Relationship between Organizational Commitment and Intention to Leave among Professional Nurses at Damanhur National Medical Institute

Background: Organizational commitment has been extensively researched as an important factor in employee retention and motivation. Aim: Determine the relationship between organizational commitment and intention to leave. Design:A descriptive correlational design was applied in this study. Setting: The study was conducted in all the units at Damanhour National Medical Institute. Sample: Study sample was 101 professional nurses. Tools: Two tools were used for data collection; Organizational commitment scale and intention to leave scale. Results:The results of the present study showed that nearly two thirds of professional nurses (62.3%) got moderate level of organizational commitment and above half of professional nurses (51.4%) had moderate level of intention to leave. Conclusion:  the present study concluded that there was significant negative correlation betweenaffective commitment, continuance commitment, normative commitment, and total organizational commitment with intention to leave. Recommendations: Therefore, it is recommended that,healthcare organization administrators should increase professional nurses’ satisfaction through competitive salaries, encourage the team work spirit and conduct periodical meetings to discuss their problems to increase their commitment and eliminate their intention to leave.


INTRODUCTION
Nursing manpower is one of the most important resources for health care organizations that represent a critical element in their success.When there is turnover intention, the quality of care provided to the population will be at risk.Organizational studies suggest that intention to leave is important for organizations and researchers because once people have actually translated their intention to quit into action, there is little likelihood of gaining access to them to understand their prior situation (Ahmed, Abdelwahab & Elguindy, 2017).A study conducted by Khater (2014) that explored the utilization and problems of nursing manpower at Ministry of Health hospitals at Egypt revealed that there was a significant shortage and misdistribution of nursing manpower.
Organizational commitment reflects the loyalty of an employee towards his or her organization (Ghorbanhosseini, 2012).Moreover, Rae, 2013 thought about organizational commitment as a desire to maintain the affiliation with an organization and is reflected through the willingness to exert high level of effort to achieve organizational goals.Overall, organizational commitment can be defined as the degree to which an employee develops a feeling of belongingness to his or her organization (Wadhwa & Verghese, 2015).Such feeling is created among the employees through constant involvement in different organizational activities.The continuous participation is usually done by searching for important suggestions from team members, listening to their issues and by increasing their involvement in organizational decision making process to a certain extent.By doing so, employees would feel to be participative and appreciated in the organization.The most commonly known forms of commitment are affective or emotional commitment which emphasize on employee attachment to an organization by accepting its values and having the desire to keep the relationship with it (Dey, Kumar, & Kumar, 2014).There are several dimensions for organizational commitment: loyalty, responsibility, the willingness to continue in the work, and faith toward the organization (Diab & Ajlouni, 2015).

Significance of the Study:
The shortage of nurses has been a persistent problem in the history in the nursing profession.
The problem has become worse in recent years.Recognizing that this shortage is an increasingly grave problem, healthcare researchers are attempting to identify how to ameliorate its effects on practicing nurses.Studies indicate that many factors may contribute to the shortage, but one of the Port Said Scientific Journal of Nursing Vol.6, No.3 , December 2019, Special Issue 165 major factors is high turnover (Liou, 2007).Organizational commitment has been extensively researched as an important factor in employee retention and motivation.There has been considerable interest in this construct due to its reported relationship with organizational efficiency and effectiveness (Beck & Wilson, 2000).

AIM OF THE STUDY:
Determine the relationship between organizational commitment and intention to leave among Professional Nurses at Damanhour National Medical Institute.

The research questions:
1. What is the organizational commitment level among professional nurses?2. Are professional nurses had intention to leave? 3. Is there a relationship between organizational commitment and intention to leave?

SUBJECTS AND METHOD:
A descriptive correlational design was used in this study.

Setting:
The study was conducted in all the units at Damanhour National Medical Institute.It is one of nine hospitals belonging to the General Organization for Teaching Hospitals and Institutes-all over Arab republic of Egypt.The hospital is totally equipped with 541 beds.With total number of units (40 units).

Subjects:
All professional nurses worked at the fore mentioned settings, who have at least one year of experience, almost (N= 101 professional nurse).

Tools:
Two tools were used to conduct this study: Tool 1: Organizational commitment scale (OCS): Organizational commitment scale (OCS) was originally developed by Meyer & Allen (1990) and they revised it in (1993).This instrument is to assess organizational commitment along affective, continuance, and normative commitment subscales.The scale consists of 18 statements in the three subscales, with each subscale containing six questions.Responses were measured on a 5point Likert-type scale for all items and measured the response categories in terms of agreement, ranging from (1) strongly disagree to (5) strongly agree.A reverse scoring for negatively worded Port Said Scientific Journal of Nursing Vol.6, No.3 , December 2019, Special Issue 166 (Items 3, 4, 5, and 13) responses was applied.The highest scores indicated negative perception of organizational commitment.Tool reliability was measured using Cronbach's alpha coefficient test.The tool was reliable and the test values was 0.775.The average score for each professional nurse was converted to a percent by multiplying professional nurse score in 100% and then divided on maximum score.Overall scores were divided into categories according to cut off point as follows: low scores = < 33%; moderate scores = 33% < 66%, and finally high scores = 66% -100%.Likert-type scale for all items and were measured the response categories in terms of agreement, ranging from (1) strongly disagree to (5) strongly agree.
The average score for each professional nurse was converted to a percent by multiplying professional nurse score in 100% and then divided on maximum score.Overall scores were divided into categories according to cut off point as follows: low scores = < 33%; moderate scores = 33% < 66%, and finally high scores = 66% -100%.

RESULTS:
Table (1): indicates that nearly two thirds of professional nurses (62.3%) got moderate level of organizational commitment, while about one quarter (24.7%) of them got low level of organizational commitment.According to affective commitment, nearly two thirds of professional nurses (65.3%) had moderate level of affective commitment and 22.7% of them had low level of affective commitment.Pertaining to continuance commitment, about two thirds of professional nurses (62.8%) had moderate level of continuance commitment.On the other hand, 20.4% of them had low level of continuance commitment.Concerning to normative commitment, above half of professional nurses (59.3%) had moderate level of normative commitment, followed by 30% of them had low level of normative commitment.

Table (2):
show that above half of professional nurses (52.5%) had moderate level of intention to leave, followed by nearly one third (30.7%) of them had low level of intension to leave, while only 16.8% of them had high level of intention to leave.
Port Said Scientific Journal of Nursing Vol.6, No.3 , December 2019, Special Issue 167 Table (3): show that there were significant negative correlation between affective commitment, continuance commitment, normative commitment, and total organizational commitment with intention to leave (p=0.001, 0.000, 0.053, and 0.000), respectively.

DISCUSSION:
Regarding to organizational commitment, findings of this study indicate that professional nurses got moderate level of organizational commitment.It might be attributed to professional nurses feel that they are part of the organization due to they participate in decision making, they had more opportunities to deal with supervisor directly, they had a clear channel of communications at hospital, had more years of experiences, and they are emotionally attached to their organization.Moreover, team spirit between health team member, fringe benefit, direct personal contact with nursing staff and their immediate manger, separate management from the whole organization, and clear internal policies lead to decrease nursing staff stress and increase their commitment to the hospital.
This finding is supported by Huang (2004)  Furthermore, Tourangeau & Cranley (2006) who studied nurse intention to remain employed: understanding and strengthening determinants in Canada and reported that the level of teamwork, which they used as an indicator for collaboration and workgroup cohesion, was a significant predictor of intention to remain employed.According to Meyer & Herscovitch (2001) who studied commitment in the workplace toward a general model and founded that the managers who communicate daily with their subordinates typically, giving feedback on performance, executing performance appraisals, providing information and so forth.These actions in turn facilitate developing or deny subordinate organizational commitment as it is the way these practices are perceived that influences levels of commitment.
This result is consistent with Vincent (2016) who suggested that managers reported moderate organizational commitment to their organization.In addition to that Lorber & Skela-Savič (2014) who studied factors affecting nurses' organizational commitment and found that there were significant differences between the perception of commitment in nursing by leaders and other health team members.In the same line Mabrouk (2004), Ali (2006), Ellicy (2012) Moreover, Lutter (2011) who studied an exploration of registered nurses' intentions to leave the profession and proved that increased perceptions of job stress, the inability to provide safe and ethical care, conflicts between work and family life, few opportunities for career advancement and professional development, few opportunities to participate in decision-making, and inadequate financial compensation have all been found to contribute to higher intentions to leave the nursing profession.Furthermore, quality of teamwork and supervisory support were also found to be major factors in preventing workplace violence and intention to leave (Estryn-Behar et al., 2008).
This result consistent with Vincent (2016) suggested that managers reported moderate intention to leave their organization.Moreover, Hassan (2013) who studied the relationship among professional nurses' leadership style, organizational commitment and intention to leave and revealed that highly statistical significant deference in terms of the intent to leave between first line nurse managers and professional nurses.In addition to that, Palumbo, Rambur, McIntosh, & Naud (2010) who studied registered nurses' perceptions of health and safety related to their intention to leave and illustrated that intention to leave is lower in those nurses who perceive better emotional health and more attention paid to safety and health initiatives.
As for correlation between organizational commitment and intention to leave, this study shows that there was significant negative correlation between affective commitment, continuance commitment, normative commitment, and total organizational commitment with intention to leave.This result may be related to professional nurses spending more time in the hospital, having strong feeling of belonging and emotional attach to the hospital, the hospital deserve their loyalty, and not decide to leave the hospital.This result is supported by Filipova (2011) who studied Port Said Scientific Journal of Nursing Vol.6, No.3 , December 2019, Special Issue 171 relationships among ethical climates, perceived organizational support, and intent-to leave for licensed nurses and suggested that nurses, who were highly collectivist-oriented, were likely to display a strong attitudinal commitment to an organization, which implies that they were more likely to accept the goals and values of the organization and evince a strong desire to maintain membership with the organization.Thus, it could be supposed that they would have less intention to leave their jobs.
This result is consistent with leone et al. (2015) found that organizational commitment had strong negative relationship with intention to leave, and also it was the strongest predictor of intention to leave.Moreover, Vincent (2016) proved that there are moderate strong positive correlation between Organizational commitment and intention to Stay.Furthermore, Bright's (2007Bright's ( , 2008) ) who studied does public service motivation really make a difference on the job satisfaction and turnover intentions of public employees?And found that middle managers felt committed to the organization and found strong correlation between personal and organizational value congruence and intention to stay.These findings were also consistent with other studies which have explored the relationship between organizational commitment and intention to stay In addition, Brunetto et al. (2013) who studied the impact of work relationships on engagement, well-being, commitment and turnover for nurses in Australia and the USA and said that higher levels of organizational commitment and sense of belonging have been linked to higher retention in, as it can be understood as a positive response to nurses' organization and work.And also Filipova (2011) who studied relationships among ethical climates, perceived organizational support, and intent-to leave for licensed nurses in skilled nursing facilities and illustrated that commitment completely mediated the relationship between perceived organizational support and intent to leave.Findings suggest that organizational ethics and support may be used as means to generate positive outcomes such as retention.
Port Said Scientific Journal of Nursing Vol.6, No.3 , December 2019, Special The findings from this study concluded that professional nurses had moderate level of organizational commitment and intention to leave.Moreover, there were significant negative correlations between intention to leave and affective commitment, continuance commitment, normative commitment, and total organizational commitment.

RECOMMENDATIONS:
Based on the findings of the present study, the following recommendations are suggested to different administrators' level; as well as to professional nurses.
A. Healthcare organization administrators should: 1. Increase professional nurses' satisfaction through competitive salaries, encourage the team work spirit and conduct periodical meetings to discuss their problems.
2. Conduct frequent meetings with professional nurses who are dissatisfied from their job; discuss their problems and their needs and try to formulate plans to overcome these problems to enhance their satisfaction level which can consequently raise their morale and commitment level and decrease level of intention to leave.
3. Monitor and report hospice professional nurse's turnover rates periodically in light of management's enhanced focus on improving professional nurse's commitment (specifically extrinsic factors which can be notably improved by management).

B. For professional nurses
1. Discuss their problems and their needs with the administrators to overcome these problems to enhance their satisfaction level which can consequently raise their organizational commitment level.

Tool 2 :
Intention to leave scale: Intention to leave scale was developed by Kim, Price, Mueller & Watson (1996) to measure nurses' turnover intention.It consists of 5 items and responses were measured by a 4-point who studied a leader's guide to the factors influencing organizational commitment: A study of nurses in Taiwan and shown that the effective factors within an organization promote nurses' commitment to that organization.Those factors were: (a) training programs, (b) organizational readiness, (c) work schedules, and (d) job security, which related to organizational structure.Furthermore, the results proposed that the factors such as (a) environmental security, (b) group cohesiveness, (c) autonomy, (d) shared decision, and (e) communication regarding personal interaction were selected as most perceived factors, and could Port Said Scientific Journal of Nursing Vol.6, No.3 , December 2019, Special Issue 169 enhanced nurses' organizational commitment.To enhance nurses' organizational commitment, organizational structure was found to be the key element of effective organizational factors within an organization that promoted nurses' commitment to an organization in order to retain nurses.Moreover, Treacy (2009) who studied organizational commitment of nurses in an acutecare hospital setting and demonstrated that hospitals that attract and retain nursing staff and create a climate in which experienced nurses can transfer their knowledge to new nurses, while maintaining quality of patient care and satisfaction among their staff will improve commitment and organizational performance.Professional practice environments allow for increased staff satisfaction, increased staff retention, increased staff recruitment ability, decreased staff burnout, increased patient satisfaction, improved patient outcomes, and numerous cost benefits to organizations.Moreover, Tella (2007) who studied work motivation, job satisfaction, and organizational commitment of library personnel in academic and research libraries in Oyo State and proved that the inter-relationship among fellow and the cooperation of colleagues and superiors enhances both organizational and professional commitment of health care providers.

Table (
2): Intention to leave among professional nurses.* Significant correlation at (p ≤ 0.05) As for intention to leave, the results of this study show that above half of professional nurses had moderate level of intention to leave and this may attributed to Professional nurses are still stable in their job, feel comfortable within the work, modified with the hospital's policies, having supervisory support and or probably because of the difficulty in finding alternative employment or fitting into a new workplace and demand to the work.This result was supported by leone et al. (2015) who studied work environment issues and intention-to-leave in Portuguese nurses: A study suggested that improving nurse' perceptions of opportunities for professional advancement and growth could be the most important strategy to improve retention and job satisfaction among professional nurses.
Khalifa (2012)12)who were studied organizational commitment and revealed that the professional nurses have moderate level of organizational commitment.
to identify their believes, values, hopes, interest and needs and knowing to what extent it match with the hospital values, believes and goals.Ahmed, R., Abdelwahab, E., Elguindy, H. (2017).Staff nurses' intention to leave nursing profession and their organizational commitment in selected hospitals at Beni-Sueif city.