Factors influencing nurses ’ job satisfaction in selected private hospitals in England

Curationis 31(3): 60-69 The quantitative descriptive survey used self-completion questionnaires to study factors influencing nurses’ job satisfaction in selected private hospitals in England. Herzberg’s Theory of Motivation was used to contextualise the results obtained from 85 completed questionnaires. In terms of Herzberg’s Theory of Motivation, the most important extrinsic (hygiene) factor was no satisfaction with their salaries compared to nurses’ salaries in other private hospitals in England, in the NHS and even at their own hospitals. However, most nurses were satisfied with the other extrinsic factors (organisation and administration policies, supervision and interpersonal relations). The most important intrinsic factors (motivators), influencing nurses’ job satisfaction was their lack of satisfaction with promotions (including the fact that their qualifications were reportedly not considered for promotions), lack of advancement opportunities and being in dead­ end jobs, and lack of involvement in decisionand policy-making activities. Nurses’ levels of job satisfaction might be enhanced if promotion policies could be consistent, advancement opportunities implemented, qualifications considered for promotions, salary issues clarified, and if nurses could be involved in decisionand policy-making. Enhanced levels of job satisfaction could help to reduce turnover rates among registered nurses at the private hospitals in England that participated in this study.


Introduction
Job satisfaction is an essential element for the maintenance of the workforce o f any organisation.Lack o f job satisfaction for employees not only leads to high turnover rates but could also have detrimental effects on the individual, like burnout (Mrayyan, 2005:42).Although turnover provides the organisation with new ideas and is a normal process, a high turnover rate leads to the inability o f an organisation to provide quality care, raises personnel recruitment, selection and orientation costs, and low ers em ployees' jo b satisfaction levels (Marquis & Huston, 2003:235).The United Kingdom (UK) imports large number of nurses annually.Unless the UK's nurses experience job satisfaction, they are likely to have high turnover rates, reducing the value added to the UK's health services by these recruitment efforts and costs.

Background information about the United Kingdom's health and nursing services
According to the 2003 census (British Population Statistics, 2003), England is one o f the most densely populated countries in the world.Nearly 84% of the total population of the UK lives in England.The total population in the UK was approximately 59,5 million in June 2003 and England had about 49.3 million people.Projections based on the 2002 midyear statistics, suggest that England's population will continue to increase.This could lead to increased dem ands for E ngland's health care services to enhance its nurses' levels of job satisfaction in order to retain them.Nurses satisfied with their jobs are less likely to resign from their current p o sitio n s than those who are not satisfied.Thus enhancing nurses' job satisfaction, should decrease nurses' turnover rates.In the late 1990s, the United Kingdom's (UK) National Health Service (NHS) stated that it needed to increase its number of nurses with 20 000 by 2004 in order to supply the required level of health services to the U K 's citizens (Buchan, 2007(Buchan, :1322)).This target was easily achieved by training increased numbers o f nurses, and by recruiting nurses internationally (by both the NHS and the UK's private health care sector).R ep ortedly 16 155 in tern a tio n ally recruited nurses joined the UK register while 14 538 did so from Britain's nurse education program m es during 2002 (Aiken, Buchan, Sochalski, Nichols & Powell, 2004:75).As many as 40-50% of the UK's newly registered nurses come from fo reig n co u n tries (B uchan, 2 0 07:1321; 1323) and there are approxim ately 670 000 nurses and m idwives on the U K 's professional register.During 2004/5 a total of 8 044 verifications o f qualifications (Buchan, 2007(Buchan, :1329) ) were requested from the Nursing and Midwifery Council (NMC), indicating that these nurses might apply for registration in other countries and leave the UK.Although the UK loses nurses to English-speaking countries, such as Australia, Canada and the United States o f A m erica (U SA ), the UK " ...remains a net importer o f nurses" (Buchan, 2007(Buchan, :1321)).The internationally recruited nurses supply the numbers required without investing UK time and m oney into these n u rse s' training.However, research is required about the job satisfaction and retention levels of nurses working in the UK, because there is a causal relationship (Cowin, 2002:284) betw een n u rse s' reten tio n and jo b satisfac tio n .A ccording to A iken (2007:1315) reten tio n o f nurses is important because shortages of nurses could lead to work overload, burnout and a lack o f job satisfaction among the rem aining nu rses, in creasing the likelihood of even greater turnover rates, potentially compromising standards of nursing care.Kingma (2007Kingma ( :1294) ) warns: " In jectin g m igrant nurses into dysfunctional health systems -ones that are not capable o f attractin g and retaining staff domestically -is not likely to meet the growing health needs of national populations".

Problem Statement
Intrinsic (m otivating) and extrinsic (hygiene) factors influence nurses' job satisfaction, and by implication their turnover rates.The participating private group of hospitals in the UK needed to identify factors influencing nurses' job satisfac tio n , to reduce th eir nurse turnover rates, enhance the quality of nursing care rendered to their patients, and to save recruitment, selection and orientation costs.

Conceptual Framework
Herzberg's Theory of Motivation was used as the theoretical framework for this study.This theory postulates that intrinsic and extrinsic factors enable individuals to satisfy their personal needs and experience job satisfaction in a w ork environm ent (B all, 2003).H erzberg's Theory o f M otivation postulates that the phenomenon of job satisfaction and/or no satisfaction, is the function of two need systems, namely, extrinsic or hygiene and intrinsic or motivation factors factors.These two groups of factors enable employees to avoid u n pleasant situ atio n s and discomfort and to meet their personal development needs (Ball, 2003).(In terms o f H erzb erg 's theory the term "no satisfaction" is used, not dissatisfaction, because the lack of satisfaction is implied, not the state o f being "dissatisfied").Table 1 summarises the most important intrinsic and extrinsic factors, in terms of H e rzb erg 's th e o ry 's co n stru cts, addressed by this study as influencing n u rs e s ' jo b satisfac tio n , and by implication their turnover rates.
According to Daft (2000:540), Herzberg maintains that an individual's attitudes to work can determine his/her successes or failures in fulfilling specific roles.Herzberg studied "what do people want from their jobs?"He asked people to explain situations where they felt good or bad in relation to their jobs.These results were categorised as extrinsic and in trin sic factors related to job satisfaction.Extrinsic (hygiene) factors relate to no job satisfaction including supervision, com pany policy and administration, working conditions and interpersonal relations.Poor hygiene factors increase employees' levels of no satisfaction.However, good hygiene factors do not improve job satisfaction but sim ply reduces levels o f no job satisfaction.Intrinsic factors (motivators) include achievements, recognition, work itself, advancement, responsibility and growth.These factors influence job satisfaction.Without motivators, employees become neutral towards their jobs.The presence o f m o tiv ato rs in creases the job satisfaction levels.Therefore intrinsic facto rs (m o tiv ato rs) focus on job satisfaction and extrinsic (hygiene) factors focus on no job satisfaction factors.Herzberg's theory's constructs indicate that once the hygiene factors are properly addressed, the motivators will p rom ote jo b satisfactio n and productivity.

Definitions of concepts
Job satisfaction is the extent to which the employee enjoys the job.Nurses' levels o f job satisfaction could influence nurse turnover rates (Mrayyan, 2005:41).In this study job satisfaction refers to individual nurses' feelings about their jobs as meeting their needs.Nurses' levels of job satisfaction are influenced by extrinsic (hygiene) and intrinsic (motivating) factors.
Factors imply "any circumstances that contribute towards a result" (Webster's C oncise E dition D ictionary and Thesaurus, 2002:118).In this article factors refer to circumstances which may influence nurses' decisions to leave the services o f a specific hospital.In terms o f H erzberg's theory, accepted as a framework for this study, factors can be in trinsic (m o tiv atin g ) or ex trinsic (hygiene).
Motivation refers to a person's actions to fulfil specific needs.Motivation, as used in this study according to H erzberg 's theory, com prises both ex trin sic (h ygiene) and intrinsic (motivating) factors.
A professional nurse, as used in this study, has undergone formal training and is registered w ith the N ursing and Midwifery Council (NMC) in the United Kingdom (UK), irrespective o f the country where the nurse trained.Ajunior professional nurse is known as a staff nurse in the UK, the junior sister is the immediate supervisor of the staff nurse and the senior sister is usually the ward or unit manager in the UK (Lephalala, 2006:12).
Recruitment in this study refers to the attractio n o f new nurses, m eeting specified needs, to jo in a specific institution's personnel.
Retention is the organisation's ability to retain employees' services for as long as possible.(High retention rates imply low turnover rates).
Turnover is the rate at which employees are replaced with new staff members in an organisation (W ebster's Concise E dition D ictionary and T hesaurus, 2002:353).Involuntary' turnover implies that the employee leaves the services of an organisation due to circumstances beyond the individual's control, such as family reasons, transfer of husband, ill health or reaching retirem en t age (Upenieks, 2005:22).Voluntary'turnover refers to em ployees who leave an organisation based on their independent decisions to do so.Voluntary turnover can be influenced both by extrinsic (conditions surrounding the job also known as hygiene factors) and intrinsic (related directly to the job, also known as motivators) factors (Sullivan, Decker & Jamerson, 2001:294).In this study the term turnover simply refers to the number of nurses who resign from the services of their employers.
Turnover rate is calculated by dividing the num ber o f resignations by the number of nurses in a given period of time, usually a calendar year (Khowaja, Merchant & Hirani, 2005:34).

Purpose, Objectives and Assumptions of the study
The purpose o f this study was to identity factors influencing nurses' job satisfaction, and thus their turnover rates, in one group of private hospitals in England.
The objectives of the study were to

Literature Review
The literature review' will be presented according to the two factor theory of Herzberg, nam ely the intrinsic and extrinsic factors affecting nurses' job satisfaction.

Extrinsic (hygiene) factors
Extrinsic factors are also called hygiene factors and do not enhance an employee's level o f job satisfaction, but reduce the level of no job satisfaction.
Group cohesion is "a sta ff m em ber' s perceptions o f integration into the o rg a n isa tio n a l and c o llea g ia l environment' (Shader, Broome, Broome, West & Nash, 2001:213).The more the individual identifies with the group, the more the ability to conform to the group's norms and values.The group and the organisation become part of the individual and withdrawal from the organisation distorts the self-concept and seems like losing part of the self.
A study in Taiwan by Yin and Yang (2001:579), indicates that salary and fringe benefits were the strongest factors influencing nursing turnover.However, this does not necessarily imply that institutions with good salaries and attractive benefits have low staff turnover rates.A study done in Jordan (M rrayan, 2005:47-48) indicates that nurses in private hospitals were more satisfied, and had higher intentions to stay, than nurses in public hospitals.Khowaja et al., (2005:34) cite Thomas' (1997) report about w'ork stress in the NHS (UK) that had been aggravated by increased workloads, nursing shortages, job insecurities and organisational changes, influencing nurses' job satisfaction negatively.Upenieks (2005:24-25) cites Billingsley's (1999) report about the UK and Canada, experiencing the same problem of nursing shortage as the USA, where n urses' job vacancies were estim ated to be 20% during 1999.
However, by 2020 the USA's projected shortage of nurses could reach 800 000, based on the employment of 3 million nurses during 2004 (Aiken, 2007:1300 citing the US Department of Health and Human services 2002).Thus the USA could exert strong pull factors on the global nurse supply, emphasising the importance that every country should p rom ote its n u rs e s ' levels o f jo b satisfaction, in order to retain its nurses' services within that specific country and/ or institution.

Intrinsic factors (motivators)
Intrinsic factors are motivators that relate to the person's job and promote his/her levels of satisfaction.In a study in the USA, Shader et al., (2001:214), found that work schedules was one factor that the institution could manipulate to enhance job satisfaction levels o f nurses.Netswera, Rankhumise and Mavundla (2005:39) that South African institutions should help their em ployees to m aintain a balance between their personal and work lives.One way o f doing so is to provide timely inform ation about w ork schedules.Strachota, Normandin, O 'Brien, Clary and Krukow (2003:113) Tang (2003:9) indicates that nurses should be encouraged to participate in d ecisio n -m ak in g re g ard in g the form ulation o f policies and the implementation of changes in a specific unit.If nurses realise that they are involved in decision-making processes, they might experience higher levels of job satisfaction and might stay longer in a specific organisation.Campbell, Fowles and Weber (2004:570) found that nurses needed more recognition to satisfy their needs for reputation, prestige and respect from others, which could lead to increased self esteem and job satisfaction.However, a lack of satisfaction of esteem needs leads to feelings o f inferiority and d isco u rag em en t, affectin g jo b satisfaction negatively.In a study conducted in Finland, Kuokkanen and Leino-Kilpi (2001:278) found that empowered nurses were more skilled and competent.If the organisation does not provide a culture of recognition and promotion for employees, then workers might need to change jobs to procure some professional advancement.According to Yin and Yang (2001:580) nurse managers' position and power could influence nurses' intentions to stay.Nurse managers who encourage p artic ip a tio n and who value contributions from staff, promote decisio n m aking and influence coordination, could enhance the positive aspects of a working environment that could help to maintain a stable nursing workforce, by reducing turnover rates.

Research Method
T his study used a quantitative exploratory descriptive design to identify and describe factors that influence turnover among nurses in a private group o f hospitals in England.Herzberg's Theory of Motivation was used as a conceptual framework for collecting and analysing data.The identified factors were categorised as extrinsic and intrinsic factors influencing n u rs e s ' jo b satisfactio n , and by implication their intentions to leave or stay with the participating group o f private hospitals in the UK.

Population
All nurses employed by the 21 hospitals o f the participating private group of hospitals in England, at the time o f the study (during January and F ebruary 2006), com prised the population o f this study.It was impossible to include all 21 hospitals in the study due to tim e and financial constraints.

Sample
Simple random sampling was used in this study to select the participating five (out o f a total o f 21) hospitals, as each hospital had an equal and independent chance of being selected (Polit & Hungler, 1999:284-286).The name o f each o f the 21 hospitals, in the participating private group of hospitals, was written on a slip o f paper, folded and placed in a box.An independent person drew five pieces o f paper (random sampling without replacement) from the box.The five hospitals' names on these slips of paper were the randomly selected hospitals participating in this study.Within each randomly selected hospital, all nurses registered with the NMC received questionnaires and no sample was drawn to select specific nurses.A total of 182 professional nurses worked at these five hospitals.Although 182 questionnaires were handed out, only 85 (46.7% out o f 182) usable completed questionnaires were returned.Thus the sample comprised these 85 completed questionnaires (N=85),

Data collection
Self-com pletion questionnaires were used to obtain data relevant to the study in order to answer the research questions.All 182 professional nurses employed by the five randomly selected hospitals during January and February 2006, received questionnaires.

Development of the questionnaire
This study attempted to identify extrinsic and intrinsic factors influencing nurses' job satisfaction, in terms of Herzberg's Theory o f Motivation.These factors were not specified as such in the questionnaire in order to avoid the possibility of creating mindsets in the respondents that were similar to these categories.
The questionnaire was discussed with two nurse researchers and a statistician.Most suggested changes pertained to rephrasing specific items so that each item had only one verb and addressed a single issue.
The questio n n aire comprised sections seeking information about:

Ethical considerations
Permission to conduct the study was sought from and granted by the healthcare authorities o f the participating private group o f hospitals in England.The matrons of the five participating hospitals were informed about the permission granted, and their permission was also requested.The matrons' co-operation was obtained to distribute the questionnaires to all reg istered nurses w orking at the participating hospitals.
In this study there was no physical harm anticipated from the completion of questionnaires distributed by the m atrons o f the five p artic ip a tin g hospitals.Every questionnaire w'as sealed in an envelope with a pen, a stam ped addressed envelope, and a leaflet with information about the research project.The information leaflet explained that participation was voluntary and depended on the discretion o f every individual; requested that completed questionnaires be posted within two weeks; assured respondents that all data would be treated in a confidential and anonymous manner and that no nurses' or hospitals' names would be mentioned in the research report.The researcher's telephone number was supplied in case more inform ation was desired.No consent form was included (to ensure the anonym ity o f each participant) but com pletion and return o f the questionnaire implied consent.

Analysis and Discussion of Data
Data analysis commenced after no further com pleted questionnaires had been received for three successive weeks -by the end of March 2006.The total number of questionnaires used in the data analysis was 85, but not all totals add up to 85 as some respondents failed to complete specific items.Data from the questionnaires w ere statistica lly analysed using the M icrosoft Excel computer program.Please note not all respondents answered every question, consequently the total num ber o f responses to specific items vary and does not always add up to 85 in tables 3 and 4. The percentages were calculated based on the number of responses to individual items.

Biographic data
Items in the questionnaire attempted to obtain inform ation about the respondents' ages, gender, marital status, number of dependants, monthly incomes and years' of experience with the specific hospital.The assumption was that biographic factors might impact on intrinsic and extrinsic factors influencing nurses' job satisfaction.
O f the 85 respondents, 32.94% (n=28) fell within the age group of 50 years of age or older.Respondents aged between 40 and 49 years were 37.65% (n=32).Only 3.53% (n=3) RNs' ages ranged from 26 to 30 years while 22 (25.88%) fell within the age group of 31 to 39.This implies that 70.59% (n=60) of the respondents were 40 years of age or older, who could retire from active nursing service with the next 20 years, but 32.94% (n=28) might retire within the next 5-10 years as they were 50 years of age or older.The nurses' ages could influence the expected rate of turnover in the participating group of private hospitals in England within the foreseeable future.However, Strachota et al. (2003:13) maintain that older nurses are likely to stay with their institutions  (n=57) perceived that the units where they were working, were adequately staffed but 32.14% (n=27) indicated that nursing shortages existed in their units.Perceived nursing shortages im pact negatively on nurses' job satisfaction and might influence their decisions to leave the services of their current employers (Khowaja et al., 2005:34;Upenieks, 2005:24-25).
T hese findings indicate that the m ajority o f the respondents were female, married and had dependants, implying that they had to combine their nursing responsibilities with those of being mothers and wives.It is thus po ssib le that th eir jo b satisfac tio n levels w ould be influenced by the perceived abilities to combine their nursing roles with those o f being mothers and wives.

Extrinsic (hygiene) factors influencing turnover
The extrinsic (hygiene) factors in flu en cin g tu rn o v er that w ere in v estig ated included w orking conditions, organisation and policy o rg a n isa tio n , group cohesion, supervision and salaries.Extrinsic (hygiene) factors em phasise aspects contributing to no satisfaction, in terms o f Herzberg's Theory of Motivation.

Working conditions
As indicated in table 3,40.51% (n=32) of the resp o n d en ts repo rted no satisfaction w ith respect shown by management and 31.59%(n=32) reported no satisfaction with communication among members of the multidisciplinary team.However, more than half of the respondents reported satisfaction with both m an ag em en t's respect and m u ltid iscip lin ary team m em b ers' communication.

Salary
As many as 67.53% (n=52) indicated that they would leave their current hospitals for better remuneration, implying that they had no satisfaction about their salaries, w hen co m paring their re sp o n sib ilities to those o f nurses w orking in other p rivate hospitals (42.31 %; n=33) or in the NHS (55.56%; n=45).A similar trend was noticed when comparing the respondents' salaries, considering their qualifications, with those o f nurses in the NHS because 56.79% (n=46) had no satisfaction in this regard; nor were 48.79% (n=40) satisfied about their salaries compared to those of nurses in other private hospitals.Even 46.25% (n=37) o f the participants reported no satisfaction when comparing their salaries and qualification to those of other nurses employed by the same hospital.Yin and Yan (2001:579) maintain that salary and fringe benefits are strong factors influencing nurses' turnover rates.

Organisation and policy administration
As many as 90.24% (n=74) and 86.58% (n=71) were satisfied with regard to the standard of operating procedures and receiving updates about equipment respectively.Almost all respondents knew where to access in form ation reg ard in g unit m anagement (87.65%; n=74) and patient care (95.06%; n=81).

Supervision
However, the majority of respondents indicated satisfactio n w ith their supervisors' feedback (89.16%; n=74); support (78.57% ; n=66) and performance appraisals (75.0%; n= 64).Thus those who re p o rted no satisfaction with these aspects of supervision were in the m inority ranging from 10.84% to 25.0%.

Group cohesion
The m ajority o f respondents indicated satisfaction in relation to interpersonal relations.As many as 79.27% (n=65) trusted the people with whom they worked, 71.95% (n=59) were satisfied with social relations with their peers and 70.73% (n=58) were satisfied with their perceived levels o f group cohesion.The resp ondents who rep o rted no satisfaction about aspects relating to interpersonal aspects were in the minority, ranging from 20.73% to 29.27%.Shader et al. (2001:213) maintain that individuals who identify w ith their co lleag u es and w ork environment are better able to conform to the group's norms and values.

• Intrinsic factors influencing turnover
The intrinsic factors that w ill be discussed in this section include the work itself, reco g n itio n , achievem ent, advancem ent and responsibility, as summarised in table 4.

Achievements
Only 9.09% (n=7) o f the respondents were satisfied with promotions but the m ajority (90.91% ; n=70) w ere not satisfied.Only 65.43% (n=53) o f the respondents w ere satisfied that qualifications were considered for promotions, while 56.25% (n=45) were satisfied that experience was a major consideration during promotions.These findings indicate registered nurses' lack o f satisfaction with the regularity of promotions and, to a lesser extent, the im portance o f q u alificatio n s and experience for getting promoted.

Recognition
O f the respondents, 83.95% (n=68) indicated satisfaction because their opinions were valued by medical staff and that senior nurses received more recognition than junior nurses (66.27%; n=55).However, only 54.22% (n=46) indicated that they were satisfied with the recognition o f add itio n al qualifications, while 45.79% (n=38) reported no satisfaction about this issue.

Responsibility
As many as 71.79% (n=56) of the respondents reported satisfaction with professional autonom y.H owever, 50.62% (n=41) and 47.56% (n=39) were not satisfied with their involvement in policy making and decision making processes respectively.Yin and Yan (2001:580) maintain that nurse managers who m anage to involve nurses in decision-m aking and policy-m aking activities, enhance the positive nature of the w ork environm ent and thereby nurses' job satisfaction.

Nature of work itself
As many as 55.56% (n=45) o f the respondents indicated that they were not satisfied with social disruptions caused in their lives by their working schedules.As many as 70.37% (n=57) were satisfied with working overtime without compensation, but being granted the overtime hours at times deemed suitable by the hospital.This finding seems to contradict that of Schader et al. (2001:215) who m aintain that this situation makes it hard for nurses to plan their personal and family lives without financial compensation, leading to higher turnover rates.Only 34.52% (n=29) were not satisfied with the sufficiency of the time to get their jobs done.

Advancement
As many as 59.49% (49) o f the respondents indicated no satisfaction because o f lack o f advancem ent o p p o rtu n ities and 46.76% (36) perceived themselves to be in dead end jobs.

Conclusions
In relatio n to the assum ptions underlying the study, the m ajor conclusions can be rephrased to state that intrinsic and extrinsic factors in flu en ced n u rs e s ' levels o f jo b satisfaction (as summarised in Tables 3  and 4).
Hygiene factors reduced the level of d issatisfactio n , nam ely, w orking conditions, supervision, organisation and administration policies, supervision and group cohesion.The highest p ercen tag e o f no satisfac tio n was accorded to salary, as 67.53% (n=52) of the respondents indicated that they would leave their hospitals for better remuneration.The respondents were not satisfied w ith th e ir salaries w hen considering their responsibilities and qualifications com pared to those o f nurses working in other private hospitals, the NHS or even in their own hospitals.Other extrinsic (hygiene) factors with which some respondents reported no satisfaction include respect shown by management and communication among m u ltid iscip lin ary team m em bers.However, m ost o f the participating nurses (ranging from 70.73% to 89.17%) were satisfied with extrinsic (hygiene) factors related to organisation and administration policies, supervision and interpersonal relations.
The issue o f promotions was the major intrinsic factor that impacted negatively on jo b satisfaction among registered nurses w orking at the participating private hospitals in England.Almost all nurses (90.0% ; n= 70) rep o rted no satisfaction with regular promotions, nor w ith the im p o rtan ce accorded to experience versus qualifications during promotions.This finding seems to correlate w ith 69.76% (n=49) who re p o rted no satisfac tio n w ith advancement opportunities and 46.76% (n=36) who reported no satisfaction about being in a dead-end job.Although the majority o f the participating nurses (71.79%; n=56) reported satisfaction with their professional autonomy, far fewer were satisfied with their participation in policy making 49.38% (n=40) and in decision making 52.43% (n=43).The nurses reported satisfaction about the other m otivating (intrinsic) factors namely, the nature of the work itself and recognition.

Limitations
The following limitations, could limit the generalisability of the research results.

Table 1
Summary of Herzberg's theoretical constructs

Table 3 :
Extrinsic (hygiene) factors influencing nurses' levels of no job satisfaction

Table 4 :
Intrinsic (motivating) factors influencing nurses' job satisfaction Nursing ... is evolving at a rapid pace not only in its practice domain, but also in its role within the health care delivery system , locally, n a tio n a lly and internationally" (Reilly & Oermann 1999:ix).Unless sufficient numbers of nurses are recruited and retained within the nursing profession, the health care clients might not receive the type of health care they are entitled to.The need to reduce turnover rates among nurses in the UK rem ains param ount, considering that the UK recruited 57 136 nurses from non-European countries from 1998 till 2003(L ephalala 2006:3).Addressing both intrinsic and extrinsic factors (in terms of Herzberg's Theory) might contribute to enhancing registered n u rse s' jo b satisfac tio n reducing turnover rates among nurses in the participating private group o f hospitals in England. "