KnE Life Sciences | The 2nd International Conference on Hospital Administration (The 2nd ICHA) | pages: 265–273

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1. Introduction

According to Accountability Performance Report of Government Agencies in 2016 by Ministry of Health of the Republic of Indonesia [2], the number of hospitals in Indonesia in the period of 2015–2016 generally increase to 5.5%, especially private hospitals by 10%. The increasing number of private hospitals requires these hospitals to have a competitive advantage or strengths that can make them a community choice. In providing value to its customers, it's not enough for the hospital to be seen only in terms of infrastructure and facilities, but also in terms of service processes in the hospital.

Health workers in hospitals consist of medical personnel, pharmacy personnel, nursing staff, other health workers, and non-health personnel. Without undermining the role of other health workers, nurses are the main force and driving force in services provided by hospitals for all clients for 24 hours [3]. The proportion of nurses in hospitals is 40–60% of other health workers, and nurses also absorbs hospital budget of more than 50% [4], but the problem of shortage of nursing staff and the high rate of turnover among nurse are the problems of nursing staff in many hospitals around the world [5].

Globally, the rate of turnover among nurse ranges from 10–21% per the year in all countries [6] and according to Nursing Management: A Systems Approach by D. Gillies (1994) [7], the optimum standard for turnover among nurses in a hospital is 10% in a year. High turnover rates have a detrimental effect on hospitals, management, financing, and service quality [8], [9]. Turnover is the flow of entering and leaving the organization among employees that often used as indicators of company performance and easily perceived negatively as a result of the company's effective efficiency policy [10].

The turnover intention of an individual is the worst impact of the organization inability to manage an individual behavior. Turnover will be high if the company is only paying attention to profits, not to the existence of its employees. However, on the opposite situation, turnover will be low if the company pays more attention to its employees, even allocates part of the company's funds to improve employee performance, such as providing regular training to each employee [11].

In Indonesia, turnover rates among nurse are quite high and often occur in private hospitals, because private hospitals are a form of company that has rules, guidelines, and commitments that are regulated internally. On the other hand, the demand for optimal health services for the community requires nurses to work professionally with a high workload [12]. From the several previous research, we can see that its results showing that the number of turnover among nurses in hospitals is quite high. In Ibnu Sina YW-UMI Makassar Hospital, data during 2010–2012 showed that in this three the years, turnover of nurses in Ibnu Sina YW-UMI Makassar Hospital is still high with the percentage for each the year was 15% in the year 2010, 12.87% in the year 2011, and 10.18% in the year 2012 [13]. Besides that, another data from a study was conducted at BaliMed Hospital during 2008–2010 showed an increase in turnover among its nurse, which was 8.68% in the year 2008 to 10.42% in the year 2009, and became 15.76% in the year 2010 [14]. Study at the Islamic Hospital `Ibn Sina' Yarsi West Sumatra Bukit Tinggi showed that from 2009–2010, the turnover rate among nurses tended to rise by 21.3% in the year 2009 to 24.3% in the year 2010 [15]. Then, study was conducted at three private hospitals at Medan City, namely Mitra Sejati Hospital, Vina Estetica Hospital, and Imelda Hospital in 2009 showed a high turnover rate among nurses, which found the rate of turnover among nurse for each hospital was 34.88% in Mitra Sejati Hospital, 26.19% in Vina Estetica Hospital, and 24.60% in Imelda Hospital [16]. In Jakarta, preliminary research in several hospitals also found high rates of turnover among nurse. Data from Zahirah Hospital showed that the percentage of turnover among its nurse from April 2009 until April 2010 was 39% [17], while the percentage of turnover among nurse at Atma Jaya Hospital in 2009–2012 was 17.3% in the year 2009, 16.2% in the year 2010, 12.8% in the year 2011, and 30.9% in the year 2012 [18].

Various studies shows that the problem of turnover intention is triggered by the emergence of individual behavior such as job characteristics, work stress, and transformational leadership patterns of a leader that will trigger job satisfaction and organizational commitment [19]. Turnover intention is the desire of an employee to move from one organization to another. There are factors that influence turnover intention, namely job characteristics, perception, leadership, organizational commitment, and job satisfaction [20]. In addition, research done by Hanafiah published in e-Journal of Psikol (2014) [21] revealed that the factors that contribute to employees' desire to change jobs are job satisfaction and job insecurity. Other studies were done by Almutairi published in Int. J. Bus. Manag (2016) [22] show that transformational leadership has a significant positive effect on organizational commitment.

Based on some of these findings, this study aims to determine predictive modeling to measure the desirability of turnover (turnover intention) among nurse in class C hospital.

2. Methods

This study used a cross-sectional design, with data collection done through using questionnaire measurement tools. Data collection was conducted from March to August 2016 in class C private hospital. For the creation and construction of predictive-oriented models, the data were processed using a variant-based Structural Equation Model (SEM) method or referred to as Smart Partial Least Square/Smart PLS.

3. Results

In accordance with tables 1 and 2, the problem-solving indicators of quality of work derived from the model because it has a loading of less than 0.50 (0.43). The results of AVE in each construct have values above 0.50, which means that each construct is valid, and also the CR (composite reliability) and alpha Cronbach values are all above the value of 0.70, which means it has good reliability (Hair et al., 2016).

Figure 1

Model outer.

fig-1.jpg
Table 1

Summary of loading, AVE, CR, Cronbach's Alpha, and R-Square.


Variable Indicator Loading AVE CR Cronbach Alpha R 2
Turnover Intention Often Thinking Out of Work 0.935581 0.841696 0.940972 0.905848 0.368444
Desire To seek work outside the organization 0.884863
Probably will leave work if there is a better chance 0.931018
Transformational leadership Intellectual Stimulation 0.897075 0.830832 0.951542 0.932312
Individual Consideration 0.935604
Inspirational Motivation 0.924571
Idealist Influence 0.887920
Job Characteristic Skill Variations 0.632032 0.622566 0.889645 0.864308 0.268135
Task identity 0.916976
Task meaning 0.732836
Autonomy 0.696439
Feedback 0.922196
Quality of Work Life Employee participation 0.773809 0.655332 0.929402 0.910506
Career development 0.818980
Proud of the company 0.848838
Fair compensation 0.742125
Facilities gained 0.877871
Job security 0.651259
Communication 0.922897
Table 2

Summary of results.


Hypothesis Original Sample (O) T -Statistic Description
Job Characteristics Self-withdrawal Desire 0.011680 0.111782 Not significant
Transformational Leadership Job Characteristics 0.517818 9.070924 Significant
Transformational leadership Self-withdrawal Desire –0.053659 0.422867 Not significant
Quality of Work Life Self-withdrawal Desire –0.568084 5.272966 Significant

In addition, the R2 value of turnover intention is 0.368444, which can be interpreted that the variability of the turnover intention construct that can be explained by the variability of transformational leadership, job characteristics, and quality of work life is 36.8%, while 63.2% has been explained by other variables exclude variables were researched through this study.

4. Discussion

Based on the results of this study, it is known that the quality of nurses' work life in the hospital has a significant effect on the desire to resign among nurse. When the quality of nurses' work life is good, the desire/intention to resign will be low. This is in accordance with the previous research [23] explained that the positive impact of quality of work life is to improve or improve the work situation from the perspective of the hospital nurse and the perspective of the organization or hospital to develop into larger than before, so that there will be a balance between satisfaction in work and the performance of hospital nurses. However, if the quality of work life is low, then a decrease in job satisfaction, a lack of organizational commitment, a non-conducive organizational culture, increased work stress, burnout, long shifts, and work-family conflicts have been identified to make nurses leave their workplaces [24–27].

From the results of this study, it is also known that there is a considerable indirect effect between transformational leadership through job characteristics on the desire to withdraw hospital nurses. This is consistent with several theories which say that transformational leadership has an influence on employee satisfaction, where with good leadership behavior, nurses will be more satisfied with their working conditions. Then, they will not only be willing to be loyal but also provide the best service with high quality for their patients [28,29]. In addition, other theories also reinforce that leadership is a science that studies comprehensively about how to direct, influence, and also supervise others to carry out tasks in accordance with the planned orders [30].

The direct influence of transformational leadership on the desirability of self-withdrawal is also illustrated in this study. This is reinforced by the theory that transformational leadership is considered as one of the most effective leadership strategies and more likely to inspire employees to continue working with their organizations compared to other leadership styles [31,32]. Transformational leadership influences commitment without using rewards or penalties. It directly influences the level of participation and must show the same relationship with participation in the organization. The commitment of organizational members is important for an organization in creating the survival of the organization itself [33,34].

5. Conclusion

The indirect effect of transformational leadership through job characteristics on the desire for retreat (turnover intention) among nurses in the hospital is the highest influence.

Where to run an organization such as a hospital, it needs a leader with a good capability to carry out operational and non-operational activities. The hospital is a large organization, it requires great thinking and action as well as effective policies and mature decisions. In accordance with the result of this study, it can be reported that transformational leadership is considered the most effective in the field of nursing and class C hospital management, where nurses feel trust, admiration, loyalty, and respect for leaders, they are motivated to do more than usual.

The suggestion of this research is to increase leadership management from the hospital to be prioritized, and hospital management also needs to pay attention to the quality of work life, in order to achieve a conductive condition of human resources to support the realization of high work productivity both physically and psychologically.

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