Job Satisfaction Among Public Sector Doctors and Nurses in India

In most countries, the efforts to attract and retain health workers have been focused on extrinsic measures of motivation, with very less focus on a better understanding of job satisfaction—an important intrinsic factor and construct. The main aim of this study was to assess job satisfaction, its seven dimensions, and motivation among health service providers (doctors and nurses) employed within the public sector in India. The study was conducted in three districts representing two states in India. The study participants represent the doctors and nurses from public health and service delivery centres. Data were collected from a total of 307 healthcare providers (152 doctors and 157 nurses).

‘Measure job satisfaction’ tool was adapted that contained 41 items capturing seven dimensions of job satisfaction on a five-point Likert scale with a higher score indicating a higher level of job satisfaction and vice versa. In addition, one single statement was used to assess motivation.

Average scores were calculated for each of the seven dimensions of job satisfaction, motivation and for overall job satisfaction. Parametric tests such as t-test and analysis of variance (ANOVA) were used for comparisons of job satisfaction scores according to the place of work, years of work experience, appointment type and health professional categories. The statistical analysis was carried out using SPSS version 22.0. Exploratory factor analysis was carried out to assess the relationship between job satisfaction and motivation and regression analysis of motivation was carried to assess predictors of job satisfaction, demographic and work-related factors’ effect on motivation.

The average scores for most of the dimensions of job satisfaction were low for both doctors and nurses with the lowest scores reported for the dimensions of ‘professional support’ and ‘personal satisfaction’ while the highest score reported for ‘satisfaction with pay’. Significant results in the difference of mean scores were found for all seven dimensions of job satisfaction except for ‘prospects’ at different levels of place of work, ‘standard of care’ at different levels of length of service and ‘training’ for different levels of types of appointment. The mean scores of motivation were found to be significantly different for different levels of place of work and also between the doctors and nurses. The regression analysis of motivation on various predictors of job satisfaction suggests that personal satisfaction and satisfaction in prospect were highly significant while other variables such as gender and place of posting were marginally significant. Understanding of job satisfaction can provide useful insights to both extrinsic as well as intrinsic aspects of work motivation, which arguably is the most critical area of health systems research that could potentially feed into streamlined and improved health workforce management policies aimed at addressing the shortage and retention of the health workforce.

Tangled pasts, healthier futures: Nursing strategies to improve American Indian/Alaska Native health equity

American Indian/Alaska Native (AI/AN) populations in the United States continue to experience overall health inequity, despite significant improvement in health status for nearly all other racial-ethnic groups over the past 30 years. Nurses comprise the bulk of healthcare providers in the U.S. and are in an optimal position to improve AI/AN health by transforming both nursing education and practice. This potential is dependent, however, on nurses' ability to recognize the distinct historical and political conditions through which AI/AN health inequities have been produced and sustained. Nurse providers, educators, and leaders must in turn recognize how the sustained conditions of marginalization and expropriation that underpin current AI/AN health inequities continue to shape contemporary AI/AN health outcomes. This manuscript builds upon the extant literature of AI/AN historical health policy and utilizes decolonial theorizations of nursing and a cultural safety framework to propose a series of immediately actionable steps for nursing intervention into AI/AN health inequity. Ultimately, we suggest that it is crucial for nurses to collaborate with AI/AN individuals and communities across educational and clinical settings to further refine these approaches in alignment with the disciplinary obligation of promoting social justice within healthcare.

Working well: a systematic scoping review of the Indigenous primary healthcare workforce development literature

BACKGROUND

Strong and effective workforce models are essential for improving comprehensive Indigenous primary healthcare service (PHC) provision to Indigenous peoples in Canada, Australia, New Zealand and the USA (CANZUS nations). This review systematically scoped the literature for studies that described or evaluated models and systems that support the sustainability, capacity or growth of the Indigenous PHC workforce to provide effective PHC provision.

METHODS

Eleven databases, 10 websites and clearinghouses, and the reference lists of 5 review articles were searched for relevant studies from CANZUS nations published in English from 2000 to 2017. A process of thematic analysis was utilised to identify key conditions, strategies and outcomes of Indigenous PHC workforce development reported in the literature.

RESULTS

Overall, 28 studies were found. Studies reported enabling conditions for workforce development as government funding and appropriate regulation, support and advocacy by professional organisations; community engagement; PHC leadership, supervision and support; and practitioner Indigeneity, motivation, power equality and wellbeing. Strategies focused on enhancing recruitment and retention; strengthening roles, capacity and teamwork; and improving supervision, mentoring and support. Only 12/28 studies were evaluations, and these studies were generally of weak quality. These studies reported impacts of improved workforce sustainability, workforce capacity, resourcing/growth and healthcare performance improvements.

CONCLUSIONS

PHCs can strengthen their workforce models by bringing together healthcare providers to consider how these strategies and enabling conditions can be improved to meet the healthcare and health needs of the local community. Improvement is also needed in the quality of evidence relating to particular strategies to guide practice.

Development and Psychometric Evaluation of a Community Program Capacity Scale for a Rural American Indian Tribe

BACKGROUND AND PURPOSE

Community-based participatory research (CBPR) is often preferred in partnerships between universities and American Indian tribes. Central to CBPR is a strong impetus for capacity building. Community capacity includes capabilities and infrastructures to provide a service(s).

METHODS

An American Indian community advisory board developed and tested an 11-item community capacity scale. A total of 128 tribal members or those who lived on the reservation completed the survey. Exploratory factor analysis assessed the factor structure and Cronbach's alpha estimated internal consistency.

RESULTS

A one-factor model demonstrated adequate model fit (comparative fit index [CFI] = .92, root mean square error of approximation [RMSEA] = .06, standardized root mean square residual [SRMR] = .07), and items were internally consistent (alpha = .79).

CONCLUSIONS

Survey development with academic and tribal partners was iterative, with time spent on partnership and consensus building, resulting in a psychometrically sound and culturally relevant community program capacity scale.

Factors supporting retention of aboriginal health and wellbeing staff in Aboriginal health services: a comprehensive review of the literature

INTRODUCTION

Aboriginal Health and Wellbeing staff are crucial for successful primary health care for Aboriginal communities. However, they are often affected by high rates of stress, burnout, and staff turn-over, which can impact primary health care delivery to Aboriginal peoples. The aim of this review was to identify organisational factors that help support the retention of Aboriginal Health and Wellbeing staff in Aboriginal Health services.

METHODS

A comprehensive literature review was undertaken. Eleven electronic databases were searched for papers published between 2002 and 2017 and supplemented by hand searching. Papers were included if they were in English, full text, peer-reviewed, and had a focus on retention of Aboriginal Health and Wellbeing staff, or health staff in comparable roles working in Aboriginal health services. Twenty-six papers were included in the final review.

RESULTS

Five key themes were identified as being important to the retention of Aboriginal Health and Wellbeing staff in Aboriginal Health Services: feeling culturally safe and secure within the workplace; teamwork and collaboration; supervision and strong managerial leadership and support from peers (to debrief, reflect, receive emotional support and strengthen coping mechanisms); professional development (the opportunity for skill development and role progression); and recognition (of work load, quality of work performed, being trusted to work autonomously, and financial remuneration that reflected the high pressure of the role).

CONCLUSION

Aboriginal Health and Wellbeing staff are fundamental to successful primary health care for Aboriginal peoples. State and Federal Governments should consider formalising recognition of the significant cultural knowledge that Aboriginal Health and Wellbeing staff bring to their roles. Formal recognition could also pave the way to revise remuneration as well as ensure adequate support mechanisms are put in place to improve retention and reduce stress and burnout affecting Aboriginal Health and Wellbeing staff.

Factors Affecting the Retention of Indigenous Australians in the Health Workforce: A Systematic Review

Indigenous Australians are under-represented in the health workforce. The shortfall in the Indigenous health workforce compounds the health disparities experienced by Indigenous Australians and places pressure on Indigenous health professionals. This systematic review aims to identify enablers and barriers to the retention of Indigenous Australians within the health workforce and to describe strategies to assist with development and retention of Indigenous health professionals after qualification. Four electronic databases were systematically searched in August 2017. Supplementary searches of relevant websites were also undertaken. Articles were screened for inclusion using pre-defined criteria and assessed for quality using the Mixed Methods Assessment Tool. Fifteen articles met the criteria for inclusion. Important factors affecting the retention of Indigenous health professionals included work environment, heavy workloads, poorly documented/understood roles and responsibilities, low salary and a perception of salary disparity, and the influence of community as both a strong personal motivator and source of stress when work/life boundaries could not be maintained. Evidence suggests that retention of Indigenous health professionals will be improved through building supportive and culturally safe workplaces; clearly documenting and communicating roles, scope of practice and responsibilities; and ensuring that employees are appropriately supported and remunerated. The absence of intervention studies highlights the need for deliberative interventions that rigorously evaluate all aspects of implementation of relevant workforce, health service policy, and practice change.

A CBPR Approach to Finding Community Strengths and Challenges to Prevent Youth Suicide and Substance Abuse

Purpose: To improve health and reduce health disparities, research partnerships with American Indian and Alaska Native communities should build on existing traditions and strengths. The overall goal of this pilot project was to clarify the needs of tribal community members and determine strengths and resources available to the community. Design: Community-based participatory research was the approach used to obtain community input. Data collection methods included, Photovoice ( n = 16), digital storytelling ( n = 4), and community capacity surveys ( n = 128). Results: Quantitative and qualitative findings supported the need to (1) address youth suicide and substance abuse on the reservation and (2) use preexisting resources available in the community. The results led to the development of a strengths-based intervention incorporating the Gathering of Native American’s curriculum. Conclusion: Integral to the development, implementation, and sustainability of the intervention was the truly reciprocal relationship developed between community and university partners.

Measuring the Success of a Pipeline Program to Increase Nursing Workforce Diversity

The purpose of this study was to understand changes in knowledge and opinions of underserved American Indian and Hispanic high school students after attending a 2-week summer pipeline program using and testing a pre/postsurvey. The research aims were to (a) psychometrically analyze the survey to determine if scale items could be summed to create a total scale score or subscale scores; (b) assess change in scores pre/postprogram; and (c) examine the survey to make suggestions for modifications and further testing to develop a valid tool to measure changes in student perceptions about going to college and nursing as a result of pipeline programs. Psychometric analysis indicated poor model fit for a 1-factor model for the total scale and majority of subscales. Nonparametric tests indicated statistically significant increases in 13 items and decreases in 2 items. Therefore, while total scores or subscale scores cannot be used to assess changes in perceptions from pre- to postprogram, the survey can be used to examine changes over time in each item. Student did not have an accurate view of nursing and college and underestimated support needed to attend college. However students realized that nursing was a profession with autonomy, respect, and honor.

Nursing and health sciences workforce diversity research using PhotoVoice: a college and high school student participatory project

This participatory study used PhotoVoice and qualitative description to (a) mentor baccalaureate nursing and college students in workforce diversity research; (b) explore barriers and facilitators encountered by rural American Indian, Hispanic, and other high school students when attending college and pursuing careers in nursing or the health sciences; and (c) model a process of social action to help existing and future students. Baccalaureate nursing and graduate students participated in all stages of research, including dissemination. Five themes emerged from analysis of PhotoVoice data: (a) being afraid; (b) believing; (c) taking small steps; (d) facing fears; and (e) using support systems. Findings underscore the importance of helping students participate in efforts to increase work-force diversity through research. Increasing nursing and health sciences workforce diversity may require strategies developed within and tailored to specific cultures and communities.