Boafo Human Resources for Health  (2018) 16:6 
DOI 10.1186/s12960-018-0269-9
RESEARCH Open Access
The effects of workplace respect and
violence on nurses’ job satisfaction in
Ghana: a cross-sectional survey
Isaac Mensah Boafo
Abstract
Background: Studies have established the negative effects of workplace disrespect and violence on the personal
and professional well-being of nurses. In spite of this, only a few have directly investigated the effects of these
issues on nurses’ job satisfaction. In Africa, research on nurses’ job satisfaction continues to focus largely on
economic factors. The aim of this paper was, therefore, to investigate the impact of the non-economic factors of
workplace violence and respect on the job satisfaction levels of nurses in Ghana.
Methods: The study employed a cross-sectional questionnaire survey. It involved 592 qualified practising nurses
working in public hospitals in Ghana. Data were collected between September 2013 and April 2014.
Results: The results showed that, overall, nurses were neither satisfied nor dissatisfied with their jobs (M= 3.19, SD
= .54). More than half (52.7%) of the participants had been abused verbally, and 12% had been sexually harassed in
the 12 months prior to the study. The majority of nurses, however, believed they were respected at the workplace
(M= 3.77, SD = .70, Mode = 4). Multiple regression analyses showed that verbal abuse and perceived respect were
statistically significant predictors of nurses’ job satisfaction. Nurses who experienced verbal abuse and low level of
respect were more likely to report low job satisfaction scores.
Conclusion: It is concluded that non-financial strategies such as safe work environments which are devoid of
workplace violence may enhance nurses’ job satisfaction levels. A policy of “zero tolerance” for violence and
low tolerance for disrespect could be put in place to protect nurses and healthcare professionals in general.
Keywords: Job satisfaction, Violence, Verbal abuse, Respect, Interactional justice, Ghana
Background 17, 18]. Other factors such as the type of hospital (e.g.
Nurses’ productivity and the quality of care they provide teaching and non-teaching), the location of hospital (rural
depend largely on the availability of adequate nursing staff or urban), the unit/department where one works, and the
[1], thus making the shortage and high turnover rates of work environment have also been shown to impact nurses’
nurses a topical issue globally [2]. The nurse-patient ratio is job satisfaction [19–22].
perceived to be inadequate in many countries, with sub- Nurses’ job satisfaction is, however, not uniformly
Saharan Africa being the worst affected region [3]. Job influenced by these factors. Whereas some are most
satisfaction contributes to this global shortage as it is often dissatisfied with pay and promotion prospects [15],
linked to nurses exiting the profession [4–7]. others are reported to be most dissatisfied with childcare
Studies conducted on the job satisfaction levels of facilities, compensation for working weekends and
hospital-based nurses show that over a quarter are dissatis- control over working conditions [23]. Studies, particu-
fied [8–11]. Sources of dissatisfaction include collegial rela- larly from low- and middle-income countries, suggest
tionships and leadership [12–14], education and promotion that pay levels exert great influence on the satisfaction
prospects [4, 15], autonomy [12, 13, 16] and pay [11, 13, levels of nurses. For instance, in a survey of nurses from
five hospitals in Addis Ababa, Ethiopia, salary was found
Correspondence: imboafo@gmail.com to be the key and pronounced factor influencing job
Department of Sociology, University of Ghana, Legon, Accra, Ghana
© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
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the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Boafo Human Resources for Health  (2018) 16:6 Page 2 of 10
satisfaction with a correlation coefficient of 0.74 [24]. Although studies often allude to lack of respect as a con-
Mohite et al. [25] reported in their Indian study that al- cern for nurses, few studies on respect exist in the nursing
though nurses reported high scores on satisfaction with literature [44]. Cotter et al. [49] noted that apart from those
their level of achievement and utilization of their abil- aligned with nursing, the perception of many people is to
ities, they expressed dissatisfaction with the level of consider nursing as inferior. Other authors support this
compensation, which statistically reduced their level of position by contending that nurses often do not get the
overall satisfaction. respect they deserve from other health professionals, par-
Job satisfaction levels of nurses in different geographical ticularly physicians [50–53]. Many nurses also experience
and socio-cultural settings need to be assessed to deter- lack of respect from patients and their relatives [54].
mine which factors impact on them the most. This may Like workplace violence, disrespect for nurses can have
assist healthcare managers and policy makers to prioritize personal and professional impacts. Persistent experience of
the issues which must be addressed to improve the satis- disrespect may lead to fear, anger, humiliation and lowered
faction levels of nurses, and consequently healthcare deliv- job satisfaction, reduced work performance, turnover
ery. This is particularly important for less-developed intentions and actual turnover, insomnia and hypertension
economies such as Ghana, where resource constraints are [43, 55]. Expression of disrespect especially by physicians
very pronounced. Arguably, non-financial factors impact- may also strain inter-professional communication and
ing negatively on nurses’ job satisfaction when addressed collaboration [42, 55]. Consequently, Middleton [50] con-
may have a positive ripple effect on overall job satisfaction. tended that “when nurses have respect, care is better”.
Workplace violence, which refers to “incidents where In spite of evidence pointing to the association between
staff are abused, threatened or assaulted in circumstances respect and occupational outcomes, there is a dearth of
related to their work, including commuting to and from studies directly investigating the association between
work, involving an explicit or implicit challenge to their nurses’ perception of the respect they receive and their job
safety, well-being or health” [26] has been found to be a satisfaction. This data scarcity also holds true for the asso-
major problem for nurses globally [27–33]. Available evi- ciation between workplace violence and nurses’ job satis-
dence suggests that rates of workplace violence against faction, particularly in Africa [56]. In Ghana, studies on
nurses may range from 9% to as high as 89% [34, 35]. Both nurses’ job satisfaction have largely focused on resource-
physical and non-physical forms of workplace violence related predictors such as salaries, opportunities for fur-
have detrimental effects on the physical and psychological ther education and promotion, poor physical environ-
well-being of nurses, and consequently quality of care they ments and lack of materials and basic equipment [9, 57].
provide, and the rate at which nurses change jobs or leave It is also remarkable that most studies on interactional
the profession [27, 32, 36–39]. Such effects range from justice focus on the relationships among members of an
physical injuries to having symptoms related to post- organisation to the exclusion of relationships among em-
traumatic stress disorder [27, 32, 34]. ployees and clients or outsiders [42, 46, 47].
Closely related to the issue of workplace violence is that This paper is, therefore, concerned with investigat-
of respect given to nurses at the workplace. Respect is a ing the impact of perceived respect and workplace
moral principle that involves valuing the dignity and worth violence on Ghanaian nurses’ job satisfaction. The
of another person [40, 41]. The notion of respect is present current paper makes a significant contribution to the
in all cultures, but the behaviours that express respect differ body of knowledge by providing empirical evidence to
across cultures [42]. Respect influences quality of care [43], the effect that job satisfaction of nurses in Africa is
recruitment and retention as it impinges on job satisfaction not only influenced by economic factors but also
of nurses [42]. Moreover, the global shortage of nurses other non-economic factors such as violence and lack
dictates that strategies put in place to attract individuals of respect at the workplace. Indeed, the current study
into the profession extend beyond financial incentives to in- is in line with the principles of the WHO’s Global
clude respecting nurses within the healthcare setting [44]. Strategy on Human Resource for Health: Workforce
The concept of respect is usually found in research on 2030 [58]. One of the principles of this strategy is to
organizational justice [45]. It falls under the category of ensure the personal, employment and professional
interactional justice, which refers to the “perceptions of the rights of all health workers, including safe and decent
quality of interaction among individuals...” [44]. Evidence working environments and freedom from all kinds of
from fields outside nursing suggests that in order to keep discrimination, coercion and violence.
employees satisfied and committed to an organisation, they The current paper provides answers to the following
need to be treated fairly and respectfully [46, 47]. In a study research questions:
of sports federation workers for instance, it was found that
interactional justice correlated positively with job satisfac- 1. Do Ghanaian nurses believe they are respected at
tion and was negatively related to turnover intentions [48]. their workplaces?
Boafo Human Resources for Health  (2018) 16:6 Page 3 of 10
2. What is the level of job satisfaction among Ghanaian selected hospital, nurses were then selected from the vari-
nurses? ous units/departments using a simple random sampling
3. What is the relationship between workplace respect technique. Data collection took place between 12:00 and
and violence and nurses’ job satisfaction? 21:00 to ensure that nurses working all shifts had equal op-
portunity for participation. The data were collected using
Methods printed (hardcopy) questionnaires. To participate in the
This paper is a part of a larger study of workplace experi- study, one had to be a professional nurse and should have
ences of Ghanaian nurses. A cross-sectional descriptive practiced for at least 12 months. A total of 1021 profes-
questionnaire survey was conducted between September sional nurses were invited to take part in the survey, of
2013 and April 2014 in 12 hospitals in Ghana comprising which 685 accepted to participate and 592 returned ques-
of two teaching hospitals, five regional hospitals and five tionnaires were valid for statistical analyses, giving a net re-
district hospitals. sponse rate of 58%. Data were collected by the researcher
and four trained research assistants. No incentives were
Sampling—hospitals provided for participation.
Five out of the ten regions of the country were purposively
selected for the study. These were Northern, Ashanti, Instrument
Greater Accra, Eastern and Volta. The reason for selecting A self-report questionnaire was utilized for data collection.
these regions was to ensure that all three major ecological Five nurses reviewed the questionnaire for face validity,
zones, namely, the coastal, forest and savannah zones, clarity and sensitivity of items. Three of the nurses were
were represented. It also ensured that the various social, from teaching hospitals, and two from district hospitals.
cultural, economic and demographic characteristics of the Based on their feedback, necessary adjustments were
entire country were captured. made before the start of the study. The final questionnaire
Nine of the ten regions had a regional hospital. The contained items on workplace violence, perceived respect,
regional hospitals in the selected regions were automatically job satisfaction and socio-demographic variables.
selected for the study. In the Ashanti Region where accord- The study utilized the Health Sector Workplace Violence
ing to the Ghana Health Service no hospital is designated Questionnaire jointly developed by the International
as a regional hospital [59], the Suntreso Government Labour Organization, International Council of Nurses,
Hospital which is located in the Kumasi metropolis was World Health Organization and Public Services Inter-
chosen to represent a regional hospital due to its location national [26]. This questionnaire was used to ensure that
and the diversity of the people it serves. Two of the three the incidence of violence reported in this study could be
teaching hospitals in the country were selected for the compared with other studies which have utilized the ques-
study. The Korle Bu and Tamale teaching hospitals located tionnaire. The three forms of violence—physical, verbal
in the Greater Accra and Northern Regions respectively and sexual—were measured using single-item scales and
were selected to ensure the sample was representative of for that matter it was not possible to determine their reli-
the northern/southern divide of the country. Finally, one abilities using Cronbach’s alpha [60]. In view of this, prior
district hospital was randomly selected from each of the to the study, these items were tested on 20 nurses who
five selected regions. Data on the districts in Ghana were were not part of the study on two occasions with a 2-week
obtained from the Ghana Statistical Service [54]. The selec- interval. The test-retest correlation coefficients for sexual
tion of district, regional and teaching hospitals was to en- abuse, verbal abuse and physical violence were 1.00, 1.00
sure that all the three levels (primary, secondary and and .90 respectively.
tertiary) of healthcare delivery in Ghana were captured. The “perceived respect” variable was informed by
The location, size and the type of cases handled by these Siegrist’s [61] Esteem Scale. The original scale contains
hospitals may have implications for workplace violence, dis- three items measuring nurses’ perception of the respect
respect and nurses’ job satisfaction. they receive from managers and peers. The scale was
modified to include respect from patients, relatives of
Sampling—participants patients, doctors and other hospital staff. The scale in
Data were collected using a multi-stage sampling tech- the present study thus contained seven items rated on a
nique. In the first stage, Korle Bu and Tamale teaching 5-point Likert scale (1 = strongly disagree; 5 = strongly
hospitals were purposively selected to ensure that both agree). The internal consistency of the scale as measured
northern and southern sectors of the country were repre- by Cronbach’s alpha was 0.86. The scale was constructed
sented. The second stage involved selecting five regional by computing the averaged sum score.
hospitals from five randomly selected regions. And in the The job satisfaction scale was informed by the Measure
third stage, one district hospital was randomly selected of Job Satisfaction scale (MJS) [62]. The scale used in the
from each of the randomly selected regions. In each of the current study was constituted by 12 items. The items on
Boafo Human Resources for Health  (2018) 16:6 Page 4 of 10
the scale covered different aspects of the job including Table 1 Socio-demographic characteristics of participants (N= 592)
work organisation, pay and promotion prospects, educa- Item description n (%)
tion and training prospects, and professional relationships. Region
The items were measured on a 5-point Likert type scale Greater Accra 249 (42.1)
with responses ranging from 1 (strongly dissatisfied) to 5
Eastern 130 (22.0)
(strongly satisfied). The overall scale had adequate internal
consistency with a Cronbach’s alpha of .77. The overall Ashanti 76 (12.8)
satisfaction scale was constructed by computing the mean Volta 51 (8.6)
sum score for the items. The methods used in this study Northern 86 (14.5)
have also been published elsewhere [63]. Gender
Female 469 (79.2)
Results
Male 123 (20.8)
Demographic and workplace characteristics
A relative majority (42.1%) of the participants worked in Age group
the Greater Accra Region. Over one fifth (22.8%) of the 21–30 398 (67.7)
participants were nurses in the Eastern Region. More than 31–40 98 (16.7)
a third (38.7%) of the participants worked in regional hos- 41–50 37 (6.3)
pitals, and a third (32.9%) worked in teaching hospitals. 51–60 55 (9.4)
Approximately 20% of the participants were males and
Marital status
80% were females. Their ages ranged from 21 to 60 years
with a mean age of 31.76 years (SD = 9.69). More than Single 310 (52.5)
half of the sample (61.3%) had Diploma qualifications Married 280 (47.5)
(see Table 1). In terms of position/rank, 53% were Staff Educational attainment
Nurses, 22.7% were Senior Staff Nurses and 4.8% were Certificate 79 (13.4)
Principal Nursing Officers (see Table 2). Participants had Diploma 363 (61.7)
been in the nursing profession for between 1 and
Bachelor’s degree or higher 146 (24.8)
40 years (M= 7.38, SD = 9.53); 17% worked in the out-
patient department (OPD), and 35.5% worked at medical Age (min = 21, max = 60,
mean = 31.76, SD = 9.69)
and surgical units. Demographic and workplace charac-
teristics of the participants are displayed in Table 1. Hospital type
District hospital 168 (28.4)
Perceived respect Regional hospital 229 (38.7)
The mean scores of the major sub-groups on the respect Teaching hospital 195 (32.9)
items are presented in Table 3. Males reported higher mean Units/department
scores on almost all the items making up the scale. How-
Critical care 119 (20.2)
ever, the differences in the means were very marginal (< .5).
Small differences were also found among nurses working in Outpatient department 100 (17.0)
the various regions of the country. Greater Accra Region Medical-surgical unit 209 (35.5)
recorded the lowest mean scores with regard to respect Special units 160 (27.2)
from patients (M= 3.45) and relatives of patients (3.19). Al- Position/grade
though marginal, this systematic difference may be ex- Staff Nurse 308 (53.0)
plained by inadequate staffing and overcrowding in public
Snr. Staff Nurse 132 (22.7)
hospitals within the region, which may in turn lead to dis-
satisfaction among consumers of health care. With regard Nursing Officer 72 (12.4)
to position, senior nurses scored higher on all the items Snr Nursing Officer 42 (7.2)
making up the respect scale compared to junior ones. Jun- Principal Nursing Officer 28 (4.8)
ior nurses were more likely to be young and single. Of Source: Field Survey 2013–2014
those who were single, 85.7% were junior nurses and 14.3%
were senior nurses (N = 580, df = 1, χ2 = 36.94, p = .000). fact the modal mark for all the items on the respect scale
Overall, the results as presented in Table 3 show was four. This means that a relative majority of nurses
similar average ratings for all items on the respect “agreed” to statements that they were respected at the
scale (3 <M < 4). The standard deviations of the various hospital.
items on the scale were small, suggesting that the means The mean score of the respect scale was 3.77 (SD = .70,
were highly representative of the scores on each item. In Mode = 4) with possible scores ranging from 1 to 5. These
Boafo Human Resources for Health  (2018) 16:6 Page 5 of 10
Table 2 Incidence of violence means that in real-life situations, there may be no gender
Item descriptions n (n%) disparities in nurses’ perceptions/experiences of respect at
Have you been verbally the workplace. No statistically significant difference was
abused in your work found between male and female nurses with regard to the
place in the past 12 level of respect received from doctors.
months?
A comparison of the scores of junior and senior nurses
Yes 312 (52.7) on the perceived respect scale showed a statistically sig-
No 280 (47.3) nificant difference in the means, t(576) = − 3.04, p < 0.01
Have you been sexually (two-tailed) with junior nurses (M= 3.70, SD = .72)
harassed in your workplace rating the respect they receive lower than senior
in the past 12 months?
nurses (M= 3.90, SD = .62). The individual items on the
Yes 72 (12.2) respect scale revealed a statistically significant difference
No 520 (87.8) between senior (M= 3.56, SD = 1.08) and junior (M= 3.32,
Have you been physically SD = 1.08) nurses with regard to their perception of
abused in your workplace the level of respect received from relatives of patients,
in the past 12 months?
t(577) = − 2.23, p < .05. Senior nurses perceived a statisti-
Yes 53 (9.0) cally significantly higher level of respect from doctors
No 539 (91.0) (M= 3.87, SD = .93) compared to junior nurses (M= 3.67,
How concerned are you SD = .91), t(576) = − 2.17, p < .05.
about violence (min = 1,
max = 5, mean = 3.05,
SD = 1.51) Workplace violence
Number of years in The results indicated that 53 (9%) experienced physical
nursing (min = 1, violence; 312 (52.7%) had suffered verbal abuse; and 72
max = 40, mean = 7.38, (12.2%) reported that they have been sexually harassed
SD = 9.53) in their workplaces in the 12 months prior to the study.
Source: Field Survey 2013–2014 Although the mean score for nurses’ concern over work-
place violence suggests that nurses were moderately con-
results, therefore, suggest that, in general, nurses believed cerned about workplace violence, the mode revealed that
they were respected by staff and consumers of healthcare many nurses were extremely concerned about workplace
services since the mean score was above the mid-point of violence (min =1, max = 5, mean = 3.05, SD = 1.51,
the scale and the modal score was four. mode = 5). Being concerned may mean that nurses
Independent samples t-test conducted to compare did not feel safe in their workplaces as far violence is
the scores for male and female nurses on the respect concerned. It is an admission that they are at risk of
scale revealed a statistically significant difference, violence. These results are worrying particularly con-
t(586) = − 3.04, p = .03, two-tailed, with male nurses sidering the fact that creating a violence-free atmosphere
(M= 3.87, SD = 0.70) scoring higher than female at the workplace is one of the principles underlying
nurses (M= 3.71, SD = 0.70). Further analyses of the WHO’s Global Strategy on Human Resource for Health
level of perceived respect from the various actors in [58]. Table 2 provides data on the incidence of workplace
the hospitals also suggested that male nurses received violence among the sample. A more detailed analysis of
a statistically significantly higher level of respect from the incidence of workplace violence among the sample
patients’ relatives (M= 3.64, SD = 1.0) compared to has also been reported elsewhere [32].
female nurses (M= 3.32, SD = 1.12), t(208.69) = − 3.06,
p < .01. Similarly, there was a statistically significant Job satisfaction
difference in the level of respect received from patients, The overall job satisfaction scale had a mean score of
t(201.96) = − 2.79, p = .01, by male (M= 3.80, SD = .99) 3.19 (SD = 0.54), with higher scores indicating greater
and female (M= 3.51, SD = 1.07) nurses. Usually, these satisfaction levels. This result means that, in general,
findings would mean that male nurses believed they were Ghanaian nurses were neither satisfied nor dissatisfied.
given greater level of respect than their female counter- One-way analysis of variance (ANOVA) suggested
parts at the hospital. However, the differences in the that, statistically, nurses working in different types of
means are almost negligible. The ratings of both male and hospitals (district, regional and teaching hospitals) did
female nurses fell within the same qualitative category on not differ in a significant way with regard to their
the scale. Moreover, the same modal score (four) was re- overall job satisfaction. Independent samples t-test
corded for both male and female nurses on the perceived comparing the scores on the overall scale revealed a statis-
respect scale, and on the items making up the scale. This tically significant difference in the scores of female
Boafo Human Resources for Health  (2018) 16:6 Page 6 of 10
Table 3 Nurses’ experience of respect
I receive respect Patients Relatives of Colleagues Supervisors Doctors Other
I deserve from patients staff
Females
Mean 3.51 3.32 3.96 3.85 3.73 3.90
N 467 467 467 467 467 467
SD 1.07 1.12 .86 .89 .90 .80
Males
Mean 3.80 3.64 4.09 3.96 3.70 3.98
N 122 122 122 122 121 122
SD .99 1.00 .85 .87 .100 .87
Northern Region:
Mean 3.72 3.58 4.06 4.03 3.63 3.91
N 86 86 86 86 86 86
SD .98 .100 .74 .77 1.00 1.01
Volta Region:
Mean 3.61 3.49 3.76 3.71 3.86 3.88
N 51 51 51 51 50 51
SD 1.15 1.16 .97 1.04 1.03 .86
Ashanti Region:
Mean 3.72 3.68 4.13 3.88 3.71 3.92
N 75 75 75 75 75 75
SD 1.01 1.02 .88 .96 1.05 .93
Eastern Region:
Mean 3.60 3.43 4.05 3.94 3.68 3.95
N 130 130 130 130 130 130
SD .96 .95 .70 .72 .74 .70
Greater Accra:
Mean 3.45 3.19 3.94 3.81 3.75 3.92
N 247 247 247 247 247 247
SD 1.20 1.12 .93 .94 .91 .82
Junior Nurses:
Mean 3.46 3.32 3.97 3.83 3.67 3.88
N 438 438 438 438 437 438
SD 1.08 1.11 .89 .89 .91 .83
Senior Nurses:
Mean 3.85 3.56 4.06 4.01 3.87 4.04
N 141 141 141 141 141 141
SD .95 1.08 .77 .83 .93 .76
Total Sample:
Mean 3.57 3.39 3.99 3.87 3.72 3.92
N 589 589 589 589 589 589
SD 1.06 1.10 .86 .89 .92 .89
Source: Field survey 2013–2014
Other staff laboratory technicians and other allied health professionals
(M= 3.17, SD = 0.53) and male (M= 3.30, SD = 0.55) With regard to position, the results of an independent
nurses; t(581) = − 2.36, p = .02. The means, however, samples t-test indicated that junior and senior nurses had
fell within the same qualitative response category similar mean scores on the overall job satisfaction scale.
(neither satisfied nor dissatisfied) on the scale. The To fulfill the main objective of this paper, the relation-
statistically significant difference could, therefore, be ship between workplace respect, violence and job satisfac-
the result of the large sample size employed. In real- tion was explored using Pearson’s correlation. Statistically
life situations, there may be no difference between significant relationships were found between workplace
the job satisfaction levels of males and females in physical violence, verbal violence, perceived respect and
Ghana. job satisfaction. Negative associations were found between
Boafo Human Resources for Health  (2018) 16:6 Page 7 of 10
workplace violence and job satisfaction. On the other dissatisfied with their jobs. This finding of neutrality re-
hand, a positive association was found between perceived garding satisfaction is consistent with other international
respect and job satisfaction. Results of the bivariate ana- studies on nurses from countries such as Israel and
lyses as presented in Table 4 suggest that workplace verbal Jordan [17, 65].
abuse explains approximately 5% of the variance in nurses’ One major finding of the current study was the fact that
job satisfaction, and perceived respect explains 14.4% of workplace verbal violence and perceived respect were
the variance in nurses’ job satisfaction. These results sug- statistically significant predictors of nurses’ job satisfaction.
gest that it is possible to enhance nurses’ job satisfaction Nurses who were exposed to verbal abuse were less
through non-economic (financial) means. satisfied with their job. This finding is consistent with the
findings of other studies which have reported a negative
Predicting job satisfaction association between workplace violence and nurses’ job
Standard multiple regression analysis was used to as- satisfaction [66–69]. This finding can also be related to
sess the ability of selected socio-demographic and other studies [70, 71], which have reported associations be-
workplace characteristics to predict nurses’ job satis- tween verbal abuse and turnover rates among nurses. If
faction. The analyses were checked to ensure that the job satisfaction is about the way people think and feel
assumptions of normality, linearity, multicollinearity, about their work, then how individuals think and feel
and homoscedasticity were not violated [64]. The pre- about certain experiences associated with their jobs such
diction model for nurses’ job satisfaction suggested as verbal violence and interactional justice, can impact
that perceived respect (t = 9.12, p < 01), experience of their satisfaction levels.
workplace verbal abuse (t = − 3.22, p < .01) and the On the issue of perceived respect, it was found that with
rank of a nurse (t = − 3.21, p < .01) were the signifi- the exception of respect from medical doctors, male nurses
cant predictors of nurses’ job satisfaction. The Beta perceived their level of respect to be higher than female
values as presented in Table 4 suggest that perceived nurses. Although the mean difference was marginal, this
respect makes the strongest unique contribution to- could be as a result of the fact that within the Ghanaian
wards explaining the variability in nurses’ job satisfac- context, male nurses are usually mistaken for medical
tion. The overall model accounted for 18% of the doctors by patients and their relatives. It could also be the
variance in nurses’ job satisfaction (see Table 5). result of the age-old tradition where males are seen as
authority figures and revered more than women. Another
Discussion interesting finding in relation to perceived respect was that
The mean score for overall job satisfaction among Ghan- junior nurses rated their respect lower than senior nurses.
aian nurses was found to be 3.19 (range 1–5). Nurses In the Ghanaian setting, older people are given higher
were, therefore, on average neither satisfied nor respect than younger persons. Similarly, people who are
Table 4 Correlational analyses—workplace violence, perceived respect and job satisfaction
Physical violence Sexual harassment Verbal abuse Respect received Job satisfaction
Physical violence Pearson correlation 1 .03 .20** − .05 − .09*
Sig (two-tailed) .46 .000 .26 .03
N 592 591 590 588 581
Sexual harassment Pearson correlation .03 1 .28** − .09* − .07
Sig (two-tailed) .461 .000 .03 .09
N 591 591 589 587 580
Verbal abuse Pearson correlation .202** .28** 1 − .19** − .22**
Sig (two-tailed) .000 .000 .000 .000
N 590 589 590 587 579
Perceived respect Pearson correlation − .046 − .09* − .19** 1 .38**
Sig (two-tailed) .264 .03 .000 .000
N 588 587 587 588 578
Job satisfaction Pearson correlation − .091* − .07 − .22** .38** 1
Sig (two-tailed) .03 .09 .000 .000
N 581 580 579 578 581
**Correlation is significant at the .01 level (two-tailed)
*Correlation is significant at the .05 level (two-tailed)
Boafo Human Resources for Health  (2018) 16:6 Page 8 of 10
Table 5 Predicting Ghanaian nurses’ job satisfaction
Variable B SE Beta t p value 95% CI for B
Constant 2.27 .12 – 19.01 .00 2.04 to 2.51
Gender
Female Reference – – – – –
Male .05 .05 .04 1.01 .32 − .05 to .15
Position
Junior Nurse Reference – – – – –
Senior Nurse − .16 .05 − .13 − 3.21 .00 − .25 to − .06
Verbally abused
No Reference – – – – –
Yes − .14 .05 − .13 − 3.22 .00 − .23 to − .06
Physically abused
No Reference – – – – –
Yes − .07 .07 − .04 − .94 .35 − .22 to .08
Sexually harassed
No Reference – – – – –
Yes .01 .07 .00 .11 .92 −.12 to .14
Perceived respect .28 .03 .36 9.12 .00 .22 to .33
R2 = .179 F (df = 6, N = 566) =
20.26, p = .000
Source: Field Survey 2013–2014
married are seen as being more responsible and are, there- important areas of dissatisfaction, other factors such as
fore, accorded higher respect than unmarried individuals workplace verbal violence, perceived respect and staffing
[72]. This could explain why junior nurses reported lower adequacy were significant determinants of nurses’ job
respect than senior nurses, since senior nurses are more satisfaction. The results of the study reported in the
likely to be older and married. Another plausible explan- current paper would therefore be of great importance to
ation could be that senior nurses have more experience and policy makers and hospital administrators who seek to
are able to relate better with patients and their relatives. improve the job satisfaction levels of nurses. As per the
The current study also established a positive associ- results, the concentration must not always be on how to
ation between the level of perceived respect and nurses’ provide financial incentives for nurses. Efforts must also
job satisfaction. Nurses may derive satisfaction from be put into creating a safe and civilised work environ-
their job if they are respected and valued in the hospital ment for nurses. This, indeed, is in line with the WHO’s
and by the general society. Indeed, it is logical and ra- Global Strategy for Health Workforce [58].
tional for people to be less satisfied with aspects of their
job such as pay if the job is fraught with stress induced Limitations
by violence and disrespect. If nurses in developing coun- This study involved nurses working in public hospitals in
tries such as Ghana work in environments where their Ghana. Its findings may not be applicable to nurses work-
personal and professional rights are respected, including ing in the private sector. The cross-sectional nature of the
working in safe environments and freedom from vio- study also implies that causal inferences cannot be drawn
lence and disrespect, they may be more likely to be less from it. The current study measured nurses’ levels of job
dissatisfied with their pay and other financial rewards. satisfaction and their perceptions of respect accorded
Although a number of studies have tried to measure them at the workplace. In terms of respect, they believed
the job satisfaction levels of nurses in Ghana, all these they were generally respected, and with regard to satisfac-
studies have concentrated on job components such as tion, they were generally neutral. However, the study was
salary and opportunities for professional development unable to establish how these compare with other health-
[9, 57]. None of these studies have assessed the impact care professionals. For instance, questions such as are
of workplace violence on nurses’ job satisfaction. The nurses more satisfied than medical doctors or hospital-
findings of the current paper have showed that for based pharmacists? Do nurses report greater levels of re-
Ghanaian nurses, although pay and promotion were spect than medical doctors or hospital-based pharmacists?
Boafo Human Resources for Health  (2018) 16:6 Page 9 of 10
These questions could not be answered by the current 2. Oulton JA. The global nursing shortage: an overview of issues and actions.
study. The limitations identified, however, provide avenues Policy, Politics, & Nursing Practice. 2006;7(3 suppl):34S–9S.
3. Buchan J, Aiken L. Solving nursing shortages: a common priority. J Clin
for future research. Nurs. 2008;17(24):3262–8.
4. Lu H, et al. Job satisfaction among hospital nurses revisited: a systematic
Conclusion review. Int J Nurs Stud. 2012;49(8):1017–38.
5. Samir N, et al. Nurses’ attitudes and reactions to workplace violence in
The current paper established that verbal abuse, respect obstetrics and gynaecology departments in Cairo hospitals. East Mediterr
and staffing adequacy influenced nurses’ job satisfaction Health J. 2012;18(3):197–204.
levels. In a resource constrained country such as Ghana, it 6. De Gieter S, Hofmans J, Pepermans R. Revisiting the impact of job
satisfaction and organizational commitment on nurse turnover intention: an
may not always be possible to increase job satisfaction individual differences analysis. Int J Nurs Stud. 2011;48(12):1562–9.
levels through financial incentives. However, policies aimed 7. Bonenberger M, et al. The effects of health worker motivation and job
at reducing workplace violence, ensuring low tolerance for satisfaction on turnover intention in Ghana: a cross-sectional study. Hum
Resour Health. 2014;12:43.
workplace disrespect and increasing staffing levels of nurses 8. Hayes, B., A. Bonner, and C. Douglas, The levels of job satisfaction, stress and
may go a long way to improve the satisfaction levels of burnout in Australian and New Zealand haemodialysis nurses. 2013.
nurses. Indeed, the Global Strategy on Human Resources 9. Anarfi J, Quartey P, Agyei J. Key determinants of migration among health
for Health [58] underscores the importance of creating a professionals in Ghana. Globalization and Poverty: Developtment ResearchCenter on Migration; 2010. p. 3–18.
safe work environment devoid of workplace violence in im- 10. Lu H, While AE, Barriball KL. Job satisfaction and its related factors: a
proving the quality of health workforce and health. questionnaire survey of hospital nurses in mainland China. Int J Nurs Stud.
2007;44(4):574–88.
Acknowledgements 11. Adams A, Bond S. Hospital nurses’ job satisfaction, individual and
The author acknowledges financial support from Edith Cowan University and organizational characteristics. J Adv Nurs. 2000;32(3):536–43.
International Postgraduate Research Scholarship (IPRS) which made the 12. Cummings GG, et al. The relationship between nursing leadership and
execution of this research project possible. nurses’ job satisfaction in Canadian oncology work environments. J Nurs
Manag. 2008;16(5):508–18.
Funding 13. Bjørk IT, et al. Job satisfaction in a Norwegian population of nurses: a
No funding was received from funding agencies. questionnaire survey. Int J Nurs Stud. 2007;44(5):747–57.
14. Williams, D. Looking for a few men. 2006.
Availability of data and materials 15. White MJ, White GB. Implicit and explicit occupational gender stereotypes.
In view of the confidential nature of the data, and consonance with the Sex Roles. 2006;55(3–4):259–66.
conditions of ethics approval, data cannot be shared. Moreover, analyses of 16. Zangaro GA, Soeken KL. A meta-analysis of studies of nurses’ job
the data are still ongoing. satisfaction. Research in nursing & health. 2007;30(4):445–58.
17. Tollison AC. Stereotype threat in male nurse-patient interactions. The
Author’s contributions University of Texas at Austin: Texas. 2013;
IMB is the sole author of this paper. He was responsible for the design and 18. Dekeyser Ganz F, Toren O. Israeli nurse practice environment
execution of the study, and prepared this manuscript. characteristics, retention, and job satisfaction. Israel journal of health policy
research. 2014;3(1):7.
Author’s information 19. Coomber B, Louise Barriball K. Impact of job satisfaction components on
IMB, BA (Hons); MSc; MPhil; PhD is a Lecturer in the Department of Sociology intent to leave and turnover for hospital-based nurses: a review of the
at University of Ghana. IMB’s research interests are diverse, including gender, research literature. Int J Nurs Stud. 2007;44(2):297–314.
sexual and reproductive health, intimate partner violence, adolescent sexual 20. Turner BS. Medical power and social knowledge. London: Sage; 1995.
risk behaviours and workplace violence. IMB has published several journal 21. Upreti, P., A study to assess the level of job satisfaction among nursing
articles and a monograph. personnel working at BPKIHS..(unpublished dissertation). BP Koirala institute
of health sciences. 2008.
Ethics approval and consent to participate 22. Ayamolowo SJ, Irinoye O, Oladoyin MA. Job satisfaction and work
The Edith Cowan University Human Research Ethics Committee approved environment of primary health care nurses in Ekiti state, Nigeria: an
this research in July 2013 (Project # 9561). The Ghana Health Service Ethics exploratory study. Int J Caring Sci. 2013;6:531–42.
Review Committee also provided ethical clearance for the study (ID # GHS- 23. Hipwell AE, Tyler PA, Wilson CM. Sources of stress and dissatisfaction
ERC 12/01/14). Participation was voluntary, and accepting to participate was among nurses in four hospital environments. Br J Med Psychol.
taken to be informed consent. 2011;62(1):71–9.
24. Negussie N. Relationship between rewards and nurses’ work motivation in
Consent for publication Addis Ababa hospitals. Ethiopian journal of health sciences. 2012;22(2)
Not applicable 25. Mohite N, Shinde M, Gulavani A. Job satisfaction among nurses working at
selected tertiary care hospitals. International Journal of Science and
Competing interests Research (IJSR). 2014;3:1006–112.
The author declares that he has no competing interests. 26. ILO, ICN, WHO, & PSI. Workplace Violence in the Health Sector Country Case
Study – Questionnaire. Geneva: WHO; 2003.
27. AbuAlRub RF, Al-Asmar AH. Psychological violence in the workplace among
Publisher’s Note Jordanian hospital nurses. J Transcult Nurs. 2014;25(1):6–14.
Springer Nature remains neutral with regard to jurisdictional claims in 28. Albashtawy M. Workplace violence against nurses in emergency
published maps and institutional affiliations. departments in Jordan. Int Nurs Rev. 2013;60(4):550–5.
29. Hanson GC, et al. Workplace violence against homecare workers and its
Received: 10 April 2017 Accepted: 5 January 2018 relationship with workers health outcomes: a cross-sectional study. BMC
Public Health. 2015;15(1):1–13.
30. Hinchberger PA. Violence against female student nurses in the workplace.
References Nurs Forum. 2009;44(1):37–46.
1. Hassmiller SB, Cozine M. Addressing the nurse shortage to improve the 31. Lepping P, et al. Percentage prevalence of patient and visitor violence against
quality of patient care. Health Aff. 2006;25(1):268–74. staff in high-risk UK medical wards. Clinical medicine. 2013;13(6):543–6.
Boafo Human Resources for Health  (2018) 16:6 Page 10 of 10
32. Boafo IM, Hancock P, Gringart E. Sources, incidence and effects of non- 65. Mrayyan MT. Jordanian nurses’ job satisfaction, patients’ satisfaction and
physical workplace violence against nurses in Ghana. Nursing Open. 2016; quality of nursing care. Int Nurs Rev. 2006;53(3):224–30.
3(2):99–109. 66. Budin WC, et al. Verbal abuse from nurse colleagues and work environment
33. Miers, M., Gender Issues and Nursing Practice 2000, London: MacMillan. of early career registered nurses. J Nurs Scholarsh. 2013;45(3):308–16.
34. Boafo IM, Hancock P. Workplace violence against nurses: a cross-sectional 67. Gerberich SG, et al. An epidemiological study of the magnitude and
descriptive study of Ghanaian nurses. SAGE Open. 2017;7(1) consequences of work related violence: the Minnesota nurses’ study.
35. Franz S, et al. Aggression and violence against health care workers in Germany–a Occupational & Environmental Medicine. 2004;61(6):495–503.
cross sectional retrospective survey. BMC Health Serv Res. 2010;10:51. 68. Harris B, Leather P. Levels and consequences of exposure to service user violence:
36. Al-Omari H. Physical and verbal workplace violence against nurses in evidence from a sample of UK social care staff. Br J Soc Work. 2011:1–19.
Jordan. Int Nurs Rev. 2015;62(1):111–8. 69. Purpora C, Blegen MA. Job satisfaction and horizontal violence in hospital
37. Çelik Y, Çelik SŞ. Sexual harassment against nurses in Turkey. J Nurs staff registered nurses: the mediating role of peer relationships. J Clin Nurs.
Scholarsh. 2007;39(2):200–6. 2015;24(15–16):2286–94.
38. Gacki-Smith J, et al. Violence against nurses working in US emergency 70. Al-Dossary R, Vail J, Macfarlane F. Job satisfaction of nurses in a Saudi
departments. J Nurs Adm. 2009;39(7/8):340–9. Arabian university teaching hospital: a cross-sectional study. Int Nurs Rev.
39. Nachreiner NM, et al. Difference in work-related violence by nurse license 2012;59(3):424–30.
type. J Prof Nurs. 2007;23(5):290–300. 71. Ham J. The relation among nurses’ experience of verbal abuse, social
40. Yaktin US, Azoury NB-R, Doumit MA. Personal characteristics and job support and their turnover intention, Unpublished master’s thesis. Suwon:
satisfaction among nurses in Lebanon. J Nurs Adm. 2003;33(7/8):384–90. Ajou University; 2013.
41. Addae S. The evolution of modern medicine in a developing country: 72. Sarpong PA. Ghana in retrospect. Tema: Ghana Publishing Corporation;
Ghana 1880–1960. Durham: Academic Press; 1996. 1974.
42. Laschinger HKS. Hospital nurses’ perceptions of respect and organizational
justice. J Nurs Adm. 2004;34(7–8):354–64.
43. Kangas S, Kee CC, McKee-Waddle R. Organizational factors, nurses’ job
satisfaction, and patient satisfaction with nursing care. J Nurs Adm.
1999;29(1):32–42.
44. Barrett L, Yates P. Oncology/haematology nurses: a study of job satisfaction,
burnout, and intention to leave the specialty. Aust Health Rev. 2002;25(3):109–21.
45. Larrabee JH, et al. Predicting registered nurse job satisfaction and intent to
leave. J Nurs Adm. 2003;33(5):271–83.
46. Usmani S, Jamal S. Impact of distributive justice, procedural justice,
interactional justice, temporal justice, spatial justice on job satisfaction of
banking employees. Review of Integrative Business and Economics
Research. 2013;2(1):351–85.
47. Al-Zu’bi HA. A study of relationship between organizational justice and job
satisfaction. International Journal of Business and Management. 2010;5(12):102.
48. Thomas P, Nagalingappa DG. Consequences of perceived organizational
justice: an empirical study of white-collar employees. Journal of Arts,
Science & Commerce. 2013;3(2):54–63.
49. Cotter DA, Hermsen JM, Vanneman R. The effects of occupational gender
segregation across race. Sociol Q. 2003;44(1):17–36.
50. Purcell D, MacArthur KR, Samblanet S. Gender and the glass ceiling at work.
Sociol Compass. 2010;4(9):705–17.
51. Rosenstein AH. Nurse-physician relationships: impact on nurse satisfaction
and retention. AJN The American Journal of Nursing. 2002;102(6):26–34.
52. Sirota T. Nurse/physician relationships survey report. Nursing. 2008;38(7):28–31.
53. Gamarnikow E. Sexual division of labour: the case of nursing. In: Kuhn A,
Wolpe A, editors. Feminism and materialism: women and modes of
production; 1978. p. 96–123.
54. Ghana Statistical Service (GSS). 2010 Population & Housing Census:
summary report of final results. Accra: Ghana Statistical Service; 2012.
55. Leape LL, et al. Perspective: a culture of respect, part 1: the nature and causes
of disrespectful behavior by physicians. Acad Med. 2012;87(7):845–52.
56. Ezzat HA, Lashin O. Violence on hospital nurses and job satisfaction. The
new Egyptian Journal of Medicine. 2005;32(6):7–16.
57. Pillinger J. Quality health care and workers on the move: Ghana National
Report. Ferney-Voltaire: Public Services International, International Migration
and Women Health and Social Care Workers Programme; 2011. Submit your next manuscript to BioMed Central 
58. WHO. Global strategy on human resources for health: workforce 2030.
Geneva: WHO; 2016. and we will help you at every step:
59. Greenberg J. Setting the justice agenda: seven unanswered questions about
“what, why, and how”. J Vocat Behav. 2001;58(2):210–9. •  We accept pre-submission inquiries 
60. Nagy MS. Using a single-item approach to measure facet job satisfaction. J •  Our selector tool helps you to find the most relevant journal
Occup Organ Psychol. 2002;75(1):77–86. •  We provide round the clock customer support 
61. Siegrist J. Adverse health effects of high-effort/low-reward conditions. J •  Convenient online submission
Occup Health Psychol. 1996;1(1):27.
62. Mrayyan MT. Jordanian nurses’ job satisfaction and intent to stay: comparing •  Thorough peer review
teaching and non-teaching hospitals. J Prof Nurs. 2007;23(3):125–36. •  Inclusion in PubMed and all major indexing services 
63. Boafo, I.M., P. Hancock, and E. Gringart, Sources, incidence and effects of non- •  Maximum visibility for your research
physical workplace violence against nurses in Ghana. Nursing open, 2016.
64. Pallant J. SPSS survival manual. London: McGraw-Hill Education; 2013. Submit your manuscript at
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