**4. Method**

#### **4.1 Design and sample**

In a descriptive-correlational nature and following a quantitative methodology a model of structural equations was created to evaluate a sample composed of 370 health professionals—physicians, nurses, medical assistants and health technicians—from a private group five-star hospital health service in southern Portugal. It is a convenience sample that allows to draw valid conclusions, since it corresponds to about 50% of the universe of the target population.

With a mean age of 33.49 years (DP = 8.96), this sample is predominantly female (71.4%), in which the participants work in an inpatient regimen (40%), outpatient (38.4%) or another type of regimen (21.6%). The majority work full time (87.6%), in a shift work regime (78.9%) and in fixed schedule (21.1%). The majority of the participants (82.7%) worked in their profession and in the private health group for more than a year (75.7%), in an exclusive regime (80.8%), the rest (19.2%) work not only in this institution, but also in other institutions.

#### **4.2 Procedure**

The information was collected through a questionnaire survey. After the request for authorization, the ethics committees of the two hospitals of this private health group approved the study. The research questionnaires were then applied to health professionals who agreed to participate individually during normal working hours in a period of time created for this purpose. Each participant received the informed consent and the questionnaire in independent envelopes, in order to guarantee the desired anonymity and confidentiality at all moments of the information collection.

#### **4.3 Instruments**

*Global empowerment-*assessed through two items from the Global Empowerment subscale of Conditions of Work Effectiveness Questionnaire II (CWEQII2) by Laschinger et al. [12], on a Likert scale ranging from (1)—totally disagree and (5)—I totally agree.

**75**

**Table 1.**

*Linking Social Support with Job Satisfaction: The Role of Global Empowerment in the Workplace*

support of superiors (4 items); and (b) social support of peers (4 items) on a scale

Satisfaction in work-evaluated through the Job Satisfaction Scale (JSS) developed by Lima et al. [48] of eight items that ranged from 1 (totally disagree) to 7

Descriptive statistics (mean, standard deviation, asymmetry and kurtosis), correlations between the variables under study (Pearson's coefficients), internal consistency coefficients (Cronbach's alpha) and the saturated structural equations model, tested to determine the relationships between global empowerment, social support of superiors and peers, and job satisfaction, were performed using the Software for Statistics and Data Science (STATA), version 13. To obtain a global representation of the relationship between social, superior and peer support, global empowerment and professional satisfaction, a saturated model of relationships was projected. This model was submitted to a structural equations test and redesigned from the standardized coefficients. The maximum likelihood (ML) method was used as a parameter estimation procedure to determine the effects (direct and

**Table 1** presents the descriptive statistics (mean, standard deviation, asymmetry and kurtosis) and the correlations (Pearson's coefficient) of the studied variables, as well as the reliability coefficients and Cronbach's alpha of the scales used. The mean value of the social support of the superiors was 3.41 (DP = 0.66) and the peers were 3.40 (DP = 0.56), indicating a tendentially positive level of support in the work environment. Global empowerment with an average of 3.42 (DP = 0.85) indicates a reasonable level of perceived global empowerment. Finally, health professionals are very satisfied at work (M = 4.53, DP = 1.02). The values of asymmetry and kurtosis are less than 1, not disrespecting the parameters that characterize normality in the data distribution (|SK| < 3 and |KU| < 10) [51]. The internal consistency

**Variables 1 2 3 4**

4. Job satisfaction 0.61\*\* 0.47\*\* 0.67\*\* (0.88) Media 3.41 3.40 3.42 4.53 Standard deviation 0.66 0.56 0.85 1.02 Asymmetry 0.80 0.59 0.35 0.19 Kurtosis 0.35 −0.23 −0.03 −0.34 *Note: Alpha of Cronbach's values was presented in parentheses diagonally. All coefficients are significant "\*\*" (p < 0.01).*

*Descriptive statistics, correlations and reliability of the scales: social support of the superiors, social support of* 

*DOI: http://dx.doi.org/10.5772/intechopen.89912*

(totally agree).

**5. Results**

**4.4 Data analysis**

indirect) and mediation [49, 50].

**5.1 Descriptive statistics and correlations**

1. Social support from superiors (0.92)

*peers,* Empowerment *global and job satisfaction (N = 370).*

2. Social support from peers 0.36\*\* (0.87)

3. Global empowerment 0.52\*\* 0.38\*\* (0.80)

ranging from 1 (totally disagree) to 4 (totally agree).

Social support-evaluated through eight items of the social support subscale of the Job Content Questionnaire (JCQ ) of Karasek and Theorell [47]: (a) social *Linking Social Support with Job Satisfaction: The Role of Global Empowerment in the Workplace DOI: http://dx.doi.org/10.5772/intechopen.89912*

support of superiors (4 items); and (b) social support of peers (4 items) on a scale ranging from 1 (totally disagree) to 4 (totally agree).

Satisfaction in work-evaluated through the Job Satisfaction Scale (JSS) developed by Lima et al. [48] of eight items that ranged from 1 (totally disagree) to 7 (totally agree).

#### **4.4 Data analysis**

*Safety and Health for Workers - Research and Practical Perspective*

toward job satisfaction, which will not be evaluated in this study.

healthy professionals, who perceive a high psychosocial level).

to about 50% of the universe of the target population.

only in this institution, but also in other institutions.

demands of the job. Thus, the positive social interactions that are established, not only between supervisors and health-care providers but also between the healthcare providers and work colleagues (peers), in terms of orientation, follow-up, constructive feedback and focus on quality, can be a powerful source of job satisfaction. This study intends to use only the first two allowances of the above model describing healthy organizations: (1) social resources in the working group (e.g., social support) and structural resources for the execution of tasks (e.g., autonomy); (2) healthy active professionals experiencing high levels of psychosocial well-being through job satisfaction. The permissive Healthy organizational outcomes such as high performance and quality of service would be a consequence of the attitude

The goal is to understand the extent to which social resources in the work group (social support from superiors and peers) and the employees' perception of global empowerment correlate with job satisfaction (attitude, a characteristic of active and

In a descriptive-correlational nature and following a quantitative methodology a model of structural equations was created to evaluate a sample composed of 370 health professionals—physicians, nurses, medical assistants and health technicians—from a private group five-star hospital health service in southern Portugal. It is a convenience sample that allows to draw valid conclusions, since it corresponds

With a mean age of 33.49 years (DP = 8.96), this sample is predominantly female (71.4%), in which the participants work in an inpatient regimen (40%), outpatient (38.4%) or another type of regimen (21.6%). The majority work full time (87.6%), in a shift work regime (78.9%) and in fixed schedule (21.1%). The majority of the participants (82.7%) worked in their profession and in the private health group for more than a year (75.7%), in an exclusive regime (80.8%), the rest (19.2%) work not

The information was collected through a questionnaire survey. After the request for authorization, the ethics committees of the two hospitals of this private health group approved the study. The research questionnaires were then applied to health professionals who agreed to participate individually during normal working hours in a period of time created for this purpose. Each participant received the informed consent and the questionnaire in independent envelopes, in order to guarantee the desired anonymity and confidentiality at all moments of the information collection.

*Global empowerment-*assessed through two items from the Global Empowerment

subscale of Conditions of Work Effectiveness Questionnaire II (CWEQII2) by Laschinger et al. [12], on a Likert scale ranging from (1)—totally disagree and

Social support-evaluated through eight items of the social support subscale of the Job Content Questionnaire (JCQ ) of Karasek and Theorell [47]: (a) social

**74**

**4. Method**

**4.2 Procedure**

**4.3 Instruments**

(5)—I totally agree.

**4.1 Design and sample**

Descriptive statistics (mean, standard deviation, asymmetry and kurtosis), correlations between the variables under study (Pearson's coefficients), internal consistency coefficients (Cronbach's alpha) and the saturated structural equations model, tested to determine the relationships between global empowerment, social support of superiors and peers, and job satisfaction, were performed using the Software for Statistics and Data Science (STATA), version 13. To obtain a global representation of the relationship between social, superior and peer support, global empowerment and professional satisfaction, a saturated model of relationships was projected. This model was submitted to a structural equations test and redesigned from the standardized coefficients. The maximum likelihood (ML) method was used as a parameter estimation procedure to determine the effects (direct and indirect) and mediation [49, 50].

## **5. Results**

#### **5.1 Descriptive statistics and correlations**

**Table 1** presents the descriptive statistics (mean, standard deviation, asymmetry and kurtosis) and the correlations (Pearson's coefficient) of the studied variables, as well as the reliability coefficients and Cronbach's alpha of the scales used.

The mean value of the social support of the superiors was 3.41 (DP = 0.66) and the peers were 3.40 (DP = 0.56), indicating a tendentially positive level of support in the work environment. Global empowerment with an average of 3.42 (DP = 0.85) indicates a reasonable level of perceived global empowerment. Finally, health professionals are very satisfied at work (M = 4.53, DP = 1.02). The values of asymmetry and kurtosis are less than 1, not disrespecting the parameters that characterize normality in the data distribution (|SK| < 3 and |KU| < 10) [51]. The internal consistency


#### **Table 1.**

*Descriptive statistics, correlations and reliability of the scales: social support of the superiors, social support of peers,* Empowerment *global and job satisfaction (N = 370).*

of the scales used, assessed using Cronbach's alpha, show appropriate reliability [52]. As expected, a moderate, positive and very significant correlation was observed between work satisfaction and social support of supervisors (r = 0.61, p < 0.01), of colleagues (r = 0.47, p < 0.01) and global empowerment (r = 0.67, p < 0.01).

#### **5.2 Mediation analysis**

With the aim of presenting a global representation of the relationship between global empowerment, social support (of supervisors and peers), and professional satisfaction, the following relationship model was projected: (1) social support (superior and peers) were considered exogenous and predictive variables; (2) global empowerment, an endogenous and exogenous mediator variable; (3) professional satisfaction, endogenous variable and outcome. This model was empirically tested from an analysis of structural equations based on correlations. The analysis carried out had the following steps: (1) design of an over-identified model and (2) redesign of the model from the significant coefficients observed in the previous model, following the guidelines emitted by Acock [49]. For this purpose, a saturated structural equation model was tested, and items that did not present significant weights were then eliminated to determine the relationships between global empowerment, social support of superiors and peers, and satisfaction at work. The estimation of the effects (direct and indirect) as well as the mediation, used the maximum likelihood estimation (ML) method, the adjustment indices of the model and the Sobel test [49, 50].

**Figure 1** shows a suitable final model. The adjustment index of the model, evaluated through the chi-square was significant (X<sup>2</sup> (2.1) = 79.271, p < 0.01). Values between 2 and 3 indicate a good fit of the model, so the values obtained showed an adjusted model.

The CFI and TLI indexes were all higher than 0.90 (CFI = 0.972; TLI = 0.953) as these values usually range from 0 to 1, the results show a satisfactory adjustment.

The adjustment indicator values, Standardized Root Mean Square Residual (SRMR) was less than 0.05 (SRMR = 0.035) and the coefficient Root Mean Square Error of Approximation (RMSEA) was from 0.087 [90% CI: 0.067–0.108], tend to hang between 0.05 and 0.08, being acceptable values up to 0.10, The results obtained are satisfactory [53, 54]. **Figure 1** also shows the standardized coefficients obtained in the structural equations model, as well as the explained variance (R2 ) of the variables global empowerment and professional satisfaction. Global empowerment had a positive and significant predictive effect (p < 0.01) on the social support of the supervisor and the peers. Beta values were 0.48 for supervisory support and 0.24 for peer support. The total variance of global empowerment, explained

**77**

**6. Discussion**

*Linking Social Support with Job Satisfaction: The Role of Global Empowerment in the Workplace*

**Direct effects Coef.** *SE* **z Beta**

Support of the superiors → 0.62 0.07 8.49 0.48 Support of the peers → 0.36 0.09 3.95 0.24

Support of the superiors → 0.45 0.11 4.64 0.27 Support of the peers → 0.48 0.10 4.39 0.26 Empowerment → 0.87 0.11 8.17 0.53

Support of the superiors → 0.54 0.09 6.15 0.29 Support of the peers → 0.31 0.09 3.65 0.14

Support of the superiors → 0.62 0.07 8.49 0.48 Support of the peers → 0.36 0.09 3.95 0.24

Support of the superiors → 1.01 0.10 10.29 0.56 Support of the peers → 0.79 0.10 6.56 0.40 Empowerment 0.87 0.11 8.17 0.53

by support from superiors and colleagues, was 38%. The professional satisfaction had a positive and significant predictive effect of global empowerment (β = 0.53, p < 0.01), support of supervisors (β = 0.27, p < 0.01) and support of peers (β = 0.26, p < 0.01). The total of the variance of professional satisfaction, explained by the

Regarding the mediating role, global empowerment mediated the influence of superior and peer support on job satisfaction. Support from superiors had a direct and indirect impact on professional satisfaction. Regarding the total effect of superior support on professional satisfaction, 48.2% (27/56) was direct, while 51.8% (29/56) was indirect. Peer support had a direct and indirect impact on job satisfaction. Concerning the total effect of peer support in professional satisfaction,

Assuming that job satisfaction is a fundamental attitude at work and an indirect indicator of efficiency and quality of service [12], it was intended to evaluate 370

global empowerment, support of superiors and peers, was 75%.

65% (26/40) was direct, while 35% (14/40) was indirect (**Table 2**).

*DOI: http://dx.doi.org/10.5772/intechopen.89912*

Support of the superiors → (No path) Support of the peers → (No path)

Empowerment (No path)

*Direct, indirect effect and total effect of the variables studied (N = 370).*

Empowerment

Satisfaction

Indirect effects Empowerment

Satisfaction

Total effects Empowerment

Satisfaction

**Table 2.**

*Note: All coefficients are significant (p < 0.01).*

**Figure 1.** *Validated final model (N = 370). All coefficients are significant (p < 0.01).*


*Linking Social Support with Job Satisfaction: The Role of Global Empowerment in the Workplace DOI: http://dx.doi.org/10.5772/intechopen.89912*

#### **Table 2.**

*Safety and Health for Workers - Research and Practical Perspective*

ated through the chi-square was significant (X<sup>2</sup>

*Validated final model (N = 370). All coefficients are significant (p < 0.01).*

**5.2 Mediation analysis**

adjusted model.

of the scales used, assessed using Cronbach's alpha, show appropriate reliability [52]. As expected, a moderate, positive and very significant correlation was observed between work satisfaction and social support of supervisors (r = 0.61, p < 0.01), of

With the aim of presenting a global representation of the relationship between global empowerment, social support (of supervisors and peers), and professional satisfaction, the following relationship model was projected: (1) social support (superior and peers) were considered exogenous and predictive variables; (2) global empowerment, an endogenous and exogenous mediator variable; (3) professional satisfaction, endogenous variable and outcome. This model was empirically tested from an analysis of structural equations based on correlations. The analysis carried out had the following steps: (1) design of an over-identified model and (2) redesign of the model from the significant coefficients observed in the previous model, following the guidelines emitted by Acock [49]. For this purpose, a saturated structural equation model was tested, and items that did not present significant weights were then eliminated to determine the relationships between global empowerment, social support of superiors and peers, and satisfaction at work. The estimation of the effects (direct and indirect) as well as the mediation, used the maximum likelihood estimation (ML) method, the adjustment indices of the model and the Sobel test [49, 50]. **Figure 1** shows a suitable final model. The adjustment index of the model, evalu-

between 2 and 3 indicate a good fit of the model, so the values obtained showed an

the variables global empowerment and professional satisfaction. Global empowerment had a positive and significant predictive effect (p < 0.01) on the social support of the supervisor and the peers. Beta values were 0.48 for supervisory support and 0.24 for peer support. The total variance of global empowerment, explained

The CFI and TLI indexes were all higher than 0.90 (CFI = 0.972; TLI = 0.953) as these values usually range from 0 to 1, the results show a satisfactory adjustment. The adjustment indicator values, Standardized Root Mean Square Residual (SRMR) was less than 0.05 (SRMR = 0.035) and the coefficient Root Mean Square Error of Approximation (RMSEA) was from 0.087 [90% CI: 0.067–0.108], tend to hang between 0.05 and 0.08, being acceptable values up to 0.10, The results obtained are satisfactory [53, 54]. **Figure 1** also shows the standardized coefficients obtained in the structural equations model, as well as the explained variance (R2

(2.1) = 79.271, p < 0.01). Values

) of

colleagues (r = 0.47, p < 0.01) and global empowerment (r = 0.67, p < 0.01).

**76**

**Figure 1.**

*Direct, indirect effect and total effect of the variables studied (N = 370).*

by support from superiors and colleagues, was 38%. The professional satisfaction had a positive and significant predictive effect of global empowerment (β = 0.53, p < 0.01), support of supervisors (β = 0.27, p < 0.01) and support of peers (β = 0.26, p < 0.01). The total of the variance of professional satisfaction, explained by the global empowerment, support of superiors and peers, was 75%.

Regarding the mediating role, global empowerment mediated the influence of superior and peer support on job satisfaction. Support from superiors had a direct and indirect impact on professional satisfaction. Regarding the total effect of superior support on professional satisfaction, 48.2% (27/56) was direct, while 51.8% (29/56) was indirect. Peer support had a direct and indirect impact on job satisfaction. Concerning the total effect of peer support in professional satisfaction, 65% (26/40) was direct, while 35% (14/40) was indirect (**Table 2**).

#### **6. Discussion**

Assuming that job satisfaction is a fundamental attitude at work and an indirect indicator of efficiency and quality of service [12], it was intended to evaluate 370

health professionals working in a private hospital group in the south of Portugal. This study was supported by the Healthy and Resilient Organization Model (HERO; [3] in [4]), which provides an interrelationship between three main components: (1) resources in the working group (e.g., social support) and structural resources for the execution of tasks (e.g., autonomy); (2) healthy active professionals experiencing high levels of psychosocial well-being; and (3) healthy organizational results such as high performance and quality of service. In a similar way, it was intended to understand the extent to which social resources in the work group (social support from superiors and peers) and structural resources for the execution of tasks (globally empowered) relate to job satisfaction (experience high levels of psychosocial well-being) in a private hospital group in southern Portugal.

The results showed the role played by social relations in organizations through the positive and significant relationship between social support (from superiors and peers) and job satisfaction. This finding is corroborated by other studies [21, 44, 55, 56]. The predictive effect of social support (from superiors and peers) on job satisfaction was equally evidenced and similar to other findings in this area [34, 44, 46, 57]. This relevant role played by social relations, as has been highlighted in the literature [42, 43], has practical implications for superiors and colleagues, who play a key role in following up and giving constructive feedback to employees regarding the quality of care. Another interesting finding was the positive and significant relationship between global empowerment and job satisfaction. These results are consistent with Kanter's structural empowerment model [11] and with some investigations [12, 37–39, 41, 58, 59]. One practical implication of this result obtained through perceived global empowerment (highlighted by the perception of structured work environments characterized by providing easier access to information, resources, opportunities and support) is the need for managers to include this variable in the management of health institutions. This measure of creating healthy environments is crucial for promoting job satisfaction, which in turn is a critical factor in individual and organizational success. Another interesting finding was the mediating effect of global empowerment between social support (from superiors and colleagues) and job satisfaction. These findings are an indication that the global perception of effectiveness at work [12] is a factor that cannot be overlooked by these health institutions, since it can reduce the magnitude of the relationship between social support (independent variable) and job satisfaction (dependent variable). This shows the prevailing power of global empowerment from the point of view of working conditions.

The above shows that carers react emotionally to certain situations that arise from these structural conditions, which in turn influences their attitudes and behaviors [11, 12]. The findings also show the direct effect of social support on job satisfaction. Whether social support came from superiors or peers, the magnitude observed was very similar. This underlines the fact that social support fostered in the workplace, whether affective or instrumental in nature, has the genuine ability, by itself, to have an effect on job satisfaction without having to be mediated by other variables. An important implication for the managers of these institutions is that they should consider creating organizational environments that prioritize the integration of teams (whether superiors or peers) through fostering support and interaction. This strategy is decisive in promoting greater social support perceived in the institution in order to directly achieve job satisfaction. This measure, applicable to the participants in this study, can be extended to all health institutions. The creation of healthy social environments is essential in providing job satisfaction (indirect indicator of quality of service), in order to maximize available resources as well as the excellence of care provided. On the other hand, private health organizations, due to their exponential growth and the high demands from stakeholders,

**79**

*Linking Social Support with Job Satisfaction: The Role of Global Empowerment in the Workplace*

especially patients, who expect a timely response and quality of service, have the additional challenge of promoting employee well-being, so that they can feel motivated, supported and valued, and thus better meet the expectations and challenges

The findings obtained in the present study should, however, be cautiously interpreted since the cross-sectional design does not allow conclusions to be drawn about the causality that a longitudinal study enables. The second limitation is that global empowerment is not the only mediating factor in the relationship between social support and job satisfaction, as there are other variables that will certainly play an equally relevant role, in mediating in this relationship. Studies of a longitudinal nature could help in better understanding the causal relationships between these variables in health care. A complementary qualitative analysis could also better explain the quality of the emotional and instrumental relationship between

The social support of superiors and peers and global empowerment seem to be two important determinants of job satisfaction in health care. The two types of social support, superior and peer, seem to affect job satisfaction both directly and indirectly through global empowerment. These findings are corroborated by Kanter's theory of structural empowerment [11]. The results show the relevance of social support (from supervisors and peers) that directly and indirectly influences positive attitudes such as job satisfaction. These findings suggest the need to invest in training and the development of social skills. These interventions are essential in fostering a culture of socio-affective support, follow-up and constructive feedback, to provide quality care but also to develop employee commitment to the organization. These results show the indispensability of an organizational culture characterized by greater effectiveness through the creation of infrastructures that enable the sharing of information, support, opportunities and resources that provide health professionals with greater autonomy and influence in their work and participation in decision-making, with a view to continuous improvement and professional development. A culture imbued with social support and empowerment fosters better management of the resources available at the unit and encourages motivation and job satisfaction by encouraging employees to feel needed, responsible and free to use their skills, abilities and skills. Moreover, it helps employees realize that they can count on organizational support, conveying the trust and respect that employ-

ees need to identify with the organization's goals and projects.

*DOI: http://dx.doi.org/10.5772/intechopen.89912*

that have been created for them.

subordinates and peers.

**7. Conclusion**

*Linking Social Support with Job Satisfaction: The Role of Global Empowerment in the Workplace DOI: http://dx.doi.org/10.5772/intechopen.89912*

especially patients, who expect a timely response and quality of service, have the additional challenge of promoting employee well-being, so that they can feel motivated, supported and valued, and thus better meet the expectations and challenges that have been created for them.

The findings obtained in the present study should, however, be cautiously interpreted since the cross-sectional design does not allow conclusions to be drawn about the causality that a longitudinal study enables. The second limitation is that global empowerment is not the only mediating factor in the relationship between social support and job satisfaction, as there are other variables that will certainly play an equally relevant role, in mediating in this relationship. Studies of a longitudinal nature could help in better understanding the causal relationships between these variables in health care. A complementary qualitative analysis could also better explain the quality of the emotional and instrumental relationship between subordinates and peers.

## **7. Conclusion**

*Safety and Health for Workers - Research and Practical Perspective*

well-being) in a private hospital group in southern Portugal.

health professionals working in a private hospital group in the south of Portugal. This study was supported by the Healthy and Resilient Organization Model (HERO; [3] in [4]), which provides an interrelationship between three main components: (1) resources in the working group (e.g., social support) and structural resources for the execution of tasks (e.g., autonomy); (2) healthy active professionals experiencing high levels of psychosocial well-being; and (3) healthy organizational results such as high performance and quality of service. In a similar way, it was intended to understand the extent to which social resources in the work group (social support from superiors and peers) and structural resources for the execution of tasks (globally empowered) relate to job satisfaction (experience high levels of psychosocial

The results showed the role played by social relations in organizations through the positive and significant relationship between social support (from superiors and peers) and job satisfaction. This finding is corroborated by other studies [21, 44, 55, 56]. The predictive effect of social support (from superiors and peers) on job satisfaction was equally evidenced and similar to other findings in this area [34, 44, 46, 57]. This relevant role played by social relations, as has been highlighted in the literature [42, 43], has practical implications for superiors and colleagues, who play a key role in following up and giving constructive feedback to employees regarding the quality of care. Another interesting finding was the positive and significant relationship between global empowerment and job satisfaction. These results are consistent with Kanter's structural empowerment model [11] and with some investigations [12, 37–39, 41, 58, 59]. One practical implication of this result obtained through perceived global empowerment (highlighted by the perception of structured work environments characterized by providing easier access to information, resources, opportunities and support) is the need for managers to include this variable in the management of health institutions. This measure of creating healthy environments is crucial for promoting job satisfaction, which in turn is a critical factor in individual and organizational success. Another interesting finding was the mediating effect of global empowerment between social support (from superiors and colleagues) and job satisfaction. These findings are an indication that the global perception of effectiveness at work [12] is a factor that cannot be overlooked by these health institutions, since it can reduce the magnitude of the relationship between social support (independent variable) and job satisfaction (dependent variable). This shows the prevailing power of global empowerment from the point

The above shows that carers react emotionally to certain situations that arise from these structural conditions, which in turn influences their attitudes and behaviors [11, 12]. The findings also show the direct effect of social support on job satisfaction. Whether social support came from superiors or peers, the magnitude observed was very similar. This underlines the fact that social support fostered in the workplace, whether affective or instrumental in nature, has the genuine ability, by itself, to have an effect on job satisfaction without having to be mediated by other variables. An important implication for the managers of these institutions is that they should consider creating organizational environments that prioritize the integration of teams (whether superiors or peers) through fostering support and interaction. This strategy is decisive in promoting greater social support perceived in the institution in order to directly achieve job satisfaction. This measure, applicable to the participants in this study, can be extended to all health institutions. The creation of healthy social environments is essential in providing job satisfaction (indirect indicator of quality of service), in order to maximize available resources as well as the excellence of care provided. On the other hand, private health organizations, due to their exponential growth and the high demands from stakeholders,

**78**

of view of working conditions.

The social support of superiors and peers and global empowerment seem to be two important determinants of job satisfaction in health care. The two types of social support, superior and peer, seem to affect job satisfaction both directly and indirectly through global empowerment. These findings are corroborated by Kanter's theory of structural empowerment [11]. The results show the relevance of social support (from supervisors and peers) that directly and indirectly influences positive attitudes such as job satisfaction. These findings suggest the need to invest in training and the development of social skills. These interventions are essential in fostering a culture of socio-affective support, follow-up and constructive feedback, to provide quality care but also to develop employee commitment to the organization. These results show the indispensability of an organizational culture characterized by greater effectiveness through the creation of infrastructures that enable the sharing of information, support, opportunities and resources that provide health professionals with greater autonomy and influence in their work and participation in decision-making, with a view to continuous improvement and professional development. A culture imbued with social support and empowerment fosters better management of the resources available at the unit and encourages motivation and job satisfaction by encouraging employees to feel needed, responsible and free to use their skills, abilities and skills. Moreover, it helps employees realize that they can count on organizational support, conveying the trust and respect that employees need to identify with the organization's goals and projects.
