Research in Nursing & Health, 2002, 25, 282–294

An Analysis of the Relationship

Between Job Satisfaction and
Job Stress in Correctional
Nurses
Nancy A. Flanagan,1* Timothy J. Flanagan2y

1
University at Buffalo, State University of New York, Buffolo, NY 14214-3049
2
College at Brockport, State University of New York, Brockport, NY 14420
Received 8 February 2001; accepted 22 May 2002

Abstract: Stamps and Piedmonte’s Index of Work Satisfaction and Harris’s

Nurse Stress Index were completed by 287 registered nurses employed in state
prison health care facilities in order to assess job satisfaction and job stress
among correctional nurses. Correctional nurses’ expectations about job satis-
faction were influenced by pay and autonomy. This finding was consistent with
studies of hospital nurses. Important sources of job satisfaction were profes-
sional status and interaction with employees. Analysis of differences between
expectations and sources of job satisfaction may provide understanding of
career benefits and sources of dissatisfaction. Time pressures and organiza-
tional support and involvement were sources of stress. Multivariate analyses
showed an inverse relationship between stress and job satisfaction. Informa-
tion about job satisfaction and work stress and their correlates may be used to
develop strategies to improve the recruitment and retention of correctional
nurses. ß 2002 Wiley Periodicals, Inc. Res Nurs Health 25:282–294, 2002

Keywords: job satisfaction; job stress; correctional nursing; Index of Work

Satisfaction

Approximately 17,000 of the 2.2 million re-
gistered nurses (RNs) employed in nursing in
2000 were employed in correctional nursing
(W. Spencer, personal communication, February
15, 2002). Correctional nurses are the largest
group of health care providers in prisons. In 1975
the American Nurses Association (ANA) recog-
nized correctional nursing as a specialty within
the profession. According to the ANA (1995),
correctional nurses’ responsibilities include:
teaching, counseling, encouraging personal ac-
countability for health care, assessment, screen-
ing, referral, medication distribution, direct client
care, and unit management. The provision of
health care services to prisoners is not discre-
tionary. Federal and state court decisions, statutes,
and agency regulations require correctional sys-
tems to provide health care services that ap-
proximate community standards. In 1998 the
International Council of Nurses (ICN) adopted a
position statement asserting that prisoners and
detainees have the right to health care and
humane treatment (ICN, 2000).
There are nearly 2 million people in U.S.
federal, state, and local prisons. The correctional
population in the United States rose 7% annually

Correspondence to Nancy A. Flanagan, School of Nursing, University at Buffalo,

State University of New York, Stockton Kimball Tower, 3435 Main Street, Buffalo NY
14214-3079.
*Assistant Professor.
y
Professor.
Published online Wiley InterScience (www.interscience.wiley.com)
DOI 10.1002/nur.10042

282 ß 2002 Wiley Periodicals, Inc.

 JOB SATISFACTION AND JOB STRESS IN CORRECTIONAL NURSING / FLANAGAN AND FLANAGAN
between 1990 and 1998, and the overall popu-
lation has tripled since 1980 (U.S. Department
of Justice, 2000). This burgeoning population
imposes increased demands on correctional health
care services. Inmates are disproportionately
young, male, and drawn from populations charac-
terized by inadequate health education, lack of
preventive care, and involvement in high-risk
behaviors such as drug use (McDonald, 1999).
Within prisons violence, homosexual activity,
and potential for communicable disease present
health risks for inmates. Analyses of prison clinic
records have shown that approximately 5–10% of
the prisoner population requests sick call daily
(Earley, 1999; McDonald, 1999). As more offen-
ders are sentenced to long minimum prison terms
or to life sentences without parole (McDonald,
1999), the aging of the prisoner population will
further stress the delivery of health care in
prisons. Because of increased inmate populations,
mandated services, and the aging of prisoners,
the cost of providing prison health care is a
rapidly expanding portion of correctional agency
budgets and tax dollars (U.S. Department of
Justice, 1999).
Thus, correctional nursing is a specialty grow-
ing in size and complexity. Moreover, the issue of
health care delivery for convicted criminals, both
during incarceration and when released back into
the community, puts nurses at the center of an
important public policy challenge (Centers for
Disease Control, 2001). The centrality of nurses
in correctional health care, in the context of
increasing prison populations, underscores the
importance of understanding occupational attri-
butes of correctional nursing. Within the past
10 years few researchers have investigated the
benefits and demands of the correctional nursing
specialty area (Droes, 1994). The present study
was developed to examine the sources and levels
of job satisfaction and job stress among correc-
tional RNs and explored the correlates of job
satisfaction and job stress.
In previous research studies investigators have
reported that correlates of nurses’ work satisfac-
tion include stress, commitment (Blegen, 1993),
intent to stay (Borda & Norman, 1997; Coward
et al., 1995), low turnover on the unit (Borda &
Norman), race, size of institution, personal in-
come (Coward et al.), and unit tenure (Decker,
1997). In a meta-analysis of 48 studies that
included RNs involved in patient care in a variety
of settings, Blegen (1993) reported a low correla-
tion between job satisfaction and age, years of ex-
perience, and education. However, Cumbey and
Alexander (1998) found a significant correlation
283
between nursing experience and job satisfaction
among RNs employed in a state public health
department. Fung-kam (1998) also found a cor-
relation between age, education, marital status,
and job satisfaction in a study of 365 RNs
employed by one acute care hospital and one
chronic care hospital in Hong Kong. In short,
several variables may help to explain job satis-
faction among nurses, but the salience of these
correlates among correctional nurses has not been
examined.
Independence and autonomy in correctional
nursing may positively affect job satisfaction by
providing broader discretion in decision making,
reduced conflict with other health care profes-
sionals, and increased status within the work
organization (Doss, 1997; Earley, 1999). Cor-
rectional nurses’ responsibilities and autonomy
are dependent on the size of the institution and
the type of inmate population. In many prisons
the nurse is the initial health care provider and the
key health care administrator (McDonald, 1999).
Unlike the nurse’s interdependent status in a large
medical center, the status of correctional nurses is
primarily independent.
Gulotta (1987) found that role ambiguity and
the security constraints of prisons are stressors in
correctional nursing and speculated that correc-
tional nurses employed by a correctional institu-
tion would have more role ambiguity and lower
job satisfaction than nurses employed by a medi-
cal center. Security is the overarching dominant
feature of prisons, and all prison personnel, in-
cluding health care professionals, are consider-
ed part of the security force (Burrows, 1995).
Dissonance between the goals of nursing and the
goals of imprisonment can create tension be-
tween health care staff and correctional offi-
cers (Alexander-Rodriguez, 1983). Peternelj and
Johnson (1995) referred to this conflict as
‘‘double-agentry.’’ Along with custody personnel,
nurses ‘‘jointly share a negotiated physical juris-
diction over the health care unit’’ (Droes, 1994,
p. 297).
Another correlate of correctional nurses’ job
satisfaction may be stress related to fear of ex-
posure to chronic infectious diseases, including
hepatitis, tuberculosis, and HIV (Earley, 1999).
Inmates are considered at high risk for health
problems and communicable disease. The major-
ity of inmates come from low-income, minority,
poorly educated, and inner-city populations
(Centers for Disease Control, 2001; U.S. Depart-
ment of Justice, 2001). Chronic medical diag-
noses such as tuberculosis, HIV, hypertension,
diabetes, substance abuse, mental illness, and
284 RESEARCH IN NURSING & HEALTH
syphilis are common (National Commission on
Correctional Health Care, 1995). Many inmates
have not received routine preventive care before
their incarceration, and misperceptions about
health care and disease prevention are also pre-
valent among the inmate population (McDonald,
1999). Previous risky behaviors of prisoners
related to drug abuse, lack of access to health
care, and sexual behavior increase the incidence
of blood-borne infections. The aggressive and
violent behavior that resulted in incarceration
may continue within the correctional facility,
leading to violent physical assaults with open-
wound injuries. It was estimated that 28% of state
prisoners and 26% of federal prisoners had been
injured since admission to prison, based on self-
report data from a 1997 national survey. Among
state prisoners more than 20% reported being
injured in an accident, and more than 10% re-
ported being injured in a fight (U.S. Department
of Justice, 2001).
Stress arises from a correctional environment
that fosters isolation, aggression, violence, and
manipulative behavior (Galindez, 1990). Because
of the type of clients that correctional nurses
serve, a nursing priority includes the maintenance
of a safe and healthy environment for the inmates,
staff, and outside community. Correctional nurses
must maintain a nonjudgmental attitude but avoid
being manipulated by inmates, as health care
complaints can be fabricated to obtain a clinic
visit to break the monotony of imprisonment. In
summary, although correctional RNs may enjoy
the benefits of autonomy, role ambiguity, fear of
exposure to infectious disease, violence, and
manipulative behavior can lead to increased
stress.
Stamps and Piedmonte’s (1986) work on job
satisfaction among nurses provided the concep-
tual framework and the instrumentation for the
present study of prison nurses’ job satisfaction
and stress. Stamps and Piedmonte’s conceptuali-
zation of job satisfaction was based on Vroom’s
(1964) multiplicative need fulfillment theory, a
widely used theoretical model from organiza-
tional psychology. In brief, according to need
fulfillment theory, work satisfaction is related
to the extent to which the work setting fulfills
important personal needs. In this perspective the
salience of needs varies, and the greater the need,
the more satisfied the individual will be when that
need is fulfilled (Stamps & Piedmonte, 1986).
Maslow’s theory of human needs served as a guide
for the identification of needs. Stamps and Pied-
monte also linked need fulfillment theory with
social reference group theory, which ‘‘significantly
departs from the need fulfillment theory because
it stresses the importance of what other people
feel in shaping the individual’s stated needs’’
(Stamps & Piedmonte, 1986, p. 3). In linking
these theoretical perspectives, Stamps and Pied-
monte combined the concepts of discrepancy
(defined as the difference between an individual’s
needs and the extent to which the job fulfills those
needs) and the social context of work (expected
outcomes are determined by a person comparing
his or her work and rewards to those of others
doing a similar job). This formulation of job satis-
faction thus combines psychological and socio-
logical perspectives on work.
Stamps and Piedmonte (1986) conceptualized
job satisfaction as comprising six components:
pay, autonomy, task requirements, organizational
policies, interaction, and professional status. Pay
is defined as the dollar remuneration and fringe
benefits received for work done. Autonomy is the
amount of job-related independence, initiative,
and freedom either permitted or required in daily
activities. Tasks or activities that must be done
as a regular part of the job are considered task
requirements. Organizational policies are the
management policies and procedures put forward
by the hospital and nursing administration of the
hospital. Interaction is defined as the opportu-
nities presented for both formal and informal
social and professional contact during working
hours. Professional status includes both the indi-
vidual’s and the community’s definitions of the
importance of a job. For Stamps and Piedmonte,
job satisfaction derives from the congruence of
workers’ expectations about these six compo-
nents of satisfaction and the degree to which
the job fulfills those expectations (reward). Con-
versely, discrepancy between expectations and
fulfillment leads to lower job satisfaction.
The perceived importance or significance of
the job, including the viewpoints of the individual
and of others (the social context), is also related
to job satisfaction. In addition, demographic fac-
tors that Stamps and Piedmonte considered cogent
to the study of work satisfaction include age,
marital status, and type of education.
Harris (1989) developed a self-report measure
of nurse stress. Harris’s research was derived
from the work of stress response theorists begin-
ning with Selye (1956). Selye conceptualized
stress as a response to disequilibrating stimuli en-
countered in the social environment. In the stress-
response perspective discerning the nature and
importance of these stressors is critical to under-
standing and diagnosing stress and to developing
strategies to deal with its potentially deleterious
 JOB SATISFACTION AND JOB STRESS IN CORRECTIONAL NURSING / FLANAGAN AND FLANAGAN
physiological and psychological effects (Lyon,
2000).
Harris (1989) found that difficulties in manag-
ing workload, conflicts among staff, lack of
involvement in decision making, perceived lack
of support, and poor communication were im-
portant dimensions of occupational stress among
experienced nurses working in a variety of hos-
pital and community settings in southwestern
England. In addition, perceived lack of prepara-
tion for the role and dealing with death and dying
were cited by Harris as sources of stress among
nurses. Harris postulated that consequences of
perceived work-related stress include depression
and that the resulting depression is inversely
related to composure, quality of patient care, and
interpersonal and cognitive effectiveness.
Hinshaw and Atwood (1983) utilized a similar
conceptualization of job stress in research on
nursing staff turnover: ‘‘Job stress involves those
demands encountered within the roles and
functions of employment’’ (p. 141). Hinshaw
and Atwood’s review of influential factors in
job stress among nurses included many of the
dimensions of nursing practice used in Harris’s
instrument development. In addition to Harris’s
work, occupational stress among RNs working in
a variety of settings has been studied (Decker,
1997; Healy & McKay, 2000), but correctional
nurses have not been included in this research.
Stress and job satisfaction among nurses has
been the subject of extensive research for many
reasons, including the relationship of these occu-
pational attitudes to measures of job performance
(Ivancevich & Matteson, 1980; Jex, 1998). In
addition, Hinshaw and Atwood (1983) and Lucas,
Atwood, and Hagaman (1993) reported that job
stress and job satisfaction were important corre-
lates of anticipated and actual job turnover among
nurses. Although this body of research is sub-
stantial and growing, correctional nurses have not
been participants in these studies.
The current study was designed to further
our understanding of these important issues. The
research questions were: (a) What are the levels
and sources of job satisfaction of correctional
nurses? (b) What are the levels and sources of job
stress of correctional nurses? (c). Is there a re-
lationship between job satisfaction and job stress?
and (d) What are the correlates of job satisfac-
tion and job stress? This was an exploratory-
descriptive study of stress and satisfaction in a
group of nurses who had not been studied pre-
viously, and it built on a conceptual orientation
developed in previous studies of nurses’ occupa-
tional attitudes.
285
METHOD
Design and Sample
A nonexperimental correlational study was desig-
ned to measure job satisfaction and job stress in
the correctional nurse population in a state prison
system in the southwestern United States. There
were 493 registered nurses employed by this
correctional system in 56 units or facilities. A
total of 287 surveys were returned, a response rate
of 58%. The typical correctional nurse in this
prison system in the southwestern United States
was white (74%), female (83%), 46 years old
(SD ¼ 9.01), and married (65%), with an asso-
ciate’s degree (51%) or bachelor’s degree (30%).
On average, these correctional nurses had been
working in nursing for 16.7 years (SD ¼ 9.78),
had been registered nurses for 14 years
(SD ¼ 10.50), had been employed in correctional
nursing for 5 years (SD ¼ 4.17), and had been
assigned to their current facility for 3.6 years
(SD ¼ 3.27). Correctional nurses brought a wide
variety of nursing experience to their current
positions.
Seventy percent of RNs responding to the
survey worked in prison units for male inmates;
9% worked in units for female inmates. The
remainder of the nurses worked in a facility that
served a correctional ‘‘campus’’ that held male
and female inmates in separate buildings. Thirty-
eight percent of RNs reported that their units
were specialized; the most frequent specialties
were psychiatric and geriatric health care. Forty-
four percent reported that their nursing unit had
in-patient beds; the median bed count for these
units was 17 beds. More than 90% of RNs
responding worked a single shift, and less than
10% reported working in rotating shifts. Nearly
69% reported they regularly worked the day shift,
20% the evening shift, and 12% the night shift.
RNs responding to the survey reported that their
most frequent daily activities were patient educa-
tion, physical exams, and medication distribution
(Table 1).
Measures
Job (work) satisfaction. The survey instru-
ment included three sections. Section 1 was the
Index of Work Satisfaction (IWS), developed by
Stamps and Piedmonte (1986). The IWS was
designed to identify components of work satisfac-
tion important to nurses, the relative importance
286 RESEARCH IN NURSING & HEALTH
Table 1. Percentage of Correctional Nurses Reporting Engagement in and Frequency of Selected Activities
Activity Daily Several Times Per Week
Patient education 69.5 13.8
Physical exams 55.6 15.5
Medication distribution 52.3 14.5
First aid 49.1 20.8
Counseling 41.2 24.7
Health screening 38.3 20.1
Staff education 22.1 16.4
Postoperative care 4.6 7.1
Drawing blood 3.2 10.4
Detoxification 1.1 0.4
of each, and the overall level of job satisfaction
among nursing personnel. Stamps and Piedmonte
assessed content validity for the IWS through
expert review. The six components of work were
identified after extensive conversations with nurses
and administrators. These six components of work
included: pay, autonomy, task requirements, orga-
nizational policies, interaction, and professional
status.
Part A of the IWS was developed to measure
expected sources of job satisfaction. Respondents
are presented with 15 forced-choice comparisons
representing the six components of work satisfac-
tion and asked to choose which item in the pair is
more important for work satisfaction or morale.
A list of the items and their definitions as defined
by Stamps and Piedmonte is included at the top of
the instrument. Part A of the IWS was presented
exactly as developed by Stamps and Piedmonte.
Part B of the IWS is comprised of 44 Likert-
type questions that reflect respondents’ agreement
or disagreement with statements about the six
components of occupational satisfaction. Partici-
pants are asked to rate from 1 to 7 (strongly dis-
agree to strongly agree) 44 statements about six
sources/rewards of their job satisfaction. Stamps
and Piedmonte evaluated 250 potential Likert-
type questions by submitting them to a panel of
experienced nurses who estimated which of the
items were related in content to the particular
component. After seven separate administrations
of the items to nurses working in community
hospitals, a 60-item scale was developed. The
validity of the Part B items was further evaluated
through a varimax factor analysis, which result-
ed in the 44-item scale, for which Stamps and
Piedmonte reported a Cronbach’s alpha of .82.
To tailor Part B of the IWS to the prison
nurse sample, a small number of minor editorial
Frequency
Weekly Occasionally Never
3.5 12.4 0.7
5.1 20.6 3.2
4.2 26.9 2.1
6.4 23.0 0.7
5.0 24.4 4.7
7.7 25.5 8.4
14.3 35.7 11.4
4.3 58.2 25.9
3.9 66.8 15.7
0.0 24.8 73.7
changes were made to selected questions. For
example, for ‘‘the administration of this hospital,’’
the wording was changed to reflect the adminis-
tration of the health care system. Similarly, items
that referred to ‘‘my service’’ in the IWS were
changed to ‘‘my unit.’’ Except for those minor
changes, the IWS was presented exactly as devel-
oped by Stamps and Piedmonte. Cronbach’s
alpha for the 44-item IWS in this sample of cor-
rectional nurses was .92, and the Guttman split-
half reliability coefficient was also .92.
Stress. Section 2 of the questionnaire con-
sisted of the 30-item Nurse Stress Index (NSI),
developed by Harris (1989). Harris and collea-
gues developed the NSI through a multistage
process of item generation (involving 329 nurses
working in a southwestern England health dis-
trict) and then sequential surveys of 529 nurses in
a variety of hospital and community settings and
470 senior nurses in the London Health District.
The Likert-type questions measure nurses’ per-
ceptions of pressure (stress) for six major areas of
stress: managing workload, organizational sup-
port and involvement, dealing with patients and
relatives, physical working conditions, home/work
conflict, and confidence and competence in role.
Each subscale consists of five items, so sub-
scale means can be used to assess the relative
importance of sources of stress. Respondents
are asked to rate each item on a scale from 1
(no pressure) to 5 (extreme pressure). Harris re-
ported a Cronbach’s alpha of .90, and a split-half
reliability coefficient of .89 for the final 30-item
NSI.
The Harris NSI was developed for a study of
hospital nurses and has been administered in
a variety of nursing practice settings, including
public and private hospitals, nursing homes, and
community based agencies (Healy & McKay,
 JOB SATISFACTION AND JOB STRESS IN CORRECTIONAL NURSING / FLANAGAN AND FLANAGAN
2000; McGowan, 2001; Webb & Pontin, 1996).
The reliability (alpha) of the 30-item scale in the
correctional nurses’ sample was .92, and the split-
half (Guttman) reliability was .88.
Correlates of job satisfaction and stress.
Section 3 of the instrument contained questions
about the work environment (gender of clients,
unit specialty, numbers of in-patient beds, shift
work, supervision responsibility, and frequency
of 10 selected nursing activities), the respon-
dents’ nursing career (years of experience, previ-
ous experience), and demographic characteristics
(age, education, gender, race/ethnicity, marital
status), all of which have been identified in
previous research as significant correlates of job
satisfaction and stress.
Procedures
After human subjects approvals were obtained,
the study was explained to nurse-managers at a
professional development seminar, and surveys
were distributed to the nurse-managers of each
correctional facility. Nurse-managers were asked
to distribute survey packets to each registered
nurse employed within the correctional unit.
Survey packets included a cover letter, a copy
of the questionnaire, and a self-addressed, stamp-
ed envelope in which to return the completed
survey directly to the researchers. Two weeks
after the initial distribution follow-up packets
were sent to the nurse-managers, who then
redistributed the surveys to the registered nurses
employed in the correctional health care system.
The second survey packet contained a different
cover letter, which encouraged nurses to partici-
pate in the survey and thanked those who had
already returned the survey.
Data Analysis
Descriptive statistics were used to answer the
research questions related to identification of the
overall level of job satisfaction and stress among
correctional nurses. Pearson product moment
correlation and analysis of variance (ANOVA)
techniques were used to answer the two research
questions: (a) Is there a relationship between
job satisfaction and job stress? (b) Which of the
environmental and demographic variables are
correlates of job satisfaction and job stress?
Multiple regression analyses were performed to
develop an explanatory model of job stress and
job satisfaction in relation to environmental and
demographic variables.
287
RESULTS
Job Satisfaction
To determine the relative value of the job satis-
faction components, as reported in Part A, fre-
quencies and percentages were calculated for the
number of times each component was selected
across the five paired comparisons in which it was
involved (Table 2). Pay was selected as the more
important expected element of job satisfaction
3.4 times out of 5 (Table 2). Thirty-eight percent
of respondents selected pay in all five paired
comparisons with other dimensions of job satis-
faction, and 57% selected pay in four of five
comparisons (Table 2). When paired with task
requirements, 77% chose pay as more important.
When paired with interaction or organizational
policies, 75–76% selected pay as more important
to job satisfaction. When paired with autonomy,
58% of respondents chose pay (Table 3).
Autonomy was the next most favored expecta-
tion, selected as more important in 2.9 of 5 paired
comparisons (Table 2). Autonomy was selected
in comparison with professional status (63% vs.
37%), with task requirements (74% vs. 26%),
and with interaction (65% vs. 35%; Table 3). Pro-
fessional status of the job was selected next,
preferred in 2.4 of 5 comparisons (Table 2). Inter-
action was selected as more important in 2.1 of
5 comparisons, task requirements in 2.0 of 5, and
organizational policies selected least often, aver-
aging 1.7 selections in 5 comparisons (Table 2).
Totals for each of the six components were
ranked. The ranking from highest to lowest was:
pay, autonomy, professional status, interaction,
task requirements, and organizational policies.
In Part B of the IWS totals for each of the six
components of sources/rewards of job satisfac-
tion were calculated and ranked. The ranking
from highest to lowest was: interaction, profes-
sional status, autonomy, task requirements, pay,
and organizational policies (Table 4). The median
IWS Part B score was 193, and the mean score
was 190.4 (SD ¼ 35.1). The theoretical range of
scores for Part B of the IWS was between 44 and
308; the actual range of scores in the present
study was between 109 and 282.
Stress. The mean score on the NSI was 80
(SD ¼ 19.7) out of a possible 150, or 53% of the
maximum possible score (Table 5). The three
items with the highest scores were: ‘‘difficult
patients,’’ ‘‘decisions or changes which affect
me are made ‘above’ without my knowledge or
involvement,’’ and ‘‘trivial tasks interfere with
288 RESEARCH IN NURSING & HEALTH

Table 2. Percentage of Items Selected in Part A of the Index of Work Satisfaction (Expected Sources of Job
Satisfaction), n ¼ 287

Job Satisfaction Components

Total Selections Task Organizational Professional

In Five Comparisons Pay Autonomy Requirements Policies Interaction Status

0/5 5.9 7.7 11.5 30.7 16.0 13.6

1/5 9.8 9.4 25.8 17.4 26.1 17.8
2/5 13.6 16.7 30.0 22.0 18.8 22.3
3/5 14.3 25.1 19.2 14.3 16.7 19.2
4/5 18.5 25.8 10.8 12.9 14.3 17.8
5/5 38.0 15.3 2.8 2.8 8.0 9.4
Average Selections in
Five Comparisons: M ¼ 3.4 M ¼ 2.9 M ¼ 2.0 M ¼ 1.7 M ¼ 2.1 M ¼ 2.4
SD ¼ 1.6 SD ¼ 1.5 SD ¼ 1.3 SD ¼ 1.5 SD ¼ 1.5 SD ¼ 1.5

my professional role.’’ Subscale means in ranked
order were: managing workload—time; organi-
zational support and involvement; managing
workload—priorities; confidence and compe-
tence in role; dealing with patients and relatives;
and home–work conflict (Table 5).
Correlates of job satisfaction and stress. Job
satisfaction and stress were correlated with
characteristics of the medical unit in which the
nurse was employed (gender of the unit popula-
tion, unit specialty, number of inpatient beds),
characteristics of a nurse’s assignment (e.g.,
whether it involved shift work, whether the
respondent was a supervisor), characteristics of
a nurse’s professional career (number of years
as an RN, number of years of active nursing
practice, years in correctional nursing, years at
current institution), and demographic attributes
(age, education level, gender, race/ethnicity, and
marital status).
Bivariate relationships between these corre-
lates and job satisfaction and stress were examin-
ed prior to the estimation of multivariate models
of job satisfaction and stress (see Table 6). From
these bivariate relationships, separate multiple
regression models, with job satisfaction and stress
scores as dependent variables, were estimated.
For the analysis of job satisfaction, all the pre-
dictor variables described above were included in
the model, as was the Nurse Stress Index score.
The NSI score was the strongest explanatory
variable, accounting for 30.3% of the variance
in job satisfaction (Table 7). Examination of
the standardized correlation coefficients (beta
weights) shows an inverse relationship between
stress and job satisfaction. Number of years’
experience in correctional nursing and age of
respondents added significantly to the explana-
tory power of the model. Taken together these
three variables produced a multiple correlation
coefficient of .60, F(3, 188) ¼ 35.18, p< .001,
and explained 35.3% of the variance in job
satisfaction (Table 7).
In the regression model for stress using the
NSI score as the dependent variable, the Index
of Work Satisfaction score entered the equation
first and explained 30.3% of the variance
(Table 8). As the job satisfaction score increased,

Table 3. Percentage of Correctional Nurses Selecting Each Source of Job Satisfaction for Each Paired
Comparison (Part A of the Index of Work Satisfaction), n ¼ 287

Job Satisfaction Component Selected

Paired Comparison Task Organizational Professional

Component Pay Requirements Policies Interaction Status Autonomy

Pay 23.0 24.0 24.6 31.7 41.5

Task requirements 77.0 35.9 49.1 56.1 74.0
Organizational policies 76.0 64.1 57.1 67.9 59.7
Interaction 75.4 50.9 42.9 47.7 65.2
Professional status 68.3 43.9 32.1 52.3 63.1
Autonomy 58.5 26.0 40.3 34.8 36.9
 JOB SATISFACTION AND JOB STRESS IN CORRECTIONAL NURSING / FLANAGAN AND FLANAGAN 289

Table 4. Total Index of Work Satisfaction Part B (Coward et al., 1995), nurses in public health
and Subscale Mean Scores (Cumbey & Alexander, 1998), and nurses in
acute and chronic care facilities in Hong Kong
Score M SD
(Fung-kam, 1998).
Total IWS Part B 190.4 35.1 In this sample of correctional RNs, pay was the
Subscales: most important expected source of job satisfac-
Interaction subscale 47.6 10.4 tion, but it was not most highly ranked in the
Professional status subscale 38.5 6.15 measurement of actual sources of job satisfaction.
Autonomy subscale 37.0 9.4 Interaction, professional status, and autonomy
Task requirements subscale 24.1 6.1
had the highest mean scores, similar to previous
Organizational requirements 24.4 8.4
subscale
results for nurses in hospitals (Johnston, 1997)
Pay subscale 18.5 7.5 and nurses in rural practice settings (Stratton,
Dunkin, Juhl, & Geller, 1995). The discrepancy
Note: IWS ¼ Index of Work Satisfaction. between expected and actual sources of job
satisfaction among correctional RNs may be
attributable in part to the nature of the prison
NSI scores declined. A participant’s age and setting. Nurses may have perceived that pay
correctional nursing experience also contributed would be the only significant source of job satis-
to explaining NSI scores. The standardized cor- faction in such a coercive and threatening setting.
relation coefficients show that NSI scores de- In the actual work setting, however, they reported
clined as age increased, but NSI scores increased other sources of job satisfaction, such as peer
as years’ experience in correctional nursing in- interaction, professional status, and autonomy,
creased. Together, the IWS score, age, and cor- which are similar to those reported by nurses
rectional nursing experience yielded a multiple working in rehabilitation and public health
R of .59, F(3, 188) ¼ 32.5; p < .001 and ex- (Crose, 1999; Cumbey & Alexander, 1998). It is
plained 33.5% of the variance in NSI scores clear that correctional nurses are similar to nurses
(Table 8). working in a variety of other settings in deriving
job satisfaction from professional elements of
the nurse role rather than from job-related dimen-
DISCUSSION sions such as salary, task requirements, and
organizational climate.
The purposes of this study were: (a) to describe Two dimensions of a nurse’s role may be
sources and levels of job satisfaction and job especially pertinent to prison nursing. These are
stress among correctional nurses and (b) to iden- the professional status accorded nurses within
tify factors that contribute to job stress and job the correctional organization, and the autonomy
satisfaction among nurses working in prisons. with which correctional RNs practice. The largest
The summary data suggest that overall, correc- segment of the correctional workforce is the secu-
tional nurses were satisfied with their job. These rity staff, most of whom are not college gradu-
findings are consistent with previous studies of ates. In this work environment the education,
nurses in rural and urban long-term care facilities training, and expertise that nurses have is unique,

Table 5. Total Nurse Stress Index and Subscale Mean Scores

Score M SD

Total Nurse Stress Index scale 80.0 19.7

Subscales:
Managing workload–time subscale 14.8 4.4
Organizational support and 14.5 5.2
involvement subscale
Managing workload–priorities 14.1 4.2
subscale
Confidence and competence in role 13.2 4.1
subscale
Dealing with patients and relatives 12.8 3.6
subscale
Home–work conflict subscale 10.1 3.9
290 RESEARCH IN NURSING & HEALTH

Table 6. Pearson Product Moment Correlation Coefficients Among Selected

Correlates of Job Satisfaction and Stress

Job Satisfaction Job Stress

Variable (IWS Part B Score) (NSI Score)

Gender of unit population
.043 .082

Unit specialty
.038
.033
Number of patient beds .037
.037
Shift work
.159* .082
Supervisor status .039
.059
Years as RN .040
.003
Years active in nursing .042 .011
Years in correctional nursing .047 .014
Years at current institution
.069 .047
Age
.090
.069
Education
.041 .117
Gender
.131*
.050
Marital status .042
.047
Race/ethnicity
.037 .032
IWS score — .561**
NSI score
.554** —

Note: NSI ¼ Nurse Stress Index; IWS ¼ Index of Work Satisfaction.

*p ¼ < .05; **p ¼ < .01.

and therefore they may be afforded elevated
professional status. In addition, because nurses
are the primary health care providers in prison,
correctional nursing involves greater professional
autonomy than nursing in many other settings
(Doss, 1997).
The emphasis on professional issues versus
organizational and work-related issues may in-
dicate a change in the nature of job satisfaction.
Tovey and Adams (1999) suggested that the
demands, complexity, and diversity of nursing
work environments are increasing because of
changes in health care delivery, the introduction
of new technology, the increased demand for
accountability, and constrained resources. They
contend that new, more sophisticated measure-
ment tools may be needed to understand job
satisfaction in this rapidly changing context.
Johnston (1997) also found that turbulence and
restructuring of care delivery affected job satis-
faction among 317 hospital RNs in a south-
western state. The absence of longitudinal studies
of nurses’ job satisfaction makes it impossible to
track differences in satisfaction and stress over
time. Research on correctional nurses is at a very
early stage, but replication studies would permit
the analysis of change over time. For example,
as Tovey and Adams (1999) suggested, research
should assess nurses’ job satisfaction and how
it changes as RNs assume new responsibilities
and roles within the same organization or as they
change employers and work environments. Such
studies could inform the development of innova-
tive strategies for recruitment and retention of
correctional nurses (Tovey & Adams, 1999).
Another limitation of job satisfaction instru-
ments is not explicitly incorporating the concept
of altruism, or care, as a source of job satisfaction.
Hospital nurses have reported that ‘‘providing good
care,’’ ‘‘praise from patients/families,’’ ‘‘seeing
patients get better,’’ the ‘‘opportunity to be involv-
ed in major events,’’ and the ‘‘emotional/spiritual

Table 7. Stepwise Regression of Stress and Selected Correlates on Index of Work Satisfaction

Model Variable R R2 Adjusted R2 F p Beta

1 Stress score .55 .31 .303 82.84 < .001
.554

2 Stress þ years in .57 .33 .319 45.04 < .001
.554
correctional nursing .139
3 Stress þ years .60 .36 .353 35.18 < .001
.574
in correctional .228
nursing þ current age
.213

Note: Stress ¼ NSI score.

 JOB SATISFACTION AND JOB STRESS IN CORRECTIONAL NURSING / FLANAGAN AND FLANAGAN
Table 8. Stepwise Regression of Job Satisfaction and Selected Correlates on Nurse Stress Index Score
Model Variable R R2
1 Job satisfaction .55 .31
2 Job satisfaction .57 .32
þ current age
3 Job satisfaction .59 .35
þ current age
þ years in
correctional nursing
Note: Job satisfaction ¼ IWS, Index of Work Satisfaction.
reward’’ of caring are great sources of satisfaction
(McNeese-Smith, 1999). Nurse theorists such as
Watson (1999), Benner (1994), and Leininger
(1991) have discussed the importance of and dif-
fering perspectives about care in the profession
of nursing. Measurement tools that include the
concept of altruism or caring might enhance our
understanding of job satisfaction among nurses in
general and among prison nurses in particular.
Because the prison setting presents formidable
challenges to providing professional and humane
care, it would be especially valuable to study the
role that altruism and care play in attracting and
retaining prison nurses.
The NSI managing workload subscale scores
suggest that correctional nurses also perceive
workload on the job (e.g., time pressures and
deadlines, trivial tasks interfering with profes-
sional role, time spent fighting fires rather than
working to a plan) as a salient stressor. This
finding is consistent with Healy and McKay’s
(2000) study of Australian nurses working in
acute care facilities, community health, and nurs-
ing homes. Healy and McKay reported that
workload, as measured by the Nursing Stress
Scale (Gray-Toft & Anderson, 1981), was the
highest perceived stressor.
The correctional nurses also reported that per-
ceived lack of understanding and support from
organizational superiors was an important source
of stress (e.g., ‘‘management misunderstands the
real needs of my department’’; ‘‘I only get feed-
back when my performance is unsatisfactory’’).
This finding was not consistent with the Healey
and McKay (2000) study of registered nurses in
Australian hospitals. In studies of hospital nurses
in the United States, however, Decker (1997)
found that perceived support of supervisors was
inversely related to job stress. Similarly, Gillies,
Franklin and Child (1990), and Keuter, Byrne,
Voell, and Larson (2000) found that perceived
support from supervisors was a feature of orga-
291
Adjusted R2 F p Beta
.303 82.84 < .001
.55
.315 44.23 < .001
.56

.12
.335 32.51 < .001
.59

.20
.17
nizational climate that ameliorated job stress.
Research of other prison employee groups indi-
cated that support of peers and supervisors within
the organization is inversely related to occupa-
tional stress among correctional officers (Triplett,
Mullings, & Scarborough, 1996).
Time pressure occasioned by insufficient re-
sources, fluctuations in workload, and competing
priorities was the third most highly rated type of
stressor in correctional nursing. The rising costs
of providing health care to increasing numbers
of prisoners may result in diminished resources.
Stressors related to competing priorities may result
from the conflict between primacy of security
in prisons and the philosophy of care under
which health care providers function (Peternelj &
Johnson, 1995). That conflict, in turn, may lead to
role ambiguity (Gulotta, 1987) and stress.
Dealing with patients and relatives was not a
highly rated subcategory of stress. The report
of low stress in this subscale may reflect that
although dealing with correctional clients is de-
manding, the virtual absence of relatives in cor-
rectional health care alleviates one potential
stressor. Finally, the correctional nurses reported
that conflicts between their roles at home and
work were comparatively less salient as a stressor
than were other sources of perceived stress. This
finding is consistent with Decker’s (1997) study
of job satisfaction and psychological distress in
acute care hospital nurses. Job/nonjob conflict as
a source of psychological distress was reported
as less important than anxiety trait, unit tenure,
social integration, experience, and relationship
with the head nurse. In addition, most RNs in the
correctional nurse sample worked stable shifts,
which may reduce home–work conflicts as a
stressor.
In the regression model for job satisfaction, the
Nurse Stress Index score was much more
important in explaining job satisfaction than
correctional nursing experience, age, shift work,
292 RESEARCH IN NURSING & HEALTH
or gender. As perceived stress increased, reported
job satisfaction declined. This strong relationship
between stress and job satisfaction is consistent
with Blegen’s (1993) meta-analysis of job satis-
faction studies among nurses.
In the regression model for the Nurse Stress
Index scores, an inverse relationship existed be-
tween job satisfaction and job stress. Age and
years of experience in correctional nursing also
were related to stress. Decker (1997) noted that
distress increased and job satisfaction lessened
the longer nurses worked in their current unit.
However, Decker also found that, among hospital
nurses, psychological distress decreased as years
of experience in nursing increased. In the current
study length of experience in correctional nursing
and age were related to job satisfaction and stress
in opposite ways. This finding may be explained
by Decker’s distinction between years of nursing
experience and unit tenure. It might be expected
that as age increases, nursing experience would
increase and job stress decrease, with a con-
comitant increase in job satisfaction. Increased
time in a single unit or specialty area instead
might lead to repetition and boredom and there-
fore to increased stress and reduced job satisfac-
tion. Work satisfaction may increase and stress
decrease if nurses move to different areas after a
specified time or if they experience job enrich-
ment through participation in professional devel-
opment activities or take on new responsibilities.
Longitudinal studies of nursing careers in specific
settings are needed to provide information about
length of unit tenure as it relates to changes in
stress and job satisfaction.
In this survey we found differences between
expected sources of job satisfaction and actual
sources of satisfaction. We did not examine this
discrepancy in relation to retention and job per-
formance. However, the relationship of job stress
and job satisfaction with absenteeism, illness,
productivity degradation, and turnover in the
workplace is well established (Borda & Norman,
1997; Fried, 1991; Stamps & Piedmonte, 1986).
Future investigators might explore how the rela-
tionship between expected and actual sources of
satisfaction and stress affects recruitment, ab-
senteeism, job performance, and retention among
correctional RNs.
Generalizability of the findings of this study is
limited to the correctional nurses in this south-
western state who responded to the survey. A
response rate of 58% was obtained for this survey.
There is no identified minimum acceptable re-
sponse rate for survey research (Fowler, 1993),
but unsolicited mail surveys commonly yield no
more than a 20% response rate for the first
mailing (Bourque & Fielder, 1995; Fink, 1995).
Follow-up mailings, monetary or gift incentives,
and phone calls may increase the response rate
(Dillman, 2000). There were two distributions
of this survey with 2 weeks between mailings.
The number of returned surveys increased by
35% after the second mailing. Because names of
respondents were not known, information about
nonrespondents could not be tracked. Surveys
were distributed by unit managers, so nurse-
manager cooperation and the influence of admin-
istrators distributing the survey may have affected
the response rate.
Corrections is a demanding setting in which to
practice nursing. Prisons present a coercive atmo-
sphere in which security concerns predominate,
concern for personal safety is ubiquitous, reso-
urces are habitually limited, and difficult clients
are the norm. Some observers have suggested that
the goal dissonance and role ambiguity associated
with the practice of nursing in such settings may
breed stress and job dissatisfaction. Despite these
challenging dimensions of the work environment,
data from this study indicate that correctional
nurses are comparatively satisfied with their work
and that they derive satisfaction from character-
istics of the work setting that are the same as those
valued in other settings. The features of prison
health care that nurses valued in this study include
the variegated nature of nursing in prisons, the
opportunity to exercise professional judgment,
the respect for nursing as a profession, and being
a member of a health care team. Moreover, the
sources of job-related stress among correctional
nurses found in this study would also be fami-
liar to nurses in other settings: the challenge of
managing the workload in the context of limited
time, interruptions, difficult clients, and an admi-
nistration within an organization perceived as
insufficiently supportive.
Most correctional RNs come to prison nursing
with experience in other health care settings, so
their job satisfaction and perceived stress is in-
formed by experience. In future research investi-
gators should examine what motivates RNs to seek
employment in prison nursing and how correc-
tional nurses compare prison nursing to previous
hospital- and community-based employment.
Research should also track the morale and job
stress of prison nurses over time and should
investigate the relationship of these measures with
job performance and retention.
Our knowledge of correctional nursing is em-
bryonic. Additional research on the challenges and
rewards of nursing in this demanding environment
 JOB SATISFACTION AND JOB STRESS IN CORRECTIONAL NURSING / FLANAGAN AND FLANAGAN
may contribute to effective career development for
prison nurses and to a better understanding of job
satisfaction and job stress and their consequences
for all nurses. As knowledge develops from this
research, it can inform the development of edu-
cation and training strategies and the improvement
of human resource policies so as to improve the
quality of work life for nurses.
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