1. Introduction
Maintaining health and wellbeing are the basic responsibilities of nurses. Nurses’ shortage or turnover can be a major crisis in healthcare services, especially during the pandemic. In Kuwait, many nurses have resigned during COVID-19, the majority finds a better working opportunity abroad with better salary along with other advantages, which in return led to an increase in the nurse’s turnover [1]. Therefore, nurse turnover is an eternal problem [2], which costs significantly to the health organisation in terms of preparing new staff with the provision of training, supervision and follow-up with the new staff. As a result, managers need to apply appropriate human resources practices to retain their staff and manage turnover.
2. Background of Nurse’s Turnover
Nurses’ shortage has been a common phenomenon in Kuwait and globally [3]. Nurses are considered as a minority proportion of the workforce of the health organisations in Kuwait, where the vast majority are overseas workers [4]. Indeed, this is not a recent problem but has been identified many years ago as a result of ineffective strategic planning along with incompetent nursing management and resourcing plans in the Health organisation/Kuwait. Therefore, many talented and qualified nurses either resign to be with family or leave the country to work abroad (non-Kuwaiti nationals). Nurse turnover is a significant issue faced in many departments, especially after the pandemic between 2020 till date, further, due to different reasons such as low pay, ineffective policy or finding a better opportunity abroad.
Generally speaking, Kuwait relies significantly on foreign nurses, for example, Egyptians, Philippines and the vast majority are Indians, the rest of the nurses are coming from 35 countries [5] [6]. In contrast, Kuwaiti nurses are a minority as mentioned earlier in which they represent 6% in 2016, this increased slightly to 8.8% in 2020 [6] from the total nursing professional’s manpower [6]. According to the Ministry of Health/Kuwait (ibid), the healthcare delivery department is one of the vital areas that is occupied mainly by foreign nurses. These huge differences in the number of nurses have led to the inability of the health system, especially with the presence of COVID, many foreign nurses migrated to western countries. In this context, Brexit led many European nurses to leave the country [7]. This in return, allows several nurses to join NHS due to the new immigration policy which enhances the worldwide opportunity for other nurses to take place within the United Kingdom. This affects other countries adversely, those who rely mostly on foreign nurses. In this perspective, there are several forms of nursing turnover, this could be negative such as resignation or punishment, but sometimes also this might happen for a positive reason such as promotion. Besides, departmental or organisational transfer for better chances of professional development, this in return affects the health organisation adversely by losing the staff.
2.1. Employee Turnover
The managers are considering employees as a vital element for organisational progression and sustainability [8]. Previously, mentioned that when the individuals are leaving their respective organisation, this could negatively affect the work output, hence, the organisation might collapse. In the meantime, the most critical challenge that faces managers in the organisation is employee turnover. The manager has to ensure that their employees are satisfied with their current job and if not, the relevant plan and policy must be implemented to avoid consequences such as losing the staff. In this regard, [9] (p: 305) identifies employee turnover as “a rotation of employees or transfers from an organisation to another between the firm’s jobs and occupations, and between the state of employment and unemployment”. [10] highlighted the importance of providing Human Resources Management to handle the issues of staff turnover through developing substantial policies that aim to enhance organisational advancement.
Sometimes a high rate of individual turnover is related to the organisation’s instability of employment [11]. For example, during the pandemic many organisations have been closed, hence, the vast majority of the employees were at risk of termination due to unstable business. Therefore, employee turnover is usually uncertain. Despite that, some elements or indications are increasing the level of individuals turnovers such as nepotism, ineffective relationships with the manager or personal preference by the manager to some staff which lead others to leave the work, further, unproductive planning such as improper staff distribution in different areas without considering their qualification or experience. As an example, nurses with Intensive Care or Emergency experience will be transferred to the outpatient department where the cases there are stable and required only follow up appointments. Poor management is a vital factor that leads employees to leave [11] [12]. When managers do not have sufficient criteria to solve employee conflicts or other organisational problems this would lead employees to leave their organisation.
2.2. Human Resource Management Definition
Human Resource Management (HRM) is a vital unit of every work in the organisation, which deals with the individual’s issues within the organisation such as hiring, firing, retention, etc. Also, it has an essential role in supporting employees’ professional development across a wide range of guidelines, policies and practices [13]. These policies and guidelines will assist to assure that the staff knowledge and skills are effectively participating in reaching organisational objectives. HRM also helps in maintaining employees’ security and safety within the organisation. In this regard, Human Resource Management (HRM) is defined as “a strategic and coherent approach to the management of an organisation’s most valued asset: the people working there who individually and collectively contribute to the achievement of its objectives” [14] (p: 4). It means that HRM is a significant part of organisational strategic planning, which help to assign the right employees in the right departments, to help them in participating effectively in the organisation’s success [15]. If the organisation’s HRM does not control employee turnover, thus, will lead organisations to lose staff knowledge, skills along with their competency. However, it is worth considering the Strategic HRM briefly, to limit staff turnover and its impact on the organisation. In this perspective, Strategic HRM is identified as follow:
“The process of defining how the organisation’s goals will be achieved through people by means of HR strategies and integrated HR policies and practices” [16] (p: 37).
This implies that to obtain an effective strategic HRM, the organisation must plan for the future effectively by developing the relevant policies and guidelines with consideration to the future needs and demands, in order to avoid any collapse in the delivered healthcare.
3. Study Aim
The study aims to eliminate employee turnover and effectively retain nurses’ staff in X organisation, with a particular reference to Human Resources Management theory.
Research question:
How can the application of human resources theory explain the relationship between human resources motivation and retention?
4. Methods
The outcome of this paper is to understand what could help to enhance nurses’ retention in their respective organisations along with mitigating their turnover. This is by exploring the reasons behind nurses’ turnover in X organisation, particularly considering the importance of effective human resources management theory in lessening nurses’ turnover. The covered method in this paper was a questionnaire for 20 nurses, further 20 interviews, for the nurses who are working in managerial and clinical positions. The selected sample has been chosen according to the roles and interests in the research.
The questionnaire was distributed to 20 nurses in the Adult and the Pediatric outpatient departments (n = 20). Further, 20 nurses (n = 20), will be interviewed from both departments. This will include males and females, senior, junior and nursing supervisors. The inclusion and exclusion criteria considered in this research are as follow; inclusion criteria: nurses from both Adult and pediatric outpatient departments, Kuwaiti and non-Kuwaiti national are included. Various pieces of knowledge are applied at the beginning of the research to confirm that appropriate studies are included or excluded. Based on, the quality of the methodology review, inclusion can include accessible search terms, target groups (nurses, nurse turnover, nurses shortage, nursing in Kuwait, human resources management, employee motivation, staff retention). However, some of the papers that are not relevant to nurses were excluded and some pieces of literature are not associated with the research aim. On the other hand, the exclusion criteria, are the nurses from other departments, or those who are not willing to participate.
Data collection was from February to May 2019 at the X organisation—government sector/Kuwait. Informed consent combined with participant information sheet obtained before the interview and questionnaire. Ethical clearance was obtained from the ethical committee. Data collection: Both Arabic and non-Arabic speaking nurses are involved.
5. Results
Data analysis was performed on the data from 40 nurses: in the outpatient department (Adult/Pediatric). Among those 40 nurses, 12 (30%) nurses were working in pediatric OPD, and 28 (70%) nurses were working in Adult OPD. The vast majority were from India 36 (90%), the remaining 2 Arab (5%) and 2 from the Philippines (5%). The majority were 35 female nurses (87.5%), the remaining were 5 male nurses only (12.5%). This includes 3 Muslims (7.5%), 7 were Hindus (17.5%) and the majority were Christian 30 (75%). Most of the participants were married 27 (67.5%) and 13 were singles (32.5%). The number of nurses who had a diploma in nursing was 13 (32.5%), 27 nurses with Bachelor’s (67.5%), no higher degree in nursing.
It is worthy to note that the nursing who work in adult and pediatric departments are divided into 2 categories; either having a direct contract with the ministry of health or an indirect contract. In this perspective 8 nurses (20%) have a direct contract with the ministry of health, remaining nurses 32 (80%) their contract is indirect with the ministry of health, through private agencies. Each category has it is policy and guidelines. In addition, senior nurses who had 5 years or more experience in Kuwait, those with 10 years experience or more they considered as nursing supervisors. Further, junior nurses who had less than 5-years of working experience in the country. All the participants responded effectively to the interview and questionnaire. Table 1 illustrates the responses of the participants.
I have selected the interview to gather more details about the reasons behind the resignation. Therefore, 16 nurses (80%) expressed that the main reason for leaving the country is low salary or allowances, in which other countries provide batter salary than what actually they are receiving in Kuwait. Besides, some countries within the Gulf Cooperation Council Countries (GCCC) provide annual ticket and accommodation allowances. Furthermore, 10 nurses (50%) highlighted that immigration visas in other countries such as the United Kingdom and Australia are more appealing. Four nurses (20%) described that they prefer to work in areas where the workload is less. Some of the nurses 10 (50%) are seeking a positive working environment where they can be treated equally. Likewise, 3 nurses (15%) stated that the rules and regulations need to be amendment such as leaves and weekly off, in comparison to other Gulf Cooperation Council Countries (GCCC). 1 nurse described that since she joins the work in 2016 no productive professional development programs there, which mitigate the chances for career
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Table 1. The participant’s responses to the questionnaires and interviews.
progression. Around three fourth of the participants 24 (60%) had not got any chances of receiving training between the years 2017-2019. Between the years 2019 to 2020, three nurses were transferred from X organisation to another health organisation due to the staff shortage there. This includes 2 from adult OPD, 1 from paediatric OPD. Also, since the pandemic, the nurses were not able to take annual leave. Consequently, 8 nurses from adult OPD were resigned (20%) along with 7 nurses from the paediatric OPD (17.5%).
6. Discussion
Nurse turnover is referred to two significant factors: the push and the pull factors. In the first instance, the push factors are related to causes that drive individuals to leave their respective organisations, such as internal reasons that influence their working conditions [17] [18] [19]. Secondly, when the individual shifts from one organisation to another due to exerting pressure or external motivation such as high salary, which will positively affect their normal working condition. Since the Brexit referendum, then the Coronavirus started thus, increasing the demand for health workers especially nurses [20] [21]. Accordingly, many countries have developed a new immigration policy that aims to attract health workers to work in the (recipient country). The main example of that is the United Kingdom (UK) where the country trying to recruit nurses from India or the Philippines [7] [20]. In return, this policy could negatively affect other countries where those nurses will resign from their own countries to get a good job opportunity in the UK. In this regard, this paper will use the applicable HR theory to retain nurses.
6.1. Motivation with Retention
Applying effective HRM are relying significantly on motivation, selection, recruitment, then finally retaining qualified and skilful employees [22]. Therefore, applying motivational theory could be useful to mitigate nurses’ turnover and retain them in their organisation. Motivation is defined as: “willingness to exert high levels of effort toward organisational goals, conditioned by the effort’s ability to satisfy some individual needs” [23] (p: 53).
This illustrates that employing motivational theories might be effective to reduce nurses’ turnover and maintaining staff retention. Motivation is surrounded by five main needs that are referred to as a hierarchy of needs see (Figure 1) [24]. These needs are distributed accordingly physiological needs such as: breathing, eating, drinking, sleeping. Then safety and security needs, after fulfiling the previous needs, the individuals will seek love and belongingness needs such as friendship and acceptance by others. Furthermore, cognitive needs where individuals will try to achieve their self-esteem needs. Additionally, self-actualisation needs, followed by caring for others and happiness. By satisfying those needs, the organisation could enhance the employee’s retention rate [25] [26]. For example, during COVID many nurses got severe infections, and some died, this leads nurses and other healthcare workers to feel insecure and end up leaving their job. X organisation needs to ensure providing a safe and clean environment, so nurses will feel safe, especially during the pandemic where all the precautions are taken. Salary is one of the most important factors that influence employees either to stay or leave their job. Further, when individuals have a productive relationship with colleagues, this will reflect positively on their performance and they would prefer to stay in their organisation [26] [27]. In return, after fulfilling the previous needs it will be difficult to leave the organisation where individuals are valued and satisfied.
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Figure 1. Maslow’s hierarchy of needs (1943; page: 375).
In the same context, Maslow’s hierarchy of needs; can be applied effectively in order to retain the nurses through the use of motivations based on the required need. For example, those who have families usually work in a department where salary is more, by increasing the salary the individuals would like to stay in their organisation regardless of the workload, increasing salary scale along with allowance will motivate employees to stay [28] [29]. Despite that, some would prefer working in the clinic rather than having more salary, where the duties are mainly in the morning. In this way, by considering individuals’ motives, the retention rate will increase, and turnover will decrease. On another hand, appreciation and value increase the employee’s loyalty and belonging to the organisation, then will help in retaining the staff [30]. Value easily can be granted through recognising and honouring the employees. Certainly, individuals opt for achieving a zenith of satisfaction of living with high dignity. This given the implication, by acquiring the previous criteria of needs and motivation, individuals can be retained easily in their job [27] [30]. Therefore, using Maslow’s hierarchy of needs might be useful to consider in order to retain the nurses.
Equally, motivation and engagement are significant frameworks that ensure the organisations are applying a sustainable and productive workforce. One of the main challenges that face organisations constantly is retaining qualified staff [31] [32] [33]. In this perspective, Employee Retention identified as:
“The implementation of integrated strategies or systems designed to increase workplace productivity by developing improved processes for attracting, developing, retaining, and utilizing people with the required skills and aptitude to meet current and future business needs” [34] (p: 2).
Further, enhancing staff retention could be possible through a psychological way to direct, produce and ensure the employee’s determination for voluntary actions is high to become goal-oriented [35] [36]. Likewise, to mitigate employee turnover, the managers must develop research or a survey to find out the level of staff satisfaction, whether they are happy and enjoying their work or if they are motivated or demotivated toward their respective organisation [37]. Goal-directed behaviour could certainly utilize to stimulate employees’ work in several ways such as: engagement and commitment with their current job to achieve a high level of productivity. This will significantly increase the retention rate and achieve the goal through the organisation’s mission and vision, strategy plan and job description [33] [38]. As a result, these must link together in a form of commitment and obligation, so while coming to work they know what is expected to do and what is their core role within the organisation this will strengthen their loyalty and relation with their respective organisation, hence, resulting in retaining them. Unmet motivational needs could have a negative impact on work, this would lead to increase staff tensions [39] then their productivity will decrease. Additionally, unsatisfied motivational needs could drive employees adversely toward building negative behaviour within the organisation. In return, staff turnover will increase. For example, if a nurse is expecting to receive a certain salary, then will receive half of what is expected, this will end with staff turnover.
Individuals getting influenced by internal motivation from their respective work, as an example: work could generate a critical psychological condition. Initially, new employees feel a personal responsibility related to their role and duty in the organisation [40]. This also could develop a feeling of belonging and commitment toward their organisation. Therefore, individuals will understand that their practice and role in the organisation will add significant value to the overall performance of the organisation. In this sense, when the employees recognised their own worth and appreciation this will enhance their self-esteem and so, their motivation will remain retained. This approach of retaining motivation is designed to generate various knowledge and skills for the employed staff [41]. In return, responsibility and meaningfulness will develop a sense of awareness in employees’ performance to enhance their retention. In order to create a significant working experience in the organisation, there are three essential factors for a successful job along with making it meaningfully [42]. As an example, employees’ participation in organisation changes or events is a positive sign of their commitment and loyalty to the organisation. Also, they should be aware of the organisation’s vision and must reflect it in their daily routine task, further delegating or dividing the tasks between employees makes them feel satisfied to contribute effectively in the organisational development. In return, when employees feel valued along with respecting their dignity, will continue in the same organisation.
Indeed, managing retention or turnover is the key factor of effective Human Resources Management (HRM). This emphasized, that employees could be staying or leaving their respective organisation due to the relationships between several variables such as: psychology, organisation structure and working environment or environmental factors. For example, autonomy, fairness and justice, communication, the working environment and workload all these factors entice workers to continue in the organisation or to quit, whereas the psychological factors include job satisfaction which is associated with organisational commitment. Further, job opportunities are an example of environmental factors that sustain employee retention [43] [44] [45]. Moreover, a good job opportunity is related to getting more salary or professional development such as promotions. On the other hand, extrinsic factors are also necessary to consider because it motivate employees and enhances their retention in the organisation. Further, good interpersonal relationships, a friendly working environment and job security those factors are important to motivate individuals to continue in the same organisation [46] [47]. Adversely, a stressful working environment could develop a negative impact on its employees [48], which will change their value to the organisation. However, some studies suggested that the capacity of employee retention could certainly be influenced by workloads because over workload will turn in staff burnout or demotivation to work, hence, resulting in employee turnover [20] [21] [49]. Employees can be definitely retained in the organisation if they are enjoying their work, for instance when employees surrounding by a positive working environment or having a flourishing relationship with other colleagues, and they are supporting each other in order to achieve the organisational goal [47] [50]. Besides, motivating employees according to their essential needs could be used effectively to attract them to stay in their jobs. This includes a good salary that is enough to fulfil employees’ needs.
Nurse turnover is also, linked to an unproductive working environment that always led to staff dissatisfaction [1]. In this perspective, a productive working environment is mainly influenced by the managers in which they are responsible for maintaining a positive environment, so, any failure to deliver that could enhance employee’s frustration then end up with job dissatisfaction and employee turnover [20] [50]. Moreover, ineffective Human Resource Management (HRM), could impact staff retention adversely [50], for example, unproductive or stressful working environment due to employee’s misbehaviour or lack of productive policy to deal with such behaviour or conflict. Therefore, poor HRM might be resulting in low employee retention rates and high staff turnover.
Certainly, the most sensitive department in organisations is the Human resources department, due to the high concerns of managing employee’s working life [51]. Using advanced technology boost the practice, also make the working field very competitive that required only talented and qualified individuals. This in return, required a dynamic human resources management department in order to challenge the market comparatively and could have a competitive advantage in the future in terms of maintaining and retaining staff. This competition to keep talented staff is not only in the health sector but also in big companies such as Land Rover, Google, Apple, etc. If the company fails to retain or secure its skilled staff this will consider as a disadvantage for the organisation’s competitive economic strengths and growth, therefore, will ruin its reputation. Staff knowledge along with skills are significant for organisational development.
Employee retention along with human resource management departments are both essential to research-oriented for the best practices to the organisational retention management [52]. In the same context, this will help to assure continuous advantages in competitive market growth within the global investment and technology. Moreover, life balance practices, employees’ competence, commitment and loyalty and hence retention to the work environment [52]. Therefore, working in a balanced environment help to retain the employees, for example, where there is a fixed holiday or leave and there is a good learning opportunity and training, here many employees prefer to stay in their respective organisation.
6.2. Flexibility, Equity and Retention
Management role is important to retain the staff by developing retention policies to mitigate staff turnover based on the understanding of the causes behind employee turnover. For example, the manager must be aware of the total number of employees whose leaving the organisation, so if the number is high, the action will be taken accordingly. This means an action plan must be developed in advance to handle employees’ turnover. If the level of turnover is high, the organisation will be affected adversely, further, it possibly led to alterations in the provided care and it decreases the quality of services. Therefore, patient dissatisfaction will emerge and workloads will increase. So a flexible working pattern is required to manage the human resources effectively. A flexible working pattern must be developed to help individuals in balancing between job and home or family.
Flexibility is highly considered as a good management attitude that assists in retaining the staff. In this context, flexibility explains as “the ability of a firm to respond to various demands from its dynamic competitive environment” [53] (p: 1). It commonly applies to encourage employees to work effectively, flexibility related to how and when they work, As a result, flexibility has a significant influence on the employee’s emotions in order to retain them in their organisation which afterwards prevent employee turnover. So, when the employee’s experience management flexibility will remain in the organisation. There are several reasons for employee turnover, thus increasing the responsibility for the management to find out why employees are leaving their organisation. One of the main reasons is when the management is strict in applying the rules and regulations, lots of employees will be leaving as an example, lack of part-time for nurses in some organisation, no permissions are allowed for any circumstance during working hours. Therefore, in this type of organisation where the rules are strict, employees will prefer to leave to find better working opportunities where the management would be flexible. Further, when the employee’s effort is highly valued and acknowledged for playing a central role in creating a competitive advantage for the organisation [54]. Hence, this recognition will be reflected in the organisation’s policies in form of a flexible and favourable working environment to enable individuals to be productive and creative. This implies that appreciating and acknowledging is significantly influence the staff to work effectively.
Also, when organisations provide a flexible working environment this could possibly enhance staff retention rate [28] [54]. Besides, part-time can lead to retaining the employees, because as mentioned earlier that insufficient salary is one of the main reasons that employees are leaving their organisation. For example, due to COVID many nurses and other healthcare providers left their organisation and travelled abroad for seeking better salaries, vice versa when the salary is according to the expectation, individuals remain in their organisation. Considering an alternative for full-time work or part-time working hours for the employees by the managers is also a form of flexibility. However, managers must be aware that might affect the work negatively if the number of nurses in the part-times are more than the full-time, it also important to provide an equal distribution to the staff considering all shifts. Manager’s role is crucial to develop the policies and ensure that the policies can be flexible.
Basically, a positive employer-employee relationship could determine a good range of suitable motivational approaches by managers. For example, when managers participate effectively in solving conflict between employees this will help to optimize employee retention rates. This through, interaction within the organisation by giving the employees the freedom to talk along with listening to their problems and concerns further, applying effective communication skills. In contrast, It has been argued that a stressful working environment can negatively affect employees’ emotions and feelings, which in return could develop in depression and burnout [46] [55]. Thus, negative feelings would demotivate a good spirit relation between individuals in the same organisation. When the employees feel stress in their organisation this will lead to either leaving the organisation temporarily such as absenteeism or permanently such as resignation.
On other hand, Equity is a critical element that influences employee retention rate. Also, curiosity about other employees in the same organisation is one of the essential factors that employees are using to determine whether to stay or to leave the organisation [55]. In other words, individuals are more interested in the relationship between others more than the number of rewards that they have received for their own efforts. As it stands, individuals are more concerned about how others are receiving salaries or rewards and comparing with their own salary. So, if the managers are fair enough with all employees in the organisation, this will motivate them to stay in the organisation. Despite that, sometimes individuals’ misperception and comparing their effort with others might lead to frustration due to feelings of imbalance or unfair system. This frustration ends with demotivation and unwillingness to remain in the organisation, due to a lack of prejudice [56]. Likewise, demotivation could be generated when the individuals realise that their efforts and participation in the organisation’s activity are not paid fairly [57]. Also, when employees are highly frustrated from the organisation due to an unfair system, they would leave their organisation to another [58]. Besides, individuals’ estimation related to what actually they deserve as fairness and equality could be considered as a motivation [56]. This will include, treating all nurses equally while dividing tasks and duties in the daily assignment sheet, rewarding nurses based on their effort. This would assist in enhancing nurses’ retention rate, and also will mitigate the risks of nurse turnover.
In this sense, equity training must be given to all managers, and it should be part of the human resources management plan to ensure being equal with all employees. The provision of equity will assist managers to reach a high retention rate along with eliminating turning over. The management of equity should be relay on staff performance, commitment then reward and recognize them based on their efforts. Both flexibility and equity are important elements that must be considered by the managers in order to maintain a successful HRM and this will enhance employee motivation to retain.
6.3. Supervision, Confidence and Retention
Employee supervision is also essential to enhance employees’ confidence and professional development while performing their jobs [52] [59]. For example, supervision, coordination and direction are critical for both managers and employees, so the managers must have adequate knowledge to develop staff learning and enthusiasm along with an understanding of the tasks of their daily routine. Therefore, when employees feel confident about their knowledge and are skilful in performing the assigned tasks, this will help them to remain in their organisations to become keen and independent [60]. Furthermore, employee supervision leads to satisfying skills in terms of intrinsic factors related to their job, it also increases their interest in the work [60] [61]. These intrinsic factors included several variables such as success rewards, allowance or appreciation [59], it is identified as “motivators” and applying these factors will lead nurses to satisfy then will motivate them to remain in their respective organisation. On the other hand, extrinsic factors including organisation policies and regulation, salary, co-worker relations, and supervisory styles, these factors known as “hygiene” factors. It mainly results from non-job-related factors, e.x: low salary will drive staff to leave for another job with a better salary, the conflict which is resulting from ineffective relationships with other employees will lead staff to leave the organisation, as a result, low staff retention [62]. This high level of discomfort or presence of unproductive relationships with other colleagues results in staff conflict which ends with leaving the organisation. So, if the managers provide support for their employees through active supervision this will lead to increase staff confidence, then eventually retention rate will be increased.
6.4. Relationship between Education and Training to Retention
Providing adequate training, significant resources of learning and education will assist employees in performing well in their organisation. Apart from that education and training are directly impact employees’ retention. Training and experience are commonly applied to assess the relevance of ability, skills and their motivational influences on employee performances [63]. Seemingly, individuals who have adequate training and experience could perform effectively in several tasks that are given to them. Indeed, the development of standardised training packages by the HRM will enhance employee retention by fulfilling training needs, as a motivational need for professional development [64]. As mentioned earlier some of the causes for staff demotivation are lack of training and engagement in professional development programmes. Indeed, training will enhance personal satisfaction for nurses. However, this could affect the organisation adversely, where some individuals will take the benefits of this training to transfer to other organisations where could have more salary or more advantages. Consequently, this issue if not wisely controlled, could result in a higher employee turnover rate. It is important to provide training for all nurses so if one will leave, there will be others who can replace them. Therefore, appropriate HRM planning is required to ensure retaining the qualified staff.
HRM training decisions and planning are important to cement the organisation base, it will also improve the performance of the employees in the future, for example, an annual training plan for employees includes internal and external conferences and seminars [65]. Based on the Management Study Guide, providing several training opportunities is vital in achieving a high level of retention and enhancing organisational performance [66] [67]. This indicates that investing in employees training will bring positive outcomes to the organisation by retaining the nurses as well as providing better care for patients. Furthermore, more significance has been given to the teamwork and collaboration between personnel than mere education, also the staff considered working in teams as a first step to ensure that the organisation is working cooperatively together [28] [68]. In this essence, the entire organisation must be committed and working as a team, so if any individual receives training, must share this knowledge with others this will support other employees in progression, at the same time will boost their unity which could be used as an efficient tool to improve staff retention.
Improving and developing employees’ knowledge and skills have long term advantages in terms of workforce planning and development. So, when the organisation is developed based on staff skills and services, this will enhance the chances for organisational survival based on staff outcome, then will lead to promoting staff retention [68] [69]. It has been stressed that employees’ enthusiasm is usually developed from effective training, in this regard to develop a strong relationship between the organisation and its employees [70]. Hence, this will robust the relationships between the organisation and its employees. For example, when the managers recommend some staff to attend an event or workshop outside the country this will give a feeling that the organisation is trusting those employees. This practical development of staff will make them engage effectively in the organisation, further, they will feel valued. As a result, viable relations will be developed between employees and the organisation. Given the implication that investing in knowledge alone cannot be beneficial for the organisation. On the contrary, HRM must assure developing a positive relationship with its employees based on trust and assure improving this knowledge to strengthen this relationship.
Moreover, the adopted HR policies and guidelines by the managers might affect workers adversely [71] [72]. For instance, if the policies stated that training or promotion could be granted for senior staff, this could lead junior staff to feel demotivated to work. These superior behaviours and attitudes could increase staff absenteeism and turnover if not addressed effectively in the policies. Despite that, productivity, quality and customer service could enhance if effective policies are developed, and all employees’ aspects are considered. In return, this possibly will increase organisation profits and services. There are different natures of employees in an organisation who can be coordinated with the application of different HR policies such as motivation approaches for keeping employees motivated [73]. For example, some staff are experts in computer work rather than dealing or communicating with patients, so each organisation must have the relevant policy that aims to assign different staff with different skills to help in achieving a high standard of care and productivity with appropriate use of the human resources.
6.5. Engagement of Staff
Employee engagement is known as effective psychological occupational feelings, which are generated from employees’ investment physically, cognitively and emotionally in their work [74]. In the same concept, employee engagement is known as “the individual’s involvement and satisfaction as well as enthusiasm for work” [75] (p: 205). Engagement aims to persuade employees’ satisfaction along with enhancing retention rate, further increasing employees’ loyalty to their organisation [76]. Furthermore, employee engagement strengthens the relationships between colleagues within the same organisation [77]. For example, a nurse’s contribution in decision making is considered as engagement in organisation activity, by participating effectively in hospital meetings and representing the hospital in conferences or other events. In return, those nurses who are engaging in the hospital activity will have high self-esteem and self-actualisation. When employees feel that they are valued by their organisation, at the same time managers are caring for their contribution in organisational decisions, the majority of nurses will continue in the organisation and the minority only might leave. This will lead the managers to increase in the application of such strategy, it also results in a substantial performance for the employees, which endorses the welfare of the individuals alongside eliminating turnover [78]. This HRM approach is having a potential influence on the productive capacity, employee loyalty, satisfying employees relations, retention rate, institutional reputation and general advances for the stakeholder [75] [79] [80]. Given the implication that engagement of staff will have a significant impact on the organisation’s performances and services. However, this staff engagement should be rotated between them, so all employees will contribute in achieving organisational goals.
7. Coping with Employees’ Turnover
In the light of the above issue related to staff turnover, various plans and strategies have been considered by the managers in X organisation, precisely HRM departments, in order to mitigate nurses’ turnover and enhance their retention. The result of the study shows that there is a relationship between human resources motivation and nurses’ retention. One of the applied HRM strategies is mainly focused on reducing workload for nurses particularly during the pandemic, for example, providing an adequate number of nurses each shift based on the international standards for nurse-patient ratios, adding teamwork and respect to the organisation values, will help nurses to remain in the organisation. In addition, some strategies aimed to reduce nurse turnover by reducing workload, empowering nurses, and simplifying documentation [81] [82] [83] [84]. When employees are highly satisfied with their current job specifications, then potentially they will remain in their job [84] [85]. In this case, it would be essential for the managers in X organisations to conduct an exit interview with the employees before leaving their organisation, this will help to find out the reasons behind employees’ turnover. Conducting an exit interview will assist to solve the issue of leaving the organisation, it also helps to promote staff retention [85]. So, the manager role is vital to attract the nurses and make sure those nurses are quite satisfied in their job by considering the previous points along with performing an existing interview to identify the causes of staff resignation. Then to use applicable human resources strategy to ensure retaining the staff and avoid further loss of nurses.
8. Conclusion
Nursing turnover is an undesirable situation for healthcare employers, it is also considered a critical issue that impacts the productivity and performance of health organisations, especially after COVID-19. The problem is that nursing turnover is not affecting the health organisation only, but it also adversely impacts patient care. Furthermore, it is disruptive, expensive, and it threatens the standard of services along with patient safety. On the other hand, attracting nurses to remain in the organisation and preventing turnover is one of the HRM strategies that is known as staff retention. This research has identified the problem in the X organisation, a particular reference to human resources management theory to seize nurse’s turnover. Apart from that, enhancing nurses’ retention rate by applying Maslow’s motivational theories, further several HRM approaches were applied in that regard such as equity, flexibility, training, engagement and supervision.
Abbreviations and Acronyms
HR: Human Resources;
HRM: Human Resources Management.