INTRODUCTION

Due to the importance that work assumes in the human life, it is pertinent to develop studies that help us to understand how it fits and combines satisfaction and work. In this sense, job satisfaction is an important subject of investigation with the aim of contributing to improve the degree of satisfaction of individuals in the work context.

Many studies^1-4 have been developed on the issue of satisfaction in order to identify the factors that influence it, as well as the consequences that result from the individual not being satisfied with their work. It is concluded that the variables involved are numerous. Due to its multidimensional nature, the definition of satisfaction is difficult to put into practice.

Each individual is a unique universe of behaviors, influenced by heredity and the environment, and the way to act depends on the personality and the learning experiences they experience⁵.

At first, it was thought it would be possible to build a global job satisfaction index, varying people's affective response along a continuum whose poles vary between little or nothing satisfied and very satisfied. But, by analyzing the aspects that most directly influence satisfaction, it was shown that there were numerous factors influencing satisfaction and that they affected individuals differently. This finding relativizes the value of the global satisfaction index⁶.

Job satisfaction is an affective or emotional reaction related to various dimensions of an individual's work. This means that job satisfaction is not a unitary concept. An individual may be relatively satisfied with one aspect of their work and dissatisfied with one or more aspects⁷.

Other factors such as:

Studying satisfaction is very important when referring to professions within the scope of human relations such as nursing, which have undergone major changes in recent years. Its goals and areas of action, in order to meet the needs of users, have constantly changed.

Market demands are increasing and have led companies to compete for public recognition by adhering to quality certification and accreditation schemes that impose and enforce compliance with standardized standards in accordance with laws and codes for consumer and worker protection. In addition to the "rankings" organized according to the quality of products/services or the volume of business, investment in innovation and development, as well as the quality of working conditions measured by the level of satisfaction of workers and customers/users⁹.

According to Nogueira⁹, the issue of quality and satisfaction with regard to the health sector is linked to the specific characteristics of health care institutions, with their varied nature and dimension, whether public or private.

In the area of ​​health, we have seen rapid and profound changes. In addition to the need to respond to the growing demands of citizens in terms of quality and rights, there are other unavoidable imperatives: the rationalization of resources, competitiveness, the safety of health care, the satisfaction of workers, as well as the satisfaction of users and providers of such care. Also the constant development of specialization of health professionals leads to the need to carry out rigorous controls to ensure that these professionals have sufficient knowledge and skills to provide safe and effective care.

Specialist nurses, due to skills obtained through their specialized training, are, without a doubt, when they’re integrated into a nursing team or care provider, the professionals best positioned to supervise this process, all from a perspective of promoting quality and safety of health care.

Excellent care makes the nursing profession more autonomous and credible. This excellence contributes to the appreciation of nursing care, not only by nurses, but also by other technicians and by citizens in general. It is necessary that nurses have a behavior that develops the conceptual structure of the profession and protects citizens' rights towards excellence in nursing and health care¹.

Job satisfaction is also considered one of the indicators of Quality of Life at Work. Well-being and Quality of Life at Work are factors that influence the quality of care¹.

In this context, the question arises whether, at a time of major reforms in the health sector, the Rehabilitation Nurses (RNs) are satisfied in the exercise of their professional activity. The troubled time in which these professionals are living, in which these professionals see a set of rights withdrawn, namely: a freeze on career progression, not enjoying the respective upgrade of step for several years; precariousness of contracts; remunerations lower than the positions held; among many others. In the particular case of specialist nurses, who invested, both in monetary value and in personal time, in their training, to acquire more skills, some professionals find themselves exercising this specialized care without being remunerated according to their function; others remain in the provision of general care, as conditions are not created for them to exercise the skills acquired in their area of ​​expertise.

This study aimed to analyze the professional satisfaction of the RNs, and to verify if the area of ​​care provision influences their professional satisfaction.

The results obtained in this study may contribute to higher levels of professional satisfaction among specialist nurses. It was also intended to deepen the knowledge about the satisfaction of nurses in different work contexts, in order to allow a systematic reflection on the subject.

METHOD

This is an analytical cross-sectional study.

The population studied was constituted by the RNs who work in Portugal. A random and representative sample was used. Nurses with the professional title of RN were included in this study, and general practitioners and nurses who had not completed the specialty were excluded from the study.

The data collection took place from November 2011 to January 2012. The instrument selected to perform the data collection was the “Nurses' Job Satisfaction Assessment Scale”, built and validated by Frederico and Loureiro¹⁰. The instrument consists of 25 items. In this study, each item was rated from 1 to 5, where 1 indicates “totally disagree” and 5 indicates “totally agree”. This scale measures the individual's level of agreement in relation to each statement.

A factor analysis was then carried out in order to explain the dependent variable. The principal component analysis technique was used, and the Equamax rotation was used as a rotation method in order to simplify the factorial matrix as much as possible.

Then, in order to statistically analyze the data, descriptive statistics were used first for the components and for the total score. The theoretical mean value for each component was defined as 3, which represents the point of indifference.

Afterwards, advance to the study of the correlation coefficients related to the components and the total score. For this, we used the non-parametric Spearman test.

Finally, to respond to the proposal, was used the parametric t-student test, unilateral, for independent samples in order to understand if the RNs who provide specialty care are more professionally satisfied than the RNs who only provide general care.

All data were entered and the analysis was performed using the statistical analysis program SPSS® v.18.0 (Statistical Package for the Social Sciences).

All ethical procedures were followed.

RESULTS

A total of 306 nurses (n=306) with a specialty in rehabilitation nursing participated in this study, most of them are female (73.20%, n=224). Regarding males, only 26.80% (n=82) of the respondents correspond. With regard to age, 33.99% (n=104) were under 35 years-old, 44.44% (n=136) were in the age group of 35 to 45 years-old and only 21.57% (n= 66) were over 45 years-old. It was found that the percentage of married nurses (68.62%, n=210), with or without registration, is relatively higher than the percentage of single nurses (24.51%, n=75), with a small percentage of divorced/separated nurses (6.54%, n=20) and widowed (0.33%, n=1). With regard to the workplace, it was found that about 68.96% (n=211) work in hospitals, 24.18% (n=74) at the level of Primary Health Care and 6.86% (n=21) elsewhere. In the studied sample, the majority of RNs (84.32%, n=258) exercise specialty care (50.33%, n=154) or general care (33.99%, n=104). The remaining RNs (15.68%, n=48) are in the area of ​​Management (10.45%, n=32) and in Teaching/Research (5.23%, n=16). As for the regional area, it was found that 45.75% (n=140) of nurses work in the North, 41.83% (n=128) in the Center and South and 12.42% (n=38) in the Azores and Madeira. As for the length of professional experience, it was found that 24.52% (n=75) reported working for 10 years or less, 23.20% (n=71) between 10 and 15 years, 27.12% (n =83) between 15 and 20 years and 25.16% (n=77) reported working for more than 20 years. In turn, in relation to length of service, in the current workplace, it is observed that 39.21% (n=120) reported working in their current workplace for 3 or more years, 21.90% (n =67) between 3 and 6 years, 29.41% (n=90) for more than 9 years and only 9.48% (n=29) reported working in the same place between 6 and 9 years. The two most frequent situations, representative of the link to the institution, were as follows: 62.09% (n=190) of nurses have a Contract in Public Functions and 32.36 (n=99) have an Indefinite Contract. The remaining RNs (5.55%, n=17) have a fixed term contract (3.59%, n=11) or another type of contract (1.96%, n=6).

FACTOR ANALYSIS

Regarding reliability, Cronbach's Alpha was 0.85. The Kaiser Meyer Olkin test defined a value of 0.84, having shown that the data are good for the application of factor analysis¹¹.

Thus, a factor analysis was carried out in order to identify the structural relationships between the variables that most contribute to the professional satisfaction of the RNs. Six factors were retained, with own value greater than 1 (Kaiser's criterion), which explains 58.26% of the total variance11.

After factor rotation, it was possible to identify the variables that most relate to each of the six factors. According to the content of the items of each factor, denominations that characterize were assigned. The extracted factors identify six dimensions of the analyzed scale, which we designate as:

Table 1 presents the data related to the empirical and theoretical average, standard deviation, maximum and minimum for each component and for the total score. By analyzing the table, it can be stated that the individuals studied have a total score index below the theoretical average, which demonstrates a slight professional dissatisfaction.

The individuals studied considered themselves satisfied with the nature of the work and with the team. They consider themselves dissatisfied with benefits and rewards, job requirements and institutional communication. They consider themselves neither satisfied nor dissatisfied with their superiors, although there is an approximation to satisfaction. The dispersion values ​​reveal a reasonable degree of agreement between the answers.

The degree of association between job satisfaction and its dimensions was then analyzed using Spearman's non-parametric test (Table 2).

With regard to the relation between job satisfaction and the dimensions studied, in general, there is a significant association (p<0.05) between job satisfaction and all its dimensions. The dimensions that showed a greater degree of association with job satisfaction were: “satisfaction with managers”; “satisfaction with communication” and “satisfaction with benefits and rewards”.

When we compare job satisfaction in different areas of care provision, it was found that it differs significantly for the RNs who provide specialty care compared to those who exercise general care. The RNs that provide general care (Mean ± standard deviation = 2.79 ± 0.43) are more professionally dissatisfied than the RN that provide specialty care (Mean ± standard deviation = 2.98 ± 0.41) (p=0.001).

DISCUSSION

With regard to the assessment of job satisfaction, in terms of total score, we found that the inquired nurses are slightly dissatisfied. This is a fact that was also pointed out by Santos, Braga and Fernandes¹.

Dissatisfaction factors are primarily related to benefits and rewards, followed by job requirements, and lastly with communication. Fontes² and Matos¹² also found that factors related to salaries and promotion systems are aspects in which nurses are more dissatisfied. Silva¹³, on the other hand, considered that nurses perceived remuneration as the component of satisfaction that least influenced them.

The nature of the work and the relationship with the team are factors with which they obtain satisfaction. The nature of the work was the most relevant factor. Second, but not least, comes satisfaction with the team. It can then be considered that a good relationship with the work team is a condition to reduce non-satisfaction as much as possible, because nursing is a profession in which human beings take care of other human beings, interacting with each other and each contact has an influence on your satisfaction. In the study by Carvalho³, satisfaction with colleagues was the dimension that caused the greatest satisfaction in nurses.

Then, there is the dimension satisfaction with the leadership in which there is an approximation to satisfaction.

Simoni¹⁴ found the opposite: nurses were more satisfied with their leadership than with their colleagues. The author associated the fact that competition or the various commitments in the performance of their social roles reduced the availability of time, which contributed to the non-strengthening of relationships between nurses.

Regarding the professional satisfaction of the RNs who exercise specialty care compared to those who exercise general care, it was found that professionals who exercised general care showed significantly lower levels of dissatisfaction compared to those who exercised specialty care.

Regarding the dimensions of satisfaction, in the dimension managers, the inquired nurses who exercised specialty care attributed a significantly higher degree of satisfaction than the inquired nurses who exercised general care. This situation may be due to the fact that it is the Rehabilitation Nurse who replaces the Head Nurse in his absence and for this reason his relationship with the heads is closer.

Regarding the nature of work dimension, nurses who practice the specialty are more satisfied because they identify more with their work. According to Simoni ¹⁴, identification with the work developed favors greater satisfaction and may result in a feeling of well-being.

CONCLUSION

Based on the analysis carried out, it is concluded that, in general, the RNs are slightly dissatisfied.

We can say that in terms of professional satisfaction, they are “satisfied” with regard to the dimensions of nature of work and team. They are “neither satisfied nor not satisfied” regarding the dimension of satisfaction with the supervisors. Finally, they are “not satisfied” with the dimensions of benefits and rewards, work requirements and communication.

Regarding the assessment of the degree of overall job satisfaction, it was concluded that the inquired RNS exercise general care are more dissatisfied than those who exercise specialty care (p=0.001).

With regard to the relationship between the different dimensions of professional satisfaction of RNs and professional characteristics, it is concluded that:

At the end of this work, it is recognized that job satisfaction, in the specific case in nursing, is an indicator of the quality of care provided to the individual and the community, and it is considered that, if the main needs that interfere in the professional and organizational life of the nurses are diagnosed, minimized and/or satisfied, the quality of care provided by them may be influenced, which constitutes the true mission of health institutions.

In this sense, it is necessary that satisfaction is valued and monitored by institutions, providing greater satisfaction to their workers, with the objective of excellence in care, as only with the participation and involvement of everyone, organizations will be able to walk towards success.

In this study, one cannot fail to bear in mind some limitations, from the outset, the limitation imposed by the existing literature that in some aspects it was not possible to compare with other studies.

This study aimed to increase knowledge about professional satisfaction currently experienced by nursing, specifically in the rehabilitation specialty, but it is far from exhausting studies on the subject. We believe that these results are important points to be analyzed and reflected upon, not presenting the end, but the beginning of future research and collaboration in the search for knowledge.

As a proposal for future studies, it is suggested to carry out works that focus on this subject in a qualitative approach, thus giving the opportunity for participants to express their feelings more freely, without pre-defined categories for analysis of the variables, which in this study is verified as a limiting aspect.