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For more than 40 years, nurse practitioners(NPs) have been working in primary caresettings and contributing to the health careof the nation.The effect of this group ofhealthcare providers has been well docu-mented by Mundinger and colleagues, aswell as Lenz and colleagues, who haverepeatedly shown that “the quality of pri-mary care delivered by NPs is equivalentto that by the physicians.”1-4

Despite the gains in both responsibilities andscope of practice for NPs, little research hasbeen done to evaluate job satisfaction with thesechanges. Misener and Cox identified only 10articles pertaining to job satisfaction amongNPs.5 A recent review of the literature revealed1 additional article that addressed this issue.6 Yetanecdotal evidence from discussions with NPssuggests that this is an issue of importance tothose in the profession.

The underpinnings for the current surveywere derived from Herzberg’s Dual FactorTheory of Job Satisfaction.7 In essence,Herzberg’s theory posits that there are 2 oppos-ing forces that contribute to the concept ofoverall job satisfaction:“intrinsic” and “extrinsic”factors. Misener and Cox operationalized theintrinsic factors as “satisfiers that arise from per-formance of the job itself.”5 Concomitantly, theextrinsic factors are the “dissatisfiers that arise

from the work environment and include work-ing conditions, interpersonal relationships, salary,status, security, policies, administration, andsupervision.”The interplay of these 2 factors iswhat contributes to one’s overall job satisfaction.

LITERATURE REVIEWAs Misener and Cox5 noted, there is a dearth ofliterature relative to NP job satisfaction.The fewstudies that were done used a host of differinginstruments, including the Index of JobSatisfaction, Minnesota SatisfactionQuestionnaire – Short Form, Personal and WorkBackground Questionnaire, Mueller andMcCloskey Satisfaction Scale,8 Misener NursePractitioner Job Satisfaction Scale (MNPJSS),5

Advanced Practice Job Satisfaction Survey(APJSS), and several independent surveys.Thecommon denominator among all the studiesappears to be the use of both intrinsic andextrinsic factors.This suggests that these studies,

Ken Miller, Susan Apold, Linda Baas, Barb Berner,and Esther Levine-Brill

Job Satisfaction Among

Nurse Practitioners

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either directly or indirectly, relied on some of the ele-ments of Herzberg’s model.7

Kacel et al used the MNPJSS with 147 NPs in aMidwestern state.6 They concluded that NPs were mostsatisfied with intrinsic factors, such as sense of accom-plishment, challenge in work, level of autonomy, patientmix, and ability to deliver quality care.They were leastsatisfied with time off to serve on professional commit-tees, research involvement, monetary bonuses, reward dis-tribution, and compensation for activities over and abovenormal duties.

In a nationwide survey of 315 neonatal NPs usingthe APJSS, Beal et al found that the best predictors of jobsatisfaction were autonomy, patient care management,outcomes, relationships, and role issues.9 The conclusionof this study showed that neonatal NPs were strongly sat-isfied with their work.

Koelbel and colleagues’ original work identified themost intrinsic satisfiers as social service, variety, moral val-ues, security, and ability utilization.10 Factors that served asdissatisfiers were compensation, advancement, companypolicies and practices, recognition, and supervision–humanrelations.Although some of these factors may still be justas relevant today as they were in the early 1990s, othersmay have improved over time.

In summary, the lack of a current, robust literaturebase limits the generalizability of the few studies thathave been done on NP job satisfaction. However, thecommon themes noted in these studies provide a solidbasis for the conduct of future studies.

INSTRUMENTATIONThe instrument used for the present study was a 58-itemsurvey composed of 51 Likert-type questions and 7 demo-

graphic questions.The Likert-type portion of the surveywas divided into 3 distinct components: job factors (16items), clinical practice factors (16 items), and personal fac-tors (19 items).The job factors included such items assalary, benefits, on-call policies, and overtime policies.Theclinical practice factors included such items as time allottedfor patient visits, availability of education materials forpatients, availability of supplies, and onsite reference library.The personal factors component included such items asrespect from your peers, respect for your expertise, respectfrom patients for the care you provide, and challenges inyour work.The job factors and clinical practice factors areequivalent to Herzberg’s8 extrinsic factors, whereas thepersonal factors represent the intrinsic factors.

The instrument was reviewed by 4 practicing NPs forboth face and content validity. It was the expert opinionthat the instrument represented the 3 domains previouslydelineated.The instrument used a 6-point Likert-typescale, with the anchors ranging from “extremely satisfied”to “extremely dissatisfied” and an option for “not applica-ble.” In addition to the 51 Likert-type questions, therewere 7 demographic questions requesting information onsubspecialty, states in which the NP practiced, nationalcertification, number of years holding advance practicenurse (APN) certification, number of years worked as anAPN, year APN graduated, and gender.The final ques-tion asked the respondent to rank order the top 5 factorsthat were most important to job satisfaction.

DESIGN AND METHODThe study used a descriptive design with frequencyanalysis.A convenience sample of 207 NPs were recruit-ed from 2 national NP conferences by the investigator orstaff person as the NPs walked by a research booth in theconvention hall exhibit area.The 58-item survey tookapproximately 7 minutes to complete.Those who com-pleted the survey were eligible for a drawing to receive a1-year membership in the professional organization.

RESULTSTwo hundred seven participants were recruited from 2conferences held in October and November 2004.Respondents represented 38 states and the Virgin Islands.A total of 95.1% (n = 196) of participants were women,and 4.9% (n = 10) were men.The average number ofyears since graduation was 8.The average number ofyears worked was 7.46, with a range of 0 (new graduate)

Despite the gains in both

responsibilities and scope of

practice for NPs, little research

has been done to evaluate job

satisfaction with these changes.

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to 30 years.The average number ofyears that the respondents held cer-tification was 7.03.

Table 1 shows the breakdown ofthe respondents by subspecialty.Themajority of the respondents werefamily NPs.The next highest groupof respondents was “Other.”The lat-ter category included respondentswho identified themselves as adult,psychiatric, neurological, infectiousdisease, school, or occupationalhealth NPs.

Job Satisfaction Factors

Table 2 lists those job factors thatenhanced NP job satisfaction.Thesefactors clearly exemplify the extrin-sic factors as operationalized byMisener and Cox.5

Clinical Practice Factors

Table 3 identifies those clinical prac-tice factors that enhance job satisfac-tion.These “environmental” factorsclearly show that diversity, in bothtypes and ages of patients seen, is animportant factor.These findings arenot surprising because a majority ofthe respondents were family NPs,whose educational preparation spansthe continuum from newborns togeriatric patients.The onsite consul-tation availability clearly showed theNP’s desire to function as a teammember.These rank orderings alsoreflect extrinsic factors.4

Personal Factors

As shown in Table 4, the overridingtheme for personal factors was qual-ity of care, which received the high-est score in any of the domains.Therespondents were more focused onthe care given than any of theextrinsic factors.Additionally, theconcept of respect for one’s expert-

Table 1. Subspecialty of Survey Respondents by Percent and Sample Size

Subspecialty Percent Sample Size (n)

FNP 51.7 106

ACNP 9.3 19

PNP 3.4 7

GNP 3.4 7

WHNP 2.9 6

Dual 8.8 18

Other 20.5 42

FNP indicates nurse practitioner; ACNP indicates acute care nurse practitioner; PNP indicatespediatric nurse practitioner; GNP indicates geriatric nurse practitioner; WHNP indicates women’shealth nurse practitioner.

Table 2. Job Factors That Enhance Nurse Practitioner Satisfaction

Monday through Friday work hours 64.3% (n = 133)

Immediate supervisor 53.1% (n = 110)

Vacation time 50.7% (n = 105)

Sick leave policies 48.8% (n = 101)

Paid educational leave 45.9% (n = 95)

Table 3. Top Five Clinical Practice Factors That Enhance Nurse PractitionerJob Satisfaction

Variety of patients seen with differing diagnoses 66.5% (n = 137)

Variety of ages of patients seen in your practice 59.2% (n = 122)

Onsite consultation with other healthcare providers 56.6% (n = 116)

Time allotted for patient visits 54.4% (n = 112)

Exam room availability 52.9% (n = 109)

ise as well as respect from one’s peers and patients was crucial to personal sat-isfaction. Opportunities to be involved with professional organizations werealso highly valued by NPs.

Table 5 represents respondents’ overall job satisfaction. Overall, 85.8% (n = 176) of the respondents reported being on a continuum from somewhatto extremely satisfied with their jobs, 13.6% (n = 28) were somewhat to verydissatisfied, and 0.6% (n = 3) did not answer the question.

DISCUSSIONFindings from this study were not congruent with the overall satisfactionrate found by other investigators. Kacel et al found that NPs’ overall job sat-isfaction rate was in the minimally satisfied to satisfied range.6 In their study,NPs were most satisfied with the intrinsic factors, such as autonomy, workchallenge, patient mix, and ability to deliver quality care.They were least sat-isfied with the extrinsic factors, such as reward distribution, compensation

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Table 4. Top Five Personal Factors That Enhance Nurse Practitioner JobSatisfaction

Quality of care you provide 86.4% (n = 181)

Respect from patients for carethat you provide 86.4% (n = 178)

Respect from your peers 73.8% (n = 152)

Respect for your expertise 65.4% (n = 134)

Opportunities to be involved with local nurse practitioner organizations 63.4% (n = 130)

Table 5. Overall Job Satisfaction of Nurse Practitioner Respondents

Extremely/very satisfied 62.9% (n = 129)

Somewhat satisfied 22.9% (n = 47)

Somewhat dissatisfied 7.8% (n = 16)

Very dissatisfied 5.8% (n = 12)

Nonresponders 0.6% (n = 3)

for services outside normal duties, lack of involvement in research, and timeoff to serve on professional committees. Misener and Cox’s study using theMNPJSS had a “mean score of 358 which corresponds to 468 on the 6-point scale and indicated an overall indication of ‘somewhat satisfied.’”5

Hence, the former 2 studies have similar findings.The findings of the current study are congruent with the general conclusion

of the previous studies.That is, intrinsic factors generated the highest satisfaction,whereas extrinsic factors produced the least satisfaction for the respondents.

Implications

The findings from this study clearly show that NPs are satisfied with theirjobs. However, there are several important lessons that can be garnered fromthis study. First, when negotiating for jobs, NPs should inquire about theenvironment in which they will be working.Talking to present and formeremployees can prevent the NP from committing to working in a nonsup-portive environment. Second, NPs who are already employed should sitdown with their colleagues and discuss how they as a team can help enhancethose elements that are identified as lower ranking “satisfiers.”Working as agroup can provide perspectives and solutions that an individual might easilyoverlook.Third, by reviewing the findings of this study, managers can identifythose factors that are identified as marginal satisfiers and work to rectify orchange those factors to enhance recruitment and retention of employees.

SUMMARYThis study showed that respondents were generally satisfied with their jobs.They rated the highest satisfiers as those that affected personal factors, espe-cially those related to quality of care and respect.The areas that provided theleast satisfaction centered on the extrinsic factors.These extrinsic factorsshould be the focal point for employers who want to improve the work envi-

ronment and, hence, improve overalljob satisfaction for NPs.

REFERENCES

1. Mundinger MO, Kane RL, Lenz ER, Totten AM,Tsai W, Cleary PD. Primary outcomes inpatients treated by nurse practitioners orphysicians. JAMA. 2000;283:59-68.

2. Mundinger M. Challenges facing familypractice and primary care. JAMA.2003;289:297-298.

3. Mundinger MO. Can advanced practice nursessucceed in the primary care market? NursEcon. 1999;17:7-14.

4. Lenz ER, Mundinger M, Kane RL, Hopkins SC,Lin SX. Primary care outcomes in patientstreated by nurse practitioners or physicians:two-year follow-up. Medical Care Res Rev.2004;61:332-351.

5. Misener TR, Cox DL. Development of theMisener Nurse Practitioner Job SatisfactionScale. J Nurs Meas. 2001;9:91-108.

6. Kacel B, Miller M, Norris D. Measurement ofnurse practitioner job satisfaction in aMidwestern state. J Am Acad Nurse Pract.2005;17:27-30.

7. Herzberg F. Work and the Nature of Man. NewYork, NY: World Publishing Co; 1966.

8. Mueller CW, McCloskey JC. Nurses’ jobsatisfaction: a proposed measure. Nurs Res.1990;39:113-117.

9. Beal JA, Steven K, Quinn M. Neonatal nursepractitioner role satisfaction. J Perinat NeonatNurs. 1997;11:65-76.

10. Koelbel PW, Fuller SG, Misener TR. Anexplanatory model of nurse practitioner jobsatisfaction. J Am Acad Nurs Pract.1991;3:17-24.

Ken Miller, PhD, RN, CFNP, FAAN,is a professor and associate dean forresearch and clinical scholarship at theUniversity of New Mexico HealthSciences Center, College of Nursing inAlbuquerque, NM. He can be reached atkpmiller@salud.unm.edu. Susan Apold,PhD, RN, CFNP, is vice president foracademic affairs and the dean of facultyat the College of Mt. St.Vincent’s inRiverdale, NY. Linda Baas, PhD, RN,CFNP, is a professor and the director ofthe acute care program at the Universityof Cincinnati College of Nursing inCincinnati, Ohio. Barb Berner, EdD,RN, CFNP, is an assistant professor atthe University of Alaska in Anchorage.Esther Levine-Brill, PhD, RN,ANP, isprofessor of nursing at Long IslandUniversity in Brooklyn, NY.1555-4155/05/$ – see front matter© 2005 Elsevier Inc. All rights reserved.

doi: 10.1016./j.nurpra.2005.06.011

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