Abstract

Background: This study aimed to provide an understanding of the relationship between the ethical climate at the workplace and job satisfaction among nurses.

Methods: 210 nurses working in selected wards in the Tehran University of Medical Sciences were asked to fill out questionnaires on their work environment and level of job satisfaction. The data collection tools included a questionnaire to obtain demographic data, the Olson moral climate questionnaire and Minnesota job satisfaction questionnaire. The data were analysed using SPSS software version 14.

Results: We found a significant positive relationship between the ethical climate and the level of job satisfaction among the nurses. Among the demographic variables, the working shift, income level and type of duties allocated had a significant relationship with job satisfaction.

Conclusion: Hospital managements should pay attention to the factors influencing job motivation among nurses, including the ethical climate of the work environment.

Introduction

Organisations are units of the community that both affect the environment and are affected by it. Organisational ethics is a set of principles that promotes similar behaviours among the organisation’s staff, and helps the organisation and staff solve problems caused by conflicts within the system, such as personal tensions and disputes related to job responsibilities (1).

Organisational ethics in healthcare is concerned with issues such as resource allocation (2), funding and setting of priorities (3), safeguarding justice and access to care (4), disclosure of risks and complaints of misconduct (5), and workplace ethics and the ethical climate in the health services (6).

The organisation’s ethical climate – also referred to here as moral climate – reflects the organisation’s rules and guidelines and their association with ethical consequences (7). It can also be a mediator of moral distress (8, 9). Moral distress occurs when a person perceives that the right course of action cannot be implemented because of institutional constraints (10). The ethical climate determines whether decisions are based on ethical criteria, as well as how employees interpret ethical questions (11). Studies have shown that an organisation’s ethical climate affects not only the moral attitudes of the organisation’s employees, but also their work output (12).

The ethical climate in healthcare settings is defined as “organizational specific conditions that facilitate the discussion on the patients’ health problems and their solutions, and provide a framework for ethical decision-making in the clinical environment.” Researchers have suggested that the promotion of an ethical climate in the workplace enables employees to better cope with ethical stress and other causes of dissatisfaction, and may increase their level of job satisfaction (8, 9).

Employees’ job satisfaction has been shown to be reflected in their attitudes towards their work. Those who are satisfied with their work have a positive attitude towards it, while those who are dissatisfied have a negative attitude (13). A positive ethical climate is also associated with high levels of job satisfaction in terms of attitudes to payment, professional progress and colleagues.

Researchers have shown that the organisation can affect the employees’ level of job satisfaction by influencing the ethical climate (14).

This study aimed to determine the relationship between the ethical climate at work and job satisfaction among nurses in a university hospital in Tehran.

Methods

Population and sample

The study sample consisted of 210 nurses working in the emergency, surgery and internal medicine wards, and the cardiac care units (CCUs) and intensive care units (ICUs) of the Tehran University of Medical Sciences (TUMS). All were graduates with either BSc or MSc degrees in nursing.

Sampling technique

The study used stratified sampling with proportional allocation. The wards were selected according to the number of nurses working there. The sample from each ward was selected randomly (using the lists of nurses working there).

Instruments

A demographic form, the Olson moral climate questionnaire (15) and the Minnesota job satisfaction questionnaire (16) were used to gather data. The moral climate is taken to reflect the ethical climate in professional settings.

The demographic form included questions on age, gender, education, type of employment, level of income, marital status and the current ward assigned.

The Olson moral climate questionnaire, which uses a Likert scale, contains 26 items on the organisation’s moral climate. Each question has five options: “almost never” (score=1), “rarely” (score=2), “sometimes” (score=3), “often” (score=4) and “almost always” (score=5). The questions concern five factors, including “communicating level with the colleagues” (items 1, 10, 18 and 23), “patients” (items 2, 6, 11 and 19), “managers” (items 3, 7, 12, 15, 20, 24), “physicians” (items 5, 9, 14, 17, 22 and 26) and “hospital” (items 4, 8, 13,16, 21 and 25). The higher the score, the more positive was the moral climate at work.

The Minnesota job satisfaction questionnaire, which also uses a Likert scale, contains 23 questions on the participants’ working conditions. Each question has five options: “very satisfied” (score=5), “satisfied” (score=4), “do not know” (score=3), “dissatisfied” (score=2) and “very dissatisfied” (score=1). The higher the score, the higher is the level of job satisfaction.

The questionnaires were designed after a review of the literature, in consultation with colleagues and experts in the field.

Ethics review

The research proposal was approved by the ethics committee of the Tehran University of Medical Sciences and permission for the study obtained from the School Research Committee.

Data collection and analysis

The researcher handed the questionnaires to the unit heads, who distributed them among the nurses in their units. The participants were provided with information on the goals of the study and assured of the confidentiality of the personal information they would be providing.

The data were analysed using the statistical programme SPSS version 14.

Results

90% of the respondents were women. The respondents’ ages ranged from 22 to 55 years, the average age being 30.8. 61% were below 31 years of age. 207 (98.6%) had a bachelor’s degree and 3 (1.4 %) had a master’s degree.

Of the 210 nurses, 28.1% worked in the ICU, 26.2% in the surgery ward, 23.3% in the internal medicine ward, 11.9% in the CCU and 10.5% in the emergency ward. Table 1 shows the frequency distribution of the demographic characteristics of the nurses.

Of the 210 nurses, 58.1% described their income as “average”, 34.8% as “unfavourable” and 5.7% as “favourable”. There are 3 missing values (1.4%).

The mean and standard deviation of the Olson moral climate questionnaire results for the investigated units was 3.36±0.69, and the mean and standard deviation of job satisfaction among the nurses was 3.17±0.63.

Pearson’s correlation co-efficient showed a significant positive correlation between the moral climate at work and job satisfaction among the nurses (r=0.39, p≤0.001) (Table 5).

The Scheffe test did not show any association between job satisfaction among the nurses and working shift (p=0.02) (Table 2).

The one-way analysis of variance test (ANOVA) showed a significant positive association between income level (p<0.001) and job satisfaction among the nurses (Table 3).

The Scheffe test showed a significant association between job satisfaction and the type of duties allocated (p=0.02) (Table 4).

Discussion

The study found that the more favourable the ethical climate, the higher the level of job satisfaction reported by the nurses.

Considering the relationship between the ethical climate at work and job attrition, Hart found a significant relationship between a poor ethical climate and job attrition. Factors such as the number of patients, the adequacy of the nursing staff, and supervision of nursing activities also influenced change of job or career (17).

According to ElÇi and Alpken, the pursuit of self-interest by employees has a negative influence on work satisfaction, whereas working with the team’s interest in mind, social responsibility, and professional codes have been found to have a positive impact <a class="reference" href="#eighteen" data-placement="top" data-trigger="hover" rel="tooltip" title="Elçi M, Alpkan L. The impact of perceived organizational ethical climate on work satisfaction. J Bus Ethics. 2009;84:297-311.” id=”18″>(18).

A study by Jaramillo et al found that the ethical climate has a positive effect on a salesperson’s satisfaction, which, in turn, leads to a lower employee turnover, greater organisational commitment, and better job performance (19). Olson considers the ethical climate an organisational variable which can be managed and modified in order to improve the work environment.

The ethical climate provides a basis for ethical decision-making in organisations. When healthcare organisations enable their employees to talk to others about difficult issues, such as those faced by nurses in the care of patients, and allow them to feel that they can consult their colleagues, managers or clinicians, they create conditions which promote ethical thinking, ethical dialogue, hope and problem-solving. The work environment affects the behaviour and beliefs of the employees; hence, the work environment must be designed to strengthen relations between nurses and physicians, and to increase job satisfaction (15).

Sumner and colleagues, while investigating why nurses in the USA leave the profession, found that nurses sacrifice their interests for their patients’ needs. They may experience

frustration and moral tension when they are unable to meet their patients’ needs and also their own (20).

Among the demographic variables, the income level and type of duties allocated to the nurses had a significant statistical relationship with job satisfaction.

There was a significantly positive association between the nurses’ income level and the level of job satisfaction. This result is consistent with other studies. Manookyan et al found that nurses’ income was directly related to their job satisfaction (21). Studies also show that the best indicator of job satisfaction is the individual perception of the level of respect and compensation the organisation offers to acknowledge individual worth and merit (22).

As for the type of work allocation among the nurses, those who worked in a team had a higher level of job satisfaction than those who worked individually. This suggests that there is a synergy in team work (23).

Conclusion

The results of our study indicate that hospital managements should pay more attention to the factors that motivate nurses and give them job satisfaction. Valuing the nursing profession, allowing scope for job diversification, and maintaining a respectful relationship with nurses all make nursing more productive and provide nurses with opportunities to improve their performance. The direct relationship between the ethical climate of the workplace and the job satisfaction of the nurses covered by this study highlights the necessity of considering measures that might strengthen the ethical climate. One way of promoting the ethical climate of the nurses’ workplace and increasing their job satisfaction is to establish a code of nursing ethics, disseminate the provisions of the code, and monitor and evaluate its implementation.

Data-sharing statement

Two more articles were captured from the thesis (24), but these have been published only in the Persian language. An article entitled “The relationship between the moral climate at work and the job satisfaction of Iranian nurses” has been published in an Iranian journal (Medical Ethics) and its abstract is not in English (25). Another article entitled “Relationship between moral distress and job satisfaction among nurses of Tehran University of Medical Sciences hospitals” has been published in Hayat and its abstract is in English (1).