Investigating the relationship between accountability and job satisfaction: A case study in hospitals affiliated to Yazd University of Medical Sciences 2017

Introduction: high accountability of employees, the organization can be helped to achieve the goals. In general, this research is to investigate the relationship between accountability and job satisfaction in nurses in an educational hospital affiliated to Yazd University of Medical Sciences Method: This study was a descriptive study of correlation type that has been conducted a cross-sectional study in 2017. We involved 190 nurses from selected educational hospitals affiliated to the Yazd University of Medical Sciences in the city of Yazd that have been chosen by stratified random sampling method. The data collection tool was Costa and M Care Accountability Questionnaire concerning 12 items, and Kendall and Smith Job Satisfaction Questionnaire were 37 items. Likert’s 5 scales were used to determine the score of accountability and job satisfaction. The data was analyzed by descriptive-analytical statistical tests and Pearson correlation coefficient, a significance level of 0.05, and in the SPSS software version 20. Results: there was no significant relationship between accountability and job satisfaction except one of job satisfaction (nature of work) (p=0.009). Also, a significant association was observed between three demographic variables of the age group (31-35) years (p=0.047) and work experience between (11-15) years (p=0.03) and the gender of women (p = 0.005) and two variables of accountability and satisfaction. Conclusion: According to the results, it is better to pay more attention to work nature to implement responsibilities more efficiently and increase job satisfaction.


INTRODUCTION
Nursing services among direct and immediate services are indisputable. They have covered a wide variety of patients, clients, groups, and communities throughout the background. 1 Nurse's job performance as one of the most important professions within the hospital. As a result, it is affected by several factors, particularly organizational commitment. 2 Clinical research nurses (CRNs) play a significant role in enhancing the quality of clinical trials. 3 The highest appearance and emergence of nursing performance is where the relationship between the nurse and the client is established to meet the needs and demands of clients to receive nursing services. 1 Concerning the current increasing scope of nurse's authorities and responsibilities compared to the past, the knowledge and skill of nurses in this area must promote; 3,4 they should also have the power of decision making. 4 The healthcare system has entered an age of accountability that rapid and unpredictable changes occur in the health care system. That professional accountability in the nursing area has had high importance. Nursing as a professional career should be responsible for providing its care legally and ethically. 1 One of the goals of the nursing profession is to promote the human personality and dignity of individuals who are under care. Nursing care should lead to the benefit of clients and prevent their damage. Therefore, ethical decision making and awareness of the reasons for choosing a decision, compared with other decisions, are the inseparable components of everyday work of nurses. 5 Accountability is the commitment that each person gives to the organization to perform the assigned duties. 4 Becoming a nurse is acquiring knowledge and learning specific skills, but becoming a nurse also includes the assimilation, attitudes, and values of the nursing profession. 5 Organizational commitment results in increased effort, motivation, job satisfaction, lower absenteeism from work, and increased retention in the organization. 6 In this regard, the more the person is accountable, the organization will promote sooner and helps the organization to achieve its goals. In general, accountability is best done during job satisfaction. 4 Responsibility is defined as the degree

ORIGINAL ARTICLE
of an individual's perseverance, conscientiousness, organization versus laziness, lack of accountability, and action without thinking. These dimensions are more summarized in a specific attribute that is indicative of accuracy, accountability, and credibility for people, contrary to the people who are lazy and undisciplined. 5 Job satisfaction is a reaction of general and overall emotion that people have about their job. 7 Job satisfaction is one's attitude toward his job. 8 In other words, job satisfaction is considered as a positive emotional feeling that, when an individual is working with satisfaction, reaches a job satisfaction, and having job satisfaction, an individual has motivation in his work. 4 Job satisfaction is defined as the feeling that a person has in comparing his/her evaluation of previous work, expectations, and job experiences with current job. 7 The importance of job satisfaction due to the very constructive role in the development and improvement of organization. 8 One of the most common internal factors effecting an organizational is personality characteristics. 9 Also, by increasing the job satisfaction of nurses in their work environment, they were accountable for their work. 10 Job satisfaction is one of the branches of job pleasure. Nurses' job satisfaction is an essential part of their lives, which can affect the patients' safety, and the performance, usefulness, and quality of care 7 found the impact of job satisfaction on organizational commitment and staff retention rate among Malaysian employees. Nawab studied the influence of compensation for staff on job satisfaction in the educational sector. 11 The study analyzes the points that to what extent people with individual, motivational, and the different socioeconomic status during work are correlated with others; 13 to what extent they are accountable, they participate in decision-making. How much they are also alien to their jobs, 14 job satisfaction from Smith, Kendall, and Hullin in the following dimensions is defined: satisfaction with the work, satisfaction with the superior, satisfaction with the colleagues, satisfaction with the promotion, and satisfaction with the salary. 19 Furthermore, organizational citizenship behavior has been defined based on the theory of Podsak off in the dimensions of Assisting Behavior, Chivalry, Organizational Loyalty, Organizational Obedience, Individual Initiatives, Civic Virtue or Behavior and Self Development. 19 People lacking the trait of conscientiousness may be blamed and criticized for the lack of validity, discipline, and high endeavor, but they enjoy experiencing short life; in other words, they are never named bored and tired. 20 The expansion of nurse's shortage and high exit of nurses from this profession is a global problem that exists both in developed and developing countries. 21 There are many matters that nurses are struggling with, which can affect their satisfaction. 21 Kurtz knows job satisfaction is a positive or pleasure emotional state resulting from an individual's assessment of his job or job experiences. 22 Concerning the high acceptance of patients in the educational hospitals of Yazd University of Medical Sciences and the significant number of nurses are working in this center compared to other hospitals and considering the importance of the subject variables, conducting this research in the mentioned spatial domain seems to be necessary. In the present study, by investigating the relationship between accountability and job satisfaction in nurses working in educational hospitals, it has been tried to present some suggestions to enhance job satisfaction in terms of the nurses' accountability.

METHOD
One hundred ninety nurses working have been selected randomly from the educational hospitals in Yazd. They have been determined by a stratified sampling method according to the size of hospitals from three educational hospitals.
The data has been utilized in the statistical sample and a questionnaire which has been arranged regarding the research variables and make them operational to test the hypothesis. The research questionnaire consists of two categories of questions; the first category is coded with alphabetical letters. For collecting data, two questionnaires of Costa and McCare Accountability Questionnaire 23 and Smith P C, Kendall LM, and Hullin's CL Job Satisfaction Questionnaire 24, 25 have been applied. The accountability questionnaire has three areas: (conscientiousness with four questions, perseverance with two questions, and organizing with six questions), and these 12 questions have been measured with Likert's 5 scales. Also, to determine and specify the statistical characteristics in terms of gender, age, marital status, place of employment, and work experience, the second category has been adjusted in two parts, which consist of two separate questionnaires to test the hypotheses of the present research.
The method of scoring questions in Likert's 5 scales as: totally disagree (1), disagree (2), to some extent (3), agree (4), and totally agree (5). Of course, some questions have been scored reversely. 25 The Scores scope of this questionnaire varies between 12 and 60. If the subjects' score counted in 12-24, 24-48, and 48-60 they would indicate lowlimit, medium limit, and high limit accountability, respectively. 23 The second part is job satisfaction questions based on Smith, Kendall, and Hullin theory. The questions include five dimensions (salary with seven questions, the nature of work with eight questions, supervision with eight questions, colleagues with seven questions, and promotion and upgrade with seven questions), that has been arranged with a total of 37 questions and with Likert's 5 scales. In this research, the validity of the data collection tool is by the symbolic or face validity method, which is confirmed due to the use of professors' and experts' viewpoints.
The scoring of this questionnaire based on the Likert's 5 scale is as follows: very high= 5, high= 4, medium= 3, low= 2 and very low= 1. The scores scope of this questionnaire varies from 37 to 185 that if the score of subjects is 87 or lower, it indicates that job satisfaction is at low limit. If the score of subjects is between 87 and 135, it indicates that job satisfaction is at medium limit. And finally, if the score of subjects is between 135 and 185, it indicates that the job satisfaction of people is an optimal level.
To analyze the data for demographic, frequency,

FINDING
The following tables show the obtained results of the study performed on 190 nurses, including selected hospitals affiliated to the Shahid Sadoughi University of Medical Sciences of the city of Yazd.
The results of Table 2 show the mean score of accountability dimensions (M=45.56±6.16) of the people under study. According to the obtained results, the mean score of the conscientiousness dimension (M=19.52) has been higher than other dimensions of accountability. As the results of table below, the accountability variable of the nurses working in the hospitals was at moderate (not that much accountable) level. Table 3 shows the mean of total score (M=109.23±15.41) and the dimensions of job satisfaction of nurses. According to the obtained results, among the satisfaction dimensions, the salary dimension had the highest mean (M=24.35±3.74), and the dimension of colleagues had the lowest mean in comparison to other satisfaction dimensions (M=19.74±4.45). And according to the obtained results, the job satisfaction variable in the nurses working in the selected hospitals was evaluated at moderate level.
Based on the findings presented in Table 4 of the conducted Pearson hypothesis test, there was a reverse correlation between job satisfaction score and accountability Score (r=-.05), and this correlation was not statistically significant (p=0.45). Also, in investigating the correlation between the accountability score and job satisfaction dimensions, a significant relationship with reverse correlation can be observed (r=-0.19) only between one of the dimensions of job satisfaction (the nature of work) with (p=0.009).
According to the results of Table 5, a positive correlation was observed between job satisfaction scores and accountability scores in the nurses of Shahid Rahnamon Hospital (r=0.77). A reverse correlation was observed in the nurses of Shahid Sadoughi and Afshar hospitals to order(r=-0.56)     and (r=-0.326), but these results were not statistically significant.

DISCUSSION
Based on the obtained results in this research, which investigates the relationship between the independent variable of accountability and the dependent variable of job satisfaction in the nurses of educational hospitals of the Shahid Sadoughi University of Medical Sciences of the city of Yazd, it can be argued that there is no significant relationship between these two variables and only between accountability with the dimension of the nature of work, a significant relationship can be observed, that while investigating similar researches conducted in this area; In a study entitled, "Investigating the relationship between accountability and job satisfaction in nurses working in the educational hospitals of Tabriz University of Medical Sciences, " there is a significant relationship between accountability and job satisfaction and two of its dimensions (job satisfaction and promotions satisfaction). Still, there is no significant relationship between accountability, and three other job satisfaction (satisfaction with supervision and monitoring, satisfaction with career colleagues, satisfaction with salary, and payment). 12 The relationship of job satisfaction and motivation for progress with mental health and accountability of female educators of Ahvaz educational institutions. The data analysis method is a correlation method that multiple and straightforward correlation coefficients between predictor variables and criterion variables have been calculated. Also, variable correlations (two variables) of job satisfaction and motivation for progress with mental health were higher than simple correlations of each one of the first two variables with the latter variable. Also, multi-variable correlation (two variables) of job satisfaction and motivation for progress with accountability were higher than the simple correlations of each of the two previous variables with the subsequent variable. 13 Investigating job satisfaction about socioeconomic and demographic factors; a case study of one of the organizations in Fars Province; the more one has a higher group correlation in the organization, he has been more satisfied with his job and organization. Independent variables (such as age, gender, etc.) have not shown significant relationship with the dependent variable directly. 14 Dennis Brooks et al. (2014), in research entitled "Policy as a factor of relationship between job satisfaction and accountability, " concluded that those who have higher job satisfaction towards the work in the organization have better accountability during work. 15 In 2014, Hall, in research entitled "Accountability and organizational support satisfaction as management among the managers, " concluded that accountability and job satisfaction have powerful links with each other. Finally, managers with high accountability have had high job satisfaction. And the remarkable point was that if the satisfaction was low, the accountability was poor too. 16 In 2009, Sorensen, in research entitled "The relationship between job satisfaction of nurses and their accountability" concluded that the results show that accountability irrelatively high and job satisfaction is at the medium limit. Accountability and job satisfaction are significantly related at the medium level. The correlation between the subscales of accountability is significant but low. 17 In a research conducted by Abdolali Lalsayizadeh et al. (1999), entitled as "Investigating job satisfaction concerning socioeconomic and demographic factors, " that the case study has been one of the organizations in Fars province. The higher was in the organization; he has been more satisfied with his job and organization. Independent variables (such as age, gender, etc.) have not directly shown a significant relationship with the dependent variable. 14

CONCLUSION
Based on the results of the research shows that there is no relationship between accountability and job satisfaction in the nurses working in the educational hospitals of the Shahid Sadoughi University of Medical Sciences of the city of Yazd. Only some of the dimensions affect this relationship. For this purpose, the following suggestions are presented: Increasing the salary payment level to the employees, especially nurses, concerning the high mean score that exists between salary and wages and the job satisfaction increase. Also, the recruitment of nurses who have more perseverance in terms of personality showed significant relationship between the work nurses do and accountability and caused positive impact on the performance of other staff. Also, by employing more nurses from women's gender groups, taking into account the individual and statistical characteristics of the analysis of questionnaires showed a direct relationship between gender and job satisfaction.
Consequently, accountability, more accountable people can be employed in nursing area. Based on the research findings of the goal of the relationship between accountability and job satisfaction of nurses, it can be concluded that there is no positive and significant correlation between job satisfaction score and accountability score among nurses of Shahid Rahnamon Hospital. With increasing accountability, job satisfaction always rises, and a reverse correlation was observed among nurses of Shahid Sadoughi and Afshar hospitals. Still, these results were not statistically significant, meaning that, with increasing accountability, job satisfaction always decreases. Also, by separating the relationship based on demographic variables, a significant relationship can be observed only in two variables of age group and work experience (31-35) years and (11-15) years, respectively.
According to the information obtained from the analyses, it is better to provide conditions and facilities based on age groups and different work experience for nurses, which result in more motivation and finally, job satisfaction. During this project, there were limitations such as the lack of scientific studies in the specific fields and poor collaboration of the research population that made the conditions hard to research.

CONFLICT OF INTEREST
There is no competing interest regarding the manuscript.

ETHICS CONSIDERATION
This study was conducted after obtaining ethical clearance from the School of Public Health -Shahid Sadoughi University of Medical Sciences, with ethical clearance reference number IR.SSU.SPH. REC.1398.155

FUNDING
The current study has not received any specific grant from the government or any private sectors.