NURSING PROFESSION and HISTORY

INTRODUCTION

Nursing is a demanding profession. Nurses are bombarded daily with many tasks and responsibilities. Nursing today is practiced in various settings and is a vital part of the health care system. Nurses are present in hospitals, schools, rehabilitation centres, nursing homes, out-patient centres, clinics, and homes. A consumer perceives these professionals as trained individuals that work to contribute to a patient's maintenance and health issues. Nursing is seen as an ever expanding field. The aim of this study was to find out the determinants of job satisfaction of nurses in Mauritius. The purpose was also to find out about the experiences of nurses in their hospital environment in Mauritius and to accumulate knowledge on the role of nurses in Mauritius. Also the criteria were that the nurses should have been educated in Mauritius and at the same time have a minimum of 2 years of experience in nursing field. According to nurses at Dr Jeetoo hospital where this study was carried out, no previous researches have been done investigating about job satisfaction among nurses in that hospital. Job satisfaction is generally regarded as an employee's attitude toward the job and job situation. Spector (1997, p. 1) defines job satisfaction simply as "the degree to which people like their jobs." Some people therefore enjoy work and consider it a central part of their lives while others do so only because they have to

NURSING PROFESSION AND HISTORY

One of the names that should not be forgotten in nursing is of Florence Nightingale. Florence Nightingale was also known as the Lady with the Lamp. Two of Florence's greatest achievements were pioneering of nursing and the reform of hospitals (Audain, 1999). She gathered data on mortality and morbidity during the Crimean War at the hospital in Scutari. She used her skills in statistical analysis to argue for reform of the British Army medical system. Nursing, according to Henderson, includes both independent and interdependent aspects that must be taken into consideration in the development of the nurse and of nursing as a profession (Evers, 2003). Virginia Henderson believed that patient care was, and is, the major objective of nurses (Tourville and Ingalls, 2003). Nursing is accountable to the patient and family to provide the highest quality of care and the knowledge to provide this care. The nurse spends the most time with the patient and family which makes him/her accountable to the interdisciplinary health care team to share information acquired that may be pertinent to their care (Hood and Leddy, 2003). The nurse is also accountable to self for his/her own actions and the actions of co-workers.

Nursing profession in Mauritius

Nurses in Mauritius assess, provide preventative, curative and rehabilitative care for the sick and disabled in a wide variety of settings including public hospitals and private clinics, the community services, and in industry. In Mauritius the regulating body for nurses is called Nursing Council of Mauritius (NCM). Although nursing has a long history of an ethic of care, the context in which nurses now practice has changed and expanded. Consequently, this has led to the establishment of the Code of Practice as nursing started orientating itself toward professionalism. (NCM Act 43) The Nursing Council of Mauritius code of practice explains what standards of care, patients and the public can expect from the workforce in the hospital, private clinics, and homes and in the community. It is not a collection of bulky rules, but instead briefly outlines a set of principles which nurses and midwives should use to inform and underpin their practice. (NCM Act 2003) According to nurses at Dr Jeetoo hospital in Mauritius most of them believed they are expected to get familiar with patient records, assists those who need help, be able to monitor their conditions and keep records of their patients. Also, they should be able to give patient counselling and educate the public about healthy living

Definition of work and culture

Different types of culture mean that different people have a different meaning of work. Things like art, music and literature are understood to be as culture in daily life as described by (Chapman 1992). As adults there is nothing that more preoccupies our lives than work. From the ages of approximately eighteen to seventy we will spend our lives working. We will not spend as much time sleeping, enjoying our families, eating, or recreating and resting as much as we will working. Whether we love our work or hate it, succeed in it or fail, achieve fame or infamy through it, like Sisyphus (Camus 1991) we are all condemned to push and chase that thing we call our job, our career, our work all of our days. "Even those of us who desperately don't want to work," wrote famous poet Ogden Nash, "must work in order to earn enough money so that they won't have to work anymore."

Job satisfaction, Mauritian culture and work

Job satisfaction is generally regarded as an employee's attitude toward the job and job situation. Spector (1997, p. 1) defines job satisfaction simply as "the degree to which people like their jobs." Some people therefore enjoy work and consider it a central part of their lives while others do so only because they have to. There have been several theories in conjunction with job satisfaction and dissatisfaction proposed by experts, but this work restricts its discussion to two main theories from two outstanding scholars, Maslow (1943) and Herzberg, et al. (1959). According to his theory, employees were motivated to satisfy when their five basic types of needs are fulfilled; they are physiological needs, safety needs, social needs, self-esteem and self-actualization. This theory suggests that there is a hierarchy of needs in which one or employee needs to satisfy his or her lower need adequately before stepping to a higher order need. Subsequently, once the employee has been able to fulfil the need, it is highly likely that the need will no longer motivate employee's behaviour at work, Stone (1998). Herzberg, et al (1959) proposed a theory known with the so-called "two-factor theory" or in other words known as "a two-hierarchy of needs," namely first is motivators or satisfiers are higher needs for achievement or the individual's need for self-actualization in his work. They are the job itself, recognition, achievement, responsibility, and advancement. These then play role to determine either the job satisfaction or job performance. Afterwards is hygiene or maintenance factors are believed to be lower order needs they are: supervision, interpersonal relations, working conditions, status, salary, and advancement. If these factors are well administered by any organization, they can prevent employees' negative attitudes or employees' dissatisfaction. Mauritius has got a mix of culture locally called "the salad of culture". This is so, because of the history of Mauritius. Different people from different parts of the world were brought into Mauritius as slaves, and this nowadays has resulted in different religions and cultures forming out. According to Central intelligence agency census, there is at present a population of more than one million of which Hindu religions is 48%, Roman Catholic 23.6%, Muslim 16.6%, other Christian 8.6%, other 2.5%, and unspecified 0.3%, none 0.4% according to the 2000 census. The ethnic group in Mauritius are as follows: Indo-Mauritian 68%, Creole 27%, Sino-Mauritian 3%, and Franco-Mauritian 2%. It is worth noting that Mauritius has 14 days of public holidays because of such difference in culture and religion thus respecting them all. According to the Central intelligence agency survey languages spoken by locals are as follows: Creole 80.5%, Bhojpuri 12.1%, French 3.4%, English; spoken by less than 1% of the population), other 3.7%, and unspecified 0.3%. In Mauritius, some people work for the satisfaction that comes from it while some strictly for money. The work force is about half of the total population and unemployment rate at 7.6%

FACTORS INFLUENCING JOB SATISFACTION AND NURSING JOB SATISFACTION

Job satisfaction is a complex variable and is influenced by factors of the job environment as well as dispositional characteristics of an individual. These factors have been arranged according to two dimensions, namely, extrinsic and intrinsic factors (Buitendach & De Witte, 2005). The extrinsic factors include things like salary, promotion opportunities, co-workers, supervision and recognition. Intrinsic factors include personality, education, intelligence and abilities, age and marital status (Mullins, 1999). According to Spector (1997), these categories of factors often work together to influence job satisfaction too. As in the field of nursing a lot of researches have been done on nurses' job satisfaction. Supervising and leadership factors were found to be playing important parts in nurses job satisfaction, according to Irvine & Evans (1995, 249). At the same time the author mentions about how the job content and environmental factors play an important role in influencing job satisfaction among nurses. According to Spector (1997), some research has attempted to investigate the interaction between job and person factors to see if certain types of people respond differently to different types of jobs. This approach states that "there will be job satisfaction when characteristics of the job are matched to the characteristics of the person"

AIMS AND OBJECTIVE OF THIS STUDY

The aim of this study was to find out the determinants of job satisfaction of nurses in Mauritius. The results obtained will not be generalised to all the working nurses in Mauritius. The purpose is to find out about the experiences of nurses in their hospital environment in Mauritius and to accumulate knowledge on the role of nurses in Mauritius. Some research questions that came out for the aims and objectives of the study are as follows: 1. What are the determinants of job satisfaction in Mauritius? 2. How do nurses feel working in Mauritius? In this study, all information has been obtained and processed anonymously, and without using any participants' names. The data was put into groups and participants were clearly instructed not to sign or write their name in any part of the paper. The box that was in the staff room was sealed, and was checked if it has been tampered with before opening. Also the criteria were that the nurses should have been educated in Mauritius and at the same time have a minimum of 2 years of experience in nursing field. According to nurses at Dr Jeetoo hospital where this study was carried out, no previous researches have been done investigating about job satisfaction among nurses in that hospital

RESEARCH METHODS

Qualitative method

The qualitative method style was used in this work because the study concentrates more at looking out for the factors that influence job satisfaction rather than to calculate it. (Dey 1993) mentioned that the qualitative data refer to the "number depend on meaning", but in some cases, the level of the clearness of our concept and subject would have great influence on the usefulness of data that collected. Saunders, M., Lewis, P. and Thornhill, A. (2003) argued that because of the interrelationship between qualitative data and its related collection process and research topic, the nature of qualitative data would have much implication on the collection process and analyzing phase. The research was conducted in three different places at Dr. Jeetoo hospital in Mauritius. They were the accident and emergency, the cancer unit and the burns units. This hospital is the main hospital and most advanced and biggest hospital in Mauritius. It has around 200 beds, and provides its services for about 25% of Mauritius population. It has both inpatient and outpatient services. The Chief Officer of the hospital was contacted by phone and permission was obtained. Afterwards, 28 nurses in the above mentioned wards were contacted and those willing to participate in the study came forward. Along with a letter (see appendices) explaining a summary of the study being conducted a questionnaire was given to the participating nurses.(See Appendix 1 and 2 ) A total of 15 questionnaires were given out and after five days the box meant for the filled questionnaire was fetched from the hospital staff rooms. Surprisingly, all the questionnaires were returned, but on closer inspection only 8 questionnaires were correctly filled. The others were half answered only and therefore those questions that could be taken into account were taken in the study. At the same time the open ended questions did not have much information on them too. Most of them, but not all had short phrases and words only.

Data collection and analysis

Qualitative data analysis was used to find the factors that influence job satisfaction among nurses. The questionnaire design played an important role in the data collection. It had to be in such a way so as to optimize the collection of qualitative data, so a semi-structure questionnaire was used, and questions were both open and close ended. Dillman (2000) points out that basically there are three types of data that can be collected through a well-designed questionnaire. They are opinion, behaviour and attribute. Therefore, each question on researcher's questionnaire is ensuing that these essential data can be effectively collected. There are two distinct models for data collection and analysis. The first states that the data is collected and then analysed and the second model states that data collection and analysis can happen concurrently (Robson, 1993). The first type is as a positivist, quantitative approach and the second as a phenomenologist, qualitative approach. Qualitative data are considered to be the "rough materials researchers collect from the world they are studying; they are the particulars that form the basis of analysis" (Bogdan & Biklen, 1992, p. 106) Content analysis method was used to process the information obtained through the questionnaire. First the data is identified, coded and then categorised. (Patton 1990, 281) So, all the questionnaires were read and then words, phrases and ideas which happened to used frequently was put down and the unit of analysis was formed by breaking those responses into words. The two main categories personal factors and job related factors were formed in advanced with the help of knowledge from previous studies, and the words were put under them. Only those words and group of words having the same meaning, or brings to the same idea was used. Those words were carefully chosen in different parts of the answers in the questionnaire, and then placed under the main categories. Once the questionnaires were no longer of use they were destroyed.

RESULTS

The response rate was 54%. Some questionnaires were not filled partially or at all, while others were not included in the results as it was considered misleading. For example a person who is between the ages of 20 to 29 and has a work experience of more than 10 years, is considered fallacious. Little information could be obtained from the questionnaire, so not all the open ended questions could be analysed properly. Questions that had been filled properly, have been process in a more approachable style.

Nurses experiences of their work place

The experiences of the nurses concerning their work were obtained from the last two questions in the questionnaire given out. (See questionnaire appendix) Explain your feelings towards this job Please write about your experiences as a nurse in this work place The nurses' experiences were divided into three different categories. They were satisfying, demanding and the wish to help. Those three categories are explained below. Many nurses mentioned their work as satisfying. This was pointed in two directions, first one being able to see patients recovering and the other one being of patients' relatives who credit them for their effort and work they do. "The biggest joy in this work is to see the patients getting better...." "....really nice and respected when patients' family understand and say thank you to me...." The workplace, working conditions and the work itself was found to be also very demanding. It was considered so, because of the responsibility it carries. Lack of staff, lack of time, and lack of resources and over crowded hospitals all made their job more demanding and stressful. Most of the nurses mentioned that at times it gets too busy and they cannot cope with some situations, which worsens the work atmosphere. "Sometimes we argue among ourselves because it's so busy and I don't know what to do first" "..........and have 2 young kids and I am forced to come to work on night shift........" "...too much responsibility for less money..." Many nurses pointed out their wish to help people who are suffering. They felt that they do something that comes from their heart. They felt that they do a noble job for the betterment of the society. ".... feel I am doing a job guided by god, to help sick..."

Factors that influence job satisfaction

Personal factors

Wish to help From this study, the nurses felt that the biggest factor that influences their job satisfaction was the wish to help the sick patients. They felt that by helping them they felt and inner peace and thus the frequency that the term "wish to help" was found in the answer to the question Explain the personal factors that influence your job satisfaction was relatively high. "....It helps me emotionally when I can help a patient...." Money Also, quite surprisingly money was one of the personal factors that influence their job satisfaction. The female nurses, some of them explained that nursing felt like a women job often, and they were adding to the overall house income, and they felt quite satisfied with their salary. At the same time, some of those nurses who were not married felt that the factors that influence their job satisfaction was money because they felt they are underpaid, and too much responsibilities. Some nurses who had comparatively more working experiences than their working mates felt that the salary is not worth it, as there is not much gap between new comers and old nurses when the question about number of years in service were looked into the questionnaire. "...salary is like peanuts..."

Job related factors

Work demand The amount of work seemed among the main factors that affect the nurses and this lead to job dissatisfaction. Nurses felt that they had a lot of work to do in one shift and the amount of time they had to do paper work and clinical work could not be in harmony. The felt that more staff should be employed and that because the hospital cuts cost all the times, the amount of work power and resources were not enough. This resulted mainly in work stress and sometimes burnout. Work appreciation and type of work Most nurses felt that their job is however appreciation by patients and the society. This helped boost their morale and thus they felt respected. At the same time, the type of work that they do sometimes brought feelings that they are doing a dirty work. They had to clean diapers and take care of the hygienic needs of patients, which sometimes felt too much. "...this place is full of dirt and infections..." "It's dirty in here" 6.3. Ethical considerations In this study, all information has been obtained and processed anonymously, and without using any participants' names. The data was put into groups and participants were clearly instructed not to sign or write their name in any part of the paper. The box that was in the staff room was sealed, and was checked if it has been tampered with before opening. The questionnaires that were given were viewed only by the author and once their purposes were over they were destroyed

DISCUSSION

Reliability and integrity of this study

This response rate in this study was 54% and the responses obtained seemed quite good too. The questionnaire was just good enough to answer this study answers. By using content analysis for this qualitative research, those categories chosen by one researcher can be different from another one, and raises eyebrows on the quality of coding too according to Wilson (1985, 411 - 412). The data obtained has been carefully analysed and divided into different sub-categories to make sure that this research comes to be as reliable as possible in Mauritius and the reader gets a clear picture concerning this study. The two main categories which were obtained through the help of knowledge from previous studies were chosen before the study results are out, thus helping towards putting the sub-categories under the main ones. At the same time, some categories were affecting others; meaning that all the factors that influence job satisfaction, influence each other too at the same time, under the same condition. The sample that was taken initially (n=15) was quite big sample and may be criticise for a qualitative study but it was done on precautionary measures because the response rate was thought to be lesser that what was expected. The response rate in this study was 54%, meaning that over half the amount of participant nurses had a wish to return the questionnaire and help in this study. The integrity of these results in my point of view will definitely differ over some years to come, as reforms and changes are under way by the government of Mauritius and the Nurse Council, so as to increase labour resources and revise nurses' pay scale. This would then mean that more nurses would be satisfied with their work, and thus factors that now are affecting job satisfaction might change maybe in a decade time. As for what the results are, it shows that money was one of the personal factors that influence job satisfaction in Mauritius. This can be because Mauritius is a developing country. The general style of the answers were not that good, as some of the questions were not filled correctly while others were not filled at all. This lead to a problem for the author as deep information and the understanding of job satisfaction among nurses in Mauritius could not be gain as properly as anticipated beforehand. The questionnaire had been designed using knowledge from previous studies and questions on the questionnaires were designed to be as accurate as possible though they were open ended style. In this way it would assure the credibility of this study. Unfortunately some of the answers were not relevant to the study at all. Moreover, at times it was difficult to classify ideas under sub categories or bring a group of ideas together to form a phrase that could be put down in this study. The factor that can affect the integrity and credibility of this study is that even English is the official language in Mauritius, at times French also is used as official language. On the flip side of the coin, a French questionnaire was put into proposal, but because the majority of the nurses voted for English questionnaire, thus the latter was chosen

Conclusion

This study has been able to answer the questions that this research sited earlier. At the same time, this study showed that in general nurses in Mauritius were quite satisfied with their work. The factors which influenced their job satisfaction seemed to be more politically and managerial oriented for example not all the nurses were happy with the work place, some found it dirty place to work while others found it reasonably good. Salary was often mentioned the open ended question concerning the job related factors that affected them. Some of them were satisfied with their salary whereas others with more experience as a nurse saw that they were not that satisfied, thus as a nurse they could not help to influence those factors. Culturally it also showed that money is an important factor in job satisfaction and job dissatisfaction in Mauritius and it depended if the work as a nurse was a primary or secondary job in a family. In general most of the nurses seem to be satisfied or quite satisfied with their work, which shows that only a minority were not happy with this field and are still working. The quality of care is not same as in Europe but still the quality of care is at an acceptable level in the Mauritian point of view. At the moment the results from this study provides an updated information about job satisfaction of nurses in Mauritius and how nurses in Mauritius feel about their work place, worj atmosphere and employer. The management of the hospital will be given the results part of this study and they could in return understand and evaluate the suggestions of the nurses trough this study. At the same time through this study, new questions raised up for example the relationship between nurses and the management. Culture and job satisfaction showed to influence each other also, but other research methods cold be used to verify this study too. Moreover it has been shown in this work that factors that influence job satisfaction can indeed be broken into different parts as mentioned by Cranny, Smith and stone

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