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Relationship between Multiple Dimensions of Organizational Justice and Turnover Intention among Staff Nurses

Aziza Zakaria Farmawy Ali*, Shaimaa Mohamed Nageeb

Nursing Administration, Faculty of Nursing, Benha University, Egypt

Abstract: Background: Turnover intention not only causes staff loss but also it is a major reason behind the loss of organizational productivity. It causes staff instability, reduces organizational efficiency, and therefore, imposes heavy financial burdens on organizations. Therefore, promotion of organizational justice can reduce nurses’ turnover intention, actual turnover, and turnover-related costs. Aim of the study: The aim of this study was to assess relationship between multiple dimensions of organizational justice and turnover intention among staff nurses. Research Design: A descriptive correlational design was utilized to achieve the aim of the current study. Study Setting: The study conducted in the medical and critical care units in the medical building at Benha university hospital, Egypt. Study subjects included 265 out from 715 staff nurses. Tools of data collection: Two tools utilized; namely, Organizational justice scale and Turnover Intentions Scale. Results: There was more than four fifths of the studied nurses (89%) had low perception of procedural justice. While (88%, 88% and 80%) had low perception of distributive justice, interactional justice and informational justice dimension respectively and that more than two third of the studied nurses (68%) had high level of turnover intention. While less than, one-fifth of them (19%) had moderate level of turnover intention. In addition, only (14%) had low level of turnover intention. Conclusion: The study concluded that there was highly statistically significant negative correlation between total organizational justice and total turnover intention level. Recommendations: Future studies are recommended to carry out by considering other factors like organizations’ policies, violation of psychological contracts, which also may affect personnel’s turnover intention.

Keywords: Multiple dimensions, Organizational justice, Staff nurses, Turnover intention

Received November 22, 2015; Revised December 03, 2015; Accepted January 07, 2016

Citation: Aziza Zakaria Farmawy Ali, Shaimaa Mohamed Nageeb, Relationship between Multiple Dimensions of Organizational Justice and Turnover Intention among Staff Nurses. American Journal of Nursing Research, 3 (3). 59-67. January 2015. doi:10.12691/ajnr-3-3-3

1. Introduction

Health care organizations are challenge with expert staff that is looking for respect as well as an enhanced work environment. Nurses represent the front line and the largest group of all health care professionals in any health care organization and they affect the quality of health care delivered to patients. Working at these settings occupies an important place in nurses' lives and their physical and emotional well-being [1]. Lately, nurses have become more interested in their rights to be fairly treated at all times [2].

Justice is a broad and multifaceted concept and discipline with the meaning of non-discrimination and fair differences. Organizational justice is used to describe the perception of a group and individual fairness of organizational behavior and their behavioral responses to that perception. Likewise, organizational justice is defined as the conditions in which nurses believe that their organization is handling them fairly or not [3].

Organizational justice improved perceptions of fairness that lead to effects essential to the organization. At the personal level, perception of fairness satisfies an individual’s needs for control, self-esteem, a feeling of belonging, and ethical obligations. While at the organizational level, fairness offers legitimacy to management, thereby decreasing counterwork behaviors, enhancing trust in authority, decreasing fear of exploitation, and encouraging collaboration. Organizational justice is a serious factor in the organization and without it; the organization would face devastating and irreparable consequences [4].

There are three types of organizational justice including distributive, procedural, and interactional justice. Distributive justice is based on the principle of equity, it is the subjective perception of nurses that the organizational resources and outcomes are fairly distributed and allocated so that they can attain the organizational objectives. A distribution would only be perceived fair if it is compatible with the allocation rules [5]. Likewise, procedural justice is defined as the perceptions of fairness in the creation and implementation of human resources policies and interventions. As well, interactional justice can be describe as perceived fairness relating to the interpersonal dealing within an organization to determine outcomes and nurses' feelings of how fairly their managers treat them. It focuses on teamwork and interdepartmental relations [6].

Interactional justice consists of two dimensions: interpersonal and informational justice [7].

Employees’ turnover is the process by which employees leave their organizations. Turnover can be voluntary (employees intend to leave the organization) or involuntary (managers make employees redundant). Employees’ voluntary turnover has adverse impacts on organizational effectiveness, efficiency, and productivity, today, occupational leave is taken into account as one of the challenges raised in all the organizations, regardless of geographic location and type of organization [8].

Employee turnover represents one of the most expensive problems of today’s organizations to the point that the cost of a resigning employee equates about a year of her/his salary [9]. Undoubtedly, high rates of voluntary turnover are often harmful to organization performance and work outcomes [10]. In this sense, given that turnover intention constitutes the final step of a series of withdrawal cognitions and/or behaviors, they are considering a useful variable to anticipate and prevent employee turnover. Besides, even when turnover intention does not lead to actual turnover, they have a negative impact on organizational effectiveness, as employees with unfulfilled turnover intention are likely to engage in other kinds of withdrawal behaviors [11].

Intention to leave is an individual’s perception of leaving his or her job though he or she is already at his or her occupational position, anticipated turnover is a status in which a person thinks or believes he or she would leave his or her current position voluntarily [12]. Unlike real leave, this type of intention is not clear. Intentions are expresses in terms of a particular behavior of interest; intention to leave a job is defined as mental thinking of likeliness to leave that job [13].

Different factors such as management strategies, lack of sufficient workforce, salaries and profits, stress, feeling of injustice, and attritive factors in an organization can be influential on this perception and the process of leaving profession, among this, organizational justice is noteworthy since it can create and strengthen the mentioned mindset or provide the background for its development [14].

Organizational justice is one of the main factors behind turnover intention [15]. Organizational justice has significant implications for both organizations and staff, staff who feel greater organizational injustice have higher turnover, while staff who have positive attitudes toward their jobs, superiors, and organizations have a stronger motivation for their job [16]. Staff with greater perceived organizational justice have greater organizational commitment and job satisfaction and are less likely to leave their organizations. Therefore, organizational commitment and job satisfaction are the other two factors behind turnover intention [17].

In order to ensure that employees are satisfied, committed, and loyal, the organization needs to be fair in its systems regarding distributive, procedural, and interactional justice [18]. When consider the relationship between organizational justice and turnover intention, [19], found that turnover intention has an inverse and significant relationship to organizational justice. The better justice by organization managers, the lower intention to leave among employees, and so more effectiveness, efficiency and better performance of employees [20].

Phayoonpun and Mat [21], found a negative and statistically significant relationship between distributive justice, procedural justice, and employee turnover intention and explained that the higher the level of employee’s perception towards fairness to the means used to determine outcomes (procedural justice) and fairness of the outcomes employees receive (distributive justice) tended to increase the level of employees’ job satisfaction, organizational commitment while reduces turnover intention.

Nurses who were treated fairly by their organizations were more likely to be more committed, had better trust in their organizations, were more satisfied, had lower turnover intentions, and showed positive and ethical behaviors at work [22].

1.1. Significance of the Study

One of the great challenges facing health care organizations is to maintain high workplace justice that is a predictor of employees' ethical behavior. The researchers observed in the field of health at Benha university hospital that when there is justice in the hospital, the workers enjoy their autonomy. Some nurses reported that the work schedule is not fair, the rewards for nurses are not fair and nurses are not allowable to reject or oppose the decisions issued by the director. Therefore, this study will be conducts to assess the relationship between multiple dimensions of organizational justice and turnover intention at Benha university hospital.

1.2. Aim of the Study

This study aims to assess relationship between multiple dimensions of organizational justice and turnover intention among staff nurses.

1.3. Research Questions

1. What is the nurses' perception towards organizational justice?

2. What is the level of turnover intention among nurses?

3. What is the relation between organizational justice, and turnover intention among staff nurses?

2. Subject and Methods

2.1. Technical Design

The technical design includes study design, study setting, subjects and tools of data collection.

2.2. Research Design

A descriptive correlational design used to achieve the aim of the present study.

2.3. Research Setting

This study was carried out in the medical and critical care units in the medical building at Benha university hospital, Egypt.

2.4. Sample

The study sample included 265 of staff nurses out from 715 staff nurses who are working in above mentioned setting and distributed as following; (19) of them working at Chest and heart surgery, (65) at Medicine units (1,2,3,4,5), (18) at neonatal ICU, (15) at Cardiac care unit, (17) at Intensive care unit, (17) at Medium intensive care unit ,(18) at Cardiac catheterization and Catheterization Intensive Care Unit, (13) at Open heart surgery, (31) at Pediatric(intensive care unit, and3 Pediatric units), (14) at Liver intensive care, (13) at Dialysis, (11) at Pediatric dialysis, and (14) at Liver units and laparoscopy where number of the beds in the medical building (478 beds).

2.5. Sample Type

It was a convenient sample of staff nurses.

2.6. Sample Size

It was consisted of 265 out from the total staff nurses number 715.

2.7. Tools of the Study

The data for this study was collected by using two tools namely: Organizational Justice Scale and Turnover Intentions Scale.

First tool: Organizational justice scale

It consisted of two parts as the following:

Part I: personal characteristics of nurses as (age, Gender, Marital status, nursing qualification and experience years).

Part II: Organizational justice scale:

Organizational justice explored using the Argentine adaptation [23], of [24]. It used to measure the staff nurse’s perception regarding organizational justice. This measure consists of 20 items which measure four dimensions distributed as following; distributive justice (4 items, e.g., “my outcomes [salary, promotions, rewards, etc.] reflect the effort I have put in to my work”), procedural justice (7 items, e.g., “the procedures that my organization uses to make decisions and arrive at my outcomes have been applied consistently”), interpersonal justice (4 items, e.g., “my boss/supervisor/manager has treated me in a polite manner”), and informational justice (5 items, e.g., “my boss/supervisor/manager has provided me with reasonable explanations regarding the procedures enacted”).

Scoring system:

Staff nurses' responses scored on five points Likert scale ranging from (1) never to (5) always. Total scores of studied staff nurses’ perception regarding organizational justice level classified as follow; low <60%, average 60-75%, and highly >75%.

Reliability of this tool

The reliability of the tool measured through assessing its internal consistency which used Cronbach alpha coefficient and it was 0.88.

Second Tool: Turnover Intentions Scale

It was developed by Vaamonde [25]. To measure the staff nurse’s turnover intention. This instrument consists of 7 items that explore the construct as a single factor (e.g., “I am thinking of leaving my job”).

Scoring system:

Staff nurses' responses scored on five points Likert scale ranging from (1 = strongly disagree to 5 = strongly agree). The overall scores will fall within the 7 to 35 range. The score summed up and converted into percent score. Level of total staff nurse’s turnover intention categorized as follows: it considered high if the score was more than 75%, considered moderate if the score was ranged from 60%- 75% while low level if the score was less than 60%.

Reliability of this tool

The reliability of the tool measured through assessing its internal consistency which used Cronbach alpha coefficient and it was 0.92.

2.8. Operational Design

The operational design for this study included three stages; preparatory phase, pilot study, and field work.

2.9. Preparatory Phase

This phase started from the beginning of March 2015 to the beginning of April 2015. It included the following: Reviewing the national and international related literature using journals, periodicals, textbooks, internet and theoretical knowledge of the various aspects concerning the topic of the study. The tools translating into Arabic language and back translation to check its accuracy. Tools validity: The tools’ contents were developed and tested for its content and face validity through a jury of five academic staff in nursing administration and mental health nursing departments from different faculties of nursing in Egypt namely; Benha faculty of nursing, Ain shams faculty of nursing, El Monofia faculty of nursing, Tanta faculty of nursing and Helwan faculty of nursing. The validity of the tools aimed to judge its clarity, simplicity, accuracy, comprehensiveness, and relevance. All items were reviewed and accepted by the jury committee.

2.10. Pilot Study

A pilot study carried out on April 2015 on 10% of study subjects that included (27 staff nurses) before starting the actual data collection to ascertain the clarity and applicability of the study tools and the feasibility of the research process. It has also served in estimating the time needed for filling the tools. It ranged between 15-20 minutes. Pilot study served to assess the reliability of data collection. The pilot study, participants were included in the study because no modification done in the study tools.

2.11. Field Work

Data collection started from the beginning of June 2015 to the end of July 2015 with visiting setting. The researcher met staff nurses and explained the aim and the nature of the study and the method of filling the questionnaire. This done individually or through group meetings. The researcher distributed the questionnaire sheets to the participated staff nurses to fill it in work times, which determined before with head nurse of each unit according to type of work and workload. The number of collected sheets from staff nurses per day ranged from 16 to17sheets in the morning, and afternoon shifts. It took from 15 to 20 minutes to complete the questionnaire sheet. Data collected two days /week in Monday and Thursday from 10 am to 1 pm in the presence of the researcher to clarify any ambiguity.

2.12. Administrative Design

Official letter requesting permission to conduct the study was issued from the Dean of faculty of nursing Benha University that were sent to the director of the hospital explaining the aim of the study. The study would not affect in any way the work.

2.13. Ethical Considerations

Oral informed consents obtained from the participants. They informed about their rights to refuse or withdraw from the study with no consequences. They reassured about the anonymity and confidentiality of the information collected, and it used only for the purpose of scientific research. No harmful maneuvers performed or used and no foreseen hazards anticipated from conducting the study on participants.

2.14. Statistical Design

Statistical analysis done by using IBM SPSS version 25 statistical software package. Cleaning of data done to be sure that there is no missing or abnormal data by running frequencies and descriptive statistics. Data presented using descriptive statistics in the form of frequencies and percentages for categorical variables, means and standard deviations for continuous variables (e.g., age), Pearson correlation analysis was used for assessment of the inter-relationships among quantitative variables. Cronbach’s reliability coefficient used to test the reliability of the scales. Regression analysis used to describe the statistical relationship between one or more predictor variables (the four dimensions of organizational justice scale) and the response variable (turnover intention scale). The significant level of all statistical analysis was at < 0.05 (P-value).

3. Results

Table 1 shows that more than one third of the studied nurses (38.8%) had age 20 to less than 30 years old. Regarding to gender the majority of them (92.5%) were females. Regarding to marital status the majority of them (79.2%) were married. Regarding to nursing qualification near half of them (47.2%) had Diploma in nursing education. Regarding to years of experiences more than one half of nurses (59.2%) had less than 10 years of experience.

Table 2 shows that mean and standard deviation of the studied nurses regarding multiple dimensions of organizational justices’ total mean score of organizational justice. As indicated from this table the highest percentage was for informational justice (35%), and the lowest is for distributive justice (31%).

Table 1. Frequency and percentage distribution of personal characteristics of the studied nurses (n=265)

Table 2. Distribution of total mean score of multiple dimensions of organizational justice as reported by the studied nurses (n=265)

Table 3. Frequency and percentage distribution of staff nurses’ perception toward dimensions of organizational justice level

Figure 1. Perception of nurses toward organizational justice (n=265)

Figure 2. Total perception of nurses toward turnover intention (n=265)

Table 3 shows that more than four fifth of the studied nurses (89%) had low perception of procedural justice. While more than four fifth of them (88%, 88% and 80%) had low perception of distributive justice, interactional justice and informational justice dimension respectively.

Figure 1 clarifies that more than four fifth of the studied nurses (86%) had low perception toward total organizational justice. While less than, one-third of them (11%) had moderate perception toward total organizational justice. Moreover, only (3%) had high perception toward total organizational justice.

Table 4. Correlation between turnover intention level and total perception of multiple dimensions of organizational justice level (n=265)

Table 5. Correlation between personal characteristics and organizational Justice level and turnover level (223)

Table 6. Summary of distributive, procedural, interactional, informational justice and turnover regression model

Figure 2 clarifies that more than two third of the studied nurses (68%) had high level of turnover intention. While less than, one-fifth of them (19%) had moderate level of turnover intention. In addition, only (14%) had low level of turnover intention.

Table 4 presents that there was highly statistically significant negative correlation between total organizational justice and turnover intention level.

Table 5 displays that there was positive highly statistical significant correlation between Age, gender, marital status, nursing qualification and years of experience and organizational justice and turnover intention for staff nurses.

Table 6 ascertains that distributive justice was negatively and significantly associated with turnover as when the distributive justice increases by one unit then the turnover decreases by 0.45 units. In addition, there is negatively significant impact for the procedural justice on turnover as when the procedural justice increases by one unit then the turnover decreases by 0.34 units. In addition, there is negatively significant impact for the Interactional justice on turnover as when the Interactional justice increases by one unit then the turnover decreases by 0.46 units. Moreover, there is negatively significant impact for the informational justice on turnover as when the informational justice increases by one unit then the turnover decreases by 0.52 units.

4. Discussion

Organizational justice is an important factor to most successful organizations. The organization needs to be fair in its system regarding justice so their employee becomes satisfied, committed and had loyalty. When employees see themselves as partners in the organization, they perceive higher level of justice. Because employees feel that, they are a part of decision making in the organization. This enhances organization productivity and employee performance. In addition, when there are free flows of communication in an organization, there are higher levels of justice on the employee [26].

Different factors such as management strategies, reduced workforce, salary and benefit, occupational stress, feeling of unfairness, and attrition in an organization can contribute to turnover intention [11].

Among these, organizational injustice is of critical significance since it can foster negative attitudes or increase turnover intention [27]. Therefore, this study aimed to assess relationship between multiple dimensions of organizational justice and turnover intention among staff nurses.

4.1. Nurses’ Perception toward Dimensions of Organizational Justice

The result of present study revealed that more than four fifth of the studied nurses had low perception of procedural justice, distributive justice, interactional justice and informational justice dimension respectively. This might be that employees not only consider the different types of justice (i.e., distributive, procedural, and interactional) but also consider the agent of the situation that is perceived as fair or unfair. In a sense, perceptions of distributive justice are based on the exchange principle: employees evaluate the organizational outputs they receive compared with their inputs to determine whether it is a fair outcome [28].

That is not congruent with the results of a similar study performed by Yaghoubi et al. [29], who conducted study entitle" The relationship between the organizational justice and organizational citizenship behavior among medical records staffs of selected hospitals of Isfahan '' and found that the lowest mean score of participants belonged to interactional justice.

The finding of the study is compatible with that of Hatam et al. [17]. who conducted study entitle "Perceptions of Organizational Justice among Nurses working in University Hospitals of Shiraz: A comparison between general and Specialty Settings'' and found that there was a significant difference in organizational justice perception of nurses between general and specialty hospitals.

In contrast to study by Zakaria et al. [30], who conducted study entitle" The relationship between nurses’ perception of organizational justice & their organizational commitment'' and stated that the nurses at King Abdullah Hospital perceived justice distribution as the highest organizational justice, Lambert [31] found that justice distributive was the lowest, whereas interpersonal justice was the highest.

The study findings are supported by other previous studies as the one carried out by Abdul-Rauf [32], who examined the impact of organizational justice perception on organizational citizenship behavior, in Sri Lanka, and reported that the participants' perception of the organizational justice was positive and the highest mean score was for the interactional justice; while the lowest was for distributive justice. However, these findings were dissimilar with a study carried out by Sayed, et al., [33], to investigate the relationship between organizational justice and turnover intention, and found that the nurses' perception of the organizational justice was negative.

4.2. Regarding Total Perception of Nurses Toward Turnover Intention

This Study Clarified that more than two third of the studied nurses had high level of turnover intention. While less than, one-fifth of them had moderate level of turnover intention. In addition, only had low level of turnover intention. [34], and [35]. posit that turnover intention is the conscious and deliberate willfulness of an individual towards voluntary permanent withdrawal from employer organization. Reasons abound for employees to nurse the feeling to leave. Employees’ wish and disposition to leave an employer organization arise from unfair and inequitable implementation of personnel policies and procedures for assessment of promotion and unfriendly treatment from co-workers.

This finding is contradicting with that of a study done by Almalki et al. [36], in the Kingdom of Saudi Arabia, to examine the relationship between quality of work life and turnover intention and found that the highest percentage of nurses had a low level of turnover intention. Likewise, in other study carried out by Mosallam, et al., [37], in Egypt, where they assessed turnover intention among intensive care unit nurses; and found that the majority of nurses had a high level of turnover intention.

4.3. Regarding Correlation between Total Level Perception of Turnover Intention and Total Perception of Organizational Justice

This Study illustrated that there was highly statistically significant negative correlation between total organizational justice and total turnover intention level. This might be due to unfair treatment leads employees to think in quitting their job or transfer to other parts of the organization to seek fairer outcomes and increase the fairness of the interpersonal exchanges [38].

This finding was consistent with those of studies done by Remei et al. [19], who conducted a study entitled “The relationship between organizational justice and turnover intention: A survey on hospital nurses”, Sayed, et al. [33], who found that there was a statistically significant negative correlation between organizational justice and nurses' turnover intention.

The results of this study are similar to the findings of previous researches for instance Karatepe [39], indicating negative relationship between organizational justice and turnover intentions.

Results of the current study are according to the study of Radzi et al. [40], indicating negative relationship between organizational justice dimensions and turnover intentions

In addition, Byrne [41], also found significant negative relationship between procedural justice and turnover intentions and interactional justice and turnover intentions

In a study done by Brashear [42], found that procedural and distributive justice has negative association with employee turnover intentions.

Additionally, a significant inverse relationship between interactional justice and turnover intention that is congruent with the results of [27,43,44], but inconsistent with the results of [45], the significant relationship between procedural justice and turnover intention is in line with the results of [46,40,47], but not in alignment with those of [48].

4.4. Regarding Correlation between Personal Characteristics and Organizational Justice Level and Turnover Level

The present study displayed that there was positive highly statistically significant correlation between Age, gender, marital status, nursing qualification and years of experience and organizational justice and turnover intention for staff nurses. From the researcher opinion, with increase in years of experience and age, nurses face many problems and situations and increase level of judgment on the organizational fairness.

This study is in disagreement with Remei et al. [19], who asserted that no relationship found between demographic variables as regards organizational Justice and turnover intention. This might be due to there were other factors that could affect nurse organizational justice and turnover intention such as the organizational rules, policies, regulations, salaries, work requirements and job satisfaction.

5. Conclusion

The study concluded that there was low perception regarding multiple dimensions of organizational justice among studied nurses, while they had high level regarding turnover intention. In addition, there was highly statistically significant negative correlation between total organizational justice and total turnover intention level.

6. Recommendation

- Future studies are recommended to carry out by considering other factors like organizations’ policies, violation of psychological contracts, which also may affect personnel’s turnover intention.

- Improve nurses' perception about the organizational justice to increase their engagement in organizational citizenship behavior.

- Encourage nurse managers to use a free flow of information, trust to nurses, open and two ways communication to improve interactional justice.

- Develop fair and consistent procedures regarding nursing personnel, performance assessment, and distribution of outcomes, rewards, and promotions.

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