Job satisfaction among pharmacists practicing in Benin City, Nigeria

Purpose: Job satisfaction is positively related to productivity and effectiveness and therefore, vital for effective functioning of any professional practice including pharmacy. The purpose of this study was to assess job satisfaction of pharmacists in Benin City and to gain insight and understanding of their expectations in various practice area. Methods: A cross-sectional study was conducted among pharmacists in various practice areas in Benin City. Job satisfaction was evaluated among 200 pharmacists recruited using convenient sampling method. The tool used was a pretested, three section self-completion questionnaire which tested job satisfaction and their indicators in pharmacy practice areas using 3 and 5 point Likert-type scales, respectively. Data were compared using ANOVA. Results: Majority of the respondents were males (116, 58.0%), married (100, 50.0%), and practiced in community pharmacies (96, 48.0%). Their overall satisfaction with their jobs had the mean scores of 2.25 ± 0.591. Compared to other practice areas, the pharmacists in academia had the highest overall job satisfaction score (2.47 ± 0.615) and this was significantly (p=0.01) higher than the overall satisfaction score of hospital pharmacists (2.04 ± 0.576). Increase in salary was the highest indicator of job satisfaction for the respondents (4.26 ± 1.218); which was followed by promotion (4.11±1.207) and recognition (3.91 ±1.254). The least indicators were motivational talk (3.36 ±1.329) and leave from work (3.37 ±1.319). Conclusion: Study participants reported to be satisfied on their job and academics were most satisfied, while hospital pharmacists were the least satisfied. Salary increase, promotion, and recognition were the major factors that influence job satisfaction for the pharmacists.


INTRODUCTION
Pharmacists are vital healthcare professionals who provide medicine-related needs and promote optimum wellness of the patients, usually through the pharmaceutical care process.
They play a major role in providing the healthcare products and services in urban and rural areas, especially through community pharmacies [1,2]. It is therefore very essential to realize that reduced pharmacist performance could cause patient harm or even death [3]. It is therefore imperative that such an essential health professional be adequately motivated to provide the highest quality of service.
The satisfaction of a pharmacist with his/her job often results in greater productivity, better quality healthcare services, and more satisfied patients [4]. Poor satisfaction at work may result in reduced productivity, absenteeism [5], reduced health outcomes and consequently patient safety [6]. Job satisfaction here refers to employees' perception about their job, and the impact on staff productivity and turnover [7]. It is a critical aspect of retention of healthcare professionals because of its direct effects on the labour market behaviour and economic efficiency [7].
Various factors have been reported to influence pharmacists' job satisfaction, among which are practice setting, long work hours, promotion opportunities and poor professional relationships with physicians [8]. The increasing and expanding role of pharmacists from the previous tradition of dispensing of medicines, to the present practice of patient centered care may also influence pharmacists' job satisfaction, especially among the hospital pharmacists. Other factors that have been shown to affect job satisfaction in practice settings include: treatment by management in the practice areas as well as other interpersonal interactions with patient and coworkers [9].
Although there are several studies in Nigeria that have addressed job satisfaction in occupational groups, there appears to be a gap in researches that address job satisfaction among pharmacists in general [10], and particularly those in academia.
This study therefore, seeks to assess job satisfaction of pharmacists in Benin City using the "Ideal Referents Model" [11] with a view to gaining insight and understanding on the expectations of pharmacists in various practice areas.

Study population and sample
The study was conducted among pharmacists who practice in community pharmacies, hospital, academia and the pharmaceutical industry in Benin City, Nigeria. A total of 200 respondents were recruited for the study and the sample size was calculated to reflect the proportion of pharmacists in academia, community, industry and hospital pharmacy with the aid of Taro Yamane's sample size formula [12].

Study design
This was a descriptive cross-sectional study of pharmacists in different practice areas in Benin City using the model which compares the current work situation, feelings and expectations of the pharmacists with what they perceive to be an ideal work situation. The main outcome measures of the study were pharmacists' satisfaction statements and indicators of job satisfaction.

Study instrument
The study tool was developed by the researchers after exhaustive review of literature and validated by experts who have been in practice in at least two pharmacy practice areas and knowledgeable in assessing satisfaction with health services. Experts checked the questions for content validity after which the study tool was pretested among twenty pharmacists of similar demographics as our sample, to ascertain clarity of the questions in the tool. These twenty pharmacists were not included in the final survey. The final instrument comprised three (3) sections; section 1 was used to obtain the sociodemographic information of the respondents, section 2 comprised 7 questions which assessed the respondents' job satisfaction on a scale of 1 -3, with 1 = dissatisfied, 2 = somewhat satisfied and 3 = very satisfied, while section 3assessed the indicators of job satisfaction for the pharmacists, using five (5) indicators on a scale of 1-5. One (1) represented the lowest indicator and 5 the highest indicator.

Data collection
The respondents were sampled based on a proportional allocation of pharmacists in the different practice areas. Subsequently, data was collected using a convenient sampling method, with respondents recruited from their practice areas based on availability and ease of access. Each respondent who consented to the study was briefed on the objectives of the study and thereafter given a copy of the questionnaire which was retrieved immediately after completion.

Data analysis
Data was entered and analyzed using SPSS version 21.0 and was presented in simple frequency tables. Means and standard deviations were determined and inferential statistics was done using ANOVA. This was used to determine differences in job satisfaction among the pharmacists. p-values ≤ 0.05 were considered significant.

RESULTS
A total of 200 pharmacists were surveyed, 48.0% of them were drawn from community practice, 24.5% from hospitals, 17% from academics and 10.5% from the industry. Majority of the respondents from community practice were employed as superintendent pharmacists (43, 44.8%), followed by owner and superintendent pharmacists (30, 31.3%), locum pharmacists (18,18.8%) and co-pharmacist (5, 5.2%). The community pharmacists were mainly males (59, 61.5 %), single (52, 54.2%), had a doctor of pharmacy degree (54, 56.3%) and practiced between 1-10 years (50, 52.1%) while majority of the respondents in hospital practice were females (28, 57.1 %), single (29, 59.2%), held doctor of pharmacy degree (23, 46.9%) and had 0 -10 years of practice (25, 51.0%). Majority of the respondents in the academia were males (21, 61.8%), married (24, 70.6%), had masters' degree (16,47.1%) with 11-20 years of practice (12,35.3%). The respondents who practiced in the industry were also mostly males (15,71.9%), married (13, 61.9%), had bachelor of pharmacy degree (9, 42.9%) with 1 -10 years in practice (13, 61.9%). Other demographics are as shown in Table 1. The overall mean job satisfaction score for all the items was (2.27 ± 0.615) and the items that received the highest satisfaction scores were those relating to satisfaction with their wards electing to study pharmacy (2.78 ± 0.46), overall satisfaction with their jobs (2.25 ± 0.591) and satisfaction with their position at their job (2.25 ± 0.655). Respondents were least satisfied with the appreciation or reward system (2.00 ± 0.673) and the opportunity to utilize their skills and abilities (2.13 ± 0.701). Details are provided in Table 2.  The difference between mean job satisfaction of respondents in various practice area is represented in Table 3. Overall, extremely significant differences were found in the mean responses of the pharmacists in the different practice areas with regard to availability of opportunity to fully utilize skill/abilities and satisfaction with position (p < 0.001), satisfaction with work environment (p < 0.001), the appreciation/reward system (p < 0.001), the value placed on the respondents by their organization (p = 0.0091) and their overall job satisfaction (p = 0.010). However, mean responses on how they would feel if their ward decided to study pharmacy were not significantly different across practice areas. (p = 0.134).
Of all the different pharmacist practice areas, pharmacists in academia had the highest overall job satisfaction score (2.47 ± 0.615) however, this was only significantly higher than the overall satisfaction score of hospital pharmacists (2.04 ± 0.576) (p = 0.010). The overall satisfaction score of community pharmacists and pharmacists in the industry did not differ from that of pharmacists in academia (p > 0.05). Based on the individual items that assessed the respondents' job satisfaction, hospital pharmacists were least satisfied with their work environment (1.94 ± 0.475) and this score was significantly less than the score of pharmacists in the other practice areas (p < 0.05). Pharmacists in academia were the most satisfied with their environment (2.47 ± 0.706). Hospital pharmacists were also least satisfied with the appreciation or reward system in their job. They had a satisfaction score of (1.65 ± 0.597) which was the lowest of the four practice areas (p <0.05). Pharmacists in the industry were most satisfied with the appreciation and reward system followed by community pharmacists and pharmacists in academia. (p< 0.05). Again, hospital pharmacists did not feel valued by their organization. They had a low satisfaction score of (1.98 ± 0.52) which was significantly lower than the satisfaction score of community pharmacists (2.36 ± 0.682) (p < 0.01) but not different from the satisfaction scores of pharmacists in the other practice areas (p > 0.05).
Community pharmacists were most satisfied with the availability and opportunity to utilize their skills and abilities with a score of (2.33 ± 0.660) which was significantly higher than the satisfaction scores of hospital pharmacists (1.80 ± 0.67) and academic pharmacists (1.94 ± 0.736). (p< 0.01 and p<0.05) respectively. There was no significant difference in the satisfaction scores of the pharmacists in the different practice areas with regard to their satisfaction with their position in their job (p >0.3865) except for hospital pharmacists who had a significantly lower satisfaction score. 1.90 ± 0.653 (p <0.01). All the pharmacists reported that they will be satisfied if their ward decides to study pharmacy (p=0.1338).

DISCUSSION
This study has shown that the pharmacists were quite satisfied with their job. This is consistent with a similar study conducted in Zimbabwe where pharmacists were reported to be highly satisfied with their job [13]. A study in southsouth Nigeria comprising only hospital pharmacists also reported moderate satisfaction by the pharmacists [10]. Other studies from India Saudi Arabia and Ethiopia have reported very low job satisfaction levels of pharmacists [2,5,14].
In this study academics were the most satisfied with their job, followed by community pharmacists and industrial pharmacists while, hospital pharmacists were the least satisfied. This is similar to a study conducted in India, where academics had the highest satisfaction level, followed by industrial pharmacists while, hospital pharmacists were least satisfied [15]. Different studies have shown varying job satisfaction levels for pharmacists in different practice areas. One study in Zimbabwe showed that pharmacists who practiced in manufacturing industries and private hospitals had higher job satisfaction than those who worked in chain retail pharmacies [13]. Also, a study conducted in the United States reported that community pharmacists had the highest rates of satisfaction, followed by hospital pharmacists, while those in chain pharmacies were significantly least satisfied than others [16]. Meanwhile, a study in Northern Ireland showed that most community and hospital pharmacists were satisfied with their job most of the time [17].
In the UK, hospital pharmacists were more satisfied when compared to community pharmacists, who are more pressured by the number of working hours, poor relationship with physicians, or by the lack of promotion opportunities [9]. Job satisfaction among  pharmacists can therefore be said to vary according to geographical location and practice setting/sector. Hospital pharmacists in the developed countries seem to be one of the groups of pharmacists most satisfied with their job, while their counterparts in the developing countries appear to be among the least satisfied [9,17,18]. Differences in work place activities and environment may also explain the variation in job satisfaction in different practice settings as observed. This differences in specific activities and tasks are usually influenced by the level of acceptance and relevant policies in various geographical locations.
This study also revealed that pharmacists in all the practice sectors would be very satisfied if their ward decides to study pharmacy. This could be attributed to the knowledge of the positive potentials in pharmacy practice which could range from personal fulfillment to selfactualization. This satisfaction seems to be especially but not significantly higher in community pharmacists, academia and hospital pharmacists respectively.
Pharmacists in academia were significantly more satisfied with their work environment than the pharmacists in the other practice areas. Again, hospital pharmacists were least satisfied. The absence of the usual rifts and disharmony among health professionals in the hospital setting, in other pharmacy practice areas may account for this difference. These other practice areas enjoy autonomy and hence, do not have to contend with the unhealthy suppression of pharmacy practice as seen in the Nigerian hospitals. The work environment may increase or reduce motivation and this may impact on overall job satisfaction. In Romania, clinical pharmacists advise physicians concerning doses and also contribute to the personalized medicine programs of all patients [9]; this enhances their awareness of relevance which may boost job satisfaction.
Community pharmacists were significantly more satisfied with their appreciation and reward system than pharmacists in the other practice areas. This could be as a result of their complete independence and control of the pharmacy as well as the ability to determine their reward by the measure of effort and resources they put in. This may also be the reason why pharmacists who practice in the pharmaceutical industry are more satisfied than pharmacists in academics and hospitals. The low satisfaction level of hospital pharmacists with regard to their reward system may not be unrelated to the politics in the leadership of Nigerian hospitals, a product of which is high disparity in pay between the hospital pharmacists and their medical counterparts. This of course may have a resultant effect of reduced motivation and enthusiasm to work. A previous study carried out among hospital pharmacists in south-south Nigeria has reported the dissatisfaction of hospital pharmacists with their remuneration [10]. Another study in India also reports pharmacists' low satisfaction with their income [15].
From the study, community pharmacists were most satisfied with the value placed on them by their community. On the other hand, hospital pharmacists were the least satisfied with the value placed on them by their community/organization, but this was not significantly different from pharmacists in the industry and academia. If workers perceive that they are valued within the job, their attitude and satisfaction towards their job will be more positive [20].
Community pharmacists also were most satisfied with their position, followed by pharmacists in the industry and academia respectively. The hospital pharmacists were the least satisfied with their position. A previous study in Nigeria on hospital pharmacists reported that majority enjoyed their status as pharmacists [10]. Similarly, a study comprising pharmacists in all the practice sectors reported that majority were satisfied with their position as pharmacists [15]. Poor satisfaction with one's position could result in demotivation, reduced or lack of interest to carry out duties as well as reduced self-esteem. Also, promotions as at when due may enhance pharmacists' satisfaction with their position, hence the need to put and maintain structures in place that will ensure promotions are given at appropriate times.
The study reveals that most pharmacists would be more satisfied if they had their own private pharmacy alongside their current job. However, this seems to be predominant among community pharmacists followed by pharmacists in the industry. Pharmacists in academia were less interested in having their own private pharmacy when compared with others. Generally, pharmacists seem to believe that their reward is proportionate with the quality of effort put into their work. However, pharmacists in the industry and community practice had significantly higher agreement level on this, while hospital pharmacists did not see a proportional relationship between quality of effort put into work and reward received.
Generally, increase in salary was the highest/primary indicator for job satisfaction for pharmacists in community practice, academia and industry, while promotion was next. This may not be unrelated to the immense relevance of finance in improved quality of life of humans. A similar study in western Nigeria reported increase in salary as a high motivator for job satisfaction among hospital pharmacists [19]. A study conducted in Malaysia also reported a significant relationship between remuneration and job satisfaction [20]. The need for adequate and satisfying remuneration can therefore not be over-emphasized among pharmacists.
However, increase in salaries was the second indicator for job satisfaction after promotion, for hospital pharmacists in this study. It is noteworthy that promotion usually translates to increase in salary and therefore, still reflects finance as a major indicator of job satisfaction. A similar study conducted in Malaysia reports that hospital pharmacists who worked in a conducive atmosphere and received a higher salary were much more likely to be satisfied with their job [20]. The importance of adequate salaries and promotions as at when due, can therefore, not be over-emphasized for pharmacists considering its impact on pharmacists' job satisfaction. However, a study on hospital pharmacists showed that less than half were not satisfied with their promotion [10].
From the study, motivational talks significantly motivated community pharmacists than pharmacists in academia. This is most likely due to the high level of patience required in building a community pharmacy and the milestones that may be encountered in the building process. On the other hand, going on leave, was the least influence on pharmacists' job satisfaction as shown in the study. Findings here show it to be the least indicator of pharmacists' job satisfaction portraying that little attention be given to the item in the motivation of pharmacists.
The strength of this study lies in the fact that it assessed job satisfaction among pharmacists in different practice sectors using the same tool which is a departure from previous studies that only focused on only one practice area. However, the interpretation and application of the findings may be limited by the relatively small sample size of the pharmacists in the different practice areas and the use of convenience sampling technique, as well as the use of just one location in Nigeria. The findings may therefore not be generalizable to other states in the country that may have different work conditions, environment, remuneration, and opportunities for pharmacists to perform optimally.

CONCLUSION
This study has shown that participants were satisfied with their job and several factors which include: remuneration, promotion, recognition, leave and motivational talks influenced job satisfaction of pharmacists at varying degrees. Academics were most satisfied with their job while hospital pharmacists were the least satisfied.

Conflict of interest
No conflict of interest is associated with this work.