1. Introduction

Work Engagement is defined as a positive affective motivational state of fulfillment, manifested as vigor, dedication, and absorption [1]. The nurse's Work Engagement is enhanced by the leadership of the administrator, which leads to an increase in remarks at the conference [2]. And nurse's Work Engagement has a positive influence on the trend of the department, and as a result leads to improvement of Patient Centered Care [3]. Studies targeting nurses in Japan revealed that Work Engagement is related to age, marital status, years of experience, employment / work style, turnover intention among Nurses, role in the workplace, assistance of superiors (Fukuoka et al., 2013, Sato et al., 2014, Matsumoto et al., 2010, Kawauchi et al., 2011) [4-7]. Therefore, based on the Job demands-resource model, the authors surveyed the relationship between Work Engagement and Job resources (support of colleagues and superiors, fulfillment, degree of discretion) for nurses working in general hospitals and psychiatric hospitals [8]. The result revealed that "fulfillment" has the strongest influence on Work Engagement.

Based on the results, the authors thought that it was necessary for the nurse to be satisfied with the work "nursing" and to have confidence as a nurse in order for the nurse to feel "fulfillment". In addition, previous studies for nurses do not clarify the relationship between Work Engagement and job satisfaction such as working conditions (such as identity security and salary).

The job satisfaction of a nurse is positively correlated with the work environment, and it is related to the type of hospital establishment entity and ward [9].

Job satisfaction affects intention to continue work [10]. And job satisfaction is necessary to bring about a good outcome of care to the patient [11, 12]. As with job satisfaction, Work Engagement affects the decline in nurse turnover rate [4].

From this fact, the authors thought that job satisfaction contributed to a decrease in turnover rate by raising Work Engagement. In other words, the authors thought that satisfying with the work is creating a psychological state in which nurses are positive to work. However, previous studies so far have not clarified the impact of job satisfaction on Work Engagement.

And the studies so far are not targeted to nurses working in psychiatric hospitals. Nurses working in many psychiatric hospitals are exposed to violence by patients [13]. In terms of job satisfaction, previous studies have revealed that violence against nurses by patients and their families lowers job satisfaction and reduces psychological well-being [14]. The authors revealed that Work Engagement falls by receiving violence from patients [15]. For this reason, since the working environment of psychiatric hospitals is distinctive, the authors decided to investigate the relationship between Work Engagement and job satisfaction of nurses working in psychiatric hospitals.

Our research aims to clarify the effect of job satisfaction on Work Engagement of nurses working in psychiatry.

By revealing the relationship between Work Engagement and job satisfaction, it will be possible to obtain new suggestions for nurses to continue working prospectively.

2. Method

2.1. Participants and Procedures

The survey was carried out at three facilities in the Kyushu region, including three psychiatric hospitals. The facilities were selected from a national public hospital with a Forensic psychiatric ward. The reason for this is to investigate the current situation of nurses working in all types of psychiatric wards. In Japan, all hospitals with Forensic psychiatric ward are national public hospitals.

In this study, for the purpose of minimizing the bias, the subjects were selected according to the following criteria.

Ÿ Nurse experience over 1 year

Ÿ Not Nursing administrator

Ÿ Regular employer

Ÿ 2 shifts including night shifts, 3 shift work.

Ÿ Not dementia wards

The authors, who received consent from the subject hospitals, distributed the survey to 336 nurses, and retrieved the anonymous surveys at collection stations using the placement method.

The surveys were collected at each facility and returned to us in a single batch. 283 surveys were collected (84.2% collection rate), and 228 surveys were considered valid (67.9% valid survey rate). The survey was conducted at psychiatric hospitals from June 12^th through June 23^th of 2017.

2.2. Questionnaire

Basic attributes for analysis were gender, age, nursing experience, psychiatric nursing experience, years in current hospital, years in current wards, and current wards.

Work Engagement: Work Engagement was measured by the Utrecht Work Engagement Scale-9(UWES-9) [16]. UWES-9 is composed of 3 sub-concepts of “vigor”, “dedication”, and “absorption”. Each of the 3 sub-scales consists of three items. The score on the sub-scales were calculated based on the Likert technique (0 point for “not at all” to 6 points for “always feel that way”). The higher the score on the UWES-9, the more positive the attitude towards work. The Cronbach α coefficient of this scale is .93 [8].

Job Satisfaction Scale: Job Satisfaciton was measured by Yamashita job satisfaction for nurse (25item) [17]. This scale translated the job satisfaction scale of medical professionals Yamashita (1995) created by Stamp et al. (1978) and amended the item. Job satisfaction scale-25 is composed of 7 sub-scales of "Confidence as a nurse (4 items)" " Relationship between nurses and doctors (3 items)" "relationship between nurses (4 items)" "autonomous nursing practice (5 items)" "Commitment to the job of nursing (4 items) "," working conditions (3 items) "and" guarantee of status (2 items) ". The Cronbach α coefficient of this scale is .82 [18].

The score on the sub-scales were calculated based on the Likert technique (1 point for” Do not think so at all “to 4 points for” Think that it is quite the same”) and evaluate with 7 factors 25-125 points. The higher the score on the Job satisfaction scales, the more Higher job satisfaction.

2.3. Analysis

Descriptive statistics were used to clarify age, years of experience, scores of scores. Correlation analysis was carried out using each subscale of UWES - 9 and job satisfaction scale. The correlation analysis method is Pearson's correlation analysis. Next, multiple regression analysis was performed. It is to analyze whether Work Engagement is affected by job satisfaction and age, years of experience. For that purpose, we analyzed the subscale of UWES - 9 as a dependent variable. The step-wise method was used as the analysis method.

We used SPSS ver.22 as our analysis software.

2.4. Ethical Considerations

Approval was obtained for this study from Saga University Medical School Research Ethical Committee (28-63) and the ethical committees of the hospitals who granted permission for our surveys. There is no conflict of interest in this research. The authors used the measurement scales by obtaining approval from the creators.

3. Result

3.1. Basic Attributes

Table 1 shows the basic attributes for the subjects. 108 nurses (47.4%) were females and 120 nurses (52.6%) were males. The mean age was 39.1 (SD±9.3). The average years of nursing experience was 15.4 years (SD±9.6), and the average years of psychiatric nursing experience was 10.5 years (SD±8.0). 79 (34.6%) of the subjects worked at Psychiatric chronic ward.

Table 1. Basic Attributes N=228

3.2. Questionnaire Score

Table 2 shows the Questionnaire score. The average score of the job satisfaction scale was between 3.0 - 3.6 and total point was 23.4 point (SD±3.4). The average score of the UWES-9 was between 2.0 - 3.7 and total point was 6.9 point (SD±3.3).

Table 2. Scales result n =228

3.3. The Relationship between Work Engagement and Job Satisfaction

Table 3 shows the correlation between UWES-9, and the sub-scale of Job satisfaction scale. Table 4 shows the results of the multiple regression analysis conducted with sub-scale scores of Work Engagement as the dependent variables, and Job satisfaction as the independent variables. There was a strong correlation between “Commitment to the job of nursing” “Confidence as a nurse” and Work Engagement. The correlation between Work Engagement and experience years was low. The correlation coefficient with the Work Engagement was low in the experience years, and no significant result was shown in the multiple regression analysis.

Table 3. Correlation between UWES-9, Job satisfaction Sale for Nurses, Nurse’s experience, Psychitric Nurse’s years of experience, Year in current hospital, and Year in current ward (Pearson coefficient of correlation) N=228

Table 4. Result of multiple regression analysis with UWES-9 as dependent variable, Job satisfaction sale for Nurses, Nurse’s experience, Psychitric Nurse’s years of experience, Year in current hospital, and Year in current ward as independent variable (multiple regression analysis, Step-wise method) N=228

4. Discussion

-Relation between Work Engagement and Job satisfaction-

The reasons of Japanese nurses continue to work are reported to be "employment form (full-time / part-time)" "commuting distance / hour" "hoped working conditions" [19]. However, in this study, the impact of working conditions on Work Engagement was limited. As in the results of this study, Jenaro et al (2010) reports that remuneration can’t be a leading factor in Work Engagement [20].

On the other hand, "Commitment to the job of nursing" and "Confidence as a nurse" had a significant influence on Work Engagement.

This suggests that working conditions motivate to continue work, but to continue work positively, it is important to enhance occupational commitment and maintain and improve Work Engagement.

A leading factor to promote Occupational commitment of nurses is a legitimate evaluation by the superior [21]. And Wong et al (2010) reveals that the leadership of the Nursing administer is a leading factor in Work Engagement [2].

Based on these facts, it can be thought that legitimate evaluation by superior and colleagues in the workplace enhances the occupational commitment of nurses and Work Engagement.

This suggests that the job commitment may play an important role in the process of the job resources of the JD - R model influencing the relationship with work (Figure 1).

Figure 1. The role of Occupational Commitment

Therefore, in order to raise Work Engagement of nurses, occupational commitment plays an important role in job satisfaction, and in order to raise occupational commitment, relationships with colleagues and superior in the workplace and leadership of the superior is important.

“Confidence as a nurse” had a significant influence on Work Engagement, but there was no previous study giving suggestion on that point. Sasaki et al (2012) use Yamashita's literature to organize the definition of confidence as follows [22]. Yamasaki et al (2010. 2011) define self-confidence (self-confidence) as a sense that you have the power (to control the outside world), and this is not a relative characteristic that comes from the superiority of comparison with others, but it is absolute confident confidence [23, 24].

It would be nursing practice to form "confidence as a nurse". The degree of "confidence as a nurse" seems to change according to the support and evaluation of colleagues and superiors on nursing practice. By getting support from colleagues and superiors, there is a possibility that you can gain confidence that nurses themselves can control their work. Need to research and clarify this point in the future, but the relationship with colleagues and superiors may have influence. It is also necessary to consider the influence of nursing practicing ability on "confidence as a nurse".

In the research conducted by the authors, the sense of "fulfillment" at work had a significant and strong influence on Work Engagement [16]. Regarding this point, accumulation of "fulfillment" leads to deepening confidence as a nurse, which may lead to an increase in work Engagement. However, in this regard, conceptual considerations such as "fulfillment" and similarity of self-confidence will be necessary.

In addition, although this study was conducted for nurses working in psychiatry, it is considered that the results were not contradictory to previous studies. In the JD - R model, "job demands (quantitative burden of work, qualitative burden of work etc...)" does not directly affect Work Engagement [25]. Similar results were obtained in our research. From this fact, even if there are stresses psychiatric stresses such as violence by patients do not have a direct influence on Work Engagement, and by receiving legitimate evaluations and support from colleagues and superiors, Work Engagement is considered to be maintained.

5. Conclusions

Work Engagement is affected by "Confidence as a nurse" and "Commitment to the job of nursing" on job satisfaction. And this tendency was not limited to nurses working in psychiatric hospitals, but was common to many nurses.

ACKNOWLEDGEMENTS

We would like to express our appreciation to the nursing management staff and the subjects who participated in our study for their time, efforts, and cooperation in our research.