Volume 19, Issue 2 (9-2022)
J Res Dev Nurs Midw 2022, 19(2): 6-9 |
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Hosseyni F, Rahmani H, Tatari M, Kashani E, Modanloo M. Relationship between Professional Commitment and Intention to leave the job among Nurses Working in Intensive Care Units. J Res Dev Nurs Midw 2022; 19 (2) :6-9
URL: http://nmj.goums.ac.ir/article-1-1241-en.html
URL: http://nmj.goums.ac.ir/article-1-1241-en.html
1- MS in Critical Care Nursing, Nursing Research Center, Golestan University of Medical Science, Gorgan, Iran
2- MS in Biostatistic, Nursing Research Center, Golestan University of Medical Science, Gorgan, Iran
3- Department of Obstetrics and Gynecology, School of MedicineSayyadShiraziHospitalGolestan University of Medical Sciences
4- Associate Professor, Nursing Research Center, Golestan University of Medical Science, Gorgan, Iran , modanloo.mahnaz@goums.ac.ir
2- MS in Biostatistic, Nursing Research Center, Golestan University of Medical Science, Gorgan, Iran
3- Department of Obstetrics and Gynecology, School of MedicineSayyadShiraziHospitalGolestan University of Medical Sciences
4- Associate Professor, Nursing Research Center, Golestan University of Medical Science, Gorgan, Iran , modanloo.mahnaz@goums.ac.ir
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Introduction
Human resources have always been considered as one of the most important factors in the social progress; therefore, one of the main concerns of managers is how to create a suitable ground for workers in all professions to increase a sense of responsibility and commitment (1). Nurses are one of the largest groups of healthcare providers, and the intention to leave the profession among nurses and the nursing shortages can cause problems, such as increased workload and stress, burnout, reduced quality of care, and increased medical costs (2-4). Therefore, managers of health organizations should monitor their employees in order to reduce turnover intention and the subsequent loss of human resources (5). Today, only organizations are able to continue to exist, which promote professional commitment and job satisfaction by caring about employees and providing a suitable ground for their activities (1, 6). The turnover intention rate among nurses in the United States, Canada, the United Kingdom, Scotland, and Germany was reported to be between 6.16% and 9.38% in 2011-2012, while this rate was between 4.29% and 7.53% in personnel younger than 30 years of age (7). Meanwhile, due to the increasing population growth, the need for healthcare services and nursing care is increasing everyday (8). In addition to the lack of experienced nurses, leaving the nursing profession imposes a significant financial burden on the society (9). NikJoo et al. reported that 55% and 19% of Iranian nurses had a moderate and high tendency to leave the nursing profession (10).
Hospitals are concerned about losing their workforce, because every hospital spends a huge amount of money to train its employees to the desired level of productivity and efficiency (11). Therefore, it is imperative to identify factors, such as professional commitment, which affect turnover intention (12). Professional commitment is a mental state that indicates a desire, need, and obligation to work in a particular profession. It becomes meaningful when a person fulfills his/her assigned duties in the best possible way, with satisfaction and practical commitment, without any monitoring system. Affective, continuous, and normative commitment are the three dimensions of professional commitment. A committed person believes that everyone should stay committed to the profession they have been trained even if they make a loss (1). Today, decreased professional commitment has had adverse outcomes, such as employees leaving the job (6). The level of education and professional commitment have been reported as two important factors affecting the intention to leave the nursing profession, so that with the increase in the level of education and professional commitment, nurses would be less willing to leave their profession in the years to come (1).
The labor shortage crisis in the healthcare system affected disease prevention and health promotion in many countries (10). Since nurses are the main human resources in healthcare organizations (13), they have a great impact on the quality of healthcare (14). Considering the financial and human costs of leaving the nursing profession in healthcare organizations, it seems essential to predict and prevent this phenomenon (15). The intensive care unit (ICU) is one of the busiest hospital wards, which can cause mental fatigue, work load-related physical injuries, and reduced satisfaction in nurses. Therefore, nurses working in the ICUs generally have a higher tendency to leave their profession. This study aimed to determine relationship between professional commitment and the intention to leave the job in nurses working in the ICUs of teaching hospitals affiliated to the Golestan University of Medical Sciences.
Methods
This cross-sectional study was carried out on all eligible nurses working in the ICUs and cardiac care units of 5 Azar and ShahidSayadShirazi hospitals in Gorgan and Amir al Momenin hospital in Kordkuy in 2019. Overall, 202 volunteer nurses who met inclusion criteria were enrolled in the study via census. The inclusion criteria were working in the ICUs at the time of study, having at least 6 months of work experience in ICUs, having an associate degree or higher education, and not having any known mental or chronic physical illness in the last 6 months.
Written informed consent was taken from all participants, and the study received approval from the Ethics Committee of the Deputy of Research and Technology of the Golestan University of Medical Sciences. Data were collected by using a demographic and professional information form and the professional commitment scale for nurses. Demographic and professional information including age, gender, marital status, level of education, workplace department (ICU, CCU, dialysis, emergency), work experience, work shift, type of employment, type of responsibility in the workplace, and average monthly overtime hours were collected.
The Hanshow's Anticipated Turnover Scale (ATS) was designed in 1985 and consists 12 items that are scored based on a 5-point Likert scale, ranging from completely agree (score 5) to completely disagree (score 1), in order to assess intention to leave nursing profession. In order to reduce bias, the items are divided into two equal categories with positive and negative phrases. Items 1, 3, 6, 8, 9, and 10 are given a reverse score. The overall score ranges between 5 and 60. Overall scores of 1-20, 21-40, and 41-60 indicate low, moderate, and high tendency to leave the job (66). The validity and reliability of scale for nurses was confirmed by Hariri et al. (2013), with internal consistency of 80% (9).
The Nurses’ Professional Commitment Scale (NPCS) is a 26-item questionnaire designed by Lachman and Aryana to operationalize the construct of nursing professional commitment in four domains including; understanding of the nursing profession, job satisfaction, involvement of nursing professionals, and sacrifice for the nursing profession. The questionnaire is scored based on a 5-point Likert scale. The overall score ranges between 26 and 130, and a higher score indicates a higher professional commitment. Validity and reliability of the Persian version of the questionnaire have been verified by Joolaee et al., with an estimated internal consistency of 74% (8).
Descriptive statistics including mean, standard deviation, and frequency distribution table were used to analyze the data. Normality of quantitative variables was assessed using the Shapiro-Wilk test. The Spearman's rank correlation coefficient was used to evaluate the relationship between quantitative variables. In order to analyze quantitative, demographic, and professional variables, the the Mann-Whitney U and the Kruskal-Wallis were used, respectively. The significant level was considered less than 0.05.
Results
The mean age of the nurses was 31.93±6.16 years (range from 23 to 57). The mean work experience of the nurses in the ICUs and general wards was 65.65±19.55 and 96.94±12.68 months, respectively. The majority of nurses were female (80.69%), married (60.9%), working in rotating shifts (92%), and with a bachelor's degree (88.1%) (Table 1).
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The mean scores of professional commitment and intention to leave the nursing profession among the subjects were 90.40±16.69 and 36.80±4.87, respectively. The highest and lowest mean scores of the professional commitment were related to the dimensions of self-sacrifice (34.59±6.61) and job satisfaction (16.06±3.60), respectively (Table 2)
There was a significant inverse association between the intention to leave the job and the total score of professional commitment and its dimensions (Table 3).
There was also a significant relationship between professional commitment and age, clinical experience, and work experience in ICUs. However, the intention to leave the job had a significant inverse relationship only with clinical work experience (Table 4)
The mean score of professional commitment differed significantly among male and female nurses (P=0.03). However, the mean total score of intention to leave did not differ between female and male nurses (P=0.12). The mean total score of professional commitment and intention to leave the job had no significant association with marital status, education level, and working shift (P>0.05).
Discussion
According to the results, the mean score of professional commitment among the subjects was higher than the median score of the questionnaire, which indicates the high level of professional commitment among the nurses. The findings of this study are consistent with the results of Shali et al. (2015), in which the total score of professional commitment of nurses was 86, indicating a high level of professional commitment among nurses (16). Similarly, Lu et al. reported the total score of professional commitment to be 84.3 among nurses in Taiwan (17). In a study in Yazd (Iran), HoseyniManesh et al. reported a moderate level of professional commitment among government personnel (18).
In the present study, the mean score of intention to leave the job was 36.80±4.87, indicating the moderate tendency to leave the nursing profession. In a previous study in Iran, 69.9% of staff in research units had a moderate tendency to leave their job (19). Consistent with our findings, other studies in Iran (20) and Belgium (21) reported moderate turnover intention among nurses.
In the present study, there was a significant inverse relationship between the total score of professional commitment and its dimensions and the tendency to leave the job in nurses working in ICUs. This finding is in agreement with results of previous studies (22, 23). Ghadiri also reported a significant association between turnover intention and environmental ethics, job satisfaction, and organizational commitment in staff of a government company (24). Therefore, professional commitment can be considered as one of the most important predictive components of turnover intention among nurses.
In our study, the mean score of professional commitment had no significant association with age, marital status, education level, income, and shift work; however, there was a significant relationship between professional commitment and gender and work experience in ICU. In a previous study in Iran, there was no significant relationship between organizational commitment and education level, age, work experience, marital status, and employment status (25). GeramiNejad et al. (2017) found no significant relationship between professional commitment and age, gender, and marital status (26). However, they reported that nurses with rotational shift work had higher professional commitment.
In line with our findings, Soudagar et al. (2012) reported a significant relationship between gender and desire to work, while women were more willing to work in the nursing profession (27). According to Mortazavi and Meybodi, male, married, and less experienced nurses have higher turnover intention (28). Other studies also demonstrated that turnover intention is higher among male and single nurses (29-31). This may be due to the fact that, men in the Iranian society are responsible for providing for the family, and nursing is not considered a high-income occupation. In addition, being a male nurse is not socially acceptable in Iran (28).
The results of some studies in Iran showed that nurses with lower salaries are more inclined to leave their jobs than other nurses (32). A study in Saudi Arabia also showed that nurses who receive lower salaries have a greater tendency to leave their jobs. The mentioned study also attributed the higher tendency of male nurses to leave the nursing profession to the poor public image of the nursing profession in Saudi Arabia (33). Sharifzadeh et al. (2013) found that gender and age could affect turnover intention among nurses, in a way that, older nurses had a higher tendency to leave (34). Myers (2010) also reported a positive correlation between turnover intention among nurses and age (35). Ahmadi et al. (2013) also showed that married women have higher tendency to leave the nursing profession, possibly due to the interference of hospital shifts and their roles at home (36).
In line with our findings, Cai and Zhou (2009) found no significant association between demographic variables and intention to leave the nursing profession (37). Contrary to these results, Politi (2009) found no relationship between age and turnover intention among nurses (38).
Nursing is a mentally and physically challenging professionbecause the know that as a healthcare provider are the most reliable source of patients’ support (39) butnumerous shifts, and mandatory or voluntary overtimes are some factors that affect nurses' job satisfaction or turnover intention. Therefore, including nurses in monthly meetings, exploiting their experiences, encouraging them to share their knowledge, and involving them in committees directly related to patient care can be effective in creating a feeling of independence and control over one's career. Furthermore, hard working conditions and different work shifts can become more bearable if accompanied by public understanding and appreciation.
Conclusion
Based on the results, there is an inverse significant association between the total score of professional commitment and its dimensions and the intention to leave the nursing profession. Professional commitment not only promotes the profession in the society, but also prevents turnover intention and output reduction.
Acknowledgements
This article has been derived from a thesis in partial fulfillment of Master of Science in critical care nursing to the Faculty of Nursing and Midwifery, Golestan University of Medical Sciences. The authors would like to express their gratitude to the Nursing Research Center and the officials of the Golestan University of Medical Sciences, as well as all participants in the study for their cooperation.
Funding source
The study has been financially supported by the Golestan University of Medical Sciences, Iran.
Ethical statement
Written informed consent was obtained from all subjects prior to participation in the study. The study was approved by the Ethics Committee of Golestan University of Medical Sciences (ethical approval code: ir.goums.rec.1398.086).
Conflict of interest
The authors declare that there is no conflict of interest regarding publication of this article.
Author contributions
MM, FH, and HR contributed to the conception and design of the study. FH collected the data. MT performed data analysis. MM, FH, EK and MT performed data interpretation. MM, FH, HR and EK evaluated and edited the manuscript.
Human resources have always been considered as one of the most important factors in the social progress; therefore, one of the main concerns of managers is how to create a suitable ground for workers in all professions to increase a sense of responsibility and commitment (1). Nurses are one of the largest groups of healthcare providers, and the intention to leave the profession among nurses and the nursing shortages can cause problems, such as increased workload and stress, burnout, reduced quality of care, and increased medical costs (2-4). Therefore, managers of health organizations should monitor their employees in order to reduce turnover intention and the subsequent loss of human resources (5). Today, only organizations are able to continue to exist, which promote professional commitment and job satisfaction by caring about employees and providing a suitable ground for their activities (1, 6). The turnover intention rate among nurses in the United States, Canada, the United Kingdom, Scotland, and Germany was reported to be between 6.16% and 9.38% in 2011-2012, while this rate was between 4.29% and 7.53% in personnel younger than 30 years of age (7). Meanwhile, due to the increasing population growth, the need for healthcare services and nursing care is increasing everyday (8). In addition to the lack of experienced nurses, leaving the nursing profession imposes a significant financial burden on the society (9). NikJoo et al. reported that 55% and 19% of Iranian nurses had a moderate and high tendency to leave the nursing profession (10).
Hospitals are concerned about losing their workforce, because every hospital spends a huge amount of money to train its employees to the desired level of productivity and efficiency (11). Therefore, it is imperative to identify factors, such as professional commitment, which affect turnover intention (12). Professional commitment is a mental state that indicates a desire, need, and obligation to work in a particular profession. It becomes meaningful when a person fulfills his/her assigned duties in the best possible way, with satisfaction and practical commitment, without any monitoring system. Affective, continuous, and normative commitment are the three dimensions of professional commitment. A committed person believes that everyone should stay committed to the profession they have been trained even if they make a loss (1). Today, decreased professional commitment has had adverse outcomes, such as employees leaving the job (6). The level of education and professional commitment have been reported as two important factors affecting the intention to leave the nursing profession, so that with the increase in the level of education and professional commitment, nurses would be less willing to leave their profession in the years to come (1).
The labor shortage crisis in the healthcare system affected disease prevention and health promotion in many countries (10). Since nurses are the main human resources in healthcare organizations (13), they have a great impact on the quality of healthcare (14). Considering the financial and human costs of leaving the nursing profession in healthcare organizations, it seems essential to predict and prevent this phenomenon (15). The intensive care unit (ICU) is one of the busiest hospital wards, which can cause mental fatigue, work load-related physical injuries, and reduced satisfaction in nurses. Therefore, nurses working in the ICUs generally have a higher tendency to leave their profession. This study aimed to determine relationship between professional commitment and the intention to leave the job in nurses working in the ICUs of teaching hospitals affiliated to the Golestan University of Medical Sciences.
Methods
This cross-sectional study was carried out on all eligible nurses working in the ICUs and cardiac care units of 5 Azar and ShahidSayadShirazi hospitals in Gorgan and Amir al Momenin hospital in Kordkuy in 2019. Overall, 202 volunteer nurses who met inclusion criteria were enrolled in the study via census. The inclusion criteria were working in the ICUs at the time of study, having at least 6 months of work experience in ICUs, having an associate degree or higher education, and not having any known mental or chronic physical illness in the last 6 months.
Written informed consent was taken from all participants, and the study received approval from the Ethics Committee of the Deputy of Research and Technology of the Golestan University of Medical Sciences. Data were collected by using a demographic and professional information form and the professional commitment scale for nurses. Demographic and professional information including age, gender, marital status, level of education, workplace department (ICU, CCU, dialysis, emergency), work experience, work shift, type of employment, type of responsibility in the workplace, and average monthly overtime hours were collected.
The Hanshow's Anticipated Turnover Scale (ATS) was designed in 1985 and consists 12 items that are scored based on a 5-point Likert scale, ranging from completely agree (score 5) to completely disagree (score 1), in order to assess intention to leave nursing profession. In order to reduce bias, the items are divided into two equal categories with positive and negative phrases. Items 1, 3, 6, 8, 9, and 10 are given a reverse score. The overall score ranges between 5 and 60. Overall scores of 1-20, 21-40, and 41-60 indicate low, moderate, and high tendency to leave the job (66). The validity and reliability of scale for nurses was confirmed by Hariri et al. (2013), with internal consistency of 80% (9).
The Nurses’ Professional Commitment Scale (NPCS) is a 26-item questionnaire designed by Lachman and Aryana to operationalize the construct of nursing professional commitment in four domains including; understanding of the nursing profession, job satisfaction, involvement of nursing professionals, and sacrifice for the nursing profession. The questionnaire is scored based on a 5-point Likert scale. The overall score ranges between 26 and 130, and a higher score indicates a higher professional commitment. Validity and reliability of the Persian version of the questionnaire have been verified by Joolaee et al., with an estimated internal consistency of 74% (8).
Descriptive statistics including mean, standard deviation, and frequency distribution table were used to analyze the data. Normality of quantitative variables was assessed using the Shapiro-Wilk test. The Spearman's rank correlation coefficient was used to evaluate the relationship between quantitative variables. In order to analyze quantitative, demographic, and professional variables, the the Mann-Whitney U and the Kruskal-Wallis were used, respectively. The significant level was considered less than 0.05.
Results
The mean age of the nurses was 31.93±6.16 years (range from 23 to 57). The mean work experience of the nurses in the ICUs and general wards was 65.65±19.55 and 96.94±12.68 months, respectively. The majority of nurses were female (80.69%), married (60.9%), working in rotating shifts (92%), and with a bachelor's degree (88.1%) (Table 1).
The mean scores of professional commitment and intention to leave the nursing profession among the subjects were 90.40±16.69 and 36.80±4.87, respectively. The highest and lowest mean scores of the professional commitment were related to the dimensions of self-sacrifice (34.59±6.61) and job satisfaction (16.06±3.60), respectively (Table 2)
There was a significant inverse association between the intention to leave the job and the total score of professional commitment and its dimensions (Table 3).
There was also a significant relationship between professional commitment and age, clinical experience, and work experience in ICUs. However, the intention to leave the job had a significant inverse relationship only with clinical work experience (Table 4)
The mean score of professional commitment differed significantly among male and female nurses (P=0.03). However, the mean total score of intention to leave did not differ between female and male nurses (P=0.12). The mean total score of professional commitment and intention to leave the job had no significant association with marital status, education level, and working shift (P>0.05).
Discussion
According to the results, the mean score of professional commitment among the subjects was higher than the median score of the questionnaire, which indicates the high level of professional commitment among the nurses. The findings of this study are consistent with the results of Shali et al. (2015), in which the total score of professional commitment of nurses was 86, indicating a high level of professional commitment among nurses (16). Similarly, Lu et al. reported the total score of professional commitment to be 84.3 among nurses in Taiwan (17). In a study in Yazd (Iran), HoseyniManesh et al. reported a moderate level of professional commitment among government personnel (18).
In the present study, the mean score of intention to leave the job was 36.80±4.87, indicating the moderate tendency to leave the nursing profession. In a previous study in Iran, 69.9% of staff in research units had a moderate tendency to leave their job (19). Consistent with our findings, other studies in Iran (20) and Belgium (21) reported moderate turnover intention among nurses.
In the present study, there was a significant inverse relationship between the total score of professional commitment and its dimensions and the tendency to leave the job in nurses working in ICUs. This finding is in agreement with results of previous studies (22, 23). Ghadiri also reported a significant association between turnover intention and environmental ethics, job satisfaction, and organizational commitment in staff of a government company (24). Therefore, professional commitment can be considered as one of the most important predictive components of turnover intention among nurses.
In our study, the mean score of professional commitment had no significant association with age, marital status, education level, income, and shift work; however, there was a significant relationship between professional commitment and gender and work experience in ICU. In a previous study in Iran, there was no significant relationship between organizational commitment and education level, age, work experience, marital status, and employment status (25). GeramiNejad et al. (2017) found no significant relationship between professional commitment and age, gender, and marital status (26). However, they reported that nurses with rotational shift work had higher professional commitment.
In line with our findings, Soudagar et al. (2012) reported a significant relationship between gender and desire to work, while women were more willing to work in the nursing profession (27). According to Mortazavi and Meybodi, male, married, and less experienced nurses have higher turnover intention (28). Other studies also demonstrated that turnover intention is higher among male and single nurses (29-31). This may be due to the fact that, men in the Iranian society are responsible for providing for the family, and nursing is not considered a high-income occupation. In addition, being a male nurse is not socially acceptable in Iran (28).
The results of some studies in Iran showed that nurses with lower salaries are more inclined to leave their jobs than other nurses (32). A study in Saudi Arabia also showed that nurses who receive lower salaries have a greater tendency to leave their jobs. The mentioned study also attributed the higher tendency of male nurses to leave the nursing profession to the poor public image of the nursing profession in Saudi Arabia (33). Sharifzadeh et al. (2013) found that gender and age could affect turnover intention among nurses, in a way that, older nurses had a higher tendency to leave (34). Myers (2010) also reported a positive correlation between turnover intention among nurses and age (35). Ahmadi et al. (2013) also showed that married women have higher tendency to leave the nursing profession, possibly due to the interference of hospital shifts and their roles at home (36).
In line with our findings, Cai and Zhou (2009) found no significant association between demographic variables and intention to leave the nursing profession (37). Contrary to these results, Politi (2009) found no relationship between age and turnover intention among nurses (38).
Nursing is a mentally and physically challenging professionbecause the know that as a healthcare provider are the most reliable source of patients’ support (39) butnumerous shifts, and mandatory or voluntary overtimes are some factors that affect nurses' job satisfaction or turnover intention. Therefore, including nurses in monthly meetings, exploiting their experiences, encouraging them to share their knowledge, and involving them in committees directly related to patient care can be effective in creating a feeling of independence and control over one's career. Furthermore, hard working conditions and different work shifts can become more bearable if accompanied by public understanding and appreciation.
Conclusion
Based on the results, there is an inverse significant association between the total score of professional commitment and its dimensions and the intention to leave the nursing profession. Professional commitment not only promotes the profession in the society, but also prevents turnover intention and output reduction.
Acknowledgements
This article has been derived from a thesis in partial fulfillment of Master of Science in critical care nursing to the Faculty of Nursing and Midwifery, Golestan University of Medical Sciences. The authors would like to express their gratitude to the Nursing Research Center and the officials of the Golestan University of Medical Sciences, as well as all participants in the study for their cooperation.
Funding source
The study has been financially supported by the Golestan University of Medical Sciences, Iran.
Ethical statement
Written informed consent was obtained from all subjects prior to participation in the study. The study was approved by the Ethics Committee of Golestan University of Medical Sciences (ethical approval code: ir.goums.rec.1398.086).
Conflict of interest
The authors declare that there is no conflict of interest regarding publication of this article.
Author contributions
MM, FH, and HR contributed to the conception and design of the study. FH collected the data. MT performed data analysis. MM, FH, EK and MT performed data interpretation. MM, FH, HR and EK evaluated and edited the manuscript.
Type of Study: Original Article |
Subject:
Nursing
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