Keywords

Supervisor Support, Fairness Perception, Job Satisfaction, Pakistan.

Introduction

Healthcare system plays a critical role in the development and strengthening of nation`s well-being across the globe (Swayne et al., 2012). The healthcare sector not only serves the basic need but also provides economic expansion opportunities (Mahmud & Parkhurst, 2007). According to the Deloitte recent annual report, the global healthcare sector is becoming increasingly competitive where there is a growing need for the committed workforce (Deloitte, 2015). Organizations today need a workforce that can deliver best services despite intense work pressure and competitiveness. The report has outlined that nations aiming for stable growth and stability in the long run, actually need to strengthen its healthcare sector. The report has also outlined that nurses have an important role (after doctors) in providing better healthcare services particularly when it comes to patient care.

Supervisor support denotes to perception about the supervisor being caring and recognizing (Rhoades & Eisenberger, 2002). Support from immediate supervisor offers great strategic benefits to employees particularly in the achievement of work goals and organizational objectives. It helps not only employees to perform the immediate task but builds the overall professional knowledge of the employee. Prominently, there is a strong significance of supervisor support on employee outcomes (Çakmak -Otluoglu, 2012; Wang et al., 2013). Studies have outlined that positive perception of employees concerning to the support from a supervisor can facilitate in responsively working and boosting employee outcomes. In the similar regard, supervisor support has also termed to be significant for nurses (Hunt, 2014; Fila et al., 2014; Burke et al., 2012; Adams & Bond, 2000).

Studies have underlined that supervisor support is important for nurses due to the fact that it helps them to work effectively thus enhancing job satisfaction. However, there are studies that have highlighted the insignificant relationship between supervisor support and job satisfaction (Abiodun et al., 2013; Rhoades & Eisenberger, 2002) in general and with regards to nurse job satisfaction in particular (Sangakala et al., 2016). Moreover, a study by Atefi et al. (2014) has outlined that supervisor support and its significance varies from one nurse to another. Similarly, a meta-analysis (Blegen, 1993) outlined lower correlation between supervisor support and job satisfaction. Thus, there are mixed results pertaining to the role and influence of supervisor support on nurse job satisfaction, requiring further empirical investigation.

Along with this, a more recently, a few studies challenge the traditional link between the job satisfaction and supervisor support by means of concluding none and inverse association (Shah et al., 2018; Brohi et al., 2018). The study concluded that supervisor support has insignificant impact on job satisfaction in nursing especially in the south Asian perspective. Hence, based on inconsistent findings, recommendations for further research and the paucity of empirical investigation on Nurses in developing economies, particularly in Pakistan; the current study aims to investigate how supervisor support can enhance nurse job satisfaction in the public sector hospitals of Pakistan which is in line with what elaborated previously regarding the worst condition of nurses’ job satisfaction in the public sector hospitals of Sindh, Pakistan.

The aim of this paper is to bridge the aforementioned theoretical and practical gaps, a quantitative study is needed to analyze the impact of supervisor support on the nurses’ job satisfaction in the public hospitals of Pakistan. One of the limitations in the existing literature is the absence of investigating the role of fairness perception and the adverse exertion faced by nurses in the workplace. In compliance, the aim of the present study is to fill the gap of the role of fairness perception and hospital environment that cause severe negative exertion and attitudinal consequences related to the profession including lack of job satisfaction (WHO, 2013). The uniqueness of the present study also lies in investigating the role of supervisor support, that is imperative to be highlighted together with the mentioned variables. Supervisor support tends to affect job satisfaction and subjects to enhance the level of job satisfaction (Griffin et al., 2001). Thus, the present study presents a fresh viewpoint in not only studying the critical impact of supervisor support in affecting job satisfaction, but the exclusivity of the present study is extended to analyze the contribution of fairness perception in moderating the relationship of supervisor support on job satisfaction and thus constitute an exclusive examination. In doing so, the present study based the theoretical support on the Frederick Herzberg two factor theory (1959) and uses the unique combination of the hygiene and motivational factor of supervisor support on the nurses’ job satisfaction. The current study has provided a pioneer attempt to study the combined effects of the above-mentioned variables in the nursing profession of Pakistan. To the best of our knowledge, the existing public sector studies on nursing lacks the theoretical support in explaining issues of nurses in Pakistan (Khaliq et al., 2011; Ansari et al., 2015). The remaining part of the study consist of following section. Section 2 explains the literature review about the job clarity and job satisfaction. Section 3 describes the methodology, section 4 clarifies the data analysis and discussion section and section 5 finalize the conclusion and policy recommendations.

Literature Review

Organizational theory defined the supervisor support change the employee’s level of the satisfaction in the organization (Eisenberger et al., 1986), supervisor support increase the employee’s satisfaction (Griffin et al., 2001). Supervisor support is described as employees’ views concerning their supervisor’s value, care about their well-being (Eisenberger et al., 1986). The supervisor is responsible for leading and motivates the employees to perform better in the organization create the environment that brings the positive attitude. The supervisor positive feedback force employees to job satisfaction (Levinson, 1965).

Supervisor support helps employees to increase the commitment and loyalty of employees through job satisfaction (Hossain & Aktar, 2012). Supervisor support was defined as the extent to which employees believe their supervisors value their contributions, offer assistance, and care about their well- being (Kossek et al., 2011; Kottke & Sharafinski, 1988). As supervisors are agents of the organization, measuring supervisor support allows employers to take corrective action to ensure that employees view supervisors favorably and create stronger organizational connections (Eisenberger et al., 2002).

Burke et al. (1992) have defined supervisor support as the perception of employees regarding the guidance, support, concern, and encouragement from their immediate supervisors. The level and extent of the support from supervisors can dominantly enhance influence individual performance.

Supervisors can responsively help employees in the workplace through expert instructions, feedback, and information which in turn results in positive employee behaviors and outcomes (Durham et al., 1997). According to Paterson et al. (2014) that supervisor support helps to foster responsive work environment whereby, Griffin et al. (2001) have highlighted it as an important component for enhancing job satisfaction. Locke (1969) stated that employees’ job satisfaction based on the supervision role. A study conducted in the schools’ teachers by Sharma & Jyoti (2006). He confirmed the relationship between supervisor support and employee’s job satisfaction has a positive relationship which increases the performance of the employee and reduces the turnover in the organization. Besides that, Sharma & Jyoti (2006) conducted another study on the universities teachers to confirm results with same variables supervisor support and employees job satisfaction. Results of the study confirmed that supervisor support has a positive relationship with employee job satisfaction among the university teachers.

Similar results were also empirically reported by Baruch-Feldman et al. (2002). Notably, empirical studies have also outlined views pertaining to the potential biasness of supervisors which may result in different results pertaining to employee outcomes (Rhoades & Eisenberger, 2002). Particularly, it has been also outlined that at times in certain professions, the supervisor support is not welcomed and thus may result in affecting individual`s personal capabilities (Beehr et al., 2010). Nursing is a critical profession whereby, they have to work in tough emergent situations and hence, it would be credible to outline how supervisor support influences their job satisfaction.

Thus, the existing literature clearly explains that there are issues in the healthcare sector especially in a nursing profession where the job satisfaction of nurses is critical to attaining the required patient care along with the growth of nurses in Pakistan (Hamid et al., 2016). In past many studies have attempted to investigate the issues regarding health care inefficiency and provide recommendations to improve the healthcare sector of Pakistan but unsuccessful to reach a consensus to resolve the matter (Sultana et al., 2011; Ansari et al., 2015; Bhatti et al., 2015; Bahalkani et al., 2011; Coomber & Barriball, 2007), however the studies lack in examining the contribution of fairness perception in investigating Job satisfaction. Although, more recently, a few studies challenge the traditional link between the job satisfaction and supervisor support by means of concluding none and inverse association (Shah et al., 2018; Brohi et al., 2018). Therefore, it will not be wrong to conclude that the literature failed to establish any consensus in this regard. Also, the focus of many remarkable studies stress on the need of identifying the cruciality of interactive associations along with investigating untapped domains (Seuring & Muller, 2008; Shashi et al., 2018). In response, the emphasis of present study relies on the public sector of Pakistan as being the least privilege and highly burdened in terms of greater health responsibilities (Hamid et al., 2016) and studying the moderating effects of fairness perception in moderating the influence of supervisor support on job satisfaction will provide useful insights in the existing environment of Job satisfaction among the nurses in the government hospitals of Pakistan.

Thus, the following hypothesis was tested:

H₁: Supervisor support is positively related to nurses’ job satisfaction.

H₂: Fairness perception is positively related to nurses’ job Satisfaction.

H₃: Fairness perception moderates on the relationship between supervisor support and job satisfaction.

Methodology

As outlined, the current study aims to empirically examine the relationship between supervisor support and job satisfaction; the unit of analysis of individuals working in the capacity of nurses in the public sector hospitals of Pakistan. Responsive conduct and effective execution of the research is only possible when the research design is carefully formulated (Bordens & Abbot, 2011). According to Davis (1996), there are no defined grounds for research design. The selection of the appropriate research design is important to establish the effective findings and recommendations (Bordens & Abbot, 2011). According to Zikmund (2003), research in social sciences is mainly based on experiments, surveys, and observational attempts. Out of these, the most common and widely applied business approach is survey design which, according to Davis (1996) is one of the most responsive approaches. According to the author, it is also one of the high cost-effective approaches which are why the majority of academic research studies with quantitative perspectives apt for this approach.

In the second stage of data collection, survey packages were mailed to the superintendent and management with stamped self-addressed envelopes for the convenient return of the questionnaires. A brief introduction clarifying the purpose of the study, telephone number and email of the researcher and supervisor was mentioned in the questionnaire. The participants of the study were assured of the complete anonymity of their responses. In fact they could be centrally adopted by a notable majority of the research studies due to its versatile nature. According to Sonquist & William (1977), the majority of the survey based studies aim at investigating the relationship between the variables and have been vital in the testing hypothesis, population explaining and developing measurable scales, developing frameworks to understand human behavior (Davis, 1996). Since the beginning of the research, the present study was strictly performed whilst keeping all ethical prospects beforehand, especially during the data collection process. Therein, all the responsible personnel in the public sector hospitals were duly contacted to ensure that the nurse's response with confidentiality and objectivity.

Results And Discussion

In this study, a total of 700 questionnaires were distributed among 50 public hospitals of Sindh province of Pakistan however, only 620 filled responses were received. A total of 80 questionnaires was not returned. Out of 620, 50 unusable or incomplete questionnaires were excluded thus, a total of 570 responses is taken for data analysis (Table 1). The response rate was 49.7 percent which may be considered as sufficient enough for a survey research (Bryman, 1988; Memon et al., 2018).

Table 1 Description Of Responses
Description of Response	Frequency
No. of distributed questionnaire	700
Questionnaires returned	620
Questionnaires not returned	80
Un-useable Questionnaire	50
Useable Questionnaire	570
Response Rate (%)	91.9%

The measurement model was developed to determine the convergent validity, discriminant validity and construct reliability of the three latent constructs i.e. fairness perception, supervisor support, and job satisfaction. The convergent validity and construct reliability were estimated by using Average Variance Extracted (AVE) and Composite Reliability (CR). Whereas, the discriminant validity between the six latent variables was estimated by using two widely-used methods i.e. Fornell-Larcker and Heterotrait-Monotrait Ratio (HTMT) matrices.

Table 2 also shows that the AVE of each of the five constructs is greater than 0.50 showing a good convergent validity (Hair et al., 2011). Furthermore, as shown in this table, the CR value is greater than 0.70 which shows good construct reliability (Hair et al., 2011:2012; Sharif & Bukhari, 2014; Arif et al., 2016; Afshan & Sharif, 2016; Sharif & Raza, 2017; Qureshi & Hamid, 2017; Afshan et al., 2018; Ahmed et al., 2017; Nadeem et al., 2016; Qureshi, 2015; Qureshi et al., 2018).

Table 2 Factor Loading, Cronbach Alpha, Composite Reliability And Average Variance Extracted
Construct	Item	Loading	Alpha	CR	AVE
Fairness Perception	FP1	0.983	0.924	0.936	0.873
	FP2	0.921
	FP3	0.949
	FP4	0.983
	FP5	0.955
Supervisor Support	SS1	0.917	0.923	0.958	0.853
	SS2	0.934
	SS3	0.934
	SS4	0.939
Job Satisfaction	JS1	0.882	0.963	0.975	0.893
	JS2	0.944
	JS3	0.931
	JS4	0.879
	JS5	0.934
	JS6	0.941
	JS7	0.941
	JS8	0.944
	JS9	0.915
	JS10	0.929
	JS11	0.938
	JS12	0.943
	JS13	0.982
Note: CR=Composite Reliability, AVE=Average variance extracted.

Table 3 provides a complete account on hypothesis testing. This table shows fairness perception has statistically significant and positive impact on job satisfaction (0.392; p=0.000). Also, supervisor support has been found statistically significant to predict job satisfaction (0.609; p=0.000). In total, these two exogenous variables predict over 56 percent of the total variance in job satisfaction (R2=0.56) which may be considered as ‘substantial’ predictive accuracy of the structural model (Cohen, 1988). Also, the moderating effect of fairness perception is also significant on job satisfaction (0.062; p=0.042).

Table 3 Hypothesis Testing Using VB-SEM
Predictors	Estimate	SE	T-Value	Sig
FP	0.392	0.062	6.322	0.000
SS	0.609	0.115	5.295	0.000
SSxFP	0.062	0.029	2.132	0.042
Adj. R2	0.56
Note: Exogenous Variable=Job Satisfaction.

Conclusion & Recommendation

In this study, supervisor support reflects the perception of the medical nurses in the public hospital of Sindh regarding the meaningful support from their immediate supervisor at the workplace. In previous studies (Dysvik & Kuvaas, 2012), perceived supervisor support has moderated the relationship between perceived job autonomy and employee turnover intention. In addition, other studies (Griffin et al., 2001) have also shown a significant moderating impact of supervisor support on employee job satisfaction.

This might be attributed to the fact that there are some professions whereby, employees have specialist skills and experience pertaining to some aspects of the work as explained by Huang et al. (2015) in their study on tour guides found an insignificant relationship whereby, it reported that since tour guides are very independent in their work therefore, supervisor support was not of much importance and value for them. Based on this argument, it is very likely that since nurses have well-defined roles and responsibilities and are skilled enough to accomplish these assigned goals as per expectations. Henceforth, the importance and vitality of supervisor support may have become less worthy. Notably, based on the questionnaire, it also asserts that the element of help and assistance are merely not of much prominence when people are working independently, equipped with core skills to perform a particularized task like in the banking sector.

The finding is a crucial learning for top management and people in key authorities regarding how supervisor support and fairness perceptions can be strategically used as an important work factor to positively enhance employee behaviors and outcomes. There are far greater benefits of supervisor support and fairness perceptions that organizations need to unveil (Choi & Mattila, 2005) in order to ensure strategic achievement of both individual and organizational objectives.

The finding of the present study is first of its kind and thereby, has forwarded a notable idea pertaining to the critical importance of fairness perception towards fostering and strengthening the influence of supervisor support on job satisfaction of the nurses in Pakistan. The empirical finding has educated that perceptions about the work, effort and how it is appreciated and rewarded play an important role in enabling people to make the most of job prospects for enriched careers. Hence, there is a great deal of satisfaction that can be derived from treating employees fairly by the supervisor.

In particular, the results imply two plausible explanations regarding this finding, in connection with nurses. The first is that the finding suggests that nurses, who were the respondents of the study, experienced and viewed them to be treated and acknowledged fairly. Accordingly, this positive perception helped them to actively capitalize on the guidance, support, recognition, and facilitation received by supervisors to further increase their job satisfaction.

Secondly, the finding also outlines that fairness perception were seen to be important by nurses to help them enhance the impact of supervisor support in improving their job satisfaction. These positive perceptions acted as an encouraging force and motivated them to make a better use of available resources to increase their job satisfaction under the better behavior and guidance of supervisor. The finding has highlighted an important arena for researchers as well as practitioners to understand how such perceptions can noticeably help the overall organization in their efforts towards increasing and maintaining job satisfaction. In other words, this also asserts that when nurses experienced positive regarding fairness perception, they were in a better position to exercise and benefit from work autonomy to enhance their job satisfaction.

Despite several crucial empirical findings and implication, the present study has some important limitations. At first, the study adopted a cross-sectional design which restricts from drawing causal explanations. Notably, longitudinal study design provides times intervals across the hypothesized exogenous and endogenous variables hence, a longitudinal design may be considered for future measuring the constructs at different instances to further strengthening the findings of the present study. Moreover, self-reporting can also be termed as another limitation of the present study which may have inflated the relationships among the exogenous and endogenous variables.

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