Level of job satisfaction among anesthetists in Khyber Pakhtunkhwa: an in-depth examination of influencing factors

Abstract

Background:

Job satisfaction is an important determinant of health staff’s motivation, retention, and performance. The main aim of this study was to assess the level of job satisfaction and associated factors among Anesthetists working at Khyber Pakhtunkhwa Hospital, Pakistan.

Methods:

A multicenter cross-sectional study was conducted from 1 March to 30 December 2022. A total of 147 anesthetists that were working in different Khyber Pakhtunkhwa hospitals were involved in this study. The structured questionnaire (Minnesota) was scored on five-point Likert scales. Data were analyzed using SPSS 26. Binary logistic regression was used to measure statistical significance between dependent and each independent variable. Variables with value of ≤0.2 on crude analysis were taken into multivariate analysis, and a value of 0.05 and 95% confidence interval (CI) was used as cutoff point.

Results:

A total of 147 anesthetists were involved in the study. The overall level of job satisfaction among anesthetist was 70.7% (95% CI: 58.3–88.6). Factors associated with job satisfaction among anesthetist were aged (AOR: 0.814, 95% CI: 0.316–2.097), being married (AOR: 1.312, 95% CI: 0.477–3.604), advancement (AOR: 0.797, 95% CI: 0.285–2.229), recognition (AOR: 2.438, 95% CI: 0.857–6.936), growth opportunities (AOR: 1.517, 95% CI: 0.444–5.184), work security (AOR: 1.150, 95% CI: 0.418–3.160), Fair benefit (AOR: 0.508, 95% CI 0.196–1.314) and safe working environment (AOR: 0.199, 955 CI: 0.196–1.314).

Conclusion:

Job satisfaction of anesthetists working different hospitals of Khyber Pakhtunkhwa was high. The only factor associated with job satisfaction was coworker relationship, advancements and achievements. and least satisfied with anesthetists recognition, organization policies, and payment and benefits.

Introduction

Anesthetists are experts in intensive care, perioperative patient care, acute and chronic pain management, as well as research, and teaching, both at undergraduate and postgraduate levels^[1]. Increased intention to quit, burnout, and dissatisfaction with one’s job all derive from participation in high-stress, high-volume workplaces. There is a severe shortage of anesthesiologists who are currently working at or near capacity^[2]. It has been demonstrated that issues with the specialization of anesthesia include workload and stress brought on by challenges with essential decision-making^[3,4]. All these produce lower job satisfaction that might impair the health of anesthetists their job performance^[5].

HIGHLIGHTS

• The overall job satisfaction among anesthetists working in Khyber Pakhtunkhwa was impressively high, with 70.7% of respondents expressing satisfaction, suggesting a relatively positive work environment despite inherent occupational challenges.

• Key factors significantly influencing job satisfaction included strong coworker relationships, opportunities for professional advancement, and a sense of achievement, underscoring the pivotal role of workplace camaraderie and career growth in anesthetists’ well-being.

• Recognition, organizational policies, and payment and benefits were the most dissatisfying domains, highlighting critical organizational shortcomings that, if addressed, could substantially enhance job satisfaction and retention rates.

• Anesthetists under the age of 30 and those who were married reported higher satisfaction levels, suggesting that demographic factors such as age and marital status may modulate perceptions of workplace satisfaction

• Despite the high overall satisfaction, aspects such as workload, rigid work schedules, and limited public recognition of anesthetists’ contributions were identified as persistent stressors that could fuel professional dissatisfaction and potential burnout if left unaddressed.

The global strategy on human resources for the health workforce 2030 published by the World Health Organization lays out the policy agenda for ensuring a workforce capable of achieving the aims of the sustainable development goals^[6]. Anesthetists might be motivated to exert and sustain effort toward organizational goals. Work satisfaction is one of the most significant elements that affects motivation among many others. The attitude and sentiments that people have toward their employment are referred to as job satisfaction. Work satisfaction is shown by positive and favorable views toward the job. On the other hand, unfavorable and negative views regarding their jobs suggest work discontent^[3,7].

According to a Switzerland study, it is necessary to assess worker happiness, enhance working conditions, and make sure that coping strategies and techniques are in place to lessen stress at work^[3]. Despite their crucial position in the operating room, intensive care unit, emergency department, and their engagement in research and teaching, little is known about the job satisfaction or workload stress levels of anesthetists^[2]. Excessive working hours, a lack of employment assistance, and difficulties with potentially fatal situations are all linked to high levels of stress and low job satisfaction. According to a Dutch study, job satisfaction is one of the most significant and thoroughly studied work attitudes in organizational behavior, and the intention to leave an employer is correlated with job discontent^[8]. Another study found that factors influencing physicians’ job satisfaction include autonomy, collegial relationships, patient-caregiver interaction, reimbursement, resource availability, and educational status^[9]. One investigation found no difference in satisfaction among men and women anesthetists^[10]. According to a research done in Kenya, unfriendly working conditions, little prospects for advancement, and inadequate health care systems cause people to become dissatisfied and demotivated at work and decide to leave the nation^[11]. A study conducted in Ethiopia reported that health care workers were dissatisfied due to a lack of motivation, an inadequate salary, a lack of training opportunities, and an inadequate number of human resources. On the other hand, those who were satisfied reported feeling satisfied from their work and from helping others^[12]. Anesthetists in Switzerland are more motivated and have greater job satisfaction when they have more control over decision-making, a flexible work schedule, and more control over their own work pace^[13]. According to an Australian study, long hours and low recognition were the unsatisfactory components of the profession, whereas high standards of practice and practical aspects were satisfying^[4]. Lack of achievement and lack of recognition are identified as dissatisfiers than working conditions and interactions with the seniors^[14].

One review commented that improving overall health and improving work satisfaction may decrease burnout among operation theatre team members^[15]. The relationship between compensation and workload, company policies, and prospects for promotion are also considered to be factors that contribute to job dissatisfaction among healthcare professionals^[16]. A meta-analysis conducted in the United Kingdom found that job satisfaction level is an important factor influencing the health of workers^[17]. Health workers may not be happy with their jobs due to company regulations, possibilities for promotion, or the relationship between income and workload^[5]. In particular, stress from managing serious disease and death, using complicated machinery, and feeling unappreciated by management or other members of various professional organizations causes burnout and unhappiness at work^[4,13,18]. According to an Austrian study, 25% of anesthetists employed by teaching hospitals were at risk for burnout syndrome, which is typified by physical and mental exhaustion. Additionally, 50% of anesthetists expressed higher levels of job dissatisfaction (P = 0.002) and intended to leave their field in the future^[19].

Anesthetists’ job happiness is a critical factor in both their health and the provision of higher-quality patient care. Anesthesia has been categorized as a specialty with a high risk of developing job discontent. Anesthetists everywhere struggle with the issue of professionals quitting their jobs because of stress, exhaustion, and long workdays. In Ethiopia, there are 1200 anesthetists serving a population of 100 million people, according to a report by the Ethiopian Association of Anesthetists. This indicates that there is a shortage of anesthesia professionals in the nation, which could result in an increase in workload and unhappiness at work^[20].

The aim of the current study is to evaluate anesthetists’ overall job satisfaction and identify the factors that influence their level of job satisfaction. This information will aid health policy makers in implementing policies that prioritize employee retention, fair workloads, incentives, and favorable working conditions. The study findings were reported as per the STROCCS guidelines^[21].

Operational definitions

“A pleasant or positive emotional state arising from the appraisal of one’s job or job experiences” is what job satisfaction is defined as. Anesthetists are qualified healthcare professionals who prepare patients for surgery and administer anesthetics to cause patients to lose sensation completely or partially during diagnostic or surgical procedures. They also continuously monitor the patient’s response to anesthesia, the stress of the procedure, and their vital signs to maintain the patient’s normal physiologic setup throughout the procedures. Anesthetists also ensure that patients experience no pain during or after the procedure and work as a team to maximize patient safety, comfort, and improved procedure outcomes^[12,22].

Methodology

Study design, area and period

This was a descriptive cross-sectional study conducted from March to November 2023 in all Khyber Pakhtunkhwa anesthetists working in public and private hospitals. A sample of 147 anesthetists were selected by universal sampling technique. All registered anesthetist working in Khyber Pakhtunkhwa and who worked in operation theatre, ICU, HDU, and pain clinics were included in this study. Anesthetists who changed their career from concern department, and those physicians who are not working in the medical field from last 5 years, and working in the administrative department were excluded..

Ethical consideration

The research was conducted with approval from the ethics committee. All procedures in this study were conducted in accordance with the International Ethical Guidelines for Human Research in Health Care and the Helsinki Declaration (2013 Revision) (2016). By keeping the respondents anonymous, the researchers were able to guarantee the confidentiality of the study. An online questionnaire that they filled out at their convenience, free from researcher interference, allowed for participant anonymity throughout the study. All gathered data was de-identified before any discovered results were published. Prior to signing an informed permission form on the first page of the questionnaire, participants were given a participant information document outlining confidentiality and anonymity. The permission form, together with the participant information page, provided detailed information about the study’s purpose, methodology, potential dangers, potential benefits, and voluntary nature. It was also emphasized that participation was completely voluntary and that there would be no repercussions if individuals decided to stop at any point. Before someone could start filling out the questionnaire, their consent was sought. All of the data was kept on a password-protected university computer as well as in the university’s “cloud” data storage, which makes use of the most recent antiviral software. In compliance with university policy, the data will be safely and securely erased, and the actual hard drive will be destroyed. Since shredding records is the safest and most environmentally responsible option, the hardcopy files will be physically destroyed. The information will be deleted in accordance with university policy after 6 years.

Data collection procedure

Data were collected using a pretested and structured interviewer administered questionnaire (Minnesota) (Additional file 1). The questionnaire was distributed in the English language. The Cronbach’s alpha reliability test was used to verify the tool’s reliability for each subscale, and the results showed that the questionnaire was consistent, with a coefficient of 0.83. At each institution, two anesthesia technologists and one anesthetist were hired as supervisors and data collectors, respectively, to ensure the quality of the data. Additionally, supervisors and data collectors received 2 days of training about the goals of the study and the procedures involved in gathering data. Additionally, at Lady Reading Hospital and Mardan Medical Complex, 5% of the sample size participated in a pretest of the questionnaire. Additionally, during the data collection period, the lead investigators and supervisor provided close supervision.

Variables and measurement

Job satisfaction was the study’s dependent variable. A five-point Likert scale with 20 items – 1 = extremely unhappy and 5 = highly satisfied – was used to quantify it. Respondents were deemed satisfied if their total score on the satisfaction scale was higher than 60.

Organizational commitment

The level of loyalty an anesthetist has to their workplace is known as organization commitment. It was measured using three dimension scales, and an organizational commitment level was indicated by a score more than 60% of the commitment scales’ total.

Anesthetists’ attitudes toward the congruence of individual and organizational goals are known as affective commitment. Three items totaling five points on a 5-point Likert scale were used to measure this, with one representing “strongly disagree” and five representing “strongly agree.”

Work environment

The term “work environment” refers to the physical characteristics of the workplace as well as the extent to which it offers meaningful work. Four items were included in the measurement, and each one had a 5-point Likert scale score.

Supervisor support

The term “supervisor support” refers to a supervisor’s obligation to prevent and address staff issues. Ten items were included in the measurement, and each item had a 5-point Likert scale score.

Recognition and reward

The way that anesthetists see their encouragement can be characterized as one of reward and recognition. One point was used to indicate strong disagreement and five points to indicate strong agreement on a 5-point Likert scale.

Coworker relationship

The term “coworker relationship” refers to the interpersonal connections that people have at work. Each of the four items used to measure it had a 5-point Likert scale.

Pay and benefit

Anesthetists’ expectations on fairness and sufficient recompense for a full day’s labor are outlined in pay and benefits. Each of the four items used to measure it had a 5-point Likert scale.

Educational opportunity

Pay and benefit refer to anesthetists’ expectations on fairness and sufficient remuneration for a full day’s labor. Four items totaling five points on a Likert scale were used to measure it.

Organizational policy

An organization’s implementation of its strategy and policies is outlined in its organizational policy. Each of the four items used to measure it had a 5-point Likert scale.

Autonomy

Participants’ autonomy in starting and maintaining job-related behaviors and procedures, such as choosing their own work style, tempo, and level of effort, is reflected in their autonomy. Two Likert-scale items, each with a 5-point rating, were used to measure it.

Performance appraisal

The participants’ feelings regarding the evaluation of their actual performance are described in the performance appraisal. Three Likert-scale items, each with a 5-point rating, were used to measure it.

Workload

The term “workload” refers to the amount of time and resources needed for an anesthetist’s work requirements. Six items, each with a 5-point Likert scale score, were used to measure it.

Study variables

The degree of job satisfaction was the study’s dependent variable. Using the Minnesota Satisfaction Questionnaire (MSQ) short form, twenty items were used to assess job satisfaction. Each item was assessed on a 5-point Likert scale, with 1 being severely dissatisfied and 5 representing strongly satisfied^[23]. The elements linked to job satisfaction were examined in earlier research of a similar nature in order to construct the questions^[24,25]. The sum of the scores on each subscale was used to evaluate the overall job satisfaction. Subsequently, in order to gauge each respondent’s degree of job happiness, those who scored higher than 60 on the total number of items on the satisfaction scale were deemed to be content with their jobs. People who received a score of 60 or lower were considered unsatisfied. To ascertain if a health professional is content with their job or not, a cut point value of 60 was taken for each domain factor. This cumulative score was applied to each variable under the domains. Therefore, healthcare professionals were classified as satisfied if their score was 60 or higher and as dissatisfied if their score was 60 or lower^[26]. Age, sex, marital status, education level, profession category, work experiences, salary, and alternative employment were the independent variables. Extrinsic or hygienic factors were also included. The intrinsic motivators were achievement, advancement, recognition and reward, growth, and the work itself or nature of work (benefit and payment, supervision support, organizational policy and strategy, work environment, staff relationship, and work security).

Statistical analysis

Data were cleaned, coded and entered and analyzed using SPSS Version 26. Mean, mode, and median were used for continuous variables whereas; percentage was used for categorical variables. Descriptive results were presented using tables and figures. Model fitness was checked using a Hosmer–Lemeshow goodness-of-fitness test. Crude odds ratios with their 95% confidence intervals (CIs) were estimated in the bivariable logistic regression analysis to assess the association between each independent variable and outcome variable. In the bivariable logistic regression, variables with P value <0.2 were fitted into the multivariable logistic regression analysis. Finally, adjusted odds ratios with their 95% CIs were estimated to assess the strength of association, and variables with P value <0.05 were considered statistically significant factors.

Results

Socio‑demographic characteristics of the study participants

Table 1 provides demographic and professional information about a group of individuals. It includes data on Age (median with interquartile range), Gender, Marital Status, Educational Status, Professional, Hospital Sector, Total Experience, Clinical Responsibilities, and Alternative Job Opportunities. The median age of the individuals is 31, with an interquartile range between 30 and 33. In terms of gender, 68% are male, and 32% are female. The majority are married (71.4%) and have MBBS (35.4%) or FCPS (29.3%) as their educational status. Most of them work as specialists (27.2%) and are employed in the public hospital sector (64.6%). Their total experience is distributed across different categories, with a notable proportion having 1–5 years (36.7%) or 6–10 years (37.4%) of experience. Regarding clinical responsibilities, the majority are involved in the operation theatre (82.3%). Finally, 39.7% of them have alternative job opportunities, while 60.3% do not. This table offers a snapshot of the characteristics of this group of individuals, shedding light on their demographics and professional backgrounds (Table 1).

Table 1.

Socio-demographic characteristics of anesthetists working at different hospitals of Khyber Pakhtunkhwa (n = 147)

Variable	Categories	Frequency	Percentage
Age [median (IQR)]		31 (30–33)
Gender	Male	100	68.0%
	Female	47	32.0%
Marital status	Single	40	27.2%
	Married	105	71.4%
	Divorced	2	1.4%
Educational status	MBBS	52	35.4%
	FCPS	43	29.3%
	MCPS	37	25.2%
	Post-graduate diploma	15	10.2%
Professional	Specialist	40	27.2%
	In-specialist	107	72.8%
Hospital sector	Public	95	64.6%
	Private	52	35.4%
Total experience	Less than 1 year	0	0.0%
	1–5 years	54	36.7%
	6–10 years	55	37.4%
	Above 10 years	38	25.9%
Clinical responsibilities	Operation theater	121	82.3%
	Intensive care unit ICU/HDU	23	15.6%
	Pain clinic	3	2.0%
Do you have alternative job opportunities?	Yes	58	39.7%
	No	88	60.3%

Level of job satisfaction

This study examines the general prevalence of job satisfaction among anesthetists in Khyber Pakhtunkhwa, Pakistan, who work at various institutions. It reveals that while 29.3% of respondents expressed dissatisfaction with their work, 70.7% of respondents said they were satisfied with their jobs. Among domain criteria, staff relationships and work successes had the highest levels of job satisfaction (70 % and 70 %, 66 %, respectively).

Data on job satisfaction and its correlation with different criteria are shown in this table. It is broken down into various categories, and for each category, the frequency of people who are content and dissatisfied is provided, along with the odds ratios and 95% CIs that correlate to each of those numbers. The table demonstrates how different factors are associated with job satisfaction. For instance, individuals aged 30 and above have an adjusted odds ratio (AOR) of 0.814 (95% CI: 0.316–2.097) for job satisfaction, compared to those under 30. Similarly, being married is associated with an AOR of 1.312 (95% CI: 0.477–3.604) for job satisfaction compared to being unmarried. The result from multiple logistic regression analyses indicates that anesthetists aged 30 or above had job satisfaction 0.814 times than those aged under 30. Means, under 30 more satisfied than older.

Compared to single anesthetists, married anesthetists reported 1.312 times more satisfaction.

The difference between anesthetists with advancement and those without was 0.797 times. Anesthetists who performed well had a satisfaction rate of 0.711 times higher than those who performed poorly. Less than half as many people reported being satisfied with their work as they were with their pleasant work (0.354 times). Anesthetists who received acknowledgment reported being 2.438 times more satisfied than those who did not, indicating that those who received recognized were happier than those who did not. Anesthetists with growth opportunities were 0.1.517 times more satisfied, indicating that they were a more satisfied group. Anesthetists with work security had a satisfaction rate of 0.1.150 times higher than those without work security, indicating a higher level of contentment. Fair benefit anesthetists had 0.508 times higher satisfaction, which indicates unfair benefit. Compared to those with equitable compensation and benefits, anesthetists were more satisfied. The satisfaction of anesthetists working in a safe environment was 0.199 times higher than that of anesthetists working in a non-safe environment.

Factors like advancement, achievement, the pleasantness of work, recognition, growth, work security, payment and benefits, and a safe working environment are also assessed in relation to job satisfaction. Some of these factors show statistically significant associations indicating their impact on job satisfaction. Overall, the table provides valuable insights into the factors influencing job satisfaction among the study participants (Table 2).

Table 2.

Bivariable and multivariable logistic regression analysis of factors with job satisfaction among anesthetists working at different hospitals of Khyber Pakhtunkhwa (n = 147)

Variable	Categories	Job satisfaction
		Unsatisfied	Satisfied	COR (95% CI)		AOR (95% CI)
		Frequency	Frequency	Exp(B)	Lower–Upper	Exp(B)	Lower–Upper
Age group	<30	16	35	Ref
	30 and above	27	69	1.168	0.557–2.449	0.814	0.316–2.097
Marital status	Unmarried	13	29	Ref
	Married	30	75	0.892	0.409 –1.945	1.312	0.477–3.604
Advancement	No	21	32	Ref
	Yes	22	72	0.466	0.225 –0.965 a	0.797	0.285–2.229
Achievement	Poor	21	28	Ref
	Good	22	76	0.386	0.184–0.808 a	0.711	0.253–2.001
Work itself	Unpleasant	23	30	Ref
	Pleasant	20	74	0.353	0.169–0.735 b	0.354	0.109–1.144
Recognition	No	28	62	Ref
	Yes	15	42	0.791	0.378–1.657	2.438	0.857–6.936
Growth	No	22	35	Ref
	Yes	21	69	0.484	0.235–0.998 a	1.517	0.444–5.184
Work security	No	21	28	Ref
	Yes	22	76	0.386	0.184–0.808 a	1.150	0.418– 3.160
Payment and benefit	Unfair	33	58	Ref
	Fair	10	46	0.382	0.171–0.856 a	0.508	0.196–1.314
Safe working environment	No	32	39	Ref
	Yes	11	65	0.206	0.093 –0.455 b	0.199	0.069–0.580 a

AOR, adjusted odds ratio; COR, crude odds ratio.

^aP < 0.05

^bP < 0.001

Factors associated with job satisfaction

Figure 1 illustrates the relationship between job satisfaction and various factors within the workplace. The percentages in the figure represent the proportion of individuals who are satisfied or dissatisfied with their jobs based on different aspects. For instance, 70.70% of individuals who report high levels of achievement are satisfied with their jobs, while 29.30% are dissatisfied. Similarly, 66.70% of those experiencing advancement in their roles express satisfaction, compared to 33.30% who are dissatisfied. The table reveals that job satisfaction is generally higher among individuals who report positive experiences in aspects such as achievement, advancement, work itself, and work security, while aspects like growth and organizational policy have a more mixed impact on job satisfaction. This information provides insights into the specific factors that contribute to job satisfaction within the studied population, which can be valuable for HR and management decisions to enhance workplace satisfaction and well-being.

Figure 1.

Level of job satisfaction among anesthetists working at different hospitals of Khyber Pakhtunkhwa (n = 147).

Discussion

Job satisfactions of health-care workers play a vital role in improving the quality of client care. In this study, the overall level of job satisfaction among anesthetists was 70%. This finding is comparable with previous studies conducted in Spain (77.2%)^[27], Nepal (76%)^[28], and Eastern India (59.6%)^[29]. The result of the present study is consistent with the survey conducted in Canada and Nigeria which indicated that 75%^[1] and 58.7%^[30] of anesthesiologists, respectively, reported overall satisfaction with their job. But our study reports were higher than Ethiopia (52.9% in Addis Ababa^[31], and 54.2% in East Gojjam Zone^[32]) and India (50%)^[33]. This might be due to high surgical regard and public image, working in a standard set up, and fair salary and incentives in case of the Pakistan study. However, our finding is lower than satisfaction rate reported in Nigeria (90.4%)^[34]. The possible explanation for the above difference could be due to the difference in socio-economic characteristics and organizational setup of health care workers.

Our study’s findings indicated that anesthetists in operating rooms reported higher levels of satisfaction than those in intensive care units and pain clinics. This could be brought on by possibilities for advancement as well as differences in pay and incentives. Professional development may also help anesthetists feel more satisfied and confident in themselves.

In contrast to earlier findings^[20,31] study revealed that while 59.3% and 51.6 % of healthcare professionals were content with their coworker interactions, only 37.8% of anesthetists felt the same way about their respective facilities. Insufficient training of OR staff and miscommunication with surgeons may lead to reduced job satisfaction in the research field. It may be claimed that handling stressful situations, communication issues, and key events could cause negative reactions toward coworkers, even if our results are very different from those of other studies.

In our study, satisfaction with working schedule was low (43.9%) in accordance with^[31,35] wherein a high workload and rigid schedule reduced job happiness. Another explanation for this could be the dearth of anesthetic specialists in the research region. High levels of satisfaction (64%) with professional development were found in this survey. This is consistent with a study conducted in Dutch^[36]which showed providing sufficient opportunities for learning and growing would produce high job satisfaction level. Scholars reported that acquiring advanced skills and promotion motivate employees and achieve high job satisfaction^[37].

According to the current study’s findings, just 39% of respondents were satisfied with acknowledgment. One could claim that there is a lack of public knowledge regarding the role of anesthetists and that the field of anesthesia is still relatively new in our nation. Academics argue that rewarding workers for their efforts is a powerful way to increase job satisfaction.

This study revealed that strong control over work and responsibility produces higher job satisfaction (67%) in good agreement with^[13]. A study conducted in Nigeria suggests that giving enough job freedom and power might help employee to feel own of the results and greater job satisfaction^[37]. Our investigation revealed that satisfaction with social interaction, such as assisting others, and patient outcome was relatively high, which was corroborated by the findings of a study conducted in Ethiopia^[35]. This might be due to the fact that anesthetists work to relief pain and suffering diseases of their clients.

Limitation of the Study

We adapted the job satisfaction questionnaire that was first created for health professionals. However, the limited sample size and absence of a standardized approach for measuring anesthetists’ job satisfaction are limitations of this study. Our study only used a small sample size and covered a single province due to resource limitations. As such, it is unlikely to be representative of Pakistan’s whole anesthesia workforce. Future research on job satisfaction could yield a more conclusive comparison with a larger sample size and better sampling methods.

Conclusion

Job satisfaction of anesthetists working different hospitals of Khyber Pakhtunkhwa was high. The only factor associated with job satisfaction was coworker relationship, advancements and achievements. and least satisfied with recognition, organization policies, and payment and benefits.

Ethical approval

The research was conducted with approval from the ethics committee of Pakistan’s Sarhad University of Information and Technology (reference number SUIT/REC/2023/004).

Consent

Written informed consent was obtained from the patient for publication and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.

Sources of funding

None.

Author contributions

M.T., H.H., S.U.F., and S.K. conceived and designed the study and collected the data. M.T., S.S., Z.J., and S.K. analyzed the data and analyzed the results. S.U.F., S.N., S.N.Q., I.U.D., M.S., and M.Z.A.S.R. helped in preparing, editing, and finalizing the manuscript for publication.

Conflicts of interest disclosure

The authors declare that there are no competing interests.

Guarantor

Sardar Noman Qayyum.

Research registration unique identifying number (UIN)

The study was registered with Institutional Review Board of Pakistan’s Sarhad University of Information and Technology (reference number: SUIT/REC/2023/004).

Provenance and peer review

Not commissioned, externally peer-reviewed.

Data availability statement

The dataset used and analyzed during current study are available from the corresponding author, Samim Noori, upon reasonable request.