Job stress, Job Performance, and Leadership support
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Occupational stress, job satisfaction and job performance among hospital nurses in Kampala, Uganda
ROSE C. NABIRYE P h D , M P H , R N 1, KATHLEEN C. BROWN P h D , R N 2, ERICA R. PRYOR P h D , R N 3 and ELIZABETH H. MAPLES P h D , M P H 4
1Lecturer, Department of Nursing, School of Health Sciences, Makerere University, Kampala, Uganda, 2Professor and Chair, 3Associate Professor, Community Health, Outcomes and Systems, School of Nursing and 4Assistant Professor, Department of Environmental Health, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
Introduction
Occupational stress, job satisfaction and job perfor-
mance are reported to be interrelated. Occupational
stress has been reported to affect job satisfaction and
job performance among nurses, thus compromising
nursing care and placing patients� lives at risk. Occu- pational stress is a complex phenomenon defined in
multiple ways by different theoretical models (Clegg
2001). In the present study occupational stress is
Correspondence
Rose C. Nabirye
Department of Nursing
School of Health Sciences
College of Health Sciences
Makerere University
Kampala
Uganda
E-mail: [email protected]
N A B I R Y E R . C . , B R O W N K . C . , P R Y O R E . R . & M A P L E S E . H . (2011) Journal of Nursing
Management 19, 760–768
Occupational stress, job satisfaction and job performance among hospital nurses in Kampala, Uganda
Aims To assess levels of occupational stress, job satisfaction and job performance among hospital nurses in Kampala, Uganda; and how they are influenced by work
and personal characteristics.
Background Occupational stress is reported to affect job satisfaction and job per-
formance among nurses, thus compromising nursing care and placing patients� lives at risk. Although these factors have been studied extensively in the US and Europe,
there was a need to explore them from the Ugandan perspective.
Methods A correlational study was conducted with 333 nurses from four hospitals in
Kampala, Uganda. A questionnaire measuring occupational stress, job satisfaction and
job performance was used. Data were analysed using descriptive statistics and A N O V A .
Results There were significant differences in levels of occupational stress, job sat-
isfaction and job performance between public and private not-for-profit hospitals,
nursing experience and number of children.
Conclusions Organizational differences between public and private not-for-profit
hospitals influence the study variables.
Implications for Nursing Management On-the-job training for nurse managers in
human resource management to increase understanding and advocacy for organi-
zational support policies was recommended. Research to identify organizational,
family or social factors which contribute to reduction of perceived occupational
stress and increase job satisfaction and job performance was recommended.
Keywords: East Africa, hospital nurses, job performance, job satisfaction, occupational stress, Uganda
Accepted for publication: 22 December 2010
Journal of Nursing Management, 2011, 19, 760–768
DOI: 10.1111/j.1365-2834.2011.01240.x 760 ª 2011 Blackwell Publishing Ltd
defined as the harmful physical and emotional response
that occurs when the requirements of the job do not
match the resources, capabilities and needs of the
worker (Bianchi 2004, Alves 2005, Lindholm 2006,
Nakasis & Ouzouni 2008). Workload as a result of
staff shortage has been reported to be the major source
of occupational stress (Lee & Wang 2002). Job
satisfaction, which refers to the level or degree to which
employees like their jobs, is affected negatively by
occupational stress (Spector 1997). On the other hand,
job satisfaction is reported to enhance job performance
which refers to how effectively an individual carries
out the roles and responsibilities related to his/her job
(AbuAlRub2004). Research has also indicated that indi-
vidual differences such as age, education and experience
affect the perception of the stressful situations, job satis-
faction and job performance (Kirkcaldy & Martin 2000,
Lee & Wang 2002).
Uganda, like all of sub-Saharan Africa, is experienc-
ing a severe human resource crisis in health care as a
result of long-standing economic and political factors.
For example, in 2004, 30 000 health care workers were
employed, but an extra 5000 qualified staff were still
needed to address the serious staff shortage (Dieleman
et al. 2007). The nursing shortage is reported to be se-
vere with one nurse/midwife for every 3065 people or
one nurse to 100 patients. The country is also charac-
terized by poor health and developmental statistics. Life
expectancy at birth for males and females is 48 and
51 years, respectively, and the infant mortality rate is
63.7 per 1000 live births; with 7.6% of gross domestic
product (GDP) expenditure on health (WHO 2005,
Index Mundi 2010). The Ugandan Ministry of Health
has acknowledged inadequate clinic and hospital facil-
ities and the ones that exist are significantly under
resourced and overcrowded with very sick patients
(Ministry of Health 2010). The situation is com-
pounded by the HIV/AIDS pandemic, leading to greater
workload and increased tasks for the nurses owing to
the high number of HIV/AIDS patients.
Bearing in mind the above conditions, there has been
continuous public outcry about poor nursing care in
Ugandan hospitals. In addition, nurses complain that
they must work long hours in spite of the high numbers
of very seriously ill patients who require constant
attention. Nurses further complain that they are stres-
sed because of the high nurse–patient ratio which is
much higher than the WHO recommended ratio of 1 : 2
for fatal complications and 1 : 5 for common illnesses
(Natukunda 2008). A shortage of staff and heavy
workloads lead to occupational stress which has been
shown to affect job performance and job satisfaction.
This situation poses a risk of continuous loss of nurses
in Uganda, either because of stress-related diseases or
attrition as a result of a lack of job satisfaction (UBOS
2005). Furthermore, poor job performance including a
reduced quality of nursing as a result of occupational
stress and lack of job satisfaction is a risk factor for
patient safety (Sveinsdottir et al. 2006).
Stress is a complex phenomenon which results from
an interaction between individuals and their work
environment, local forces, pressures and culture that
requires customized interventions (Muscroft & Hicks
1998). Furthermore, individual characteristics such as
age, nursing education and experience have been re-
ported to affect the perception of stress and the use of
coping strategies. Researchers found that younger
public health nurses with a shorter length of current
work experience, a higher level of education and less
pre-job or job continuing education perceived more
occupational stress (Kirkcaldy & Martin 2000, Lee &
Wang 2002). Thus, the perception of stress and its ef-
fects on job satisfaction and job performance may differ
significantly in different work settings (Evans 2002). To
better understand the practice of nursing in Uganda, the
present study examined four hospitals in Kampala to
assess the levels of occupational stress, job satisfaction
and job performance among the nurses, and examined
the interrelationship of these three variables.
Conceptual framework
The present study was guided by Lazarus and Folk-
man�s cognitive theory of stress and coping (Lazarus & Folkman 1984) and Karasek�s Demand–Control Model (Karasek 1979). According to Lazarus and Folkman
(1984), stress is defined by the interaction between the
individual and the environment. Demands from the
environment exceeding the available resources result in
either stress or coping, dependent on the individual�s appraisal of the environmental effects or stressors. The
variables in the theory that guided this research are
personal and work characteristics. Work characteristics
are environmental stressors whereas personal charac-
teristics facilitate the individual nurse�s ability to con- duct the appraisal of the stressors. The nurse�s perception of how much control he/she has is a factor
which leads to feelings of stress when the situation is
perceived during appraisal as uncontrollable. The De-
mand–Control Model (Karasek 1979) assumes that
psychological strain results from joint effects of work
demands and the decision-making freedom available for
the employee facing the demands. In other words, jobs
with high demands but with low control increase the
Hospital nurses in Kampala, Uganda
ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 760–768 761
risk of stress, thus less job satisfaction and poorer job
performance. The assumption in the model is that
psychological strain results when work demands are
high, and there is low or no decision-making freedom
available for the employee facing the demands. In other
words, jobs with high demands but with low control
increase the risk of stress. The variables in this model,
which guided the study, are job demands and job strain
(workload pressures) as seen in Figure 1.
Literature review
A lot of research has been conducted on occupational
stress, job satisfaction and job performance among
nurses in the US, Europe and South Africa. However,
very little has been done in the other parts of Africa as a
result of the limited research skills and ability to publish
by nurses in Africa (Adejumo & Lekalakala-Mokgele
2009).
Occupational stress
Research has demonstrated that the sources of occu-
pational stress, its levels and its effects vary greatly
depending on local forces such as the nature of work,
work setting and cultural orientation. Thus, significant
differences in occupational stress among nurses in dif-
ferent countries may exist owing to different work
settings and levels of social support (Evans 2002).
Organizational support and perceived social support
are associated with decreased occupational stress (Ab-
uAlRub 2004, Jenkins & Elliott 2004). In addition to
social support, the support perceived by the individual
from the organization is an important factor associated
with occupational stress. The organization may be
instrumental in reducing job demands by improving the
availability of resources such as equipment, adequate
staffing, and promoting policies that facilitate work
performance. Understanding the perception of social
and organizational support among nurses will aide
stakeholders to develop programmes that enhance job
satisfaction.
Occupational stress and job satisfaction
Previous researchers have reported an inverse or nega-
tive relationship between perceived stress and job
satisfaction; that is, as stress increases, job satisfaction
decreases (Flanagan & Flanagan 2002, Sveinsdottir
et al. 2006, Zangaro & Soeken 2007). Job stress and
job satisfaction have also been reported to be influenced
by personal characteristics. For example, significant
inverse correlations were reported between job satis-
faction and age, and years of nursing experience with
job stress (Ernst et al. 2004). Other personal charac-
teristics such as mental and physical health, marital
status, education level, rural/urban setting and per-
ceived HIV stigma were reported to have significant
influence on job satisfaction.
Occupational stress and job performance
A high level of occupational stress has been found to
reduce quality of nursing care. A shortage of nursing
staff owing to turnover as a result of occupational stress
was associated with increased patient mortality rates in
an intensive care unit (Sveinsdottir et al. 2006). How-
ever, in a previous study on job stress, recognition, job
performance and intention to stay at work among Jor-
danian hospital nurses, it was reported that recognition
of nurses� performance had a direct and buffering effect on job stress and the level of intention to stay at work
(AbuAlRub & Al-Zaru 2008). This is consistent with
other literature which has reported that recognition
leads to job satisfaction and low turnover (Cartledge
2001). Morale is another factor which affects nurses� performance. Nurses� morale can be boosted by creating an environment characterized by supportive supervi-
sion, positive feedback and good communication. Job
satisfaction and nurses� perceptions that they are valued may lead to improved work place efficiency and output
(Stapleton et al. 2007).
In summary, occupational stress and its related effects
on job satisfaction and job performance have been
found to differ among professions and work settings.
However, although previous studies regarding these
variables and their relationships have been conducted
worldwide, the majority have been with American and
European nurses in their work settings. Therefore, given
the significance of occupational stress and its relation-
ships with job satisfaction and job performance for
nurses and patients as illustrated by the conceptual
model, the present study was done to assess the situa-
tion in Ugandan hospitals.
Methods
Sample and data collection
The present study used a correlational, cross-sectional
design. The total number of eligible nurses from the
four hospitals was 1242 (52 in private hospital one, 140
in private hospital two, 250 in private hospital three
and 800 in the public hospital). Based on a power
analysis for partial correlation and regression analyses,
the sample size of 321 was considered adequate. Cri-
teria for inclusion in the sample of nurses consisted of
R. C. Nabirye et al.
762 ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 760–768
being a qualified nurse, a full-time employee of the
hospital for at least 6 months, between the ages of 20
and 60 years, and working on a general surgical, med-
ical, paediatric or obstetric/gynaecological ward.
For recruitment, the senior nursing officers in each
hospital facilitated a meeting between the researcher
and the staff nurses who met the sample criteria. At
each of the meetings the objectives of the study were
explained and volunteers were recruited to complete the
survey. The staff nurses were also asked to recruit
others not at the meeting. The research assistants visited
each of the general wards in each hospital several times
to continue to recruit the staff nurses. The number of
nurses recruited was proportionate to the number of
nurses per hospital.
In total, 400 nurses expressed interest, met the crite-
ria and received a questionnaire. Of the questionnaires
distributed 333 were returned (83% return rate). Of
these, 196 were from the public hospital, 25 from pri-
vate hospital 1, 71 from private hospital 2 and 41 from
private hospital 3. This is a sample of 26% of the total
nurses (n = 1242) in all four hospitals. The data were
collected in a 1-month period between March and April
of 2009.
The nurses signed a consent form and completed a
self-administered questionnaire that included measures
of occupational stress, job satisfaction, job perfor-
mance, as well as other personal and work character-
istics. The participants were asked to place the
completed questionnaires in sealed boxes provided on
the wards/units which could only be opened by the
research team.
Instruments
Three instruments were part of the self-administered
questionnaire, and were used to assess and measure
occupational stress, job satisfaction and job perfor-
mance. These included the Nurse Stress Index (NSI)
(Harris 1989), the Job Satisfaction Survey (JSS) (Spector
1997) and the Six Dimension Scale of Nursing Perfor-
mance (6-DSNP) (Schwirian 1978). The questionnaire
also included a section to identify and assess personal
characteristics such as age, gender, marital status,
number of children, nursing education, nursing experi-
ence and type of ward/unit.
The NSI aims at measuring stress among nurses in
hospital and community settings and consists of six
subscales: workload pressures related to insufficient
time (managing workload 1), workload pressures owing
to resources and conflicting priorities (managing
workload 2), organizational support and involvement,
dealing with patients and relatives, home and work
conflicts, and confidence and competence in role items.
The NSI has acceptable levels of reliability and validity
with an overall Cronbach�s alpha of 0.90 (Harris 1989). The JSS aims to assess the degree to which people like
their jobs by assessing nine facets or sub-scales: pay,
promotion, supervision, fringe benefits, contingent re-
wards, operating conditions, coworkers, nature of work
and communication. Reliability and validity of the
instrument was established with an overall Cronbach�s alpha score of 0.91 (Spector 1997). The 6-DSNP as-
sesses the nurse�s effectiveness in carrying out his/her roles and responsibilities in relation to patient care. The
area examined include: leadership, critical care, teach-
ing/collaboration, planning/evaluation, interpersonal
relations/communication and professional develop-
ment. Reliability and validity of the 6-DSNP was
established and Cronbach�s alpha coefficients for each sub-scale ranged from 0.90 to 0.97 (Schwirian 1978).
The three instruments were reviewed by five Ugandan
nurses who were not working in any of the study hos-
pitals to confirm that the language was appropriate and
understandable in the context of nursing in Uganda.
Data analysis
All data were analysed using S P S S v.16 (SPSS Inc., Chi-
cago, IL, USA). Descriptive analyses included frequen-
cies and percentages for categorical variables and means
and standard deviations (SDs) for continuous variables.
The data were grouped by hospitals and group differ-
ences in mean NSI, JSS and 6-DSNP scores were eval-
uated using one-way analysis of variance. When there
was a difference in variance, a Tukey�s post-hoc test was completed to further examine those differences. This
was done to identify if there were statistical differences
in means for the variables under study by work or
personal characteristics.
Ethical considerations
Institutional Review Board approvals were received
from the University of Alabama at Birmingham (UAB),
Makerere University College of Health Sciences in
Kampala, Uganda and the hospitals where the study
was conducted.
Results
Demographic characteristics of the sample are shown in
Table 1. The participants were aged between 20 and
60 years with a mean age of 36 years (SD = 9.1).
Hospital nurses in Kampala, Uganda
ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 760–768 763
A majority of the participants were female (95%). More
than one-third (41%) had between one and two chil-
dren and 29% had between three and four children.
There were no significant demographic differences be-
tween the nurses in the four hospitals.
Occupational stress
Descriptive analysis of levels of occupational stress by
demographic characteristics (age, gender, marital status
and number of children) indicated that nurses of all age
groups experience high stress, with mean scores ranging
from 75.5 to 90.3 on the NSI scale (range between 30
and 150, with the higher number equal to more stress).
The older age group of 50–60 years reported the highest
mean score of 90.3 followed by the 40–49 years age
group with a mean score of 84.9. There was a signifi-
cant difference in occupational stress mean scores
among the age groups (F = 4.99, P = 0.002). Post-hoc
tests revealed that the youngest age group (20–29 years)
was significantly less stressed than the 30- to 39- or the
40- to 49-year-old age groups (all P < 0.05). Significant
differences in mean scores for occupational stress by
number of children were found (F = 3.56, P = 0.015),
with post-hoc results indicating that nurses with no
children had significantly lower occupational stress than
those who had 1–2 or 3–4 children (all P < 0.05).
Occupational stress in relation to work and charac-
teristics (hospital, nursing education, ward/unit, nursing
experience, responsibility and hours worked on a typi-
cal day) was also examined. The public hospital had the
highest mean score of occupational stress (mean =
88.27, SD = 20.87) whereas the three private hospitals� means ranged from 73.35 to 76.09. Further analysis
indicated a significant difference in mean scores of stress
among the different hospitals (F = 14.46, P < 0.001).
The nurses with a higher educational level reported the
highest stress levels with the means ranging from 82.42
for the Baccalaureate-prepared nurses to 91.61 for the
diploma-registered nurses. There were also significant
differences in stress levels among all the different edu-
cation level groups (F = 4.16, P = 0.001).
No significant differences in levels of stress were
found in nurses from different wards/units. The nurses
who had worked for more than 20 years reported the
highest levels of occupational stress (mean = 90.50,
SD = 25.55) whereas nurses with five or less years of
experience reported the lowest levels of stress
(mean = 73.54, SD = 18.42). The differences in stress
levels between working experience groups was statisti-
cally significant (F = 6.663, P < 001). Post-hoc results
revealed that occupational stress levels for nurses with
1–5 years of experience were significantly lower than
for nurses with 6–10, 11–15 or 21 or more years of
experience (P < 0.05).
The results indicated that there was no significant
difference in mean stress levels between nurses with
extra responsibility and those without. However, there
was a statistically positive relationship between hours
worked on a typical day and occupational stress in that
as hours worked increased, so did occupational stress
(F = 8.588, P < 0.001).
Job satisfaction
According to the JSS tool, participants can be assigned
to satisfaction, ambivalent or dissatisfaction categories
(Spector 1997). The majority of respondents were
ambivalent as to whether they were satisfied with their
jobs or not (68%), 17.4% reported satisfaction with
their job whereas 15% reported dissatisfaction.
Job satisfaction levels among the age groups were
shown to be statistically different (F = 5.623,
P = 0.001) with post-hoc results revealing that nurses in
the 20–29 year age group had statistically higher job
satisfaction than the 30–39 or 40–49 years age groups.
Significant differences in levels of job satisfaction were
found among the hospitals (F = 11.30, P < 001). Reg-
istered Nurses reported the lowest job satisfaction
whereas the Enrolled Nurses and midwives reported
the highest levels of job satisfaction with mean scores.
These results indicated that the difference in job
Table 1 Socio-demographic characteristics of the sample frequencies and percentages (n = 333)
Characteristic Frequency %
Age* 20–29 91 27.33 30–39 135 40.54 40–49 71 21.32 ‡50 36 10.81
Gender Female 317 95.20 Male 16 4.80
Marital Status Married 206 61.86 Divorced/separated 32 9.61 Widow/widower 11 3.30 Never married 84 25.23
Number of children� 0 68 20.42 1–2 138 41.44 3–4 98 29.43 ‡5 29 8.71
*Mean = 36.02; SD = €9.11. �Mean = 2.19; SD = €1.84.
R. C. Nabirye et al.
764 ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 760–768
satisfaction levels by level of nursing education was
statistically significant (F = 3.961, P = 0.002). In addi-
tion, a significant difference in job satisfaction was
indicated among the years of nursing experience groups
(F = 6.597, P < 0.001). Post-hoc results revealed that
nurses with less years of nursing experience had more
job satisfaction than those with more experience.
Although nurses without extra responsibility (not
ward or unit in-charges or deputies) reported a slightly
higher level of job satisfaction than those with this
responsibility, the difference was not significant. Like-
wise, there were no statistically significant differences in
job satisfaction between nurses working on different
ward/units.
Job performance
Job performance was assessed using column B overall
mean scores of the 6-DSNP which assesses nurses� self- rated job performance quality. The mean score for
teaching and collaboration scale was the lowest at 2.76
(SD = 0.57) whereas professional development and
critical care had the highest mean scores of 3.23
(SD = 0.56) and 3.17 (SD = 0.43), respectively. A sig-
nificant difference in job performance means among the
number of children groups was observed. Nurses
without children had higher mean scores for job per-
formance than those with five or more children. No
significant differences in job performance were found by
age group or by marital status.
Significant differences in job performance were also
found by type of hospital with the public hospital
having the lowest mean score (F = 7.95, P < 0.001).
However, there was no significant difference in job
performance mean scores between the nursing educa-
tion groups. As seen in Table 2, the groups which
reported higher perceived occupational stress also
reported lower job satisfaction and job performance.
In summary, analysis of the influence of hospital type
on means of occupational stress, job satisfaction and
job performance revealed statistically significant differ-
ences between the hospitals. Post-hoc results indicated
significant differences in occupational stress, job satis-
faction and job performance by type of hospital (public
vs. private not-for-profit). Nurses in the public hospital
reported more occupational stress, had less job satis-
faction and rated themselves more poorly on job per-
formance than those in private not-for-profit hospitals.
Table 2 Comparison of means for occupational stress, job satisfaction and job performance by work and personal characteristics
Characteristic
Occupational stress Job satisfaction Job performance
Mean (SD) Mean (SD) Mean (SD)
Hospital Public 88.3 (20.9) 123.00 (18.8) 2.96 (0.45) Private 1 76.1 (23.5) 129.84 (14.7) 3.32 (0.40) Private 2 72.2 (20.0) 136.95 (16.5) 3.15 (0.34) Private 3 73.4 (16.4) 132.46 (21.3) 3.12 (0.38)
F = 14.46, P < 0.0001 F = 11.30, P < 0.0001 F = 7.95, P < 0.0001 Nursing education
Enrolled nurse 75.4 (21.6) 134.27 (20.2) 3.12 (0.36) Enrolled midwife 79.2 (17.0) 132.07 (17.3) 3.02 (0.37) Registered nurse 85.0 (21.0) 123.14 (16.3) 3.11 (0.42) Registered midwife 80.0 (20.1) 127.00 (17.2) 2.84 (0.49) Double trained 91.6 (25.7) 123.84 (23.3) 3.00 (0.47) BSN and above 82.4 (15.9) 126.27 (19.2) 3.19 (0.44)
F = 4.16, P = 0.001 F = 3.96, P = 0.002 F = 3.60, P = 0.004 Ward/unit
Medical 83.28 (21.8) 127.47 (19.9) 3.11 (0.42) Surgical 87.29 (22.1) 123.95 (16.8) 2.98 (0.43) Obs./Gyn. 79.09 (19.5) 130.44 (18.9) 2.95 (0.45) Pediatrics 80.48 (23.8) 126.75 (20.4) 3.17 (0.37)
F = 1.94, P = 0.124 F = 1.47, P = 0.222 F = 4.34, P = 0.005 Nursing experience (years)
1–5 73.54 (18.4) 135.53 (19.6) 3.13 (0.40) 6–10 83.21 (22.0) 125.71 (17.3) 3.02 (0.45) 11–15 87.34 (18.1) 119.70 (17.4) 3.06 (0.35) 16–20 79.02 (19.8) 126.37 (18.0) 2.95 (0.47) 21+ 90.50 (25.6) 128.20 (20.8) 3.03 (0.47)
F = 6.66, P < 0.001 F = 6.60, P < 0.001 F = 1.46, P = 0.214
Hospital nurses in Kampala, Uganda
ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 760–768 765
Discussion
The results indicated that nurses in Ugandan hospitals
experience moderate levels of occupational stress. In the
present study, the older age groups, 40–49 and 50 years
and above, and nurses with more than 20 years of
experience reported the highest stress scores. These re-
sults contradicted previous studies in the United States
in which young public health nurses and those with less
experience perceived more occupational stress than
older nurses (Kirkcaldy & Martin 2000). Bachelor of
Science in Nursing (BSN) or higher educational levels
reported higher perceived stress, which is in agreement
with previous research (Lee & Wang 2002).
It is not clear why nurses with higher education and
more experience perceived more stress, but one possible
explanation could be role conflict and role ambiguity. It
has been reported that organizational and management
attributes of work environments and institutional set-
tings influence work-related stress among nurses (Sve-
insdottir et al. 2006). In Uganda, nurses with BSN or
masters degrees have no clear roles in the public hos-
pitals and have no scheme of service in the Public Ser-
vice. Role conflict and role ambiguity may contribute to
stress for these nurses. However, as the current study
did not explore organizational factors related to occu-
pational stress, there is a need for further research to
identify sources of stress for nurses with higher educa-
tional qualifications in Uganda.
With regards to job satisfaction, nurses with lower
educational qualifications (Enrolled Nurses and
Enrolled Midwives) reported the highest levels of job
satisfaction whereas those with higher education qual-
ifications (RN, BSN and higher) reported the lowest
levels of job satisfaction. Nursing experience also
influenced job satisfaction with less experienced nurses
reporting higher levels of job satisfaction than those
with more experience. It is not clear why those with a
higher education level and more experienced nurses in
the present study reported less satisfaction in their jobs.
These results indicate a pattern which may be unique
to the Ugandan situation. It can be argued that older
nurses in Uganda may report more job stress because
of social responsibilities such as caring for family
members and a probable lack of social support. Nurses
with less experience are usually younger and have less
responsibility, especially in the social context of
Uganda. The older, more experienced nurses may have
larger families to care for, with the associated stress of
those responsibilities and the possible perception that
work could be interfering with their family lives (Patel
et al. 2008). The number of children or the size of the
family has financial implications for the nurse in the
Ugandan social structure. In Uganda, employed family
members are expected to provide financial support for
their immediate and extended family members. Fur-
thermore, higher levels of job satisfaction and job
performance were found in nurses with no children
than in nurses who had children. These results dem-
onstrate the influence of family size in relation to job
stress, job satisfaction and job performance for nurses
in Uganda.
In the present study, the lower job satisfaction found
among experienced nurses may also be as a result of the
fact that nurses who have worked for more than
10 years are often seeking promotion or advanced
opportunities. These nurses could also be interested in
becoming involved in decision and policy making at
their workplace or receiving recognition for good work.
This was observed in a recent study on satisfaction and
intention to stay among current health workers in
Uganda by the Ministry of Health (Ministry of Health
2007). Previous literature has demonstrated that nurses
are likely to report low job satisfaction if they do not
receive promotion and advancement opportunities
(Lephalala et al. 2008).
Results of the present study indicated a significant
difference in job performance means by type of hospi-
tal. Furthermore, the public hospital had the lowest
mean score for job performance among the four hos-
pitals and there was a significant difference in means for
the different hospitals. These results concur with a study
done in Thailand where nurses in the public hospitals
had more stress than those in private hospitals (Tyson
& Pongruengphant 2004). Although no study compar-
ing the public and private hospitals has been conducted
Work and personal factors Cognitive factors Behavioural outcome
Workplace factors:
- Type of hospital Type of ward/unit
- Responsibility
- Hours worked on a typical day
Occupational stress
Job performance
Job satisfaction
Personal characteristics:
- Age - Nursing education - Nursing experience - Marital status - Number of
children
•
Figure 1 Conceptual framework.
R. C. Nabirye et al.
766 ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 760–768
in Uganda, this may be an indication that there are
differences in organizational support issues between the
public and private not-for-profit hospitals.
The present study had several limitations. Occupa-
tional stress measurement was based on self-report ra-
ther than by physiological biochemical analyses of
blood or by physical and mental status assessments. The
instruments utilized in the present study were based on
American and European populations and may not have
been culturally appropriate for the Ugandan nurses, and
the use of a convenient sample may have biased the
results.
Implications for nursing management
The Uganda Ministry of Health and nurse managers
should put in place policies which enhance organiza-
tional support to the nurses such as hiring, retention
and promotion policies. This will ensure that more
nurses are on the job, reduce the work overload and
increase job satisfaction and job performance. Further,
Nurse Managers and other administrators in health care
settings should be trained in human resource and
organizational management so that they are equipped
with skills to address the above issues.
Implications for nursing practice
Nurse Managers should identify motivation strategies
such as good communication and recognition for
excellent work, which may motivate workers and thus
reduce perception of occupational stress and increase
job satisfaction among their nurses. Nurse leaders
should also advocate for better working conditions that
would improve nurse satisfaction with their jobs, such
as better pay, fringe benefits and provision of adequate
resources.
Implications for further research
The results of this study highlight the fact that nursing
experience and family responsibility influence hospital
nurses� perception of occupational stress, job satisfac- tion and job performance in Uganda. Furthermore, it
indicates that there are differences in perception of
occupational stress, job satisfaction and job perfor-
mance among nurses in public and those in private not-
for-profit hospitals. Therefore, further research on
organizational factors which influence job satisfaction
and job performance in public vs. private not-for-profit
hospitals in Uganda is recommended. In addition,
research on how family and or social support influences
nurses� perception of occupational stress, job satisfac- tion and job performance is recommended.
Acknowledgements
The following are acknowledged for the scholarship awards which enabled the principal researcher to complete her Doc- toral Program and research: UAB-ICER Training Grant, Sig- ma Theta Tau Nu Chapter, The Gladys Farmer Colvin Memorial Scholarship, Makerere University Staff Develop- ment and Training Division and Makerere University School of Graduate Studies.
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