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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 14  |  Issue : 1  |  Page : 17-24

Staff nurses’ intention to leave nursing profession and their organizational commitment in selected hospitals at Beni-Sueif city


1 Department of Nursing, Beni-Suef University, Beni-Suef, Egypt
2 Assistant Professor of Nursing Administration, Faculty of Nursing, Cairo University, Cairo, Egypt
3 Lecturer of Nursing Administration, Faculty of Nursing, Beni-Suef University, Cairo, Egypt

Date of Submission09-Jan-2017
Date of Acceptance30-Jan-2017
Date of Web Publication13-Jun-2017

Correspondence Address:
Rady Mubarak Ahmed
Department of Nursing, Beni-Suef University, Beni-Suef, 83512
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2090-6021.206940

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  Abstract 

Background
Nurses’ intention to leave their profession has been found to forecast their actual decision to leave. Therefore, it is alarming that many nurses have an intention to quit their profession and might be indicative that nurses are not committed to their profession.
Aim
The current study aimed at exploring the intention to leave the nursing profession and organizational commitment among staff nurses in a selected hospital at Beni-Suef city.
Participants and methods
An exploratory descriptive study was designed. The sample of the study consisted of 180 staff nurses who had at least 5 years of experience in the study setting and who agreed to participate. Data were collected using two adopted questionnaires: staff nurses’ organizational commitment questionnaire and staff nurses’ intention to leave the nursing profession questionnaire.
Results
This study revealed that staff nurses had a higher intention to leave their hospital and the profession and had a moderate level of total organizational commitment. There was a statistically significant negative correlation between organizational commitment and intention to leave the nursing profession.
Conclusion
This study concluded that the majority of staff nurses at Beni-Suef General Hospital were female, married, had nursing diploma, and had 10 years or more of experience within the hospital. They had a higher intention to leave the hospital and the profession and moderate level of organizational commitment.
Recommendation
The study recommends that the hospital manager develop retention strategies for staff nurses and that decision makers develop policies to prevent this problem. Future research is warranted for investigating the contributory factors of this problem.

Keywords: intention to leave nursing profession, nursing organizational commitment, nurses retention


How to cite this article:
Ahmed RM, Abdelwahab EA, Elguindy H. Staff nurses’ intention to leave nursing profession and their organizational commitment in selected hospitals at Beni-Sueif city. Egypt Nurs J 2017;14:17-24

How to cite this URL:
Ahmed RM, Abdelwahab EA, Elguindy H. Staff nurses’ intention to leave nursing profession and their organizational commitment in selected hospitals at Beni-Sueif city. Egypt Nurs J [serial online] 2017 [cited 2018 Jun 25];14:17-24. Available from: http://www.enj.eg.net/text.asp?2017/14/1/17/206940


  Introduction Top


Retention of existing staff nurses and their intention to leave the profession are worldwide concerns. Retention of staff nurses is a common concern among nursing heads and policy makers at a time when many countries have reported a shortage of qualified nurses (Currie and Carr Hill, 2012; Sherman et al., 2013; Aiken et al., 2014). Intention to leave the nursing profession has become a personnel problem and challenge to nursing service administration these days in the health sector. Ongoing workforce instability in many countries is raising questions on the impact of nurses’ turnover on the well-being of the nurse, quality of patient care, and system costs (Vati, 2013). Organizational commitment is an issue of prime importance, especially to the management and owners of the organizations. Organizational commitment is directly related to an organization’s profitability and competitive position in the market. Organizational commitment directly affects employees’ performance and is therefore treated as an issue of great importance (Vijayashree and Jagdischchandra, 2011). There is evidence that low nurse retention and their intention to leave their profession in healthcare practice are associated with lack of organizational commitment and loyalty (Aiken et al., 2014).

Significance of the study

Nursing manpower is one of the most important resources for healthcare organizations that represent a critical element in their success. When there is turnover intention, the quality of care provided to the population will be at risk. Organizational studies suggest that intention to leave is important for organizations and researchers because once people have actually translated their intention to quit into action, there is little likelihood of gaining access to them to understand their prior situation. A study conducted by Khater (2014) that explored the utilization and problems of nursing manpower at Ministry of Health hospitals at Beni-Suef governorate revealed that there was a significant shortage and misdistribution of nursing manpower. A serious trend was observed among staff nurses at Beni-Suef city to leave or escape from nursing profession to other careers, which aggravates the nursing shortage. Unfortunately, the majority of nurses who left were highly experienced and talented, which affected the quality of care. Therefore, this study is significant as it explored staff nurses’ intention to leave the nursing profession and their organizational commitment in the selected hospital to determine the magnitude of the problem. The results obtained will be helpful to hospital managers to understand the attitude of staff nurses toward intention to leave and their organizational commitment level and plan creative strategies for retention of staff nurses.


  Aim Top


This study aimed at exploring the intention to leave nursing profession and organizational commitment among staff nurses in the selected hospital at Beni-Suef city.

Research questions

Q1. Is there an intention to leave the nursing profession among staff nurses in the selected hospital at Beni-Suef city?

Q2. What is the level of organizational commitment among staff nurses in the selected hospital at Beni-Suef city?


  Participants and methods Top


Research design

An exploratory descriptive study was designed.

Setting

The study was conducted at Beni-Suef General Hospital, which is affiliated to the Ministry of Health and provides both inpatient and outpatient services. It is the only general hospital in Beni-Suef governorate. Its bed capacity is 331 beds and it offers services that cover all specialties where patients either come directly or are referred from rural hospitals. The hospital provides diagnostic, curative, and surgical services.

Sample

A convenient sample of 180 staff nurses was included in the study sample out of the total population of 400 nurses who met the inclusion criteria.

Inclusion criteria

Staff nurses (male/female) who had at least 5 years of experience in the study setting and agreed to participate in the study were eligible for participation.

Exclusion criteria

Nurses who did not meet the inclusion criteria were excluded.

Data collection tools

Two data collection tools were used in the study: staff nurses’ organizational commitment tool and staff nurses’ intention to leave the nursing profession tool. An acceptance letter was obtained from the tool designers with regard to the use of these tools.

The first tools (staff nurses’ organizational commitment tool): it was adopted from Elguindy and Abed (2014), who used an Arabic version of the tool developed by Meyer and Allen (1991). It consists of four sections. The first section includes demographic data specific to each participant, such as code number, sex, age, etc. The second section measures affective commitment (seven items). The third section measures continuance commitment (seven items), and the fourth section measures normative commitment (six items). The responses were on a five-point Likert scale ranging from 1 for strongly disagree to 5 for strongly agree.

The second tool(staff nurses’ intention to leave the nursing profession tool): it was adopted from Mohamed and Mohamed (2013), who used and translated the tool developed by Peterson (2009). It consists of two sections. The first section is the intention to leave the hospital section, which is a three-item scale asking respondents how likely they are to stay in their current position or leave. The second section asks the respondent about the propensity to leave the nursing profession using the same three responses. The responses were scored on a three-point Likert scale: yes, uncertain and no scored 2, 1, and 0, respectively. A higher score meant no intention to leave the profession and a lower score meant a higher intention to leave the profession.

Ethical considerations

Official permission was obtained from the Ethical Committee at the Faculty of Nursing, Cairo University. Each nurse was informed about the purpose of the study and its importance. The researcher emphasized that participation in the study was entirely voluntary and that the participant could withdraw at any time without an explanation. Confidentiality was assured through coding the data. Informed written consent was obtained from the nurses who met the criteria of selection and agreed to be included in the study.

Pilot study

A random selection of 10% (20 nurses) of staff nurses was done. The questionnaires were completed without difficulty, adding support to the validity of the instrument. Little modification was done. The time required for completion of the tool was 10-15 min. A pilot study helped the investigator plan for data collection.

Data collection procedure

An official permission from the manager of the hospital was obtained. All nurses were invited to participate in the study. The purpose and nature of the study were explained to each participant individually and written informed consent was obtained. The investigator informed them that participation was voluntary and that they could withdraw at any time. Confidentiality of information was assured.

The questionnaires were filled in by the nurses while they were on duty. The questionnaire sheets were distributed to each nurse at the beginning of the shift and collected at the end of that shift. When a shift was too busy to allow sufficient time for the nurse to complete the tool, the participant was allowed to return the tool within 2 days. The return rate was 97%. Approximately 6 weeks were consumed in data collection. Data collection lasted from the middle of January 2016 to the end of February 2016.

Statistical analysis

The collected data were coded and entered into the statistical package for the social sciences (SPSS, 20.0; Armonk, NY: IBM Corp.). Data were presented using descriptive statistics in the form of frequencies and percentages for categorical variables. Means and SDs were used for continuous variables. Pearson’s correlation analysis was used for assessment of the inter-relationships between the organizational commitment and intention to leave the nursing profession.


  Results Top


[Figure 1],[Figure 2],[Figure 3],[Figure 4],[Figure 5] summarize the findings related to the participant’s personal data. The majority (99%) of nurses were female and married (85%). The number of nurses within the age category 25 years to less than 30 years was almost equal to the number between 30 and less than 40 years and those aged 50 years and more (28, 28, and 27%, respectively). More than half (56%) of the nurses had nursing diploma. A minority (9%) of nurses had a Bachelor’s degree in nursing. Half (50%) of the nurses had 10 years or more of experience within the hospital.
Figure 1: Distribution of the studied sample as regards their sex (n=180)

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Figure 2: Distribution of the studied sample as regards their age (n=180)

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Figure 3: Distribution of the studied sample as regards their marital status (n=180)

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Figure 4: Distribution of the studied sample as regards their educational level (n=180)

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Figure 5: Distribution of the studied sample as regards their experience within the hospital (n=180)

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[Table 1] summarizes the mean score of intention to leave. The total mean score of intention to leave was 12.86, with a mean percentage of 71.44, which was a high score, meaning that nurses had a high intention to leave. The mean score of intention to leave the hospital was 6.46, with a mean percentage of 71.77, which was a high score, meaning that nurses had a higher intention to leave their hospital. The mean score of intention to leave the profession was 6.40, with a mean percentage of 71.11, which was a high score, meaning that nurses had a higher intention to leave the nursing profession. The mean scores of intention to leave the hospital and the profession were equal. The mean percentages of intention to leave the hospital and the profession were almost equal (71.77 and 71.11%, respectively).
Table 1: Mean score of nurses’ intention to leave (n=180)

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[Table 2] illustrates the percentage distribution of nurses’ intention to leave the hospital. More than half (52.2%) of the nurses did not prefer continuing to work in their hospital. More than half (53.3%) of the nurses preferred to leave as soon as possible. More than one-third (38.9%) of the nurses reported that they would not return to the hospital if they left.
Table 2: Percentage distribution of nurses’ intention to leave the hospital (n=180)

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[Table 3] shows the percentage distribution of nurses’ intention to leave the profession. More than half (51.7%) of the nurses did not prefer to continue working in the nursing profession. Nearly half (48.3%) of the nurses preferred to leave as soon as possible. More than one-third (40%) of nurses reported that they would not return to the profession if they left.
Table 3: Percentage distribution of nurses’ intention to leave the profession (n=180)

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[Table 4] summarizes the total mean score of staff nurses’ organizational commitment and its subcategories: affective, continuance, and normative commitment. The mean score of total organizational commitment was 56.24, with a mean percentage of 63.90, which means that staff nurses had a moderate level of commitment. The mean score of affective commitment was 22.82, with a mean percentage of 65.2, and the mean score of continuance commitment was 18.01, with a mean percentage of 60.3, which means that nurses had a moderate level of both types of commitment. The mean score of normative commitment was 15.73, with a mean percentage of 52.43, which means that staff nurses had a low level of normative commitment. The highest mean was for affective commitment (22.82), with a mean percentage of 65.2, whereas the lowest mean was for normative commitment (15.73), with a mean percentage of 52.43.
Table 4: The mean score of organizational commitment and its subcategories (n=180)

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[Table 5] displays the percentage distribution of nurses’ affective commitment. Almost two-thirds (66.4%) of nurses were not happy to spend the rest of their career within the hospital and nearly two-thirds (63.3%) of them were not enjoying discussing their hospital with people. More than half (51.1%) of the nurses did not consider the hospital problems to be their own. More than half (55.2%) of the nurses were not feeling as though they were a part of the hospital family. More than half (56.9%) of the nurses were not emotionally attached to their hospital. Nearly half (48.9) of them were not feeling a strong sense of belonging to their hospital.
Table 5: Percentage distribution of nurses’ affective commitment (n=180)

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[Table 6] shows the percentage distribution of staff nurses’ continuance commitment. More than half (56.4%) of the nurses were afraid of what might happen if they quit their job without having another one lined up. More than half (58.3%) of the nurses found that it would be hard for them to leave the hospital right now, even if they wanted to. Half (51.1%) of the nurses perceived that their lives would be disrupted if they decided to leave the hospital now. Almost two-thirds (62.7) of nurses agreed that remaining in their hospital was a matter of necessity as much as desire. More than half (59.8%) of the nurses were feeling that they have few options to consider leaving their hospital. More than half (57.9%) of the nurses were not considering leaving their hospital because of scarcity of available alternatives. More than half (58.4%) of the nurses were not considering leaving because it would require considerable personal sacrifice.
Table 6: Percentage distribution of staff nurses’ continuance commitment (n=180)

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[Table 7] presents nurses’ normative commitment. The majority (76%) of nurses perceived that persons must be loyal to their hospitals. More than half (59.5%) of the nurses perceived that loyalty is important and therefore they felt a sense of moral obligation to remain. More than half (57%) of the nurses felt that it was right to leave the hospital if they got an offer for a better job elsewhere. More than half (54.7%) of the nurses were taught to believe in the value of remaining loyal to one hospital. Nearly half (47.5%) of the nurses perceived that things were better in the days when people stayed with one hospital for most of their career.
Table 7: Percentage distribution of nurses’ normative organizational commitment (n=180)

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[Table 8] represents the correlation between organizational commitment and intention to leave the profession. There was a highly statistically significant negative correlation between organizational commitment and intention to leave the profession (r=−0.514). The more committed the staff, the less the intention to leave the profession.
Table 8: Correlation between organizational commitment and intention to leave the profession

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[Table 9] summarizes the correlation between intention to leave the profession and age and educational level. There was a significantly weak negative correlation between nurses’ intention to leave the profession and their age (r=−0.227). There was no significant correlation between nurses’ intention to leave the profession and their educational level (r=0.059).
Table 9: Correlation between intention to leave the profession and age and educational level

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[Table 10] summarizes the correlation between organizational commitment and age and educational level. There was a significantly weak positive correlation between nurses’ organizational commitment and their age (r=0.208). There was no significant correlation between nurses’ organizational commitment and their educational level (r=−0.062).
Table 10: Correlation between organizational commitment and age and educational level

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  Discussion Top


Regarding the intention to leave the nursing profession in the current study, the total mean score of intention to leave was high among staff nurses in Beni-Suef General Hospital, which means that nurses had a high level of intention to leave. The mean score of nurses’ intention to leave the hospital was high, which means that nurses had a high level of intention to leave the hospital. The mean score of nurses’ intention to leave the profession was high, which means that nurses had a high level of intention to leave the profession. The mean scores of intention to leave the hospital and the profession were almost equal, meaning that staff nurses’ intention to leave both the hospital and the profession was of the same degree. This finding might be because nursing had not been a childhood ambition for many nurses and the majority of them may decide to apply to the university to study their primary educational choices. Also when diploma nurses wanted to complete their study in the nursing field, the policies of nursing education were a barrier and hence they started studying another field to gain a higher educational degree.

This finding was consistent with that of Tummers et al. (2013), who conducted a study about nurses’ intention to leave the profession in the Netherlands and found that there was a high intention to leave nursing. Similar results were reported by Elguindy and Abed (2014), who found that nurses had a moderate intention to leave the hospital, and by McKillop and Minnes (2011), who found that participants expressed moderate intention to leave their employment. Contradictory findings were reported by Mohamed and Mohamed (2013), who found that the mean score of nurses’ retention in their units and the profession was high, meaning that nurses had higher willingness to remain in their units, hospitals, and the profession in general.

Regarding organizational commitment of nurses in the present study, the total mean score of organizational commitment was moderate, which means that nurses had a moderate level of organizational commitment to their hospital. The mean score of affective commitment and continuance commitment was also moderate, meaning that nurses had a moderate level of both types of commitment. The mean score of normative commitment was low, which means that nurses had a low level of normative commitment. This means that the degree of staff nurses’ commitment to their hospital is quite moderate. This may be because in Egypt once a person finds a job in a governmental organization he usually remains in that job for life because of its benefits, such as job security, leaves, and some financial benefits, especially those after retirement.

This study’s result agreed with that of Elguindy and Abed (2014), who found that the mean score of staff nurses’ organizational commitment was moderate, which was a good score as it indicated that nurses were committed to their hospital and the profession. Lorber and Savič (2014) in Slovenian hospitals found that the level of commitment among staff nurses was high to medium. Similar findings were also reported by El-Demerdash et al. (2013), who found in their study that three-fourths of staff nurses had a moderate level of total organizational commitment. Dadgar et al. (2013) at Zahedan University of medical sciences found that the highest mean score among participants was in continuance commitment and the lowest was in affective commitment. This result is inconsistent with that of Dorgham (2012), who found that the studied participants had low commitment toward their hospital, as they did not feel emotionally attached to their hospital or they felt that the hospital did not deserve their loyalty.

The present study found a significant negative correlation between organizational commitment and intention to leave the nursing profession. The more committed the staff nurses, the less their intention to leave the profession. The negative correlation between organizational commitment and intention to leave was logical and anticipated. This finding was consistent with those of Elguindy and Abed (2014), who reported a significantly strong negative correlation between organizational commitment and intention to leave the profession, and Omar et al. (2012), who found a significant negative correlation between organizational commitment and intention to leave.

The current study found a significantly weak negative correlation between intention to leave and age, meaning that older nurses had a lower intention to leave their hospital and the profession. Similar results in many studies revealed that younger nurses have a stronger intention to leave the profession compared with older nurses (Cortese, 2012; Salminen, 2012; Mohamed and Mohamed, 2013).

The current study also found a significantly weak positive correlation between total organizational commitment and age, meaning that older nurses are more committed to their hospital and the profession. This might be due to their accommodation to the hospital culture, their increased skills, capabilities, and maturation of their cognitive abilities. This weak correlation may also be attributed to the fact that older nurses experience a sense of stability and security due to prolonged years of experience in their job that helps them cope with and manage emergencies and difficult work situations. Similar findings were reported by Elguindy and Abed (2014), who found a significant relationship between nurses’ age and their general commitment level.


  Conclusion Top


This study concluded that the majority of staff nurses at Beni-Suef General Hospital were female, married, had nursing diploma, and had 10 years or more of experience within the hospital. They had a higher intention to leave the hospital and the profession and moderate level of organizational commitment.

Recommendations

The study recommends that hospital managers develop retention strategies for staff nurses and that decision makers develop policies to prevent this problem. Future research into the contributory factors of this problem is warranted.

Limitations of the study

The study was proposed to be conducted at two hospitals: Beni-Suef General Hospital and Beni-Suef Health Insurance Hospital. Unfortunately, the general authority for health insurance refused to allow the study to be conducted in its affiliated hospital at Beni-Suef. With the advice of my supervisors, we decided to conduct the study in Beni-Suef General Hospital with a larger sample. [19]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Abed F, Elguindy H (2014). The relationship between organizational commitment and anticipated turnover among staff nurses in university hospital. Egypt J Health Care 5:237–251.  Back to cited text no. 1
    
2.
Aiken LH, Sloane DM, Bruyneel L, Van den Heede K, Griffiths P, Busse R et al. Walter Sermeus, for the RN4CAST Consortium (2014). Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. Lancet 383:1824–1830.  Back to cited text no. 2
    
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Cortese CG (2012). Predictors of critical care nurses’ intention to leave the unit, the hospital, and the nursing profession. Open J Nurs 2:311–326.  Back to cited text no. 3
    
4.
Currie EJ, Carr Hill RA (2012). What are the reasons for high turnover in nursing? A discussion of presumed causal factors and remedies. Int J Nurs Stud 49:1180–1189.  Back to cited text no. 4
    
5.
Dadgar H, Barahouei F, Mohammadi M, Ebrahimi M, Ganjali A (2013). The relationship between organizational culture, job satisfaction, organizational commitment and intention to stay of health personnel’s of Zahedan University of Medical Sciences. World Appl Sci J 21:1220–1228.  Back to cited text no. 5
    
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Dorgham SR (2012). Relationship between organization work climate and staff nurses organizational commitment. Nat Sci 10:80–91.  Back to cited text no. 6
    
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El-Demerdash SM, Basal AA, Al-Deeb GA (2013). The relationship between burnout and organizational commitment among nurses at Tanta University Hospital. J Nurs Health Sci 2:20–28.  Back to cited text no. 7
    
8.
Khater M (2014). Nursing manpower at ministry of health hospitals in Beni-Suef governorate: utilization and problem. Egypt J Health Care 5.  Back to cited text no. 8
    
9.
Lorber M, Savič B (2014). Factors affecting nurses’ organizational commitment in Slovenian hospitals. Obzor Zdrav Neg 48:294–301.  Back to cited text no. 9
    
10.
McKillop J, Minnes P (2011). Occupational satisfaction, strain, and intention to quit among direct care providers assisting individuals with developmental disabilities. J Dev Disabils 17:7.  Back to cited text no. 10
    
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Meyer JP, Allen NJ (1991). A three-component conceptualization of organizational commitment, Hum Res Manag Rev 1:61–89.  Back to cited text no. 11
    
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Mohamed NA, Mohamed SS (2013). Impact of job demand and control on nurses intention to leave obstetrics and gynecology department. Life Sci J 10:223–229.  Back to cited text no. 12
    
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Omar K, Anuar K, Abdul Majid A, Johari H (2012). Organizational commitment and intention to leave among nurses in Malaysian public hospitals. Int J Bus Soc Sci 3:194–199.  Back to cited text no. 13
    
14.
Peterson J (2009). Job stress, job satisfaction, and intention to leave among new nurses, University of Toronto, unpublished dissertation.  Back to cited text no. 14
    
15.
Salminen H (2012). Turning the tide: registered nurses’ job withdrawal intentions in a Finnish university hospital. SA J Hum Res Manag 10:1–11.  Back to cited text no. 15
    
16.
Sherman RO, Chiang-Hanisko L, Koszalinski R (2013). The ageing nursing workforce: a global challenge. J Nurs Manag 21:899–902.  Back to cited text no. 16
    
17.
Tummers LG, Groeneveld SM, Lankhaar M (2013). Why do nurses intend to leave their organization? A large scale analysis in long term care. J Adv Nurs 69:2826–2838.  Back to cited text no. 17
    
18.
Vati J (2013). Principles and practices of nursing management and administration. New delhi, India: Jaypee Brothers Medical Publisher pp. 382–386.  Back to cited text no. 18
    
19.
Vijayashree L, Jagdischchandra M (2011). Locus of control and job satisfaction: PSU employees. Serb J Manag 6:193–203.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]



 

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