1. Introduction
Work-related satisfaction is described as a positive emotional state emerging from appreciation associated with work, which may affect employees’ behaviour and performance at work [
1,
2]. Factors such as mastery of work and expectation fulfilment contribute to better work-related satisfaction, and mastery of work may also contribute to enhanced quality of life (QoL) and work engagement. Furthermore, acquiring useful qualifications to overcome challenges at work has been associated with better work engagement and greater work-related satisfaction [
3,
4].
Clinicians working in treatment for substance use disorder (SUD) report an overall high level of burnout and low work-related satisfaction [
5,
6]. In this regard, high workload, burnout and work-related stress have been associated with low work-related satisfaction and QoL among clinical staff members [
4,
7,
8,
9]. The differences in work-related satisfaction have not been attributed to gender [
6,
10], profession [
6,
11], or seniority [
12] among clinicians working in SUD services. While some studies show that work-related satisfaction increases with age [
12], others have found no such association [
6,
10]. The severity of dependency is normally decisive for service intensity, where people with severe SUD are provided with high-intensity services as compared to low-intensity services [
13]. The findings from previous research on the association between work-related satisfaction and service intensity are diverging. Some suggest that clinicians who work in low-intensity services for people with SUD or mental health problems, report higher work-related satisfaction than clinicians in high-intensity services [
14], while others find no differences in work-related satisfaction among clinicians in low- versus high-intensity services [
6,
8].
As Broome, Knight, Edwards and Flynn [
8] argued, the interest in employees’ work-related satisfaction can partly be attributed to its ability to influence clinicians’ performance at work, as well as the service quality. For example, previous research showed that low work-related satisfaction among clinicians was associated with negative attitudes towards inpatients [
15,
16], and diminished service quality [
17,
18]. Factors such as high workload [
8], rapid turnover [
19,
20], and low social support among the employees [
5,
21,
22] have been associated with lower work-related satisfaction in SUD and mental health services. Additionally, conflicting expectations between inpatient and employers may burden healthcare clinicians and influence their work-related satisfaction adversely [
23].
1.1. Enabling Environments
People who need substantial change and development to manage their everyday lives and overcome the psychosocial consequences of SUD, often require specialised inpatient treatment [
24,
25,
26,
27]. People with SUD have long been the subject of controlling measures in society in general, and in SUD treatment in particular [
28,
29], and the environment at the services to which people refer to undergo vast change processes, such as inpatient SUD treatment, is tightly controlled [
30]. The treatment practice and the service staff that undertake it perform an essential function in, and exert a profound influence on, inpatients’ everyday lives and their change processes [
30].
Some of the core tasks at facilities providing inpatient SUD treatment include promoting change and development [
30,
31,
32]. Environmental factors that have been shown to foster positive change (i.e., contextual psychosocial factors that enable development, satisfaction and well-being) include user involvement and empowerment, diversity of treatment options, individualised treatment measures, and the opportunity to pursue individually defined goals [
33,
34,
35,
36].
These factors represent some of the primary values in the notion of recovery [
37,
38,
39], which is defined as a process of change in life domains that are affected by the negative psychosocial consequences of SUD or mental health problems [
40]. Over the past few decades, a recovery orientation framework has increasingly been endorsed in services for people with SUD or mental health problems worldwide [
41,
42,
43,
44]. Services that draw values and measures from the recovery tradition, such as inpatient SUD treatment services, are known as recovery-oriented services [
45,
46]. Patients in recovery-oriented treatment report better treatment outcomes (e.g., self-efficacy, hope, supporting relations), compared to patients in services that are not recovery-oriented [
47,
48]. Additionally, patients rate the quality of recovery-oriented services more favourably than services that are not recovery-oriented [
49]. In line with this, patients who are satisfied with the treatment service stay longer and experience better treatment outcomes, in terms of well-being, social function and substance use [
50,
51].
While several factors have been suggested as facilitators of change and development among inpatients, research suggests that staff members are also affected by contextual psychosocial factors that are emphasised in the therapeutic orientation at treatment facilities [
11,
12,
52,
53]. Studies have shown that recovery-oriented mental health clinicians experience greater work-related satisfaction than those who perceive the practice as less recovery-oriented [
11,
12,
52]. As shown in previous research, recovery-oriented clinicians are more optimistic on behalf of the patients recovery opportunities [
54,
55], and experience better social support in the workforce [
53]. Other therapeutic orientations that emphasise the importance of an enabling psychosocial environment are patient-centred and trauma-informed care. These therapeutic orientations share values that are similar to those of recovery orientation, and have also been associated with greater work-related satisfaction among mental health and SUD clinicians [
56,
57].
1.2. Aims of This Study
Low work-related satisfaction among staff members may reduce inpatients’ opportunities to pursue change and development [
15,
16,
17,
18,
30]. Knowledge of the measures that concurrently contribute to greater work-related satisfaction among clinicians, and better conditions for inpatients to attain change and development, is arguably of interest for the SUD treatment field. This study contributes to the literature by exploring the association between environmental factors that enable inpatients to attain change and development, and factors that influences work-related satisfaction among staff members.
Based on the findings of previous research on clinicians working with SUD or mental illness, which have been reviewed during the introduction, we hypothesised that environmental psychosocial factors at SUD treatment facilities play an important role in clinicians’ work-related satisfaction. As there is a lack of knowledge due to the role of recovery-oriented interventions among clinicians in SUD, the study aimed to investigate the role of recovery-oriented interventions in describing clinicians’ perceptions of work-related satisfaction at inpatient SUD treatment facilities.
4. Discussion
This study investigated the role of recovery orientation in clinicians’ perceptions of various factors that have been associated with work-related satisfaction in inpatient SUD treatment. Clinicians’ perceptions of recovery orientation at treatment facilities were investigated using the following three RSA-N subscales: goals and choice, involvement, and individually tailored and varied. Clinicians’ work-related satisfaction was assessed using the following two scales from QPSNordic: positive challenges at work and mastery of work. Two block-wise multiple regression analyses were performed. Positive challenges at work was used as the hypothesised outcome variable in the first model, and mastery of work was used in the second model.
The results suggest that clinicians’ work-related satisfaction was positively influenced by inpatients’ opportunities to pursue their goals and choices, and negatively influenced by the degree of inpatient involvement at the facilities. Characteristics of the treatment practice, such as personalised measures or diversity of treatment options, did not significantly affect work-related satisfaction.
The results also show that the goals and choice subscale had the strongest influence on clinicians’ reports on both the outcome variables in the regression analyses. This subscale provides information on the degree to which clinicians perceive that measures at their respective treatment facilities promote inpatients’ individually defined goals, and the extent to which inpatients’ choices are supported and respected. Clinicians who perceived that these choices were respected, and that the practice at their respective treatment facilities provided inpatients with the opportunity to define and pursue their goals, reported significantly higher levels of mastery of work and positive challenges at work.
Previous studies have explored how recovery orientation, as a unidimensional variable, contributes to work-related satisfaction, without exploring the influence of individual recovery-orientated interventions. Kraus and Stein [
12] reported that mental health clinicians who perceive the services in which they work as recovery-oriented, are more likely to experience higher levels of professional accomplishment and job satisfaction than those without such an experience. Osborn and Stein [
11] found that the variance observed in mental health providers’ reports of job satisfaction could partly be accounted for by their perceptions of recovery orientation at their respective agencies. Rabenschlag, Konrad, Rueegg and Jaeger [
52] showed that clinicians’ perceptions of the practice as being recovery-oriented increased and their job satisfaction improved after implementing recovery orientation in an SUD and mental illness treatment facility. Moreover, one year later, job satisfaction was significantly higher among clinicians working at the facility compared to a control group [
52].
Our findings are in line with these studies. Moreover, our study contributes to the literature by exploring the influence of individual domains of recovery orientation on clinicians’ work-related satisfaction. Specially, the results from our study contribute by illustrating that treatment measures that enable inpatients to pursue their goals and choices seem to exert a positive influence on clinicians’ work-related satisfaction. As such measures appear to be beneficial for both inpatients and clinicians, they should be enhanced in the programme at SUD treatment facilities.
The results of both regression analyses in this study showed that clinicians who perceived a higher degree of inpatient involvement at their treatment facilities were more likely to report lower levels of positive challenges at work, and mastery of work. The involvement subscale provides information about the extent to which inpatients are involved in the development and planning of the treatment programme and staff training, and whether inpatients are represented in advisory boards of treatment facilities. These results were not as significant, and did not predict as high a variance in the outcome variables as the goals and choice subscale. However, the direction of the results of both regression analyses was similar, and the contribution of involvement was significant, although it had a stronger influence on mastery of work than on positive challenges at work.
These results are in line with those of Jorgensen and Rendtorff [
75], who suggested that patient involvement can be perceived by mental health professionals as time-consuming, challenging, and sometimes frustrating. The patients become experts when the treatment practice is oriented towards patient involvement and shared decision making. Other studies have also suggested that clinicians may find that patient involvement challenges their expertise as professionals [
23,
34,
76,
77]. This may contribute to explaining this study’s findings, suggesting that clinicians’ perceptions of mastery of work seemed to be influenced by inpatient involvement at their facilities.
Additionally, the results of this study showed that
quantitative job demands also contributed significantly to clinicians’ perceptions of mastery of work. High workloads, working overtime, and low work-related self-efficacy among clinicians have been associated with low satisfaction, burnout, and impaired well-being at work [
4,
6,
8]. This may partly explain the negative influence that
involvement seemed to have on clinicians’ perceptions of mastery at work.
Some measures have been suggested as beneficial for promoting user involvement in services for people with SUD or mental health problems. Clinicians need adequate information about the subject of user involvement and the measures used to achieve it [
78,
79]. Moreover, they need sufficient time and resources to implement these measures [
75]. Such measures may reduce the pressure on clinicians and increase the information provided to inpatients about their opportunities for involvement.
Finally, our results showed that variance in either
positive challenges at work or
mastery of work scores could not be accounted for by clinicians’ perceptions of treatment measures as individually tailored and varied. The
individually tailored and varied subscale concerns characteristics of the treatment programme, and provides information on the extent to which clinicians believe that their treatment facilities offer a diversity of treatment options that can be customised to meet inpatients’ individual needs. Recovery orientation shares certain values with patient-centred and trauma-informed care, such as empowering and individualised treatment measures [
80,
81,
82]. The results of this study diverge from previous findings regarding the influence of trauma-informed and patient-centred care on clinicians’ work-related satisfaction. In a synthesis of several systematic reviews, Park, Giap, Lee, Jeong, Jeong and Go [
57] found that a patient-centred orientation at the workplace has a positive influence on clinicians’ job satisfaction and confidence in their work. Hales, Green, Bissonette, Warden, Diebold, Koury and Nochajski [
56] reported that clinicians’ workplace satisfaction, associated with fulfilment and possessing necessary skills, improved after trauma-informed care was implemented at an SUD treatment facility.
Park, Giap, Lee, Jeong, Jeong and Go [
57] and Hales, Green, Bissonette, Warden, Diebold, Koury and Nochajski [
56] found a positive association between clinicians’ work-related satisfaction and empowering treatment measures, such as promoting inpatients’ goals and choices. Our results are partly consistent with these findings. Conversely, unlike these studies, we did not find an association between individualised treatment measures, such as providing individually tailored services, and clinicians’ work-related satisfaction.
These conflicting results may be attributed to several factors, one being that such therapeutic orientations are not directly comparable. However, the value of providing treatment measures based on patients’ individual needs is clearly present in recovery-oriented, patient-centred and trauma-informed care alike [
80,
83]. Our findings may indicate that variance in clinicians’ work-related satisfaction should not be attributed to perceptions of treatment measures as individually tailored and varied. Further research is required to identify confounding factors, and to gain a more profound understanding of the role of the individual domains of recovery orientation on clinicians’ work-related satisfaction.
Limitations
Certain limitations of this study should be noted. First, the questionnaire did not gather information on education level, income, and employment status (full- or part-time). One reason for this was that we wished to limit the number of items in the questionnaire, due to the workload and time pressure that clinicians in the SUD field experience [
5,
6]. Another reason is that research suggests that the variance in clinicians’ work-related satisfaction cannot be explained by income, education level, or employment status [
5,
11,
12]. Second, the study’s cross-sectional design means that no causality can be established, and that confounding factors may be present. This should be considered when interpreting the results of this study. However, the hypothesised directions of influence between the variables were based on previous findings [
11,
12,
52]. Third, the data were obtained using a self-report questionnaire, which entails the risk of social desirability bias. However, the risk was reduced by the fact that the questionnaires were completed anonymously. Lastly, the response rate, albeit acceptable, was moderate (46 percent). However, the sample included participants from 50 of 54 eligible inpatient SUD treatment facilities in Norway, which suggests that it is broadly representative of the target population.