Should I stay or should I go? The impact of working time and wages on retention in the health workforce

Human Resources for Health

Kea G Tijdens²  Daniel H de Vries¹  Stephanie Steinmetz¹ 

[1] Department of Sociology & Anthropology, University of Amsterdam, Amsterdam, the Netherlands;Amsterdam Institute for Advanced Labor Studies (AIAS), University of Amsterdam, Amsterdam, the Netherlands

关键词: Working time;    Wage satisfaction;    Survey data;    Remuneration;    Job satisfaction;    Intention to stay;    Intention to quit;    Health workforce retention;    Commuting time;   

Others  :  821739
DOI  :  10.1186/1478-4491-12-23

 received in 2013-09-03, accepted in 2014-03-25,  发布年份 2014

【 摘 要 】

Background

Turnover in the health workforce is a concern as it is costly and detrimental to organizational performance and quality of care. Most studies have focused on the influence of individual and organizational factors on an employee’s intention to quit. Inspired by the observation that providing care is based on the duration of practices, tasks and processes (issues of time) rather than exchange values (wages), this paper focuses on the influence of working-time characteristics and wages on an employee’s intention to stay.

Methods

Using data from the WageIndicator web survey (N = 5,323), three logistic regression models were used to estimate health care employee’s intention to stay for Belgium, Germany and the Netherlands. The first model includes working-time characteristics controlling for a set of sociodemographic variables, job categories, promotion and organization-related characteristics. The second model tests the impact of wage-related characteristics. The third model includes both working-time- and wage-related aspects.

Results

Model 1 reveals that working-time-related factors significantly affect intention to stay across all countries. In particular, working part-time hours, overtime and a long commuting time decrease the intention to stay with the same employer. The analysis also shows that job dissatisfaction is a strong predictor for the intention to leave, next to being a woman, being moderately or well educated, and being promoted in the current organization. In Model 2, wage-related characteristics demonstrate that employees with a low wage or low wage satisfaction are less likely to express an intention to stay. The effect of wage satisfaction is not surprising; it confirms that besides a high wage, wage satisfaction is essential. When considering all factors in Model 3, all effects remain significant, indicating that attention to working and commuting times can complement attention to wages and wage satisfaction to increase employees’ intention to stay. These findings hold for all three countries, for a variety of health occupations.

Conclusions

When following a policy of wage increases, attention to the issues of working time—including overtime hours, working part-time, and commuting time—and wage satisfaction are suitable strategies in managing health workforce retention.

【 授权许可】

   
2014 Steinmetz et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Albaugh JA: Keeping nurses in nursing: the profession’s challenge for today. Urol Nurs 2003, 23:193-199.
• [2]Waldman JD, Kelly F, Sanjeev A, Smith HL: The shocking cost of turnover in health care. Health Care Manage Rev 2004, 29(1):27.
• [3]Cohen A, Golan R: Predicting absenteeism and turnover intentions by past absenteeism and work attitudes: an empirical examination of female employees in long term nursing care facilities. Career Dev Int 2007, 12:416-432.
• [4]International Council of Nurses: Global Nursing Shortage: Priority Areas for Intervention. Geneva, Switzerland: International Council of Nurses; 2006:42.
• [5]Atencio BL, Cohen J, Gorenberg B: Nurse retention: is it worth it? Nurs Econ 2003, 21:262-299.
• [6]Hayes LJ, O’Brien-Pallas L, Duffield C, Shamian J, Buchan J, Hughes F, Spence Laschinger HK, North N, Stone PW: Nurse turnover: a literature review. Int J Nurs Stud 2006, 43:237-263.
• [7]Coomber B, Louise Barriball K: Impact of job satisfaction components on intent to leave and turnover for hospital-based nurses: a review of the research literature. Int J Nurs Stud 2007, 44:297-314.
• [8]Timmermans S, Almeling R: Objectification, standardization, and commodification in health care: a conceptual readjustment. Soc Sci Med 2009, 69:21-27.
• [9]Colley H, Henriksson L, Niemeyer B, Seddon T: Competing time orders in human service work: towards a politics of time. Time Soc 2012, 21:371.
• [10]Ylijoki O-H, Mantyla H: Conflicting time perspectives in academic work. Time Soc 2003, 12:55-78.
• [11]Ferrinho P, Van Lerberghe W, Julien M, Fresta E, Gomes A, Dias F: How and why public sector doctors engage in private practice in Portuguese-speaking African countries. Health Policy Plan 1998, 13:332-338.
• [12]Dovlo D: Retention and deployment of health workers and professionals in Africa. Report for the Consultative Meeting on Improving Collaboration between Health Professions and Governments in Policy Formulation and Implementation of Health Sector; Addis Ababa. 28 January to 1 February 2002
• [13]Smigelskas K, Padaiga Z: Do Lithuanian pharmacists intend to migrate? J Ethn Migr Stud 2007, 33:501-509.
• [14]Nguyen LR, Nderitu S, Zuyderduin E, Luboga AS, Hagopian A: Intent to migrate among nursing students in Uganda: measures of the brain drain in the next generation of health professionals. Hum Resour Heal 2008, 6:5. BioMed Central Full Text
• [15]Tijdens K, De Vries DH, Steinmetz S: Health workforce remuneration: comparing wage levels, ranking, and dispersion of 16 occupational groups in 20 countries. Hum Resour Health 2013, 11:11. BioMed Central Full Text
• [16]Blaauw D, Ditlopo P, Maseko F, Chirwa M, Mwisongo A, Bidwell P, Thomas S, Normand C: Comparing the job satisfaction and intention to leave of different categories of health workers in Tanzania, Malawi, and South Africa. Glob Health Action 2013, 6:19287.
• [17]Manlove EE, Guzell JR: Intention to leave, anticipated reasons for leaving, and 12‒month turnover of child care center staff. Early Child Res Q 1997, 12:145-167.
• [18]Arnold J, Mackenzie Davey K: Graduates’ work experiences as predictors of organizational commitment, intention to leave and turnover: which experiences really matter? Appl Psychol 1999, 48:211-238.
• [19]Rambur B, Val Palumbo M, McIntosh B, Mongeon J: A statewide analysis of RNs’ intention to leave their position. Nurs Outlook 2003, 51:181-188.
• [20]Tzeng HM: The influence of nurses’ working motivation and job satisfaction on intention to quit: an empirical investigation in Taiwan. Int J Nurs Stud 2002, 39:867-878.
• [21]Mor Barak ME, Nissly JA, Levin A: Antecedents to retention and turnover among child welfare, social work, and other human service employees: what can we learn from past research? A review and metanalysis. Soc Serv Rev 2001, 75:625-661.
• [22]Coward RT, Hogan TL, Duncan RP, Horne CH, Hilker MA, Felsen LM: Job satisfaction of nurses employed in rural and urban long term care facilities. Res Nursing Health 1995, 18:271-284.
• [23]Emberland JS, Rundmo T: Implications of job insecurity perceptions and job insecurity responses for psychological wellbeing, turnover intentions and reported risk behavior. Safety Sci 2010, 48:452-459.
• [24]Mishra SK, Bhatnagar D: Linking emotional dissonance and organisational identification to turnover intention and emotional well-being: a study of medical representatives in India. Hum Resour Manage 2010, 49:401-419.
• [25]Bluedorn AC: The theories of turnover: causes, effects and meaning. Res Soc Org 1982, 1:75-128.
• [26]Lee TW, Mowday RT: Voluntarily leaving an organization: an empirical investigation of Steers and Mowday’s model of turnover. Acad Manage J 1987, 30:721-743.
• [27]Alexander JA, Lichtenstein R, Joo Oh H, Ullman E: A causal model of voluntary turnover among nursing personnel in long‒term psychiatric settings. Res Nurs Health 1998, 21:415-427.
• [28]Price JL, Mueller CW: Professional turnover: the case for nurses. Health Syst Manage 1981, 15:1-160.
• [29]Mueller CW, Price JL: Economic, psychological, and sociological determinants of voluntary turnover. J Behav Econ 1990, 19:321-335.
• [30]Irvine D, Evans M: Job satisfaction and turnover among nurses: integrating research findings across studies. Nurs Res 1995, 1995(44):246-253.
• [31]Kiyak H, Asumen KH, Kahana EF: Job commitment and turnover among women working in facilities serving older persons. Res Aging 1997, 19:223-246.
• [32]Aiken LH, Buchan J, Sochalski J, Nichols B, Powell M: Trends in international nurse migration. Health Aff 2004, 23:69-77.
• [33]Tai TWC, Bame SI, Robinson CD: Review of nursing turnover research, 1977–1996. Soc Sci Med 1998, 47:1905-1924.
• [34]Zurn P, Dolea C, Stilwell B: Nurse Retention and Recruitment: Developing a Motivated Workforce. Geneva: World Health Organization, Department of Human Resources for Health; 2005.
• [35]McCarthy G, Tyrrell M, Cronin C: National Study of Turnover in Nursing and Midwifery. Dublin: Department of Health and Children; 2002. [http://www.dohc.ie/publications/pdf/tover.pdf webcite]
• [36]Ben‒Dror R: Employee turnover in community mental health organization: a developmental stages study. Community Ment Health J 1994, 30:243-257.
• [37]Koeske GF, Kirk SA: The effect of characteristics of human service workers on subsequent morale and turnover. Adm Soc Work 1995, 19:15-31.
• [38]Jinnett K, Alexander JA: The influence of organizational context on quitting intention: an examination of treatment staff in long‒term mental health care settings. Res Aging 1999, 21:176-204.
• [39]McKee GH, Markham SE, Dow Scott K: Job stress and employee withdrawal from work. In Stress and Well‒Being at Work: Assessments and Interventions for Occupational Mental Health. Edited by Campbell Quick J, Murphy LR, Hurrell JJJr. Washington, DC: American Psychological Association; 1992:153-163.
• [40]Yin JT, Yang KA: Nursing turnover in Taiwan: a meta-analysis of related factors. Int J Nurs Stud 2002, 39:573-581.
• [41]Strachota E, Normandin P, O’Brien N, Clary M, Krukow B: Reasons registered nurses leave or change employment status. J Nurs Admin 2003, 33:111-117.
• [42]Henderson Betkus M, MacLeod MLP: Retaining public health nurses in rural British Columbia. Can J Public Health 2004, 95:54-58.
• [43]Bhuian SN, Menguc B: Evaluation of job characteristics, organizational commitment and job satisfaction in an expatriate, guest worker, sales setting. J Personal Sell Sales Manag 2002, 22:1-12.
• [44]Mueller CW, McCloskey JC: Nurses’ job satisfaction: a proposed measure. Nurs Res 1990, 39:113-117.
• [45]Larrabee JH, Janney MA, Ostrow CL, Withrow ML, Hobbs GR Jr, Burant C: Predicting registered nurse job satisfaction and intent to leave. J Nurs Admin 2003, 33:271-283.
• [46]Stordeur S, D’Hoore W, van der Heijden B, Dibisceglie M, Laine M, van der Schoot E: Leadership, job satisfaction and nurses’ commitment. In Working Conditions and Intent to Leave the Profession among Nursing Staff in Europe. Edited by Hans-Martin Hasselhorn HM, Tackenberg P, Müller BH. Wuppertal: SALTSA, University of Wuppertal; 2003. Report No 7:28–45
• [47]Ellenbecker CH: A theoretical model of job retention for home health care nurses. J Adv Nurs 2004, 47:303-310.
• [48]Laschinger HK, Finegan J, Shamian J, Wilk P: A longitudinal analysis of the impact of workplace empowerment on work satisfaction. J Organ Behav 2004, 25:527-545.
• [49]El Jardali F, Dimassi H, Dumit N, Jamal D, Mouro G: A national cross-sectional study on nurses’ intent to leave and job satisfaction in Lebanon: implications for policy and practice. BMC Nurs 2009, 8:3. BioMed Central Full Text
• [50]Siefert K, Jayaratne S, Chess WA: Job satisfaction, burnout and turnover in health care social workers. Health Soc Work 1991, 16:193-202.
• [51]Oktay JS: Burnout in hospital social workers who work with AIDS patients. Soc Work 1992, 37:432-439.
• [52]Tett RP, Meyer JP: Job satisfaction, organizational commitment, turnover intention, and turnover: path analysis based on meta‒analytic findings. Pers Psychol 1993, 46:259-293.
• [53]Hellman CM: Job satisfaction and intent to leave. J Soc Psychol 1997, 137:677-689.
• [54]Lum L, Kervin J, Clark K, Reid F, Sirola W: Explaining nursing turnover intent: job satisfaction, pay satisfaction, or organizational commitment? J Organ Behav 1998, 19:305-320.
• [55]Hom PW, Griffeth RW: Employee Turnover. South-Western: Cincinnati, OH; 1995.
• [56]Griffeth RW, Hom PW, Gaertner S: A meta-analysis of antecedents and correlates of employee turnover, update, moderator tests, and research implications for the next millennium. J Manage 2000, 26:463-488.
• [57]Tang TLP, Kim JW, Tang DSH: Does attitude toward money moderate the relationship between intrinsic job satisfaction and voluntary turnover?’. Hum Relat 2000, 53:213-245.
• [58]Tanova C, Holtom B: Using job embeddedness factors to explain voluntary turnover in 4 European countries. Int J Hum Resour Man 2008, 19:1553-1568.
• [59]Mueller CW, Wallace JE, Price JL: Employee commitment: resolving some issues. Work Occupation 1992, 19:211-236.
• [60]Allen NJ, Meyer JP: The measurement and antecedents of affective, continuance and normative commitment to the organization. J Occup Psychol 1990, 63:1-18.
• [61]Lu KY, Lin PL, Wu CM, Hsieh YL, Chang YY: The relationship among turnover intentions, professional commitment, and job satisfaction of hospital nurses. J Prof Nurs 2002, 18:214-219.
• [62]Rhodes SR, Steers RM: Managing Employee Absenteeism. Reading, MA: Addison‒Wesley; 1990.
• [63]Taunton RL, Boyle DK, Woods CQ, Hansen HE, Bott MJ: Manager leadership and retention of hospital nurse staff. West J Nurs Res 1997, 19:205-226.
• [64]Krausz M, Koslowsky M, Eiser A: Distal and proximal influences of turnover intentions and satisfaction: support for a withdrawal progression theory. J Vocat Behav 1998, 52:59-71.
• [65]Galletta M, Portoghese I, Battistelli A, Leiter MP: The roles of unit leadership and nurse-physician collaboration on nursing turnover intention. J Adv Nurs 2012, 69:1771-1784.
• [66]Galletta M, Portoghese I, Penna MP, Battistelli A, Saiani L: Turnover intention among italian nurses: the moderating roles of supervisor support and organizational support. Nurs Health Sci 2011, 13:184-191.
• [67]Donoghue C: Nursing home staff turnover and retention: an analysis of national level data. J Appl Gerontol 2010, 29:189-206.
• [68]Russel EM, Williams SW, Gleason-Gomez C: Teachers’ perceptions of administrative support and antecedents of turnover. J Res Childhood Educ 2010, 24:195-208.
• [69]Shields MA, Ward M: Improving nurse retention in the National Health Service in England: the impact of job satisfaction on intentions to quit. J Health Econ 2002, 20:677-701.
• [70]Liou SR, Cheng CY: Organisational climate, organisational commitment and intention to leave amongst hospital nurses in Taiwan. J Clin Nurs 2010, 19:1635-1644.
• [71]Torka N, Schyns B, Looise JK: Direct participation quality and organisational commitment: the role of leader-member-exchange. Employee Relat 2010, 32:418-434.
• [72]Shader K, Broome M, Broome CD, West M, Nash M: Factors influencing satisfaction and anticipated turn-over for nurses in an academic medical center. J Nurs Admin 2001, 31:210-216.
• [73]Couper M: Web surveys: a review of issues and approaches. Publ Opin Q 2000, 64:464-481.
• [74]Groves R: Survey Errors and Survey Costs. Wiley Interscience: Hoboken, NY; 2004.
• [75]Lee S, Vaillant R: Estimation for volunteer panel web surveys using propensity score adjustment and calibration adjustment. Socio Meth Res 2009, 37:319-343.
• [76]Schonlau M, Van Soest A, Kapteyn A, Couper M: Selection bias in web surveys and the use of propensity scores. Socio Meth Res 2009, 37:291-318.
• [77]Steinmetz S, Tijdens KG: Can weighting improve the representativeness of volunteer online panels? Insights from the German WageIndicator data. Concepts Meth 2009, 5:7-11.
• [78]Steinmetz S, Tijdens KG, Raess D, De Pedraza P: Measuring wages worldwide –exploring the potentials and constraints of volunteer web surveys. In Advancing Social and Business Research Methods with New Media Technologies. Edited by Sappleton N. Hershey, PA: IGI Global; 2013.
• [79]Unemployment Rate: Annual Data [http://epp.eurostat.ec.europa.eu/portal/page/portal/product_details/dataset?p_product_code=TIPSUN20 webcite]
• [80]Hans-Martin Hasselhorn HM, Tackenberg P, Müller BH (Eds): Working Conditions and Intent to Leave the Profession among Nursing Staff in Europe. Wuppertal: SALTSA, University of Wuppertal; 2003. Report No 7
• [81]Ding A, Hann M, Sibbald B: Profile of English salaried GPs: labour mobility and practice performance. Br J Gen Pract 2008, 58:20-25.