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ORIGINAL ARTICLE
Year : 2020  |  Volume : 23  |  Issue : 3  |  Page : 371-375

Job satisfaction among health professionals in a federal tertiary hospital in Nigeria


1 Department of Orthopaedic Surgery, National Orthopedic Hospital, Enugu, Enugu State, Nigeria
2 Department of Radiation Oncology, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria
3 Department of Orthopedic Surgery, Federal Medical Centre, Owerri, Nigeria
4 Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria

Date of Submission29-May-2019
Date of Acceptance25-Nov-2019
Date of Web Publication5-Mar-2020

Correspondence Address:
Dr. O A Lasebikan
Department of Orthopedic Surgery, National Orthopedic Hospital, P.M.B 01294, Enugu, Enugu State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_292_19

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   Abstract 


Background: Job satisfaction of health workers is essential in building up employee motivation and efficiency. The objective of this study is to ascertain the level of job satisfaction among health professionals in a federal tertiary health institution in Nigeria. Methodology: This study was done at the National Orthopedic Hospital, Enugu (NOHE), in south-east Nigeria. Two hundred and thirty-six health workers were recruited from the various clinical departments via a systematic sampling technique. A questionnaire documenting relevant sociodemographic data and assessing the level of satisfaction with the financial remunerations, working conditions, infrastructure and equipment, learning and academic sponsorships, welfare packages, and performance appraisal systems was administered to them. Results: The findings revealed a relatively low level of job satisfaction among the staff of NOHE especially with regards to financial remuneration, working conditions, tools and infrastructure, learning and training opportunities/sponsorship, leadership style, and welfare packages with increasing dissatisfaction in that order. However, the average staff is satisfied with the performance appraisal system as regards promotion. Conclusion: The majority of the clinical staff have a low level of job satisfaction. A review of the salary structure of health professionals as well as improving the working conditions, tools, and infrastructures in the hospital is needed.

Keywords: Health professional, job satisfaction, Nigeria, tertiary hospital


How to cite this article:
Lasebikan O A, Ede O, Lasebikan N N, Anyaehie U E, Oguzie G C, Chukwujindu E D. Job satisfaction among health professionals in a federal tertiary hospital in Nigeria. Niger J Clin Pract 2020;23:371-5

How to cite this URL:
Lasebikan O A, Ede O, Lasebikan N N, Anyaehie U E, Oguzie G C, Chukwujindu E D. Job satisfaction among health professionals in a federal tertiary hospital in Nigeria. Niger J Clin Pract [serial online] 2020 [cited 2020 Apr 2];23:371-5. Available from: http://www.njcponline.com/text.asp?2020/23/3/371/280025




   Introduction Top


A healthcare professional is an individual who provides preventive, curative, promotional, or rehabilitative healthcare services in a systematic way to people, families, or communities. A healthcare professional may operate within the branches of healthcare including medicine, surgery, dentistry, midwifery, pharmacy, psychology, nursing, or allied health professions. They include a wide variety of human resources, trained to provide healthcare services, often working in hospitals, health centers, and other healthcare service delivery points.[1]

Health workers in a health institution are broadly divided into clinical and nonclinical staff. Clinical staff constitutes the health professionals often referred to as core clinical staff and they are broadly categorized into the medical and paramedical personnel. The medical staff is the medical doctor while the paramedical team comprises the nurses, pharmacists, laboratory scientists, physiotherapists, and other allied medical staff which varies with the services rendered by the health institution.

The efficiency of the health sector is dependent on teamwork by the various categories of professionals, of which the medical doctor serves as the head of the team. However, the satisfaction a health professional derives from doing their job goes a long way to determine their commitment to work. The workload in government/public hospitals, especially in a populous and resource-limited region, can be quite enormous, because the cost of treatment is subsidized by the government, to make it affordable for its citizens.

The government tertiary hospital also has the highest concentration of specialists in the various fields of medicine and therefore serves as a referral center for complex cases from other primary and secondary hospitals of both public and private domains. Besides, such institutions also double as training centers for various cadres of human resources in the health sector ranging from medical students to specialist doctors, as well as paramedical personnel. Therefore, the level of motivation of the health professionals enhances their ability to cope with the enormous workload and still offer quality service to the populace.

The impact of job satisfaction is very crucial to the quality of service delivery in the health institutions around the world because the level of satisfaction of an individual in his chosen career determines his commitment to service delivery. Mowday in his study observed that higher job satisfaction correlates with better employee performance and a higher level of patients' satisfaction.[2] The efficiency of the health sector depends to a large extent on how effectively human resources are utilized and motivated.

This study is expected to evaluate the level of job satisfaction among health professionals in the National Orthopedic Hospital, Enugu; a regional federal tertiary hospital in the south-eastern part of Nigeria for the management of trauma, orthopedics, burns, plastic and reconstructive surgical cases. The findings from this study will be significant in sensitizing the policymakers in the federal ministry of health and the management of the tertiary hospitals to understand the working conditions of health professionals, and to implement activities that will motivate the staff, towards quality healthcare service delivery.


   Methodology Top


The study was conducted amongst health professionals in National Orthopedic Hospital Enugu (NOHE). Ethical clearance was received from the hospital ethical committee and verbal informed consent was obtained from each participant. The hospital, as of 1st of January, 2016, had a total staff strength of 1069. The health professionals/Clinical staffs are 708 while the other support/nonclinical staffs are 361. The required sample size for this survey was calculated by the formula[3]:



Where Zα/2 = 1.96 at 95% confidence interval, P = proportion of target population which is 0.66 for the clinical staff, q = 1-p = 0.34, and E = accuracy which is set at 10%. This gave a minimum sample size of 87 people. However, we used a final sample size of 236 which represents a third of the population of the clinical staff. A systematic sampling technique was used within each department (stratum). Each member of staff was numbered, and every third person was selected for the interview. The total number chosen from each stratum is proportionate to the total staff number in the department. The different cadres of staff within each department were represented.

A questionnaire entitled “Level of health professional's job satisfaction in National Orthopedic Hospital” was used in collecting data for the study. The selected health professionals were required to indicate what they perceive as their level of satisfaction in the various areas of study. The questionnaire has two sections: Section A deals with the sociodemographic information of the respondents while Section B assessed the perception of the respondents' job satisfaction concerning different factors, based on the extract from the Minnesota Satisfaction Questionnaire (MSQ).

The factors measured are (a) compensation (financial remuneration) (b) working condition, tools and infrastructure (c) management style as regards welfare facilities (d) learning and training opportunities for career advancement (e) performance appraisal system of the hospital. On-the-spot administration and collection of the questionnaire were done. A four-point Likert scale was used, and the respondents/health professional were requested to tick the option that best matches their opinion in each question (a) strongly satisfied (SS) – 4 points (b) satisfied (S) – 3 points (c) dissatisfied (D) – 2 points (d) strongly dissatisfied (SD) – 1 point.

We calculated the mean score for each item. Any item with a mean value of less than 2.5 was regarded as dissatisfied. Any item with a mean value greater than 2.5 was considered as satisfied. While a mean value of 2.5 indicates neutrality, i.e. neither satisfied nor dissatisfied. Data were further analyzed by IBM SPSS Software Version 20. Chi-square was used to analyze the relationship between the different categories with different aspects of satisfaction. A P value of less than 0.05 was considered significant.


   Results Top


The response rate for this survey was 100%, probably due to the on-the-spot administration and collection of the questionnaire utilized in the study. The majority of the participants were females, 63.1% while the nursing service department had the highest frequency. The majority of the workers are within the age group of 30 to 39 years while most of the workers have been employed for less than 10 years. The majority of the workers have tertiary education with 26.3% of them having a postgraduate qualification. [Figure 1] shows the various departments interviewed in the study while [Table 1] summarizes the sociodemographics of the participants.
Figure 1: The various strata (departments) studied. The nursing service and health attendants having the highest number of staff strength were the most frequent. (Original)

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Table 1: The Sociodemographic variables of the participants

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The average health worker is generally unsatisfied with the financial remuneration (2.2), working conditions, tools and infrastructure (1.98), training opportunities and sponsorships (1.84) and leadership policy regarding welfare packages (1.46). However, they are generally satisfied with the performance appraisal system being practiced in the hospital (2.56). [Table 2] summarizes the response of the participants to the various items in the questionnaire.
Table 2: The response of the participants to the various items in the questionnaire. Values are expressed as percentages

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Lower-income earners, below ₦ 300,000 per month, are generally more dissatisfied with the level of financial remuneration than those earning above this amount, P < 0.001. However, the higher income earners were more disappointed with the working conditions, tools and infrastructure (P < 0.001), the leadership policy regarding welfare packages (P < 0.001), and training opportunities and sponsorships (P < 0.001). Performance appraisal systems showed a higher rate of satisfaction among the lower-income earners and staff with lower academic qualifications (lower than a tertiary degree), P < 0.001.


   Discussion Top


Many authors have defined job satisfaction in different ways. Hoppock defined job satisfaction as any combination of psychological, physiological, and environmental circumstances that lead a person to express satisfaction with their job.[4] Gilbert et al. defined the domain of job satisfaction as “all characteristics of the job itself and work environment which people find rewarding, fulfilling, and satisfying, or frustrating and unsatisfying”.[5] Similarly, Locke defined job satisfaction as a “pleasurable or positive emotional state resulting from the appraisal of one's job or job experiences”.[6] Although several factors influence job satisfaction, satisfaction with compensation in terms of financial remuneration has been found to strongly correlate with overall job satisfaction.[7],[8]

This study shows that despite the majority of workers, 64.9%, having a tertiary degree, most of them, 87%, earn less than ₦ 300,000 per month. Therefore, it is not surprising to find that the average staff of the hospital is dissatisfied with the financial remuneration, with a mean score of 2.2. Mohebbifar et al. observed that good wages ranked first among employee's viewpoints of motivational factors for quality healthcare service delivery in Iran University Medical Sciences, Tehran.[9] This implies that dissatisfaction with one's salary will automatically adversely affect the person's motivation to put in his best at the workplace, for quality healthcare service delivery. Yami et al. in his study identified human resources as a vital component in health services delivery.[10]

Therefore, the job satisfaction of health workers is highly crucial in building up employee motivation and efficiency. Mowday observed that higher job satisfaction determines better employee performance and a higher level of patients' satisfaction.[2] Interactions with some doctors and nurses have shown that monetary incentives primarily drive the current rate of emigration of health workers to other countries such as the United Kingdom, Canada, and the Middle East to seek greener pastures. It is believed that health workers in such climes are better remunerated and have better working conditions. Negussie as well documented poor remuneration was the most common reason for job dissatisfaction among nurses in a government teaching hospital in Ethiopia.[11]

Because the workload in government tertiary hospitals is quite enormous as they offer specialist healthcare services at subsidized rates and also serve as referral centers for specialist care for patients from private and government primary and secondary healthcare facilities, the level of financial remuneration should correspond to the workload. Barnes recognized the need to address the issue of realistic workload concerning salary, to increase the satisfaction of health professionals on their job, thereby improving healthcare provision.[12]

The average staff of NOHE was even more dissatisfied with the working conditions, tools, and infrastructure, with a mean score of 1.98 than with the level of dissatisfaction with the financial remuneration (2.2). The reason may be that the poor working conditions are experienced by all, with doctors and nurses inclusive, so the dilution effect seen in the satisfaction level with salaries by the doctors who earn more is not experienced here. Furthermore, this dissatisfaction is higher with high salary earners, especially with pay above ₦ 300,000. Mohebbifar et al. identified good working conditions, as the second motivational factor, next to good wages, from an employees' viewpoint.[9] However, comparative analysis of the categories of the profession with the level of satisfaction with work conditions, tools and infrastructure was not statistically significant (P value- 2.02).

Training and retraining are an essential part of modern-day medicine, so lack of support by the hospital management for this exercise can be discouraging. Harris and Burman in 2016, identified motivation and job satisfaction as a means of encouraging further training by nurses while time constraints and employer's discouragement were the critical inhibitors of nurses to return to school.[13] The bureaucratic limitation concerning further education in 49.3% of health workers is one of the prime reasons for job dissatisfaction in a specialized university hospital.[12] Comparative analysis of dissatisfaction with learning and training opportunities with major professions and salary was not significant, with a P value of 0.472 and 0.152, respectively.

The highest level of dissatisfaction was recorded concerning leadership policies as regards welfare, which cuts across all professions and has a mean score of 1.46. However, the management of NOHE has taken steps in this regard by organizing an end-of-year event during which recognition was given to the outstanding employees of the hospital, based on a recommendation after our study. Such activities undoubtedly will go a long way in improving workers' motivation and commitment as each person strives to get such recognition at similar future events.

The only area where participants expressed some level of satisfaction is with the performance appraisal level, as regards promotion with a mean score of 2.56. Negussie established a strong correlation between job advancement/promotion and job satisfaction in a study among nurses in a specialized university hospital.[11] Jaiswal et al. also identified rewards, as one of the motivational factors for all categories of staff in a tertiary care government hospital in India. Compensation in the form of promotion with attendant salary increase is the ultimate goal of a performance appraisal system.[14] However, this satisfaction with the appraisal system was found to be higher with the lower salary earners (P < 0.001).


   Conclusion Top


The level of job satisfaction among the hospital staff is low, and considering the uniformity of salary scale attainable in all federal government hospitals, it is probable that the low level of satisfaction among the health professionals in this study may be existent in other similar institutions. Such a situation has a far-reaching negative impact on healthcare service delivery. The performance appraisal vis-à-vis promotion remains the current morale booster.

Recommendations

Based on this study, we make the following recommendations:

  1. There should be a concerted effort on the part of the Government to review the financial remunerations of the hospital staff to be commensurate with the workload of the profession.
  2. The performance appraisal system as practiced should be maintained with regards to the regularity of promotion but should be improved upon with regards to the criteria for advancement based on diligence and exemplary service.
  3. The hospital management should improve its leadership policies to be in favor of staff welfare, to motivate them towards higher productivity. In addition to the end-of-year events and staff recognition, the recommencement of some old programs in the hospital such as payment of 13th-month salary should be considered.
  4. Management should strive to improve the working conditions, tools, and infrastructures in the hospital probably via public-private partnership initiatives in situ ations of limited Government funds provision.
  5. Finally, the management should encourage the staff through sponsorship of training, to acquire more knowledge, to enable them to render up-to-date healthcare services to the populace.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
https://en.m.wikipedia.org/wiki/Health_professional. [Last accessed on 2018 May 01].  Back to cited text no. 1
    
2.
Mowday RT. Strategies for adapting to a high rate of employee turnover. Hum Resour Manage J 1984;23:365-80.  Back to cited text no. 2
    
3.
Habib A, Johargy A, Mahmood K, Humma. Design and determination of the sample size in medical research. IOSR-JDMS 2014;13:21-31.  Back to cited text no. 3
    
4.
Hoppock R. Job Satisfaction. Harper and Brothers: New York; 1935. p. 47.  Back to cited text no. 4
    
5.
Churchill GA, Ford NM, Walker OC. Measuring the job satisfaction of industrial salesmen. J Mark Res 1974;11:254-60.  Back to cited text no. 5
    
6.
Timothy J, Ryan K. Job satisfaction: Subjective well being at work. In: Eid M, Larsen RJ, editors. The Science of Subjective Well-Being. New York: Guilford Press; 2008. p. 394.  Back to cited text no. 6
    
7.
Akshay R. Job satisfaction among healthcare employees: An empirical analysis. IJCBM 2014;3:526-32.  Back to cited text no. 7
    
8.
Leshabari MT, Muhondwa EP, Mwangu MA, Mbembati NA. Motivation of health care workers in Tanzania: A case study of Muhimbili national hospital. East Afr J Public Health 2008;5:32-7.  Back to cited text no. 8
    
9.
Mohebbifer R, Kiaei MZ, Khosravizadeh D, Mohseni M. Comparing the perspectives of managers and employees of teaching hospitals about Job motivation. Glob J Health Sci 2014;6:112-8.  Back to cited text no. 9
    
10.
Yami A, Hamza L, Hassen A, Jira C, Sudhakar M. Job satisfaction and its determinants among health workers in Jimma university specialized hospital, South West Ethiopia. Ethiopian J Health Sci 2011;21:19-27.  Back to cited text no. 10
    
11.
Negussie N. Job satisfaction of Nurses at Jimma University specialized teaching hospital, Ethiopia. J Egypt Public Health Assoc 2016;91:15-9.  Back to cited text no. 11
    
12.
Barnes DS. Job satisfaction and rehabilitation, professional administration and management. Q Am Occup Ther Assoc J 1998;14:1-2.  Back to cited text no. 12
    
13.
Harris PW, Burman ME. Nurses returning to school: Motivations, inhibitors and job satisfaction. J Prof Nurs 2016;32 85-93.  Back to cited text no. 13
    
14.
Jaiswal P, Singhai AK, Gadpayle AK, Sachdeva S, Padaria R. Level of motivation amongst health personnel working in a tertiary care government hospital of New Delhi, India. Indian J Community Med 2014;39:235-40.  Back to cited text no. 14
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