|Year : 2015 | Volume
| Issue : 3 | Page : 213-219
Stress and job satisfaction among pharmacists in Riyadh, Saudi Arabia
Amal K Suleiman
Department of Clinical Pharmacy, College of Pharmacy, Princess Nora Bint Abdul Rahman University, Riyadh, Kingdom of Saudi Arabia
|Date of Web Publication||3-Aug-2015|
Amal K Suleiman
Assistant Professor, Clinical pharmacy, College of Pharmacy -Al Ain University of Science and Technology - UAE
Kingdom of Saudi Arabia
Objective: The aim of the study was to measure job satisfaction and stress levels among pharmacists in Riyadh, Saudi Arabia, and to explore the main causes of dissatisfaction and stress-related factors.
Materials and Methods: A self-administered survey was hand-distributed using a cluster area sampling technique. Data were entered into a statistical analysis system database with a significance level of P < 0.05, using Chi-square, descriptive statistics, and regression analysis.
Results: The setting of a pharmacy was found to significantly affect the job satisfaction of pharmacists. 48% of independent community pharmacists were satisfied with their job compared with 62% of dispensary pharmacists and 74% of chain community pharmacists. Marital status and years of experience significantly affected job satisfaction, and married pharmacists had lower levels of satisfaction than their unmarried counterparts. Pharmacists who dispensed a higher number of prescriptions had higher levels of satisfaction. Furthermore, job-related stress factors, such as the setting of the pharmacy and years of experience, had a significant effect on the stress level related to the responsibility of patient care. Participants also reported other job stressors: Long working hours, difficulty in obtaining casual or sick leave, and low salaries.
Conclusion: Independent community pharmacists in Riyadh had lower levels of job satisfaction than their counterparts in dispensaries and chain pharmacies. Primarily, efforts should be made to raise the levels of job satisfaction for pharmacists in order to improve their motivation and competence. Failure to reduce stress among workers puts both pharmacists and patients at risk.
ملخص البحث :
هدفت هذه الدراسة للتعرف على مدى الرضا الوظيفي ومستوى التوتر لدى الصيادلة العاملين في الصيدليات، اضافة إلى العوامل المؤثرة في الرضا الوظيفي والمرتبطة بالتوتر. شملت هذه الدراسة 294 صيدلي يعملون في صيدليات داخل مدينة الرياض. وخلصت الى أن نسبة الرضا الوظيفي كانت اقل ضمن الصيادلة العاملين في الصدليات الخاصة (%84) مقارنة مع %26 للصيادلة العاملين في صيدليات المراكز الصحية، و %47 للصيادلة العاملين لدى الصيدليات ذات السلسلة الكبيرة، ومع ازدياد عدد الوصفات الطبية التي يتم صرفها، والحالة الاجتماعية لغير المتزوجين وجد أن نسبة الرضا اكبر لديهم. وبينت الدراسة ان من العوامل التي زادت التوتر لدى الصيادلة، طول ساعات العمل، الصعوبة في الحصول على اجازة مرضية، وتدني الرواتب. يوصي الباحث بضرورة رفع مستويات الرضا الوظيفي وتقليل التوتر لدى الصيادلة.
Keywords: Community pharmacy, dispensary pharmacy, job satisfaction, job stress, pharmacists, Saudi Arabia
|How to cite this article:|
Suleiman AK. Stress and job satisfaction among pharmacists in Riyadh, Saudi Arabia
. Saudi J Med Med Sci 2015;3:213-9
| Introduction|| |
Stress is commonly described as feeling worried, overwhelmed, or run-down. Baum  defined stress as any uncomfortable emotional experience combined with predictable physiological, biomechanical, and behavioral changes. Stress can contribute to illnesses such as obesity, heart disease, and depression, and there is a strong link between chronic stress and insomnia.  A profession may be satisfying, but also highly stressful, and this can be manifested through reduced job satisfaction and heightened intentions of leaving one's employer.  Job satisfaction has been defined as the affective orientation that an employee has towards his or her work.  Unlike many scientific occupations, which involve limited public interaction, the role of pharmacist offers a rare balance of independence and interaction with customers. This makes the profession rather demanding. For example, a patient may have had a long wait at the hospital  and may have arrived at the pharmacy in a negative mood.  Patients want to be listened to by their health providers  and many, because of their illness, become irascible and vulnerable.  Although pharmacy practice can be very satisfying, it can also be stressful.  The long hours and heavy workloads, which are characteristic of the profession, make it essential for pharmacists to have strong stress management skills.  Mott et al.  found that out of 1,737 practicing pharmacists in the United States, 67.2% expressed satisfaction with their job. Another study of Australian pharmacists found that dissatisfaction with the professional environment was the main reason for leaving the profession.  According to another study, workplace stress is the reason why 81% of pharmacists consider quitting. 
Mott et al.  demonstrates that poor job satisfaction and a stressful atmosphere are directly associated with performance, especially for professionals like pharmacists. These performance problems may include incorrect filling of prescriptions, lack of detection of drug interactions and poor patient counseling, and the possibility of a high staff turnover. The relationship between job stress and job satisfaction among pharmacist has become the topic of discussions among academics as well as pharmacists because it has been realized that pharmacists now have to deal with greater professional responsibility and pressure of work. The quest for job satisfaction is not easy. Most of the time it is associated with job stress.  There is a strong negative relationship between occupational stress and job satisfaction.  There is also an average correlation of job satisfaction with occupational stress.  Managing and handling job stress is a vital challenging task. Ability to control job stress increases productivity while failure to do so may lead to many problems in the workplace. 
According to Baum,  the primary factor in employee retention is employee job satisfaction and reduction of stress. Previous research has shown that individuals have job satisfaction when they have achieved something, or have little stress. This influences them to want to contribute to the growth and expansion of their company. ,, In this regard, a wide variety of interventions and prevention programs have been developed and used to reduce job stressors and their resultant health problems. These interventions can be carried out at the personal level of the job, throughout the organization, or at a state or national level by means of laws and regulations. European regulations and labor-management agreements that deal with job stress are examples of solutions achieved through national regulations that address organizations, and which are international in scope in that they cover all countries of the European Union. A 1-year follow-up of a recent intervention program at a Canadian hospital that included a team developed according to the principles of German "health circles,"  has shown positive health benefits. Recently Shapiro et al.  suggested the potential benefits of a meditation-based intervention for health care professionals Those who participated in the stress-reduction programs reported less perceived stress and greater self-esteem when compared with controls. The study suggests that an 8-week stress-reduction programs intervention may be effective for the reduction of stress, improvement in the quality of life and self-esteem in health care professionals.
The literature states that many factors - such as gender, age, and practice settings - can affect a pharmacist's job satisfaction in various pharmacy settings. , Some studies found low levels of job satisfaction among community pharmacists. This was because these pharmacists felt that their skills were used less than hospital pharmacists and did not participate in patient care. ,, In Saudi Arabia, unlike in other countries, community pharmacies are owned by Saudi business people and are usually managed by expatriate pharmacists who mainly come from other Arab countries. This is because Saudi pharmacists working in the public sector get salaries and benefits that are more than 3 times greater than those in privately-owned businesses.  Furthermore, by law, only male pharmacists can work at community pharmacies. Most Saudi pharmacies are commercial ventures, in which community pharmacists play limited clinical roles in dispensing medication.  One study found that, managerial functions represented more than half of the total routine and critical work of the pharmacist positions surveyed.  Previous studies that examined a range of aspects of pharmacy practice in Saudi Arabia, both in community pharmacies and in hospitals, only focused on patients' perceptions, views and satisfaction levels regarding the role of pharmacists as healthcare providers. So far, no studies have provided a clear picture of the level of job satisfaction and job-related stress among pharmacists in Saudi Arabia. The aim of the present study was to fill this gap. It was therefore, to measure the levels of job satisfaction among community pharmacists in Riyadh, and discover the factors that could lead to job stress and low levels of job satisfaction in this group.
| Materials and methods|| |
The target population of the study was pharmacists who currently practiced at community pharmacies in a range of socioeconomic areas of Riyadh. These pharmacists voluntarily agreed to participate in the study, which started on June 2, 2013 and ended late in February 2014. We obtained a sample-frame from the Directorate of Pharmacy at the Ministry of Health in Riyadh. At the time this study commenced, Riyadh had a total of 2,000 community pharmacies. Based on Riyadh Municipality areas, we divided the city of Riyadh into 15 municipal districts. We used a cluster area sampling technique that involved visiting each of the 15 areas, and randomly selecting every third one we came across from the community pharmacies (independent and chain pharmacies) without giving any prior notice. Krejcie and Morgan's approach to determining sample size for survey research was used  with 95% confidence interval, and 5% precision.  The appropriate target sample size to represent the population adequately was determined as 322. Because a low response rate was anticipated from this population and under the assumption that some addresses in our sampling frame might be impossible to reach, we decided that 480 survey instruments should be distributed.
The research was quantitative in nature and a self-administered survey method was adopted. We used a pre-validated questionnaire from the literature,  which had to be translated into Arabic, localized for use in Saudi Arabia, and subsequently retranslated into English to ensure appropriateness and equivalency. The questionnaire comprised the following four domains:
Part 2 asked respondents whether, given the choice, they would choose the same profession again; a four-point Likert scale was used, with response options ranging from 1 (definitely not) to 4 (definitely). For part 3, we used a Likert scale with which pharmacists could express how often they experienced job-related stress and conflict in a range of situations; the options were rarely or never, sometimes, most of the time, and all of the time.
- Demographic characteristics and occupation information of the participants;
- Job satisfaction;
- Job-related stress; and
- An optional "free-text response" part (here, participants were able to write comments about their job-related satisfaction and stress).
We then conducted a pilot study on 24 community pharmacists, using internal consistency to assess reliability and validity. The result of this study's reliability was 0.871, a satisfactory figure considering the acceptable cut-off value of 0.70.  The participants of the pilot study were not included in the final sample. The results of the pilot test were used to refine the questionnaire (where needed) to improve the content validity and the clarity of the wording, and to make the overall design more user-friendly.
We distributed three copies of the questionnaire to the selected pharmacies, along with a cover letter that explained the goals of the study, the investigator's intentions, information on anonymity, and instructions for the return of the completed questionnaire. We included the researcher's personal phone number in case respondents required any further information. The cover letter encouraged all of the pharmacists who worked at the chosen pharmacy to complete the questionnaire. After the responses were received, we coded the data and entered it into a statistical analysis system database to perform statistical analysis. We used regression analysis and Chi-square to test for any significant differences between the groups (significance level was set to P < 0.05). For part 4, we analyzed the qualitative data (from the free-responses section) using content analysis to identify recurring themes.
| Results|| |
Of the 480 questionnaires distributed, 407 completed questionnaires were received, 13 of which were rejected because of lack of completeness. After screening the response data, five further responses were classified as outliers and also excluded. The remaining 394 useable responses represented a response rate of 82%. We considered this total acceptable based on a power calculation that involves a margin of error (accuracy) of ±5% and a 95% confidence interval. Because Saudi regulations prohibit females from working at community pharmacies (they may only work at hospital pharmacies), all of the respondents were males.
Respondents comprised chain community pharmacists (n = 179), independent community pharmacists (n = 122), and dispensary pharmacists (n = 93). Just over half of the respondents (50.3%) were aged 22-30, and 58.6% had between 1 and 10 years' experience. [Table 1] summarizes the participants' demographic and practice setting details.
As for job satisfaction, nearly half of the independent community pharmacists indicated that they were satisfied with their job "most of the time;" a further 11% indicated that they had no satisfaction in their present position. The corresponding figures for dispensary pharmacists were 62% and 7%, respectively, while for chain community pharmacists the figures were 74% and 3%, respectively.
Of the independent community pharmacists, 44.3% (n = 54) indicated that they would not choose the same profession again, while 77.4% (n = 72) of dispensary pharmacists and 82.1% (n = 147) of chain community pharmacists said that they would choose the same profession again. Independent community pharmacists had a greater likelihood than dispensary and chain community pharmacists of "never or sometimes" being satisfied with their jobs (P < 0.05). The Chi-square analysis did not reveal any statistically significant relationship between job satisfaction and age (P < 0.43). Marital status (P < 0.009) and years of experience (P < 0.022) significantly affected pharmacists' job satisfaction, with married pharmacists appearing to be less satisfied than their unmarried counterparts.
Regression analysis showed that the pharmacists' job satisfaction appeared to rise with the number of prescriptions they dispensed (P < 0.05) [Table 2], with chain community pharmacists indicating greater satisfaction levels than independent community pharmacists. Most of the community pharmacists who dispensed >30 prescriptions daily considered themselves satisfied, while the least satisfied group were those pharmacists who dispensed fewer than 15 prescriptions daily.
|Table 2: LSMEAN of relationship between job satisfaction and number of prescriptions dispensed daily|
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As for job-related stress, regression analysis [Table 3] revealed that the setting of the pharmacy practice had a significant (P < 0.05) effect on whether or not responsibility for patient care was considered a stressful feature of their job. Chain pharmacists indicated the lowest levels of stress regarding the responsibility of patient care; these levels differed significantly (P < 0.05) from the most stressed group of pharmacists, that is, those working in single independent pharmacies.
|Table 3: LSMEAN for the effect of pharmacy practice settings on patient care responsibility|
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It was also found that the number of years of experience that a respondent had in pharmacy practice had a significant (P < 0.05) effect on whether the responsibility of patient care formed a stressful feature of their job [Table 4].
|Table 4: LSMEAN for the effect of years of experience on pharmacy practice versus patient care responsibility|
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Pharmacists who had 10 or less years of experience had the highest mean stress levels in terms of the responsibility of patient care. These levels were significantly higher than what was obtained for pharmacists with 11 or more years of experience.
Participants added comments in the space provided at the end of the questionnaire. We manually extracted a number of issues from these comments, which reflected what seemed to be the most salient aspects of job stress and/or satisfaction. We created the various categories by identifying the similarities and differences in the statements: These categories were labeled as shown in [Table 5].
| Discussion|| |
This paper reports on the levels of job satisfaction among community pharmacists in Riyadh, Saudi Arabia, as well as the probable causes of job stress and low job satisfaction in this group. Although we measured general job satisfaction, a number of factors that are difficult to control could have affected the results. The study revealed that pharmacists in chain community pharmacies were the most satisfied of the participants, followed by those in dispensaries. Independent community pharmacists were the least satisfied, largely because they felt they were less likely to use their professional skills (e.g., patient-oriented functions such as clinical activities and direct patient care) than their counterparts in dispensaries or chain community pharmacies. This finding could be partly explained by the belief among patients in Riyadh that chain pharmacies offer a wider range of medicines and they are able to order drugs from other branches in the chain. In contrast, independent pharmacies offer more over-the-counter drugs, which means that from a patient's perspective, there is less need for professional pharmacists.  Pharmacists in dispensaries and large pharmacies thought they were more likely to use their professional skills than community pharmacists. ,
Dispensary and chain pharmacists had the lowest levels of stress regarding responsibility for patient care, while pharmacists in single independent pharmacies were the most stressed. Independent pharmacies had fewer pharmacists than chain pharmacies and dispensaries. This was likely to affect when a pharmacist from an independent pharmacy was able to take sick leave or a holiday. As he often worked alone for up to 12 h a day, including holidays it is very difficult to take some time off. Chain pharmacies, on the other hand, usually have more than one pharmacist working (8-10 h a day), and it is also somewhat easier to communicate with management in the head office. In a similar study of job satisfaction and sources of stress of health professionals in Jordan, community pharmacists in a large pharmacy chain were found to be the most satisfied and least stressed of the groups surveyed. , Other studies have shown that workers in lower paid jobs tend to experience greater stress because they have less control over their responsibilities, and that low grade in employment is associated with a perception of unfairness. 
The least satisfied pharmacists in our study were those who dispensed the fewest prescriptions on a daily basis. This result is in accordance with the finding that those pharmacists then had more time to engage in clinical dispensing-related duties. However, pharmacists' job satisfaction increased as they spent a greater proportion of their time on patient-oriented activities. ,,
The present study, like those of Al Khalidi and Wazaify  and McCann et al.  showed that the pharmacists with the greatest experience had the most job satisfaction. Schommer et al.  found that older pharmacists tend to perceive their employment as a way of supplementing their income or as a means of remaining in contact with society.
This study gave pharmacists room to express their opinions on job satisfaction and job-related stress factors. Their perspectives raised several recurring themes. A report from Northern Ireland found that the main source of work-related stress among pharmacists was working conditions.  The present study showed that low satisfaction with work conditions could be a reflection of long working hours (10-12 h/day) and the fact that some independent pharmacies did not give days off to compensate for overtime. Pharmacists also had problems when requesting for leave because of the difficulty of finding locums. Interactions between physicians and pharmaceutical companies can potentially result in unethical and inappropriate prescriptions, which can lead to dissatisfaction among pharmacists. A related study in Jordan revealed similar events with similar consequences.  In that study, dissatisfaction was more common among pharmacists in single independent community pharmacies.
Although the pharmacists in the present study were not asked about their salaries, they did report that they were poorly paid. This is because they signed their contracts before coming to Saudi Arabia. At the time the salary offered seemed high compared with salaries in their home country; however, the cost of living in Saudi Arabia (particularly in Riyadh) is very high, which means the salary is not as generous as they thought. According to the Saudi Arab news agency,  the salaries offered by companies to expatriate pharmacists are lower than those received by Saudi pharmacists working in the pharmacies of government hospitals. All the pharmacists in the study sample were male, due to the fact that only male pharmacists are allowed to work in community pharmacies in Saudi Arabia. Furthermore, there were no Saudi pharmacists in the study. This is because most of owners of community pharmacies are Saudis who are not pharmacists, and owing to the severe shortage of Saudi pharmacists these community pharmacies are managed by expatriate pharmacists from neighbouring Arab countries  Most of the 150-200 pharmacists who graduate from a pharmaceutical college in Riyadh each year, join the public sector because of better salaries and opportunities for promotion. 
It may not be possible to generalize the results of the present study, which only analyzed pharmacists in Riyadh, to pharmacists in other parts of Saudi Arabia. Furthermore, since the response targets were not hospital pharmacists, we were unable to generalize our data to cover all pharmacists. The original survey instrument should be revised and tailored to suit the situation of all Saudi pharmacy practices. The drop-and-pick technique used in this study created the possibility of nonequivalence in understanding the questionnaire. To minimize this risk, the researcher encouraged participants to seek clarification whenever necessary, by telephone and E-mail. Despite the efforts to limit the social bias in participants' responses, the presence of the pharmacists' employers while they were completing the questionnaire could have affected their responses.
| Conclusion|| |
Our findings indicate different levels of job satisfaction amongst pharmacists in different practice settings in Riyadh. We found that pharmacists from dispensaries and large community pharmacies were less satisfied than those who worked in independent pharmacies. We also found that a number of job-related stress factors reduced job satisfaction amongst pharmacists, particularly those in independent pharmacies. This finding could have implications for patient safety and the provision of pharmaceutical care, and could hopefully be used to bring about improvements. There is a need for further research into both the causes of and solutions to stress among pharmacists. Pharmacists in chain and dispensing pharmacies in Riyadh reported moderate levels of job-related stress. These levels were significantly higher for independent community pharmacists, which could impact on patient safety. These findings indicate that improvements must be made in the provision of pharmaceutical care. For the proper implementation of pharmaceutical care services, Saudi Arabian regulators should review the impact of major changes in pharmacies on stress and job satisfaction. Future research should investigate why there is no encouragement for Saudi nationals to work as pharmacists in community pharmacies in Saudi Arabia.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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