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Byline: Muhammad Imran Sahir, Dr. Nazar Hussain Phulpoto and Dr. Zafar Uz Zaman


Employees are a vital and valuable asset of an institution. An institution's success might not be realized without its worker's support and involvement. This study examined intrinsic factors of motivation which influence the intention to leave among Health Department's employees in District Okara (Punjab) Pakistan. The researcher through literature review identified three factors; training and development opportunities, employee recognition, and peer relations, which significantly influence intention to leave (ITL). This study has selected a sample size of 214 employees of Health Department, including doctors, nurses and nutrition supervisors. After conducting the survey, 201 accurately filled questionnaires were received back. The results of this study indicate that all independent variables have an inverse relationship with the dependent relationship. However, training and development opportunities had a strong inverse relationship with employees' intention to quit.

Thus, the study findings affirm the assumptions considered and offer suitable recommendations and directions for future study.

Keywords: Training and Development Opportunities, Recognition, Peer Relations and Intention to Leave (ITL).


The success and growth of any organization depend on its human resources. Employees' intention to leave is one of the intense challenges for any organization which creates long-lasting effects on the organization. Employees' turnover is a serious issue especially in the field of HR management (Hassan, 2014). Over the last two decades, the issue of workers turnover still exists among all other managerial problems of the organizations in the world. The rate of workforce turnover is very high even in industrially developed nations. Achievement of higher levels of performance by the employees is associated with their satisfaction regarding the working environment of the organization. The organization should follow the vibrant policies to reduce the gap between top-level management and middle-level management to resolve the issue of worker turnover in organizations (Naeem, Ramzan, and Aisha, 2013).

In many developing as well as advanced countries, employees' intention to quit creates critical challenges for the HR management. World Health Organization (WHO), points out the global issues of scarcity of labor and healthcare personnel; in fact, this phenomenon is insistent in underdeveloped nations according to the Healthcare Performance Indicator reports. WHO, during the third Global Forum on Human Resources for Health, reported that the entire world by the year 2035 would face 12.9 million of the shortage of healthcare staff (World Health Organization, 2013).

In recent decades, many countries have been facing problems relating to healthcare system due to a shortage of nurses. This problem is widespread in developed countries (like USA and UK), but it is also alarming in developing countries. The World Health Organization (WHO), estimated the entire world needs about two million increases in healthcare workforce to meet the global health goals set by WHO. Migration of nurses is an international phenomenon, especially in emigration countries. Many developed countries resolve this issue, by employing nurses from developing countries. The data collected by WHO revealed that the highest deficiency of nurses is in the Asian region, where dominant nations have a larger population. The ratio of nurses to population is very low in these countries. Due to insufficient health budgets, it is not possible for developing countries to attract and hire nurses (Ivkovic, 2011).

A recent study conducted in Pakistan indicated that the rate of turnover among nurses in Pakistan from the year 1996 to 1999 was above 30%. The reasons behind this turnover were emigration of nurses to the United Kingdom and the United States of America, who resigned for better pay prospects in the developed economies. However, the USA Board estimated that international nurses' turnover rate was 15% (Khowaja, Merchant and Hirani, 2005).

Research Significance and Scope

In public sector hospitals especially, those situated in the rural areas and small cities, most of the doctors, nurses and nutrition supervisors are not satisfied with their jobs, and many of them quit their jobs for better job opportunities. The reason for their turnover intention is not their incompetency, but other factors. The doctors and nurses' turnover in developing countries like Pakistan is very high, which in turn creates problems for governing authorities to provide appropriate health care facilities to the citizens. It is of the critical need to have comprehensive studies on the factors which influence the employee intention to leave in the healthcare sector. The findings of this research will contribute to the literature about factors involved in employees' intention to quit the job. It will enlighten the policy-making management of the government health department to develop employee retention strategies.

Understanding of these factors may help the government policymakers in reducing the intention of turnover among employees and the overcome the turnover cost.

Literature Review

Intention To Leave (ITL)

A considerable amount of theoretical and empirical literature has identified various factors which influence employees' turnover. It is observed that the employee intention to quit the job is a crucial stage before the actual turnover occurs (AlBattat and Som, 2013). Hassan (2014), used turnover intention as a dependent variable to find reasons behind this trend. Decker, Harris-Kojetin, and Bercovitz (2009), used intention to leave as a dependent variable with motivation factors. Rizwan and Mukhtar (2014), explained that employees should be monitored by managers and satisfaction should be provided to the employees about the intrinsic and extrinsic factors of the job. Moreover, giving importance to leaving intentions, may reduce the actual turnover and save the cost of the organization for new recruitment, training, and replacement of the staff. Jadoo et al., (2015), asserted that one-half of the participant's doctors in his research study were actively seeking alternative job opportunity.

Their intention to quit was associated with working conditions, demographic factors, and job dissatisfaction. The retention of these doctors was possible by motivating them through competitive salaries; intrinsic rewards improve working conditions and better supervision. By detailed literature review, it is considered that intrinsic and extrinsic factors of motivation significantly influence employee intention to stay or quit in the organization (Alam, 2015).

Training and Development Opportunities

Training and development programs are associated with those specialized skills which are required by the organizations from their employees, to achieve organizational goals (Jehanzeb, Rasheed and Rasheed, 2013). To retain employees for the long run, organizations should provide training and develop opportunities for their employees, to inculcate self-achievement and growth. Momanyi and Kaimenyi (2015), observed that limited training and development opportunities resulted in inadequate promotion and career advancement, which ultimately lead to turnover intention in employees. Hassan (2014), mentioned promotion opportunities as an independent factor of intention to leave and further the promotion opportunities were only possible with training and development in organizations.

Nawaz and Pangil (2016), suggested that the employees expect better salaries, fair appraisal system, sound training and development programs and career growth opportunities within the organizations for positive attachment and to minimize the chances of leaving the organization. Furthermore, the career growth concerns are entirely associated and influence employee intention to quit. Chang, Chou, and Cheng (2007), proclaimed that if organizations satisfy the career and development needs of the employees, then employee's turnover intentions may decrease. They suggested that managers must pay more attention to employees' career needs and must introduce well-planned training and development. Kadiresan, Selamat, Selladurai, and Mohamed (2015), suggested that training and development enhance the productivity and performance of the employees which result in a reduction of employees' turnover intention in the organizations.

Jehanzeb et al., (2013), explored that training and development programs are positively related to organizational commitment and to get their commitment, employees should be strongly recognized with goals, mission, and values of the organization, through appropriate training programs. Hence training and development motivate employees to work and retain them in the organizations. Long, Perumal, and Ajagbe (2012), explicated that training and development opportunities are not just a way to obtain competencies, but they are necessary for employees to accomplish organization's goals and objectives. Joarder and Sharif (2011), described that through training and development, employees could enhance their knowledge and skills which is needed for standardized performance in the technological work environment. According to Kim (2014), turnover intention among workforce decreases when they perceive career advancement opportunities in their current job.


Recognition includes monetary and non-monetary benefits provided by the organization to their employees for achievement of organizational goals (Awan and Tahir, 2015). Agyeman and Ponniah (2014), reported that 20% respondents of their research study considered recognition and reward as a major factor which leads to employee's retention in the organization. Hence, the absence of recognition and appreciation may cause turnover intention among employees. Kassa (2015), indicated that Recognition had a positive and significant effect on employee retention, and lack of this factor of motivation may cause turnover intention. Momanyi and Kaimenyi (2015), observed that employees expect recognition for their work. Thus recognition and turnover intention have an association. Rewards and recognition play a vital role in ensuring a long-term relationship with employees with the organizations. Recognition is motivation for employees to serve long-time in the organizations and for better performance.

Recognition and appreciation of work are also considered as non-financial incentives, which result in significant reduction in employee turnover intention (Khan and Qadir, 2016). A research study by Arnold (2016), indicated that lack of recognition significantly affects turnover intention among employees. According to the results of their research, 80% of participants posited that their boss did not appreciate their work. It is opined that to develop a sense of appreciation among employees; organizations should use tools like spot bonuses, achievement certificates and prizes in front of their co-workers, this strategy will retain employees.

Peer Relations

Relations with peers include a relationship in which one employee has no authority over other and have the same level of command in organizational hierarchy (Awan and Tahir, 2015). It is found that there is an inverse association between peer relations and workers intention to leave. Lack of peer support increases employee dissatisfaction which leads to turnover intention among employees (Bateman, 2009). Employees share the same physical space during their work life in the organization. Peers relationships are core component of motivation, and lack of this relation may cause intention to leave the job. Positive coworker relations have motivation for employees, but negative relationships with coworkers may experience a decline in motivation and foster intention to quit (Basford and Offermann, 2012).

Chang, Wang, and Huang (2013), found an intention to leave organization was less among those employees who had access to not only coworkers but also had social interactions with supervisors, than the employees who have limited degree of such access. It is evidenced that peers in working life have a significant impact on employees' attitude to the job. Supportive coworkers' relations, created an environment where employees strongly committed to the organization. It could be difficult for an employee to leave the organization in such a peer 's supportive environment and it has a positive impact for newcomers in the organization for their commitment (Riaz, Anjum and Anwar, 2016).

Research Methodology

Research Hypothesis

From the research model above, following hypotheses are developed for the study.

h1: There is significant association between training and development opportunities and intention to leave.

h2: There is a significant association between recognition and intention to leave.

h3: There is significant association among peer relations and intention to leave.

Sample Size

The current study is carried out in government BHUs, RHCs, THQs and DHQs in District Okara, (Punjab) Pakistan. The total target population of the study is 480 persons including 200 Medical Doctors, 200 Nurses, and 80 Nutrition Supervisors. For this study, the decision about the sample size is made based on the table that has been simplified by Krejcie and Morgan (1970). According to the table the correct sample size for this research is identified as 214. The sample size represents 45% of the total population which includes 90 medical Doctors, 90 Nurses and 34 Nutrition Supervisors.

Research Findings And Results Descriptive Analysis

Although 214 sets of questionnaires were handed over to respondents, out of those, only 201 sets were found complete (94% response rate).

Table 1. Demographic Information of the Respondents





Job Title



###Nutrition Supervisors###31###15.4%


###Under 35 years###139###69%

###Above 35 years###62###31%

Education Level

###Nursing Diploma###83###41%



###M. Phil###20###10%

Area of Posting

###Urban (DHQs and THQs)###67###33.3%

###Suburban (RHCs)###61###30.3%

###Rural (BHUs)###73###36.4%

Inferential Analysis

Pearson's Correlation

With the help of collected data through survey questionnaire, correlation tool is applied to find the extent to which all factors like Training and Development Opportunities, Recognition and Peer Relations have a relationship with Intention to Leave.

Table 2. Pearson Correlations

###Training and Development###Peer



Training and Development




Peer Relations###0.479**###0.424**###1


The above table indicates the correlation analysis among dependent variable, i.e. intention to leave and with the following independent variables; training and development opportunities, recognition, peer relations. The relationship among all independent variables with the intention to leave (DV) has significant negative values (-0.745, -0.651 and -0.598 respectively). A significant inverse association has been found among all three factors and intention to leave. It also reflects that all independent variables are positively correlated with each other.

The findings show that correlation among training and development opportunities and recognition with the intention to leave (DV) is strong, which falls in the range +-0.61 to +-0.80. Thus, only one independent variable, peer relations has an association with intention to leave which has a moderate value of -0.598, which falls in the range of +-0.41 to +-0.60. Hence, it is concluded that all these factors have a significant inverse association with employee intention to leave. This also indicates that one unit increase in independent variable factors corresponds a decrease in intention to leave values (-0.745, -0.651 and -0.598 respectively).

Multiple Regression Analysis

Table 3. Multiple Regression Coefficient Analysis



###B###Stand. Error###Beta


Training andDevelop.###-0.402###0.043###-0.294###-9.355###0.000


Peer Relations###-0.253###0.047###-5.374###0.000

The above table describes all independent variables, i.e. training and development opportunities, recognition, and peer relations are making a significant contribution to the regression equation (P<0.05). The value of beta computed that training and development opportunities have the highest Beta ([beta]=-0.467) that denotes it as most significant contributor to intention to leave. Followed by recognition with ([beta]=-0.294), and peer relations with ([beta]=-0.250), respectively. The Unstandardized coefficient values explain the contribution of all independent variables to the dependent variable. All independent variables have an inverse association with intention to leave (ITL).

Hypothesis Testing

The multiple regression results indicate different values for each of the three independent variables, which help in accepting and rejecting the hypotheses. Detail of each hypothesis is given below:

h1: There is a significant association between training and development opportunities and intention to leave.

In case of training and development opportunities, the Beta value is - 0.467 and p-value is 0.000 which is less than 0.05; it shows that there is an inverse association between training and development opportunities and intention to leave (ITL). Hence, hypothesis 1 is accepted.

h2: There is a significant association between recognition and intention to leave

The Beta value of recognition is -0.294 and p-value is 0.000 which is less than 0.05 (p<0.05); it reflects a significant inverse association between recognition and intention to leave (ITL). Hence, hypothesis 2 is accepted.

h3: There is a significant association between peer relations and intention to leave

In case of peer relations, the Beta value is -0.250 and p-value is 0.000 which is less than 0.05 (p<0.05); it indicates the association between peer relations and intention to quit is significant. So, hypothesis 3 is accepted.

Limitations Of The Study

This research is conducted on a small sample size of one district, so the results might not be universally generalized. The actual behavior and customs of Pakistani employees could be different from employees of other districts, provinces or even from other countries. This research study is conducted in public sector employees so that these results could vary on private sector employees. The researcher analyzed and measured intention to leave rather than actual turnover so these findings could be different with actual turnover results. The other limitation of the study is that R square of this study is 0.689; therefore 68.9% variance in intention to leave is described by three independent variables. Though, there are still 31.1% in intention to leave variance unexplained in the present study. It is indicated that other potential factors can affect the variance of intention to leave.

Discussion and Conclusion

The first independent variable, Training and development Opportunities is proved to have a significant impact on employees' intention to leave. It means if Health Department may manage and create enough opportunities for training and development of doctors as well as other employees, it may reduce intention to leave. These findings are consistent with (Khan and Qadir, 2016), which explains that when employees do not find enough opportunities for their career development in an organization, they prefer to leave such organization as soon as they find a better opportunity. This result is supported by other research findings such as Hassan (2014), and De Gieter et al., (2012).

The second independent variable, recognition which has immense importance and significant impact on employees' intention to leave. Doctors and other employees of public sector institutions would be strongly motivated to carry on their services if they are properly appreciated and recognized. These findings are consistent with (Khan and Qadir, 2016), which describe that recognition system of an institution plays a significant part in ensuring long-run employment relationship with the organization.

The third independent variable, Peer relations is also negatively correlated with intention to leave and has a significant contribution in explaining the intention to leave among health sector employees. This factor also influences health sector employees' decision of turnover intention. These findings are consistent with research findings of Balkan, Serin, and Soran (2014); Ajaz and Mehmood (2015).

Recommendations For Future Research

There are some other intrinsic factors of motivation including achievement, interesting work, work itself and autonomy that should be explored in future research. There are some constraints which need to be resolved to get more accurate results about employees' intention to leave. It is suggested for future researchers to determine the impact of intrinsic factors on intention to leave in a diverse culture. The same research should be conducted in a broader scope, in other districts and provinces of Pakistan or different institutional setting.


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Publication:New Horizons
Article Type:Report
Geographic Code:9PAKI
Date:Jun 30, 2018

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