Executive summary

Organizational commitment is a feeling of one's dedication towards the employing

organization, his/her willingness to work hard for that organization, and the intention to
remain with that organization. This research project seeks to determine the causative factors
behind the organisational commitment and turnover intentions of the new graduate nurses.
High rate of vacancy affect hospital efficiency because of the cost associated with recruiting
and orienting replacement nurses, and supervising new nurses. This project will identify the
main reasons as to why new graduate nurses quitting their job. To do this, the research will
focus on Factors affecting Organisational commitment and Turnover intentions.

This project is consisting the introduction part in which the section cover the meaning,
background, components of organisational commitment, factors affecting organisational
commitment, determinants of turnover and also the scope and objective of the study is to
identify the factors affecting nurses turnover in hospitals.

The research project is also covering a comprehensive review of past literature on this topic.
This will introduce the perceptions and opinions of other past researchers into the study.
Moreover, these past researchers will contribute towards the topic through their literature.
The quantitative research method will be utilized in this project to help further comprehend
the research question.

This research project is covering the Research Methodology in which Population, size of
sample, source, methods and tools for research is defined and the research is based on
Primary data. This study targeted 200 currently working nurses out of which 50 nurses
responded. The data is collected through questionnaire and it is analysed by using SPSS and
information is shown in Table and Pie charts.

The Findings and conclusion part is consisted of all the findings from the Data analysis
which is written down and on that basis Suggestions are given that help the hospital to take
that necessary steps to increase the organisational commitment and reduce employee
turnover. At the end the project also covers bibliography and annexure.

0
 Chapter 1
Introduction

1
1.1Background of the study

Nurses are the heart of the healthcare organisations but recruitment and retention of nurses to
work in the high stress, complex environment of the hospitals, however, are challenging. For
new graduate nurses, this environment is daunting.
Because of their influence on patient safety and health outcomes, nurse turnover and turnover
intent have received considerable attention worldwide. Therefore, highly committed and
dedicated nursing workforce is necessary to ensure the continuity of quality patient care and
services, organizational efficiency, performance, and productivity.
Nursing care encompasses physical, emotional, mental and social needs, in order to improve a
patient’s health and wellbeing. Caring is the central core and the essence of nursing. The
important issue of care is access to proper care and increasing patients’ satisfaction. Job
performance of nurses is affected by many factors including organizational commitment. This
study aimed to determine the relationship between organizational commitment and nurses caring
behaviour.
Nurse turnover has a negative impact on the ability to meet patient needs and provide a high
quality of care, which may create more stress on other staff due to increased workloads. This can
lead to critical changes in the behaviour of nurses towards their jobs resulting in low work
satisfaction, low productivity, and leaving the organization.
The report published by the WHO have revealed that the employees in the health-sector leave
their organisation more often due to push and pull factors. The pull factors include better
remuneration and better standard of living, while the push factors include the lack of facilities,
lack of promotion, and ineffective management. These factors not only affect the productivity of
the healthcare organisations but also impact the quality of the patient care and the reputation of
the healthcare organisation. Thus, it becomes more apparent for the healthcare organisations to
ensure the commitment of their employees (which includes nurses and doctors) and reducing the
turnover and ensuring the productivity.

2
1.2 Indian Health Care Sector
Health care is the largest service sector in India. It is projected to grow from USD 45 billion in
2005 to USD 160 billion by 2017 with an expected CAGR of 16.5 percent.

Source: India brand equity foundation 2016

Figure: Growth Trend of Health Care Sector (in USD)

The advancement of health care sector has been driven by population growth, improved health
insurance penetration, increased disposable income, government initiatives and emphasis on
public-private partnership (PPP) models.
This sector is equipped with erudite knowledge, technologies and interventions for the delivery
of health services to the population, but there are considerable deviations between the current
and 38 expected health outcomes. Further, the health care system is also burdened with
substantial challenges like improving universal access, affordability and quality of health
services, dynamic trends of diseases, reducing mortality rates, improving physical infrastructure,
coverage of health insurance, shortage of trained health care workforce, etc.
The enormous health care requirements of the country are juxtaposed against the inadequate
financial resources and managerial capacities of this sector. Thus, the existing health system is
incapable of making optimum utilisation of these interventions to deliver services to the citizens
in a comprehensive and adequate way.

3
1.3 Organisational commitment: It is broadly defined as an individual employees' strong
emotional linkage to the organization. It is the individual’s psychological attachment to an
organisation. Usually organisational commitment and job satisfaction are closely correlated
together with lower levels of intention to leave the organisation.

Organizational commitment is the employees’ state of being committed to assist in the

achievement of the organization’s goals, and involves the employees’ levels of identification,
involvement, and loyalty.

1.3.1 Organizational commitment has three components: affective, continuous and

normative commitment

(1)Affective commitment, (employees' emotional connection to the organization);

Affective or moral commitment occurs when individuals fully embrace the goals and values of
the organization. They become emotionally involved with the organization and feel personally
responsible for the organization's level of success. These individuals usually demonstrate high
levels of performance, positive work attitudes, and a desire to remain with the organization.

(2) Continuance, (perceived costs related to exit from the organization)

Continuance commitment is also driven to a great extent by organizational culture, and when an
employee finds an organization to be positive and supportive, he/she will have a higher degree of
continuance commitment. Important organizational factors like employee loyalty and employee
retention are components of continuance commitment.

(3) Normative commitment, (moral duty to stay in the organization)

Normative commitment occurs when individuals remain with an organization based on expected
standards of behaviour or social norms. These individuals value obedience, cautiousness, and
formality. Research suggests that they tend to display the same attitudes and behaviours as those
who have affective commitment.

The level of organizational commitment and the predictability in organizational commitment that
can be explained by factors, including perceived organisational support, components of job
satisfaction including pay scale, autonomy, task requirement, organizational policies, interaction,
and professional status as well as years of experience.

1.4 Factors affecting organisational commitment:

1. Perceived Organizational Support

Perceived Organizational Support (POS) refers to employees’ perception concerning the extent
to which the organization values their contribution and cares about their well-being. POS has
been found to have important consequences employee performance and well-being.

4
2. Autonomy

Autonomy is the degree to which a job provides an employee with the discretion and
independence to schedule their work and determine how it is to be done. Higher levels of
autonomy on the job have been shown to increase job satisfaction, and in some cases, motivation
to perform the job.

Employee autonomy is believed to have minimized some of the relational barriers between
superiors and subordinates. Therefore, autonomy may improve workplace functions through the
ideas and suggestions of employees, and foster relationships with a greater degree of trust
between management and employees.

3. Subordinate – supervisor interpersonal relationship

Supervisors’ behaviour includes sharing appropriate information, recognizing and rewarding

good performance and not abusing the vulnerability of others. The extent to which the supervisor
displays these behaviours will thus largely determine subordinate commitment level

4. Job characteristics

The extent that a job is structured to provide regular feedback as well

As a sense of task completion.
When tasks are intrinsically satisfying, employees tend to be more committed.
Commitment is low when employees are given repetitive routine tasks to complete.
A job that allows a high degree of autonomy and the absence of close supervision increases
commitment.

1.5. Turnover intention

Turnover intention refers to the intention of employees to quit the organization. Intentions are a
statement about a specific behaviour of interest .Turnover intent is the probability that an
individual will change his or her job within a certain time period and thus it leads to actual
turnover.

While the phenomenon of turnover intention in the nursing sector has a more serious impact than
on any other sector. There can be many consequential impacts on the organization as turnover
may lead to low productivity in nurses, poor nursing care , and added costs to the organization.
Numerous variables, both individual and organizational, have been found to influence nurses'
turnover intention.

Turnover can be categorized as voluntary turnover and involuntary turnover. When employees
decides to leave the organization their own choice, is called voluntary turnover, while, when an
organization removes an employee is called involuntary turnover.

1.6. Determinants for Voluntary Turnover:

5
There are various determinants for voluntary turnover such as: Job Satisfaction, Job Stress
(Psychological), Quality of work Life (Economic) and Age, Tenure, Marital Status
(Demographic) etc.

1. Quality of Work Life

Quality of work life constitutes a major part of any employee’s life. As most the time of an
employee’s life is spent on their jobs so it is important to have better quality of work life. It
refers to the quality of relationship between employees and the total working environment. It is a
multi dimensional concept which constitutes many dimensions that have an influence on the job
of the employees and are also considered for measuring the quality of work life. These factors
are adequate and fair compensation, safe and healthy working condition, opportunity to use and
develop human capacities, opportunity for career growth, and social integration in the work
force, work and quality of life.

2. Organisational Justice

Organizational justice is the study of the fairness in an organization and how the people perceive
it. “At its most general level, organizational justice is an area of psychological inquiry that
focuses on perceptions of fairness in the workplace”.

When employees feel that they are treated fairly by the organization in every aspect, they are
inclined to show more positive attitude and increased commitment towards their jobs.

3. Job stress

Stress is state of mental or emotional strain or tension resulting from adverse or demanding
circumstances. Stress on the job is costly for employers, reflected in lower productivity, reduced
motivation, job skills, and high turnover. Thus control over the job stress can help the Human
Resource Managers to reduce the organizational cost by reducing the turnover rate.

4. Job Satisfaction

Job satisfaction is the end feeling of a person after performing a task. To the extent that a
person’s job fulfils his dominant needs and is consistent with his expectations and values, the job
will be satisfying.

The level of job satisfaction seems to have some relation with various aspects of work
behaviours such as absenteeism, turnover and productivity. Most of the studies showed that low
absentee employees were more satisfied with their jobs. Less satisfied employees are more likely
to quit their jobs than more satisfied employees. Job satisfaction is seen to be the stronger
predictor of turnover intention.

6
 Chapter 2
Research objectives
And Research
Questions

7
2.1. Objective of the study:

To determine the factors affecting the organisational commitment and turnover intentions in
health care sector:

1. To identify the factors related to graduate nurses commitment to their organisation and
intention to stay or leave.
2. To obtain the graduate nurses perspective and the factors that affects their decisions to
remain with their employers.

2.2. Scope of the study:

The purpose of this study is to determine the perception of the early graduate nurses on the job
dimensions, organisational commitment and turnover intention to build logical relationships
among these variables.

The study was mainly undertaken to identify the level of graduate nurses attitude, the
dissatisfaction factors they face in the organization, why they choose to stay and for what reason
they prefer to change their job.

The research concentrates on the employees of health care units of Delhi NCR specifically,
Karol Bagh, Chanakyapuri, South Extension (Delhi), Palam Vihar (Gurgaon). Further, only
specific category of health care employees namely nurses and have excluded employees like
pharmacists, laboratory technicians and radiology technicians to reveal a clear and concrete
picture of the current health care set up.

2.3Research questions:

This research will strive towards finding the answers to the following questions:

In order to determine the multiple correlations between the predictors (Salary, Age, Work
experience and level of education) on the degree of organisational commitment and (reward
system, medical benefits, fair promotions) on turnover intentions among graduate nurses in Delhi
NCR, an answer was sought to the following research question:

What are the multiple correlations between the predictors (Salary, Age, Work experience and
level of education) and the nurses’ organisational commitment?

Does relationship exist between organisational commitments on turnover intentions among early
graduate nurses?

8
 Chapter 3
Literature Review

9
The present chapter deals with a review of related literature and studies on organizational
commitment and related variables. Concerns related to the complex issue of nursing turnover
continue to challenge healthcare leaders in every sector of health care. Voluntary nurse turnover
is shown to be influenced by inter-related factors, and there is increasing evidence of its negative
effects on nurses, patients and health care organizations. The objectives were to conduct a
comprehensive review of the related literature to examine recent findings related to the issue of
nursing turnover and its causes and consequences.

The literature review revealed that aged care nurses perceived they were not appreciated and
were treated differently than other health care professionals. Nurses are receiving almost no
attention and no effort was made to make them feel as if they were important parts of the
building organisation and management team. These feelings led to problems that caused low
morale, lack of job satisfaction and the perception of very little or no organisational support
(Wynd 2003; Grau et al 1991). This perception could contribute to a lack of organisational
commitment. On the other hand, it was found that nurses have been very important parts of the
health care system. The nursing work force of the next decade is forecasted to be driven by an
increasing demand and decreasing supply of registered and licensed practical nurses, second only
to aging of that workforce (laschinger et al 2001; McNeese-Smith 2001). Therefore, health care
administrators must work harder to promote and develop methods for building organisational
commitment among nurses and among other clinicians, before that imminent shortage occurs.

To carry out the review for the purpose of the present study, the key concepts, namely
organizational commitment, organizational support, work life balance and ethical leadership
behaviour have been focused upon and the review is organized around them.

Organisational commitment refers to an employee’s attachment and identification with the

organisation as a whole (Mowday et al., 2013). Further, commitment is a force that binds an
individual to a target and to a course of action relevant to that target (Meyer and Herscovitch,
2001).

Meyer and Allen (1991) proposed three dimensions of commitment, namely affective,
continuance, and normative. Affective commitment is based on intrinsic personal desire, which
entails emotional attachment, identification, and involvement in the organisation. Continuance
commitment is the awareness of the cost related with leaving the organisation (loss of personal
investments, limited employment alternatives). Lastly, normative commitment is the feeling of
obligation to continue in the employment.

Martin (2008) reports that employees’ trust on the firm, satisfaction with job and labour
conditions, the perception of flexibility, access to relevant information and feeling of
independence can enable them to be committed to the organisation.

Chew and Chan (2008) confirm that HR practices like fit between person and organisation,
remuneration, recognition, challenging assignments, training and career development can
positively influence employee commitment. Froese and Xiao (2012) suggested that, when the
HRM system of a company matches with the work values of the employee, it would lead to
enhanced job satisfaction and organisational commitment.

10
Consequently, Meyer and Maltin (2010) advocated the features of a committed employee as one
who stays with the organisation through thick and thin, attends work regularly, protects
company’s assets, shares company’s goals, performs effectively, displays organisational
citizenship behaviour, and is less likely to leave the organisation.

Further, employee commitment can result in enhanced organisational citizenship behaviour, job
performance (Tourigny et al., 2013), service quality (Tsai and Wu, 2011), low intention to quit
(De Gieter et al., 2011) and customer-oriented precocial behaviour (Hsu et al., 2011) in health
care organisations.

Turnover intention

Turnover intention refers to the subjective estimation of the employee regarding the probability
of leaving the organisation in near future (Carmeli and Weisberg, 2006). It is a conscious and
deliberate wilfulness to leave the organisation (Tett and Meyer, 1993).

Castle et al. (2007) indicated that the turnover intention consists of a progression of three phases,
thinking about leaving, thinking about searching a job and searching a job. The decision to leave
an organisation is initiated by job dissatisfaction followed by search of alternative jobs, accepting
a job offer and lastly leaving the organisation. Maertz and Campion (2004) identified eight
motivational forces that are the reasons of voluntary turnover namely affective, calculative,
contractual, behavioural, alternative, normative, moral and constituent forces.

Applebaum et al. (2010) indicated that level of job satisfaction, career prospects, mobility, and
satisfaction with one’s personal life interact together to affect turnover intention among nurses.

Determinants of organisational commitment and turnover intentions among nurses:

Quality of work life

The relationship between Quality of work life and employee commitment is based on the social
exchange theory, which suggests that a person receiving a benefit is under a strong normative
obligation to reciprocate the benefit in some way (Ojedokun et al., 2015). Employees who enjoy
a sense of better QWL are likely to exhibit confidence at their jobs and this affirmative attitude
may result in commitment towards the organisation (Sirgy et al., 2001).

Farjad and Varnous, 2013, Almarshad, 2015). Huang et al. (2007) concluded that the QWL
dimensions of work-life balance, supervisory behaviour, and compensation and benefits can
enhance employee’s commitment to the organisation.

Lee et al. (2007) have observed that QWL has a greater influence on the commitment of
employees through the satisfaction of higher order needs (social, esteem, self-actualization,
knowledge, and aesthetic). Further, developing friendly workplace, promoting respect and
recognition, supporting employee’s desire for knowledge, and creating work to maximise
employee’s potential can aid in satisfaction of higher order needs.

In health care organisations, the increase in quality of work life of nurses leads to a significant
increase in organisational commitment (Eren and Hisar, 2016).Lee et al. (2013) found that four

11
QWL dimensions, a supportive milieu with job security and professional recognition, work
arrangement and workload, work/home life balance, and nursing staffing and patient care
negatively predicted nurses’ intention to leave the organisation

Physical Work Environment

Physical work environment is defined as the facilities, equipment, resources and operational
climate that employees’ encounter and interact at their workplace. A healthy work environment
provides the physical, cultural and psychological working conditions that can maximise the
health and well-being of employees (Grimes and Robert, 2010).

According to the Canadian Health Service Research Foundation, the factors that affect the work
environment of workers are high workload, insufficient staffing, and physical environment,
inputs in decision-making and organisational communications. Aiken et al. (2002) found that low
staffing patterns and poor perception of the work environment were significantly related to poor
quality of care.

Sharma and Dhar (2016) suggested that the emphasis on progressive organisational culture,
supportive work environment, transparent organisational structure and procedures could
positively influence commitment of nurses.

McGuire and McLaren (2009) suggested that positive work environment could influence the
well-being of employees and generate higher levels of commitment.

Occupational Stress

Occupational stress refers to a negative psychological state that arises from the interaction of
employees and their work environment that they perceive to be exceeding their capability and
resources, thus disturbing their mental and physical well-being. The primary focus of
occupational stress studies has been on the relationship between stressors, strain and coping
mechanisms. Stressors are the environmental conditions that elicit an emotional response; strain
is the individual response to stressors; and coping is the individual effort to minimise stress
(Mazzola et al., 2011).

The underlying sources of stress among health care employees are insufficient time and
resources to complete tasks, coping with changing responsibilities, conflicting work-family
demands, lack of 73 involvement in planning and decision-making, inadequate pay, staff
shortage, and being involved in the emotional distress of patients (Tyson et al., 2002; Saha et al.,
2011).

Klassen and Chiu (2011) indicated that employees with high level of work related stress have
less commitment to 98 their job and a stronger desire to quit the profession.

Career Growth and Development

Career growth and development can be defined as the range of work roles or opportunities
available to an employee in the organisation to develop a particular set of skills, knowledge,
qualifications, experience, etc. The development of innovative tools, techniques and procedures

12
in hospitals requires the health care employees to maintain clinical competence through
continuing education and training (Ross et al., 2013).

Bulut and Culha (2010) revealed that the organisational training dimensions like ‘motivation for
training’, ‘access to training’, ‘benefits from training’ and ‘support for training’ have a positive
effect on the commitment of employees.

Career opportunities and development can reduce the intention of employees to exit the
organisation (Korunka et al., 2008).

Job Characteristics

Job characteristics can be defined as the specific aspects of the job that can be recognised,
assessed and which influences employee behaviour. Hsu and Liao (2016) advocated that the
commitment of employees could be enhanced through efficient job characteristics such as
increased task identity, task significance, autonomy, and feedback.

Hackman and Oldham, (1980) depicts that job is motivating when it provides greater task
identity (completing a whole piece of work from beginning to end), skill variety (the chance to
use diverse skills on different task), task significance (substantial impact of work outcomes on
others), autonomy (discretion in decision making, work methods and work scheduling), and
‘feedback (information regarding performance).

Organisational support

The Royal College of Nursing (2005) views that positive interactions and support from
colleagues are associated with a reduction in emotional exhaustion, burnout, psychosomatic
symptoms and sickness absence.

Lee et al. (2013) found that organisational support with job security and professional recognition,
work arrangement and workload, work/home life balance, and nursing staffing and patient care
negatively predicted nurses’ intention to leave the organisation.

Rousseau and Aubé (2010) proposed that the support provided by immediate supervisor and co-
workers can create positive work experiences by satisfying the needs for esteem, approval, and
affiliation, which can improve the employee’s affective attachment with the organisation.

Job Security

Job security is defined as the employee’s perception at the job level about job stability or
permanence (Sverke et al., 2002; Probst, 2005). It is a psychosocial motivator as well as a
sentinel indicator of employment conditions and the way work is organised.

Employees in private health care units commonly are in temporary jobs and face job insecurity,
which is characterised by a lack of control over future work, income opportunities, and fewer
rights (Benach and Muntaner, 2007; Richardson, 2008).

13
Further, health care employees also show higher turnover intention and develop a negative
attitude, when they experience high levels of job insecurity (Mauno et al., 2005). Job security is a
basic rudimentary expectation of health care employees as well as a part of their psychological
contract (Hyde et al., 2009).

Employee Welfare

Employee welfare refers to a set of policies and programs, which provides support to the
employees and their families as well as enhance personal effectiveness and quality of life (Berry
et al., 2010). Welfare plans are influenced by several factors like government regulations, the
strategy of the organisation, business unit activity, industry type, and general competitive and
economic environment as well as cultural factors (Oliver and Cravens, 2001).

In health care sector, providing employees with canteens, subsidised meals, medical facilities,
and education facilities for children, childcare or elderly care facilities, retirement benefits,
recreational facilities, subsidised transport facilities, housing allowances, provision of loans, etc.
are regarded as welfare benefits. The implementations of employee welfare schemes are capable
of attracting and retaining employees, turnover reduction, spawning cooperative behaviour,
meeting employee’s needs better, improving their morale as well as QWL (Lin et al., 2011;
Hassan, 2014).

Grievance Management

A grievance can be defined as any dispute that arises between an employer and employee, which
relates to the implied or explicit terms of the employment agreement (Hunter and Kleiner, 2004).

Roche and Teague (2012) conceptualised two contrasting grievance management approaches,
formal and informal. The first approach is traditional consisting of formal and hierarchical
procedures (compulsory or voluntary) and sometimes involve a third party. The second approach
is softer, remedy oriented and proactive to prevent grievances by making the employee feel
valued and involved. In most organisations, the grievance related to employment relations is
informally discussed by the aggrieved employee with the immediate supervisor and is often
resolved without entering the formal grievance.

Effective grievance redressed mechanism can increase motivation and encourage health care
workers to serve in rural, remote, and underserved areas (Lisam et al., 2015). Further, the
existence of a credible grievance system that encourages prompt redressal can enhance employee
trust and lead to employee engagement thus leads to organisational commitment and reduced
turnover.

Compensation and Rewards

According to Sweins and Kalmi, (2008) compensation is a driver of employee attitudes and
behaviours and is vital for appreciating employee worth, attracting potential job incumbents, and
retaining existing employees.

14
Rewards received by health care employees comprise of monetary incentives, development
opportunities, recognition, respect within a hierarchical system, and enhanced public image of
the profession (Hasselhorn et al., 2004; Van Vegchel et al., 2005).

Tremblay (2008) evidenced that satisfaction with pay reduced employee turnover intention by
enhancing affective commitment and increasing the cost associated with leaving the
organisation. Wang et al. (2010) found that pay satisfaction significantly influences employee
commitment and more specifically, the financial pay satisfaction was the strongest predictor of
employee commitment.

15
 Chapter 4
Research
Methodology

16
4.1 Introduction

This chapter focuses on research methodology that is used in the study.

Research methodology is a collective term for the structured process of conducting research.
There are many different methodologies used in various types of research and the term is usually
considered to include research design, data gathering and data analysis.

Right from selecting the topic and carrying out till recommendations research methodology
drives the researcher in the right track. The entire research plan is based on the concept of right
methodology.

4.2 Research Design

This study used descriptive research. Descriptive research involves collecting data that describe
events and then organizes, tabulates, depicts, and describes the data Collection. It often uses
visual aids such as graphs and charts to aid the reader in understanding the data distribution and
therefore offered a better clarification on commitment and turnover intentions of early graduate
nurses.

4.3 Population of the study

This Study Targeted 200 currently working Nurses of Delhi NCR.

4.4 Sampling Method

Convenience sampling is a type of non-probability sampling that involves the sample being
drawn from that part of the population that is close to hand. This type of sampling is most useful
for pilot testing.

4.5 Data Source

Primary data:

Primary data collected from a structured Questionnaire, This is the most popular tool for data
collection. A questionnaire contains questions that the researcher wishes to ask his respondents
which are always guided by objective depending upon study.

Secondary Data

Secondary data is a type of data that has already been published in books, newspapers,
magazines, journals, online portals etc.

The data was collected by downloading several research papers on the topic.

4.6 Sample Size

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The Sample size of this study is 50.

4.7 Method of Data Collection

The questionnaire was in a structured format in which the questions asked from the respondents
were very precise and concisely stated in advance, thus maximizing standardisation. A five-point
Likert scale was used ranging from ‘Strongly Disagree’(1), ‘Disagree’( 2), ‘Neutral’ (3), ‘Agree’
(4) ,’Strongly Agree’( 5).

4.8 Instrument Used

SPSS Statistics is a software package used for interactive or batched, statistical analysis.

18
 Chapter-5
Data Analysis
(Data Result & Interpretation)

19
 1. Gender

Interpretation: Majority of nurse respondents were female.

20
2. Age

Interpretation: Majority of the respondents were of the age group 20-29.

21
3. Education

Interpretation: Majority of the respondents have completed bachelor level of

education.

22
4. Monthly salary

Interpretation: Majority of the respondent’s monthly salary range between

18001-25000.

23
5. Work experience (years)

Interpretation: Work experience of majority of the respondents was 0-1 i.e. most
of the respondent nurses were freshers.

24
6. Rank

Interpretation: Respondents participated were from staff nurse position mostly

(74%).

25
7. Hospital category

Interpretation: Majority of respondents were from private hospitals.

26
8. Hospital level

Interpretation: Majority of Respondents were from tertiary level of hospital

27
9. Hospital Bed Capacity

Interpretation: Majority of respondents were from the hospitals with hospital bed
capacity 150 & above.

28
10. I intend to stay in my current organisation for a very long time /OCI

Interpretation: Majority of the respondents agreed that they intended to stay in

their organisation for a very long time.

29
 11. In my organisation, there are opportunities for continuing education/OC2

Interpretation: Most of the respondents agreed that in there organisation,

there are opportunities for continuing education.

30
12. I am willing to change my organisation for better opportunities/OC3

Interpretation: Majority of the respondents willing to change their organisation

for better opportunities.

31
13. I like to put in efforts in my work because I enjoy my work/OC4

Interpretation: Most of the respondents agreed that they enjoy their work.

32
14. The performance appraisal system in my organisation is very good/OC5

Interpretation: Majority of the respondents agreed that the performance appraisal

system in their organisation is very good.

33
15. In my organisation staffing of the ward is/OC6

Interpretation: Majority of the respondents stated that in their organisation the

staffing is standard.

34
16. I feel rotation of nurses across the ward in my organisation is convenient/OC7

Interpretation: Most of the respondents agreed that rotation of nurses across the
ward in their organisation is convenient.

35
17. I am satisfied with the existing grievance settlement system of my organisation/0C8

Interpretation: Majority of the respondents were satisfied with the existing

grievance settlement system of their organisation.

36
 18. I feel the reward system of my organisation is good and unbiased/OC9

Interpretation: Majority of the respondents felt that the reward system of their
organisation is good and unbiased

37
 19. The tools and equipment I need to do my job are readily available/OC10

Interpretation: Majority of the respondents agreed that tools and equipments are
readily available to do their job.

38
 20. I have access to training programs for learning new skills/gaining knowledge

Interpretation: Respondents were agreed that they have access to training

programs for learning new skills/gaining knowledge.

39
 21. The employees in my organisation get due recognition from the supervisors for a
job well done. /OC12

Interpretation: Majority of the respondents disagreed that in their organisation

they get due recognition from the supervisors for a job well done.

40
22. I feel salary provided by my organisation is very competitive/OC13

Interpretation: Majority of respondents agreed that the salary provided by their

organisation is very competitive.

41
23. Promotions are fair and equitable in my organisation/OC14

Interpretation: Majority of the respondents agreed that promotions are fair and
equitable in their organisation.

42
24. I have the flexibility to arrange my work schedule to meet my personal/family
responsibilities/OC15

Interpretation: Majority of the respondents were agreed that there is flexibility in

their organisation to arrange their work schedule to meet personal/family
responsibilities.

43
25. Medical benefits provided by my organisation are very good/OC16

Interpretation: Majority of the respondents agreed that medical benefits provided

by their organisation are very good.

26. I often think about leaving my organisation/OC17

44
Interpretation: Most of the respondents agreed that they often think about leaving
their organisation.

45
27. I recommend my organisation as a good workplace to work at (OC18)

Interpretation: Most of the respondent nurses would like to recommend their

hospitals as a good workplace to work at.

46
Chapter 5

Findings &
Conclusions

47
 Findings:
By analysing the data, it is found that

● More than 70%, Respondents intended to stay in their organization for a very long time
● More than 65%, Respondents stated that there are opportunities for continuing education
in their organization
● More than 70%, Respondents were willing to change their organization for better
opportunities.
● More than 55%, Respondents believed that the performance appraisal system in their
organization is very good.
● Around 62%, Respondents stated that staffing of the ward is standard in their
organization.
● More than 65%, Respondents were satisfied with the existing grievance system in their
organization.
● More than 60%, Respondents think that the reward system in their organization is good
and unbiased.
● More than 65% , Respondents believed that the tools and equipment needed to do their
job are readily available
● More than 55% , Respondents stated that in their organization they have access to
training programs for learning new skills/gaining knowledge
● Around 50% respondents think they don’t get due recognition from their supervisors.
● More than 55%, Respondents think that the salary provided by the organization is
competitive.
● More than 55%, respondents think that promotions are fair and equitable in my
organization
● More than 70%, Respondents believed that medical benefits provided by their
organization are very good.
● More than 50% , Respondents often think about leaving their organization
● More than 55%, Respondents stated that they would recommend their organization as a
good place to work.

Correlation

All analyses were conducted at the 0.05(p) significance level.

Negative correlation existed between organizational commitment and turnover intentions(r= -

0.45, p =.001) of nurses.

Positive correlation existed between organizational commitment and age (r = 0.38, p=0.05).

Negative correlation existed between turnover intentions and work experience(r=0.24, p=0.095)
and positive correlation existed between organizational commitment and work
experience(r=0.041, p= 0.03)

48
Data showed that there is positive correlation of organisational commitment with the level of
education(r=0.44, p=0.01) and also with recognition and support from the supervisors(r=0.48,
p=0.00) and salary (r= 0.50, p= 0.00)

Data showed that turnover intention is negatively correlated with promotions(r= -0.43, p=
0.002), reward system(r= -0.286, p=0.044) and medical benefits(r= -0.34, p=0.013).

Conclusion
The overall objective of the study was to determine the factors affecting organisational
commitment and turnover intentions of early graduate nurses. It is observed that both the

49
external and internal factors are responsible for employee turnover. In the external factors
opportunity for growth and promotion outside, location and work life space are the important
And in the internal factors compensation, work timing, relations with supervisor / manager,
training and work load are important respectively. The results of the present study showed that
the participated nurses’ organizational commitment score was moderate totally. Reaching its
objects, the organization needs to its employees who do their work with interest, passion
and committed to that organization.

The study suggested that the relationship existed between the dependent variable organizational
commitment and independent variable like age, work experience, pay structure, educational
level, and promotions and there is positive correlation existed between them.

In the present sample, new graduate nurses were likely to leave their organisation for better
opportunities. This result suggested a greater probability of early turnover for new graduate
nurses respondents in the present study.

This study also suggested that organisational commitment among new graduate nurses determine
their turnover intention. When new graduate nurses are satisfied with their jobs and pay and feel
committed to the organisation, the turnover intent decrease.

Limitations

1. Respondents may have hidden some facts due to personal bias.

2. The study is conducted within a short period of time so it is not possible to collect the
information from the all hospitals of the Delhi NCR.
3. The restricted sample size was one of the limitations.

50
 Chapter 6
Suggestions
Bibliography,
Glossary & Annexure

Suggestion

51
Create a Positive Working Environment

Hospitals should create an efficient, two-way interview process that showcases what the
institution has to offer and analyses the candidate’s behavioural competencies. Non-clinical skills
like positive attitude, teamwork, collaboration, drive and initiative impact performance and
retention.

Team collaboration and supportive work environments

Positive perceptions of work environment, working group friendliness and warmth, and
adherence to job standards inversely influenced turnover and intention to leave.

Provide Opportunities for Professional Development

Hospitals can improve quality of care by helping nurses advance their education to the bachelor’s
level and beyond.

Reduce Overtime

“If hospitals implement measures to reduce shift and workweek length, and set guidelines for
what is an acceptable amount of overtime, nurses will not feel obligated to tack on extra hours.”

Adopt a Nurse Residency Program

Residency programs can help experienced nurses feel less frustration and greater satisfaction
when assisting with orientation.

Reward Longevity and Excellence

Hospital can achieve a voluntary turnover rate of less than 1 percent by creating a culture where
nurses want to stay, due to the rewards offer by the hospitals. For example,

● Staff members received up to five days of pay when the hospital met its goals.
● An incentive program allowed nurses to earn for accomplishments like presenting at a
conference, completing a fellowship program or receiving thank you notes from patients.
● Nurses with 15 or more years at the hospital automatically received an additional five
days of vacation time.

52
Practice Shared Governance

Shared governance measures like self-staffing, which enables nurses to select shifts based on
availability, can give nurses a sense of ownership over their unit.

Advancing Nurse Education

Nurses can continue their education to enhance the quality of patient care and pursue more
advanced career opportunities.

Bibliography

Books

53
 1. Gupta C.B., (2011), Human Resource Management (15th Edition), Sultan Chand
Publication, Delhi

Websites

https://journals.sagepub.com/doi/abs/10.1177/227868211562722
8 accesses on 19/01/2019 at 5.00 pm
https://www.sciencedirect.com/science/article/pii/S2352013217302892?via%3Dihub
accessed on 25/01/2019 at 11.00 am

https://bizfluent.com/info-8206028-types-employee-turnover.html accessed on 02/02/2019 at

5p.m.

https://www.tandfonline.com/doi/citedby/10.1080/03069880120085992?scroll=top&needAccess
=true accessed on 01/03/2019 at 10.00 pm

Research Paper
1. ALLEN, N. and MEYER, J. 1990. The measurement and antecedents of affective,
continuance and normative commitment to the organization. Journal of Occupational
Psychology, 63: 1–18.
2. ARNOLD, J. 1985. Tales of the unexpected: surprises experienced by graduates in the
early months of employment. British Journal of Guidance and Counselling, 13: 308–
319.
3.Global Journal of Management and Business Studies. ISSN 2248-9878 Volume 3,
Number 10 (2013), pp. 1219-1230 © Research India Publications
4.Dasgupta, P. (2014). Examining the Relationship between Turnover Intention of
Nurses with Job Satisfaction, Affective, Occupational, and Group Commitments: Study in
Private Hospitals. Jindal Journal of Business Research, 3(1–2), 29–38.
https://doi.org/10.1177/2278682115627228

Annexure

1. Gender
❏ Male

54
 ❏ Female
2. Age (years)
❏ 20-29
❏ 30-39
❏ 40 & above
3. Education
❏ Bachelor
❏ Master or PG Diploma
❏ Other
4. Monthly Income
❏ Less than or equal to 18000
❏ 18001-25000
❏ 25001-30000
❏ 30001-50000
❏ 50001-75000
❏ 75000 & above
5. Work Experience (years)
❏ 0-1
❏ 1.1-3
❏ 3.1-5
❏ 5.1 & above
6. Rank
❏ Staff Nurse Position
❏ Managerial Position
Other
7. Hospital Category
❏ Public
❏ Private
8. Hospital Level
❏ Primary
❏ Secondary
❏ Tertiary
9. Hospital Bed Capacity
❏ Less than 50
❏ 50-75
❏ 76-149
❏ 150 & above

10. I intend to stay in my current organisation for a very long time

● Strongly Disagree
● Disagree
● Neutral
● Agree
● Strongly Agree

55
11. In my organisation, there are opportunities for continuing education
● Strongly Disagree
● Disagree
● Neutral
● Agree
● Strongly Agree
12. I am willing to change my organisation for better opportunities
● Strongly Disagree
● Disagree
● Neutral
● Agree
● Strongly Agree

13. I like to put in efforts in my work because I enjoy my work

● Strongly Disagree
● Disagree
● Neutral
● Agree
● Strongly Agree

14. The performance appraisal system in my organisation is very good

● Strongly Disagree
● Disagree
● Neutral
● Agree
● Strongly Agree

15. In my organisation staffing of the ward is

● Strongly Disagree
● Disagree
● Neutral
● Agree
● Strongly Agree
16. I feel rotation of nurses across the ward in my organisation is convenient
● Strongly Disagree
● Disagree
● Neutral
● Agree
● Strongly Agree

17. I am satisfied with the existing grievance settlement system of my organisation

● Strongly Disagree
● Disagree
● Neutral

56
 ● Agree
● Strongly Agree

18. I feel the reward system of my organisation is good and unbiased

● Strongly Disagree
● Disagree
● Neutral
● Agree
● Strongly Agree

19. The tools and equipment I need to do my job are readily available
● Strongly Disagree
● Disagree
● Neutral
● Agree
● Strongly Agree

20. I have access to training programs for learning new skills/gaining knowledge
● Strongly Disagree
● Disagree
● Neutral
● Agree
● Strongly Agree

21. The employees in my organisation get due recognition from the supervisors for a job well
done.
● Strongly Disagree
● Disagree
● Neutral
● Agree
● Strongly Agree

22. I feel salary provided by my organisation is very competitive

● Strongly Disagree
● Disagree
● Neutral
● Agree
● Strongly Agree

23. Promotions are fair and equitable in my organisation

● Strongly Disagree
● Disagree
● Neutral
● Agree

57
 ● Strongly Agree

24. I have the flexibility to arrange my work schedule to meet my personal/family responsibilities
● Strongly Disagree
● Disagree
● Neutral
● Agree
● Strongly Agree

25. Medical benefits provided by my organisation are very good

● Strongly Disagree
● Disagree
● Neutral
● Agree
● Strongly Agree

26. I often think about leaving my organisation

● Strongly Disagree
● Disagree
● Neutral
● Agree
● Strongly Agree

27. I recommend my organisation as a good workplace to work at

● Strongly Disagree
● Disagree
● Neutral
● Agree
● Strongly Agree

58