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Diagnosing the Nursing Practice Environment: An Importance-Performance Analysis of Job Satisfaction Across Clinical
Ya-Wen Lee1,2, Chih-Hao Lin3, Shuo-Jen Chang4
1Department of Administration, Lutung Christian Hospital, Changhua, Taiwan.
Research in Nursing & Health
|August 13, 2026
Summary
Job satisfaction for nurses is lowest at intermediate career stages, driven by a lack of professional autonomy. Improving structural empowerment is key to nurse retention.
Area of Science:
- Nursing Practice Environment
- Healthcare Management
- Organizational Psychology
Background:
- Job satisfaction is crucial for nurse retention.
- Understanding factors influencing job satisfaction across different career stages is essential.
- Previous research indicates a gap in addressing environmental factors impacting nursing morale.
Purpose of the Study:
- To identify priority areas for improving the nursing practice environment using importance-performance analysis.
- To examine the relationship between clinical ladder levels and job satisfaction.
- To pinpoint specific factors contributing to dissatisfaction among registered nurses.
Main Methods:
- Cross-sectional secondary data analysis of 8009 survey responses from registered nurses.
- Data collected across nine waves between 2020 and 2025 at a tertiary medical center in Taiwan.
- Sequential regression and importance-performance analysis applied to survey data.
Main Results:
- Personal and job-related characteristics explained only 3.2% of job satisfaction variance.
- Job satisfaction showed a U-shaped distribution, with lowest levels in competent (N2) nurses.
- Professional autonomy was identified as a high-importance, low-performance area, indicating a significant autonomy gap.
Conclusions:
- Nurse retention issues are linked to structural conditions, especially for intermediate-level nurses lacking decision-making authority.
- Healthcare organizations should focus on environmental diagnosis and structural empowerment for retention.
- Enhancing professional autonomy and participation in decision-making are critical for improving nurse job satisfaction and retention.
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