There has been a significant growth of the primary health care nursing workforce in recent decades in response to health system reforms and the changing health needs of the community(1-4). In Australia, there are now over 13,000 nurses identifying as working in general practice settings compared with less than 3,000 a decade ago(5). While government strategies have created a positive policy environment for the growth of nursing in primary care much of this growth has been adhoc and has not incorporated mechanisms for the monitoring and evaluation of workforce growth(6).
Job satisfaction is an important factor contributing to provider well-being and is a recognised antecedent to nursing retention(7, 8). The notion of job satisfaction is a combination of the nature of the work, how an individual feels about their work and the persons’ expectation of what the work should provide(9). To this end, job satisfaction encompasses factors such as the work environment and conditions, role conflict and ambiguity, stress and conflict, role perceptions and professional commitment(7). Given the complexity of these issues it is apparent that exploration of job satisfaction needs to be undertaken in specific clinical settings rather than being generalised across clinical areas. Given the rapid growth of nursing in primary health care it is timely to explore the job satisfaction of nurses working in this context. Understanding issues like job satisfaction and career intentions are essential to building workforce capacity and skill mix within the healthcare environment, as well as promoting provider well-being(7).
b) Methods/Strategies
Initially an integrative review of the literature was conducted using the approach of Whittemore and Knafl(10) to critically synthesise the international literature around job satisfaction and career intention in primary health care(7).
As nurses in general practice comprise the largest group of nurses in Australian primary health care, in 2017, an online survey of general practice nurses within South Western Sydney Primary Health Network (SWS PHN) was conducted using Survey Monkey. Job satisfaction was measured using a tool reported by Delobelle(8), whilst career intention were measured using a modified version of the Nurse Retention Index(11). The survey was distributed to all nurses via email as well as being advertised on the SWS PHN website and newsletters.
c) Results/Outcomes
The review comprised twenty peer-reviewed papers. There was a lack of consensus on the factors which impacted job satisfaction across studies. The review highlighted that further robust research in specific clinical settings was required to build an evidence base.
Of the 354 eligible general practice nurses, 93 completed the survey (26.3% response). Participants were largely satisfied with their employment. Relationships with co-workers, having people to talk to, feeling like part of the team and having a sense of pride in the job created the highest satisfaction. In contrast, the lowest satisfaction was related to remuneration, performance evaluation and training opportunities.
Age and years of nursing experience were both significantly related to job satisfaction (p<0.05). In terms of modifiable factors, having a nurse leader, being able to work to the extent of one’s scope of practice and not feeling isolated, alone or lacking support were all statistically significantly related to high levels of satisfaction.
Half of the participants agreed or strongly agreed that they intended to remain employed in general practice for the foreseeable future. However, 6.7% participants disagreed and 43.4% participants indicated that they were unsure about their future career intentions. Twenty percent of participants agreed that they would like to leave general practice nursing and find other employment.
d) Conclusions/Implications
Though most participants were satisfied in their job, a significant group were still unsure about their career future in general practice. This highlights the need for further interrogation of the data and exploration of the career intentions of these participants.
These data provide important local insights that can inform practice support programs and workforce planning. At a broader level these data inform policy makers, professional groups and primary health care organisations. The modifiable factors identified in this study to significantly impact job satisfaction provide evidence upon which to build professional support and retention strategies. Implementing evidence-based strategies to address the issues around job satisfaction and future career intentions will ensure that the nurses employed in Australian general practice are satisfied, promote provider well-being and ensure that skilled nurses are retained. This has a clear flow on effect to workforce capacity, the healthcare environment and quality of patient care delivered.