Introduction

Sustainable Development Goal 3 (SDG 3) has been one of the key goals for all partners of health globally. SDG 3 is targeted at reducing to a level of less than 70 per 100,000 live births of global maternal mortality rate, decreasing neonatal mortality to at least 12 per 1,000 live births and under-5 mortality to at least 25 per 1,000 live births by stopping preventable deaths of mothers, newborns and children under the age of five by 2030 [1, 2].

An organisation with a strong and sustainable workforce is likely to achieve quality healthcare services. A strong and healthy workforce is a great tool for effective health service delivery and achieving excellent health outcomes. The health workforce especially midwives are among the principal experts for achieving Goal 3 of the SDG [3, 4]. As a result, health organisations consider human resources as a vital asset in the healthcare systems without which knowledge cannot be imparted and care cannot also be affected. In the area of service delivery, employee behaviour can either tarnish the image or bring success and quality service to an organisation. Therefore, employees are viewed as the most important asset to enhance the creation of wealth if only they are pleased with their job and remain faithful to them [5, 6].

It is estimated that a working individual spends at least six hours of their time at work and therefore must get some satisfaction from it which will, in turn, impact productivity. Since one’s job and the work environment become part of the individual, it behoves both the employer and the employee to assess their satisfaction level for better job outcomes. This is because a satisfied workforce will put in additional effort to meet organizational goals [7, 8].

Job satisfaction in an organisation is regarded as an important measure of high productivity and improved work. There is a relationship between staff turnover, non-attendance of employees, workplace accidents and job satisfaction. Job satisfaction is an extremely vital phenomenon of study because globally, it has been established to determine quality care and patient safety [9]. According to Locke (p. 317), job satisfaction is defined as a “pleasurable emotional state of the appraisal of one’s job, as achieving or facilitating one’s job value” [10]. In effect, one who likes his or her work may be considered as having job satisfaction and vice versa.

A Global shortage of healthcare workers, including nurses and midwives, has been a worrying phenomenon over the years. According to World Health Statistics on the health workforce, it is predicted that the world would have a shortage of over 14 million healthcare workers by 2030 if the current development does not change. Currently, there is an expected shortage of about over 9 million nurses and midwives; and the regions that have been predicted to be highly affected are Sub-Saharan Africa (SSA) and South-East Asia [11, 12]. The health workforce shortage in SSA is quite disturbing. In the past decade, the average doctor-to-patient ratio in SSA was recorded to be 2 doctors per 10,000 population and 11 nurses or midwives per 10,000 population, compared with 19 doctors and 49 nurses or midwives per 10,000 for the Americas, and 32 doctors and 78 nurses or midwives per 10,000 for Europe [13]. Anecdotal evidence suggests that the situation has improved; it is still estimated that by 2035, the world would have recorded a 12.7 million shortage of health workforce [14]. Moreover, the global midwifery report showed that the number of midwifery staff to provide healthcare to women and new-borns is woefully inadequate with 73 countries in the world confronted with critical deficiencies of midwives, and this can lead to preventable mortality of mothers and/ or the new-borns [15–17].

The shortage of the nursing workforce is the most impactful in Africa [18], as they form a chunk of the health workforce. This episode contributes to defeating the aims of healthcare systems worldwide making it difficult for nurses/midwives to meet the health needs of their people [19].

In Ghana, nurses and midwives work in very challenging work environments which include a shortage of staff, work overload, inadequate logistics coupled with the poor interpersonal relationship between midwives and labouring mothers. In addition to this, inadequate training capacity, ineffective management structures in place and poor working conditions coupled with limited financial and non-financial motivation contribute to increased attrition and poor morale and performance [20–22]. Yet they have been identified as the bigger workforce to help sustain the SDG 3 Target 1; Global maternal mortality rate (MMR) should be below 70 per 100,000 live births by 2030 [2].

The Greater Accra Region of Ghana is equally faced with problems of reproductive health services and high MMR. Accra Metro Health Directorate reports indicated that maternal death has remained high despite all attempts to reduce it. In the year 2019, the metropolis recorded an institutional maternal mortality rate (MMR) of 305 per 100,000 live births. There was a decrease in MMR in 2020, which recorded 277 per 100,000 live births and in 2021 had further increased to 359 per 100,000 live births as stated in the Greater Accra Region Human Resource Directorate 2019 Report [23]. Despite all the challenges, Ghanaian midwives continue to work hard to save mothers and their babies but there is a paucity of data on midwives’ job satisfaction in SSA, especially in Ghana. The study assessed the relationship between job satisfaction and practice environment and the determinants of midwives’ job satisfaction in the Accra Metropolis.

Materials and methods

Results

Socio-demographic characteristics

As presented in Table 1, from an eligible 196 participants, 183 questionnaires were retrieved, giving a response rate of 93.4%. All participants were females and most of them (73.2%, n = 134) were married. The majority of the participants (51.4%; n = 94) were between the ages of 26 and to 35years. In terms of academic qualifications, the majority of the participants (49.2%, n = 90) were diploma midwifery holders, and staff midwives formed the majority (35%, n = 64) in terms of rank. Almost forty per cent (37.2%, n = 68) of the participants reported they have worked as midwives for a period between 1–3 years, and close to half of the participants (44.3%, n = 81) indicated that they work at the obstetric/maternity unit.

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Table 1. Demographic characteristics of participants.

https://doi.org/10.1371/journal.pone.0282251.t001

Job satisfaction of midwives

The levels of job satisfaction among the midwives were assessed as presented in Table 2. The composite mean score of overall job satisfaction was 3.05 (SD = 0.56). The composite mean scores of the various sub-scales are as follows: personal satisfaction on the job (n = 3.60), satisfaction with workload (n = 3.21), satisfaction with professional support (n = 3.01), satisfaction with prospects (n = 3.82) and satisfaction with the standard of care (n = 2.67). However, satisfaction with their pay had a low composite mean score of 2.01 (SD = 0.33).

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Table 2. Job satisfaction of midwives.

https://doi.org/10.1371/journal.pone.0282251.t002

Relationship between professional practice environment and job satisfaction

The Pearson Product Moment Correlation was used to examine the relationship between midwives’ practice environment and overall job satisfaction. The results are presented in Table 3. The results showed midwives’ job satisfaction to have a moderately significant correlation with all the facets of the practice environment; nurse manager leadership, ability and support (r = .444, p < .001), collegial nurse-physician relationship (r = .349, p < .001), staffing and resource adequacy (r = .356, p < .001), the nursing foundation for quality of care (r = .406, p < .001). However, midwives’ participation in hospital affairs showed a weak but statistically significant positive relationship with job satisfaction (r = 142, p < .006). Thus, an increase in any of the parameters of the work environment leads to a corresponding increase in midwives’ job satisfaction.

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Table 3. Correlations between the practice environment dimension and overall job satisfaction.

https://doi.org/10.1371/journal.pone.0282251.t003

Predictors of midwives’ job satisfaction

A multiple linear regression analysis was used to determine the predictors of midwives’ job satisfaction in the model as presented in Table 4. In the model, the five components of midwives’ work environment significantly explained 48.9% of the variance in job satisfaction [R² = .489, F_{(8, 174)} = 20.784, p = .001]. Nurse manager leadership, ability and support, collegial midwife-physician relations, staffing and resource adequacy contributed 29%, 7.4% and 22.3% respectively to the model. Additionally, midwives’ participation in hospital affairs and nursing foundation for quality care contributed 10.0% and 15.1% respectively. In examining the variables, four of them emerged as significant predictors of job satisfaction in the model: nurse manager leadership, ability and support (p < .001), staffing and resource adequacy (p < .001) and nursing foundation for quality of care (p < .05).

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Table 4. Predictors of midwives’ job satisfaction.

https://doi.org/10.1371/journal.pone.0282251.t004

Discussion

The roles of organisations are numerous but one most important roles are to satisfy their workers because a satisfied employee works efficiently and effectively to achieve organisational goals [30, 31]. The findings of the current study suggested that midwives were satisfied with their work which is congruent with the findings of other studies [32–34]. Similarly, Munyewende et al. [35] in South Africa reported that nurses’ job satisfaction was relatively high. Though midwives indicated their satisfaction with the workload, the reason could be attributed to the high number of professional midwives in the Accra metropolis. However, the findings of the current study on the salaries of midwives revealed that they were not satisfied considering their vital role in achieving SDG3 and the increased workload due to their limited numbers in healthcare delivery. This finding is consistent with other studies that reported that nurses in the Philippines, Nigerian and Ethiopian nurses were moderately satisfied with their job but dissatisfied with their salaries [36–38]. Other studies with similar findings include Öncü et al [39], Okafor and Chimereze [40], Hashish and Ashour [41], and Semachew et al [42], in addition, reported that poor salary was one of the factors that pushed health workers to migrate to the Western world. Therefore, poor salary aside from other findings may determine the midwives’ job satisfaction.

With the moderate correlation between job satisfaction and facets of the work environment, previous research work by Klopper et al [43], Cummings et al [44] and Dhamija, Gupta and Bag [45] reported similar findings. Apart from improving the midwifery workforce, there is a need for authorities to also include young midwives in decision-making because they form the bulk of the working population.

In the current study, job satisfaction among midwives’ was predicted by the number of years RM have worked, nurse manager leadership, ability and support, staffing and resource adequacy, and nursing foundation for quality of care. Previous studies by Aloisio et al [46], Lu et al [47], and Hayes et al [34] reported that years nurses have worked have an impact on stress and burnout which eventually affects job satisfaction. The implication is that when people gain experience over the years, it helps them to manage their stress better. Likewise, Mousazadeh et al [48] explain that older nurses had job satisfaction, a higher probability of promotion and good life. Again, poor management practices and resource inadequacy are important indicators of midwives’ dissatisfaction with their jobs [49]. Human and material resource inadequacy continues to pose a challenge to improving maternal health and the SDG 3 in SSA including Ghana. Midwives are the key service providers of care and support for mothers throughout pregnancy, delivery and puerperium, and newborns at the critical stage in their lives [38]. Every effort must be made to keep midwives happy at the post so that they will work hard toward reducing maternal mortality in the facilities. Though Skilled Birth Attendants (SBA) are helping with the shortfall, the disproportion of high numbers of SBA as against RMs is an area of concern in the sub-region. Even though there has been an improvement in the number of midwives trained and SBA in recent times in Ghana, there must be an equitable regional distribution of SBA [50] to curtail increased workload to improve job satisfaction.

Conclusion

The practice environment is a significant determinant of nurses’ job satisfaction, according to recent research. Additionally, these characteristics interact with one another, indicating that managerial activities intended to increase workplace satisfaction should consider both aspects of the leadership role and employment setting. Nurse managers need to be careful to keep the work environment and people’s attitudes in sync with one another. Job satisfaction can be increased by improving the workplace, but this effect can be strengthened by prioritizing strong material and people resources and by upholding intrinsic rather than external work values. Higher job satisfaction for nurses can result from working in a setting that offers consistent and coordinated good working conditions, competitive compensation, and a solid infrastructure for providing high-quality nursing care. This also seems to suggest that using compensation alone won’t be sufficient to increase midwives’ job happiness. This feature may also aid in our understanding of the well-known conundrum that increased pay does not necessarily translate into higher job satisfaction in the context of healthcare, but another factor including nurse managers’ leadership and support.

Acknowledgments

The authors would like to thank all registered midwives from the study sites who voluntarily participated in the study.