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Behind the Sirens: Exploring Job Satisfaction in Zagreb’s Emergency Medical Services

1 Marino Čanađija

1 Nora Knez

2,3Biljana Filipović

¹ Teaching Institute of Emergency Medicine of the City of Zagreb, Zagreb, Croatia

² University of Applied Health Sciences, Zagreb, Croatia

3 Faculty of Health Studies, University of Rijeka, Rijeka, Croatia

Article received: 23. 09. 2025.

Article accepted: 23. 01. 2026.

DOI: 10.24141/2/10/1/8

Author for correspondence:

Marino Čanađija

Teaching Institute of Emergency Medicine of the City of Zagreb

E-mail: canadija@hitnazg.hr

Keywords: job satisfaction, emergency medical services, personnel management, healthcare workforce, workplace conditions

Abstract

Introduction. Emergency medical service (EMS) profes- sionals operate in high-pressure environments, making job satisfaction crucial for workforce retention, mental

well-being, and overall service quality. Identifying key determinants of job satisfaction in EMS is essential for optimizing workplace policies and reducing burnout.

Aim. This study aims to examine the relationship be- tween demographic characteristics, education levels, and work experience with various dimensions of job satisfaction among EMS professionals in the Teach- ing Institute of Emergency Medicine of the City of Zagreb.

Methods. A cross-sectional study was conducted among 176 EMS employees at the Teaching Institute of Emergency Medicine of the City of Zagreb between November and December 2023. Workplace satisfac- tion was assessed using the Job Satisfaction Survey (JSS), covering nine dimensions: Pay Score, Promo- tion Score, Supervision, Fringe Benefits, Contingent Rewards, Operating Conditions, Coworkers, Nature of Work, and Communication. Data were analysed us- ing descriptive and inferential statistical methods, including the Mann-Whitney U test, Kruskal-Wallis test, and Spearman’s correlation, with a significance threshold of p < 0.05.

Results. Overall job satisfaction was predominantly ambivalent (median total JSS 112); 14.2% were satis- fied and 2.3% dissatisfied. Men reported higher Na- ture of Work satisfaction than women (p = 0.001). Drivers reported the highest Nature of Work satisfac- tion (p < 0.001), and physicians reported higher Pay satisfaction than drivers (p = 0.032). Operating Con- ditions differed by tenure (p = 0.008), but post-hoc comparisons were not significant.

Conclusion. In this sample, overall job satisfaction was not high but largely ambivalent. Priority areas for improvement are Promotion, Fringe Benefits, Con- tingent Rewards, and Pay, while Nature of Work and Supervision were comparatively higher.

Introduction

Job satisfaction has been described as “a pleasur- able or positive emotional state resulting from the appraisal of one's job or job experiences” (1,2). It is a positive emotional state that arises from achiev- ing workplace goals and is influenced by personal experiences, values, and beliefs (3). There is broad agreement among scholars examining the psychoso- cial aspects of work, supporting Locke’s theory from the late 1960s. This perspective suggests that job satisfaction stems from a complex and dynamic in- teraction between living conditions, labor relations, work processes, and the degree of control workers have over their professional and personal environ- ments (3,4).

From a managerial standpoint, it is considered a cru- cial factor influencing individual and organizational performance, with a strong connection to the quality of services delivered. (5) Service management coor- dinates healthcare workers to ensure quality clinical practice and patient safety. Their role is crucial in or- ganizational and emergency planning. (6)

sional group plays a crucial role in shaping job sat- isfaction and work engagement among paramedics. Stronger group identification and workplace cohesion have been positively correlated with job satisfaction, particularly among female paramedics who exhibit a higher sense of cognitive centrality in their profes- sional identity (12). Understanding these influences is essential for improving workplace environments, reducing burnout, and enhancing the quality of pa- tient care.

Given the demanding nature of EMS work, it is es- sential to identify factors influencing job satisfaction to enhance workplace conditions and employee re- tention. The increasing demands of emergency medi- cal services highlight the need for psychological and physical support systems to enhance job satisfaction and prevent burnout among EMS personnel (11).

This study examines job satisfaction among EMS pro- fessionals in Zagreb, focusing on the effects of gen- der, education, and work experience across various job satisfaction dimensions using the Job Satisfac- tion Survey (JSS) as the primary tool for assessment (13).

Emergency Medical Service (EMS) plays a crucial role           in ensuring timely and effective healthcare inter-

ventions in critical situations (7). However, the chal- lenging nature of EMS work, characterized by long hours, high-pressure decision-making, and exposure to emotionally charged incidents, can significantly impact employees’ job satisfaction (8). Studies in- dicate that nearly half of prehospital EMS workers experience moderate to high levels of burnout, with notable differences in stress perception and job sat- isfaction across professional roles, where physicians report higher satisfaction levels compared to para- medics and nurses (9). In healthcare, job satisfaction is shaped by multiple factors that impact profession- als' overall well-being and commitment to their work. Studies have highlighted that gender, age, education level, work experience, workplace conditions, salary, working hours, and career advancement opportuni- ties play a significant role in determining job satis- faction (10). Job satisfaction among EMS profession- als is influenced by various workplace factors, with supervisory support being one of the strongest pre- dictors of overall satisfaction (11). Recent research suggests that social identification within the profes-

Aim

The study aims to provide actionable insights for improving the work environment and enhancing overall employee well-being in high-stress medical settings by identifying key drivers of satisfaction and dissatisfaction.

Methods

Study Design and Participants

A cross-sectional study was conducted at the Teach- ing Institute of Emergency Medicine of the City of Zagreb between November and December 2023. All active clinical and non-clinical staff were invited; 176 complete responses were received. The final sample comprised 40 Medical Doctors (MD), 68 nurses, 57 drivers, and 11 other staff (Table 1). Inclusion cri- teria were current employment at the Institute and age ≥18 years; there were no exclusion criteria be- yond incomplete questionnaires. Data were collected using online and paper self-administered question- naires. The online survey was accessed via a secure link and did not record names, IDs, or IP addresses. Paper questionnaires were returned to staff, and the research team entered paper forms into an electronic database without personal identifiers.

Approval for the study was obtained from the Eth- ics Committee of the Teaching Institute of Emer- gency Medicine of the City of Zagreb (approval no. 4641/2023, September 21, 2023).

Instrument

Job satisfaction was measured with Paul E. Spector’s 36-item Job Satisfaction Survey (JSS), covering nine facets (4 items each): Pay, Promotion, Supervision, Fringe Benefits, Contingent Rewards, Operating Con- ditions, Coworkers, Nature of Work, and Communica- tion. Items are rated 1–6 (strongly disagree–strongly agree) (13). Each subscale contains 4 items (range 4–24); the total score (36 items) ranges 36–216. In this sample, internal consistency was α = 0.916 for total and acceptable-to-good for most subscales. We used the official Croatian translation of Spector’s JSS, obtained from the author’s repository, with permis- sion (14,15). Negatively worded items were reverse- scored (recode = 7 − result), so higher values indicate greater satisfaction. For interpretive categories, we used the absolute approach: after reverse-scoring, mean item ≥4 denotes “satisfied”, ≤3 “dissatisfied”, and 3–<4 “ambivalent” (mapped to totals: 144–216 / 36–108 / 108–144). (13,15)

Facet definitions:

• Pay — satisfaction with salary level and fair- ness of pay.

• Promotion — opportunities for advancement and fairness/transparency of promotion.

• Supervision — quality of immediate supervi- sion (support, competence, fairness).

• Fringe Benefits — satisfaction with benefits (e.g., health insurance, leave, pension).

• Contingent Rewards — recognition and re- wards contingent on good performance (e.g., praise, bonuses, awards).

• Operating Conditions — rules, procedures, and “red tape” that make work easier or harder.

• Coworkers — relationships and cooperation with colleagues.

• Nature of Work — intrinsic interest, meaning- fulness, and enjoyment of the work itself (not autonomy).

• Communication — flow and clarity of informa- tion within the organization.

Statistics

Analyses were performed in Jamovi (v2.6). Continu- ous variables were assessed for normality with the Shapiro–Wilk test and summarized as median (IQR); categorical variables as n (%). Between-group differ- ences were tested with the Mann–Whitney U test (two groups) and the Kruskal–Wallis test (≥3 groups), with Dunn pairwise comparisons using Holm adjustment when global tests were significant. Associations be- tween satisfaction scores (total and domain-specific) and continuous variables were examined with Spear- man’s rank correlation (ρ). All tests were two-tailed with α = 0.05; correlation magnitudes were inter- preted as weak (|ρ|<0.30), moderate (0.30≤|ρ|<0.70), strong (0.70≤|ρ|<0.90), and very strong (|ρ|≥0.90).

Internal consistency was excellent for total JSS (Cron- bach’s α = 0.916) and acceptable-to-good for most subscales: Pay 0.734, Promotion 0.823, Supervision

0.796, Fringe Benefits 0.662, Contingent Rewards

0.753, Coworkers 0.670, Nature of Work 0.708, Com- munication 0.746. Operating Conditions showed low α = 0.239 and should be interpreted with caution. Shapiro–Wilk indicated non-normal distributions for most facets (p from 4.4×10⁻⁶ to 0.041); Coworkers (p = 0.067) and Total (p = 0.058) were approximately normal.

Results

Job Satisfaction Scores by Sex and Education Level

Of 176 participants, the median age was 40 years; 73.3% were men and 26.7% were women. Women reported higher Pay scores than men (median 11 vs 8, p = 0.003), whereas men reported higher Nature of Work scores than women (median 19 vs 16, p = 0.001). Participants with higher education reported higher Pay scores (median 10 vs 8, p = 0.012), while those without higher education reported higher Op- erating Conditions (median 14 vs 12, p = 0.005) and Nature of Work (median 19 vs 17, p < 0.001).

Job Satisfaction Scores by Work Experience

Only Operating Conditions differed by work experi- ence (Kruskal–Wallis H = 15.60, p = 0.008), but no pairwise contrasts remained significant after Holm adjustment. No statistically significant differences were found for any other JSS dimension with respect to work experience.

Job Satisfaction Scores by Occupation

Across occupations, significant differences were ob- served for Pay (p = 0.031), Operating Conditions (p

= 0.007), and Nature of Work (p = 0.001) (Table 3). Post-hoc testing showed that Pay was higher in phy- sicians than drivers (p = 0.032), while other pairwise comparisons were not significant. For the Nature of Work, drivers scored higher than physicians (p < 0.001) and higher than nurses (p = 0.001); the nurs- es vs physicians comparison was not significant af- ter adjustment (p = 0.078). For Operating Conditions, drivers scored higher than physicians (p = 0.048) and higher than other staff (p = 0.020); remaining con- trasts were not significant. Total JSS did not differ by occupation (p = 0.883).

Job Satisfaction Scores by Department and Supervisory Position

Because non-medical departments were very small, department-level results are presented descriptively. In supervisory status comparisons, supervisors re-

ported higher Nature of Work scores (median 20 vs 18, p = 0.024) and higher Total JSS scores (median 122 vs 112, p = 0.048) than non-supervisors.

Job Satisfaction Scores by Age

Age showed a weak negative correlation with Op- erating Conditions (p = −0.222, p = 0.003). No sig- nificant correlations were observed for other dimen- sions, including total satisfaction (p > 0.05).

Discussion

The findings indicate predominantly ambivalent over- all job satisfaction, with higher scores for Nature of Work and Supervision, and lower for Promotion, Fringe Benefits, Contingent Rewards, and Pay. These find- ings align with existing research, which highlights the complex interplay of workplace conditions, compensa- tion structures, and professional development oppor- tunities in shaping job satisfaction among emergency healthcare workers. Aligned with global trends, as-

Pay Score

6.5

Promotion Score

11.5

(9.25–

13.5)

6 (5–10) 9 (6.5–

11.5

15.5 (13.75–

17.25

5

0.124

10.5

(6–12)

6 (5–10)

0.069

(4–11.5)

10 (6.5–

13)

8 (6–13) 14.5 (14.25–

14.75)

10 0.558 10 (9–15) 9.5 (6–13) 0.144

Supervision Score

18.5

(17.75–

20.25

0.159

14.5)

12.25

13.25)

Operating Conditions

Coworkers

Nature of Work

Communication

15.5)

9.5 (8.25–

11.75)

17

(14.75–

19.75)

21

(18.25–

23.25)

13.5

(10.75–

16.75)

14 (12–

16)

18 (15–

21)

11 (10–

13.5)

17

(13.75–

21)

13.5 (11.25–

15.75)

13.3)

12 0.37 13 (11.5–

17)

13 (11.8–

16)

0.804

0.83

0.024

0.116

pects such as Pay, Supervision, and the Nature of work emerged as key determinants of satisfaction (10). However, Operating procedures and Communication challenges were frequently highlighted as sources of dissatisfaction. The findings revealed significant dif- ferences in satisfaction levels across gender, educa- tion, and years of work experience.

The analysis revealed that women had significantly higher scores in the Pay Score dimension, suggesting a potential perception of greater financial fairness or sat- isfaction among female employees. This finding may reflect a contextual discrepancy, as prior research often points to lower pay satisfaction. (16) However, in the emergency medicine context, this result might be influ- enced by specific organizational factors or compensa- tion structures. It is also worth noting that while wom-

en reported higher satisfaction with pay, studies have consistently shown that they face significant challeng- es in achieving work-life balance in emergency medi- cine roles, which can negatively impact their overall job satisfaction in other domains. (16) Research suggests that women in healthcare roles often have lower salary expectations than their male counterparts, which may contribute to a greater perception of fairness in com- pensation despite actual wage disparities. The differ- ences in expectations are influenced by gender norms, career advancement opportunities, and perceived self- worth in the profession. (17,18) This highlights the complex interplay of factors impacting job satisfaction and underscores the importance of considering tan- gible and intangible aspects of workplace well-being. (19)

Men scored higher in Nature of Work, indicating greater perceived intrinsic meaningfulness and en- joyment of daily tasks, rather than decision-making autonomy. This finding aligns with existing research showing that men and women prioritise different as- pects of job satisfaction. Men tend to place greater emphasis on autonomy and job engagement, while women are more likely to value pay equity and work- place support systems (20).

The relationship between work experience and satis- faction with Operating Conditions is also notable. Less experienced employees reported higher satisfaction in this domain, whereas those with longer tenures expressed greater dissatisfaction. This supports the honeymoon-hangover effect proposed by Boswell et al., which suggests that new employees initially experi- ence high job satisfaction due to novelty and optimism. Over time, exposure to workplace challenges leads to decreasing job satisfaction (21). The study also found that older employees reported lower satisfaction with Operating Conditions, which may be linked to greater physical and cognitive demands in EMS roles as profes- sionals age. The findings reinforce the importance of targeted retention strategies, such as professional de- velopment programmes and workplace mental health initiatives, to sustain job satisfaction among experi- enced EMS personnel. Interpretation of Operating Con- ditions warrants caution given its low internal consist- ency (α = 0.239) in this sample.

From an occupational perspective, differences in satis- faction across roles within EMS highlight the need for targeted interventions. Differences in Pay satisfaction across occupations likely reflect role-specific remunera- tion structures within EMS; in our sample MDs reported higher pay satisfaction than drivers, whereas other facets (e.g., Nature of Work) favored drivers. Higher Nature of Work among men and drivers is interpreted as greater intrinsic meaningfulness/enjoyment of daily tasks, not autonomy or decision-making responsibil- ity. The Operating Conditions facet reflects rules, pro- cedures and bureaucratic barriers; the negative asso- ciation with tenure suggests increasing sensitivity to administrative burden over time. Interventions should prioritise streamlining procedures, rather than mental- health programmes per se, for this facet.

The supervisory role factor also contributed to over- all job satisfaction, with supervisors reporting higher satisfaction with both the Nature of Work and total job satisfaction scores. This may be attributed to the enhanced autonomy, leadership opportunities, and

sense of accomplishment associated with supervi- sory positions (22). Additionally, supervisors often have more opportunities for professional develop- ment and career advancement, which can further enhance their job satisfaction. Given that supervi- sory support plays a critical role in job satisfaction, improving managerial strategies and fostering sup- portive work environments could mitigate stress and enhance workforce retention in EMS (11).

Limitations

While this study provides important insights, several limitations should be acknowledged. The use of con- venience sampling may limit the generalizability of findings beyond the Zagreb EMS workforce. Although questionnaires were anonymous and contained no identifying fields, paper-based return within the work- place may have reduced perceived anonymity and introduced social desirability bias. Additionally, the cross-sectional design prevents establishing causal relationships between job satisfaction factors. Future research should explore longitudinal trends in job sat- isfaction and assess the impact of intervention strate- gies designed to improve job conditions and well-be- ing. Because part of the data was collected on paper, perceived anonymity may have been lower (particu- larly if questionnaires were returned directly to staff), which could have influenced responses.

Conclusions

Overall job satisfaction was predominantly ambivalent rather than high, indicating room for improvement but no evidence of uniformly low satisfaction across do- mains. Satisfaction was highest for Nature of Work and Supervision, and lowest for Promotion, Fringe Benefits, Contingent Rewards and Pay. Men and drivers reported higher Nature of Work; longer tenure was associated with poorer Operating Conditions. These results priori- tise interventions in career progression, recognition/ remuneration and streamlining procedures.

Author contributions

Conceptualization and methodology (MČ, NK); data curation and formal analysis (NK); investigation and project administration (MČ); and writing – original draft and review & editing (BF). All authors have ap- proved the final manuscript.

Conflict of interest

The authors declare no conflicts of interest.

Acknowledgments

The authors thank all EMS professionals who partici- pated in the study and the Teaching Institute of Emer- gency Medicine of the City of Zagreb for their support

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not- for-profit sectors.

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