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Year : 2020  |  Volume : 9  |  Issue : 1  |  Page : 22-29

Evaluation of nurse interns' satisfaction and hospital as an educational environment in nursing internship training program, Saudi Arabia

1 Department of Medical-Surgical Nursing, Faculty of Nursing, Menoufia University, Al Minufya, Egypt; Department of Nursing, Faculty of Applied Medical Sciences, Albaha University, Al Bahah, Saudi Arabia
2 Department of Nursing, Faculty of Applied Medical Sciences, Albaha University, Al Bahah, Saudi Arabia

Date of Submission20-Sep-2019
Date of Decision15-Dec-2019
Date of Acceptance30-Dec-2019
Date of Web Publication26-Feb-2020

Correspondence Address:
Dr. Waled Amen Mohammed Ahmed
Department of Nursing, Faculty of Applied Medical Sciences, Albaha University, Al Bahah
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjhs.sjhs_151_19

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Background/Objective: New nurse interns are known to eagerly anticipate their internship training year but often find themselves confronted with several obstacles during this period. The aim of this study was to evaluate the nurse interns' satisfaction and hospital as an educational environment. Methods: A descriptive cross-sectional study was carried out on 195 nursing students (or interns during the internship year) at the Albaha University, Faculty of Applied Medical Sciences in 2017–2018. The hospitals that were encompassed in this study were King Fahad Hospital and Prince Meshari Hospital. The tools of study were divided into the following sections: sociodemographic and personal datasheet; Postgraduate Hospital as an Educational Environment Measure; and satisfaction scale. Results: According to the study results, the interns were highly satisfied. This finding illustrates a highly significant correlation between the overall satisfaction scale with role autonomy, perception of teaching, perception of social support, and the overall score of Postgraduate Hospital as an Educational Environment Measure. Furthermore, their satisfaction levels were found to be highly significantly correlated with average (P = 0.002) wherein about 43.08% and 21.54% denoted moderate and high levels of satisfaction, respectively. Pediatric intensive care units and neonatal intensive care units were reported to be the areas with the greatest satisfaction levels. Conclusion: The nurse interns were found to be highly satisfied, and the relationship of the hospital as an educational environment was reported as the most influential factor on their satisfaction during the internship training program.

Keywords: Hospital as an educational environment, nurse interns' satisfaction, nursing internship training program, Saudi Arabia

How to cite this article:
Mohammed BM, Ahmed WA. Evaluation of nurse interns' satisfaction and hospital as an educational environment in nursing internship training program, Saudi Arabia. Saudi J Health Sci 2020;9:22-9

How to cite this URL:
Mohammed BM, Ahmed WA. Evaluation of nurse interns' satisfaction and hospital as an educational environment in nursing internship training program, Saudi Arabia. Saudi J Health Sci [serial online] 2020 [cited 2022 Jan 22];9:22-9. Available from: https://www.saudijhealthsci.org/text.asp?2020/9/1/22/279388

  Introduction Top

Clinical experiences are regarded as an important aspect of nursing education, and students' experiences evaluation are capable of providing useful parameter for improvement, underpinning the significance of the standpoint of those who deliver clinical nursing education.[1],[2] A clinical learning environment refers to a mutual engagement of forces which influence expected clinical learning outcomes. It is regarded as the essence of the nursing curriculum and environment.[3],[4] This clinical environment is known to be extremely beneficial to those candidates for several reasons such as determining their mistakes,[5] augmenting their critical thinking skills,[6] ensuring holistic care for patients,[7] and developing clinical judgment and ethical decision-making skills.[7],[8]

With regard to nursing students' prospective, clinical learning environment is known to be “the most anxiety-stimulating aspect of nursing education.”[9] To that end, an old study[10] concluded that the clinical internship environment can help nursing students assume active professional roles such as identifying style discipline and professional ethics, which result in nurturing their clinical skills and enhancing their sense of responsibilities. Meanwhile in a more recent study,[11] it was concluded that problems solving skills, behavioral skills, attitudes and knowledge can be affected within this environment. Similarly, several studies have pointed out that during in the first few months in an internship program, the new graduate nurse experience reality shock and lack of confidence. Some researchers mentioned that the junior nurse need at least one year for job mastery because the health care culture emphasizes specialization, technology, and perfectionist standards.[12],[13] However, research on the effects of this program is confined by small-size studies and the myriad experiences of single institutions.

As mentioned by,[14] there is paucity of literature reviews which have studied the internship programs for new nurse interns in relation to their satisfaction during this period. Nurse satisfaction has been defined as the feeling of happiness about his or her work. Job satisfaction portrays the sense of contentment in an individual's job.[15] The satisfaction levels of an employee is indicative of their attitude concerning the extent of obsequiousness toward the job and institution itself[16],[17] and impacts their role behavior.[18] According to Mueller and McCloskey,[19] social integration assumes great importance for the job satisfaction of recently graduated registered nurses. Furthermore,[20] posited that continued support at workplace denotes a vital aspect of their perceived satisfaction. To elaborate further, Azimian et al.[21]observed that to make an effective and smooth transition from the nest to a new role, these nurses needed the support of both the organization and that of the staff. In addition, colleagues are capable of providing support via feedback, debriefing and praise. Finally, organizations support may be in form of offering structured mentorship programs that can improve job satisfaction, minimize stress and increase their self-confidence among those nurses.

In Albaha University, no research has been carried out so far explore the relationship between the satisfaction of nurse interns and hospitals as an educational environment. Therefore, this study is conducted to explore the relationship between their socio-demographic data, their level of satisfaction, and their perception to hospital as an educational environment. Therefore, there is a compelling need to conduct this research, which might be useful or nurse interns as well as the educational institution and administrative board. Such information could enhance nurse interns' clinical qualifications and improve their learning outcomes.

  Methods Top


A descriptive cross-sectional study.


This study was carried out amongst nursing students at Albaha University, Faculty of Applied Medical Sciences (FAMS). The hospitals encompassed included King Fahad Hospital and Prince Meshari Hospital.

Duration of study

Data were collected from the beginning of December, 2017 till mid–August, 2018 (9 months).


For this study, the purposive sampling was utilized for 200 internship nurses from Albaha University. The data collection tools were then sent across to the interns using their official E-mails. Their responses were collected on excel spread sheet.

Inclusion criteria

Nurse interns who successfully completed the program within 5 years and those who were willing to participate at the time of the study and graduated from FAMS, Albaha University.

Exclusion criteria

Nurse interns from different academic universities. Nurse interns who did not complete their internship training year until the time of data collection.

Sampling technique: Sampling and sample size

All graduates from FAMS who met the inclusion criteria from the Albaha University were asked to participate electronically in this study. The tools were distributed to the university graduates electronically and respondents of both genders were asked to participate in the study. Only 195 graduates responded to the study.

Data collection tools

Data were collected through using the following tools:

Tool I - The first instrument “Sociodemographic and personal datasheet”

It was developed by the investigator to collect preliminary personal data about each subject. It includes age, gender, marital status, region of training, GPA, type of program whether regular or bridging nursing program, previous working experience, period of clinical training.

Tool II - The second instrument “Postgraduate Hospital as an Educational Environment Measure”

The Postgraduate Hospital as an Educational Environment Measure (PHEEM) was developed by Roff et al.[22] This instrument measures three domains of learning environment in teaching hospitals for internship training. These domains imply perception of social support; perception of teaching; and perception of autonomy. It is an electronically self-administered inventory. It is considered a practical, valid, reliable, reproducible and transferable instrument which could be used effectively in evaluating the hospital as an educational environment. It is composed of 40 statement “items.” The interns were asked to indicate their agreement using a five-point Likert scale (0: Strongly disagree, 4: Strongly agree); the higher the score, the more positive the environment. The four negative statements (questions 7, 8, 11, and 13) were scored in reverse. As mentioned,[23] the PHEEM was selected on the recommendation of the research advisory group, a group of medical educators at SCFHS, trainers and residents. This inventory has been used for four major residency programs at Taiba University Teaching Hospitals,[24] and for all residents in King Fahd Hospital, Dammam University[25] and finally for family medicine residency training program.[23]

Tool III - The third instrument “satisfaction scale”

This was developed by Al-Mahmoud.[26] This tool is a rating scale that contains 25 items. Each item is rated on a three point Likert scale ranging from 1 (Disagree) to 3 (Agree) that examine satisfaction levels.

Statistical analysis

The data were collected on excel spread sheet, then processed, tabulated, and analyzed by IBM SPSS Statistics for Windows, Version 22.0. (Armonk, NY: IBM Corp.). Descriptive statistics were expressed as mean, standard deviation (X + SD), number and percentage. P > 0.05 was considered as statistically insignificant and P≤ 0.05 was considered as statistically significant. The independent t-test was used to assess the association between interns perception and mean score of satisfaction.

Ethical consideration

Permission was obtained from the deanship of scientific researches Albaha University. Interns, who have willing to participate, received a brief explanation about the purpose and the outcomes of the study and assuring them that their participation is voluntary with the right to withdraw without any penalty. Furthermore, individuals were assured that all information will be kept confidential by which the researcher only have the right to review. Consent was implied via return of the questionnaires.

  Results Top

The study sample included 195 nurse interns. Their age ranged from 21 to 35 years, with a mean age of 26 ± 3.75. The majority (84.6%) were females. Sixty percent were single. All married, divorced and separate individuals had up to four children (37.9%). In relation to taking care of elderly relatives, 63.5% were taking care of elderly relative in her/his family. In reference to internship training, 67.2% was regular BScN educational program and did not repeat any clinical course in their internship year (81.5%). About 75% of the total sample had previous work experience. The overall nurse interns' satisfaction was highly significantly correlates with GPA (P = 0.002) where about 43.08% and 21.54% moderate and Low level of satisfaction, respectively. In regard to age, gender, marital status, educational program whether regular or bridging program as well as training place-related variables such as clinical area of training nor region of training, there are no significant relations on nurse interns' satisfaction.

While the effect of these variables on PHEEM total score, and subscale among studied sample, the correlation analysis shows that a highly significant correlation between GPA and overall PHEEM where the majority of the sample who have a high GPA (68.7%); were have a more positive than negative but room for improvement as well as about 10.8% rated that the hospital as an excellent educational environment. It also reveals the existence of a significant correlation between last clinical training area and nurse interns' overall PHEEM (P = 0.04).

In regard to region of training, there is a significant relationship with overall PHEEM (P = 0.033). The majority who trained in Albaha district expressed about 72.4% and 71.4% as having a positive than negative but room for improvement and excellent educational area for training and considered their training area as an excellent media for their internship year.

[Table 1] illustrates the frequency of nurse interns' subjects in each PHEEM scales category was aggregated to the corresponding category. It is clear that most of the nurse interns' subjects perceived a more positive perception of one's job, their teaching was moving in a right direction and perceived social support from their training place as a not a pleasant place (with percentage of 55.9, 54.9 and 58.5% respectively). It also noticed that the majority of the subjects had the score PHEEM as perceived a more positive than negative but room for improvement (with percentage of 68.7%).
Table 1: Frequency distribution of Postgraduate Hospital as an Educational Environment Measure as perceived by nurse interns' (n=195)

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[Table 2] illustrates the positive significant correlation between perception of teaching and role autonomy (r = 0.884). In addition, perception of social support had a positive and significant correlation with role autonomy and perception of teaching (r = 0.792, 0.766 respectively). Finally, overall PHEEM showed a positive and significant correlation with all subscales. However, overall PHEEM correlation equally with role autonomy and perception of teaching (r = 0.962) than the perception of social support (r = 0.874).
Table 2: Correlational matrix subscales and overall scale of Postgraduate Hospital as an Educational Environment Measure (n=195)

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Both [Table 3] and [Table 4] demonstrate that the overall PHEEM score was 97.54 (SD: 21.48) of a 160 maximum score which revealed the critical issues in the nursing internship training program. The PHEEM items were presented and ranked based on the average score of all nurse interns' responses for each item. Moreover, none of the items produced a mean score above three. Moreover, it also illustrates a highly significant correlation between the overall satisfaction scale with role autonomy, perception of teaching, perception of social support as well as overall score of PHEEM (P < 0.001).
Table 3: Summary of ranked mean score of each Postgraduate Hospital as an Educational Environment Measure Individual Items and subscales and its correlation with the overall satisfaction scale

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Table 4: The interpretation of nurse interns' education environment measured by Postgraduate Hospital as an Educational Environment measure overall score and subscales

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[Table 5] shows nurse interns' satisfaction toward internship training program. It can be noticed that the highest percent 75.981% of studied respondents agreed that” they have increased their level of knowledge, followed by 73.3% for “they have followed internship policies,” 70.3% that the internship increases their feeling of being connected to people in the organization, and 69.2% of them agreed that they know methods of their evaluation.
Table 5: Nurse interns' satisfaction toward internship training program

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  Discussion Top

In contemporary time, health care delivery systems confronted with a lot of challenges. Nursing interns are one of the future components of this system, who should be prepared very well to meet these challenges.[27],[28] A positive environment is a prerequisite for improving the learning outcomes.[29] The flavors of the working environment is considered as an influential parameter in professional development among medical practitioners.[30] Nursing is one of the professions that are highly liable to job dissatisfaction.[31] Several studies conveyed that job satisfaction is correlated to marital status,[32] age,[33],[34] and length of experience.[32],[34]

In relevance to the relationship between certain socio-demographic and training place related variables of studied respondents and their satisfaction, the results of this study revealed that there were no statistically significant relationships between all studied interns' demographic variables except (age, and marital status). Whereas their perception of the hospital as an educational media during internship training program revealed the statistical relationship except their GPA, clinical training area, and region of training. These findings might be related to the fact that all the studied respondents had closed or the same age. These results are contradicted with “Greene's survey”[35] who found that the first source of job dissatisfaction among nurses who their age were under 32 years was life/work balance. Furthermore, Newhouse et al.[36] claimed that nurse internship study did not give description of demographics, while the studies of Salt et al.[37] and Rhéaume et al.[38] only reported age and gender.

The findings of the current study indicated that a significant relationship was found between job satisfaction and area of work, and this was supported by Rahnavard's study.[39]

The results of this study showed that nurse interns' satisfaction and their perception of the hospital as an educational environment were highly satisfactory. Among them, students who had the highest satisfaction score of roles of autonomy, their perception of teaching and social support within the hospital. The lowest score is the social support where the interns' stated that the hospital is not a pleasant place and this was related to the low perceived support from their clinical teachers and other health team members. The results may pertained to the internship hospitals are not the affiliated ones of the Albaha University, lack of awareness among their clinical teachers, so students are not fully satisfied and this came in accordance with[26] study results. In addition, Wallace[40] added that many studies have concluded that the transition to new nurse role can be facilitated effectively through nurse internship programs. These nurses, who are coached, mentored, and who feel like a member from a team are more likely to be satisfied and committed to their institution. This were also supported by Genn[3] who stated that nurses' perception of their training environment are correlated and resulted in valuable outcomes as their achievements, satisfaction and success. However, these results were slightly better than in all PHEEM domains in the study of Khoja[23] whereas there was apparent weaknesses in family medicine residency training program where there were unfavorable environment as adversely affect the training outcomes.

This study found a positive relationship between the nurses' perceptions of role autonomy and their satisfaction. The nurses interns' surveyed perceived themselves to have a high degree of autonomy and they reported that the hospital has good quality accommodation for junior nurses, especially when on any nursing activities; they were regularly get good feedback from senior nurses which related to their strengths and weaknesses as well as their clinical teachers were well organized and provide good counseling opportunities for junior interns' nurses who fail to complete their training satisfactorily. Moreover, these results came in compatible with Spence's study,[41] and as discussed by O'Driscoll et al.[42] who stated that successful mentorship might be based on interns' preparedness, readiness and willingness to learn and also came in harmony with other similar studies, satisfaction from mentorship supervision was found to be differentiated according to the method of supervision, the frequency of meetings,[43],[44] and the clinical settings.[45],[46] Chandler[47] enumerated several approaches to be taken to develop the new nurse; these approaches implies supportive as well as inquisitive environment which characterized by intimacy and good staff relationships, and a wise preceptor who having supportive behaviors and constructive criticism. Finally, Villanueva et al.[48] reported that a widespread practice to support new graduates to work is the use of preceptors, experienced clinical nurses who steer new nurses through orientation. During this stage, nursing preceptors can facilitate the acquisition of a professional role as nurse to the new graduate without inadequate feelings or frustration. This mentoring can be compared to a mother–child rapport. Preceptors should nurture the new nurses, show them how to perform skills, and help them develop critical thinking skills.[49] Sherman and Dyess[50],[51] concluded that educational support had positive effects on nurses' professional skills while as without this support, they never felt that they gained the confidence they needed to perform on the units. Both of them added that it is important that the preceptor and new graduate nurse work closely, side by side, to gain clinical knowledge.

In relation to work environment and interns' satisfaction, previous study mentioned that there is a positive relationship between job satisfaction, organizational commitment and supportive work environment which will positively affect patient outcomes.[52] In addition, he indicated the critical importance of understanding how the characteristics of organization can have a direct effect on work environment. This environment, in turn, can directly affect nurses' job satisfaction and high-quality patient outcomes. The current study results revealed that some clinical area is highly satisfied to nurse interns like pediatric intensive care unit and neonatal intensive care unit, and this may pertain that the majority of the studied sample were female; these areas may interest them because they were feminine and these may need further assessment. In regard to the last result, there was no any available study that support or contradicted to these finding.

The current study concluded that during nursing internship training program, the hospital is considered as the most influential factor in nurse interns' satisfaction. Nurse interns' perception of role autonomy, perception of teaching, and perception of social support well-documented are related with their satisfaction. Therefore, satisfaction could be used as an important parameter to evaluating the effectiveness of clinical learning environments whether it is satisfying their needs and expectations. Additionally, the hospital as an educational environment is considered an important determinant of the achievement and success on part of nurse interns. The availability of mentorship, hospital team support, and enhanced perception of nurse interns' role autonomy are important aspects in effective nursing education.

Also, this study has some limitations which could include; small sample size, purposive sampling technique at one faculty, the validity of data collection tools was not done, and the lack of generalizability of study findings. Further studies with more sample size using randomized sampling technique needs to be conducted. A representative sample size will enhance the ability of generalizability of the findings.


The appreciations are extended to the interns for their kind collaboration. This study was funded by a grant from the Deanship for Scientific Research at Albaha University. We would like to express the sincerest gratitude, indebtedness and appreciation to Deanship of Scientific Research, at Albaha University which supports our project.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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