Full Length Research Paper
The influence of affective, continuance and normative
commitments on the turnover intentions of nurses at
Makassar’s private hospitals in Indonesia
Ria Mardiana Yusuf *, Siti Haerani and Muhlis Hasan
Economic Faculty of Hasanuddin University, Tamalanrea Street Km 10, Makassar, 90245, Indonesia.
This study examined the effect of affective, continuance, and normative commitments on the turnover
intentions of nurses at Makassar private hospitals and the dominant aspect of these commitments. The
cross sectional study that involved 140 data was done with generic nurses, using stratified random
sampling. Data were collected by using questionnaires and analyzed with multiple regression analysis.
The result showed that affective, continuance and normative commitments have a simultaneously
negative significant effect on turnover intentions of the nurses at private hospitals in Makassar,
Indonesia. Another outcome discovered was that affective commitment had dominant effect on the
nurses’ turnover intentions. However, continuance commitment had no significant effect on turnover
intentions of the nurses at private hospitals in Makassar, a city in Indonesia.
Key words: Affective commitment, continuance commitment, normative commitment, turnover intention.
INTRODUCTION
Globalization drive has fundamentally changed the
workforce of any organization. Cascio (1998) found out
five kinds of changes faced by an organization:
1) Change in production market and services.
2) Change in technology.
3) Change in structure and organizational design.
4) Change in character of managers' activity.
5) Change in character of job itself.
dominated by organizations that are able to give best
services and quality products. This condition will be faced
by all organizations and even hospitals and industries in
Indonesia (Armansyah, 2007).
Global issue forced almost all organizations to redesign
the structure of their organizations, technology and even
organizational culture. Kiechel (1993) and Cascio (1998)
recommended several adjustments for organizations to
anticipate the effect of globalization. They are:
These organizational changes have become the
triggering factor for pushing traditional research paradigm
that focuses on achieving productivity and leaving other
important factors such as quality behind. Furthermore, a
shift to focus on globalization issue and competition puts
forward the concepts of quality optimization in product
and services. This has a trickle down effect and
consequently moves global market mechanism to be
1) Redesign organization to downsizing.
2) Change the organizational hierarchy integration into
networking.
3) Rewarding the capability of employee in comparison
with their position.
4) Change the business competition paradigm from
productivity to service quality.
5) Direction of job is customer’s satisfaction.
6) Focus on organizational resources that can energize
organization to the battle of competition.
*Corresponding author. E-mail riamard67@gmail.com.
(06241)585415-(062411)587218.
As one of the biggest organizations, hospitals nowadays
have an urgent role as a public health institution that has
Tel:
the entire infrastructure needed for the health of the
society. This makes the objective of hospital
management to emphasize more on social context.
Unfortunately in the recent years, hospitals have become
economic oriented, like being effective and efficient in
quality and also satisfying all customers. In Asian Medical
Journal, we found that Sulastomo (2000) wrote that
almost all hospitals in South-east Asian countries
acquired most of their medical equipment from USA. For
this reason, management of hospitals must give attention
to capitalizing operational and maintenance of those
equipment. The consequence is that
hospitals must
transform their function into social-economic orientation.
Like other service industries, the only aspect that is
concerned most is service quality (Sulastomo, 2000).
Accordingly, the good management concerning all these
quality of services cannot be separated from the problem
of managing the ability and capacity of
employees’
services, especially that of the nurses. Previous studies
proved that nurses are supposed to be internal
customers. Satisfaction among internal customers will
lead to satisfying external customers (Rutledge et al.,
1996). Fisher (2003) found that optimal performance will
be achieved by the employees if they are satisfied with
their job, and then they will be retained in the
organization (Zaghloul et al., 2008).
The common phenomena in almost all hospitals over
the world showed that the turn over level of nurses were
high (Laphalala, 2006), and turnover is almost the latest
choice for the nurses, if they do not feel comfortable
anymore with their recent job. The consequence is that
the hospitals will be faced with high operational cost, if
they have to recruit another nurse (Laphalala, 2006).
Generally, there are several reasons for nurses’
decision with regard to their turnover from one hospital to
the other. Organizational commitment was found to be
very critical in turnover intentions (Karsh et al., 2005;
Khatri and Homma 2001; Guimaraes and Igbaria, 1992).
Puspasari (2003) found that in the average turnover of
employees in Puri Cinere hospital was 10.4% and all of
them were from nursery unit around 54.75%.
This research study provides an analytical review of
turnover intentions among nurses in seven (7) private
hospitals in Makassar City of Indonesia, and the
commitment factors that significantly contributed to it. The
main objective is to analyze and verify whether
organizational
commitment
such
as
affective,
continuance and normative commitments influence
significantly the turnover intentions of hospitals’ nurses.
LITERATURE REVIEW
A long record of research has linked commitment
organization to turnover intentions of employees and also
the reasons for high turnover at organizations.
Organizational commitment refers to the degree to which
employees believe in and accept the goals of an
organization and desire to remain with the organization
(Luthans, 1998). To measure the organizational
commitment, Allen and Meyer (199) developed three
types of commitments namely: affective, continuance and
normative. Affective commitment refers to the emotional
attachment, identification with and involvement within an
organization. Continuance commitment is based on the
underlying cost related with employees’ work termination.
Normative commitment relates to keeping membership in
an organization. Furthermore, Allen and Meyer (1991)
found that affective commitment has a negative influence
on turnover intentions and absenteeism of employee. On
the contrary, affective commitment has a positive
influence on the acceptance of change.
The result of several investigations indicates that
employees with strong affective commitment work harder
and more effectively in their jobs than employees with
weak affective commitment (Johnston and Snizek, 1991;
Meyer and Allen, 1997; Preston and Brown, 2004).
Guimaraes and Igbaria (1992) found that organizational
commitment is an intervening variable of intentions of
turnover and job satisfaction. Furthermore, Kathri et al.
(2001) discovered that high employees’ turnover in
Singapore, Malaysia, South Korea and Taiwan occurs
because of the procedural justice and low organizational
commitment.
Karsh et al. (2005) proposed that job satisfaction and
organizational commitment are predictors of turnover
intentions. Wasti (2003) also proved that organizational
commitment is a predictor of turnover intentions in
Turkey. Korunka et al. (2005) found a significant negative
correlation between turnover intentions and job
satisfaction. This is similar to the result of the research by
Harrell et al. (1986).
Howard and Homma (2001) found that job satisfaction
alone is not sufficient to predict the turnover intentions.
They suggested that organizational commitment should
also be included in the turnover model as another
independent variable. A research by Morrison (2004) also
found that organizational commitment is negatively
correlated with turnover intentions. This study assessed
all three components of board members’ commitment to
the organization affected by turnover intentions of nurses
at private hospitals in Makassar City of Indonesia.
Considering the previous research evidence, the
hypotheses of this research are:
1)
The
organizational
commitment
(affective,
continuance, and normative commitment) will be
negatively affect to turnover intentions of the nurses at
private hospitals in Makassar, Indonesia.
2) Among affective, continuance and normative
commitment, affective commitment will be dominantly
affect to turnover intentions of the nurses at private
hospital in Makassar, Indonesia.
The following model depicts the relationship among the
independent and dependent variables to form the theoretical
farmework (Figure 1.)
Figure 1. The influence of affective, continuance and normative commitment toward
turnover intentions of private hospital’s nurses in Makassar Indonesia.
METHODOLOGY
Population and sample technique
Population of this research consists of generic nurses of the private
hospitals in Makassar Indonesia. The names of the hospital were
Grestelina Hospital, Stella Maris Hospital, Hikmah Hospital,
Akademis Hospital, Ibnu Sina Hospital, Faisal Hospital and
Luramay Hospital. The sample was chosen by using the
proportionate stratified random sampling on the size of nurses’
population in each hospital. According to the method, the whole
sample was 140 respondents of nurses. Source of data was taken
from respondent using questionnaire and secondary data from the
hospital being studied. Model testing was developed in this
research via a multiple regression.
Data collection technique
Data were collected through personally administered
questionnaires at the workplace to save time, survey and interview
guidance. The questionnaire included items to measure affective
commitment, continuance commitment and normative commitment.
Affective commitment was measured by 9 items of organizational
ccommitment questionnaires (OCQ) of Allen and Meyer. (1990).
Continuance commitment was determined by 7 items OCQ of Allen
and Meyer (1990). And normative commitment was measured by 6
items OCQ of Allen and Meyer (1990). To collect the turnover
intentions data, we employed the Mobley (1979) questionnaire,
which consists of 5 items. Closed questions are used in these
questionnaire, and the options to answering the questions, Likert
scale model was used.
Data test of validity and reliability
Test of validity and reliability is conducted before the instruments
are used to gather data. The test of validity uses Pearson
correlation. The value of the correlation is then compared to the
critical value. The instruments are valid when the value of the
correlation from the research is bigger than the critical value. Result
of validity test of the instrument consisting 27 items exceeded the
lower limit of correlation coefficient of 0.4140. Because the
instruments have high validity, it proves that the data collected are
valid.
The test of reliability was done using Cronbach’s alpha. The
conclusion is that all item explaining organizational commitment
(such as affective, continuance and normative) is reliable because
all alpha of the variables exceeded the lower limit of alpha
Cronbach’s alpha standard > 0.60. The alpha coefficient of affective
commitment is 0.679; the continuance commitment is 0.691;
normative commitment is 0.633; and the turnover intention is 0.744.
The following is the reliability test table of the questionnaire items of
affective, continuance, normative commitments and turnover
intentions (Table 1).
After conducting validity and reliability test among the items of
the questionnaires, we conducted a test of classical assumption on
the data’s range. Table 2 is the result of the normality test, which
enables us to see through curve or scatter diagram. The following
scatter diagram from the test is depicted in Exhibit 1.
As seen in Exhibit 1, plots of the entire data are long between the
line, and the line itself tends to be on the upper right side. It means
that the data are distributed normally. Subsequently, multicolinearity
was tested and the value shows through variance inflation factors
(VIF). So, if VIF value < 10 with coefficient of tolerance > 0.1 or on
the contrary (Hair et al., 1998), it means that there is no
multicolinierity between independent variables. The result of
multicolinearity is shown in Table 3.
Table 3 shows that all coefficient of VIF is smaller than 10 and all
coefficient of tolerance is bigger than 0.1. This means that there is
no multicolinierity between all independent variables.
Heteroscedasticity is a kind of classical assumption test used to
observe the normality of range data through the spreadness of
data. This means that if the data were spread and did not make a
certain configuration, data will be categorized and normally
distributed. The earlier mentioned Exhibit showed the result of
heteroscedasticity test.
According to Exhibit 2, configuration of scatter plot diagram was
spread into various directions, yet, there are some data, which are
far away from the center of diagram, and spread randomly above
And below zero digits,Therefore,the conclusion of data category
and below zero digits. Therefore, the conclusion of data category
was normally distributed statistically.
Table 1. Reliability statistics
Cronbach’s alpha
0.679
0.691
0.744
0.633
Variable
Affective commitment
Continuance commitment
Normative commitment
Turnover intention
N of items
9
7
5
6
Table 2. The result of multicolinearity test
Coliniearity VIF
Coliniearity statistics
tolerance
0.832
0.773
0.736
Independent variable
Affective commitment
Cognitive commitment
Continuance commitment
1.202
1.294
1.358
Dependent Variable: IT
1.0
ExpectedCumProb
0.8
0.6
0.4
0.2
0.0
0.0
0.2
0.4
0.6
0.8
1.0
Observed Cum Prob
Exhibit 1. The scatter plot.
Table 3. The result of multicolinearity test
Independent variable
Affective commitment
Cognitive commitment
Normative commitment
Colinearity statistics tolerance
0.832
0.773
0.736
RESULT AND DISCUSSION
The
description
of
affective
continuance commitment, normative
and turnover intentions
commitment,
commitment
1) Affective commitment is classified as high. It means
that nurses gave a high appreciation to the feeling of
Coliniearity VIF
1.202
1.294
1.358
emotion
connected
with
their
present
hospital
organization, and to be a part of it. They have a high
sense of belonging there, and also they are very proud
being nurses in these hospitals. The distribution of
frequent affective commitment variable is shown in Table
4.
2) Continuance commitment is classified as sufficient. It
conveys that the nurses find it very difficult to quit from
Table 3. Respondents profile (n=104).
Background variable
Gender
Male
Female
Frequency (people)
104
16
88
Percentage (%)
100
15.40
84.60
Cumulative (%)
15.40
100.00
Age
21 – 30 years old
31 – 40 years old
> 40 years old
104
72
24
6
100
71.20
23.10
5.80
71.20
94.20
100.00
Edicational level
Senior high school
Diploma
College
Other
104
23
73
6
2
100
22.10
70.20
5.80
1.90
22.10
92.30
98.10
100.00
Marriage
Married
Not married
104
47
57
100
45.20
54.80
45.20
100.00
Work length
Below 2 years
2 – 4 years
above 4 years
104
26
34
44
100
25.00
32.70
42.30
25.00
57.70
100.00
Nursing room
Intencive care unit
ICCU
Pregnant
Interna
Surgery
Other
104
15
30
6
18
17
18
100
14.40
28.80
5.80
17.30
16.30
17.30
14.40
43.30
49.00
66.30
82.70
100.00
Dependent Variable: IT
5
4
RegressionStudentizedResidual
3
2
1
0
-1
-2
-3
-2
-1
0
1
Regression Standardized Predicted Value
Exhibit 2. The scatter plot ZPRED and SRESID.
2
Table 4. Frequent distribution score of affective commitment.
Frequency
Scores
Low
Middle
High
Total
Percentage
(people)
9 – 20
21 – 33
34 – 45
104
Category
(%)
0
42
62
100.00
Interval
0.00
40.38
59.62
100
Table 5. Frequency distribution of continuance commitment.
Frequency
Low
Middle
High
Total
Interval
Scores
7 –15
16 – 25
26 – 35
Frequency
People
2
73
29
104
Percentage
(%)
1.92
70.19
27.88
100.00
Frequent
(people)
3
60
41
104
Percentage
(%)
2.88
57.69
39.42
100.00
Frequent
(people)
56
48
0
104
Percentage
(%)
53.85
46.15
0.00
100.00
Table 6. Frequent distribution scores of normative commitment.
Frequency
Low
Middle
High
Total
Interval
Scores
6 – 13
14 – 22
23 – 30
Table 7. Frequent distribution scores of turnover intention.
Frequency
Low
Middle
High
Total
Interval
Scores
5 – 11
12 – 19
20 – 25
their present hospital organization before they get a new
job. They do not have enough courage to leave, and
have no choice to leave the hospitals. The description of
continuance commitment frequent distribution is seen in
Table 5.
3) Normative commitment is classified as sufficient. It
means that the nurses feel loyal enough to remain in their
current hospital; therefore, they will not leave the hospital
even though there is a new job waiting for them. And they
feel that in this hospital, they have enough duty to take
care of. The frequent distribution of normative
commitment of nurses at Makassar is seen in Table 6.
4) Turnover Intentions is classified as low. It conveys that
the nurses will respond very well if there is possibility or
alternative work outside their present hospital. The
description of frequent distribution scores of nurses’
turnover intention is shown in Table 7.
Table 8 shows the analysis of different turnover intention
of nurses based on demographic factors such as gender,
educational level, age, marriage status, and length of job
by using analysis of variance. Table 9 is the summary of
ANOVA test of turnover intention.
According to the ANOVA test, it was found that the
differences on the intention of nurses’ turnover are based
on their age. It showed by the coefficient of adjusted R2 =
Table 8. Summary of ANOVA test of turnover intentions.
Demografic factor’s
Gender
Education
Age
Marriage status
Length of job
aDependent
R Squared
0.010
0.068
0.069
0.020
0.017
Adjusted R squared
0.000
0.040
0.050
0.011
-0.002
df
1
2
2
1
2
F
1.028
2.440
3.726
2.121
0.879
Sig.
0.313
0.069
0.027
0.148
0.418
variable: Turnover intention.
Table 9. The summary of multiple regression tests.
Variable*
Constant
Commitment affective (X1)
Commitment continuance (X2)
Commitment normative (X3)
Coefficient
21.443
-0.081
-0.061
-0.074
Multiple R
R Square (R2)
F Value
Significant
Standard error
1.543
0.038
0.053
0.049
T
13.896
-2.120
-1.138
-1.266
Sig.
0.000
0.036
0.258
0.027
= 0.570
= 0.325
= 16.053
= 0.000
*Dependent variable: IT.
0.050, significant at the level of confidence of 95%.
Which means that the fluctuation of turnover intention is
significantly influenced by the age factor of about 50%;
meanwhile,
the other demographic factors (such as
gender, education, marriage status and length of job)
have no significant influence to differentiate the nurses’
turnover intention, because the significant level is above
standard (0.05%). This finding is relevant to the findings
of Mowday et al., (1982) and Zeffane (1994), that age
has a negative significant correlation due to employees’
intention to turnover. Therefore, the fact is that almost all
nurses are in the age range of 21 to 30 (about 72%),
which means that at these ages, the nurses are
categorized as young and role tryouts. Luthans (1998)
found that the stages of 20 to 35 are the stages that
usually result in taking a number of different jobs, and in
general are very unstable and restive unproductive period
in the person’s career. The indication is the younger the
employee’s age is, the bigger the employee’s intention to
leave.
RESULTS
The result of the influence of affective, continuance and
normative commitments on turnover intentions of private
hospitals’ nurses in Makassar, Indonesia is summarized
in Table 10.
The analysis showed that affective, continuance and
normative commitments of private hospital nurses have a
negative significant influence on turnover intentions. It is
proved by coefficient determination (R2) that 0.325 or
32.5 and 67.5% are influenced by other factors outside
the model studied, even though the determination
coefficient is above 50%.
Partially, the negative significant influence of affective
commitment on turnover intentions is as much as -0.081
or -8.1%. The negative influence of continuance
commitment is as much as -0.061 or -6.1%. But the
influence of this continuance commitment on turnover
intentions is insignificant. It is proved by the point of
significant of 0.258 > 0.005. Also the negative significant
influence of normative commitment on turnover intentions
is as much as -0.074 or -7.4%.
Generally, interpretation of the multiple linear
regression showed that if affective commitment,
continuance commitment and normative commitment
increase, it will make the turnover intentions to decrease.
Furthermore, among those three variable commitments,
the affective commitment has a dominant negative
significance on turnover intentions.
DISCUSSION
The result of the test shows that in a simultaneous
method, increase of affective, continuance and normative
commitments gave a negative effect on turnover
intentions of the nurses at private hospitals in Makassar.
This result is in congruence with previous studies done
by scientists. Porter et al. (1991), Dole and Schroder
(2001), Necowits and Roznowski (1994) and Zeffane
(1994) had found that the antecedent of turnover
intentions is organizational commitment. Khatri and
Homma
(2001)
discovered
that
organizational
commitment was found to be very critical in turnover
intentions.
The study conducted by Karsh et al. (2005) assumed
that turnover intention is not predicted alone by
organizational commitment, but also by job satisfaction.
Guimares
and Igbaria
(1992) discovered
that
organizational commitment can be an intervening
variable of job satisfaction and turnover intentions.
Similar with other researchers, Howard and Homma
(2001), Samad (2006), and Moncrief et al. (1997) found a
negative correlation between organizational commitment
and turnover intentions.
Partial testing proves that there is strong negative and
significant influence of affective commitment on turnover
intentions. It supports Burton et al., (2005). They found
that the high affective commitment will decrease the
turnover intentions of nurses to leave the hospital. In this
research, we also found that the high affective
commitment of the nurses is as a result of the positive
perception of nurses about the hospital. They felt glad
and proud to be a part of the hospital.
Furthermore, they felt that their values are the same as
hospital’s values; and ‘hospital’, according to those
nurses, ‘is their second home’.
These origins encourage the finding of Allen and Meyer
(1990). They said that psychological aspect initiates
affective commitment through individual feelings to be
part of the organization.
Different from other studies
which showed that continuance commitment has an
influence on turnover intentions (Porter et al., 1991; Dole
and Schroder, 2001; Necowits and Roznowski, 1994;
Zefanne, 1994), this research discovered that nurses’
continuance commitment has an insignificant influence
on turnover intentions. The difference of these findings is
because of the differences observed in respondents’
characteristics. The previous study used employee of
business organization. In the mean time, this study uses
nurses as respondents. According to the theory of Allen
and Meyer (1990), continuance commitment was the
costs that the employee associates with leaving the
organization, which means that employees will be
committed to the organization due to cost and benefit for
not leaving
the organization.
Insignificance
of
continuance commitment is based on the social strength
of the mind of job nurses. They will persevere in a
hospital even though they are offered another job with
more return.
The negative insignificant influence of
continuance
commitment on turnover intentions of nurses should be
taken care of by hospital management with increase in
the intrinsic return and planning of the employee’s career
path (Angle and Perry, 1981).
This study also found out the negative significant
influence of normative commitment on turnover
intensions. This result encouraged previous studies done
by Porter et al. (1991), Dole and Scroeder (2001),
Necowits and Roznowski (1994) and Zeffane (1994).
Negative commitment involves the employee’s feelings of
obligation to stay with the organization (Allen and Meyer,
1990). The emerging of employee’s feeling is similarity
value between norm and culture among nurses, since the
norms that they should maintain is the reason why they
hold on to the hospital. Furthermore, the nurses are
convinced that loyalty is the most important matter, since
it is their moral obligation to the hospital. To
accommodate the proof of this normative commitment,
hospital management must be able to support nurses
through clear mission statement, values and culture.
Conclusion
The influence of organizational commitment refers to
affective, continuance and normative commitments. The
influence of affective and continuance commitments of
private hospitals’ nurses in Makassar Indonesia is
significantly negative. Partially, affective commitment has
a dominant negative significant effect on turnover
intentions of nurses at private hospitals in Makassar,
Indonesia.
RECOMMENDATION
Since affective, continuance and normative commitments
influence turnover intentions, it is necessary to pay
attention to these three kinds of commitments; and they
should be managed simultaneously to optimize the
nurses’
affective,
continuance
and
normative
commitments.
In view of the fact that there is a dominant influence of
affective commitment on turnover intentions, it is
essential for hospital management to compose the
hospital culture, which is more family relational, and pay
attention to the psychological need of the nurses like the
financial aspect.
For further study, we need to observe other antecedent
factors affecting turnover intentions, such as motivation,
job satisfaction and job characteristics.
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