Job Satisfaction and Some of Its Related Factors in Midwives of Tehran Health Centers
Background: Job satisfaction, which is affected by various factors, indicates positive or negative attitude of employees towards their own occupation and affects the quality of service.
Objectives: The present study aimed at investigating job satisfaction and some of its related factors in midwives of Tehran primary health centers in 2014.
Methods: The present cross sectional study was conducted on 125 employed midwives in Tehran health centers in 2014. Random quota sampling method was used to collect data. Moreover, data were gathered using a self-report questionnaire and analyzed using descriptive and analytic statistical methods (Chi square and Pearson’s correlation coefficient test).
Results: The mean age of the participants was 37.38 ± 8.34 years, and the mean score of job satisfaction of midwives was 59.25 ± 1.33, which is considered moderate. A significant direct relationship was obtained between job satisfaction and the current job promotion system (P = 0.003), and modeling other colleagues (P = 0.05), moreover, a reverse relationship was found between job satisfaction and role ambiguity of midwifery (P = 0).
Conclusions: Considering the findings of the present study, it seems necessary to pay more attention to the factors that increase job satisfaction of midwives such as decreasing role ambiguity and improving job promotion system in midwifery to improve their job satisfaction and the quality of care they provide to patients.
Keywords: Midwives; Job Satisfaction; Health Centers
One of the most important issues that has concerned health system managers and planners is investigating job satisfaction among health care providers including midwives (1-3). Emphasis on effective human resources in the field of health and attention on the factors that lead to providing better services by health personnel is increasing (4, 5). Midwives play an important role in promoting public health at 3 levels of care system including hospitals, primary health centers, and family-society (6). Midwives are effective members in delivering fertility health services to women and their children. The applicants of fertility services expect the followings from their care providers: appropriate interactions, discipline in providing services, understanding patients’ condition, and receiving quality care (7, 8).
Rakhshani’s study proved that lack of adequate quality in services is related to job dissatisfaction (9). Job dissatisfaction would decrease the quality of care and cause mental and physical damages to health care providers (10). In contrast, providing job satisfaction for care providing groups, including midwives, improves the quality of delivered services, so improving job satisfaction of care providers results in increasing patients’ satisfaction. The researchers believed that employees’ satisfaction is one of the most important factors in increasing efficiency, personnel’s empathy towards the organization, interest and attachment to the work environment, increase in service quality and quantity, establishing good human relations at work, creating proper interactions, improving personnel’s morale, and promoting enthusiasm and decreasing stress (11-14). Satisfied employees are more genuine and creative at work. Furthermore, researchers proved that there is a direct relationship between employees and clients’ satisfaction (15, 16). Job dissatisfaction may cause employees’ insufficiency and frustration and may decrease the quality of care (15-17).
Enjoying job satisfaction would not only increase organization’s benefits but also would increase employees’ commitment to the organization and promotion of physical and mental health (15). Piree (2009), in his study, explained that organizational variables such as job satisfaction can increase personnel’s morale in an organization (18).
Job satisfaction can be divided into 6 categories according to staff attitude: (1) work: all duties that must be conducted at a certain place; (2) salary: the money that is monthly paid to the staff as their wage; (3) organization: A place or a ministry where someone is working; (4) coworkers: the personnel that work together in one place; (5) promotion: reaching a higher position or a position with more responsibilities; (6) manager: individual/individuals who work as the person in charge at an organization (1, 19).
Researchers believed that several factors affect job satisfaction, and some of them are as follow: workplace, work atmosphere, having independence at work, relationship with coworkers and management, salary, employment conditions, working hours, and the amount of responsibility (20-22).
Whereas various studies have been conducted on physicians and nurses’ job satisfaction, very few studies have been done on midwives’ job satisfaction (18, 21), and small number of studies have been published about job satisfaction of Tehran midwives, and its influencing factors such as role ambiguity has rarely been studied. Thus, the present study was conducted at Tehran primary health centers on midwives during 2014 to find the rate of job satisfaction and some of its related factors to help, although slightly, improve midwifery services and quality of care and boost mothers and midwives’ satisfaction.
This descriptive cross sectional study was conducted on 125 midwives of Tehran primary health centers who were selected through random quota sampling. Tehran has 6 original primary health centers, and they have several subcategories as medical health centers based on their geographical area. The study environment included North, South, West, Shemiranat, and Northwestern health centers of Tehran. All health centers were university affiliated (governmental). Inclusion criteria were having at least 2 years of trainings, working at least 6 months in the health center, and providing informed consent to participate in the study. Sample size was calculated by the following formula, with 95% power and 0/001 Error:
Data collection tool was a 3 part self-report questionnaire. The first part included individuals’ demographic characteristics, and the second part was the Minnesota satisfaction questionnaire. Chronbach’s α for this questionnaire is 0.91 (2, 23). Short form of the Minnesota satisfaction questionnaire includes 21 questions that is proper for health centers. According to the questionnaire, the minimum and maximum scores of job satisfaction were 21 and 105, respectively; the higher the score, the higher the rate of job satisfaction. The third part of the questionnaire included 3 questions about job related factors that were put at the end of the questionnaire (including the influence of current job promotion system in midwifery, the presence of role ambiguity in midwifery, and the rate of modeling from colleagues). All questions of the second and third parts of the questionnaire were measured based on a 5-point Likert scale ranging from 1 (minimum) to 5 (maximum). The scientific validity of the questionnaire was confirmed by 10 academic members of Tehran University of Medical Sciences, Faculty of Nursing and Midwifery, using the initial study. In the initial study, 10 midwives from south health center of Tehran filled the questionnaire; and after 2 weeks, the same people again filled the questionnaire. Then, a correlative coefficient of r = 93% was calculated for the midwives’ job satisfaction and some of its related factors questionnaire.
Therefore, the questionnaire’s durability was confirmed.
2.1. Statistical Analysi
The total scores of midwives’ job satisfaction and investigation of its related factors were analyzed using descriptive and inferential statistical tests (Chi square, and Pearson’s correlation coefficient) using SPSS Version 16.
The mean age of the participants was 37.38 ± 8.34 years; most of the midwives (80%) had a bachelor’s degree and were mostly (59%) permanent employees. Demographic characteristics of the participants are presented in Table 1. The mean score of job satisfaction among midwives was 59.25 ± 1.33, which is considered moderate. Of the midwives, 10.4% had a low job satisfaction, 48% had a moderate job satisfaction, and 41.6 % had a high rate of job satisfaction. The minimum level of satisfaction belonged to possibility of improvement at work with individual average of 1.97 ± 1.008, and the maximum level of satisfaction belonged to the ability to guide and lead the patients with individual average of 3.74 ± 0.86 (Table 2). Table 3 demonstrates the relationship between some variables and job satisfaction.
Demographic Characteristics of the Midwives in Tehran Health Centers
The Mean of Job Satisfaction Among Midwives of Tehran Health Centers in 2014
The Relationship Between Job Satisfaction of Midwives in Tehran Health Centers with Demographic Characteristics and Some Occupational Factors
Boosting job satisfaction of fertility health care providers including midwives improves the quality of provided care, prevents probable damages, and increases the satisfaction of the service receivers. The current study was conducted to investigate job satisfaction and some of its related factors among midwives of Tehran health centers.
The results of the present study revealed that the mean of job satisfaction in midwives of Tehran health centers was at a moderate level; in other words, about half of the participants had a moderate job satisfaction (48%). Nehrir et al., in their study, assessed the score of job satisfaction among nurses to be 43.17 (24), but Monjamed et al. found a rate of 78.2% for job satisfaction among nurses (14). In Jahani et al. study, 82% of the staff of Arak hospital had a moderate job satisfaction (25).
In the present study, a significant relationship was obtained between job satisfaction and income. No statistically significant relationship was observed between job satisfaction and demographic characteristics such as age, work experience, marital status, and educational level. Nehrir et al., in their study, mentioned a significant relationship between job satisfaction and educational degree and gender of the studied participants (24). Jahani et al., in their study, observed a significant relationship between gender, education, type of employment, and job and working shift with job satisfaction (25). Asegid et al. (2014) mentioned a quotation from Rambur that elder individuals have more job satisfaction than the younger.
The existence of job stability was one of the questions in the field of job satisfaction in the present study. Less than half of (39%) the participants were satisfied with their job stability. In a study by Yaghouti, the rate of job security was 69.7% (26), whereas in Mirza-Beygi et al. study, satisfaction with job security was 44.5% (27). In studies of Monjamed et al., Mirmolaei et al., and Shahbazi, the minimum satisfaction rate was related to job security. However, in a study conducted by Jahani et al., the minimum rate of satisfaction belonged to the benefits from job difficulty, establishing equity, facing no discrimination, and welfare facilities (6, 12, 14, 25). In the present study, the minimum rate of satisfaction belonged to possibility of promotion at work with a mean satisfaction score of 1.97 ± 1, the probability of being rewarded for proper functioning with a mean satisfaction score of 2 ± 1, and feeling successful in the field of midwifery with a mean satisfaction score of 2.07 ± 1.18. Thus, authorities should pay more special attention to midwives problems and job satisfaction.
In the present study, no significant relationship was found between job satisfaction and working experience. The relationship between working experience and job satisfaction has a U- shape, meaning that in the first years of employment, the personnel’s satisfaction would decrease and stay so for several years, then, it would increase. Moreover, it means that the personnel’s expectations are high at the time of employment and if their expectations are not met, they feel dissatisfied with their job. As the personnel become more experienced and mature, their initial expectations become more realistic and reachable, and hence, their job satisfaction would increase simultaneously (28).
However, some studies have shown that people with more working experience have less job satisfaction due to exhaustion (27). The findings of the present study on working experience were similar to those of Asghari and Rashedi et al. (29). Luddy believed that working experience has a weak relationship with job satisfaction (30); and studies conducted on the effect of marital status on job satisfaction have shown similar results. In the present study, no relationship was obtained between marital status and job satisfaction. The study of Cimete et al. (2003) showed that the mean score of job satisfaction was higher among female employees who were divorced or widowed compared to the singles and the married (31).
In the study of Rashedi et al. and Mogharrab et al., no relationship was observed between marital status and job satisfaction in operation room technicians, which were similar to our study. According to Rashedi, the reason for this problem is that married individuals, because of having more problems in their married lives, pay less attention to job satisfaction than singles. In the study of Asgari, like the present study, most of the participants were married (29, 32).
One of the other factors of job satisfaction discussed in the present study was role ambiguity in midwifery. Most participants believed that the level of role ambiguity in midwifery is very high. The present study found a significant reverse relationship between job satisfaction and role ambiguity, meaning that the more the role ambiguity in midwifery, the less the job satisfaction of the midwives.
According to the results of the statistical tests, for every increase in the score of role playing, the job satisfaction of midwives increases by 76 scores. The expectations from midwives are very high in health centers. As it had been observed in the gathered data, more than half of the participants were dissatisfied because of the different and unrelated works that they had to do in health centers; the reason seems to be using midwives everywhere due to lack of human resources. Also, it has been observed that in some health centers, despite the lack of midwifery resources for providing fertility health services, the subsidiary duties of midwives are so time consuming that would keep them from doing their own work. To provide excellent fertility health service, having proper number of midwives is necessary. Furthermore, to achieve the best results for the health of mothers and their infants, midwives should be working at their own level (1). Providing sufficient midwifery resources can guarantee the health of the next generation.
Another factor relating to job satisfaction in the present study was the system of job promotion in the field of midwifery. Most of the participants believed that the current system of job promotion in midwifery has been unsuccessful or ineffective in creating motivation and job satisfaction. The statistical results revealed a significant relationship between job promotion system and job satisfaction. Moreover, the results of the linear regressive test showed that for every increase in the score of job promotion system, job satisfaction of midwives would be increased by 57 scores.
One of the related factors in this case was being rewarded for proper and decent functioning. According to the results of the present study, the rate of satisfaction from this case was the lowest. Apparently, midwives believe that lack of facilities for continuing their education also contributes to their lack of satisfaction because educational support and creating an appropriate conditions for them to receive trainings, are among the factors that improve job satisfaction (33).
Another factor that was related to job satisfaction in the present study was the rate of modeling from colleagues. About half of the participants reported that the rate of modeling from colleagues was moderate for them; and the results of the satisfaction tests revealed a significant relationship between modeling from colleagues and job satisfaction. Linear regressive test results also revealed that for every improvement in the score of modeling, job satisfaction is improved by 54 points. Modeling from colleague is related to positive work atmosphere and friendly relation with colleagues, and if moral atmosphere is positive at the workplace and modeling is conducted in an appropriate direction, the patients’ satisfaction would also increase.
By improving work ethics and relationships with coworkers at the work environment, we could use modeling from colleagues as a useful instrument or provide better health services. Positive cooperation and successful team coordination can enforce job satisfaction (34).
Considering the importance of job satisfaction among midwives and its effect on improving quality of midwifery care, the present study examined the rate of midwives’ job satisfaction and some of its related factors in midwives of Tehran health centers. Considering the findings of this study, it is suggested that more attention be paid to the factors that increase job satisfaction among the midwives including decreasing the role ambiguity of the midwives and improving job promotion system to elevate the quality of provided care and satisfaction of midwives and patients. However, due to small sample size, the results cannot be generalized extensively and there is a need for further studies in this area.
4.2. Ethical Consideration
The aim of the study was explained to the participants, and voluntary participation in the study was emphasized. Moreover, confidentiality, collecting information without intruding the participants, and a wish to withdraw from the study at any time have been respected.
This study was approved by the ethical committee of Tehran University of Medical sciences with Number 250/1682. We would like to thank and appreciate the research vice-chancellor of Tehran University of Medical Sciences, Midwifery and Nursing Faculty of Tehran University of Medical Sciences, and all the midwives in Tehran health centers who completed the questionnaires patiently. With best wishes for all the midwives.
- 1. Asegid A, Belachew T, Yimam E. Factors Influencing Job Satisfaction and Anticipated Turnover among Nurses in Sidama Zone Public Health Facilities, South Ethiopia. Nurs Res Pract. 2014;2014:909768. [DOI] [PubMed]
- 2. Gholami Fesharaki M, Talebiyan D, Aghamiri Z, Mohammadian M. Reliability and validity of “job satisfaction survey” questionnaire in military health care workers. J Mil Med. 2012;13(4):241-6.
- 3. Abarghouei MR, Sorbi MH, Abarghouei M, Bidaki R, Yazdanpoor S. A study of job stress and burnout and related factors in the hospital personnel of Iran. Electron Physician. 2016;8(7):2625-32. [DOI] [PubMed]
- 4. Watson AM, Thompson LF, Meade AW, editor(s). Measurement invariance of the job satisfaction survey across work contexts. 22nd Annual Meeting of the Society for Industrial and Organizational Psychology; 2007; New York.
- 5. Niazi S, Jahani MA, Mahmoodi G. Evaluation of human resources in the hospitals affiliated to babol university of medical sciences and social security of qaemshahr city based on the standards of the iranian ministry of health. J Babol Uni Med Sci. 2016;18(2):56-63.
- 6. Mirmolaei T, Dargahi H, Kazemnejad A, Mohajerrahbari M. Job satisfaction of midwives [In persion]. J Hayat. 2005;11(2):87-95.
- 7. Farajkhoda T, Latifnejad R, Abbasi M. Developing the professional codes of ethics for reproductive health care provider and it's assessment from their view points in Yazd health care centeres. Shahid Beheshti Uni Med Sci. 2013.
- 8. Nursing A, Council M. National competency standards for the midwife. Australian Nursing and Midwifery Council; 2006. ISBN 0977510816.
- 9. Rakhshani F. Survey the quality of family planning services at health centers in Zahedan in 2000. Zahedan J Res Med Sci. 2001;3(4):9-15.
- 10. Zolfaghari B, Kabiri P, Oveis Gharan; S. . Method of preparing a standard questionnaire to determine patient satisfaction in hospitals. Res Med Sci. 1999;3(3):136-4.
- 11. Hampton G, Peterson R. Job satisfaction of certified nurse midwives: An examination. Admin Iss J. 2012;2(2):112-26. [DOI]
- 12. Hooman H. Preparation and standardization of job satisfaction scale. Center Gov Manag. 2002;15(3):11-32.
- 13. Internationale JID, Infirmières CID, Baumann A. Positive practice environments: quality workplaces. International Council of Nurses; 2007. ISBN 9295040805.
- 14. Monjamed Z, Ghorbani T, Mostofian F, Oveissipour R, Nakhost Pandi S, Mahmoudi M. A nationwide study of level of job satisfaction of nursing personnel in Iran [In Persion]. J Hayat. 2005;10(4):39-48.
- 15. DiMeglio K, Padula C, Piatek C, Korber S, Barrett A, Ducharme M, et al. Group cohesion and nurse satisfaction: examination of a team-building approach. J Nurs Adm. 2005;35(3):110-20. [DOI] [PubMed]
- 16. Tzeng HM. The influence of nurses' working motivation and job satisfaction on intention to quit: an empirical investigation in Taiwan. Int J Nurs Stud. 2002;39(8):867-78. [DOI] [PubMed]
- 17. Abbaschian R, Avazeh A, Rabi SiahkaliS S. Job satisfaction and its related factors among nurses in the Public Hospitals of Zanjan University of Medical Sciences, 2010. Prev Care Nurs Midwifery J. 2011;1(1):17-24.
- 18. Pieri Z. A study of work ethic and social factors affective on that among personnels of department islamic culture in Zanjan city (Master thesis). Islamic Azad Uni Zanjan Branch. 2009.
- 19. Soleimani N, Abbaszadeh N, Niaz Azari B. The relationship work ethics to staffs’job satisfaction and job stress in vocational and technical education organization in Tehran [In Persion]. Quart J New App Edu Admin. 2012;3:21-36.
- 20. Lorber M, Skela Savic B. Job satisfaction of nurses and identifying factors of job satisfaction in Slovenian Hospitals. Croat Med J. 2012;53(3):263-70. [DOI] [PubMed]
- 21. Heidarzadegan A, Kazemi Y, Sanatizadeh F. Relationship among educational managers'self-control, creativity and leadership styles [In Persion]. J Edu Psychol Stud. 2013;9(16):39-54.
- 22. Gorgich EAC, Arbabisarjou A, Taji F, Barfroshan S. Job satisfication and external effective factors in operating room nurses working educational hospitals in 2015: A cross-sectional questionnaire study. Global J Health Sci. 2016;9(1):74. [DOI]
- 23. Jalili M, Joolaei S. The relationship between stress, moral, ethical work environment and job satisfaction in nurses of Tehran medical university hospitals. Tehran Uni Med Sci. 2011.
- 24. Nehrir B, Ebadi A, Tofighi S, Karimi Zarchi AA, Honarvar H. Relationship of job satisfaction and organizational commitment in hospital nurses. J Mil Med. 2010;12(1):23-6.
- 25. Jahani F, Farazi A, Rafiei M, Jadidi R, Anbari Z. Job satisfaction and its related factors among hospital staff in Arak in 2009. Arak Med Uni J. 2010;13(1):32-9.
- 26. Yaghoti A. Job satisfaction and its related factors, and solutions in Imam Khomeini Hospital, Tehran. Tehran Uni Med Sci. 2005.
- 27. Mirzabeigi G, Salemi S, Sanjari M, Shirazi F, Heidari S, Maleki S. Job satisfaction among Iranian nurses. J Hayat. 2009;15(1):49-59.
- 28. Oshagbemi T. Personal correlates of job satisfaction: empirical evidence from UK universities. Int J Soc Econ. 2003;30(12):1210-32. [DOI]
- 29. Asgari M, Rafat A, Rashedi V. Job satisfaction in operating room technician of Hamadan University of Medical Sciences’ hospitals, 2012. Pajouhan Sci J. 2012;11(1):37-40.
- 30. Luddy N. Job satisfaction amongst employees at a public health institution in the Western Cape University of the Western Cape; 2005;
- 31. Cimete G, Gencalp NS, Keskin G. Quality of life and job satisfaction of nurses. J Nurs Care Qual. 2003;18(2):151-8. [PubMed]
- 32. Mogharab M, Madarshahian F, Aliabadi N, Rezaei N, Mohammadi A. Job satisfaction of nurses working in Birjand teaching hospitals. J Birjand UniMed Sci. 2005;12(3):9-15.
- 33. Saari LM, Judge TA. Employee attitudes and job satisfaction. Hum Resour Manage. 2004;43(4):395-407. [DOI]
- 34. Bjork IT, Samdal GB, Hansen BS, Torstad S, Hamilton GA. Job satisfaction in a Norwegian population of nurses: a questionnaire survey. Int J Nurs Stud. 2007;44(5):747-57. [DOI] [PubMed]