Intention to Leave the Firm

¶ … Saudi Arabia there are a large number of nurses from other nations as the demand in the country for nurses is higher than the supply that the country has. This is not a strange situation as there is a shortage of nurses all over the world and retention rates of nurses are not high (Almalki, et al., 2011). This situation has also been created by the increase in the population which has required that the Saudi health care system accommodate increased numbers.

This has brought about the need to handle the recruitment of nurses and their subsequent retention in better ways (Almalki et al., 2011). There is a serious need for better strategies to handle nurse recruitment and retention because where the retention is low, and nurses are fewer, more patients are lost and the failure in terms of rescue rates is higher (Needleman, et al., 2011).

Where there are strategies in place to improve the job experience of nurses, the patients benefit as well because of the better care that they are offered (Hayes, et al., 2010). Nurses who experience a less than desirable work experience are more likely to leave their jobs sooner. They are not in a position to offer the best level of care.

For a country like Saudi Arabia which has a high demand for nurses, there is a real need to identify and evaluate the things that contribute to the negative work experience of the nurses as cause them to opt out of the career. There is a gap in this area as it has not been methodically examined. These studies have been carried out elsewhere but the results cannot be generalized to the situation in Saudi Arabia.

This is because nurses face their own unique problems in the country and there are different dynamics from other countries. Culture is an issue that is pertinent in Saudi Arabia, the structures of the healthcare institutions is also different as are the organizational systems and the experience in the work setting (Alasmari and Douglas, 2012). This study thus aims to add to the knowledge that is available on how a nurses' decision to leave the critical care employment is related to the satisfaction that the nurse experiences on the job.

It is an exploratory study that is focused on Saudi Arabia and it seeks to increase the knowledge on how job satisfaction and intention to leave are related so that ways to reduce this turnover among nurses are developed. The study will thus be about the views of nurses who are working in Saudi Arabia on job satisfaction and its impact on the decision and intention to leave employment and the profession.

Context and Background of the Study Saudi Arabia is a country that stands apart from others in terms of it cultural setting, its religion and the lifestyles of its people. This Islamic nation will be the focus of the study. This unique nation will thus be described to provide a proper context of the study. The history of the country will be explored as will other factors such as the economy, the demographics and social structure. The system of provision of healthcare in the country will also be addressed.

Economy Historically, the Saudi Arabian kingdom did not rely on oil for its wealth as this had not been discovered. Instead activities such as fishing, agriculture and trade were some of these activities. The country's economy also depended on the income from the tourists who travelled to the nation because of religion making their way to Makkah and Madinah as part of their pilgrimage. Oil was discovered after the nation allowed exploration by geologists from the America. These prospectors concentrated on the eastern region of the nation (Alshmemri, 2014).

Demography The figures for the Saudi Arabian population in 2012 were given as just under 30 million with 31% of these being made up of people from other nations. These were statistics given by the Central Department of Statistics and Information of Saudi Arabia. The composition of the Saudi nationals consisted of a majority 90% Arab composition and 10% of the population were of different descent (CDSI, 2013). Society and Culture The Kingdom of Saudi Arabia follows the accepted practices of Islam as well as the culture of the Arabs.

The faith of the people of Saudi Arabia looks at Allah as the one who ends life, who brings disease and who gives vitality. The effect of the religion can be felt in all spheres of the society. Family values are upheld in the Muslim context. The interactions by members of families are governed by Islamic values such as being loyal, being truthful, showing mercy, respecting others and adhering to other Muslim standards.

The education system also reflects Islam as the males and the females do not learn in the same classrooms all the way to university level. However, they have equal opportunities to access scholarship s that are offered to be educated outside the country. Historically, the men of the country had higher privileges than the women and were considered above them. with the passing of the years this situation has been gradually changing (Alshmemri, 2014).

Healthcare System In the kingdom of Saudi Arabia, systems of health care have been improving as they have been accommodating improvements in technology, modern infrastructure as well as reflecting the improved economy. A lot of developments have been made in this regard in the last few years. The country actually boasts highly advanced systems in line with developed nations. Healthcare has been a priority issue in the country.

The government expenditure towards this sector has been high so that the quality of healthcare provided has improved and the number of institutions offering healthcare has also increased. In Saudi Arabia, there are numerous entities offering healthcare. These include hospitals that are run by the government, hospitals both private and public run by the Ministry of Higher Education, Medical Services for Security Forces, Armed Forces Medical Services, the National Guard of Health Affairs, the Royal Commission for Jubail and Yanbu and the Aramco Hospitals (Alshmemri, 2014).

The government of Saudi Arabia views the development of health care as a key part of developing the nation. It is thus an issue that is given due attention. Three levels of healthcare including primary, secondary and tertiary levels are offered by the Ministry of Health. The primary level is what is available to most people and is in over 2000 centers all over the country. The secondary level is offered to the population in the form of the government run hospitals.

The third level of healthcare is that which is specialized and includes centers for treating major diseases such as heart issues, kidney problems and diabetes (MOH, 2011). As the country continues to develop, the healthcare services are also expected to become more advanced (Alshmemri, 2014). Statement of the Problem Healthcare systems and structures in Saudi Arabia have been improving over the last few decades.

With this improvement, it has become obvious that the job satisfaction of nurses is crucial for the future stability of this sector as well as the adequacy in provision of healthcare (Al-Dossary, et al., 2012). Studies have revealed that there are various things that contribute to the job satisfaction of nurses and some of these include but are not limited to the nurse's level of education, the work environment in which they practice, the age of the nurse and even their experience.

Through this study, factors affecting the job satisfaction of nurses within Saudi Arabia will be established and these can help especially where the Ministry of Health needs to formulate policies that deal with enhancing the job satisfaction of nurses. Information on these factors will also allow strategies to be formulated which will see fewer nurses leave their jobs and thus guarantee stability. Thus this study will seek to find the solution for the problem of nurse's decision to leave their employment by finding out what factors influence their job satisfaction.

Purpose of the Study This study has its purpose as finding out the degree of satisfaction on the job experienced by nurses working in Saudi Arabian public hospitals. The research will focus on finding out and examining what aspects cause and increase job satisfaction of the nurses working specifically in Najran. This will help in formulating strategies that will enhance job satisfaction which is expected to impact the quality of care given to patients.

The literary gap that this study aims to address is that of the lack of research into the area of job satisfaction of nurses in Saudi public hospitals and the scarcity of research done in the area of job satisfaction of nurses in general. To measure organizational commitment, the affective and continuance scales, the study will use Meyer and Allen's (2004) revised TCM Employee Commitment Survey. The TCM Employee Commitment Survey is a valid instrument used to measure affective, continuance, and normative commitment. This study will use a self-administered questionnaire.

The researchers will adapt the 'Index of Work Satisfaction Questionnaire' by Paula L. Stamps to measure nurses' job satisfaction levels. Another variable involved in this study is the perceived organizational support that will be measured by 36-item Survey of Perceived organizational support (POS)developed by Eisenberger. This one-dimensional scale will be used to measure employee's perceptions of organizational support. The study will use turnover intention scale i.e. the two-item scale turnover intentions scale adapted from Cammann et al. (1979), as presented in Cook et al.

(1981) to assess nurses' viewpoint of the possibility of willingly ending their exiting job. Intent to leave variables had been gauged with two-item questions. Significance and Aims of the Study The study's aim is to determine the public hospital nurses' level of job satisfaction in Saudi Arabia as well as what nurses perceive to be the reason for the large numbers of their own leaving their positions.

The research's significance is basically the determination of the elements that impact on job satisfaction so that the Saudi healthcare system can be stabilized and saved from imminent collapse were the trend of nurses leaving their jobs to continue. This is a crucial national issue as it ultimately impacts on the healthcare provision to the citizens of the country. It is thus a matter of priority to all the policymakers, the directors and manager and all involved in the healthcare industry.

The Ministry of Health will benefit as it will be able to encourage stability in this industry and also be able to attract more nurses into the system. The research will also add to the existing knowledge on job satisfaction and the impact on the decision to leave in the care environment in Saudi Arabia, especially the critical care environment. What the study finds out will be related to the intention by nurses to leave their positions.

The study hopes that by identifying the factors affecting job satisfaction, and improving on this, can result in a reduction in the number of nurses leaving employment and thus improve on retention of the same in the system. It is a research that is of utmost importance to the Ministry of Health and the people in charge of making policy decisions as they seek to address the turnover rates of nurses in critical care.

Literature Review Job satisfaction is a term that has been described differently by various studies and scholars. Alasmari and Douglas (2012) put forward the definition of Cumbey and Alexander (1998) who defined it as a feeling that is affective and which is dependent on how one relates with colleagues, a person's own attributes, their values, and what they expect from their workplace and the entity they work for (p. 40). Some authors define it as how one feels or their perception of their work. Hayes, et al.

(2010) grouped factors related to a nurse's job satisfaction under the intra-personal, interpersonal and extra-personal labels. The intra-personal factors are those that are within the nurse such as their coping mechanisms. The interpersonal factors are those that are relational with regard to their colleagues such as their level of autonomy, how well they interact with others. The extra-personal are those that are around the nurse in terms of the organizational policies of the hospital and the prospects of improving their education (Hayes, et al., 2010).

Alasmari and Douglas (2012) state that the inter-personal factors have been thoroughly researched and these have been related to the satisfaction levels on the job, the stress experienced. Some of these factors have been the level of independence and the degree of teamwork between the doctor and the nurse (Alasmari and Douglas, 2012). The individual's perceived likelihood of leaving their job or the organization that they are working for in the coming days is the definition given by Vandenberg and Nelson (1999, p.1315) as the intention to leave (Alasmari and Douglas, 2012).

This intention to leave, according to some scholars is a good indicator of the decision that will be made to leave the organization. It is paramount that the reasons for leaving be identified and addressed through plans designed to retain staff. Literature has been inconclusive on the decision to leave and the relationship with job satisfaction. This has been attributed to the methods used to assess this. It is expected that where definitions are standardized, then research will be conclusive.

Alasmari and Douglas (20120 state that it is not expected that a single definition will be upheld, though further research is expected to provide a clearer view of the relationship. A problem that has been identified when studying the job satisfaction levels of nurses has been the instruments that have been used to measure this. Some of the instruments that have been used for these have not had their psychometric features reported as they are modified by the researchers.

Some studies have also been problematic because of using methods which do not allow inferences on the cause to be made. Some of these are the cross-sectional research studies. However, some researchers have used longitudinal studies and these have been successful in evaluating the intention to leave by the nurses. It is also important to note that there have been no experimental studies done in this area examining how the strategies used by organizations to improve job satisfaction have affected the intention to leave (Alasmari and Douglas, 2012).

In reviewing literature that is available it has become clear that there is no data that has been collected in Saudi Arabia on the satisfaction of nurses on their jobs and even on their intention to exit their employment. Alasmari and Douglas (2012) cite the work of Al-Aameri (2000) who collected data on RNs of government hospitals in the country.

In his study it was found out that on a 5-point scale, nurses had a mean score of 3.67 in terms of satisfaction and on a 7-point scale their commitment to their jobs was 4.87. In this study, the nurses who were the most satisfied were those who had the most experience, the ones who were more mature and the ones who were divorced. For the nurses who expressed the most commitment to their jobs, the married ones were the majority.

There was also a study carried out by Al-Ahmadi (2002) in the MOH hospitals of Riyadh, Saudi Arabia. These studies showed that out of the 366 nurses who participated, there was only a fair level of satisfaction on the job Alasmari and Douglas (2012). The study was able to relate the satisfaction on the job with the conditions of the work environment, the way the nurses were supervised, how well they were paid and even how well their skills were made use of.

The nurses who had more advanced education experienced less satisfaction on the job but those with more years of experience had a low positive correlation (Alasmari and Douglas, 2012). Thus there are only a small number of studies that have evaluated how job satisfaction is related to the intention to leave.

From the 923 nurses studied by Al-Ahmadi in the year 2009 in Riyadh, it was found out that the nurses who had high levels of satisfaction and were more committed to their jobs were those who had high performance records (Alasmari and Douglas. 2012). The intention to leave was also well predicted by how difficult a nurse's job was as well as the style of leadership adopted by their supervisor and this was revealed in a study of 267 nurses in a university hospital (Alasmari and Douglas, 2012). Hayes et al.

(2010) point out that the patient outcome as well as the excellence of care are all related to the level of job satisfaction that a nurse experiences on the job. This excellence of care is jeopardized where a nurse is suffering job dissatisfaction and the likely outcome is that the nurse will leave their job and possibly their profession.

The way in which an employee sees the organization finding value in the service that they give and the way the organization takes care of the employee is referred to as Perceived Organizational Support (POS). Thus POS affects how well the employee performs their role as well as their welfare.

Where it is high, the individual feels that it is their duty to help achieve the goals of the organization and they are thus more committed as they believe that when they perform well they will be recognized and or rewarded for their efforts. In this way problems of employees absenting themselves from work and leaving employment are reduced (Perceived Organizational Support, n.d.). Eze (2014) carried out a survey on how burnout is influenced by POS and self-efficacy.

Through this study, it was found out that they both influence burnout in the nurse. The study noted that nurses require a lot of support from organizations because of the role that they play in the care given to a patient. The study also noted that in order for these nurses to perform better they required the support of their supervisors and in this way their productivity will be higher. Working together as a team was also seen as helpful in determining high performance of duties.

Where the employees are supported, they are more committed to the organization and there is more stability in the organization (Eze, 2014). In a study carried out in Malaysia, Ramoo et al. (2013) found out that nurses in the country were only moderately satisfied in their jobs. They reported that in the case of Malaysia, motivation featured highly as a determinant of job satisfaction.

Some of the things that contributed the most included the opportunity for a nurse to grow in the profession, the jobs they were assigned to do, their level of independence and the status that they held (Ramoo, et al., 2013). Many times, demography features highly when looking at the issue of job satisfaction. This is because the expectations of the person feature highly when considering job satisfaction.

Some of the factors thus considered include the age of the nurse, their level of education, their gender and even how much experience that have on the job. Studies on these demographics have not been conclusive.

Some of the things that cause a nurse to be dissatisfied with their job include the style of leadership adopted by their supervisors, the area within which they work, the amount of compensation they receive, the resources available in their work environment, the amount of work they are expected to carry out and the level of stress that they have to deal with. 39% of nurses intended to leave their jobs in a research done in Macao.

Some of the things that they cited as contributing to this decision included the remuneration they received, the work atmosphere, their work experience and their age. It is therefore clear that where there is an intention to leave employment, there is always reason for the same and it is imperative that these reasons be identified and addressed (Ramoo, et al., 2013). The level at which the employees of an organization are committed and participate well will determine the degree of success that that organization enjoys (Tolentino, 2013).

The benefits that come about as a result of the commitment of employees include less costs in terms of operations, lower employee turnover, more efficiency and improved employee and thus organizational performance. Allen and Meyer (2004) state that where the commitment of the organization is solid, then the employees are motivated to work towards achieving the goals of the organization.

In such an organization, the employee identifies himself/herself with the organization that they work for and through this, they are able to keep the goal in mind and put up with small things that may be dissatisfying (Tolentino, 2013). When thus considering the intention to leave, the organizational commitment must be considered as a variable as it impacts on the commitment of the employee and their loyalty to the organization. An employee who is loyal will be unlikely to leave the organization.

Researchers have agreed on this point, that employees are unlikely to leave an organization to which they feel they have a high level of commitment to. Meyer and Allen (2004) stated that those employees who were more affectively committed to an organization as demonstrated by their greater emotional attachment to it, performed better and found more meaning in their work than those with emotional attachment that was less (Omar, et al., 2012). Where these employees were found the organization was expected to compete better and survive longer.

Thus companies with high performance levels were expected to have more committed employees. These employees according to Omar, et al., (2012) feel obligated to their employer and thus support the company fully, work hard and stay loyal. The studies carried out by these researchers revealed that there was a negative link amid organizational commitment and the intent to leave the firm.

The studies also demonstrated that for effective retention strategies to be formulated in the public hospitals in Malaysia, moral obligation needed to be considered as a variable which impacted the organizational commitment and the intention to leave. Thus there is an inverse relationship between the intention to leave and the existence of organizational commitment and one of the partial mediators in this relationship is the moral obligation of the nurse (Omar, et al., 2012). Many research studies have been carried out on the intention to leave.

Nevertheless, it is still an issue that requires more research more so because of the way it is an issue that is affecting many nations around the world in this day (Galleta, Portoghese and Battistelli, 2011). It is an issue that has affected the developing world in various ways. Nurses who have received training quickly move to private hospitals or look for better opportunities in the developed world thus creating a crisis in their countries. Several reasons have caused this movement.

This paper will however focus on organizational commitment as a factor affecting the decision to leave (Kumar and Koh, 2011). Dissatisfaction with the job is an accepted indicator of the intention to leave the healthcare industry. The relationship between the nurse and their environment will have an impact on their level of motivation, their level of productivity as well as their intention to stay.

Some studies carried out in the past indicated that the movement of physicians from public hospitals was as a result of the decreased level of motivation, turnover intention and little satisfaction derived from their jobs. The turnover intention has been viewed as a terminal step in the decision to leave one's workplace. This is the stage at which employees seek better opportunities elsewhere. It is actually seen as the strongest predictor of the decision to leave in the healthcare industry (Jadoo, et al., 2015).

Where the turnover intention is detected early through measures aimed at determining job satisfaction, then the problem would be dealt with before employee turnover increases (Oluwafemi, 2013). Autonomy ranked highly in terms of indicating job satisfaction among nurse practitioners in many studies. Other major indicators of this were the remuneration received, the availability of bonuses, the rewards and how they were distributed, and even how well the employees were compensated for other work done that was beyond the call of duty.

Literature related to nurse practitioners had been focused on their work, relation with patients and physicians. Little has been researched on job satisfaction. Thus it is difficult to say whether their intention to leave is related to their level of job satisfaction or whether it is related to the role they play or the work that they perform as they provide care. There is also a gap in the literature that is available on the anticipated turnover of these.