A Survey of Job Satisfaction among Midwives Working in Hospitals

Human resources is the main contributing factor to production and service provision, which ensures organizational survival and success (1). One of the characteristics of a healthy organization is that the manager takes active interest in employees’ physical and mental health and understands that employees’ productivity and efficiency will enhance efficiency and productivity throughout the organization (2). Researchers defined the concept of job satisfaction as an overall satisfaction with most of the occupation-specific conditions, including payment, promotion, and job security, and the most important factors in securing it are the behaviors of colleagues and supervisors. Management styles, communication, and rewards can also affect staff's attitude and performance (3).In other words, job satisfaction refers to one's set of positive and negative attitudes towards their job and it is affected by many factors, namely salary, communications, policies, procedures, job size, discipline, and personal characteristics of the staff (4).

In fact, job satisfaction is a positive emotional state resulting from job evaluation or job experience, which has various dimensions and factorsand affects many positive organizational variables such as productivity, compassion within the organization, psycho-logical attachment to the workplace, proper communication, and improved morale and interest (5-7).

Different aspects of job satisfaction have been investigated in several countries. According to the existing studies, the highest level of job satisfaction was reported in America (41%), followed by Scotland (38%), UK (36%), Canada (33%), and Germany (17%) (8). Rambeur et al. (2003) revealed that the level of job satisfaction was 17% among German nurses (9), and Watson (1999) estimated that midwives' level of job satisfaction was 81% in Australia (10).

Nourani Saadoldin et al. in a study in performed in Mashhad, Iran, found that the majority of midwives (59.0%) were satisfied with their job (11).

Mir-Molaei in 2004 noted that only 1.6% of midwives had high level of job satisfaction (12). A study by Mousavi conducted in Tehran military hospitals in 2014 showed that nurses' overall job satisfaction was good and the mean scores of
the motivational and hygiene factors were
78.55% and 75.69%, respectively. Additionally, the highest and lowest job satisfaction scores pertained to a sense of responsibility at work and salary issues (13). In a study by Mousavi Tabar (2014), nurses' job satisfaction in public and military hospitals was at a moderate level and those working in military hospitals had lower levels of satisfaction compared to nurses working in public hospitals (14). The results of previous studies revealed that job satisfaction not only affects occupational efficiency and quality and employee's retention rate, but also it determines many organizational variables such as productivity (15).

However, studies have shown that employee’s job satisfaction for different aspects of health and motivational factors has a direct impact on job satisfaction and improved performance. The study by Masoudsal (2010) in Yasouj, Iran, revealed a direct relationship between hygiene factors and motivational factors (16). Mir-Molaei in a study of midwives in Tehran, Iran, found a relationship between job satisfaction and occupational position, job security, salary and benefits, management policymaking, and communication with colleagues (12). Kousha (2011) in East Azarbaijan, Iran, investigated five aspects of job satisfaction, including structural and managerial, personal, social, the nature of job, and environmental and welfare among doctors and nurses. They reported the highest satisfaction mean score in individual factors aspect and the highest dissatisfaction score in environmental and welfare factors aspect (17).

Thus, the assessment of employee satisfaction in large organizations such as a university of medical sciences with the same management and rather similar support would help identify the factors influenced by the management of any of the foregoing sets so that those interfereable causes are identified and resolved (15, 17). Considering the scarcity of information on this issue, we attempted to evaluate job satisfaction among midwives working in maternity hospitals affiliated to Abadan School of Medical Sciences, Abadan, Iran.

Materials and Methods

This cross-sectional study was carried out among all midwives working in maternity hospitals with an associate degree or higher and at least one year of work experience in maternity hospitals. The standard sample size was determined to be 100, and the participants were selected using the census sampling method.

The data collection tools comprised of
a demographic form and Herzberg's Job Satisfaction Questionnaire. This questionnaire, which was designed by Dant et al. in 1996 based on Herzberg's Two-Factor Theory, gauges the level of job satisfaction in the eight domains of occupational position, job security, wages
and benefits, working conditions, management policy-making, supervision, communication with colleagues, and communication in personal life. The questionnaire is rated using a Likert-type scale with the scores within the ranges of 72-214, 215-359, and 360-504 reflecting low, moderate, and high levels of job satisfaction, respectively. The questionnaire contains 36 statements on satisfaction and 36 statements on job dissatisfaction, in each of which both motivational and hygiene factors are evaluated.

In general, the questionnaire consists of two parts, validity of the first part and reliability of the second part were 93.7% and 92%, respectively (13). Mirmolaei (2004) in a study conducted in Iran established the content validity and test-retest reliability of this instrument (α=0.96) (12).

Prior to the onset of the study, we obtained the approval of Deputy of Research and Technology of Abadan School of Medical Sciences and submitted a letter of introduction to the eligible hospitals. The researcher presented to the hospitals (hospitals with maternity wards) and explained the study objectives to the hospital officials. We obtained written informed consent from the participants and ensured them of the confidentiality of the data, and then distributed the questionnaires among the midwives working in all the shifts based on codes and collected them after being completed by the subjects at the end of the shift.

The findings were categorized and interpreted through calculating absolute and relative frequency of the tests. To analyze the data, Chi-square test, independent t-test, and Pearson correlation coefficient were used in SPSS, version 22. The significance threshold was set at 0.05.

Results

In general, 100 midwives working in hospitals affiliated Abadan School of Medical Sciences were enrolled, the mean age of whom was 35.37±7.3 years; most of the subjects (39.4%) were within the age group of 25-35 years. Additionally, married subjects and those with Bachelor’s degree constituted 69.7% and 91.9% of the participants, respectively. The mean work experience of the midwives was 11.23±7.8 years, with 43.4% of the subjects having 6-18 years of work experience. Moreover, 63%, 21%, and 15% of the subjects were employed in public hospitals, hospitals affiliated to the Ministry of Oil, and social security hospitals, respectively.

The mean job satisfaction score was 302.14±19, which denoted moderate satis-faction. The mean satisfaction scores of the motivational and hygiene factors were 60.69±7.4 and 103±49, respectively (Table 1). We found that the subjects had moderate level of job satisfaction in the eight domains of occupational nature and position (48%), job security (46%), salary and benefits (61%), occupational and environmental conditions (90%), relationship with colleagues (87%), supervision (91%), management policymaking (80%), and personal relations (85%; Table 2).

Moreover, we found a significant positive correlation between overall job satisfaction and its dimensions; this correlation was the strongest in the management policymaking dimension (r=0.385), while the personal relations dimension showed the lowest correlation (r=0.038; Table 2).

Chi-square test reflected a significant association between work experience and job satisfaction (P=0.000; χ²=15.241), while there was no significant relationship between job satisfaction and other personal factors, namely age, educational level, marital status, type of hospital, and place of employment.

Discussion

Given the importance of the midwives' role in improving health status at both family and community levels, enhancing midwives' job satisfaction will increase the quality of healthcare and treatment services, and in turn, boost patients and families' health status. Therefore, we aimed to evaluate the level of job satisfaction among midwives working in hospitals affiliated to Abadan School of Medical Sciences in 2015. In this study, the mean score for job satisfaction was 302.41±19, demonstrating that 95% of the midwives had moderate job satisfaction. In a study by Mirmolaei (2004), half of midwives had moderate satisfaction (12). The study by Bagheri (2013) exhibited that the majority of healthcare providers had moderate job satisfaction (18), while the results of Watson (1999) showed that most midwives in Australia (81%) had high job satisfaction (10). This discrepancy may be due to the poor working conditions of midwives in Iran compared to developed countries (13). According to our findings, midwives’ satisfaction in all the dimensions were moderate, except for the job security dimension. In terms of job security, 54% of the subjects had low satisfaction. Our findings were consistent with those of Jahani (2010), Monjamed (2004), Mirmolaei (2001), and Hadizadeh (2015) (12, 19-21).

In The results of this study on the management policymaking dimension indicated that most people were moderately satisfied with the management procedure of the hospital. VV supervision by a direct and responsible authority is a factor affecting job satisfaction (23).

In a study by Monjamed (2004), the majority of subjects were satisfied with nursing management (20). In the present study, the dimension of personal relations had the highest rate of satisfaction (87% at moderate level and 5% at a high level) compared to the other dimensions of satisfaction. The findings of Ghorbani (2014) were consistent with the present results in terms of communication with colleagues (22). Also, among the dimensions studied here, the supervision dimension had the highest rate of satisfaction (91%), which reflects participants' relative satisfaction with the competence of their authorities. Jahani stated that the majority of employees were satisfied with their direct supervisor and considered authorities' proper management as one of
the factors ensuring the success of health
and treatment systems (19). Sabooteh (2013) believed that if the staff are supported by the manager, they will do their job with less stress and interpersonal relationships, job satisfaction, self-confidence, and quality of work will be improved (24).

The results on personal relations showed that most of the subjects had moderate job satisfaction. Mirmolaie also found that midwives had low to moderate job satisfaction (12). In
his study, Mogharab (2005) indicated to job dissatisfaction among the majority of nurses (23). It is, therefore, clear that improving external factors can enhance job satisfaction among midwives, and in turn, increase their hope and desire to provide better services to patients. Improving employees' performance is hinged upon identifying the factors affecting it.

The findings of this study revealed that health and motivational factors can influence the level of job satisfaction among midwives, which is consistent with the results of
Karimi et al. (2007), Castillo and Cano (2004),
and Ashekar (2003). Consequently, it is recommended that through preparation of sanitary and creation of motivation, midwives can be supported more efficiently (25, 26).

The findings of this study revealed that the most important hygiene factors influencing job satisfaction among midwives include a friendly relationship with colleagues, adequate salary, appropriate physical work environment, provision of equipment, facilities and other necessary conditions, and job security. In addition, the most important motivational factors affecting midwives' level of satisfaction are a sense of responsibility and success in work, interest in the type of work, honor and dignity of the profession, sense of independence and autonomy in work (Table 1).

In a study, Cong (2007) showed that factors such as personal appreciation, performance promotion, written appreciation, promotion and encouragement, and explicit admiration and praise are among the most important factors that affect staff's motivation (27). In another study, Dansen (2004) came to the conclusion that internal independence, occupational status and conditions, as well as payment are key to employee satisfaction and performance (28).

Our results showed that the highest correlation existed between job satisfaction and management policymaking. Components of
this dimension include decisions related to midwifery, supports offered to obstetricians by managers, the possibility of expressing opinions, supports offered for career advancement by managers, implementation of administrative rules and regulations, possibility of holding in-service training, and fitness of assigned
duties with the job description. Midwives' dissatisfaction in this dimension is indicative of weakness in administrative and management system in all the above components.

One of the limitations of this study is that the participants were limited to the midwives working in hospitals and midwives working in health centers were not included in the study. Another limitation was the use of a self-
report questionnaire. Future complementary
studies with more objective methods such as observation are recommended.

Conclusion

Considering the moderate job satisfaction of midwives in this study, the factors enhancing job satisfaction among midwives such as relationship with colleagues, which is indicative of proper cooperation and assistance amongst them, should be addressed by the respective authorities. High satisfaction in this dimension is indicative of
the fact that friendly relations and creating
an environment away from stress between colleagues have been effective in enhancing overall job satisfaction, which can be used
to improve other dimensions of employee satisfaction, including management policymaking and supervision. High job satisfaction, by creating favorable organizational climate, can prevent fatigue and psychological distress among colleagues, and eventually, promote patient care services. Appropriate career standards should be implemented to reduce stress and increase operational efficiency. In this regard, the implementation of appropriate punishment and reward systems, and provision of recreational and sport facilities should be considered by the respective authorities.

Acknowledgements

This article is the result of a research project approved by the Deputy of Research of Abadan School of Medical Sciences, Abadan, Iran. We wish to thank the authorities of School of Nursing and Midwifery of Abadan School of Medical Sciences and the respected colleagues who participated in this study.

Conflicts of interest

The authors declare no conflicts of interest.