The relationship between job satisfaction, autonomy and self-efficacy among school nurses in Bahrain. Mixed method

Location where research will be carried out :
Private School Nurses in Bahrain
Project title:
The relationship between job satisfaction, autonomy and self-efficacy among school nurses in Bahrain. Mixed method
Aims
The main purpose of the study is to determine the relationship between job satisfaction with intra-personal and extra-personal factors, such as autonomy and self-efficacy, among Private School Nurses in Bahrain.
To achieve the above purpose, the following specific objectives were set:
1) To create a profile of school nurses in Bahrain
2) To explore the systematic and holistic scope to the role of school nurses in Bahrain
3) To determine the relationship between job satisfaction, autonomy and self-efficacy among school nurses in Bahrain
Methods to be used & Study Protocol:
The proposed methodology for this research is to distribute the questionnaires to school nurses from private schools in Bahrain, using the measure of job satisfaction (MJS), autonomy questionnaires (Hampton Peterson, Factual Autonomy Scale) and the General Self-Efficacy Scale (GSE) questionnaire. Item, scale and factor correlations will be computed using a variety of statistical analyses available from SPSS. Each hypothesis will be tested for results and statistical significance. Mixed methods approaches will be used (qualitative and quantitative). By using quantitative and qualitative methods, this study will provide a respectable result (Newrnan & Benz, 1998) that the researcher is striving to obtain. The participants will be all school nurses from public & private schools in Bahrain (i.e., a total of about 150). These participants will fill out a questionnaire in order to deliver the quantitative result. In addition, 30 purposeful school nurses (i.e., 15 each from public and private schools) will participate in interviews to provide the qualitative result. The participant consent form will be used with all nurses, as they have been informed that they were not obliged to take part if they do not wish to do so; for the quantitative frame, the project questionnaire will be given to the gatekeeper (the headmaster of the school) and he/she will give it to the school nurse whom is working under his/her supervision.
For the quantitative frame, an audio recorder will be used during the interviews with the 30 selected purposeful school nurses. They will sign a consent form, then the researcher will make suitable appointments for the participants to be interviewed in a quiet and stress-free environment .
Facilities available:
Part-time scholarship from Ministry of Health and full cooperation from Ministry of Education.
Description of proposed additional research (continue onto 4 pages , minimum)
Background:

Job satisfaction is an important concept that has several dimensions and many ways it can be used to characterise work-related behaviours. It is often studied in organisational behaviour research as well as to determine how it is affected by job design and supervision. However, what makes a job satisfying or dissatisfying not only functions as part of the nature of the job, but is also related to what individuals expect that their job should provide them. Maslow’s work (1954, 1970) demonstrated that there was a range of hierarchical needs that jobs met physiological, safety, belongingness and love, esteem, and ultimately self-actualization. According to Spector (1997), scholars have been able to determine job satisfaction among employees by looking at their needs, which is becoming less popular. The cognitive processes and attitudinal perspectives theories (Spector, 1997) have replaced this.
Herzberg, Mausner and Snyderman, (1993) who came up with the two-factor theory to explain job satisfaction among employees also studied Job satisfaction. They came up with satisfaction and dissatisfaction factors as key factors that determine job satisfaction (Herzberg, Mausner and Snyderman, 1993). One factor consists of intrinsic factors, which are “motivators;” and “‘satisfiers,” such as achievement, recognition, doing the work itself and having the responsibility that goes along with it. The other was defined as extrinsic factors, which they termed “hygiene” factors or de-motivators, also known as job “dissatisfiers,” that included such things as company policy, supervision, salary, and working conditions. This theory has dominated the study of job satisfaction for decades and has been the basis for the development of many survey instruments that claim to measure job satisfaction, many of which have attempted to measure job satisfaction among nurses.
In a meta-study of job satisfaction studies among nurses, Lu, While and Louise Barriball (2005) examined 1,189 published research papers from several databases, from different countries, and found a range of findings from quantitative studies and qualitative studies that measured job satisfaction among nurses. All of these studies point to the fact that job satisfaction is a complex phenomenon; many related factors were identified in the studies, using such independent variables as job involvement, autonomy, role conflict and ambiguity, job stress, pay, promotional chances, and many others.
According to Hayes et al. (2010), job satisfaction attributes among nurses can be grouped into 1) factors that affect the nurses individually or within (intra-personal); 2) factors that affect the nurse and colleagues at the workplace (inter-personal); 3) and external factors which affect nurses without their knowledge or ability to control them (extra-personal). While noting that interpersonal relationships are important to job satisfaction, this research will focus on intra-personal and extra-personal aspects of job satisfaction.
In summary, Lu, While and Louise Barriball (2005, p 222) found that the research revealed, “job satisfaction of hospital nurses is closely related to job stress, role conflict and ambiguity, organisational commitment and professional commitment.” The research also suggests that worldwide nurse shortages are likely to place even greater demands upon nurses and will increase levels of work-related stress over time and increase dissatisfaction.
Based on the evidence found in published research, one can conclude that extensive research on job satisfaction of varying degrees has been done. The studies analysed job satisfaction with a wide variety of independent variables, focussing almost exclusively on hospital nurses. Other nursing contexts have been almost completely neglected or ignored. The purpose of this study is to examine critically the factors associated with job satisfaction amongst school nurses. The environment in which nurses operate in schools is unique as compared to the nursing profession. The National Association of School Nurses defines school nursing as a “specialized practice of professional nursing that advances wellbeing, academic success and lifelong achievement and health of students. To that end, school nurses facilitate normal development and positive student response to interventions; promote health and safety, including a healthy environment; intervene with actual and potential health problems; provide case management services; and actively collaborate with others to build student and family capacity for adaptation, self-management, self-advocacy, and learning” (Nasn.org, 2010). More specifically, they have a role that is rather unique among professional nursing that includes responsibilities for such things as: 1) facilitating normal development and positive student response to interventions, 2) provision of quality leadership that promotes health and safety among nurses through a healthy environment, 3) provision of quality health care and coming up with intervention programs that focus on actual health problems suffered by patients and preventing potential problems from occurring; and 4) efficient management of case services through the use of clinical judgement (Role of the School Nurse in Providing School Health Services, 2008).
One of the remarkable aspects about this scope of responsibilities is that a sole practitioner with little assistance or medical oversight who performs all of these duties for a population that a typical hospital nurse would find daunting usually performs them. The NASN, AAP, American School Health Association (ASHA), and CDC all recommend school nurse-to-student ratios of 1:750 for children in regular education (Fleming, 2011, p 9). The depth and breadth of success requirements under those conditions are extensive. As Fleming’s report (2011, p 12) concludes, the profession of nursing is one that requires a high degree of independence, critical thinking, and a multitude of clinical and public health competencies. He went further and stated that such qualities are developed through experience in the nursing profession and are not guaranteed by a degree (Fleming, 2011). One might ask how these qualities are achieved and, if so, how they can be sustained. Undoubtedly, many factors foster the development of those qualities.
Hackman and Oldham (1976) showed that autonomy, including core job dimensions such as task significance and feedback, promotes outcomes on such job aspects as “positive motivation, performance, satisfaction, absenteeism, and turnover.” Moreover, self-concordance theory indicates that individuals who pursue goals for autonomous reasons, such as for the intrinsic pleasure produced by pursuit of the goal, exhibit better adjustment than those who pursue goals for controlled (e.g., extrinsic) reasons (Sheldon and Elliot, 1999). Another study indicated that there is a significant relationship between job satisfaction stress, collaboration and autonomy among nurses (Zangaro & Soeken, 2007). Furthermore, Hayes et al., (2010) conducted research that identified a range of important factors associated with nurses’ job satisfaction in acute hospital settings. They found that coping strategies, co-worker interaction, autonomy, provision of adequate resources and education opportunities are some of the primary job satisfaction factors (Hayes et al., 2010).
Scholars have identified autonomy as the main significant factor that contributes to job satisfaction and retention among nurses (Luszczynska, Scholz and Schwarzer, 2005). Self-Efficacy can be described as the process by which individuals have the capabilities to exercise control over demands that affect them through their beliefs (Luszczynska, Scholz and Schwarzer, 2005). Autonomy and self-efficacy are believed to be inherent in job satisfaction among school nurses. Both autonomy and self-efficacy affect job performance among nurses.
According to Bandura (1997, 2006) Self-efficacy can be defined as “an individual’s belief in his or her capacity to muster the cognitive, motivational, and behavioural resources required to perform in a given situation”. One can live a more active and self-determined life if he pursues what he believes in or is capable of producing. When one is able to control his or her environment, he will be able to do more to achieve his or her desires (Scholz et al., 2002). It is also established that self-efficacy plays a major role in shaping the feelings, actions and the way people think when carrying out various activities to accomplish their desires. Bandura (1997) further stated that individuals with high self-efficacy have high goals and usually choose to perform tasks that are more challenging in order to accomplish their goals in life. The concept of self-efficacy can be described or linked to domain-specific aspects of the individuals. This is evident when one can have beliefs in different domains to achieve a particular aspect in life. According to Schwarzer and Jerusalem, (1999) self-efficacy amongst individuals can be described as the self-confidence that one has when coping with different situations in life. General self-efficacy (GSE) can be described as the process by which people in different environments use various domains in order to achieve their goals (Scholz et al., 2002).
The research model is based on the concept of the Affective Events Theory (AET), which says that job satisfaction is to be conceptualised as an evaluative judgement about one’s job. These evaluative judgments are driven and determined by the interaction of personal traits that can result in positive or negative experiences on the job and manifests as job satisfaction or job performance (Weiss and Cropanzano, 1996). In addition, Hackman and Oldham (1980, p. 60) further stated that if certain characteristics are present in a job, “then jobholders will experience a positive, self-generated subjective `kick’ when they perform well and this internal reinforcement serves as an incentive for continued good performance.” These types of affective experiences in the workplace lead to attitudinal and behavioural actions that emanate from the individual. Each individual’s response is unique as determined by their perceptions of the job, its attributes and what they expect from it. In other words, individuals bring their own unique qualities to the job and make of it and take from it what they are able to. In the case of school nurses, their perception of job satisfaction is a function of qualities of the work environment and how their personal attributes interact with work conditions, positively or negatively.
Given the breadth of their job responsibilities, sole practitioners’ successful performance, usually with relatively few supporting services, calls for the type of personal resourcefulness that is often lacking in hospital nursing. In this situation, their job satisfaction measures are likely to be influenced by the extent that they are able to control or cope with work circumstances that emerge from the disparate and widespread nature of their duties. Given this somewhat unstructured work environment and the need to respond to many diverse demands, there are two personal attributes or qualities that contribute to the job success and satisfaction of school nurses who work under these conditions autonomy and self-efficacy. In a situation with scarce resources, the school nurse needs the flexibility to act quickly and allocate whatever resources are available, without interference from nonmedical personnel. Likewise, the school nurse needs to feel confident that he or she has the knowledge and skills to perform the task effectively and in a timely manner.
Research Question:
The following research questions will be answered in order to achieve the purpose of the study.
1. What is the profile of school nurses in Bahrain?
2) what is the the systematic and holistic scope to the role of school nurses in Bahrain?
3) What is the relationship between job satisfaction, autonomy and self-efficacy among school nurses in Bahrain?

Research Hypotheses:
This research will examine the following hypotheses:
Two Factor Correlations with Job Satisfaction
1. There is a significant positive relationship between autonomy and overall job satisfaction
2. Overall job satisfaction and self-efficacy are positively correlated
Job Satisfaction scale correlations with autonomy and self-Efficacy
3. The personal satisfaction scale is positively correlated with autonomy and self-efficacy
4. Satisfaction with workload scale is positively correlated with autonomy and self-Efficacy
5. There is a significant positive association between autonomy, self-efficacy and satisfaction with professional support scale
6. Satisfaction with the training scale is positively correlated with autonomy and self-efficacy
7. Satisfaction with the pay scale is positively correlated with autonomy and self-Efficacy
8. Satisfaction with the prospects scale is positively correlated with autonomy and self-Efficacy
9. Satisfaction with the standards of care scale is positively correlated with autonomy and self-efficacy
Work Situation Factors
10. Overall job satisfaction will correlate positively with nurse-student ratios below 1:750
11. There is a significant positive association between school nurses with administrative staff support and overall job satisfaction
Age and Experience Factors
12. There is a significant association between older school nurses and job satisfaction
13. There is no significant association between older school nurses and job satisfaction
14. Older school nurses will have higher self-efficacy scores than younger nurses
15. School nurses with a higher level of education will have higher autonomy scores than lesser educated nurses
16. School nurses with a higher level of education will have higher self-efficacy scores than lesser educated nurses
Population, Sample, and Sample Selection:
Choosing a study sample is an important step in any research project, because it is rarely practical, efficient, or ethical to study whole populations. According to Marshall (1996), valid inferences can be made to the general population if the sample size is optimum and drawn from the population.
The target population of this study is private school nurses in Bahrain. When conducting research, the sample group selected should be representative of the population so that all data collected can be analysed and generalisations made should apply to the entire population (NHS, 2003). According to Mertens (2005, p. 4), the target population is usually the population linked to the findings of the study.
Mixed methods approaches will be used (qualitative and quantitative). By using quantitative and qualitative methods, this study will provide a respectable result (Newrnan & Benz, 1998) that the researcher is striving to obtain. The participants will be all school nurses from public & private schools in Bahrain (i.e., a total of about 150). These participants will fill out a questionnaire in order to deliver the quantitative result. In addition, 30 purposeful school nurses (i.e., 15 each from public and private schools) will participate in interviews to provide the qualitative result. The participant consent form will be used with all nurses, as they have been informed that they were not obliged to take part if they do not wish to do so; for the quantitative frame, the project questionnaire will be given to the gatekeeper (the headmaster of the school) and he/she will give it to the school nurse whom is working under his/her supervision.
For the quantitative frame, an audio recorder will be used during the interviews with the 30 selected purposeful school nurses. They will sign a consent form, then the researcher will make suitable appointments for the participants to be interviewed in a quiet and stress-free environment
The above number of study subjects is deemed sufficient in helping the research to collect enough data and meet the study objectives, because it consists of all the private schools in Bahrain. The present research will make use of the total population of the private school nurses in Bahrain in order to understand job satisfaction and the personal attributes that help make that possible in their daily work environment, and how productive they can be through satisfaction in the work place.
Study Setting and Recruitment:
The present research study will be conducted in the private schools of Bahrain that have school nurses. Access to the private schools of Bahrain will be granted by the ethics committee of the university, ethics committee of the Ministry of Education and ethics committee of the Ministry of Health. The approval form will help with ensuring that the research procedure will be abided and followed so that the participants benefit from the study by having taken part in it. The ethical approval will also help the researcher stick to the research process within the stipulated period and make sure that he does not cause harm or introduce risk during the study process. Confidentiality will also be maintained in the sense that the data collected from the participants is only used for the research process not for other purposes and is properly stored and protected
Data Collection:
The success of any study depends on the quality of data collection methods chosen and employed (Haber and Wood, 2006). Quantitative research is a scientific inquiry aimed at learning new facts, testing ideas, etc., and is concerned with investigating things that we can observe and measure in some way (Haber and Wood, 2006). Health research is both global and local in nature. Generation of new knowledge using scientific methods is the basis for new tools, strategies, and approaches to garner local knowledge that is specific to the particular circumstances for each country, which can provide a decision about obtaining the greatest health benefit from existing tools and limited resources.
Choosing an appropriate method and instrument is difficult and must be appropriate to the study question, setting, and population. Questionnaires constitute an effective approach to gather the information for a study; they require less time, energy, and cost (Nieswiadomy, 2010).
The questionnaire was adopted from another study that tackled the same problem in a different country. Permission was granted by the author, who emailed the original tool of study. Mild modification was done for the instrument to suit private school nurses in Bahrain in demographic data, and a pre-test will be done.
The researcher will use a structured and self-administered questionnaire that includes two parts. Part one is concerned with demographic data while part two focusses on school nurses’ job satisfaction. Questionnaire administration amongst the study participants will take approximately 15–20 minutes (Appendix I, II, III).
Once access to participants is obtained, the researcher will distribute the questionnaire. Participants will be instructed to deposit their questionnaire after completion in a sealed envelope that will be mailed to the researcher. The time for participants to respond is four weeks.
Structured and semi-structured questionnaires will be employed, because Saunders et al. (2009) stated that they are the most common data collection tools that have been used by scholars and researchers in business economics and management studies across the globe. This is because the advantages of using questionnaires outweigh other forms of data collection, such as interview schedules. Questionnaires are not time consuming and are hence easily administered (Saunders et. al., 2009). It is also important to note that questionnaires require time management for organisation and planning of how it can be administered to the study participants (Pedhazur and Schemelkin, 1991). Questionnaires can be used especially when the researcher has limited time and resources at hand to carry out the study. Questionnaires can also enable the researcher to carry out the study more easily because they can be administered quickly and efficiently.
Using this method, the researcher will arrange with the participant on how to get the questionnaires, how the researcher will follow up to make sure that the study participants answer the questions and how they will return the completed questionnaire to the researcher. Administering questionnaires helps the research obtain honest answers, since it gives the study subjects the ability to express their views without challenges or fear, because questionnaires use codes or numbers instead of the actual names of the participants. Questionnaires also make the participants feel comfortable, since they have the room and freedom to give the response that they deem to be proper. Questionnaire as the method of data collection is very important as compared to other instruments, because they help the researcher achieve a high response rates.
Validity:
When the study achieves its intended purpose or what it was designed for, then it can be described as valid. The validity of the study can also be used to describe the instrument of the study and the tests measured. For instance, the instruments are designed and tested by other scholars; therefore, the construct validity of design and tests will be adhered to, and thus the relationship between job satisfaction and personal attributes will be determined. The external validity of the study determines how the methods used in the study are appropriate and the reason they were used in the study. The results of the study will be generalised because it takes a case study approach that applied the positivism and interpretivism approaches; hence, the data of the study were triangulated.
The study employed the quantitative exploratory approach to achieve the research objectives. Therefore, the findings of the study can be generalised to the private school nurses in Bahrain and other regions in the Arabian Gulf.
Because the tools employed in the study have been used by several scholars and have accurately assessed the job satisfaction and personal attributes, the tools are valid. The validity of the tool can be achieved if the tool produces an accurate outcome according to the purpose it was designed for. These instruments are rationale for autonomy, measure of job satisfaction and rationale for self-efficacy instruments.
The Measure of Job Satisfaction scale was determined through the convergent validity, with a score of higher than 0.50 being acceptable (Lloyd et al., 1998). Other studies conducted by Adebayo and Ezeanya (2011) found that the tools were valid, with scores of 0.16 and 0.51 for task identity and autonomy respectively. This was supported Teo (2013) and Charalambous et al. (2013) who found a validity score of 0.9 using confirmatory factor analysis.
Reliability:
Reliability can be described as the extent to which the study has achieved its objectives and purpose, and the finding of the study can be replicated or used in another study using the same research methods, instruments and approaches in a different area. The reliability of the study depends on how the findings of the results will be analysed and interpreted so that they can make meaningful results and reflect that the study is original. According to Marshall and Rossman (1999), the reliability of the study helps to determine how the results of the study will be replicated. Replication of the study findings determines the reliability of the study instruments and the methods of data collection used. The study will employ research data collection instruments and tools designed, tested and used by various scholars in determining job satisfaction among nurses. The instruments that will be employed in the study are reliable and have been replicated by other scholars; they include rationale for autonomy, measure of job satisfaction, and rationale for self-efficacy instruments. The study will use the Hampton Peterson Scale (Hampton, 2012) and the 2-item Factual Autonomy Scale (FAS) to measure autonomy; the GSE scale to measure self-efficacy among nurses; and the MJS scale to measure job satisfaction among nurses. All the instruments are reliable with Cronbach’s alpha value of more than 0.75.
Reliability of the study tool can be determined by how consistently it produces the same results when it is used in similar circumstances and using the same approach. The ability of the research tool to produce the same results in the studies when used by different researchers is key when it comes to the reliability of the study.
The MJS scale used in this study is reliable and hence used by many scholars in nursing careers. A study conducted by Alasmari and Douglas (2019) in Saudi Arabia found the MJS scale tool reliable with Cronbach’s alphas of subscales ranging from .86 to .92; Radoslavova and Velichkov (2005) found the scale with 0.76 to 0.86. Lloyd et al. (1998) found a reliability scale of 0.70, which is acceptable.
Pilot Test:
Researchers usually test their tools through a pilot study, which is usually a small-scale study with similar characteristics than the actual research study. It is conducted as a pre-test for a new or modified tool in order to determine the feasibility and reliability of that tool (Polit and Beck, 2008). As the instrument used was modified, the pilot test will be administered to three private school nurses. Moreover, the private school nurses will be asked to mark any ambiguous or difficult questions. The study will use the think-aloud cognitive interview approach. A cognitive interview can be described as the process where responses are collected during the administration of the survey questions to evaluate the quality of the responses during the survey. It is an approach used by researchers to correct to correct challenges arising from the questions while carrying out survey studies from the questions when carrying out the survey studies (Beatty, 2003). This can be achieved through think-aloud and probing approaches. The think-aloud approach is important because it is standardised, and there is a reduced chance of introduction of bias during data collection, plus the interviewer must not have knowledge of the study and corrects problems introduced with the interview probing approach of changing the content of the survey (Conrad, Blair, and Tracy, 2000). The probing approach also helps the researcher to have verbal information, which he or she might find useful for the study.
Ethical Considerations:
People think of ethics or morals as the rules for distinguishing between right and wrong, or a code of professionalism that distinguishes between acceptable and unacceptable behaviour (Resnik, 2011). Risks and harm in the research can be minimised and benefits maximised if the researcher follows research ethics such as respecting human dignity, privacy and autonomy (Resnik, 2011). Ethical approval will be obtained from the University ethics review committee, the ethics committee of the Ministry of Education and the ethics committee of the Ministry of Health. Ethical review is usually sought from the ethics committee in the University Ethics Review Committee, the Ministry of Education and the Ministry of Health because they have to understand the research process of the nurses and take full responsibility for helping the nurses to secure all research information and ensure that they adhere to confidentiality standards for the data. Ethical review will also ensure that the researcher abides by the rules and regulations of ethics and follows the appropriate procedures as stipulated in the research.
Because the researcher is an employee of the Ministry of Health, the study will help improve the quality and quantity of nursing skills and training of the private school nurses in Bahrain . The information from this study will be important because Ministry of Health will be directed to take a part in the private school nurses health managers to understand the nurses’ needs to enhance quality of services that are provided to the private school staffs and students. The satisfaction of the private school nurses will encourage them to learn more and develop their careers effectively with the appointed Health Manager of the Ministry of Health .
The Ministry of Education will also provide feedback to the Ministry of Education School Health Department about the quality of the service and its precaution of deficiency to the students in the Kingdom. The challenges that Private school nurses face regarding job satisfaction will also be articulated and dealt with effectively by the Ministry of Education in order to increase the number of private school nurses that are working in the private school. The study will also provide recommendations to the management of the private schools to teach nurses how they can feel content with their jobs.
The researcher will also take care of the potential negative risks that the participants may face and will safeguard the participants from the potential negative risks. This will be realised in the study because participants will be made aware that they are not obliged to answer any questions they find uncomfortable and that they can withdraw from participating in the study at any time if they do not wish to continue participating in the study (Ensign, 2003). Because the study involves the private school nurses, key ethical principles such as respect, informed consent, beneficence, veracity and justice will be adhered to.
The purpose of the study will be made clear to the participants, who will have the opportunity either to agree to participate in the study or to decline. The informed consent will also contain detailed information about the research process, which will be clear and concise. Their informed consent must be given freely, without coercion, and must be based on a clear understanding of what participation involves (Ensign ,2003).
The anonymity of the research participants will be enhanced to ensure that the participants are protected. Because the study will focus on the school nurses in Bahrain, the study will make sure that the participants are not known and are not coerced by using the pseudo-codes.
The information collected from the study will be kept confidential and only accessed by the researcher and used for the purpose of the study.

Data Analysis:
Data analysis will be conducted using SPSS version 21. Parametric and non-parametric research methods, which are key in the analysis, will be carried out in order to answer the research questions and answer the research hypothesis. The analysis will be done in sections. Demographic variables of the study will cover the first part of the analysis, which will involve descriptive statistics where distribution of the data will be done. Questions related to the study objectives and research questionnaires will be analysed using the descriptive statistics, reliability analysis, factor analysis, bi-variate analysis, regression analysis and chi-square test.
Descriptive analysis will be conducted to determine the distributions of the variables where mean and standard deviation will be computed. This will be conducted on the rationale for autonomy, measure of job satisfaction and rationale for self-efficacy variables, where distributions and summaries will be carried. Descriptive statistics will help the researcher to understand the distributions of the variables in relation to the demographic variables and other variables within each sub-scale. Histograms, bar graphs and pie charts will be used to show the distribution of the variables. The histograms will help the researcher to understand whether or not the data are positively skewed, negatively skewed or normally distributed.
Factor analysis is a data analysis method that is applied when the researcher has several variables and wants to understand the relationship between certain factors. Factor analysis also helps in reducing the number of variables in the model. Factor analysis will be conducted on the measure-of-job-satisfaction instrument to determine the variables that contribute to job satisfaction among school nurses in Bahrain. Factor analysis will be used to determine which factors are key with regard to job satisfaction when using the measure-of-job-satisfaction instrument and other instruments in the study. For instance, contributing factors will include determining using factor analysis “on” persona attributes, pay, work load, training, prospects, professional support and standard of care, which affect job satisfaction.
Reliability analysis will also be conducted whereby Cronbach’s Alpha will be calculated and help to determine if the study findings are reliable and can be replicated by other studies and nursing schools across the globe. This analysis will be conducted on rationale for the variables of autonomy, measure of job satisfaction and rationale for self-efficacy to determine reliability. This will further be carried out on the sub-scales of the job satisfaction variables as highlighted by measure of job satisfaction, which include personal satisfaction, work load, professional support, training, pay, prospects and standard of care among private school nurses in Bahrain. Reliability analysis will help the researcher to understand if the instruments used in the study are able to meet the objectives and if they can be replicated by other studies. Through reliability analysis, the researcher will be in a position to understand whether or not the findings of the study are reliable and can be generalised.
The transformation of the variables will be carried out in all of the sub-scales of the rationale for autonomy, measure of job satisfaction and rationale for self-efficacy. After the sub-scales have been determined, correlation analysis will be done to determine the relationship among autonomy, self-efficacy, personal satisfaction, work load, professional support, training, pay, prospects and standard of care among school nurses in Bahrain. The transformation of the variables is important because it will allow the researcher to group variables in each sub-scale and to get the total and sub-total scores in each sub-scale used in the study instruments.
Bivariate analyses are also key in this present study because they will help in determining the association between two variables. The tests that will be carried out will include correlation, chi-square and regression analysis. For instance, they can be used to determine the association among job satisfaction, autonomy and self-efficacy among nurses. The findings will be reported using tables, charts and text.
Research Model:
The research model is based on the concept of the Affective Events Theory (AET) which says that job satisfaction is to be conceptualized as an evaluative judgment about one’s job. These evaluative judgments are driven and determined by the interaction of personal traits that can result in positive or negative experiences on the job and manifests themselves as job satisfaction or job performance (Weiss and Cropanzano, 1996). According to Hackman and Oldham (1980, p. 60), if certain characteristics are present in a job, “then jobholders will experience a positive, self-generated subjective `kick’ when they perform well and this internal reinforcement serves as an incentive for continued good performance.” These types of affective experiences in the workplace lead to attitudinal and behavioral actions that emanate from the individual. Each individual’s response is unique as determined by their perceptions of the job, its attributes and what they expect from it. In other words, individuals bring their own unique qualities to the job and make of it, take from it what they are able to. In the case of school nurses, their perception of job satisfaction is a function of the qualities of the work environment and how their personal attributes interact with work conditions, positively or negatively.
Given the breadth of their job responsibilities, usually as a sole practitioner, with relatively few supporting services, successful performance calls for the type of personal resourcefulness that often not the case in hospital nursing. In this situation, their job satisfaction measures are likely to be influenced by the extent that they are able to control or cope with work circumstances that emerge from the disparate and widespread nature of their duties. Given this somewhat unstructured work environment and the need to respond to many diverse demands, there are two personal attributes or qualities that contribute to job success and job satisfaction of school nurses who work under these conditions – autonomy and self-efficacy. In a situation with scarce resources, the school nurse needs the flexibility to act quickly and allocate whatever resources are available, without interference from non-medical personnel. Likewise, the school nurse needs to feel confident that he or she has the knowledge and skills to perform the task effectively and in a timely manner.

In this adaptation of the Affective Events Theory (Weiss and Cropanzano, 1996; Wegge et al., 2006), the autonomy and self-efficacy of the school nurse has a direct bearing on the nurse’s job satisfaction. The literature suggests that these two concepts are directly relevant to several dimensions of job performance.
Rationale for Autonomy
The suggested measurement of autonomy is the 3 item autonomy scale used in the Hampton Peterson Scale (Hampton, 2012) and the 2 item Factual Autonomy Scale (FAS) developed by Paul E. Spector and Suzy Fox, (2003). Both instruments have been used in research settings like this one.
Hampton Peterson Scale – Dimension 6 – Job Autonomy
1. I do not have close supervision.
2. I make most of my own decisions regarding work.
3. Independence is permitted if not required where I work.
Note. All items are measured on a scale where 1 = strongly agree to 7 = strongly disagree.

Factual Autonomy Scale (FAS)

In your present job, how often do you have to ask permission… Never Rarely Sometimes Quite often Extremely often or always
… to take a rest break?
… to take a lunch/meal break?
… to leave early for the day?
… to change the hours you work?
… to leave your office or work station?
… to come late to work?
… to take time off?
How often do the following events occur in your present job? Never Once or twice Once or twice per month Once or twice per week Every day
How often does someone tell you what you are to do?
How often does someone tell you when you are to do your work?
How often does someone tell you how you are to do your work?

Rationale for Self-Efficacy Scale (GSE)
This is the 10 item scale developed by Ralf Schwarzer & Matthias Jerusalem (1995) is shown below:
The General Self-Efficacy Scale (GSE)
1 I can always manage to solve difficult problems if I try hard enough.
2 If someone opposes me, I can find the means and ways to get what I want.
3 It is easy for me to stick to my aims and accomplish my goals.
4 I am confident that I could deal efficiently with unexpected events.
5 Thanks to my resourcefulness, I know how to handle unforeseen situations.
6 I can solve most problems if I invest the necessary effort.
7 I can remain calm when facing difficulties because I can rely on my coping abilities.
8 When I am confronted with a problem, I can usually find several solutions.
9 If I am in trouble, I can usually think of a solution.
10 I can usually handle whatever comes my way.
Response Format
1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true
Permission has been given to use this instrument.
Measuring Job Satisfaction
The concept of job satisfaction has been described above. It is intended that job satisfaction be measured using the Measure of Job Satisfaction (Appendix 1) which is a 38-item scale including five subscales: personal satisfaction (10 items), satisfaction with workload (7 items), satisfaction with professional support (9 items), satisfaction with pay and prospects (8 items), and satisfaction with training (4 items) (Traynor & Wade, 1993). The MJS scale is widely used by nursing researchers (Barrett & Yates, 2002; Chirwa et al., 2009; Chou et al., 2002; Wade, 1993) and has demonstrated reliability and validity (van Saane, Sluiter, Verbeek & Frings- Dresen, 2003). In the case of assessing job satisfaction among critical care nurses in a public hospital in Saudi Arabia , Cronbach’s alphas of subscales ranged from .86 to .92. (Alasmari and Douglas, 2012).
1. The nature of the investigation is designed as follows:
2. The Measure of Job Satisfaction (MJS) developed by Michael Traynor will be administered to private school nurses in Bahrain. The factors that will be measured are:
3. Factor # Items
4. Personal Satisfaction (6)
5. Satisfaction with Workload (8)
6. Satisfaction with Professional Support (8)
7. Satisfaction with Training (5)
8. Satisfaction with Pay (4)
9. Satisfaction with Prospects (6)
10. Satisfaction with Standards of Care (6)
11. There are 43 items in all that will give an overall rating of job satisfaction.
The question becomes what personal attributes go into determining job satisfaction in a situation where a solo performer that requires a high degree of independence, critical thinking, and a multitude of clinical and public health competencies. Two possible explanations are offered in this research: one is “autonomy: (i.e. its existence on the job or desire for it); the other is “self-efficacy” (i.e. belief in one’s competence to cope with a broad range of stressful or challenging demands).
Conclusion:
Finally, this study will show that it is important for the Private School nurses in Bahrain to work in harmony with school staff to provide the maximum health service to students and to have a healthy work environment, reinforcing student health. By exploring and identifying the problems, if any, that face school nurses at private schools in their line of duty in Bahrain that make their job unsatisfactory, the Ministry of Education will: enhance the school health program and develop policies that support and strengthen the private school nurses; change service in the community based on the transition from student to young adulthood; and provide the family with integrated values, practices, and beliefs that promote a healthy lifestyle.

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Appendix:

Attachment 1 :Measure of Job Satisfaction (MJS)

Introduction

The MJS was developed from the responses of a random sample of more than 700 community nurse members of the Royal College of Nursing to an item bank derived from the literature and from talking to key informants.1

The MJS is a group measure designed to monitor the morale of community nurses following changes in legislation and the delivery of health and social care in the U.K.2 Norms for different groups of U.K. nurses are enclosed. The MJS has also been designed for anonymous completion and takes approximately 10 minutes to complete.

Coding and Scoring Key

This updated version of the MJS was developed using a second sample of 650 community nursing staff. It comprises 7 subscales which may be combined to give a measure of ‘Overall Job Satisfaction’. There are 43 items all of which are scored as follows:

Very satisfied 5
Satisfied 4
Neither satisfied nor dissatisfied 3
Dissatisfied 2
Very dissatisfied 1

Analysis

The MJS is sensitive to differences in satisfaction over time and to differences in level of satisfaction between different groups of staff (Figure 1). Therefore it should be analysed according to job title. The first 43 items form 7 subscales of job satisfaction. Item mean scores are calculated for each subscale by dividing the sum of item scores by the number of items comprising that scale. For example, the ‘Satisfaction with Standards’ scale consists of 6 items. The item mean score would be the sum of all items divided by 6. Similarly ‘Overall Job Satisfaction’ is the sum of the first 43 items divided by 43.

The last question, item 44, is included to give an indication of global satisfaction. With large samples it can be used to give an indication of the relative importance of different aspects of job satisfaction. For example, a larger correlation between ‘Personal Satisfaction’ and item 44 than between ‘Satisfaction with Pay’ and item 44 would suggest that personal satisfaction may be more important than pay. Such relative importance may vary between different groups of staff and/or over time.

The Scales

‘Personal Satisfaction’ 6 items, Cronbach alpha=0.85

21. The feeling of worthwhile accomplishment I get from my work
27. The amount of personal growth and development I get from my work
28. The extent to which my job is varied and interesting
30. The amount of independent thought and action I can exercise in my work
38. The extent to which I can use my skills
39. The amount of challenge in my job
‘Satisfaction with Workload’ 8 items, Cronbach alpha=0.88

6. The time available to get through my work
14. The amount of time spent on administration
15. My workload
20. Overall staffing levels
23. The amount of time available to finish everything that I have to do
24. What I have accomplished when I go home at the end of the day
37. The hours I work
40. The time available for patient/client care
‘Satisfaction with
Professional Support’ 8 items, Cronbach alpha=0.89

2. The degree to which I feel part of a team
3. The opportunities I have to discuss my concerns
10. The amount of support and guidance I receive
13. The people I talk to and work with
22. The degree of respect and fair treatment I receive from my boss
29. The support available to me in my job
35. The overall quality of the supervisions I receive in my work
42. The contact I have with colleagues
‘Satisfaction with Training’ 5 items, Cronbach alpha=0.85

5. Being funded for courses
18. The opportunities I have to adance my career
19. The extent to which I have adequate training for what I do
26. Time off for in-service training
31. The opportunity to attend courses

‘Satisfaction with Pay’ 4 items, Cronbach alpha=0.90

1. Payment for the hours I work
4. My salary/pay scale
9. The degree to which I am fairly paid for what I contribute to this organisation
36. The amount of pay I receive
‘Satisfaction with Prospects’ 6 items, Cronbach alpha=0.88

12. My prospects for promotion
16. My prospects for continued employment
25. The amount of job security I have
32. The possibilities for a career in my field
34. The outlook for my professional group/branch of nursing
41. How secure things look for me in the future of this organisation
‘Satisfaction with
Standards of Care’ 6 items, Cronbach alpha=0.90

7. The quality of work with patients/clients
8. The standard of care given to patients/clients
11. The way that patients/clients are cared for
17. The standard of care that I am currently able to give
33. The general standard of care given in this unit
43. Patients are receiving the care that they need
‘Overall Satisfaction’ 43 items, Cronbach alpha=0.95

This scale is calculated using all the above items.
Attachment 2 :Measures of Autonomy

Hampton Peterson Scale – Dimension 6 – Job Autonomy
1. I do not have close supervision.
2. I make most of my own decisions regarding work.
3. Independence is permitted if not required where I work.
Note. All items are measured on a scale where 1 = strongly agree to 7 = strongly disagree.
Factual Autonomy Scale (FAS)

Attachment 3 : The General Self-Efficacy Scale (GSE)
12. 1 I can always manage to solve difficult problems if I try hard enough.
13. 2 If someone opposes me, I can find the means and ways to get what I want.
14. 3 It is easy for me to stick to my aims and accomplish my goals.
15. 4 I am confident that I could deal efficiently with unexpected events.
16. 5 Thanks to my resourcefulness, I know how to handle unforeseen situations.
17. 6 I can solve most problems if I invest the necessary effort.
18. 7 I can remain calm when facing difficulties because I can rely on my coping abilities.
19. 8 When I am confronted with a problem, I can usually find several solutions.
20. 9 If I am in trouble, I can usually think of a solution.
21. 10 I can usually handle whatever comes my way.
22. Response Format
1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly
Attachment 4: Define Study Terms
Barriers:
Theoretical Definition: The problems that could arise when the school nurses face obstructions in the school health program (Akpabio 2010).
Operational Definition: An obstacle that prevents movement or access. Problems could arise when the nurses are unaware of their expected roles because of limited training
Implementation:
Theoretical Definition: Implementation is an intentional modification of the existing routinely embedded relationships and practices of the hospital department (May 2013).
Operational Definition: The act of accomplishing some aim or executing some order.
School health nurses:
Theoretical Definition: School health services are limited to posting a nurse in all schools, with their roles properly defined, to improve the current health situation for all students in all schools (Akpabio 2010).
Operational Definition: School nursing is a specialized practice of professional nursing that advances the well-being, academic success, and lifelong achievements of students.
Role of school health nurses:
Operational Definition: The role of school nurses is to facilitate positive student responses to normal human development; promote health and safety in the school environment; intervene with actual and potential health problems; provide case management services; and actively collaborate with others to build student and family capacity for adaptation, self care, self-advocacy, and learning.(AlHajeri et al. 2009).
Theoretical Definition: The role of school nursing is the modification or removal of health-related barriers to learning and the promotion of an optimum level of wellness. (Lordi and Brodley 2000).
Public schools:
Theoretical Definition: Public schools are funded by the government and directed by the Ministry of Education. They provide educational opportunities for every citizen to develop mental, physical, and emotional potential and skills. Public schools draw up, implement, and evaluated plans to achieve the requirements of quality to enhance the quality and effectiveness of education (Ministry of Education 2013).
Operational Definition: The term public school is a government-run school, open to the public, anywhere in the country.
Attachment 5: Consent Form:
Code:_________________
Study Title: Job satisfaction among Private School Nurses in Bahrain: Intra-Personal and Extra-Personal coloration
I, _________________, am willing to participate in the above study. I understand that my consent is voluntary, and that I can withdraw from the study at any time without prejudice. The researcher has fully informed me about the research aims and methods, and I agree to my contributions being used for future academic publication.

Signature:___________________________
Date:________________________________
Attachment 6: Letter to Seek Permission to Carry out the Research Study from the Ethical Research Committee
Mr./Mrs.
Director of Research Committee,
Research Title: Job satisfaction among Private School Nurses in Bahrain: Intra-Personal and Extra-Personal coloration.
Dear Mr./Mrs.
My name is __________. I am an PhD student at the ……. University of…….. I hope to conduct a research study about the job satisfaction among school nurses performing their roles in Bahrain and school health nurses in the Ministry of Education in the Kingdom of Bahrain. The sample criteria will be Bahraini and non-Bahraini school nurses working in private schools in Bahrain. To access the research sample, I request a permission letter from the Ministry of Education to conduct the study in Bahraini public schools. The participants will be a purposive sample. Confidentiality and anonymity will be ensured during the research process. I would greatly appreciate your permission to conduct this study. If you have any questions regarding this study, I am available to meet at a time convenient to you. I enclose a copy of the research proposal. If you have any questions, please do not hesitate to call me.
I look forward to hearing from you,
Yours Faithfully,
_________________________

Attachment 7: Proposed Cost of Study
Resources Cost
Articles Purchases 150+ BD
Stationary and Travel expanses 6500+ BD
Internet/Phone-calls 600+ BD
laptop 700 BD
other Fee 300+ BD
Study Cost 190940 +BD
Attachment 8: Outcome of School Health Program in Ministry of Health
The primary goals of the School Health Program are to:
1. provide instruction to develop the knowledge, skills, attitudes, and behaviors related to healthy living;
2. support the provision of support services for students and their families;
3. create a healthy social and physical environment within the school;
4. integrate the concepts of personal health management, health promotion, and education;
5. incorporate strategies which are comprehensive, interdisciplinary, and outcome-based;
6. be taught by teachers who are competent and qualified in health education and promotion; and
7. provide sufficient instruction time to elicit behavior change (AlHajeri et al. 2009).
Attachment9: Recourses
From: obliquepanic@gmail.com [obliquepanic@gmail.com] On Behalf Of Michael Traynor [michael@obliquepanic.com] Respond: Sent: 30 May 2014 12:25
To: Faten Hasani
Subject: Re: use Measure of Job Satisfaction tool in to my research paper
Dear Faten
yes I am happy for you to use the Measure of Job Satisfaction. You will find all the documentation you need at my ResearchGate page. Good luck with your research.
Michael
Request :On 30 May 2014 09:02, Faten Hasani <FH12805@rcsi-mub.com<mailto:FH12805@rcsi-mub.com>> wrote:
Dear Mr. Michael Traynor ,
I am an MSc student at the Medical University of Bahrain, The Royal College of Surgeons in Ireland. I hope to conduct a research study about the Job satisfaction of nurses performing their roles in privet school in Bahrain and in the Bahraini Ministry of Education for my PhD study. The sample criteria will be nurses working in Bahraini privet schools .I would like to use Measure of Job Satisfaction tool in to my research paper and I request a permission letter from you to use the tool. Please your help is needed to complete my study.
Yours Faithfully,
Faten Ali
Ministry of Health,
Specialist School Nurse,
Bahrain

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