Most of the nurses were satisfied with their jobs (87.5% and 92.3% for junior and senior nurses, respectively). These levels of job satisfactions are higher than those reported from other studies. , According to Ofili et al. in a study done in University of Benin Teaching Hospital, Nigeria, 56% of nurses were either highly dissatisfied or dissatisfied with their jobs, 9% were undecided, while 36% were highly satisfied or satisfied with their job. The reason for these higher levels of job satisfaction is probably related to better conditions of service in recent times, which were not previously the case at the beginning of the 21 st century in Nigeria. Moreover, nurses are becoming more democratic in their leadership style and this encourages teamwork.
The mean number of dependents from this study was higher (5 ± 2) for senior nurses compared to junior nurses (4 ± 2), but the difference was not statistically significant. Although the present study did not report any significant correlation between the number of dependents and job satisfaction, a previous study showed that nurses having 2-3 children were more satisfied with their jobs.  Studies have shown that age, position, specialty and length of service showed low correlation with job satisfaction. , More researches are required to understand the relative importance of identified factors of job satisfaction. 
An earlier work posited that autonomy and task delegation strongly predicts job satisfaction.  Another study, however, reported that impact of time on job satisfaction was highly dependent on specialism and nurses were more satisfied with relationship rather than salary.  Some nurses are dissatisfied because they felt being devalued.  Other studies have shown that nurses felt they were not treated as clinicians or peers by doctors and hospital managers but as assistants, at risk of being replaced by less-qualified personnel who cost less to employer. 
Majority of junior nurses (42.5%) from this study perceived themselves to be of democratic leadership style compared to senior nurses (51.2%), who perceived themselves to be of autocratic leadership style. Obviously, from the literature, there is no one style of management and leadership consciously used within nursing as a specific method to cope with certain issues that nurses and ward managers are facing. However, what emerges is that predominantly health care has moved away from the traditional autocratic style and towards a combination of transactional and transformational leadership. Majority of the nurses (88.1% and 98.8%) believe that their performance had improved, but improved performance was higher among senior nurses. This agrees with previous studies that job satisfaction is associated with better performance as nurses perform better if they are satisfied in their jobs. ,
The report of this study showed that other aspects of socio-demographic and work information had very weak correlations with job satisfaction and performance. Democratic leadership styles showed a strong association with job satisfaction, whereas autocratic leadership showed a very strong association with performance. Therefore, nurses in AKTH were more satisfied with democratic leadership style, but performance was better with autocratic leadership. This agrees with reports of other studies which referred to a participative management style as enhancing job satisfaction.  from the study in Ado Ekiti, Awosusi and Jegede  found no difference in employee satisfaction with leadership styles. Nurses who possess democratic, transformational, and transactional leadership features provide better conditions for their patients, and the satisfied patients bring satisfaction to the nurses.  Better performance with autocratic leadership style in this study may be because that some democratic leaders find it difficult to enforce group decisions and employees can take advantage of this weakness to perform poorly.
Although the level of job satisfaction in this study was generally high, the senior nurses were more satisfied with their jobs than their junior colleagues, further the level of job satisfaction in this study was higher than those reported from other studies. Most of the senior nurses perceived themselves as autocratic in their leadership styles compared to the junior nurses who perceived that they were democratic. Socio-demographic variables showed weak correlations with job satisfaction and performance. In general, nurses were more satisfied under democratic leadership than autocratic one, but their performance under the autocratic leadership was better than under the democratic leadership.
In conclusion, there are generally high levels of job satisfaction among nurses in AKTH and this is associated with leadership styles more than other socio-demographic and work variables. The senior nurses were more satisfied with their job than the junior nurses. In contrary to the null hypothesis as per this study, job satisfaction was significantly higher with democratic leadership style than autocratic leadership style. At the other hand, performance was significantly higher with autocratic leadership style than democratic leadership style.
The authors recommend that:
- Job satisfaction among nurses may improve if senior nurses become more democratic in their leadership styles
- Job performance may better improve if democratic leadership style is not taken for weakness on the part of the leader; therefore, to get the job done, even the democratic leaders should exhibit the ability to enforce group decisions
- A multicentre study is highly anticipated to address other regional issues that may affect job satisfaction, performance and leadership styles of nurses in Nigeria
- The classification of leadership styles based on behavioural theory into democratic and autocratic leadership styles is an important limitation of this study and may have been partly responsible for high number of nurses who were undecided as to leadership styles of their superiors. Further studies should explore other leadership styles such as transactional, transformational and Laissez-faire leadership styles.
| Acknowledgement|| |
The author also acknowledges the valuable contributions of Dr. SDA Shuaibu in the making of this manuscript.
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[Table 1], [Table 2], [Table 3], [Table 4]