The Impact of Saudi Nurses’ Happiness on Their Turnover Intentions ()
1. Introduction
Employee happiness is a mindset that enables employees to improve their performance and achieve their potential in the job or career. Highly happy employees are more productive, engaged and loyal to the company. In general, if employees in any company are satisfied, then their intention to leave is low. Therefore, this means that employee happiness is an important goal for organizations [1] .
Globally, day after day, the healthcare system is facing various growing challenges. On the other hand, the most significant challenge is the growing demand for health care, which puts human resources and funding at risk [2] . Nurses are the largest health care providers in any health system globally and nationally [3] . The World Health Organization (WHO) stated that almost 28 million people are part of the global nursing workforce. Moreover, 59% of the work force is in the nursing profession. Although there are 19.3 million professional nurses, 6 million are associate professional nurses, and the remainder are not classified [4] .
The shortage of the nurses around the world is imperative as in 2030 the nurses’ needs will be around 36 million to meet the global need [4] . Therefore, happiness is of great importance to all professions, particularly the nursing profession, because nurses are in direct and constant contact with patients and clients whose unique conditions require nurses to be altruistic, self-confident, dedicated, creative, kind, and energetic [5] . So, the nursing shortage and nurses’ turnover are problems facing health care systems around the world [3] .
A nurse’s turnover is defined as a nurse’s decision to likely leave the current job in the nursing field and look for another career opportunity. Moreover, nurse turnover has been found to be associated with many factors, such as length of working hours, demographic variables, gender, childbearing, job satisfaction levels, workload and organizational attitudes, work environment, staff empowerment and support, nurse-physician relationship, age, nurses’ participation in hospital activities and tasks, and burnout. Thus, nursing turnover intention has significant negative economic impacts on healthcare organizations. Several studies have been conducted to estimate the cost of nurses’ turnover intentions [3] .
Nurses in Saudi Arabia are similar to the rest of the world as the largest group of the workforce is nurses and they are essential to all aspects of care [6] . The latest published statistics by the Ministry of Health (MOH) in KSA show that nurses account for 107,846 of the (MOH) workforce; thus, 62% are Saudi nurses. Specifically, Saudi citizens represent 62% of the entire (MOH) nursing workforce. In Medina, the total number of nurses is 8046, which is around 7% of the MOH workforce. However, around 72% of them were Saudi nurses [7] .
In Saudi Arabia, the nursing profession has faced many challenges and issues, such as a nurses’ shortage, especially among Saudi nurses, and repeated work environment issues or personal issues. Because of perception, atavism tradition, many nurses would be hesitant to continue in the nursing profession for such reasons, either work-related issues or personal issues, resulting in nursing turnover [2] . Moreover, nurses happiness becomes important, because happiness or unhappiness may affect nurses’ abilities to care for their patients [5] . Several studies have been conducted in overseas countries, but very few about the impact of Saudi nurses’ happiness and their intention to turn over in Saudi Arabia. There was a gap in the knowledge of the current study.
The study will fill the gap in knowledge about the impact of the Saudi nurse’s happiness on their turnover intention in Saudi Arabia. Therefore, it will guide the policy makers and nursing leaders and mangers in the hospitals and the Ministry of Health to investigate and explain the Saudi nurses’ happiness and its impact on their turnover intention in the Saudi Arabia mainly in Medina region. Therefore, the main purpose of the study will investigate the impact of Saudi nurses’ happiness on their intention to turnover in a big governmental hospital in the western part of Saudi Arabia within the Medina region.
Research Hypothesis:
H0. There is no relationship between the nurses’ happiness on their intention to turnover among Saudi nurses.
H1. The happy Saudi nurses will have a lower turnover intention among Saudi nurses in the Medina region.
2. Materials and Methods
2.1. Study Design
The current study was a quantitative, cross-sectional, and correlational study as it is imperatively seen as being scientific in nature [8] . The sampling was a quota, convenience sample from the two big governmental hospitals of Saudi nurses in the Medina region of Saudi Arabia. Moreover, quota sampling is quicker and easier to conduct in any type of research because random sampling is not used [9] .
The sample calculation was done according to the total number of Saudi nurses. The sample size of the sample is calculated by using the Rao-soft website: http://www.raosoft.com/samplesize.html with a margin of error of 5% and a confidence level of 95%. The sample size was 275 and the respondent was 281 Saudi nurses. The Inclusion and exclusion criteria of the selected participants are 1) Saudi nurse’s male or female working in the mentioned setting in Medina. To ensure that the study setting and type of participants are maintained, the nurses describe their experience and provide a deep insight into the studied phenomena in both big hospitals; 2) Saudi nurses who have experience in nursing for not less than 3 months. So, nurses who have worked a sufficient time in nursing, so they have enough clinical experience to share with the researcher their experience to gain deep insight into the studied phenomena shown in Table 1.
2.2. Measures
A self-report questionnaire in the English language was used in this study. First, the Oxford Happiness Inventory (OHI) developed by Hills & Argyle was used to measure the happiness of the Saudi nurses in the present study. It contains 29 items and seven subscales. Moreover, (OHI) items are responded to on a Likert-type scale, the six points of which are “Strongly disagree”, to “Strongly agree”. Therefore, the total (OHI) score ranges from 29 to 174 the higher the score, the greater the happiness. The validity and reliability of the Persian (OHI)
![]()
Table 1. The sampling criteria of participants.
were verified in previous studies, and Cronbach’s alpha was reported to be 0.98. The overall Oxford Happiness Inventory is based on the participants answers, considering all Nursing Happiness survey items, by adding the item score to get the total score per participant using the below scale [10] . In the present study, its Cronbach’s α was 0.877 which is accepted. Moreover, demographic data to identify the participants’ background: such as age, gender, years of experience, and qualifications, was included.
The second tool is the Turnover Intention Scale (TIS) was developed by Bothma & Roodt to evaluate the Saudi nurses’ intention to leave their current job using the six-item Turnover Intention Scale. The respondents were asked to rate each item using a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The overall Turnover Intentions scale is based on the participants answers, considering all nurse’s (TIS) items, by adding the item score to get the total score per participant using the below scale Moreover, the shortened version of the TIS-6 has reported turnover reliability scores of α = 0.80, indicating good reliability [11] . In the present study, Cronbach’s α was 0.731.
2.3. Ethical Considerations
Permission to conduct the study was obtained from the Institutional Review Board (IRB) and the Human Research Ethics Committee from multiple settings (KSU) IRB committee and Madinah (IRB) committee before conducting the study. Upon obtaining formal approval and after receiving permission to enter the hospitals, the collection of data for the current study was done during the period from June 9, 2022, to the mid of October 2022. In addition, data collection (Link) was available from day one in data collection until the last day. The reminder invitations were sent according to the following: day one of the data collection, every 4 weeks from the starting day as a reminder to the head nurses to remind their staff about their participation in the study.
Participants were reassured of data confidentiality by using the anonymity procedure. Each participant started filling out the questionnaire, was considered as an agreement to participate. A brief explanation of the study was given to them. All participants were ensured privacy and confidentiality and the researcher was provided with a contact address if they wanted to know the results of the study. Moreover, voluntary participation of the Saudi nurses was maintained and they have the right to withdraw from the study at any time.
2.4. Statistical Analysis
The quantitative data were analyzed by Statistical Package for the Social Science (SPSS) the latest version according to the research hypothesis. Analysis of the study findings was done using various analytical methods. The collected data were coded, organized and tabulated into specially designed formats to be suitable for computer filling. Descriptive statistics consisted of frequencies and percentages used to analyze sample characteristics. Means and standard deviations were used to analyze levels of nurses’ happiness, Quality of work life, and turnover intentions.
For correlational statistics, Regression analysis (ANOVA, Coefficients) and correlations to measure the relationships between independent variables nurses’ happiness and dependent variable turnover intentions, with their degree of strength, along with correlation association strength with confidence intervals (CI) of 95%, and p < 0.05 and a 5% margin of error. A parametric or non-parametric test was chosen based on the normality. Trustworthiness was maintained.
3. Results
3.1. Descriptive Analysis
The present study results of the 281 nurses shows that the majority 91.5% of the nurses were female aged from 30 - 40 years old (54.1%) and (62.6%) of the nurses had bachelor qualifications; more than half of them are married (60.5%) as shown in Table 2.
The findings of the study as presented in Table 3 show that almost two thirds of Saudi nurses were shifted (217 nurses) mandatory (203 nurses) in their work-place (77.2%, 72.2%) respectively and the majority 77.6 of the participating nurses didn’t receive additional compensation for rotating shifts. Moreover, the majority 73.7% of the participating nurses were staff nurses while the minority of them were unit educators and unit manager (0.7%, 1.4%). In addition, 221 of the participated nurses did not receive additional compensation for being the charge nurse (78.6%).
![]()
Table 2. Demographic data of Saudi Nurses who participated in the study.
![]()
Table 3. Workplace characteristics of Saudi Nurses who participated in the study.
3.2. Overall Level of the Saudi Nurses’ Happiness and Their Turnover Intentions
The results of the participants were analyzed based on the overall scale of (QHI) and (TIS) as shown in Table 4. The following table shows that 51.2% of the participants had a moderate happiness level, and 36.7 had a high happiness level. It is clear from the table that 76.2% of the participants had a desire to leave, and 23.8% had a desire to stay.
3.3. Study Hypotheses Results/Regression Analysis
These correlations coefficient table notes that the p-value was found to be less than 0.05 which means that there is statistically significant difference. The correlation coefficient between the dependent variable turnover intentions and the independent variables happiness statistical significance difference less than 0.05.
The table also illustrates that the p-values are more than 0.05, which indicates the existence of a good direct relationship between independent & dependent variables, as the strength of the relationship is 0.532, and positive strength relationship between happiness and turnover intentions with p = value 0.179 as shown in Table 5.
![]()
Table 4. Saudi nurses’ overall level of the Saudi nurses’ happiness and their turnover intentions.
![]()
Table 5. The Pearson correlations between the study variables.
4. Discussion
Happiness among nurses is an experience that helps them continue the nursing profession by increasing their job satisfaction. To explore how nurses’ happiness levels will lower the number of problems and difficulties experienced by these health workers through necessary interventions that will increase their happiness level in the nursing profession [5] .
So, the overall aim of the study was to investigate the impact of Saudi nurses’ happiness on their intention to turnover in a big governmental hospital in the western part of the Kingdom of Saudi Arabia using quantitative research method. This study drew on self-administrated questionnaires that were collected from 281 Saudi nurses working in Medina region, Saudi Arabia.
The present study participants highlight that almost 60.5% were married which is congruent with another study result, majority of the respondents were female (89.3%), married (63.8%), and baccalaureate nursing degree graduates (80.8%) [12] . As nurses work in the rotating shifts during their hospital rotations. The current study shows that almost two thirds of Saudi nurses were shifted mandatory in their work-place (77.2%, 72.2%) respectively. Moreover, the majority 77.6% of the participated nurses didn’t receive additional compensation for rotating shifts. This is in line with Alharbi and her colleagues study that concluded most of the respondents (71%) rotated shifts and 79% had mandatory rotated shifts, with 81.5% having no additional compensation for rotating shifts [13] .
Achieving and maintaining a stable nursing workforce is an important goal in ensuring the well-being of Saudi Arabia’s rapidly growing population. However, a high turnover of expatriate staff and low recruitment of Saudi nationals have led to a serious shortage in the profession, particularly of well-qualified and experienced nurses [14] . The results of the participants were analyzed based on the overall scale of (QHI). The result shows the number of participants according to each classification as it is 51.2% of the participants had a moderate happiness level, and 36.7 had a high happiness level as this result answers the first research question. The result was a descriptive study which was congruent with the present study, as it was done with 121 nurses who accepted to participate in the study out of 323 nurses who worked at a research and training hospital in Rize Province, Turkey. Nurses’ happiness level was found to be higher than the average level (moderate level) [15] . This highlights the need for nursing leaders and decision-makers to assess the level of their staff nurses’ happiness and its underlying causes.
The research findings found that 214 (76.2%) out of 281of Saudi nurses have a desire to leave their job while less than a quarter of the participants have a desire to stay in their job (23.8%) this answer the second research question. A finding is not compatible with a study finding that revealed 39.7% of the nurses intended to leave their job [16] . Moreover, the present study illustrates that the p-values are more than 0.05, which indicates the existence of a good direct relationship between independent & dependent variables, as the strength of the relationship between happiness and turnover intentions with p = value 0.179.
5. Conclusions and Recommendations
Our results were critical and alarming; however, these findings could be explained by the fact that the Saudi nurse in the study sites were more than half of the participants had moderate happiness levels. Hospital nurses are challenged by their hectic nursing job and their family commitments every day. In the end, the nurses are struggling very hard to achieve a good balance between their professional and family life [17] . The present results alarm that more than 75% of the Saudi nurses had a desire to leave. Moreover, there it is clear from the analysis that the relationship between happiness and turnover intentions is negative. Hence, such relationships warrant managers and decision-makers to develop nurses’ retention strategies in the organization [18] . Achieving and maintaining a stable nursing workforce is an important goal in ensuring the well-being of Saudi Arabia’s rapidly growing population [14] . Moreover, there is an urgent need for a local nursing workforce planning strategy to recruit more national nurses and retain the current expatriate workforce [19] .
The limitations of the present study are that the researcher found difficulties when searching databases to find updated research and statistics from the Gulf region. Moreover, another limitation of this study was the long process to get the IRB and start data collection. The study was quantitative study as it shows only the relationships and the significance, so, the mixed study would explore deeply the phenomena.
About the Authors
Hana K. Alotheimin, a senior nurse leader in Medina Regional Nursing Administration and Home Healthcare Hana, is a post-graduate program director of the home health care diploma program at SCFHS. I am a member of the counseling committee for regional nursing in the Medina Cluster. I’m a founding and board member of the home medicine association. I am a member of the Saudi Scientific Society of Home Healthcare. I am a member of the Saudi Nurses Association, member of the Scientific Committee of the Advance Home Health Care Nursing Diploma (SCFHS), Certified Examiner in SCFHS. She also participates as a speaker in many courses and as an organizer. She is interested in nursing research, nursing development, and education.
Acknowledgements
I would like to acknowledge the participated nurses in this study and the nursing directors, nursing supervisor, and head nurses for their support during the study.
Abbreviations