Introduction

Today, globalization, migration, nursing scarcity, new diseases, the aging population, and high quality care are complex issues that result in ethical problems for nurses (1,2). For this reason, it is expected that nurses should be aware of professional values and use them in decision making processes while dealing with ethical problems (2,3). Professional values are standard guidelines, directions for professional actions, and clinical decision-making (4).

Contemporary nurses are expected to pay attention to professional values and reflect such values in their care practices (5-7). The results of several studies have shown that professional values enable nurses to assess care quality sensitively and enhance their care performances (3,8-10). Therefore, it is extremely important to enhance professional values among nurses in order to improve and professionalize nursing practices (10). When nurses raise awareness of professional values, they can successfully transfer these values into their professional practices, which eventually results in enhanced patient care and increased job satisfaction (11-13).

Job satisfaction is characterized by the rapport between professional expectations and gains and this primarily signifies the professional attitudes, beliefs, knowledge, emotions, behaviors, and judgements of employees (14,15). Job satisfaction is important in a nurse’s work life (15). Nurses constitute the majority of human resources in medical care with 24-hour medical service. As nurses spend most of their days in their workplaces, job dissatisfaction will absolutely lead to life dissatisfaction in turn. In this case, physical, mental and social well-being might be impaired in the long-term. Consequently, nurses may experience job dissatisfaction and Burnout syndrome that manifests itself as distraction from their professional responsibilities, intentions to leave the profession, and high turnover rates (12,16). It has been recently revealed that nurses with high levels of job satisfaction report more positive feelings and professional attitudes (14,15,17).

Pediatric nurses support children by addressing important issues and dealing with their problems. In addition to meeting the child’s needs, nurses communicate and collaborate with families and also fight with them. Pediatric nurses are responsible for enabling and facilitating ethical decision making in both children and their parents (9) as well as providing counseling and support to children and their parents to promote and maintain their health (1). Pediatric nursing is a special field of nursing that focuses on providing medical care particularly for children and their parents from infancy to late adolescence (3,18,19). Especially pediatric nurses may be at higher risk due to the fact that children are usually seen as helpless and vulnerable (17). The major concerns that may affect job satisfaction in pediatric nurses are the difficult work conditions and the relatively more intensive care needed for pediatric patients (20). Therefore, pediatric nurses should raise awareness concerning professional values in order to ensure developed nursing practices, quality nursing care, professionalization, and enhanced job satisfaction. Studies to date have examined mainly nurses working with adult patients and their professional values and job satisfaction (11,12,15).

It has been widely determined that the perception of professional values and job satisfaction play a great role in the professional careers of nurses. It has also been reported that developing professional values significantly improves the care satisfaction of patients and job satisfaction of nurses, enhances care quality and decreases the intent to leave the profession (11,12). Although recent studies have suggested a correlation among the concepts such as job satisfaction, professional values, and care quality, there is still a need for evidence-based studies to elaborate these correlations. This study also was conducted to pave the way for further studies by providing comprehensive data in this field. It is essential for nurses to integrate professional values into their professional practices in order to ensure professionalization and enhanced job satisfaction (11,12). However, professional values of pediatric nurses had not been thoroughly investigated to date. The aim of this study, therefore, was to provide data and pave the way for future studies and focus on perceptions of professional values and job satisfaction levels of pediatric nurses in particular and their influencing factors.

Materials and Methods

Research Design

This study was conducted with a cross-sectional design.

Participants and Setting

The study was conducted with 134 pediatric nurses working in three public hospitals in Turkey. All pediatric nurses (Total=175) in the city were included in the study. Therefore, no sampling method was used. Some nurses said that they were too busy and so did not want to participate in the study. The response rate was 93.7%.

Data Collection

The data were collected between February 2016 and August 2016. Before the data collection, the participants were informed about the aim of the study. Given that their participation in the study would be voluntary, their written consents were obtained. The researchers distributed and collected the data forms on the same day. There was no time limitation for the participants to complete the forms.

Data Collection Tools

The personal information form, the Nursing Professional Values scale (NPVS), and the Minnesota Satisfaction Questionnaire (MSQ) were administered. The personal information form included questions about the descriptive characteristics of the participants such as age, gender, marital status, and their number of children as well as their educational status, current position at work, duration of service in the pediatric unit, and their shift work. The NPVS was used to analyze the professional values of the pediatric nurses. Developed by Weis and Schank (21), the NPVS is a five-point Likert scale with five subscales. In 2005, Orak adapted the scale into Turkish and conducted its reliability and validity testing (22). The scale has a total of 36 items and five subscales, namely dignity, responsibility, taking action, security and autonomy (22). The arithmetic mean was used to evaluate the total scores of the scale. An average score above 3.5 indicates high professional values. Higher scores signify that pediatric nurses place a great emphasis on professional values. The Cronbach’s Alpha coefficient of the scale was found to be 0.95 (22). In the present study, the Cronbach’s Alpha coefficient of the scale was found to be 0.92. The MSQ was used to assess job satisfaction levels of the pediatric nurses. Its original version with three subscales was developed by Weiss, Dawis and England (23). The reliability and validity study of the Turkish version of the questionnaire was conducted by Baycan (24). The Cronbach’s alpha coefficient of the questionnaire was found to be 0.77. The total score of the scale and subscales were evaluated using the arithmetic mean. An average score above 3.5 indicates high job satisfaction. Sabanciogulları and Dogan (15) reported that the Cronbach’s Alpha coefficient of the questionnaire was 0.90 (15). In the present study, the Cronbach’s alpha coefficient of the scale was 0.88.

Statistical Analysis

The data were analyzed using the Statistical Program, version SPSS 23.0. The demographic characteristics of the pediatric nurses in the study were assessed. Professional values and job satisfaction scales were tested for reliability with Cronbach’s Alpha coefficient. The data analysis was conducted with frequency, percentage distribution, arithmetic mean, analysis of variance, t-test, Tukey test, and Pearson correlation analysis. The analysis of the results was predicated on the basis of a significance level of 0.05. Ethical principals were followed in the study.

Ethical Considerations

Ethical approval for this study was given by Akdeniz University Clinical Trials Ethics Committee (approval number: 70904504-23). The participants were informed about the study. Written permission from the hospitals and written consent from the participants were obtained.

Results

The results of the study revealed that the average age of the pediatric nurses was 32±0.77 years (min=18 max=51), the average duration of working in the professional service was 15±1.44 years (min=2, max=32), and the average duration of working as pediatric nurse was 7±1.36 years (min=1, max=18). It was also found that 97.8% of the participants were female and 45.5% were aged between 26-36 years. While 73.1% of the participants were married, 38.1% had no child. It was also reported that 71.6% of the participants received education in a nursing high school. 87.3% of the participants were clinical nurses, 75.4% had been working as a pediatric nurse for 10 years or less, and 59% were working in day and night shifts.

It was concluded that the professional values scores of the pediatric nurses were high; whereas, the job satisfaction scores were at moderate levels. Table 1 shows the NPVS and MSQ scores of the pediatric nurses. Table 2 shows the factors influencing the professional values and job satisfaction levels of the pediatric nurses.

The results also indicated a positive and high correlation between pediatric nurses’ perception of professional values and their job satisfaction levels (Table 3).

Discussion

As a result of the study, it was found that the pediatric nurses perceived their professional values as high. This was satisfying in terms of reflecting the professionalism of the pediatric nurses. In a limited number of studies conducted with pediatric nurses, it was determined that the professional values scores of the nurses were high (3,9,25). Professional values are important in the development of nursing care quality (3,8-10). In addition, pediatric nurses are responsible for supporting the families of the patients in many cases (1,9). Pediatric nurses can provide effective care by being aware of the needs of the children and their families as well as the means of optimum healthcare services and opportunities of families under all circumstances. Children are different from adults in terms of biological, psychological, and social aspects and they are also more vulnerable than adults in terms of exposure to violations of rights. Ethical issues caused by all of these main differences in pediatric nursing have brought new discussions into the open (26). At this point, it is important for pediatric nurses to perceive professional values as high in order to make correct decisions. Therefore, it is thought that pediatric nurses perceive professional values as high, reflect them in practices and implement them in order to protect and promote the child’s health. In the present study, the job satisfaction level of the pediatric nurses was found to be moderate. According to studies in different countries, job satisfaction levels of nurses are moderate (12,13,20,27). In a limited number of studies conducted with pediatric nurses, it was determined that their job satisfaction scores were moderate (14,17,28). Our results are compatible with the literature.

The pediatric nurses who were single, had a bachelor’s degree, had been working in child nursing for 11-15 years, were in the position of clinical nurse specialist and working on the daytime shift had higher professional value scores. There are different statuses for nursing education in Turkey. Pediatric nurses with 4 years of university education may be considered to have higher professional values than others. In the study conducted by Yazıcıoğlu Sorucuoğlu and Güdücü Tüfekci (3) with 224 pediatric nurses, they stated that the professional values of those nurses who were single and nursing nurses were significantly higher (3). In another study conducted with pediatric nurses, professional value scores of post-graduate and day shift nurses were found to be high (25). The results of the present study are partially consistent with the literature. Those pediatric nurses who were married, had a bachelor’s degree, had been working in child nursing for 11-15 years, in the position of clinical nurse specialist and working on the daytime shift had higher a job satisfaction level. In studies on the job satisfaction levels of pediatric nurses (14), job satisfaction levels of nurses who were working continuously in daytime work and were graduates (27) were higher than others.

The fact that nurses strive to provide quality care to patients, look out for them, advocate for them, and support them to make conscious decisions can be achieved only with an adoption of professional values and high job satisfaction (13,29). The results of this study also suggested a positive and moderately significant correlation between the perception of professional values and job satisfaction. In the study conducted by Yarbrough et al. (11), they found that attempts to improve the professional values of nurses resulted in enhanced job satisfaction. Similarly, it was reported that there was a positive significant correlation between professional values and job satisfaction in nurses (12). This result was compatible with the results of previous studies. It can be reasonably suggested that raising awareness concerning professional values will improve the job satisfaction of nurses.

Study Limitations

The present study has several limitations. One of the limitations is that the data were obtained only from three public hospitals in Antalya, Turkey. Future studies with larger sample groups are needed in Turkey. Another limitation of this study is that the majority of the participants were female. For this reason, the results of this study cannot be generalized to mixed gender groups.

Conclusion

The mean scores of the professional values of the pediatric nurses were high and their job satisfaction scores were moderate. Marital status, education level, working duration in pediatric nursing, working position, and shift were related to the professional values of pediatric nurses and their job satisfaction. It was found that there was a positive and moderate correlation between the perception of professional values and job satisfaction in pediatric nurses.

In the light of the results of this study, it is recommended that the professional values and job satisfaction of pediatric nurses are improved. Additionally, it is considered to be crucial to implement new strategies to maintain professional values in order to increase job satisfaction levels. Nevertheless, there is still an urgent need to conduct further studies investigating the professional values of pediatric nurses. It is also suggested that the factors that influence the professional values of pediatric nurses are analyzed, and thus the professional values of pediatric nurses are improved. Further studies are needed to validate the results of this study and to evaluate the possible impacts of interventions to enhance professional values and job satisfaction. It is recommended that educational and promotional programs are designed to enhance the pediatric nurses’ perceptions concerning professional values.

The results of this study will be valuable for nursing managers of pediatric units to understand current levels of professional values and job satisfaction. These have significant implications for policy makers in re-examining aspects of management and nursing practice. These findings can guide pediatric nursing managers to highlight the importance of awareness on professional values among pediatric nurses as caregivers with high job satisfaction. Nursing managers play an important role in the formation of safe working environments and the enhancement of job satisfaction due to their tasks and responsibilities as well as their authorizations. This study, therefore, is thought to provide substantial data in this field in Turkey and to guide the Ministry of Health, nursing managers, hospital management, and non-governmental organizations to design well-established and unbiased programs for pediatric nurses. Finally, it is recommended that similar studies with pediatric nurses in different medical settings are conducted so that nursing managers can evaluate the validity of the test results.

Acknowledgments

The authors would like to thank all participants in this study.

Ethics

Ethics Committee Approval: Ethical approval for this study was given by Akdeniz University Clinical Trials Ethics Committee (approval number: 70904504-23).

Informed Consent: Written permission from the hospitals and written consent from the participants were obtained.

Peer-review: Externally peer-reviewed.

Authorship Contributions

Concept: A.K., D.Ç., A.İ.D., Design: A.K., D.Ç., Data Collection or Processing: A.K., D.Ç., Analysis or Interpretation: A.K., A.İ.D., Literature Search: A.K., D.Ç., Writing: A.K., D.Ç., A.İ.D.

Conflict of Interest: No conflict of interest was declared by the authors.

Financial Disclosure: The authors declared that this study received no financial support.