Int J Clin Pharm (2015) 37:335–341 DOI 10.1007/s11096-015-0064-9
RESEARCH ARTICLE
Eritrean pharmacists’ job satisfaction and their attitude to re-professionalize pharmacy in to pharmaceutical care Merhawi Teklai Awalom • Abel Fekadu Tesfa • Medhanie Elias Kidane • Mulugeta Russom Ghebremedhin Ambesajir Habtemichael Teklesenbet
•
Received: 28 January 2014 / Accepted: 2 January 2015 / Published online: 31 January 2015 Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2015
Abstract Objective Job satisfaction is a very important contributing factor for a person’s productivity and motivation. Naturally, if people are not satisfied with what they practice, they will probably need to change or reshape their way of practice at a certain period in time. Pharmacists are not exception to this principle and have been observed to re-professionalize pharmacy in to clinical and/or pharmaceutical care in many parts of the world. Thus, this survey aims to investigate the Eritrean pharmacists’ current level of job satisfaction and their views on re-professionalization of pharmacy. Method A cross-sectional survey was conducted among all Eritrean pharmacists who reside inside Eritrea. Main outcome measures Opinion of pharmacists about job satisfaction and re-professionalization of pharmacy into pharmaceutical care. Results Out of the 95 questionnaires distributed 86 were completed and returned giving a response rate of 90.5 %. Nearly three fourth of the respondents (71 %) have chosen pharmacy as their ever profession and they want to encourage their children or their close relatives to pursue it as a career. Sixty four percent of the pharmacists are either partially or fully unsatisfied to spend the remainder of their working life in a job like their current one and this has a strong statistical association with less years of experience (p = 0.007) and place of work of the younger pharmacists (p = 0.008).
M. T. Awalom (&) A. F. Tesfa M. E. Kidane School of Pharmacy, Asmara College of Health Sciences, Asmara, Eritrea e-mail: [email protected] M. R. Ghebremedhin Pharmacovigillance Centre, Ministry of Health, Asmara, Eritrea A. H. Teklesenbet Nakfa, Eritrea
Majority of the study participants (86 %) believe there is a great mismatch between pharmacists’ level of education and level of practice in the work area. This was significant with lower age (p = 0.002), less years of experience (p = 0.006) and later year of admission to university (p = 0.000). Ninety five percent of the pharmacists perceive that the current role of the Eritrean pharmacists needs to be redefined and re-oriented. Conclusion Although the Eritrean pharmacists are proud to be pharmacy professionals, they want to redefine and reorient their current role into pharmaceutical care. Keywords Attitude Eritrea Job satisfaction Pharmacists Profession Re-professionalization
Impacts on practice •
• •
Policy makers and stakeholders should be aware that Eritrean pharmacists’ current role needs redefining and redirecting Solutions should be sought for the main reasons of professional dissatisfaction of pharmacists in Eritrea The current knowledge and skills of pharmacists in patient care should be properly exploited until successful re-professionalization is attained
Introduction Job satisfaction is a very important contributing factor for a person’s productivity and motivation [1]. Job satisfaction can be defined in a number of ways. Two of these are the degree of personal gratification one receives from one’s work and the pleasure and feeling of accomplishment
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employees derive from performing their jobs well [2, 3]. In other words, job satisfaction is the extent a person receives fulfillment or gratification from his or her workplace activities, the attitude toward the job as a whole [4]. Based on the work of Victor H. Vroom [5], ‘‘Individuals are satisfied with their job to the extent to which their jobs provide them with what they desire, and they perform effectively in them to the extent that effective performance leads to the attainment of what they desire ‘‘. There are two ways that are most often used to measure job satisfaction. The first encompasses specific features of a job (a facet item) that result in either satisfaction or dissatisfaction, and the second includes a global satisfaction scale without reference to particular aspects of the work (a facet free item) [3]. Pharmacists’ level of satisfaction with their work activities has been found to be a prominent predictor of job turnover; that is, an increase in job satisfaction can reduce the likelihood of job turnover [6–9]. Job dissatisfaction often correlates with many other negative effects: such as absenteeism, work fatigue, burnout, low quality of work, decreased commitment to the profession and counter productivity. Any of these consequences are costly [10]. Job dissatisfaction may also affect the way that patients view the pharmacist and patients may then be inclined to limit their interactions with the pharmacist [11]. The job satisfaction of health-care workers has a positive association with patients’ satisfaction and contributes to the continuity of care [12]. It is important to realize that a decrease in pharmacist performance could cause patient harm or even death [13, 14]. Several factors, including pharmacists’ perceived utilization of their skills and feelings about the types of activities performed at work, along with the type of practice setting, affect levels of job satisfaction [15, 16]. Evidences have shown that, as the number of clinical activities increase, satisfaction also increases. More than 30 years ago, for instance, US hospital pharmacists generally were not satisfied with their jobs unless they were also involved in administrative or clinical activities [17–19]. Since that time, the role of US pharmacists has been changing from primarily distributive to more clinical practice, and this has been associated with greater job satisfaction [16]. Now, it is clear that pharmacy has an important role to play in the health care reform process (A paradigm shift in pharmacy practice is occurring). To do so, however, the role of the pharmacist needs to be redefined and reoriented [20].The movement towards pharmaceutical care is a critical factor in this process [21]. Pharmaceutical care is defined as the pharmacist’s contribution to the care of individuals in order to optimize medicines use and improve health outcomes [22]. The introduction of pharmaceutical care is required more in developing countries to aid in the resolution of
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medication-related problems [23]. Since Eritrea is classified as one of the low-income countries possessing resource-limited health settings, the introduction of pharmaceutical care seems very relevant. Naturally, if people are not satisfied with what they practice, they will probably need to change/reshape their way of practices at a certain period in time. Pharmacists are not exception to this principle and have been observed to re-professionalize pharmacy in to clinical and/or pharmaceutical care in many parts of the world. In Eritrea, the Ministry of Health is responsible for all matters pertaining to national planning and coordination of the health care sector. The pharmacy profession is still in its traditional stage. The job description of pharmacists and pharmacy technicians in the work area is virtually the same. At this time, however, hard work is being undertaken by Asmara College of Health Sciences (ACHS), and the Eritrean Pharmaceutical Association (ERIPA) to reprofessionalize the profession from a product-oriented profession to a patient- oriented one. And it is a common place to hear from many Eritrean pharmacists that they are not satisfied with their current job and want to participate in clinical activities. To our knowledge, no study on either job satisfaction or need for re-professionalization of pharmacy among pharmacists in Eritrea has previously been conducted. Thus, this survey aims to investigate the Eritrean pharmacists’ current level of job satisfaction and their views in re-professionalization of pharmacy.
Aim To explore Eritrean pharmacists’ job satisfaction, to identify reasons for dissatisfaction, and to assess if Eritrean pharmacists have the stance of re-professionalization pharmacy into pharmaceutical care
Method Research design and population A facet item, cross- sectional descriptive survey was conducted among all Eritrean pharmacists who lived inside the country at the time of the survey. At first, 120 pharmacists (including 4 researchers ? 2 reviewers of the questionnaire = 6) were identified from the ERIPA and from the Ministry of Health of Eritrea (MoH). We included all practicing pharmacists during the study period (August– September 2013). Out of those who were identified from MoH and ERIPA, 98 fulfilled the inclusion criteria and three were not able to be contacted. Finally, 95 pharmacists
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were included in the study, and a questionnaire was administered to each participant personally by the researchers and the pharmacists were informed to return it back to the same person who gave them the questionnaire. Instruments The survey items were developed using information from reviewing available literature and by discussion among the researchers. Content validity and clarity of the first draft of the questionnaire was reviewed and assessed by two senior pharmacists and two senior college members who have good experience in epidemiological research. The final version of the questionnaire consisted of: demographic data and set of opinion statements regarding pharmacists’ current job satisfaction and their need to reprofessionalize pharmacy in to clinical pharmacy, for which respondents were requested to indicate their level of agreement using a five-point likert scale response format (strongly agree = 5, agree = 4, neutral =3, disagree = 2 and strongly disagree = 1).
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Results Demographic data A total of 95 questionnaires were initially distributed; out of these 86 were completed and returned (response rate = 90.5 %). Eighty seven percent of the respondents were males. Mean age of the pharmacists was 36 (SD ± 11.35) years, with a range of 25–69 years. The mean years of working experience of the pharmacists was 9.49 (SD ± 2.19) years, with a range of 1–43 years. Fifty seven percent of the respondents were admitted to university before 2003, and a quarter of the pharmacists (25.6 %) currently work in private community pharmacies followed by pharmacists who currently work in governmental hospital pharmacies (23.3 %), Ministry of Health (16.3 %), Governmental college (12.8 %), Governmental Community Pharmacies (10.5 %), Governmental Pharmaceutical Plant/drug distributors (10.3 %) and private drug distributors (1.2 %). Pharmacists’ job satisfaction
Data analysis Descriptive and inferential statistical tests were used to analyze demographic characteristics and the questionnaire statements. Data were captured and cleaned using CSPro version 4.1. It was then analyzed using PASW version 18. During analysis the five point likert scale was collapsed into 3 category (strongly agree and agree in to ‘‘Agree’’, neutral is left as ‘‘Relatively agree’’ and disagree and strongly disagree into ‘‘Disagree’’). The responses of the pharmacists to the questionnaire statements were presented as percentages. Measures of variation and central tendencies were applied to identify the mean age, mean years of experience of the pharmacists and for their respective ranges. Crosstabulation was employed between some of the questionnaire statements, and between some of the statements and some selected demographic characteristics. Non-parametric Kendall’s tau-b tests were applied to observe the influence of age, gender, years of experience, year of admission to university/college and current place of work on their level of job satisfaction and their stance for reprofessionalization of pharmacy. Statistical significance was accepted at p value \0.05. Ethical issues Verbal consent was obtained from all the participants before they were given the questionnaire. Besides, a written letter of consent was attached to the front page of the questionnaire.
From this research it was noted that 64 % of the pharmacists are either partially or fully unsatisfied to spend the remainder of their working life in a job like their current one and this has a strong statistical association with less years of experience (p = 0.007) and place of work of the younger pharmacists (p = 0.008) where majority of them work in governmental pharmaceutical work places. Taking everything into account, close to two-third of the participants (64 %) are either relatively or fully dissatisfied. This issue has also a strong correlation with lower age (p = 0.005), less years of experience (p = 0.001) and later year of admission to university (p = 0.002). Approximately half of the respondents think that they have the opportunity to use their skills and knowledge at their place of employment. However, this associated significantly with lower age (p = 0.001), less years of experience (p = 0.001), and later year of admission to university (p = 0.000). Nearly three fourth of the respondents (71 %) have chosen pharmacy as their ever profession and they want to encourage their children or their close relatives to pursue it as a career. Almost all of them (95 % agreed ? 5 % relatively agreed), have got the attitude of contributing much more than what they are doing with their present knowledge and skills provided that their professional potentials are properly utilized. The majority of the pharmacists (86 %) believe there is a great mismatch between pharmacists’ level of education and level of practice in the work area. This correlated significantly with less years of experience (p = 0.006), lower age (p = 0.002), and later year of admission to university (p = 0.000). Sixty seven
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percent of the study participants consider that the premise (s) in which they work is inconvenient to carry out their professional activities and this was correlated significantly with lower age (p = 0.008), less years of experience (p = 0.002), later year of admission to university (p = 0.000) and place of work of the younger pharmacists (p = 0.041). Half of the respondents believe that they perform non-professional tasks more than the professional activities, which was found to be associated significantly with less years of experience (p = 0.002) and place of work of the younger pharmacists (p = 0.000). The number of pharmacists who have agreed with the idea ‘‘Since I am utilizing a little part of my knowledge, I am afraid of losing it in the future’’- slightly outweighs (49 %) from those who have not agreed (40 %). This has a strong association with place of work of the younger study participants (p = 0.002). More than half of the respondents (57 %) disagreed with the idea of being consulted by physicians on professional matters. Similarly, more than half of the pharmacists (55 %) found physicians either partially or totally uncooperative on job related matters. The majority of the pharmacists felt they were respected by their fellow health professionals (75 %) and the public (86 %). Pharmacists attitude for re-professionalization Ninety five percent of the pharmacists perceived that the current role of the Eritrean pharmacists needs to be redefined and reoriented. Ninety two percent of the respondents have good awareness of the re-professionalization of pharmacy into patient- oriented in many parts of the world, but this has a strong statistical correlation with later year of admission to university (p = 0.005). Most of the pharmacists (94 %) have aspired to see pharmacy in Eritrea reprofessionalized into pharmaceutical care. Likewise, virtually all of them (98 %) perceived that pharmacists’ job satisfaction can increase with more clinical participation. Almost all of them (99 %) agreed that pharmacy can mature by accepting its social responsibility to reduce preventable drug related morbidities and mortalities (Table 1).
Discussions Job dissatisfaction may trigger consequences as absenteeism or, at a more critical, the abandonment of the profession [24]. The high response rate of the pharmacists to the questionnaire may imply that the pharmacists have a strong desire for re-professionalization of the profession into clinical pharmacy. In Eritrea, pharmacists’ functions are
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mainly limited to drug dispensing, procurement, manufacturing and inventory control, which in turn limit the interaction of pharmacists with patients and thereby reduce their job satisfaction (Table 2). The majority of the pharmacists felt unchallenged by physicians on professional matters and probably the younger and less experienced pharmacists were less satisfied with the level of cooperation they obtain from physicians when they try to communicate job related issues. This may suggest, younger pharmacists as compared to older peers, expected more interaction and cooperation from physicians. The pharmacists agreed that they were respected by their fellow health professionals and the public. However, the younger and less experienced pharmacists felt that the level of respect received was less as compared to the older pharmacists. This may be attributed to the difference in the place of work of the young and old pharmacists. An investigation conducted in China revealed that hospital pharmacists had been neglected for a long time; the professional role of hospital pharmacists was often undervalued both by physicians and patients [25]. In this study the pharmacists supported the idea that even with the present knowledge and skills they can contribute much more than they are doing at the moment towards patient care. This was found to be consistent with their responses to the statement ‘‘There is a great mismatch between pharmacists’ education and level of practice’’. This could indicate that pharmacists are over educated but underutilized. According to Kahaleh and Gaither [26], the opportunity to use skills fully was identified as the most important factor in the perception of an ideal job. The strong association in response of these pharmacists with age and years of experience for the opportunity to make use of their knowledge and skills at their place of employment was found to be consistent with their agreement with the statement—‘‘There is a big mismatch between pharmacists’ level of education and the level of practice in the ground’’. This is further augmented by the finding that they are more commonly engaged in nonprofessional work at their place of work. This may indicate that the new pharmacy graduates are less satisfied with the current practice of pharmacy in Eritrea as compared to their senior colleagues. Similar studies in UK and Ethiopia showed that the more satisfied pharmacists were the ones with more years of service and an advanced age [27, 28]. The primary determinants of job satisfaction are intrinsic aspects of the job; that is, factors that make people satisfied are the work that they do or the way in which they are used [29]. The place of work of the pharmacists is strongly correlated with the utilization of professional knowledge and engagement in professional activities at the place of work.
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Table 1 Pharmacists’ opinions towards Job satisfaction of pharmacists (N = 86) Response (%)
P value*
Agree
Relatively agree
Disagree
Age
Yr. EXP
Yr. Adm
P. WK
Physicians consult me often on professional matters
22
22
57
0.709
0.134
0.083
0.521
My fellow health professionals treat me with professional respect
75
19
6
0.280
0.690
0.033
0.081
The public gives me professional respect/credit I am satisfied with the ‘‘on- the -job’’ relationship I have with other health professionals
86 44
7 27
7 29
0.001 0.168
0.012 0.107
0.076 0.014
0.019 0.564
I have the opportunity to make use of my skills and knowledge at my place of employment
54
19
27
0.001
0.001
0.000
0.207
The idea of spending the remainder of my working life in a job like my current one is satisfying The pharmacy premises/building in which I work is wide/convenient enough to carry out my professional activities
36
18
46
0.116
0.007
0.057
0.008
33
18
49
0.008
0.002
0.000
0.041
Physicians cooperate when I communicate ‘‘ job-related’’ matters with them
44
33
22
0.095
0.006
0.081
0.160
Knowing what I know now, if I had to decide all over again, I would still choose pharmacy
71
16
13
0.774
0.524
0.451
0.18
If my children/my close relatives/friends were interested in pharmacy, I would encourage them to pursue it as a care
71
15
14
0.669
0.356
0.6
0.218
Even with the present knowledge and skills, if my professional potentials are properly utilized I can contribute more than what I’m doing at this time
95
5
0
0.822
0.459
0.849
0.513
At my work place, the non-professional tasks that I do outweigh the professional ones
31
19
50
0.09
0.002
0.034
0
Since I am utilizing (applying) a little of part from what I have learnt, my professional knowledge is keeping on reducing
49
11
40
0.132
0.019
0.012
0.002
I believe there is a great mismatch between pharmacists’ level of education and what they really practice in the work place
86
7
7
0.002
0.006
0
0.038
All things considered, I am satisfied with my current job
36
23
41
0.005
0.001
0.002
0.121
Yr. EXP years of experience, Yr. Adm year of admission, P. WK place of work * Non-parametric Kendall’s tau-b tests were used to determine p value
Table 2 Pharmacists’ perceptions towards there-professionalization of pharmacy (N = 86) Response (%)
P value*
Agree
Relatively agree
Disagree
Age
Yr. Exp
Yr. Adm
P. WK
The Current role of Eritrean pharmacists needs to be redefined and reoriented
95
2
2
0.056
0.067
0.038
0.334
I already have good awareness on the re-professionalization of pharmacy from medication oriented to patient oriented i
92
6
2
0.112
0.125
0.005
0.053
My professional dream is to see the profession of pharmacy re-professionalized into patient oriented role
94
5
1
0.084
0.122
0.019
0.931
Pharmaceutical care could offer pharmacists with more public credibility and trust
93
6
1
0.022
0.065
0.01
0.26
Pharmacists’ job satisfaction can increase if they involve in clinical activities
98
2
0
0.754
0.278
0.15
0.144
Pharmacy can mature more as a profession by accepting its social responsibility to reduce preventable drug-related morbidity and mortality
99
0
1
0.308
0.308
0.313
NA
Yr. Exp years of experience, Yr. Adm year of admission, P. WK place of work * Non-parametric Kendall’s tau-b tests were used to determine p value
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This may be attributed to the diverse nature of place of work of the different groups of pharmacists. The results of this study strengthened earlier findings in USA that job satisfaction varied according to work environment [26]. The response of the pharmacists to the statement ‘‘All things considered, I am satisfied with my current job’’ was found to greatly vary with years of experience, age and year of admission to university/college. Perhaps, the aged and more experienced pharmacists have been taught with the drug-oriented pharmacy curriculum. In addition to this, the majority of them run either their own businesses or are occupying better job positions. This was further supplemented by the similarity of the findings of the size/ level of convenience of the pharmacy premises in which they work. Job position was consistently found to be a significant predictor of job satisfaction [29].The high correlation in years of experience and place of work of the pharmacists with their responses to the idea of spending the remainder of their professional life in a job like their current one may go in favor of the aforementioned discrepancies. The high percentage of agreement of the pharmacists that they will ever choose pharmacy as their career and wish to see their off springs or close relatives as pharmacists is good evidence that the respondents don’t regret by achieving pharmacy as a profession. However, they want to redirect their current role into patient- oriented practice for a greater professional satisfaction. This has been reinforced by the support of almost all of the pharmacists to the idea that their professional dream is to see pharmacy re-professionalized in to pharmaceutical care. Eritrean pharmacists believe that pharmacists’ job satisfaction can increase if they get involved in clinical activities. This finding was consistent with the findings of similar studies conducted in USA and Japan [17, 19, 30].
Limitations It was assumed that differences found in job satisfaction between pharmacists were due to job activities, not individual unhappiness with amount of income, length of working hours or other social factors. Besides, all data were self reported and are therefore subject to bias.
Conclusions Based on the results of this research the younger and less experienced pharmacists are comparatively more dissatisfied with the traditional pharmacy practice in Eritrea. Although the Eritrean pharmacists are proud to be pharmacy professionals, they want to redefine and reorient their current role in to pharmaceutical care. However, the
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pharmacists consider themselves as a huge asset even with present knowledge and skills towards patients’ drugtherapy. Therefore, the MOH, ERIPA and ACHS should give due emphasis to these findings and work hand-in-hand to fulfill the current need of pharmacists so as to make them more satisfied and more productive in pharmacotherapy. Acknowledgments We are grateful to all pharmacists who participated in the study. We would like to thank pharmacists Semere Ghebregiorgis and Kifle Aforki, as well as Mr. Andom Yohannes for reviewing the first draft of the questionnaire. Many thanks to Dr. Mismay Ghebrehiwet and Mr. Chan Ving Fai for prove-reading the final version of the manuscript. Many thanks also to Mr. Andebrhan Tewelde for his assistance in analysis. Funding ERIPA and PHARMACOR Eritrea supported the printing of the questionnaire. No other financial support was received. Conflicts of interest
None.
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RESEARCH ARTICLE
Eritrean pharmacists’ job satisfaction and their attitude to re-professionalize pharmacy in to pharmaceutical care Merhawi Teklai Awalom • Abel Fekadu Tesfa • Medhanie Elias Kidane • Mulugeta Russom Ghebremedhin Ambesajir Habtemichael Teklesenbet
•
Received: 28 January 2014 / Accepted: 2 January 2015 / Published online: 31 January 2015 Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2015
Abstract Objective Job satisfaction is a very important contributing factor for a person’s productivity and motivation. Naturally, if people are not satisfied with what they practice, they will probably need to change or reshape their way of practice at a certain period in time. Pharmacists are not exception to this principle and have been observed to re-professionalize pharmacy in to clinical and/or pharmaceutical care in many parts of the world. Thus, this survey aims to investigate the Eritrean pharmacists’ current level of job satisfaction and their views on re-professionalization of pharmacy. Method A cross-sectional survey was conducted among all Eritrean pharmacists who reside inside Eritrea. Main outcome measures Opinion of pharmacists about job satisfaction and re-professionalization of pharmacy into pharmaceutical care. Results Out of the 95 questionnaires distributed 86 were completed and returned giving a response rate of 90.5 %. Nearly three fourth of the respondents (71 %) have chosen pharmacy as their ever profession and they want to encourage their children or their close relatives to pursue it as a career. Sixty four percent of the pharmacists are either partially or fully unsatisfied to spend the remainder of their working life in a job like their current one and this has a strong statistical association with less years of experience (p = 0.007) and place of work of the younger pharmacists (p = 0.008).
M. T. Awalom (&) A. F. Tesfa M. E. Kidane School of Pharmacy, Asmara College of Health Sciences, Asmara, Eritrea e-mail: [email protected] M. R. Ghebremedhin Pharmacovigillance Centre, Ministry of Health, Asmara, Eritrea A. H. Teklesenbet Nakfa, Eritrea
Majority of the study participants (86 %) believe there is a great mismatch between pharmacists’ level of education and level of practice in the work area. This was significant with lower age (p = 0.002), less years of experience (p = 0.006) and later year of admission to university (p = 0.000). Ninety five percent of the pharmacists perceive that the current role of the Eritrean pharmacists needs to be redefined and re-oriented. Conclusion Although the Eritrean pharmacists are proud to be pharmacy professionals, they want to redefine and reorient their current role into pharmaceutical care. Keywords Attitude Eritrea Job satisfaction Pharmacists Profession Re-professionalization
Impacts on practice •
• •
Policy makers and stakeholders should be aware that Eritrean pharmacists’ current role needs redefining and redirecting Solutions should be sought for the main reasons of professional dissatisfaction of pharmacists in Eritrea The current knowledge and skills of pharmacists in patient care should be properly exploited until successful re-professionalization is attained
Introduction Job satisfaction is a very important contributing factor for a person’s productivity and motivation [1]. Job satisfaction can be defined in a number of ways. Two of these are the degree of personal gratification one receives from one’s work and the pleasure and feeling of accomplishment
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employees derive from performing their jobs well [2, 3]. In other words, job satisfaction is the extent a person receives fulfillment or gratification from his or her workplace activities, the attitude toward the job as a whole [4]. Based on the work of Victor H. Vroom [5], ‘‘Individuals are satisfied with their job to the extent to which their jobs provide them with what they desire, and they perform effectively in them to the extent that effective performance leads to the attainment of what they desire ‘‘. There are two ways that are most often used to measure job satisfaction. The first encompasses specific features of a job (a facet item) that result in either satisfaction or dissatisfaction, and the second includes a global satisfaction scale without reference to particular aspects of the work (a facet free item) [3]. Pharmacists’ level of satisfaction with their work activities has been found to be a prominent predictor of job turnover; that is, an increase in job satisfaction can reduce the likelihood of job turnover [6–9]. Job dissatisfaction often correlates with many other negative effects: such as absenteeism, work fatigue, burnout, low quality of work, decreased commitment to the profession and counter productivity. Any of these consequences are costly [10]. Job dissatisfaction may also affect the way that patients view the pharmacist and patients may then be inclined to limit their interactions with the pharmacist [11]. The job satisfaction of health-care workers has a positive association with patients’ satisfaction and contributes to the continuity of care [12]. It is important to realize that a decrease in pharmacist performance could cause patient harm or even death [13, 14]. Several factors, including pharmacists’ perceived utilization of their skills and feelings about the types of activities performed at work, along with the type of practice setting, affect levels of job satisfaction [15, 16]. Evidences have shown that, as the number of clinical activities increase, satisfaction also increases. More than 30 years ago, for instance, US hospital pharmacists generally were not satisfied with their jobs unless they were also involved in administrative or clinical activities [17–19]. Since that time, the role of US pharmacists has been changing from primarily distributive to more clinical practice, and this has been associated with greater job satisfaction [16]. Now, it is clear that pharmacy has an important role to play in the health care reform process (A paradigm shift in pharmacy practice is occurring). To do so, however, the role of the pharmacist needs to be redefined and reoriented [20].The movement towards pharmaceutical care is a critical factor in this process [21]. Pharmaceutical care is defined as the pharmacist’s contribution to the care of individuals in order to optimize medicines use and improve health outcomes [22]. The introduction of pharmaceutical care is required more in developing countries to aid in the resolution of
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medication-related problems [23]. Since Eritrea is classified as one of the low-income countries possessing resource-limited health settings, the introduction of pharmaceutical care seems very relevant. Naturally, if people are not satisfied with what they practice, they will probably need to change/reshape their way of practices at a certain period in time. Pharmacists are not exception to this principle and have been observed to re-professionalize pharmacy in to clinical and/or pharmaceutical care in many parts of the world. In Eritrea, the Ministry of Health is responsible for all matters pertaining to national planning and coordination of the health care sector. The pharmacy profession is still in its traditional stage. The job description of pharmacists and pharmacy technicians in the work area is virtually the same. At this time, however, hard work is being undertaken by Asmara College of Health Sciences (ACHS), and the Eritrean Pharmaceutical Association (ERIPA) to reprofessionalize the profession from a product-oriented profession to a patient- oriented one. And it is a common place to hear from many Eritrean pharmacists that they are not satisfied with their current job and want to participate in clinical activities. To our knowledge, no study on either job satisfaction or need for re-professionalization of pharmacy among pharmacists in Eritrea has previously been conducted. Thus, this survey aims to investigate the Eritrean pharmacists’ current level of job satisfaction and their views in re-professionalization of pharmacy.
Aim To explore Eritrean pharmacists’ job satisfaction, to identify reasons for dissatisfaction, and to assess if Eritrean pharmacists have the stance of re-professionalization pharmacy into pharmaceutical care
Method Research design and population A facet item, cross- sectional descriptive survey was conducted among all Eritrean pharmacists who lived inside the country at the time of the survey. At first, 120 pharmacists (including 4 researchers ? 2 reviewers of the questionnaire = 6) were identified from the ERIPA and from the Ministry of Health of Eritrea (MoH). We included all practicing pharmacists during the study period (August– September 2013). Out of those who were identified from MoH and ERIPA, 98 fulfilled the inclusion criteria and three were not able to be contacted. Finally, 95 pharmacists
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were included in the study, and a questionnaire was administered to each participant personally by the researchers and the pharmacists were informed to return it back to the same person who gave them the questionnaire. Instruments The survey items were developed using information from reviewing available literature and by discussion among the researchers. Content validity and clarity of the first draft of the questionnaire was reviewed and assessed by two senior pharmacists and two senior college members who have good experience in epidemiological research. The final version of the questionnaire consisted of: demographic data and set of opinion statements regarding pharmacists’ current job satisfaction and their need to reprofessionalize pharmacy in to clinical pharmacy, for which respondents were requested to indicate their level of agreement using a five-point likert scale response format (strongly agree = 5, agree = 4, neutral =3, disagree = 2 and strongly disagree = 1).
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Results Demographic data A total of 95 questionnaires were initially distributed; out of these 86 were completed and returned (response rate = 90.5 %). Eighty seven percent of the respondents were males. Mean age of the pharmacists was 36 (SD ± 11.35) years, with a range of 25–69 years. The mean years of working experience of the pharmacists was 9.49 (SD ± 2.19) years, with a range of 1–43 years. Fifty seven percent of the respondents were admitted to university before 2003, and a quarter of the pharmacists (25.6 %) currently work in private community pharmacies followed by pharmacists who currently work in governmental hospital pharmacies (23.3 %), Ministry of Health (16.3 %), Governmental college (12.8 %), Governmental Community Pharmacies (10.5 %), Governmental Pharmaceutical Plant/drug distributors (10.3 %) and private drug distributors (1.2 %). Pharmacists’ job satisfaction
Data analysis Descriptive and inferential statistical tests were used to analyze demographic characteristics and the questionnaire statements. Data were captured and cleaned using CSPro version 4.1. It was then analyzed using PASW version 18. During analysis the five point likert scale was collapsed into 3 category (strongly agree and agree in to ‘‘Agree’’, neutral is left as ‘‘Relatively agree’’ and disagree and strongly disagree into ‘‘Disagree’’). The responses of the pharmacists to the questionnaire statements were presented as percentages. Measures of variation and central tendencies were applied to identify the mean age, mean years of experience of the pharmacists and for their respective ranges. Crosstabulation was employed between some of the questionnaire statements, and between some of the statements and some selected demographic characteristics. Non-parametric Kendall’s tau-b tests were applied to observe the influence of age, gender, years of experience, year of admission to university/college and current place of work on their level of job satisfaction and their stance for reprofessionalization of pharmacy. Statistical significance was accepted at p value \0.05. Ethical issues Verbal consent was obtained from all the participants before they were given the questionnaire. Besides, a written letter of consent was attached to the front page of the questionnaire.
From this research it was noted that 64 % of the pharmacists are either partially or fully unsatisfied to spend the remainder of their working life in a job like their current one and this has a strong statistical association with less years of experience (p = 0.007) and place of work of the younger pharmacists (p = 0.008) where majority of them work in governmental pharmaceutical work places. Taking everything into account, close to two-third of the participants (64 %) are either relatively or fully dissatisfied. This issue has also a strong correlation with lower age (p = 0.005), less years of experience (p = 0.001) and later year of admission to university (p = 0.002). Approximately half of the respondents think that they have the opportunity to use their skills and knowledge at their place of employment. However, this associated significantly with lower age (p = 0.001), less years of experience (p = 0.001), and later year of admission to university (p = 0.000). Nearly three fourth of the respondents (71 %) have chosen pharmacy as their ever profession and they want to encourage their children or their close relatives to pursue it as a career. Almost all of them (95 % agreed ? 5 % relatively agreed), have got the attitude of contributing much more than what they are doing with their present knowledge and skills provided that their professional potentials are properly utilized. The majority of the pharmacists (86 %) believe there is a great mismatch between pharmacists’ level of education and level of practice in the work area. This correlated significantly with less years of experience (p = 0.006), lower age (p = 0.002), and later year of admission to university (p = 0.000). Sixty seven
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percent of the study participants consider that the premise (s) in which they work is inconvenient to carry out their professional activities and this was correlated significantly with lower age (p = 0.008), less years of experience (p = 0.002), later year of admission to university (p = 0.000) and place of work of the younger pharmacists (p = 0.041). Half of the respondents believe that they perform non-professional tasks more than the professional activities, which was found to be associated significantly with less years of experience (p = 0.002) and place of work of the younger pharmacists (p = 0.000). The number of pharmacists who have agreed with the idea ‘‘Since I am utilizing a little part of my knowledge, I am afraid of losing it in the future’’- slightly outweighs (49 %) from those who have not agreed (40 %). This has a strong association with place of work of the younger study participants (p = 0.002). More than half of the respondents (57 %) disagreed with the idea of being consulted by physicians on professional matters. Similarly, more than half of the pharmacists (55 %) found physicians either partially or totally uncooperative on job related matters. The majority of the pharmacists felt they were respected by their fellow health professionals (75 %) and the public (86 %). Pharmacists attitude for re-professionalization Ninety five percent of the pharmacists perceived that the current role of the Eritrean pharmacists needs to be redefined and reoriented. Ninety two percent of the respondents have good awareness of the re-professionalization of pharmacy into patient- oriented in many parts of the world, but this has a strong statistical correlation with later year of admission to university (p = 0.005). Most of the pharmacists (94 %) have aspired to see pharmacy in Eritrea reprofessionalized into pharmaceutical care. Likewise, virtually all of them (98 %) perceived that pharmacists’ job satisfaction can increase with more clinical participation. Almost all of them (99 %) agreed that pharmacy can mature by accepting its social responsibility to reduce preventable drug related morbidities and mortalities (Table 1).
Discussions Job dissatisfaction may trigger consequences as absenteeism or, at a more critical, the abandonment of the profession [24]. The high response rate of the pharmacists to the questionnaire may imply that the pharmacists have a strong desire for re-professionalization of the profession into clinical pharmacy. In Eritrea, pharmacists’ functions are
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mainly limited to drug dispensing, procurement, manufacturing and inventory control, which in turn limit the interaction of pharmacists with patients and thereby reduce their job satisfaction (Table 2). The majority of the pharmacists felt unchallenged by physicians on professional matters and probably the younger and less experienced pharmacists were less satisfied with the level of cooperation they obtain from physicians when they try to communicate job related issues. This may suggest, younger pharmacists as compared to older peers, expected more interaction and cooperation from physicians. The pharmacists agreed that they were respected by their fellow health professionals and the public. However, the younger and less experienced pharmacists felt that the level of respect received was less as compared to the older pharmacists. This may be attributed to the difference in the place of work of the young and old pharmacists. An investigation conducted in China revealed that hospital pharmacists had been neglected for a long time; the professional role of hospital pharmacists was often undervalued both by physicians and patients [25]. In this study the pharmacists supported the idea that even with the present knowledge and skills they can contribute much more than they are doing at the moment towards patient care. This was found to be consistent with their responses to the statement ‘‘There is a great mismatch between pharmacists’ education and level of practice’’. This could indicate that pharmacists are over educated but underutilized. According to Kahaleh and Gaither [26], the opportunity to use skills fully was identified as the most important factor in the perception of an ideal job. The strong association in response of these pharmacists with age and years of experience for the opportunity to make use of their knowledge and skills at their place of employment was found to be consistent with their agreement with the statement—‘‘There is a big mismatch between pharmacists’ level of education and the level of practice in the ground’’. This is further augmented by the finding that they are more commonly engaged in nonprofessional work at their place of work. This may indicate that the new pharmacy graduates are less satisfied with the current practice of pharmacy in Eritrea as compared to their senior colleagues. Similar studies in UK and Ethiopia showed that the more satisfied pharmacists were the ones with more years of service and an advanced age [27, 28]. The primary determinants of job satisfaction are intrinsic aspects of the job; that is, factors that make people satisfied are the work that they do or the way in which they are used [29]. The place of work of the pharmacists is strongly correlated with the utilization of professional knowledge and engagement in professional activities at the place of work.
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Table 1 Pharmacists’ opinions towards Job satisfaction of pharmacists (N = 86) Response (%)
P value*
Agree
Relatively agree
Disagree
Age
Yr. EXP
Yr. Adm
P. WK
Physicians consult me often on professional matters
22
22
57
0.709
0.134
0.083
0.521
My fellow health professionals treat me with professional respect
75
19
6
0.280
0.690
0.033
0.081
The public gives me professional respect/credit I am satisfied with the ‘‘on- the -job’’ relationship I have with other health professionals
86 44
7 27
7 29
0.001 0.168
0.012 0.107
0.076 0.014
0.019 0.564
I have the opportunity to make use of my skills and knowledge at my place of employment
54
19
27
0.001
0.001
0.000
0.207
The idea of spending the remainder of my working life in a job like my current one is satisfying The pharmacy premises/building in which I work is wide/convenient enough to carry out my professional activities
36
18
46
0.116
0.007
0.057
0.008
33
18
49
0.008
0.002
0.000
0.041
Physicians cooperate when I communicate ‘‘ job-related’’ matters with them
44
33
22
0.095
0.006
0.081
0.160
Knowing what I know now, if I had to decide all over again, I would still choose pharmacy
71
16
13
0.774
0.524
0.451
0.18
If my children/my close relatives/friends were interested in pharmacy, I would encourage them to pursue it as a care
71
15
14
0.669
0.356
0.6
0.218
Even with the present knowledge and skills, if my professional potentials are properly utilized I can contribute more than what I’m doing at this time
95
5
0
0.822
0.459
0.849
0.513
At my work place, the non-professional tasks that I do outweigh the professional ones
31
19
50
0.09
0.002
0.034
0
Since I am utilizing (applying) a little of part from what I have learnt, my professional knowledge is keeping on reducing
49
11
40
0.132
0.019
0.012
0.002
I believe there is a great mismatch between pharmacists’ level of education and what they really practice in the work place
86
7
7
0.002
0.006
0
0.038
All things considered, I am satisfied with my current job
36
23
41
0.005
0.001
0.002
0.121
Yr. EXP years of experience, Yr. Adm year of admission, P. WK place of work * Non-parametric Kendall’s tau-b tests were used to determine p value
Table 2 Pharmacists’ perceptions towards there-professionalization of pharmacy (N = 86) Response (%)
P value*
Agree
Relatively agree
Disagree
Age
Yr. Exp
Yr. Adm
P. WK
The Current role of Eritrean pharmacists needs to be redefined and reoriented
95
2
2
0.056
0.067
0.038
0.334
I already have good awareness on the re-professionalization of pharmacy from medication oriented to patient oriented i
92
6
2
0.112
0.125
0.005
0.053
My professional dream is to see the profession of pharmacy re-professionalized into patient oriented role
94
5
1
0.084
0.122
0.019
0.931
Pharmaceutical care could offer pharmacists with more public credibility and trust
93
6
1
0.022
0.065
0.01
0.26
Pharmacists’ job satisfaction can increase if they involve in clinical activities
98
2
0
0.754
0.278
0.15
0.144
Pharmacy can mature more as a profession by accepting its social responsibility to reduce preventable drug-related morbidity and mortality
99
0
1
0.308
0.308
0.313
NA
Yr. Exp years of experience, Yr. Adm year of admission, P. WK place of work * Non-parametric Kendall’s tau-b tests were used to determine p value
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This may be attributed to the diverse nature of place of work of the different groups of pharmacists. The results of this study strengthened earlier findings in USA that job satisfaction varied according to work environment [26]. The response of the pharmacists to the statement ‘‘All things considered, I am satisfied with my current job’’ was found to greatly vary with years of experience, age and year of admission to university/college. Perhaps, the aged and more experienced pharmacists have been taught with the drug-oriented pharmacy curriculum. In addition to this, the majority of them run either their own businesses or are occupying better job positions. This was further supplemented by the similarity of the findings of the size/ level of convenience of the pharmacy premises in which they work. Job position was consistently found to be a significant predictor of job satisfaction [29].The high correlation in years of experience and place of work of the pharmacists with their responses to the idea of spending the remainder of their professional life in a job like their current one may go in favor of the aforementioned discrepancies. The high percentage of agreement of the pharmacists that they will ever choose pharmacy as their career and wish to see their off springs or close relatives as pharmacists is good evidence that the respondents don’t regret by achieving pharmacy as a profession. However, they want to redirect their current role into patient- oriented practice for a greater professional satisfaction. This has been reinforced by the support of almost all of the pharmacists to the idea that their professional dream is to see pharmacy re-professionalized in to pharmaceutical care. Eritrean pharmacists believe that pharmacists’ job satisfaction can increase if they get involved in clinical activities. This finding was consistent with the findings of similar studies conducted in USA and Japan [17, 19, 30].
Limitations It was assumed that differences found in job satisfaction between pharmacists were due to job activities, not individual unhappiness with amount of income, length of working hours or other social factors. Besides, all data were self reported and are therefore subject to bias.
Conclusions Based on the results of this research the younger and less experienced pharmacists are comparatively more dissatisfied with the traditional pharmacy practice in Eritrea. Although the Eritrean pharmacists are proud to be pharmacy professionals, they want to redefine and reorient their current role in to pharmaceutical care. However, the
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pharmacists consider themselves as a huge asset even with present knowledge and skills towards patients’ drugtherapy. Therefore, the MOH, ERIPA and ACHS should give due emphasis to these findings and work hand-in-hand to fulfill the current need of pharmacists so as to make them more satisfied and more productive in pharmacotherapy. Acknowledgments We are grateful to all pharmacists who participated in the study. We would like to thank pharmacists Semere Ghebregiorgis and Kifle Aforki, as well as Mr. Andom Yohannes for reviewing the first draft of the questionnaire. Many thanks to Dr. Mismay Ghebrehiwet and Mr. Chan Ving Fai for prove-reading the final version of the manuscript. Many thanks also to Mr. Andebrhan Tewelde for his assistance in analysis. Funding ERIPA and PHARMACOR Eritrea supported the printing of the questionnaire. No other financial support was received. Conflicts of interest
None.
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