Nurses' Motivation and Satisfaction at Work: an Exploratory Study at the Centro Hospitalar S. João

n. 558 April 2015 ISSN: 0870-8541 Nurses' Motivation and Satisfaction at Work: An Exploratory Study at the Centro Hospitalar S. João Fátima Gomes 1 Teresa Proença 2,3 1 Hospital de São João 2 FEP-UP, School of Economics and Management, University of Porto 3 CEF.UP, Research Center in Economics and Finance, University of Porto 1 Nurses’ Motivation and Satisfaction at Work: an exploratory study at the Centro Hospitalar S. João Fátima Gomes Hospital de S. João [email protected] Teresa Proença CEF.UP, Faculdade de Economia, Universidade do Porto [email protected] Abstract This study aims to assess nurses’ motivation and satisfaction and measure the impact of socio-demographical and socio-professional variables, namely professional contract. A questionnaire was delivered to a sample consisting of 560 nursing professionals of the second major Hospital in Portugal, Hospital São João (HSJ): 277 nurses on public contract, 173 on open ended contract and 110 on fixed term contract. Results show that the relationship with the patients is the most important factor for nurses’ satisfaction, followed by satisfaction with the job content. Remuneration is the factor in which nurses show the least satisfaction. Nurses with a fixed contract, the most insecure of all, are the ones with greater motivation and satisfaction, contrary to what is expected according to content motivational theories. However, they also have greater expectation that their performance can improve their contract, what may explain the previous results. This paper also suggests that work and the type of contract has an impact on personal life and vice-versa, namely on the intent of leaving the job, on the marital status and the number of children. Keywords: motivation, satisfaction, nursing, professional contract JEL Codes: J28 2 1. Introduction The current economic environment in Portugal has aggravated the crisis that is felt in every sector, including employment. The uncertainties in health organizations accentuate and lead to political, social, judicial and economic changes that seek to respond to and soften the crisis situation. Among the many changes, work and contractual relationships have changed the most, with a rapid and extensive transformation that is causing profound impact and apprehension among health professionals as workers and as citizens. Many professionals have been made redundant, for others the professional contract has been altered, and those who have more recent qualifications are not given employment opportunities or financial compensation, among other difficulties. In light of the effects of the economic and social crisis it is timely to review professional worker’s motivation, specifically whether nurses are unmotivated, and if so, what factors de-motivated them – or to the contrary, motivated them to maintain their best work performance in health organizations to which they are bonded. Nursing professionals have been compromised with different kinds of contracts and, therefore, in spite of having similar duties and jobs, are subject to different rules with all the implications this can bring. The employment contracts that coexist in EPEs (Entidades Públicas Empresariais – Public Corporations) have three types of contracts: the Open Ended Contract (OEC), the Fixed Term Contract (FTC) and the older public contract CTFP, (Contrato de Trabalho em Funções Públicas): - OEC: is agreed upon for situations where the time duration which the worker will be needed cannot be determined at first. In this contract the Organization can only end the contract in special cases and established conditions in the labor law, thus tending to be durable. - FTC is agreed upon for a determined period, renewable for one-year periods for a maximum of three years, since it aims to meet the temporary needs of the organization, under article 140º, n.º 2, paragraph a), of the labor law approved by the n.º7/2009 Law, 12th February. This contract has greater job insecurity for nurses compared to the former, since at the end of the period the contract cannot be renewed and they will become unemployed. - CTFP - is the older public contract and it is the most secure and most favorable to employees concerning health benefits, hour load and vacations days. 3 In Table 1 a comparison of the different labor conditions for the three types of contracts is presented. In general, the CTFP has more advantages for employees. According to the Working Hours and Attendance Regulation of the Centro Hospitalar S. João – WHAR, the number of vacation days is higher in the CTFP. The hour load is another difference, with 35 weekly hours of work for the CTFP and 40 weekly hours of work for the FTC and OEC. This difference is balanced by the Attendance Award which the latter two employ in their monthly wage. The CTFP also allows ADSE health benefits (Directorate-General of Social Protection for the Public Services Officials) that are extendible to family members. This is not extendible to the OEC. Since ADSE does not extend to OEC, the social fulfillment of the right to social security is put into effect by the Social Security System, approved by Law n.º 4/2007, of 16th January, which defines the general framework in which it is settled and its objectives, namely the fulfillment of this right and the promotion of social protection. Security and stability at work, more vacation days and the benefits of ADSE are the three big advantages of the CTFP. Table 1 – Types of contracts and their characteristics Kinds of Contracts Conditions CTFP OEC FTC Hour load 35 hours/week 40 hours/week 40 hours/week Vacation days 25 days + 1 for each 10 working years + 1 for each 10 working years past 39 years-old. 22 days + 3 days (in conformity with absences throughout that year). 22 days + 3 days (in conformity with absences throughout that year). Social Protection ADSE Social Security System Social Security System Attendance Award Non applied Present Present Absence Regime or Justified Absence from work EX: Without loss of privilegies Attendance Award loss in conformity with the WHAR. Attendance Award loss in conformity with the WHAR. Employment Bond Definitive Definitive and soluble in specific cases in conformity with the labor law Renewable for oneyear periods and three years maximum. Career Development In conformity with the diploma which regulates the special nursing career. Need for Collective Agreement Need for Collective Agreement 4 Based on various need theories, nurses who have their security needs satisfied should feel more motivated than those with unstable contractual bonds, in spite of wage and benefit reductions that have occurred in all groups The purpose of this paper is to contribute to a better understanding of the factors which motivate nurses and to promote guidance about the management of this professional group. A sample of nursing professionals at the second major Hospital in Portugal, Hospital São João (HSJ), was queried. 2. Motivation and Satisfaction at Work There are numerous definitions of motivation, emphasizing either the energetic character of motivation behavior at the beginning of the pursuit of a goal (content or need theories) or the cognitive character, which supports the underlying decision mechanisms along the course and intensity of motivated behavior (process theories) (Carneiro, 2009). Content theories identify human needs and explain motivational factors, identifying behaviors which satisfy the needs. They are characterized by the importance attributed to various needs and to the methods used in their satisfaction. According to these theories, a satisfied employee is a productive employee, i.e., the person attains the expected performance and productivity if he/she feels that his needs are satisfied. Abraham Maslow (1954), unquestionably the most prominent author of need theory, established his ideas on the assumption of an upward hierarchical need satisfaction. He holds that the higher level needs can only be reached after all the preceding needs are satisfied. Nevertheless, Maslow (1954) acknowledges that exceptions may arise when needs of a superior nature are at stake, and can be met before the immediately preceding level is satisfied. Initially his theory had seven distinct levels, but after some modifications five categories were formed under the following ascending order: physiological needs which refer to homeostasis maintenance and are indispensable to survival; security needs which include the desire of protecting oneself as well as one’s family from danger; social needs which refer to the desire to belong to a group and of being accepted by others; esteem needs which are the individual’s desire for distinguishing himself in the group where he participates and more specifically of obtaining prestige and power; self-fulfillment needs which include the desire for 5 psychological growth, continuous improvement of personal capacities and excellence, bestowing a permanent challenge for the individual’s life (Ramos, 1990). Besides Maslow, Herzberg (1959) also made a valuable contribution without opposing Maslow’s ideas, but looking at the Satisfaction side of work instead. Steuer (1989) refers to motivation as manifesting the created tension for a need and that satisfaction expresses the feeling of attending to that need. Satisfaction at work is considered to be a pleasant emotional state resulting from the individuals’ assessment of their work, which results from the persons’ perspective on the satisfaction of their most important values at work (Locke, 1969, 1976). Satisfaction and dissatisfaction at work are considered by some authors as the two extremes of the same phenomenon, which is noticeable in studies whose scales measure this construct by using both concepts in opposing extremes in Lickert’s scales (Begley & Czajka, 1993; O’Driscoll & Beehr, 2000). However, other authors, such as Herzberg (1959) with his dual-factor or motivational-hygiene theory, make a distinction between satisfaction and dissatisfaction, considering them as two distinct phenomena. For Herzberg (1959) not every need motivates, since some only avoid dissatisfaction. For this author, motivation is divided in two categories: hygiene factors – considered as extrinsic and preventive of dissatisfaction, and are related with the work context in the way a person feels about the company, working conditions, wages, benefits, status and interpersonal relationships; motivational factors – intrinsic factors related to the person’s feeling concerning the job position, personal fulfillment, performance acknowledgement and responsibilities associated with the job, which are in themselves gratifying. Process theories focus on the cognitive processes underlying the conscious mechanisms of decision making. According to these theories, satisfaction is a result of performance and productivity attained, whereas according to need theories, satisfaction allows performance. Among process theories, the theory of cognitive dissonance (Festinger, 1954) and its derivatives; Equity theory (Adams, 1963) and Expectancy theory (Vroom, 1964), are the ones that stand out. The Theory of Cognitive Dissonance, formulated by Festinger (1954), comes from the assumption that human beings, by means of an individual process of self-evaluation, form their own self-image and use it as a comparative measure concerning other people or the characteristics that they consider similar to their own. Inconsistencies between an 6 individual’s self-evaluation and the exterior results in cognitive dissonance – a mechanism that generates stress. This is the vehicle that drives a person to develop overcoming behaviors and to achieve a state of consonance or psychological balance. The Equity Theory (Adams, 1963) holds that in the workplace persons are constantly comparing their contributions (performance, responsibilities) and their compensations (wage, acknowledgement) with their work peers. Thus, a perception equity or inequity emerges. If the worker perceives inequity, either due to insufficient or excessive compensation, he/she tends to behave in a way so as to balance that correlation by increasing or decreasing his/her performance levels in a quest for equity. There are studies which demonstrate increases of performance in workers with excessive compensation (Adams & Rosembaum, 1962) and performance decrease in workers with compensations deficit (Goodman & Friedman, 1969). Vroom’s Expectancy Theory (1964) argues that motivation stems from the individual’s estimates about achieving a goal, to which he /she assigns a given value. The effort will depend on the interaction of three cognitive factors: valence (the value which a person attributes to a certain goal or reward), instrumentality (the possibility that performance may be used to achieve a reward) and expectancy (the person’s expectation of achieving the goals and the proposed performance). These three factors together determine the motivational level of a person, represented by VIE (Valence x Instrumentality x Expectancy). According to the author, motivation is a multiplied product, which implies that when one of them is zero, the final outcome will also be a void motivation. The motivational process results, therefore, from the interrelationship between the three aforementioned factors. If a person expects to be capable of accomplishing a certain task (Expectancy) and that the accomplishment can lead him/her to reach a fulfilled goal or reward (Instrumentality) to which value is attributed (Valence), it can be stated that the person is properly motivated. Another important relationship to take into account in work satisfaction is workers’ health. Some studies point to a positive association between satisfaction at work and health quality (Henne & Locke, 1985; Peterson & Dunnagan, 1998). This means that work satisfaction is associated with good health quality and dissatisfaction at work is associated with health problems like fatigue, digestive problems and muscle pains, among others. Henne and Locke (1985) corroborate these results, mentioning that satisfaction is an emotional state and that emotions imply involuntary physical responses where the 7 satisfaction level (emotional state) can act as a stress agent, causing some the abovementioned symptoms. 3. Nurses’ Motivation and Satisfaction In what concerns nurses’ motivation and satisfaction, many authors show results which partly confirm Herzberg’s predictions (Fonseca, 1999; Steffen, 2008; Al-Enezi, 2009). Rewards lead to an increase of behavior repetition, and so when the worker is rewarded he/she continues to produce better, while punishment does not have a permanent effect and leads to negative attitudes. In accordance to Glina and Rocha (2000), the worker needs two fundamental requirements in his daily practice: to be healthy and have satisfaction at work. Health and satisfaction at work for healthcare practitioners are interconnected with professional status, interaction, remuneration, working conditions and organizational rule indicators (Steffen, 2008). One of the current factors regarding motivation in the nursing profession is connected with remuneration. Batista, Vieira, Cardoso and Carvalho (2005) have concluded that even though remuneration is a motivational factor at work it is not the main motivator. Other factors have been mentioned by nurses, such as stability attained at work and commitment to the population. Curiously, when these authors evaluated dissatisfaction, remuneration was indicated as one of the factors of greatest dissatisfaction in nurses’ work. Nurses considered themselves to be poorly paid, taking into consideration the kind of work that is done, the hour load and responsibility assumed. Tavares (2010) concluded that, even though remuneration is a motivational factor at work in general, it isn’t for nurses. The author indicated other motivational factors such as: liking what one does, an acceptable relationship with the multi-professional team, the possibility of professional growth, the hour load and the working conditions given by the organization. Yet, where remuneration is concerned, Vévoda, Ivanová, Nakládalová and Marečková (2011) concluded from a study at 122 hospitals in the Czech Republic that nurses considered wages and the care given to the patients as the most important factors at work. Many other studies have emphasized various motivational and satisfaction factors in the nursing profession. Ferreira (1996) published a study conducted at Coimbra Pediatric 8 Hospital with a sample of 109 nurses, showing that the nurses’ satisfaction was connected to relationship variables with other hospital professionals and their relationship with patients, while dissatisfaction was linked to remuneration, structural conditions, incentives and career development perspectives. Fonseca (1999), who conducted a study with the goal of understanding the degree of professional satisfaction of nurse managers of the northern central area hospitals, concluded that the conditions that most influenced nurses’ satisfaction were security, autonomy and self-fulfillment. Andrade (2001) conducted a study in six hospitals of northern Portugal with a sample of 209 nurses in Pediatric service, and concluded that the nurses were moderately satisfied overall. He mentioned that older nurses and those with a higher professional category reported the greatest satisfaction. The determinant factors for satisfaction in decreasing order of importance were; organizational communication, working hours, the physical conditions in the workplace, autonomy and remuneration. Seixas (2009), in his study with a sample of 42 nurses, concluded that the interpersonal relationships are the cause of greatest satisfaction for the nurses. Ferreira (2011) in a study with 388 nurses from the Primary Healthcare in Braga District, concluded that the professionals with the highest satisfaction are those who work in shifts with a fixed-term contract, with management functions, with five years of service or less and who are thirty-five years old or less. For Staufenbiel, Kroll, & König (2006) a worker’s motivation is strongly affected by insecurity at work. However, these authors also say that insecurity can work as a motivation factor if the professional sees insecurity as a challenge – he/she may fight for the renewal or improvement of his/her employment contract and so have a better performance. They mention that this insecurity has consequences at social and demographic levels for a country, since it leads to the postponement of marriage, creating a family, and parenthood. The insecurity can also be responsible for the intent of resignation (Greenhaus et al., 1997). Uncertainties in career development have shown to be important factors, not only for the intent to leave but also for decreased motivation (Greenhaus et al., 1997). Melo (2001) and Carneiro (2009) indicated the head nurse as the most responsible for the motivation of a group toward fulfilling the organization goals. Continuing with nurses’ motivation and satisfaction, Yaktin (2003) conducted a study of 421 nurses in Lebanon, to better understand the relationships between personal characteristics and nurses’ satisfaction. The outcomes revealed that personal 15 The final factorial solution found five factors with a total of 50% of the explained variance. The internal consistency values of the first three factors come near Nunnaly’s proposal (1978). However, the values of the last two factors are well beneath the referred proposal, imposing caution for making conclusions based on these factors since the internal consistency levels did not allow confirmation of the relationship between the items which correspond to each of these factors, they have been considered independently, without integrating any composite variable. The first Factor was called the “Expectation Performance - Bond”, since the variables which constitute it are related with the expectation or hope that a good performance will allow a safer bond to the organization. The second Factor was called the “Value Bond - Performance” since these items are related to the nurses’ opinion in respect to the impact that the bond has on performance, this is, how the employment contract influences motivation for work and, consequently, having good or bad performance. The third Factor was called “Acknowledgement and Security”, since these items are related to the recognition that the nurses have in the team, as well as in the fulfillment of their personal objectives and the security which they project at work. 6.2 Exploratory Factor Analysis of the Questionnaire of Satisfaction (SQ) The SQ was initially composed of 29 items and obtained an internal consistency value of 0.91, measured by Cronbach’s alpha value. In this case the first attempt at factor analysis found seven factors with 61% of explained variance. Next, items that did not saturate in any of the found factors (considering saturation levels inferior to 0.45) were removed. Finally, factor analysis was conducted to optimize the least number of factors to the greatest explained variance percentage (cf. Table 6). Table 6: Matrix of Saturation for the SQ Factor η α My superior’s preoccupation with my welfare. 0.91 Supervision 28.88% 0.90 My superior’s acknowledgement. 0.89 Participation opportunities given by my superior. 0.85 Relationship with my superiors. 0.73 The importance of my job. 0.73 Job content 10.02% 0.77 The nature of the tasks I carry out. 0.68 Possibility to do work I like. 0.68 To afford good services to the population. 0.67 The patient’s confidence in my performance. 0.54 Professional acknowledgement. 0.66 Social Acknowledgement and Development 8.34% 0.73 Social Prestige/status which this profession gives me. 0.62 16 The success that I achieved in my career. 0.56 Possibility of career development. 0.55 The contract I have. 0.72 Working Conditions 6.09% 0.72 Numbers of vacation days. 0.72 Hour load. 0.69 The job’s stability and security 0.60 Wage increases. 0.77 Remuneration 4.12% 0.61 Payment of extraordinary work. 0.69 Monthly Remuneration. 0.67 The relationship with the patient’s/user’s family. 0.83 Relationship with Patients 3.86% 0.84 The relationship with the patient/user. 0.82 η= % Explained variance; α= Cronbach’s alpha The final solution found six factors with a total of 61.31% of explained variance. The internal consistency values of all the factors are in conformity with Nunnaly’s proposal (1978) with the exception of the fifth factor, with α= 0.61. The factors were designated in accordance to the concept being analyzed in the respective items. 6.3 Exploratory Factor Analysis of the Comparative Questionnaire of Satisfaction (CSQ) The CSQ was initially composed of 29 items and obtained an internal consistency value of 0.91, measured by Cronbach’s alpha value. The first attempt of factor analysis found five factors with 60% of explained variance. Next, was the removal of items that did not saturate any of the found factors (considering the saturation levels inferior to 0, 45) and the consecutive factor analysis with the aim to optimize the relation of minor number of factors to the greatest percentage of explained variance (cf. Table 7). Table 7: Matrix of Saturation for the CSQ η α My superior’s preoccupation with my welfare. 0.92 Compared supervision 30.99% 0.90 My superior’s acknowledgement. 0.91 Participation opportunity given by my superior. 0.89 Relationship with my superiors. 0.75 Formative opportunities. 0.59 Skill development opportunities. 0.59 The relationship with the patient/user. 0.88 Compared job content 12.45% 0.84 To afford good services to the population. 0.83 The relationship with the patients/users’ family. 0.83 The nature of the tasks I carry out. 0.82 The patient’s confidence in my performance. 0.66 Possibility to do work I like. 0.59 The importance of my job. 0.57 The contract that I have. 0.83 Compared working conditions 9.30% 0.77 Job stability and security 0.76 Hour load. 0.74 Numbers of vacation days. 0.69 Future perspectives in relation to employment. 0.47 17 Wage increases. 0.83 Compared Remuneration 6.44% 0.69 Possibility of career development. 0.66 Payment of extraordinary work. 0.66 Monthly Remuneration. 0.61 Social Prestige/status which this profession gives me. 0.72 Compared Social Acknowledgement and Development 4.34% 0.71 The success that I achieved in my career. 0.69 Professional acknowledgement. 0.62 η= % explained variance; α= Cronbach’s alpha The final factor solution found five factors with a total of 63.50% of explained variance. The internal consistency values of all the factors are in conformity with Nunnaly’s recommendations (1978). The names attributed to these factors are similar to the previous satisfaction scale, adding the “Compared” designation. The “Relationship with the patients” factor found in the QST does not appear individualized in this scale, but is included in job content, which is also reasonable 6.4 Descriptive Analysis of the Scales The descriptive analysis of the results on the scales had in mind the Average and Standard Deviation calculus (cf. Table 8). Table 8: Descriptive Statistics for the dimensions of the scales being studied Dimension n M DP Intent of resignation 477 2.02 0.90 Motivation Expectation Performance-Bond 486 2.81 0.77 Value Bond –Performance 498 3.77 0.94 Acknowledgement and Security 503 3.29 0.56 Satisfaction Satisfaction with the relationship with the patients 497 4.21 0.66 Satisfaction with the nature of the job 493 3.97 0.60 Satisfaction with the supervision 486 3.51 0.85 Satisfaction with the working conditions 495 3.26 0.82 Satisfaction with the social acknowledgement and development 495 2.65 0.80 Satisfaction with the remuneration 493 1.79 0.71 Compared Satisfaction Compared satisfaction with the nature of the job 475 3.90 0.60 Compared satisfaction with the supervision 478 3.37 0.76 Compared satisfaction with the working conditions 482 2.97 0.87 Compared satisfaction with the social acknowledgement and development 483 2.95 0.90 Compared satisfaction with the remuneration 476 1.99 0.74 The highest value in the Motivation Scale was found in the “Value Bond-Performance” dimension and the lowest was in the “Expectation Performance-Bond” dimension. This result shows that nurses consider a stable and secure situation at work to be important to 18 performance, and that they have low expectations regarding the idea that good performance will lead to a better contractual situation (increased security). As for the Satisfaction scale, the highest value was found in the “Satisfaction with the relationship with the patients” dimension, followed by the satisfaction with “job content” and the lowest was in “Satisfaction with the remuneration.” Nurses also did not show high satisfaction with social acknowledgement and development. In the Compared Satisfaction scale, the highest average value was achieved in the “Compared Satisfaction with the job content,” which was already one of the highest in the Satisfaction scale. The lowest value was found in the “Compared Satisfaction with the remuneration.” Here, as in the Satisfaction scale, the nurses do not give emphasis to remuneration as a Satisfaction factor. It is also important to mention that all the average values of the compared satisfaction dimensions are lower than the absolute satisfaction values, which reveals a perception of inequity among nurses. The dimension of ‘Intent of resignation’ was low. 6.5 Motivation, satisfaction and employment contract First in Table 9, every obtained result in every dimension is compared for each type of contract. Table 9: ANOVA for the comparison of motivation and satisfaction dimensions in each type of employment contract Scale Dimensions Contract M DP F Intent of resignation Intent of resignation CTFPb 1.92 0.89 3.70** OECa 2.16 0.90 FTC 2.04 0.91 Motivation Expectation Performance -Bond CTFPc 2.75 0.82 9.91*** OECc 2.79 0.65 FTCa, b 3.30 0.69 Value Bond -Performance CTFP 3.74 0.96 0.54 OEC 3.83 0.87 FTC 3.83 1.00 Acknowledgement and Security CTFP 3.32 0.56 1.73 OEC 3.26 0.53 FTC 3.18 0.61 Satisfaction Satisfaction with the nature of the job CTFPb 4.03 0.55 7.73*** OECa,c 3.83 0.65 FTCb 4.11 0.68 Satisfaction with the remuneration CTFPc 1.71 0.69 25.73*** OECc 1.73 0.61 FTCa, b 2.50 0.83 Satisfaction with the working conditions CTFPb,c 3.67 0.61 118.43*** OECa 2.74 0.76 FTCa 2.70 0.66 Satisfaction with the supervision CTFPb 3.59 0.84 3.37** OECa 3.38 0.87 FTC 3.49 0.80 Satisfaction with the relationship with the patients CTFPb 4.26 0.62 3.77** OECa 4.10 0.68 FTC 4.33 0.78 19 Satisfaction with social acknowledgement and development CTFPb 2.78 0.80 14.20*** OECa,c 2.40 0.71 FTCb 2.89 0.89 Compared Satisfaction Compared satisfaction with the supervision CTFPb, c 3.55 0.70 15.65*** OECa 3.15 0.79 FTCa 3.24 0.69 Compared satisfaction with the nature of the job CTFPb 3.97 0.55 10.46*** OECa, c 3.74 0.66 FTCb 4.10 0.48 Compared satisfaction with the working conditions CTFPb, c 3.44 0.69 136.19*** OECa 2.34 0.74 FTCa 2.40 0.74 Compared satisfaction with the remuneration CTFPb, c 2.01 0.77 11.85*** OECa, c 1.84 0.61 FTCb, c 2.44 0.77 Compared satisfaction with social acknowledgement and development CTFPb 3.13 0.85 16.13*** OECa, c 2.68 0.84 FTCb 3.21 0.81 *p<0.05;**p<0.01;***p<0.001; Tukey’s multiple comparison test (p<0.05) aDifferent for the CTFP; bDifferent for the OEC; cDifferent for the FTC; Table 9 shows that the intent of leaving the job is reduced for every contract type, but mainly for nurses with CTFP. As for the Motivation variables, it was found that the nurses with FTC are those who present greater expectation that better performance will facilitate an improvement in the employment contract. This outcome leads us to conclude that these nurses maintain the expectation of improving the bond through performance. As for the Satisfaction, in four of the six dimensions the nurses with FTC are the most satisfied. The nurses with CTFP only present higher satisfaction in respect to supervision and working conditions. The nurses with OEC show the greatest dissatisfaction in four of the six dimensions. As for the Compared Satisfaction, the highest values of satisfaction were divided between the nurses with FTC (being higher in three dimensions) and CTFP (higher in the remaining two). Next, Pearson’s correlations were calculated between the dimensions of the scales and the length of service in general, in the institution and the length of time in the professional category (cf. Table 10). Table 10: Correlations between the motivation and satisfaction dimensions and the lengths of service and category Scale Dimensions Length of time in the professional category Total Length of service Length of service in this institution 20 Intent of Resignation Intent of Resignation -0.07 -0.10* -0.11* Motivation Expectation Performance -Bond -0.07 -0.07 -0.08 Value Bond -Performance -0.03 -0.03 -0.03 Acknowledgement and Security -0.05 -0.12* -0.08 Satisfaction Satisfaction with nature of the job -0.01 0.12** 0.10* Satisfaction with the remuneration -0.14** -0.07 -0.01 Satisfaction with the working conditions .25** 0.46** 0.46** Satisfaction with the supervision 0.07 0.12** 0.06 Satisfaction with the relationship with the users -0.02 0.14** 0.12** Satisfaction with the social acknowledgement and development 0.08 0.24** 0.21** Compared Satisfaction Compared satisfaction with the supervision 0.13** 0.24** 0.20** Compared satisfaction with the nature of the job 0.03 0.15** 0.13** Compared satisfaction with the working conditions 0.30** 0.50** 0.50** Compared satisfaction with the remuneration -0.04 0.07 0.08 Compared satisfaction with the social acknowledgement 0.08 0.21** 0.19** *p <0.05;**p <0.01;***p <0.001 The most important correlations were found in the dimensions of Satisfaction with the working conditions and the Compared Satisfaction with the working conditions, both with moderate positive correlations in the length of service being analyzed. This is, as the length of service increases, so does satisfaction, mainly satisfaction with the working conditions. Negative correlations stand out. The nurses least satisfied with their remuneration are those who have longer service in a category; those with shorter lengths of service believe that the value of the bond is important for performance. The results of each of the dimensions have also been compared taking gender into consideration (cf. Table 11). Table 11: T-Test for the comparison of the motivation and satisfaction dimensions in terms of gender. Dimensions Gender n M DP T-Test Intent of Resignation Masculine 103 2.30 1.03 3.60*** Feminine 372 1.94 0.85 Motivation Expectation Performance –Bond Masculine 104 2.69 0.75 -1.82 Feminine 379 2.84 0.77 Value Bond –Performance Masculine 105 3.86 0.93 1.10 Feminine 390 3.75 0.94 21 Acknowledgement and Security Masculine 105 3.72 0.51 1.69 Feminine 395 3.27 0.57 Satisfaction Satisfaction with the nature of the job Masculine 104 3.91 0.70 -1.32 Feminine 386 3.99 0.57 Satisfaction with the remuneration Masculine 103 1.83 0.73 0.76 Feminine 387 1.77 0.70 Satisfaction with the working conditions Masculine 103 3.17 0.82 -1.15 Feminine 389 3.28 0.82 Satisfaction with the supervision Masculine 104 3.36 0.86 -2.03* Feminine 380 3.55 0.84 Satisfaction with the relationship with the users Masculine 104 4.17 0.77 -0.93 Feminine 390 4.23 0.61 Satisfaction with the social acknowledgement and development Masculine 103 2.56 0.83 -1.35 Feminine 389 2.68 0.79 Compared Satisfaction Compared Satisfaction with the supervision Masculine 102 3.25 0.75 1.99* Feminine 374 3.41 0.76 Compared Satisfaction with the nature of the job Masculine 101 3.81 0.68 -1.80 Feminine 373 3.93 0.57 Compared satisfaction with the working conditions Masculine 104 2.87 0.89 -1.02 Feminine 377 2.97 0.90 Compared satisfaction with the remuneration Masculine 101 1.98 0.74 -0.17 Feminine 373 1.99 0.74 Compared satisfaction with social acknowledgement and development Masculine 104 3.00 0.87 0.30 Feminine 376 2.97 0.87 ***p<0.001; *p<0.05; Normality assumptions and homogeneity of fulfilled variables Men show greater “intent of leaving the job” compared to women, and the opposite is seen in “satisfaction with the supervision” and “compared satisfaction with the supervision”, which have higher results among women. The dimensions of the scales were also compared considering the variable of having/not having children (Table 12). Chart 12: T-Test for the comparison of motivation and satisfaction in terms of presence/absence of children. Dimensions Children N M DP T-Test Intent of Resignation No 222 2.12 0.95 2.23* Yes 245 1.94 0.86 Motivation Expectation Performance -Bond No 228 2.89 0.70 2.35* Yes 249 2.72 0.82 Value Bond -Performance No 231 3.82 0.89 0.86 Yes 257 3.75 0.97 Acknowledgement and Security No 235 3.29 0.54 -0.17 22 Yes 258 3.30 0.57 Satisfaction Satisfaction with the job content No 229 3.89 0.66 -2.64** Yes 254 4.04 0.54 Satisfaction with the remuneration No 230 1.87 0.72 2.57** Yes 253 1.71 0.67 Satisfaction with the working conditions No 231 2.98 0.82 -7.31*** Yes 254 3.50 0.74 Satisfaction with the supervision No 227 3.42 0.87 -2.21* Yes 249 3.59 0.83 Satisfaction with the relationship with the users No 233 4.18 0.64 -1.33 Yes 255 4.25 0.66 Satisfaction with the social acknowledgement and development No 230 2.53 0.78 -3.13** Yes 255 2.75 0.80 Compared Satisfaction Compared Satisfaction with the supervision No 228 3.25 0.76 -3.27*** Yes 241 3.48 0.75 Compared satisfaction with nature of the job No 227 3.84 0.63 -2.32* Yes 239 3.97 0.56 Compared satisfaction with working conditions No 230 2.62 0.86 -8.27*** Yes 243 3.26 0.82 Compared satisfaction with the remuneration No 226 1.99 0.73 -0.04 Yes 241 1.99 0.76 Compared satisfaction with social acknowledgement and development No 229 2.85 0.86 -3.04** Yes 243 3.09 0.86 ***p<0.001; *p<0.05; Normality assumptions and homogeneity of fulfilled variables According to Table 12, the “intent of leaving the job” is higher in nurses without children, who also have higher expectations that good performance will facilitate improvement of the Bond. Regarding satisfaction and compared satisfaction, in the great majority the nurses with children are those who feel more satisfied – with the exception of satisfaction with the remuneration. The results of the questionnaires have also been compared in what concerns marital status. Since the “divorced” (n=31) and “widow” (n=1) were smaller in number compared to other groups – the “Married/Non-marital Cohabitation” (n=281) and “Single” (n=191) – only the last two groups have been compared (Table 13). Table 13: T-Test for the comparison of motivation and satisfaction in terms of married and single marital status. Dimensions Marital Status n M DP T-Test Intent of Resignation Single 181 2.12 0.95 1.98* Married/Non-marital Cohabitation 265 1.95 0.85 Motivation Expectation Performance –Bond Single 185 2.92 0.73 2.83** 23 Married/Non-marital Cohabitation 270 2.72 0.77 Value Bond –Performance Single 187 3.87 0.89 2.23* Married/Non-marital Cohabitation 279 3.68 0.97 Acknowledgement and Security Single 190 3.30 0.56 0.85 Married/Non-marital Cohabitation 281 3.26 0.55 Satisfaction Satisfaction with the job content Single 185 3.91 0.64 -1.37 Married/Non-marital Cohabitation 276 3.99 0.58 Satisfaction with the remuneration Single 186 1.87 0.70 2.12* Married/Non-marital Cohabitation 276 1.73 0.69 Satisfaction with the working conditions Single 188 2.97 0.75 -6.17*** Married/Non-marital Cohabitation 275 3.42 0.79 Satisfaction with the supervision Single 185 3.48 0.78 -0.66 Married/Non-marital Cohabitation 271 3.53 0.87 Satisfaction with the relationship with users Single 189 4.16 0.67 -1.09 Married/Non-marital Cohabitation 277 4.23 0.66 Satisfaction with the social acknowledgement and development Single 186 2.59 0.76 -1.02 Married/Non-marital Cohabitation 277 2.66 0.81 Compared Satisfaction Compared satisfaction with the supervision Single 187 3.27 0.70 -2.33* Married/Non-marital Cohabitation 261 3.44 0.76 Compared satisfaction with the nature of the job Single 183 3.86 0.61 -0.86 Married/Non-marital Cohabitation 261 3.91 0.58 Compared satisfaction with the working conditions Single 188 2.65 0.81 -5.63*** Married/Non-marital Cohabitation 264 3.12 0.89 Compared satisfaction with the remuneration Single 184 2.05 0.71 1.46 Married/Non-marital Cohabitation 261 1.95 0.74 Compared satisfaction with social acknowledgement and development Single 186 2.92 0.82 -0.65 Married/Non-marital Cohabitation 265 2.97 0.89 ***p<0.001;**p<0.01; *p<0.05; Normality assumptions and homogeneity of fulfilled variables; the other marital status were excluded from this sample because they had less participants. As seen in Table 13, single nurses show higher intent of leaving the job, expectation performance-bond, value bond-performance and satisfaction with remuneration. In satisfaction with the working conditions, compared satisfaction with the working conditions and compared satisfaction with the supervision, married nurses had higher values. 24 Following the previous analysis, a cross-check was conducted between the variables Marital Status and type of contract (Table 14). Table 14: Chi-squared Test for the cross-checking the Marital Status and Type of contract (% in line) Marital Status/Bond CTFP OEC FTC χ2 Single 53 (28.5%) 99 (53.2%) 34 (18.3%) 93.99*** Married/Non-marital Cohabitation 200 (72.7%) 67 (24.4%) 8 (2.9%) ***p<0.001 Table 14 shows that there is a relationship between Marital Status and Contract (p<0.001), since there are more married people with a CTFP bond than with OEC. Within the group of people with a CTFP bond, 72.7% are married in contrast to 24.4% within the group of OEC. A cross-check between the children and type of contract variables was also made. As seen in Table 15, an association was found between children and type of contract (p<0.001). More people with children have a CTFP than in OEC and FTC contracts. 82.6% of the nurses with children have a CTFP bond, 15.2% have an OEC bond and 2.2% have FTC (Table 15). Table 15: Chi-squared Test for the cross-checking of the Children and Type of contract variables (% in line) Children/Bond CTFP OEC FTC χ2 Without Children 61 (26.9%) 131 (57.7%) 35 (15.4%) 142.02*** With Children 185 (82.6%) 34 (15.2%) 5 (2.2%) ***p<0.001 It is clear that the great majority of nurses with children have a CTFP bond (82.6%), whereas the majority of the nurses without children have OEC (57.7%). 31 to the OEC and FTC. Given these results, we can conclude once more that the kind of employment bond is fundamental, given the greater or lesser security and stability provided by it. Hence, we verify that the nurses up to 35 years-old and with CTFP are those who invest the most in building a family life. With respect to cross-checking the Children and Contract variables with the abovementioned restrictions, the bigger percentage within the “with children” condition was situated in the nurses in CTFP, even though together they are inferior. Given these results we can conclude that the nurses in OEC, even though they are married and therefore have more probability of having children, do not have any. The workers on contract are of a younger age and in principle they still don’t have children or if they intend to have them they keep postponing it given their employment instability and insecurity. 8. Conclusion This research intended to explore the factors that give more motivation and satisfaction among nurses, taking into consideration socio-professional and socio-demographic variables. The relationship with the patients was the most valued factor, followed by satisfaction with the job content. Remuneration was the factor in which nurses showed the least satisfaction, followed by social acknowledgement and development. One of the main conclusions is that nurses feel more satisfied in matters related to social and human factors than with remuneration. The type of employment contract is an important variable in what concerns nurses’ motivation. Nurses with FTC have a greater expectation that their performance can improve their contract. This could explain why they find more satisfaction in certain dimensions (such as satisfaction with the relationship with patients, satisfaction with the remuneration, satisfaction with the job content and satisfaction with the social acknowledgement and development). Regarding the intent of leaving the current workplace, men show more willingness to change, as well as nurses without children and nurses with an OEC contract. This paper also suggests that work has an impact on personal life and vice-versa. Single nurses showed higher propensity to resign from current employment, because of less security and stability at work (due to the kind of the contract that they have). Also, the fact of 32 having / not having children is related to the type of contract, considering that nurses in insecure bonds have fewer children. Considering the critical moment of unpredictable uncertainties at a social, political, judicial and economic level, the present study emerges at a time in which employers resort more and more to employee contract flexibility as a way of responding to the demand for professionals and to the difficulties of being able to assure a stable contract. Concerning the Centro Hospitalar de São João that has welcomed this study, the results might provide indicators for reflection about the degree of professional satisfaction of nurses. Motivation as a component of an organizational environment is a fundamental factor for the success of an organization, from which the managers cannot be detached. Knowing the factors that influence the motivation of professionals is complex, but motivating them isn’t easy either, since every individual is unique. To successfully motivate people is without a doubt one of the most challenging of tasks, but it is the thing which gives the most satisfaction to those who can, mainly in times of crisis. We believe that with this research we have contributed to a better comprehension of the factors which motivate nurses and provide them greater satisfaction at work. We hope that the results might provide important indicators in relation to the degree of professional satisfaction among nurses. As suggestions for future research, we propose an exploration of the same issues among other health professionals and in other organizations. This could be a launching point for future studies involving nurses from over all the national territory. As for the limitations, the lack of balance found in the gathering of the sample can be pointed out. If on the one hand there are as many nurses in CTFP as in OEC, the gathering did not reflect that data. 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