An-Najah National University Faculty of Graduate Studies FACTORS AFFECTING JOB SATISFACTION FOR NURSING IN GOVERNMENTAL HOSPITALS IN THE WEST BANK - PALESTINE - A CROSS-SECTIONAL STUDY By Ayman Taqtoq Supervisor Dr. Mohammed Hayek This Thesis is Submitted in Partial Fulfillment of the Requirements for the Degree of Master of Public Health Management, Faculty of Graduate Studies, An-Najah National University, Nablus - Palestine. 2024 II FACTORS AFFECTING JOB SATISFACTION FOR NURSING IN GOVERNMENTAL HOSPITALS IN THE WEST BANK - PALESTINE - A CROSS-SECTIONAL STUDY By Ayman Taqtoq This Thesis was Defended Successfully on 16/1/2024 and approved by Dr. Mohammed Hayek Supervisor Signature Dr. External Examiner Signature Dr. Internal Examiner Signature III Dedication This thesis is dedicated to: My great father and my dear mother, for being my first teacher, who always encouraged me to continue my educational path and the reason for what I have become today My beloved brothers and sisters, to all my family, the blessing of life My friends who encourage and support me, all the people who trust and believe in me IV Acknowledgements I would like to thank Dr. Mohammed Hayek very much for giving me the opportunity to complete my master's thesis under his brilliant supervision, and thank you for all the advice, ideas, ethical support and compassion in guiding me through this research. Finally, special thanks to everyone who cooperated with me in completing the research work, directly or indirectly. V Declaration I, the undersigned, declare that I submitted the thesis entitled: FACTORS AFFECTING JOB SATISFACTION FOR NURSING IN GOVERNMENTAL HOSPITALS IN THE WEST BANK – PALESTINE - A CROSS-SECTIONAL STUDY I declare that the work provided in this thesis, unless otherwise referenced, is the researcher’s own work, and has not been submitted elsewhere for any other degree or qualification. _____________________________________ Student's Name: _____________________________________ Signature: _____________________________________ Date: VI List of Contents Dedication ....................................................................................................................... III Acknowledgements ......................................................................................................... IV Declaration ....................................................................................................................... V List of Contents ............................................................................................................... VI List of Tables ............................................................................................................... VIII List of Figures ................................................................................................................. IX List of Appendices ........................................................................................................... X Abstract ........................................................................................................................... XI Chapter One: Introduction and Theoretical Background .................................................. 1 1.1 Introduction ................................................................................................................. 1 1.2 Problem Statement ...................................................................................................... 5 1.3 The importance of study ............................................................................................. 6 1.3.1 First: Theoretical significance ................................................................................. 6 1.3.2 Second: Applied importance .................................................................................... 7 1.4 Aim of study ............................................................................................................... 8 1.5 Objectives ................................................................................................................... 8 1.6 Study hypothesis ......................................................................................................... 9 1.7 Concepts and Operational Definition ......................................................................... 9 1.7.1 Concepts Definition ............................................................................................... 10 1.7.2 Operational Definition ........................................................................................... 12 1.8 Previous Studies and Theoretical Background ......................................................... 13 1.8.1 International studies ............................................................................................... 14 1.8.2 Regional studies ..................................................................................................... 15 1.8.3 Arab Studies ........................................................................................................... 16 Chapter Two: The Methodology ..................................................................................... 18 2.1 Study Design ............................................................................................................. 18 2.2 Study Setting ............................................................................................................. 18 2.3 Study population ....................................................................................................... 18 2.4 Study sample ............................................................................................................. 19 2.5 Study time frame ....................................................................................................... 20 2.6 Data Collection tool .................................................................................................. 20 VII 2.7 Statistical Analysis Methods ..................................................................................... 21 2.8 Validity and Reliability of the Questionnaire ........................................................... 21 2.8.1 Validity .................................................................................................................. 21 2.8.2 Reliability ............................................................................................................... 22 2.9 Study procedures ....................................................................................................... 23 2.10 Ethical consideration ............................................................................................... 23 Chapter Three: Results .................................................................................................... 24 3.1 Socio-demographic characteristics ........................................................................... 24 3.2 Factors affecting job satisfaction of nursing staff in hospitals due to the variable of gender ...................................................................................................................... 25 3.3 Factors affecting job satisfaction for nursing staff in hospitals due to age variable .................................................................................................................... 27 3.4 Factors affecting job satisfaction for nursing staff in hospitals due to educational level variable ............................................................................................................ 30 3.5 Factors affecting job satisfaction for nursing staff in hospitals due to the variable of marital status ............................................................................................................ 33 3.6 Factors affecting job satisfaction for nursing staff in hospitals due to the variable of experience ................................................................................................................ 35 3.7 The level of job satisfaction for nursing staff in hospitals ........................................ 35 3.8 Factor affecting job satisfaction for nursing staff in hospitals of the west bank– Palestine ........................................................................................................ 36 Chapter Four: Discussion, Conclusion, and Recommendations ..................................... 38 4.1 Discussion ................................................................................................................. 38 4.2 Conclusions ............................................................................................................... 43 4.3 limitation of the study ............................................................................................... 45 4.4 Recommendation ...................................................................................................... 46 4.4.1 Recommendations for policy makers .................................................................... 46 4.4.2 Recommendations for further studies .................................................................... 48 List of Abbreviations ...................................................................................................... 49 References ....................................................................................................................... 50 Appendices ...................................................................................................................... 55 ب ............................................................................................................................... الملخص VIII List of Tables Table 2.1: The number population of nursing staff in each hospital .............................. 19 Table 2.2: Internal consistency validity for the study instrument ................................... 22 Table 2.3: Reliability of the study instrument ................................................................ 22 Table 3.1: Demographic characteristics of study sample (n= 300) ................................ 25 Table 3.2: Independent t- test results for the differences in the factors affecting job satisfaction for nursing in hospitals according to gender variable (n=300) . 26 Table 3.3: One way ANOVA results for the differences in the factors affecting job satisfaction for nursing staff in hospitals according to age variable (n=300) ...................................................................................................................... 27 Table 3.4: LSD post hoc results for the differences in the total score of job satisfaction and all domains according to age variable (n= 300) .................................... 28 Table 3.5: One way ANOVA results for the differences in the factors affecting job satisfaction for nursing in hospitals according to education level variable (n=300) ......................................................................................................... 31 Table 3.6: LSD post hoc results for the differences in the total score of job satisfaction, relationships with colleagues and management, and organization supportive activities according to education level variable (n= 300) ............................ 31 Table 3.7: One way ANOVA results for the differences in the factors affecting job satisfaction for nursing staff in hospitals according to marital status variable (n=300) ......................................................................................................... 34 IX List of Figures Figure 3.1: Means of response on work environment domain according to gender variable ......................................................................................................... 26 Figure 3.2: Means of response on relationships with colleagues and management domain according to age variable ................................................................ 28 Figure 3.3: Means of response on organization supportive activities domain according to age variable .............................................................................................. 29 Figure 3.4: Means of response on work environment domain according to age variable ...................................................................................................................... 29 Figure 3.5: Means of response on the total score of job satisfaction according to age variable ......................................................................................................... 30 Figure 3.6: Means of response on relationships with colleagues and management domain according to education level variable ............................................. 32 Figure 3.7: Means of response on organization supportive activities domain according to education level variable ........................................................................... 32 Figure 3.8: Means of response on the total score of job satisfaction according to education level variable ............................................................................... 33 Figure 3.9: Means of response on work environment domain according to marital status variable ......................................................................................................... 34 Figure 3.10: The effect of organization supportive activities on job satisfaction for nursing staff in hospitals of the west bank – Palestine ................................ 36 X List of Appendices Appendix A: Faculty of Graduate studies approval ........................................................ 55 Appendix B: IRB approval ............................................................................................. 56 Appendix C: The General Administration of Health Education and Scientific Research ....................................................................................................... 57 Appendix D: Consent form ............................................................................................. 58 Appendix E: TOOL ........................................................................................................ 59 Appendix F: Tables of Study .......................................................................................... 61 Table F.1: LSD post hoc results for the differences in work environment domain according to marital status variable (n= 300) .............................................. 61 Table F.2: One way ANOVA results for the differences in the factors affecting job satisfaction for nursing staff in hospitals according to experience variable (n=300) ......................................................................................................... 61 Table F.3: LSD post hoc results for the differences in the total score of job satisfaction and all domains according to experience variable (n= 300) ........................ 62 Table F.4: 5- point Likert scale ....................................................................................... 62 Table F.5: Means, standard deviations, and percentages for the level of job satisfaction for nursing staff in hospitals of the west bank - Palestine (n= 300) ........... 63 Table F.6: The relationship between job satisfaction and its domains for nursing staff in hospitals of the west bank - Palestine (n= 300) ........................................... 64 Table F.7: Summary of Multiple regression results for determining the main factor affecting job satisfaction for nursing staff in hospitals ................................ 64 Appendix G: Figures of Study ........................................................................................ 65 Figure G.1: Means of response on relationships with colleagues and management domain according to experience variable .................................................... 65 Figure G.2: Means of response on organization supportive activities domain according to experience variable .................................................................................. 65 Figure G.3: Means of response on work environment domain according to experience variable ......................................................................................................... 66 Figure G.4: Means of response on the total score of job satisfaction according to experience variable ...................................................................................... 66 Figure G.5: The effect of organization supportive activities on job satisfaction for nursing staff in hospitals of the west bank – Palestine ................................ 67 XI FACTORS AFFECTING JOB SATISFACTION FOR NURSING IN GOVERNMENTAL HOSPITALS IN THE WEST BANK - PALESTINE - A CROSS-SECTIONAL STUDY By Ayman Taqtoq Supervisor Dr. Mohammed Hayek Abstract Background: Recent years have seen a significant increase in the importance of job satisfaction for healthcare organizations, particularly in the nursing profession and its bearing on patient care. This study aim is to evaluate the factors affecting job satisfaction of nursing in West Bank hospitals – Palestine. Methodology: A cross-sectional research design was used in the current study on 300 participants nurses working at hospitals were recruited conveniently; data were collected by using the Job Satisfaction Questionnaire. while a stratified random sampling method was used to choose the location for the study. Results: The results indicated that the level of job satisfaction for nursing was high, with an average of (72.2%). While the highest response was in the field of relations with colleagues and management, with an average of (74%). It also indicated that the lowest response was in the field of work environment, (62.2%). The results also showed that the main factor and area affecting job satisfaction is supporting the organization (R²= 0.799, at ((p ≤ 0.05)). It also showed the degree of overall job satisfaction and areas ,the activities supporting the organization and the work environment showed statistically significant differences at (p ≤ 0.05) due to socio-demographic Conclusions: The success of an organization is greatly dependent on its workforce; hence health care organizations need to understand how important employee job satisfaction. It is advisable to monitor employees' job satisfaction levels annually Keywords: Job satisfaction; Factors affecting job satisfaction; Nursing staff, Hospitals; Palestine. 1 Chapter One Introduction and Theoretical Background 1.1 Introduction In recent years, the healthcare sector has grown significantly. The standard of medical care and hospital services is highly valued by the public. In the healthcare system, nursing is a crucial profession since it is crucial to patient care and the efficient operation of hospitals (Hayes, Bonner, & Pryor, 2010) . With an estimated 19.3 million nurses out of a total of 43.5 million health workers worldwide, nurses are without a doubt the greatest workforce in the healthcare sector. TEAM, )2020), registered nurses are nurse practitioners. These medical professionals can collect patient histories, conduct physical examinations, order lab work, interpret test results, write prescriptions for medications, approve treatment plans, and counsel patients and their families on ongoing care thanks to additional education (TEAM, 2020) . The expectations, values, practice environment, and personal traits of nurse practitioners (NPs), whose experiences in clinical practice differ by hospital, make up the dynamic, multifaceted concept of job satisfaction. NPs may exhibit lower levels of job satisfaction and perceive less support from the organization. NPs working in hospitals may have less job satisfaction as a result of inadequate organizational support. Conversely, AlRashidi & Sumaida, (2020), discovered a positive correlation between NP job satisfaction and greater organizational support for empowerment. According to Larkin, Cierpial, Stack, Morrison, & Griffith, (2008), empowerment refers to an employee's capacity to gather information, opportunities for growth, and assistance in order to carry out their duties inside the company. Research indicates that elevating job happiness might mitigate employee attrition and yield favorable outcomes for staff retention. For instance, (Haile, 2023)found that when NPs were more satisfied with their jobs, they showed reduced turnover and improved patient outcomes. Similarly Hariyati, Handiyani, Novieastari, & Levy, (2018), found a relationship between NPs' job satisfaction and their intention to quit their current employment and the practicing conditions. Furthermore, Assiri, Shehata, & Assiri,(2020), came to the conclusion that raising job satisfaction is critical to maintaining a sufficient nursing staff and providing 2 high-quality treatment. Job satisfaction is seen as a global issue, but it is also crucial to enhance the caliber of care provided and foster a suitable work environment in healthcare organizations (Rokka & Khanal, 2023). Therefore, many organizations work to enhance the synergistic forces and environmental cohesion of their employees. Some see creating such an environment as a step towards raising the standard of living at work (Rokka & Khanal, 2023). Healthcare shortage is a problem for many healthcare organizations. High turnover rates among nursing staff, which amounted to approximately 36.6%, is a problem in many countries and has a negative impact on patient care The continuing scarcity of nursing staff in the healthcare industry It has an impact on a number of things, including organizational productivity and the level of health services provided (Yürümezoğlu & Kocaman, 2019). Job satisfaction is described as the fulfillment of occupational needs or desires, and therefore has potential effects on the quality of patient care, safety, and retention Rokka & Khanal, (2023), job satisfaction can be defined as ―a function of the behavior, personality, feeling, or emotional response of nursing staff to a situation related to their work and their work environment. However, the definition of nursing job satisfaction is not one on which there is strong consensus. As a result, nursing researchers may encounter difficulties when deciding on the best conceptual definition of nursing job satisfaction Gil, (2022), so Long working hours, heavy patient loads, and intense interactions are hallmarks of the demanding nature of the nursing profession. These difficulties, as well as the complex healthcare system and complicated administrative procedures found in government hospitals, can have a big impact on how satisfied nursing staff are with their jobs. To create a friendly and welcoming work atmosphere and ensure the provision of the best possible patient care, it is essential to understand the elements that either increase or decrease nurse job satisfaction (Tengah & Otieno, 2019). Many of the internal and external factors that nursing staff encounter on a daily basis in their professional lives have an impact on job satisfaction. These factors may range from internal factors such as autonomy, recognition, and opportunities for professional advancement to external factors such as compensation, workload, and organizational 3 Culture Tengah & Otieno, (2019), for patient safety and high-quality care, healthcare teams must effectively communicate and collaborate. The relationships that nursing staff members have with their colleagues, doctors, and other healthcare professionals can have a big impact on how satisfied they are with their jobs. The total job satisfaction of nursing is influenced by a healthy workplace culture that fosters open communication, mutual respect, and teamwork. This atmosphere also helps nursing provide outstanding patient care (Khamisa, Peltzer, Ilic, & Oldenburg, 2016). Job satisfaction is affected by a number of factors. The physical setting and working circumstances of a hospital might affect how contented nursing staff members feel with their positions. It has been demonstrated that nurses are more satisfied with their needs when they have a favorable experience in their work environment. The study's findings indicate that a drop in sadness and intention to leave the profession is strongly correlated with an improvement in nurses' needs fulfilment Shin, (2023), on the other hand, organizational culture, which comprises the prevalent values, norms, and attitudes inside the hospital that might shape nursing staff job satisfaction, is one of the elements that significantly influences the satisfaction of the nursing staff. Higher levels of job satisfaction can be attributed to an environment that is supportive and positive (Mutonyi, Slåtten, Lien, & Piñero, 2022). While the management and leadership style may have a significant impact on the nursing staff's job satisfaction. A leader can affect the employees' emotions, performance, and job satisfaction by effectively communicating his ideas and feelings to them. This is due to the fact that leaders not only have an impact on employees' feelings and thoughts, but also on their motives, values, demands, and expectations, all of which have a direct bearing on how well they perform their jobs (Bayır & Karadağ, 2015). In addition, the workload, the ratio of nursing staff to patients, and the overall demand for nursing time and energy to meet them are additional significant elements in the job satisfaction of the nursing staff. Thus, adequate personnel levels result in less burnout and more job satisfaction. Inadequate working conditions, such as increased workload and staff shortages, have been identified by international organizations like the World 4 Health Organization (WHO), the International Council of Nurses (ICN), and the International Labor Organization (ILO). These elements contribute to an excessive workload, exhaustion, both physically and mentally, and a high level of stress in this line of work. The nursing care it entails easing patients' suffering and fostering healing as well as giving them mental and physical comfort. In addition to individualized care that considers each patient's particular needs and choices, caring in nursing also entails respecting the patient's autonomy and dignity. Insufficient nurse staffing in healthcare facilities causes increased workload, physical and mental tiredness, and high levels of stress, all of which have a negative impact on the satisfaction of healthcare employees, particularly the nursing staff. There is evidence that understaffing (high patient-to-nurse ratios) and increasing job unsatisfaction are caused by a high workload and a failure to match the number of nurses with actual needs for treatment Gil, (2022), while having good working connections with coworkers, physicians, and other healthcare professionals can increase job satisfaction, disagreements or a lack of collaboration can have the opposite impact, which helps the organization retain nurses (Sabei, Al- Rawajfah, AbuAlRub, Labrague, & Burney, 2022). Inadequate working conditions, such as an increased workload, a lack of human resources, fixed-term contracts that reduce job security, a lack of supplies to provide services, and low salaries, have been identified by international organizations like the World Health Organization (WHO), the International Council of Nurses (ICN), and the International Labor Organization (ILO) as having an impact on nurses' health and job satisfaction. These elements lead to a significant degree of stress in this line of work, weariness, physical and mental depletion, and work overload. The Organization for Economic Cooperation and Development (OECD) states that the data it provides is typical for the participating nations, resulting in an average European nurse-patient ratio of 8.8 nurses per 1000 people. In contrast, this ratio is 5.6 in Spain. A high degree of stress, weariness, physical and mental depletion, and work overload are all caused by the inadequate nurse-to-patient ratio in healthcare facilities. Furthermore, the idiosyncrasies of employment contracts' kind and temporalities have a direct impact on how satisfied medical professionals. There is proof that understaffing (increased patient- nurse ratios) results from a heavy workload and a failure to match the number of nurses 5 to the real demands of care. This causes an increase in dissatisfaction, resulting in a higher probability of mistakes, decreased patient safety and reduced quality of care. 1.2 Problem Statement A key factor in determining the overall quality of healthcare services offered in government hospitals is the job satisfaction of nursing personnel. Nursing, which forms the backbone of the healthcare system, is essential to patient care, hospital safety, and overall performance. Nevertheless, despite their important contribution, there is still continued worry about nursing work satisfaction, which could have an impact on staff morale, retention rates, and ultimately patient outcomes. This study aims to evaluate the factors affecting job satisfaction of nursing, the critical elements affecting nursing practitioners' job satisfaction at public hospitals. Healthcare organizations and policymakers can create focused strategies and interventions to enhance employee well-being, improve the work environment, and ultimately optimize the delivery of healthcare services by thoroughly understanding the factors that affect nursing job satisfaction. Workload, staffing levels, professional development opportunities, management communication and support, work-life balance, rewards and recognition, organizational culture, and the availability of necessary resources are just a few of the factors that could have an impact on job satisfaction. The goal of the study is to identify both the positive elements that contribute to nursing professionals' job satisfaction and the detrimental elements that may result in discontent and burnout. The nursing staff at various government hospitals will be surveyed as part of a combination of quantitative methods to gather data. In order to provide evidence-based insights into the specific elements influencing job satisfaction in this setting, the research will analyze the collected data to uncover patterns, correlations, and trends. Ultimately, this research seeks to fill a significant knowledge gap regarding the factors affecting job satisfaction among nursing professionals in governmental hospitals. The findings will not only contribute to the existing body of literature on nursing job satisfaction but will also serve as a foundation for evidence-based recommendations to improve working conditions, support staff retention, and enhance overall healthcare services in governmental hospitals. Addressing these issues can lead to a more positive and fulfilling work environment for nursing, which in turn positively impacts patient care and outcomes. 6 1.3 The importance of study Research on the factors affecting hospital nurses' job satisfaction is very important for the fields of organizational management and healthcare. Nurse job satisfaction is an important factor that affects healthcare personnel well-being and is crucial to the general standard of patient care. The performance, retention, and general efficacy of healthcare organizations are all directly correlated with nurses' job happiness, who are the backbone of healthcare delivery. It is imperative to look into the factors influencing job satisfaction among nursing staff in West Bank hospitals in order to improve the quality of healthcare services, retain more employees, maximize workforce productivity, put employee well-being first, and inform management and policy decisions. This research adds to the worldwide conversation on healthcare worker dynamics and helps the community's healthcare system. 1.3.1 First: Theoretical significance The theoretical significance of this research lies in its potential to advance our understanding of job satisfaction among nursing in government hospitals, provide insights for improving management of the nursing workforce, and provide evidence- based recommendations for improving the work environment in healthcare settings. In several main ways:  Enhancement of Job Satisfaction Theory: This study can offer important insights into the applicability and modification of current job satisfaction theories by methodically examining the variables that affect job satisfaction especially within the setting of nursing in governmental hospitals. It might result in the creation of a more sophisticated and contextually appropriate theoretical framework that takes into account the special difficulties and dynamics experienced by nursing professionals in this particular situation (Dugguh, 2014).  This study may identify the most important elements influencing nursing staff work satisfaction in public hospitals through thorough empirical investigation. This identification of important variables can help us better understand the nuances of job satisfaction in this field and lay the groundwork for further study and useful treatments. 7  The conclusions drawn from this study can be used to guide the creation of evidence- based management practices that will improve work satisfaction and, as a result, the general standard of healthcare services offered in governmental hospitals. These implications may also apply to human resource management, hiring, retaining, and training strategies developed specifically to meet the special requirements of nursing professionals working in this environment.  By shedding insight on how job satisfaction affects individual and organizational outcomes in the healthcare industry, the study can advance the area of organizational behavior more broadly. This can deepen our understanding of the relationship between organizational performance, employee wellbeing, and work satisfaction in a crucial area of society.  The results of this study can be used as a starting point for future investigations into particular facets of job satisfaction or investigations into the causal relationships between identified factors and their effects on a variety of outcomes, including the standard of patient care, staff turnover, and overall hospital performance. 1.3.2 Second: Applied importance Understanding and addressing the factors affecting nursing satisfaction have several applied implications:  Nursing satisfaction plays an important role in employee retention. If a nurse is dissatisfied with the work environment, they may be more likely to leave their position, which leads to high turnover rates.  It is through nursing satisfaction, motivation, and focus on providing high-quality care to patients, as studies have shown a positive relationship between nursing satisfaction and patient outcomes, this could lead to improved patient safety and overall healthcare quality  Job satisfaction among nursing can directly impact the occurrence of medical errors. Dissatisfied and stressed nursing may be more prone to making mistakes or overlooking important details, potentially compromising patient safety. By identifying and addressing factors that negatively affect nursing satisfaction,  The research can shed light on the needs and expectations of nursing in their professional roles. This knowledge can be used to design better training programs, 8 continuing education opportunities, and career advancement pathways for nursing Investing in their professional growth can further improve job satisfaction and performance.  The general work environment in hospitals has a significant impact on nursing satisfaction. By addressing the causes of unhappiness, it is possible to foster a more optimistic and encouraging work environment. This can improve employee morale, collaboration, and well-being, starting a positive feedback loop that improves the overall hospital environment. 1.4 Aim of study Evaluate the factors affecting job satisfaction of nursing in West Bank hospitals – Palestine 1.5 Objectives 2 To Examining the relationship between demographic characteristics (age, gender, educational level, hospital name, marital status) and job satisfaction 3 To Investigate the factors affecting job satisfaction for nursing in governmental hospitals due to gender variable 4 To Examine factors affecting job satisfaction for nursing in governmental hospitals due to age variable. 5 To Investigate factors affecting job satisfaction for nursing in hospitals due to educational level variable. 6 To investigate factors affecting job satisfaction for nursing in hospitals due to marital status variable 7 To assess factors affecting job satisfaction for nursing in hospitals due to experience variable. 8 To understand the level of job satisfaction among nursing staff with factors (relationships with colleagues and management, Organization supportive activities and work environments). 9 To Evaluation The level of job satisfaction in nursing is affecting by a combination of intrinsic and extrinsic factors, including (relationships with colleagues and management, Organization supportive activities and work environments). 9 1.6 Study hypothesis H1: There is a statistically significance relation at (p ≤ 0.05) between demographic characteristics (age, gender, educational level, marital status and Experience) and job satisfaction for nursing in West Bank hospitals. H2: There is no statistically significance relation at (p ≤ 0.05) between factors affecting job satisfaction for nursing in hospitals and gender variable. H3: There is no statistically significance relation at (p ≤ 0.05) between factors affecting job satisfaction for nursing in hospitals and age variable. H4: There is a statistically significance relation at (p ≤ 0.05) between factors affecting job satisfaction for nursing hospitals and education level variable. H5: There is a statistically significance relation at (p ≤ 0.05) between factors affecting job satisfaction for nursing hospitals and marital status variable. H6: There is a statistically significance relation at (p ≤ 0.05) between factors affecting job satisfaction for nursing hospitals and experience variable. H7: The level of job satisfaction among nursing staff is positively correlated with factors (relationships with colleagues and management, Organization supportive activities and work environments). H8: The level of job satisfaction in nursing is affecting by a combination of intrinsic and extrinsic factors, including (relationships with colleagues and management, Organization supportive activities and work environments). 1.7 Concepts and Operational Definition Conceptual definitions in research refer to the exact and lucid elucidation of theoretical or abstract notions employed in a study. These definitions are essential for creating a shared understanding of the precise meanings assigned to important terms or variables in the context of the research between readers and researchers. By preventing ambiguity and promoting clarity, conceptual definitions make sure that all study participants are aware of the intended meaning of key ideas. Researchers can effectively convey their ideas and increase the accessibility and reproducibility of their 10 work by providing precise definitions for terminology used. In this section, conceptual definitions and operational definitions related to this study are defined and include the following concepts (job satisfaction, workload and staffing levels, work environment, professional development, work-life balance, communication and leadership, patient care). 1.7.1 Concepts Definition These concept definitions give readers a basic understanding of the terms and concepts that are essential to the study of the variables influencing job satisfaction for nurses working in hospitals. Conceptual definition of Job Satisfaction: The level of fulfilment one experiences from their work is known as job satisfaction, and it is a crucial metric for assessing employee performance. "A pleasant or positive emotional state resulting from the evaluation of one's job or job experiences" is how Locke described job satisfaction. Job satisfaction among hospital nursing staff is influenced by several aspects, such as leadership styles, opportunities for professional development, workload, and interpersonal relationships. All of these components need to be taken care of in order to provide nursing personnel with a happy and rewarding work environment. Job satisfaction is positively correlated with both the quality of care provided and the patients' impression of that level of care, and it has been determined to be the most reliable indicator of patient satisfaction in the nursing profession (Dor & Halperin, 2022) . Conceptual definition of Workload and Staffing Levels: The quantity of duties, patient load, and staffing levels can all have a big impact on how satisfied staff nurses are with their jobs. Burnout and a decline in job satisfaction may be caused by heavy workloads and insufficient staffing (Griffiths, Saville, & Ball, 2.19). Conceptual definition of Work Environment: Job satisfaction is influenced by both the social and physical features of the work environment, including the buildings, tools, coworkers, and workplace culture. Nursing staff satisfaction might benefit from a friendly and courteous workplace (Akinwale & George, 2020). 11 Conceptual definition of Professional Development: For nursing staff job satisfaction, opportunities for skill development, professional development, and learning are essential. A hospital that is being funded to develop nursing staff is more likely to satisfy staff members (Ohlén & Segesten, 1998) Conceptual definition of Work-Life Balance: Overall job satisfaction depends on striking a balance between work and personal obligations. Those nursing who are able to balance their job and personal obligations report higher levels of satisfaction (Fukuzak, Iwata, Ooba, Takeda, & Inoue, 2021) Conceptual definition of Communication and Leadership: According to research on leadership communication, it is the use of communication as a tool for exercising leadership, or as a socially constructed interactive process that constitutes leadership, or as a process that is itself leadership. There are three basic perspectives on communication: discourse, meaning-making, and communication as a means of conveying messages (Team, 2022). Conceptual definition of Patient Care: A complete and multifaceted approach to meeting each person's healthcare needs, patient care focuses on promoting, maintaining, or regaining health and well-being. It includes a broad range of tasks and offerings provided by healthcare professionals from different specialties, such as nursing, medicine, allied health, and support personnel (Leininger, 2002) . Describe the factors that affect job satisfaction. 12 1.7.2 Operational Definition Introduction An operational definition is a precise and unambiguous statement that characterizes a concept or variable in terms of the methods or operations used to measure or manipulate it in research and scientific investigations. Because they give a detailed explanation of how a specific concept or variable is observed, measured, or altered in a study, operational definitions are essential. Operational definitions offer precise and quantifiable ways to evaluate the different aspects that affect nursing staff job satisfaction in public hospitals. They act as guidance for the research study's data collecting and analysis. Operational definitions of job satisfaction: a composite score resulting from replies to a standardized survey questionnaire is used to quantify job satisfaction. The survey consists of a series of Likert-scale inquiries intended to gauge how nursing perceive various aspects of their work, such as work conditions, pay, relationships with coworkers and supervisors, chances for professional advancement, and compatibility between personal values and organizational objectives. Strongly Dissatisfied to Strongly Satisfied are the two extremes of the Likert scale. Operational definitions of Workload and Staffing Levels: The number of patients receiving nursing care over a given period of time, such as a shift, is referred to as the workload. The nursing to patient ratio dictates the number of staff members needed. The Job Satisfaction Questionnaire was used to gauge the workload and staffing levels. Operational definitions of Work Environment: The physical and social aspects of the workplace include things like workspace organization, comfort, and cleanliness, as well as interactions with coworkers and supervisors. The social component will be measured using a job satisfaction survey that asks about connections at work and the overall environment. Operational definitions of Professional Development: Professional development comprises taking part in workshops, training sessions, and continuing education programmers, according to the operational definition. The amount of professional 13 development opportunities provided to nurses and their participation rates in a job satisfaction survey will be monitored in order to gauge this component. Operational definitions of Work-Life Balance: The ability of nursing personnel to successfully manage their work schedules and personal responsibilities is related to work-life balance. This will be determined by asking nursing about their work-life balance and how satisfied they are with the flexibility of their schedules in a questionnaire regarding job satisfaction. Operational definitions of Communication and Leadership: Clear and prompt communication from superiors as well as chances to participate in decision-making are necessary for effective communication and leadership. The effectiveness of leadership and nursing staff perceptions of communication quality will be examined through job satisfaction surveys. Operational definitions of Nursing Work Index (NWI): This questionnaire evaluates the work environment and various aspects of nursing practice, including job satisfaction. 1.8 Previous Studies and Theoretical Background Introduction Previously published scientific papers were collected, which discussed the same title, objectives, and keywords as this study. This gives us access to a robust database of our research. The keywords used in the search process in the database are: Hospitals, job satisfaction, factors affecting job satisfaction, Nursing. A set of keywords associated with the study title and study objectives is pre-selected. The literature review of scientific research is a basis for clarifying the researchers' approach to topics related to the research topic. Previous studies are the nucleus for drawing scientific frameworks for research, as no scientific research can be conducted without previous studies. The following is a presentation of the most important studies available to researchers from the previous studies that were dealt with. The subject matter of this study, some of which are directly related to the current study and others are partially related to its components. The focus was on the main objectives of the studies and the most important findings so that we can compare them with the results of the current research. 14 The studies were presented in the form of international studies, Arab studies, and regional studies. 1.8.1 International studies A study was conducted by Cantarelli, Vainieri, & Seghieri, (2023), where the results of his study indicated that there are evidence or factors that enhance the interdependence between levels of governance as they may constitute an enhancement or a threat to motivation and job satisfaction, so these factors are necessary to investigate employee satisfaction and their perception of the organizational climate at a different administrative level. While a study according to Gil,(2022), indicated that there are lower levels of satisfaction in relations with senior management and the organizational structure of the unit, the results also indicated that there are higher levels in relations with the direct manager and their subordinates. Also, the study was indicated by Adamopoulos, (2022), that information and knowledge led to an understanding of the mechanisms that increase job satisfaction Contribute to the improvement of psychosocial risks, and well-being to take appropriate measures and measures Create a healthy and healthy work. While the results of a study conducted According to the researcher's Demircioglu & Wal, (2021) showed that innovation climate has a statistically significant and positive effect on both job satisfaction and emotional commitment, and that job satisfaction plays a positive role in this relationship. While a survey conducted according Holland, Tham, Sheehan, & Cooper, (2019), revealed that nurses' satisfaction with work-life balance served as a mediating factor between perceived workload and increased intention to leave the field. In another context, a study was conducted by Tengah & Otieno, (2019), in which the demographic characteristics were discussed with the job satisfaction of nurses. The results indicated that the job satisfaction of a nurse is greatly affected by her age, workload. In another online survey conducted by Vermeir, Degroote, Vandijck, Mariman, & Deveugele, (2017), using the narrative review method. The results showed that there is a relationship between good communication and job satisfaction for nurses, and this positively affects reducing the intention to leave the institution and reducing the risk of burnout. While a study was conducted by Khamisa, Oldenburg, Peltzer, & Ilic, (2015), was found that in addition to job satisfaction, burnout is a greater predictor of employee difficulties. It also showed that the biggest difference in the mental health of the nurses 15 resulted from burnout.. On the other hand, a search of contemporary literature was done by Hayes, Bonner, & Pryor, (2010), explored the elements that influence the job satisfaction of nurses. The findings demonstrated that boosting employee happiness with their jobs needs collaboration between nurses and their management. Job satisfaction is a complicated and varied subject. The relevance of nursing management in acute care settings was also highlighted by the same study. While, a study was conducted by Biresaw, Boru, & yimer, (2020), aimed to assess the quality of nursing work life and associated factors in Amhara Region Referral Hospitals, Northwest Ethiopia.Institution based cross-sectional study design was used among 461 nurses working in Northwest Ethiopia. Data were collected by a pre-tested, self-administered questionnaire of Brook's and Wisconsin Quality of Life Index The quality of good nursing work life was found to be 40.8%. Factors such as: public image of a society (AOD = 5.55, 95%CI: 2.39–12.84), nursing position (AOR = 3.01, 95%CI: 1.63–8.25), working department (AOR = 4.13, 95% CI: 1.06–16.1), educational status [ (AOR: 2.36, 95%CI: 1.20–4.66)], availability of safe place to rest (AOR = 2.01, 95%CI: 1.07–3.75) and availability of a safe drinking water (AOR = 2.33, 95%CI: 1.24–4.37) were associated with a good quality of nursing work life. 1.8.2 Regional studies Work-life balance had a significant and positive impact on nurses' performance in their area of work, according to a cross-sectional study by Rony, Numan, & Alamgir, (2023),in his study, multinomial logistic regression analysis identified variables that have a significant impact on work-life imbalance. Pearson correlation revealed a positive relationship between work-life imbalance, adverse effects of work on family, unfavorable influence of family on career, and employees' unsatisfaction. While a non- experimental survey was conducted by Hariyati, Handiyani, Novieastari, & Levy, (2018), the results indicated a moderate positive relationship between satisfaction with CPD and NCLS (R: 0.42, p = 0.0001). while, A study was conducted in Nepal discussing the same context by Poudel & Sharma, (2019), aimed to find out the factors influencing job satisfaction among nurses working in the teaching hospital, Chitwan. A descriptive cross-sectional research design was used and 135 nurses working for at least 3 months in Chitwan Medical Teaching Hospital were taken as a study sample. It was a simple random sampling technique to select the required sample. The study's findings 16 indicated that 57.85% of nurses, or more, are satisfy with their jobs. for organization and management policies, nurses' job satisfaction was higher (4.18 ± 0.04) than it was for the salary and benefits they receive from the organization (3.01 ± 0.19). Professional background (p = 0.04), total nursing work experience (p = 0.004), work ward/unit (p = 0.014), designation (p = 0.007), number of patients assigned to the entire ward (p = 0.001), and ward leadership style (p = 0.001) were factors impacting job satisfaction. 1.8.3 Arab Studies In a study conducted by AlRashidi & Sumaida, (2020), the study found that among male and female nurses, there was a statistically significant association between the administrative factor and the psychological factor at the 0.05 level, with a correlation coefficient of 0.828. There is less than 0.01 at the significance level (0.00). At Al-Iman General Hospital in Riyadh, there is also a statistically significant correlation between the administrative worker, the training worker, and the rewards and incentives worker for nurses. Additionally, the research showed that there were no statistically significant differences in the sample members' levels of satisfaction with all factors based on their marital status, educational background, On the other hand, a cross-sectional study was conducted by Assiri, Shehata, & Assiri, (2020), distributing an online questionnaire, the results indicated that 216 females (60.8%) of the total participants. 267 nurses (75.2%) reported that they like the type of work they do, and 245 (69%) were provided with satisfactory equipment to accomplish my work. The study also indicated that there is a statistically significant relationship between organizational support and job satisfaction with their effect on quality of care. While a study was conducted by(Mahmoud & Reisel, (2014), where the results indicated that job security positively affects job satisfaction. Both job satisfaction and OCBs fully mediate the relationship between job security and patient satisfaction. Obedience OCBs partially mediate the relationship between job satisfaction and patient satisfaction. On the other hand, the study was conducted by Alzahrani, Almarwani, Asiri, & Alhowaymel, (2022), The study's objective was to determine how satisfied patients were with the level of nursing care they received while they were in the hospital. where the method of cross-sectional description was applied. The decision has been made. A convenient sample of 238 patients from hospitals spread throughout two Saudi Arabian governorates. The Arabic version of the Patient Satisfaction with Quality of Nursing Care Questionnaire 17 (PSNCQQ-Ar) was used to gauge patient satisfaction. The findings showed that there are notable variations in the overall standard of nursing care between the governorates in Saudi Arabia (M = 4.65, p < 0.001). The study found a significant relationship between the socio-demographic characteristics of patients—urban versus suburban residence, length of hospital stay, accompanying family member, age, education level, marital status, employment status, and employment status—and the patients' satisfaction with nursing care (p = 0.038, p = 0.017, p = 0.017, and p = 0.038). Monitoring the quality of nursing care services on a frequent basis is necessary to improve the hospital stay ex. 18 Chapter Two The Methodology Introduction The approaches that were employed to address the study objective are explained in depth in this chapter. This has implications for the study's design, environment, participants, tools employed, study sample, and sampling methodology. 2.1 Study Design A descriptive cross-sectional study. Data were collected from participants using a convenience sampling method, while a stratified random sampling method was used to choose the location for the study. 2.2 Study Setting In 2023, the number of hospitals affiliated with the Ministry of Health in Palestine reached 31, with a capacity of 3,909 beds, representing 56.7% of hospital beds in Palestine. The number of Ministry of Health hospitals in the West Bank is 18, with a capacity of 1.898 beds, equivalent to 44.3% of West Bank hospital beds ((PHIC), Policy, & Unit, 2023). The number of Ministry of Health hospitals in the Gaza Strip reached 13 hospitals with a capacity of 2.011 beds in the Gaza Strip, constituting 77.0% of the hospital beds in the Gaza Strip. The study conducted in the following hospitals (Alia Governmental Hospital, Salfit Governmental Hospital, Rafidia Governmental Hospital, Al-Mostaqbal Hospital – Ramallah, ST-Lukes Hospital- Nablus, Al- UNORWA Hospital – Qalqilya and Al-Israa Hospital – Tulkarm ). 2.3 Study population All nurse’s working in the mentioned hospitals in the West- Bank will be included. Table (2.1) Shows a breakdown of population data (the number of nursing staff in each of the aforementioned hospitals in 2022),. 19 Table 2.1 The number population of nursing staff in each hospital Name of the hospital The number of nursing in each hospital (# pop) Sample size for total population Governmental Hospitals Alia Governmental Hospital 299 Salfit Hospital 82 Rafidia Hospital 251 Privet Hospital Al-Mostaqbal Hospital - Ramallah 30 ST-Lukes Hospital- Nablus 35 Non- Governmental Hospitals Al-UNORWA Hospital - Qalqilya 40 Al-Israa Hospital – Tulkarm 40 Total 777 300 Source: ((PHIC), Policy, & Unit, 2023)  Inclusion criteria All staff nurses working in the hospitals were included, regardless of educational level or job position and agree to participate in the current study.  Exclusion criteria Nursing will be excluded if he has less than one year of experience. Because nursing is in a trial period of three months to one year, this group was excluded from participating in the study. 2.4 Study sample In order to select participants relevant to the research design, the hospitals was selected by using a stratified-probability sample and participants, the non-probability convenience sampling technique was used. With a confidence level of 95% and a margin of error of 5%. On the basis of the sample size formula, 300 participants were reached. (Raosoft's sample size calculator, available at raosoft.com/sample size). 20 2.5 Study time frame The study was conducted between (1 September 2023 and 1 December 2023) in hospitals in the West Bank (Alia Governmental Hospital, Salfit Governmental Hospital, Rafidia Governmental Hospital, Al-Mostaqbal Hospital – Ramallah, ST-Lukes Hospital- Nablus, Al-UNORWA Hospital – Qalqilya and Al-Israa Hospital –Tulkarm 2.6 Data Collection tool The questionnaire Job Satisfaction Survey (JSS) - Developed by Spector in 1985. was used (Yasmin, Rn, Bhuiyan, & Hossen, 2023). The researcher used Google share link to distribute questionnaire by E-mail. A pilot study was conducted with 30 participants to determine if the study tool is reliable for, and suitable for the Palestinian culture, the results of this pilot study were not included in the study sample; Cronbach Alpha values was calculated for all items of the questionnaire was (0.93). The study tool, which has been translated into Arabic, was used to collect the data. The information sheet, informed consent was provided in both English and Arabic as participation in this study was non-compulsory, and information about the aim of this study were provided to the participants. They were informed that they can withdraw from the study at any time. It was emphasized that the privacy of the study is maintained and that it is for scientific research purposes throughout the study period. The questionnaire (JSS) was included two parts: The first part: was discussed the demographic characteristics (age, gender, educational level, marital status and Experience). The second part was discussed the factors that affect the job satisfaction of nursing in hospitals in the West Bank. It consists of three parts: Yasmin, Rn, Bhuiyan, & Hossen, (2023) ,Relationships with colleagues and management.  Organization supportive activities  Work environments 21 2.7 Statistical Analysis Methods Data analysis was performed to issue the statistical package for social sciences SPSS (23) The following tests were used in this study (Means, standard deviations, and percentages were used as descriptive statistics) in order to determine the relationship between the total degree of job satisfaction and its domains. In addition to ensuring the validity of the study tool, Pearson correlation coefficient was used. To determine the relationship between the overall degree of job satisfaction and its fields, and to ensure the validity of the study tool, stepwise linear regression was used. The independent samples t-test was used to determine differences in job satisfaction according to the gender variable. The one-way ANOVA test was used to identify differences in job satisfaction according to the variables of age, educational level, marital status, and experience. Finally, the LSD post hoc test was used to determine the sources of differences between the means. In order to identify the stability of the study tool, the Cronbach alpha equation was used. 2.8 Validity and Reliability of the Questionnaire 2.8.1 Validity The validity of the questionnaire indicates that it measures what it was found to measure Middleton, (2019), the questionnaire was distributed in its initial form to experts in the field of public health management, where they evaluated its suitability for measuring the matters they examined, and the validity of the tool was confirmed. The results of this sample were examined by conducting a pilot study that included 30 nurses to verify the validity of the study instrument. Internal consistency validity was used by extracting the individual correlation values between the items and the total score for the entire scale, as shown in the table (2.2). 22 Table 2.2 Internal consistency validity for the study instrument N Items R P- value 1 Satisfaction with duty roster 0.66 0.000** 2 Relationship with your co-workers 0.62 0.000** 3 Relationship with departmental in-charge 0.76 0.000** 4 Relationship with nursing supervisor 0.85 0.000** 5 Relationship with the Nursing Superintendent 0.83 0.000** 6 Satisfaction with the working department 0.47 0.008** 7 Feel safe and secured working in your organization 0.76 0.000** 8 Feel safe on night duty 0.76 0.000** 9 Nursing supervisors supervise your work on night duty 0.88 0.000** 10 Separate workplace changing room 0.69 0.000** 11 How satisfied are you with the hand washing station in the workplace? 0.67 0.000** 12 Separate toilet facilities at work place 0.60 0.000** 13 Separate room for treatment in case of illness 0.53 0.003** 14 Problem with getting weekends off 0.52 0.003** 15 problem with getting your leisure leave and allowance 0.67 0.000** 16 Problem obtaining maternity leave for nurses 0.58 0.001** 17 Problem getting work instructions from supervisors 0.78 0.000** 18 Meetings with supervisors at your workplace 0.53 0.003** ** Significant correlation at (p ≤ 0.01). The results in table (2.2) revealed that there were statistically significant and positive correlations at (p ≤ 0.01) between the total score of job satisfaction and all items, as the values of Pearson correlation ranged between (0.47 to 0.88). Based on these findings, the study instrument is valid and achieves what it is intended to measure. 2.8.2 Reliability A Cronbach’s alpha equation was applied to ensure the study instrument reliability as illustrated in table (2.3). Table 2.3 Reliability of the study instrument Domains of job satisfaction N of items Cronbach’s alpha Relationships with colleagues and management 5 0.87 Organization supportive activities 4 0.80 Work environment 9 0.86 Entire instrument 18 0.93 23 The alpha Cronbach value 0.91-1.00: excellent, 0.81-0.90: good,0.71-0.80: acceptable and Good, 0.61-0.70: acceptable, 0.01-0.60 unacceptable. The results in table (2.3) revealed that the reliability coefficient of the entire instrument of job satisfaction is (0.93), and reliability coefficients for the domains of job satisfaction are (0.87, 0.80, 0.86) respectively. Based on these findings, the study instrument has a high degree of reliability and achieves the study goals. 2.9 Study procedures Once the participants agreed to participate, a Google drive link was generated. This link was distributed by email to all participants in the target hospitals, and these participants completed the survey link via email after the researcher had obtained their permissions. Information sheet, informed consent was provided in English and Arabic because participation in this study would be non-compulsory, information about the aim of this study was provided to the participants. They were also informed that they could withdraw from the study at any time. It was emphasized that the privacy of the study was preserved and that it was intended for scientific research purposes throughout the study period. (Appendix ―E‖) 2.10 Ethical consideration Graduate studies approval was obtained from An-Najah University to conduct the study, then graduate ethics approval was obtained from the Institutional Review Board ―IRB‖ at An-Najah National University in Nablus - Palestine. After that, the Department of Health Education and Scientific Research was contacted for approval to The study was applied in government hospitals. Private hospital administrations were contacted separately in order to allow the study to be conducted in the private hospitals under study. UNRWA administration was also contacted in order to conduct the study in its affiliated hospitals under study. 24 Chapter Three Results In this chapter, the sociodemographic characteristics of the study participants are described. We also show the factors affecting the job satisfaction of nursing staff in hospitals in the West Bank - Palestine, due to the variables of gender, age, educational level, marital status, and experience. The level of job satisfaction of the nursing staff was also discussed, and finally, knowledge of the factors that affect the job satisfaction of the nursing staff in hospitals in the West Bank. 3.1 Socio-demographic characteristics To identify the distribution of the variable values, a descriptive analysis was done on the data, dividing it into ratios and numbers. The number of responses provided by respondents is referred to as frequency in descriptive analysis. The study's analysis of the nursing staff demographic is depicted in Table (3.1). According to the findings, 36% of the study's respondents were male, whilst 64% of the respondents were female. Additionally, it was demonstrated that 45.7% of respondents to the study belonged to the 30- 45-year-old age group. The study also showed that, at a rate of 62%, respondents were most in favor of nursing staff that possess a bachelor's degree in nursing, while married individuals received the highest answer, at 60.3%. The data also showed that the highest response rate (31.3%) was seen among nursing staff with 11–15 years of work experience. 25 Table 3.1 Demographic characteristics of study sample (n= 300) Variables Level of variables F % Gender Male 108 36 Female 192 64 Total 300 100% Age Under 30 years 73 24.3 30-45 years 137 45.7 Above 45 years 90 30 Total 300 100% Education level Diploma 66 22 BA 186 62 MA 48 16 Total 300 100% Marital status Married 181 60.3 Single 96 32 Divorced and widower 23 7.7 Total 300 100% Experience 1-5 years 45 15 6-10 years 77 25.7 11- 15 years 94 31.3 Above 15 years 84 28 Total 300 100% 3.2 Factors affecting job satisfaction of nursing staff in hospitals due to the variable of gender The results show in table (3.2) illustrated that there were no statistically significant differences at (p ≤ 0.05) in the total score of job satisfaction and its domains (relationships with colleagues and management, and organization supportive activities) of nursing staff in hospitals in the west bank – Palestine due to the variable of gender. Whereas, statistically significant differences were noticed in the domain of work environment according to gender variable in favor of males (Fig. 3.1). 26 Table 3.2 Independent t- test results for the differences in the factors affecting job satisfaction for nursing in hospitals according to gender variable (n=300) Domains of job satisfaction Gender N Mean± SD T P- value Relationships with colleagues and management Male 108 3.74± 0.62 0.88 0.378 Female 192 3.68± 0.58 Organization supportive activities Male 108 3.41± 0.70 -0.36 0.716 Female 192 3.44± 0.69 Work environment Male 108 3.20± 0.47 2.31 0.022* Female 192 3.06± 0.54 The total score Male 108 3.45± 0.50 0.94 0.349 Female 192 3.39± 0.54 * Significant differences at (p ≤ 0.05). Figure 3.1 Means of response on work environment domain according to gender variable 27 3.3 Factors affecting job satisfaction for nursing staff in hospitals due to age variable The results shows in table (3.3) that there were statistically significant differences at (p ≤ 0.05) in the total score of job satisfaction and its all domains for nursing in hospitals according to age variable. LSD as a post hoc test was applied to determine the sources of differences according to age variable as illustrated in table (3.4). Table 3.3 One way ANOVA results for the differences in the factors affecting job satisfaction for nursing staff in hospitals according to age variable (n=300) Domains of job satisfaction Age N Mean± SD F P- value Relationships with colleagues and management Under 30 years 73 3.55± 0.50 4.65 0.010* 30- 45 years 137 3.70± 0.63 Above 45 years 90 3.84± 0.60 Organization supportive activities Under 30 years 73 3.28± 0.64 7.59 0.000* 30- 45 years 137 3.36± 0.68 Above 45 years 90 3.66± 0.71 Work environment Under 30 years 73 2.98± 0.46 15.48 0.000* 30- 45 years 137 3.02± 0.49 Above 45 years 90 3.35± 0.54 The total score Under 30 years 73 3.27± 0.42 10.92 0.000* 30- 45 years 137 3.36± 0.52 Above 45 years 90 3.62± 0.53 * Significant differences at (p ≤ 0.05). While the results in table (3.4) showed that there were statistically significant differences at (p ≤ 0.05) in the total score of job satisfaction and the domains of organization supportive activities and work environment according to age variable (above 45 years) and the other age categories in favor of (above 45 years). In addition, statistically significant difference was found in relationships with colleagues and management between (above 45 years) and (under 30 years) for (above 45 years). No significant differences were noticed in the other residual post hoc caparisons between means as shown the figures (3.2),(3.3),(3.4),(3.5) 28 Table 3.4 LSD post hoc results for the differences in the total score of job satisfaction and all domains according to age variable (n= 300) Domains of job satisfaction Means Categories of age Under 30 years 30-45 years Above 45 years Relationships with colleagues and management 3.55 -0.15 -0.29* 3.70 -0.14 3.84 Organization supportive activities 3.28 -0.08 -0.38* 3.36 -0.30* 3.66 Work environment 2.98 -0.04 -0.37* 3.02 -0.33* 3.35 The total score 3.27 -0.09 -0.35* 3.36 -0.26* 3.62 * Significant differences at (p ≤ 0.05). Figure 3.2 Means of response on relationships with colleagues and management domain according to age variable 29 Figure 3.3 Means of response on organization supportive activities domain according to age variable Figure 3.4 Means of response on work environment domain according to age variable 30 Figure 3.5 Means of response on the total score of job satisfaction according to age variable 3.4 Factors affecting job satisfaction for nursing staff in hospitals due to educational level variable The results in table (3.5) showed that there were statistically significant differences at (p ≤ 0.05) in the total score of job satisfaction, the domains of relationships with colleagues and management, and organization supportive activities for nursing in hospitals according to education level variable. In addition, no statistically significant differences were noticed in the domain of work environment according to this variable. To determine the sources of differences, LSD post hoc test was applied as illustrated in table (3.6). 31 Table 3.5 One way ANOVA results for the differences in the factors affecting job satisfaction for nursing in hospitals according to education level variable (n=300) Domains of job satisfaction Education level N Mean± SD F P- value Relationships with colleagues and management Diploma 66 3.89± 0.65 4.75 0.009* BA 186 3.63± 0.58 MA 48 3.73± 0.53 Organization supportive activities Diploma 66 3.77± 0.65 10.83 0.000* BA 186 3.32± 0.63 MA 48 3.40± 0.84 Work environment Diploma 66 3.20± 0.54 1.50 0.229 BA 186 3.09± 0.50 MA 48 3.05± 0.56 The total score Diploma 66 3.62± 0.55 6.95 0.001* BA 186 3.35± 0.48 MA 48 3.39± 0.58 * Significant differences at (p ≤ 0.05). While, the results in table (3.6) showed that there were statistically significant differences at (p ≤ 0.05) in the total score of job satisfaction, the domains of relationships with colleagues and management, and organization supportive activities according to education level variable between (diploma) and (BA, and MA) in Favor of (diploma). In addition, no statistically significant differences were noticed in all the comparisons between (BA) and (MA) as shown the figures (3.6, 3.7, 3.8). Table 3.6 LSD post hoc results for the differences in the total score of job satisfaction, relationships with colleagues and management, and organization supportive activities according to education level variable (n= 300) Domains of job satisfaction Means Categories of education level variable Diploma BA MA Relationships with colleagues and management 3.89 0.26* 0.16* 3.63 -0.10 3.73 Organization supportive activities 3.77 0.45* 0.37* 3.32 -0.08 3.40 The total score 3.62 0.27* 0.21* 3.35 -0.06 3.39 * Significant differences at (p ≤ 0.05). 32 Figure 3.6 Means of response on relationships with colleagues and management domain according to education level variable Figure 3.7 Means of response on organization supportive activities domain according to education level variable 33 Figure 3.8 Means of response on the total score of job satisfaction according to education level variable 3.5 Factors affecting job satisfaction for nursing staff in hospitals due to the variable of marital status The results in table (3.7) showed that there were no statistically significant differences at (p ≤ 0.05) in the total score of job satisfaction, the domains of relationships with colleagues and management, and organization supportive activities for nursing staff in hospitals according to marital status variable. Whereas, there were statistically significant differences in the domain of work environment according to this variable. 34 Table 3.7 One way ANOVA results for the differences in the factors affecting job satisfaction for nursing staff in hospitals according to marital status variable (n=300) Domains of job satisfaction Marital status N Mean± SD F P- value Relationships with colleagues and management Married 181 3.65± 0.65 2.57 0.078 Single 96 3.82± 0.50 Divorced and widower 23 3.67± 0.45 Organization supportive activities Married 181 3.46± 0.74 1.86 0.157 Single 96 3.44± 0.65 Divorced and widower 23 3.16± 0.47 Work environment Married 181 3.08± 0.53 6.41 0.002* Single 96 3.24± 0.49 Divorced and widower 23 2.85± 0.40 The total score Married 181 3.39± 0.59 2.91 0.056 Single 96 3.50± 0.46 Divorced and widower 23 3.23± 0.32 * Significant differences at (p ≤ 0.05). To determine the sources of differences, LSD post hoc test was applied The results in table) Appendix F.8) showed that there were statistically significant differences at (p ≤ 0.05) in work environment domain according to marital status variable between (single) and (married, divorced and widower) in favor of (single), and between (married) and (divorced and widower) for (married) as shown the figure (3.9) Figure 3.9 Means of response on work environment domain according to marital status variable 35 3.6 Factors affecting job satisfaction for nursing staff in hospitals due to the variable of experience The results in table (Appendix F.9) showed that there were statistically significant differences at (p ≤ 0.05) in the total score of job satisfaction and its all domains for nursing staff in hospitals according to experience variable. To determine the sources of differences according to experience variable, LSD as a post hoc test was applied The results in table (Appendix F.10) showed that there were statistically significant differences at (p ≤ 0.05) in the total score of job satisfaction and all domains according to experience variable between (above 15 years) and the other experience categories in favor of (above 15 years), and no statistically significant differences were noticed in the other residual post hoc caparisons between means as shown the figures. (Appendix G.10, G.11, G. 12, G.13) 3.7 The level of job satisfaction for nursing staff in hospitals To explore the level of job satisfaction for nursing staff in hospitals of the West-Bank. descriptive statistics (means, standard deviations, and percentages) were calculated for each item and the domain to which it belongs as presented in the attached table (Appendix F.11). The results shown in table (Appendix F.12). revealed that the level of job satisfaction for nursing in governmental hospitals in the west bank – Palestine was high, as the mean of response for the total score was (3.41). In addition, the highest response was on the domain of relationships with colleagues and management, as the mean for the total score was high (3.70). Whereas, the lowest response was on the domain of work environment, as the mean for the total score was moderate (3.11). Concerning the items, the highest response was on item (2) (Relationship with your co-workers) as the mean of response was high (4.01), Whereas, the lowest response was on item (14) (Separate room for treatment in case of illness) as the mean of response was low (2.56). 36 3.8 Factor affecting job satisfaction for nursing staff in hospitals of the west bank – Palestine The results in table (Appendix F.13), revealed that there were statistically significant and positive relationships at (p ≤ 0.01) between the total score of job satisfaction and it all domains, as the values of Pearson correlation were (0.87, 0.89, and 0.82) respectively. To determine the main factor (domain) affecting job satisfaction, a stepwise multiple regression was applied as shown in table (F.14). The results in table ((Appendix F.14) (indicated that t-value were statistically significant at (p ≤ 0.05), and the main important factor and domain affecting job satisfaction was organization supportive domain (R²= 0.799, at (p ≤ 0.05). this result means that organization supportive activities explain (79.90%) of job satisfaction for nursing Staff in hospitals of the west bank - Palestine (Figure. 3.10). Figure 3.10 The effect of organization supportive activities on job satisfaction for nursing staff in hospitals of the west bank – Palestine This result means that organization supportive activities explain (79.90%) of job satisfaction for nursing staff in hospitals. 37 Summary The research on "Factors that Affect the Job Satisfaction of Nursing Staff in Hospitals" investigated various elements influencing the job satisfaction of nursing professionals within hospital settings. The study employed a comprehensive approach, considering both intrinsic and extrinsic factors contributing to nurses' overall job satisfaction. Key findings highlighted the significance of workplace conditions, including staffing levels, workload, and the availability of resources, in shaping nurses' job satisfaction. Additionally, interpersonal relationships, communication within the team, and leadership styles emerged as crucial factors affecting nurses' contentment with their jobs. Opportunities for professional growth, training, and recognition were also identified as influential elements in determining job satisfaction among nursing staff. The research underscores the complex interplay of multiple factors that impact the well- being and job satisfaction of nursing professionals in hospital environments. 38 Chapter Four Discussion, Conclusion, and Recommendations In this chapter, a discussion, conclusions, and recommendations will be presented. 4.1 Discussion The quality of patient treatment, employee retention, and overall organizational success are all strongly impacted by job satisfaction, which is a crucial aspect of the well-being of healthcare workers. This cross-sectional study clarifies the complex variables affecting hospital nursing staff members' job satisfaction. Encouraging a pleasant work environment is contingent upon addressing these aspects completely, which will eventually improve the quality of patient care as well as the well-being of nursing staff. The goal of the current study was to Examining the factors affecting job satisfaction of nursing in West Bank hospitals – Palestine. The outcomes were therefore discussed. Additionally, it was compared to earlier studies in order to generate a number of significant recommendations that would aid decision-makers. The results of the research demonstrated a complex web of factors influencing job satisfaction, offering important new perspectives on the particular difficulties faced by nurses in this field. Thus, workload and staffing numbers are two of the primary elements that influence job satisfaction. Inadequate staffing and a heavy workload were found to be major factors in nursing staff discontent with their jobs. Nursing staff have significant challenges in meeting patient care requirements and staffing levels, which can negatively impact their job satisfaction and general well-being. Opportunities for professional growth are another element influencing job satisfaction. Furthermore, management and leadership are significant elements that influence job satisfaction through Determine which management and leadership styles are most important in determining how satisfied a worker is with their work. Nursing staff members who had supportive leadership, open communication, and a happy work atmosphere reported feeling more satisfied with their jobs. On the other hand, poor management techniques were linked to employee discontent, higher intents to leave the work, and a desire to quit. For nursing personnel, striking a healthy work-life balance is essential. Job satisfaction was higher among those who felt that their personal and professional lives were balanced. Work-life balance-promoting elements include things like flexible scheduling and encouraging 39 workplace rules. According to this study, the highest response was in favor of females, as their response rate to the study was 64%, and 36% of the participants were male. Because nursing is a field dominated by women in Palestinian society, nurses were more responsive as they felt that the research was more applicable to their own experiences. They believe that the study directly addresses issues related to their professional development, job satisfaction, and working life. Women often excel at communicating, so this may be motivated by a desire for career advancement or better working conditions. They may also be more likely to tell their friends about research opportunities. This may increase the rate of awareness and participation among nurses (Ayalew, et al., 2019). The study supported the findings of this investigation. It was revealed that women constitute 60.8% of the participants in the study and the answers, and they are more likely to participate in studies that examine the variables affecting job satisfaction because of their direct impact on their general health and work-life balance. This is due to the fact that women are more likely to be encouraged to take an active role in initiatives that enhance their workplace. The results of this study also showed that there are statistically significant differences in job satisfaction between age groups over 45 in relation to leaders, reason, communication, and work environment. Many nurses reach a certain amount of job stability by the time they are 45 years old. They might now be in more senior roles, including leadership responsibilities in nursing or specialized fields, which gives them a sense of achievement and contentment in their work. Older nurses may value the steadiness of their profession, which includes complete benefits and job security in addition. These elements give a sense of financial security and well-being, which enhances total job satisfaction. While The findings of this study were disagreed with by Costeira, (2023), Yusuf & Wulandari, (2023), who both came to the conclusion that job satisfaction among hospital nursing staff is unaffected by the age variable. 40 The results showed that there were statistically significant differences in job satisfaction, areas of relations with colleagues and management, and activities supporting the organization according to the education level variable between (diploma), When the organizational culture is consistent with the values of the nursing staff who have a diploma, they are more likely to feel job satisfaction. Organizations that adhere to high ethical standards and prioritize patient safety also contribute to the satisfaction of nursing staff who value ethical practices in the field of health care. Nurses with diplomas value opportunities for continuing learning and professional development. Organizations that invest in the growth of their nursing staff demonstrate a commitment to career advancement and job satisfaction, by training them and facilitating the task of their educational attainment by involving them in upgrading programs in Palestinian universities to obtain a bachelor’s degree and linking them to financial and administrative incentives ((PHIC), Policy, & Unit, 2023). While a study agreed by Rokka & Khanal, (2023), with the results of the current study, which indicated that there is a statistically significant relationship between job satisfaction and the educational level variable among nurses, while a study disagreed by Yusuf & Wulandari,(2023), indicated that there is no relationship between demographic characteristics and job satisfaction, as they do not affect job satisfaction among nurses. According to the findings, there is a statistically significant correlation between marital status (single) and the area of employment satisfaction (work environment). This suggests that an individual's workplace is a social setting where they can engage with their coworkers. Good social connections at work can boost a person's sense of connection and belonging, which might affect how they perceive their social standing. Building professional relationships and networking are frequently facilitated by workplaces. The employment can serve as a significant source of social interactions for single people, particularly those without family networks, which could have an impact on their social standing. While a study by Ravari, Bazargan, Vanaki, & Mirzai,(2012), contradicted the results of the current study, as his study indicated that there is no statistically significant relationship between marital status and job satisfaction. The findings showed that the variables of experience (more than 15 years) and work 41 satisfaction are statistically significantly correlated. The explanation for this is that nursing staff with more experience typically has greater confidence in their clinical judgement and expertise. They are more equipped to make wise judgements when they have more autonomy in their jobs, which can enhance job satisfaction. The healthcare system, company policies, and the general work environment all become increasingly acquainted to nurses. Their capacity to adjust to obstacles and changes is improved by this familiarity, which results in a more satisfying and productive work environment. While a study agreed by Chien & Yick, (2016), With the current study's findings, which showed a statistically significant correlation between nursing staff job satisfaction and their work experience. While a study contradicted by Costeira, (2023) ,with the results of the current study, which indicated that there is a weak relationship between job satisfaction and professional experience . The results indicated that the average response for the total score was (3.41), which indicates a high degree of job satisfaction for nurses working in hospitals. The field of relations with management and co-workers received the highest response rate, while the work environment received the lowest rate. The reason is that most hospital administrations adopted programs such as training and scientific development programs, which were approved with administrative and financial incentives, which contributed greatly to nurses’ satisfaction , While this contradicted a study by Fitzsimons, Ahmad, & Froelicher, (2023), which indicated that nursing are not satisfied with their work and the reason is the lack of open and transparent communication within the workplace, and the staff were not informed of the changes, policies and decisions that may affect their work. Regarding the work environment, a study by Yasmin, Rn, Bhuiyan, & Hossen, (2023), contradicted the results of the current study, as the study, in which the majority of the sample was female, indicated that the satisfaction rate with the work environment was 89.1%, as most nurses feel comfortable working in their area. In addition, with regard to the level of job satisfaction, a study conducted by Haile, (2023), showed a contradiction with the current study as it indicated that nurses in public hospitals in Addis Ababa have very low levels of job satisfaction. Lack of training and growth is one of the main factors associated with low job satisfaction. Lack of administrative support and limited participation in decision- making were the most important factors that contributed to low job satisfaction. The 42 results proved that the main factor and area influencing job satisfaction is the area supporting the organization, and this result means that activities supporting the organization explain (79.90%) of nursing job satisfaction in hospitals in the West Bank - Palestine. The results of this study and a study conducted by Jasiński & Derbis, (2022), were consistent; the study was indicated that good influence at work, work engagement, and job satisfaction are all factors directly related to helping managers and co-workers. Positive workplace attitudes and employee engagement were partial mediators in the relationship between superior support and job satisfaction. On the other hand, good influence at work and work engagement fully moderated the association between support from coworkers and job satisfaction. Therefore, understanding these variables is essential for healthcare institutions to implement effective tactics that increase the work environment for nursing staff, thus increasing the consequences for patients and the overall level of healthcare delivery Summary This study explores the complex factors affecting nursing job satisfaction in hospital environments. The study takes a thorough approach to identifying and analyzing several aspects that either enhance or decrease nursing job satisfaction, acknowledging the significance of this element in guaranteeing high-quality patient care and the efficacy of the healthcare system as a whole. The study's discussion section summaries the main conclusions and throws light on the intricate interactions between several variables that affect nursing job satisfaction. It looks at both internal and external variables, including pay, opportunities for professional growth, organizational culture, nursing-patient ratios, workload, and leadership support. The research attempts to offer a detailed knowledge of the potential and limitations in improving job satisfaction among nursing practitioners by looking at these elements. The discussion of the study's findings for hospital executives, legislators, and other healthcare professionals are also covered in the conversation. It highlights the necessity of focused interventions and tactics to lessen unfavorable effects on job satisfaction and, as a result, foster an atmosphere that is more favorable for nursing to work in. This study also emphasizes the advantages of higher job satisfaction, such as better patient outcomes, higher retention rates, and a favorable effect on the healthcare system as a whole. The importance of continuing research in this field is highlighted in the study's conclusion in order to help methods 43 adjust to the changing healthcare environment. In order to address the factors that have been identified and create a more fulfilling and long-lasting work environment for nursing, it promotes ongoing communication among stakeholders, which eventually improves patient outcomes and healthcare delivery. 4.2 Conclusions This cross-sectional study explores a range of variables that influence job satisfaction of hospital nursing staff members. The complex nature of the nursing profession requires a sophisticated understanding of the factors that enhance or diminish job satisfaction. The research findings provide insightful information for regulatory leaders, legislators, and health care managers who want to promote working conditions that support the health of nurse practitioners. This study emphasizes how crucial workload management is in determining how satisfied nursing personnel are with their jobs. Reducing stress and preventing burnout can have a substantial impact on nursing overall job satisfaction levels when overwork demands are addressed and efficiency-boosting methods are put into practice. The interpersonal connections and team dynamics that exist within healthcare teams are equally important. The foundation of job satisfaction is a collaborative and upbeat work environment that emphasizes the importance of team- building activities and efficient communication techniques. Opportunities for professional growth have become clear as a major factor in nursing staff members' job satisfaction. Providing opportunities for career advancement, training courses, and ongoing education are crucial for promoting a sense of fulfilment and professional progress. Employers who place a high priority on and make sustained investments in the professional growth of their nursing staff stand to gain from improved patient care and better job satisfaction. Workplace assistance, which includes proper resources, acknowledgment, and encouraging leadership, has become essential to achieving job satisfaction. Hospitals and other healthcare facilities need to understand how important a role they play in determining the working conditions for nursing. Ensuring a good and supportive work environment for nursing staff requires policies that priorities their mental health and well-being, as well as activities that acknowledge and reward their achievements. It is critical to recognize the limits of this cross-sectional study as we draw to a close. Although it offers an instantaneous picture of the current level of job satisfaction, longitudinal research is necessary to fully understand the dynamics