Working conditions and job satisfaction of hospital nurses: a comparative study between Mongolia and Japan.

Objective: This study examines the job satisfaction of Mongolian hospital nurses by comparing their status and workload of Mongolian nurses with Japanese nurses' one. Settings and participants/
Methods: Survey data were collected from randomly selected 200 nurses (100 were Mongolians and the other 100 were Japanese) who agreed to participate in the survey. Data were collected through a self-administered survey questionnaire. Survey items were age, the duration of work experience, work position, health condition, accumulated fatigue, stress level, and whether having family members who need child care or nursing care. Collected data were analyzed by t-test and Wilcoxon Rank Sum test.
Results: The average age of Mongolian nurses was significantly lower than that of Japanese nurses. Consequently, the average work experience of Mongolian nurses was less than that of Japanese nurses. More Japanese than Mongolian nurses had family members in need of care. Job satisfaction and status were significantly higher among Japanese than Mongolian nurses. However, Japanese nurses have family members who need child care or nursing care at a higher rate than Mongolian nurses. Job satisfaction of Japanese nurses about their work and job status was significantly higher than Mongolian nurses' one. However, the opposite result was found in the job satisfaction about their workload. The influence of the relationships among nurses on the job satisfaction was significantly greater in Mongolian nurses than in Japanese nurses. Job satisfaction of Japanese nurses about their salaries was significantly higher than Mongolian nurses' one.
Conclusion: In order to raise nurses' job satisfaction in Mongolia, it is necessary to raise their "occupational status" and salary of nurses. ©2019 The Japanese Association of Rural Medicine.

Introduction

In an effort to expand its international cooperation, Japan has provided medical devices and sent nursing instructors to Mongolia to improve the level of care there.

However, the problem is that the number of young people in Mongolia who want to enter nursing is not increasing.

As a result of examining the previous research, there were a few researches on nursing education[1], [2]) and nursing education curriculum[3]) in Mongolia. But there is no survey report on job satisfaction for nurses working in Mongolia. And there is no research comparing Japan and Mongolia on nurse job satisfaction.

Thus, the current study examined realities for nurses in Japan and Mongolia and it compared the two countries to identify problems in nursing in order to help improve the level of care in Mongolia.

Objective

This study examines the job satisfaction of Mongolian hospital nurses by comparing their status and workload of Mongolian nurses with Japanese nurses’ one.

Settings and Participants

Survey data were collected from randomly selected 200 nurses (100 were Mongolians and the other 100 were Japanese) who agreed to participate in the survey. All of our participants were working in a hospital that with up to 500 hospital beds.

We collected these survey data between July 2016 and June 2017.

Methods

A self-completed questionnaire: Subjects were given a modified Japanese version of the Stamps’ Index of Job Satisfaction in nursing devised by Ozaki[4]). And survey items were age, the duration of work experience, work position, health condition, accumulated fatigue, stress level, and whether having family members who need child care or nursing care. Collected data were analyzed by t-test and Wilcoxon Rank Sum test.

Ethical Considerations

This study was approved by the ethical committee of Mongolian hospitals, Japanese Hospitals and the Ministry of Health Mongolia.

Results

Nurses demographics

Average age of nurses in Mongolia was significantly younger than Japanese nurses’ one. Consequently, average year of work experience of Mongolian nurses is shorter than Japanese one (Figures 1, 2, 3). However, Japanese nurses have family members who need child care or nursing care at a higher rate than Mongolian nurses (Figure 4).

Figure 1

Age of nurses (Mongolia).

Figure 2

Age of nurses (Japan).

Figure 3

Age of nurses.

Figure 4

Family members who need child care or nursing care.

Job satisfaction

Job satisfaction of Japanese nurses about their “Social status of occupation” was significantly higher than Mongolian nurses’ one. Mongolian nurses: 25.45 ± 6.9. Japanese nurses: 32.32 ± 4.9. P-value: P<0.001 (Figure 5). However, the opposite result was found in the job satisfaction about their workload.

Figure 5

Occupational status.

The influence of the relationships among nurses on the job satisfaction was significantly greater in Mongolian nurses than in Japanese nurses. Mongolian nurses: 30.14 ± 5.3. Japanese nurses: 27.19 ± 3.9. P-value: P<0.001 (Figure 6). On the other hand, no significant difference was found in the influence of the relationships between nurses and doctors. Mongolia: 12.48 ± 3.0. Japan: 21.81 ± 3.1 P-value: P<0.79 (Figure 7).

Figure 6

Relationships among nurses.

Figure 7

Relationships between nurses and doctors.

Job satisfaction of Japanese nurses about their salaries was significantly higher than Mongolian nurses’ one. Mongolian nurses: 25.60 ± 7.4. Japanese nurses: 28.87 ± 8.0. P-value P<0.003 (Figure 8).

Figure 8

Salary.

Discussion

Mongolian nurses are younger than their Japanese counterparts. Thus, Mongolian nurses presumably have more stamina and energy than their Japanese counterparts. Stamina and energy are absolutely essential to withstanding the strains of nursing. Young nurses often have a significant advantage in learning techniques as well. Since the average lifespan in Mongolia is 69.46 years by WHO 2014, Mongolia would naturally have a large number of young nurses as a proportion of the population.

Nurses need extensive knowledge and decision-making ability. Experience is also absolutely essential to dealing with patients of different age groups. Nurses need many years of experience.

A higher proportion of Japanese families have children or elderly parents to care for, so Japanese nurses work while caring for children or elderly parents.

The average lifespan in Mongolia is predicted to increase as advances are made in medical care. Like in Japan, the demand for nurses in Mongolia will inevitably increase. A support system is needed to help nurses continue working in order to respond to the increased demand for nurses and to increase the number of nurses with years of experience.

Mongolian nurses were less satisfied with their “occupational status” than their Japanese counterparts. This may be because Mongolian nurses have a lower social status than their Japanese counterparts. That said, Japanese nurses also had a low social status. The year 2000 marked the first time when Nursing Departments were established in Mongolian hospitals and nurses were able to become heads of Nursing Departments. Public awareness of the substantial role nurses play in hospital administration will probably take some time to be established.

The prevalence of illness in Mongolia has changed from acute conditions due to an infection or accident to lifestyle-related diseases. Nurses should play a major role in medical settings involving a patient with a number of chronic illnesses. Nurses need to contribute to preventing illness and managing recovery. The incidence of lifestyle-related diseases is projected to increase in Mongolia, and nurses will play a crucial role in that country. Nurses should be granted the social status commensurate with that role and responsibility, and the public needs to be better educated in that regard.

Nurses in Mongolia are highly satisfied with their work. Nurses described having pride in their profession and their work. This is outstanding. In Mongolia, basic nursing education is taught primarily by physicians, and nursing students are taught that nursing merely means “assisting with care”. This is likely why nursing is referred to as “assisting with care”. Mongolian nurses are probably satisfied to be “assisting with care” rather than “providing care”, which refers to a solitary task. The exact nursing tasks Mongolian nurses find satisfying need to be studied further from the perspective of nursing as “an independent discipline and an independent profession”.

Mongolian nurses were significantly more satisfied with “interaction among nurses” as part of their jobs. This indicates that Mongolian nurses interact closely.

Nursing is a team effort. Interaction among nurses directly affects the outcomes of care. Close interaction among nurses is extremely advantageous.

Mongolia has 9,605 nurses and midwives. In contrast, Japan has 1,452,635 by WHO 2008. Based on these numbers alone, conditions presumably exist to facilitate coordination and cooperation among nurses in Mongolia. Another factor presumably affecting those conditions is the Mongolian national character that has developed in the country’s frigid climate.

There were no significant differences between Japan and Mongolia in terms of the relationships between nurses and physicians. Nurses in both countries were not satisfied with those relationships. Results revealed that trouble coordinating and cooperating with physicians is still a problem that needs to be overcome in both countries.

Results revealed relationships among nurses and coordination of medical personnel in different professions substantially affected job satisfaction. The good relationships among nurses in Mongolia will affect the job satisfaction of Mongolian nurses in the future as well, and these relationships are probably attributable to the tone set by Mongolian culture. This aspect should be valued.

According to research, the factor that most influences job satisfaction is “salary”. Mongolian nurses were significantly less satisfied with their “salary” than their Japanese counterparts. This response was greatly affected by their overall assessment of “job satisfaction” as nurses.

The value of money differs markedly in Japan and Mongolia, precluding a simple comparison of salary amounts. Nonetheless, Mongolian nurses were not satisfied with their “salary” in comparison to their Japanese counterparts.

The incidence of chronic illnesses, as exemplified by lifestyle-related diseases, is increasing in Mongolia. In response to that reality, nurses will probably play a large role and shoulder more responsibility in the future. Ensuring that nurses receive “compensation” commensurate with their role and responsibility will help to prevent nurse turnover and increase the number of nurses.

Conclusion

In order to raise nurses’ job satisfaction in Mongolia, it is necessary to raise their work and job status and salary of nurses.