Job satisfaction of Moroccan nurses: Arabic validation of Kuopio University Hospital Job satisfaction Scale and survey results

Job satisfaction of Moroccan nurses: Arabic validation of Kuopio University Hospital Job satisfaction Scale and survey results | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Job satisfaction of Moroccan nurses: Arabic validation of Kuopio University Hospital Job satisfaction Scale and survey results Wafâa AL HASSANI, Youness EL ACHHAB, Abdelilah MERABTI, Abdelghaffar EL-AMMARI, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7010474/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Retaining nurses hinges on fostering supportive work environments, yet cross-national benchmarking is limited by a lack of psychometrically comparable Arabic instruments. This study aimed to translate and validate the Kuopio University Hospital Job Satisfaction Scale (KUHJSS) in Moroccan Arabic and identify organizational and demographic determinants of nurses’ job satisfaction. Methods A cross-sectional survey design was employed. A total of 220 registered nurses and midwives from four public hospitals and primary care centers in Fez completed the translated version of the KUHJSS. The instrument was translated using a forward-backward translation process. Exploratory and confirmatory factor analyses (EFA and CFA) were conducted, and Cronbach’s α was calculated to assess internal consistency. Group differences in factor means were examined using independent-sample t-tests and one-way ANOVA. As several variables were not normally distributed, nonparametric tests were applied. Results EFA-CFA supported a stable five-factor structure comprising 32 items, which accounted for 48.4% of the total variance and demonstrated excellent internal consistency (Cronbach’s α = 0.74–0.93). Items from the “Leadership” and “Sense of Community” domains merged into a single factor, consistent with findings from other Mediterranean adaptations. The most pronounced score differences were associated with modifiable workplace conditions rather than fixed demographic variables. Staff who rated their unit’s care quality as “high” reported significantly higher Leadership and Sense of Community scores compared to those with lower ratings ( p < 0.001). Scores were also significantly higher in primary care and university hospitals compared to regional hospitals ( p = 0.031). Midwives reported the highest levels on both the Leadership and Sense of Community and Motivating Factors scales ( p = 0.021), while age, gender, and professional tenure showed only minor associations. Conclusion The Arabic KUHJSS is a reliable, valid tool for Moroccan nurses. Job satisfaction relates mainly to relational leadership, participatory climate, and perceived care quality; all amenable to organizational action. Multi-site longitudinal studies that add workload and staffing metrics should test whether strengthening these levers sustainably boosts satisfaction and retention. job satisfaction validation nursing staff determinants Figures Figure 1 Figure 2 Introduction Job satisfaction plays a critical role in contemporary healthcare systems, significantly influencing both healthcare professionals' personal well-being and the quality of patient care provided [ 1 ]. It reflects the degree to which individuals feel contentment and fulfillment within their professional roles, shaped by multiple interconnected factors. Previous research highlights professional development opportunities, collaborative relationships with colleagues, and supportive management as pivotal determinants influencing healthcare professionals' job satisfaction [ 2 – 4 ]. Moreover, evidence indicates a positive correlation between job satisfaction among nursing staff and the overall quality of patient care, suggesting that high-quality care environments typically reflect greater levels of staff contentment [ 5 , 6 ]. Conceptually, job satisfaction is defined not only as the extent to which employees find their roles enjoyable and fulfilling but also in relation to the fulfillment of their professional expectations [ 7 ]. Unmet expectations can lead to dissatisfaction, negatively impacting employees' attitudes, professional ethics, and even their perceptions of life's meaning [ 8 – 10 ]. Additionally, working conditions substantially influence healthcare workers' psychological well-being, further underscoring the necessity of fostering positive workplace environments [ 11 ]. Thus, understanding and enhancing job satisfaction is paramount for promoting both nurse well-being and optimal patient care outcomes. In Morocco, a 2024 scoping review of the health workforce showed that job satisfaction (particularly among nurses) is one of the most frequently reported organizational challenges, underscoring the urgency of workplace reforms to retain and motivate staff [ 12 ]. A locally validated, easytoadminister scale is crucial to pinpoint how satisfied Moroccan nurses truly are, identify the workplace factors that matter most, and track the impact of any retention focused reforms. Although two Moroccan studies have recently validated job satisfaction tools for the overall health workforce [ 13 , 14 ], they combine nurses with physicians and administrative staff, masking the profession specific drivers of satisfaction unique to nursing practice. Consequently, a rigorously validated, nurse exclusive scale is still needed to capture the nuanced realities of bedside care, generate precise diagnostic data, and guide reforms aimed at retaining and motivating Morocco’s largest cadre of health professionals. While several nurse specific job satisfaction instruments exist; most notably the McCloskey/Mueller Satisfaction Scale (MMSS), the Index of Work Satisfaction (IWS) and the Practice Environment Scale of the Nursing Work Index (PES‑NWI), the Kuopio University Hospital Job Satisfaction Scale (KUHJSS) remains the most congruent choice for a Moroccan validation study. Unlike the MMSS, whose content is weighted toward scheduling and compensation and has shown cultural fit problems even in recent Indonesian [ 15 ] and Middle‑Eastern adaptations [ 16 ] and unlike the IWS and PES‑NWI, which emphasize broad organizational climate more than individual fulfilment and omit quality of care items [ 17 , 18 ], the KUHJSS was built from the ground up around bedside nursing realities and explicitly links leadership, teamwork, professional growth and care quality in a single 37‑item structure [ 19 ]. Its psychometric strength has been confirmed not only in Finland (α = 0.85–0.93) but also in cross‑cultural replications; first in Greece and Cyprus [ 20 ], and most recently in a Central-European critical care sample [ 21 ], without loss of factorial integrity. The instrument has been utilized in multiple international studies, including those by [ 4 ] in Finland and Norway, and by [ 22 ] in Finland, Italy, and the United States. With its cross cultural robustness, manageable length, and explicit coverage of care quality domains identified as priorities in recent Moroccan workforce studies, the KUHJSS provides a more contextsensitive and methodologically rigorous foundation for assessing nurses’ job satisfaction than the others. Accordingly, this study aimed to translate and validate the KUHJSS in Moroccan Arabic and identify organizational and demographic determinants of nurses’ job satisfaction. By establishing its psychometric soundness and profiling the key determinants of nurse satisfaction, we seek to furnish decision‑makers with a context‑specific tool capable of guiding evidence‑based workforce reforms. Method Design and ethics This study employed a crosssectional, descriptive, and quantitative design conducted in publicly operated hospitals. All reporting follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines to ensure methodological transparency and rigor. Ethical approval for the project was obtained from the Scientific Research Ethics Committee in Euromed University, authorizing data collection in the healthcare hospitals of Fez. After clearance, nursing managers and nursing staff received written information detailing the study’s objectives, procedures, and the safeguards that would preserve participants’ anonymity and confidentiality. Participation was strictly voluntary and informed consent to participate was obtained from all of the participants in the study. Permission to use the KUHJSS scale was obtained from the original author prior to its translation and administration. Participants and data collection Participants were nurses employed in the public health sector included in the study. According to the 2024 regional staffing roster ( https://cartesanitaire.sante.gov.ma/ ), almost 2,000 paramedical professionals were employed in the public sector. Using convenience sampling, data were collected in 2024 through a selfadministered, webbased questionnaire. The survey link and study information were initially shared by email, presented to nurse managers during site visits, and relayed through designated contact persons at each hospital. These intermediaries then forwarded the invitation to nurses working across multiple clinical units. To maximize participation, several reminder emails were sent at scheduled intervals throughout the data collection period. An a priori samplesize calculation was conducted with G*Power 3.1 to ensure the study was sufficiently powered. Assuming a medium effect size (Cohen’s d = 0.50), a twotailed meancomparison test, an alpha level of 0.05, and a desired statistical power of 0.95, the analysis indicated that a minimum of 210 participants was required. Globally, 260 questionnaires were received (13% response rate). Forty were excluded because respondents held exclusively administrative positions and were not engaged in clinical workflows. The resulting analytic sample comprised exactly 220 participants, meeting the predetermined requirement and preserving ≥ 95% statistical power for the primary analyses. Instrument The KUHJSS is a nursespecific instrument designed in Finland to quantify job satisfaction within hospital settings. It was created through a systematic literature review, expert panel appraisal, pilot testing with 172 nurses and a largescale psychometric evaluation involving 2,708 Finnish nursing staff, establishing solid content and construct validity [ 19 ]. Items measure multiple dimensions of job satisfaction including: leadership (7 items); requiring factors of work (8 items), motivating factors of work (6 items); working environment (4 items); working welfare (4 items); participation in decision-making (4 items) and sense of community (4 items). Translations and validations, including a Greek version successfully tested with nurses in Cyprus and Greece, have reproduced good psychometric qualities, supporting the scale’s crosscultural applicability [ 20 ]. KUHJSS is now widely used to explore relationships between nurses’ job satisfaction, leadership practices, patient satisfaction and safety outcomes, making it a robust, multidimensional measure for workforce research in hospitals. Translation and cultural adaptation The KUHJSS was translated into Arabic through a rigorous forward-backward translation process by bilingual experts. An expert panel reviewed translations for cultural relevance and clarity. A pilot test was conducted with 10 nurses to refine language and cultural appropriateness. According to the participants’ suggestions, minor phrasal corrections of some items (13, 16 and 22) were made to the scale. Item 5 of the leadership subscale was divided into two distinct components to capture both administrative and clinical aspects of leadership more precisely. Data Analysis Factor analysis was conducted using Jamovi 2.3.28. An exploratory factor analysis (EFA) using principal axis factoring with Promax rotation was conducted to assess the construct validity of the scale in line with current EFA best-practice recommendations [ 23 ]. Factor retention was guided by three criteria: eigenvalues greater than 1, factor loadings of at least 0.40, and visual inspection of the Scree Plot. Given that the scale was translated into another language and applied within a different healthcare system and cultural context, the EFA was followed by a confirmatory factor analysis (CFA) to further validate the factor structure. The analyses were treated as if the scale were newly developed, in order to rigorously evaluate its psychometric properties in the new setting. The Bartlett’s test of sphericity was significant (χ² = 4535, p < 0.001), and the Kaiser-Meyer-Olkin measure of sampling adequacy was 0.884, both indicating that the data were suitable for EFA. Internal consistency reliability was assessed via Cronbach’s alpha. Descriptive and inferential statistics were used to analyze the data. Demographic variables were grouped using practical and reliable categorization schemes. Age was categorized into three groups: 20 years. Work experience in total, was classified into four categories: ≤2 year, 3–5 years, 6–10 years, and > 11 years. Perceptions of care quality were rated using a scale system (2 = worst, 10 = best) and categorized into three groups: poor (2–5), moderate (6–7), and excellent (8–10). Based on the EFA, five subscale mean scores were calculated by averaging item responses within each dimension, yielding scores ranging from 1 (lowest satisfaction) to 5 (highest). The normality of these mean scores was assessed using the Kolmogorov-Smirnov test. As several variables were not normally distributed, nonparametric tests were applied; specifically, the Mann-Whitney U test for two-group comparisons and the Kruskal-Wallis test for comparisons involving more than two groups. Results Sample characteristics A total of 220 nursing professionals participated in the study, and their sociodemographic characteristics are summarized in Table 1. Women represented 65.0% of the sample (n = 143), and just over half of the respondents (54.2%) were 31–40 years old. Nursing staff represented 64.1% of participants (141/220), technical and administrative staff 25.4%, and midwives 10.5%. Participants had a mean ± SD of 13.10 ± 6.71 years of overall professional experience and 8.13 ± 6.32 years of experience in their current unit. Approximately one-third (34.3%) of the sample rated the quality of care in their unit between 8 and 10 on a 10-point scale. Table 1 Characteristics of study participants (n = 220) Characteristic n % Gender Women 143 65.0 Men 77 35.0 Age (years) 37.4* 7.65** 22–30 40 18.7 31–40 116 54.2 41–62 58 27.1 Occupational group Nursing staff 141 64.1 Midwife 23 10.5 Other 56 25.4 Establishment University hospital 71 32.2 Hospital regional 55 25.0 Primary health center 37 16.8 Others 57 25.9 Working experience in nursing (years) 13.10* 6.79** 20 27 12.3 Working experience in current unity (years) 8.13* 6.32** ≤2 49 22.3 3–5 47 21.4 6–10 53 24.1 >10 71 32.3 Estimated quality of nursing care in unity 6.61* 1.67** ≤5 62 28.7 6–7 80 37.0 8–10 74 34.3 * Mean value; ** Standard deviation. Factor analysis The EFA yielded five factors (Table 2), accounting for 48.4% of the total variance, with eigenvalues ranging from 10.750 to 1.005 and Cronbach’s alpha coefficients varied from 0.74 to 0.93. This factor structure was supported by the scree plot analysis (Fig. 1). One item showed a moderate positive loading on Factor 2 (0.483) and a smaller negative cross-loading on Factor 3 (− 0.421); as its strongest and conceptually relevant association was with Factor 2, the item was retained in that factor. Six items had loadings below the accepted threshold of 0.40. These included three items (26, 27, and 28) from the “Working Welfare” dimension, the first two items (8 and 9) from the “Requiring Factors of Work” dimension, and one item (21) from the “Motivating Factors of the Work” dimension. Table 2 Results of exploratory factor analyses of Arab version of KUHJSS Factor Items (1) Leadership and Sense of Community (2) Requiring Factors of Work (3) Motivating Factors of the Work (4) Working Environment (5) Participation in Decision-Making 1. My manager/director is genuinely interested in the well-being of the staff. 0.774 2. My manager/director treats the staff fairly and equally. 0.852 3. My manager/director encourages staff to take part in the planning of our unit’s operation. 0.920 4. My manager/director provides the staff with feedback aimed at improving work processes 0.879 5a. My manager/director keeps me thoroughly informed about matters concerning my unit (administrative aspect) 0.862 5b. My manager/director keeps me thoroughly informed about matters concerning my unit (clinical aspect) 0.822 6. My manager/director facilitates the staff’s continuous professional development 0.742 7. My manager/director is interested in work results and outcomes 0.844 8. My workload is appropriate 9. There are usually enough staff in my unit 10. I do not find my work too stressful 0.760 11. I am satisfied with my working hours 0.726 12. Combining work and personal life is successful 0.708 13. The workload is distributed evenly in my unit 0.429 14. My salary is appropriate in relation to the demands of my work 0.527 15. The upper management of the hospital district appreciates my work 0.416 16. My work is interesting 0.606 17. I appreciate my own work 0.866 18. I can apply a wide range of my skills and expertise in my work 0.563 19. My work tasks are suitably challenging -0.421 0.483 20. Client feedback motivates me in my work 0.466 21. I am willing to work in this hospital district in the future 22. My unit has appropriate work facilities 0.814 23. My unit has appropriate equipment to ensure quality of care 0.894 24. My work unit is comfortable 0.715 25. My work unit is safe and secure 0.734 26. I look after my personal well-being 27. I am happy with my current health 28. I am active in developing myself professionally 29. I feel I am a competent employee 0.535 30. I have opportunities to make independent decisions in my work 0.674 31. I have opportunities to plan my work independently 0.776 32. I have a chance to influence decision-making in my unit 0.476 33. I have a chance of career development in the hospital district 0.474 34. I trust the expertise of my colleagues 0.418 35. There is a good community spirit in my unit 0.491 36. The flow of information works well in my unit 0.490 37. New employees are welcomed in my unit 0.438 Eigen values 10.750 2.250 2.068 1.155 1.005 Cronbach’s alpha value 0.93 0.76 0.74 0.85 0.84 The first factor combined items from the original “Leadership” and “Sense of Community” dimensions of the initial questionnaire. Additionally, the item “ The upper management of the hospital district appreciates my work ”, originally part of the “Requiring Factors of Work” dimension, also loaded onto this factor. The second factor corresponded to the “Requiring Factors of Work” dimension; however, the first two items within this factor had loadings below the acceptable cut-off of 0.40. The third factor aligned with the “Motivating Factors of the Work” dimension and retained all related items except for the last one (Item 21), which also loaded below 0.40. In contrast, the fourth (“Working Environment”) and fifth (“Participation in Decision-Making”) factors retained all items from their respective original dimensions. The structure of the five-factor model was further illustrated through a CFA path diagram (Fig. 2), which visually presents the standardized loadings of each observed item on its respective latent factor, as well as the inter-factor correlations. The visual model reinforces the statistical results, confirming that most items strongly and significantly loaded onto their designated factors, with standardized estimates generally above 0.60. Notably, items such as K-3 (0.842), K-4 (0.824), and K-24 (0.801) showed particularly high loadings, indicating strong construct representation. Inter-factor correlations displayed in the diagram ranged from 0.21 (between Factors 2 and 3) to 0.54 (between Factors 1 and 4), aligning with the covariance estimates. These moderate associations reflect the conceptual interrelatedness of the satisfaction dimensions, while also supporting their distinctiveness. Together, the visual and statistical findings confirm the structural integrity and discriminant validity of the KUHJSS's five-factor model. The five-factor model yielded a significant chi‐square test, χ²(452) = 1020, p < 0.001, indicating deviation from exact fit, while incremental and absolute fit indices suggested acceptable approximation: CFI = 0.841, TLI = 0.826, SRMR = 0.093, and RMSEA = 0.076 (90% CI: 0.069–0.082). Information criteria further supported the model’s relative parsimony (AIC = 17 502; BIC = 17 868), confirming that the Arabic adaptation of the KUHJSS provides a robust factorial structure for assessing job satisfaction among Moroccan nurses. [Table 2 should appear here] Factors related to job satisfaction Table 3 presents the mean KUHJSS Arab version scores and corresponding p -values across demographic and professional subgroups. Female nurses scored significantly higher than males on Leadership and Sense of community (2.95 vs 2.65, p = 0.005), while no gender difference emerged for the other four factors or for overall job satisfaction. Age influenced only the Requiring factors of work, rising from 2.70 in nurses aged 22–30 to 3.22 in those aged 41–62 ( p = 0.003). Professional role mattered as well: midwives recorded the highest means for Leadership and Sense of community (3.63) and Motivating factors (4.17) compared with nursing staff and other health workers ( p = 0.003 and 0.021, respectively). Career stage effects were limited to workplace participation and climate: nurses with < 6 years’ experience rated the Working environment (3.16) and Participation in decision-making (3.84) most favorably, with scores dipping between 6–10 years before partially rebounding thereafter ( p = 0.005 and 0.029). Length of service in the current unit showed no significant impact on any KUHJSS dimension ( p > 0.20). Organizational setting exerted a comparable influence. Leadership and Sense of community was higher in primary care centers than in other facilities ( p = 0.031), whereas the Working environment received its best ratings in university hospitals ( p = 0.018). Finally, perceived care quality generated the strongest gradient: nurses who rated unit quality as high (8–10/10) reported markedly higher scores on Leadership and Sense of community, Motivating factors, Working environment, and overall satisfaction (all p ≤ 0.038) than colleagues perceiving moderate or low quality. Collectively, these findings indicate that leadership climate, organizational context, and care quality; rather than demographic attributes alone, drive the principal variations in nurses’ job satisfaction within this sample. Table 3 Mean scores of job satisfaction dimensions by demographic and professional Characteristics (n = 220). Characteristic Leadership /Sense of Community Requiring Factors of Work Motivating Factors of the Work Working Environment Participation in Decision-Making Total Job satisfaction Gender Women 2.95 2.59 3.57 2.75 3.40 3.29 Men 2.65 2.58 3.52 2.88 3.39 3.26 p 0.005 0.903 0.492 0.270 0.978 0.593 Age (years) 22–30 3.38 2.70 3.90 2.80 3.52 3.26 31–40 3.29 2.94 3.98 2.81 3.41 3.28 41–62 3.26 3.22 3.89 2.81 3.29 3.29 p 0.761 0.003 0.560 0.999 0.410 0.962 Occupational group Nursing staff 3.35 2.96 3.96 2.85 3.49 3.32 Midwife 3.63 2.91 4.17 2.78 3.23 3.35 Other 3.01 3.02 3.82 2.67 3.21 3.15 p 0.003 0.804 0.021 0.495 0.058 0.123 Establishment University hospital 3.37 2.90 4.00 3.08 3.46 3.36 Hospital regional 3.38 3.12 3.96 2.64 3.34 3.29 Primary health center 3.44 2.73 3.93 2.57 3.26 3.19 Others 3.02 3.06 3.86 2.74 3.43 3.22 p 0.031 0.069 0.531 0.018 0.630 0.384 Working experience in nursing (years) 20 3.47 3.17 3.92 2.93 3.18 3.33 p 0.212 0.061 0.847 0.005 0.029 0.059 Working experience in current unity (years) ≤2 3.34 2.94 3.94 2.80 3.61 3.33 3–5 3.25 2.90 3.88 2.68 3.32 3.21 6–10 3.37 3.00 3.89 2.82 3.28 3.27 >10 3.24 3.01 4.02 2.85 3.38 3.30 p 0.821 0.852 0.415 0.811 0.208 0.746 Estimated quality of nursing care in unity ≤5 2.89 2.80 3.82 2.46 3.22 3.04 6–7 3.28 3.02 3.95 2.65 3.44 3.27 8–10 3.66 3.03 4.05 3.19 3.49 3.48 p < 0.001 0.146 0.038 < 0.001 0.155 < 0.001 Discussion Nurses’ job satisfaction has become a truly trans-national concern: the latest State of the World’s Nursing 2025 report stresses that retaining the 29 million-strong workforce now hinges as much on improving work experience as on expanding head-counts, a challenge shared by health systems on every continent [ 24 ]. Because international mobility is accelerating and policy makers increasingly look abroad for solutions, researchers must rely on instruments that allow meaningful comparisons across settings. The KUHJSS answers this need: developed through rigorous psychometric work in Finland (37 items, seven dimensions) [ 19 ], it has since been translated and validated in multiple languages without loss of structural validity [ 20 , 21 ]. By further validating the KUHJSS in our setting instead of designing a de novo local tool, we contribute to a growing measurement “common language” that facilitates pooled analyses, benchmarking, and collaborative interventions aimed at lifting job satisfaction worldwide. Our combined EFA - CFA approach produced a robust five-factor model that captures 48.4% of the total variance and demonstrates excellent internal consistency (Cronbach’s α = 0.74–0.93). The most striking deviation from the Finnish original was the merger of every item from the “Leadership” and “Sense of Community” domains; along with the statement “Upper management of the hospital district appreciates my work”, into a single latent factor. In practice, this reflects day-to-day reality in our hospitals, where staff experience frontline supervision and team solidarity as two inseparable facets of the same relational climate. A nearly identical amalgamation was observed in the Greek adaptation: its combined “Leadership” and “Team Spirit” factor explained 47% of the variance and showed α = 0.71–0.88 [ 20 ]. Spanish studies likewise report that nurses’ job satisfaction hinges simultaneously on managerial style, team cohesion, and shared decision-making, treating them as mutually reinforcing levers for well-being [ 25 ]. The recurrence of this fusion across Morocco, Greece, and Spain therefore appears to mark a distinctly Mediterranean pattern in which collegial support is viewed as an intrinsic attribute of effective leadership rather than a separate construct. By contrast, the Polish validation, conducted in a culturally more individualistic Central-European context, retained a clear boundary between “Leadership” and peer-related dimensions even after item trimming [ 21 ], underscoring the cultural specificity of our findings. At the item level, our pattern of high- and low-loading statements faithfully mirrored those seen in the Greek and Polish validations, suggesting that the very same questions persistently emerge as either strong or fragile indicators, regardless of cultural context. Six statements failed to reach the 0.40 loading threshold, suggesting that they may not resonate sufficiently within our cultural and organizational context. In the Polish critical-care sample, Sak-Dankosky et al. [ 21 ] likewise reported several low-loading welfare and staffing items and ultimately arrived at a leaner three-factor configuration after removing seven items; despite the shorter form, reliability remained robust (α = 0.79–0.92) and the model fit indices improved substantially. Taken together, these findings support the scale’s cross-cultural portability while highlighting the need to revise items that hinge on country-specific staffing norms or benefit packages. From a psychometric standpoint, the moderate inter-factor correlations we observed (r = 0.21–0.54) demonstrate acceptable discriminant validity while also confirming that the dimensions of job satisfaction are complementary facets of a single overarching construct, rather than completely independent domains. Practically, our results argue for interventions that are simultaneously leadership-focused and environment-focused: strengthening participatory leadership, improving the physical work setting, and streamlining demanding work processes are likely to generate synergistic gains across all five satisfaction domains. Future research should test the stability of this five-factor model with longitudinal samples and explore whether a shortened 30- to 32-item version (omitting persistently weak items identified here and in the Greek and Polish studies) can retain psychometric rigor while reducing respondent burden. Our subgroup analyses show that the steepest shifts in KUHJSS scores are driven by changeable workplace conditions (leadership climate, care-quality perceptions, and facility type) rather than by fixed personal attributes such as age, gender, or tenure. Consistent with our pattern, Sanner-Stiehr et al. [ 22 ] reported from a three-country sample of 1,433 nurses that organizational context accounted for the bulk of KUHJSS variance, with leadership scoring uniformly high across settings. Leadership/Sense of community rose by almost half a point among staff who judged unit quality as “high” and was also higher in primary-care and university-hospital settings than in regional hospitals. These patterns align with recent evidence linking a positive psychosocial climate and perceived care quality to stronger professional well-being and lower intent to leave the profession [ 5 , 26 ]. Leadership itself appears to be the pivotal lever. Female nurses (midwives most of all) posted the strongest Leadership/Sense of community scores, a pattern consistent with evidence that relational, inclusive leadership styles resonate in female-dominated disciplines and stimulate nurses’ willingness to step into formal managerial roles [ 27 , 28 ]. Age and career stage exerted only selective effects (older staff valued “Requiring factors of work”; nurses with < 6 years’ experience viewed their environment and decision-making most favorably), but these differences were modest next to the influence of organizational setting and perceived quality. Together with meta-analytic data linking supportive climates to lower burnout and better patient outcomes, our findings reinforce the view that skillful, community-building leadership simultaneously serves staff and service quality [ 5 ]. Practically, the results argue for prioritizing leadership development and unit-level quality initiatives when aiming to raise job satisfaction in our nursing context. Equipping front-line managers with relational skills, embedding participatory governance structures, and making care-quality metrics visible could lift multiple KUHJSS domains at once, irrespective of gender or tenure. The absence of any tenure-satisfaction link implies that a nurturing work climate can sustain nurses’ engagement well beyond the initial adjustment phase. Longitudinal trials that track whether improvements in perceived care quality mediate lasting gains in satisfaction are now warranted. Practically, our findings point toward organizational levers rather than individual attributes, as the most promising targets for boosting staff morale. Transformational and relational-leadership programs consistently raise nurse satisfaction, reduce burnout, and improve retention [ 29 – 31 ]. Embedding participatory/shared-governance structures gives bedside nurses a formal voice in policy and resource decisions, which in turn elevates job satisfaction and patient outcomes [ 32 ]. Finally, making unit level care quality metrics highly visible and actionable has been linked to better perceived quality, lower burnout, and higher satisfaction among nursing staff [ 5 ]. Equipping front-line managers with relational skills, instituting shared-decision councils, and routinely feeding back quality dashboards could therefore lift multiple KUHJSS domains at once, irrespective of gender or tenure. The absence of a tenure satisfaction association in our data suggests that a supportive climate can sustain nurses’ engagement well beyond the initial adjustment period; an observation that echoes longitudinal work demonstrating that work-environment resources, rather than time in post, drive longer-term engagement and satisfaction [ 33 ]. Rigorous longitudinal or quasi-experimental trials are now warranted to test whether targeted improvements in perceived care quality mediate durable gains in job satisfaction and, ultimately, retention. This study’s insights should be read cautiously. We used a convenience sample from four public facilities in one Moroccan region, curbing generalizability. Cross-sectional, self-reported data invite common-method bias and preclude causal inference, while unit quality was gauged by a single global item and factorial invariance of the Arabic KUHJSS was not tested. Most tellingly, our final model explained just 48% of the variance in job satisfaction, indicating that unmeasured factors (workload, staffing ratios, and work-life balance) remain to be explored through larger, probability-based, longitudinal designs combining subjective and objective indicators. Conclusions The KUHJSS Arabic version proved reliable and structurally sound, capturing five inter-related facets of job satisfaction in Moroccan nurses and confirming that effective leadership is experienced as inherently collegial. Satisfaction varied chiefly with modifiable unit conditions (leadership style, participatory governance, and perceived care quality) while age, gender, and tenure played only minor roles. Half the variance remains unexplained; larger multi-site studies should factor in workload, staffing, and work-life balance and test whether relational leadership plus visible quality metrics lift satisfaction and retention. Abbreviations KUHJSS: Kuopio University Hospital Job Satisfaction Scale EFA: Exploratory Factor Analysis CFA: Confirmatory Factor Analysis Declarations Ethics approval and consent to participate This study was conducted in accordance with the ethical standards of the institutional research committee and with the Declaration of Helsinki. The Scientific Research Ethics Committee in Euromed University approved the study protocol under the reference CERS/UEMF-2025/EC01/01. Permission to collect data was obtained from the facilities administrative authorities. Participation was strictly voluntary and informed consent to participate was obtained from all of the participants in the study. Consent for publication Not applicable. Availability of data and materials All data generated or analyzed during this study are included in this published article. Competing Interests The authors declare no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors' contributions Study design: W.A., Y.E., T.K., C.N.; Data collection: A.M., A.E., Z.M.; Data analysis: W.A., Y.E., A.E.; Manuscript preparation: W.A., Y.E., T.K., C.N. All authors read and approved the final manuscript. Acknowledgements The authors would like to thank all nurses who participated in the study. Clinical trial number Not applicable. References Alkhateeb M, Althabaiti K, Ahmed S, Lövestad S, Khan J. A systematic review of the determinants of job satisfaction in healthcare workers in health facilities in Gulf Cooperation Council countries. Glob Health Action 2025;18:2479910. https://doi.org/10.1080/16549716.2025.2479910. Kalisch BJ, Lee H, Rochman M. Nursing staff teamwork and job satisfaction: Nursing staff teamwork and job satisfaction. J Nurs Manag 2010;18:938–47. https://doi.org/10.1111/j.1365-2834.2010.01153.x. Reeves S, Pelone F, Harrison R, Goldman J, Zwarenstein M. Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database Syst Rev 2017;2018. https://doi.org/10.1002/14651858.CD000072.pub3. Ylitörmänen T, Turunen H, Mikkonen S, Kvist T. Good nurse–nurse collaboration implies high job satisfaction: A structural equation modelling approach. Nurs Open 2019;6:998–1005. https://doi.org/10.1002/nop2.279. Li LZ, Yang P, Singer SJ, Pfeffer J, Mathur MB, Shanafelt T. Nurse Burnout and Patient Safety, Satisfaction, and Quality of Care: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024;7:e2443059. https://doi.org/10.1001/jamanetworkopen.2024.43059. Yesilbas H, Kantek F. Relationship between structural empowerment and job satisfaction among nurses: A meta‐analysis. 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Transforming nursing work environments: the impact of organizational culture on work-related stress among nurses: a systematic review. BMC Health Serv Res 2024;24:1526. https://doi.org/10.1186/s12913-024-12003-x. Al Hassani W, Achhab YE, Nejjari C. Challenges faced by human resources for health in Morocco: A scoping review. PLOS ONE 2024;19:e0296598. https://doi.org/10.1371/journal.pone.0296598. Al Hassani W, El Achhab Y, Taiebine M, Nejjari C. Development and Validation of a Scale to Measure Job Satisfaction Among Human Resources for Health in Morocco. Cureus 2024. https://doi.org/10.7759/cureus.57438. El Mouaddib H, Sebbani M, Mansouri A, Adarmouch L, Amine M. Job satisfaction of primary healthcare professionals (public sector): A cross-sectional study in Morocco. Heliyon 2023;9:e20357. https://doi.org/10.1016/j.heliyon.2023.e20357. Juanamasta IG, Aungsuroch Y, Fisher ML, Nursalam. Reliability and Validity of the Indonesian Version of the McCloskey/Mueller Satisfaction Scale. J Nurs Manag 2023;2023:1–7. https://doi.org/10.1155/2023/9999650. Clinton M, Dumit NY, El-Jardali F. Rasch Measurement Analysis of a 25-Item Version of the Mueller/McCloskey Nurse Job Satisfaction Scale in a Sample of Nurses in Lebanon and Qatar. Sage Open 2015;5:2158244015592167. https://doi.org/10.1177/2158244015592167. Lake ET, Gil J, Moronski L, McHugh MD, Aiken LH, Lasater KB. Validation of a short form of the practice environment scale of the nursing work index: The PES‐5. Res Nurs Health 2024;47:450–9. https://doi.org/10.1002/nur.22388. Zangaro GA, Soeken KL. Meta-Analysis of the Reliability and Validity of Part B of the Index of Work Satisfaction Across Studies. J Nurs Meas 2005;13:7–22. https://doi.org/10.1891/jnum.2005.13.1.7. Kvist T, Mäntynen R, Partanen P, Turunen H, Miettinen M, Vehviläinen-Julkunen K. The Job Satisfaction of Finnish Nursing Staff: The Development of a Job Satisfaction Scale and Survey Results. Nurs Res Pract 2012;2012:1–11. https://doi.org/10.1155/2012/210509. Sapountzi-Krepia D, Zyga S, Prezerakos P, Malliarou M, Efstathiou C, Christodoulou K, et al. Kuopio University Hospital Job Satisfaction Scale (KUHJSS): its validation in the Greek language. J Nurs Manag 2017;25:13–21. https://doi.org/10.1111/jonm.12418. Sak-Dankosky N, Serafin L, Kvist T, Czarkowska-Pączek B. Determinants of critical care nurses’ job satisfaction: A cross-sectional study including cultural validation of Kuopio University Hospital Job Satisfaction Scale. Pielegniarstwo XXI Wieku Nurs 21st Century 2025;23:290–6. https://doi.org/10.12923/pielxxiw-2024-0044. Sanner‐Stiehr E, Stevanin S, Mikkonen S, Kvist T. Job satisfaction and generational nursing characteristics among registered nurses in the United States, Italy and Finland: Results of a survey study. J Nurs Manag 2021;29:2364–73. https://doi.org/10.1111/jonm.13397. Grieder S, Steiner MD. Algorithmic jingle jungle: A comparison of implementations of principal axis factoring and promax rotation in R and SPSS. Behav Res Methods 2021;54:54–74. https://doi.org/10.3758/s13428-021-01581-x. World Health Organization. State of the world’s nursing report 2025. Geneva: World Health Organization; 2025. Acea‐López L, Pastor‐Bravo MDM, Rubinat‐Arnaldo E, Bellon F, Blanco‐Blanco J, Gea‐Sanchez M, et al. Burnout and job satisfaction among nurses in three Spanish regions. J Nurs Manag 2021;29:2208–15. https://doi.org/10.1111/jonm.13376. Koch P, Zilezinski M, Schulte K, Strametz R, Nienhaus A, Raspe M. How Perceived Quality of Care and Job Satisfaction Are Associated with Intention to Leave the Profession in Young Nurses and Physicians. Int J Environ Res Public Health 2020;17:2714. https://doi.org/10.3390/ijerph17082714. Al Sabei S, Ross AM, Al Yahyaei A, Labrague L, Al-Rwajfah O, Deterding K. Motivation to Lead: A Study of the Supportive Nursing Leadership Environment. J Nurs Manag 2024;2024:2652746. https://doi.org/10.1155/2024/2652746. Sung C-M, Lin Y-T. Preliminary Study on the Relationship Between Organizational Climate, Leadership Style, and Job Satisfaction in the Context of Nurse Practitioners. Hu Li Za Zhi 2024;71:46–57. https://doi.org/10.6224/JN.202410_71(5).07. AbdELhay ES, Taha SM, El-Sayed MM, Helaly SH, AbdELhay IS. Nurses retention: the impact of transformational leadership, career growth, work well-being, and work-life Balance. BMC Nurs 2025;24:148. https://doi.org/10.1186/s12912-025-02762-1. Notarnicola I, Duka B, Lommi M, Grosha E, De Maria M, Iacorossi L, et al. Transformational Leadership and Its Impact on Job Satisfaction and Personal Mastery for Nursing Leaders in Healthcare Organizations. Nurs Rep 2024;14:3561–74. https://doi.org/10.3390/nursrep14040260. Ystaas LMK, Nikitara M, Ghobrial S, Latzourakis E, Polychronis G, Constantinou CS. The Impact of Transformational Leadership in the Nursing Work Environment and Patients’ Outcomes: A Systematic Review. Nurs Rep 2023;13:1271–90. https://doi.org/10.3390/nursrep13030108. Kutney-Lee A, Germack H, Hatfield L, Kelly S, Maguire P, Dierkes A, et al. Nurse Engagement in Shared Governance and Patient and Nurse Outcomes. JONA J Nurs Adm 2016;46:605–12. https://doi.org/10.1097/NNA.0000000000000412. Nagai S, Ogata Y, Yamamoto T, Fedyk M, Bell JF. A Longitudinal Study of the Impact of Personal and Professional Resources on Nurses’ Work Engagement: A Comparison of Early-Career and Mid-Later-Career Nurses. Healthcare 2022;11:76. https://doi.org/10.3390/healthcare11010076. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7010474","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":494503221,"identity":"db5527cd-88a2-489f-a9e6-7fd8e7b666b9","order_by":0,"name":"Wafâa AL HASSANI","email":"","orcid":"","institution":"Euromed University of Fes, UEMF","correspondingAuthor":false,"prefix":"","firstName":"Wafâa","middleName":"AL","lastName":"HASSANI","suffix":""},{"id":494503223,"identity":"16a89a1d-4ead-465c-9a50-4b3bc5de2649","order_by":1,"name":"Youness EL 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analysis.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7010474/v1/683c6b72bb85077c3a9c4aad.png"},{"id":88257812,"identity":"6a57c516-64a3-4007-b8d6-607e7c56145f","added_by":"auto","created_at":"2025-08-04 14:45:51","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":372206,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe five-factor model according to confirmatory analysis (standardized estimates).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7010474/v1/54ad394243c8deece17433c6.png"},{"id":88260208,"identity":"317ff8e1-0ce4-459e-9877-0f2dedc4ecc5","added_by":"auto","created_at":"2025-08-04 15:09:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1736823,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7010474/v1/7c187fa4-b057-4efb-b63c-992bf5ca44ab.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Job satisfaction of Moroccan nurses: Arabic validation of Kuopio University Hospital Job satisfaction Scale and survey results","fulltext":[{"header":"Introduction","content":"\u003cp\u003eJob satisfaction plays a critical role in contemporary healthcare systems, significantly influencing both healthcare professionals' personal well-being and the quality of patient care provided [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It reflects the degree to which individuals feel contentment and fulfillment within their professional roles, shaped by multiple interconnected factors. Previous research highlights professional development opportunities, collaborative relationships with colleagues, and supportive management as pivotal determinants influencing healthcare professionals' job satisfaction [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e–\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Moreover, evidence indicates a positive correlation between job satisfaction among nursing staff and the overall quality of patient care, suggesting that high-quality care environments typically reflect greater levels of staff contentment [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eConceptually, job satisfaction is defined not only as the extent to which employees find their roles enjoyable and fulfilling but also in relation to the fulfillment of their professional expectations [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Unmet expectations can lead to dissatisfaction, negatively impacting employees' attitudes, professional ethics, and even their perceptions of life's meaning [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e–\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Additionally, working conditions substantially influence healthcare workers' psychological well-being, further underscoring the necessity of fostering positive workplace environments [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Thus, understanding and enhancing job satisfaction is paramount for promoting both nurse well-being and optimal patient care outcomes.\u003c/p\u003e\u003cp\u003eIn Morocco, a 2024 scoping review of the health workforce showed that job satisfaction (particularly among nurses) is one of the most frequently reported organizational challenges, underscoring the urgency of workplace reforms to retain and motivate staff [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. A locally validated, easytoadminister scale is crucial to pinpoint how satisfied Moroccan nurses truly are, identify the workplace factors that matter most, and track the impact of any retention focused reforms. Although two Moroccan studies have recently validated job satisfaction tools for the overall health workforce [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], they combine nurses with physicians and administrative staff, masking the profession specific drivers of satisfaction unique to nursing practice. Consequently, a rigorously validated, nurse exclusive scale is still needed to capture the nuanced realities of bedside care, generate precise diagnostic data, and guide reforms aimed at retaining and motivating Morocco’s largest cadre of health professionals.\u003c/p\u003e\u003cp\u003eWhile several nurse specific job satisfaction instruments exist; most notably the McCloskey/Mueller Satisfaction Scale (MMSS), the Index of Work Satisfaction (IWS) and the Practice Environment Scale of the Nursing Work Index (PES‑NWI), the Kuopio University Hospital Job Satisfaction Scale (KUHJSS) remains the most congruent choice for a Moroccan validation study. Unlike the MMSS, whose content is weighted toward scheduling and compensation and has shown cultural fit problems even in recent Indonesian [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] and Middle‑Eastern adaptations [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and unlike the IWS and PES‑NWI, which emphasize broad organizational climate more than individual fulfilment and omit quality of care items [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], the KUHJSS was built from the ground up around bedside nursing realities and explicitly links leadership, teamwork, professional growth and care quality in a single 37‑item structure [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Its psychometric strength has been confirmed not only in Finland (α = 0.85–0.93) but also in cross‑cultural replications; first in Greece and Cyprus [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], and most recently in a Central-European critical care sample [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], without loss of factorial integrity. The instrument has been utilized in multiple international studies, including those by [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] in Finland and Norway, and by [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] in Finland, Italy, and the United States. With its cross cultural robustness, manageable length, and explicit coverage of care quality domains identified as priorities in recent Moroccan workforce studies, the KUHJSS provides a more contextsensitive and methodologically rigorous foundation for assessing nurses’ job satisfaction than the others.\u003c/p\u003e\u003cp\u003eAccordingly, this study aimed to translate and validate the KUHJSS in Moroccan Arabic and identify organizational and demographic determinants of nurses’ job satisfaction. By establishing its psychometric soundness and profiling the key determinants of nurse satisfaction, we seek to furnish decision‑makers with a context‑specific tool capable of guiding evidence‑based workforce reforms.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003e\u003cb\u003eDesign and ethics\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study employed a crosssectional, descriptive, and quantitative design conducted in publicly operated hospitals. All reporting follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines to ensure methodological transparency and rigor.\u003c/p\u003e\u003cp\u003eEthical approval for the project was obtained from the Scientific Research Ethics Committee in Euromed University, authorizing data collection in the healthcare hospitals of Fez. After clearance, nursing managers and nursing staff received written information detailing the study’s objectives, procedures, and the safeguards that would preserve participants’ anonymity and confidentiality. Participation was strictly voluntary and informed consent to participate was obtained from all of the participants in the study. Permission to use the KUHJSS scale was obtained from the original author prior to its translation and administration.\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants and data collection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipants were nurses employed in the public health sector included in the study. According to the 2024 regional staffing roster (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://cartesanitaire.sante.gov.ma/\u003c/span\u003e\u003cspan address=\"https://cartesanitaire.sante.gov.ma/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), almost 2,000 paramedical professionals were employed in the public sector. Using convenience sampling, data were collected in 2024 through a selfadministered, webbased questionnaire. The survey link and study information were initially shared by email, presented to nurse managers during site visits, and relayed through designated contact persons at each hospital. These intermediaries then forwarded the invitation to nurses working across multiple clinical units. To maximize participation, several reminder emails were sent at scheduled intervals throughout the data collection period.\u003c/p\u003e\u003cp\u003eAn a priori samplesize calculation was conducted with G*Power 3.1 to ensure the study was sufficiently powered. Assuming a medium effect size (Cohen’s d = 0.50), a twotailed meancomparison test, an alpha level of 0.05, and a desired statistical power of 0.95, the analysis indicated that a minimum of 210 participants was required. Globally, 260 questionnaires were received (13% response rate). Forty were excluded because respondents held exclusively administrative positions and were not engaged in clinical workflows. The resulting analytic sample comprised exactly 220 participants, meeting the predetermined requirement and preserving ≥ 95% statistical power for the primary analyses.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInstrument\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe KUHJSS is a nursespecific instrument designed in Finland to quantify job satisfaction within hospital settings. It was created through a systematic literature review, expert panel appraisal, pilot testing with 172 nurses and a largescale psychometric evaluation involving 2,708 Finnish nursing staff, establishing solid content and construct validity [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Items measure multiple dimensions of job satisfaction including: leadership (7 items); requiring factors of work (8 items), motivating factors of work (6 items); working environment (4 items); working welfare (4 items); participation in decision-making (4 items) and sense of community (4 items).\u003c/p\u003e\u003cp\u003eTranslations and validations, including a Greek version successfully tested with nurses in Cyprus and Greece, have reproduced good psychometric qualities, supporting the scale’s crosscultural applicability [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. KUHJSS is now widely used to explore relationships between nurses’ job satisfaction, leadership practices, patient satisfaction and safety outcomes, making it a robust, multidimensional measure for workforce research in hospitals.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTranslation and cultural adaptation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe KUHJSS was translated into Arabic through a rigorous forward-backward translation process by bilingual experts. An expert panel reviewed translations for cultural relevance and clarity. A pilot test was conducted with 10 nurses to refine language and cultural appropriateness. According to the participants’ suggestions, minor phrasal corrections of some items (13, 16 and 22) were made to the scale. Item 5 of the leadership subscale was divided into two distinct components to capture both administrative and clinical aspects of leadership more precisely.\u003c/p\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eFactor analysis was conducted using Jamovi 2.3.28. An exploratory factor analysis (EFA) using principal axis factoring with Promax rotation was conducted to assess the construct validity of the scale in line with current EFA best-practice recommendations [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Factor retention was guided by three criteria: eigenvalues greater than 1, factor loadings of at least 0.40, and visual inspection of the Scree Plot. Given that the scale was translated into another language and applied within a different healthcare system and cultural context, the EFA was followed by a confirmatory factor analysis (CFA) to further validate the factor structure. The analyses were treated as if the scale were newly developed, in order to rigorously evaluate its psychometric properties in the new setting. The Bartlett’s test of sphericity was significant (χ² = 4535, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001), and the Kaiser-Meyer-Olkin measure of sampling adequacy was 0.884, both indicating that the data were suitable for EFA. Internal consistency reliability was assessed via Cronbach’s alpha.\u003c/p\u003e\u003cp\u003eDescriptive and inferential statistics were used to analyze the data. Demographic variables were grouped using practical and reliable categorization schemes. Age was categorized into three groups: \u0026lt;30, 31–40, and 41–62 years. Work experience in the current unit, was classified into four categories: ≤5 year, 6–10 years, 11–20 years, and \u0026gt; 20 years. Work experience in total, was classified into four categories: ≤2 year, 3–5 years, 6–10 years, and \u0026gt; 11 years. Perceptions of care quality were rated using a scale system (2 = worst, 10 = best) and categorized into three groups: poor (2–5), moderate (6–7), and excellent (8–10). Based on the EFA, five subscale mean scores were calculated by averaging item responses within each dimension, yielding scores ranging from 1 (lowest satisfaction) to 5 (highest). The normality of these mean scores was assessed using the Kolmogorov-Smirnov test. As several variables were not normally distributed, nonparametric tests were applied; specifically, the Mann-Whitney U test for two-group comparisons and the Kruskal-Wallis test for comparisons involving more than two groups.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eSample characteristics\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA total of 220 nursing professionals participated in the study, and their sociodemographic characteristics are summarized in Table\u0026nbsp;1. Women represented 65.0% of the sample (n = 143), and just over half of the respondents (54.2%) were 31–40 years old. Nursing staff represented 64.1% of participants (141/220), technical and administrative staff 25.4%, and midwives 10.5%. Participants had a mean ± SD of 13.10 ± 6.71 years of overall professional experience and 8.13 ± 6.32 years of experience in their current unit. Approximately one-third (34.3%) of the sample rated the quality of care in their unit between 8 and 10 on a 10-point scale.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eCharacteristics of study participants (n = 220)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003eCharacteristic\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003en\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003e%\u003cbr\u003e\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eGender\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eWomen\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e143\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e65.0\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eMen\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e77\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e35.0\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eAge (years)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e37.4*\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e7.65**\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e22–30\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e40\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e18.7\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e31–40\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e116\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e54.2\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e41–62\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e58\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e27.1\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eOccupational group\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eNursing staff\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e141\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e64.1\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eMidwife\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e23\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e10.5\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eOther\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e56\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e25.4\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eEstablishment\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eUniversity hospital\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e71\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e32.2\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eHospital regional\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e55\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e25.0\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003ePrimary health center\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e37\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e16.8\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eOthers\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e57\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e25.9\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eWorking experience in nursing (years)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e13.10*\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e6.79**\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026lt;6\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e24\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e10.9\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e6–10\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e60\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e27.3\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e11–20\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e109\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e49.5\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026gt;20\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e27\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e12.3\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eWorking experience in current unity (years)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e8.13*\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e6.32**\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e≤2\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e49\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e22.3\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e3–5\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e47\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e21.4\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e6–10\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e53\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e24.1\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026gt;10\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e71\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e32.3\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eEstimated quality of nursing care in unity\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e6.61*\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e1.67**\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e≤5\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e62\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e28.7\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e6–7\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e80\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e37.0\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e8–10\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e74\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e34.3\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cem\u003e* Mean value; ** Standard deviation.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactor analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe EFA yielded five factors (Table\u0026nbsp;2), accounting for 48.4% of the total variance, with eigenvalues ranging from 10.750 to 1.005 and Cronbach’s alpha coefficients varied from 0.74 to 0.93. This factor structure was supported by the scree plot analysis (Fig.\u0026nbsp;1). One item showed a moderate positive loading on Factor 2 (0.483) and a smaller negative cross-loading on Factor 3 (− 0.421); as its strongest and conceptually relevant association was with Factor 2, the item was retained in that factor. Six items had loadings below the accepted threshold of 0.40. These included three items (26, 27, and 28) from the “Working Welfare” dimension, the first two items (8 and 9) from the “Requiring Factors of Work” dimension, and one item (21) from the “Motivating Factors of the Work” dimension.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eResults of exploratory factor analyses of Arab version of KUHJSS\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003eFactor\u003cbr\u003eItems\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003e(1)\u003cbr\u003eLeadership and Sense of Community\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003e(2) Requiring Factors of Work\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003e(3) Motivating Factors of the Work\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003e(4)\u003cbr\u003eWorking Environment\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003e(5) Participation in Decision-Making\u003cbr\u003e\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e1. My manager/director is genuinely interested in the well-being of the staff.\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.774\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e2. My manager/director treats the staff fairly and equally.\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.852\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e3. My manager/director encourages staff to take part in the planning of our unit’s operation.\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.920\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e4. My manager/director provides the staff with feedback aimed at improving work processes\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.879\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e5a. My manager/director keeps me thoroughly informed about matters concerning my unit (administrative aspect)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.862\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e5b. My manager/director keeps me thoroughly informed about matters concerning my unit (clinical aspect)\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.822\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e6. My manager/director facilitates the staff’s continuous professional development\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.742\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e7. My manager/director is interested in work results and outcomes\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.844\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e8. My workload is appropriate\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e9. There are usually enough staff in my unit\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e10. I do not find my work too stressful\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.760\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e11. I am satisfied with my working hours\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.726\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e12. Combining work and personal life is successful\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.708\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e13. The workload is distributed evenly in my unit\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.429\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e14. My salary is appropriate in relation to the demands of my work\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.527\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e15. The upper management of the hospital district appreciates my work\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.416\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e16. My work is interesting\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.606\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e17. I appreciate my own work\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.866\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e18. I can apply a wide range of my skills and expertise in my work\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.563\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e19. My work tasks are suitably challenging\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e-0.421\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.483\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e20. Client feedback motivates me in my work\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.466\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e21. I am willing to work in this hospital district in the future\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e22. My unit has appropriate work facilities\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.814\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e23. My unit has appropriate equipment to ensure quality of care\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.894\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e24. My work unit is comfortable\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.715\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e25. My work unit is safe and secure\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.734\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e26. I look after my personal well-being\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e27. I am happy with my current health\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e28. I am active in developing myself professionally\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e29. I feel I am a competent employee\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.535\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e30. I have opportunities to make independent decisions in my work\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.674\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e31. I have opportunities to plan my work independently\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.776\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e32. I have a chance to influence decision-making in my unit\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.476\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e33. I have a chance of career development in the hospital district\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.474\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e34. I trust the expertise of my colleagues\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.418\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e35. There is a good community spirit in my unit\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.491\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e36. The flow of information works well in my unit\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.490\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e37. New employees are welcomed in my unit\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.438\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eEigen values\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e10.750\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e2.250\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e2.068\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e1.155\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e1.005\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eCronbach’s alpha value\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.93\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.76\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.74\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.85\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0.84\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe first factor combined items from the original “Leadership” and “Sense of Community” dimensions of the initial questionnaire. Additionally, the item “\u003cem\u003eThe upper management of the hospital district appreciates my work\u003c/em\u003e”, originally part of the “Requiring Factors of Work” dimension, also loaded onto this factor. The second factor corresponded to the “Requiring Factors of Work” dimension; however, the first two items within this factor had loadings below the acceptable cut-off of 0.40. The third factor aligned with the “Motivating Factors of the Work” dimension and retained all related items except for the last one (Item 21), which also loaded below 0.40. In contrast, the fourth (“Working Environment”) and fifth (“Participation in Decision-Making”) factors retained all items from their respective original dimensions.\u003c/p\u003e\n\u003cp\u003eThe structure of the five-factor model was further illustrated through a CFA path diagram (Fig.\u0026nbsp;2), which visually presents the standardized loadings of each observed item on its respective latent factor, as well as the inter-factor correlations. The visual model reinforces the statistical results, confirming that most items strongly and significantly loaded onto their designated factors, with standardized estimates generally above 0.60. Notably, items such as K-3 (0.842), K-4 (0.824), and K-24 (0.801) showed particularly high loadings, indicating strong construct representation.\u003c/p\u003e\n\u003cp\u003eInter-factor correlations displayed in the diagram ranged from 0.21 (between Factors 2 and 3) to 0.54 (between Factors 1 and 4), aligning with the covariance estimates. These moderate associations reflect the conceptual interrelatedness of the satisfaction dimensions, while also supporting their distinctiveness. Together, the visual and statistical findings confirm the structural integrity and discriminant validity of the KUHJSS's five-factor model.\u003c/p\u003e\n\u003cp\u003eThe five-factor model yielded a significant chi‐square test, χ²(452) = 1020, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001, indicating deviation from exact fit, while incremental and absolute fit indices suggested acceptable approximation: CFI = 0.841, TLI = 0.826, SRMR = 0.093, and RMSEA = 0.076 (90% CI: 0.069–0.082). Information criteria further supported the model’s relative parsimony (AIC = 17 502; BIC = 17 868), confirming that the Arabic adaptation of the KUHJSS provides a robust factorial structure for assessing job satisfaction among Moroccan nurses.\u003c/p\u003e\n\u003cp\u003e[Table\u0026nbsp;2 should appear here]\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFactors related to job satisfaction\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;3 presents the mean KUHJSS Arab version scores and corresponding \u003cem\u003ep\u003c/em\u003e-values across demographic and professional subgroups.\u003c/p\u003e\n\u003cp\u003eFemale nurses scored significantly higher than males on Leadership and Sense of community (2.95 vs 2.65, \u003cem\u003ep\u003c/em\u003e = 0.005), while no gender difference emerged for the other four factors or for overall job satisfaction. Age influenced only the Requiring factors of work, rising from 2.70 in nurses aged 22–30 to 3.22 in those aged 41–62 (\u003cem\u003ep\u003c/em\u003e = 0.003). Professional role mattered as well: midwives recorded the highest means for Leadership and Sense of community (3.63) and Motivating factors (4.17) compared with nursing staff and other health workers (\u003cem\u003ep\u003c/em\u003e = 0.003 and 0.021, respectively). Career stage effects were limited to workplace participation and climate: nurses with \u0026lt; 6 years’ experience rated the Working environment (3.16) and Participation in decision-making (3.84) most favorably, with scores dipping between 6–10 years before partially rebounding thereafter (\u003cem\u003ep\u003c/em\u003e = 0.005 and 0.029). Length of service in the current unit showed no significant impact on any KUHJSS dimension (\u003cem\u003ep\u003c/em\u003e \u0026gt; 0.20).\u003c/p\u003e\n\u003cp\u003eOrganizational setting exerted a comparable influence. Leadership and Sense of community was higher in primary care centers than in other facilities (\u003cem\u003ep\u003c/em\u003e = 0.031), whereas the Working environment received its best ratings in university hospitals (\u003cem\u003ep\u003c/em\u003e = 0.018). Finally, perceived care quality generated the strongest gradient: nurses who rated unit quality as high (8–10/10) reported markedly higher scores on Leadership and Sense of community, Motivating factors, Working environment, and overall satisfaction (all \u003cem\u003ep\u003c/em\u003e ≤ 0.038) than colleagues perceiving moderate or low quality. Collectively, these findings indicate that leadership climate, organizational context, and care quality; rather than demographic attributes alone, drive the principal variations in nurses’ job satisfaction within this sample.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eMean scores of job satisfaction dimensions by demographic and professional Characteristics (n = 220).\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003eCharacteristic\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003eLeadership /Sense of Community\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003eRequiring Factors of Work\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003eMotivating Factors of the Work\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003eWorking Environment\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003eParticipation in Decision-Making\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003eTotal Job satisfaction\u003cbr\u003e\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003eGender\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eWomen\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.95\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.59\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.57\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.75\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.40\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.29\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eMen\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.65\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.58\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.52\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.88\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.39\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.26\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u003cem\u003ep\u003c/em\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.903\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.492\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.270\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.978\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.593\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003eAge (years)\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e22–30\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.38\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.70\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.90\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.80\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.52\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.26\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e31–40\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.29\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.94\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.98\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.81\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.41\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.28\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e41–62\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.26\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.22\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.89\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.81\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.29\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.29\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u003cem\u003ep\u003c/em\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.761\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.560\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.999\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.410\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.962\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003eOccupational group\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eNursing staff\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.35\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.96\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.96\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.85\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.49\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.32\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eMidwife\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.63\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.91\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e4.17\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.78\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.23\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.35\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eOther\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.01\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.02\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.82\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.67\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.21\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.15\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u003cem\u003ep\u003c/em\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.804\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u003cstrong\u003e0.021\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.495\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.058\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.123\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eEstablishment\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eUniversity hospital\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.37\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.90\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e4.00\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.08\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.46\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.36\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eHospital regional\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.38\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.12\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.96\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.64\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.34\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.29\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003ePrimary health center\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.44\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.73\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.93\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.57\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.26\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.19\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eOthers\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.02\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.06\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.86\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.74\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.43\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.22\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u003cem\u003ep\u003c/em\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u003cstrong\u003e0.031\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.069\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.531\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u003cstrong\u003e0.018\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.630\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.384\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003eWorking experience in nursing (years)\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026lt;6\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.53\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.01\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.90\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.16\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.84\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.49\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e6–10\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.18\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.75\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.92\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.45\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.38\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.14\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e11–20\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.26\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.03\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.97\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.87\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.35\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.30\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026gt;20\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.47\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.17\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.92\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.93\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.18\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.33\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u003cem\u003ep\u003c/em\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.212\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.061\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.847\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u003cstrong\u003e0.029\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.059\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003eWorking experience in current unity (years)\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e≤2\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.34\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.94\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.94\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.80\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.61\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.33\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e3–5\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.25\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.90\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.88\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.68\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.32\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.21\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e6–10\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.37\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.00\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.89\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.82\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.28\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.27\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026gt;10\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.24\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.01\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e4.02\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.85\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.38\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.30\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u003cem\u003ep\u003c/em\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.821\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.852\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.415\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.811\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.208\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.746\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003eEstimated quality of nursing care in unity\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e≤5\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.89\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.80\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.82\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.46\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.22\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.04\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e6–7\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.28\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.02\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.95\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e2.65\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.44\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.27\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e8–10\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.66\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.03\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e4.05\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.19\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.49\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e3.48\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u003cem\u003ep\u003c/em\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.146\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u003cstrong\u003e0.038\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e0.155\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eNurses\u0026rsquo; job satisfaction has become a truly trans-national concern: the latest State of the World\u0026rsquo;s Nursing 2025 report stresses that retaining the 29\u0026nbsp;million-strong workforce now hinges as much on improving work experience as on expanding head-counts, a challenge shared by health systems on every continent [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Because international mobility is accelerating and policy makers increasingly look abroad for solutions, researchers must rely on instruments that allow meaningful comparisons across settings. The KUHJSS answers this need: developed through rigorous psychometric work in Finland (37 items, seven dimensions) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], it has since been translated and validated in multiple languages without loss of structural validity [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. By further validating the KUHJSS in our setting instead of designing a de novo local tool, we contribute to a growing measurement \u0026ldquo;common language\u0026rdquo; that facilitates pooled analyses, benchmarking, and collaborative interventions aimed at lifting job satisfaction worldwide.\u003c/p\u003e\u003cp\u003eOur combined EFA - CFA approach produced a robust five-factor model that captures 48.4% of the total variance and demonstrates excellent internal consistency (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.74\u0026ndash;0.93). The most striking deviation from the Finnish original was the merger of every item from the \u0026ldquo;Leadership\u0026rdquo; and \u0026ldquo;Sense of Community\u0026rdquo; domains; along with the statement \u0026ldquo;Upper management of the hospital district appreciates my work\u0026rdquo;, into a single latent factor. In practice, this reflects day-to-day reality in our hospitals, where staff experience frontline supervision and team solidarity as two inseparable facets of the same relational climate.\u003c/p\u003e\u003cp\u003eA nearly identical amalgamation was observed in the Greek adaptation: its combined \u0026ldquo;Leadership\u0026rdquo; and \u0026ldquo;Team Spirit\u0026rdquo; factor explained 47% of the variance and showed α\u0026thinsp;=\u0026thinsp;0.71\u0026ndash;0.88 [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Spanish studies likewise report that nurses\u0026rsquo; job satisfaction hinges simultaneously on managerial style, team cohesion, and shared decision-making, treating them as mutually reinforcing levers for well-being [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The recurrence of this fusion across Morocco, Greece, and Spain therefore appears to mark a distinctly Mediterranean pattern in which collegial support is viewed as an intrinsic attribute of effective leadership rather than a separate construct. By contrast, the Polish validation, conducted in a culturally more individualistic Central-European context, retained a clear boundary between \u0026ldquo;Leadership\u0026rdquo; and peer-related dimensions even after item trimming [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], underscoring the cultural specificity of our findings.\u003c/p\u003e\u003cp\u003eAt the item level, our pattern of high- and low-loading statements faithfully mirrored those seen in the Greek and Polish validations, suggesting that the very same questions persistently emerge as either strong or fragile indicators, regardless of cultural context. Six statements failed to reach the 0.40 loading threshold, suggesting that they may not resonate sufficiently within our cultural and organizational context. In the Polish critical-care sample, Sak-Dankosky et al. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] likewise reported several low-loading welfare and staffing items and ultimately arrived at a leaner three-factor configuration after removing seven items; despite the shorter form, reliability remained robust (α\u0026thinsp;=\u0026thinsp;0.79\u0026ndash;0.92) and the model fit indices improved substantially. Taken together, these findings support the scale\u0026rsquo;s cross-cultural portability while highlighting the need to revise items that hinge on country-specific staffing norms or benefit packages.\u003c/p\u003e\u003cp\u003eFrom a psychometric standpoint, the moderate inter-factor correlations we observed (r\u0026thinsp;=\u0026thinsp;0.21\u0026ndash;0.54) demonstrate acceptable discriminant validity while also confirming that the dimensions of job satisfaction are complementary facets of a single overarching construct, rather than completely independent domains. Practically, our results argue for interventions that are simultaneously leadership-focused and environment-focused: strengthening participatory leadership, improving the physical work setting, and streamlining demanding work processes are likely to generate synergistic gains across all five satisfaction domains. Future research should test the stability of this five-factor model with longitudinal samples and explore whether a shortened 30- to 32-item version (omitting persistently weak items identified here and in the Greek and Polish studies) can retain psychometric rigor while reducing respondent burden.\u003c/p\u003e\u003cp\u003e Our subgroup analyses show that the steepest shifts in KUHJSS scores are driven by changeable workplace conditions (leadership climate, care-quality perceptions, and facility type) rather than by fixed personal attributes such as age, gender, or tenure. Consistent with our pattern, Sanner-Stiehr et al. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] reported from a three-country sample of 1,433 nurses that organizational context accounted for the bulk of KUHJSS variance, with leadership scoring uniformly high across settings. Leadership/Sense of community rose by almost half a point among staff who judged unit quality as \u0026ldquo;high\u0026rdquo; and was also higher in primary-care and university-hospital settings than in regional hospitals. These patterns align with recent evidence linking a positive psychosocial climate and perceived care quality to stronger professional well-being and lower intent to leave the profession [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eLeadership itself appears to be the pivotal lever. Female nurses (midwives most of all) posted the strongest Leadership/Sense of community scores, a pattern consistent with evidence that relational, inclusive leadership styles resonate in female-dominated disciplines and stimulate nurses\u0026rsquo; willingness to step into formal managerial roles [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Age and career stage exerted only selective effects (older staff valued \u0026ldquo;Requiring factors of work\u0026rdquo;; nurses with \u0026lt;\u0026thinsp;6 years\u0026rsquo; experience viewed their environment and decision-making most favorably), but these differences were modest next to the influence of organizational setting and perceived quality. Together with meta-analytic data linking supportive climates to lower burnout and better patient outcomes, our findings reinforce the view that skillful, community-building leadership simultaneously serves staff and service quality [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePractically, the results argue for prioritizing leadership development and unit-level quality initiatives when aiming to raise job satisfaction in our nursing context. Equipping front-line managers with relational skills, embedding participatory governance structures, and making care-quality metrics visible could lift multiple KUHJSS domains at once, irrespective of gender or tenure. The absence of any tenure-satisfaction link implies that a nurturing work climate can sustain nurses\u0026rsquo; engagement well beyond the initial adjustment phase. Longitudinal trials that track whether improvements in perceived care quality mediate lasting gains in satisfaction are now warranted.\u003c/p\u003e\u003cp\u003ePractically, our findings point toward organizational levers rather than individual attributes, as the most promising targets for boosting staff morale. Transformational and relational-leadership programs consistently raise nurse satisfaction, reduce burnout, and improve retention [\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Embedding participatory/shared-governance structures gives bedside nurses a formal voice in policy and resource decisions, which in turn elevates job satisfaction and patient outcomes [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Finally, making unit level care quality metrics highly visible and actionable has been linked to better perceived quality, lower burnout, and higher satisfaction among nursing staff [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Equipping front-line managers with relational skills, instituting shared-decision councils, and routinely feeding back quality dashboards could therefore lift multiple KUHJSS domains at once, irrespective of gender or tenure.\u003c/p\u003e\u003cp\u003eThe absence of a tenure satisfaction association in our data suggests that a supportive climate can sustain nurses\u0026rsquo; engagement well beyond the initial adjustment period; an observation that echoes longitudinal work demonstrating that work-environment resources, rather than time in post, drive longer-term engagement and satisfaction [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Rigorous longitudinal or quasi-experimental trials are now warranted to test whether targeted improvements in perceived care quality mediate durable gains in job satisfaction and, ultimately, retention.\u003c/p\u003e\u003cp\u003eThis study\u0026rsquo;s insights should be read cautiously. We used a convenience sample from four public facilities in one Moroccan region, curbing generalizability. Cross-sectional, self-reported data invite common-method bias and preclude causal inference, while unit quality was gauged by a single global item and factorial invariance of the Arabic KUHJSS was not tested. Most tellingly, our final model explained just 48% of the variance in job satisfaction, indicating that unmeasured factors (workload, staffing ratios, and work-life balance) remain to be explored through larger, probability-based, longitudinal designs combining subjective and objective indicators.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe KUHJSS Arabic version proved reliable and structurally sound, capturing five inter-related facets of job satisfaction in Moroccan nurses and confirming that effective leadership is experienced as inherently collegial. Satisfaction varied chiefly with modifiable unit conditions (leadership style, participatory governance, and perceived care quality) while age, gender, and tenure played only minor roles. Half the variance remains unexplained; larger multi-site studies should factor in workload, staffing, and work-life balance and test whether relational leadership plus visible quality metrics lift satisfaction and retention.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eKUHJSS: Kuopio University Hospital Job Satisfaction Scale\u003c/p\u003e\n\u003cp\u003eEFA: Exploratory Factor Analysis\u003c/p\u003e\n\u003cp\u003eCFA: Confirmatory Factor Analysis\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical standards of the institutional research committee and with the Declaration of Helsinki. The Scientific Research Ethics Committee in Euromed University approved the study protocol under the reference CERS/UEMF-2025/EC01/01. Permission to collect data was obtained from the facilities administrative authorities. Participation was strictly voluntary and informed consent to participate was obtained from all of the participants in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy design: W.A., Y.E., T.K., C.N.; Data collection: A.M., A.E., Z.M.; Data analysis: W.A., Y.E., A.E.; Manuscript preparation: W.A., Y.E., T.K., C.N. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all nurses who participated in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAlkhateeb M, Althabaiti K, Ahmed S, L\u0026ouml;vestad S, Khan J. A systematic review of the determinants of job satisfaction in healthcare workers in health facilities in Gulf Cooperation Council countries. Glob Health Action 2025;18:2479910. https://doi.org/10.1080/16549716.2025.2479910.\u003c/li\u003e\n\u003cli\u003eKalisch BJ, Lee H, Rochman M. Nursing staff teamwork and job satisfaction: Nursing staff teamwork and job satisfaction. 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Nurs Rep 2024;14:3561\u0026ndash;74. https://doi.org/10.3390/nursrep14040260.\u003c/li\u003e\n\u003cli\u003eYstaas LMK, Nikitara M, Ghobrial S, Latzourakis E, Polychronis G, Constantinou CS. The Impact of Transformational Leadership in the Nursing Work Environment and Patients\u0026rsquo; Outcomes: A Systematic Review. Nurs Rep 2023;13:1271\u0026ndash;90. https://doi.org/10.3390/nursrep13030108.\u003c/li\u003e\n\u003cli\u003eKutney-Lee A, Germack H, Hatfield L, Kelly S, Maguire P, Dierkes A, et al. Nurse Engagement in Shared Governance and Patient and Nurse Outcomes. JONA J Nurs Adm 2016;46:605\u0026ndash;12. https://doi.org/10.1097/NNA.0000000000000412.\u003c/li\u003e\n\u003cli\u003eNagai S, Ogata Y, Yamamoto T, Fedyk M, Bell JF. A Longitudinal Study of the Impact of Personal and Professional Resources on Nurses\u0026rsquo; Work Engagement: A Comparison of Early-Career and Mid-Later-Career Nurses. Healthcare 2022;11:76. https://doi.org/10.3390/healthcare11010076.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"job satisfaction, validation, nursing staff, determinants","lastPublishedDoi":"10.21203/rs.3.rs-7010474/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7010474/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eRetaining nurses hinges on fostering supportive work environments, yet cross-national benchmarking is limited by a lack of psychometrically comparable Arabic instruments. This study aimed to translate and validate the Kuopio University Hospital Job Satisfaction Scale (KUHJSS) in Moroccan Arabic and identify organizational and demographic determinants of nurses\u0026rsquo; job satisfaction.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional survey design was employed. A total of 220 registered nurses and midwives from four public hospitals and primary care centers in Fez completed the translated version of the KUHJSS. The instrument was translated using a forward-backward translation process. Exploratory and confirmatory factor analyses (EFA and CFA) were conducted, and Cronbach\u0026rsquo;s α was calculated to assess internal consistency. Group differences in factor means were examined using independent-sample t-tests and one-way ANOVA. As several variables were not normally distributed, nonparametric tests were applied.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eEFA-CFA supported a stable five-factor structure comprising 32 items, which accounted for 48.4% of the total variance and demonstrated excellent internal consistency (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.74\u0026ndash;0.93). Items from the \u0026ldquo;Leadership\u0026rdquo; and \u0026ldquo;Sense of Community\u0026rdquo; domains merged into a single factor, consistent with findings from other Mediterranean adaptations. The most pronounced score differences were associated with modifiable workplace conditions rather than fixed demographic variables. Staff who rated their unit\u0026rsquo;s care quality as \u0026ldquo;high\u0026rdquo; reported significantly higher Leadership and Sense of Community scores compared to those with lower ratings (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Scores were also significantly higher in primary care and university hospitals compared to regional hospitals (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.031). Midwives reported the highest levels on both the Leadership and Sense of Community and Motivating Factors scales (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.021), while age, gender, and professional tenure showed only minor associations.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe Arabic KUHJSS is a reliable, valid tool for Moroccan nurses. Job satisfaction relates mainly to relational leadership, participatory climate, and perceived care quality; all amenable to organizational action. Multi-site longitudinal studies that add workload and staffing metrics should test whether strengthening these levers sustainably boosts satisfaction and retention.\u003c/p\u003e","manuscriptTitle":"Job satisfaction of Moroccan nurses: Arabic validation of Kuopio University Hospital Job satisfaction Scale and survey results","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-04 14:45:47","doi":"10.21203/rs.3.rs-7010474/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-07-30T16:12:39+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-23T15:56:24+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-04T21:19:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-03T12:43:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-07-03T12:40:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"225bb3e2-2088-421c-ab95-27542c3066ac","owner":[],"postedDate":"August 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-08-04T14:45:47+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-04 14:45:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7010474","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7010474","identity":"rs-7010474","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}