Comparing the job satisfaction and intention to leave of different categories of health workers in Tanzania, Malawi, and South Africa

Intention to leave the current health facility among healthcare workers in Ethiopia: Systematic review and meta-analysis

BACKGROUND

Strengthening workforce management to address retention challenges is worldwide concern. Ethiopia did different human resource reforms to improve retention and performance of available health workforce to step up towards universal health coverage. However, there is limited and fragmented research on intention to leave their current facility and related factors on health workers. This review was done to assess pooled national prevalence of intention to leave their current health facility and related factors among Ethiopian health workers.

METHODS

This systematic review and meta-analysis followed PRISMA guidelines. Authors prepared a review protocol per Joanna Briggs Institute (JBI) manual for evidence synthesis and got registered from PROSPERO for transparency. The authors conducted a comprehensive search of PubMed, Web of Science, Cochrane, Google Scholar and African Index Medicus databases and grey literature like WHO library from 8 June 2022 to 30 May 2023. Pooled prevalence of intention to leave current health facility and related factors was computed using MedCalk, Meta Essentials and R software. Publication bias was assessed using Egger's test and a funnel plot.

RESULTS

Pooled prevalence of intention to leave among health workers in Ethiopian healthcare setting was found to be 63.52% (95% CI (58.606-67.904)) for random effects model at Q = 141.5689 (I2(inconsistency) = 90.82%, P < 0.0001). Only organizational justice OR = 0.29 (0.14-0.61) was found to be a significantly associated factor for health workers' intention to leave their current healthcare setting in Ethiopia.

CONCLUSION

More than 6 in 10 of the health workers in Ethiopia were ready to leave their current healthcare facility. This result was higher than studies done in other parts of the world, even in African countries. The associated factor for health workers' intention to leave their current health facility was only organizational justice. So, health authorities should improve their organizational justice to retain their employees.

Turnover intention and its associated factors among nurses in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Nurses turnover intention, representing the extent to which nurses express a desire to leave their current positions, is a critical global public health challenge. This issue significantly affects the healthcare workforce, contributing to disruptions in healthcare delivery and organizational stability. In Ethiopia, a country facing its own unique set of healthcare challenges, understanding and mitigating nursing turnover are of paramount importance. Hence, the objectives of this systematic review and meta-analysis were to determine the pooled proportion ofturnover intention among nurses and to identify factors associated to it in Ethiopia.

METHODS

A comprehensive search carried out for studies with full document and written in English language through an electronic web-based search strategy from databases including PubMed, CINAHL, Cochrane Library, Embase, Google Scholar and Ethiopian University Repository online. Checklist from the Joanna Briggs Institute (JBI) was used to assess the studies' quality. STATA version 17 software was used for statistical analyses. Meta-analysis was done using a random-effects method. Heterogeneity between the primary studies was assessed by Cochran Q and I-square tests. Subgroup and sensitivity analyses were carried out to clarify the source of heterogeneity.

RESULT

This systematic review and meta-analysis incorporated 8 articles, involving 3033 nurses in the analysis. The pooled proportion of turnover intention among nurses in Ethiopia was 53.35% (95% CI (41.64, 65.05%)), with significant heterogeneity between studies (I2 = 97.9, P = 0.001). Significant association of turnover intention among nurses was found with autonomous decision-making (OR: 0.28, CI: 0.14, 0.70) and promotion/development (OR: 0.67, C.I: 0.46, 0.89).

CONCLUSION AND RECOMMENDATION

Our meta-analysis on turnover intention among Ethiopian nurses highlights a significant challenge, with a pooled proportion of 53.35%. Regional variations, such as the highest turnover in Addis Ababa and the lowest in Sidama, underscore the need for tailored interventions. The findings reveal a strong link between turnover intention and factors like autonomous decision-making and promotion/development. Recommendations for stakeholders and concerned bodies involve formulating targeted retention strategies, addressing regional variations, collaborating for nurse welfare advocacy, prioritizing career advancement, reviewing policies for nurse retention improvement.

Intention to leave and associated factors among health professionals working at public hospitals in East Gojjam zone, Northwest Ethiopia, cross-sectional study

BACKGROUND

The most important element of health systems for meeting the population's healthcare demands is the workforce. The main issue facing the health industry, particularly in emerging nations, has been their shortage and turnover. Thus, the purpose of this study was to assess the intention of leaving and related variables among medical professionals employed at East Gojjam zone public health hospitals.

METHODS

An institution based cross-sectional study was conducted among 561 randomly selected health professionals working at public hospitals in East Gojjam Zone from 04 March 2019 to 30 March 2019. Self-administered structured questionnaire was used for data collection. Both bi-variable and multivariable logistic regression analysis were fitted. Variables having P-value less than 0.2 during bi-variable regressional analysis were entered in to multivariable logistic regression analysis and Adjusted Odds Ratio (AOR) with 95% confidence interval (CI) was used to declare the associated factors with intention to leave.

RESULTS

Overall, 61.3% (95% CI: 57.2, 65.4) of health professionals were intended to leave their working organizations. Dissatisfaction with work nature (AOR: 3.01; 95% CI: 2.05, 4.43), work environment (AOR: 1.83, 95% CI: 1.25, 2.68), Remuneration (AOR: 1.89; 95% CI: 1.29, 2.76), having low normative commitment (AOR: 0.55; 95% CI: 0.38, 0.81) and being unmarried (AOR: 1.78; 95% CI: 1.23, 2.58) were satistically significant factors with intention to leave their working organizations.

CONCLUSIONS

The health professionals' intention to leave their working organizations was high, three-fifth of the health professionals had intention to leave their organization which might result great service quality compromization and decrease the responsiveness of the health institutions in the study area. Dissatisfaction with remuneration, working environment, work nature, low normative commitment and being unmarried were factors associated with health professional's intention to leave their working organizations. Therefore, hospital administrators, supervisors, and Healthcare policymakers need to emphasize on retention of health workers at their working organization by taking into account the above significant variables. Such as, through creating an attractive working environment and designing better benefit mechanisms.

Mixed method evaluation of a learning from excellence programme for community health workers in Neno, Malawi

BACKGROUND

Community Health Workers (CHWs) play an essential role in linking communities to facility-based healthcare. However, CHW programmes have often been hampered by low levels of staff motivation, and new tools aimed at improving staff motivation and work environment are needed. One such intervention is the "Learning from Excellence" (LfE) programme. We aimed to assess feasibility, outputs, and impact of a co-designed LfE programme on CHW motivation, in Neno District.

METHODS

We conducted a convergent mixed-method evaluation of the LfE programme. Co-design of the programme and forms took place between October 2019 and January 2020. LfE forms submitted between September and November 2020 were analysed using descriptive statistics and memos summarising answers to the open-ended question. To investigate experiences with LfE we conducted in-depth semi-structured interviews with key stakeholders, CHWs, and site supervisors, which were analysed thematically. A pre-post intervention questionnaire was developed to assess the impact of the co-designed LfE intervention on CHW motivation and perceived supervision. Outcomes were triangulated into a logic model.

RESULTS

In total 555 LfE forms were submitted, with 34.4% of CHWs in Neno District submitting at least one LfE report. Four themes were identified in the interviews: LfE implementation processes, experience, consequences, and recommendations. A total of 50 CHWs participated in the questionnaire in January 2020 and 46 of them completed the questionnaire in December 2020. No statistically significant differences were identified between pre-and post-LfE measurements for both motivation (Site F: p = 0.86; Site G: p = 0.31) and perceived supervision (Site F: p = 0.95; Site G: p = 0.45). A logic model, explaining how the LfE programme could impact CHWs was developed.

CONCLUSIONS

Many CHWs participated in the LfE intervention between September 2020 and November 2020. LfE was welcomed by CHWs and stakeholders as it allowed them to appreciate excellent work in absence of other opportunities to do so. However, no statistically significant differences in CHW motivation and perceived supervision were identified. While the intervention was feasible in Neno District, we identified several barriers and facilitators for implementation. We developed a logic model to explain contextual factors, and mechanisms that could lead to LfE outcomes for CHWs in Neno District. The developed logic model can be used by those designing and implementing interventions like LfE for health workers.

Health extension workers' level of job satisfaction in western Hararghe Zone, eastern Ethiopia: an institutional-based cross-sectional study

Background

There is a concern that job dissatisfaction among health extension workers (HEWs) reduces the benefit of investment in the execution of health extension programs. Hence, the purpose of this study was to explore the level of job satisfaction and factors affecting it among the HEWs in the West Hararghe Zone, Oromia Regional State, eastern Ethiopia.

Method

An institutional-based cross-sectional study was conducted among 416 randomly selected health extension workers from 20 September 2020 to 20 October 2020. A pretested, structured questionnaire was used to collect the data. STATA 14.2 was used for data analysis. Bivariable and multivariable binary logistic regression analyses were also performed. Statistical significance was set at P < 0.05.

Results

The overall level of satisfaction of health extension workers was 51.8% [95% confidence interval (CI): 46.97%, 56.6%]. Earning more than 5,260 ETB as salary [adjusted odds ratio (AOR) = 1.69, 95% CI: 1.01, 2.85], working more than 10 km from the district town (AOR = 1.59, 95% CI: 1.01, 2.53), receiving supportive supervision (AOR = 1.64, 95% CI: 1.06, 2.55), and not living with parents (AOR = 1.94, 95% CI: 1.24, 3.04) were significantly associated factors with HEW job satisfaction.

Conclusion

Nearly half of the health extension workers were dissatisfied with their jobs. Supportive supervision, compensation, distance, and parental home location were all predictors of job satisfaction. It is critical to establish intervention tactics that may satisfy and motivate HEWs to expand health coverage, strengthen health extension programs, and improve service delivery.

The mediating effect of job satisfaction and emotional exhaustion on the relationship between psychological empowerment and turnover intention among Chinese nurses during the COVID-19 pandemic: a cross-sectional study

BACKGROUND

Turnover intention occurs frequently in nurses and psychological empowerment has been shown to be major factors that influence turnover intention. However, little is known about the driving force behind turnover intention among nurses in China during the COVID-19 pandemic.

OBJECTIVES

To investigate the mediating role of job satisfaction and emotional exhaustion on the association between psychological empowerment and turnover intention among Chinese nurses during the COVID-19 pandemic.

METHODS

A cross-sectional design was conducted in China. A total of 507 nurses completed scales of psychological empowerment, job satisfaction, emotional exhaustion and turnover intention anonymously. Descriptive analysis, Pearson's correlation analysis in SPSS 23.0 and structural equation modeling (SEM) by Mplus 7.4 RESULTS: Psychological empowerment had a significantly effect on turnover intention through three significantly indirect pathways: (1) through job satisfaction (B = -0.14, SE = .03, 95% CI = [-.19, -.09]). (2) through emotional exhaustion (B = -0.07, SE = .02, 95% CI = [-.11, -.03]). (3) through the chain mediating effect of "job satisfaction → emotional exhaustion" (B = -0.12, SE = .02, 95% CI = [-.16, -.09]).

CONCLUSIONS

Intervention measures to reduce the incidence of turnover intention of nurses should include the evaluations of work demands and emotional exhaustion of nurses and organization's management strategies to promote their psychological empowerment and job satisfaction.

Job satisfaction among rehabilitation professionals employed in public health facilities in KwaZulu-Natal

Background

Job satisfaction is essential in stimulating productivity and efficiency in the health sector. Dissatisfied employees are likely to leave, which places an added burden considering the shortage of health workers. Rehabilitation professionals form a critical component of the public health workforce.

Objective

The aim of the study was to document the level of job satisfaction and factors associated with job satisfaction among rehabilitation professionals employed in public health facilities in KwaZulu-Natal.

Methods

A cross-sectional survey was conducted. A self-administered questionnaire was utilized. A Chi-square test and logistic regression were used to assess associations and to identify factors associated with job satisfaction. A p-value less than 0.05 was deemed statistically significant.

Results

Most participants (59%) reported a low level of overall job satisfaction. The participants were dissatisfied about not getting recognition for work related to their specific professions (61.3 %) and not being considered for career advancement (74.3 %). In addition, inadequate financial rewards (87.2%) and benefits (71.3%) were also linked to low job satisfaction.

Conclusion

Participants displayed a low level of job satisfaction. Rehabilitation services should be prioritized, and appropriate recognition should be granted to rehabilitation professionals in order to enhance job satisfaction.

Organisational commitment, job satisfaction and intention to leave among physicians in the public health sector of Cyprus: a cross-sectional survey

OBJECTIVES

Organisational commitment, job satisfaction and intention to leave constitute important characteristics of health professionals' employment status. Our study aimed at investigating the level of organisational commitment, job satisfaction in association with intention to leave among physicians.

DESIGN

A cross-sectional study.

SETTING

A survey was conducted using self-administered questionnaires (the Organizational Commitment Questionnaire and the Job Satisfaction Survey) among all physicians working in the public health sector of Cyprus (October 2016-January 2017).

PARTICIPANTS

Out of 690 physicians working in the public health sector who received an invitation to participate, 511 completed the survey and 9 were excluded. Therefore, 502 physicians were included in the final analysis (response rate 73%). A total of 188 cases were excluded because they were undetermined with respect to their intention to leave and a total of 75 cases were excluded from the regression analysis due to missing values on at least one variable or due to having values considered as outliers. Therefore, a total of 239 physicians (120 men and 119 women) were included in the current analysis.

PRIMARY AND SECONDARY OUTCOME MEASURES

Physicians' intention to leave.

RESULTS

A considerably large percentage of physicians (72.8%) working in the public hospitals and healthcare centres of Cyprus reported their intention to leave their job. Moreover, the majority of employees in public hospitals (78.4%) intended to leave their job, while only 21.6% of employees in health centres reported an intention to leave (p<0.001). The study also confirmed that organisational commitment and job satisfaction were negatively correlated with intention to leave. In addition, the results of this study demonstrate that certain demographics also influence physicians' intention to leave including age, gender and medical specialisation.

CONCLUSIONS

Certain physicians' demographics, organisational commitment and job satisfaction constitute important parameters influencing physicians' intention to leave their job.

Job satisfaction among health professionals in a District of North West province, South Africa

Background

Job satisfaction has become an area of relevance and debate in public health as it is directly linked to staff absenteeism, retention and turnover of the workforce and as such, influences the organisational commitment of the workers and the quality of health services provided. It is therefore essential to discern what drives healthcare professionals to remain working in the public health sector.

Aim

This study aimed to determine job satisfaction and its associated factors among healthcare professionals.

Setting

North-West province South Africa.

Methods

A cross-sectional study was conducted among 244 healthcare professionals of different categories in three district hospitals. A self-administered structured questionnaire with 38 questions to measure job satisfaction was used to collect data. The chi-square test was used to compare groups, and a p-value < 0.05 was considered statistically significant.

Results

Overall, 62% of the participants were not satisfied with their job. The most common factors that participants were not satisfied with include job security (52%), standard of care (57%), opportunity to develop (59%), payment or wages (76%), workload (78%) and working environment (89%). Job satisfaction was significantly influenced by age, job category and years of service.

Conclusions

The predictors of job satisfaction include age, category of employees and years of service. Interventions are required to improve the degree of job satisfaction among health care professionals.

Contribution

Findings of this study will assist informing plans that are geared towards enhancing healthcare worker job satisfaction, retention and consequent health systems strengthening.

Level of job satisfaction and associated factors among rural health extension workers in Hadiya Zone, Southern Ethiopia

BACKGROUND

The improvement of various health outcomes, including the reduction of maternal, neonatal, infant, and child mortality as well as the increased use of maternity and newborn health services, was significantly assisted by rural health extension workers. Implementing health extension programs and offering the community high-quality healthcare services requires job satisfaction. In the study area, there has been little research on job satisfaction and related variables. Therefore, the purpose of this study was to evaluate the degree of job satisfaction among rural health extension workers in the Hadiya zone, Southern Ethiopia, as well as associated factors.

METHODS

A facility-based cross-sectional study was conducted among 262 rural health extension workers from May 30, 2021, to July 02, 2021. A simple random sampling method was used to select six rural districts. Data were gathered utilizing structured interviewer-administered questions and skilled data collectors. EpiData V4.4.1 was used to store the data, and SPSS Version 25 was used for analysis. To determine the relationship between the variables, bivariate and multivariate logistic regressions were used. The association was reported using the adjusted odds ratio (AOR) with a 95% confidence interval (95%CI), and the significance level was set at a p-value of 0.05.

RESULTS

This study showed that 52.7% of rural health extension workers were satisfied with their jobs. Support from Keble leaders [AOR = 5.3; 95% CI (2.6, 11.1)], on-job training [AOR = 5.7, 95% CI (2.2, 14.9)], supportive supervision [AOR = 4.3; 95% CI (1.7, 10.8)] and reward or recognition [AOR = 7.4, 95% CI (3.0, 18.1)] were factors that associated with job satisfaction of health extension workers.

CONCLUSION

According to this study, more than half of rural health extension workers were happy with their jobs. Health extension workers' job satisfaction was affected by support from keble leaders, supportive supervision, on-the-job training, and recognition and rewards. In order to increase the happiness of the health extension workers, supporting supervision must be strengthened and the best performers must be recognized.

Engaging physicians and nurses in balanced scorecard evaluation-An implication at Palestinian hospitals and recommendations for policy makers

Introduction

Healthcare workers (HCWs) are seldom involved in balanced scorecard (BSC) deployments. This study aims to incorporate Palestinian HCWs in the BSC to create health policy recommendations and action plans using BSC-HCW1, a survey designed and validated based on BSC dimensions.

Methodology

In this cross-sectional study, the BSC-HCW1 survey was delivered to HCWs in 14 hospitals from January to October 2021 to get them involved in PE. The differences between physicians' and nurses' evaluations were assessed by the Mann-Whitney U-test. The causal relationships between factors were analyzed using multiple linear regression. The multicollinearity of the model was checked. Path analysis was performed to understand the BSC strategic maps based on the Palestinian HCWs' evaluations.

Results

Out of 800 surveys, 454 (57%) were retrieved. No evaluation differences between physicians and nurses were found. The BSC-HCW1 model explains 22-35% of HCW loyalty attitudes, managerial trust, and perceived patient trust and respect. HCWs' workload time-life balance, quality and development initiatives, and managerial performance evaluation have a direct effect on improving HCWs' loyalty attitudes (β = 0.272, P < 0.001; β = 0.231, P < 0.001; β = 0.199, P < 0.001, respectively). HCWs' engagement, managerial performance evaluation, and loyalty attitudes have a direct effect on enhancing HCWs' respect toward managers (β = 0.260, P < 0.001; β = 0.191, P = 0.001; β = 0.135, P = 0.010, respectively). Quality and development initiatives, HCWs' loyalty attitudes, and workload time-life balance had a direct effect on improving perceived patient respect toward HCWs (β = 254, P < 0.001; β = 0.137, P = 0.006, β = 0.137, P = 0.006, respectively).

Conclusion

This research shows that it is important to improve low-performing indicators, such as the duration of time HCWs spend with patients, their knowledge of medications and diseases, the quality of hospital equipment and maintenance, and the inclusion of strengths and weaknesses in HCWs' evaluations, so that HCWs are more loyal and less likely to want to leave. For Palestinian hospital managers to be respected more, they must include HCWs in their action plans and explain their evaluation criteria. Patients will respect Palestinian HCWs more if they prioritize their education and work quality, spend more time with patients, and reflect more loyalty. The results can be generalized since it encompassed 30% of Palestinian hospitals from all categories.

Intention to leave the profession and related factors in nurses: A cross-sectional study in Kermanshah, Iran

AIM

To investigate the intention to leave the profession and its related factors among nurses in Kermanshah, western Iran.

DESIGN

Cross-sectional study.

METHODS

A total of 377 nurses were enrolled in a stratified random sampling method. Data were collected by the Anticipated Turnover Scale and a sociodemographic information form. and analysed by descriptive and inferential statistics (logistic regression analysis).

RESULTS

The results showed that 49.6% (n = 187) of nurses tended to leave the profession and the mean score of intention to leave was 36.6 ± 0.5 of 60. There were no statistically significant differences between nurses who intended to leave and those who did not in terms of age, marital status, gender, type of employment, type of shift and work experience. But a statistically significant association was found between workplace (p = 0.041, adjusted OR = 2.07) and job title (p = 0.016, adjusted OR = 0.58) and intention to leave the profession.

PATIENT OR PUBLIC CONTRIBUTION

No.

Job Burnout and Job Satisfaction among Healthcare Service Providers in a Daycare Center for Individuals with Autism Spectrum Disorders in Low-Resource Settings

Job satisfaction and burnout are components of job morale. In general, and among healthcare provider personnel, these are psychological factors of the job and under the influence of different conditions and the organizational management of the healthcare systems. Both job burnout and job satisfaction among healthcare service providers have received scant attention in the literature, particularly in the healthcare systems of the Kurdistan Region of Iraq (KRI) as one low- or middle-income country (LMIC). The burnout rate and job satisfaction in a daycare center for children with autism spectrum disorders were reviewed and measured using a sample consisting of 34 employees from three different sections. The Maslach Burnout Inventory-Third Edition (MBI-3) and the Job Descriptive Index (JDI) were used. The relationships between the two scales and their consisting factors were examined using Pearson Correlation and Chi-square test to understand the correlation and levels of significant difference between the expected and the observed frequencies. There was a significant negative correlation between job burnout and satisfaction with the job and some significant correlations between the factors of the scales. Lower levels of emotional exhaustion and depersonalization factors of the burnout scale were statistically correlated. It was shown that the personnel were mainly satisfied with their jobs through their choices in the four parts of the job satisfaction scale. Further investigations are needed to understand different contributing factors to job satisfaction and burnout among healthcare providers in KRI. The current study might highlight the importance of understanding the healthcare providers' perspectives on their careers.

Impact of Patient Safety Culture on Job Satisfaction and Intention to Leave Among Healthcare Workers: Evidence from Middle East Context

Background

The association between patient safety culture and staff outcomes remains unclear to date. This study aimed to identify the relationship between patient safety culture/job satisfaction and intention to leave among healthcare workers.

Methods

A cross-sectional study was conducted using an online survey. Multinomial logistic regression analysis was used to investigate the association between the safety culture dimensions and the outcomes in terms of job satisfaction and intention to leave.

Results

Majority were females (77.2%); age between (20-30) years were (66.1%). 1-5 years work experience was reported by (98.2%); nurses accounted for (75.7%). (62.1%) reported very good patient safety grade. (78.3%) of respondents had no intention to leave; (84.3%) reported they like their job, (70.5%) stated that working in this hospital is like being part of a large family. However, (38%) said the hospital is not a good place to work, and morale in their clinical area is low. The overall composite scores were highest for "teamwork within hospital units (81.4)", and "organizational learning (79.4)", while lowest for "communication openness (37)",staffing (26.5)", and "non-punitive response to error (22.1)". Females were two times more likely to leave their jobs compared to males (AOR: 2.36, 95% CI: 1.24-3.46); intention to leave was 3.35 (95% CI = 2.19-5.09). As for job satisfaction, ages between 31-40 years tend to like their job two times more than other age groups (AOR: 1.90, 95% CI = 1.02-3.55). The safety culture domains "staffing" and "hospital management support for patient safety" were linked to a higher odds ratio for job satisfaction.

Conclusion

Aside from gender and age, the dimensions of safety culture, including staffing, hospital management support, hospital handover, and transition, may have a signification impact on job satisfaction and intention to leave among healthcare workers.

Relationships between job satisfaction, organizational commitment, burnout and job performance of healthcare professionals in a district-level health care system of Shenzhen, China

BACKGROUND

Existing research indicates that job satisfaction has effects on job performance, but little evidence exists about the mechanism through which the satisfaction-performance association operates. This study aims to examine the effect of job satisfaction on job performance in a district-level health care system of China and to explore the effect mechanism mediated by organizational commitment and burnout.

METHODS

Cluster sampling was used in this study. All healthcare professionals in the Nanshan Medical Group, who were at work in the last 3 months and able to complete online questionnaire independently were invited to participate the anonymous online survey. Job satisfaction, organizational commitment, burnout and job performance were measured by tools, which have been validated in China. Descriptive statistics were used for the socio-demographic variables and the four job psychological variables. Pearson correlation coefficients was used to determine associations among each of the psychological variables. Linear regression was used to examine association between job performance and other three psychological variables. PROCESS macro was used to examine the mediation effects of organizational commitment and burnout on the association between job satisfaction and performance.

RESULTS

In total, 1,200 healthcare professionals completed the anonymous online survey. Job satisfaction, organizational commitment, and job performance were positively correlated with one another, with burnout negatively correlated with them. Linear regression revealed that demographic characteristics, job satisfaction, organizational commitment, and burnout explained 5, 6, 2, and 9% of the variance in job performance. Path analysis showed that the coefficient of the direct effect of job satisfaction on job performance was 0.18, the coefficients of the indirect effects of job satisfaction on job performance through organizational commitment and burnout were 0.17 and 0.37, respectively. The coefficients of the indirect effects of organizational commitment on job performance through burnout was -0.04, but it was not significant.

CONCLUSION

It is promising to improve job performance of providers in Chinese healthcare systems by improving job satisfaction and reducing burnout. Tailored support policies for female healthcare professionals, appropriate incentive mechanisms and improving multidisciplinary healthcare delivery are potential to improve job performance of healthcare professionals in integrated healthcare systems.

Investigating the Relationship between Job Burnout and Job Satisfaction among Chinese Generalist Teachers in Rural Primary Schools: A Serial Mediation Model

BACKGROUND

Job burnout has become a widespread phenomenon in school settings. However, little is known about the mental health condition of the growing cohort of generalist teachers in rural primary schools. Drawing on the job demands-resource model and social exchange theory, this study examines the correlation between job burnout and job satisfaction through perceived organizational support and work engagement.

METHODS

We recruited 639 Chinese generalist teachers in rural primary schools as the study subjects and developed a serial mediation model to assess the hypothesized construct. The data acquired online via Wenjuanxing Software were confirmed as valid and analyzed with SPSS and SmartPLS.

RESULTS

The participants scored above the median in perceived organizational support, work engagement, and job satisfaction, and had scores close to the median for job burnout. Statistically significant differences among the investigated variables were found in gender, age, experience, and degree. Job burnout was negatively predictive of perceived organizational support, work engagement, and job satisfaction (each p = 0.000). Perceived organizational support mediated the association between job burnout and work engagement (p = 0.000) and the connection between job burnout and job satisfaction (p = 0.000), while work engagement mediated the association between job burnout and job satisfaction (p = 0.000) and the association between perceived organizational support and job satisfaction (p = 0.000).

CONCLUSIONS

Perceived organizational support and work engagement as two sequential mediators buffered the detrimental impact of job burnout on job satisfaction among Chinese generalist teachers in rural primary schools. Targeted strategies should be implemented to diminish generalist teachers' feelings of burnout, being unsupported by organizations, disengagement at work, and dissatisfaction with the job.

Prevalence and pattern of migration intention of doctors undergoing training programmes in public tertiary hospitals in Ekiti State, Nigeria

BACKGROUND

Emigration of Nigerian doctors, including those undergoing training, to the developed countries in Europe and Americas has reached an alarming rate.

OBJECTIVE

This study aimed at assessing the prevalence, pattern, and determinants of migration intention among doctors undergoing residency and internship training programmes in the public tertiary hospitals in Ekiti state, Nigeria.

METHODS

This was a cross-sectional study using a quantitative data collected from 182 doctors undergoing residency and internship training at the two tertiary hospitals. An adapted semi-structured questionnaire was used to collect information on migration intention among the eligible respondents. Univariate, bivariate and multivariate data analyses were done. The level of significance was determined at p-value < 0.05.

RESULTS

Majority (53.9%) of doctors undergoing training were between 30-39 years, and the mean age was 33.2 ± 5.7 years, male respondents were 68.1%, and 53.8% of the respondents were married. The proportion of doctors undergoing training who had the intention to migrate abroad to practice was 74.2%. A higher proportion of the internship trainees, 79.5%, intended to migrate abroad to practice while the proportion among the resident doctors, was 70.6%. Among the respondents who intended to migrate abroad to practice, 85(63%) intend to migrate abroad within the next 2 years, while the preferred countries of destination were the United Kingdom 65(48.2%), Canada 29 (21.5%), Australia 20 (14.8%) and the United States 18(13.3%). Seventy percent of respondents who intend to migrate abroad had started working on implementation of their intention to migrate abroad. The majority of the junior resident doctors, 56(72.7%), intend to migrate abroad compared with the senior resident doctors, 21(27.3%), (χ² = 14.039; p < 0.001). The determinants of migration intention are the stage of residency training and level of job satisfaction.

CONCLUSION

There is a high prevalence of migration intention among the doctors undergoing training in the public tertiary hospitals in Ekiti State, Nigeria, with the majority already working on their plans to migrate abroad. Doctors undergoing training who are satisfied with their job and those who are in the senior stage of residency training programme are less inclined to migrate abroad.

RECOMMENDATIONS

The hospital management in the tertiary hospitals should develop retention strategies for human resources for health, especially doctors undergoing training in their establishment, to avert the possible problems of dearth of specialists in the tertiary health facilities. Also, necessary support should be provided for the residency training programme in the tertiary health institutions to make transition from junior to senior residency stage less strenuous.

Factors motivating intent to leave amongst radiographers employed by public tertiary hospitals in the Gauteng Province, South Africa

Background

The elements of job satisfaction can be categorized into intrinsic and extrinsic factors. The presence of a higher level of intrinsic factors will result in increased motivation amongst employees, whilst extrinsic factors will result in job dissatisfaction. Decreased job satisfaction levels amongst healthcare professionals are known to create an intent to leave. Hence the need to explore these factors amongst radiographers employed by tertiary hospitals in the Gauteng province of South Africa.

Objective

To determine the influence of intrinsic and extrinsic factors of job satisfaction on intent to leave amongst radiographers employed by public tertiary hospitals in the Gauteng province.

Methods

A quantitative cross-sectional survey guided the study, and a self-administered questionnaire was used to collect data. The sampling technique used for this study was disproportional stratified sampling.

Results

The study had a response rate of 62%. A significant number of the participants (50%) were between the ages of 21-33 years. Also, worth noting that 51% of the participants were newly qualified, 28% were employed for a period of 10-20 years and only 20% were employed for a period greater than 20 years. Diagnostic radiography had the most number of participants at 55%, followed by radiation therapist at 24%, nuclear medicine radiographers at 13%, mammography radiographers at 5% and only 3% were sonographers. Pearson's correlation showed a significant negative correlation with the following extrinsic factors: supervision, r= -.344, p=.000; satisfaction with PMDS, r=-.302, p=.000; human resources processes, r=-.249, p=.001; infrastructure, r=-.236, p=.001; the OSD policy, r=-.233, p=.002; satisfaction with remuneration, r=-.202, p=.006; satisfaction with CPD activities, r=-.201, p=.007; and satisfaction with equipment, r=-.163, p=.029.

Conclusion

Both intrinsic and extrinsic factors are associated with an intent to leave amongst radiographers employed by public tertiary hospitals in the Gauteng province.

Association between Burnout, Job Dissatisfaction and Intention to Leave among Medical Researchers in a Research Organisation in Malaysia during the COVID-19 Pandemic

Employee turnover could affect the organisation's performance. Job dissatisfaction and burnout have been identified as factors influencing the intention to leave. Thus, this study aimed to determine the level of intent to leave, and predictors associated with intention to leave among medical researchers in Malaysia. A cross-sectional, stratified random sampling study was conducted among researchers in a research organisation under the Ministry of Health. Respondents answered an online questionnaire that included sociodemographic information, job dissatisfaction, burnout, and intention to leave. A total of 133 researchers participated. More than one-third (41.4%) of the researchers had a moderate and high level of intention to leave. Burnout and job dissatisfaction were identified as significant predictors. Burnout was noted to have a positive relationship with the intent to leave (β = 0.289, 95% CI (B): 0.287, 1.096). Meanwhile, job satisfaction was found to have a negative relationship with the intention to leave (β = -0.348, 95% CI (B): -0.768, -0.273). Burnout among researchers is quite worrisome as more than two-thirds of the researchers experienced moderate to high burnout. Reducing burnout and job dissatisfaction would increase work performance and produce high-quality research output, hence decreasing the turnover rate.

Linking health worker motivation with their stated job preferences: A hybrid choice analysis in Ethiopia

Understanding health worker job preferences can help policymakers better align incentives to retain a motivated workforce in the public sector. However, in stated preference choice modelling, health worker motivation to do their jobs has not been incorporated, perhaps surprisingly, as an important antecedent to health worker job choices. This paper is the first application of a hybrid choice model to measure the extent to which variations in the job preferences of community health workers (CHWs) can be explained by multidimensional motivation. We interviewed 202 CHWs in Ethiopia in 2019. Motivation was assessed quantitatively using a series of thirty questions, on a five-point Likert scale. Stated preferences for hypothetical jobs were captured using an unlabelled discrete choice experiment. We estimated three models and explored which best fitted choice data. We found that the hybrid choice model fitted better than simpler choice models and provides additional behavioural insight into the preferences of CHWs. Intrinsically motivated CHWs had strong disutility towards a higher than average salary, but preferred good facility quality and good health outcomes. On the contrary, CHWs who were assessed to be extrinsically motivated had disutility attached to a heavy workload and preferred higher than average salaries. We show a link between heterogeneity in the job preferences of CHWs and their motivation, demonstrating that its important for policy makers and managers to understand this link in order to get health workers to exert more effort in return for the right incentives and to retain a motivated workforce in the long run.

Work Motivation of Primary Health Workers in China: The Translation of a Measurement Scale and Its Correlation with Turnover Intention

Background

High turnover intention, as a manifestation of low work motivation, is a crucial barrier to strengthening primary health systems worldwide, including in China. Targeting those being less motivated will be a realistic choice to retain primary health workers. This study translate, adapt, and validate the Work Motivation Scale for Health Workers (WMSHW) scale to directly measure and rate health workers' motivation composition based on Self-Determination Theory, and assessed how health workers with different levels of motivation being associated with the turnover intention.

Methods

The process of translation and cross-cultural adaptation followed the recommendations of international guidelines. Participants include 1341 health workers within 75 primary health institutions from 6 provinces in China. The reliability and validity of the scale was analyzed. Cluster analysis in a person-centered approach and logistic regression analysis was used to understand how different combinations of motivations related to intention to leave.

Results

Confirmatory factor analysis indicated that the modified five-factor model had a better fit than the other models in accordance with the original English version. The factor loads were high and ranged from 0.70 to 0.9. Cronbach's alpha coefficients for five dimensions of the Chinese WMSHW ranged from 0.81 to 0.94, indicating the scale's high internal consistency. Four distinct clusters of work motivation were found in this study, representing low motivated, highly controlled, highly autonomous and highly motivated primary health workers. Compared with low motivation group, both controlled and autonomous motivation groups were more likely to have lower turnover intention. The negative relationship between motivation and intention to leave became stronger with the level of motivation increasing: highly controlled cluster (OR: 0.47; 95% CI: 0.35-0.63), highly autonomous (OR: 0.27; 95% CI: 0.18-0.41) and highly motivated (OR: 0.20; 95% CI: 0.15-0.27).

Conclusion

The Chinese version of WMSHW showed satisfactory reliability and validity and can be used as an instrument for measuring and rating the work motivation of Chinese health workers. The primary health workers were grouped into four motivation levels based on this scale. Both controlled and autonomous motivation could work in reduce the turnover intention, and the influence of autonomous motivation on retaining was stronger.

How to Engage Health Care Workers in the Evaluation of Hospitals: Development and Validation of BSC-HCW1-A Cross-Sectional Study

Organizations worldwide utilize the balanced scorecard (BSC) for their performance evaluation (PE). This research aims to provide a tool that engages health care workers (HCWs) in BSC implementation (BSC-HCW1). Additionally, it seeks to translate and validate it at Palestinian hospitals. In a cross-sectional study, 454 questionnaires were retrieved from 14 hospitals. The composite reliability (CR), interitem correlation (IIC), and corrected item total correlation (CITC) were evaluated. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used. In both EFA and CFA, the scale demonstrated a good level of model fit. All the items had loadings greater than 0.50. All factors passed the discriminant validity. Although certain factors' convergent validity was less than 0.50, their CR, IIC, and CITC were adequate. The final best fit model had nine factors and 28 items in CFA. The BSC-HCW1 is the first self-administered questionnaire to engage HCWs in assessing the BSC dimensions following all applicable rules and regulations. The findings revealed that this instrument's psychometric characteristics were adequate. Therefore, the BSC-HCW1 can be utilized to evaluate BSC perspectives and dimensions. It will help managers highlight which BSC dimension predicts HCW satisfaction and loyalty and examine differences depending on HCWs' and hospital characteristics.

Magnitude of job satisfaction and intention to leave their present job among nurses in selected federal hospitals in Addis Ababa, Ethiopia

Background

Job dissatisfaction issues and health workers’ intention to leave is an increasing problem that threatens the function of the health care sector worldwide, especially in developing countries, including Ethiopia. As part of future evidence, this study was intended to assess nurses’ job satisfaction and intention to leave their current work and its associated factors in federal public hospitals in Addis Ababa, Ethiopia.

Method

An institutional based cross-sectional study design was used to conduct the study. A simple random sampling technique was employed to select 408 nurses from selected federal hospitals in Ethiopia. Self-administered questionnaire was used to collect the data. Logistic regression was employed to identify the predictor variables with consideration of statistical significance at P <0.05 adjusted odds ratios calculated at 95% CIs.

Result

The magnitudes of job satisfaction and intention to leave their current job among nurses in this study were 47.7% and 80.6%, respectively. Salary is imbalanced with demands [AOR = 2.85 (1.24, 6.57)], managers who have no personal plan for developing skills [AOR = 3.74 (1.58, 8.87)], stressful jobs [AOR = 0.28 (0.11, 0.71)], health problems are a reason for having thoughts about changing jobs [AOR = 3.02 (1.17, 7.79)], and a lack of development [AOR = 4.13 (1.51, 11.3)] were identified as determinant factors for intention to leave.

Conclusion

The overall intention to leave their current job among nurses working in selected federal hospitals in Ethiopia was high. The government of Ethiopia should balance the salary of nurses with the current market level. Hospital leaders should plan the way nurses develop their educational and job carrier levels.

Women family physicians' working conditions and career satisfaction: a multinational study

BACKGROUND

As the proportion of women in family medicine increases, their well-being and job satisfaction become concerns.

OBJECTIVES

This study aimed to uncover the working conditions and career satisfaction of women family physicians across multiple countries.

METHODS

A cross-sectional survey of the WONCA Working Party on Women and Family Medicine listserv members to assess working conditions and career satisfaction, with snowballing recruitment. Aspects of physician job satisfaction were measured using the validated Physician Work-Life Survey and calculated as the sum of the scores of each positive item divided by the total number of questions and multiplied by 10. The association between satisfaction and the continent and the country income level was performed using a one-way ANOVA test (P < 0.05).

RESULTS

A total of 315 participants across 49 countries responded to the survey with 205 complete responses. Women family physicians reported high overall career satisfaction (8.2 ± 2.3) but were less satisfied with some aspects of their career such as pay (5.3 ± 3.4), personal time (3.5 ± 2.6), and administrative tasks (3.2 ± 3.7). Despite the widespread experience of sexism at work, satisfaction with personal career aspects was universal at the continent and income level, while satisfaction with other career aspects relevant to relationships in work environment and resources varied.

CONCLUSION

Women family physicians around the world are overall satisfied with their careers. However, variation in certain working conditions among countries leaves room for improvement, drawing attention to the need for national review of working environments and pay scales.

Discrete choice analysis of health worker job preferences in Ethiopia: Separating attribute non-attendance from taste heterogeneity

When measuring preferences, discrete choice experiments (DCEs) typically assume that respondents consider all available information before making decisions. However, many respondents often only consider a subset of the choice characteristics, a heuristic called attribute non-attendance (ANA). Failure to account for ANA can bias DCE results, potentially leading to flawed policy recommendations. While conventional latent class logit models have most commonly been used to assess ANA in choices, these models are often not flexible enough to separate non-attendance from respondents' low valuation of certain attributes, resulting in inflated rates of ANA. In this paper, we show that semi-parametric mixtures of latent class models can be used to disentangle successfully inferred non-attendance from respondent's "weaker" taste sensitivities for certain attributes. In a DCE on the job preferences of health workers in Ethiopia, we demonstrate that such models provide more reliable estimates of inferred non-attendance than the alternative methods currently used. Moreover, since we find statistically significant variation in the rates of ANA exhibited by different health worker cadres, we highlight the need for well-defined attributes in a DCE, to ensure that ANA does not result from a weak experimental design.

'The Good Doctor': the Making and Unmaking of the Physician Self in Contemporary South Africa

In this article we examine the figure of the doctor in animated debates around public sector medicine in contemporary South Africa. The loss of health professionals from the South African public system is a key contributor to the present healthcare crisis. South African medical schools have revised curricula to engage trainee doctors with a broader set of social concerns, but the disjunctures between training, health systems failures, and a high disease burden call into question whether junior doctors are adequately prepared or whether conditions of care extend beyond medical training. A concern with 'resilience' suggests a correct ethical relation to a putative obligation to provide care in a struggling system. By examining the ways in which trainee doctors are expected to 'cope' with the demands of medical practice, to adopt the correct moral posture in relation to the urgency of care, and to enact a desirable ethical relation to the broader social and political context of medical practice, we examine the picture of humanist concern that animates the subjectivities and techniques of the self called for by this training, and advocate for endurance as an alternative framework for understanding the political and ethical relations between doctors, patients and health systems.

Exploring effort-reward imbalance and professional quality of life among health workers in Cape Town, South Africa: a mixed-methods study

BACKGROUND

In the context of a growing appreciation for the wellbeing of the health workforce as the foundation of high-quality, sustainable health systems, this paper presents findings from two complementary studies to explore occupational stress and professional quality of life among health workers that were conducted in preparation for a task-shifting intervention to improve antenatal mental health services in Cape Town.

METHODS

This mixed-methods, cross-sectional study was conducted in public sector Midwife Obstetric Units and associated Non-Profit Organisations in Cape Town. Semi-structured interviews and a quantitative survey were conducted among facility-and community-based professional and lay health workers. The survey included demographic as well as effort-reward imbalance (ERI) and professional quality of life (PROQOL) questionnaires to examine overall levels of work-related psychosocial stress and professional quality of life, as well as differences between lay and professional health workers. Qualitative data was analysed using a thematic content analysis approach. Quantitative data was analysed using STATA 12.

RESULTS

Findings from 37 qualitative interviews highlighted the difficult working conditions and often limited reward and support structures experienced by health workers. Corroborating these findings, our quantitative survey of 165 professional and lay health workers revealed that most health workers experienced a mismatch between efforts spent and rewards gained at work (61.1% of professional and 70.2% of lay health workers; p = 0.302). There were few statistically significant differences in ERI and PROQOL scores between professional and lay health workers. Although Compassion Satisfaction was high for all health worker groups, lay health workers also showed elevated levels of burnout and compassion fatigue, with community-based health workers particularly affected.

CONCLUSIONS

Findings of this study add to the existing evidence base on adverse working conditions faced by South African public-sector health workers that should be taken into consideration as national and local governments seek to 're-engineer' South Africa's Primary Health Care system. Furthermore, they also highlight the importance of taking into consideration the wellbeing of health workers themselves to develop interventions that can sustainably foster resilient and high-quality health systems.

Understanding the factors affecting attrition and intention to leave of health extension workers: a mixed methods study in Ethiopia

BACKGROUND

The Health Extension Program (HEP) is Ethiopia's flagship community health program, launched in 2003. Health Extension Workers (HEWs) are key vehicles for the delivery of the HEP. While it is believed that there is high attrition among HEWs, the magnitude of or reasons for attrition is unknown. Their intention to leave their jobs in the next 5 years has also never been investigated on a national scale. This study aimed to assess the magnitude of, and factors affecting HEWs' attrition and intention to leave in Ethiopia.

METHODS

The study used mixed methods to address the research objectives. Using stratified random sampling and regions as strata, 85 districts from nine regions were randomly selected in Ethiopia. Within each study district, six kebeles (village clusters) were randomly selected, and all HEWs working in these kebeles were interviewed to capture their 5-year intention to leave. The study team developed a data-extraction tool for a rapid review of district-level documents covering the period June 30, 2004 through June 30, 2019 to gather their attrition figures. We used survival analysis to model attrition data and checked model goodness-of-fit using the Cox-Snell residual test. We additionally collected qualitative data from HEWs who had left their positions.

RESULTS

The attrition of HEWS over the lifespan of the HEP was 21.1% (95% CI 17.5-25.3%), and the median time to exit from HEWs workforce was 5.8 years. The incidence rate was 3.1% [95% CI 2.8-3.4]. The risk of attrition was lower amongst HEWs with level four certifications, with children, and among those working in urban settings. By contrast, HEWs who were not certified with a certificate of competency (COC), who were deployed after 2008, and those who were diploma/degree holders were more likely to exit the HEWs workforce. The magnitude of intention to leave was 39.5% (95% CI 32.5-47%) and the primary reasons to leave were low incentives, dearth of career development opportunities (50.8%), high workload (24.2%), and other psychosocial factors (25%).

CONCLUSION

Although the magnitude of attrition is not worryingly high, we see high magnitude in HEWs' intention to leave, indicating a dissatisfied workforce. Multiple factors have contributed to attrition and intention to leave, the prevalence of many of which can be reduced to fit the needs of this workforce and to retain them for the sustained delivery of primary healthcare in the country. Ensuring HEWs' job satisfaction is important and linked with their career development and potentially higher rates of retention.

Assessment and correlation between job satisfaction and burnout among radiographers

INTRODUCTION

Previous research on job satisfaction (JS) and burnout has focused on physicians and nurses. However, limited work has evaluated radiographers' JS and burnout, factors affecting them and the correlation between them. The aim of this study is to assess the level and specific factors affecting burnout and JS among radiographers and to examine the correlation between them.

METHODS

A questionnaire consisting of socio-demographic information and two validated instruments (Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS (MP)) and JS Survey (JSS)) was distributed to radiographers. The MBI included 22 questions and JSS consisted of 36 questions. Mean scores were used to compare responses between participants according to demographic characteristics. Correlation between JS and burnout was examined using Pearson correlation test, with P < 0.05 determining statistical significance.

RESULTS

308 radiographers returned a completed questionnaire, 48.4% of participants were male, 48.7% had 1-6 years of experience and 61.4% examined >25 patients per day. Total emotional exhaustion, depersonalization and personal accomplishment scores were 28.7, 11.3 and 35.8 respectively. Most participants felt dissatisfied with pay (n = 221, 71.8%), opportunities for promotion (n = 202, 65.6%), fringe benefits (n = 239, 77.6%), contingent rewards (n = 231, 75.0%), operating procedures (n = 190, 61.7%) and communication (n = 162, 52.6%). Burnout was associated with work experience and caseload and JS was associated with section of work. Most of the JS domains were significantly inversely related to emotional exhaustion and depersonalisation domains. Emotional exhaustion and depersonalization drew a significant positive correlation. Emotional exhaustion and depersonalization drew a significant positive correlation.

CONCLUSION

Participating radiographers are mostly dissatisfied about their jobs and they suffer a high level of emotional exhaustion.

IMPLICATIONS FOR PRACTICE

To avoid the consequences of burnout and decreased JS on individuals and organizations, efforts should be done in alleviating the main factors affecting them.

Exploring the Associations between Perceived Organizational Support and Job Burnout among Chinese Academic Journal Editors: A Moderated Mediation Model

BACKGROUND

Job burnout (JB) has become a prevalent emotional and psychological syndrome across diverse contexts, especially in the face of the COVID-19 pandemic. This study aimed to examine the relationship between perceived organizational support (POS), job satisfaction (JS), self-efficacy (SE), and JB, alongside their mechanism of interplay.

METHODS

We took 210 Chinese academic journal editors as the research participants and designed a moderated mediation model to examine the posited construct. All the data were gathered online and analyzed with the statistical software SPSS and SmartPLS.

RESULTS

The participants comprised 117 women (55.71%) and 93 men (44.29%). There were significant differences among observed variables in age, experience, and title. POS had a significant negative predictive effect on JB (95% CI = -0.43; -0.06). JS mediated the relationship between POS and JB (95% CI = -0.48; -0.11). SE moderated the association between JS and JB (95% CI = 0.04; 0.75) but did not function as a moderator in the relationship between POS and JS (95% CI = -0.01; 0.24).

CONCLUSIONS

POS, JS, and SE were crucial determinants of JB among Chinese academic journal editors. Targeted interventions should be initiated to diminish editors' feelings of being unappreciated, inefficient, dissatisfied, and unaccomplished at work.

Stated job preferences of three health worker cadres in Ethiopia: a discrete choice experiment

Attracting, training and retaining high-quality health workers are critical for a health system to function well, and it is important to know what health workers value in their roles. Many studies eliciting the labour market preferences of health workers have interviewed doctors or medical students, and there has been little research on the job preferences of lower-skilled cadres such as community health workers, mid-skilled clinical care staff such as nurses and midwives, or non-patient facing staff who manage health facilities. This study estimated the job preferences of public health sector community health extension workers (HEWs), care providers including nurses and midwives, and non-patient-facing administrative and managerial staff in Ethiopia. We used a discrete choice experiment to estimate which aspects of a job are most influential to health worker choices. A multinomial logistic regression model estimated the importance of six attributes to respondents: salary, training, workload, facility quality, management and opportunities to improve patient outcomes. We found that non-financial factors were important to respondents from all three cadres: e.g., supportive management [odds ratio (OR) = 2.96, P-value = 0.001] was the only attribute that influenced the job choices of non-patient-facing administrative and managerial staff. Training opportunities (OR = 3.45, P-value < 0.001), supportive management (OR = 3.26, P-value < 0.001) and good facility quality (OR = 2.42, P-value < 0.001) were valued the most amongst HEWs. Similarly, supportive management (OR = 3.22, P-value < 0.001), good facility quality (OR = 2.69, P-value < 0.001) and training opportunities (OR = 2.67, P-value < 0.001) influenced the job choices of care providers the most. Earning an average salary also influenced the jobs choices of HEWs (OR = 1.43, P-value = 0.02) and care providers (OR = 2.00, P-value < 0.001), which shows that a combination of financial and non-financial incentives should be considered to motivate health workers in Ethiopia.

Predictors of job satisfaction and intention to stay in the job among health-care providers in Uganda and Zambia

BACKGROUND

A shortage of competent health-care providers is a major contributor to poor quality health care in sub-Saharan Africa. To increase the retention of skilled health-care providers, we need to understand which factors make them feel satisfied with their work and want to stay in their job. This study investigates the relative contribution of provider, facility and contextual factors to job satisfaction and intention to stay on the job among health-care providers who performed obstetric care in Uganda and Zambia.

METHODS

This study was a secondary analysis of data from a maternal and newborn health program implementation evaluation in Uganda and Zambia. Using a Likert scale, providers rated their job satisfaction and intention to stay in their job. Predictors included gender, cadre, satisfaction with various facility resources and country. We used the Shapley and Owen decomposition of R2 method to estimate the variance explained by individual factors and groups of factors, adjusting for covariates at the facility and provider levels.

RESULTS

Of the 1134 providers included in the study, 68.3% were female, 32.4% were nurses and 77.1% worked in the public sector. Slightly more than half (52.3%) of providers were strongly satisfied with their job and 42.8% strongly agreed that they would continue to work at their facility for some time. A group of variables related to facility management explained most of the variance in both job satisfaction (37.6%) and intention to stay (43.1%). Among these, the most important individual variables were satisfaction with pay (20.57%) for job satisfaction and opinions being respected in the workplace (17.52%) for intention to stay. Doctors reported lower intention to stay than nurses. Provider demographics and facility level and ownership (public/private) were not associated with either outcome. There were also differences in job satisfaction and intention to stay between Ugandan and Zambian health-care providers.

CONCLUSION

Our study suggests that managers play a crucial role in retaining a sufficient number of satisfied health-care providers providing obstetric care in two sub-Saharan African countries, Uganda and Zambia. Prioritizing and investing in health management systems and health managers are essential foundations for high-quality health systems.

Health professional's job satisfaction and its determinants in Ethiopia: a systematic review and meta-analysis

Background

Health professional’s job satisfaction is directly related to patient satisfaction and quality of care. Without satisfied health professionals the health system is not functional, and the national and global health related plans are not achieved. However, little is known on the level of health professional’s job satisfaction in sub Saharan African countries including Ethiopia. In addition, in Ethiopia there is no summarized evidence helped us an input to design strategies. Therefore, we aimed to assess the pooled prevalence of health professional’s job satisfaction and its determinants in Ethiopia.

Methods

Articles were searched from PubMed, PsycINFO, Hinari, Science Direct, web of science and African journal of online (AJOL) databases, Google and Google scholar. A standardized Microsoft excel spread sheet and STATA software version 16 were used for data extraction and analysis respectively. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis to write this report. A random effect meta-analysis model was used to determine the pooled prevalence of job satisfaction. I² was done to check heterogeneity. Egger’s test and funnel plot were conducted to detect publication bias. Subgroup analysis was also conducted. Association was expressed through pooled odd ratio with a 95% CI.

Result

In this review and meta-analysis, a total of 29 studies were included. The pooled prevalence of health professional’s job satisfaction was 46.17% [95% CI (43.08, 49.26)]. The heterogeneity and publication bias test results were I² = 87.3%, P <  0.001 and Eggers’, P = 0.16. Female sex; OR: 2.20 [95% CI (1.63, 2.97)], working environment; OR: 9.50 [95% CI (6.25, 14.44)], opportunity for professional growth and development; OR: 5.53 [95% CI (1.56, 19.56)], staff relationship; OR: 3.89 [95% CI (1.65, 9.17)] and supportive supervision; OR: 5.32 [95% CI (1.77, 15.92)] were associated with health professional’s job satisfaction.

Conclusion

More than half of professionals were dissatisfied with their jobs. Therefore, the ministry of health and stakeholders better to design strategies to increase the level of satisfaction. Furthermore, it is better to strengthen staff relationship and making the working environment more attractive and equipped.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-021-00664-7.

Nurses' intention to leave their job in sub-Saharan Africa: A systematic review and meta-analysis

INTRODUCTION

Nurses' intention to leave their job is a worldwide concern. Internal and external brain drain factors are the main reason for nurses' intention to leave their job. So far, in Sub Sahara Africa, several observational studies have been done on nurses' intention to leave their job. However, a comprehensive review that would have a lot of evidence for designing an intervention is lacking. Hence, this study aimed to the pooled status of nurses' intention to leave their job.

METHODS

In the current meta-analysis, the target variables were searched from different electronic databases. These electronic databases are Pub Med, Google Scholar, Science Direct, African Index Medicus, African Journal Online, EMB ASE, and the Cochran Library. To determine the pooled proportion of intention to leave their job in Sub- Saharan Africa, all the necessary data was extracted by using a standardized data extraction format. We analyzed the data by using Stata 15 statistical software. Heterogeneity between the primary studies assessed by Cochran Q and I-square tests. A random-effect model computes to estimate the pooled nurses' intention to leave their job.

RESULT

We included fifteen full-text studies in the current meta-analysis. The findings of this meta-analysis revealed that the pooled proportion of nurses' intention to leave their job in sub-Saharan Africa was 50.74% (95% CI; 41.33, 60.14; I2 = 95.80%). The subgroup analysis showed that the highest pooled proportion of intention to leave their job (58.03% (95% CI: 47.93, 68.12)) in East Africa. The lowest pooled estimation to leave their job among nurses showed that South Africa (33.04% (95%CI: 20.45, 45.63)).

CONCLUSION

In the current study, there was a high proportion of nurses indentation to leave their job. Nurses' intention to leave their job also varied from region to region in the study area. Therefore, health managers and stakeholders focus on design sufficient development and career opportunities, positive working atmosphere, and secure their autonomy.

Prevalence and Associated Factors of Burnout syndrome among Nurses in Public Hospitals, Southwest Ethiopia

BACKGROUND

The Burnout syndrome has been defined as a response to the chronic work-related stress typically found in professionals working in care service organizations. Therefore, this study aimed at assessing the prevalence of burnout syndrome and factors associated with burnout syndrome among nurses in public hospitals, Southwest Ethiopia, 2018.

METHOD

An institutional-based cross-sectional study was conducted from February 1st, 2018 to April 1st, 2018. Total number of nurses who fulfill the inclusion criterias were enrolled. Data was collected using the predesigned tool. Data were entered using EPI INFO version 7 and was exported to statistical packages for social science (SPSS) version 21.0 for analysis. Logistic regression was employed and odds ratio with a 95% confidence interval was used. Variables with a P value of less than 0.05 was considered statistically significant.

RESULTS

A total of 282 eligible nurses were enrolled in the study with a mean age of 28.71 [SD ±7.047]. The prevalence of burnout syndrome among nurses was 96(34%). Predictor variables like; educational status, job title, work experience, fatigue, and social support were found to be strong predictor variables for burnout syndrome.

CONCLUSION

This study revealed that a considerable proportion of nurses had burnout syndrome. Therefore, improved educational status and strong social support should be encouraged among nurses working in the health setting for the betterment of health care services, job satisfaction and quality of care in general.

Job Satisfaction Among Methadone Maintenance Treatment Clinic Service Providers in Jiangsu, China: A Cross-sectional Survey

OBJECTIVE

Service providers' job satisfaction is critical to the stability of the work force and thereby the effectiveness of methadone maintenance treatment (MMT) programs. This study aimed to explore MMT clinic service providers' job satisfaction and associated factors in Jiangsu, China.

METHODS

This secondary study used baseline data of a randomized interventional trial implemented in Jiangsu, China. A survey was conducted among 76 MMT service providers using the computer-assisted self-interview (CASI) method. Job satisfaction responses were assessed via a 30-item scale, with a higher score indicating a higher level of job satisfaction. Perceived institutional support and perceived stigma due to working with drug users were measured using a 9-item scale. Correlation and multiple linear regression analyses were performed to identify factors associated with job satisfaction.

RESULTS

Correlation analyses found a significant association between job satisfaction and having professional experience in the prevention and control of HIV, other sexually transmitted infections, or other infectious diseases (P = 0.046). Multiple regression analyses revealed that working at MMT clinics affiliated with Center for Disease Control and Prevention sites was associated with a lower level of job satisfaction (P = 0.014), and perception of greater institutional support (P = 0.001) was associated with a higher level of job satisfaction.

CONCLUSION

Job satisfaction among MMT clinic service providers was moderate in our study. Our findings suggest that institutional support for providers should be improved, and that acquisition of additional expertise should be encouraged.

It is beyond remuneration: Bottom-up health workers' retention strategies at the primary health care system in Tanzania

Although Tanzania is operating a decentralized health system, most of the health workers' retention strategies are designed at the central level and implemented at the local level. This study sought to explore the bottom-up health workers' retention strategies by analyzing experiences from two rural districts, Rombo and Kilwa in Tanzania by conducting a cross-sectional exploratory qualitative study in the said districts. Nineteen key informants were purposefully selected based on their involvement in the health workers' retention scheme at the district and then interviewed. These key informants included district health managers, local government leaders, and in-charges of health facilities. Also, three focused group discussions were conducted with 19 members from three Health Facility Governing Committees (HFGCs). Qualitative content analysis was deployed to analyze the data. We uncovered health-facility and district level retention strategies which included, the promotion of good community reception, promotion of good working relationships with local government leaders, limiting migration within district facilities and to districts within the region, and active head-hunting at training institutions. Retention of health workers at the primary health care level is beyond remuneration. Although some of these strategies have financial implications, most of them are less costly compared to the top-bottom strategies. While large scale studies are needed to test the generalizability of the strategies unveiled in our study, more studies are required to uncover additional bottom-up retention strategies.

Job satisfaction and turnover intention of preventive medicine workers in northern Vietnam: Is there any relationship?

To access the relationship between job satisfaction and turnover intention of preventive medicine workers in Vietnam, we conducted a cross-sectional study using a purposive convenience sample of 12 preventive medicine centers in 3 provinces of northern Vietnam (Hai Duong, a plain province, Yen Bai, a mountainous province, and Hanoi, the capital of Vietnam). Overall, 400 preventive medicine staff were invited to participate, and 383 questionnaires were analyzed (153 from 3 provincial centers and 230 from 9 district centers). All eligible participants completed the questionnaire, which included questions relating to general information, job satisfaction, intention to quit. We identified significant associations between turnover intention and personal factors, including age, marital status, education level, professional degree, and length of employment at the current center. The bivariate analysis also indicated that job satisfaction had an inverse relationship with turnover intention, as expected. The correlations varied between facets and overall job satisfaction, from -0.19 for community support to -0.37 for overall job satisfaction. These correlations remained significant after controlling for personal factors using hierarchical multiple regressions. The results indicated that facet and overall job satisfaction were significant predictors of turnover intention, while overall job satisfaction was the strongest predictor (β = 0.37, P < .001). This study could contribute to local system development and the international understanding of job satisfaction and turnover intention among preventive medicine workers. Addressing the aspects of job satisfaction that were found to have the lowest scores may help the preventive medicine system to retain staff.

Assessing the impact of a motivational intervention to improve the working lives of maternity healthcare workers: a quantitative and qualitative evaluation of a feasibility study in Malawi

BACKGROUND

Globally too many mothers and babies die during childbirth; 98% of maternal deaths are avoidable. Skilled clinicians can reduce these deaths; however, there is a world-wide shortage of maternity healthcare workers. Malawi has enough to deliver 20% of its maternity care. A motivating work environment is important for healthcare worker retention. To inform a future trial, we aimed to assess the feasibility of implementing a motivational intervention (Appreciative Inquiry) to improve the working lives of maternity healthcare workers and patient satisfaction in Malawi.

METHODS

Three government hospitals participated over 1 year. Its effectiveness was assessed through: a monthly longitudinal survey of working life using psychometrically validated instruments (basic psychological needs, job satisfaction and work-related quality of life); a before and after questionnaire of patient satisfaction using a patient satisfaction tool validated in low-income settings with a maximum score of 80; and a qualitative template analysis encompassing ethnographic data, semi-structured interviews and focus groups with staff.

RESULTS

The intervention was attended by all 145 eligible staff, who also participated in the longitudinal study. The general trend was an increase in the scores for each scale except for the basic psychological needs score in one site. Only one site demonstrated strong evidence for the intervention working in the work-related quality of life scales. Pre-intervention, 162 postnatal women completed the questionnaire; post-intervention, 191 postnatal women participated. Patient satisfaction rose in all three sites; referral hospital 4.41 rise (95% CI 1.89 to 6.95), district hospital 10.22 (95% CI 7.38 to 13.07) and community hospital 13.02 (95% CI 10.48 to 15.57). The qualitative data revealed that staff felt happier, that their skills (especially communication) had improved, behaviour had changed and systems had developed.

CONCLUSIONS

We have shown that it is possible to implement Appreciative Inquiry in government facilities in Malawi, which has the potential to change the way staff work and improve patient satisfaction. The mixed methods approach revealed important findings including the importance of staff relationships. We have identified clear implementation elements that will be important to measure in a future trial such as implementation fidelity and inter-personal relationship factors.

Using Employment Data From a Medical University to Examine the Current Occupation Situation of Master's Graduates in Public Health and Preventive Medicine in China

Aims: The purposes of this study are (1) to understand the current employment situation of master's graduates in Public Health and Preventive Medicine (PHPM) and (2) to provide evidence for career guidance and training of competent PHPM personnel. Methods: The master's graduates of the School of Public Health from the years 2014-2018 who majored in PHPM were chosen as research subjects. Questionnaires were distributed, and completed questionnaires were collected. The employment situation and characteristics of these graduates were analyzed based on the questionnaire data. Results: The employment rate of these graduates was 95.45%. They were employed mainly in hospitals, followed by colleges and centers for disease control and prevention. The initial salaries were low. Graduates whose jobs barely or not at all matched their areas of specialization were 23.64 or 6.36%, respectively. Nevertheless, the percentage of students who had remained with their jobs since graduation was 82.73%. A total of 40% of the graduates were neutral about or dissatisfied with their jobs. Furthermore, 29% of them claimed that they were undervalued by their employers. Last, but not least, graduates were encouraged to gain experience in creativity, organizational or management skills, social networking experience, and interpersonal and professional skills. Conclusion: Overall, the employment status of master's graduates in PHPM is good. Problems such as low initial salaries, jobs not matching graduates' areas of specialization, and feelings of being undervalued by employers were observed. It is necessary to improve employment outcomes by revising training models, formulating employment policies, and implementing training efforts.

Health Professionals Job Satisfaction and Associated Factors in Ethiopia: A Systematic Review and Meta-analysis

BACKGROUND

Health professionals' job satisfaction is crucial for health professionals' life which determines health care service quality. This study aimed to estimate pooled prevalence of job satisfaction of health professionals and associated factors in Ethiopia.

METHODS

Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) was followed to prepare this study. Studies were searched from PubMed (EBSCOhost), Directory of open access journals (DOAJ), Global health, African Index Medicus, IRIS (WHO digital publication), African Journals Online (AJOL), Google Scholar, and Google. Random-effect model was used to estimate the pooled prevalence of job satisfaction and associated factors. Heterogeneity was assessed using I 2 test statistics. Publication bias was checked using funnel plot, Egger's regression test, and sensitivity analysis.

RESULT

The pooled prevalence of health professionals' job satisfaction was computed from 35 studies, and it was 46.68% (95%, confidence interval (CI): 41.82, 51.54, I 2 = 95.8%). Specifically, job satisfaction was 57.56%, 48.80%, 48.57%, 48.48%, 44.56%, 39.20%, and 16.5% among pharmacy professionals, health officers, midwives, nurses, anesthetists, physicians, and health extension workers, respectively. Secured working environment (pooled odds ratio [POR] = 6.50, 95% CI: 3.41-9.58), coworkers relationship (POR = 5.14, 95% CI: 1.27, 9.02), good relationship with supervisors (POR = 5.86, 95% CI: 2.56-9.16) and having bachelor's degree (POR = 2.52, 95% CI: 1.31, 3.72) were significantly associated with job satisfaction.

CONCLUSION

Job satisfaction among Ethiopian health professionals is considerably low. Secured working environment, positive relationships among staff, and having a bachelor's enhanced the job satisfaction. Designing strategies to improve safety in the work environment and improved communication among workers could improve job satisfaction.

New Registered Nurse Transition to the Workforce and Intention to Leave: Testing a Theoretical Model

BACKGROUND

The transition of new nurses into practice has been identified as challenging, and new nurses report having intentions to leave (ITL) jobs. Concerns of ITL are worrisome for the nursing profession, especially when faced with the need to replace an aging nursing workforce and to maintain quality patient care.

PURPOSE

Guided by components of Meleis et al.'s mid-range transition theory, the purpose of this study was to test a theoretical model linking transition and ITL, as well as the personal, community and societal conditions of transition.

METHODS

A predictive, non-experimental design using cross-sectional data was employed. Ontario registered nurses, who had graduated within two years, were randomly selected to complete a mailed questionnaire in 2015 (N = 217). Structural equation modeling was undertaken to test the model.

RESULTS

The new nurses reported a relatively positive transition; yet, 44% of the respondents indicated leaving their first job, and 1% departed the nursing profession. A revised model of the constructs showed a more adequate fit with the data, but overall, the hypothesized model was not supported and methodological validity of tools questioned. From the modeling, lower role stress led to a positive transition.

CONCLUSIONS

Given organizational and governmental investments in orientation and transition programs, challenges in measuring transition and ITL requires additional research. Our findings highlight the value of organizations supporting new nurses by reducing role stress through reasonable workloads and expectations, which in turn contributes to a positive transition.

The impact of data feedback on continuous quality improvement projects in Rwanda: A mixed methods analysis

Background

Injuries are a leading cause of death and disability globally. Over 90% of injury-related mortality happens in low- and middle- income countries (LMICs). Rwanda's pre-hospital emergency system – Service d'Aide Medicale Urgente (SAMU) – and their partners created an electronic pre-hospital registry and Continuous Quality Improvement (CQI) project in 2014. The CQI showed progress in quality of care, sparking interest in factors enabling the project's success. Healthcare workers (HCW) are critical pieces of this success, yet we found a void of information linking pre-hospital HCW motivation to CQI programs like SAMU's.

Methods

Our mixed methods approach included a 40-question survey using questions regarding HCW motivation. We scored the surveys to compare SAMU staff motivation with other HCWs in LMICs, and used a Likert scale to elicit agreement or disagreement. A semi-structured interview based on employee motivation theory qualitatively explored SAMU staff motivation using constructivist grounded theory. To find interview themes, two researchers independently performed line-by-line analysis.

Results

SAMU staff received 5–21% higher motivation scores relative to other cohorts of HCWs in LMICs. Questions showing disagreement (five) asked about reprimand, damaged social standing, and ease of using the CQI technology. Three questions did not show consensus. Questions showing agreement (23) and strong agreement (nine) asked about organizational commitment, impact, and research improving patient care. Major themes were: improvements in quality of care, changes in job expectations, views on research, and positive experiences with data feedback.

Conclusions

The CQI project provides constant feedback vital to building and sustaining successful health systems. It encourages communication, collaboration, and personal investment, which increase organizational commitment. Continuous feedback provides opportunities for personal and professional development by uncovering gaps in knowledge, patient care, and technological understanding. Complete, personalized data input encouraged by the CQI improves resource allocation, building robust health systems that improve HCW agency and motivation.

The application of Herzberg's two-factor theory of motivation to job satisfaction in clinical laboratories in Omani hospitals

BACKGROUND

Job satisfaction is an important condition for staff retention in most healthcare Organizations. As a concept, job satisfaction is linked to motivation theory. Herzberg's two factor theory of motivation is used in this study to explore what motivational elements are associated with job satisfaction among medical laboratory professionals (MLPs) in Oman.

METHODS

A mixed-method approach was adopted, and focus group discussions (FGDs) were used for data collection. The FGDs were conducted in the main hospitals in Oman. Data were analyzed by directed content analysis, and frequencies of statements related to factors were calculated for a comparison with the Herzberg theory.

RESULTS

The following job dissatisfaction factors (hygiene) were identified: health and safety, heavy workload, salary, promotion, recognition and organizational policies. The satisfaction (motivators) were: relationships with co-workers, relationship with leaders, and professional development.

CONCLUSIONS

The job dissatisfaction reported was resulted from the absence of hygiene factors and some of the motivators in accordance with Hertzberg's theory. Hospital managers need to address these factors, defined by Hertzberg, in order to improve motivation and job satisfaction.

Nurses' intention to leave their job and associated factors in Bahir Dar, Amhara Region, Ethiopia, 2017

BACKGROUND

Intention to leave is an employee's plan of tendency to leave the current working institute to find an alternative job in the near future. Even though nurses are the backbone of patient caring, there was no study done on intention to leave their job in North West Ethiopia. Therefore, the aim of this study was to assess nurses' intention to leave their job and associated factors in Bahir Dar, North West Ethiopia, 2017.

METHODS

An institutional-based cross-sectional study was conducted from 1st March to 30th March 2017. After proportional sample size allocation, 210 participants were selected by simple random sampling method. Data were collected by using a self-administered structured questionnaire. Statistical Package for Social Science version 23.0 was used to enter, clean, code and analyze the collected data. The association between independent and dependent variables was assessed by using bivariable and multivariable logistic regression model. Factors that had statistically significant association with the dependent variable (P < 0.05) were identified as significant in the multivariable logistic regression analysis.

RESULT

From a total of 210 nurses, 191 of them were participating in this study making a response rate of 90.95%. From all nurses, 64.4%of them were employed in the hospital. In this study, nurses' overall intention to leave their job was 64.9% (95% CI: [57.6, 71.2]). Nurses' intention to leave their job was determined by disagree in recognition (AOR = 4.83; 95%CI: [1.73, 13.50]), and work itself (AOR = 31.30; 95%CI: [7.16, 136.78]).

CONCLUSION

Nurses' intention to leave their job in the current study was high. The contributing factors for this problem were disagree in recognition at work and work itself. Hence, we recommended that hospital and health center managers should maintain recognition at work and work itself to retain nurses.

Factors Influencing Nurses’ Intention to Leave and Intention to Stay: An Integrative Review

Nursing retention is a critical issue for organization. High nurses’ turnover impact negatively on an organization requirement to meet patient needs and quality care. This integrative review aims to critically review and synthesize published studies to obtain better understanding of the determinants of nurse’s intention to leave or stay in the organization. Thirty-seven studies which met the inclusion criteria from different locations using a variety of instruments and research designs were identified using PRISMA guideline. Many factors including job satisfaction, organizational commitment, quality of work life, work environment, leadership style, bullying at work, family reason, and job security were identified to be associated negatively with nurse’s intention to leave and positively with intention to stay in organization. More qualitative studies are needed to understand in depth, the reasons and factors that underlie and influence turnover, intention to leave or remain in organization.

Leadership Styles of Nurse Managers and Turnover Intention

The shortage of experienced nurses is a concern in health organizations. This study investigated the leadership styles of nurse managers' impact on turnover intention among nurses in hospitals. A descriptive correlational research design was used. Samples of 250 nurses working in five hospitals were selected to complete self-administered questionnaire. Findings show that participatory and transformational leadership styles are predominantly practiced. Correlation analysis revealed that participative and transformational leadership styles decreases turnover intention while autocratic and laissez-faire leadership styles increases turnover intention. Therefore, leadership styles of nurse managers are determinants of nurses' turnover intentions.

Job satisfaction, burnout, and turnover intention among primary care providers in rural China: results from structural equation modeling

BACKGROUND

Low job satisfaction, severe burnout and high turnover intention are found to be prevalent among the primary care providers (PCPs) in township health centers (THCs), but their associations have received scant attention in the literature. In light of this, this study aims to examine the relationships between job satisfaction, burnout and turnover intention, and explore the predictors of turnover intention with a view to retaining PCPs in rural China.

METHODS

Using the multistage cluster sampling method, a cross-sectional survey was conducted in Shandong Province, China. 1148 PCPs from 47 THCs participated in this study. Job satisfaction, burnout and turnover intention were measured with a multifaceted instrument developed based on the existing literature, the Maslach Burnout Inventory and the participants' responses to a Likert item drawn from the literature, respectively. The relationships of the three factors were examined using Pearson correlation and structural equation modeling, while the predictors of turnover intention were investigated using multivariate logistic regression.

RESULTS

The subscale that the PCPs were most dissatisfied with was job rewards (95.12%), followed by working environment (49.65%) and organizational management (47.98%). The percentages of the PCPs reporting high-levels of emotional exhaustion, depersonalization and reduced personal accomplishment were 27.66, 6.06, and 38.74%, respectively. About 14.06% of the respondents had high turnover intention. There was a significant direct effect of job satisfaction on burnout (γ = - 0.52) and turnover intention (γ = - 0.29), a significant direct effect of burnout on turnover intention (γ = 0.28), and a significant indirect effect (γ = - 0.14) of job satisfaction on turnover intention through burnout as a mediator. Work environment satisfaction, medical practicing environment satisfaction, and organizational management satisfaction proved to be negative predictors of turnover intention (p < 0.05), whereas reduced personal accomplishment was identified as a positive predictor (p < 0.05).

CONCLUSIONS

Plagued by low job satisfaction and severe burnout, the PCPs in rural China may have high turnover intentions. Job satisfaction had not only negative direct effects on burnout and turnover intention, but also an indirect effect on turnover intention through burnout as a mediator. Targeted strategies should be taken to motivate and retain the PCPs.