Demographic and Organisational Factors as Predictors of Retention Among Health Care Workers in South West Nigeria

Demographic and Organisational Factors as Predictors of Retention Among Health Care Workers in South West Nigeria

Kudirat O. Alli

Business Administration and Management, Federal Polytechnic, Ile-Oluji, Nigeria

DOI: https://dx.doi.org/10.47772/IJRISS.2023.7012013

Received: 28 October 2023; Revised:  20 November 2023; Accepted: 21 November 2023; Published: 29 December 2023

ABSTRACT

Retention of healthcare workers in Nigerian healthcare facilities is a crucial issue in Nigeria, which has a deficiency of qualified medical personnel. In recent times, unlike ever witnessed before, the quality and accessibility of healthcare services in Nigeria are seriously threatened by low healthcare worker retention. The cause of low retention among healthcare workers in Nigeria is unknown, hence, a need to investigate the predictive influence of demographic and organizational factors on employee resilience among healthcare workers in Nigeria. A total of 798 healthcare workers (92 medical doctors, 401 nurses, 92 radiologists, 75 pharmacists, 134 MBBS, and Equivalent while 4 technicians) were purposively selected for the study. Outcomes revealed that gender (β = .26, t= 8.55, p<.05), age (β = .22, t= 4.24, p<.05), state of origin (β = .06, t= 2.09, p<.05), marital status (β = .23, t= 7.17, p<.05)   and education (β =-.38, t= -11.24 p<.05), job satisfaction (β = -.18, t= -2.95, p<.05) and perceived organizational support (β = .22, t= 2.99 p<.05) significantly predicted retention among healthcare workers. It was concluded that being female and unmarried, having negative/low job satisfaction, and perceiving positive/high organizational support predicted employee retention.

Keywords: retention, turnover, healthcare workers, organization, demographic

INTRODUCTION

Healthcare workers are a valuable resource for every healthcare facility and the nation at large. They are the most crucial assets required to ensure the health safety of a nation. As a result, the failure or success of a nation’s healthcare system is frequently tied to its ability to attract, retain, and adequately compensate talented and capable healthcare personnel. According to reports, Nigeria is Africa’s leading exporter of labour; between 2021 and 2022, around 13609 healthcare workers (majorly nurses) left Nigeria for the United Kingdom and more than 100 medical consultants left for Saudi Arabia and other countries (Lawal, et al, 2022). Thus, the Nigerian healthcare industry is confronted with significant difficulties in retaining healthcare workers (Zurn, Zapata & Okoroafor, 2021), which may affect the delivery of necessary healthcare services in the country and the nation’s progress toward obtaining universal health coverage.

Unlike ever experienced, the brain drain in the Nigerian healthcare industry is alarming; more than six hundred of the clinical staff at the University College Hospital in Ibadan, Oyo State, were reported to have quit their jobs, and more than 150 nurses quit their positions at the tertiary hospital’s teaching hospital in Lagos State (Ogungbile, 2023). Majority of the country’s brilliant healthcare workers are departing for better pay and working environments to other countries that promise better service conditions (Anetoh & Onwudinjo, 2020). The loss of healthcare personnel, such as doctors, nurses, and other allied health professionals, has a significant impact on how well the healthcare system as a whole operates. Push factors like low pay, low prospects for professional advancement, poor working conditions, and inadequate infrastructure all play a role in the retention of qualified healthcare personnel.

Holliday (2021) defines employee retention “as the ability of an organisation to avert employee turnover or the number of employees who quit their jobs either freely or involuntarily”. It refers to strategies an organisation utilize to reduce the likelihood of employee turnover and the processes it implements to keep its critical talent. Instead of the loss of a poor performer, employee retention methods largely concentrate on voluntary turnover that is harmful to the organisation. Sometimes referred to as “why an employee stays”, employee retention emphasizes turnover that may be prevented, such as when an experienced employee quits his/her job to relocate out of the country, as demonstrated by low rates of retention in Nigerian hospitals borne out of poor working condition, poor salary, outdated medical equipment in most hospitals and recognition of the effort of healthcare workers in developed economies.

Organizations that do not value employee retention as part of their corporate strategy pay a high price in the recruitment of new employees and training as retention will be low in such organisations. Those who invest in enhancing staff retention and tackling turnover concerns, on the other hand, receive huge benefits in terms of increased revenue, greater productivity and work quality, and enhanced employee morale. This is because highly motivated employees vow their devotion and loyalty to companies that have a strong employee retention program. Consequently, the purpose of this study is to investigate factors that can help the Nigerian healthcare industry retain its qualified healthcare employees to stay back in Nigerian healthcare facilities.

Retaining employees can be complex because employee needs are versatile and insatiable, this means that various factors motivate different employees to stay in an organisation.  McClelland’s theory of needs attempts to explain and predict the individual’s behaviour and performance based on his or her needs, namely; achievement, power, and affiliation. The achievement-seekers are always looking to excel, the power-seekers are looking to control and have authority, and the affiliation seekers are looking for harmonious relationships with other people (Royle & Hall, 2012). The need for affiliation generally is about becoming more social and spending more time in social relationships, workgroups, and desiring to be loved.

In recent times, several demographic factors and organizational factors associated with why employees leave (turnover) have gained the attention of researchers in the inquiry into the impending issue of why employees stay (retention). Evidence has shown that similar factors influence these dissimilar organizational behaviours; turnover and retention (Govindaraju, 2018). Studies have shown that demographic factors such as age, gender, marital status, and education influence employee retention and turnover in various settings. For example, Marufu, et al. (2021) reported that demographic factors such as level of education, age, gender, and work experience as well as organizational and social factors influence retention among hospital nurses in their systemic review of nurses while Abubakar, Chauhan, and Kura (2014) reported that age and gender predicted turnover intention among registered nurses in Nigerian public hospitals. Similarly, Emirglue, Akovab, and Tanriverdic (2015) reported that age, gender, marital status, education, as well as some organizational and social factors determined turnover intention among employees in Istanbul. Marital status and educational level were reported by Chivandire (2017) as determinants of retention among academic staff in Zimbabwean Universities.

In terms of age, most studies reported that younger employees (31- 40 years) had a lower retention propensity than employees that are above 40 years (Fredrick, 2018; Kumar et al., 2023). Similarly, Agbator and Olori (2020) reported among maritime firms that employees within the age brackets of 21-30 years had lower retention propensity. The significant impact of gender, marital status, and education has also been reported. Females were reported to have higher retention than men (Katekhaye & Dhone, 2023). Furthermore, Abubakar et al (2014) reported among registered nurses in Nigerian public hospitals that female nurses had more intention to stay while males had higher intention to leave their organization or the profession. It was further reported that education impacted healthcare professionals’ intention to keep practicing in a military hospital (House, et al., 2022) while lower qualifications of some employees influenced their intention to stay at their current employment (Agbator & Olori, 2020; Kumar, et al., 2023).

Evidence has shown that a positive work environment (Nawrat, 2021), perception of organizational support (Akinsola, unpublished), and job satisfaction (de Vries, et al., 2023) are top predictors of employee decision which includes the decision to stay (retention) in an organization. The work environment involves all the physical, psychosocial, and organizational factors surrounding the workplace (Markey, Ravenswood & Webber, 2012). Based on this definition, the work environment encompasses the work itself, feedback, work pressure, recognition, performance appraisal, and other attributes that do not focus on individual characteristics (Hanai, 2021). Several studies have confirmed the supportive influence of a positive work environment on employee retention; among 234 employees of Adamawa State University Mubi, Nigeria (Torsabo & Ezekiel, 2021); among 400 healthcare workers from rural areas in Zamfara state, Nigeria (Lawal & Ciroma, 2020).

The perception employees have towards their jobs and the extent to which their employer values their contribution and well-being influences employees’ retention decisions. Meaningful work, training, and development, relationships with other workers are all features of job satisfaction; the absence of which can influence employees’ decision to stay or leave the organisation. Akinwale and George (2020) averred in their study among nurses in government tertiary hospitals in Nigeria that job satisfaction predicted retention. A similar conclusion was also reached by De Sousa Sabbagha, et al, (2018) in their predictive study among employees of the South African foreign exchange bank division. Studies have also confirmed a positive relationship between job satisfaction and employee retention (Biason, 2020; Shafiuddin & Al Nassibi, 2022).

Nargotra and Sarangal (2021) investigated the influence of perceived organizational support on employee intention to stay among 323 employees working in private telecom companies. They reported that perceived organizational support had a significant positive influence on the intention to stay. Similarly, Smith (2005) found a positive association between perceived organizational support and retention among child welfare staff. Furthermore, key factors such as work engagement, co-worker relationships, and a supportive work environment were found to influence employee satisfaction among 384 educators in the Saudi Ministry of Higher Education (Alharthey et al., 2022). They reported the influence of working environment, perceived organizational support, and supportive work environment as predictors of employee retention.

Based on these findings from the literature, it is confirmed that demographic factors and organizational factors influence employee retention among various groups of employees, but there is a paucity of studies relating to the problem of retention among healthcare workers in Nigeria. This study will therefore fill the gap in knowledge by investigating the predictive influence of some of these demographic and organizational factors on healthcare worker retention in Nigeria’s healthcare industry.

The following are the specific objectives of the study:

• examine the predictive influence of demographic factors (gender, age, marital status, education) on employee retention; and
• examine the predictive influence of work environment, job satisfaction, and perceived organizational support on employee retention.

In line with the objectives, the following are the research hypotheses.

1. Demographic factors (gender, age, marital status, education) will significantly predict employee retention among healthcare workers in Nigeria.
2. Work environment, job satisfaction, and perceived organizational support will independently and jointly predict employee retention.

METHODS

Design

This study employees a correlational research design. The independent variables are demographic factors (gender, age, marital status, education), work environment, job satisfaction, and perceived organizational support.

Sample and participants

The sampling technique employed was a purposive sampling technique which allows the selection of participants based on the purpose of the study. A total of 798 (493 females, 305 males) healthcare workers from private and government hospitals in Nigeria participated in the study. Participants in early adulthood were 323 (40.5%), middle adulthood 396 (49.6%) while those in late adulthood were 68 (8.5%). In terms of marital status, 431 (54%) of the participants were married, 333 (41.7%) were unmarried, 18 (2.3%) were divorced and 16 (2.0%) were widowed. Concerning their profession 92 (11.5%) were medical doctors, 401(50.3%) were nurses, 92 (11.5%) were Radiologist, 75 (9.4%) were Pharmacist, 134 (16.8%) had MBBS and Equivalent while 4 (0.5%) were Technicians.

Instrument

A well-structured questionnaire was used to gather information from the study participants. The questionnaire has five sections which include the socio-demographic section and four other sections that were made up of questions from psychological instruments measuring our constructs of interest.

Socio-demographic characteristics

This section gathered information on the personal and career characteristics of the respondents which shall include; age, gender, marital status, employment history, years of employment, etc.

Work environment Scale

The work environment of the healthcare workers will be measured with a 10-item scale developed by Rossberg, Eiring and Friis (2004).  Some of the items on the scale read ”How often does it happen that you are worried about going to work”? The scale was scored on a five point scale of 1(Not at all), to 5 (to a very large extent). Cronbach alpha of .82 was reported for this scale. Cronbach’s alpha 0.90 was established as the reliability coefficient for the scale in this study.

Perceived Organizational Support Scale (SPOS)

Perceived organizational support will be measured with the SPOS 8-item scale developed by Eisenberger, Huntingdon, Hutchinson and Sowa (1986). The SPOS is a one-dimensional self-report 5-point rating scale. Cronbach’s alpha reliability of the scale is 0.94. Cronbach’s alpha 0.95 was established as the reliability coefficient for the scale in this study.

Job Satisfaction Scale

Job satisfaction will be measured with a 36-item scale developed by Spector. The scale has 9 dimensions but only 2 dimensions (employee satisfaction with training and development, and employee satisfaction with co-workers). The reliability alpha for the scale was reported as .77 for both dimensions. Cronbach’s alpha 0.80 was established as the reliability coefficient for the scale in this study.

Employee Retention Scale

Employee retention will be measured with a 3 item scale developed by Kundu and Lata (2017). An example of an item in the scale includes: I will not change the organization easily. The reliability alpha for the scale was reported as .90. Cronbach’s alpha 0.94 was established as the reliability coefficient for the scale in this study.

Procedure

            Participants were approached at their place of work after due consultation with the Management of each of the health facilities.  Each participant was given an informed consent form before the questionnaire was handed out and the researcher discussed the relevance of the study with the participants before giving out the questionnaire.  Also, the researcher made it known to the participants that their responses would be confidential.

 Statistical Analysis

The data for the study were analyzed using Statistical Package for Social Science (SPSS) 23.0 version software. Descriptive statistics such as percentages were used for the analysis of socio-demographic variables while inferential statistics was utilized for the hypotheses. Hypotheses 1 and 2 were tested with multiple regression, and also t-test of independence was used to compare the means of groups based on the demographic characteristics of the respondents.

RESULT

Table 1: Socio-demographic characteristics of respondents (n=788)

Table 2: Zero-order correlations showing the inter-variable relationship between Demographic and Organizational Factors and Retention

**. Correlation is significant at the 0.01 level (2-tailed).

*. Correlation is significant at the 0.05 level (2-tailed).

Table 2 shows that there is a significant positive relationship between sex (r=.30, p < .05), age (r=.09, p< .01), state of origin (r=.07, p < .05), and marital status (r=.23, p < .01) while there is a significant negative relationship between education (r=-.34, p < .01) and retention. The table further shows a significant negative relationship between sex (r=-.10, p< .01) and job satisfaction, and sex (r=-.10, p< .01) and perceived organizational support. However, there is significant positive relationship between age (r=.12, p< .01), state of origin (r=.80, p< .05), religion (r=.10, p< .01), education (r=.10, p< .01), work environment (r=.80, p< .01), job satisfaction (r=.83, p< .01) and perceived organizational support.

Figure 1 above shows there was significant gender difference on retention between males and females (t_716.47 = -9.22, p<.05) healthcare workers. Thus, there is evidence that female (x̄=11.82, SD=3.38, N=493) healthcare workers stay significantly longer than the male (x̄=9.73, SD=2.9, N=305) health care workers; the average retention rate for females was 2.08 times higher than the average retention rate for males.

Table 3 Multiple Regression Showing the Predictive Influence of Demographic Factors on Retention among Health Care Workers in Ondo State

Table 3 above revealed that demographic factors (gender, age, state of origin, marital status, religion, and education) jointly predicted retention among healthcare workers. The results showed the joint predictive influence of the demographic factors was significant F (7,778) =44.53, R²=.29, p <.05). The demographic factors explain 29% of the variance observed in retention among healthcare workers.  The result further showed that gender (β = .26, t= 8.55, p<.05), age (β = .22, t= 4.24, p<.05), state of origin (β = .06, t= 2.09, p<.05), marital status (β = .23, t= 7.17, p<.05)   and education (β =-.38, t= -11.24 p<.05) significantly predicted retention among healthcare workers. The result further showed that religion (β = .02, t= .47, p>.05) did not significantly predict the retention of healthcare workers.

Table 4 Multiple Regression Showing the Predictive Influence of Organisational Factors on Retention among Health Care Workers in Ondo State

Table 4 above revealed that a linear multiple regression was conducted to examine the predictive influence of the organizational factors (work environment, job satisfaction, and perceived organisational support) on the criterion variable (retention) among healthcare workers. The results showed that the predictive influence of the organizational factors was significant F (3,794) =4.17, R²=.02, p <.05). The organizational factors explain 2% of the variance observed in retention among healthcare workers.  The result further showed that job satisfaction (β = -.18, t= -2.95, p<.05) and perceived organizational support (β = .22, t= 2.99 p<.05) significantly predicted retention among healthcare workers. The result further showed that the work environment (β = -.08, t= -1.39, p>.05) did not significantly influence the retention of healthcare workers.

DISCUSSION

The results of this study showed a significant positive relationship between participants’ gender, age, and marital status, and a significant negative relationship between education and retention. The outcomes of the study confirmed the researcher’s assertion that demographic factors (gender, age, state of origin, marital status, and education) significantly predict employee retention. This result is similar to the findings of Chivandire (2017) who established a significant relationship between marital status, educational level, and retention. Similarly, Marufu, Collins, Vargas, et al. (2021) reported that demographic factors such as level of education, age, gender, and work experience influenced retention among hospital nurses in their systemic review of nurses.

Furthermore, female healthcare workers have a higher intention to stay than male healthcare workers. This result is in line with the findings of Katekhaye and Dhone (2023); Agbator and Olori (2020) who reported that female employees have higher retention than their male colleagues. A possible explanation for higher retention among female healthcare workers is the inability to get new jobs easily due to the employment gap from staying out of jobs to take care of children, fear of getting another job that suits other areas of their life such as family and fear of sexual harassment in a new workplace. When women feel safe in an environment and perceive positive support, they find it difficult to search for jobs elsewhere, hence higher retention among female employees

The result further revealed that marital status influenced employee retention with unmarried employees having higher retention to stay back in the Nigerian healthcare industry than the married healthcare workers. A similar result was also reported by Emiroglue, et al. (2015) among employees in Istanbul, Chiavandire (2017) among academic staff in Zimbabwe universities and Agbator and Olori (2020) among employees in Rivers State, Nigeria. Unmarried healthcare workers stay due to the compensatory economic and social ties associated with most immigration requirements. Most of the healthcare workers leaving for the United Kingdom and Canada spend a lot of money on the relocation process, their economic, work history, and educational status are compared and graded together, giving married employees higher chances of leaving than unmarried employees.

The result of this study further revealed a joint significant predictive influence of organizational factors (work environment, job satisfaction, and perceived organizational support) on employee retention. Independently, job satisfaction significantly negatively predicted retention while perceived organizational support significantly positively predicted retention. This result exposed that the higher the perception of job satisfaction of healthcare workers the lower their retention and vice versa. The result further revealed that the positive perception that healthcare workers hold about the extent to which the organisation values their wellbeing influences their decision to stay (high retention) with the organization while the negative perception of the organisation’s value of wellbeing influences the decision to leave (low retention).

In line with the outcome of this study, Biason (2020); Shafiuddin and Al Nassibi (2022) also reported in their study that job satisfaction predicted retention but they reported a positive relationship, this means that the positive perception of job satisfaction predicted higher retention in their studies. The outcome of this current study revealed a negative relationship between job satisfaction and retention, which implies that a positive perception of job satisfaction reduced retention among employees. A possible explanation for this is that, though the employees experienced or perceived positive job satisfaction (paid well, trained by the organization, have good working relationships with colleagues and supervisor), they just want to leave the country for greener pastures and experience the world outside their own.

Furthermore, Nargotra and Sarangal (2021) reported among 323 employees working in private telecom companies that perceived organizational support had a significant positive influence on intention to stay. Likewise, Smith (2005) found a positive association between perceived organizational support and retention among child welfare staff. This study exposed that the perception employees hold about how employers/organizations value their well-being determines their intention to stay or leave the organization. Employees who perceive that their employers value them stay while those who perceive otherwise leave.

Against the outcome of our study, Gangwani and Dubey (2016) reported that good working environment influences employee retention among employees in IT professions in India. They explained that work environment that encompasses the mission, philosophy, technology, managerial practices and relationship with employees plays a significant role in the reason why employees choose to stay with the organisation. Though a contrary opinion was reported in this study, this can be due to the culture differences between the population of study and also difference in occupation of the participants.

CONCLUSION

The study concludes that gender, age, state of origin, education, and marital status significantly predict employee retention. Also, job satisfaction and perceived organizational support significantly predict employee retention. Outcomes of this study reveal that being female, unmarried, having negative/low job satisfaction, and perceiving positive/high organizational support predict employee retention.

RECOMMENDATIONS

Based on the outcome of this study, the following recommendations are put forward to increase retention among healthcare workers:

1. The government and other stakeholders in the health industry should give more consideration to unmarried females during recruitment into the healthcare industry as they have a higher propensity to stay back in the country and not leave when compared to married female healthcare workers and men.
2. Due to the hazardous nature of the industry, healthcare workers need a lot of organizational support and satisfaction on the job. It is therefore recommended that training, equitable salary, opportunity for growth, paid vacation and leave, recognition, and adequate provision of standard personal protective equipment should be embedded in their work package to encourage them to stay in the industry and country.

Limitations

The study sample focuses on only healthcare workers in South West Nigeria, therefore, the outcome may not be the same if other geopolitical zones were considered. On this note, the findings of the study should be generalized with caution.

ACKNOWLEDGEMENT

The author disclosed receipt of financial support for the research and publication of this article: this study was accomplished under the financial sponsorship of the Tertiary Education Trust Fund (TETFUND) under the TETFund Institution-Based Research Intervention (IBR) reference – TETFUND/DR&D/CE/POLY/ONDO/IBR/2022/VOL. II

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