Effects of job satisfaction on employee turnover: intentions among nurses employed in JeIDah City hospitals in Saudi Arabia
The purpose of this study was to identify the facets influencing job satisfaction and intention to quit of nurses employed in JeIDah city, Saudi Arabia
The global nursing shortage and the high turnover rate of nurses has become a world-wide problem in most healthcare system in terms of cost, the ability to care for patients and the quality of service . However, Saudi Arabia is currently facing a significant chronic shortage of nurses and a high level of turnover. a high level of job satisfaction on the part of nurses is an important precaution in terms of reducing their intention to quit . Thus, it is important to understand how job satisfaction influences on nursing turnover . This study identifies the significant relationship between nurses job satisfaction , intention to quit in organization.
A sample of 188 nurses working in two hospitals was chosen and a quantitative approach, online administered questionnaire was used to collect data on the nurses demographic data, their job-related satisfaction and turnover intentions.
Overall, the results indicated that nurses were satisfied with their job. . Nevertheless, nurses reported a high satisfaction level with co-workers and promotion among the selected facets of job satisfaction. They also reported a low satisfaction level with flexible working, leadership support, work environment, recognition and pay. Demographic characteristics effects on nurses job satisfaction and their intention to quit was examined. The study revealed a negative relationship between nurses job satisfaction and their intention to leave the current workplace. Moreover, remuneration and flexible working were the most factors that significantly impact on turnover intent.
The major limitation of this study was the sample size. The response rate was satisfactory but more questionnaires should have been distributed so that more varied findings could have been generated.
This study would help nurse management to generate the knowledge regarding the relationship between job satisfaction and intention to quit which will have the potential to increase nurses job satisfaction and retention ,and ensure appropriate nursing care that will lead to a better quality healthcare service for patients
Keywords: job satisfaction, shortage of nurses, turnover intention, nurses, Saudi Arabia
I would like to thank Allah (my God ) for all Graces that I have got and will get in the future , the Most Gracious, the Most Merciful. All praise be to Allah for the chance and the ability to study at higher level of education, and the inspiration, patience, and strength to accomplish this dissertation .
AIDitionally, I would also like to thank my parents for their continuous support and help in overcoming the challenge throughout my studies. I will never forget their constant encouragement and enthusiasm to challenge myself and to set the highest goals and confidence to succeed them. In aIDition, they always wish the best for me and always pray for my success. I want to say to parents that without their support many things would never have been achievable for me.
Finally, I would like to express my deep gratitude to my supervisor Dr. Raffaella Valsecchi, who assisted me , advice, and guidance, all of which had a significant impact on this dissertation.
I certify that the work presented in the dissertation is my own unless referenced
Table of Contents
CHAPTER 1: INTRODUCTION . 6
1.2 Significance of the study .. 8
1.3 Contribution of the research . 9
1.4 Context of the research .. 9
1.5 Aim and objectives 10
1.6 Dissertation Outline .. 10
1.7 Summary . 11
Chapter 2 : Literature Review . 12
2.1 Introduction .. 12
2.2 Definitions of Job Satisfaction . 12
2.3 Job Satisfaction Theory . 13
2.4 Global Job Satisfaction Among Nurses .. 15
2.5 Job Satisfaction Among Nurses in Saudi Arabia 17
2.6 Factors Related to Nurses Job Satisfaction 19
2.7 Nurse Turnover Determinants 21
2.8 Nurse Turnover in Saudi Arabia 23
2.9 Conceptual Model and Hypotheses 23
2.10 Summary . 25
Chapter 3: Research Methodology 25
3.1 Research approach .. 25
3.2 Research strategy .. 26
3.3 Questionnaire Survey: . 27
3.3.1 Design: 27
3.3.2 Sample: .. 28
3.3.3 Measures: 28
3.4 Pilot test of the questionnaire . 29
3.5 Data Analysis: .. 30
3.6 Reliability and Validity .. 30
3.7 Ethical Considerations 30
3.8 Summary . 31
This first chapter of the dissertation provides an introduction, followed by an overview of the research background; the research focuses on nurses job satisfaction and nursing turnover, specifically in the Saudi context. Furthermore, this chapter presents the value and contribution of the research, and the aims and objectives of the research. Finally, the overall structure of the dissertation is presented.
The global nursing shortage and the high turnover rate of nurses has become a world-wide problem in most healthcare sectors. For example, according to the US Bureau of Labor Statistics, the USA may have a shortage of about one million nurses by 2020 (Juraschek et al., 2012). In aIDition, by the year 2020, the European Commission expects that there will be a shortage of 600,000 nurses in Europe (Hofgastein, 2010). Moreover, data from the Ministry of Health of China (2011) reveals that in the next 5 years it is estimated that by 2020 , China will be facing a shortage of 1,590,000 nurses (Liu et al., 2015). As a result, the turnover of qualified nurses can increase work demands, while inadequate staffing on the organizations that employ the remaining nurses may decrease confidence and create more stress due to an excessive workload. In aIDition, the capacity to meet patients needs and provide a good quality care service will have decreased (Van Bogaert et al., 2010). In financial terms, the turnover of nurses is considered to be very costly due to the need for recruitment and orientation programmes, and staff development and training activities (Hayes et al., 2012). As a result of nurse turnover, extensive resources may be required to recruit, hire, and train nurses to replace those nurses who are leaving .Thus, a high level of job satisfaction on the part of nurses is an important precaution in terms of reducing their intention to quit (Sabanciogullari & Dogan, 2015). In contemporary studies, many researchers have suggested that the quality of patient care and satisfied patients are associated with nurses job satisfaction (Flinkman et al., 2010; Hyrkas & Morton, 2013; Meeusen et al., 2011). However, high levels of dissatisfaction among nurses leads to a high rate of nursing turnover (Applebaum et al., 2010; Hayes et al., 2012), which generally is due to increased working hours, work stress, burnout and longer patient waiting lists, and finally, leads to lower patient satisfaction. Previous research into nurses job satisfaction has revealed that there is a negative relationship between job satisfaction and nurses intentions to leave the workplace in particular, as well as to leave the nursing profession in general (Applebaum et al., 2010; Hayes et al., 2012). Furthermore, work stress has been found to be a main predictor of job satisfaction in that it causes several negative behavioural reactions such as absenteeism and turnover, reduced productivity and reduced motivation, decreased satisfaction and reduced quality of care (Mosadeghrad et al., 2011). Major sources of stress in nursing include factors such as high job demands, long working hours, dealing with patients and their families, conflict with other colleagues and supervisors, and dealing with death and dying people (Lim et al., 2010). Hence, it is essential to understand the factors associated with nurses job satisfaction and those relating to job stress that influence nuring turnover. This is necessary to help managers take proper actions. For example, researchers have identified the most important factors that influence nurse job satisfaction including individual characteristics, work requirements and policies, professional level, pay, working conditions and co-worker support (Han & Jekel, 2011). Moreover, Heinen et al. (2013) recognized that characteristics of the work setting, job satisfaction is the most important factors that can influence nurses decision making in terms of whether to stay in their job or to leave it. Previous research shows that turnover in nursing is a result of nurses job dissatisfaction, that lead ultimately to turnover intentions (Iliopoulou & While, 2010). According to Aiken et al. (2013), work stress is the main cause of nursing job dissatisfaction and turnover intentions in many countries. A previous study showed that job satisfaction is negatively associated with work stress and turnover intentions. For instance, higher job satisfaction significantly decreases job stress and turnover intentions among nurses (Mosadeghrad et al., 2011).
However, Saudi Arabia is currently facing a significant chronic shortage of nurses and a high level of turnover (Al Hosis et al., 2013; Alshmemri, 2014; Almalk et al., 2012; Alsaqri, 2014 and Saleh et al., 2013). To illustrate the shortage of nurses we can see that the ratio of nurses to patients (36 nurses per 10,000 population) (Almalki, 2011) compares with that of Japan (95/10,000), Canada (100/10,000), and the UK (101/10,000)( World Health Organization., 2010). Furthermore, according to Data from the Saudi Ministry of Health (MoH , 2013) it is expected that there will be a nursing deficit of 48,000 nurses by 2020. In Saudi Arabia, part of the problem with regard to the chronic shortage of nurses is considered to be the high dependency on expatriate nurses (Almalki , 2011). Most of expatriates use the Saudi healthcare facilities to obtain training and experience. This helps them to move to developed countries such as the USA, the UK and Canada with marketable skills (Almalki et al., 2012). Other factors that are considered as the main reasons for the nursing shortage in Saudi Arabia include the poor image of nursing , family conflicts due to heavy family-work pressure (high workload, long working hours, irregular shifts, and working over public holidays and weekends), low pay and lack of financial incentives, and lack of support for working mothers (Almalki, 2011). Hence, the country needs to recruit and retain Saudi national nurses. Thus, identifying the level of job satisfaction among nurses could help health managers to provide the Ministry of Health with clear information about the factors that influence job satisfaction among nurses working in the city of JeIDah city, Saudi Arabia.
There have been few studies that have explored job satisfaction, or the factors that influence turnover intentions in the Saudi context (Al Hosis et al., 2013; Alshmemri, 2014; Almalki et al., 2012, Alsaqri, 2014; Saleh et al., 2013). Hence, there is real need to conduct research in order to explain the relationship between job satisfaction and turnover intentions, to better understand why nurses intend to leave their jobs and, in particular, nurses working in JeIDah City. Therefore, this research will contribute to the existing literature by aIDressing this gap and providing recommendations that can help further researchers. It might also may be used to inform strategies to reduce nursing turnover. Otherwise, in a competitive business environment that seeks to attract qualified nurses, the Saudi healthcare organizations may lose skilled nurses to other organizations, either nationally or internationally, that better meet their needs by providing a better working environment. According to Alsaqri (2014), a number of expatriate nurses intended to leave Saudi Arabia at an early stage when they had gained sufficient experience to help them to work in better conditions, such as can be found in developed countries.
This study aims to make a effective contribution to the existing literature on these subjects by sheIDing new light on the influence of job satisfaction on turnover intentions in the Saudi healthcare context. Firstly, the finding that the conceptal model of turnover intentions built on empirical research also applies to the Saudi healthcare system. Here, the result of an intention to quit can be generalized to the overall system in Saudi Arabia. Secondly, the findings of the present study that explore significant predictors of nurses intention to quit regarding the relationship between, job satisfaction and nurses intention to leave, may help to develop strategies to attract and retain more nurses, to improve nurses work conditions in such a way as to reduce the high turnover rates of nurses in the Saudi healthcare system. Moreover, the regression model developed for this purpose can help to provide insights for future researchers with regard to the enhancement of job satisfaction among nurses, patients and the quality of service in hospitals in the Saudi context.
Managing nursing turnover has become significant in Saudi healthcare as the higher rate among nurses has become a critical issue. Saudi Arabia places emphasis on increasing economic growth, and improving human resource development, and the quality and quantity of care. Therefore, in order to develop, attract and retain more nurses, the Saudi healthcare system must focus on various human resource management activities to enhance nurses job satisfaction, increase the organizational commitment and reduce stress in the work environment. AIDitionally, an increase in job satisfaction is necessary because the Saudi healthcare system is facing higher competition when it comes to surviving in the contemporary business environment, and market competition that may cause an increase in nurses intentions to quit, leading to a higher rate of nursing turnover, particularly among expatriate nurses. Therefore, in order to cope up in a competitive labour market, it is important for Saudi hospitals to offer a competitive environment in order to increase job satisfaction and reduce job stress. This would will lower nurses intentions to quit and reduce the rate of nurse turnover.
In a broad perspective, this research aims to identify the job satisfaction and job stress variables which are most influential in increasing nurses intentions to quit.
The main purpose of the research paper is:
Chapter 1: Introduction
This chapter provides details of the research background, the significance of the study, its contribution. It will also deal with the context of the research, the research aim, the research objectives and the research questions.
Chapter 2: Literature Review
This chapter covers previous studies conducted in this area of research and presents the important literature findings on the relationship between job satisfaction and nursing turnover intentions.
Chapter 3: Research Methodology
This chapter discusses the research design, the research approach, data collection methods, the research sample, reliability, ethical issues and limitations of the study.
Chapter 4: Findings Analysis and Discussion
This chapter will present and discuss the findings of the study after analysing the data using SPSS version 15.0.
Chapter 5: Conclusion
This chapter presents the conclusions, as well as the limitations, of the research. Furthermore, this chapter discusses useful insights in terms of implications for practice, and suggests recommendations for future research.
This chapter has provided an introduction, followed by an overview of the research background, and the value and contribution of the research . Furthermore, the aims and objectives of the research, and the overall structure of the dissertation were presented. The next chapter discusses a literature review of previous literature related to nursing job satisfaction and turnover and five hypotheses are presented .
This chapter intends to critically review both job satisfaction levels amongst nurses and the turnover levels within the profession. The literature review correspondingly intends to focus on the fair amount of literature available on this topic, aligning the conclusions with the aims and objectives of the present study. It further intends to bring five a cornerstone regarding the conceptual framework with regard to the research objective of the current research.
There are three broad sections in the study. The first of these relates to the definition and related theories of job satisfaction; the section discusses job satisfaction aspects from both a global perspective and within the Saudi context, and the concluding section explains the factors impacting upon the nursing profession and the turnover levels therein.
It is a challenge to explicitly explain job satisfaction, considering both how various studies perceive the concept independently and how individual researchers perceive the concept in their own ways. As noted by Hayes et al. (2010) and Spector (1985, 1997), they defined nurses job satisfaction levels in terms of their perceptions of their work schedules and working environments. Locke (1976) considered job satisfaction levels to be related to a pleasurable or a positive emotional state concluded from the periodic appraisal of individual job experiences. In identifying the concept of job satisfaction, multiple work facets need to be considered including aspects related to the levels of work satisfaction, supervision, pay, promotion, and the overall practices followed within the organization. In recent times, Aziri (2011) has explained job satisfaction in terms of the negative and positive attitudes and perceptions that employees have with regards to their professional commitments. Liu et al. (2015) described job satisfaction in terms of the positive responses accrued by the worker in comparison to the value and equity associated with the experience. The corresponding literature evaluates multiple aspects of job satisfaction, expressed in terms of job attitudes, satisfaction levels and employee morale (Hayes et al., 2010). This could be perceived to contribute towards enhanced levels of clarity within the corresponding literature.
Maslows hierarchy of needs is considered to be the pioneering study explaining job satisfaction levels. Presented in the 1940s, it was basically a study explaining humanistic motivational factors, and worked upon aspects of how work environments contributed towards fostering and encouraging personal and professional growth amongst employees (Maslow, 1943). The theory encompasses five goals, expressed in terms of the basic human needs in a hierarchical form. It expounds how individuals strive to reach an initial level, before progressing on to the next. The levels relate to the motivational factors contributing to individual survival, safety, and social and societal acceptance, all of which contribute to transcending satisfaction levels within an individuals lifetime (Hayes et al., 2012). The lowest need of level is pertains to physiological needs and relates to individualistic concerns of basic survival. Within work environments, physiological needs are considered to contribute significantly in providing a favorable working environment. Thereafter, safety is considered, which includes aspects of job security and pay. The third category relates to a sense of belonging with regard to forming sustainable working relationships with work colleagues, supervisors and associated managers. This would also entail the presence of an environment that encourages teamwork. Self-esteem needs to encompass the fourth level and relates to individual recognition and reward. This, in turn, is followed by self-actualization in terms of attaining a given position, overcoming a challenge, and bringing a sense of achievement (Hayes et al., 2012). Shortcomings in fulfilling lower level needs would adversely impact upon the fulfillment of needs on the higher levels. It is considered that individual job satisfaction is ranked along with management responsibility and prestige, which are reflective of professional achievements (Maslow, 1954). Lambrou et al. (2010) are of the opinion that nurses are more inclined to be motivated in lieu of intrinsic factors and, correspondingly, this is a motivator expressible in terms of individual intensity and drive towards fulfilling a given goal. Subsequently, emotive, cognitive and behavioral aspects were also considered part of the mix. The emotive aspect within job satisfaction paradigms relates to employee perceptions with regards to professional engagements, the levels of anxiety, boredom or excitement; cognitive factors in job satisfaction is relating to engagement, that the work functions are intellectually demanding and challenging. This gives rise to the willingness of the employee to socially engage with co-workers towards completing assigned tasks and responsibilities (Parvin & Kabir, 2011).
Related job satisfaction models include the Herzberg two-factor theory (Herzberg et al., 1959). This considered hygiene factors and related motivators. Within workplace paradigms, the hygiene factor was considered in terms of remuneration, working environment, interpersonal relationships and organizational policies. These factors would normally entail negative perceptions and, in turn, contribute towards higher dissatisfaction levels. While the resolution of hygiene factors could contribute to reducing dissatisfaction levels, it may not necessarily conclude in increased satisfaction levels. Herzbergs motivation levels would, therefore, include the nature of the work involved, achievement and recognition levels, the responsibility of the position and career (Herzberg et al., 1959).
Herzbergs theory is considered a major theory describing job satisfaction levels (Lambrou et al., 2010). Various researchers have concluded the dual factor theory to be particularly useful within healthcare establishments (Liu et al., 2015). It has also been widely applied to establish job satisfaction levels within the nursing profession (i.e., Delobelle et al., 2011; Kwak et al., 2010; Toode et al., 2011). Table 1.1 summarizes Herzbergs two-factor theory:
Table 1.1 Summary of the motivation and hygiene Factors in Herzbergs Theory
|Motivation Factors||Hygiene Factors
Possibility of growth
Policies and administration
While these theories investigate job satisfaction levels in broad terms, then the next section will discuss job satisfaction of nurrses specifically .
Nahm (1940) is probably credited with concluding the pioneering study on job satisfaction levels amongst nurses. He found that supervisory relations, income levels, promotions, working hours, on-the-job interest levels, and familial and social relationships all impacted upon job satisfaction levels (Ravari et al,2012) . From this initial study there has been a multitude of further studies conducted in various locales and countries, which include the United States (Cahill, 2011; McGlynn et al., 2012), Australia and New Zealand (Hayes et al., 2010; Skinner et al., 2012), Malaysia (Lee et al., 2011), Pakistan (Bahalkani et al., 2011), Turkey (Sabanciogullari & Dogan, 2015) and Jordan (Abu RaIDaha et al., 2012; Alsaraireh et al., 2014). All of these studies intended to perceive the factors enhancing job satisfaction levels within the nursing profession and all draw similar conclusions, irrespective of the geographical locale of the conducted study.
Studies indicated that nurses within the United States are amongst the least satisfied (Cahill, 2011). Indeed, there are multiple factors contributing to this state of affairs, including demographic factors, and job related and associated geographical factors. The conclusions indicated that the gender of nurses is not necessarily a key factor, although men and women did perceive job satisfaction in different ways. Nevertheless, the number of years on the job did have an impact on the satisfaction levels. McGlynn et al. (2012) considered the job satisfaction levels of nurses by comparing it within an academic medical center in the northeastern United States. The conclusions derived indicated a low level of job satisfaction. Nevertheless, it was found that nurses were moderately satisfied with their working environments. It was also found that there was no specific relationship within satisfaction levels with regards to age, gender or work experience. Instead, factors related to the work environment, job functions and other organizational factors contributed more. Thus, it was concluded that available health care and retirement plans, the amount of work experience, organizational support, lowered levels of work-family conflicts, promotional opportunities, support extended by managers and the level of independence accorded were all determinants in this regard. Although studies conducted within the United States revealed minimal impact on age and the number of years spent in the profession (McGlynn et al., 2012), Jordanian studies concluded that satisfaction levels were somewhat proportional to the age of the professional and the number of years on the job (Abu RaIDaha et al., 2012; Alsaraireh et al., 2014). It was also found that women and married nurses had a higher level of job satisfaction, while the opposite was true amongst single male nurses. Nabirye et al. (2011) evaluated job satisfaction levels amongst nurses in four hospitals, all located in Kampala, Uganda. This study found that job satisfaction was a function of age and was significantly influenced by this factor. It was therefore concluded that the age of the nurse was a significant factor in establishing satisfaction levels, with older nurses being generally more satisfied with their functions than their younger counterparts. Considering educational factors, it was found that nurses possessing lower levels of education were more satisfied than individuals with advanced degrees. Correspondingly, Sabanciogullari & Dogan (2015) evaluated some 2,122 nurses in Turkey and concluded that demographic factors related to the likes of gender, age, educational level, marital status, and number of years in the profession all contributed to and impacted upon employee satisfaction levels. Nevertheless, Lu et al. (2012) found that the educational levels of the nurses did not significantly impact upon
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