ORIGINAL RESEARCH: EMPIRICAL RESEARCH – QUANTITATIVE
Work-to-family conflict as a mediator of the relationship between job satisfaction and turnover intention I-Hui Chen, Roger Brown, Barbara J. Bowers & Wen-Yin Chang Accepted for publication 5 May 2015
Correspondence to I.-H. Chen: e-mail: [email protected] I-Hui Chen PhD RN Assistant Professor Department of Nursing, Asia University, Taichung City, Taiwan Roger Brown PhD Professor Schools of Nursing, University of Wisconsin-Madison, Wisconsin, USA Barbara J. Bowers PhD RN Professor Schools of Nursing, University of Wisconsin-Madison, Wisconsin, USA Wen-Yin Chang PhD RN Professor Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taiwan
C H E N I . - H . , B R O W N R . , B O W E R S B . J . & C H A N G W . - Y . ( 2 0 1 5 ) Work-to-family conflict as a mediator of the relationship between job satisfaction and turnover intention. Journal of Advanced Nursing 71(10), 2350–2363. doi: 10.1111/jan.12706
Abstract Aims. To investigate the mediating effect of work-to-family conflict on the relationship between job satisfaction and turnover intention among licensed nurses in long-term care settings. Background. The considerable research on turnover in long-term care has primarily focused on the impact of job satisfaction on turnover intention. Given the well-documented high turnover rate in nursing home staffing, dissatisfaction is expected to continue. Alternatives (e.g. reduction in work-to-family conflict) for reducing turnover under the circumstance of job dissatisfaction have not been investigated extensively. Design. A cross-sectional mailed survey. Methods. A convenience sample comprising 200 nurses from 25 private nursing homes in Central Taiwan was created. Data were collected from nurses about their level of turnover intention, job satisfaction and work-to-family conflict in 2012. A composite indicator structural equation model was used to examine the mediation model of this study. Results. Overall, 186 nurses (93%) returned the completed questionnaires. Consistent with published research from other countries, turnover intention in our study was significantly and negatively associated with job satisfaction and significantly and positively associated with work-to-family conflict. In addition, job dissatisfaction indirectly influenced turnover intention through high work-tofamily conflict. Conclusion. Findings from this study indicate the importance of work-to-family conflict to nurse turnover. While work setting has a strong, well-documented influence on job satisfaction, limiting job satisfaction efforts to work setting improvements may not yield the hoped-for results unless work-to-family conflict is also considered and addressed. Keywords: job satisfaction, long-term care, nurses, nursing, nursing homes, turnover, turnover intention, work-to-family conflict
2350
© 2015 John Wiley & Sons Ltd
JAN: ORIGINAL RESEARCH: EMPIRICAL RESEARCH – QUANTITATIVE
Why is this research needed? Long-term care has faced the serious challenge of nurse turnover and job dissatisfaction is widespread among nurses, resulting in numerous studies to examine how job satisfaction contributes to turnover. New contributions explaining the dynamic relationship
Mediating role of work-to-family conflict
these studies have provided little insight into the dynamic relationship between job satisfaction and turnover intention while considering the high LTC nurse turnover problem. The level of LTC nurse job dissatisfaction is unlikely to decrease until the problem of high nurse turnover is solved. Hence, we examined other pathways to reducing or preventing turnover under the situation of job dissatisfaction.
between job satisfaction and turnover intention are required to find pathways to decrease turnover among nurses in long-term care.
What are the key findings? Work-to-family conflict is a determinant of turnover intention of nurses in long-term care settings. Work-to-family conflict mediates the relationship between job satisfaction and intent to turnover among long-term care nurses.
How should the findings be used to influence policy/ practice/research/education? Supervisors and managers should be aware of the deleterious effects of work-to-family conflict on the turnover process. Future research on turnover should consider the importance of work-to-family conflict.
Introduction Globally, the negative impact of nurse turnover on healthcare organizations, staff remaining at the work site and patient care has been well documented (Mukamel et al. 2009, Castle & Lin 2010, O’Brien-Pallas et al. 2010, Gilmartin 2013). However, most published research on factors contributing to nurse turnover has focused on hospital nurses (McGilton et al. 2013), despite nursing home (NH) nurses having the highest turnover rates (Castle 2006a, Chu et al. 2014), including those in Taiwan. The only published study on turnover among long-term care (LTC) nurses working in residential care facilities designed mainly for disabled older people in Taiwan reported an annual rate exceeding 50% (Hsiung et al. 1992). This rate is similar to rates reported internationally (Mukamel et al. 2009). The rapid increase in the demand for LTC in Taiwan, coupled with the documented high LTC nurse workforce turnover, makes this a pressing concern (Kuo et al. 2014). Although much is known about the factors leading to nurse turnover, most of the published studies have explored the relationship between job satisfaction and turnover intent. However,
© 2015 John Wiley & Sons Ltd
Background Healthcare researchers have focused on nursing turnover for several decades. Most of the turnover literature used turnover intention, rather than actual turnover, as it is more feasible to investigate turnover intention than to find employees who have actually left. A well-established positive relationship exists between turnover intention and actual turnover, supporting the use of turnover intention (Castle et al. 2007a,b, Hayes et al. 2012). Turnover is defined as the process whereby employed nurses leave an organization (Flint & Webster 2011), whereas turnover intention is defined as the intention of an individual nurse to voluntarily leave current organization (Tett & Meyer 1993). According to the theoretical assumptions of Fishbein and Ajzen (1975), behavioural intention is the best predictor of actual behaviour, and turnover intention is depicted as the immediate precursor to actual turnover (De Gieter et al. 2011, Van Dam et al. 2013). Based on this assumption, researchers have examined the relationships between several work-related factors and turnover intention. For example, researchers have studied the relationship between turnover intent and various factors such as job satisfaction, job stress, work demand and control over work. In addition, other factors contributing to each of these factors have been identified. Particularly, job satisfaction has been documented as the most critical factor influencing hospital nurse turnover, retention and recruitment (Hayes et al. 2012, Lu et al. 2012). Because of the awareness created by research on the relationship between job satisfaction and turnover, current efforts to decrease LTC nurse turnover focus on creating healthy, supportive work environments (Castle et al. 2007a, Hughes 2008, McGilton et al. 2013). In particular, job satisfaction has been viewed as an essential indicator of a healthy work environment in LTC (Pineau Stam et al. 2013, Kuo et al. 2014) and reflects the attitudes of workers towards their work environment (Castle 2006b). LTC research has documented the significant relationship between job satisfaction and turnover. For instance, a longitudinal survey of 1799 nursing staff from 72 NHs in the
2351
I.-H. Chen et al.
USA reported that lower job satisfaction was significantly associated with higher turnover intention (Castle et al. 2007b). Therefore, given that Taiwan has a high LTC nurse turnover rate, currently employed nurses may have a high level of job dissatisfaction (Li et al. 2013). Employees struggling with work- and family-life balance are gaining increasing attention because of global changes in social structure (e.g. the increased prevalence of dual-career couples and single-parent families). Specifically, work–family conflict occurs when the responsibility demands from work domain and family domain are mismatched (Greenhaus & Beutell 1985, Netemeyer et al. 1996). Work–family conflict suggests a bidirectional relationship, involving both workto-family conflict (WFC) and family-to-work conflict (FWC). Evidence has shown that WFC is strongly associated with work-related factors (Masuda et al. 2012). In addition, WFC is more prevalent than FWC among nurses (Simon et al. 2004, Grzywacz et al. 2006, Anafarta 2011). Accordingly, we focused on WFC, which is defined as the work of an employed person interfering with his or her family life (Frone et al. 1997). Human resource management-based studies have documented a negative impact of WFC on the quality of life (both work and family) of an employee and have identified WFC as a contributor to turnover (Allen et al. 2000, Post et al. 2009, Amstad et al. 2011, Haar et al. 2012, Huffman et al. 2013, Karatepe & Azar 2013). Research on management and business administration documented WFC as a predictor of employee intent to leave (Allen et al. 2000, Byron 2005). This is particularly true for female employees (Carlson et al. 2011). Female employees who work in demanding occupations are more likely to experience conflicts between work and family as they try to maintain roles as housewives and mothers (Cinamon & Rich 2002). One study in the United States reported that 918% of 1213 female nurses experienced WFC (Grzywacz et al. 2006). Furthermore, international studies have also reported that nurses experience moderate-to-severe WFC (Anafarta 2011, Brewer et al. 2012, Shacklock & Brunetto 2012, Wang & Tsai 2014). In addition, researchers have examined the relationships between WFC and nurse turnover (e.g. Shacklock & Brunetto 2012) and between WFC and job satisfaction (Yildirim & Aycan 2008, Cohen & Liani 2009, Cortese et al. 2010). For instance, Cohen and Liani (2009) studied a sample of Israeli female employees, including nurses, administrators and clerical and maintenance workers, in public hospitals and reported that low job satisfaction had significant and negative effects on WFC, whereas Cortese et al. (2010) reported that WFC inversely contributed to job satisfaction among nurses working in an Italian hospital. 2352
Overall, the existing studies on nurse turnover investigated the direct relationships between job satisfaction, WFC and intent to leave. Little is known about the relationships among job satisfaction, WFC and turnover intention. Moreover, it is unclear whether the relationship between job satisfaction and turnover intent is mediated by WFC. Taiwan has experienced one of the most dramatic reductions in birth rates, a marked increase in the number of employed women and rapid ageing. The resulting changes in social and family structures have remarkably increased the likelihood of employees experiencing struggles with work- and family-life balance, particularly for women with demanding occupations such as nursing. Therefore, WFC is a much greater issue for Taiwan. A report from World Health Organization and European Observatory on Health Systems and Policies (Wiskow et al. 2010) has stated that work–family balance plays a vital role in creating and maintaining an attractive, supportive and healthy work environment in healthcare sectors, thus promoting a familyfriendly workplace. Nevertheless, many studies related to working environment have not considered WFC.
Hypothetical model A model was developed based on the work–family fit theory (Barnett 1998) and empirical evidence obtained from previous studies (Figure 1). The model was to explore the relationships among job satisfaction, WFC and turnover intention, which suggests that job satisfaction influences turnover intention through its effect on WFC. On the basis of the following theoretical argument, WFC was identified as a mediator between job satisfaction and turnover intention. Work–family fit is conceptualized as the level of an individual’s ability to comprehend and optimize their plans and resources in the workplace to meet the family needs (Barnett et al. 1999). If workers are unable to optimize their family plans because of factors related to the work environment, their attitudes towards their jobs become negative and subsequently, they are more likely to experience
Work-to-family conflict
Job satisfaction
Tumover intention
Figure 1 A hypothesized model depicting work-to-family conflict as a mediator between job satisfaction and turnover intention. © 2015 John Wiley & Sons Ltd
JAN: ORIGINAL RESEARCH: EMPIRICAL RESEARCH – QUANTITATIVE
conflict and distress and ultimately leave their jobs. Conversely, if workers are able to realize and optimize their plans for their work and home, they tend to experience harmony and low distress (Barnett et al. 1999, Clarke et al. 2004, Rothausen 2009).
The study Aims We examined the relationships among job satisfaction, WFC and turnover intention, and investigated the role of WFC as a mediator between job satisfaction and turnover intention among LTC nurses.
Mediating role of work-to-family conflict
nurse in the participating facilities. In the covering letter, participants were given written explanations about the purpose of the study, the inclusion and exclusion criteria for the study, procedures of the study, their rights as human participants (particularly that their responses were confidential) and suggestions for completing this survey in a private and quiet area rather than at the workplace. The participants were asked to mail the completed questionnaire back to the PI directly within 2 weeks, using the pre-addressed, postage-paid return envelope. The $5 gift certificate was included as a token of appreciation of their time and effort. Each questionnaire included a unique number identifying only the facility.
Ethical considerations Design The study employed a cross-sectional survey, where the responses of a convenience sample of nurses employed in 25 private NHs in central Taiwan were recorded. This reflects that 90% of the NHs in Taiwan are privately owned organizations (Taiwan Ministry of Health and Welfare 2010). Among these NHs, 24% were large-sized facilities with at least 150 beds, 20% were medium-sized facilities with a range of 100-149 beds and 56% were small-sized facilities with less than 100 beds.
The Institutional Review Board (IRB) of a university approved the study (submission ID no.: 2012-0103). In addition, approval was obtained from each NH participating in the study. Nurses in each NH were informed about the purpose of the study and the necessary approvals obtained in this regard. They were informed about the voluntary participation and confidentiality of data and that returning the completed questionnaire represented their consent.
Instruments: validity and reliability Sample Nurses from the previously mentioned NHs were recruited based on the following inclusion criteria: (a) either registered (RNs) or licensed practical nurses (LPNs); (b) provided direct care to residents; (c) employed full- or parttime; (d) able to read Chinese; and (e) aged ≥20 years. Male nurses were excluded from this study. Turnover intention is higher in male nurses than in female nurses and the proportion of male nurses in the Taiwanese workforce is only 1% (Hsu et al. 2010); therefore, it seemed reasonable to control for gender differences by excluding male nurses from this study. For determining the minimum sample size, we selected 10 participants for one parameter (Soeken 2010). We studied 14 parameters in this study; therefore, the required sample size for this study was 140. Overall, 200 nurses were recruited from June–August 2012.
Data collection The principal investigator (PI) personally delivered packets including a covering letter, a $5 gift certificate (USD), a questionnaire and a postage-paid return envelope to each © 2015 John Wiley & Sons Ltd
The questionnaire comprised 38 questions, was classified into four parts and is described in detail in the following section. Turnover intention Turnover intention was the outcome variable and was measured using four items in this study. The Chinese version of the turnover intention scale, based on the work of Mobley et al. (1978), was translated by Huang (1984). Items were rated on a 5-point Likert scale, ranging from 1 (strongly disagree)-5 (strongly agree). An example item is ‘I intend to leave both my present job and employer.’ A mean score was computed, with a high score signifying a high level of turnover intention. This scale has been reported to range from 072-082 (Cronbach’s alpha) for hospital nurses in Taiwan with adequate content validity in various studies (Huang 1984, Yen 2004, Chen et al. 2006). The Cronbach’s alpha for our study sample was 072. Job satisfaction Job satisfaction, the independent variable, was measured using the short form of the Minnesota Satisfaction 2353
I.-H. Chen et al.
Questionnaire (MSQ) (Weiss et al. 1967). This 20-item measure was translated into Chinese by Liao (1978). Each item was rated on a 5-point Likert scale, ranging from 1 (very dissatisfied)-5 (very satisfied). Participants were asked to rate the extent to which they were satisfied with various aspects of their job (e.g. ‘the competence of my supervisor in making decisions’). A mean score was computed, with a high score indicating a high level of job satisfaction. Previous research has suggested adequate content validity for the MSQ and the Cronbach’s alpha ranged from 071-092 for the nursing population in Taiwan (Pan 1994, Huang 2006, Huang et al. 2011). In our study, the Cronbach’s alpha for job satisfaction was 092. Work-to-family conflict WFC, the mediator variable in this study, was measured using nine items rated on a 5-point Likert scale, ranging from 1 (strongly disagree)-5 (strongly agree). WFC measurement was adopted from the work of Carlson et al.(2000), which was translated into Chinese by Lu et al.(2005). The scale of Carlson et al. included WFC and FWC subscales, both of which assessed three types of conflicts (i.e. time-, strain- and behaviour-based). Participants were asked to rate the extent to which they agreed with statements such as ‘My work keeps me from my family activities more than I would like.’ A mean score was computed, with a high score indicating a high level of WFC. Previous studies have suggested that this scale has adequate content validity and the Cronbach’s alpha for the nursing population in Taiwan for this scale ranged from 084-090 (Lu et al. 2005, Kao et al. 2008, Yang 2008). The Cronbach’s alpha for the sample in our study was 091. Covariates The survey included demographic questions that were treated as covariates. These were age in years, marital status, level of education, number of years working in the current NH and the number of years of working in the nursing profession. These variables are commonly used as covariates in turnover research because workers’ demographics have been shown to influence their intention to leave.
Data analysis Descriptive analyses were performed using SPSS Version 190 for Windows (SPSS Inc., Chicago, IL, USA). Descriptive statistics were used to describe demographics and the levels of job satisfaction, WFC and turnover intention of the participating nurses. Means, standard deviations (SDs), percentages and minimum and maximum values were calculated for these 2354
variables. In addition, factor correlations (i.e. Pearson correlations) among job satisfaction, WFC and turnover intention were computed. The Sidak method was employed to avoid the problem of false positives resulting from multiple significance testing (Blakesley et al. 2009). Modelling a latent structural equation model was difficult because of the small sample size of this study. However, justifying measurement error in the tested model is vital. A composite indicator structural equation (CISE) modelling approach allowed us to estimate fewer parameters than those observed in the latent structural equation modelling, which is an advantage when modelling small samples. In addition, the CISE approach incorporates measurement error into the model. Furthermore, studies have reported that the CISE approach is as effective as the multiple indicator structural equation (McDonald et al. 2005). Accordingly, to study the relationships among job satisfaction, WFC and turnover intention, CISE modelling (McDonald et al. 2005), using maximum likelihood (as implemented in the Mplus 7 program), was performed (Muthen & Muthen 1998–2012). In the CISE analysis, a multi-item scale is treated as a single indicator of a construct and its error variance is fixed to equal the product of its variance multiplied by the quantity one minus its estimated reliability. That is, the scale items were averaged to create a composite measure, and a variance estimate and reliability coefficient (Cronbach’s alpha) were obtained on each composite. To fix the error variance in the CISE model, the error variance was created as the product of the composite variance and the quantity one minus the composite reliability. To determine the mediating effect of WFC, we used bootstrapping, rather than using the Baron and Kenny (1986) method, because of the non-normal distribution of a mediation effect (Preacher & Hayes 2008). Confidence intervals for estimates of direct, indirect and total effects were generated through bootstrapping with 5000 iterations. Absolute and relative indices were computed to evaluate the overall model fit. Non-significant chi-square (Kline 2011), ratio of chi-square/degrees of freedom (d.f.)
Work-to-family conflict as a mediator of the relationship between job satisfaction and turnover intention I-Hui Chen, Roger Brown, Barbara J. Bowers & Wen-Yin Chang Accepted for publication 5 May 2015
Correspondence to I.-H. Chen: e-mail: [email protected] I-Hui Chen PhD RN Assistant Professor Department of Nursing, Asia University, Taichung City, Taiwan Roger Brown PhD Professor Schools of Nursing, University of Wisconsin-Madison, Wisconsin, USA Barbara J. Bowers PhD RN Professor Schools of Nursing, University of Wisconsin-Madison, Wisconsin, USA Wen-Yin Chang PhD RN Professor Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taiwan
C H E N I . - H . , B R O W N R . , B O W E R S B . J . & C H A N G W . - Y . ( 2 0 1 5 ) Work-to-family conflict as a mediator of the relationship between job satisfaction and turnover intention. Journal of Advanced Nursing 71(10), 2350–2363. doi: 10.1111/jan.12706
Abstract Aims. To investigate the mediating effect of work-to-family conflict on the relationship between job satisfaction and turnover intention among licensed nurses in long-term care settings. Background. The considerable research on turnover in long-term care has primarily focused on the impact of job satisfaction on turnover intention. Given the well-documented high turnover rate in nursing home staffing, dissatisfaction is expected to continue. Alternatives (e.g. reduction in work-to-family conflict) for reducing turnover under the circumstance of job dissatisfaction have not been investigated extensively. Design. A cross-sectional mailed survey. Methods. A convenience sample comprising 200 nurses from 25 private nursing homes in Central Taiwan was created. Data were collected from nurses about their level of turnover intention, job satisfaction and work-to-family conflict in 2012. A composite indicator structural equation model was used to examine the mediation model of this study. Results. Overall, 186 nurses (93%) returned the completed questionnaires. Consistent with published research from other countries, turnover intention in our study was significantly and negatively associated with job satisfaction and significantly and positively associated with work-to-family conflict. In addition, job dissatisfaction indirectly influenced turnover intention through high work-tofamily conflict. Conclusion. Findings from this study indicate the importance of work-to-family conflict to nurse turnover. While work setting has a strong, well-documented influence on job satisfaction, limiting job satisfaction efforts to work setting improvements may not yield the hoped-for results unless work-to-family conflict is also considered and addressed. Keywords: job satisfaction, long-term care, nurses, nursing, nursing homes, turnover, turnover intention, work-to-family conflict
2350
© 2015 John Wiley & Sons Ltd
JAN: ORIGINAL RESEARCH: EMPIRICAL RESEARCH – QUANTITATIVE
Why is this research needed? Long-term care has faced the serious challenge of nurse turnover and job dissatisfaction is widespread among nurses, resulting in numerous studies to examine how job satisfaction contributes to turnover. New contributions explaining the dynamic relationship
Mediating role of work-to-family conflict
these studies have provided little insight into the dynamic relationship between job satisfaction and turnover intention while considering the high LTC nurse turnover problem. The level of LTC nurse job dissatisfaction is unlikely to decrease until the problem of high nurse turnover is solved. Hence, we examined other pathways to reducing or preventing turnover under the situation of job dissatisfaction.
between job satisfaction and turnover intention are required to find pathways to decrease turnover among nurses in long-term care.
What are the key findings? Work-to-family conflict is a determinant of turnover intention of nurses in long-term care settings. Work-to-family conflict mediates the relationship between job satisfaction and intent to turnover among long-term care nurses.
How should the findings be used to influence policy/ practice/research/education? Supervisors and managers should be aware of the deleterious effects of work-to-family conflict on the turnover process. Future research on turnover should consider the importance of work-to-family conflict.
Introduction Globally, the negative impact of nurse turnover on healthcare organizations, staff remaining at the work site and patient care has been well documented (Mukamel et al. 2009, Castle & Lin 2010, O’Brien-Pallas et al. 2010, Gilmartin 2013). However, most published research on factors contributing to nurse turnover has focused on hospital nurses (McGilton et al. 2013), despite nursing home (NH) nurses having the highest turnover rates (Castle 2006a, Chu et al. 2014), including those in Taiwan. The only published study on turnover among long-term care (LTC) nurses working in residential care facilities designed mainly for disabled older people in Taiwan reported an annual rate exceeding 50% (Hsiung et al. 1992). This rate is similar to rates reported internationally (Mukamel et al. 2009). The rapid increase in the demand for LTC in Taiwan, coupled with the documented high LTC nurse workforce turnover, makes this a pressing concern (Kuo et al. 2014). Although much is known about the factors leading to nurse turnover, most of the published studies have explored the relationship between job satisfaction and turnover intent. However,
© 2015 John Wiley & Sons Ltd
Background Healthcare researchers have focused on nursing turnover for several decades. Most of the turnover literature used turnover intention, rather than actual turnover, as it is more feasible to investigate turnover intention than to find employees who have actually left. A well-established positive relationship exists between turnover intention and actual turnover, supporting the use of turnover intention (Castle et al. 2007a,b, Hayes et al. 2012). Turnover is defined as the process whereby employed nurses leave an organization (Flint & Webster 2011), whereas turnover intention is defined as the intention of an individual nurse to voluntarily leave current organization (Tett & Meyer 1993). According to the theoretical assumptions of Fishbein and Ajzen (1975), behavioural intention is the best predictor of actual behaviour, and turnover intention is depicted as the immediate precursor to actual turnover (De Gieter et al. 2011, Van Dam et al. 2013). Based on this assumption, researchers have examined the relationships between several work-related factors and turnover intention. For example, researchers have studied the relationship between turnover intent and various factors such as job satisfaction, job stress, work demand and control over work. In addition, other factors contributing to each of these factors have been identified. Particularly, job satisfaction has been documented as the most critical factor influencing hospital nurse turnover, retention and recruitment (Hayes et al. 2012, Lu et al. 2012). Because of the awareness created by research on the relationship between job satisfaction and turnover, current efforts to decrease LTC nurse turnover focus on creating healthy, supportive work environments (Castle et al. 2007a, Hughes 2008, McGilton et al. 2013). In particular, job satisfaction has been viewed as an essential indicator of a healthy work environment in LTC (Pineau Stam et al. 2013, Kuo et al. 2014) and reflects the attitudes of workers towards their work environment (Castle 2006b). LTC research has documented the significant relationship between job satisfaction and turnover. For instance, a longitudinal survey of 1799 nursing staff from 72 NHs in the
2351
I.-H. Chen et al.
USA reported that lower job satisfaction was significantly associated with higher turnover intention (Castle et al. 2007b). Therefore, given that Taiwan has a high LTC nurse turnover rate, currently employed nurses may have a high level of job dissatisfaction (Li et al. 2013). Employees struggling with work- and family-life balance are gaining increasing attention because of global changes in social structure (e.g. the increased prevalence of dual-career couples and single-parent families). Specifically, work–family conflict occurs when the responsibility demands from work domain and family domain are mismatched (Greenhaus & Beutell 1985, Netemeyer et al. 1996). Work–family conflict suggests a bidirectional relationship, involving both workto-family conflict (WFC) and family-to-work conflict (FWC). Evidence has shown that WFC is strongly associated with work-related factors (Masuda et al. 2012). In addition, WFC is more prevalent than FWC among nurses (Simon et al. 2004, Grzywacz et al. 2006, Anafarta 2011). Accordingly, we focused on WFC, which is defined as the work of an employed person interfering with his or her family life (Frone et al. 1997). Human resource management-based studies have documented a negative impact of WFC on the quality of life (both work and family) of an employee and have identified WFC as a contributor to turnover (Allen et al. 2000, Post et al. 2009, Amstad et al. 2011, Haar et al. 2012, Huffman et al. 2013, Karatepe & Azar 2013). Research on management and business administration documented WFC as a predictor of employee intent to leave (Allen et al. 2000, Byron 2005). This is particularly true for female employees (Carlson et al. 2011). Female employees who work in demanding occupations are more likely to experience conflicts between work and family as they try to maintain roles as housewives and mothers (Cinamon & Rich 2002). One study in the United States reported that 918% of 1213 female nurses experienced WFC (Grzywacz et al. 2006). Furthermore, international studies have also reported that nurses experience moderate-to-severe WFC (Anafarta 2011, Brewer et al. 2012, Shacklock & Brunetto 2012, Wang & Tsai 2014). In addition, researchers have examined the relationships between WFC and nurse turnover (e.g. Shacklock & Brunetto 2012) and between WFC and job satisfaction (Yildirim & Aycan 2008, Cohen & Liani 2009, Cortese et al. 2010). For instance, Cohen and Liani (2009) studied a sample of Israeli female employees, including nurses, administrators and clerical and maintenance workers, in public hospitals and reported that low job satisfaction had significant and negative effects on WFC, whereas Cortese et al. (2010) reported that WFC inversely contributed to job satisfaction among nurses working in an Italian hospital. 2352
Overall, the existing studies on nurse turnover investigated the direct relationships between job satisfaction, WFC and intent to leave. Little is known about the relationships among job satisfaction, WFC and turnover intention. Moreover, it is unclear whether the relationship between job satisfaction and turnover intent is mediated by WFC. Taiwan has experienced one of the most dramatic reductions in birth rates, a marked increase in the number of employed women and rapid ageing. The resulting changes in social and family structures have remarkably increased the likelihood of employees experiencing struggles with work- and family-life balance, particularly for women with demanding occupations such as nursing. Therefore, WFC is a much greater issue for Taiwan. A report from World Health Organization and European Observatory on Health Systems and Policies (Wiskow et al. 2010) has stated that work–family balance plays a vital role in creating and maintaining an attractive, supportive and healthy work environment in healthcare sectors, thus promoting a familyfriendly workplace. Nevertheless, many studies related to working environment have not considered WFC.
Hypothetical model A model was developed based on the work–family fit theory (Barnett 1998) and empirical evidence obtained from previous studies (Figure 1). The model was to explore the relationships among job satisfaction, WFC and turnover intention, which suggests that job satisfaction influences turnover intention through its effect on WFC. On the basis of the following theoretical argument, WFC was identified as a mediator between job satisfaction and turnover intention. Work–family fit is conceptualized as the level of an individual’s ability to comprehend and optimize their plans and resources in the workplace to meet the family needs (Barnett et al. 1999). If workers are unable to optimize their family plans because of factors related to the work environment, their attitudes towards their jobs become negative and subsequently, they are more likely to experience
Work-to-family conflict
Job satisfaction
Tumover intention
Figure 1 A hypothesized model depicting work-to-family conflict as a mediator between job satisfaction and turnover intention. © 2015 John Wiley & Sons Ltd
JAN: ORIGINAL RESEARCH: EMPIRICAL RESEARCH – QUANTITATIVE
conflict and distress and ultimately leave their jobs. Conversely, if workers are able to realize and optimize their plans for their work and home, they tend to experience harmony and low distress (Barnett et al. 1999, Clarke et al. 2004, Rothausen 2009).
The study Aims We examined the relationships among job satisfaction, WFC and turnover intention, and investigated the role of WFC as a mediator between job satisfaction and turnover intention among LTC nurses.
Mediating role of work-to-family conflict
nurse in the participating facilities. In the covering letter, participants were given written explanations about the purpose of the study, the inclusion and exclusion criteria for the study, procedures of the study, their rights as human participants (particularly that their responses were confidential) and suggestions for completing this survey in a private and quiet area rather than at the workplace. The participants were asked to mail the completed questionnaire back to the PI directly within 2 weeks, using the pre-addressed, postage-paid return envelope. The $5 gift certificate was included as a token of appreciation of their time and effort. Each questionnaire included a unique number identifying only the facility.
Ethical considerations Design The study employed a cross-sectional survey, where the responses of a convenience sample of nurses employed in 25 private NHs in central Taiwan were recorded. This reflects that 90% of the NHs in Taiwan are privately owned organizations (Taiwan Ministry of Health and Welfare 2010). Among these NHs, 24% were large-sized facilities with at least 150 beds, 20% were medium-sized facilities with a range of 100-149 beds and 56% were small-sized facilities with less than 100 beds.
The Institutional Review Board (IRB) of a university approved the study (submission ID no.: 2012-0103). In addition, approval was obtained from each NH participating in the study. Nurses in each NH were informed about the purpose of the study and the necessary approvals obtained in this regard. They were informed about the voluntary participation and confidentiality of data and that returning the completed questionnaire represented their consent.
Instruments: validity and reliability Sample Nurses from the previously mentioned NHs were recruited based on the following inclusion criteria: (a) either registered (RNs) or licensed practical nurses (LPNs); (b) provided direct care to residents; (c) employed full- or parttime; (d) able to read Chinese; and (e) aged ≥20 years. Male nurses were excluded from this study. Turnover intention is higher in male nurses than in female nurses and the proportion of male nurses in the Taiwanese workforce is only 1% (Hsu et al. 2010); therefore, it seemed reasonable to control for gender differences by excluding male nurses from this study. For determining the minimum sample size, we selected 10 participants for one parameter (Soeken 2010). We studied 14 parameters in this study; therefore, the required sample size for this study was 140. Overall, 200 nurses were recruited from June–August 2012.
Data collection The principal investigator (PI) personally delivered packets including a covering letter, a $5 gift certificate (USD), a questionnaire and a postage-paid return envelope to each © 2015 John Wiley & Sons Ltd
The questionnaire comprised 38 questions, was classified into four parts and is described in detail in the following section. Turnover intention Turnover intention was the outcome variable and was measured using four items in this study. The Chinese version of the turnover intention scale, based on the work of Mobley et al. (1978), was translated by Huang (1984). Items were rated on a 5-point Likert scale, ranging from 1 (strongly disagree)-5 (strongly agree). An example item is ‘I intend to leave both my present job and employer.’ A mean score was computed, with a high score signifying a high level of turnover intention. This scale has been reported to range from 072-082 (Cronbach’s alpha) for hospital nurses in Taiwan with adequate content validity in various studies (Huang 1984, Yen 2004, Chen et al. 2006). The Cronbach’s alpha for our study sample was 072. Job satisfaction Job satisfaction, the independent variable, was measured using the short form of the Minnesota Satisfaction 2353
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Questionnaire (MSQ) (Weiss et al. 1967). This 20-item measure was translated into Chinese by Liao (1978). Each item was rated on a 5-point Likert scale, ranging from 1 (very dissatisfied)-5 (very satisfied). Participants were asked to rate the extent to which they were satisfied with various aspects of their job (e.g. ‘the competence of my supervisor in making decisions’). A mean score was computed, with a high score indicating a high level of job satisfaction. Previous research has suggested adequate content validity for the MSQ and the Cronbach’s alpha ranged from 071-092 for the nursing population in Taiwan (Pan 1994, Huang 2006, Huang et al. 2011). In our study, the Cronbach’s alpha for job satisfaction was 092. Work-to-family conflict WFC, the mediator variable in this study, was measured using nine items rated on a 5-point Likert scale, ranging from 1 (strongly disagree)-5 (strongly agree). WFC measurement was adopted from the work of Carlson et al.(2000), which was translated into Chinese by Lu et al.(2005). The scale of Carlson et al. included WFC and FWC subscales, both of which assessed three types of conflicts (i.e. time-, strain- and behaviour-based). Participants were asked to rate the extent to which they agreed with statements such as ‘My work keeps me from my family activities more than I would like.’ A mean score was computed, with a high score indicating a high level of WFC. Previous studies have suggested that this scale has adequate content validity and the Cronbach’s alpha for the nursing population in Taiwan for this scale ranged from 084-090 (Lu et al. 2005, Kao et al. 2008, Yang 2008). The Cronbach’s alpha for the sample in our study was 091. Covariates The survey included demographic questions that were treated as covariates. These were age in years, marital status, level of education, number of years working in the current NH and the number of years of working in the nursing profession. These variables are commonly used as covariates in turnover research because workers’ demographics have been shown to influence their intention to leave.
Data analysis Descriptive analyses were performed using SPSS Version 190 for Windows (SPSS Inc., Chicago, IL, USA). Descriptive statistics were used to describe demographics and the levels of job satisfaction, WFC and turnover intention of the participating nurses. Means, standard deviations (SDs), percentages and minimum and maximum values were calculated for these 2354
variables. In addition, factor correlations (i.e. Pearson correlations) among job satisfaction, WFC and turnover intention were computed. The Sidak method was employed to avoid the problem of false positives resulting from multiple significance testing (Blakesley et al. 2009). Modelling a latent structural equation model was difficult because of the small sample size of this study. However, justifying measurement error in the tested model is vital. A composite indicator structural equation (CISE) modelling approach allowed us to estimate fewer parameters than those observed in the latent structural equation modelling, which is an advantage when modelling small samples. In addition, the CISE approach incorporates measurement error into the model. Furthermore, studies have reported that the CISE approach is as effective as the multiple indicator structural equation (McDonald et al. 2005). Accordingly, to study the relationships among job satisfaction, WFC and turnover intention, CISE modelling (McDonald et al. 2005), using maximum likelihood (as implemented in the Mplus 7 program), was performed (Muthen & Muthen 1998–2012). In the CISE analysis, a multi-item scale is treated as a single indicator of a construct and its error variance is fixed to equal the product of its variance multiplied by the quantity one minus its estimated reliability. That is, the scale items were averaged to create a composite measure, and a variance estimate and reliability coefficient (Cronbach’s alpha) were obtained on each composite. To fix the error variance in the CISE model, the error variance was created as the product of the composite variance and the quantity one minus the composite reliability. To determine the mediating effect of WFC, we used bootstrapping, rather than using the Baron and Kenny (1986) method, because of the non-normal distribution of a mediation effect (Preacher & Hayes 2008). Confidence intervals for estimates of direct, indirect and total effects were generated through bootstrapping with 5000 iterations. Absolute and relative indices were computed to evaluate the overall model fit. Non-significant chi-square (Kline 2011), ratio of chi-square/degrees of freedom (d.f.)
