Chapter 3 explains the research method being used in the study.

Chapter 3 explains the research method being used in the study. It describes the instruments associated with the chosen research method and design used; this includes information regarding instrument origin, reliability, and validity. Chapter 3 details the planned research approach, design, and analysis. An outline of the assumptions/limitations/delimitations to the choice of method and design is provided in chapter 3. Chapter 3 provides information on how the proposed research design aligns with IRB requirements.

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DSE: Chapter 3 – Evaluation Rubric

Criteria Does Not Meet 0.01 points Meets 1 point

Introductory
Remarks

The section is missing; or some topic areas are not
included in the Introduction or are not explained clearly.

The chapter outline is not provided and/or is unclear.

The reader is adequately oriented to the topic areas
covered. An outline of the logical flow of the chapter is
presented.

All major themes/concepts are introduced.

Research
Methodology
and Design

There is a lack of alignment among the chosen research
method and design and the study’s problem, purpose,
and research questions.

There is a lack of justification and alternate choices for
methods.

For Qualitative Studies: Lacks clear discussion of the
study phenomenon, boundaries of case(s), and/or
constructs explored.

Describes how the research method and design are
aligned with the study problem, purpose, and research
questions.

Uses scholarly support to describe how the design
choice is consistent with the research method, and
alternate choices are discussed.

For Qualitative Studies: Describes the study
phenomenon, boundaries of case(s) and/or constructs
explored.

Population and
Sample

Lacks a description of the instruments associated with the
chosen research method and design used. Details
missing regarding instrument origin, reliability, and
validity.

For Quantitative Studies: (e.g., tests or surveys). Lacks
explanation of any permission needed to use the
instrument(s) and cites properly. Instrument permissions
are missing in appendices

Provides a description of the instruments associated
with the chosen research method and design used.
Includes information regarding instrument origin,
reliability, and validity.

For Quantitative Studies: (e.g., tests or surveys).
Includes any permission needed to use the
instrument(s) and cites properly.

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DSE: Chapter 3 – Evaluation Rubric

For Qualitative Studies: (e.g., observation
checklists/protocols, interview or focus group discussion
Handbooks). Did not clearly explain the process for
conducting an expert review of instruments (e.g.,
provides justification of reviewers being credible –
reviewers may include, but not limited to NCU
dissertation team members, professional colleagues,
peers, or non-research participants representative of the
greater population); and/or did not clearly explain use of a
field test if practicing the administration of the instruments
is warranted.

For Pilot Study: Does not clearly explain the procedure
for conducting a pilot study (did not conduct pilot) if using
a self-created instrument (e.g., survey questionnaire);
does not include explanation of a field test if practicing
the administration of the instruments is warranted.

For Qualitative Studies: (e.g., observation
checklists/protocols, interview or focus group discussion
Handbooks). Describes process for conducting an
expert review of instruments (e.g., provides justification
of reviewers being credible – reviewers may include,
but not limited to NCU dissertation team members,
professional colleagues, peers, or non-research
participants representative of the greater population);
describes use of a field test if practicing the
administration of the instruments is warranted.

For Pilot Study: Explains the procedure for conducting
a pilot study (requires IRB approval for pilot) if using a
self-created instrument (e.g., survey questionnaire);
explains use of a field test if practicing the
administration of the instruments is warranted.

Operational
Definitions of
Variables
(Quantitative
Studies Only)

Discussion of the study variables examined is lacking
information and/or is unclear.

Describes study variables in terms of being measurable
and/or observable.

(Reviewer – mark Meets/NA for Qualitative studies)

Procedures Procedures are not clear or replicable. Steps are missing;
recruitment, selection, and informed consent are not
established. IRB ethical practices are missing or unclear.

Describes the procedures to conduct the study in
enough detail to practically replicate the study, including
participant recruitment and notification, and informed
consent. IRB ethical practices are noted.

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DSE: Chapter 3 – Evaluation Rubric

Data Collection
and Analysis

Does not clearly provide a description of the data and the
processes to collect data. Lack of alignment between the
data collected and the research questions and/or
hypotheses of the study.

For Quantitative Studies: Does not clearly provide the
data analysis processes including, but not limited to,
clearly describing the statistical tests performed and the
purpose/outcome, coding of data linked to each RQ, the
software used (e.g., SPSS, Qualtrics).

For Qualitative Studies: Does not clearly identify the
coding process of data linked to RQs; does not clearly
describe the transcription of data, the software used for
textual analysis (e.g., Nivo, DeDoose), and does not
justify manual analysis by researcher. There is missing or
unclear explanation of the use of a member check to
validate data collected.

Provides a description of the data collected and the
processes used in gathering the data. Explains
alignment between the data collected and the research
questions and/or hypotheses of the study.

For Quantitative Studies: Includes the data analysis
processes including, but not limited to, describing the
statistical tests performed and the purpose/outcome,
coding of data linked to each RQ, the software used
(e.g., SPSS, Qualtrics).

For Qualitative Studies: Identifies the coding process
of data linked to RQs. Describes the transcription of
data, the software used for textual analysis (e.g., Nivo,
DeDoose), and describes manual analysis by
researcher. Describes the use of a member check to
validate data collected.

Assumptions/
Limitations/
Delimitations

Does not clearly outline the assumptions/limitations/
delimitations (or has missing components) inherent to the
choice of method and design.

For Quantitative Studies: Does not include or lacks key
elements such as, but not limited to, threats to internal
and external validity, credibility, and generalizability.

For Qualitative Studies: Does not include or lacks key
elements such as, but not limited to threats to credibility,
trustworthiness, and transferability.

Outlines the assumptions/limitations/delimitations to the
choice of method and design.

For Quantitative Studies: Includes key elements such
as, but not limited to, threats to internal and external
validity, credibility, and generalizability.

For Qualitative Studies: Includes key elements such
as, but not limited to threats to credibility,
trustworthiness, and transferability.

March 2023 4

DSE: Chapter 3 – Evaluation Rubric

Ethical
Assurances

Lacks discussion of compliance with the standards to
conduct research as appropriate to the proposed
research design and is not aligned to IRB requirements.

Describes compliance with the standards to conduct
research as appropriate to the proposed research
design and aligned to IRB requirements.

Summary Chapter does not conclude with a summary of key points
from the Chapter – elements are missing, incomplete,
and/new information is presented.

Chapter concludes with an organized summary of key
points discussed/presented in the Chapter.

Enhancing Employee Engagement in a Healthcare Organization: A Key Strategy to Reduce Turnover and Enhance Patient Care Quality

Dissertation Manuscript

Abstract

Acknowledgments

Table of Contents

Table of Contents

Chapter

: Introduction

Statement of the Problem

Purpose of the Study

Introduction to Theoretical or

Conceptual Framework

Introduction to

Research Methodology and Design

Research Questions

Significance of the Study

Definitions of Key Terms

Summary

Chapter 2: Literature Review

Conceptual Framework

Subtopic

Summary

Chapter 3: Research Method

Research Methodology and Design

Population and Sample

Materials or Instrumentation

Operational Definitions of Variables

Study Procedures

Data Analysis

Assumptions

Limitations

Delimitations

Ethical Assurances

Summary

Chapter 4: Findings

XXX of the Data

Results

Evaluation of the Findings

Summary

Chapter 5:

Implications

, Recommendations, and

Conclusions

Implications

Recommendations for Practice

Recommendations for Future Research

Conclusions

References

Appendix A XXX

Appendix B XXX

Chapter 1: Introduction

The rate at which employees leave a company and are replaced by new hires is known as employee turnover and is a significant concern for businesses in all industries (Perreira et al., 2018). Turnover substantially affects business profitability, staff morale, and even crucial elements like the standard of patient care in medical facilities. This study explores the lived experiences of healthcare employees regarding the effects of employee engagement on turnover and resulting impact on patient care.

Maintaining a steady and engaged staff is difficult for firms in the modern, competitive, and dynamic business environment. An organization’s equilibrium is upset by turnover, which affects its performance and operational continuity (Zucco, 2023). Due to the direct impact of high turnover rates on patient treatment quality and safety, the healthcare industry is particularly vulnerable to its effects. The loss of seasoned healthcare workers strains resources and jeopardizes the efficient provision of medical care, possibly resulting in medical errors and decreased patient satisfaction (Giallouros et al., 2023).

This study focuses on the lived experiences of healthcare employees regarding the effects of employee engagement on turnover and resulting impact on patient care. Understanding the complex nature of turnover as driven by staff engagement variables and the ensuing ramifications for patient care is at the heart of the issue statement. This study offers practical insights to help healthcare institutions reduce turnover rates while improving patient care by investigating the interactions between turnover, employee engagement, and care quality.

Background

Employee turnover has drawn much attention in theoretical and applied studies, and it has significant ramifications for many industries, including healthcare. The occurrence of employees leaving a company and being replaced by new personnel is referred to as turnover. Due to its considerable influence on corporate performance, employee well-being, and service quality, it has received a great deal of research. This study aims to better understand the complex nature of turnover and the relationship between it and employee engagement, especially in the context of patient care quality in healthcare settings (Greer & Felicia, 2018).

Numerous studies have examined turnover from various perspectives, indicating its adverse effects on businesses (Giallouros et al., 2023; Gilmartin et al., 2022; Saadeh & Suifan, 2020)
. High turnover rates have been linked to higher hiring and training expenses, decreased productivity, messed-up team dynamics, and declining quality of delivered goods or services. These results are significant in the healthcare industry since employee stability and coordination are essential for high-quality patient care. Additionally, healthcare companies frequently struggle to find and keep skilled workers, which worsens the effects of turnover (Jose et al., 2022).

From an empirical perspective, studies have repeatedly shown the adverse effects of turnover on the standard of patient care (Bae, 2022; Chung et al., 2021; Namin et al., 2021). According to studies on increasing turnover rates among healthcare workers, including nurses and doctors, inadequate communication, coordination, and continuity of care might compromise patient safety and treatment outcomes (Alkhraishi et al., 2023; Poon et al., 2022, Renjith et al., 2021). Given the complex relationship between turnover and patient care quality, it is imperative to address turnover-related problems to ensure the best possible level of healthcare delivery.

By tying topics like employee engagement and employee turnover have attracted theoretical interest in addition to its practical ramifications. Employee emotional dedication, involvement, and commitment to their work and business are characteristics of employee engagement
(Turner & Turner, 2020). The subject of how employee engagement and turnover, patient care quality is impacted by turnover is vital. This issue highlights a significant gap in the literature, necessitating a thorough investigation of the underlying dynamics and probable explanations.

By exploring the lived experiences of healthcare employees regarding the effects of employee engagement on turnover and resulting impact on patient care, the current study seeks to bridge the information gap. This study aims to clarify the mediating and moderating factors that affect this link by studying the interaction between these two constructs. This study aims to advance knowledge of the effects of turnover on staff engagement and the caliber of patient care through in-depth analysis and theoretical investigation (Gilmartin et al., 2022).

The importance of this study rests in its ability to inform the strategies and interventions that healthcare organizations may implement regarding the lived experiences of healthcare employees regarding the effects of employee engagement on turnover and resulting impact on patient care. With the knowledge acquired from this study, healthcare administrators may develop evidence-based strategies to boost employee engagement, increase staff retention, and ultimately raise patient care standards. The theoretical contributions of this work will also increase our comprehension of the intricate interactions between turnover and engagement, adding to the body of knowledge on organizational behavior and human resource management (Eliyana & Fauzan, 2018).

Statement of the Problem

The problem to be explored is the relationship of employee engagement to turnover and the effects of turnover on patient care. This study seeks to identify the factors contributing to the lived experiences of healthcare employees regarding the effects of employee engagement on turnover and resulting impact on patient care. The importance of employee engagement in addressing the intricate link between staff turnover and the caliber of patient care is the clear emphasis of this research. Healthcare organizations frequently need help with the practical challenge of keeping talented and dedicated staff sustaining the standard of patient care (Zajac et al., 2021). The continuity of patient treatment and care coordination is disrupted by the high turnover rates typical of the healthcare industry and affects nurses, doctors, and technicians.

According to empirical research, increasing turnover rates resulting from low employee engagement among healthcare professionals directly threaten patient safety and treatment effectiveness because they cause communication breakdowns and fragmented patient care (Alenezi et al., 2019). Both patients and healthcare workers are affected by the consequences. Employees deal with increased stress, burnout, and decreased job satisfaction as businesses struggle with ongoing hiring needs and a steady stream of new applicants (Calecas et al., 2019). In addition, the difficulties brought on by staff turnover may result in patients receiving unequal and subpar care. The importance of understanding the complex interactions between worker turnover, engagement, and patient care quality within the particular setting of healthcare organizations is underlined by this study. Although the negative consequences of turnover on patient care outcomes are acknowledged, the methods by which employee engagement lessens these effects are still unknown (Poon et al., 2022).

If this problem is not addressed, a cycle of employee disengagement and turnover-related problems could start, consistently making it more difficult to provide high-quality patient care (Zuhlke, 2019). Concerns about employee turnover may impact patient satisfaction, medical errors, and patient safety. Additionally, healthcare organizations can need help with increased hiring and training costs, a damaged employer reputation, and difficulties luring top-tier professionals (Greer, 2021). This study aims to thoroughly investigate the complex relationship between staff engagement, turnover, and patient care quality to offer valuable insights and remedies. This research aims to provide healthcare organizations with practical solutions to improve employee retention, raise engagement, and ultimately improve the quality of patient care within a particular setting by exploring the fundamental mechanisms underlying this complex interaction.

Purpose of the Study

The purpose of this study is to explore how the relationship of employee engagement and turnover impact patient care. This qualitative research study aims to understand better the complex connections between patient care quality, staff engagement, and employee turnover in healthcare organizations. This study intends to explore the impacts of turnover on employee engagement and patient care quality using a phenomenological research design (Renjith et al., 2021). The crucial issue raised in the preceding sections, where excessive turnover rates in healthcare organizations have been found to compromise patient care, is directly addressed by this research.

Introduction to Conceptual Framework

The conceptual framework that will guide this qualitative study is the Job-Demands-Resources (JD-R) model developed by Arnold Bakker and Evangelia Demerouti in 2006. The JD-R model was developed to explain how employee performance and well-being is influenced by the organizational environment (Bakker & Demerouti, 2007). Demerouti et al. (2001) asserted that job resources and job demands are the key constructs of the JD-R model. This theory posits that employee outcomes are shaped by the interplay between job demands and job resources. Job demands encompass factors like challenges associated with turnover, while job resources include elements that foster employee engagement and facilitate effective patient care delivery.

Engaged employees exhibit higher commitment, discretionary effort, and a propensity to enhance organizational outcomes (Hancock et al., 2013). Increased turnover rates can trigger heightened stress, workloads, and diminished morale among remaining employees, potentially impacting their engagement levels. Reduced engagement may disrupt care coordination, communication, and quality, influencing patient care outcomes (Poon et al., 2021). The turnover of healthcare professionals due to low engagement within the healthcare organization could be explained using the JD-R model (Bakker & Demerouti, 2007). On the other hand, employee engagement may be categorized as a job resource in that highly engaged employees are less likely to quit and are highly committed to their assigned duties (Hancock et al., 2013). As per the model, job resources such as improved autonomy, opportunities for career development, mentoring and support from colleagues and the management positively motivated employees.

The choice of JD-R model for this study will help the researcher identify and discuss the causes of employee turnover in healthcare organizations as described under the job demands category of the model. On the other hand, the job resources category will allow the researcher to discuss the different factors that motivate employees, improve work engagement, and consequently mitigate turnover intentions. The researcher will use this model to develop the research questions that will guide the study as well as the semi-structured interview questions that will be used to collect the data needed for thematic analysis. An extensive discussion of the JD-R model and its use in research will be discussed in Chapter 2.

Introduction to Research Methodology and Design

This section outlines the research methodology and design that will be used by the researcher to explore the lived experiences and the perceptions of employees in healthcare organizations regarding the effects of employee turnover and engagement on the quality of care offered to patients in healthcare organizations. The research methodology that will be used in this study is qualitative research methodology. Cypress (2018) asserted that qualitative research methodology is used by researchers when the goal is to investigate a phenomenon using participant’s experiences, perceptions, thoughts and opinions. The primary goal of this study is to provide an in-depth understanding of how healthcare organizations might reduce turnover-related problems and enhance patient care outcomes. Using participants experiences and perceptions will allow the researcher to provide an in-depth understanding of how employee turnover impacts the engagement of healthcare professionals as well as the quality of patient care within the selected healthcare organizations (Patton, 2014).

The qualitative research design of choice for this study will be phenomenological research design. Phenomenological research design is used by researchers to investigate a phenomenon of interest using participants’ lived experiences (Moustakas, 1994). The goal of phenomenological research is to explore a problem based on the participants have experienced the phenomenon and how the phenomenon has influenced them (Neubauer et al., 2019). In this study, the effects of turnover on employee engagement and quality of care in healthcare organizations will be explored from the perspective of healthcare professionals who have experienced the effects of turnover on their successful engagement with work and quality of care they have offered to patients. Phenomenological research design aligns with the purpose and problem under investigation in the sense that it will allow the researcher to investigate the effects of turnover on the engagement of healthcare professionals and quality of care provided by healthcare organizations.

Sample and Participants

The sample for this study will be identified and recruited through purposeful sampling technique. Purposive sampling is a non-probability sampling technique used by researchers to recruit participants based on their experiences and judgement that they will provide the researcher with the information needed to investigate the phenomenon of interest (Palinkas et al., 2015). Campbell et al. (2020) asserted that purposive sampling allows the researcher to recruit participants who are knowledgeable and experienced with the phenomenon being investigated. Using purposeful sampling, the researcher will recruit healthcare professionals who have experienced the impacts of turnover on their work engagement and quality of care offered to patients by healthcare organizations. With purposive sampling, the researcher intends to recruit at least 20 healthcare professionals Mercy Medical Clinic, a long-standing suburban healthcare facility, and Johns Hopkins Hospital, a well-known urban medical facility.

Data Sources

The sources of data for this study will be semi-structured interviews. The interviews will allow the researcher to explore participants’ lived experiences and perceptions of turnover on engagement and patient care standards. Using semi-structured interviews, the researcher will engage in candid discussions with the healthcare professionals to solicit detailed information on the phenomenon under investigation (Roulston & Choi, 2018).

Data Analysis

Thematic analysis, a widely recognized qualitative analytic approach, will be employed to analyze the collected data. This systematic process involves identifying, examining, and reporting patterns and themes present in the data. The analysis comprises data familiarization, initial coding, theme identification, evaluation, definition, labeling, and final report generation (Braun & Clarke, 2006; Vaismoradi & Snelgrove, 2019).

Research Questions

RQ1:
How do healthcare professionals describe the relationship between turnover on their engagement in healthcare organizations?

RQ2:
How do healthcare professionals describe the effects of turnover on the standards of patient care?

RQ3:
What strategies do healthcare professionals describe as effective in engaging employees to reduce turnover?

Significance of Study

This study addresses a critical and substantial gap in the existing healthcare literature by focusing on the profound implications of high personnel turnover caused by low employee engagement for patient care quality within healthcare organizations. The escalating staff turnover rates have been unequivocally associated with disruptions in the continuity of care compromising the quality of patient safety and outcomes (Renjith et al., 2021). Although researchers have recognized the challenges of turnover in healthcare organizations, yet a comprehensive understanding of how it interconnects with employee engagement and its impact on patient care remains limited. Therefore, this study seeks to bridge this gap by exploring how healthcare professionals describe the effects of turnover on their engagement and quality of patient care using their lived experiences.

The findings of this study will have both practical and academic implications. The academic implications of this qualitative study will be to provide an understanding of the negative impacts of turnover on healthcare professional’s work engagement and quality of patient care (Renjith et al., 2021). While prior research has touched upon these elements individually, a comprehensive exploration of their interconnectedness still needs to be developed (Poon et al., 2022). This study advances our comprehension of organizational behavior and human resource management dynamics, particularly within the unique context of healthcare delivery. This study will enrich the academic discourse by providing a more holistic perspective on these intricate relationships. The findings of this research seek to broaden the theoretical frameworks, enriching them with insights derived from organizational behavior theories.

The practical implication of this study is anchored on the benefits that healthcare organizations, policy makers and human resource specialists will draw from this study’s findings. In existing literature, there is evidence that high rates of turnover among healthcare professionals negatively affect the quality of patient care and engagement of healthcare professionals (Zuhlke, 2019). By understanding the effects of turnover on employee engagement and quality of patient care, healthcare organizations will be able to develop strategies that will reduce employee turnover, improve the retention of healthcare professionals and quality of patient care (Renjith et al., 2021).

Among policymakers, the findings of this study will inform the development of policies that will help healthcare organizations institute strategies that may help enhance the retention of healthcare professionals and increase their engagement within the healthcare sector (Poon et al., 2022). Therefore, by investigating the impacts of turnover on the engagement of healthcare professionals, this study will provide healthcare organizations with the opportunity to optimize care and develop strategies that will not only improve the engagement of healthcare professionals but also discourage them from leaving the workforce.

Definitions of the Key theories in the conceptual framework.

Employee Turnover

The frequency with which departing employees are replaced by fresh hiring includes the departure of qualified healthcare workers, including nurses, doctors, and technicians, and affects the workforce’s stability and the efficiency of operations (McMahon, 2018).

Employee Engagement

The employees’ devotion to their jobs and organizations on an emotional level influences their discretionary effort and contribution to organizational outcomes, including job satisfaction, organizational commitment, and work-related stress (McMahon, 2018).

Patient Care Quality

The efficiency, security, and overall experience of providing healthcare, including facets like coordination of care, communication, and therapeutic results, display the caliber of patient care and service healthcare organizations deliver (Browne, 2019).

Organizational Performance

The extent to which an organization meets its aims and objectives. It has many components, including productivity, service quality, and financial performance, and is impacted by engagement, turnover, and patient care quality (Saadeh et al., 2020).

Healthcare Professionals

Skilled individuals working in healthcare settings, including nurses, physicians, and technicians, play crucial roles in providing medical care and services to patients (Browne, 2019).

Job Satisfaction

The level of contentment and fulfillment that employees experience in their roles within an organization. It is influenced by factors such as job design, work environment, and the degree to which personal expectations are met (Alkhraishi et al., 2023).

Organizational Commitment

The degree to which employees support their company’s mission, vision, and core values. Organizational commitment illustrates their fidelity and readiness to go above and beyond for the company’s benefits (Saadeh et al., 2020).

Work-Related Stress

The physical and psychological strain experienced by employees due to job demands, pressures, and challenges. It can impact employee well-being and engagement levels (Saadeh et al., 2020).

Communication

Effective communication depends on sharing knowledge, suggestions, and feedback between medical professionals, patients, and healthcare providers and high-quality patient care (McMahon, 2018).

Care Coordination

Organizing and coordinating various aspects of patient care involves multiple healthcare professionals and interventions to ensure seamless and integrated treatment (Browne, 2019).

Summary

In healthcare organizations, employee turnover
is a problem that should be addressed promptly. Employee turnover is defined as the process through which employees leave a business and are replaced by new hires (McMahon, 2018). In this chapter, the researcher highlighted the significant effects of turnover, specifically how it affects organizational performance, staff morale, and the standard of patient care in healthcare settings (McMahon, 2018). The disruptive impact of turnover is addressed, particularly its effects on operational continuity and performance in today’s competitive business environment. The study’s central issue is the effects of turnover on employee engagement and quality of patient care. The loss of seasoned healthcare workers burdens resources and compromises the delivery of medical services, resulting in medical errors and worse patient satisfaction (Zuhlke, 2019).

The researcher also used this chapter to introduce the purpose of the study, the conceptual framework, and the research methodology and design that will be used for this study. Besides the mentioned areas, the academic and the practical significance of the study were discussed. Discussing the research’s theoretical and practical implications highlights its potential contributions to organizational behavior, human resource management, and healthcare delivery strategies. To understand the adverse effects of workforce turnover on the standard of patient care, the study’s essential terms, definitions, and deeper analysis of the literature review will be discussed in Chapter 2.

Chapter 2: Literature Review

Introduction

Employee engagement refers to the level of interest, passion, and involvement an employee shows in tasks and organization. Gupta & Sharma (2016) describe employees by focusing on the behaviors where employees show commitment to working in their organizations with extra dedication, energy, and a sense of purpose in their daily work. Lack of employee engagement in healthcare organizations is increasingly recognized as having a high turnover rate, thus affecting patient care quality. High turnover is a critical issue in many industries. However, the experience is especially problematic in the healthcare industry because workers’ turnover directly affects patients’ health outcomes and job morale (Anthony, 2018). This results in interference with care delivery and scheduling, stress on staff and systems, and potential negative consequences for the patients, organization, and staff.

Stability is critical to healthcare organizations’ staff and employees, especially in today’s unpredictable environment. Staff turnover is costly to organizations and impacts the quality of service and patient care since experienced staff leave an organization and are replaced by inexperienced subordinates (Mazzetti et al., 2020).

The central element that can significantly influence these challenges is the link between the engagement of the employees and turnover. Engagement leads to involvement in one’s work and decreases turnover intention, enhancing positive patient care outcomes. Considering the specifics of the changes in employee engagement and the correlation to turnover helps healthcare organizations attain higher staff retention rates and, subsequently, the ability to deliver quality care (Renjith et al., 2021). Thus, this research focuses on the relationship between strategies to engage employees and the turnover rate and sets up that engagement of employees is a way of increasing patient-centered care (Kartal, 2018). Thus, understanding these factors can help healthcare organizations implement the proper preventive measures for turnover and ultimately improve the quality of patient service delivery.

Search Process

This literature review was conducted through a systematic search for research studies focused on employee engagement, turnover, and patient care quality in healthcare organizations. Several libraries and databases were visited to collect the relevant literature, including prestigious ones like PubMed, CINAHL, and Google Scholar, which have been used to provide a wealth of information. These databases were selected because they comprise extensive peer-reviewed journals and articles on healthcare organizations. The initial search for articles was performed with PubMed as it is one of the most significant and credible resources in the medical and healthcare communities, offering many articles concerning patient care quality and the impact of the healthcare workforce. CINAHL was also helpful since it is indexed for nursing and allied health literature and provides information on staff engagement and retention in clinical settings. Google Scholar enriched the pool of identified materials by extending the databases to interdisciplinary ones and adding dissertations, conference proceedings, and non-peer-reviewed reports that might provide fresh viewpoints and more recent information (Gusenbauer & Haddaway, 2020).

Additionally, other relevant papers and journals were researched to complement the findings from the databases mentioned above. These were peer-reviewed journals encompassing organization management and health care, human resource management, and organizational psychology, including the Journal of Healthcare Management, Human Resource Management Review, and Journal of Organizational Behavior. Sources such as the World Health Organization (WHO), the American Hospital Association (AHA), and the Institute for Healthcare Improvement (IHI) were also helpful to industry reports. Such reports may contain contemporary information, promising tendencies, and practical models and examples that can be read in scholarly publications.

The research conducted an efficient literature review using a list of keywords and other terminologies to help retrieve all necessary literature. Primary search terms were used as “employee engagement,” “healthcare turnover,” and “patient care quality.” To narrow down the search and focus on features of the given topic, specific terms and phrases were utilized, including the following ones: retention models, health care human capital, job contentment, burnout, staffing densities, work context, organizational devotion, health care administration, and personnel productivity. The identified studies utilized Boolean operators (AND Or NOT) to link or exclude relevant terms in the different search fields, improving the accuracy of the search. For instance, if the words “employee engagement” and “healthcare turnover” entered the search criteria, it was easy to find articles that showed the relationship between them. There was a sign for using ‘patient care quality’ as part of the identifiers since it helped exclude a list of filtered studies that specifically examined the impact of turnover on patients. Including terms like ‘retention strategies’ and ‘job satisfaction’ expands the results to facets of workforce maintenance at a later stage and its impact on commitment and turnover (Bramer et al., 2018). This process was done in stages during the systematic review (SR), which took several months. It involved multiple phases: searching through the abstracts, reading through the body, and checking the other sources mentioned in the given documents to look for more literature. It also ensured that significant works were included because the process was iterative, starting with formulating the research questions and literature review.

The initial searches created a list of thousands of articles that were further refined according to the research questions and inclusion criteria, such as year of publication (the last ten years were preferred), the type of articles, and the relevance in healthcare. Several options under the search, including different filters like year of publication, peer-reviewed articles, and specific journals, were used to sort out the information that could be overwhelming. Researchers classified articles by the topics they addressed, including those that explored engagement approaches, those that evaluated the effects of high turnover, and those that examined impacts on patient care quality. The argument in this literature review is influential due to the systematic procedure applied while focusing on source selection and evaluation. The choice of literature is also crucial since the ways they are intertwined are thoroughly explained, and the result is a coherent and justified analysis. The synthesis of literature amplifies knowledgeable ideas and reveals the necessary future research direction so that recommendations for strategy development could be promoted for its application to increase employee engagement and decrease turnover in healthcare facilities (Shaffril et al., 2021).

Conceptual Framework

The theoretical framework of this study focuses on Employee Engagement, Turnover, and Patient care Quality in healthcare organizations; it is based on several theoretical models. The first set of theories selected is the Job Demand-Resources (JD-R), Social Exchange Theory, COR, and the last one is the Self Determination Theory (SDT). Altogether, these frameworks collectively provide a sound understanding of how employee engagement and turnover relate to patient care quality in elaborate ways, which creates the groundwork for evaluating the relations between all these factors in the healthcare sector. This study utilizes the Job Demands-Resources (JD-R) Model developed by Bakker and Demerouti (2007). According to this model, job resources are defined as the opportunities that the individual may access in the Workplace, including the psychosocial condition at work, the level of physical demands, and the work structure. Further, other conditions that facilitate optimal job demands and contribute to employees’ engagement and well-being are also categorized under job resources, including promotive support and autonomy, categorized as instrumental resources.

The JD-R model was selected because it postulates that high job demands and varying resources characterize the healthcare environment. Some of the latest research articles that have been conducted include a study by Lesener et al. (2019), where they show and estimate the fact that when the healthcare workers in a particular organization feel that the resources available are sufficient, they are likely to work harder thus the turnover intentions being low in the organization (Lesener et al., 2019). As for the opposite scenario, when employers expect workers to perform more and offer less help and support, this causes people to experience burnout, and many of them start quitting, which shrinks the pool of competent staff and lowers the quality of care for patients. This paper encompasses a literature review in which it can be deduced that the Job Demands-Resources (JD-R) model is highly applicable in healthcare. Applying this model will assist in discovering how to allocate resources and loads between the staff members to increase their participation and employment rates.

In another study, Jenny et al. (2020) utilized the JD-R model in healthcare organizations, using the example of employee engagement as a strategic approach to demonstrate high turnover rates and increased patient quality. Expanding the JD-R model, which recognizes the balance between the demands and resources for working individuals and organizations, the present study focuses on the importance of the proper resources-demands ratio in health care. Thus, the study also demonstrates how this ratio affects the promotion of health and productivity outcomes and the need to balance the provision of resources and demands for engagement. Understanding this ratio is necessary in healthcare organizations because they are at high stakes, and the demands are immeasurable. Furthermore, developing this ratio helps maintain employees’ motivation and commitment to their roles to their duty, positively impacting patient care outcomes (Jenny et al., 2020).

Another critical theory that complements this study is the Social Exchange Theory, which Blau (1964) contributed. This theory postulates that employees’ involvement in each business is influenced by mutual obligations between them and their employers. Whenever companies want to ensure that their subordinates respond kindly, the management should show appreciation and provide for the workers. This theory holds much meaning in the healthcare sector, where the relationship of the subordinates with the management determines their level of motivation in the organization and the rate at which they may decide to resign from service.

A recent study by Inam et al. (2021) highlighted the critical role of social exchange in developing a work culture that positively impacts employees’ commitment and less turnover (Inam et al., 2021). Paying attention to one’s employees and providing them with the tools and training that they need to succeed are key to success for organizations within the healthcare industry, no less because such action results in better employee retention, a rise in staff satisfaction, and a subsequent increase in patients’ satisfaction levels.Refuting the proposition advocated by some developing countries that focused on enacting HRM practices as sufficient to spearhead organizational performance, Mohammad et al. (2021) underscores the centrality of social exchange in the framework of HRM practices. Thus, using the data of their study, they highlighted the subtle relationships within the healthcare organizations analyzed, especially regarding the concept of engagement. This paper highlights several organizational HRM strategies, such as recruitment, training, and internal promotion, which are crucial methods for promoting employees’ commitment to their work, thereby increasing organizational performance.

Nevertheless, the study provides insight into the unexpected conclusions relative to the effectiveness of Performance Appraisal (PA) and Reward-Based (RB) systems. Moreover, this highlights the complexity of social exchange for the patient regarding the usage of HRM in healthcare settings where the established practices may need to be linked to performance. This paper also seeks to adopt the social exchange theory to provide the theoretical framework of the pattern of engagement between healthcare professionals and organizations. Through this understanding, the paper intends to determine how healthcare employees, patients, and organizations can help achieve better results and lower employee turnover rates in healthcare delivery.

Another valid theory for this study is the Conservation of Resources (COR) Theory, which was postulated by Hobfoll (1989). According to COR theory, people’s motivation is to gain, maintain, and, when necessary, protect resources (Fatima et al., 2018). Regarding health care, resources include time, energy, and people, such as friends and families. When such resources are at the brink of being sabotaged or utilized almost to their optimal capacity, such employees will be stressed out and consequently develop burnt out, which, in the long run, will lead to high turnover rates. To his fundamental concept of COR theory, contemporary research studies have been applied in healthcare settings, as demonstrated by Knight et al. (2019), and these indicate that resource conservation helps enhance employee engagement and minimization of turnover as observed (Knight et al., 2019). Therefore, such organizations must ensure that healthcare workers are well equipped with these resources to help reduce stress and, in turn, enhance the quality of patient care
.

The literature review by Wu and Lee (2020) based on the Conservation of Resources (COR) Theory explores the engagement patterns in healthcare organizations and their effects on knowledge sharing. The study emphasized the significance of personal and external resources in supporting knowledge sharing in the healthcare sector. From the analysis of the COR Theory, work engagement is revealed as a desirable personal resource attributable to the intrinsic motivation of employees and, hence, favorably influencing knowledge-sharing behaviors (Fatima et al., 2018). Also, the research stresses that external sources, including transformational leadership, are crucial to support KSAWS in healthcare work groups. As the COR framework conducts the study, it supports concepts of knowledge sharing as an active process in healthcare organizations (Fatima et al., 2018). It is because of the development and utilization of individual and environmental resources. These results further support the imperative of using strategies to improve employee engagement in the sphere of healthcare organizations, which can foster not only a decrease in the rate of turnover but also the improvement of the quality of patient care through the dissemination of the information received by healthcare employments as well as by the practical connections between them (Wu & Lee, 2020).

Lastly, the Self-Determination Theory (SDT) by Deci and Ryan (1985) delved deep into employee engagement levels. An analysis of SDT deals with intrinsic motivation and satisfaction of basic psychological needs such as autonomy, competence, and relatedness. In healthcare, self-determination theory (SDT) can be applied because independence is at the core of many healthcare professionals’ lives. Satisfying the employees’ psychological needs in the Workplace may improve their job satisfaction. This results in an improvement in the rate of workers specializing in their duties and, as a result, lowers turnover rates (Deci & Ryan, 1985). A few published studies by Van Dorssen-Boog et al. (2020), which were aimed at identifying the relationship between HCAHPS domains and employees’ turnover rates, assert that the need for autonomy, competence, and relatedness in the organization is ignored in the health care industry (Van Dorssen-Boog et al., 2020). For instance, if nurses can influence decisions made and have good relationships with other members of staff, then they will prefer to work for the organization and deliver excellent services to their clients.

In research conducted by Wikaningtya et al. (2023), they used the Self-Determination Theory (SDT) to examine the turnover intention of vocational nurses in a hospital, and the following results came out. Even though this is done for a specifically selected hospital, the study’s findings present valuable recommendations for other types of healthcare institutions. The study highlights the complexity of relationships between various antecedents of turnover intention: mental workload, personal, organizational fit, and fulfillment of basic psychological needs. Ironically, the study also establishes that mental workload indirectly affects turnover intention through a mediating variable: the frustration of basic psychological needs of competence and relatedness. Moreover, although person-organization fit increases employees’ perception of the need for autonomy, it does not directly influence the level of their actual intention to leave the organization. More specifically, the study sheds light on ISW to change extrinsic to intrinsic motivation and decrease the nurses’ turnover intention (Wikaningtyas et al., 2023). This research echoes the existing literature on employee engagement in healthcare organizations. It underlines the importance of acknowledging people’s inherent needs for satisfaction through their work and creating supportive organizational environments to prevent turnover and improve patient care outcomes.

Literature Review

The literature review aims to capture the complex link between employee engagement and turnover in healthcare systems, especially targeting non-clinical support staff, nurses, and other caregivers. It also investigates how engagement and turnover rates relate to organizational culture and leadership behavior, the characteristics of the workforce, and how these features affect the professional quality of patient care. Furthermore, it outlines the limitations of current literature, especially regarding assessing targeted approaches to increasing learners’ engagement and decreasing staff turnover rates, as well as potential avenues for further research. Overall, there is a positive correlation between employee engagement and patient safety, but the strength of the relationship varied.

Employee Engagement in Healthcare

Through a qualitative research study, Bandera (2021) explored employee engagement and voluntary turnover of non-clinical support staff in healthcare organizations. This research aimed to determine aspects of employee engagement. It also affects the turnover rate and involved participants with clerical, administrative, technical, and secretarial positions in the South Atlantic region of the United States (Tannady et al., 2019). The study applied Kahn’s theory of employee engagement to explore the phenomenon and drew participants from 11 purposively and snowball-sampled healthcare workers with over three years of practice experience (Saks et al., 2020). The results showed that ’employee engagement,’ which may be described as the level of commitment people develop towards an organization and its goals, impacted turnover intentions in the study group, which was the non-clinical support staff. Ironically, one of the causes of turnover was labeled ‘lack of care,’ which affected 72% of participants. In doing so, the study was consistent with previous studies that show that negligence commonly contributes to turnover (Saks et al., 2020). In addition, it also defined the psychological climate required for healthcare organizations and stressed psychological safety, psychological availability, and psychological meaningfulness (Seyyedmoharrami et al., 2020). For interpersonal risk, there is psychological safety, where one can take a risk: a psychological presence means being available for tasks, meaning wherein the value work and the project. Five key themes were identified through semi-structured interviews and thematic analysis: employee engagement, degree of psychological safety and psychological availability, meaningfulness, and turnover rate. The study’s findings pointed to the fact that voluntary turnover heavily depends on the employees’ level of engagement, and the proposed solutions were centered around providing psychological safety and meaningful work. Bandera (2021) also pointed to the need for additional quantitative research to examine employee engagement and turnover in varied locations and within various healthcare organizations to draw ideas about HR practices worldwide.

Likewise, Forde-Johnston and Stoermer (2022) explored the concept of staff engagement in the context of the healthcare sector, with nurses taken as the subject of interest, and summarized the literature on the practices used to enhance staff engagement and, thereby, retention.
Organizational commitment is employees’ passion for their organization, preferably in production, satisfaction, and motivation. The paper also reviewed the instruments for measuring employees’ critical factors of situational engagement, emphasizing the healthcare sector and nurse turnover rate (Saks et al., 2020). Perceived features explaining the extent of engagement were teamwork, support, and promotion opportunities. The study used comparative content analysis of the narratives that originated from the Listening to Staff (L2S) forums in which the nurses were allowed to air their opinions and contribute to developing retention strategies (Seyyedmoharrami et al., 2020). These forums empowered people to come up with retention plans as a result of the autonomy that they enjoyed. An analysis of the statistics showed a decline in nursing staff turnover after the L2S events, with proof of the success of the engagement program. In their policy article, Forde-Johnston and Stoermer (2022) advocated for unit-level and individual solutions to the retention problems because the type of retention issue differs with the professional fields and organizational sub-units. The study also stressed the importance of nursing executives being receptive to suggestions from the workforce on retention and the inclusion of regional managers in the retention strategies. These actions help deal with workforce deficiency and the attraction of the existing staff of nurses.

In a more recent study by Winarno et al. (2022), the authors focused on the UK service sector organizations and examined the link between the perceived realized HRM practices and perceived organizational support, affection classified as engagement, and self-reported intentions of turnover. The present research was concerned with examining the moderating and mediating variables that help to define the relationship between the given practices of HRM and specific behaviors of employees. According to the study, the relationship between perceived HRM practices, OCBs, and turnover intentions significantly varies with the level of employee engagement. The authors postulated that perceived organizational support and LMX should mediate EE and its behavioral consequences. The study’s overall findings were that perceived HRM practices were positively related to organizational outcomes, whereby employee engagement emerged as an essential determinant in moderating turnover intentions and positive behavioral outcomes (Calecas, 2019). The results provided preliminary evidence that organizations that espouse principles of sound HRM can develop commitment levels consistent with the organizational objectives.

Further, the variables that were unveiled to act as moderate variables that help define the relationship between engagement and performance results include perceived organizational support and leader-member exchange. The study emphasized the role of compliance culture and subordinates’ and supervisors’ interactions in determining engagement and employee conduct. The ideas for improving the subordinate-supervisor relationship presented by Winarno and colleagues (2022) should be helpful for healthcare leaders who would like to strengthen organizational support for HRM practices. By identifying factors that enable or hinder engagement in the Workplace, healthcare organizations can reduce turnover intention and improve the quality of staff performance, which will, in one way or another, improve patient care.

Turnover in Healthcare Organizations

Voluntary turnover is a significant issue for healthcare organizations that has far-reaching implications for maintaining organizational integrity and, more importantly, delivering quality patient care. Corbin (2020) categorizes turnover in healthcare as voluntary, which entails the staff members being let go of their own accord for various reasons, including promotion, retirement, resignation, or otherwise involuntary dismissal. The increasing age of employees makes healthcare organizations face challenges because many retiring employees are not easy to recruit (Bae, 2022). Job satisfaction, perception of workload, receiving or not receiving recognition at the Workplace, organizational support, and restructuring are some of the determinants contributing to voluntary turnover. In contrast, involuntary turnover results from restructuring or downsizing (Corbin, 2020).

The significance of turnover goes beyond the simple correlation with staffing. Still, it causes disruptions in the continuity of patient care, in addition to generating service discontinuities that can pose a direct impact on healthcare. The costs include not only the expenses connected with the first employment of the new workers and their training but also the decrease in productivity during the organizational changes. High turnover is directly related to low morale, demoralized workers, and increased workload for the few workers that are left behind, thus worsening the organization’s performance. Furthermore, turnover destabilizes the multidisciplinary delivery teams and erodes the organizational expertise necessary for building and sustaining adequate patient-clinician relationships (Giallouros et al., 2023). There is no universal solution for turnover, but it should be accentuated by restoring employees’ organizational commitment and job satisfaction and establishing support systems in healthcare organizations, as Corbin (2020) notes.

Willard-Grace et al. (2019) also undertook a cross-sectional online survey to determine the turnover in healthcare organizations with particular references to primary care clinicians and other healthcare employees. They argue that voluntary and involuntary turnover negatively impacts workforce cohesiveness, patient care, and organizational performance. Staff turnover destabilizes teams, causes additional costs relevant to hiring and training, and aggravates human capital weakness, particularly in healthcare, especially in rural settings (Saks et al., 2020). Other antecedents of turnover include work-to-family conflict, work burnout, job satisfaction, job demands, and workplace environment. Paying particular attention to burnout, a state similar to exhaustion and depersonalization alongside a decreased rate of personal achievement, it has been established that it is highly correlated with decreased job satisfaction coupled with increased turnover intent among the workers in the health sector (Willard-Grace et al., 2019).

Turnover in Healthcare Organizations

Willard-Grace et al. (2019) also undertook a cross-sectional online survey to determine the turnover in healthcare organizations with particular references to primary care clinicians and other healthcare employees. They argue that voluntary and involuntary turnover negatively impacts workforce cohesiveness, patient care, and organizational performance. Staff turnover destabilizes teams, causes additional costs relevant to hiring and training, and aggravates human capital weakness, particularly in healthcare, especially in rural settings (Saks et al., 2020). Other antecedents of turnover include work-to-family conflict, work burnout, job satisfaction, job demands, and workplace environment. Paying particular attention to burnout, a state like exhaustion and depersonalization alongside a decreased rate of personal achievement, it has been established that it is highly correlated with decreased job satisfaction coupled with increased turnover intent among the workers in the health sector (Willard-Grace et al., 2019).

Consequences of Turnover in Healthcare

This paper describes the problems associated with turnover rates, including medical errors, patient complaints, and disruption in care services. In addition, turnover affects workforce planning and funding for staffing since the need for healthcare staff is still rising. Treating the causes of employee turnover, including healthcare employee burnout and job dissatisfaction, are critical factors that can support the healthcare system’s employee turnover rates (Willard-Grace et al., 2019). A quantitative cross-sectional survey by Mengstie (2020) examined the relationship between perceived organizational justice and turnover intentions of hospital healthcare workers. Employee turnover, which spans mobility within and between organizations by either choice or force, is a determinant of organizational operations, employee satisfaction, and organizational performance, particularly in the healthcare segment (Hancock et al., 2013).

Mengstie (2020) postulated that perceived organizational justice significantly influences turnover intentions because organizations with a high perception of fairness and equity would have high perceptions of retention. Perceived justice causes demoralization and a high turnover rate among employees. Other comprehensible factors, including dissatisfaction, burnout, lack of support, and promotion, are frequent causes of general voluntary turnover (Bae, 2022). Furthermore, contractual turnover may emanate from retrenchments or dismissals, and these are unfavorable forces affecting the morale and performance of the workforce, affecting patient care services (Poon et al., 2022). Mengstie (2020) opines that psychological justice, such as equitable, procedural, and remunerative justice, enhances working relationships and optimizes patient care. According to Poole et al. (2022), turnover intention is now a trending problem in healthcare, particularly concerning COVID-19. The pandemic has compounded the work demands without a proportional staffing upgrade, especially in the health sector, thus resulting in increased turnover among health workers worldwide. The research provokes essential concerns about the efficacy of incentives focused on decreasing attrition in healthcare employees. The pandemic has augmented work enlists for health care staff, which has resulted in their fatigue, burnout, and low morale, which therefore increases their turnover intentions (Poon et al., 2022).

The review also looks at the peculiar concerns of specific occupational categories of the healthcare workforce, including migrant ones and others. Other factors such as language, religion, and color finish the concept of turnover intentions in these groups. Further studies should investigate other antecedents of turnover intentions in HWCW and the ways of enhancing job quality and preventing burnout (Poon et al., 2022). Schaap and Olckers (2020) sought to add to the knowledge of the volatile nature of voluntary turnover within organizations by analyzing the retention factors and attitudinal determiners connected to it. They described their research as focusing on all the factors of ER rather than the partial factors, which other researchers have done before. Schaap and Olckers (2020) highlighted that gender affects the relationship between ER factors and turnover precursors, which include affective commitment, job satisfaction, and turnover intentions, which implies that it is essential to appreciate these complex interactions to design sound retention strategies for the current workforce.

This study is critical in healthcare settings since a slight shift in the degree of engagement of employees has led to adverse impacts on the quality of care to patients. Organizational engagement is determined to play a significant role in turnover, meaning that every organization should ensure that engagement levels have low turnover rates. One of the reasons for keeping employee commitment and job satisfaction is that healthcare organizations must maintain staff and deliver quality patient care. However, pressure in organizations, culture, and leader behavior are some factors that hamper engagement and turnover intention (Schaap & Olckers, 2020).

Studying the role of distributed leadership by conducting a survey based on the Share Governance program, Quek et al. (2021) examined the perception of direct care nursing staff in one of the large UK hospitals on engagement, empowerment, job satisfaction, and turnover intentions. The study gave a theoretical and quantitative understanding of the effects of distributed leadership on the engagement and turnover of ASN employees. The study also indicates high levels of distributed leadership, where decision-making is delegated and collaborative work, improving the efficiency of employees’ responsibilities and the degree of organizational commitment that decreases turnover intentions and increases employee satisfaction. It also analyzed the moderating role of job satisfaction in the connection between engagement and turnover: in this regard, the role of a positive work climate and shared leadership in retaining employees is stressed (Quek et al., 2021).

Impact of Turnover on Patient Care Quality

Sabei et al. (2020) systematically investigated the impact of turnover on patient care quality within nursing environments in Oman. However, this study reiterated that nurses’ turnover intention is highly related to patient care quality. The proposed vital concern, involvement in the role of hospital affairs, staffing adequacy, and perceived quality of care, was found to be peer-crucial antecedents to turnover intention and the subsequent outcomes that include burnout and perceived care quality (Sabei et al., 2020). The study pointed out that workplace practices such as nurse engagement and adequate staffing act as moderators to lessen the impact of turnover intention in a negative manner for patient care.

Further, in the same study, the authors used the logistic regression analysis to find that hospital and nurse characteristics predicting lower turnover intentions include factors such as aspects of hospital employee satisfaction and benefit packages. This analysis also pointed out that the level of job satisfaction exists as a mediator that reduces the extent of the link between poor workplace environment and turnover intention. The hint is that boosting job satisfaction could help nurse retention and patient care outcomes. Additionally, the study established that staff turnover was injurious to the continuity of care and safety of the patients with nurses (Sabei et al., 2020). The study also emphasized that the high turnover leads to the variability of caregiver involvement and may, therefore, negatively impact patients’ care due to shift changes and decreased awareness of patients’ history and treatment plans. They point out that this situation not only affects the other remaining nurses but also the quality and extent of care that is given to patients.

A similar study conducted by Bautista et al. (2020) also supported these findings that addressed how nursing turnover rates predicted the quality of patient care. Their study was done with 427 staff nurses in a tertiary-level private hospital in Metro Manila, Philippines. The highlighted stressor in their research was workload, which negatively affected job satisfaction and perceived care quality among the nurses. Heavy workloads significantly undermine nurses’ ability to provide attentive patient care, reducing patient satisfaction and potentially compromising patient safety (Bautista et al., 2020).

Regarding workload and nurse conflicts, Bautista et al. (2020) noted a positive correlation to examine the impacts of high-stress working environments in specific organizations and the relation of turnover intentions to the quality of their patient-oriented work. Patient turnover is vital because continuity of care is necessary for satisfaction due to patient’s dependency on specific caregivers. This disruption is associated with reduced patient satisfaction with healthcare providers. Since they intend to leave soon, their departure creates a knowledge-skill “vacuum” that entry-level personnel take time to fill. Therefore, this knowledge gap increases the chances of making errors and reduces the efficiency of healthcare services because of a need for more knowledge of hospital policies and patients’ needs (Bautista et al., 2020).

Nurse conflict of interest is a situation where, through affinity, perception, or other influences, personal interests affect the nurse’s decision-making or overall responsibilities (Milliken, 2018). This can cause ethical issues, poor collaboration, and reduced quality of healthcare services. Such conflicts may include those resulting from work priorities and preferences or bias based on social relations. These conflicts can lead to inter and intrapersonal conflicts that, in turn, raise stress levels, decrease satisfaction at work, and, in some cases, contribute to higher turnover rates. Conflict of interest among the nursing staff also leads to high turnover, so the working environment becomes less motivating and has low satisfaction level. Resolving these conflicts through staffing and conflict management training can decrease turnover, increase client satisfaction, and enhance patient care results (Bautista et al., 2020). Gandhi and Grabowski (2021), supported by various detailed reports in their paper, strengthen the message that nursing staff turnover significantly negatively affects the quality of patient care in nursing homes. Based on the large sample of data from the CMS, the study demonstrates that turnover rates are unacceptably high – with an average turnover of only 6 percent of the ninety facilities in the sample studied in the 15,645 facilities included. Such turnover rates imply a high rate of change in the workforce, which is very unhelpful to the patient because of the fluctuations in care provided (Gandhi & Grabowski, 2021).

A study by Gandhi and Grabowski (2021) showed that high employee turnover rates fueled adverse patient care outcomes. This high turnover reduces the chances of the employed nurses developing good relationships with the residents, which RCFs need so much for the proper care of their residents. Particular attention should be paid to patients with high turnover rates receiving a lower quality of care due to instability; all patients need constant, attentive, and available care for their conditions that require ongoing, repeated attention and adequate care plans. Further, excessive fluctuation of staff groups leads to such negative consequences as enhanced rates of medical mistakes, inadequate communication, and poor organization of the activities that form the provisions of care. The simplest and the most profound relationship that can be drawn is between turnover and star ratings. Interestingly, our results reveal that when turnover increases, adjusted star ratings or ratings adjusted for the size of the facility decline, thus implying poor performance and lower ratings. This is another way for us to understand that turnover is not only a staffing issue but a concern that compromises the quality of patient care. Lower-rated Long-Term Care Hospitals are observed to be far more vulnerable to falls, pressure ulcers, and infections, which require adequate, routine, and competent care.

Besides, it nurtures links between turnover and patient turnover, which results in satisfaction. Other similar aspects that patients and families consider significantly include fostering patient relations and operative steadiness. These relationships are broken when employee switchovers are frequent, leading to dissatisfaction among the patients, who perceive a decrease in the quality of health care they are receiving. This could also be seen at the community level because their satisfaction is severely reduced, which may have a more significant effect on the occupancy factor of the facility in question. This work is also based on others quoted by Gandhi and Grabowski (2021) regarding the matter of high turnover resulting in pecuniary ramifications and an effect on the quality of patient care. It also has other employee benefits, such as increased remuneration and job satisfaction. At the same time, it negatively affects the finances of the health facilities through high turnover rates, implying high costs of recruiting and training new employees when many funds could otherwise be channeled to factors such as the development of patient care and services infrastructure (Eliyana et al., 2018). It also leads to never-ending training processes and constant turnover; the facility is always bringing in fresh employees, so even the novices are being assigned to the care of residents, which is detrimental to care quality.

These crucial outcomes highlight the need to include turnover in improving patient care outcomes in nursing homes. If turnover rates are to be reported to the nursing home compared to site factors like policies, the payers and policymakers will also be put in a position to know what may help to advance towards the decrease in turnover. Nursing homes may focus on activities to improve staff turnover, such as improving the satisfaction of employees their wages and encouraging them to advance in the profession. However, it can be stated that the insights provided by Gandhi and Grabowski (2021) are relevant to my particular focus on the subject, namely, employee engagement in healthcare organizations, as it sheds light on the difference between engaged vs. marginally motivated workers coupled with high turnover rates and the subsequent decline in patient satisfaction. Those with open minds will likely work with their employer longer to produce the quality services needed for patient experience (Gandhi & Grabowski, 2021). Thus, knowing how the Workplace could encourage employee engagement could be appropriate for minimizing turnover effects analyzed in this research. Regarding staff engagement, the key messages evolve as it is a pathway for improving organizational performance and staff retention and enhancing health care quality.

Recent studies have pointed out the excessive negative impact of nurse burnout and turnover rates on patient care quality and hospital outcomes. According to Kelly et al.’s 2021 study, 54% of nurses showed moderate-level burnout-emotional exhaustion scores increased by 10%, while the cynicism score rose by 19% in one year. Therefore, these authors established a strong association between burnout and organizational turnover. For every unit increase on the emotional exhaustion scale, the probability of a nurse leaving increased by 12%. This high turnover rate can significantly affect the quality of care provided to the patients, as would be obtained from the systematic review by Shin et al. (2019), which reported inverse relationships between nurse staffing levels and hospital-acquired conditions. Not all these relationships reached statistical significance, but most studies reviewed indicated that lower levels of nurse staffing are associated with higher rates of hospital-acquired conditions and underscore that adequate nurse staffing is a crucial determinant of the quality of patient care. Consequences of burnout among nurses extend beyond issues of turnover and staffing. Kwon et al. (2021) reported moderate to high levels of emotional labor and burnout among nursing staff within the setting of a South Korean university hospital; 23% of participants had medical errors within the previous six months. Significant positive correlations were found between emotional labor burnout and turnover intention; their study reflected a complex interplay that may impact patient safety outcomes. These outcomes impress healthcare organizations, who need to adopt concrete policies regarding nurse burnout and turnover. This may be done through frequent measurement of burnout, support for the welfare of employees, improvement in working conditions, and considering job assignments when managing emotional labor. In so doing, hospitals would have a possible opportunity to reduce their turnover rates and that of hospital-acquired conditions, thereby upscaling the quality of care.

Consequences of burnout among nurses extend beyond issues of turnover and staffing. Kwon et al. (2021) reported moderate to high levels of emotional labor and burnout among nursing staff within the setting of a South Korean university hospital; 23% of participants had medical errors within the previous six months. Significant positive correlations were found between emotional labor burnout and turnover intention; their study reflected a complex interplay that may impact patient safety outcomes. These findings impress on healthcare organizations the urgent need to adopt concrete policies regarding nurse burnout and turnover. This may be done through frequent measurement of burnout, support for the welfare of employees, improvement in working conditions, and considering job assignments when managing emotional labor. In so doing, hospitals would have a possible opportunity to reduce their turnover rates and that of hospital-acquired conditions, thereby upscaling the quality of care.

Strategies to Enhance Employee Engagement and Reduce Turnover

As Ghazawy et al. (2021) expressed, employee engagement plays an important role or function in facilities dealing with health issues, especially concerning patient safety and care. Their findings underscore the significance of organizational conditions in fostering engagement among healthcare professionals, particularly nurses. Key determinants identified include motivational factors, incentives, and autonomy in decision-making, which are crucial for sustaining high levels of work engagement (Ghazawy et al., 2021). Prospective strategies revealed in the study focus on the aspect of resource availability. Ghazawy et al. (2021) found that the availability of essential utilities, appropriate instruments, and sufficient arrangements help reduce stress at work workplace and increase satisfaction levels, which increases the morale of employees in the healthcare sector.

Furthermore, organizational support that entails developmental opportunities, including career map advancement schemes and feedback mechanisms, plays a critical role in the level of engagement of nurses. These initiatives help create positive interaction among the nursing workforce, thus raising workforce engagement (Greer et al., 2018). The mentioned environments support participation in knowledge-sharing processes and maintain interest in specific topics among staff members (Ghazawy et al., 2021). Thus, performance feedback is revealed as one of the key drivers for increasing individuals’ awareness and motivation to act aligned with organizational objectives among nurses (Ghazawy et al., 2021). Furthermore, avenues for professional development through education and training are outlined as recommendations that can be used to increase employees’ satisfaction and boost the engagement bar (Ghazawy et al., 2021). Regarding turnover intentions, the study has proposed the following interventions: Better work-life balance, Career growth opportunities, and finally, incentives and promotions (Ghazawy et al., 2021). They are essential strategies that must be taken to reduce turnover as a risk factor and build a stable staff in the context of healthcare organizations. Increasing work engagement not only benefits the performance of healthcare workers but also reduces their turnover intentions, which underlines the value of the concept of healthcare managers’ practice (Ghazawy et al., 2021). He further explains that to reduce turnover and enhance employee retention, organizations should apply specific frameworks, for example, the 5Es: engage, empower, energize, enable, and encourage (Ghazawy et al., 2021).

To harmonize the nursing workforce and structure an optimal working environment, regularity of performance feedback, and sustaining complicated skills, increased prospects in elevating nurses” commitment have been discovered in healthcare facilities. These activities increase job performance, decrease turnover intentions, enhance patient care quality, and preserve jobs. Tomietto et al. (2019) undertook an extensive literature review to establish a complex relationship between work engagement, perceived work ability, job satisfaction, and turnover intentions among nurses. Their work gives a comprehensive account of practical steps and recommendations regarding the improvement of the levels of employee involvement and the rates of turnover in healthcare institutions. Stressing that work engagement defines organizational commitment and the well-being of new social workers, work engagement the authors designed and tested a theoretical model to calculate engagement’s contribution to perceived work ability. That is why developing the appropriate engagement-promoting psychosocial climate seems critically important, as it brings improved job satisfaction, reduced turnover intentions, and enhanced workforce satisfaction.

A comparison between a tested model and an adaptation of it by Tomietto et al. (2019) shows acceptable fit indices on the preliminary and multi-group tests. Their findings emphasized the strong relationship between work engagement and workability regarding the nurses, stating that higher levels of work engagement will positively predict perceived work ability. There is uniqueness in the findings of this relationship to moderately and positively enhance job satisfaction and reduce turnover intention among nursing staff. These dynamics suggested specific strategies for different age groups, which pointed out motivational frameworks to increase participation and continuity rates. Recognizing and providing for the needs of nurses in the various age categories is significant, especially for healthcare organizations that aspire to develop and implement efficient human resource management strategies. Approaches like skills enhancement, training and development chances, and motivational approaches that suit young nurses specifically appeal to the younger lot of nurses. For older nurses, leveraging their experience through mentorship opportunities and promoting work-life balance can reduce turnover rates.

Another contribution of this study is identifying job satisfaction as a moderator of workability and turnover intention. Proper organizational policies and effective practices should be implemented regarding a friendly working environment, favorable remunerations, appropriate staff numbers, and the possibility of getting psychological help to improve nurses’ satisfaction with their work and their perceived work ability. These interventions not only enhance workforce loyalty but also assist building of organizational infrastructure. The study by Tomietto et al. (2019) also recommends engagement models’ ongoing assessments and modifications in response to shifting nursing demands. Evaluation techniques and proactive monitoring of the levels of engagement are fundamental for efficiently identifying such problems. Based on the need of nursing for functioning capacity, work satisfaction, and organizational indexes leading to the quality of the patient’s care and diminished turnover levels, it is crucial for the stakeholders to be involved in formulating personal and environmental fit strategies.

Emerging Trends

Recent research on employee engagement and turnover in healthcare settings reflects the evolving challenges faced by the industry, particularly in the wake of the COVID-19 pandemic. They articulate the relationships between burnout, job satisfaction, and turnover intention among the healthcare workforces. Schlosser et al. (2022) investigated how the changes within the work nursing environment after the pandemic affected the nurse retention rate, highlighting the significance of the use of resilience-building interventions as well as enhancing organizational support. Their research posits that healthcare organizations that have adopted the culture to capture the psychological impact of the pandemic have higher engagement and lower turnover. Based on this, Jiménez-Picon and his colleagues explored the link between burnout and emotional intelligence and realized that improving emotional competencies may prevent turnover intention. The idea of ‘moral injury’ has emerged more recently in literature; Čartolovni et al. (2021) explore the prevalence and effects of moral injury on HCWs and satisfaction and turnover intentions. Their work confirms the necessity to address the issues of ethical conflicts and moral suffering at work as a strategy to enhance the workforce’s solidity. Within organizational practices, Vries et al. (2023) examined the outcome of diverse retention initiatives undertaken by hospitals to address the current scarcity of healthcare workers.

Towards this end, their study sorts out matters concerning schedule flexibility, opportunities for career advancement, and comprehensive wellness programs as possessing advantages for enhancing high satisfaction levels and keeping down turnover rates. Furthermore, technology has been found to help aspects of diagnosis like AI and telemedicine by Amjad et al. (2023) while stating that technology attributes help to offload many loads of burden but continuously train healthcare workers to make them relevant and interested in using aspects of technology. Altogether, these papers depict the complexity of the definition and concept of employee engagement and turnover in the contemporary healthcare organization, underlining the importance of combining uniting approaches and considering human factors and organizational conditions to stabilize the healthcare staff and strengthen its commitment.

Gaps in Literature

A literature review on employee engagement, turnover, and patient care quality in hospital organizations reveals the directions where current research is insufficient and raises questions that remain beyond answers. Specifically, the causal pattern in the current studies has established a complex relationship between engagement and turnover in the healthcare organization; thus, the current study aims to examine how engagement influences turnover in the healthcare organization. Despite the interest shown in the idea of employee engagement as a means of reducing turnover, as presented in Bandera (2021) and Forde-Johnston and Stoermer (2022), there is a gap in research focusing on the antecedents as well as the process by which engagement impacts on the turnover hypotheses and patterns. Second, the literature analysis points out the need for more studies to evaluate the impact of targeted interventions and strategies to improve engagement levels and minimize turnover among healthcare employees. Although works like that of Ghazawy et al. (2021) contribute to establishing work engagement as a key to guaranteeing patient safety while enhancing care quality, there needs to be more research on the effectiveness of interventions designed for improving engagement and its consequent effects on the turnover rate This void calls for more experimental and follow-up research to evaluate the effectiveness of efforts to
enhance employee engagement and theorized decreased turnover in each organization and the simultaneously improved quality of patient care from the hospital.

Moreover, whereas several studies have explored the relationship between turnover and the quality of patient care, most notably in the nursing workplace settings, there may be a need for further enrichment concerning the various facets of the quality of care influenced by turnover. Although there are existing papers that explain how turnover is a predictor of adverse outcomes like patient safety and experience, as discussed by Sabei et al. in their 2020 study, there is limited scholarly work that elaborates on the mediator variables through which turnover is associated with different aspects of healthcare quality like medication errors, patient outcomes, and readmission rates. Furthermore, the literature review raises awareness of a vital shortcoming that has to do with contextual factors, including culture, practices from the leadership team, and demography of the workforce in determining the dynamics of employee engagement, staff turnover, and quality of patient care in the healthcare facilities under focus. Although some authors like Quek et al. (2021) have tried to investigate the effects of leadership distribution on engagement and turnover intentions of nursing personnel, it is still important that more detailed research efforts are brought to bear on these phenomena in ways that are more sensitive to context-related contingencies in the healthcare sector and among various groups of patients. Based on these gaps, this study finds it necessary to venture further into the concept of patient engagement employed by healthcare organizations to curb turnover and improve the quality of patient care. Thus, these gaps can be addressed in future studies in order to help expand the knowledge of what makes engagement crucial in terms of turnover and patient outcomes in healthcare organizations while guiding the design of scientifically sound interventions and policies that may enhance staff retention and advance the quality of health care.

Additionally, future studies should focus on several specific areas. First, researchers should explore the relationship between employee engagement and turnover and look at the processes and antecedents through which the relationship arises in healthcare organizations. This could include looking at moderating psychological, organizational, and social variables that influence the relationship between engagement and turnover. Furthermore, there needs to be more experimental or longitudinal research assessing the impact of targeted interventions that may be employed to increase employment engagement levels, especially where the goal is to decrease turnover. These should target broad classes of interventions, including leadership development, teamwork, and job redesign, and these should measure the direct effects on turnover and the quality of patient care. Therefore, it is necessary for future studies to identify exactly which aspects of quality in the healthcare context, including medication errors, patient outcomes, and readmission rates, will be impacted by turnover. Exploring the intermediary variables through which these outcomes are associated with turnover will enable the comprehensiveness of turnover effects on healthcare quality. However, organizational culture, leadership, and workforce characteristics should be examined more deeply to examine their mediating effect on the relationship between employee engagement, turnover, and patient care quality. Subsequent research should be conducted with specific regard to the contingencies of the healthcare context so that observations are helpful in different healthcare settings. Future studies could then build comprehensive theoretical and empirical models that capture engagement, turnover, and care quality, such that best practices for retaining employees and enhancing care quality can be translated into operating healthcare organizations. This line of inquiry will help extend the knowledge about how to engage people, resulting in decreased turnover and better patient outcomes.

Summary

The literature review revealed various dynamics of employee engagement, turnover, and impacts on patient care quality in health sectors. The study highlighted the importance of employee engagement as a critical factor influencing employee turnover and organizational performance, especially within the care sector, by illustrating the relationship between the level of engagement or the lack thereof, employee attrition rates, and patients” experiences. The crucial conceptual area discussed included defining employee engagement, understanding the losses that healthcare organizations and, ultimately, the patients bear due to turnover, and linking engagement and turnover based on theoretical and empirical studies. From the existing literature, some critical findings were highlighted about the factors affecting engagement and turnover and the approaches that could be used for reducing turnover and increasing engagement; nonetheless, several gaps in the knowledge were observed.

The reviewed literature reveals several consistencies: Employee engagement is a crucial predictor that might effectively predict turnover and raise the quality of patient care; Organizational culture, leadership behavior, and workforce characteristics were highlighted as significant antecedents of engagement and turnover patterns. However, as to the details of how each of these theoretical frames relates to engagement and turnover, the moderating mechanisms through which engagement affects turnover rates. Furthermore, there were discrepancies between the two frames regarding the interventions reported to improve engagement and reduce turnover and the moderating effects of turnover on various aspects of patient care. Such gaps are evident in the need to conduct further studies to understand these intricate relationships and develop future interventions and policies to increase workforce retention and the quality of care offered within healthcare organizations. However, more studies are needed to compare the effectiveness of targeted engagement with other types of engagement and the mediational mechanisms connecting engagement to turnover and patient outcomes. Furthermore, the development of studies examining cross-sectional and interactive engagement and turnover tendencies in different healthcare areas and relieving power populations is needed. Such gaps should be filled to improve the knowledge of the connected mechanisms further, helping to work out proper measures aimed at increasing the confident interest of employees, decreasing their turnover rates, and, accordingly, raising the quality of patients’ care.

Chapter 3 will expand on the findings from the literature review and propose the research methodology and design to analyze the correlation between employee engagement, employee turnover, and patient care quality in healthcare organizations. Considering the outlined research limitations and gaps within the existing literature, the study adopts a strict methodological paradigm based on theoretical principles and empirical data to address such issues.

Chapter 3: Research Method

Begin writing here…

Checklist:

☐ Begin with an introduction and restatement of the problem and purpose sentences verbatim.

☐ Provide a brief overview of the contents of this chapter, including a statement that identifies the research methodology and design.

Research Methodology and Design

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Checklist:

☐ Describe the research methodology and design. Elaborate upon their appropriateness in relation to the study problem, purpose, and research questions.

☐ Identify alternative methodologies and designs and indicate why they were determined to be less appropriate than the ones selected. Do
not simply list and describe research methodologies and designs in general.

Population and Sample

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Checklist:

☐ Describe the population, including the estimated size and relevant characteristics.

☐ Explain why the population is appropriate, given the study problem, purpose, and research questions.

☐ Describe the sample that will be (proposal) or was (manuscript) obtained.

☐ Explain why the sample is appropriate, given the study problem, purpose, and research questions.

☐ Explain the type of sampling used and why it is appropriate for the dissertation proposal methodology and design. For qualitative studies, evidence must be presented that saturation will be (proposal) or was (manuscript) reached. For quantitative studies, a power analysis must be reported to include the parameters (e.g., effect size, alpha, beta, and number of groups) included, and evidence must be presented that the minimum required sample size will be (proposal) or was (manuscript) reached.

☐ Describe how the participants will be (proposal) or were (manuscript) recruited (e.g., email lists from professional organizations, flyers) and/or the data will be (proposal) or were (manuscript) obtained (e.g., archived data, public records) with sufficient detail so the study could be replicated.

Materials or Instrumentation

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☐ Describe the instruments (e.g., tests, questionnaires, observation protocols) that will be (proposal) or were (manuscript) used, including information on their origin and evidence of their reliability and validity. OR as applicable, describe the materials to be used (e.g., lesson plans for interventions, webinars, or archived data, etc.).

☐ Describe in detail any field testing or pilot testing of instruments to include their results and any subsequent modifications.

☐ If instruments or materials are used that were developed by another researcher, include evidence in the appendix that permission was granted to use the instrument(s) and/or material(s) and refer to that fact and the appendix in this section.

Operational Definitions of Variables

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XXX

Text…

Checklist:

☐ For quantitative and mixed methods studies, identify how each variable will be (proposal) or was (manuscript) used in the study. Use terminology appropriate for the selected statistical test (e.g., independent/dependent, predictor/criterion, mediator, moderator).

☐ Base the operational definitions on published research and valid and reliable instruments.

☐ Identify the specific instrument that will be (proposal) or was (manuscript) used to measure each variable.

☐ Describe the level of measurement of each variable (e.g., nominal, ordinal, interval, ratio), potential scores for each variable (e.g., the range [0–100] or levels [low, medium, high]), and data sources. If appropriate, identify what specific scores (e.g., subscale scores, total scores) will be (proposal) or were (manuscript) included in the analysis and how they will be (proposal) or were (manuscript) derived (e.g., calculating the sum, difference, average).

Study Procedures

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☐ Describe the exact steps that will be (proposal) or were (manuscript) followed to collect the data, addressing what data as well as how, when, from where, and from whom those data will be (proposal) or were (manuscript) collected in enough detail the study can be replicated.

Data Analysis

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☐ Describe the strategies that will be (proposal) or were (manuscript) used to code and/or analyze the data, and any software that will be (proposal) or was (manuscript) used.

☐ Ensure the data that will be (proposal) or were (manuscript) analyzed can be used to answer the research questions and/or test the hypotheses with the ultimate goal of addressing the identified problem.

☐ Use proper terminology in association with each design/analysis (e.g., independent variable and dependent variable for an experimental design, predictor and criterion variables for regression).

☐
For quantitative studies, describe the analysis that will be (proposal) or was (manuscript) used to test each hypothesis. Provide evidence the statistical test chosen is appropriate to test the hypotheses and the data meet the assumptions of the statistical tests.

☐
For qualitative studies, describe how the data will be (proposal) or were (manuscript) processed and analyzed, including any triangulation efforts. Explain the role of the researcher.

☐
For mixed methods studies, include all of the above.

Assumptions

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☐ Discuss the assumptions along with the corresponding rationale underlying them.

Limitations

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☐ Describe the study limitations.

☐ Discuss the measures taken to mitigate these limitations.

Delimitations

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☐ Describe the study delimitations along with the corresponding rationale underlying them. An example of delimitations are the conditions and parameters set intentionally by the researcher or by selection of the population and sample.

☐ Explain how these research decisions relate to the existing literature and theoretical/conceptual framework, problem statement, purpose statement, and research questions.

Ethical Assurances

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Checklist:

☐ Confirm in a statement the study will (proposal) or did (manuscript) receive approval from Northcentral University’s Institutional Review Board (IRB) prior to data collection.

☐ If the risk to participants is greater than minimal, discuss the relevant ethical issues and how they will be (proposal) or were (manuscript) addressed.

☐ Describe how confidentiality or anonymity will be (proposal) or was (manuscript) achieved.

☐ Identify how the data will be (proposal) or were (manuscript) securely stored in accordance with IRB requirements.

☐ Describe the role of the researcher in the study. Discuss relevant issues, including biases as well as personal and professional experiences with the topic, problem, or context. Present the strategies that will be (proposal) or were (manuscript) used to prevent these biases and experiences from influencing the analysis or findings.

☐ In the dissertation manuscript only, include the IRB approval letter in an appendix.

Summary

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☐ Summarize the key points presented in the chapter.

☐ Logically lead the reader to the next chapter on the findings of the study.

Chapter 4: Findings

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Checklist:

☐ Begin with an introduction and restatement of the problem and purpose sentences verbatim and the organization of the chapter.

☐ Organize the entire chapter around the research questions/hypotheses.

XXX of the Data

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Checklist:

☐ For qualitative studies, clearly identify the means by which the trustworthiness of the data was established. Discuss credibility (e.g., triangulation, member checks), transferability (e.g., the extent to which the findings are generalizable to other situations), dependability (e.g., an in-depth description of the methodology and design to allow the study to be repeated), and confirmability (e.g., the steps to ensure the data and findings are not due to participant and/or researcher bias).

☐ For quantitative studies, explain the extent to which the data meet the assumptions of the statistical test and identify any potential factors that might impact the interpretation of the findings. Provide evidence of the psychometric soundness (i.e., adequate validity and reliability) of the instruments from the literature as well as in this study (as appropriate). Do
not merely list and describe all the measures of validity and reliability.

☐ Mixed methods studies should include discussions of the trustworthiness of the data as well as validity and reliability.

Results

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Checklist:

☐ Briefly discuss the overall study. Organize the presentation of the results by the research questions/hypotheses.

☐ Objectively report the results of the analysis without discussion, interpretation, or speculation.

☐ Provide an overview of the demographic information collected. It can be presented in a table. Ensure no potentially identifying information is reported.

Research Question 1/Hypothesis
Text…

☐ Report all the results (without discussion) salient to the research question/hypothesis. Identify common themes or patterns.

☐Use tables and/or figures to report the results as appropriate.

☐ For quantitative studies, report any additional descriptive information as appropriate. Identify the assumptions of the statistical test and explain how the extent to which the data met these assumptions was tested. Report any violations and describe how they were managed as appropriate. Make decisions based on the results of the statistical analysis. Include relevant test statistics,
p values, and effect sizes in accordance with APA requirements.

☐ For qualitative studies,
describe the steps taken to analyze the data to explain how the themes and categories were generated. Include thick descriptions of the participants’ experiences. Provide a comprehensive and coherent reconstruction of the information obtained from all the participants.

☐ For mixed methods studies,
include all of the above.

Evaluation of the Findings

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Checklist:

☐ Interpret the results in light of the existing research and theoretical or conceptual framework (as discussed in Chapters 1 and 2). Briefly indicate the extent to which the results were consistent with existing research and theory.

☐ Organize this discussion by research question/hypothesis.

☐ Do
not draw conclusions beyond what can be interpreted directly from the results.

☐ Devote approximately one to two pages to this section.

Summary

Begin writing here…
Checklist:
☐ Summarize the key points presented in the chapter.

Chapter 5: Implications, Recommendations, and Conclusions

Begin writing here…
Checklist:

☐ Begin with an introduction and restatement of the problem and purpose sentences verbatim, and a brief review of methodology, design, results, and limitations.

☐ Conclude with a brief overview of the chapter.

Implications

Begin writing here…
Checklist:

☐ Organize the discussion around each research question and (when appropriate) hypothesis individually. Support all the conclusions with one or more findings from the study.

☐ Discuss any factors that might have influenced the interpretation of the results.

☐ Present the results in the context of the study by describing the extent to which they address the study problem and purpose and contribute to the existing literature and framework described in Chapter 2.

☐ Describe the extent to which the results are consistent with existing research and theory and provide potential explanations for unexpected or divergent results.

☐ Identify the most significant implications and consequences of the dissertation (whether positive and/or negative) to society/desired societal outcomes and distinguish probable from improbable implications.

Research Question 1/Hypothesis
Text…

Recommendations for Practice

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Checklist:

☐ Discuss recommendations for how the findings of the study can be applied to practice and/or theory. Support all the recommendations with at least one finding from the study and frame them in the literature from Chapter 2.

☐ Do
not overstate the applicability of the findings.

Recommendations for Future Research

Begin writing here…
Checklist:

☐ Based on the framework, findings, and implications, explain what future researchers might do to learn from and build upon this study. Justify these explanations.

☐ Discuss how future researchers can improve upon this study, given its limitations.

☐ Explain what the next logical step is in this line of research.

Conclusions

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Checklist:

☐ Provide a strong, concise conclusion to include a summary of the study, the problem addressed, and the importance of the study.

☐ Present the “take-home message” of the entire study.

☐ Emphasize what the results of the study mean with respect to previous research and either theory (PhD studies) or practice (applied studies).

References

Alenezi, A., McAndrew, S., & Fallon, P. (2019). Burning out physical and emotional fatigue: Evaluating the effects of a program aimed at reducing burnout among mental health nurses,
28(5), 1045-1055. https://doi.org/10.1111/inm.12608

Alkhraishi, m. Y., Eivazzadeh, N., & Yeşiltaş, M. (2023). The impact of burnout on turnover intention among nurses: The mediating role of job satisfaction.
Hacettepe Sağlık İdaresi Dergisi,
26(1), 1-28.

Amjad, A., Kordel, P., & Fernandes, G. (2023). A review on innovation in healthcare sector (telehealth) through artificial intelligence.
Sustainability,
15(8), 6655.

https://doi.org/10.3390/su15086655

Bae, S. H. (2022). Noneconomic and economic impacts of nurse turnover in hospitals: A systematic review.
International Nursing Review,
69(3), 392-404.

https://doi.org/10.1111/inr.12769

Bakker, A. B., & Demerouti, E. (2007). The job demands‐resources model: State of the art.
Journal of Managerial Psychology,
22(3), 309–328. https://doi.org/10.1108/02683940710733115

Calecas, K. J. (2019). Job satisfaction, employee engagement, and turnover intention in federal employment.

https://scholarworks.waldenu.edu/dissertations/6978/

Campbell, S., Greenwood, M., Prior, S., Shearer, T., Walkem, K., Young, S., Bywaters, D., & Walker, K. (2020). Purposive sampling: Complex or simple? research case examples.
Journal of Research in Nursing,
25(8), 652–661. https://doi.org/10.1177/1744987120927206

Čartolovni, A., Stolt, M., Scott, P. A., & Suhonen, R. (2021). Moral injury in healthcare professionals: A scoping review and discussion.
Nursing ethics,
28(5), 590-602.

https://doi.org/10.1177/0969733020966776

Chung, H., Quan, W., Koo, B., Ariza-Montes, A., Vega-Muñoz, A., Giorgi, G., & Han, H. (2021). A threat of customer incivility and job stress to hotel employee retention: do supervisor and co-worker supports reduce turnover rates?
International Journal of Environmental Research and Public Health,
18(12), 6616.

https://doi.org/10.3390/ijerph18126616

Cypress, B. (2018). Qualitative research methods: A phenomenological focus.
Dimensions of Critical Care Nursing,
37(6), 302-309. https://doi.org/
10.1097/DCC.0000000000000322

De Vries, N., Boone, A., Godderis, L., Bouman, J., Szemik, S., Matranga, D., & De Winter, P. (2023). The race to retain healthcare workers: a systematic review on factors that impact retention of nurses and physicians in hospitals.
INQUIRY: The Journal of Health Care Organization, Provision, and Financing,
60, 00469580231159318.

https://doi.org/10.1177/00469580231159318

Demerouti, E., Bakker, A. B., Nachreiner, F., & Schaufeli, W. B. (2001). The job demands-resources model of burnout.
Journal of Applied Psychology,
86(3), 499–512. https://doi.org/10.1037/0021-9010.86.3.499

Eliyana, A., & Fauzan, R. (2018). Enhancing the employee engagement: The mediating role of exchange ideology.
Jurnal Pengurusan,
53, 61-71.

Fatima, T., Majeed, M., & Shah, S. Z. (2018). Jeopardies of aversive leadership: A conservation of resources theory approach. Frontiers in psychology, 9, 1935.

Giallouros, G., Nicolaidesa, C., Gabrielb, E., Economouc, M., Georgioud, A., Diakourakisa, M., Soterioua, A., & Nikolopoulose, G. K. (2023, June 28).
Enhancing employee engagement through integrating leadership and employee job resources: evidence from a public healthcare setting. Taylor & Francis Online.

https://doi.org/10.1080/10967494.2023.2215754

Gilmartin, H. M., Hess, E., Mueller, C., Connelly, B., Plomondon, M. E., Waldo, S. W., & Battaglia, C. (2022). Learning environments, reliability enhancing work practices, employee engagement, and safety climate in VA cardiac catheterization laboratories.
Health Services Research,
57(2), 385-391.

https://doi.org/10.1111/1475-6773.13907

Greer, & Felicia, T. (2018). Enhancing employee engagement between upper-management and frontline employees: The design of an intervention.

Greer, C. R. (2021).
Strategic human resource management. Pearson Custom Publishing.

Hancock, J. I., Allen, D. G., Bosco, F. A., McDaniel, K. R., & Pierce, C. A. (2013). Meta-Analytic Review of Employee Turnover as a Predictor of Firm Performance. Journal of Management, 39(3), 573-603.

https://doi.org/10.1177/0149206311424943

Jiménez-Picón, N., Romero-Martín, M., Ponce-Blandón, J. A., Ramirez-Baena, L., Palomo-Lara, J. C., & Gómez-Salgado, J. (2021). The relationship between mindfulness and emotional intelligence as a protective factor for healthcare professionals: systematic review.
International Journal of Environmental Research and Public Health,
18(10), 5491.

https://doi.org/10.3390/ijerph18105491

Kelly, L. A., Gee, P. M., & Butler, R. J. (2021). Impact of nurse burnout on organizational and position turnover.
Nursing outlook,
69(1), 96-102.

https://doi.org/10.1016/j.outlook.2020.06.008

Kwon, C. Y., Lee, B., Kwon, O. J., Kim, M. S., Sim, K. L., & Choi, Y. H. (2021). Emotional labor, burnout, medical error, and turnover intention among South Korean nursing staff in a University hospital setting.
International Journal of Environmental Research and Public Health,
18(19), 10111.

https://doi.org/10.3390/ijerph181910111

Milliken, A. (2018). Nurse ethical sensitivity: An integrative review.
Nursing ethics,
25(3), 278-303.

Namin, B. H., Øgaard, T., & Røislien, J. (2021). Workplace incivility and turnover intention in organizations: A meta-analytic review.
International Journal of Environmental Research and Public Health,
19(1), 25.

https://doi.org/10.3390/ijerph19010025

Neubauer, B. E., Witkop, C. T., & Varpio, L. (2019). How phenomenology can help us learn from the experiences of others.
Perspectives on Medical Education,
8(2), 90–97. https://doi.org/10.1007/s40037-019-0509-2

Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoagwood, K. (2015). Purposeful sampling for qualitative data collection and analysis in Mixed Method Implementation Research.
Administration and Policy in Mental Health and Mental Health Services Research,
42(5), 533–544. https://doi.org/10.1007/s10488-013-0528-y

Perreira, T. A., Berta, W., & Herbert, M. (2018). The employee retention triad in health care: Exploring relationships amongst organizational justice, affective commitment and turnover intention.
Journal of clinical nursing,
27(7-8), e1451-e1461.

Poon, Y. S. R., Lin, Y. P., Griffiths, P., Yong, K. K., Seah, B., & Liaw, S. Y. (2022). A global overview of healthcare workers’ turnover intention amid COVID-19 pandemic: A systematic review with future directions.
Human resources for health,
20(1), 1-18.

https://doi.org/10.1186/s12960-022-00764-7

Renjith, V., Yesodharan, R., Noronha, J. A., Ladd, E., & George, A. (2021). Qualitative methods in health care research.
International journal of preventive medicine,
12.

https://doi.org/10.4103%2Fijpvm.IJPVM_321_19

retaining, Re-attracting, and Renewing experienced nursing talent. In
Global Talent Management During Times of Uncertainty (pp. 123-137). Emerald Publishing Limited.

https://www.emerald.com/insight/content/doi/10.1108/978-1-80262-057-320221010/full/html

Roulston, K., & Choi, M. (2018). Qualitative interviews.
The SAGE handbook of qualitative data collection, 233-249.

Saadeh, I. M., & Suifan, T. S. (2020). Job stress and organizational commitment in hospitals: The mediating role of perceived organizational support.
International Journal of Organizational Analysis,
28(1), 226-242.

Saks, A. M., & Gruman, J. A. (2020).
Essentials of Job Attitudes and Other Workplace Psychological Constructs (1st ed.). Routledge.

Seyyedmoharrami, I., Dehaghi, B. F., Abbaspour, S., Zandi, A., Tatari, M., Teimori, G., & Torbati, A. G. (2019). The relationship between organizational climate, organizational commitment and job burnout: Case study among employees of the university of medical sciences. The Open Public Health Journal, 12(1).

http://dx.doi.org/10.2174/1874944501912010094

Shin, S., Park, J. H., & Bae, S. H. (2019). Nurse staffing and hospital‐acquired conditions: A systematic review.
Journal of clinical nursing,
28(23-24), 4264-4275.

https://doi.org/10.1111/jocn.15046

Tannady, H., Tannady, H., & Zami, A. (2019). The Effect of Organizational Culture and Employee Engagement on Job Performance of Healthcare Industry in Province of Jakarta, Indonesia. Quality-Access to Success, 20(169).

https://openurl.ebsco.com/EPDB%3Agcd%3A2%3A28139634/detailv2?sid=ebsco%3Aplink%3Ascholar&id=ebsco%3Agcd%3A135425147&crl=c

Tapp, H., Runyon, M., & Taylor, Y. (2022). Enhancing participant diversity during recruitment for a national COVID-19 surveillance study using stakeholder engagement.

https://doi.org/10.1370/afm.20.s1.2664

Turner, P., & Turner, P. (2020). Employee engagement and the employee experience.
Employee Engagement in Contemporary Organizations: Maintaining High Productivity and Sustained Competitiveness, 1-26.

https://link.springer.com/chapter/10.1007/978-3-030-36387-1_1

Vaismoradi, Mojtaba & Snelgrove, Sherrill (2019). Theme in Qualitative Content Analysis and Thematic Analysis [25 paragraphs]. Forum Qualitative Sozialforschung / Forum: Qualitative Social Research, 20(3), Art. 23,

http://dx.doi.org/10.17169/fqs-20.3.3376

Zajac, S., Woods, A., Tannenbaum, S., Salas, E., & Holladay, C. L. (2021). Overcoming challenges to teamwork in healthcare: A team effectiveness framework and evidence-based guidance.
Frontiers in Communication,
6, 606445.

https://doi.org/10.3389/fcomm.2021.606445

Zuhlke, D. G. (2019).
The impact of ethical leadership on trust levels between employees (Doctoral dissertation, Capella University). https://www.proquest.com/openview/fd52e404bd0960416fecd0d43a0253f0/1?pq-origsite=gscholar&cbl=18750&diss=y”diss=y
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