A Multicenter Cross-Sectional Study of Job Satisfaction and Associated Factors Among Nurses in Selected Hospital Settings in Germany, Iran, and Canada Publisher



Behjat F ; Aryamloo P ; Ranjbaran S ; Heinrich J ; Ramezanpoor N ; Dehghan M ; Schulz J
Source: BMC Nursing Published:2026

Abstract

Purpose: This study aimed to examine job satisfaction and its associated factors among nurses working in selected hospital settings in Germany, Iran, and Canada. Methods: A multicenter cross-sectional study was conducted from April 2017 to June 2019 across four tertiary-care teaching hospitals. A total of 521 registered nurses (271 from Iran, 186 from Germany, and 64 from Canada) completed a structured 50-item questionnaire assessing job satisfaction, workplace challenges, and sociodemographic characteristics. The questionnaire was developed based on established frameworks of job satisfaction and refined through expert review. Principal component analysis (PCA) identified eight dimensions of job satisfaction. Given deviations from normality, non-parametric statistical methods were applied alongside robust comparative analyses. Results: Nurses from the participating hospital in Canada reported the highest levels of overall job satisfaction, followed by those from the hospital in Germany and the hospital in Iran (p < 0.001). Significant differences were observed in interpersonal relationships, leadership, perceived workload, and work–life balance (all p < 0.001). Higher job satisfaction was associated with older age, longer work experience, and fewer weekly working hours. Across all sites, overall job satisfaction showed positive correlations with supportive leadership, effective communication, manageable workload, opportunities for professional development, and work–life balance, and negative correlations with perceived workload and intention to leave. Across all settings, insufficient income and administrative burden were consistently reported as key workplace challenges. While site-specific differences were observed, these findings should be interpreted cautiously due to variations in sample characteristics, response rates, and the absence of formal cross-cultural measurement equivalence testing. Conclusion: Job satisfaction varied across the participating hospital settings and was consistently associated with organizational and work-related factors, particularly workload, leadership, and work–life balance. The findings suggest that while core determinants of job satisfaction appear broadly similar, their relative influence may differ across organizational contexts. Given the study design and sampling approach, results should not be interpreted as representing national-level differences. Implications for practice: Efforts to improve nurse job satisfaction should focus on modifiable organizational factors, including leadership practices, workload management, and flexible work arrangements, while taking local workplace conditions into account. Clinical trial number: Not applicable. © The Author(s) 2026.