Relationship between Family-Work and Work-Family Conflict with Organizational Commitment and Desertion Intention among Nurses and Paramedical Staff at Hospitals.

BACKGROUND: High turnover intention rate is one of the most common problems in healthcare organizations throughout the world. There are several factors that can potentially affect the individuals' turnover intention; they include factors such as work-family conflict, family-work conflict, and organizational commitment. The aim of this research was to determine the relationship between family-work and work-family conflicts and organizational commitment and turnover intention among nurses and paramedical staff at hospitals affiliated to Shiraz University of Medical Sciences (SUMS) and present a model using SEM.
METHODS: This is a questionnaire based cross-sectional study among 400 nurses and paramedical staff of hospitals affiliated to SUMS using a random-proportional (quota) sampling method. Data collection was performed using four standard questionnaires. SPSS software was used for data analysis and SmartPLS software for modeling variables.
RESULTS: Mean scores of work-family conflict and desertion intention were 2.6 and 2.77, respectively. There was a significant relationship between gender and family-work conflict (P=0.02). Family-work conflict was significantly higher in married participants (P=0.001). Based on the findings of this study, there was a significant positive relationship between work-family and family-work conflict (P=0.001). Also, work-family conflict had a significant inverse relationship with organizational commitment (P=0.001). An inverse relationship was seen between organizational commitment and turnover intentions (P=0.001).
CONCLUSION: Thus, regarding the prominent and preventative role of organizational commitment in employees' desertion intentions, in order to prevent negative effects of staff desertion in health sector, attempts to make policies to increase people's organizational commitment must be considered by health system managers more than ever.

INTRODUCTION

Today is the world of organizational systems and the success of any organization depends on the use and allocation of productive resources in organizations, especially human resources.[1,2] Organizations apply different sources to achieve productivity improvement as their ultimate goal. Among all these, human resource, as the most effective one, strongly affects the ultimate productivity of organizations.[3] As the productivity of human resources is the main factor forming the productivity of all organizational productive factors, focusing on human resources is the main factor in improving the organizational productivity.[4,5] Therefore, nowadays the necessity of attention to productivity in organizations has been considered more than ever and the factors influencing the efficiency of human resources have been studied. Studies done in this field show that one of the factors affecting the productivity of human resources is employees’ organizational commitment.[6,7] Management experts call employees’ attitudes toward organizations and their psychological dependence on their jobs and organizations, organizational commitment.[8] Studies show that organizational commitment can affect the ultimate productivity of the organizations in different ways. One of these ways is the impact of organizational commitment on the employees’ desertion intention. Results of several studies suggest that employees who have greater organizational commitment have less intention to leave their jobs.[6,9,10]

A large amount of organizations’ costs are spent on investment in human resources[11] and these investments might be useless as a result of events such as staff desertion. Losing the staff’s skills and experiences and replacing them with new inexperienced staff will cause a lot of problems for the organization and it will finally have a negative impact on the organization’s capacity to provide high-quality outputs.[12] When employees work in an environment that contradicts their family environment and conditions, they will most likely be looking for new work environment to experience less stress due to inconsistency and contradiction between work and family environments[13] which could potentially increase the probability of desertion intention and can be a cause of failure in achieving organizational goals.[14] However, in today’s societies, due to various reasons including great changes in the nature of work environments and family lives, managing work and family responsibilities has become a growing problem[15] so that everybody needs to spend limited time resources, and mental and physiological abilities equally in different aspects of his/her life.[16] Sometimes work and business problems negatively influence the people’s personal lives and, consequently, work-family conflict appears. On the other hand, sometimes family life issues as well as personal problems may result in disorders in their work and business lives and this way, family-work conflict occurs.[17] According to various researches, the first domains that get seriously damaged by work-family conflict are Job satisfaction as well as family life satisfaction.[18,19] Hence, the balance between family and business life and the organizational commitment of human resources is one of the factors influencing the success of organizations[20] because having committed employees in an organization not only results in reduction in absenteeism, delay and replacement, but also increases the organizational performance, mental freshness of the employees and better manifestation of organizational transcendent goals.[21]

In this regard, the growing needs of health care organizations to health care staff on the one hand and high costs of training them on the other hand highlight the importance of considering the human resources in the health sector. The Issues related to human resources such as the lack of organizational commitment, contradiction between work and family environments and also the desertion of staff may cause the sensitive health system to face problems such as the shortage of human resources and lead to reducing the service quality as well as endangering the society’s public health.

Therefore, in order to strengthen the health systems against these challenges and prevent staff desertion and to improve their performance, it seems necessary for organizations to have more comprehensive understanding of the nature and human relations of human phenomena such as family-work and work-family contractions, organizational commitment, and desertion in clinical staffing of hospitals in order to continue the investments and provide high quality services in the health system. Therefore, with respect to the position and importance of human resources in health organizations, the present study used Structural Equation Modeling (SEM) technique to investigate the internal relationship between four variables affecting employee performance (family-work contraction, work-family contraction, organizational commitment and desertion intention) in hospitals affiliated to SUMS and by providing a suggested model of the relationship between variables under the study, there was an attempt to evaluate the proposed model.

MATERIALS AND METHODS

After obtaining approval from Local Research Ethics Committee of the SUMS, this cross-sectional study was started; we calculated the sample size of 338 persons using Cochran formula (with the significance level of 95%) but we increased the sample size to 400, considering 15% non-responder rate from previous experiences in this field. We obtained oral informed consent from nurses and paramedical staff working in hospitals affiliated to SUMS. Then, using a random-proportional (quota) method, the number of nurses and paramedic pharmacists in each hospital was calculated by dividing the total number of nurses and staff by the estimated sample size.

Questionnaire Design, Validity and Reliability

The instruments used for data collection in this study were two sets of structured questionnaires. Section A included demographic information and section B, specific questions about family-work conflict FWC and WFC (18 questions) as well as organizational commitment (9 questions) and intention to leave (4 questions). In order to evaluate the FWC and WFC, a questionnaire was applied for which the validity and reliability was approved in Iran.[22] In the questionnaire, options “never”, “rarely”, “sometimes”, “often” and “always” were given 1 to 5 points, respectively. Organizational commitment was measured using a scale with approved validity and reliability in Iran.[23] In this questionnaire, the options I totally agree, I agree, neither agree nor disagree, disagree, and totally disagree were given 1 to 5 points, respectively. The employees’ intention to leave was measured using a valid and reliable questionnaire.[23] In this questionnaire, the options I totally agree, I agree, neither agree nor disagree, disagree, and totally disagree had 5 to 1 points, respectively.

After data collection, SPSS 18 was used to analyze data through descriptive statistics such as frequency, mean, standard deviation, variance and ANOVA when appropriate. Kolmogrov-smirnov test was used for evaluation of normality of data. The significance level was set at 0.05. Then the SmartPLS software was used for estimation, model fit and modification. The model was estimated by two methods: PLS and T-statistics estimation. In the PLS method, the model was evaluated by using the path coefficient. The coefficient values show the effect of two variables on each other, while the sign of path coefficients (- or +) shows the direction of the relationship between two variables on the path so that the negative scores indicate an inverse relationship between the two variables while the positive ones show a direct relationship between two variables on the path. In the T-statistics method, values more than 1.96 were considered the acceptable range. Thus, the only routes that had T values more than 1.96 were considered statistically significant. After the initial estimation of the model, its reliability and validity were examined through the measurement model as well as the structural model. In the measurement model, the reliability at the structure level was measured using Cronbach’s alpha and the combinatorial reliability at “indicator Level “was measured by standardized factor loadings. The validity was assessed using convergent validity and discriminate validity as well. Evaluation of the structural part was also done by using the coefficient of determination (R2), the path coefficient and Predictor Relationship (Q2).

Evaluation of Measurement Section

The reliability of the measurement model at the structure level was evaluated by using Cronbach’s Alpha and composite reliability. It should be noted that the optimal values of Cronbach’s alpha were considered to be higher than 0.7 and optimal values for combining reliability were higher than 0.6, as well.

To check the reliability of the measurement model at the indicator level, the standardized outer loading for each indicator and its corresponding structure was calculated and investigated. Since the acceptable level of outer loading was the values higher than 0.4, variables with outer loading less than 0.4 were removed from the model. These variables (items 19 and 26 of the questionnaire) had an outer loading less than 0.4 (respectively 0.34 and 0.39) and were excluded at model revising stage. Also, the validity of measurement model was examined by using convergent validity and discriminant validity. To examine the convergent validity, the average variance extracted (AVE) was used. According to this principle that AVE more than 0.5 indicates a good convergent validity, the validity of the model was evaluated.

Discriminate Validity at Structure Level

Discriminant validity at structure level was assessed by Fornell and Larcker criterion, the measurement of which was done by cross loading test. According to this criterion, the average variance extracted (AVE) from the square of the highest correlation coefficient of the intended latent variable has to be larger than other latent variables. In this case, discriminant validity at structure level exists. Next, discriminant validity at indicator level was evaluated. The measurement criterion for discriminant validity at indicator level is cross-loading. Items whose cross-loading was more than 0.5 were considered undesirable and excluded (at model modification stage). Convergent validity assessment and modification of the PLS developed model was carried out simultaneously by adopting iterative process.

Evaluation of Structural Section of the Model

After evaluating the measurement section, the structural section of the model was assessed. To evaluate the structural section of the model, the coefficient of determination (R2), the path coefficient and Predictor Relationship (Q2) were evaluated. The coefficient of determination values (R2) equal to 0.19 and lower were described as weak. The (Q2) value higher than zero shows that the observed values have been well reconstructed and the model has predictive relationship, but the (Q2) value lower than zero shows the lack of predictive relationship. After evaluating the model as mentioned above, the required modifications were applied to the initial model. In this study, in order to modify the model, items whose factor loading was lower than 0.4 were removed. In addition, based on the cross loading test, an indicator (item) which had cross loading more than 0.4 was eliminated.

Final Model

After these modifications, the revised model of the current research was run and the measurement and structural models were examined again. This way, according to the fit indices provided by the software, the model was revised and the intended modifications were applied to the model. Some improvements in measurement indices were made, and the average variance extracted for organizational commitment and WFC was also improved. Moreover, there were no standardized factor loadings less than 4.0 in the model. Eventually, the final model differed from the original one, i.e. the relationship between FWC and desertion intention was not confirmed in the final model and this relationship was removed from the final model.

RESULTS

Findings of the data analysis using SPSS 18 software showed that more than half of the study population (65.3%) was between the ages of 35-26 and the majority of them (77.1 %) were women. Most of the study subjects (38.3%) had an educational degree higher than BA/BSc.; half of the subjects (3.67%) were nurses, and the percentage of married people (64.2%) was higher than that of single people (35.8%). The findings related to means and standard deviations of variables showed that the average scores of work-family contradiction and desertion intention were less than average.[3] The means of these variables were 2.6 and 2.77, respectively. Besides, the average score of family-work conflict and organizational commitment was higher than the criterion scored (3.44 and 3.07, respectively). Also, examination of the relationship between demographic characteristics and studied variables showed that the respondents’ job type had no significant relationship with any variables. Gender and marital status had a significant relationship with FWC (P=0.0001 and P=0.026, respectively). Although there was a statistically significant relationship between age and work experience with FWC (P=0.024) and desertion intention (P=0.028), the correlation coefficients between demographic characteristics with these two variables were weak and almost zero. However, the correlation coefficient between age and work experience with turnover intention was negative, indicating a significant inverse relationship between these variables (P=0.03). Also, ANOVA test results showed that there was a direct relationship between the type of employment (P=0.03), education (P=0.018), and number of children (P=0.0001) with FWC and there was a reverse significant relationship between the number of children and intention to leave the job (P=0.03).

1-The results of the model estimation stage:

SmartPLS software was used to analyze the data, test the research hypotheses, and estimate, evaluate and modify the model. Estimation of the model was done using T estimating and PLS methods. Results of model estimation are shown in table 1 and figure 1.

Table 1

Findings from estimation of the initial conceptual model using T estimating and PLS method

Number	Path	T value	PLS (method) path coefficients
1	Family-Work Conflict Organizational Commitment	0.29	0.018
2	Family-Work conflict Turnover Intention	1.019	0.052
3	Work-Family Conflict Family-Work Conflict	17.02	0.565
4	Work-Family Conflict Organizational Commitment	3.89	-0.224
5	Work-Family Conflict Turnover Intention	1.47	0.088
6	Organizational Commitment Turnover Intention	10.39	-0.496

Figure 1

Initial conceptual model.

According to the path coefficients’ sign in table 1, WFC had an inverse relationship with organizational commitment while organizational commitment had an inverse relationship with desertion intention, and on the routes 1, 2, 3 and 5 there was a direct relationship between the two variables. In model estimation by using T value estimation, paths that had T values higher than 1.96 were considered as significant routes.

2-The findings of the evaluation stage

A- The findings of the assessment of the measurement model

The reliability of the measurement model at structure level was evaluated by using Cronbach’s Alpha and composite reliability, and the related information is shown in table 2. As can be seen in table 2, alpha values obtained for all variables were over 0.8. This implied an appropriate internal correlation among the items of this study. Furthermore, the combination reliability value in this study (all of which were higher than 0.8) showed that the obvious variables used in the present research are reliable indexes to measure the latent variable. Hence, the reliability of the measurement model at structure level was confirmed.

Table 2

Indicators assessing the reliability of measurement model

Variable	Composite reliability		Cronbach’s alpha
	Condition	Amount	Condition	Amount
Family-work conflict	Optimal	0.899477	Optimal	0.877077
Work-family conflict	Optimal	0.879699	Optimal	0.841085
Communicate	Optimal	0.886386	Optimal	0.851495
Turn over intention	Optimal	0.928000	Optimal	0.897136

Validity of the measurement model was evaluated using convergent validity and discriminant validity. To examine the convergent validity, the average variance extracted (AVE) was calculated. The Information related to minimum average variance extracted (AVE) is shown in table 3.

Table 3

Average variance extracted (AVE) to assess the convergent validity

Variable	Average of Variance Extracted (AVE)
	Amount	Condition
Family-work conflict	0.502449	Optimal
Work-family conflict	0.459249	Close to the optimal
Communicate	0.453688	Close to the optimal
Turn over intention	0.763622	Optimal

Since AVE value equal to 0.5 indicates a good convergent validity, table 3 reveals that latent variables had relatively sufficient convergence reliability. Discriminant validity at structure level was assessed by Fornell and Larcker criterion. Findings related to Fornell and Larcker criterion are shown in table 4. Bold values in table 4 written on the diameter are the mean values of the variance extracted (AVE) for each structure, and the numbers in parentheses are the correlation coefficients between the structures. Hence, the measurement model at structure level has desirable discriminant validity, too. Then, discriminant validity was assessed at indicator level.

Table 4

The mean values of the variance extracted (AVE) for each structure, and the numbers in parentheses are the Correlation coefficients between the structures

Variable	Condition	Turn over intention	Communicate	Work-family conflict	Family-work conflict
Family-work conflict	Optimal	(0.156166)2	(-0.109083)2	(0.565436)2	0.502449
Work-family conflict	Optimal	(0.224239)2	(-0.214683)2	0.459249	(0.565436)2
Communicate	Optimal	(-0.520856)2	0.453688	(-0.214683)2	(-0.109083)2
Turn over intention	Optimal	0.763622	(-0.520856)2	(0.224239)2	(0.156166)2

The measurement criterion for discriminant validity at indicator level was cross-loading. In order to have discriminant validity, each indicator’s load at reflection model should be greater on its related structure than on other structures. Since in the present study item 17 had cross loading more than 0.5 on two structures, it was considered undesirable and removed (in the revision stage).

B- The findings of the evaluation of the structural model

After evaluating the measurement section, the structural section of the model was assessed, using determination coefficient, (R2), path coefficients, and the predictor relation (statistic Q2). The related information is shown in table 5. According to the results in the Table, values above zero for (Q2) statistics and values higher than 0.19 for (R2) showed that the observed values in this study were well reconstructed and the structural section was well fitted.

Table 5

Assessment of structural by determination Coefficient of (R2) and (Q2)

Variable	Predictor Relationship (Q2)		Coefficient of determination (R2)
	Condition	Amount	Condition	Amount
Family-work conflict	Optimal	0.144510	Optimal	0.319718
Work-family conflict *	-	-	-	-
Communicate	Optimal	0.016656	Low	0.046311
Turn over intention	Optimal	0.216310	Optimal	0.286390

3-The findings of reform model stage

After evaluating the model, corrections were applied to the original one. In this study, in order to modify the model, items that had a factor loading less than 0.4 were eliminated. Thus, two items, COM1 and COM8, out of organizational commitment items were removed. In addition, based on cross loading test, one WFC8 item out of work-family conflict items that had a loading factor more than 0.5 was removed, too. After these modifications, the modified model was accomplished, and then measurement and structural sections of the model were investigated. This way, regarding the fit indicators provided by the software, modifications were applied to the model, and model evaluation indices in the measurement section were improved and the average variance extracted (AVE) for organizational commitment and WFC was also improved. Besides, no standardized factor loading less than 0.4 was seen in the model. By this modification, determination coefficient of family-work contradiction FWC decreased but determination coefficient of the final dependent variable (desertion intention) slightly increased. In addition, determination coefficient of organizational commitment slightly increased, too. However, the increase of determination coefficient was 0.002 for desertion intention and 0.01 for organizational commitment but the decrease of determination coefficient was 0.4 for FWC. In the structural section of the model, the first correction (deletion of three items) led to the significance of the path between WFC and desertion intentions. Furthermore, the direct relationship between WFC and FWC, the inverse relationship between WFC and organizational commitment, the inverse relationship between WFC and desertion intentions, and the inverse relationship between organizational commitment and turnover intentions were confirmed as the researcher expected. Therefore, the WFC variable not only had a direct effect on desertion intention, but also indirectly affected desertion intention, and as WFC increased, turnover intention enhanced, too. In addition, as WFC increased, the organizational commitment changed reversely and decreased. In the end, the final model changed compared to the original one, i.e. the relationship between FWC and desertion intention was not confirmed in the final model and this relationship was eliminated from the final model. Eventually, the modified model was obtained, as shown in figure 2.

Figure 2

Final research model after model modification

DISCUSSION

Data analysis showed that among the demographic variables, marital status, number of children, education level, and type of employment had a statistically significant positive relationship with FWC while the number of children, age and work records had a reverse impact on turnover intentions. Modeling results of this study indicated that WFC and FWC had a positive relationship. This has been confirmed theoretically in previous studies.[22,24-27]

In a study on the cause of this relationship, many researchers believed that the person’s job is the main source of contradiction between work and family, because people usually cannot have much control over their work, and the work environments put pressure on family environments.[28]

Also, based on the findings of this study, a strong statistically significant inverse relationship was observed between work-family conflict and organizational commitment. Thus, employees who experience high work-family conflict experience less effective commitment to the organization. Findings of another study agreed with those of the present study.[24,29-31] Results of another study showed that there was a statistically significant inverse relationship between work-family conflict and organizational commitment.[32] In a study done in Iran, results of the modeling study on a group of nurses showed that individuals who experience more work-family conflict have less commitment to their organizations.[18] However, in another research, the hypothesis about the relationship between work-family contradiction and organizational commitment has been rejected.[33] In another study on the relationship between WFC and organizational commitment it was shown that when a person is experiencing WFC, his/her tasks require behaviors that do not show the person’s real value and needs. Consequently, he/she cannot do the job properly and this increases the person’s distress and it negatively affects his/her emotional responses, such as organizational commitment.[27]

The present research showed an inverse and statistically significant relationship between organizational commitment and desertion intentions. Results of this hypothesis testing are also in the same line with those of the studies done by other researchers who concluded that there was a significant inverse relationship between organizational commitment and desertion intentions,[9,10,34] Also, other studies indicated that organizational commitment had a negative effect on people’s willingness to quit their jobs.[14,35,36] However, results of another study stated that there was no statistically significant relationship between organizational commitment and turnover intentions.[37] Individuals refer to their emotional and cognitive resources to decide whether to leave or stay in the organization; in assessment of emotional resources, if a person realizes that he/she has low organizational commitment (as an emotional source), his/her desire to leave increases. Conversely, if a person feels more committed to the organization, he/she will have little tendency to leave the organization. Thus, organizational commitment inversely affects the people’s desertion intentions.[38,39] Therefore, it might be said that the probability of quitting job is less in individuals committed to the organization. Nowadays, people’s desertion intentions that appear in various ways such as absenteeism and desertion are seen in most organizations. This phenomenon brings about various financial and human costs that lead to disruption of the organization‘s optimal function. So, predicting and preventing labor desertion in organizations are very important, especially in the health system whose output is directly associated to the quality of human resource.[37] Finally, the hypothesis regarding the direct relationship between work-family and family-work conflict with turnover intentions was rejected in this study. This is probably due to the high level of organizational commitment in the research sample because high organizational commitment prevents the people from leaving their organizations.

CONCLUSION

Findings of this study showed that WFC can lead to family-work contradiction (FWC) and it can also have a negative impact on organizational commitment. On the other hand, organizational commitment has a reverse effect on employees’ turnover intentions. Organizational commitment, as an effective variable, modifies negative effects of work-family and family-work conflicts, and with respect to the inverse relationship between organizational commitment and turnover intentions, organizational commitment can reduce turnover intention rate.

Thus, regarding the prominent and preventative role of organizational commitment in the employees’ desertion intentions, in order to prevent negative effects of staff desertion in health sector, attempts to make policies to increase the people’s organizational commitment must be considered by health system managers more than ever. As we have done this study on nursing staff which is a limitation for this study, we recommend other studies on other healthcare workers.