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The relationships among turnover intentions, professional commitment, and job satisfaction of hospital nurses
The Relationships Among Turnover Intentions, Professional Commitment, and Job Satisfaction of Hospital Nurses KUEI-YUN LU,* PI-LI LIN,† CHIUNG-MAN WU,† YA-LUNG HSIEH,† AND YONG-YUAN CHANG‡
This study investigated the relationships among turnover intentions, professional commitment, and job satisfaction of registered nurses. A structured, selfadministered questionnaire, including the Professional Commitment Scale, job satisfaction, turnover intentions, and demographic data, was distributed to 2,550 registered nurses. A total of 2,197 subjects completed the questionnaires with an 86.2 per cent response rate. All of the subjects were women. The mean age was 28.56 years. Seventy-two per cent of respondents had graduated with an associate’s degree and 59 per cent were unmarried. There was a positive correlation between job satisfaction and professional commitment, intention to leave the organization, and between intention to leave the profession. The negative correlation was significant between professional commitment and turnover intentions, and between job satisfaction and turnover intentions. The discriminant analysis showed that 38.4 per cent of job satisfaction was correctly classified in predicting intention to leave the organization, and 30.5 per cent in predicting the intention to leave the profession. Thirty per cent of professional commitment was correctly classified in predicting intention to leave the organization, and 39.7 per cent in predicting the intention to leave the profession. The study suggests that there were different moderators that affect different turnover intentions of staff nurses. (Index words: Turnover intention; Job satisfaction; Professional commitment; Hospital nurses) J Prof Nurs 18:214-219, 2002. Copyright 2002, Elsevier Science (USA). All rights reserved.
*Associate Professor, Department of Nursing, Meiho Institute of Technology, Taiwan; PhD candidate, Department of Health Administration, School of Public Health, University of South Carolina, Columbia, SC. †Instructor, Department of Nursing, Meiho Institute of Technology, Taiwan. ‡Associate Professor, School of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan. Address correspondence and reprint requests to Dr. Yong-Yuan Chang: School of Public Health, Kaohsiung Medical University, No. 100. Shih-Chuan 1st Rd, Kaohsiung 807, Taiwan. Copyright 2002, Elsevier Science (USA). All rights reserved. 8755-7223/02/1804-0009$35.00/0 doi:10.1053/jpnu.2002.127573 214
A
CCORDING TO THE DATA of The Examination Yuan of the Republic of China, about 50,000 graduates passed the nursing licensure test between 1950 and 1999. Furthermore, according to the data from the Department of Health, Taiwan, only about half of the nurses were registered in 1999. Therefore, there are a lot of trained nurses that do not work as nurses. Such a high turnover rate results in attrition of nursing education and a waste of hospital resources. Many believe that proper management of nursing job turnover can improve the financial health and longterm survival of health care institutions and improve nursing quality (Pooyan, Eberhardt, & Szigeti, 1990). Although research on nursing is not new, the methodology, variables, and statistical analyses used vary substantially across studies, and many have spent considerable time and effort to identify the impact of work-related factors to explain individuals’ turnover behavior (i.e., pay, role conflict, work overload) (Davidson, Folcarelli, Crawford, Duprat, & Clifford, 1997; George & Jones, 1996; Irvine & Evans, 1995; Morres, Singh, & Tun, 1983). Research interest in studying commitment has continued since it has been shown to be consistently related to employee turnover, job satisfaction, and job intention (Lum, Kervin, Clark, Reid, & Sirola, 1998). Commitment to nursing is of concern to Western scholars, and specific conceptualizations of commitment have been considered (Meyer & Allen, 1997; Morrow, 1993). In the 1970s, nursing scholars interpreted commitment as a concept in existentialism. From an existentialist’s point of view, people who are committed will develop devotion to values that cause them to dedicate thousands of hours in pursuit of something. Practitioners who are committed to their cause express themselves in styles of communication that interpreters from outside the discipline are unable to understand in all their nuances (Altschul, 1979). If a nurse is truly committed, she or he will feel part of everything that nursing brings, including its problems,
Journal of Professional Nursing, Vol 18, No 4 (July–August), 2002: pp 214-219
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TURNOVER INTENTIONS AND PROFESSIONAL COMMITMENT
frustrations and future (Celemence, 1966). The committed nurse never acts out a role; self-involvement is absolute because the ideal is an ideal of the total self (Mills, 1971). A number of conceptual frameworks have been developed to explain nurse turnover behavior. That job satisfaction can effectively predict anticipated turnover has been reported in numerous studies (Lucas, Atwood, & Hagaman, 1993; Pooyan et al., 1990). However, Irvine and Evans (1995) found only a small negative relationship between job satisfaction and turnover intention, although the intention was a direct antecedent to leave the job. Related to turnover intentions, commitment surpassed job satisfaction and other work-related factors (Lum et al., 1998). The importance of employees’ commitment has been widely advocated (Aryee & Tan, 1992; Bedeian & Kemery, 1991; Blau & Lunz, 1998; Chang, 1999). Commitment may provide an important source of occupational meaning and continuity in an era when organizations have become fluid and unable to provide employment security (Colarelli & Bishop, 1990). Professional commitment had an incremental effect on a professional’s intention to leave the organization in one study (Blau & Lunz). Enhancing professional commitment in nursing has the potential to produce benefits for both the individual and their organization (Cohen, 1998; Cohen, 1999). A review of the literature shows that three aspects of commitment have been applied to many domains. They are willingness to exert effort on its behalf, a desire to remain in the profession, and identifying with the profession by acceptance of its goals and values (Aranya, Pollock, & Amernic, 1981; Aryee, Wyatt, & Min, 1991; Morrow, 1983). The study reported here was designed to investigate the relationships between turnover intentions, professional commitment, job satisfaction, and demographic data among hospital nurses in Taiwan.
Methodology SAMPLE
Questionnaires were sent to a random sample of one fourth of hospital nurses (n ⫽ 2,550) in the southern area of Taiwan. Subject names and addresses were provided by three Taiwan Nurses’ Associations. Each questionnaire was prefaced with a letter that explained the objectives of the study, and assured respondents of the anonymity and confidentiality of their response. A total of 2,197 nurses responded, yielding a response
rate of 86.2 per cent. Ages ranged from 18 to 60 years with a mean age of 28.56 years. All of the respondents were women, 41 per cent of respondents were married, and 89 per cent did not have a college degree. MEASURES
The Professional Commitment Scale was developed and revised by the authors (Lu, Chiou, & Chang, 2000). Twenty-six items were retained on the basis of principal components analysis with varimax rotation, indicating that a three-factor solution accounted for 52.58 per cent of the total variance. Factor 1 was identified as willingness to make effort (13 items); factor 2 was identified as maintaining as a membership (8 items); and factor 3 was identified as belief in goals and values (5 items). Item responses were rated on a fourpoint scale (1 ⫽ strongly certain, 4 ⫽ strongly uncertain). Internal consistency using Cronbach’s ␣ was .944. Intraclass coefficient (ICC) was .895 when identical forms were administered 3 weeks apart. The two turnover intention variables, intention to leave the organization and intention to leave the profession, were measured by the items based on Blau and Lunz’s (1998) definition. Respondents were asked to indicate their agreement with the following items, “I intend to leave the organization,” and “I think about leaving my job related to the nursing profession.” Re-
TABLE 1. Distributive Statistics of Study Variables Variable
Marital status Unmarried Married Degree of education Vocational school Associate degree BSN MSN
Age Wage (NT) Communication time Family support Age of the youngest child Years in organization Intention to leave organization Intention to leave profession Overall commitment Willingness of effort Remain in profession Belief in goals and values Job satisfaction NOTE. N ⫽ 2,197.
n
%
1,271 870
59.36 40.64
364 1,572 230 7
16.75 72.34 10.58 .32
Mean
SD
28.56 36.16 20.01 3.34 2.31 5.96 2.67 2.59 71.22 32.92 23.60 14.69 28.17
7.07 8.38 18.07 .55 1.26 6.04 .75 .80 10.59 6.58 3.85 2.59 4.63
216
LU ET AL
TABLE 2. Intercorrelations Among Variables Variable
1
2
3
4
1 2 3 4 5 6 7 8 9 10 11 12
.623* .038 .730* .495* .104* .734† ⫺.099* .031 .047† ⫺.019 .025
⫺.113* .051 .222* .049† .458* ⫺.023 .089* ⫺.096* ⫺.085* ⫺.054†
⫺.133* .304* .030 ⫺.071* ⫺.080* ⫺.101* ⫺.042 .054† .058*
.246* ⫺.029 .489 .056 .161* .126* ⫺.087† ⫺.073†
5
.070* .495* ⫺.034 ⫺.012 .052† .013 .025
6
.056† ⫺.026 .015 .014 ⫺.005 ⫺.023
7
8
9
10
11
⫺.090* ⫺.024 .019 .063 .043
.194* .350* ⫺.204* ⫺.274*
.386* ⫺.480* ⫺.370*
⫺.380* ⫺.547*
.602*
NOTE. 1, age; 2, marital status; 3, educational level; 4, age of the youngest child; 5, wage; 6, communication time; 7, years in organization; 8, family support; 9, job satisfaction; 10, professional commitment; 11, intention to leave organization; 12, intention to leave profession. *Spearman’s correlation is significant at the .01 level (two-tailed). †Spearman’s correlation is significant at the .05 level (two-tailed).
sponses were rated on a four-point scale (1 ⫽ strongly disagree, 4 ⫽ strongly agree) (Blau & Lunz, 1998). Job satisfaction was measured with a four-point scale consisting of 10 items developed by the authors. Reliability with Cronbach’s ␣ was .94 and ICC was .89. The scale included questions about work-related issues such as autonomy, organizational policies, work environment, and the perceived managerial state. Family support was measured by asking respondents the following item, “How do the most significant people support your job?” and was rated on a four-point scale (1 ⫽ strongly support, 4 ⫽ strongly not support). Descriptive statistics were used to explore the variables. Correlation matrices were generated to examine the relationships between variables. Discriminant analyses were used to estimate the percentage of correct classifications for the four-group classification of intention to leave the organization and intention to leave the profession (1 ⫽ strongly disagree, 4 ⫽ strongly agree) on job satisfaction and professional commitment. Results
Descriptive statistics are shown in Table 1. The range of monthly incomes was N.T.$ (New Taiwan
dollar) 28,000-110,000 with a mean of N.T.$ 36,160 (U.S. $1,100). In terms of tenure, the average stay in an organization was 6 years. The mean communication time between nurses was 20 minutes, family support was 3.34, and mean age of the youngest child was 2.31. The mean job satisfaction score was 28.17; intention to leave profession was 2.59; intention to leave organization was 2.67; and a mean score of 71.22 for overall professional commitment. Table 2 presents a matrix of correlation coefficients between variables. There were significant negative correlations between turnover intentions and marital status, wage, age of the youngest child, family support, job satisfaction, and professional commitment, whereas educational level was positively correlated with turnover intentions. Unmarried nurses had significantly higher professional commitment as well as greater intention to leave and lower job satisfaction than married nurses. Educational level was significantly related to job satisfaction and turnover intentions but unrelated to professional commitment. Nurses’ wages were positively correlated only with professional commitment. The nurses whose youngest child’s age was more than 3 years had higher job satisfaction and professional commitment and lower turn-
TABLE 3. Discriminant Analysis of the Four Groups’ Classification of Job Satisfaction on Intention to Leave Organization Predicted Group Membership Actual Group
Strongly Disagree
Disagree
Agree
Strongly Agree
Total
Strongly disagree Disagree Agree Strongly agree Ungrounded cases
88 (52.7%) 159 (27.4%) 115 (9.4%) 4 (2.0%) 9 (33.3%)
57 (34.1%) 278 (47.8%) 425 (34.8%) 25 (12.6%) 11 (40.7%)
16 (9.6%) 91 (15.7%) 336 (27.5%) 40 (20.1%) 2 (7.4%)
6 (3.6%) 53 (9.1%) 345 (28.3%) 130 (65.3%) 5 (18.5%)
167 581 1,221 199 27
NOTE. In total, 38.4 per cent of the original grouped cases were correctly classified.
217
TURNOVER INTENTIONS AND PROFESSIONAL COMMITMENT
TABLE 4. Discriminant Analysis of the Four Groups’ Classification of Job Satisfaction on Intention to Leave Profession Predicted Group Membership Actual Group
Strongly disagree
Disagree
Agree
Strongly Agree
Total
Strongly disagree Disagree Agree Strongly agree Total
130 (55.1%) 226 (37.0%) 204 (17.9%) 20 (10.3%) 3 (21.4%)
53 (22.5%) 192 (31.4%) 310 (27.2%) 28 (14.4%) 5 (35.7%)
17 (7.2%) 80 (13.1%) 227 (19.9%) 32 (16.4%) 2 (14.3%)
36 (15.3%) 113 (18.5%) 398 (34.9%) 115 (59.0%) 4 (28.6%)
236 611 1,139 195 14
NOTE. In total, 30.4 per cent of the original grouped cases were correctly classified.
over intentions. Job satisfaction was positively correlated with professional commitment and negatively correlated with turnover intentions, and both correlations were significant. Professional commitment was negatively correlated with turnover intentions. Intention to leave the organization was positively and significantly correlated with intention to leave the profession. In the discriminant analysis, 38.4 per cent of nurses can be correctly classified as having the intention to leave the organization and 30.4 per cent as intending to leave the profession because of lack of job satisfaction (Tables 3 and 4). On the other hand, 30.5 per cent of nurses can be correctly classified as having the intention to leave the organization and 39.7 per cent as having the intention to leave their profession on the basis of their professional commitment (Tables 5 and 6). There was an 8 per cent to 9 per cent classification difference in job satisfaction and professional commitment between the prediction to leave the organization and intention to leave the profession. Discussion
The main objective of the study was to examine the relationships between turnover intentions and professional commitment among registered nurses. Marital status, family support, and age of the youngest child were correlated with professional commitment, orga-
nizational satisfaction, and turnover intentions that reflected family status as an important factor for nurses in nursing career commitment. In this study, most of the nurses had graduated from junior colleges with associate’s degrees. The mean age was 28.56 years, which indicated that many nurses had resigned from working before middle age. Relationships among nurses’ background information, turnover intentions, job satisfaction, and professional commitment are numerous and varied in the literature. Significant correlation between age and professional commitment was consistent with a number of studies (Blau, 1985; Cherniss, 1991; Korabik & Rosin, 1996; Morrow & Wirth, 1989; Waugaman & Lohrer, 2000) but inconsistent with other studies (Colarelli & Bishop, 1990; Steffy, 1988). The findings of significant correlations between professional commitment and salary (Cherniss, 1991), educational level (Morrow & Wirth, 1989), years in organization (Cohen, 1998), and years in profession (Cherniss, 1991) were inconsistent with the results of previous studies. Unmarried nurses had higher professional commitment than married nurses and that was not consistent with many studies (Korabik & Rosin, 1996; Cherniss, 1999) with the exception of Blau’s (1985) study. The relationship between status of children and professional commitment also was not consistent with the research (Cherniss, 1988; Steffy, 1991). These various results may be owing to differences of culture, the
TABLE 5. Discriminant Analysis of the Four Groups’ Classification of Professional Commitment on Intention to Leave Organization Predicted Group Membership Actual Group
Strongly Disagree
Disagree
Agree
Strongly Agree
Total
Strongly disagree Disagree Agree Strongly agree Ungrounded cases
87 (52.4) 230 (39.6%) 228 (18.7%) 26 (13.2%) 8 (28.6%)
32 (19.3%) 135 (23.2%) 185 (15.2%) 16 (8.1%) 5 (17.9%)
34 (20.5%) 121 (20.8%) 309 (25.3%) 27 (13.7%) 5 (17.9%)
13 (7.8%) 95 (16.4%) 497 (40.8%) 128 (65.0%) 10 (35.7%)
166 581 1,219 197 28
NOTE. In total, 30.5 per cent of the original grouped cases were correctly classified.
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LU ET AL
TABLE 6. Discriminant Analysis of the Four Groups’ Classification of Professional Commitment on Intention to Leave Profession Predicted Group Membership Actual Group
Strongly disagree Disagree Agree Strongly agree Ungrouped cases
Strongly Disagree
Disagree
Agree
Strongly Agree
Total
132 (56.2%) 238 (39.0%) 130 (11.4%) 9 (4.6%) 1 (6.7%)
56 (23.8%) 175 (28.7%) 203 (17.9%) 6 (3.1%) 2 (13.3%)
43 (18.3%) 152 (24.9%) 420 (36.9%) 42 (21.6%) 5 (33.3%)
4 (1.7%) 45 (7.4%) 384 (33.8%) 137 (70.6%) 7 (46.7%)
235 610 1,137 194 15
NOTE. In total, 39.7 per cent of the original grouped cases were correctly classified.
number of subjects, and the use of a different instrument to measure professional commitment. Both of the mean scores of intention to leave the organization or profession are higher than the results in Blau and Lunz’s (1998) study of 2.1. However, the mean score of professional commitment was 2.70, which is consistent with Blau and Lunz. The findings of this study show a correlation between professional commitment and intention to leave the organization or profession that was also reported in another study (Bedeian & Kemery, 1991). The result of discriminant analysis indicates that professional commitment is more effective in predicting intention to leave the nursing profession than intention to leave the organization at 9.2 per cent. Professional commitment related to the intention to leave the profession was more strongly correlated than the intention to leave the organization. Job satisfaction was more effective in predicting intent to leave the organization than intention to leave the nursing profession at 8 per cent. Job satisfaction related to organizational leave intention was more strongly correlated than professional leave intention. The present findings are in accordance with Gardner’s (1992) findings, which emphasized the importance of professional commitment in nursing and Cohen’s (1999) findings, which indicated that there is a stronger relationship to work outcomes
than job involvement. The findings also are in accordance with results in a number of studies that show that professional commitment was negatively correlated with turnover intention among nurses (Aryee, Chay, & Chew, 1994; Blau & Lunz, 1998). Thus, professional commitment and job satisfaction have more influence on nurses remaining in nursing than other forms of commitment. Morrow (1983) suggested that professional commitment is a more stable commitment than feelings about one’s organizational job. Brierley (1996) confirmed that the correlation between organizational commitment and organizational turnover was greater than that between professional commitment and organizational turnover. We would like to emphasize that intention to leave the organization and to leave the nursing profession stem from different attitudes. Therefore, enhancing job satisfaction for nurses likely will produce benefits for both the individuals and their organizations. A focus on promoting the intrinsic values of the nursing profession should be integrated in the strategies to improve professional commitment and for nursing organizations to use to retain nurses. Existentialism, as a philosophy of commitment by nursing scholars as described, should be emphasized in continuing educational programs of nurses.
References Altschul, A. T. (1979). Commitment of nursing. Journal of Advanced Nursing, 4, 123-135. Aranya, N. A., Pollock, J., & Amernic, J. (1981). An examination of professional commitment in public accounting. Accounting, Organization Social, 64, 271-280. Aryee, S., Chay, Y. W., & Chew, J. (1994). An investigation of the predictions and outcomes of career commitment in three career stages. Journal of Vocational Behavior, 44, 1-16. Aryee, S., & Tan, K. (1992). Antecedents and outcomes of career commitment. Journal of Vocational Behavior, 40, 288-305.
Aryee, S., Wyatt, T., & Min, M. K. (1991). Antecedents of organizational commitment and turnover intentions among professional accountants in different employment settings in Singapore. Journal of Social Psychology, 131, 545-556. Bedeian, A. G., & Kemery, E. R. (1991). Career commitment and expected utility of present job as predictors of turnover intention and turnover behavior. Journal of Vocational Behavior, 39, 331-343. Blau, G. (1985). The measurement and prediction of career commitment. Journal of Occupational Psychology, 58, 277-288.
TURNOVER INTENTIONS AND PROFESSIONAL COMMITMENT
Blau, G., & Lunz, M. (1998). Testing the incremental effect of professional commitment on intent to leave one’s profession beyond the effects of external, personal, and work-related variables. Journal of Vocational Behavior, 52, 260-269. Brierley, J. A. (1996). The measurement of organizational commitment and professional commitment. Journal of Social Psychology, 136, 265-267. Celemence, S. M. (1966). Existentialism: A philosophy of commitment. American Journal of Nursing, 66, 500-505. Chang, E. (1999). Career commitment as a complex moderator of organizational commitment and turnover intention. Human Relations, 52, 1257-1278. Cherniss, C. (1991). Career commitment in human service professionals: A biographical study. Human Relations, 44, 419-437. Cohen, A. (1998). An examination of the relationship between work commitment and work outcomes among hospital nurses. Scandinavia Journal of Management, 14, 1-17. Cohen, A. (1999). Relationships among five forms commitment: An empirical assessment. Journal of Organizational Behavior, 20, 285-308. Colarelli, S. M., & Bishop, R. C. (1990). Career commitment. Group & Organization Studies, 15, 158-176. Davidson, H., Folcarelli, P., Crawford, S., Duprat, L. J., & Clifford, J. C. (1997). The effects of health care reforms on job satisfaction and voluntary turnover among hospitalbased nurses. Medical Care, 35, 634-645. Gardner, D. L. (1992). Career commitment in nursing. Journal of Professional Nursing, 8, 155-160. George, J. M., & Jones, G. R. (1996). The experience of work and turnover intentions: Interactive effects of value attainment, job satisfaction, and positive mood. Journal of Applied Psychology, 83, 318-325. Korabik, K., & Rosin, H. M. (1996). The impact of children on women managers’ career behavior and organizational commitment. Human Resource Management, 34, 513-528. Lu, K. Y., Chiou, S. L., & Chang, Y. Y. (2000). A study of the professional commitment changes from nursing stu-
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dents to registered nurses. The Kaohsiung Journal of Medical Science, 16, 39-46. Irvine, D. M., & Evans, M. G. (1995). Job satisfaction and turnover among nurses: Integrating research finding across studies. Nursing Research, 44, 246-253. Lucas, M. D., Atwood, J. R., & Hagaman, R. (1993). Replication and validation of anticipated turnover model for urban registered nurses. Nursing Research, 24, 29-41. Lum, L., Kervin, J., Clark, K., Reid, F., & Sirola, W. (1998). Explaining nursing turnover intent: Job satisfaction, pay satisfaction, or organizational commitment. Journal of Organizational Behavior, 19, 305-320. Meyer, J. P., & Allen, N. J. (1997). Commitment in the workplace. Thousand Oaks, CA: Sage Publications, Inc., 8-22. Mills, H. E. (1971). Commitment—the soul of nursing practice. South Carolina Nursing, 23, 53-54, 105-107. Morres, B., Singh, B. B., & Tun, A. (1983) Ananalysis of the factors which impinge on a nurse’s decision to enter, stay in, leave or re-enter the nursing profession. Journal of Advanced Nursing, 8, 227-235. Morrow, P. C. (1983). Concept redundancy in organizational research: the case of work commitment. Academy Management, 8, 486-500. Morrow, P. C. (1993). The theory and measurement of work commitment. Greenwich, CT: Jai Press Inc., 33-49. Morrow, P. C., & Wirth, R. E. (1989). Work commitment among salaried professionals. Journal of Occupational Behavior, 34, 57-68. Pooyan, A., Eberhardt, B. J., & Szigeti, E. (1990). Workrelated variables and turnover intention among registered nurses. Nursing & Health Care, 11, 254-258. Steffy, B. D. (1988). The impact of family and career planning variables on the organizational, career, and community commitment of professional women. Journal of Vocational Behavior, 32, 196-212. Waugaman, W. R., & Lohrer, D. J. (2000). From nurse to nurse anesthetist: The influence of age and gender on professional socialization and career commitment of advanced practice nurses. Journal of Professional Nursing, 16, 47-56.
This study investigated the relationships among turnover intentions, professional commitment, and job satisfaction of registered nurses. A structured, selfadministered questionnaire, including the Professional Commitment Scale, job satisfaction, turnover intentions, and demographic data, was distributed to 2,550 registered nurses. A total of 2,197 subjects completed the questionnaires with an 86.2 per cent response rate. All of the subjects were women. The mean age was 28.56 years. Seventy-two per cent of respondents had graduated with an associate’s degree and 59 per cent were unmarried. There was a positive correlation between job satisfaction and professional commitment, intention to leave the organization, and between intention to leave the profession. The negative correlation was significant between professional commitment and turnover intentions, and between job satisfaction and turnover intentions. The discriminant analysis showed that 38.4 per cent of job satisfaction was correctly classified in predicting intention to leave the organization, and 30.5 per cent in predicting the intention to leave the profession. Thirty per cent of professional commitment was correctly classified in predicting intention to leave the organization, and 39.7 per cent in predicting the intention to leave the profession. The study suggests that there were different moderators that affect different turnover intentions of staff nurses. (Index words: Turnover intention; Job satisfaction; Professional commitment; Hospital nurses) J Prof Nurs 18:214-219, 2002. Copyright 2002, Elsevier Science (USA). All rights reserved.
*Associate Professor, Department of Nursing, Meiho Institute of Technology, Taiwan; PhD candidate, Department of Health Administration, School of Public Health, University of South Carolina, Columbia, SC. †Instructor, Department of Nursing, Meiho Institute of Technology, Taiwan. ‡Associate Professor, School of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan. Address correspondence and reprint requests to Dr. Yong-Yuan Chang: School of Public Health, Kaohsiung Medical University, No. 100. Shih-Chuan 1st Rd, Kaohsiung 807, Taiwan. Copyright 2002, Elsevier Science (USA). All rights reserved. 8755-7223/02/1804-0009$35.00/0 doi:10.1053/jpnu.2002.127573 214
A
CCORDING TO THE DATA of The Examination Yuan of the Republic of China, about 50,000 graduates passed the nursing licensure test between 1950 and 1999. Furthermore, according to the data from the Department of Health, Taiwan, only about half of the nurses were registered in 1999. Therefore, there are a lot of trained nurses that do not work as nurses. Such a high turnover rate results in attrition of nursing education and a waste of hospital resources. Many believe that proper management of nursing job turnover can improve the financial health and longterm survival of health care institutions and improve nursing quality (Pooyan, Eberhardt, & Szigeti, 1990). Although research on nursing is not new, the methodology, variables, and statistical analyses used vary substantially across studies, and many have spent considerable time and effort to identify the impact of work-related factors to explain individuals’ turnover behavior (i.e., pay, role conflict, work overload) (Davidson, Folcarelli, Crawford, Duprat, & Clifford, 1997; George & Jones, 1996; Irvine & Evans, 1995; Morres, Singh, & Tun, 1983). Research interest in studying commitment has continued since it has been shown to be consistently related to employee turnover, job satisfaction, and job intention (Lum, Kervin, Clark, Reid, & Sirola, 1998). Commitment to nursing is of concern to Western scholars, and specific conceptualizations of commitment have been considered (Meyer & Allen, 1997; Morrow, 1993). In the 1970s, nursing scholars interpreted commitment as a concept in existentialism. From an existentialist’s point of view, people who are committed will develop devotion to values that cause them to dedicate thousands of hours in pursuit of something. Practitioners who are committed to their cause express themselves in styles of communication that interpreters from outside the discipline are unable to understand in all their nuances (Altschul, 1979). If a nurse is truly committed, she or he will feel part of everything that nursing brings, including its problems,
Journal of Professional Nursing, Vol 18, No 4 (July–August), 2002: pp 214-219
215
TURNOVER INTENTIONS AND PROFESSIONAL COMMITMENT
frustrations and future (Celemence, 1966). The committed nurse never acts out a role; self-involvement is absolute because the ideal is an ideal of the total self (Mills, 1971). A number of conceptual frameworks have been developed to explain nurse turnover behavior. That job satisfaction can effectively predict anticipated turnover has been reported in numerous studies (Lucas, Atwood, & Hagaman, 1993; Pooyan et al., 1990). However, Irvine and Evans (1995) found only a small negative relationship between job satisfaction and turnover intention, although the intention was a direct antecedent to leave the job. Related to turnover intentions, commitment surpassed job satisfaction and other work-related factors (Lum et al., 1998). The importance of employees’ commitment has been widely advocated (Aryee & Tan, 1992; Bedeian & Kemery, 1991; Blau & Lunz, 1998; Chang, 1999). Commitment may provide an important source of occupational meaning and continuity in an era when organizations have become fluid and unable to provide employment security (Colarelli & Bishop, 1990). Professional commitment had an incremental effect on a professional’s intention to leave the organization in one study (Blau & Lunz). Enhancing professional commitment in nursing has the potential to produce benefits for both the individual and their organization (Cohen, 1998; Cohen, 1999). A review of the literature shows that three aspects of commitment have been applied to many domains. They are willingness to exert effort on its behalf, a desire to remain in the profession, and identifying with the profession by acceptance of its goals and values (Aranya, Pollock, & Amernic, 1981; Aryee, Wyatt, & Min, 1991; Morrow, 1983). The study reported here was designed to investigate the relationships between turnover intentions, professional commitment, job satisfaction, and demographic data among hospital nurses in Taiwan.
Methodology SAMPLE
Questionnaires were sent to a random sample of one fourth of hospital nurses (n ⫽ 2,550) in the southern area of Taiwan. Subject names and addresses were provided by three Taiwan Nurses’ Associations. Each questionnaire was prefaced with a letter that explained the objectives of the study, and assured respondents of the anonymity and confidentiality of their response. A total of 2,197 nurses responded, yielding a response
rate of 86.2 per cent. Ages ranged from 18 to 60 years with a mean age of 28.56 years. All of the respondents were women, 41 per cent of respondents were married, and 89 per cent did not have a college degree. MEASURES
The Professional Commitment Scale was developed and revised by the authors (Lu, Chiou, & Chang, 2000). Twenty-six items were retained on the basis of principal components analysis with varimax rotation, indicating that a three-factor solution accounted for 52.58 per cent of the total variance. Factor 1 was identified as willingness to make effort (13 items); factor 2 was identified as maintaining as a membership (8 items); and factor 3 was identified as belief in goals and values (5 items). Item responses were rated on a fourpoint scale (1 ⫽ strongly certain, 4 ⫽ strongly uncertain). Internal consistency using Cronbach’s ␣ was .944. Intraclass coefficient (ICC) was .895 when identical forms were administered 3 weeks apart. The two turnover intention variables, intention to leave the organization and intention to leave the profession, were measured by the items based on Blau and Lunz’s (1998) definition. Respondents were asked to indicate their agreement with the following items, “I intend to leave the organization,” and “I think about leaving my job related to the nursing profession.” Re-
TABLE 1. Distributive Statistics of Study Variables Variable
Marital status Unmarried Married Degree of education Vocational school Associate degree BSN MSN
Age Wage (NT) Communication time Family support Age of the youngest child Years in organization Intention to leave organization Intention to leave profession Overall commitment Willingness of effort Remain in profession Belief in goals and values Job satisfaction NOTE. N ⫽ 2,197.
n
%
1,271 870
59.36 40.64
364 1,572 230 7
16.75 72.34 10.58 .32
Mean
SD
28.56 36.16 20.01 3.34 2.31 5.96 2.67 2.59 71.22 32.92 23.60 14.69 28.17
7.07 8.38 18.07 .55 1.26 6.04 .75 .80 10.59 6.58 3.85 2.59 4.63
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LU ET AL
TABLE 2. Intercorrelations Among Variables Variable
1
2
3
4
1 2 3 4 5 6 7 8 9 10 11 12
.623* .038 .730* .495* .104* .734† ⫺.099* .031 .047† ⫺.019 .025
⫺.113* .051 .222* .049† .458* ⫺.023 .089* ⫺.096* ⫺.085* ⫺.054†
⫺.133* .304* .030 ⫺.071* ⫺.080* ⫺.101* ⫺.042 .054† .058*
.246* ⫺.029 .489 .056 .161* .126* ⫺.087† ⫺.073†
5
.070* .495* ⫺.034 ⫺.012 .052† .013 .025
6
.056† ⫺.026 .015 .014 ⫺.005 ⫺.023
7
8
9
10
11
⫺.090* ⫺.024 .019 .063 .043
.194* .350* ⫺.204* ⫺.274*
.386* ⫺.480* ⫺.370*
⫺.380* ⫺.547*
.602*
NOTE. 1, age; 2, marital status; 3, educational level; 4, age of the youngest child; 5, wage; 6, communication time; 7, years in organization; 8, family support; 9, job satisfaction; 10, professional commitment; 11, intention to leave organization; 12, intention to leave profession. *Spearman’s correlation is significant at the .01 level (two-tailed). †Spearman’s correlation is significant at the .05 level (two-tailed).
sponses were rated on a four-point scale (1 ⫽ strongly disagree, 4 ⫽ strongly agree) (Blau & Lunz, 1998). Job satisfaction was measured with a four-point scale consisting of 10 items developed by the authors. Reliability with Cronbach’s ␣ was .94 and ICC was .89. The scale included questions about work-related issues such as autonomy, organizational policies, work environment, and the perceived managerial state. Family support was measured by asking respondents the following item, “How do the most significant people support your job?” and was rated on a four-point scale (1 ⫽ strongly support, 4 ⫽ strongly not support). Descriptive statistics were used to explore the variables. Correlation matrices were generated to examine the relationships between variables. Discriminant analyses were used to estimate the percentage of correct classifications for the four-group classification of intention to leave the organization and intention to leave the profession (1 ⫽ strongly disagree, 4 ⫽ strongly agree) on job satisfaction and professional commitment. Results
Descriptive statistics are shown in Table 1. The range of monthly incomes was N.T.$ (New Taiwan
dollar) 28,000-110,000 with a mean of N.T.$ 36,160 (U.S. $1,100). In terms of tenure, the average stay in an organization was 6 years. The mean communication time between nurses was 20 minutes, family support was 3.34, and mean age of the youngest child was 2.31. The mean job satisfaction score was 28.17; intention to leave profession was 2.59; intention to leave organization was 2.67; and a mean score of 71.22 for overall professional commitment. Table 2 presents a matrix of correlation coefficients between variables. There were significant negative correlations between turnover intentions and marital status, wage, age of the youngest child, family support, job satisfaction, and professional commitment, whereas educational level was positively correlated with turnover intentions. Unmarried nurses had significantly higher professional commitment as well as greater intention to leave and lower job satisfaction than married nurses. Educational level was significantly related to job satisfaction and turnover intentions but unrelated to professional commitment. Nurses’ wages were positively correlated only with professional commitment. The nurses whose youngest child’s age was more than 3 years had higher job satisfaction and professional commitment and lower turn-
TABLE 3. Discriminant Analysis of the Four Groups’ Classification of Job Satisfaction on Intention to Leave Organization Predicted Group Membership Actual Group
Strongly Disagree
Disagree
Agree
Strongly Agree
Total
Strongly disagree Disagree Agree Strongly agree Ungrounded cases
88 (52.7%) 159 (27.4%) 115 (9.4%) 4 (2.0%) 9 (33.3%)
57 (34.1%) 278 (47.8%) 425 (34.8%) 25 (12.6%) 11 (40.7%)
16 (9.6%) 91 (15.7%) 336 (27.5%) 40 (20.1%) 2 (7.4%)
6 (3.6%) 53 (9.1%) 345 (28.3%) 130 (65.3%) 5 (18.5%)
167 581 1,221 199 27
NOTE. In total, 38.4 per cent of the original grouped cases were correctly classified.
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TURNOVER INTENTIONS AND PROFESSIONAL COMMITMENT
TABLE 4. Discriminant Analysis of the Four Groups’ Classification of Job Satisfaction on Intention to Leave Profession Predicted Group Membership Actual Group
Strongly disagree
Disagree
Agree
Strongly Agree
Total
Strongly disagree Disagree Agree Strongly agree Total
130 (55.1%) 226 (37.0%) 204 (17.9%) 20 (10.3%) 3 (21.4%)
53 (22.5%) 192 (31.4%) 310 (27.2%) 28 (14.4%) 5 (35.7%)
17 (7.2%) 80 (13.1%) 227 (19.9%) 32 (16.4%) 2 (14.3%)
36 (15.3%) 113 (18.5%) 398 (34.9%) 115 (59.0%) 4 (28.6%)
236 611 1,139 195 14
NOTE. In total, 30.4 per cent of the original grouped cases were correctly classified.
over intentions. Job satisfaction was positively correlated with professional commitment and negatively correlated with turnover intentions, and both correlations were significant. Professional commitment was negatively correlated with turnover intentions. Intention to leave the organization was positively and significantly correlated with intention to leave the profession. In the discriminant analysis, 38.4 per cent of nurses can be correctly classified as having the intention to leave the organization and 30.4 per cent as intending to leave the profession because of lack of job satisfaction (Tables 3 and 4). On the other hand, 30.5 per cent of nurses can be correctly classified as having the intention to leave the organization and 39.7 per cent as having the intention to leave their profession on the basis of their professional commitment (Tables 5 and 6). There was an 8 per cent to 9 per cent classification difference in job satisfaction and professional commitment between the prediction to leave the organization and intention to leave the profession. Discussion
The main objective of the study was to examine the relationships between turnover intentions and professional commitment among registered nurses. Marital status, family support, and age of the youngest child were correlated with professional commitment, orga-
nizational satisfaction, and turnover intentions that reflected family status as an important factor for nurses in nursing career commitment. In this study, most of the nurses had graduated from junior colleges with associate’s degrees. The mean age was 28.56 years, which indicated that many nurses had resigned from working before middle age. Relationships among nurses’ background information, turnover intentions, job satisfaction, and professional commitment are numerous and varied in the literature. Significant correlation between age and professional commitment was consistent with a number of studies (Blau, 1985; Cherniss, 1991; Korabik & Rosin, 1996; Morrow & Wirth, 1989; Waugaman & Lohrer, 2000) but inconsistent with other studies (Colarelli & Bishop, 1990; Steffy, 1988). The findings of significant correlations between professional commitment and salary (Cherniss, 1991), educational level (Morrow & Wirth, 1989), years in organization (Cohen, 1998), and years in profession (Cherniss, 1991) were inconsistent with the results of previous studies. Unmarried nurses had higher professional commitment than married nurses and that was not consistent with many studies (Korabik & Rosin, 1996; Cherniss, 1999) with the exception of Blau’s (1985) study. The relationship between status of children and professional commitment also was not consistent with the research (Cherniss, 1988; Steffy, 1991). These various results may be owing to differences of culture, the
TABLE 5. Discriminant Analysis of the Four Groups’ Classification of Professional Commitment on Intention to Leave Organization Predicted Group Membership Actual Group
Strongly Disagree
Disagree
Agree
Strongly Agree
Total
Strongly disagree Disagree Agree Strongly agree Ungrounded cases
87 (52.4) 230 (39.6%) 228 (18.7%) 26 (13.2%) 8 (28.6%)
32 (19.3%) 135 (23.2%) 185 (15.2%) 16 (8.1%) 5 (17.9%)
34 (20.5%) 121 (20.8%) 309 (25.3%) 27 (13.7%) 5 (17.9%)
13 (7.8%) 95 (16.4%) 497 (40.8%) 128 (65.0%) 10 (35.7%)
166 581 1,219 197 28
NOTE. In total, 30.5 per cent of the original grouped cases were correctly classified.
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LU ET AL
TABLE 6. Discriminant Analysis of the Four Groups’ Classification of Professional Commitment on Intention to Leave Profession Predicted Group Membership Actual Group
Strongly disagree Disagree Agree Strongly agree Ungrouped cases
Strongly Disagree
Disagree
Agree
Strongly Agree
Total
132 (56.2%) 238 (39.0%) 130 (11.4%) 9 (4.6%) 1 (6.7%)
56 (23.8%) 175 (28.7%) 203 (17.9%) 6 (3.1%) 2 (13.3%)
43 (18.3%) 152 (24.9%) 420 (36.9%) 42 (21.6%) 5 (33.3%)
4 (1.7%) 45 (7.4%) 384 (33.8%) 137 (70.6%) 7 (46.7%)
235 610 1,137 194 15
NOTE. In total, 39.7 per cent of the original grouped cases were correctly classified.
number of subjects, and the use of a different instrument to measure professional commitment. Both of the mean scores of intention to leave the organization or profession are higher than the results in Blau and Lunz’s (1998) study of 2.1. However, the mean score of professional commitment was 2.70, which is consistent with Blau and Lunz. The findings of this study show a correlation between professional commitment and intention to leave the organization or profession that was also reported in another study (Bedeian & Kemery, 1991). The result of discriminant analysis indicates that professional commitment is more effective in predicting intention to leave the nursing profession than intention to leave the organization at 9.2 per cent. Professional commitment related to the intention to leave the profession was more strongly correlated than the intention to leave the organization. Job satisfaction was more effective in predicting intent to leave the organization than intention to leave the nursing profession at 8 per cent. Job satisfaction related to organizational leave intention was more strongly correlated than professional leave intention. The present findings are in accordance with Gardner’s (1992) findings, which emphasized the importance of professional commitment in nursing and Cohen’s (1999) findings, which indicated that there is a stronger relationship to work outcomes
than job involvement. The findings also are in accordance with results in a number of studies that show that professional commitment was negatively correlated with turnover intention among nurses (Aryee, Chay, & Chew, 1994; Blau & Lunz, 1998). Thus, professional commitment and job satisfaction have more influence on nurses remaining in nursing than other forms of commitment. Morrow (1983) suggested that professional commitment is a more stable commitment than feelings about one’s organizational job. Brierley (1996) confirmed that the correlation between organizational commitment and organizational turnover was greater than that between professional commitment and organizational turnover. We would like to emphasize that intention to leave the organization and to leave the nursing profession stem from different attitudes. Therefore, enhancing job satisfaction for nurses likely will produce benefits for both the individuals and their organizations. A focus on promoting the intrinsic values of the nursing profession should be integrated in the strategies to improve professional commitment and for nursing organizations to use to retain nurses. Existentialism, as a philosophy of commitment by nursing scholars as described, should be emphasized in continuing educational programs of nurses.
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