Cross-national differences in nurse practitioner job satisfaction: A systematic review and meta-analysis

Nurse practitioners (NPs) play a critical role in meeting global health care needs, yet their job satisfaction varies across countries because of differences in regulation, role clarity, and organizational support. Although numerous studies have examined NP job satisfaction within individual nations, cross-national evidence remains limited.

To systematically review and meta-analyze international evidence on NP job satisfaction and to examine subgroup differences based on demographic and professional characteristics.

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, we searched Cumulative Index to Nursing and Allied Health Literature, Embase, ProQuest Nursing and Allied Health, PubMed, the Cochrane Library, and 2 Chinese databases for studies published between 2014 and 2024. Ultimately, 35 studies involving 36,756 NPs were included. Because the Misener Nurse Practitioner Job Satisfaction Scale is the most widely used and consistently reported cross-national instrument, it was selected as the common metric for pooling outcomes. Consequently, 15 studies using this scale contributed to the cross-national meta-analyses.

Job satisfaction differed significantly across countries, with the highest levels observed in the United States, followed by Taiwan and Canada. Subgroup analyses revealed no significant differences by sex or educational attainment, and substantial heterogeneity was present. Overall, structural and organizational contexts-rather than demographic factors-appear to shape international variation in NP job satisfaction. These findings underscore the need for clearer role definitions, standardized measurement approaches, and stronger structural support to inform workforce planning and sustain the NP profession globally.

Strengthening regulatory support, expanding practice autonomy, and improving organizational resources may enhance NP retention and job satisfaction across diverse health care systems.