As a result of job dissatisfaction, nurses experience excruciating stress, which lowers the quality of care that is provided to critically ill patients, thereby leading to missed nursing care [22]. Jordanian nursing practice environment is characterized by a heavy workload, inter-professional conflicts, lack of decision-making ability, a non-supportive work environment, and unavailability of staff support [23]. Such inadequacy is attributed to the negative work environment, which affects the nurses’ job satisfaction and the intent to stay. Therefore, there is an increasing demand for health care due to the constant nursing shortage [24]. In addition, weak or low salary compression has been reported to avert Jordanian nurses from career promotion and professional advancement opportunities [24].

Nurses' job dissatisfaction can be due to a variety of reasons, such as high patient ratios, a heavy workload, a low-income package, or a lack of job stability. Besides, the feeling of demoralization and disempowerment among nurses indicate missed care and the absence of support [11].

Among the above-mentioned factors for job dissatisfaction of Jordanian nurses, physicians’ domination and unclear job descriptions are major issues that result in job dissatisfaction and turnover [24]. As a result, satisfied nurses, in turn, tend to stay longer in their job than dissatisfied nurses. This positively influences patients’ satisfaction levels and health status through high-quality nursing care [25]. The major reasons behind missed nursing care in Jordanian hospitals are a lack of labor resources and a low number of nurses per shift [26].

MNC is a prevalent issue in a variety of healthcare settings. Patient safety is always a top issue in nursing practice, and MNC poses a risk to it [27, 28]. Additionally, MNC and its contributing components provide crucial benchmarks for determining the standard of nursing care. Nurses' employee satisfaction may rise when patient care is of higher quality. As a result, finding the effective elements is more crucial than only MNC [27].

Within the Jordanian context, and up to the researcher’s knowledge, there is a significant lack of studies addressing the association between job satisfaction and missed nursing care, especially among nurses working in critical care units of public Jordanian hospitals, which is the overwhelming concern of the present study. The present study is expected to fill this research gap and provide research-based evidence regarding the association between job satisfaction and missed nursing care.

The purpose of this study was to investigate the relationship between job satisfaction and missed nursing care (MNC) within critical care units (CCUs).

This study aimed to seek answers to the following research questions:

1. What is the level of job satisfaction among Jordanian nurses?

2. What are the reasons for the prevalence of MNC among Jordanian nurses?

3. What is the association between job satisfaction and MNC among Jordanian nurses?

4. Is there a relationship between MNC and factors leading to missed care among Jordanian nurses?

5. What is the relationship between MNC, job satisfaction, and certain socio-demographic variables among Jordanian nurses?

A descriptive, cross-sectional study design was used to assess the relationship between nursing job satisfaction and missed nursing care in critical care units.

The nurses working in critical care units in Jordan were the target population for this study. All accessible nurses who were employed at one teaching hospital and two government hospitals were recruited to participate in the study if they met the inclusion criteria. The inclusion criteria included a bachelor's degree in nursing or higher qualification, 1-year experience of working in the critical care areas and being involved in direct patient care in critical care units (CCUs), such as intensive care units (ICUs), cardiac care units (CCUs), surgical intensive care unit (SICU), general intensive care unit (GICU), long term intensive care unit (LTICU) and medical intensive care unit (MICU). The exclusion criteria included participants with academic degrees lower than bachelor's, nurses with less than one year of experience, nurses in directing or managerial positions, and those not working in critical care units (CCUs). All nurses working in critical care units who met the inclusion criteria were invited to participate in the study. A convenience sampling technique was used to recruit critical care nurses participating in this study. The convenience sampling method was used due to the limited time window for conducting this research. The sample size was calculated based on power analysis. The sample size for the study was calculated by the G*Power electronic application version 3.0, using a small to medium effect size, alpha equal to 0.05, and 0.80 as a statistical level of power [10,28]. So, 165 participants were acquired from three hospitals. Another 10% of participants were added to compensate for the expected attrition, and the number of participants was increased to 181 to reduce the chance of sample error due to technical issues, such as dropout or incomplete data sheets, and increased sample representation. A total of 186 questionnaires were distributed by the researcher. However, a total of 183 questionnaires were received back by the researcher and three questionnaires did not return as they were lost by the participants. Out of these, a total of 181 questionnaires were found to be valid for the data analysis as two questionnaire sheets were found to have incomplete data. Therefore, the final number of participants who completed the study was 181 out of 186 nurses from different critical care units, which revealed a response rate of 97.3%.

The first teaching hospital, situated on the Jordan University of Science and Technology campus in northern Jordan, encompasses a total area of 95,583 m2 with a capacity of 683 beds. The critical care units include the neurosurgical intensive care unit, medical intensive care unit, cardiac intensive care unit, catheterization laboratory unit, intermediate cardiac care unit, and cardiac care unit. The second hospital, a government facility in the Irbid governorate, has a capacity of 230 beds with critical care units located in the main building. Lastly, the third government hospital in the Ma’an governorate, south of Amman, has a capacity of 146 beds with critical care units housed in the main building. Middle region hospitals were excluded from this study due to approval constraints, and the hospitals that were chosen involved the highest number of critical care unit nurses.

This study utilized a three-part questionnaire: A) demographic data; B) the MISSCARE Survey to assess missed nursing care (MNC); and C) the nursing-workplace satisfaction questionnaire (NWSQ) for job satisfaction.

Section A involved 14 items covering socio-demographic and professional aspects, like unit name, gender, age, marital status, experience in the critical care unit, education level, working hours, years of nursing experience, missed shifts, intent to leave current position, patient care adequacy, and recent admissions and discharges.

Section B, the MISSCARE survey, involved 41 items split into parts A and B. Part A, with 24 items on a 5-point Likert scale, evaluated the frequency of missed care, while Part B identified reasons for MNC across three domains: labor resources, material resources, and communication/teamwork. A pilot study with 40 nurses established reliability coefficients of 0.81, 0.76, and 0.79 for parts A and B, and the whole survey, respectively.

Section C, the NWSQ, involved the use of a 5-point Likert scale across 17 items to assess job satisfaction. It covered three domains: job satisfaction, doing the job, and work environment.

The questionnaires were administered in English. The participating nurses were proficient in English as English language proficiency is a pre-requisite in most nursing programs in Jordan. The institutions involved in this study, in particular, mandate English competency. It is worth noting that English is the medium of instruction in Jordanian nursing schools; therefore, the nurses were able to understand and accurately respond to the questionnaire. No translation was required, preserving the integrity of the questionnaire's language and ensuring the consistency of responses.

The study, post obtaining IRB approval from the Jordan University of Science and Technology (JUST) (IRB number 652/2021), the hospital administration, and the Jordanian Ministry of Health, was conducted between February 2, 2022, and April 2, 2022. The researcher personally distributed the questionnaires during the nurses' break times to ensure minimal disruption to their work schedules.

The questionnaire, designed for manual completion, took approximately 10-15 minutes. The researcher was present during different shifts from 8 AM to 11 PM to cater to the varied working hours of the critical care unit staff and to provide any needed assistance or clarification regarding the study.

An initial meeting was held with head nurses to explain the study's objectives and significance and to give an overview of the data collection tool. Nurses expressing interest were asked for oral consent, following which they received the questionnaire with instructions for completion and providing written consent. They were reassured about the confidentiality of their responses and their sole use for research purposes.

The completed questionnaires were collected by either dropping them in a designated box at the nursing supervisor's office or directly handing them over to the researcher, ensuring a seamless process despite its seemingly labor-intensive nature. The presence of the researcher during this period provided participants with immediate support and facilitated the timely completion and collection of responses.

The data were stored and analyzed on a suitable personal computer. Version “26” of the Statistical Package for Social Studies (SPSS) was used. The descriptive statistics (frequencies, percentages, means, and standard deviations) were used to analyze the socio-demographic characteristics of the enrolled nurses working in the critical care units and their responses to the study questionnaire. In particular, means and standard deviations were used to answer the first research question: what is the level of job satisfaction among Jordanian nurses? In addition, means, standard deviations, frequencies, and percentages were used to answer the second research question: what are the reasons for the prevalence of MNC among Jordanian nurses? To answer the third research question (what is the association between job satisfaction and MNC among Jordanian nurses?), we used Pearson’s correlation coefficient. Furthermore, we used regression analysis to answer the fourth question (is there a relationship between MNC and factors leading to missed care among Jordanian nurses?) and the fifth one [what is the relationship between MNC, job satisfaction, and socio-demographic variables (age, gender, marital status, educational level, working hours, nursing experience, experience at the current unit, missed days or shifts, the number of patients cared for, the number of patient admissions or discharges, and their plans for staying at work or leaving the current position) among Jordanian nurses?]. A significance level of α≤0.05 was used as a statistical significance threshold in this study.

A total of 186 eligible participants were recruited in this research study as follows: 121 participants were from the teaching hospital, 35 participants were from the first government hospital, and 30 participants were from the second government hospital. However, a total of 183 questionnaires were retrieved by the researcher and three questionnaires did not return. Thus, a total of 181 questionnaires were found to be valid for the data analysis as two questionnaire sheets were found to have incomplete data. Therefore, the final number of participants who completed the study was 181 nurses from different critical care units, which revealed a response rate of 97.3%.

The socio-demographic characteristics of the participating nurses, as presented in Table 1, indicated an average age of 29.6±4.04 with male nurses slightly predominating at 54.1% (n=98). Most participants worked in ICU (50.8%, n=92), were married (69.1%, n=125), worked full-time in their units, and held a bachelor's degree (89%, n=161). The average experience was 4.4±2.2 years overall, with 3.5±1.9 years in the current unit. While 40.3% (n=73) reported at least one day or shift missed due to illness, injury, or extra rest in the past three months, 87.8% (n=159) were not planning job changes. Staffing inadequacy was perceived 75% of the time by 44.8% (n=81) of nurses. The average workload involved caring for 2.9±1.53 patients per shift, admitting 1.7±1.38, and discharging 1.5±1.29.

Table 2 presents the mean scores and standard deviations for responses to the missed nursing care scale (MNCS). The most frequently missed care activities included turning patients every 2 hours (2.53 ±1.43), mouth care (2.37 ±1.36), patient education on illness and tests (2.36 ±1.47), focused reassessments (2.35 ±1.42), and discharge planning (2.34 ±1.36). Less commonly missed care included monitoring intake/output (1.91 ±1.26), assessing vital signs as ordered (1.98 ±1.35), timely toileting assistance (1.96 ±1.27), medication effectiveness assessments (2.03 ±1.17), and attending interdisciplinary care conferences (2.05 ±1.24). The overall MNCS score was 2.18±0.40 out of 5, indicating care was rarely missed.

The results presented in Table 3 represent the reported reasons for the missed nursing care as perceived by the enrolled critical care nurses. The results showed that among the teamwork or communication reasons, “caregiver being off the unit or unavailable” was the most significant reason for missed nursing care (24.3%, n=44), followed by tension or communication breakdowns with the medical staff (22.7%, n=41), inadequate handoff from previous shift or sending unit (18.8%, n=34), and lack of back up support from team members (18.8%, n=34).

The results showed that with respect to material resources, “medications being not available when needed” was the most significant factor (21.5%, n=39) for missed nursing care. In addition, it was found that among the reasons concerning labor resources, an unexpected rise in patient volume and/or acuity on the unit was the most significant factor influencing missed nursing care (23.8%, n=43), followed by heavy admission and discharge activity (21%, n=38).

In addition, Table 4 shows that 39.8% (n=72) of the nurses had a good satisfaction level, whereas 58% (n=105) had a moderate level of job satisfaction, and 2.2% (n=4) had a poor level of job satisfaction.

The results presented in Table 5 represent the Pearson’s correlation coefficient between the nursing-workplace satisfaction questionnaire (NWSQ) and missed nursing care scale (MNCS, Part A). The results have shown a statistically significant weak negative correlation between nurses’ total score job satisfaction and missed nursing care score (R=-0.177, P=0.012). This indicates that as job satisfaction increases, missed nursing care decreases.

The results presented in Tables 6-8 represent the linear regression model for the missed nursing care dependent variable based on the enrolled critical nurses’ demographic characteristics. Multiple linear regression was calculated to predict missed nursing care based on the enrolled nurse’s demographic characteristics. A non-significant regression equation was found [F (14,166) =0.899, p˃0.05], with an R² of 0.070.

The results presented in Tables 9 and 10 represent the linear regression model for the nursing job satisfaction dependent variable based on the enrolled critical nurses’ demographic characteristics. Multiple linear regression was calculated to predict nursing job satisfaction based on the enrolled nurse’s demographic characteristics. A non-significant regression equation was found [F (14,166) =1.406, p=0.155], with an R² of 0.106.

The summary of the linear regression model for nursing job satisfaction is given in Tables 9-11.