Post Graduate Centre, Management and Science University, University Drive, Off Persiaran Olahraga, Selangor, Malaysia
*Corresponding Author’s Email: fongchinmun@gmail.com
Keywords: Pilot Study; Registered Nurses; Private Hospital
Nursing profession is a high demand profession that requires individual capacity to cope and manage under intense physical and emotional dynamics in the workplace (Permarupan et al., 2020). New employees can be costly, as new hires need to be trained and mould to be familiar with the policies, procedures and operation in a healthcare setting (Antwi & Bowblis, 2018). Retention of registered nurses could be considered as one of the most challenging elements in healthcare organisations globally (Bobbio & Manganelli, 2015). Due to the nurses’ boundary- spanning roles, the task of today has become more demanding and competitive in contributing to the health and wellbeing of society in Malaysia (Othman & Nasurdin, 2019).
The purpose of this research is to study the relationship between family social support, employee engagement, working environment and condition, manager and peer support and development opportunities as independent variables, job satisfaction as mediating variable and employee retention as dependent variable. The data was collected via survey questionnaires to all of the respondents.
A cross-sectional study was conducted in one of the private hospitals in Kuala Lumpur, Malaysia. The population of the study includes registered nurses who were working in medical and surgical wards. Total 30 sample size were taken as pilot study before proceeding to the actual study. The response rate reached 100%. Pilot study was conducted to determine the feasibility of using a survey questionnaire and data collection processes (Fraser et al., 2018). The objective of the pilot study is to increase the probability of success in the main study by testing the viability of the study in term of content validity (Fraser et al., 2018).
Statistical analysis was performed by IBM SPSS version 23.0. Descriptive analysis was performed for demographic profile. Reliability analysis was done to measure the internal consistency in each and overall construct.
This study was conducted after approved by the Pantai Hospital Kuala Lumpur Research and Ethics Committee (PHKL REC Approval Number: PHKL-EC-2020-0004). Informed consent was obtained from all the participants before questionnaire administration.
The instrument for this research was in a form of questionnaire. The questionnaire was comprised of four categories, which are section A, B, C and D (Table 1). Section A was in a nominal and ordinal scale to form a questionnaire that consist of 5 items related to respondents’ demographic profiles such as gender, race, age, duration of working experience and average working hours per day. The nominal scales are used to identify gender and race. The ordinal scales were used to determine the nurses’ age, duration of working experience and average of working hours per day. Section B comprised of items that were related to independent variables that include family social support, employee engagement, working environment and condition, manager and peer support and development opportunities. Section C was related to mediating variable on job satisfaction and lastly section D comprised of items related to dependent variable, employee retention. Section B, C and D are using interval scale to determine on the independent variables, mediating variable and dependent variable which were measured by using five-point Likert scales which are one (strongly disagree) to five (strongly agree).
Table 1: Summary of Questionnaires Layout
Section | Variables | Dimensions | Sum of Items |
A | Demographic profile | 5 | |
B | Independent variables | Family social support | 6 |
Employee engagement | 6 | ||
Working environment and condition | 6 | ||
Manager and peer support | 6 | ||
Development opportunities | 6 | ||
C | Mediating variable | Job satisfaction | 6 |
D | Dependent variable | Employee retention | 6 |
The research instrumentation was in a form of close ended questions that adapted from previous studies (Table 2). The questionnaire was easily understood for the respondents to select the one nearest to their own standpoint. Fixed alternative questions are less time consuming for respondents to complete the questionnaires. The questionnaire was adapted from Bhatia & Srilatha (2016), Jain & Nair (2017), Motlou et al., (2016), Rosales et al., (2013) and Razak et al., (2016). In total 47 questions were distributed from Section A to D in this study.
Table 2: Research Instrumentation
Section | Dimensions | Count | Items |
B | Family social support | 1 | Someone in my family ask me regularly about my workday. |
2 | When I have problem in workplace, my family member express concern. | ||
3 | My family members help me in the household task. | ||
4 | My family give me assistance in dealing with my work- related issue. | ||
5 | My family give me good suggestions to go through difficult times at work. | ||
6 | My family listen to my work-related problem or stress. | ||
Employee engagement | 7 | I feel like I am being part of this hospital. | |
8 | Management spends time listening to nursing employees. | ||
9 | I am happy in my autonomy involvement in decision making. | ||
10 | My peers listen to my work-related problems. | ||
11 | I enjoy working with my co-workers. | ||
12 | Generally, I trust my superior and colleagues. | ||
Working environment and condition | 13 | My place of work is pleasant. | |
14 | The environment in the workplace has trust and friendliness. | ||
15 | I have too much to do at work. | ||
16 | I am satisfied with the current physical working conditions. | ||
17 | My organisation helps the employees learn the need job skills. | ||
18 | The tools and equipment used in my work make my job getting easier. | ||
Manager and peer support | 19 | My manager cares about my opinions. | |
20 | My manager shows concern on me. | ||
21 | My manager and colleagues give me advice about problems encountered on my job. | ||
22 | My colleagues help me in making work-related decisions. | ||
23 | I am encouraged to handle and solve problem by myself. | ||
24 | It is easy to get along and support from my colleagues. | ||
Development opportunities | 25 | There are opportunities to grow in this hospital. | |
26 | I have chances of promotion and advancement in this hospital. | ||
27 | My hospital provides training to employees to achieve better performance. | ||
28 | I have received sufficient training in this hospital to do my job effectively. | ||
29 | My involvement in work helps me gain skill and knowledge. | ||
30 | My involvement in work provides me with a sense of accomplishment. | ||
C | Job satisfaction | 31 | I do feel the work that I do is appreciated. |
32 | I am satisfied with management support. | ||
33 | My involvement in my work help me feel personally fulfilled. | ||
34 | I will be praised if I over perform my work. | ||
35 | I am satisfied with my work. | ||
36 | In summary, I am very satisfied working in this company. | ||
D | Employee retention | 37 | When I get up, I feel like going to work. |
38 | The morale I my unit is very high and my team are always happy. | ||
39 | I always looking forward to the next working day. | ||
40 | This job offers me long term security. | ||
41 | I will recommend other nurses working in this hospital. | ||
42 | I will not think in leaving this job. |
Demographic information and reliability test result were generated and analysed via IBM SPSS version 23.0 after gathered all the 30 questionnaires from the subjects. Demographic data were obtained in the survey as it helps to identify the characteristics of the small-scale sample in the findings. The demographic variables from the pilot study conducted was summarised in Table 3.
Table 3: Demographic Information
Demographic Variables | Frequency | Percent (%) | Cumulative Percent (%) |
Gender: Female Male | 30 0 | 100 0 | 100 |
Race: Chinese Malay Indian Others | 0 15 10 5 | 0 50 33.3 16.7 | 0 50 83.3 100 |
Age: 30 years old and below 31 – 40 years old 41 -50 years old Above 50 years old | 21 8 1 0 | 70 26.7 3.3 0 | 70 96.7 100 |
Nursing working experience in the current hospital: 1 month – 5 years 6 – 10 years 11 – 15 years More than 15 years | 20 7 3 0 | 66.7 23.3 10 0 | 66.7 90 100 |
Average working hours per day: 7 – 10 hours 11 – 13 hours 14 – 16 hours More than 16 hours | 22 6 1 1 | 73.3 20 3.3 3.3 | 73.3 93.3 96.7 100 |
100% of the registered nurses were female. Majority of them were Malay in their races (50%, n=15), followed by Indian (33.3%, n=10) and followed by others (16.7%, n=5). As for the ranging of age, most of them 30 years old and above (70%, n=21%), followed by 31 – 40 years old (26.7%, n=8) and 41 – 50 years old (3.3%, n=1). None of them above 50 years old.
With regards to the nursing working experience in the current hospital, 66.7% (n=20) of the respondents had 1 month until 5 years, 23.3% (n=7) of them already work from 6 to 10 years and 10% (n=3) had work from 11 to 15 years in the current hospital. However, none of them work more than 15 years in the medical surgical wards.
In term of average working hours per day, 73.3% (n=22) of the respondents work in between 7 to 10 hours and 20% (n=6) of them fall in between 11 to 13 hours. Simultaneously, 3.3% (n=1) reaching 14 to 16 hours and more in their average working hours per day.
Cronbach’s alpha is a measure of the internal consistency or reliability between several items, measurements or rating to estimate how reliable are the responses of a questionnaire that evaluated by subjects to identify the stability of the tools (Bujang et al., 2018). The value of Cronbach’s alpha ranges from zero to one with higher level indicating the items are measuring the same dimension and if the value is low or near to zero, it indicates all the items are not measuring the same dimension (Bujang et al., 2018). The result of the reliability analysis was summarised in Table 4.
Table 4: Reliability Test Result
Construct | Number of Items | Cronbach’s Alpha Value |
Family social support | 6 | 0.936 |
Employee engagement | 6 | 0.882 |
Working environment and condition | 6 | 0.893 |
Manager and peer support | 6 | 0.919 |
Development opportunities | 6 | 0.950 |
Job satisfaction | 6 | 0.938 |
Employee retention | 6 | 0.904 |
All constructs | 42 | 0.972 |
Development opportunities reached the highest Cronbach’s α = 0.950, followed by job satisfaction (Cronbach’s α = 0.938), family social support (Cronbach’s α = 0.936), manager and peer support (Cronbach’s α = 0.919), employee retention (Cronbach’s α = 0.904), employee engagement (Cronbach’s α = 0.882) and working environment and condition (Cronbach’s α = 0.893). The overall constructs Cronbach’s α = 0.972. All the Cronbach’s α value were acceptable and had high level of internal consistency that allowed to proceed for actual study as Cronbach’s α acceptable value should be above 0.70 (Tayakol & Dennick, 2011). No items were required to be amended or dropped.
Engaged workers are more inspired, energetic, have a better connectivity with their jobs, and able to manage productively towards the work demands (Othman & Nasurdin, 2019). Work related support from superior and peers act as the core elements of social support that can relate in burnout (Sellar et al., 2019). A leader with high concern for her subordinates has been found to contribute more employees’ satisfaction as both can feel the respect and warm relationship (Irabor & Okolie, 2019). The nature of connections including communication between the boards and nursing personnel impacts the workers themselves as well as affect organizational effectiveness by influencing productivity and turnover rates (Brunetto et al., 2014). Job contentment depicts contented level of an employee with their job and it is part of life satisfaction (Irabor & Okolie, 2019). It is essential to ensure employees job satisfaction is at the maximum level to improve work happiness and subsequently lead to retention (Hee et al., 2019). Employees who perceive they are being treated satisfactory within their organisational contributions will perform within meeting expectation level and tend to remain in the same organisation (Avanzi et al., 2014). Employee satisfaction has a direct relation on behaviour in the workplace and with good rating of employee satisfaction, it will improve the retention rate among workers (Abuhashesh et al., 2019). Nursing administration should increase their focus on developing strategies to assist and encourage junior administrative to strengthen the career prospects and increase satisfaction level within individual (Chiou-Fen et al., 2019).
The study had designed a survey questionnaire using five-point Likert scale and disseminated to 30 registered nurses working in medical surgical wards in one of the tertiary hospitals in Kuala Lumpur, Malaysia as a pilot study. Instrument development, descriptive and reliability analysis process were explained. 100% of the registered nurses were female and most of them were Malays (50%, n=15). Majority of their working experience were in between 1 month to 5 years (66.7%, n=20) and 73.3% (n=22) average working in between 7 – 10 hours per day. The Cronbach’s α of each and overall construct ranging in between 0.882 to 0.972. All the values showed high level of internal consistency.
Employee retention is a challenging issue for most of the developed and developing countries. Previous studies revealed that it is mainly focused on recruitment and selection activities of nurses. Moreover, it is important to attract and retain more dedicated and quality professional nursing staff. Considerable studies have established that job satisfaction as a main predictor of turnover intention. Therefore, it is crucial to identify significant predictors of job satisfaction which will consequently reduce turnover intention among staff nurses in Malaysia healthcare industry.
The authors declare that they have no conflict of interest.
We would like to extend a special thank you to all who had assisted us in this study and especially the Ethics Committee team to facilitate in this research.
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