A Study of Employee Retention in Holy Family Hospital, New Delhi

A STUDY OF EMPLOYEE RETENTION IN HOLY FAMILY
HOSPITAL, NEW DELHI

Dissertation submitted to the JAMIA MILLIA ISLAMIA
In partial fulfillment of the requirements
For the award of the Degree of
MASTERS OF ARTS (HUMAN RESOURCE MANAGEMENT)
BY
HABIB UR RAHMAN
SUPERVISED BY
DR. RUBINA NUSRAT
DEPARTMENT OF SOCIAL WORK

UGC CENTRE OF ADVANCED STUDY
FACULTY OF SOCIAL SCIENCES
JAMIA MILLIA ISLAMIA
NEW DELHI- 110025
INDIA
2017
1
Declaration
This is to certify that the dissertation entitled, “A STUDY OF EMPLOYEE RETENTION IN

HOLY FAMILY HOSPITAL, NEW DELHI” submitted by me in partial fulfillment for the award
of the Degree of MASTER OF ARTS (HUMAN RESOURCE MANAGEMENT) of this University. This
dissertation has not been previously submitted for any other degree/diploma of this or any other
University and is my original work.
Habib ur Rahman
(Name & Signature of the Student)
I recommend this dissertation be placed before the examiners for evaluation.
Dr. Rubina Nusrat

(Name & Signature of the Faculty Supervisor)
2
CERTIFICATE
On the basis of the declaration submitted by Mr. Habib ur Rahman , student of M. A. HUMAN
RESOURCE MANAGEMENT (Semester – III), 2016, I hereby certify that the dissertation
titled “A STUDY ON EMPLOYEE RETENTION IN HOLY FAMILY HOSPITAL.” which is being
submitted to the Department of Social Work, Jamia Millia Islamia, New Delhi in partial
fulfillment of the requirement for the award of the degree of Masters of Arts in Human Resource
Management, is an original contribution to existing knowledge and faithful record of research
carried out by her under my guidance and supervision. To the best of my knowledge this work
has not been submitted in part or full for any Degree or Diploma to this University or elsewhere.
I consider this dissertation fit for submission and evaluation.
Dr.Rubina Nusrat
Date and Place:
3
ACKNOWLEDGEMENTS
I am deeply indebted to my Faculty Advisor Dr. Rubina Nusrat, Assistant Professor, Jamia
Millia Islamia, for her whole-hearted supervision during my organizational attachment period. I
am also grateful to Ms. Gena Lona Dias e. Soares my organizational supervisors. It would have
been very difficult to prepare this report up to this mark without their guidance.
I would also like to express my word of thanks to my parents for their endless support; I owe my
deepest gratitude to my friend Sidra Fatima for her valuable guidance, encouragement and
support through the course of this project.
Lastly, I would also like to convey my gratitude to the employees Holy Family Hospital. Who
helped me gather and complete the data with sincere inputs leading to a successful analysis for
my report. I would also like to express my genuine thanks to all those who gave me good advice,
suggestions, inspiration and support.
Place:
Date:
4
TABLE OF CONTENTS
Sr. No PARTICULARS PAGE NO.
1. INTRODUCTION 8-16
2. LITERATURE REVIEW 33
3. RESEARCH METHODOLOGY 37
4. DATA ANALYSIS & INTERPRETATION 58
5. MAJOR FINDINGS& SUMMARY 61
6. RECOMMENDATIONS & CONCLUSION 64
7. REFERENCES 67
8. ANNEXURE 69
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Table Of Figures
Figure 1-Age ................................................................................................................................................ 39
Figure 2-Educational Qualification .............................................................................................................. 40
Figure 3-Work Duration .............................................................................................................................. 41
Figure 4-Employee Relation ........................................................................................................................ 42
Figure 5-Recruitment and Selection ........................................................................................................... 43
Figure 6-Appointment and Promotions ...................................................................................................... 44
Figure 7-Duties and Responsibilities ........................................................................................................... 45
Figure 8-Salaries comparing to private hospital ......................................................................................... 47
Figure 9-Salaries and Wages ....................................................................................................................... 48
Figure 10-Satisfaction ................................................................................................................................. 49
Figure 11-Training and Development ......................................................................................................... 50
Figure 12-Reward and Recognition ............................................................................................................. 51
Figure 13-Job related Problems .................................................................................................................. 52
Figure 14-Job related Problems .................................................................................................................. 53
Figure 15-Duties and Responsbilities .......................................................................................................... 54
Figure 16-Leaving Job.................................................................................................................................. 55
Figure 17-Leaving Job.................................................................................................................................. 56
Table 1-Age ................................................................................................................................................. 38

Table 2-Educational Qualification ............................................................................................................... 39
Table 3-Work Duration ............................................................................................................................... 40
Table 4-Employee Relation ......................................................................................................................... 41
Table 5-Recruitment and Selection ............................................................................................................. 43
Table 6-Appointment and Promotions ....................................................................................................... 44
Table 7-Duties and Responsibilities ............................................................................................................ 45
Table 8-Salaries comparing to private hospital........................................................................................... 46
Table 9-Salaries and Wages ........................................................................................................................ 47
Table 10-Satisfaction................................................................................................................................... 48
Table 11-Training and Development........................................................................................................... 49
Table 12-Reward and Recognition .............................................................................................................. 51
Table 13-Job related Problems ................................................................................................................... 52
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Table 14-Organizational Culture and Work Environment........................................................................... 53
Table 15-Duties and Responsbilities ........................................................................................................... 54
Table 16-Leaving Job Source: Primary data ........................................................................................... 55
Table 17-Retention Factors ......................................................................................................................... 56
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CHAPTER- I
INTRODUCTION
The Indian healthcare sector comprises of many segments, which include hospitals, medical
infrastructure, medical devices, clinical trials, outsourcing, telemedicine, and health insurance.
Its delivery market is estimated at US$ 18.7 billion and employs over four million people,
making it one of the largest service sectors in the economy today. In the year 2004, total national
healthcare spending had reached 5.2% of GDP, or US $34.9 billion and was expected to rise to
5.5% of GDP, or US $60.9 billion by 2009.
Today, the industry has grown at about 13 per cent and is expected to grow at 15 per cent per
year over the next four to five years. The growth of managed care has had major financial
implications for health care delivery. One of the major implications is the quality of care which
is directly affected by the quality of work life of patient care personnel (nurses) and the level of
satisfaction they see in their jobs.
Staffing levels of patient care personnel in hospitals comprise of registered nurses, licensed
practical nurses, and unlicensed assistive personnel. However, the proportion of these nurses
varies, and is usually adjusted to reduce the overall cost of patient care. But the fact is that, on an
average, minimum nurse-to-patient ratios for the day shift of typical medical-surgical nursing
units rage between 1:4 and 1:10. Apart from the number of nurses employed, cost reduction
techniques also include the kind of facilities and work life provided to nurses on duty in
hospitals. Ideally, this ratio should increase, but in order to have efficacious and cost-effective
nursing staff, it becomes important to provide a congenial working environment, fair and
equitable compensation, safety and healthy work place, personal and professional development,
job security, ethical organizational actions, employee privacy issues, constitutionalism and
supportive work culture.
Provision of all these facilities will improve their quality of work life which in turn will boost
their level of job satisfaction. The quality of service provided by the hospitals is of utmost
importance for improving its in-patient rate and the nurses in the hospitals play a vital role
maintaining this level of service. So in order to improve the quality of its service and
organizational effectiveness hospitals must ensure high commitment from its patient-care
personnel which is derived if they experience a sense of job satisfaction that is directly affected
by their Quality of Work Life (QWL). Thus, in the present paper, the key providers of improving
8
organizational performance of hospitals, that is, nurses, have been studied in the context of their
QWL (Quality of Work Life) and resultant job satisfaction, at few sample private and
government hospitals of Ahmadabad.
Nurse’s recruitment, retention and attrition are complex issues. Nurses are considered as the core
of care and vital role in health care system. According to Institute for Health care Improvement
(IHI), hundreds of hospitals in India have struggled against nursing shortage. Dynamic health
workforces are current issue for leadership and management in nursing. Nurse Leaders and
managers have the responsibility to manage limited resources, including human resources
related to nursing service. In the history of nursing profession the crisis of nurses‟ turnover
remains a serious problem.
The turnover is caused by many factors including worker’s value systems and work
environments. Nurse’s recruitment and retention strategies are areas that have not been studied
broadly. To minimize the turnover is a priority for nurse administrators who face continuously
this problem at their workplace.
This thesis will focus on description, analysis of issue through literature review, management
along with leadership theory and recommendations to increase employee’s retention.
Retention
Employee retention refers to the various policies and practices which let the employees stick to
an organization for a longer period of time. Every organization invests time and money to groom
a new joinee, make him a corporate ready material and bring him at par with the existing
employees. The organization is completely at loss when the employees leave their job once they
are fully trained. Employee retention takes into account the various measures taken so that an
individual stays in an organization for the maximum period of time.
An effective Employee Retention Program is a systematic effort to create and foster an
environment that encourages employees to remain employed by having policies and practices in
place that address their diverse needs. The way it was in the past, New York State jobs were
considered desirable and sufficient candidates could be found to fill most critical jobs.
Moreover, once employed, workers would often spend their entire careers in State service. In areas
where there was turnover, new employees could be recruited easily. The way it is...today there is a
high demand in the public and private sectors for workers in critical areas such as health care,
9
information technology, engineering, and auditing. The supply of qualified workers is limited
and good workforce planning requires a twofold approach of aggressive recruitment and
innovative retention strategies. Retention policies need to focus on elimination of unwanted
turnover.
It is a function of the HR department tasked with reducing the number of employees leaving the
company by improving key processes and conditions. The ultimate aim is happier, loyal
employees that actively want to remain with the company.
The first task, and one of the hardest, is measurement of key factors influencing retention rates,
such as employee engagement, salary expectations, perception of working environment
and perception of managerial ability.
Once these measurements have been taken and the biggest influencers of employees leaving
have been identified, initiatives can then be planned and implemented to improve the retention
rate, employees leaving the company but not subsequently replaced, leaving to a chronic
reduction in workforce numbers, form part of the attrition rate.
Having invested time and resources hiring and training the employee, the manager wants to
make sure that the person stays; doing so requires understanding the forces driving employees to
leave.
Turnover
The rate at which employees leave the firm, Turnover intention is defined as the voluntary choice
of an employee to leave an organization (Dougherty, Bluedorn & Keon, 1985). The reasons for
leaving the organization can range from negative work conditions to new career opportunities.
There is a broad consensus in the literature that turnover intention is the immediate precursor of
actual turnover (Tett & Meyer, 1993).
Huber, (2006) defines turnover as “the loss of an employee due to transfer. Similarly
Mrayyan ,( 2005) adds that “ the number of resignation or termination divided by the
average of direct or indirect care of registered nurses full-time equivalent position for the
same year” Moreover Sullivan& Decker (2004), declare that term turnover means when
number of staff vacate a position. The employees choose to leave voluntarily. It is also
defined as a situation in which employee quit job weather it is dysfunctional or functional.
10
Unwanted turnover is expensive
Costs to the employer can include separation benefits, lost productivity, recruitment costs,
training costs, and diminished services as new employees get up to speed. In their book,
Retaining Valued Employees, Griffeth and Hom report that turnover costs run as high as 200
percent of the exiting employee’s salary, depending on his other skill level. According to the
newsletter of the International Association of Professionals in Employment Security,
“When a valuable employee leaves, it costs the Employer money - possibly up to a third of the
employee’s annual salary.”An effective Employee Retention Program is a systematic effort to
create and foster an environment that encourages employees to remain employed by having
policies and practices in place that address their diverse needs.
Moreover, once employed, workers would often spend their entire careers in State service. In
areas where there was turnover, new employees could be recruited easily. The way it is...today
there is a high demand in the public and private sectors for workers in critical areas such as
health care, information technology, engineering, and auditing. The supply of qualified workers
is limited and good workforce planning requires a twofold approach of aggressive recruitment
and innovative retention strategies. Retention policies need to focus on elimination of
unwanted turnover.
Unwanted turnover is expensive. Costs to the employer can include separation benefits,
lost productivity, recruitment costs, training costs, and diminished services as new
employees get up to speed. In their book, Retaining Valued Employees, Griffeth and Hom
report that turnover costs run as high as 200 percent of the exiting employee’s salary, depending
on his or her skill level. According to the newsletter of the International Association of
Professionals in Employment Security, “When a valuable employee leaves, it costs the employer
money - possibly up to a third of the employee’s annual salary.
Retention strategies for reducing voluntary turnover

In any case given the variety of things prompting employees to leave voluntary, what can one do
to manage voluntary turnover? We are going to list some tactics and strategies as follow
Motivation
Motivation can be defined as the driving force that moves us to pursue a certain goal, or trigger a
particular action. It can be considered as the desire within a person causing him or her to act.
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People generally act for a motive and that is to achieve a specific objective. The term motivation
can be described in many different formats and views, but according to Stephen Robbins, this is
the process that accounts for an individual intensity, direction and persistence of effort towards
attaining a goal. Below are a description of what a process and content theory of motivation are,
their features and how each applies to the workplace.
A process theory define motivation as a rational cognitive process occurring within the individual
e.g. Adams’ Equity theory. While on the other hand, a content theory define motivation in terms of
need satisfaction, e.g. Maslow’s Hierarchy of needs theory. Both of these theories defer in a
significant way because each one recognizes motivation and it features differently to the other.
When motivation theory is being considered the first theory that comes to mind is Maslow’s
hierarchy of need theory. According to this theory individual strives to seek higher need when
lower needs are fulfilled. Once a lower level need is satisfied, it no longer serves as a source of
motivation. Needs are motivators only when it is not satisfied.
Next is Hertzberg two factor theory, the two factors are hygiene and motivation. Hygiene factors:
A series of hygiene factors create dissatisfaction if individuals perceive them as inadequate or
inequitable, yet individuals will not be significantly motivated if these factors are viewed as
adequate or good. Hygiene factors are extrinsic and include factors such as salary or remuneration,
job security and working conditions. Motivators: They are intrinsic factors such as sense of
achievement, recognition, responsibility, and personal growth.
The hygiene factors determine dissatisfaction, and motivators determine satisfaction. Hertzberg
theory conforms with satisfaction theories which assert that “a satisfied employee tends to work in
the same organization but this satisfaction does not always result in better performance”. The other
theory of motivation is Adam’s equity theory, it states that if the individual perceives that the
rewards received are equitable, that is, fair or just then they feel satisfied. Two main types of
motivation have been noted, namely intrinsic and extrinsic. Intrinsic motivation comes from the
inner self while extrinsic motivation arises when external factors require one to perform something.
Job Satisfaction
Employee satisfaction or job satisfaction is, quite simply, how content or satisfied employees are
with their jobs. Employee satisfaction is typically measured using an employee satisfaction survey.
These surveys address topics such as compensation, workload, perceptions of management,
12
flexibility, teamwork, resources, etc. Employee satisfaction is the extent to which employees are
happy or content with their jobs and work environment.
One of the most often cited definitions on job satisfaction is the one given by Spector according to
whom job satisfaction has to do with the way how people feel about their job and its various
aspects. It has to do with the extent to which people like or dislike their job. That is why job
satisfaction and job dissatisfaction can appear in any given work situation. Job satisfaction
represents a combination of positive or negative feelings that workers have towards their work.
Meanwhile, when a worker employed in a business organization, brings with it the needs, desires
and experiences which determinates expectations that he has dismissed. Job satisfaction represents
the extent to which expectations are and match the real awards. Job satisfaction is closely linked
to that individual's behaviour in the work place.
Job satisfaction is a complex and multifaceted concept which can mean different things to different
people. Job satisfaction is usually linked with motivation, but the nature of this relationship is not
clear. Satisfaction is not the same as motivation. Job satisfaction is more of an attitude, an internal
state. It could, for example, be associated with a personal feeling of achievement (Mullins, 2005).
Identify the issue

Identifying an issue is an important first step, effectively conducted exit interviews provide
useful insight into turnover problem areas,, many employers routinely administer attitude
surveys to monitor employees about matters such as supervision and pay, open door policies and
anonymous “hotlines” help management identify and remedy moral problems.
Compensation
The most obvious explanation for why employees quit is often also the correct one: low pay,
particularly for high performers and key employees, enhanced pay has recently been the
retention tool of choice for many employers.
Selection
Retention starts up in front, with the selection and hiring of the right employees, selection refers
not just to the worker but also choosing the supervisors.
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Professional growth
One expert says “professionals who feel their company cares about their development and
progress are much more likely to stay”. Periodically discuss with employees their career
preferences and prospects, and help them lay out career plans.
Meaningful work an ownership of goals

People can’t do their job if they don’t know what to do or what their goals are. Therefore,
retaining employees requires making it clear what your expectations are regarding their
performance and what their responsibilities are.
Promote Work-Life balance

In survey conducted by Robert half and careerbuilders.com, workers indentified “flexible work
arrangement” and “telecommuting” as two top benefiters that would encourage them to choose
one job or another.
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ABOUT THE ORGANIZATION
Holy Family Hospital, New Delhi is a 303 bedded multi-specialty hospital run by the New Delhi
Holy Family Hospital Society and managed by the Delhi Catholic Archdiocese. It is registered as
charitable Non-Profit Organization under the Societies Registration Act XXI of 1860. Founded
by the Medical Mission Sisters in 1953, the vision and values of the Founder- Mother (Dr.) Anna
Dengel, are an integral part of the philosophy of this hospital.
Initially, the hospital was founded by the Medical Mission Sisters in 1953. The foundation stone
was laid by His Excellency, Dr. Sarvapalli Radhakrishnan, Vice President of India in the
presence of Ms Rajkumari Amrit Kaur, India's Minister of Health, Subsequently the running of
the hospital handed over to the Delhi Catholic Archdiocese in 1990.
At present his grace, most Rev. Anil J.T. Couto, Archbishop of Delhi is the Chairman of the
Governing Body of the hospital. Rev Fr. Geroge P.A. is the Director and Dr.S.Warsi is the
Medical Superintendent, Holy Family Hospital, New Delhi is registered under the Delhi Nursing
Home Act and is an ISO 9001:2000 certified hospital.
Vision
To be known as a centre providing holistic, competent and ethical super specialty medical
care with core value of compassion and empathy.
Mission
To provide multidimensional comprehensive medical care to strengthen the preventive,
promotive, curative, emergency and rehabilitative services including education and training in
medical, paramedical and support facility.
Objectives
Holy Family Hospital is committed to provide Quality Health Care Services to the community at
large and to the needy for maximum patient’s satisfaction, In order to achieve this; the Holy
Family Hospital would strive for the following objectives:
To make qualitative services available to all persons irrespective of their caste, creed and
religion.
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 To develop a cheerful working environment with well-trained and motivated staff.
 To provide necessary training to all personnel to enhance their working skills
 To contribute towards National and Social cause as required by the government and
under any legal provisions.
 Continuous improvement by improved quality of performance and increased efficiency
by optimum utilization of resources.
 To be open and attentive to the signs of the time and respond to the health needs of the
society.
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CHAPTER-II
LITERATURE REVIEW
Health care industry relies a lot on advanced medical technology, but it is also a labor intensive
industry. In recent times there has been increase in healthcare costs and healthcare staff shortages
leading to healthcare organizations undergoing changes. Some of these changes have lead to
increased performance expectations and efficiency leading to decrease in staff morale and
increase in attrition. In this paper, the terms “health care professionals” and “human resources for
health” are used interchangeably, comprise of doctors, nurses, paramedics, hospital
administrators. Researchers have identified the effect of shortage of skilled workers in hospitals
lead to high patient mortality, job dissatisfaction and burnout. The migration of health
professionals has been debated to be one of the main reasons of attrition and has been the main
focus of such studies. It has been argued that opportunities for professional training, higher
salaries and perks and better living conditions act as “pull” factors, surplus production of health
personnel, resultant unemployment, less attractive salary, stagnation or underemployment
coupled with lack of infrastructure act as “push” factors for the youth to migrate. A number of
strategies have been discussed to counteract migration. Human resources management plays a
significant role in retaining health care workers.
Health care industry relies a lot on advanced medical technology, but it is also a labor-intensive
industry. As the Indian healthcare industry experiences phenomenal growth, hospitals are
moving forward towards excellence rather than survival and gearing up to fulfil the gaps in three
key areas of people, process and technology. India is the one of the most populous country with
larger population in rural areas with an estimated 27.5% of Indians still living below the poverty
line and cannot afford the healthcare provided by private organizations due to cost and
unreachable locations. Most of them utilize the public healthcare provided by the government
organizations. In a recent survey of dichotomy existing in the utilization of private and public
health services in India it emerged that a bias towards the use of private health services in spite
of the earlier mentioned problems may be due to the view that public healthcare services are not
of good quality.
17
Even with greater number of health care professionals viz, doctors, nurses, pharmacists,
paramedics getting trained the Indian healthcare sector is suffering from acute shortage of
healthcare professionals and facilities delivering quality healthcare services to the citizens.
According to survey carried out in 2008-09, India has only around 85,000 doctors practicing
modern medicine and 1.5 million nurses to serve its more than one billion population. It has 0.8
beds/ 1000 population, and 0.6 doctors / 1000 population (lowest in the world). This means 6
doctors per 10,000 patients with a doctor/ nurse ratio of 0.83 compared to china having 20. This
large disparity has indicates a high attrition of knowledge workers in healthcare.
Implementation and utilization of information technology in healthcare (commonly identified as
Health Information Technology or HIT) has proven to be of immense benefit like, improved
patient care, reduced waste and inefficiency in services, reduction in adverse drug effects and
medical errors etc. Since healthcare professional job satisfaction also has important implications
for quality healthcare delivery, the relationship between the use of HIT and career satisfaction
should be probed. In an earlier small scaled study it was determined that using more information
technology was the strongest positive determinant of physician’s being very satisfied with their
careers.
India has joined the bandwagon of information technology adaptors and is one of the main global
forerunners in this area. A number of government policies and programs have been developed
pertaining to use of healthcare information technology (HIT) to improve the quality of healthcare
delivery. Major private hospitals (corporate) and public hospitals at state level have implemented
hospital information systems for patient management, employee management, inventory,
pharmacy, laboratory etc. While there are articles that indicate there is greater danger of brain
drain in the area of healthcare in India, there are no detailed studies that offer effective retention
strategies for reducing the attrition in Indian scenario.
The aim of this paper is to develop a probable strategy that could use implementation of
information technology as a probable strategy to reduce attrition. To achieve this objective, I use
the primary data collected from nurses and secondary data from hospital library.
This literature review contains an overview of the development and establishment of approaches
to stress that leads to attrition, particularly in the nursing profession and organizational settings.
18
Employee Engagement, Employee Satisfaction And Patient Satisfaction
The first part of the study involves a review of over 40 studies on “employee engagement”,
“employee satisfaction” and “patient satisfaction” specific to the health care industry. This
review provides initial insights into the possible relationship between these constructs at a health
care organization. Over the years much research has looked at the areas of customer satisfaction
and employee satisfaction. Recent research has put even more of an emphasis on how human
resource management practices such as employee engagement, recognition programs, and
internal marketing efforts can increase employee satisfaction and retention. Fewer studies
demonstrate the need for health care administrators to take a closer look at human resource
management practices of their organization and efforts to improve the quality of care by
changing employee engagement, satisfaction, and loyalty. While relatively few academic studies
in the health care industry appear to exist which look at the connection between employee
satisfaction and patient satisfaction, those that do look at this topic show a relationship exists.
Many health care administrators are increasingly showing concern for delivering high quality
care in which both the customer (patients) and providers (employees) are satisfied while
maintaining a strong financial environment (Love et al., 2008). This represents a shift in
management theory from the 1990s when cost cutting and the bottom line nominated concerns in
the health care industry (Brown 2002).
DEFINING EMPLOYEE ENGAGEMENT

Ketter (2008) in his research noted that the health care industry is no exception to this
phenomenon inhuman resource management theory and practice. Nursing shortages in particular
have helped make engagement an important topic in this industry. With regard to health care
specifically, research has frequently uncovered a lack of loyalty to the organization and the
nursing profession.
A variety of definitions exist for “employee engagement.” Gibbons (2006) reviewed research
on employee engagement and determined several different definitions. Additionally, the review
showed that previous studies covered 20 key drivers of employee engagement. A blended
definition created by Gibbons defines employee engagement as: “A heightened emotional
connection that an employee feels for his or her organization that influences him or her to exert
greater discretionary effort to history her work. “Effects of Employee Engagement, Employee
19
Engagement Empowerment” Managers in all industries have made employee engagement a hot
button issue because of growing evidence that engagement has a positive correlation with
individual, group, and organizational performance in areas such as productivity, retention,
turnover, customer service, and loyalty.
Brown (2002) , Brown in his research noted that nurse administrators face the challenge of
repairing “broken” relationships with nurses because of changes in management policies over
time. During the 1990s, health care organizations tried to adopt cost cutting strategies employed
by many other industries, thereby taking the focus away from the quality of care to patients. This
conflict ultimately left nurses feeling disengaged and underpowered in their roles in delivering
patient care and at odds with the financial performance initiatives of health care administrators,
Research has shown, as expected, that when employees are disengaged in their jobs they are
more likely to leave because they feel unappreciated.
Curran (2001), in his research also found that, these findings highlight the importance of
creating engaged employees and the important role of administrators and other leaders in this
process. These findings suggest that hospitals that have highly accessible leaders, provide
support for autonomous decision making, and provide access to empowerment structures have a
greater likelihood of increasing employee satisfaction and thus reducing attrition.
Fukuyama (1995), Further compounding this issue, surveys with nurses have indicated that they
exhibit loyalty to patients but often do not feel the same level of loyalty to their employer
because they feel hospital executives are not in touch with the demands of patient care.
REDUCED JOB STRESS AND TURNOVER

Morrison, et al. (2007) outlined several ways in which the lack of engagement and high
turnover rates impact health care organizations. Some of these factors include turnover costs,
which according to Waldman & Kelly (2004) range between 3.4% and 5.8% of their operating
budget. High turnover rates are also thought to lead to higher discharge costs according to
JCAHO (2005) so there are financial concerns to administrators beyond just recruitment and
retention costs. Plus when employees feel unsatisfied and unappreciated and leave the
organization this puts higher workloads and stress levels on those who remain and ultimately
further drives down satisfaction for both employees and patients.
20
Joiner et al. (2004) in their empirical research has shown a negative relationship between
empowerment and job stress, suggesting that as employees are more empowered their job stress
decreases, in addition to stress, increased employee satisfaction helps reduce employee turnover,
leaves of absence, and lower work-related disability and violence claims.
Laschinger, et al. (2004) in their studies suggests that changes in access to structural
empowerment impacted staff nurses‟ feelings of psychological empowerment and satisfaction
with their jobs over a three-year time frame. Nurses at magnet hospitals experience higher levels
of empowerment and job satisfaction due to greater access to work empowerment structures
when compared with nurses from non- magnet hospitals
Berlowitz et al, (2003) found that when employees are more active in decision making not only
in nursing practice and unit management but also patient care, they feel more engaged which
leads to higher satisfaction and lower turnover rates .Changes in the perception of employee
empowerment appear to have long-lasting positive effects on employee satisfaction.
BETTER RELATIONSHIP WITH THE MANAGEMENT

Wagner (2006) in his study determined that a primary factor in employee’s satisfaction and
loyalty to that employer is the employee’s relationship with his or her immediate supervisor.
This finding further demonstrates the need for health care administrators to be concerned with
employee satisfaction as hospitals face nursing shortages.
Brunetto et al, (2006) further compounded that when management helps an employee feel
engaged and offers them the support and resources necessary to provide quality patient care,
employees are not only more satisfied with their employer but also remain more loyal. While
many studies show that engagement and empowerment in health care settings can lead to greater
job and organizational satisfaction, not everyone has found a connection between the two.
Suominen, et al. (2006) determined that based on their study of a multidisciplinary teammate the
Rheumatism Foundation Hospital in Finland, job satisfaction is not related to any of the fields of
empowerment. While this differs from previous studies, it does raise the question of when and
how does empowerment and engagement impact employee satisfaction.
It also is in line with Curran‟s (2001) findings that nurses indicated management that is out of
touch with the realities of patient care lead to lower nurse satisfaction and loyalty. The quality of
relationships including communication between management and employees not only impacts
21
the employees themselves but also has an impact on organizational effectiveness by affecting
productivity and turnover rates,
EFFECT OF EMPLOYEE SATISFACTION ON PATIENT CARE AND PATIENT

SATISFATION
Rathert et al. (2007) also determined that satisfied employees also were found to lead to
shortened lengths of stay for patients and lower variable costs.
JCAHO et al. (2005) provide a unique study which combined data on employee and client
satisfaction. Their findings suggest that employee satisfaction with their organization is a better
predictor of client satisfaction than employees‟ job satisfaction. The authors suggest that based
on their findings, job-related training is the activity most relevant for client satisfaction, despite
showing no relation with job satisfaction. Their study also demonstrated the volatile relationship
between employee and client satisfaction which can be in conflict. For example, while
employees are more satisfied when they have regular work schedules this decreases client
satisfaction as employees are deemed less available to patients. This shows that employee and
patient satisfaction are related, but sometimes at conflict with each other. Employee satisfaction
also appears to have a strong relationship with the quality care delivered and related costs. When
employees are more satisfied it helps reduce stress, turnover, leaves of absence, and lower work-
related disability and violence claims.
Nurse and other health care employee satisfaction have been found to have several impacts on
the quality of care delivered which ultimately influences the level of patient satisfaction.
According to Mailam F (2005), in his study determined that quality leadership in health care
organizations helps foster an environment that provides quality care which is linked with patient
satisfaction. Organizations who seek to improve patient satisfaction and encourage return visits
or customer loyalty should focus on improving the quality of care. As many studies suggest,
quality leadership that provides empowering work environments are more likely to result in
engaged employees and tend to be the most successful at increasing the quality of care provided.
This again gets at the point that management plays an integral role in the level of care provided
even when they are not directly involved. The concept of internal marketing in the health care
sector suggests that the best way to satisfy patients is by viewing employees as internal
customers and that by understanding and meeting employees needs, wants, expectations, and
22
concerns their level of satisfaction will increase thereby leading to better quality of care and
higher patient satisfaction.
The findings from Peltier studies (2003, 2004, and 2007) suggest that by focusing on improving
the quality of care, health care organizations can not only improve patient satisfaction, but also
improve employee satisfaction and loyalty to the organization. This in turn will further impact
the quality of care because of the interrelationship of this chain provides a summary of the
effects of higher employee engagement on three areas reported in the literature review: (1)
Employees, (2) Patients, and (3) Organizational Financial provides a list of recommended
methods for improving engagement in health care settings from the literature review-
 Effects of Higher Employee -Engagement Levels on Employees
 Effects of Higher Employee- Engagement & Satisfaction on Patients
 Effects of Higher Employee- Engagement/Satisfaction on Financial Performance
 Improves employee productivity-Improves relationships with management
 Reduces job stress
 Increases employee satisfaction
 Increases retention & turnover
 Improved care quality
 Increased patient satisfaction
 Increased patient loyalty
 Lower employee recruitment/retention and training costs
 Higher patient loyalty to organization
 Possibly lower costs related to the delivery of patient care(because of shorter patient
stays)
 Empowerment in decision making
 Management accessibility & leadership styles
 Recognition programs
 Workplace culture
 Organizational communication
 Trust & respect
 Company reputation
23
Newman et al. (2001) chain outlines a clear interrelationship between employee satisfaction, the
quality of care, and patient satisfaction.
Atkins et al., (1996) showed that employee dissatisfaction negatively impacts the quality of care
and ultimately has an adverse effect on patient loyalty and in turn hospital profitability.
Quality improvement initiatives were shown to have a positive correlation with employee
satisfaction as well as client satisfaction in a study of Swedish healthcare (Kammerlind, et al,
2004). Health care employee morale also demonstrates a strong correlation with patient
satisfaction scores, showing that the lack of commitment and engagement has far- reaching
impacts on more than just employee turnover.
ANALYSIS OF ISSUE THROUGH ANOTHER LITERARTURE REVIEW

Literature review on nursing turnover guides about problems, and helps nurse leaders to
minimize nursing shortage. There are several factors which could contribute for nursing
turnover. The research- based literature illustrates the reasons why nurses quit their job willingly
or against their will. Their services are liable to be terminated at any time. They are less
benefited as compare to government employees. For instance there is no opportunity for nurses
to get deputation for higher education, study loan from the organization.
Mostly low salary is a hurdle for nurses to get advanced professional education at their own,
limited chances for professional development. Similarly, they have less leave with pay as
permanent nurses can avail 45 days leaves per year while other employees don’t have leave
system. There are many young nurses who have the potentials and eagerness to enhance their
education, but policy does not allow employees for deputation and scholarship contacted
personally some of those nurses; the information that came to my knowledge is contract policy,
work load, less facilities as compare to permanent workers, long night duty 12 hours, lack of
support from seniors and non nursing duties. Huber (2006) believes that the nurses‟ shortage is
problem of every state and global trend. The reasons are comprehensive, that need to be
observed separately. Factors are including nursing education that affect new graduates, and work
environment to affect the ability of workplace which catch the attention of new nurse to preserve.
In USA, UK, Canada, different factors are identified for high turnover in nurses. Arnetz et al,
1995, Collin et al, 2000, Davidson, et al 1997 Wai Chi et al, 1998, cited by Gardulf et al (2005),
believe that lack of career development, support from supervisors, frustration with internal
24
management, less autonomy in workplace decision making. Moreover poor communication
within organization, less time for complicated jobs, and lack of cooperation was also mentioned.
Flanagan (2006) in his study demonstrates an anticipated turnover model in her replicated study
that relates turnover and job satisfaction. Other factors especially in psychiatric units, like prison
environment, role uncertainty, type of client could be the factors for turnover. Andrew et al cited
by Jasper (2005) states that “challenges of getting the right staff in the right place, whilst at
nursing shortage. They present the results of a study exploring student opinions, of three
initiatives to attract student nurses to local health care employment upon qualification”
(p.280).According to Hadley 1990, Kinney 1994 cited by Rowe &Sherlock (2005), “verbal
abuse; it is any statement to a victim that results in emotional damage, which limits her /his
happiness and productivity” (p.24).
It is difficult to estimate the actual cost of nursing turnover. There are lots of operating cost
required in hiring a new nurse ,for example, “recruiting, selection, orientation, on – the- job
training and temporarily replacing a nurse who quit or fire”(Sullivan &Decker, 2004 p.303.).
Nursing turnover is in the dire need to understand and control successfully. Moreover cost
involves; advertisement, loss of experienced nurses, medication errors and impact on quality of
patient care by novice nurses.
Another study was done by Fochsen et al. (2005), in Sweden, reveals the same factors that force
the nurses to leave job. Low income, less professional growth, limited independence, unfriendly
working environment; personal reasons and satisfaction are most significant factors to quit jobs.
From the organizational point of view, employees‟ commitment is important to resolve
managerial problems, such as well- incorporated teams and people’s devotion. Less
consideration to contract workers causes more turnovers. Job uncertainty is another perception
that associated with provisional services. It can cause constant worry and frustration for
extension of job. In contract employees there is a sense of isolation from regular employees, due
to discrimination in rules and regulation like, no chance for profession growth and organizational
recognition.
25
MANAGEMENT STRATEGIES
IHI (2008) further suggested that they could review the literature on nurse staffing about the
importance of rapid selecting of new nurse. A recruitment and reimbursement Committee,
including a nurse leader could also be formed, to watch issues related to recruiting nurses, and to
serve as an important link between nursing and the human resources department. Against these
conditions, during the past several years Institute of Health Improvement (2008), has worked to
make stronger its nursing agenda and its ability to employ and preserve nurses. According to IHI
persuasiveness could support the nurse in all phases at work. Nurse leaders can use the same
methodology for nursing issues as to improve care for acute myocardial infarction patients to
reduce medication errors and quality of care. Rely on evidence to find out what strategy can
work, test ideas in small ways, and spread the successful strategies. Management of a Holy
Family could follow the same strategy by giving priority to retain nurses. Welch (2005) believes
that before hiring right people, check their integrity, intelligence and maturity.
IHI (2008) also believes that it is important to support local nursing schools, both economically
and by providing training opportunities and faculty, In addition to make financial aid to both.
This is a great recruiting opportunity, the student nurses are familiar with the system, and
hospital management already knows them. Holy Family Hospital has a school of nursing
associated, student nurses are getting general nursing and midwifery training and are later placed
in Holy Family.
In addition, a nurse manager can serve as a link among the nursing schools and hospital to make
sure that needs are being met for both organizations, and regularly obtain feedback about the
working relationship through formal surveys and personal contact.
In addition to these suggestions library and internet facility could be provided to learn and
contribute in nursing research. If these facilities would be provided at Holy Family Hospital, I
believe that turnover rate of nurses surely be declined.
Rowe & Sherlock (2005) in their studies suggested that various techniques might be used to
reduce verbal abuse like, involvement of nurses in policies and procedures, it will lessen
exhaustion. Counselling of staff is necessary to boost up their morale. Nurse Managers could
formulate strict policy for abuse and prompt report from victim and action accordingly.
This harmony provides not only essential leadership support for unit nurses, but also educating,
counseling, and role-modeling.
26
At Holy Family Hospital nurse could have permanent job. Each nurse manager at her unit could
watch and listen for problems and take appropriate action, by checking new nurses, making sure
that she is available to them as a resource for information, guidance, and a friendly listener.
Nurse Managers can observe new nurses to how they are doing. If they see a nurse is beginning
to show signs of problem, like absenteeism, she could get involved in a silent way to see how she
can help.
CAUSE OF LEAVING
i) SOCIAL ENVIRONMENT
The social environment of the workplace is the initiator of a nurse's plan to stay or leave.
Moreover social environment is a determinant of work disappointment (a depressing influence),
and work excitement (an encouraging influence). Moos (1994) said that these factors directly
influence workplace stress, leading to job satisfaction or dissatisfaction. According to Bratt et al.
(2000), Job satisfaction or dissatisfaction is the powerful forecaster of intent to stay or leave the
job.
ii) BURNOUT
Burnout can cause job dissatisfaction. Garret and McDaniel (2001) in their studies said that
environmental uncertainties are very important in all features of burnout.
Aiken et al. (2002) reported that nurses with the lowest nurse-to-patient ratio experience less
burnout and dissatisfaction than those with highest ratios. The researchers claim that 43% of
nurses who said strong levels of burnout and disappointment intended to quit their jobs within a
year. Only few nurses did not complain of dissatisfaction.
iii) AUTONOMY
Nurses always desire increased autonomy working environment, Aiken et al.(2002) claim that
autonomy is one of the factors which has decreased emotional exhaustion of nurses in American
magnet hospitals. In another research on this hospital showed that autonomy had influenced the
managerial trust, their appraisal of the quality of patients care and also job satisfaction
(Laschinger and Thomson 2001).
Davidson et al. (1997) established the value of autonomy by representing that decreased job
satisfaction is connected with decreased autonomy.
27
Bruffey(1997) said autonomy is ultimately influenced by the leadership of their managers. There
is a positive connection between job satisfaction and nursing leadership. Management system,
allow the nurses to do their jobs effectively, was related to job satisfaction.
iv) WORK PRESSURE

Bratt et al. (2000) identified the work pressure is the most familiar and important factor of
organizational work satisfaction/dissatisfaction.
McNeese-Smith (1999), identified several factors of work load which bring job stress for nurses.
These were:
i) Overload due to heavy patient assignment, too many patient needs, and/or too few staff
members to meet these needs
ii) Exhaustion
iii) Fear of making a mistake due to exhaustion and
iv) High patient acuity.
Bratt et al. (2000) reported some additional work stress factors which influence the nurses to
leave the job. These include rapid turnover of patients, shift work, lack of available equipment,
managerial pressures, excessive noise and lack of space.
According to Aiken et al.(2002), Nurses with increased patient loads in workplace were more
likely to explain experience of burnout, job dissatisfaction and emotional exhaustion than their
colleagues with less patient loads. So autonomy is a key factor to reduce work stress for work
load. Because work load is a originator of nurse intention to leave.
v) JOB SATISFACTION OF NURSES

There is a lack of agreement on the meaning of nurse satisfaction (Hale 1986, cited by Maylor et
al 2000).Two definitions stemming from the 1980 stand out.
The first one highlights psychological factors according to Bush(1988), the perception that one’s
job fulfils or permit the fulfilment of one’s significant job values, providing and to the extent that
those values are congruent with one’s requirements. The second one highlights workplace factors
like recognition of achievement, enough staffing, appreciation, autonomy, childcare facilities and
quality patient care.
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vi) DETERMINANT OF JOB SATISFACTION
Job satisfaction analysis is driven by attempts to concentrate on the issues of industrial action,
leaving or turnover and personal joy at work. Researchers are interested in the bond between job
satisfaction and efficiency and financial and non-financial reward.
According to the influential work of Freeman (1978), job satisfaction can be separated into
those considering labour force as a whole, those analysing qualified groups such as lawyers,
nurses and academics, those which inspect the impact of individual characteristics like age, sex,
race/education and those which explore the outcome of job- related features such as trade union
membership, self employment and establishment size. Some important determinants of work
place satisfaction have been recognized which may be supportive in the thought of job
satisfaction in nursing. Diversity of individual characteristics has been identified to have special
effects on reports of job satisfaction. That diversity includes gender, race, age, marital status,
children and education. The major effects are usually connected with gender and age.
RETENTION STRATEGIES
i) CREATING A MOTIVATING CLIMATE
Because the organization has such an impact on the factors that extrinsically motivate
employees, it is important to examine organizational climates or attitudes that have direct
influence on worker morale and motivation.
Huston and Marquis (1989) said that frequently organizations overtly or covertly reinforce the
image that each and every employee is expendable and that a great deal of individual recognition
is in some way harmful to both the individual and the individual’s productivity within the
organization.
Just the opposite is true. Individuals who have a strong self-concept and perceive themselves to
be winners are willing to take risks and increase their productivity to achieve their productivity.
Peters and Waterman (1982) stress that organizations must be designed to make individual
employees feel like winners. The focus must be on degrees of winning rather than on degrees of
losing.
Another wrong attitude held by some organizations is at the opposite extreme. Korman et al
(1981) supported that if a small reward results in desired behaviour, then a larger reward will
result in even more of the desired behaviour. That means an employee’s motivation should
29
increase proportionately with the amount of incentive or reward. Nurse Managers should think
excellence and achievable goals, and reward performance in a way that is valued by their staff.
ii) MANAGING CAREER DEVELOPMENT IN NURSING
Some philosophies about responsibilities for career development have been reflected in nursing.
Donner and Wheeler (2001) have argued that nurses do require taking greater responsibility for
career planning and development. They should follow a framework discussed by King (2001)
which includes identifying opportunities, developing and implementing a good career progress.
Donner and Wheeler (2001) added that to deliver high quality of caring service all educators,
employers and professional business organizations should work with nurses on their career
development plans and activities.
According to (UKCC 1999), in UK, for long period it has been known that continuing
professional development (CPD) has a significant function in nurses individual career
development and retention. It also enhances the quality of patient care. There was a debate for a
long time that local health service employers must recognize and understand the value of
appropriately controlled CPD programmes in attracting, motivating and retaining high quality
staff (DH 1998). Strategy for CPD for nurses were set out in Making a Difference ( Robson and
Banett 2007) in which it was debated that CPD should include not only attending courses but
also learning at work through experience, critical incidents, audit and reflection, maintained by
peer review ,mentorship and clinical supervision. It was a matter of great concern that
practitioners and employers were puzzled by the creation of new courses and lack of apparent
links to career paths and that a more determined structure was needed.
iii) WORKING CONDITIONS
From a human resource management viewpoint, it can be said that working conditions have an
effect on staff morale. Good working conditions will contribute to improving retention staff (DH
1997). The different ways in which working environment can affect nurses and manipulate their
decisions about direction and retention in the occupation have risen from a substantial body of
study on job satisfaction and workplace stress.
Reconsidering the previous history on stress among general nurses, McVicar (2003) expressed
that the major sources of stress identified are leadership, work pressure, management style,
coping with emotional or touching demands of care, and relationships between occupational
groups. He also added shift working and lack of reward also emerging from more recent
30
research. Deep study on job or workplace satisfaction in nursing profession has exposed that
aspects of work which recognized in the stress literature also come into view as sources of
satisfaction or dissatisfaction.
Nolan et al (1999) said, staffing levels enough for nurses to feel confidence to offer better
quality care if there are availability of supplies and equipment. And it also depends on the nature
of work place relationships with colleagues and nursing managers.
Positively it has long been acknowledged that both physically and mentally nursing is a
challenging work.
Davies (1995), find out that handling and lifting patients and „being on one’s feet every day is
not very easy. It can cause not only work stress but also bodily injury like strained backs. The
emotional element of nursing can be equally important and demanding, involving caring for
patients when they are dealing with death and dying and loving for upset patients and relatives.
Rise of these demanding emotional elements to overcome the challenge can be a source of
satisfaction. On the other hand, low morale and work stress can be created when nurses feel
under-supported and under resourced in working environment, particularly in relation to staffing.
iv) SOCIAL AND RECREATIONAL PROGRAMS
Another positive working state that has gained popularity in recent years is the condition of
social and fun programs in favour of employees.
Huston and Marquis (1989) said that community programs might be include functions like as
teas, dinners, and receptions to nobility employee activities and longevity of service. Other social
events could include yearly Christmas party and summer barbecue or picnics. Those programs
allow the employees and their families to appearance social relationships both inside and outside
the organizational environment. In years of 1970s more than 50,000 American companies had
developed some form of recreation program for their workers (Famularo 1986).
These programs are commonly used to link employee relationship and success needs which are
generate a sense of belonging, improving self-confidence, and growing employer faithfulness.
Employees find it easier to recognize with a corporation that cares in relation to their off-the job
human requirements and the meaningful relationships with link employees who work jointly
cooperatively both inside and outside the organization (Huston and Marquis 1989, p 373).
31
v) JOB SECURITY
Job security is an elementary human require that in support of many people and that is more
important than both salary and progression. Organizations that are loyal to job safekeeping
“make every stab to afford continuous employ or income for at least some activities or program
to support this commitment. (Luxenberg 1983, cited by Huston and Marquis 1989).
Quite a few of these forces motivates employees toward unionism, grave clash in superior-
subordinate relation, and fears of transform be related to employee’s clutch for security (Strauss
and Sayles 1972). Union provide a guarantee to employees by objection process that they will
not be terminated illegally. Most of the non-union company should also provide a grievance
process to increase worker security so that employees need not fear being terminated unfairly
(Huston and Marquis 1989)
vi) WORK VALUE
According to Ford (2009), a patient has returned to Aintree University Hospitals NHS
Foundation Trust to thank nurses who potentially saved his life by spotting a serious heart
condition during routine tests prior to an eye operation.
vii) PAY
Buchan et al (1998) Even though disappointment with payment has long been known as a key
rationale for poor retention, a revision of study preceding the beginning of the current upgrading
programme concluded that the connection between payment and retention is complex and is the
most important one of several factors that may shape labour market behavior.
Sausman (2003), in recent times, employment opportunities for women, the leading group in the
nursing labour force, have been enlarged and this has decreased nurse’s relative income in
relation to the labour force as a whole. Subsequently, the observation that others may be earning
more money for same or less liability may influence the decisions to leave nursing job for high-
paid professions.
viii) MOVING TO GRADUATE WORKFORCE
Another significant side of the nursing retention challenge is the argument about whether nursing
should turn into an all-graduate profession at the aim of registration. From long time some
healthcare occupations like medicine and pharmacy had an all-degree route to registration, and
others like physiotherapy have recently joined them. There is an argue about whether nursing
should go for it or not.
32
According to Hayward (1992), low minority of nurses had finished their education to degree
standard through a four-year course from the late 1960s.The Royal College of Nursing focus on
nurse education expressing that every nurses should be educated to degree standard at
registration; a position also favoured by Heads of University departments for Midwifery,
Nursing and diverse constitutional and Health Visiting bodies. Yet, this observation is not
commonly held and to be truth, the college motion debate on the move to all graduate entry was
closely defeated at the yearly meeting in 2003. (Robinson and Bannett 2007)
According to UKCC (1999), In the 1990 a lot of universities started offering three-year nursing
degrees. Then these offers were increasingly expanded and seven per cent of qualifiers were
successfully graduates in England by the end of 1990. Both the diploma and the degree
programme were offered in England. On the other hand, as module of the revision of pre-
registration and post-registration nursing education projected in Modernising Nursing Careers, a
review is to be completed of whether modification are required to the standard level at which the
pre-registration nursing course is offered in the near future (DH 2006).
ix) TRAINING
It is held that the need for nursing staff to undertake further training after qualification is
important for three major reasons.
According to Beishon et al.(1995) First , by ensuring that they update their clinical nursing skills
at regular intervals, they will more likely to continue deliver high quality of patient care .Finally,
training is of crucial importance to nursing staff and their chances for further career
development. The UKCC hopes to increase the amount of care given by qualified nursing staff
than unqualified staff.(Beishon et al.1995)
33
CHAPTER-III
RESEARCH METHODOLOGY
In this chapter we shall discuss the methodology that was applied while pursuing the study; the
methodology entails objectives of the study, research design, universe, sampling size, sampling
technique and tools used for collection of data.
This body of research will establish the extent of the problem of attrition in Holy Family
Hospital and act as a possible opportunity for managers to assess the situation and proceed to
rectify the problem within the organization.
Objectives
The objectives of the study were as follow:-
 To study the traditional retention techniques been practiced by Holy family Hospital.
 To examine the role of compensation package in retaining the satisfied employees in the
organization.
 To find out the factors of satisfaction that influences the employees towards retention in
Holy Family Hospital.
Study Area
The study was conducted in Holy Family Hospital which is located on Okhla road, New
Delhi.
Type of Research
The researcher used quantitative research method for collecting data as it helped in
generating numerical data that can be transformed into usable statistics. And the quantitative
data collection method is more structured than qualitative data collection.
Research Design
 Descriptive Research: The researcher used descriptive research design. This type of
research is suitable because the researcher has to obtain information regarding the current
status of employee’s turnover and retention at Holy family Hospital. This research is done to
collect detailed factual information without changing the environment where study is to be
conducted. A descriptive study is that which is concerned with describing the characteristics
34
of a particular individual, or a group. This type of research design is used to describe
characteristics of the phenomena under study as it exists.
 Sampling Design: None probability purposive sampling design was used for sampling,
purposive sample is a non-probability sample that is selected based on characteristics of a
population and the objective of the study. Purposive sampling is also known as judgmental,
selective, or subjective sampling.
 Sample Size: 40 Nurses was contacted from Holy Family Hospital, Okhla road, new Delhi.
Source of Data
 For secondary data- For secondary data researcher will do content analysis and use the
sources like books, internet, research papers, journals and past studies. Data which are not
originally collected but rather obtained from a published source are known as secondary data.
 For primary data- The objective of the study has been accomplished with the help of
primary data collected from 40 Nurses. The selected samples are met in person and the data
has been collected with the help of questionnaire. Primary data refer to the data collected
from primary sources. The primary data were obtained by distributing questionnaires among
the employees. The questionnaire contributed main source of primary data.
 Tool of data collection- The tool for data collection is through questionnaire.
The Questionnaire
The initial section of the questionnaire (Question one to three) was designed to get an
overview of the demographic data of the respondents. It contained age, educational
qualification and no. of years working in the Holy Family Hospital.
Question four was designed on Likert scale to know whether nurses are provided with the
training opportunities to extend their skills and abilities.
Question five, six, seven and eight were formulated to know whether the nurses are satisfied
with the wages given to them, and if any other organization claims that they get high wages
would they leave the job. They were asked to mark the option according to the level of
satisfaction. By asking these questions, researcher wanted to establish relationship between
attrition and job satisfaction.
35
Question nine and ten was designed on Likert scale to know if their work is recognized by
their supervisor and job related problems are solved at the workplace.
Question eleven and twelve was designed on Likert scale to know about their satisfaction with
the organizational culture, job environment and employee relation.
Question thirteen and fourteen was designed on Likert scale to know whether nurses are
satisfied with the recruitment selection and promotion process in Holy Family Hospital.
Question fifteen was designed on Likert scale that asked respondents whether they have clear
understanding of their job.
Question sixteen was designed on Likert scale and question seventeen was a multiple choice to
know whether respondent think about leaving the job and what are the possible reasons for
leaving the job.
Question eighteen was a multiple choice in which researcher wanted to know the factors that
would help retain employees in Holy Family Hospital and thus establishing relationship
between attrition and retention in the same.
Question nineteen was a multiple choice where respondents suggested some strategies to retain
employees in the Holy Family Hospital.
Data Analysis
In this stage of research, the collected data was processed and analyzed. The processing stage
included the editing, coding, classification and tabulation of collected data that was ready to
analyse. The researcher used quantitative method for research so data analysis was done in MS
Excel and SPSS as it is more convenient and easy to use.
Limitations
While conducting the research study there were various limitations involved in this research
work which are as follows
 Smooth interaction with respondents was restricted.
 Researcher was not allowed to visit the nursing area so it causes restriction in the data
collection.
 Language barriers as some of the respondents did not entirely understand the English
language.
36
 Lack of awareness of the HR terms for example, performance recognition, organizational
culture, employee relations etc.
 The employees were sceptical about giving out actual truth as the researcher was from the
human resources. They assumed it was an internal audit taking place by the HR
department. Thus, some responses may not be true.
37
CHAPTER-IV
DATA ANALYSIS & INTERPRETATION
The study was conducted across a number of variables in order to assess the objectives of the
study in the light of the data collected from field. The data collected has been processed by
editing, coding, classification and tabulation. The data is analyzed using the Microsoft Excel and
SPSS. It has been further interpreted and the findings have been drawn from the analysis.
The respondents selected for the study were the employees of Holy Family Hospital.
Demographic Profile of the respondents

In this section, we shall highlight the demographic profile of respondents in terms of age,
educational qualification, and work duration.
Age of the respondents: In this section, we are going to discuss the age variations found in the
data collected from the respondents.
Table No-1 Age of the respondents (n=40)

S No Variables Frequency Percentage
1 Less than 25 20 50%
2 25-30 13 32%
3 30-35 6 15%
4 35 Years above 1 3%
Table 1-Age
Source: Primary data
It is found from the data as shown in the table, 50% of the respondents were less than the age of
20, and 32% of the respondents were within the range of 25-30, and 15% of the employees were
within the range of 30-35 , and only one of the employee was above 35 years of age.
38
Figure No-1 Age of the respondents (n=40)
Age
3%
15% Less than 25

25-30
50% 30-35
32% 35 years above
Figure 1-Age
Educational Qualification of the respondents:

In this section, we are going to discuss the variations of the educational qualification found in the
data collected from the respondents.
Table No-2 Educational Qualification (n=40)

1 B.Sc Nursing 19 47%
2 M.Sc Nursing 1 3%
3 GNM 20 50%
4 Other Diploma 0
Table 2-Educational Qualification
It is found from the data as shown in the table that most of the respondents were from B.Sc
Nursing i.e, 47% and none of them did diploma. 50% of the nurses did GNM. And only one
respondent was from M.Sc nursing.
The respondents selected for the study were the employees of Holy Family Hospital.
39
Figure No-2 Educational Qualification (n=40)
Educational Qualification
0%
BSC Nursing
50% 47% MSC Nursing

GNM
Other diploma
3%
Figure 2-Educational Qualification
Work duration: In this section, we are going to discuss the variations of the work duration
found in the data collected from the respondents.
Table No-3 Working Duration of respondents (n=40)

1 Less than 6 months 8 20%
2 6 Months-1 Year 10 25%
3 1-5 Years 17 42%
4 5 Years above 5 13%
Table 3-Work Duration
From the above table we can see that the 45% nursing staff at Holy Family Hospital have worked less
than 1 year, 42% of the staff comes within the range of 1-5 years , and 13% of the respondents are above
5 years, and it was also found that 45% of respondents were working with the Holy Family Hospital from
less than 1.5 years.
40
Figure No-3 Duration of Work (n=40)
Duration of work with HFH
13% 20%
<6 months
6months-1year
1-5 years
42% 25% 5 years above
Figure 3-Work Duration
1. TRADITIONAL RETENTION TECHNIQUES OF THE HOLY FAMILY HOSPITAL.

In Holy Family hospital, there are various traditional ways through which employees are retained
in the long run. The techniques have been enumerated as follows:
Employee Relations:
In this section, the researcher discussed the variations found in the data collected from the
respondents regarding employee relation.
Table No-4 Employee Relations (n=40)
S No Variable Frequency Percentage
1 Strongly agree 2 5%
2 Agree 20 50%
3 Disagree 12 30%
4 Strongly Disagree 0 0%
5 Not Sure 6 15%
Table 4-Employee Relation
The data in the table shows that, 50% of the respondents agreed that the organization is
committed to build strong employee relation.5% of the respondents strongly agree, 30% of the
41
employees were disagreed that the organization is committed to build strong employee relations,
none of the respondent strongly disagreed to the claim and surprisingly 15 % of the respondents
were not sure or either not aware of the term Employee relations.
Figure No-4 Employee Relations (n=40)
2% Employee relations
15% Strongly agree

agree
10%
45% Disagree
Strongly Disagree
28% Not Sure
Figure 4-Employee Relation
It has been observed based on the interaction with employees, that the employee relations is not
good at holy Family Hospital, almost 50% of the employees disagreed to the claim that this
organization is committed to build strong employee relations.
Recruitment, selection processes, and appointments, promotions:

respondents regarding recruitment and selection process and also all appointments and
promotion is based on merits.
42
Table No-5 Recruitment and selection (n=40)
1 Strongly agree 1 2.5%
2 agree 18 45%
3 Disagree 11 25%
4 Strongly Disagree 4 7.5%
5 Not Sure 6 20%
Table 5-Recruitment and Selection
The data from the study in the above table shows that, 54% of the respondents agreed that the
recruitment and selection process in the holy family hospital is transparent and impartial, 2.5%
strongly agreed, 25% of the respondents disagreed to the claim, and 7.5% of the respondents
strongly disagreed, and 20% of the respondents were not sure or neutral in this term.
Figure No-5 Recruitment and selection (n=40)
Recruitment & Selection Process

2%
20% Strongly agree

agree
8% 45% Disagree
Strongly Disagree
Not Sure
25%
Figure 5-Recruitment and Selection
It has been observed based on the interaction with HR employees and staff nurses that the
recruitment and selection process is transparent, but this process based on reference, It was
observed that none of the job vacancy was advertised online or in any news paper, most of the
employees come to hospital based on reference.
43
Table No-6 Appointments and promotions (n=40)
2 Agree 18 45%
3 Disagree 10 25%
5 Not Sure 8 20%
Table 6-Appointment and Promotions
Data from the study in the above table shows that, 45% of the employee agreed that all the
appointments and promotions are based on merits and performance, 2.5% strongly agreed and
25% of the respondents disagree to the term that promotions are based on performance, 7.5% of
the respondents choose to strongly disagree to the claim, and 20% of the respondents were not
sure.
Figure No-6 Appointments and promotions (n=40)
Appointments and Promotions are Impartial

0%
8%
25% Strongly agree
17% agree
Disagree
Strongly Disagree
Not Sure
50%
Figure 6-Appointment and Promotions
44
Duties and Responsibilities:
respondents regarding duties and responsibilities of the employees, the respondents were asked if
their respective supervisors made them clear with their duties and responsibilities.
Table No-7 Duties and responsibilities (n=40)

2 Agree 20 50%
3 Disagree 7 17.5%
5 Not Sure 3 7.5%
Table 7-Duties and Responsibilities
The above table shows that, 50% of the respondents agreed that their supervisor and the
organization made them clear about their jobs and responsibilities, 25% of the respondents
strongly agreed, and 17.5% of the employees disagreed to the claim, none of the respondents
were strongly disagreed, and 7.5% of the respondents were neutral.
Figure No-7 Duties and responsibilities (n=40)
Aware of Duties and Responsibilities

2%
20% Strongly Agree

Agree
8% 45% Disagree
Strongly disagree
Not Sure
25%
Figure 7-Duties and Responsibilities
45
2. ROLE OF COMPENSATION PACKAGE IN RETAINING EMPLOYEES IN THE
HOSPITAL.
High salaries comparing to the Private Hospitals:

In this section the researcher is discussing the view of the respondents regarding the claim that
the Holy Family Hospital pay more salaries to its nursing staff, we can see the variation in the
table.
Table No-8 Salaries comparing to private hospital (n=40)

2 agree 25 62.5%
3 Disagree 5 12.5%
5 Not Sure 5 12.5%
Table 8-Salaries comparing to private hospital
It is found from the data as shown in the table that 62% of the employees agreed to the claim
that the hospital pays higher salaries to its nursing staff, 10% percent of the respondents were
strongly agreed to the term, 12.5% of the respondents disagreed, only 2.5 % of the respondents
were strongly disagreed, and 12.5% of the respondents were not sure or they were not aware of
private hospital wages, these respondents were those who were fresh graduates and joined the
Hospital recently.
46
Figure No-8 Salaries comparing to private hospital (n=40)
30
25
20
15
Series 1
10
0
Strongly Agree Agree Disagree Strongly Not Sure
disagree
Figure 8-Salaries comparing to private hospital
Salaries and wages are fair considering workload:

In this section we have discussed the comparative study of workload and salaries of wages, the
respondents were asked if they think their salaries/wages are fair considering their workload.
Table No-9 Salaries and wages (n=40)

2 agree 10 25%
3 Disagree 26 65%
5 Not Sure 0 0%
Table 9-Salaries and Wages
The data in the above table shows that, a significant number of respondents are disagree to the
claim that their salary/wages are fair considering their workload, 65% of the respondents
disagree that they do not get enough salaries comparing to their workload, and 25% agreed to the
claim, 2.5% were strongly agreed, and 7.5% of the respondents strongly disagreed to the claim,
none of the employees remain neutral.
47
Figure No-9 Salaries and wages (n=40)
Salaries comparing to workload

8% 0%2%
Strongly Agree
25% Agree
Disagree
65% Strongly disagree

Not Sure
Figure 9-Salaries and Wages
Based on the interactions with the respondents and employees it has been observed that there is a
lot of job stress and work overload in the over organization, the current staff is asking for
additional staff , and they are not satisfied with the salaries and wages they get comparing to
their work load.
The salaries and wages are satisfactory:
respondents regarding their satisfaction of their wages and salaries, the respondents were asked if
the wages and salaries in Holy Family Hospital are satisfactory.
Table No-10 Satisfaction (n=40)

2 agree 9 22.5%
3 Disagree 27 67.5%
5 Not Sure 0 0%
Table 10-Satisfaction
The data from the study in the above table shows that, a significant number of the respondents
were not satisfied from the salaries and wages they get, 67% disagree to the claim, 22.5% agreed
48
that they were satisfied,5% were strongly agreed and 5% of the respondents were strongly
disagreed, not of the respondent remained neutral.
Figure No-10 Satisfaction (n=40)
Emplyee satisfaction
5% 0% 5%
Strongly Agree
22% Agree
Disagree
Strongly disagree
68% Not Sure
Figure 10-Satisfaction
3. FACTORS OF SATISFACTION THAT INFLUENCES THE EMPLOYEES

TOWARDS RETENTION IN HOLY FAMILY HOSPITAL.
Training and Development:

In this section the researcher is discussing the training and development practices in the holy
family hospital, the respondents were the nursing staff of the holy family hospital.
Table No-11 Training and Development (n=40)

2 Agree 28 70%
3 Disagree 3 8%
5 Not Sure 0 0%
Table 11-Training and Development
49
The researcher found that the 70% of the employees agreed that the holy family hospital provide
training and development opportunities for the employees, 22% of the respondents were strongly
agreed, only 8% of the respondents were disagreed to the claim the the holy family hospital
provide training and development opportunity, none of the responded strongly disagreed to the
claim.
Figure No-11 Training and Development (n=40)
30
25
20
15
10
0
Strongly Agree Agree Disagree Strongly disagree Not Sure
Figure 11-Training and Development
The nursing staffs of which majority is from south Indian region sees the Holy Family Hospital
as a best destination for career development opportunity, the hospital owns an institute and they
offer various diplomas.
50
Recognition and Reward:
In this section, we are going to discuss variations found in the data collected from the
respondents regarding reward and recognition.
Table No-12 Reward and recognition (n=40)

2 agree 22 55.5%
3 Disagree 11 27.5%
5 Not Sure 2 5%
Table 12-Reward and Recognition
The above table shows that 55.5% of the respondents agreed that their supervisor recognize their
performances and reward them accordingly, 7.5% of the respondents strongly agreed, 27.5% of
the respondents disagreed to the claim, 5% were strongly disagreed, and 5% were not sure or
either not aware of the term performance recognition.
Figure No-12 Reward and recognition (n=40)
25
20
15
10 No. Respondents
0
Strongly Agree Disagree Strongly Not Sure
Agree disagree
Figure 12-Reward and Recognition
51
Job related problems:
respondents regarding Job related problems, the respondents were asked wither if the supervisor
of the respondent is willing to listen to his/her job related problems, the data found is as follow.
Table No-13 Job related problems (n=40)

2 agree 22 55%
3 Disagree 9 22.5%
5 Not Sure 1 2.5%
Table 13-Job related Problems
The table again shows that 55% of the respondents were agreed that their supervisor listen to
their job related problems, 12.5% of the respondents strongly agreed and 22.5% of the
respondents disagreed to the claim that their supervisor is willing to listen to the employees job
related problems, 7.5% were strongly disagreed and only one respondent were not sure about the
term.
Figure No-13 Job related problems (n=40)
20
18
16
14
12
10
8 No.of respondents
6
4
2
0
Strongly Agree Disagree Strongly Not Sure
Agree disagree
Figure 13-Job related Problems
52
Organizational culture and working environment:
respondents regarding Organizational culture and job environment.
Table No-14 Organizational culture and work environment (n=40)

2 agree 28 70%
3 Disagree 7 17.5%
5 Not Sure 1 2.5%
Table 14-Organizational Culture and Work Environment
It was found from the study that 70% of the respondents agreed to the claim that organizational
culture and working environment is good at Holy Family Hospital, 7.5% of the respondents
strongly agreed, and 17.5% of the respondents disagreed to the term, 2.5% strongly disagreed,
and 2.5% were not sure about their answer.
Figure No-14 Organizational culture and work environment (n=40)
30
25
20
15
No. Respondendts
10
0
Strongly Agree Agree Disagree Strongly Not Sure
disagree
Figure 14-Job related Problems
53
Duties and Responsibilities:
respondents regarding duties and responsibilities of the employees, the respondents were asked if
their respective supervisors made them clear with their duties and responsibilities.
Table No- 15 Duties and responsibilities (n=40)

2 Agree 20 50%
3 Disagree 7 17.5%
5 Not Sure 3 7.5%
Table 15-Duties and Responsbilities
The above table shows that, 50% of the respondents agreed that their supervisor and the
organization made them clear about their jobs and responsibilities, 25% of the respondents
strongly agreed, and 17.5% of the employees disagreed to the claim, none of the respondents
were strongly disagreed, and 7.5% of the respondents were neutral.
Figure No- 15 Duties and responsibilities (n=40)
Aware of Duties and Responsibilities

2%
20% Strongly Agree

Agree
8% 45% Disagree
Strongly disagree
25% Not Sure
Figure 15-Duties and Responsbilities
54
Thinking about leaving the job:
respondents regarding their plan or intention of leaving the organization; the respondents were
asked if they are thinking of leaving their job.
Table No-16 Leaving Job (n=40)
2 agree 19 47%
3 Disagree 12 30%
5 Not Sure 7 17.5%
Table 16-Leaving Job Source: Primary data
The data from the study in the above table shows that, significant numbers of the employees are
thinking or have the intentions about leaving the organization, 47% of the employee were agreed
that they are thinking about leaving their jobs, 2.5% are strongly agreed, 30% of the respondents
were disagreed, 2.5% of the respondents strongly disagreed, and 17.5% of the respondents were
neutral.
Figure No-16 Leaving Job (n=40)
Thinking about leaving the Organization

2%
18%
3% Strongly Agree
Agree
Disagree
47% Strongly disagree
30% Not Sure
Figure 16-Leaving Job
55
Factors leading to retention in the organization:
respondents regarding the factors that would influence their decision to stay with the
organization; the respondents were asked that what factors would most influence their decisions
to stay with the organization.
Table No-17 Retention Factors (n=40)
S No Variable Frequency Percentage Ranking
1 Training and Development 9 22.5% III
2 Wages 11 27.5% II
3 Work Environment 5 12.5% IV
4 Good will 14 35% I
5 Opportunities to work under 1 2.5% V
qualified doctors
Table 17-Retention Factors
The table shows that there are few factors that would influence the decisions of the employees to
stay with the organization, 22.5% says they admire Training and development of the Holy
Family Hospital, 27.5% says wages, 12.5% says work environment, 35% says good will, and
only 2.5% says opportunities to work under qualified doctors.
Figure No-17 Retention Factors (n=40)
Factors influencing decision of the employees

3%
Training and Development
22% Wages
35%
Work Environment
27%
Goodwill
13%
Figure 17-Leaving Job
56
4. PATH ANALYSIS OF RETENTION PROCESS
Factors Suggestions
Implementation of Showcasing of the Good Will

Good Will
Retention
Provide Incentive Policy
Wages
Training & Development Knowledge enhancement through trainings
Work Environment Enrich job culture and working environment
Opportunity of work
Creation of exposure and opportunity window to work
under Qualified under qualified doctors
From the study conducted by the researcher on Retention in the Holy family hospital, it can be
inferred that the major factor that would help in retaining the employees is good will, while
wages, training and development, work environment and opportunity of work under qualified
doctor are few other factors that would contribute up to some extent in retaining nurses in
hospital.
For the above said problem researcher would like to suggest that organization should focus on
the above mentioned areas to minimize the attrition in the hospital, thereby retaining trained and
experienced nurses in the hospital.
57
CHAPTER-V
MAJOR FINDINGS & SUMMARY
The larger purpose of this study was to determine Employee Retention in Holy Family Hospital.
The sample size for the study was 40. The topic for the research chosen by the researcher is “A
STUDY ON EMPLOYEE RETENTION” based on the study, following are the results
interpreted by the researcher. This study shows relationship between HRM practices with
nursing satisfaction. The objective of the study is to analyze the implementation of Human
Resources Management functions which includes Recruitment, selection, training and
development, performance appraisal, compensation and employee relations.
MAJOR FINDINGS:
The main findings from the study were as follow.
1. Maximum no of the respondents belonged to young age of less than 25 years; Tha
Holy Family Hospital is an ideal destination for fresh nursing graduates.
2. Majority of the respondents were from G.N.M (General Nursing and Midwifery) and
B.Sc nursing professions, and majority of the respondents were from the south Indian
region, although the topic of this studies is about Employee Retention but the
researcher managed to find out the reasons that, why majority of the nursing staff
were from the south Indian region specifically Kerala, the reason could be as follow.
 Nursing, as a profession, would owe its popularity to Missionaries & the Christian
faith. With south Indian region specifically Kerala having a significant Christian
population, the popularity of this profession should come as no surprise.
 Women in Kerala have had more freedom to work than in many other places across
the country.
 Kerala does not have many industries nor creates many jobs. So this factor drives
people to all-weather professions like Nursing.
 Related to the above is the fact that out-migration resulted in the absence of men folk
from most households. And some of the women folk had to also work to support
families. Nursing provided a good option.
58
 A nursing education was the best option - in terms of accessibility & affordability.
Engineering & Medical education were very expensive and there barely existed a
robust infrastructure (pre-early 2000s).
 Nursing was also a very uncontroversial profession & has an air of respectability
attached to it. You're serving & taking care of people. It's akin to God's work. Thus,
considered ideal for women.
 The lack of jobs factor & with people finding success outside Kerala, resulted in a
great advertisement for the profession & more & more people took it up. This led to
more and more nursing colleges opening up and a cyclic situation developed.
 Nursing also proved to be the easiest & one of the most legal ways to go abroad. The
earning potential plus the inspirational factor involved in moving abroad thus proved
to be a huge magnet.
3. Maximum of the respondents agreed that the Holy Family Hospital pay higher
salaries comparing to the private hospitals, even few of the respondents disagreed to
the claim.
4. It has been found from the study that the process of reward and recognition is
transparent in the hospital, majority of the respondents agreed that their performance
is being recognized by their supervisor, although there is no proper reward system in
the organization.
5. The majority of the respondents agreed that their supervisor listen to their job related
problems and consider their problems in any decision related to their job.
6. It has been found from the study , that the employee relations is not good at holy
Family Hospital, almost 50% of the employees disagreed to the claim that this
organization is committed to build strong employee relations.
7. It was also found from the study that the nurses in Holy Family Hospital were not
satisfied with their salaries.
8. It was found out from the study that workload on employees (nurses) was too much
that lead to increase in attrition rate of the hospital.
9. Holy Family Hospital is making internal and external circular of vacancies which
results in generating the feeling of fulfilment on being considered for filling the
vacant positions.
59
10. For induction hospital follows a formal and systematic process which has been
confirmed by explicit response of employees.
11. However, employees are giving volatile responses in matter of satisfaction of job
profile. It implies that hospital is not deploying right person for right job.
12. The nursing staffs of which majority is from south Indian region sees the Holy Family
Hospital as a best destination for career development opportunity, the hospital owns
an institute and they offer various diplomas, this gives them the opportunity to
develop their job related skills
13. It has been found based on the data and its analysis that the recruitment and selection
process is transparent, but this process based on reference, It was also found that none
of the job vacancy was advertised online or in any news paper, most of the employees
come to hospital based on reference.
14. One of the major reasons behind the attrition of the nurses is, finding a government
job in the country.
15. Another reason for attrition is finding job abroad, most of the nurses leave the
organization for the purpose of high salaries, especially to the gulf countries where
the nursing profession is low in local residents, they pay high salaries and wages to
the nurses, those salaries are much higher comparing to the Holy Family Hospital.
16. The factors leading to maximum retention is the Good will of the organization and the
factor leading to least retention levels is the opportunities to work under qualified
doctors.
17. Almost half of the respondents of the study are thinking about leaving their job, it
means that there are few factors of employee retention that the Holy Family Hospital
is not implying or practicing.
60
CHAPTER-VI
RECOMMENDATION AND CONCLUSION
Recommendations:
Following suggestions can be looked upon as communicated by employees to improve the
retention strategy of nurses and reduce the attrition rate of the hospital. Following
recommendations can be drawn from the study:-
 According to the study, the factor leading to least retention level in the organization is
opportunity to work under qualified and experienced doctors, so the Hospital should
create opportunity for the nurses to learn and work under qualified doctors so that their
technical skills can be improved.
 Enhance the knowledge levels of the nurses through relevant trainings and new
technologies.
 Enhance the job culture and working environment in the Holy Family Hospital.
 Create a better incentives and reward policy, it will help the organization to reduce
turnover.
 Creation of exposure and opportunity window for nurses to work under qualified doctors
And there are some Generic recommendations that the Holy Family Hospital should be
practicing to retain the employees.
 Respectful collegial communication and behaviour:
In a study of nearly 20,000 employees around the world (conducted with HBR), It is
found that when it comes to garnering commitment and engagement from employees,
there’s one thing that leaders need to demonstrate: respect. No other leadership behavior
had a bigger effect on employees across the outcomes that were measured. Being treated
with respect was more important to employees than recognition and appreciation,
communicating an inspiring vision, providing useful feedback — or even opportunities
for learning, growth, and development.
 Communication-rich culture.
Effective communication is vital for efficient management and to improve industrial
relations. In modern world the growth of telecommunication, information technology and
the growing competition and complexity in production have increased importance of
61
communication in organizations large and small irrespective of their type and kind. A
corporate executive must be in a position to communicate effectively with his superiors,
colleagues in other departments and subordinates. This will make him perform well and
enable him to give his hundred percent to the organization.
 Presence of adequate number of qualified nurses.
One of the Major findings from this study was that there was workload on nurses, it means
there was not enough nursing staff, Employees want a life. That’s why they work for
organization rather than owning their own business. They want to know that they can
have a life outside of work. If you’re continually forcing your employees to work
mandatory overtime, the suggestion is to hire more employees. That way the organization
doesn’t continually throw money away on employee turnover.
 The presence of expert, competent, credible, visible leadership.
Effective leadership is one key element in the success of a group, the leader should have
all the qualities which are required for effective leadership, the leader should listen
openly to others , offer and accept constructive suggestions, give clear directions, set and
meet deadlines, give formal and informal presentations, help members identify and solve
problems, set an example of desired behavior, show appreciation of others' contributions,
show understanding, encourage members to exchange ideas, handle conflict, guide the
group in goal setting and decision making, delegate responsibilities, ask questions of the
group to prompt responses, and create a productive atmosphere.
 Shared decision making at all levels.
Involving employees in the decision-making process not only gives them confidence and
a sense of empowerment but also motivates them to be more productive, it also gives the
employees a sense of belongingness and lead them to build strong commitment to
towards the achieving organizational goals.
 Recognition of nurses for their meaningful contribution to the practice:

Employee recognition is all about acknowledging the hard work and accomplishments of
the individuals and teams within your organization, Employee recognition is the
acknowledgement of an individual or team's behavior, effort and accomplishments that
support the organization's goals and values. To be effective, employee recognition must
62
be sincere and heartfelt. Employees will sense if their efforts are acknowledged only out
of duty or if comments are lacking in sincerity. Acknowledgement of effort and
accomplishments must be timely in order to be effective. Remember that each person has
their own preferences for how they want to be recognized - what one appreciates could be
a real turn-off for someone else.
CONCLUSION
Employee retention refers to the various policies and practices which let the employees stick to
an organization for a longer period of time. Every organization invests time and money to groom
a new joinee, make him a corporate ready material and bring him at par with the existing
employees. The organization is completely at loss when the employees leave their job once they
are fully trained. Employee retention takes into account the various measures taken so that an
individual stays in an organization for the maximum period of time.
Taking this into account this study sought to find whether there is a relationship between
employee satisfaction and employee retention.
The analysis and interpretation of data on study of Employee Retention in Holy Family Hospital
led to the following conclusions:
 Nursing staff of 2 to 5 years tenure are in large amount this shows that turnover rate is
very high.
 Salary structure is low compared to other nearby hospitals
 Staff is not getting benefits which they usually get in governmental organizations
like medical benefits for them and their families.
 Nurses are not satisfied by current appraisal system.
 Hospital has good surroundings, healthy working environment and enough number of
tools and resources.
63
CHAPTER-VIII
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 Dobbins, M., B. Davies, E. Daneseco, N. Edwards and T. Virani. 2005. "Changing
Nursing Practice: Evaluating the Usefulness of a Best-Practice Guideline Implementation
66
ANNEXURE I
QUESTIONNAIRE
The following questions concern your position and other personal information, completion of this is
information is voluntary, and is confidentially assured, no individual data will be reported.
1. Age.
 Less than 25
 From 25 to 29
 From 30 to 35
 From 35 to 40
2. Educational Qualification.
 B.Sc Nursing
 M.Sc Nursing
 GNM
 Other Diploma
3. How long have you been working in holy family hospital.
 <6 months
 6 months -1 year
 1-5 years
 5 years above
4. This organization has provided me with training opportunities enabling me to
extend my range of skills and abilities.
(a) Strongly Agree (b) Agree (c) Disagree (d) Strongly Disagree (e) Not sure
5. The organization claims that you get high wages comparing to private hospitals.
6. If I had another job offer that paid the same as the one I have, I’d leave this job.
7. Your salary/wage is fair considering your Workload.
8. The Wages and salaries paid to you by the Holy Family Hospital are Satisfactory.
9. Your performance is being recognized by your supervisor and you are rewarded accordingly.
10. Your supervisor is willing to listen to your job‐related problems and recognize your work.
67
11. The Organizational culture and Job environment is good at Holy Family Hospital.
12. This organization is committed to build strong relationship between employees.
13. The recruitment and selection processes in this organization are impartial.
14. All appointments and promotions in this organization are based on merits.
15. Your Supervisor has made you clear with your duties and responsibilities of your job
16. I think a lot about leaving organization.
17. Which of the following factors would most influence your decision to stay with the
organization?
 Training and Development
 Wages
 Working environment
 Organizational goodwill or brand name for career development and progression.
 Opportunity of working under qualified doctors.
68

A Study of Employee Retention in Holy Family Hospital, New Delhi

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A STUDY OF EMPLOYEE RETENTION IN HOLY FAMILY

HOSPITAL, NEW DELHI

DEPARTMENT OF SOCIAL WORK

This is to certify that the dissertation entitled, “A STUDY OF EMPLOYEE RETENTION IN

I recommend this dissertation be placed before the examiners for evaluation.

Dr. Rubina Nusrat

I consider this dissertation fit for submission and evaluation.

Date and Place:

Sr. No PARTICULARS PAGE NO.

4. DATA ANALYSIS & INTERPRETATION 58

5. MAJOR FINDINGS& SUMMARY 61

6. RECOMMENDATIONS & CONCLUSION 64

Table 1-Age ................................................................................................................................................. 38

Retention strategies for reducing voluntary turnover

Identify the issue

Meaningful work an ownership of goals

Promote Work-Life balance

DEFINING EMPLOYEE ENGAGEMENT

REDUCED JOB STRESS AND TURNOVER

BETTER RELATIONSHIP WITH THE MANAGEMENT

EFFECT OF EMPLOYEE SATISFACTION ON PATIENT CARE AND PATIENT

ANALYSIS OF ISSUE THROUGH ANOTHER LITERARTURE REVIEW

iv) WORK PRESSURE

v) JOB SATISFACTION OF NURSES

Demographic Profile of the respondents

Table No-1 Age of the respondents (n=40)

15% Less than 25

Educational Qualification of the respondents:

Table No-2 Educational Qualification (n=40)

50% 47% MSC Nursing

Table No-3 Working Duration of respondents (n=40)

Duration of work with HFH

Figure 3-Work Duration

1. TRADITIONAL RETENTION TECHNIQUES OF THE HOLY FAMILY HOSPITAL.

15% Strongly agree

28% Not Sure

Figure 4-Employee Relation

Recruitment, selection processes, and appointments, promotions:

Figure No-5 Recruitment and selection (n=40)

Recruitment & Selection Process

20% Strongly agree

Figure 5-Recruitment and Selection

Appointments and Promotions are Impartial

Figure 6-Appointment and Promotions

Table No-7 Duties and responsibilities (n=40)

Aware of Duties and Responsibilities

20% Strongly Agree

Figure 7-Duties and Responsibilities

High salaries comparing to the Private Hospitals:

Table No-8 Salaries comparing to private hospital (n=40)

Figure 8-Salaries comparing to private hospital

Salaries and wages are fair considering workload:

Table No-9 Salaries and wages (n=40)

Salaries comparing to workload

65% Strongly disagree

Figure 9-Salaries and Wages

Table No-10 Satisfaction (n=40)

Figure No-10 Satisfaction (n=40)

68% Not Sure

3. FACTORS OF SATISFACTION THAT INFLUENCES THE EMPLOYEES

Training and Development:

Table No-11 Training and Development (n=40)