Geriatric Nursing 35 (2014) 351e356
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Feature Article
The Job Embeddedness instrument: An evaluation of validity and reliability Orin Edward Reitz, PhD * Mennonite College of Nursing, Illinois State University, 209 Edwards Hall, Mail Code 5810, Normal, IL 61790-5810, USA
a r t i c l e i n f o
a b s t r a c t
Article history: Received 14 January 2014 Received in revised form 10 April 2014 Accepted 14 April 2014 Available online 08 July 2014
A cross sectional correlational mailed survey was used to assess the validity and reliability of the Job Embeddedness (JE) instrument for predicting nurse retention. A regression model using the variables of JE and age were predictive of nurse retention in a sample of Registered Nurses (RNs) working in long term care (LTC) settings. This study supports the multi-dimensionality, validity and reliability of the underlying JE construct. However a different factor structure was suggested that better fit the data. Long term care organizations (LTC) may benefit from a strategy of increasing the embeddedness of their existing employees in order to increase nurse retention. Job embbededness could be used as a foundation to provide effective nurse retention strategies in LTC settings. Ó 2014 Mosby, Inc. All rights reserved.
Keywords: Nurse turnover Nurse retention Job embeddedness Confirmatory factor analysis
Registered nurses working in the long term care setting Excessive nursing turnover is a costly and expensive problem for health care organizations in long term care (LTC) settings. Direct costs related to nurse turnover include recruitment and training costs for newly hired nurses1 and costs of hiring contract and temporary personnel.2 Revenues for nursing homes and assisted living facilities may be lost due to closed beds, closed units or from deferring patients elsewhere for care when adequate nurse staffing is not maintained.2,3 More importantly low nurse staffing due to excessive turnover may result in poor patient outcomes4 because the knowledge, wisdom and skills of a departing experienced nurse is not retained by the organization, even with effective orientation and preceptor programs.5 The workforce environment for long term care is also being shaped by the changing demographics in the United States (US), resulting in an increased demand for nursing services as the baby boom generation reaches retirement age. At the same time the U.S. population ages, the largest cohort of nurses (also from the baby boom generation) will reach retirement age. The increase in demand for nursing services and potential decrease in supply of nurses threatens the delivery of quality health care.6 The aging of the nurse workforce and estimates that 55% of the nurse workforce plans to retire by 20207 make retaining experienced nurses a high
* Corresponding author. Tel.: þ1 309 438 3437; fax: þ1 309 438 4410. E-mail address: [email protected]. 0197-4572/$ e see front matter Ó 2014 Mosby, Inc. All rights reserved. http://dx.doi.org/10.1016/j.gerinurse.2014.04.011
priority to maintain high quality care and positive patient outcomes. The number of elderly requiring residential care (including nursing care facilities, alternative residential care or home health care) is expected to increase from 15 million in 2000 to over 27 million by the year 2050.8 In addition long term care (LTC) nurses have higher turnover rates than nurses working in acute care settings. Estimates of first year turnover in LTC settings range from 14 to 37%.9 It was estimated that 19,400 LTC nurse positions remain vacant.9 This trend is expected to continue to grow. Nurses working in LTC settings reported significantly higher emotional exhaustion than nurses working in similar acute care settings10 and may be one reason for higher turnover. In addition high RN turnover is associated with high certified nursing assistants (CNA) turnover compounding the problem of maintaining adequate staffing. Effective RN retention interventions may possess a spillover effect positively impact CNA retention.11 Increasing the retention of nurses working in LTC settings is one possible way to meet the growing demand for nursing services. Nurse turnover is defined as a nurse’s voluntary termination of employment with a particular organization while nurse retention is the continuation of employment between the organization and nurse.12 Using a retention based strategy to combat excessive turnover demonstrates a different fundamental approach. Instead of focusing on preventing turnover, an approach that emphasizes retention may be more effective. Although turnover and retention are related, evidence suggests that there are fundamental differences why a nurse remains with a particular organization (retention)
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or why this same nurse leaves the organization (turnover).13 The Job Embeddedness (JE) instrument was developed to integrate nonwork factors into a model for retention.13 The JE instrument has been used in a variety of settings13e17 including nurses18,19 and has proven effective in explaining the variation in voluntary turnover above traditional measures such as job attitudes. However no studies could be located that used the JE instrument using a sample of RNs working in long term care settings. The use of the JE construct may form the basis to develop effective nurse retention interventions. This study will attempt to fill in the gaps of our theoretical understanding of RN retention in the long term care setting. Although JE has demonstrated to explain additional incremental variation above job satisfaction and organizational commitment,13 no studies could be located that used JE with a sample of RNs working in LTC settings. It is hypothesized that JE will be predictive of nurse retention as operationalized as self-reports of intent to stay. However the validity and reliability of the JE instrument should be established for RNs in LTC settings. The purpose of this study was to examine the validity and reliability of the JE instrument with a sample of LTC RNs. Conceptual framework Traditional research on employee turnover has focused on job attitudes typically, job satisfaction and organizational commitment.20,21 Although the research has supported the relationship between job satisfaction and organizational commitment with employee turnover much of the variance of turnover remains unexplained.22e25 Individual characteristics such as age and tenure also influence nurse retention.22e24 Even when nurse turnover factors are combined, there is an inadequate picture of nurse retention and intention to stay. Without a more thorough understanding of nurse retention, the resources for building effective retention interventions remain deficient. Job Embeddeness (JE) has been shown to explain a larger share of variance in turnover in other populations of workers than either job satisfaction or organizational commitment.13,18 Job embeddedness can be thought as a three by two matrix representing the fit, links and sacrifice between an employee and both the community and the organization.13 Fit is defined as an employee’s perception of their compatibility with the surrounding community and the current organization. Links reflect informal and formal influences with other people or activities within the organization or environment. Sacrifice involves an employee’s belief of what they would have to give up when leaving their job13 (see Table 1). Unlike much of the traditional job turnover research, JE possesses a fundamental difference focusing not on why an employee does not leave the current job (prevention of turnover) but rather on why this same employee would remain at the current job. Initially it may appear that the two concepts, employee turnover and employee retention, are opposite ends of a continuum of the same construct, employment. However previous research has supported the proposition that the reasons an employee remains at
the current job are distinctly different than the reasons this same employee leaves the same job. Herzberg, Mausner and Snyderman26 differentiate motivation factors, factors that motivate an employee to remain at the present job, and hygiene factors, factors that make an employee want to leave the current job. Motivating factors are intrinsic to the work itself (for example providing care in a nursing job) while hygiene factors includes things such as salary, working conditions and inter-personal relationships. So while the lack of adequate salary may be a critical factor in an employee’s decision to quit the current job (turnover), adequate salary does not ensure the employee will remain at the current job (retention). Current research has supported the differences between retention and turnover. Factors that prevent turnover are felt to be qualitatively different than factors that encourage retention.27 The JE construct incorporates these retention factors and guided this study. Method This study used a cross sectional correlational mailed survey research design of Registered nurses (RNs) who work at nursing homes across the United States. Sample Inclusion criteria included working as a staff nurse that currently provides direct care to patients in a long term care settings and having an active RN license. The majority of study participants worked as RNs in nursing homes or assisted care facilities. Directors of nursing, administrators and nursing supervisors were excluded. Human subjects’ protections were ensured through institutional review at Illinois State University. Informed consent procedures were explained and integrated into the cover letter. Measures The JE instrument developed by Mitchell et al13 was used to assess the level of job embeddedness for RNs working in LTC settings. The JE instrument is a forty item tool using fill-in-the-blank and five point Likert-type items designed to measure JE for a variety of professions and industries13,15e18 (see Table 2). The JE instrument includes six subscales; organizational fit, community fit, organizational links, community links, organizational sacrifice and community sacrifice. Total JE scores were computed by standardizing and averaging each subscale and summing these products. This procedure was utilized in order to provide each subscale the same weight when calculating the total JE regardless of the number of items each subscale possesses. Individual demographic data including age, race, educational level, family income and gender were collected. Organizational characteristics of the nursing home (profit or not for profit status) were also collected. Nurse retention was operationalized as selfreport of intent to stay. Two separate questions, “Do you plan to work at your current organization for the next year” and “I intend to
Table 1 Job embeddedness dimensions. JE dimension
Organization
Community
Fit
Organizational fit: An employee’s perceived compatibility with the organization Organizational links: Formal or informal connections that exist between an employee and other people or groups in the organization Organizational sacrifice: What an employee would have to give up to break free from links from the organization
Community fit: How well a person perceives that they fit in the surrounding community and environment Community links: The significant influence of family and other social institutions and their influence on decision making Community sacrifice: The ease that links can be broken between the employee and the surrounding environment
Links Sacrifice
From Mitchell TR, Holtom BC, Lee TW et al. Why people stay: Using job embeddedness to predict voluntary turnover. Acad Manage J 2001;44:1102e1121.
O.E. Reitz / Geriatric Nursing 35 (2014) 351e356 Table 2 Original forty item Job Embeddedness instrument. Fit-community 1. I love the place where I live. 2. The weather where I live is suitable for me. 3. This community is a good match for me. 4. I think of the community where I live as home. 5. The area where I live offers the leisure activities that I like. Reported Cronbach’s alpha coefficient for original JE instrument .79 Fit-organization 1. I like the members of my work group. 2. My coworkers are similar to me. 3. My job utilizes my skills and talents well. 4. I feel like I am a good match for this company. 5. My values are compatible with the organization’s values. 6. I fit with the company’s culture. 7. I like the responsibility and authority I have at this company. 8. I can reach my professional goals working for this organization. 9. I feel good about my professional growth and development. Reported Cronbach’s alpha coefficient for original JE instrument .86 Links-organization 1. How long have you been at your present position? 2. How long have you worked for this company? 3. How long have you worked in this industry? 4. How many coworkers do you interact with regularly? 5. How many coworkers are highly dependent on you? 6. How many teams are you on? 7. How many committees are you on? Reported Cronbach’s alpha coefficient for original JE instrument .62 Links-community 1. Are you currently married? 2. If you are married, does your spouse work outside the home? 3. Do you own the home you live in? 4. My family roots are in this community. 5. How many family members live nearby? 6. How many of your close friends live nearby? Reported Cronbach’s alpha coefficient for original JE instrument .50 Sacrifice-organization 1. I have a lot of freedom on this job to decide how to pursue my goals 2. The perks on this job are outstanding 3. I feel that people at work respect me a great deal 4. I would sacrifice a lot if I left this job 5. My promotional opportunities are excellent here 6. I am well compensated for my level of performance 7. The benefits are good on this job 8. The health care benefits provided by this organization are excellent 9. The retirement benefits provided by this organization are excellent 10. The prospects for continuing employment with this company are excellent Reported Cronbach’s alpha coefficient for original JE instrument .82 Sacrifice-community 1. Leaving this community would be very hard. 2. People respect me a lot in my community. 3. My neighborhood is safe. Reported Cronbach’s alpha coefficient for original JE instrument .59 Total Cronbach’s alpha for forty item JE instrument ¼ .91 (Mitchell et al, 2001) From Mitchell TR, Holtom BC, Lee TW et al. Why people stay: Using job embeddedness to predict voluntary turnover. Acad Manage J 2001; 44:1102e1121.
remain at the present organization for the next 12 months” were asked using a five point Likert scale. The responses to these items were added together to arrive at the outcome variable. These items were located on different pages of the survey in order to assess reliability.
Procedures for data collection An initial power analysis indicates that 138 participants were needed to participate based on seven variables (JE total score, five demographic variables and profit status of the organization), 80%
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statistical power, .05 alpha level and a small effect size (r2 ¼ .05). A mail survey using the Tailor Design Method28 was utilized for data collection. The list of RNs working at nursing homes was attained from a private seller of information. Potential participants were randomly chosen from this list of RNs working in long term care settings. A packet consisting of a cover letter, a questionnaire and a business reply envelope was sent to each potential participant with an identification number in order to identify non-responders. Once a survey was received the participant was removed from the mailing list and the identifying number removed from the survey thus protecting the confidentiality of the respondent. A reminder postcard was then sent to each non-responder seven to ten days later. Assuming a response rate of 25%, 552 surveys were sent out in three successive mailings. Once a survey was received this participant was removed from the list for subsequent mailings. The identifier was then removed from the survey in order to protect confidentiality of the participant. Two subsequent mailings were sent to potential participants in order to increase response rate. Many addresses were outdated and returned or were not filled out because the potential participant no longer worked in nursing or no longer worked in the long term care setting (n ¼ 207). Of the remaining 345 surveys, 101 were received for a final response rate of 29.28%. Twenty nine of participants did not meet inclusion criteria, leaving a total of 82 useable surveys. Data analysis and results Data were analyzed using PASW SPSS 19.0 software (SPSS Inc., Chicago, IL) and IBM SPSS AMOS software version 19.0. Missing data for this study were minimal (.4 and explaining a significant level of the variation (>50%) of the JE instrument. A scree plot indicated that a four to six factor structure would explain the required level of variation of JE. However after an initial principal component analysis was conducted one factor had only two items and was thus eliminated. Items that loaded on multiple factors were then eliminated. Subsequent factor analysis indicated a respecified model using 23 items loading on five factors. This respecified model explained 65.65% of the variation of the original forty item JE instrument. A
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Table 3 Sample characteristics compared with RNs working in long term care settings in U.S. Characteristic
Current study
NSSRN (2008)
Age Mean (SD) Range Married Gender Female Male Race/ethnic background White non-Hispanic Native American/Alaskan Native Hispanic Asian or Pacific Islander Multi-racial or other Total family income $100,001 Highest level of education completed Diploma Associate’s degree Bachelor’s degree Master’s degree Doctoral degree Profit status of organization For profit Not for profit
53 (median) 51.3 years (10.78) 28e82 74.1% (n ¼ 60)
46 (median)
92.7% (n ¼ 76) 7.3% (n ¼ 6) 85.0% 5.0% 1.3% 5.0% 2.5%
¼ ¼ ¼ ¼ ¼
93.4% 6.2%
68) 4) 1) 4) 2)
83.2% .3% 3.6% 5.8% 1.7%
45.6% (n ¼ 36) 50.6% (n ¼ 40) 3.83 (n ¼ 8)
12.4% 47.5% 40.1%
7.4% 42.0% 30.9% 18.5% 1.2%
(n (n (n (n (n
74%
(n (n (n (n (n
¼ ¼ ¼ ¼ ¼
6) 34) 25) 15) 1)
12.9% 36.1% 38.6% 12.3% .9%
62.2% (n ¼ 28) 37.7% (n ¼ 17)
US Dept. of Health and Human Services. The Registered Nurse population: Findings from the 2008 Sample Survey of RNs. http://bhpr.hrsa.gov/healthworkforce/ rnsurveys/rnsurveyinitial2008.pdf; Accessed 23.10.13.
confirmatory factor analysis was then conducted in order to confirm the factor structure obtained from the exploratory factor analysis. Results from this respecified five factor model indicated a relatively good fit with the data: c2 ¼ (221) 305.9, p < .001, CFI ¼ .913, PNFI ¼ .657 and RMSEA ¼ .069. Standardized estimates of the respecified five factor 23 item instrument are presented in Table 4. All subsequent analyses were run with the respecified 23 item five factor model. The outcome variables, “I plan to work at the organization for the next year”, and “I intend to stay employed at the organization for the next 12 months,” were significantly related r ¼ .905 (p < .001), thus reinforcing the validity of the two items. These two items were summed in order to arrive at the outcome variable. Using a multiple regression with intent to stay and plan to work at the same organization as the outcome variable, the total JE score, the demographic variables (age, race, gender, family income and educational level) and the profit status of the organization were entered in the regression model. Total job embeddedness and age were predictive of nurse retention and accounted for 13.6% and 5.8% of the variation of intent to stay respectively. The other demographic variables and profit status of the organization were not significantly associated with intent to stay and thus excluded from the model. Thus the hypothesis that total JE was significantly related to intent to stay was supported. These two variables, total JE and age statistically significantly predicted intent to stay, F(1,66) ¼ 12.603, p < .0005, R2 ¼ .194. Inspection of the bs indicated that total job embeddedness was positively associated with the outcome variable, intent to stay while age was negatively associated with intent to stay. The more embedded the RN was the more likely they were to remain at their current job while the older they were the less likely they were to remain at the same job. The greater the level of job embeddedness the more likely the individual was to intend to stay at their current position. The ability to forecast the outcome variable supports the predictive validity of the JE instrument.
Table 4 Job embeddedness re-specified 23 item five factor model. Item
Standardized estimates
Organizational Match (how well a person perceives that they match the organization) 1. I feel like I am a good match for this company. .86 2. My values are compatible with the organization’s values. .86 3. I fit with the company’s culture. .87 4. I like the responsibility and authority I have at this .89 company. 5. I can reach my professional goals working for this .71 organization. 6. I feel good about my professional growth and .61 development. 7. I feel that people at work respect me a great deal. .73 8. The prospects for continuing employment with this .68 company are excellent. Reported Cronbach’s alpha coefficient for respecified organizational match factor ¼ .925 Vesting (programs that make it difficult to leave without incurring a penalty) 1. I would sacrifice a lot if I left this job. .54 2. The benefits are good on this job. .90 3. The health care benefits provided by this organization .86 are excellent. 4. The retirement benefits provided by this organization .75 are excellent. Reported Cronbach’s alpha coefficient for vesting factor ¼ .835 Community Match (How well an employee matches with the surrounding environment) 1. This community is a good match for me. .84 2. I think of the community where I live as home. .64 3. The area where I live offer leisure activities I like. .66 4. The weather where I live is suitable for me. .54 Reported Cronbach’s alpha for community match factor ¼ .787 Work teams (number and extant of work related teams and committees) 1. How many coworkers do interact with regularly? .64 2. How many coworkers are highly dependent upon you? .66 3. How many work related teams are you on? .84 4. How many committees are you on? .74 Reported Cronbach’s alpha for work teams factor ¼ .766 Family and friends (number and extent of family and friend connections) 1. My family roots are in this community. .51 2. How many family members live nearby? .81 3. How many of your close friends live nearby? .61 Reported Cronbach’s alpha coefficient for original JE instrument ¼ .662 Total Cronbach’s alpha for 23 item respecified five factor JE instrument ¼ .836.
Mitchell et al found the JE instrument to have an overall Cronbach’s alpha of .87e.89.13,19 Previous research using a sample of RNs found the Cronbach’s alpha of the JE instrument to be .91.18 A Cronbach’s alpha of greater than .7 indicates a suitable level of internal consistency for scales in the early stages of development.32 In the present study of RNs working in the long term care setting, a Cronbach’s alpha of .836 was found for the JE instrument. More specifically the Cronbach’s alpha found for each of the subscale in the current study is as follows: organizational match .925, vesting .835, community match .787, work teams .766 and friends and family .662. Although the respecified five factor 23 item model has a lower Cronbach’s alpha then the original forty item JE instruments, the internal consistency of the respecified model is within acceptable range. The Cronbach’s alpha of the respecified 23 item five factor model is presented in Table 4. Discussion The respecified JE model contains five distinct factors including organizational match, community match, vesting, work teams
O.E. Reitz / Geriatric Nursing 35 (2014) 351e356
and friends and family. Evaluation of this new factor structure demonstrated a unique set of factors that will be examined. The organizational match factor of JE is very similar to the organizational fit dimension originally proposed by Mitchell et al.13 Two items, “I like the members of my work group” and “My job utilizes my skills and talents well” were omitted from this factor due to low factor loadings. The item “My coworkers are similar to me” was omitted because it loaded on multiple factors. Two additional items, “I feel that the people at work respect me a great deal” and “The prospects for continuing employment with this company are excellent” were added to this factor. This factor appears to capture the affective component of match between the organization and employee. The importance of this factor has been supported by previous research examining the fit between the employee and organization33 and between the employee and the job.34 However the organizational match factor appears to capture the affective facet including the employee’s emotional attachment to the organization. The vesting factor encompasses aspects of the organizational sacrifice factor. Several items were omitted from the organizational sacrifice component because they did not have adequate factor loadings or loaded on other factors. The four items for the vesting factor relate to benefits the organization provides (see Table 4) and the sacrifice related to leaving this job. Although related to Mitchell et al’s organizational sacrifice factor of JE, the proposed factor is narrower because it focuses on benefits and the sacrifice involved with giving up these benefits. Surprisingly the item “I am well compensated for my level of performance” did not load on this factor. The community match factor is very similar to the community fit dimension of the original JE instrument. Two items were removed from the original factor, “I love the place I live” and “The weather where I live is suitable for me” were omitted. The work teams factor of the respecified model was similar to organizational links factor. Three items related to tenure, “How long have you been at your present position,” “How long have you worked for this company” and “How long have you worked in nursing” were omitted. The last factor, friends and family was similar to the community links dimension of JE except items relating to marriage and home ownership were excluded. Results support that the total JE score and age predicts intent to stay. These variables accounted for approximately 19.4% of the variation in nurse retention. Job embeddedness appears to be associated with intent to remain at the present job. The more embedded an employee is the more likely they are to remain at the current job. The older an RN is the less likely they were to continue at the present position. With the exception of age and total JE none of the other variables entered into regression equation help predict nurse retention and were thusly excluded. Previous research has indicated that the profit status of a health care organization may be related to retention.35 The profit status of an organization was not predictive of intent to stay. This finding may be due to the small sample size (n ¼ 57). Many survey participants may not have known the profit status (for profit or not for profit) and thus were unable to answer the question. This discrepancy requires further investigation. Implications The proposed respecified factor structure of the JE construct possesses several implications. The importance of the fit between the organization and the employee becomes evident when the underlying structure of the JE is evaluated. Hiring decisions should be based on the affective match between the employee and the organization. The importance of the structuring of the benefits package an organization offers its employees with significant
355
penalties for leaving the organization may be an effective approach to increasing the JE of the employee. The suggested factor structure reinforces the importance of community factors as essential components of the JE construct. The results of this study support several implications for employers of RNs in long term care settings. A different approach may be used to view nurse retention. Job embeddedness focuses on retention, not preventing nurse from leaving (turnover) and provides a unique way to understand nurse retention. Instead of preventing turnover, an employer may want to focus on ways to increase embeddedness of the RN and thus increase retention. In order to increase retention of RNs working in LTC settings, no one recipe or template to increase retention is suggested. An individualized approach capitalizing on the unique strengths of both the organization and community in relation to the employee should be more effective in increasing JE. Using JE as a strategy to increase nurse retention means a critical analysis of the community and organization should be accomplished to lay the foundation to design effective nurse retention strategies. For example an organization with superior recreational facilities may be able to leverage these facilities to increase employee retention. Initiatives aimed at having either individual employees or employees within the organization participate and use the facilities could increase the employees’ embeddedness. Holtom and O’Neill give specific examples of interventions designed to increase retention by increasing the nurse’s JE. These interventions focus on increasing a particular dimension of JE. For example the fit-organization dimension of JE can be increased by providing new employees chances to socialize with other group or team members. The sacrifice-community dimension of JE could be increased by the establishment of a program to offer home buying assistance.18 Another implication of using JE as a conceptual framework to develop effective nurse retention strategies emphasizes the importance of socialization both within the organization and outside the organization. Strengthening the links to the community may be accomplished by providing incentives to encourage community participation. One cost effective way to encourage community involvement could be to possibly mention community activities in the employee newsletter, bulletin board or at staff meetings. A strategy of recruiting within the community may be more effective in increasing retention in LTC settings. Persons living within the local community will probably be much more embedded in the community. Financial assistance to help educate local residents so they can fulfill the roles needed in LTC settings may be the most effective way to keep and retain a stable workforce. Relocation incentives may not be as effective in retaining nurses in the long run. If relocation incentives are used, interventions designed to strengthen the embeddedness of the relocated nurses such as providing for opportunities of socialization outside of the organization should be utilized. Future research and limitations This study has several limitations. The use of self-report items of intent to stay at the current job and planning to work at the same organization for the next year relied on the participant’s honesty regarding their future employment intentions. The connection between JE and nurse retention would be strengthened by using actual employment data instead of self-reports of intent to stay. Nurse workforce studies may benefit from examining the JE of other direct care workers such as CNAs and licensed practical nurses (LPNs) who provide the majority of care in LTC settings. Another limitation of this study relates to the sample size. Although only a feasibility study, a relatively small sample size (n ¼ 82) of RNs was used, limiting the generalizability of the
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findings. Future research should aim at replicating the research in a larger sample of RNs working in LTC settings. The profit status of an organization was also not predictive of intent to stay. This finding may be due to the small sample size (n ¼ 57). Many survey participants may not have known the profit status (for profit or not for profit) and thus were unable to answer the question. While the current study did not find the organizational profit status to be predictive of intent to stay, past research has found organizational status32 to be predictive of intent to stay for RNs. This discrepancy calls for future research. The use of a mailed survey design approach may have limited responses. An overall response rate of 29.28% suggests that a strategy that uses alternative data collection methods (e.g. internet surveys as well as mailed survey) may be more effective in reaching a more representative sample. Conclusions The purpose of this study was to assess the validity and reliability of the JE construct. No other study has examined the JE of RNs working in LTC settings. However different five factor 23 item respecified model of the JE construct was suggested. This study supports not only the validity and reliability of the JE instrument but also the multi-dimensionality of the JE construct. Health care organizations providing long term care services presently struggling with high turnover may benefit increasing the embeddedness of their existing employees and thus increasing retention. Job embbededness could be used as a foundation to provide effective nurse retention strategies in LTC settings. This represents a shift from trying to prevent turnover to trying to increase retention, a fundamental shift in conceptualizing staffing in LTC settings. Acknowledgments Conflict of interest: This study was supported by a University Research Grant from Mennonite College of Nursing at Illinois State University, Normal, IL. The editor in chief has reviewed the conflict of interest checklist provided by the author and has determined that the author has no financial or any other kind of personal conflicts with this paper. Author contributions: I wish to acknowledge the technical assistance provided by Assistant Professor Dr. MyoungJin Kim, Mennonite College of Nursing Illinois State University. The author, O.E. Reitz, is solely responsible for the content of this study. References 1. Jones C, Gates M. The costs and benefits of nurse turnover: a business case for nurse retention. Online J Issues Nurs. 2007;12:547e553. 2. Jones C. The costs of nurse turnover: part 1: an economic perspective. J Nurs Adm. 2004;34:562e570. 3. Jones C. The costs of nurse turnover, part 2: application of the nursing turnover cost calculation methodology. J Nurs Adm. 2005;35:41e49. 4. Aiken L, Clarke S, Sloane D, et al. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. J Am Med Assoc. 2002;288:1987e1993.
5. Bleich M, Cleary B, Davis K, et al. Mitigating knowledge loss: a strategic imperative for nurse leaders. J Nurs Adm. 2009;39:160e164. 6. Buerhaus PI, Staiger DO, Auerbach DI. The Future of the Nursing Workforce in the United States: Data, Trends, and Implications. Boston: Jones & Bartlett Publishers; 2009. 7. Hader R, Saver C, Steltzer T. No time to lose. Nurs Manag. 2006;37:23e29. 48. 8. U.S. Dept. of Health and Human Services. The Future Supply of Long Term Care Workers in Relation to the Aging Baby Boom Generation, Report to Congress, http://aspe.hhs.gov/daltcp/tcwork.pdf; 2003. Accessed 20.09.13. 9. Rosseter RJ. Nursing Shortage Fact Sheet, http://www.aacn.nche.edu/ media-relations/NsgShortagesFS.pdf; 2009. Accessed 19.09.13. 10. de Jonge J. Managing job stress in nursing: what kind of resources do we need? J Adv Nurs. 2008;63:75e84. 11. Brannon D, Zinn J, Mor V, et al. An exploration of job, organizational, and environmental factors associated with high and low nursing assistant turnover. Gerontologist. 2002;42:159e168. 12. O’Brien-Pallas L, Griffin P, Shamian J, et al. The impact of nurse turnover on patient, nurse, and system outcomes: a pilot study and focus for a multicenter international study. Policy Polit Nurs Pract. 2006;7:169e179. 13. Mitchell TR, Holtom BC, Lee TW, et al. Why people stay: using job embeddedness to predict voluntary turnover. Acad Manage J. 2001;44: 1102e1121. 14. Stone P, Du Y, Cowell R, et al. Comparison of nurse, system and quality patient care outcomes in 8-hour and 12-hour shifts. Med Care. 2006;44: 1099e1106. 15. Crossley CD, Bennett RJ, Jex SM, et al. Development of a global measurement of job embeddedness and integration into a traditional model of turnover. J Appl Psychol. 2007;92:1031e1042. 16. Cunningham GB, Fink JS, Sagas M. Extensions and further examination of the job embeddedness construct. J Sport Manag. 2005;19:319e335. 17. Mallol CM, Holtom BC, Lee TW. Job embeddedness in culturally diverse environment. J Bus Psychol. 2007;22:35e44. 18. Reitz OE, Anderson MA, Hill PD. Job embeddeness and nurse retention. Nurs Adm Q. 2010;34:190e200. 19. Holtom BC, O’Neill BS. Job embeddedness: a theoretical foundation for developing a comprehensive nurse retention plan. J Nurs Adm. 2004;19: 216e227. 20. Gelinas L, Bohlen C. The business case for retention. J Clin Syst Manag. 2002;4:14. 21. Mobley WH. Employee Turnover: Causes, Consequences, and Control. Reading, MA: Addition-Wesley; 1982. 22. Hinshaw AS, Atwood JR. Nursing staff turnover, stress, and satisfaction: models, measures, and management. Annu Rev Nurs Res. 1983;1:133e153. 23. Irvine DM, Evans MG. Job satisfaction and turnover among nurses: Integrating research findings across studies. Nurs Res. 1995;44:246e253. 24. Maertz CP, Campion MA. 25 years of voluntary turnover research: a review and critique. Int Rev IO Psychol. 1998;13:49e81. 25. Tai TW, Bame SI, Robinson CD. A review of nursing turnover research, 1977e1996. Soc Sci Med. 1998;47:1905e1924. 26. Herzberg F, Mausner B, Snyderman BB. The Motivation to Work. New York: John Wiley; 1959. 27. Mittal V, Rosen J, Leana C. A dual-driver model of retention and turnover in the direct care workforce. Gerontologist. 2009;49:623e634. 28. Dillman DA. Mail and Internet Surveys: The Tailored Design Method. 2nd ed. New York: John Wiley & Sons; 2000. 29. Steiger JH, Lind JC. Statistically based tests for the number of common factors. Presented Psychometric Society Annual Meeting Iowa City, IA, 1980. 30. Carmines EG, Zellar RA. Reliability and Validity Assessment. Beverly Hills, CA: Sage; 1979. 31. James LR, Mulaik SA, Brett JM. Causal Analysis: Assumptions, Models, and Data. Beverly Hills, CA: Sage; 1982. 32. Nunelly JC. Psychometric Theory. New York: McGraw-Hill; 1967. 33. Chatman JA. Matching people and organizations: selection and socialization in public accounting firms. Acad Manage Rev. 1991;36:459e484. 34. Saks AM, Ashforth BE. A longitudinal investigation of the relationship between job information sources, applicant perceptions of the fit, and work outcomes. Pers Psychol. 1997;50:395e426. 35. Castle NG, Engberg J. Organizational characteristics associated with staff turnover in nursing homes. Gerontologist. 2006;46:62e73.
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Feature Article
The Job Embeddedness instrument: An evaluation of validity and reliability Orin Edward Reitz, PhD * Mennonite College of Nursing, Illinois State University, 209 Edwards Hall, Mail Code 5810, Normal, IL 61790-5810, USA
a r t i c l e i n f o
a b s t r a c t
Article history: Received 14 January 2014 Received in revised form 10 April 2014 Accepted 14 April 2014 Available online 08 July 2014
A cross sectional correlational mailed survey was used to assess the validity and reliability of the Job Embeddedness (JE) instrument for predicting nurse retention. A regression model using the variables of JE and age were predictive of nurse retention in a sample of Registered Nurses (RNs) working in long term care (LTC) settings. This study supports the multi-dimensionality, validity and reliability of the underlying JE construct. However a different factor structure was suggested that better fit the data. Long term care organizations (LTC) may benefit from a strategy of increasing the embeddedness of their existing employees in order to increase nurse retention. Job embbededness could be used as a foundation to provide effective nurse retention strategies in LTC settings. Ó 2014 Mosby, Inc. All rights reserved.
Keywords: Nurse turnover Nurse retention Job embeddedness Confirmatory factor analysis
Registered nurses working in the long term care setting Excessive nursing turnover is a costly and expensive problem for health care organizations in long term care (LTC) settings. Direct costs related to nurse turnover include recruitment and training costs for newly hired nurses1 and costs of hiring contract and temporary personnel.2 Revenues for nursing homes and assisted living facilities may be lost due to closed beds, closed units or from deferring patients elsewhere for care when adequate nurse staffing is not maintained.2,3 More importantly low nurse staffing due to excessive turnover may result in poor patient outcomes4 because the knowledge, wisdom and skills of a departing experienced nurse is not retained by the organization, even with effective orientation and preceptor programs.5 The workforce environment for long term care is also being shaped by the changing demographics in the United States (US), resulting in an increased demand for nursing services as the baby boom generation reaches retirement age. At the same time the U.S. population ages, the largest cohort of nurses (also from the baby boom generation) will reach retirement age. The increase in demand for nursing services and potential decrease in supply of nurses threatens the delivery of quality health care.6 The aging of the nurse workforce and estimates that 55% of the nurse workforce plans to retire by 20207 make retaining experienced nurses a high
* Corresponding author. Tel.: þ1 309 438 3437; fax: þ1 309 438 4410. E-mail address: [email protected]. 0197-4572/$ e see front matter Ó 2014 Mosby, Inc. All rights reserved. http://dx.doi.org/10.1016/j.gerinurse.2014.04.011
priority to maintain high quality care and positive patient outcomes. The number of elderly requiring residential care (including nursing care facilities, alternative residential care or home health care) is expected to increase from 15 million in 2000 to over 27 million by the year 2050.8 In addition long term care (LTC) nurses have higher turnover rates than nurses working in acute care settings. Estimates of first year turnover in LTC settings range from 14 to 37%.9 It was estimated that 19,400 LTC nurse positions remain vacant.9 This trend is expected to continue to grow. Nurses working in LTC settings reported significantly higher emotional exhaustion than nurses working in similar acute care settings10 and may be one reason for higher turnover. In addition high RN turnover is associated with high certified nursing assistants (CNA) turnover compounding the problem of maintaining adequate staffing. Effective RN retention interventions may possess a spillover effect positively impact CNA retention.11 Increasing the retention of nurses working in LTC settings is one possible way to meet the growing demand for nursing services. Nurse turnover is defined as a nurse’s voluntary termination of employment with a particular organization while nurse retention is the continuation of employment between the organization and nurse.12 Using a retention based strategy to combat excessive turnover demonstrates a different fundamental approach. Instead of focusing on preventing turnover, an approach that emphasizes retention may be more effective. Although turnover and retention are related, evidence suggests that there are fundamental differences why a nurse remains with a particular organization (retention)
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or why this same nurse leaves the organization (turnover).13 The Job Embeddedness (JE) instrument was developed to integrate nonwork factors into a model for retention.13 The JE instrument has been used in a variety of settings13e17 including nurses18,19 and has proven effective in explaining the variation in voluntary turnover above traditional measures such as job attitudes. However no studies could be located that used the JE instrument using a sample of RNs working in long term care settings. The use of the JE construct may form the basis to develop effective nurse retention interventions. This study will attempt to fill in the gaps of our theoretical understanding of RN retention in the long term care setting. Although JE has demonstrated to explain additional incremental variation above job satisfaction and organizational commitment,13 no studies could be located that used JE with a sample of RNs working in LTC settings. It is hypothesized that JE will be predictive of nurse retention as operationalized as self-reports of intent to stay. However the validity and reliability of the JE instrument should be established for RNs in LTC settings. The purpose of this study was to examine the validity and reliability of the JE instrument with a sample of LTC RNs. Conceptual framework Traditional research on employee turnover has focused on job attitudes typically, job satisfaction and organizational commitment.20,21 Although the research has supported the relationship between job satisfaction and organizational commitment with employee turnover much of the variance of turnover remains unexplained.22e25 Individual characteristics such as age and tenure also influence nurse retention.22e24 Even when nurse turnover factors are combined, there is an inadequate picture of nurse retention and intention to stay. Without a more thorough understanding of nurse retention, the resources for building effective retention interventions remain deficient. Job Embeddeness (JE) has been shown to explain a larger share of variance in turnover in other populations of workers than either job satisfaction or organizational commitment.13,18 Job embeddedness can be thought as a three by two matrix representing the fit, links and sacrifice between an employee and both the community and the organization.13 Fit is defined as an employee’s perception of their compatibility with the surrounding community and the current organization. Links reflect informal and formal influences with other people or activities within the organization or environment. Sacrifice involves an employee’s belief of what they would have to give up when leaving their job13 (see Table 1). Unlike much of the traditional job turnover research, JE possesses a fundamental difference focusing not on why an employee does not leave the current job (prevention of turnover) but rather on why this same employee would remain at the current job. Initially it may appear that the two concepts, employee turnover and employee retention, are opposite ends of a continuum of the same construct, employment. However previous research has supported the proposition that the reasons an employee remains at
the current job are distinctly different than the reasons this same employee leaves the same job. Herzberg, Mausner and Snyderman26 differentiate motivation factors, factors that motivate an employee to remain at the present job, and hygiene factors, factors that make an employee want to leave the current job. Motivating factors are intrinsic to the work itself (for example providing care in a nursing job) while hygiene factors includes things such as salary, working conditions and inter-personal relationships. So while the lack of adequate salary may be a critical factor in an employee’s decision to quit the current job (turnover), adequate salary does not ensure the employee will remain at the current job (retention). Current research has supported the differences between retention and turnover. Factors that prevent turnover are felt to be qualitatively different than factors that encourage retention.27 The JE construct incorporates these retention factors and guided this study. Method This study used a cross sectional correlational mailed survey research design of Registered nurses (RNs) who work at nursing homes across the United States. Sample Inclusion criteria included working as a staff nurse that currently provides direct care to patients in a long term care settings and having an active RN license. The majority of study participants worked as RNs in nursing homes or assisted care facilities. Directors of nursing, administrators and nursing supervisors were excluded. Human subjects’ protections were ensured through institutional review at Illinois State University. Informed consent procedures were explained and integrated into the cover letter. Measures The JE instrument developed by Mitchell et al13 was used to assess the level of job embeddedness for RNs working in LTC settings. The JE instrument is a forty item tool using fill-in-the-blank and five point Likert-type items designed to measure JE for a variety of professions and industries13,15e18 (see Table 2). The JE instrument includes six subscales; organizational fit, community fit, organizational links, community links, organizational sacrifice and community sacrifice. Total JE scores were computed by standardizing and averaging each subscale and summing these products. This procedure was utilized in order to provide each subscale the same weight when calculating the total JE regardless of the number of items each subscale possesses. Individual demographic data including age, race, educational level, family income and gender were collected. Organizational characteristics of the nursing home (profit or not for profit status) were also collected. Nurse retention was operationalized as selfreport of intent to stay. Two separate questions, “Do you plan to work at your current organization for the next year” and “I intend to
Table 1 Job embeddedness dimensions. JE dimension
Organization
Community
Fit
Organizational fit: An employee’s perceived compatibility with the organization Organizational links: Formal or informal connections that exist between an employee and other people or groups in the organization Organizational sacrifice: What an employee would have to give up to break free from links from the organization
Community fit: How well a person perceives that they fit in the surrounding community and environment Community links: The significant influence of family and other social institutions and their influence on decision making Community sacrifice: The ease that links can be broken between the employee and the surrounding environment
Links Sacrifice
From Mitchell TR, Holtom BC, Lee TW et al. Why people stay: Using job embeddedness to predict voluntary turnover. Acad Manage J 2001;44:1102e1121.
O.E. Reitz / Geriatric Nursing 35 (2014) 351e356 Table 2 Original forty item Job Embeddedness instrument. Fit-community 1. I love the place where I live. 2. The weather where I live is suitable for me. 3. This community is a good match for me. 4. I think of the community where I live as home. 5. The area where I live offers the leisure activities that I like. Reported Cronbach’s alpha coefficient for original JE instrument .79 Fit-organization 1. I like the members of my work group. 2. My coworkers are similar to me. 3. My job utilizes my skills and talents well. 4. I feel like I am a good match for this company. 5. My values are compatible with the organization’s values. 6. I fit with the company’s culture. 7. I like the responsibility and authority I have at this company. 8. I can reach my professional goals working for this organization. 9. I feel good about my professional growth and development. Reported Cronbach’s alpha coefficient for original JE instrument .86 Links-organization 1. How long have you been at your present position? 2. How long have you worked for this company? 3. How long have you worked in this industry? 4. How many coworkers do you interact with regularly? 5. How many coworkers are highly dependent on you? 6. How many teams are you on? 7. How many committees are you on? Reported Cronbach’s alpha coefficient for original JE instrument .62 Links-community 1. Are you currently married? 2. If you are married, does your spouse work outside the home? 3. Do you own the home you live in? 4. My family roots are in this community. 5. How many family members live nearby? 6. How many of your close friends live nearby? Reported Cronbach’s alpha coefficient for original JE instrument .50 Sacrifice-organization 1. I have a lot of freedom on this job to decide how to pursue my goals 2. The perks on this job are outstanding 3. I feel that people at work respect me a great deal 4. I would sacrifice a lot if I left this job 5. My promotional opportunities are excellent here 6. I am well compensated for my level of performance 7. The benefits are good on this job 8. The health care benefits provided by this organization are excellent 9. The retirement benefits provided by this organization are excellent 10. The prospects for continuing employment with this company are excellent Reported Cronbach’s alpha coefficient for original JE instrument .82 Sacrifice-community 1. Leaving this community would be very hard. 2. People respect me a lot in my community. 3. My neighborhood is safe. Reported Cronbach’s alpha coefficient for original JE instrument .59 Total Cronbach’s alpha for forty item JE instrument ¼ .91 (Mitchell et al, 2001) From Mitchell TR, Holtom BC, Lee TW et al. Why people stay: Using job embeddedness to predict voluntary turnover. Acad Manage J 2001; 44:1102e1121.
remain at the present organization for the next 12 months” were asked using a five point Likert scale. The responses to these items were added together to arrive at the outcome variable. These items were located on different pages of the survey in order to assess reliability.
Procedures for data collection An initial power analysis indicates that 138 participants were needed to participate based on seven variables (JE total score, five demographic variables and profit status of the organization), 80%
353
statistical power, .05 alpha level and a small effect size (r2 ¼ .05). A mail survey using the Tailor Design Method28 was utilized for data collection. The list of RNs working at nursing homes was attained from a private seller of information. Potential participants were randomly chosen from this list of RNs working in long term care settings. A packet consisting of a cover letter, a questionnaire and a business reply envelope was sent to each potential participant with an identification number in order to identify non-responders. Once a survey was received the participant was removed from the mailing list and the identifying number removed from the survey thus protecting the confidentiality of the respondent. A reminder postcard was then sent to each non-responder seven to ten days later. Assuming a response rate of 25%, 552 surveys were sent out in three successive mailings. Once a survey was received this participant was removed from the list for subsequent mailings. The identifier was then removed from the survey in order to protect confidentiality of the participant. Two subsequent mailings were sent to potential participants in order to increase response rate. Many addresses were outdated and returned or were not filled out because the potential participant no longer worked in nursing or no longer worked in the long term care setting (n ¼ 207). Of the remaining 345 surveys, 101 were received for a final response rate of 29.28%. Twenty nine of participants did not meet inclusion criteria, leaving a total of 82 useable surveys. Data analysis and results Data were analyzed using PASW SPSS 19.0 software (SPSS Inc., Chicago, IL) and IBM SPSS AMOS software version 19.0. Missing data for this study were minimal (.4 and explaining a significant level of the variation (>50%) of the JE instrument. A scree plot indicated that a four to six factor structure would explain the required level of variation of JE. However after an initial principal component analysis was conducted one factor had only two items and was thus eliminated. Items that loaded on multiple factors were then eliminated. Subsequent factor analysis indicated a respecified model using 23 items loading on five factors. This respecified model explained 65.65% of the variation of the original forty item JE instrument. A
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O.E. Reitz / Geriatric Nursing 35 (2014) 351e356
Table 3 Sample characteristics compared with RNs working in long term care settings in U.S. Characteristic
Current study
NSSRN (2008)
Age Mean (SD) Range Married Gender Female Male Race/ethnic background White non-Hispanic Native American/Alaskan Native Hispanic Asian or Pacific Islander Multi-racial or other Total family income $100,001 Highest level of education completed Diploma Associate’s degree Bachelor’s degree Master’s degree Doctoral degree Profit status of organization For profit Not for profit
53 (median) 51.3 years (10.78) 28e82 74.1% (n ¼ 60)
46 (median)
92.7% (n ¼ 76) 7.3% (n ¼ 6) 85.0% 5.0% 1.3% 5.0% 2.5%
¼ ¼ ¼ ¼ ¼
93.4% 6.2%
68) 4) 1) 4) 2)
83.2% .3% 3.6% 5.8% 1.7%
45.6% (n ¼ 36) 50.6% (n ¼ 40) 3.83 (n ¼ 8)
12.4% 47.5% 40.1%
7.4% 42.0% 30.9% 18.5% 1.2%
(n (n (n (n (n
74%
(n (n (n (n (n
¼ ¼ ¼ ¼ ¼
6) 34) 25) 15) 1)
12.9% 36.1% 38.6% 12.3% .9%
62.2% (n ¼ 28) 37.7% (n ¼ 17)
US Dept. of Health and Human Services. The Registered Nurse population: Findings from the 2008 Sample Survey of RNs. http://bhpr.hrsa.gov/healthworkforce/ rnsurveys/rnsurveyinitial2008.pdf; Accessed 23.10.13.
confirmatory factor analysis was then conducted in order to confirm the factor structure obtained from the exploratory factor analysis. Results from this respecified five factor model indicated a relatively good fit with the data: c2 ¼ (221) 305.9, p < .001, CFI ¼ .913, PNFI ¼ .657 and RMSEA ¼ .069. Standardized estimates of the respecified five factor 23 item instrument are presented in Table 4. All subsequent analyses were run with the respecified 23 item five factor model. The outcome variables, “I plan to work at the organization for the next year”, and “I intend to stay employed at the organization for the next 12 months,” were significantly related r ¼ .905 (p < .001), thus reinforcing the validity of the two items. These two items were summed in order to arrive at the outcome variable. Using a multiple regression with intent to stay and plan to work at the same organization as the outcome variable, the total JE score, the demographic variables (age, race, gender, family income and educational level) and the profit status of the organization were entered in the regression model. Total job embeddedness and age were predictive of nurse retention and accounted for 13.6% and 5.8% of the variation of intent to stay respectively. The other demographic variables and profit status of the organization were not significantly associated with intent to stay and thus excluded from the model. Thus the hypothesis that total JE was significantly related to intent to stay was supported. These two variables, total JE and age statistically significantly predicted intent to stay, F(1,66) ¼ 12.603, p < .0005, R2 ¼ .194. Inspection of the bs indicated that total job embeddedness was positively associated with the outcome variable, intent to stay while age was negatively associated with intent to stay. The more embedded the RN was the more likely they were to remain at their current job while the older they were the less likely they were to remain at the same job. The greater the level of job embeddedness the more likely the individual was to intend to stay at their current position. The ability to forecast the outcome variable supports the predictive validity of the JE instrument.
Table 4 Job embeddedness re-specified 23 item five factor model. Item
Standardized estimates
Organizational Match (how well a person perceives that they match the organization) 1. I feel like I am a good match for this company. .86 2. My values are compatible with the organization’s values. .86 3. I fit with the company’s culture. .87 4. I like the responsibility and authority I have at this .89 company. 5. I can reach my professional goals working for this .71 organization. 6. I feel good about my professional growth and .61 development. 7. I feel that people at work respect me a great deal. .73 8. The prospects for continuing employment with this .68 company are excellent. Reported Cronbach’s alpha coefficient for respecified organizational match factor ¼ .925 Vesting (programs that make it difficult to leave without incurring a penalty) 1. I would sacrifice a lot if I left this job. .54 2. The benefits are good on this job. .90 3. The health care benefits provided by this organization .86 are excellent. 4. The retirement benefits provided by this organization .75 are excellent. Reported Cronbach’s alpha coefficient for vesting factor ¼ .835 Community Match (How well an employee matches with the surrounding environment) 1. This community is a good match for me. .84 2. I think of the community where I live as home. .64 3. The area where I live offer leisure activities I like. .66 4. The weather where I live is suitable for me. .54 Reported Cronbach’s alpha for community match factor ¼ .787 Work teams (number and extant of work related teams and committees) 1. How many coworkers do interact with regularly? .64 2. How many coworkers are highly dependent upon you? .66 3. How many work related teams are you on? .84 4. How many committees are you on? .74 Reported Cronbach’s alpha for work teams factor ¼ .766 Family and friends (number and extent of family and friend connections) 1. My family roots are in this community. .51 2. How many family members live nearby? .81 3. How many of your close friends live nearby? .61 Reported Cronbach’s alpha coefficient for original JE instrument ¼ .662 Total Cronbach’s alpha for 23 item respecified five factor JE instrument ¼ .836.
Mitchell et al found the JE instrument to have an overall Cronbach’s alpha of .87e.89.13,19 Previous research using a sample of RNs found the Cronbach’s alpha of the JE instrument to be .91.18 A Cronbach’s alpha of greater than .7 indicates a suitable level of internal consistency for scales in the early stages of development.32 In the present study of RNs working in the long term care setting, a Cronbach’s alpha of .836 was found for the JE instrument. More specifically the Cronbach’s alpha found for each of the subscale in the current study is as follows: organizational match .925, vesting .835, community match .787, work teams .766 and friends and family .662. Although the respecified five factor 23 item model has a lower Cronbach’s alpha then the original forty item JE instruments, the internal consistency of the respecified model is within acceptable range. The Cronbach’s alpha of the respecified 23 item five factor model is presented in Table 4. Discussion The respecified JE model contains five distinct factors including organizational match, community match, vesting, work teams
O.E. Reitz / Geriatric Nursing 35 (2014) 351e356
and friends and family. Evaluation of this new factor structure demonstrated a unique set of factors that will be examined. The organizational match factor of JE is very similar to the organizational fit dimension originally proposed by Mitchell et al.13 Two items, “I like the members of my work group” and “My job utilizes my skills and talents well” were omitted from this factor due to low factor loadings. The item “My coworkers are similar to me” was omitted because it loaded on multiple factors. Two additional items, “I feel that the people at work respect me a great deal” and “The prospects for continuing employment with this company are excellent” were added to this factor. This factor appears to capture the affective component of match between the organization and employee. The importance of this factor has been supported by previous research examining the fit between the employee and organization33 and between the employee and the job.34 However the organizational match factor appears to capture the affective facet including the employee’s emotional attachment to the organization. The vesting factor encompasses aspects of the organizational sacrifice factor. Several items were omitted from the organizational sacrifice component because they did not have adequate factor loadings or loaded on other factors. The four items for the vesting factor relate to benefits the organization provides (see Table 4) and the sacrifice related to leaving this job. Although related to Mitchell et al’s organizational sacrifice factor of JE, the proposed factor is narrower because it focuses on benefits and the sacrifice involved with giving up these benefits. Surprisingly the item “I am well compensated for my level of performance” did not load on this factor. The community match factor is very similar to the community fit dimension of the original JE instrument. Two items were removed from the original factor, “I love the place I live” and “The weather where I live is suitable for me” were omitted. The work teams factor of the respecified model was similar to organizational links factor. Three items related to tenure, “How long have you been at your present position,” “How long have you worked for this company” and “How long have you worked in nursing” were omitted. The last factor, friends and family was similar to the community links dimension of JE except items relating to marriage and home ownership were excluded. Results support that the total JE score and age predicts intent to stay. These variables accounted for approximately 19.4% of the variation in nurse retention. Job embeddedness appears to be associated with intent to remain at the present job. The more embedded an employee is the more likely they are to remain at the current job. The older an RN is the less likely they were to continue at the present position. With the exception of age and total JE none of the other variables entered into regression equation help predict nurse retention and were thusly excluded. Previous research has indicated that the profit status of a health care organization may be related to retention.35 The profit status of an organization was not predictive of intent to stay. This finding may be due to the small sample size (n ¼ 57). Many survey participants may not have known the profit status (for profit or not for profit) and thus were unable to answer the question. This discrepancy requires further investigation. Implications The proposed respecified factor structure of the JE construct possesses several implications. The importance of the fit between the organization and the employee becomes evident when the underlying structure of the JE is evaluated. Hiring decisions should be based on the affective match between the employee and the organization. The importance of the structuring of the benefits package an organization offers its employees with significant
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penalties for leaving the organization may be an effective approach to increasing the JE of the employee. The suggested factor structure reinforces the importance of community factors as essential components of the JE construct. The results of this study support several implications for employers of RNs in long term care settings. A different approach may be used to view nurse retention. Job embeddedness focuses on retention, not preventing nurse from leaving (turnover) and provides a unique way to understand nurse retention. Instead of preventing turnover, an employer may want to focus on ways to increase embeddedness of the RN and thus increase retention. In order to increase retention of RNs working in LTC settings, no one recipe or template to increase retention is suggested. An individualized approach capitalizing on the unique strengths of both the organization and community in relation to the employee should be more effective in increasing JE. Using JE as a strategy to increase nurse retention means a critical analysis of the community and organization should be accomplished to lay the foundation to design effective nurse retention strategies. For example an organization with superior recreational facilities may be able to leverage these facilities to increase employee retention. Initiatives aimed at having either individual employees or employees within the organization participate and use the facilities could increase the employees’ embeddedness. Holtom and O’Neill give specific examples of interventions designed to increase retention by increasing the nurse’s JE. These interventions focus on increasing a particular dimension of JE. For example the fit-organization dimension of JE can be increased by providing new employees chances to socialize with other group or team members. The sacrifice-community dimension of JE could be increased by the establishment of a program to offer home buying assistance.18 Another implication of using JE as a conceptual framework to develop effective nurse retention strategies emphasizes the importance of socialization both within the organization and outside the organization. Strengthening the links to the community may be accomplished by providing incentives to encourage community participation. One cost effective way to encourage community involvement could be to possibly mention community activities in the employee newsletter, bulletin board or at staff meetings. A strategy of recruiting within the community may be more effective in increasing retention in LTC settings. Persons living within the local community will probably be much more embedded in the community. Financial assistance to help educate local residents so they can fulfill the roles needed in LTC settings may be the most effective way to keep and retain a stable workforce. Relocation incentives may not be as effective in retaining nurses in the long run. If relocation incentives are used, interventions designed to strengthen the embeddedness of the relocated nurses such as providing for opportunities of socialization outside of the organization should be utilized. Future research and limitations This study has several limitations. The use of self-report items of intent to stay at the current job and planning to work at the same organization for the next year relied on the participant’s honesty regarding their future employment intentions. The connection between JE and nurse retention would be strengthened by using actual employment data instead of self-reports of intent to stay. Nurse workforce studies may benefit from examining the JE of other direct care workers such as CNAs and licensed practical nurses (LPNs) who provide the majority of care in LTC settings. Another limitation of this study relates to the sample size. Although only a feasibility study, a relatively small sample size (n ¼ 82) of RNs was used, limiting the generalizability of the
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findings. Future research should aim at replicating the research in a larger sample of RNs working in LTC settings. The profit status of an organization was also not predictive of intent to stay. This finding may be due to the small sample size (n ¼ 57). Many survey participants may not have known the profit status (for profit or not for profit) and thus were unable to answer the question. While the current study did not find the organizational profit status to be predictive of intent to stay, past research has found organizational status32 to be predictive of intent to stay for RNs. This discrepancy calls for future research. The use of a mailed survey design approach may have limited responses. An overall response rate of 29.28% suggests that a strategy that uses alternative data collection methods (e.g. internet surveys as well as mailed survey) may be more effective in reaching a more representative sample. Conclusions The purpose of this study was to assess the validity and reliability of the JE construct. No other study has examined the JE of RNs working in LTC settings. However different five factor 23 item respecified model of the JE construct was suggested. This study supports not only the validity and reliability of the JE instrument but also the multi-dimensionality of the JE construct. Health care organizations providing long term care services presently struggling with high turnover may benefit increasing the embeddedness of their existing employees and thus increasing retention. Job embbededness could be used as a foundation to provide effective nurse retention strategies in LTC settings. This represents a shift from trying to prevent turnover to trying to increase retention, a fundamental shift in conceptualizing staffing in LTC settings. Acknowledgments Conflict of interest: This study was supported by a University Research Grant from Mennonite College of Nursing at Illinois State University, Normal, IL. The editor in chief has reviewed the conflict of interest checklist provided by the author and has determined that the author has no financial or any other kind of personal conflicts with this paper. Author contributions: I wish to acknowledge the technical assistance provided by Assistant Professor Dr. MyoungJin Kim, Mennonite College of Nursing Illinois State University. The author, O.E. Reitz, is solely responsible for the content of this study. References 1. Jones C, Gates M. The costs and benefits of nurse turnover: a business case for nurse retention. Online J Issues Nurs. 2007;12:547e553. 2. Jones C. The costs of nurse turnover: part 1: an economic perspective. J Nurs Adm. 2004;34:562e570. 3. Jones C. The costs of nurse turnover, part 2: application of the nursing turnover cost calculation methodology. J Nurs Adm. 2005;35:41e49. 4. Aiken L, Clarke S, Sloane D, et al. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. J Am Med Assoc. 2002;288:1987e1993.
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