Assessment of Job Satisfaction of Nurses with Nursing Reforms in the Health Care System of the Republic of Kazakhstan

Research Article

Austin J Nurs Health Care. 2020; 7(1): 1053.

Assessment of Job Satisfaction of Nurses with Nursing Reforms in the Health Care System of the Republic of Kazakhstan

Z Baigozhina, G Bariyeva*, V Koykov, A Abdrakhmanova, G Kabdullina and A Mergentay

Department of Education and Science, Republican Center for Health Development, Nur-Sultan, Kazakhstan

*Corresponding author: G Bariyeva, Department of Education and Science, Republican Center for Health Development, Nur-Sultan, Kazakhstan

Received: October 20, 2020; Accepted: October 26, 2020; Published: November 02, 2020


The level of satisfaction of medical workers is one of the main factors for their effective work. First of all, this concerns nurses, since they are the largest group of medical staff and make a significant contribution to the provision of medical services. Today, their role is especially growing due to the introduction in the national health care system of the position of a nurse practitioner, having the level of applied and academic bachelor’s degrees. The level of satisfaction of health workers is one of the basic conditions for their effective work. The aim of this study is to study the level of satisfaction of nurses in general, and in particular, the implementation of the new reform of nursing, as well as to determine the factors influencing the satisfaction of nurses. This cross-sectional study was conducted using a questionnaire posted on the Survey Monkey online platform. A total of 468 nurses from 49 medical organizations throughout the Republic took part in the survey. Statistical processing of the results was carried out using the STATA 14.2 software and using the methods of descriptive statistics, bivariate analysis with the Chi-square test and the Fisher test, multiple logistic regressions. According to the results of this study, more than 80% of nurses have opportunities for professional growth, and the organization’s leadership supports them in this endeavor. More than half of the respondents noted that the hospital administration sends nurses for additional training in case of errors in their activities. Nurses receive more praise and support from senior and head nurses (96%) than from medical staff (56%). Social relevance, recognition in the professional community and professional results that lead to higher earnings were identified by nurses as significant incentives for highquality and conscientious work. The satisfaction of nurses was associated with the availability of opportunities for professional growth, support and praise from the leadership, participation in organizational decision-making. With the introduction of the new reform of nursing, it is expected that the activities of nurses in Kazakhstan will meet the international level in accordance with the needs of modern healthcare and will improve the quality, efficiency and safety of medical services.

Keywords: Healthcare System; Nurses; Satisfaction; Medical Staff; Nursing Reform


The satisfaction of medical workers is one of the important factors in the providing of high-quality medical care in the health care system. Therefore, employee satisfaction is becoming an increasingly important aspect of healthcare organizations around the world. For example, in Turkey, the satisfaction of medical personnel with work was 60%, and the remaining 40% of unsatisfied medical workers noted the reasons as insufficient wages and inappropriate working conditions [1]. In the United States of America, using the Satisfaction of Employees in Health Care Survey, a rather high degree of satisfaction of health workers was revealed, which amounted to 79.88% [2]. As part of the nursing development program (2009-2014) in the Russian Federation, a study was carried out in five different medical institutions (hereinafter referred to as MPIs), where more than 70% of nurses were satisfied with their work. The highest rates were among employees of multidisciplinary healthcare institutions, obstetric and dental clinics, the lowest among those working in oncology and psychiatry [3].

Due to the fact that medical workers are the key link in the provision of medical services to the population, the factors affecting their level of satisfaction should be studied and taken into account in building the correct management system both at the level of medical organizations and at the level of the healthcare system as a whole. The level of satisfaction of medical personnel directly depends on such indicators of the result of the provision of medical services as safety, quality service, patient satisfaction, as well as the quality of the relationship between a medical professional and a patient4. In many countries, job satisfaction is measured by cognitive (evaluative), affective (or emotional), and behavioral components [5-7]. In addition, the rational use of the results of assessing job satisfaction can be an excellent tool for increasing the efficiency of medical organizations, retaining the staff of medical and paramedical personnel and attracting new specialists [8,9].

According to studies, 50% of medical services are provided by nurses, and in some countries this figure reaches 80% [10]. It has been argued that happy employees are more productive and achieve better results than those who are unhappy with their work [10-12]. A study in the United States and twelve European countries found that a significant proportion of nurses in each country reported about inadequate quality of care, high nursing burnout, job dissatisfaction, and intention to leave their current positions [13]. According to a study conducted by Professor Golenkov, among nurses who chose the profession independently and consciously, job satisfaction was 86%; among those who made a decision about a profession on the advice of relatives and friends - 76%. The nurses, whose choice was random, reported almost complete dissatisfaction with their work. In the group of nurses who were satisfied with their work, such indicators as financial situation, self-development, achievements, spiritual satisfaction, as well as professional life, family life and social life were significantly higher than in the group of employees who were dissatisfied with their work [3].

Widespread worldwide tendencies in national health systems are a steady growth of an aging population, a high prevalence of chronic diseases and an increase in the cost of their treatment, an increase in the incidence of various etiologies, especially among the poor. In this regard, special attention has begun to be paid to a healthy lifestyle, disease prevention, replacing inpatient care with outpatient care or replacing doctors with nurses [14-16]. All of these factors are prompting countries around the world to create a new modern model of nursing, including the introduction of such a new specialty in primary care as the nurse practitioner, who is an autonomous, licensed, registered nurse whose work is aimed at making an initial diagnosis, prescribing an appropriate treatment and prevention of diseases [17,18]. In the United States, where nurses see patients and prescribe treatment on their own, it was found that the quality of care among adults has improved, nursing satisfaction has increased, health care costs have decreased, and the use of emergency care has decreased [19].

In the Republic of Kazakhstan, an active reform of the nursing service has been carried out in recent years, including increasing the role and status of nurses in the treatment and diagnostic process, introducing clinical nursing guidelines and standard operating procedures, increasing the potential of specialists working in the industry and introducing new positions for nursing specialists - nurses extended practice, chief nurses (deputy chief physicians for nursing). So in 2014, the training of nurse practitioners was launched for the first time as a pilot project within the World Bank Project. This is a comprehensive project that covers all aspects of the implementation of this new model, starting with student education, employment and subsequent monitoring of their performance [20]. Since this new model of nursing service was introduced relatively recently, there is a need for constant monitoring of the level of knowledge, skills and study of nurses satisfaction level in general, as well as the implementation of a new reform of nursing, including the identification of factors influencing the satisfaction of nurses with their work. The aim of this study is to investigate the overall level of satisfaction with the work of nurses, and in particular with regard to the implementation of the new reform of nursing, as well as to identify the factors influencing the satisfaction of nurses.

Materials and Methods

To achieve this goal, the method of analytical cross-section open uncontrolled study was chosen. In order to comprehensively assess the effectiveness of the nursing service reform, in the Republic of Kazakhstan, the authors have developed a unique questionnaire to study the satisfaction of nursing staff with their work and their attitude towards the new nursing reform. This questionnaire was reviewed and approved by the Expert Council of the Republican Center for Health Development (hereinafter - RCHD). The survey consisted of 26 questions and was posted on the Survey Monkey online platform. A link to the online questionnaire was sent to 49 medical organizations involved in the implementation of the new model of nursing (pilot organizations).

Nurses with Technical and Vocational Education (TVE), academic bachelor’s and applied bachelor’s degrees, of any gender and nationality, over 18 years old, working in pilot medical organizations of the Republic, with good mental and physical health, were invited to participate in the survey. The exclusion criteria for participants were those under 18 years of age and those who did not wish to participate in the study, since participation in the study was voluntary. 468 nurses from 49 medical organizations of the Republic participated in the survey. The coverage of responses was 100%.

STATA statistical package version 14.2 was used to analyze the data. Univariate analysis for both explanatory and outcome variables were conducted using descriptive statistics. Bivariate analysis for categorical explanatory variables and outcome variable was performed with Pearson`s Chi-square test and the Fisher’s exact test.


Characteristics of Participants

According to Table 1, survey participants were mainly represented by hospital nurses (n = 267, 57.05%) and senior nurses (n = 56, 11.97%). Some respondents marked the answer option “other” (n = 68, 14.53%), where the following answers were indicated: infection control nurse, laboratory assistant, medical statistician, masseur and secondary school nurse. During the distribution of respondents by specialties, it was revealed that most of them are nurses with a TVE education (n = 435, 92.9%), and the smallest number of respondents have a master’s level in nursing (postgraduate) (n = 2, 0.43%). Most of the respondents reported that they have more than 10 years of work experience (n = 251, 53.63%). Many of the participants do not have qualification categories (n = 212, 45.30%). However, the share of respondents with the highest category was 36.32% (n = 170). According to the answers of the respondents, almost half of them take advanced training courses, participate in seminars, master classes in their specialty every year (n = 221, 47.2%). However, none of the descriptive data is statistically significant, which suggests that nursing satisfaction is not related to job title, specialty, and length of service, category, and professional development.