Assessment of Factors Affecting Turnover Intention Among Nurses Working at Governmental Health Care Institutions in East Gojjam, Amhara Region, Ethiopia, 2013
Girma Alem Getie1, Erdaw Tachbele Betre2, Habtamu Abera Hareri1
2Department of Nursing and Midwifery, College of Allied Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
To cite this article:
Girma Alem Getie, Erdaw Tachbele Betre, Habtamu Abera Hareri. Assessment of Factors Affecting Turnover Intention Among Nurses Working at Governmental Health Care Institutions in East Gojjam, Amhara Region, Ethiopia, 2013. American Journal of Nursing Science. Vol. 4, No. 3, 2015, pp. 107-112. doi: 10.11648/j.ajns.20150403.19
Abstract: Background: The growth and success of any organization usually depends on its employees. Turnover in health care institutions has significant challenge on customer service levels, company profits, and cause training and expatriation losses cost. In light of current concerns over nursing shortages, nurse’s turnover intent is a topic of great importance. The healthcare community needs to be concerned about nursing turnover intention and the effect on the projected nursing shortage. The evaluation of nursing turnover intention and the association between turnover intention and various predictors needs to be determined. To comprehend the factors of nurses’ turnover intention can help the top management in designing effective strategies to overcome this issue. Method: Cross-sectional study design was used. Data was collected from March 2013 to April 2013 by using a structured questionnaire. A total of 372 respondents were filed the questionnaire with the response rate of 87.84%.Odds ratio and regression analysis were performed at a P value of 0.05. Result: Findings suggested that 59.4% of respondents indicating a turnover intention from their current health care institution. Family arrangement is significantly associated with nurses’ turnover intention (P-0.009, 95% C.I. 1.20-3.50).In this study procedural justice was significantly associated with nurses’ turnover intention (P 0.013, 95% C.I. 1.14-3.02). Lack or low procedural justice in the health institutions increases the turnover intention of nurses. Organizational commitment was found to significantly association with nurses’ turnover intention (P-0.026, 95% C.I. 1.07-2.84). The study shows that level of salary was significantly associated with nurses’ turnover intention (p. 0.007, 95%C.I., 1.22-3.52). The result shows that training opportunity affect turnover intention. Low training opportunity significantly associated with nurses’ turnover intention (P.0.000, 95%C.I., 1.54- 4.35). Nurses with lower salary demonstrated higher intent of turnover than higher salary employees. Lack of transport was also significantly associated with nurses’ turnover intention (P. 0.018, 95%C.I., 1.13-3.71) in these study findings. The result indicated that job satisfaction is significantly associated with nurses’ turnover intention (P. 0.029, 95%C.I. 1.06-2.97). Conclusion: Nurses are useful to the health care institution to provide quality care. If the health care institution want to reduce nurses’ turnover, then it is important to understand factors which increase nurses’ turnover intentions. The results of this study suggest that interventions should be carried out to reduce the nurses’ turnover intention in East Gojjam governmental health care institutions.
Keywords: Turnover Intention, Nurses, Health Care Institution
1. Back Ground
In today’s job environment, where competition is intensifying particularly due to globalization, human resource development has significance. Organizations are continually trying to maintain their highly-skilled employees and to encourage them to improve their abilities. The lack of retention ability in an organization has led to the loss of skilled and experienced employees. Turnover can decrease customer service levels, lower company profits, and cause training and expatriation losses . Turnover of qualified nurses has consequences for health organizations as well as the profession as a whole. Nurse turnover can have a negative impact on the capacity to meet patient needs and provide quality care .
The healthcare industry requires a more skilled workforce today as a result of advancement in medical technology and the demand for more sophisticated patient care .
Turnover is a major problem worldwide especially in developing countries, particularly in Africa. Turnover is very detrimental and costly for the organization, both voluntary and involuntary . Managers and researchers consider turnover as a problem because of costs associated with it and difficulties that organizations face in the recruitment and retention of proficient employees .So, understanding the prospective antecedents of turnover is very important to diminish the problem .
Turnover rate could be reduced, if factors affecting nurses’ turnover intention are investigated. These factors, if identified, might lead to recommendations that could enable health care institutions in East Gojjam to retain more nurses and save costs on recruitment, selection, in-service education and placement of nurses. The reduction in turnover intention help to improve quality of care rendered to clients in East Gojjam.
Understanding more about the interrelationships between individual factors, organizational factors, environmental factors and job satisfaction with turnover intent can be used by nurse administrators and nurse mangers to develop and institute practices designed to increase job satisfaction and thus retain nurses . Patients, nurses, society, health care organizations, will potentially benefit from the knowledge derived from the study.
1. To determine the rate of turnover intention among nurses working at East Gojjam Governmental Health Care Institutions.
2. To assess the determinant factors affecting nurses’ turnover intention among nurses working at East Gojjam Governmental Health Care Institutions.
3. Sampling Procedure
In East Gojjam there are 18 woredas (Motta, Hulet Ejjue Enesie, Enarge Enawga, Goncha Siso Enesie, Enebsie Sarmider, Enemay, Shebel, Dejen, Debay Tilatgin, Awabel, Basoliben, Aneded, Bibugn, Machakel, Debrelias, Gozamen, Debremarkos and Sinan).
Woredas were selected by using simple random sampling. From 18 woredas eight woredas (Motta, Dejen, Awabel, Gozamen, Debremarkos, Aneded, Goncha Siso Enesie and Enebsie Sarmider) were selected. In these eight woredas there were 41 health centers and 2 hospitals with a total of 449 nurses. By simple random sampling 423 nurses were included in the study as the study participant.
4. Instrument and Measurement
A structured self-administered questionnaire was used to collect data from participants. It was adapted from Almalki et al, Katamba, Nebiat and Lewis [2,7,8,9].The organizational factors and job satisfaction were measured by using five point likert scales. Response choices for eachitem were a 1-5 Likert scale with the choices: 1= strongly disagree 2=disagree 3=indifferent 4= agree and 5=strongly agree. Negative items were reverse coded so that the answers indicated low to high level as the questions were negatively worded ( 1-strongly agree, 5 strongly dis agree). The items each had response choices that ranged from one to five with one being the lowest level of and five indicating the highest level. The responses to the whole items of organizational factors and job satisfaction for each factor by each respondent were added together and scored from hundred. . Turnover intention was measured with yes or no item. Data collectors were nurses who had diploma or above in nursing profession. Training was given to the data collectors to control the quality of the data. In order to evaluate the clarity of the questions in the questionnaire and to ensure that the validity and reliability of the instrument and the reactions of the respondents to the questions, pre-test was done prior to the actual data collection. Of the 423 questionnaires distributed personally among the data collectors 372 questionnaires were received back with a response rate of 87.94%. This number is similar or higher to the sample of other studies that have analyzed the turnover intentions (10, 11, 8).The collected data was cleaned, coded and entered in Epi data version 3.1 and transferred to SPSS version 16.0 for analysis.
From the total of 372 nurses 221 (59.4%) have turnover intent from the current health care institution.
The five top reasons for leaving a current position were: Poor payment 195 (52.4%), poor training opportunities 184 (49.5%), poor organizational commitment 141 (37.9%), unfair system in the organization 138 (37.1%) and not enough job satisfaction 137 (36.8).
|Reasons for leaving||Frequency||Percentage (%)|
|Poor training opportunities||184||49.5|
|Poor organizational commitment||141||37.9|
|Unfair system in the organization||138||37.1|
|Not enough job satisfaction||137||36.8|
|Lack of recreational places||131||35.2|
|Absence of regular promotion||128||34.4|
|Lack of transportation||114||30.6|
|Location of the health institution||100||26.9|
|Lack of Autonomy in my job||98||26.3|
|Lack of electricity||90||24.2|
|No immediate supervisor support||89||23.9|
|Absence of Coworker support||68||18.3|
|Variables||Turnover intention N/%||P-value||AOR||95.0% C.I. for EXP(B)|
|Family arrangement||Lives with||70 (50.4)||69 (49.6)||1||1||1|
|Lives far||81 (34.8)||152 (65.2)||0.009*||2.048||1.199||3.499|
|Having children||Yes||44 (46.3)||51 (53.7)||0.620||0.859||0.473||1.563|
|No||107 (38.6)||170 (61.4)||1||1||1|
|Organizational commitment||Low||72 (32.9)||147 (67.1)||0.026*||1.742||1.069||2.839|
|High||79 (51.6)||74 (48.4)||1||1||1|
|Payment||Low||85 (33.6)||168 (66.4)||0.007*||2.067||1.215||3.517|
|High||66 (55.5)||53 (44.5)||1||1||1|
|Procedural justice||Unfairness||69 (32.5)||143 (67.5)||0.013*||1.857||1.142||3.021|
|Fairness||82 (51.2)||78 (48.8)||1||1||1|
|Autonomy||Low||61 (36.7)||105 (63.3)||0.364||1.279||0.752||2.173|
|High||90 (43.7)||116 (56.3)||1||1||1|
|High||82 (52.9)||73 (47.1)||1||1||1|
|Training opportunity||Low||75 (31.5)||163 (68.5)||0.000*||2.586||1.537||4.352|
|High||76 (56.7)||58 (43.3)||1||1||1|
|Job satisfaction||Unsatisfied||69 (33.5)||137 (66.5)||0.029*||1.774||1.060||2.971|
|Satisfied||82 (49.4)||84 (50.6)||1||1||1|
|Transportation||Lack||80 (34.8)||150 (65.2)||0.018*||2.051||1.133||3.712|
|Enough||71 (50.0)||71 (50.0)|
|Recreational places||Lack||89 (36.5 )||155 (83.5)||0.515||0.822||.456||1.482|
|Enough||62 (48.4)||66 (51.6)|
|Location||Urban||75 (52.4)||68 (47.6)||1||1||1|
|Rural||76 (33.2)||153 (66.8)||0.008*||2.099||1.215||3.627|
*Significant at P<0.05; AOD - Adjusted odds ratio
This cross-sectional study revealed that the overall prevalence rate of turnover intention in the study was high (59.4%) compared to the previous researches conducted in Saudi Arabia 40% and in Japan 44.3% of nurses intended to leave their job [2,12]. The possible explanation may be due to; this study includes both the urban and rural nurses. The inclusion of rural nurses may increases the turnover intention rate. The difference in the study period, and infrastructure in the health institutions may affect the rate of turnover intention. The study in Japan was done only in Hospitals but this study was conducted both on hospital and health center nurses.
Family arrangement is significantly associated with nurses’ turnover intention (P-0.009, 95% C.I. 1.199-3.499). Nurses live far from their family/husband/wife had 2.05 times more turnover intention as compared to nurses live with their family/husband/wife. From the nurses who had turnover intent 24.2% of them indicated that due to family arrangement. This result is nearly consistent with the research done in Oromia region which indicates that 31.4% of health extension workers had reflected a concern of both transfer and family problems. This increases their turnover intention .
In this study procedural justice was significantly associated with nurses’ turnover intention (P 0.013, 95% C.I. 1.142-3.021) which is consistent with the previous studies [14,15,16]. Lack or low procedural justice in the health institutions increases the turnover intention of nurses. The reason may be when nurses perceive that administration is compensating all the staff members in just a manner, and they are not subject to prejudice or biases, their turnover intention is reduced.
With the increase of technological advances and changes, there is a need for organizations to address employee satisfaction, organizational commitment and work itself. The success, survival and competing power of organizations depend on the commitment of their members, supporting their individual developments and ensure their participations .
Organizational commitment was found to significantly association with nurses’ turnover intention (P-0.026, 95% C.I. 1.069-2.839). This result is consistent with the previous studies [18,19,20,21]. Even though the study only measured turnover intention can be regarded as a strong predictor to the actual behavior and it has consistent positive relationship with actual turnover. When the organizational commitment of an employee is high, turnover intention is low.
Payment is commonly regarded as the most incentive to motivate employees to perform certain activity or raise their job performance. Although some may value financial reward unimportant, undoubtedly money can be used to obtain desired variables . Low salary was repeatedly, consistently and unanimously mentioned as the main factor pushing employees out of the public health sector [22,19].
The study shows that level of salary was significantly associated with nurses’ turnover intention (p. 0.007, 95%C.I., 1.215-3.517). Nurses with lower salary demonstrated higher intent of turnover than higher salary employees. These results are consistent with prior studies that nurses’ intention to leave is negatively associated with lower salary[2,23,24]. A handsome pay is mandatory for job satisfaction and to retain nurses .
Career development and life-long learning activities in nursing promote job satisfaction, increased retention of nurses and enable continued provision of high-quality care. Satisfaction with promotion was the variable to make a significant contribution to the prediction of turnover intention . Promotion opportunities were found to be important to employees. It is imperative that all key employees have a view of his future role in the organization otherwise he/she may decide to leave the organization for a career elsewhere . The study findings also indicate a significant association between promotion and nurses’ turnover intention.
It is by now widely acknowledged that health workers, as an integral part of health systems, are a critical element in improving health outcomes. The World Health Report2006: working together for health sounded the alarm that, without sufficient numbers of adequately trained and supported health workers, there is a significant risk of not attaining the health-related Millennium Development Goals (MDGs) (WHO, 2006) .
The result shows that training opportunity affect turnover intention. Low training opportunity significantly associated with nurses’ turnover intention (P.0.000, 95%C.I., 1.537- 4.352). This result is consistent with the previous studies [7,27].
In the majority of countries, rural and remote areas are usually lacking sufficient numbers of health workers. Approximately one half of the global population lives in rural areas, but these areas are served by only 38% of the total nursing workforce and by less than a quarter of the total physicians’ workforce. At the country level, imbalances are even more prominent .
The study finding indicates that rural nurse had 2.1 times more intent to leave their current health care institution as compared to urban nurses. This is consistent with the previous studies . Preference of location may be at the urban or the rural. Location decisions are more dependent on personal and professional than on financial factors . Conversely, the study conducted in Mexico shows that urban nurses shows more turnover intention than rural nurses . Lack of transport was also significantly associated with nurses’ turnover intention (P. 0.018, 95%C.I., 1.133-3.712) in these study findings. Which is supported by lack of transport is quoted internationally as reason why staffs leave health services in rural areas . Being rural was significantly associated with nurses’ turnover intention.
Job Satisfaction is important aspects of organizational effectiveness, productivity and job performance and may impact on turnover intention and absenteeism . The result indicated that job satisfaction is significantly associated with nurses’ turnover intention (P. 0.029, 95%C.I. 1.060-2.971). This suggests that the more one is satisfied with one’s job the less one is likely to think of leaving or quitting one’s job. This finding tends to support many previous studies that have found job satisfaction as a key antecedent of worker turnover intention [6, 11, 31, 32].
In this cross-sectional study, individual factors, organizational factors, environmental factors and job satisfaction contributing to nurses’ turnover intentions were analyzed. Family arrangement, procedural justice, organizational commitment, promotion, payment, training opportunity, location of health institution, lack of transportation and job satisfaction were found significantly associated with nurses’ turnover intention.
Based on the results of the study the following were recommended:
1. Although the results of a single survey cannot in themselves be considered as a solid foundation for making decisions, the results of this study suggest that interventions should be carried out to reduce the nurses’ turnover intention in East Gojjam.
2. Any policies or initiatives in East Gojjam governmental health institutions that aim to retain nurses should address the need to increase employee job satisfaction.
3. Top managements should consider organizational-related factors such as procedural justice, organizational commitment, promotion and training opportunity while managing their nurses’ turnover intent.
4. Interviewing and hiring rural nurses requires addressing applicant background and lifestyle preferences to reduce nurses’ turnover intention.
5. National wide study should be conducted to assess the factors affecting nurses’ turnover intention.
9. Strength and Limitation
1. The sample includes both the urban and rural nurses.
2. This study is the first in its kind in the area and could generate new ideas about the factors affecting nurses’ turnover intention for further studies.
3. The sample size procedure and analysis methods utilized were appropriate to the study and considered as one of the strength of the study.
1. There are other factors that were not assessed in this study but they may affect nurses’ turnover intention.
2. Lack of similar study in the country to compare results.
3. The data of this study were collected through questionnaire only. Therefore, accuracy of the feedback is dependent on the voluntary cooperation of the respondents.
Our special admiration goes to Addis Ababa University, College of Allied Health Science, School of graduate studies for financial support.
We would also like to express our appreciation to East Gojjam Health Bureau, study woredas and each health institution for their cooperation to give full information.
We would like to acknowledge the data collectors and study participants.