Comparing Job Expectations and Satisfaction: A Pilot Study Focusing on Men in Nursing

Purpose: The purpose of this study is to evaluate undergraduate male nursing job expectations and compare it to those continuing graduate students and male nursing alumni. Principle Results: Working male nurses’ alumni had significantly higher perception of professional status compared to both baccalaureate and graduate male nursing students (p=.028). In addition, male nurses’ alumni reported higher perception of professional status compared to graduate male nursing students (p=.007). Meanwhile, baccalaureate male nursing students reported higher expectation of satisfaction with pay compared to Alumni male nurses with BSN (p=.046). Major Conclusions: The findings of this study help inform both the academic and health institutions practices regarding male nurses’ expectations and factors that influence their job satisfaction in an attempt to increase male nurses’ recruitment and retention.


Introduction
In 2014, the United States affordable care act (ACA) became effective increasing the demand for nurses in the health care workforce to meet the health needs of the increasingly diverse patients' population [1,2]. In addition to the expected increase for nurses, more nurses are expected to approach retirement age or work part-time, amplifying the long-lasting issue of nursing shortage in the U.S. [3,4,5]. Previous attempts to reduce nursing shortage and enhance diversity within the health care profession began since the 1970s, with nursing institutions targeting more men and minorities into the nursing workforce. These attempts did not have much success, until the 1990s campaign by Johnson and Johnson [2]. Since the campaign, the nursing profession witnessed a slow but steady increase in the number of men entering its profession [6]. According to the American community survey, within the last 40 years, the percentage of men who are registered nurse tripled and the percentage of men who are licensed practical, while the number of licensed vocational nurses doubled [6]. The highest representation of men in nursing seen in the nurse anesthesia (41% were men) [6]. A similar trend was also observed in nursing educational institutions; according to the American Association of Colleges of Nursing, the percentage of male nurses enrolled into nursing schools increased within five years from 11.4% to 12.5% in undergraduate students, from 9% to 12.5% in Doctoral of Nursing practice, and from 7.5% to 10. 2% in PhD program [7,8,9,10,11]. However, the proportion of men in the nursing profession is still relatively small; men represent 9% of the overall nursing workforce [3,6]. Therefore, understanding the factors that contribute to attracting and retaining men into the nursing discipline became a research priority [1,2,3,4,5,6,7].
Research on job satisfaction among male nurses indicated that salary, autonomy, and social relationships within work are among the main factors that predict male nurses' job satisfaction [4]. High income and expected increase in future earnings often play an important role in attracting men to nursing; nursing is ranked among the top 5 highest paid professions in the United States. Male nurses have higher salaries and faster career advancement compared to their female colleagues with same work responsibilities and working hours. On average male nurses with a bachelor degree earn around 60,000 a year, and can earn up to 162,000 per year for higher and more specialized degrees such as nurse anesthesia [4,6]. In addition, men reported choosing nursing due its high work autonomy, flexible working hours and job security [4,6]. Thus, men in more advance education and specialization such as nurse anesthesia, in which male nurses represents more than 40% of its total number, often report job security as a main reason for choosing nursing as a career [4,6]. Despite all these incentives, studies on male nurses' job satisfactions reported mixed results [4]. Studies also reported that male nurse are twice as likely than female nurses to leave the nursing profession or change the profession within four years of entering nursing [3]. Moreover, most men who initially choose nursing as their first choice career end-up working in administrative positions or pursuing positions in educational institutions [4]. Thus, more studies are needed to address the factors that influence a male nurse's decision to leave bedside nursing.
Previous studies conducted on male nurses focused on their decision to enter nursing employed small sample sizes and often compared between male and female nurses' job satisfaction [5]. Given that most male nurses switch career within the first four years of their nursing profession, the purpose of the study is to evaluate undergraduate male nursing job expectations and compare it to continuing graduate students and male nursing alumni. The findings of this study may help inform both the academic and health institutions practices regarding male nurses' expectations and factors that influence their job satisfaction in an attempt to increase male nurses' recruitment and retention.
Specifically, the study aims to: 1. Explore the undergraduate male nursing students' job satisfaction expectations. 2. Compare between undergraduate male nurses job satisfaction expectations, the job satisfaction of those who are continuing graduate education and alumni.

Instruments
Both graduate and alumni male nurses completed the IWS questionnaire. Meanwhile, the undergraduate male nurses completed a modified version of the index work satisfaction questionnaire (IWS), which replaces each of the 44-items' "Job satisfaction" term with a "Job expectation of satisfaction". Participants completed the questionnaires at one-time point

Index of Work Satisfaction (IWS)
IWS is a two-part instrument developed by Stamps and Piedmonte [12,13] to assess participants job expectation and satisfaction, which is defined "the extent to which people like their jobs" (p. 13) [8,9]. IWS assess nurses' satisfaction with nursing profession by evaluating six components: pay; autonomy; task requirements; organizational policies; professional status and interaction on a seven-point Likert scale. The IWS reports the overall level of satisfaction of profession and separately for each of the six components. Part A is composed of scoring 15 pairs (measure of how important each of the six components is to the respondent). The scores calculated from the Part A were used to weight each of the six components importance in meeting job expectation. Meanwhile, part B consists of 44-items used to measure job expectation or satisfaction [8]. Although both IWS-parts were measured, in this study the means of the six components between the study groups were reported instead of the weighted means. The IWS reported good internal consistency (Cronbach's α =.82-.91) and validity [9].

Component Definition
Pay "Dollar remuneration and fringe benefits received for work done" [14] (p. 339) Autonomy "Amount of job related independence, initiative, and freedom, either permitted or required in daily work activities" [14] (p. 339) Task Requirements "Tasks or activities that must be done as a regular part of the job" [14] (p. 339) Organizational Policies "Management policies and procedures put forward by the hospital and nursing administration of this hospital" [14] (p. 339) Professional Status "Opportunities presented for both formal and informal social and professional contact during working hours" [14] (p. 339) Interaction "Overall importance or significance felt about your job, both in your view and in the view of others" [14] (p. 339)

Demographics' Questionnaire
An author self-developed questionnaire was used to assess participants' age, race, educational level, and current employment in nursing, years of experience, average annual salary, and formal training in nursing.

Procedure
Undergraduate, graduate and alumni male nurses participated in the study using an online cross-sectional survey. Questionnaires were send via school email. Contacts for alumni were obtained in collaboration with the Student Affairs & Alumni Relations department. The data collection was conducted over a period of two months, in which nonrespondent participants were send weekly email reminders. The study was approved by the University of Pittsburgh Institutional Review Board (IRB). Letters served as the consent to participate.

Data Analysis
A cross-sectional design was used to examine undergraduate male students' expectation of job satisfaction and graduate students and alumni job satisfaction. Data was analyzed using the SPSS (IBM Corp, 2016). For continuous variables, participant demographics were described using means and standard deviation. For categorical variables, demographics were descried using frequencies and percentages. Kruskal-Wallis tests were used to assess for statistically significant differences between the four groups concerning the variables of interest. Furthermore, Mann-Whitney test was used to examine the differences in job satisfaction between the three groups' nurses.

Results
Of the 73 undergraduate, graduate and alumni male nurses (BSN and Graduate) only 46 (63%) had complete responses. The mean age of the participants were 29.18 ± 9.2 years. This sample of students comprised of primarily Caucasian ((n = 59; 80.8%), graduate level (n= 31; 43.1%), and currently working in nursing (n = 33; 45.2%). From those currently working in nursing 87.9% (n=29) were general nurses, and 24.7% (n=18) of participants received a formal job training in nursing. See table 1. To examine the overall difference between the three main groups, Kruskal-Wallis tests was performed. The result of this analysis revealed that alumni (BSN and Graduate) nurses reported a higher level of professional status compared to both BSN and graduate students (H (2) = 7.165, p=.028). The study results also showed graduate alumni had the highest level of mean expectation of job satisfaction, followed by undergraduate male students, BSN-alumni and graduate students (See Figure 1). In regard to the sixcomponents of job satisfaction, the results also indicated that graduate students reported the highest mean level satisfaction with pay (Mean score = 4.48). However, BSN-alumni male nurses reported the lowest (Mean score = 3.17). On the other hand, graduate alumni male nurses reported the highest mean satisfaction with level of autonomy (Mean score = 4.75), while BSN male students reported the lowest mean (Mean score = 4.26). Mean satisfaction with task requirement was highest among both graduate alumni male nurses and graduate students (Mean score = 3.88, 3.87). The lowest mean satisfaction with task requirement was among BSN alumni male nurses (Mean score = 3.29). Likewise, graduate male nurses reported the highest mean satisfaction with organizational policies (Mean score = 3.91), while, BSN alumni male nurses reported the lowest mean satisfaction with organizational policies (Mean score = 3.23). In contrast to the above discussed job satisfaction components, mean professional status level was the highest among BSN alumni male nurses (Mean score= 5.81) and lowest among graduate alumni male nurses (Mean score= 4.12). BSN alumni male nurses also expressed the highest mean level of satisfaction with professional interaction (Mean score= 5.30) and undergraduate male students expressed the lowest mean expectation of satisfaction with professional interaction (Mean score= 4.50). Man-Whitney test was performed to examine the difference in means between different groups ((BSN students vs. BSN-alumni) and (graduate students vs. graduatealumni)). The results of these analyses indicated that The BSN students reported higher expectation of pay satisfaction compared to BSN Alumni (Man- Whitney U= 22, p=.046). Meanwhile, the graduate students reported satisfaction on higher professional status compared to graduate-alumni (Man-Whitney U= 33.5, p=.027).
Further analysis on within group comparison revealed the following findings: Professional status had the highest reported mean expectation of job satisfaction among both BSN students and BSN alumni male nurses' subgroups, while pay was the lowest mean level of expectation of job satisfaction reported, similarly, graduate students reported the highest satisfaction with professional status. However, these graduate students were least satisfied with nursing profession task requirement. Graduate alumni were most satisfied with nursing profession level of autonomy and were least satisfied with the pay. The job satisfaction, interaction component was subdivided into two-groups: nurse-nurse and nurse-physician. The decision to pursue graduate level is different based on the interaction subgroups, those who remain in the nursing profession value physician-nurse compared to nurse-nurse. However, the differences between the four groups were not significant for both nurse-nurse (H (3) =.850, p=.838), and nurse-physician (H (3) = 4.550, p=.208).

Discussion
The pilot study examined the differences in job satisfaction components between BSN-students, graduate students, BSNalumni and graduate alumni participants groups. Overall results indicate that these four groups differed significantly in their professional status satisfaction level (p=.028). The highest level of professional status level of satisfaction was reported by BSN-alumni male nurses followed by: graduate students, BSN students and graduate alumni male nurses.
In regard to the differences between the six-components of job satisfaction among the groups: professional status level of satisfaction was also significantly different between graduate students and graduate alumni (p=.027). In contrast to expectations, the professional status level of satisfaction was significantly higher among graduate students compared to graduate alumni. This indicates that male nurses who entered work force after graduate school had lower satisfaction with their professional status compared to students who are currently pursuing graduate study. The result of which can be attributed to inconsistency between male graduate student expectation of professional status level of satisfaction and the actual professional status level of satisfaction after their education.
Expectation of satisfaction with pay was also significantly different between BSN students and BSN alumni male students, with lower level of pay satisfaction observed in BSN alumni male nurses (p=.046). Those who decided to pursue nursing as a profession had lower expectation on pay satisfaction, compared to graduate students and graduate alumni male nurse. Therefore translating into an even lower satisfaction with pay after entering nursing work force. This observation may be attributed to the difference in motivation to pursue a job in nursing profession. According to Moore and Dienemann, men decision to enter nursing workforce is influenced by both internal (i.e. caring for others, respect for community, self-validation and having more meaningful thing to do in life) and external factors (i.e. payment, opportunity for career advancement, autonomy, flexible hours, and job security [4]. Although all men who entered nursing reported altruistic motivation as a main reason for choosing nursing profession, those who chose to pursue graduate studies (graduate students and graduate-alumni) maybe more influenced by external factors than those who remain in bedside nursing (BSN-alumni). In fact, those who chose nursing as a second career were more likely to remain in the same position or choose an advance role in direct patient care and were least likely to pursue administrative or educational positions despite being the least satisfied with their pay among the four subgroups [4].
A unique finding was the differences between BSN male alumni and other subgroups (BSN students, graduate students and graduate male alumni) in terms of interaction categorizes. Accordingly, those male nurses who remained in direct patient care placed more value on physician-nurse interaction than nurse-nurse interaction. This observation was completely the opposite in all the other subgroups. Although the interaction finding was not significant, future studies should investigate the differences between these groups based on interaction. This study is one of the first one that explores the difference between expectation of Job satisfaction among BSN male students and the level of job satisfaction among graduate male students and alumni.

Limitations
This study has four main limitations: 1) A small sample size (n = 73 with 46 completed questionnaires). This factor limits the generalizability of results to larger populations of male nursing students and male nursing professionals; 2) low response rate among male alumni nurses; 30 the use of cross-sectional design did not allow us to evaluate changes in job satisfaction and its component over time; and 4) the use of a single setting.

Conclusion
In conclusion, information from this pilot study showed that there was some difference between the four groups in the professional status level of satisfaction. Subgroup comparison also revealed that there was a difference in the level of satisfaction with pay between BSN students and BSN-male alumni. In addition, subgroup comparison indicated that there was a difference in the level of satisfaction with professional status between graduate students and graduate male alumni. Thus, evaluating the differences between these four groups can form the basis for future studies that aim to enhance male nurses' recruitment and retention within hospital and educational settings.
The results of the study described in this paper present a number of avenues for future research on the area of male job satisfaction. Future studies should address the unit of practice for alumni and years of experience in nursing. In addition, future studies should conduct a longitudinal study on undergraduate male students that evaluate the differences in their job expectation of satisfaction as they progress with their educational levels. Future studies also should include larger sample sizes to examine the differences between these four groups in terms of job satisfaction. These findings can form the basis for future interventions used to recruit and retain male nurses in both hospital and educational settings.