title: Examining domains of community health nurse satisfaction and motivation: results from a mixed-methods baseline evaluation in rural Ghana.
abstract: BACKGROUND
  A strong health system requires a competent and caring workforce. A more satisfied and motivated health workforce should be more willing to serve in difficult areas, have lower turnover, and theoretically provide better care to patients. This paper examines the motivation, satisfaction, and correlation with clinical knowledge, of community health nurses (CHNs), a cadre of provider focused on maternal, newborn and child health in rural Ghana.
  
  
  METHODS
  This study employed three methods of evaluation. Two quantitative measurements were used: (1) a survey of health worker satisfaction and motivation and (2) a clinical knowledge assessment focusing on maternal, newborn and child health. Both were administered to all rostered CHNs working in the five sampled districts in the Greater Accra and Volta regions in Eastern Ghana (N = 205). Qualitative interviews (N = 29) and focus group discussions (N = 4) were held with selected CHNs in the same districts. These data were analysed using NVivo (Version 10) and Stata (Version 13.0) based on domains of extrinsic and intrinsic motivation including general satisfaction, work environment and access to resources, respect and recognition received and opportunities for advancement.
  
  
  RESULTS
  CHNs desired more training, especially those who were posted at the community level (a Community-based Health Planning and Services post or "CHPS") versus at a health facility. CHNs working at CHPS believed their work to be more difficult than those posted at health facilities, due to challenges associated with foot travel to visit patients at home, and they were more likely to report having insufficient resources to do their jobs (48% vs 36%). However, CHNs posted at health facilities were more likely to report insufficient opportunities for career advancement than the CHPS nurses (49% vs 33%). CHNs generally reported good relationships with colleagues and being respected by patients but desired more respect from supervisors. The median score on the knowledge assessment was 78%. On average, subgroups of CHNs with different reported levels of satisfaction did not perform differently on the knowledge assessment.
  
  
  CONCLUSIONS
  CHNs in Ghana were satisfied overall but desired more training, more guidance and supervision, fair pay and opportunities to advance in their career. Improving health worker satisfaction and morale may be important for health worker retention and certain aspects of care but may not have a significant influence on clinical knowledge or performance.
authors.affiliation: Department of International Health, Johns Hopkins School of Public Health, 615 N. Wolfe St., E8011, Baltimore, MD, 21205, USA. esacks@jhu.edu.|USAID Maternal and Child Survival Program (MCSP)/ICF International, Washington, DC, USA. esacks@jhu.edu.
authors.forename: Emma
authors.initials: E
authors.lastname: Sacks
authors.affiliation: John Snow, Inc., Rosslyn, VA, USA. Soumya_alva@jsi.com.
authors.forename: Soumya
authors.initials: S
authors.lastname: Alva
authors.affiliation: John Snow, Inc., Rosslyn, VA, USA. Carmela_magalona@jsi.com.
authors.forename: Sophia
authors.initials: S
authors.lastname: Magalona
authors.affiliation: Concern Worldwide US, New York, NY, USA. linda.vesel@concern.net.
authors.forename: Linda
authors.initials: L
authors.lastname: Vesel
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D002983:Clinical Competence; D003153:Community Health Services; D005260:Female; D005869:Ghana; D006268:Health Facilities; D006801:Humans; D007231:Infant, Newborn; D007588:Job Satisfaction; D008297:Male; D000068101:Maternal-Child Health Services; D008875:Middle Aged; D009042:Motivation; D064691:Nurses, Community Health; D012111:Residence Characteristics; D019035:Rural Health Services; D012424:Rural Population; D011795:Surveys and Questionnaires; D000078329:Workforce; D055815:Young Adult