title: Positive practice environments influence job satisfaction of primary health care clinic nursing managers in two South African provinces.
abstract: BACKGROUND
  Nurses constitute the majority of the health workforce in South Africa and they play a major role in providing primary health care (PHC) services. Job satisfaction influences nurse retention and successful implementation of health system reforms. This study was conducted in light of renewed government commitment to reforms at the PHC level, and to contribute to the development of solutions to the challenges faced by the South African nursing workforce. The objective of the study was to determine overall job satisfaction of PHC clinic nursing managers and the predictors of their job satisfaction in two South African provinces.
  
  
  METHODS
  During 2012, a cross-sectional study was conducted in two South African provinces. Stratified random sampling was used to survey a total of 111 nursing managers working in PHC clinics. These managers completed a pre-tested Measure of Job Satisfaction questionnaire with subscales on personal satisfaction, workload, professional support, training, pay, career prospects and standards of care. Mean scores were used to measure overall job satisfaction and various subscales. Predictors of job satisfaction were determined through multiple logistic regression analysis.
  
  
  RESULTS
  A total of 108 nursing managers completed the survey representing a 97% response rate. The mean age of respondents was 49 years (SD = 7.9) and the majority of them (92%) were female. Seventy-six percent had a PHC clinical training qualification. Overall mean job satisfaction scores were 142.80 (SD = 24.3) and 143.41 (SD = 25.6) for Gauteng and Free State provinces respectively out of a maximum possible score of 215. Predictors of job satisfaction were: working in a clinic of choice (RRR = 3.10 (95% CI: 1.11 to 8.62, P = 0.030)), being tired at work (RRR = 0.19 (95% CI: 0.08 to 0.50, P = 0.001)) and experience of verbal abuse (RRR = 0.18 (95% CI: 0.06 to 0.55, P = 0.001).
  
  
  CONCLUSIONS
  Allowing nurses greater choice of clinic to work in, the prevention of violence and addressing workloads could improve the practice environment and job satisfaction of PHC clinic nursing managers.
authors.affiliation: Centre for Health Policy & Medical Research Council Health Policy Research Group, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Private Bag X3, Wits 2050 Braamfontein, Johannesburg, South Africa. pascalia.munyewende@wits.ac.za.
authors.forename: Pascalia Ozida
authors.initials: PO
authors.lastname: Munyewende
authors.forename: Laetitia Charmaine
authors.initials: LC
authors.lastname: Rispel
authors.forename: Tobias
authors.initials: T
authors.lastname: Chirwa
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D058445:Bullying; D002055:Burnout, Professional; D003430:Cross-Sectional Studies; D005221:Fatigue; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D009718:Nurse Administrators; D009726:Nurses; D009818:Office Nursing; D011320:Primary Health Care; D012456:Salaries and Fringe Benefits; D013019:South Africa; D011795:Surveys and Questionnaires; D014754:Violence; D016526:Workload; D055815:Young Adult