International SEPT Program, University of Leipzig

RESEARCH REPORT

QUALITY OF WORK LIFE AND TURNOVER INTENTION:

A CROSS-SECTIONAL STUDY OF REGISTERED NURSES
IN HO CHI MINH – VIET NAM

Name of Student : NGUYEN THI NGOC TRAM

Email of Student : xilun1987@yahoo.com
SEPT ID Number : 2013-MBA-M-24
Matriculation Number : 3636422
Module Number : 301Research Report
Supervisor : Prof. Dr. Md. Noor Un Nabi
:Prof. Dr. Nguyen Ngoc Duc
Date of submission : 30/04/2015
Table of Contents
List of Abbreviations ............................................................................................................................. 4
List of Figures ........................................................................................................................................ 4
List of Tables ......................................................................................................................................... 5
1. INTRODUCTION ........................................................................................................................ 6
1.1 Background to research issue ................................................................................................. 6
1.1.1 The nursing workforce worldwide .................................................................................. 6
1.1.2 The nursing workforce in Viet Nam ............................................................................... 7
1.2 Problem statement .................................................................................................................. 8
1.3 Research purpose and objectives .......................................................................................... 10
1.4 Research questions................................................................................................................ 10
1.5 Description of research module ............................................................................................ 10
1.5.1 Description of the relation model of the research framework....................................... 10
1.5.2 Research hypotheses ..................................................................................................... 12
1.6 Investigated variables and constructs ................................................................................... 13
1.6.1 Summary of variables and constructs ........................................................................... 13
1.6.2 List of variables and constructs ..................................................................................... 14
1.7 Research methodology.......................................................................................................... 18
1.7.1 Study design and sample ............................................................................................... 18
1.7.2 Data collection .............................................................................................................. 18
1.7.3 Pre-test plan................................................................................................................... 19
1.7.4 Data coding and cleansing ............................................................................................ 19
2. DATA DESCRIPTION .............................................................................................................. 20
2.1 Response rate ........................................................................................................................ 20
2.2 Nurse Demographic Profile .................................................................................................. 21
2.2.1 Gender profile ............................................................................................................... 23
2.2.2 Age profile .................................................................................................................... 23
2.2.3 Marital status profile ..................................................................................................... 24
2.2.4 Ethnicity profile ............................................................................................................ 25
2.2.5 Education profile ........................................................................................................... 26
2.2.6 Job status profile ........................................................................................................... 26

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 2.2.7 Nursing tenure profile ................................................................................................... 27
2.2.8 Organizational tenure profile ........................................................................................ 27
2.3 Description of Quality of Nursing Work Life ...................................................................... 28
2.3.1 QWL Rating .................................................................................................................. 28
2.3.2 Describing QWL ........................................................................................................... 29
2.4 Description of Turnover Intention ........................................................................................ 34
3. PROJECTION ABOUT THE MASTER THESIS.................................................................. 40
3.1 General trends of the datasets of the study ........................................................................... 40
3.2 Further plan for the master thesis ......................................................................................... 40
3.2.1 Assessment of reliability ............................................................................................... 40
3.2.2 Assessments of validity ................................................................................................. 40
3.2.3 Data analysis ................................................................................................................. 41
3.2.4 Inferential analysis ........................................................................................................ 41
3.2.5 Master thesis plan.......................................................................................................... 42
4. Bibliography ................................................................................................................................. 43
5. Appendix ...................................................................................................................................... 47

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List of Abbreviations
 RNs : Registered Nurses
 QWL : Quality of Work Life
 QNWL : Quality of Nursing Work Life
 USA : United States of America
 ATS : Anticipated Turnover Scale
 AACN : American Association of Critical-care Nurses
 SPSS :Statistical Package for the Social Sciences
 NHS : British National Health Service

List of Figures
Figure 1: The proposition of health staff per 10,000 compare to countries in regions.

Figure 2: The theoretical framework: the effects of Quality of Work Life on turnover intention.

Figure 3: Gender distribution within the study sample.

Figure 4: Age categories for the study sample.

Figure 5: Marital status of respondents.

Figure 6: Number of dependent children profile.

Figure 7: Ethnicity of respondents.

Figure 8: Educational level of respondents.

Figure 9: Employment status profile.

Figure 10: Nursing tenure profile

Figure 11: Organizational tenure of respondents.

Figure 12: Intending to leave vs. intending to stay among nurses.

Figure 13: Turnover intention of respondents by gender.

Figure 14: Turnover intention of respondents by age.

Figure 15: Turnover intention of respondents by marital status.

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Figure 16: Turnover intention of respondents by dependent children.

Figure 17: Turnover intention of respondents by level of education.

Figure 18: Turnover intention of respondents by years as RNs.

Figure 19: Turnover intention of respondents by tenure in the organization.

List of Tables
Table 1: Description of variables and scales.

Table 2: List of constructs and variables in section 1&2.

Table 3: Identification of outliers.

Table 4: Survey response rates.

Table 5: Demographics of the nurse respondents in Ho Chi Minh City.

Table 6: Dependent children by martial status.

Table 7: Total scores and sub-scores for QWL items.

Table 8: Frequency of the factors influencing the work life/home life among nurses.

Table 9: Frequency of factors influencing the work design dimension among nurses.

Table 10: Frequency for factors influencing the work context dimension among nurses.

Table 11: Frequency for factors influencing the work world dimension among nurses.

Table 12: Turnover intention

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1. INTRODUCTION
1.1 Background to research issue

1.1.1 The nursing workforce worldwide

In virtually to all countries, nurses are the largest healthcare provider group as well as the
highest percentage of patient cares, thus their services are essential to the provision of safe and
effective care (Buchan & Calman,2004). Unfortunately, health systems worldwide reported being
experiencing several shortages of qualified Registered Nurses (RNs) (Almalki, FitzGerald & Clark,
2012). According to the Bureau of Labor Statistics‟ Employment Projections 2012-2022, nursing is
listed to be one of the top occupation with expected growth from 2.71 million in 2012 to 3.24 million
in 2022 (Rosseter, 2014). Besides, there is also an expected need for 525,000 replacement nurses in
the workforce that will add up to the total jobs opening for nurses to 1.5 million by 2022 (Rosseter,
2014).Not surprisingly, nursing shortage is not new phenomenon and it is bringing in its wake a
serious crisis in terms of adverse impacts on the health and well-being of populations. Many
countries have experienced cyclical shortage for several decades, however the current shortage
differs markedly from past ones in that today‟s health systems are suffering from pressures exerted
on both supply and demand(Buchan & Calman, 2004).The aging populations, a growing burden of
chronic diseases, and increasing population growth rates are the major factors which causeda
significant increase in the demand for nurses and health services (Miller, 2007; Rosseter, 2014;
Buchan, & Calman, 2004). At the same time,there are several factors which attributes to the
dwindling and worsen supply of available nurses in some countries includinga decline in the number
of young people entering the profession, nursing faculty shortages, aging of the nursing workforce,
low job satisfaction, inadequate resource for training and retaining sufficient numbers of nurses, and
the growth of alternative career opportunities for women (Miller, 2007; Rosseter, 2014; Buchan &
Calman, 2004). It is argued that a shortage of nurses continues to be challengeable when the supply
and demand for nurse still remains significantly misbalancing.

In the tandem to this issue is the high rate of turnover among RNs. According to (Tai, Bame &
Robinson, 1998), nursing has experienced a high turnover rate compared to other healthcare
professionals; for instance, nursing turnover rate is higher than other healthcare workers by 2.3% per
year (Stone, Mooney-Kane, Larson, Pastor, Zwanziger & Dick, 2007). According
toStrachota,Normandi, O'Brien, Clary & Krukow(2003), hospital nursing turnover rate ranked from

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15% to 26% while higher turnover rate ranging from 53% to 100% was reported for nurses working
in long-term healthcare industry. The turnover of nurses continuously remains as a chronic problem
because healthcare administrators are challenging to satisfy and to retain them at every level of
healthcare system (Miller, 2007). Consequence, high rate of nursing turnover negatively affects the
effectiveness and efficiency of health care systems by reducing the health care quality, damaging
work climate, and increasing medical costs. Obviously, there are additional costsfor healthcare
organizations in term of recruiting new employees.The annual nurse staffing survey by the Florida
Hospital Association indicated that filling nursing position could yield a cost of approximately 158.8
million in 2001. Besides its financial expenditures, high turnover also effects work climate where
constant turnover increases conflicts, and reduces satisfaction among stayers (Wallace-Walters,
1992) as well as the effectiveness and efficiency of healthcare delivery system (Fang, 2001).
Therefore, health care systems worldwide not only suffer from the recent shortage of nurses but also
thechallenges related to high turnover rates.

1.1.2 The nursing workforce in Viet Nam

According to (Nguyen et al., 2013), the healthcare system in Viet Nam has been faced several
challenges in term of human resource development, particularly in nursing field. Despite of a recent
increase in the number of health workers, Khuong (2010) states that shortage of human resources
remains as challengeable problems for the healthcare system in Viet Nam as the proposition of nurse
per doctor does not assure the comprehensive care (1.15 compare to 1:3.5 as requirement). In
addition, the proposition of nurse per 10,000 is lowest in South East Asia and around three times
lower than Western Pacific (see Figure 1). According to (Nguyen et al., 2013), low income and poor
working condition are found as the main reasons for nurses to leave the public health sectors or even
the nursing profession. Nurses working in public health sector often engage in private practice in
term of seeking way to earn more income; and many nurses even leave the profession to seek
employment in other industries (Khuong, 2010). Many studies in western countries (Brooks &
Anderson, 2004; Brooks, Storfjell, Omoike, Stemler, Shaver & Brown, 2007; Hsu & Kernohan,
2006) demonstrate the significant association between the quality of work life, job satisfaction level,
turnover rate, and intention of nurse. However, there is still no database system or limited
information on health human resources covering nursing turnover and its contributors in the
Vietnamese public and private sectors in term of aiding the health human resources management.

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 Figure 1: The proposition of Health staff per 10,000compare to countries in the regions
Source from:(Khuong, 2010)
1.2 Problem statement
The nursing shortage has been compounded by the rising number of nurse turnover (Miller,
2007, p. 1). Turnover is costly to health organizations as the cost of replacing a hospital nurse is
estimated to rank from $42,000 to $64,000 (Strachota et al., 2003). Additionally, with nurses
working in long-term care the replacing cost can be up to $59,550 (Steward, 2004). Therefore, the
contributors to the nursing shortage as well as the high cost of turnover have drawn high attention in
a number of recent studies in term of addressing these critical challenges (Brooks et al., 2007;
Almalki et al., 2012; Chan & Morrison, 2000). The majority of these studies demonstrate the
magnitude of Quality of Nursing Work Life (QNWL) to these critical problems. Additionally, several
studies also acknowledgethat actual turnover could be predicted by intention to leave among nurses
(Hayes et al., 2006; Mor Barak, Nissly & Levin, 2001); and there is a significant correlation between
the level of QNWL and intention to leave their current position (Almalki et al., 2012; Brooks et al.,
2007). A number of various definitions and explanations of QWL have been suggested; however,
Brooks‟ model (2001) is found to be the most quoted definition for recent researches on QNWL
(Brooks & Anderson, 2004; Brooks et al., 2007; Almalki et al., 2012). Brooks defined QNWL as
“the degree to which registered nurses are able to satisfy important personal needs through their
experiences in their work organization while achieving the organization’s goal” (Brooks

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&Anderson, 2004, p. 323). Brooks et al., (2007) conducted a study on 1554 nurses in the Mid-
Western USA; and its findings indicated that delivering retention interventions could improve work
context and work design. Some authors Almalki et al (2012) also found that there was significant
association between the level of QNWL and their intention to leave (r = -0.024 to -0.497, P < 0.01)
using Brooks „model. Additionally, retention to stay in current employment is deterred by poor
QWL and this also is a barrier to entry into nursing profession(Abo-Znadh, 1998). Therefore,
assessing the perception of quality of nursing work life, exploring their turnover intention, and
examining the relationship between these concepts are important in the light of the current nurses‟
shortage worldwide which is exacerbated by low job satisfaction and high turnover rates (Almalki et
al., 2012).

The general and nursing specific QWL literature was synthesized; and the common intrinsic,
extrinsic, general factors affecting their QWL were found to be shared among nurses in different
countries. The literature also demonstratesthat the four dimensions of QNWL: (1) Work Life/ Home
Life, (2) Work Design, (3) Work Context, and (4) Work world which werefound by Brooks
(2001),significantly represent the QWL elements suitable for nurses. This concept has been
repeatedly used in recent nursing studies across the world and this definition is demonstrated to
include both the goals of the organization and the needs of RNs. This QNWL model has been used
by Brooks et al., (2007) and Almalki et al., (2012) with high test-retest reliability (r = 0.90) and
Cronbach‟s alpha for the subscales from 0.56 to 0.88 (Brooks & Anderson 2004).

In the other hands, several theories which related to nurses‟ turnover werealso synthesized. It
demonstrates that nurses‟ turnover is significantly affected by the QWL as poor QWL is considered
as hindrance to their retention and as obstacles to entry into nursing profession(O' Brien-Pallas &
Baumann, 1992; Almalki et al., 2012). Some authors (Brooks et al., 2007; Almalki et al., 2012)
indicate that improving QNWL inversely associates with their turnover intention, ultimately actual
turnover. It is argued that job satisfaction is recently used to assess the QWL in the field of healthcare
organization as there is an immense body literature which exploring the relationship between job
satisfaction and nurses‟ intention to leave (Blackwell Holland, 1992;Kudo et al., 2006; Lu et al.,
2002; Omar, Majid & Johari, 2012). There is limited attention which has been focused on the
relationship between QWL and nurses‟ turnover intention; and most of available studies on this
subject come from hospital-based research in Western countries. According (Almalki et al., 2012),
further examination of the QNWL across countries particularly in developing where there is a lack of
information is necessary. It is clear that study on assessing the level of QNWL, identifying major

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factors affecting the QNWL, and exploring the relationship between the level of QNWL and turnover
intention, is significant for healthcare administrators and policy makers across countries (especially
developing countries as Viet Nam) in term of human resource development as well as addressing a
void in the scholarly literature.

1.3 Research purpose and objectives

The purpose of this research is to improve nurses‟ retention by providing evidence-based
information through assessing the QWL among nurses and exploring the relationship between
QNWL and their turnover intention to leave. Hence, the study objectives are as follows:

1. To assess the perception of QWL among nurses employed in Ho Chi Minh hospitals.

2. To assess the nurses‟ turnover intentionin Ho Chi Minh hospitals.

3. To examine whether the four QWL dimensions (work context, work design,work world,
andwork life/home life) are useful as a predictor of nurses‟ turnover intention in Ho Chi Minh
hospitals.

4. To determine the QWL dimension that makes the best contribution to explaining nurses‟
turnover intention in Ho Chi Minh City.

1.4 Research questions

The following research questions will be answered:

1. What is the perception of QWL among nurses employed in Ho Chi Minh hospitals?

2. What is the current state of nurses‟ turnover intention in Ho Chi Minh hospitals?

3. Are the QWL dimensions (work context, work design,work world, andwork life/home life)
useful as a predictor of nurses‟ turnover intention in Ho Chi Minh hospitals?

4. What does the QWL dimension make the best contribution to explaining nurses‟ turnover
intention in Ho Chi Minh City?

1.5 Description of research module

1.5.1 Description of the relation model of the research framework

Drawing from literature review, a model which represents the possible relationship between
QWL factors with nurses‟ turnover intention is proposed in Figure2. This framework represents a set

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of propositions concerning the impacts of the determinants to turnover. It consists of the four
dimensions of QNWL which are chosen as the independent variables commonly correlated with
nurses‟ satisfaction and turnover intention. The arrows show the expected direction of the
relationships between variables and their expected relative variables. This conceptual framework is
also served as the cognitive map and guides this study.

The four dimensions of QNWL, derived from Brooks‟ Model, include: (1) work life/home life,
(2) work design, (3) work context, and (4) work world. The “work life/home life” dimension is
described as “the interface between the life experiences of nurses in their place of work and in the
home” while the “work design” dimension refers to “the composition of nursing work and describes
the actual work nurses do” (Brooks & Anderson, 2005, p.323). The “work context” dimension is
“the practice settings in which nurses work and explores the impact of the work environment on both
nurses and patient system”; in the other hands, “ work world” dimension includes “the effects of
broadsocietal influences and changes on the practice of nursing” (Brooks & Anderson, 2005, p.
323).

The proposed model assumes that work-life factors which are presented by Brooks & Anderson
(2005) affect the level of QNWL, resulting in significant changes in the behavioral intention of
nurses towards their job. This intention of stay or leave their current employment then processes into
actual action. The correlation between the level of QWL and nurses‟ behavior action assumes that the
QWL adversely affects nurses‟ actual turnover through the mediating effects of nurses‟ intention to
leave. For instance, nurses with turnover intention would be increased when QWL is rated low; and
finally this intention would turn into actual action of leaving the current organization.

Work life/ Home Life

QUALITY
Work Context
OF
NURSING
WORK Turnover Intention
LIFE Work Design

Work World

Figure 2: The theoretical framework: the effects of QWL on turnover intention

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 1.5.2 Research hypotheses

As mentioned earlier, the four dimensions of QNWL that are used in the framework (work
life/ home life, work design, work context, and work world) derived from a study by Brooks (2001).
This is chosen as the earlier research has used this model repeatedly and successfully in the nursing
profession across countries including Asia context, thus it is somewhat familiar to the Vietnamese
nursing scenario. In addition, it has been cited use in the international literature. Several earlier
studies (Brooks & Anderson, 2004; Brooks et al., 2007; Almalki et al., 2012) demonstrated that the
four dimensions of Brooks‟ QNWL have played a significant role in determining their QWL and
turnover intention. Thus, the four dimensions of Brooks‟ QNWL are regarded as the most suitable
one for this research as its nature is rather familiar.

As mentioned in the literature review, health organizations are likely to retain nurses and to
gain leverage in hiring when they offer better the quality of work life (Almalki et al., 2012; Brooks et
al., 2007). Some authors (Lee et al., 2012; Almalki et al., 2012) stated that the QWL is considered as
the best predictors of nurses‟ turnover intention. To answer the research questions, the hypotheses
areraised to study the relationship of the independent (QWL) and dependent variables (turnover
intention) as follows:

Research question 3: Are the QWL dimensions (work context, work design,work world,
andwork life/home life) useful as a predictor of nurses‟ turnover intention in Ho Chi Minh hospitals?

Hypothesis 1:TheQWL dimensions (work life/home life, work design, work context, and
work world) are useful in predicting turnover intention

H1a: Work life/Home life dimension negatively associates with turnover intention.

H1b: Work design dimension negatively associates with turnover intention.

H1c: Work context dimension negatively associates with turnover intention.

H1d: Work world dimension negatively associates with turnover intention.

Research question 4: What does the QWL dimension make the best contribution to
explaining nurses‟ turnover intention in Ho Chi Minh City?

Hypothesis 2: Among the four dimensions of QWL, the work context dimension makes the
most significant contribution in explaining the turnover intention of nurses.

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1.6 Investigated variables and constructs

1.6.1 Summary of variables and constructs

This section briefly summaries the empirical evidence on the two main variables QNWL and
turnover intention as well as discusses about the theoretical significance of each variable and its
linkage with the proposal model.

Quality of Nursing Work life: The definitions of QNWL are basically considered in the
twofold: a „process‟ or an „outcome‟ according the different authors‟ viewpoint; however, “the
boundary between the two groups is not entirely discrete” (Vagharseyyedin et al, 2010, p.791). From
the perspective of defining QWL as an „outcome‟, QWL was a set of beneficial outcomes of working
life which was considered as a dependent variable; and this would be affected by different
independent variables related to organization and workers such as working condition, job stress, and
so on. In the other hand, QWL defined as a „process‟ saw QWL as the quality of interaction between
every dimension of work and employees. According to (Sale & Smoke, 2007), a broad range of
organizational, occupational, and non-work factors were identified and included in the QWL scale.
Moreover, Brooks & Anderson (2004), Robertson (1990), and Brooks et al., (2007) are only three
studies using QWL instruments that had been psychometrically tested, while other studies has used a
combination of various questionnaires, or qualitative approaches, or researcher-made instruments in
term of developing QWL instruments (Vagharseyyedin et al, 2010,p.789). The importance of QWL
to the staff‟s commitment, job satisfaction, and quality of healthcare have been confirmed through
seminal and assessment studies on QWL in health care organization with the focus on nurses
(Attridge & Callahan 1990; Hsu & Kernohan, 2006; Brooks& Anderson, 2004; Vagharseyyedin et
al., 2010). It is argued that Brooks‟ study (2001) is the critical study for QNWL after comparing
results of the reviewed papers; because the four dimensions (work life/home life, work context, work
design, and work world) which included in the Brooks‟ scale cover diverse aspects of nursing work
life (Almalki et al., 2012, p. 81). Obviously, the validity and reliability of the scale are high
compared to other assembled instruments (Brooks,2001; Khani et al, 2008; Brooks &
Anderson,2004).

Turnover intention: Turnover intention is defined as the employees‟ own estimated probability
which they plan to sever membership with their employers at some point in the near future
(Vandenberg & Nelson, 1999, p.1315). Likewise, Mor Barak, Nissly & Levin (2001) described it as
“seriously considering leaving one‟s current job” (p.633). However, the term “intention to leave”

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needs to be interpreted with caution, as turnover and intention are two different concepts (Klassen,
2013; Omar, Majid& Johari., 2012). “Intention to leave” is just only “intent” toward leaving which
not involving the act of individual leaving the organization or profession as turnover. Therefore, it
seems to be reasonable to predict the actual turnover by assessing turnover intention; as several
studies have demonstrated that turnover intention is the best and accurate lead predictors of actual
turnover (Almalki et al., 2012; Omar et al., 2012; Price, 1977). Several prior studies have provided
empirical evidence that the QWL plays a significant role in determining nurse‟s intention to leave
their current job (O‟Brien-Pallas & Baumann, 1992; Almalki et al., 2012; Takase, Yamashita & Oba,
2008). For instance, nurse turnover are inversely related to autonomy in decision making, assess to
more family-responsive practices benefits, and higher relative pay and benefits which obviously
improve Nurses‟ QWL (Almalki et al., 2012). In addition, the impacts of individual-work related
variables (work life factors) on nurses‟ intention to leave have been examined in a number of studies.
For instance, turnover is associated with family and family needs (Applebaum, Fowler, Fiedler,
Osinubi & Robson, 2010); job satisfaction (Omar et al., 2012; Shader et al., 2001); workload (Chan
& Morrison, 2000) and other several characteristics of working units (O‟Brien-Pallas et al., 2010).

1.6.2 List of variables and constructs

The questionnaire has three sections: (1) Quality of Nursing Work Life; (2) The Anticipated
Turnover (ATS); (3) Demographic Information (see Table 1 & 2).

Section 1 is designed to measure the independent variables where participants are asked to
indicate their perception on QNWL by 42-items questionnaire with A 6-point Likert scale
ranging from (1) Strongly Disagree to (6) Strongly Agree ( Adapted from Brooks‟ Survey of
QNWL, 2001).
Section 2 is designed to measure dependent variables where participants are asked to express
their opinion of the possibility of voluntarily leaving their current job by a 12 items-
questionnaire with a 7-point Likert scale ranging from Disagree Strongly and Strong Agree
(adapted Hinshaw & Atwood, 1984).
Section 3 is designed to measure the demographic variables by using nominal scales of two
and more than three categories.

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 Number
No Description of Scale
variables

SECTION 1: QUALITY OF NURSING WORK LIFE

1A Work life /Home life dimension 7

A six-point Likert-scale from
1B Work design dimension 10
“strongly disagree” (1) to “strongly
1C Work context dimension 20
agree” (6)
1D Work world dimension 5

SECTION 2: TURNOVER INTENTION

A seven-point Likert scale ranging

Anticipated turnover intention 12 from “disagree strongly” (DS) to
“agree strongly” (AS)

SECTION 3: DEMOGRAPHIC INFORMATION

Gender 1 Nominal

Age 1 Ordinal

Ethnicity 1 Nominal

Marital status 1 Nominal

Dependent children 1 Ordinal

Education level 1 Ordinal

Employment status 1 Nominal

Nursing tenure 1 Ordinal

Organizational tenure 1 Ordinal

Table 1: Description of variables and scales

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 Constructs Variables Questions Source
QUALITY OF NURSING WORK LIFE
QWL1 I am able to balance work with my family needs.
It is important for me to be provided employees
QWL2 on-site/ near childcare services.
QWL3 I have energy after work.
The system of working hours are negatively
QWL4 affects my life.
Work life /Home life
dimension My organization‟s policy for vacation is
QWL5 appropriate for me and for my family.
It is important for organization to assist in
QWL6 providing care for elderly parents of their
employees.
It is important for me to be provided employees
QWL7 on-site ill childcare survives.
QWL8 I receive sufficient assistance from nursing
assistants and service workers.
QWL9 I have the autonomy to make client/patient care
decisions.
QWL10 I am satisfied with my job.
QWL11 I perform many non-nursing tasks.
QWL12 My workload is too heavy.
Work design dimension QWL37 I have enough time to do my job well.
QWL14 I am able to provide good quality client/patient
care.
Adapted
QWL15 I experience many interruptions in daily work
routine. from
QWL16 I receive quality assistance from nursing Brooks
assistants and service workers. (2001)
QWL17 There are enough RNs in my work setting.
I receive feedback on my performance from my
QWL18 nurse manager/supervisor.
I am able to communicate well with my nurse
QWL19 manager/supervisor.
I am recognized for my accomplishments by my
QWL20
Management nurse manager/supervisor.
and My nurse manager/supervisor provides adequate
QWL21 supervision.
supervision
I am able to participate in decisions made by my
QWL22 nurse manager/supervisor.
Work Nursing policy and procedures facilitate my
context QWL23 work.
dimension QWL24 Upper-level management has respect for nursing.
Friendships/ relationships with co-workers are
QWL25 acceptable.
I communicate well with physicians in work
QWL26 setting.
Co-worker I am able to communicate well with other co-
QWL27 workers (lab technician, pharmacist assistant,
etc.).
QWL28 There is teamwork in my work setting.
QWL29 I feel respected by physicians in my work setting.

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 I receive support to attend continuing education
QWL30 and training programs.
Development My work setting provides career advancement
QWL31 opportunities.
opportunities
It is important to have opportunity to further my
QWL32 nursing education without leaving the current job.
QWL33 I feel a sense of belonging in my work place.
I feel safe from personal harm (physical,
QWL34 emotional or verbal) at work.
I have adequate client/patient care supplies and
Work QWL35 equipment.
environment
It is important to have a designated private break
QWL40 area for the nursing staff.
The security department provides a secure
QWL36 working environment.
In general, society has an accurate image for
QWL13 nurses.
My salary is adequate for my job, given a current
QWL38 job market conditions.
Work world QWL39 I believe my job is secure.
My work impacts the lives of patients, families,
QWL41 community.
I would be able to find my same job in another
QWL42 organization with about same salary and benefits.
TURNOVER INTENTION
ATS1 I plan to stay in my position.
I am quite sure I will leave my position in the
ATS2 foreseeable future.
Deciding to stay or leave my position is not a
ATS3 critical issue for me at this point in time.
I know whether or not I will be leaving this
ATS4 organization within a short time.
If I got another job offer tomorrow, I would give Adapted
ATS5 it serious consideration. from
Anticipated turnover I have no intentions of leaving my present Hinshaw &
ATS6 position.
intention Atwood
I have been in my position about as long as I want (1984)
ATS7 to.
ATS8 I am certain I will be staying here.
I don‟t have any specific idea how much longer I
ATS9 will stay.
ATS10 I plan to hang on to this job.
There are big doubts in my mind as to whether or
ATS11 not I will really stay in this organization.
ATS12 I plan to leave this position shortly.

Table 2: List of constructs and variables in section 1 & 2

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1.7 Research methodology

1.7.1 Study design and sample

This study used a cross-sectional survey design to investigate the perception of QWL and
turnover intention of RNs in Ho Chi Minh City - Viet Nam. The population of this study covered all
RNs employed as staff nurses, on a full, part-time, or contingent status, for a period of three months
or longer in Ho Chi Minh City. The 247 questionnaires were distributed. The minimum requirement
of sample is equal to or greater than five times of the number of independent variables (N = 210);or
is equal to n = 50+8m = 82 (where m = 4 is the number of independent variables) (Tabachnick &
Fidell, 2007). Therefore, a sample size of 204 as observed in this survey is more than adequate for
this study.

1.7.2 Data collection

This study was conducted in hospitals across Ho Chi Minh City, Viet Nam. The following
procedures were used to collect data.

1. Based on the personal relationship with some Clinical Nurse Managers, a list of the
hospitals in Ho Chi Minh City which agreed to participate in the study was established; and this list
was used to direct the appropriate number of surveys to each participated hospitals. The Clinical
Nurse Managers of the study hospitals were met in advance to provide clarification and orientation to
the research study; and then they distributed the questionnaire packets to individual nurse.
2. Each participated nurse was provided a survey package which included a cover letter,
questionnaire, and an individual envelope. The cover letter explained the purpose of the study,
researcher‟ contact details as well as the steps taken to maintain confidentiality of responses. There
were three main sections in the questionnaire used in this research as follows: (1) Brooks‟ QNWL
scale, Anticipated Turnover Scale (ATS), (3) demographic information. Respondents were asked to
seal their own completed survey in the individual provided envelope and then returned to the Clinical
Nurse Managers. Every two weeks, the researcher sent a reminder letter by email to all Clinical
Nurse Managers of the participated hospitals. The completed questionnaires were collected from all
Clinical Nurse Managers at the end of the data collection period. The data collection was completed
over an eight week period.

Page 18 of 50
 1.7.3 Pre-test plan

For the suitability of the used tools in the local context in Ho Chi Minh City, the
questionnaire was contextualized and translated into Vietnamese language. The pilot test was
conducted with a convenience sample of 10 RNs in one hospital (Hospital of tropical diseases) in
term of testing the process and the two instruments in this study, Brooks‟ QWNL and ATS including
the content validity, structure of questions, reliability, appropriateness and time taken to complete the
survey. According to Cooper & Schindler (2003) and Miller (2007), a pilot test is an important initial
step prior to data collection as it will ensure content validity and reliability of instrument as well as to
improve the question wording and format; and the size of pilot group can range from 10 to 100.

The average time needed to complete the survey ranged 15 to 25 minutes. Valuable
feedbacks from nurse participants were taken into consideration and there was not a lot of continuity
of responses. Therefore,these counts did not warrant additional changes to the survey that would
affect the reliability and validity of the instrument.

1.7.4 Data coding and cleansing

An identification number was given to each returned questionnaire and the survey responses
were coded numerically to indicate the variable values prior to data entry. A standard data cleansing
process using single and multiple field frequency analysis was employed to clean the codding errors
after the data were entered into SPSS for Windows (v.20). Then, five percentages (5%) of the survey
responses were randomly assessed to compare the original and verified data set after the cleansing
process(Day, 2005).

Various statistical tests related to statistical assumption of normality, missing data, and outliers
were concerned prior to analyses being conducted. Normality of the data wasassessed graphically
with histograms through examination of skewness and kurtosis of the data. The data was found to be
acceptably normal for analysis as there was not obvious sign of skewness being noted. In addition,
the normal probability plots were visually examined and found to cluster around a straight line,
which suggested that the survey data followed a normal distribution ( Ho, 2006; Coak, Steed & Ong,
2010).

Missing value and outliers were also checked for the survey data. A number of missing values
in completed surveys (less than 2%) was very slow and their pattern was random. Underlying the use
of regression analysis, cases with standarddised residual values above 3.3 or less than 3.3 were

Page 19 of 50
classified as outliers(Almalki et al., 2012). According to (Pallant, 2007; Tabachnick& Fidell, 2001),
finding a few number of outling residuals is not uncommon with the large samples and there is not
requirement for further investigations. Only two outliers (case 39 and case 94) were indentified
across all cases which have shown in table 3.

Case Number Standardized values

39 3.577

94 3.403

Table 3: Identification of outliers

2. DATA DESCRIPTION
This chapter reports on the quantitative results of this study. A profile for the study sample
which includes the demographics of respondents and the response rate are firstly provided. The
descriptive statistics for the perception of nurses in Ho Chi Minh City towards their QWL are
presented followed bythe descriptive statistics of their turnover intention.

2.1 Response rate

The questionnaire was distributed to a total of 247 registered nurses at the eight hospitals in Ho
Chi Minh City, including Hospital of District10, 30-4 Hospital, Hospital of Children 1, Hospital of
Tropical Disease, Eye Hospital of Ho Chi Minh, Tu Du Hospital, Nguyen Tri Phuong Hospital, and
People Hospital 115. The total number of returned questionnaire was 218 (N = 218), representing the
overall 88% response rate. However, the total usable data was 204 (n = 204) reflecting an effective
response rate was 83%, after fourteenincomplete surveys were excluded due to missing responses on
over 50% of the items.Of the 8 participating sites, the response rate per site varied between a low of
70% to a high of 94%, and theywere summarized in Table 4.

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 Hospital Mailed Returned Usable Response Effective
survey Survey Returned Rate Response
Survey Rate

Hospital of District 10 65 60 58 92% 89%

Tu Du Hospital 30 24 22 80% 73%

Eye Hospital of Ho Chi Minh 32 30 28 94% 88%
Hospital of Children 1 25 23 20 92% 80%
Hospital of Tropical Diseases 30 29 28 97% 93%
30-4 Hospital 25 21 19 84% 76%
Nguyen Trai Hospital 20 14 14 70% 70%
People Hospital 115 20 17 15 85% 75%
TOTAL 247 218 204 88% 83%

Table 4: Survey Response Rates

2.2 Nurse Demographic Profile

A demographic profile of the respondents are clarified by the following characteristics,
including gender, age, education, marital status, kinship responsibility, year of nursing experience,
and years of current job. The variables measured on categorical scales such as ordinal and nominal
data includinggender, age, marital status, ethnicity, education, job status, years of nursing, years of
current job that were calculated by frequencies and percentage. Only the variable (number of
dependent children) measured on a conscious scale was calculated by using mean, distribution, and
percentage.

Regarding to their social demographical information, the majority of respondents were

female (n = 160, 78.4%), aged between 20 to 29 years old (n = 102, 50%), married (n = 125, 61.3%),
with children (n = 107, 52.5%). In term of ethnicity, 96.6% of the respondents self-identified as
Kinh, which only 3.4% (n = 7) identifying as any other ethnicity. Over quarter-fifth of the sample (n
= 181, 88.7%) held less than a Bachelor Degree in nursing and were full-time employed (n = 179,
87.7%). With respect to the number of years working as a nurse, 34.3% (n = 70) had worked less
than 3 years and 44.6% (n = 91) from 3 to 10 years. The proportion of working experience in current
organization was 36.3% (n = 74) for less than 3 years and 47% (n = 96) from 3 to 10 years. Table 5
presents a summary of the demographic variables.

Page 21 of 50
Variable Count(n = 204) %
Gender n = 204
Male 44 21.6
Female 160 78.4
Age n = 204
20 – 29 years old 102 50
30 – 39 years old 76 37.3
40 – 49 years old 19 9.3
50 – 59 years old 7 3.4
Marital status n = 204
Never married 76 37.3
Married 125 61.3
Divorced 2 1
Widowed 1 0.4
Dependent Children n = 204
Yes 107 52.5
No 97 47.5
Ethnicity n = 204
Kinh 197 96.6
Thai 2 1
Chinese 3 1.4
Others 2 1
Education level n = 204
Vocational degree 136 66.7
Associated degree 45 22
Bachelor degree 23 11.3
Nursing tenure n = 204
< 3years 70 34.3
3 to 10 years 91 44.6
11 to 20 years 38 18.6
21 to 30 years 5 2.5
Organizational tenure n = 204
< 3years 74 36.3
3 to 10 years 96 47
11 to 20 years 30 14.7
21 to 30 years 4 2

Table 5: Demographics of the nurse respondents in Ho Chi Minh City

Page 22 of 50
 2.2.1 Gender profile

The gender distribution among the respondents is shown in Figure 3. A majority of

respondents, 160 nurses, were female, while approximately one-fifth (21.6%) were male nurses.

Gender Profile (n = 204)

21.6% MALE

FEMALE
78.4%

Figure 3: Gender distribution within the study sample

2.2.2 Age profile

The data from this study revealed that the respondents ranged in age from 20 to 59 years old.
Approximately 50% and 37.3% were in the 20-29 and 30-39 age groups, respectively. It can be
deduced that the majority of nursing workforce in Ho Chi Minh is young, as these two age groups
collectively accounted for over three-quarters (87.3%) of the total sample are younger than 41 years
old. The age categories of the respondents are illustrated in Figure 4.

Figure 4: Age categories for the study sample

Page 23 of 50
 2.2.3 Marital status profile

A graphical representation regarding the marital status of the respondents is illustrated in

Figure 5. It clearly stated that most of the respondents (61.3%) were married; following by 37.3%,
1% and 0.4% were single, divorced, and widowed respectively. Over haft (51.5%) of the respondents
stated that they are married and have children (see Table 6). In addition, 47.5% (97) of the
respondents had no children while twenty-four percent (56) of the respondent has one child, twenty-
seven percent of the respondent had two children, and only 1.5 percent (3) of the respondents had
three children living with them (see Figure 6).

Marital Status Profile (n = 204)

0.4% 1%

Never married
37.3%
Married
Divorced
61.3%
Widowed

Figure 5: Marital status of respondents

Marital Status
Never married Married Divorced Widowed
Number % Number % Number % Number %
Yes 0 - 105 51.5% 2 1.0% 0 -
Dependent
-
Children No 76 37.3% 20 9.8% 0 1 0.5%

Table 6: Dependent children by marital status

Page 24 of 50
 Number of Dependent Children Profile ( n = 204)
1.5%

27% not have children

47.5% 1 child
2 children
3 children
24%

Figure 6: Number of dependent children profile

2.2.4 Ethnicity profile

The majority (96.6%) of the respondents reported being Kinh. Other ethnic groups reported by
respondents were 1% Thai and 1.4% Chinese. Only one percent (n = 2) of the respondent indicated
that they were Chru and San Chay (see Figure 7).

1% Ethnicity Profile (n = 204)

1.4% 1%
Kinh
Thai
Chinese
96.6% Others

Figure 7: Ethnicity of respondents

Page 25 of 50
 2.2.5 Education profile

A breakdown of educational level of the respondents is shown in Figure 8. It indicated that

over haft the sample, 66.7% (136), held Vocational Degrees; 22% (45) of the respondents had an
Associate Degree, and 11.3% (23) had a Bachelor Degree. No respondents indicated that they had a
Master Degree.

Education Profile (n = 204)

11.3%

Vocational Degree
22% Associates Degree
66.7%
Bachelor Degree

Figure 8: Educational level of respondents

2.2.6 Job status profile

Most of the respondents (87.7%) reported being full-time employed, 4.4% of the respondents
were part-time employees, and only 1 respondent was contingentemployee.

Employement Status Profile (n = 204)

0.5% 7.4%
4.4%
Full-time
Part-time
Contingent
87.7%
Other

Figure 9: Employment Status Profile

Page 26 of 50
 2.2.7 Nursing tenure profile

Approximately hafts (44.6%) of the respondents have been in nursing experience between three
to ten years, while 34.3% of the nurses have worked as a RN for less than three years. Following by
18.6 % of the sample reported being in nursing experience between eleven to twenty years. Only
2.5% (5) of the respondents had nursing experience between twenty-one to thirty years.

Nursing Tenure Profile (n = 204)

2.5%

18.6% < 3 years

34.3%
3 - 10 years
11 - 20 years
44.6% 21 - 30 years

Figure 10: Nursing tenure profile

2.2.8 Organizational tenure profile

The largest group of respondents (47%) has worked with the current organization between
three to ten years. Nurses who worked for the current organization for less than three years
comprised 36.3% of the sample. 14.7% of the sample reported being in current organization between
eleven to twenty years while only two percent (4) of the sample have worked with the current
organization between twenty–one to thirty years. No respondent reported being in the current
organization for more than thirty years. Figure 11 show the categories of organizational tenure

Page 27 of 50
 Organisational Tennure Profile (n = 204)
2%

14.7%
< 3 years
36.3%
3 - 10 years
11 - 20 years
21 - 30 years
47%

Figure 11: Organizational tenure of respondents

2.3 Description of Quality of Nursing Work Life

This section provides descriptive statistics for the concept of QWL by using frequencies,
percentages, means, standard deviations and other statistical measures. The respondents wereasked
about their work life experience in order to gain an understanding of the perception of nurses in Ho
Chi Minh toward their QWL.

2.3.1 QWL Rating

Regarding to discriminate quantitatively about the quality of work life, a composite scale is
calculated; and its total possible scale score for the 42-items questionnaire can range from 42 to 252.
A low overall QNWL is indicated by a low total scale score, while a high total score indicates a high
QNWL. The same is true for each subscale, a low score indicating a less favorable environment and
another way around.An actual range of the sample was from 132 to 229 (M = 174.6), which is higher
than the average score on Brooks‟ Scale (147); suggesting that they were pleased overall with their
nursing work life situations. Table 7 illustrates the range scores for the QWL items.

Page 28 of 50
 Possible Actual
Scale Average Mean SD
range range

42 – Item scale 42 - 252 147 132 - 229 174.6 19.1

7– Item work life /home life subscale 7 - 42 24.5 18 - 38 29.5 3.58

10 – Item work design subscale 10 - 60 35 25 - 54 39.7 5.1

20 – Item work context subscale 20 - 120 70 66 - 120 86.1 10.9

5 – Item work world subscale 5 - 30 17.5 8 - 29 19.4 3.5

Table 7: Total scores and sub-scores for QWL items

2.3.2 Describing QWL

Referring to the strategy of analysis used by Brooks and Anderson (2004), the 6-point rating
scale of Brooks „QNWL was combined into two groups of Disagree and Agree. The “Agree” group
consists of nurses who responded with positive rating of agree to strongly agree (ratings of 4, 5 and
6), while the negative responses with rating of strong disagree to disagree (ratings of 1, 2 and 3) are
included in the “Disagree” group.

2.3.2.1 Work life/home life dimension

Most respondents of the sample were satisfied with seven items in Work life/Home life
dimension as all the percentage ratios within “Agree” section were greater than 50%. More than 95%
(n = 195) of the respondents thought on-site child care was important, and 96% (n = 196) reported
their need to have on-site child care for ill children, 95% (n = 193) agreed that it is important to offer
care for their elderly parents. Approximately 90% of the respondents stated that they were able to
balance work with their family needs, but only two-third (65%) of respondents had energy after
work. Over haft at 58% (n=117) reported that working hours did not suit their daily day as it had
been negatively affected them. Finally, over three-quarter (76%, n = 156) agreed that the policy for
vacation was appropriate both for the nurses and their family. Table 8 depicts the frequency of agreed
or disagreed responses to the questions related to work life/home life dimension.

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AWork life/Home Life Dimension

Item Agree Disagree

No. % No. %

Q1 Ability to balance work with family needs 185 90.7 19 9.3

Q2 Important to have on-site/near childcare services 195 95.6 9 4.4

Q3 Energy left after work 134 65.7 70 34.3

Q4 The system of working hours negatively affects my life 117 57.4 87 42.6

Q5 Appropriate policy for vacation both for me and my 156 76.5 48 23.5
family

Q6 Important to assist in providing care for elderly parents 193 94.6 11 5.4

Q7 Important to offer on-site ill child care services 196 96.1 8 3.9

Table 8: Frequency of the factors influencing the work life/home life among nurses

2.3.2.2 Work design dimension

Workload, non-nursing work, and work interruptions were of concern. Approximately two-
third (63.7%, n = 130) of respondents reported that their workload was too heavy, similarly 64% (n =
131) indicated that they had to perform many non-nursing tasks. Only a small proportion of nurses
(31%) reported not experiencingmany interruptions during their daily work. Even in the light of
these results, 79% (n = 161) felt satisfied with their job, 84% (n = 171) stated that they provided
good quality patient care, 87% (n = 177) said they had enough time to do jobs, and 72% agreed that
they had autonomy to make client/patient care decisions. In term of nursing skill, 81% of the
respondents indicated that they had both sufficient and quality assistances from nursing assistants and
services workers (see table 9).

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BWork design Dimension

Item Agree Disagree

No. % No. %

Q8 Sufficient assistance from nursing assistants and services 165 80.9 39 19.1
workers.

Q10 Satisfaction with job 161 78.9 43 21.1

Q12 Workload is too heavy 130 63.7 74 36.3

Q9 Autonomy to make client/patient care decisions 147 72.1 57 27.9

Q11 Perform many non-nursing tasks 131 64.2 73 35.8

Q15 Many interruption during daily work routine 140 68.6 64 31.4

Q37 Enough time to do jobs 177 86.8 27 13.2

Q17 Enough RNs in work setting 133 65.2 71 34.8

Q14 Ability to provide quality client/patient care 171 83.8 33 16.2

Q16 Quality assistance from nursing assistants and services 167 81.7 37 18.1
workers.

Table 9: Frequency of factors influencing the work design dimension among nurses

2.3.2.3 Work context dimension

In term of relationships with unit management, approximately 95% (n = 193) reported that they
had good communication with the nurse manager; and around 92% of the respondents agreed that
they received adequate supervision, feedback from the nurse manager and had chance to participate
in decision–making processes. Less positive were recognition of accomplishments made by the nurse
manager (90%, n = 183) and the support received from nursing policy and procedure (89%, n = 182).

Page 31 of 50
An important finding is that over 94% (n = 192) of respondents felt respected by the upper-level
management.

Regarding to relationship with co-workers, most of responded nurses were satisfied with
factors relating to their co-workers. Ninety-eight (98%, n = 200) agreed that there was teamwork in
their work setting and approximately 92% stated that they had good friendships/relationship with
their co-workers. The majority (over 92%) of respondents reported that they have good
communication with both other co-worker and physicians. Not surprisingly, 4.9% of the respondents
did not feel respected by physicians.

More positively, approximately 91% of the sample agreed that the opportunity to further their
nursing education without leaving current job was as important as receiving support to attend
continuing education and training program (89%, n = 181). The proportion of nurses who stated that
their work organization provided adequate opportunities for career advancement was 83% (n = 170).

For the working environment, 95% (n = 194) of the respondents agreed that having a private
break-area for nurses was important, and over 90% stated that they felt being provided a secure
working environment and safe from personal harm (emotional, verbal and physical) at work. Also
approximately 80% reported that they have client/patient adequate care supplies and equipment. Only
a very small proportion (8.8%, n = 18) of the sample did not express a sense of belonging in their
work place.

C Work context Dimension

Item Agree Disagree

No. % No. %

Management and supervision

Q19 Good communication with nurse manager/supervisor 193 94.6 11 5.4

Q21 Received adequate supervision from nurse manager/supervisor 188 92.2 16 7.8

Q18 Enough feedback from nurse manager/supervisor 187 91.7 17 8.3

Q22 Participate in decisions made by nurse manager/supervisor 188 92.2 16 7.8

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Q20 Recognition of accomplishments 183 89.7 21 10.3

Q23 Nursing policy and procedures facilitate the work 182 89.2 22 10.8

Q24 Upper-level management has respect for nursing 192 94.1 12 5.9

Co-workers

Q25 Friendship/relationships with co-workers 187 91.7 17 8.3

Q28 Availability of teamwork 200 98 4 2

Q27 Good communication with other co-workers 188 92.2 16 7.8

Q29 Feel respected by physicians 194 95.1 10 4.9

Q26 Good communication with physicians 189 92.6 15 7.4

Development opportunities

Q31 Career advancement opportunities 170 83.3 34 16.7

Q32 Important to have the opportunity to further nursing education 185 90.7 19 9.3

Q30 Support to attend continuing education/training programs 181 88.7 23 11.3

Work environment

Q35 Adequate client/patient care supplies and equipment 163 79.9 41 20.1

Q33 Belong to the workplace 186 91.2 18 8.8

Q40 Important to have break-area for nurses 194 95.1 10 4.9

Q36 Security department provides secure environment 183 89.7 21 10.3

Q34 Safe from personal harm at work 180 88.2 24 11.8

Table 10: Frequency for factors influencing the work context dimension among nurses

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 2.3.2.4 Work world dimension

Nearly 84% (n = 170) of nurses in this research stated that society has an accurate image of
nurses. Of concern, however, was that only 54% (n = 111) of the sample reported that they believed
their work impacting the lives of others. The proportion of nurses who stated an adequate salary
given a current job market was less positive with only 67% (n = 137). Not surprisingly,
approximately 78% (n = 159) of respondents thought that they would be able to find the same job in
another organization with about same salary and benefits; as there is a critical shortage of nursing
workforce in Viet Nam. Furthermore, almost 84% agreed that their job is secure, thus they do not
expect to lose them unexpectedly.

D Work world Dimension

Item Agree Disagree

No. % No. %

Q13 Society has an accurate image of nurses 144 70.6 60 29.4

Q38 Salary is adequate 137 67.2 67 32.8

Q39 Job is secure 170 83.3 34 16.7

Q42 Ability of find the same job in another organization 159 77.9 45 22.1

Q41 Nursing work impacts lives of others 111 54.4 93 45.6

Table 11: Frequency for factors influencing the work world dimension among nurses

2.4 Description of Turnover Intention

The sample was asked about their perception of the voluntary termination of their current job
by using the Anticipated Turnover Intention Scale (ATS) which was developed by Hinshaw and
Atwood in 1978. The ATS is self-report instrument which contains 12 items in Likert format with 7
response options: strongly disagree (1) tostrongly agree (7). The numbers of items designated as
negative or positive are equal on the ATS scale (Hinshaw & Atwood, 1984). For positive items,
“Agree strongly” is scored 7 and “Strongly disagree” is scored 1. The inverse is true for negative
items. The ATS score for nurses who agree with items that indicate no intent to leave, is lowered by
the reverse scoring of items. The score is calculated by dividing the simple sum of all items by the
total number of items in the scale (12 items). A higher intent to remain in a current job is associated

Page 34 of 50
with a lower score while a higher ATS score suggests a higher intent to leave a position (Hinshaw &
Atwood, 1984). The possible score of ATS ranged from 1 to 7 with the possible mean score of 4. The
ATS score in this study ranged from 1.92 to 5.25 and the mean for the entire sample was 3.7 and a
standard deviation of 0.516. The total mean score was below the theoretical mean (4). Table 12
illustrates the descriptive statistics of the possible and actual range of scores, theoretical and actual
means, and the standard deviation for ATS.

Theoretical Results

ATS Possible Range Mean Actual range Mean SD

1-7 4 1.92 – 5.25 3.7 0.516

Table 12: Turnover intention

The sample was dichotomized into two groups: Nurses with intent to leave (leaver) and
without intent to leave (stayer) based on their mean ATS score (Citation Hinshaw & Atwood, 1984).
For this study, nurses with an ATS score < 4.0 were categorized as “stayer”. Conversely, those with
an ATS score ≥ 4.0 were categorized as “leavers”. Results suggested that approximately 36% (n =
73) of the respondents stated that they had intent to leave their current joband over 64% (n = 131)
were without intent to leave. The mean ATS for nurses who had intent to stay was 3.44 (SD = 0.472),
while the mean ATS for nurses with intent to leave was 4.13 (SD = 0.217).

Turnover Intention

35.8% Intending to stay

Intending to leave
64.2%

Figure 12: Intending to leave vs. intending to stay among nurses

Page 35 of 50
 The scores for turnover intention were analyzed according to gender, age, marital status,
dependent children, level of education, yeas as a RN, and years in the current organization.
Approximately one fifth of respondents who indicated an intention to leave their current employment
was male nurses (31.8%, n=14), compared to 80% (n =59) of the females. Approximately haft of
“leavers” (48%, n = 35) aged between 30 – 39 years, followed by the age group between 20 to 29
years with 38% (n = 28). About 65% of the respondents who reported to have an intention to leave
were the married nurses and it was two times higher than the never married ones (35.6%). With
regard to the dependent children, over half of the leavers‟ group (59%) was the nurses with
dependent children. Furthermore, respondents were more likely to indicate turnover intention if they
have aVocational degree (64.4%) compared to an Associate degree (26%) and a Bachelor degree
(9.6%). Roughly, approximately forty-four percentages of the “leavers” reported to have nursing and
organizational experiences between three to ten years, followed by the group of less than three years
(35.6% for organizational tenure and 31.5% for nursing tenure). The significance of the relationship
between turnover intention and all demographic variables are illustrated from Figure 11 to Figure 17.

Intending to stay Intending to leave

77.1%

80.8%

22.9%
19.2%

Male Female

Figure 13: Turnover intention of respondents by gender

Page 36 of 50
 Intending to stay Intending to leave
56.6%

31.3%
47.9%
38.4%

9.9%
8.2%
2.3% 5.5%

20 - 29 30 - 39 40 - 49 50 - 59

Figure 14: Turnover intention of respondents by age

Intending to stay Intending to leave

59.5%

38.2% 64.4%

35.6%

2.3%

Never-married Married Divorced/Widowed

Figure 15: Turnover intention of respondents by marital status

Page 37 of 50
 Intending to stay Intending to leave

48.9% 51.1%

58.9%

41.1%

Have children Have no children

Figure 16: Turnover intention of respondents by dependent children

Intending to stay Intending to leave

67.9%

64.4%

19.8%
26% 12.2%
9.6%

Vocational degree Associates degree Bachelor degree

Figure 17: Turnover intention of respondents by level of education

Page 38 of 50
 Intending to stay Intending to leave

45%

35.9%

43.8%
31.5% 18.3%

19.2%

5.5%
0.8%

< 3 years 3 - 10 years 11 - 20 years 21 - 30 years

Figure 18: Turnover intention of respondents by years as RNs

Intending to stay Intending to leave

48.9%

36.6%

43.8%
35.6%
13.7%
16.4%

0.8% 4.1%

< 3 years 3 - 10 years 11 - 20 years 21 - 30 years

Figure 19: Turnover intention of respondents by tenure in the organization

Page 39 of 50
3. PROJECTION ABOUT THE MASTER THESIS
3.1 General trends of the datasets of the study
Generally, the nurse participants in this research were satisfied with their quality of work life
and there was no prior research on quality of nursing work life in Viet Nam to compare with the
current study. However, these findings are consistent with findings of a number of previous
researches where nurse were satisfied with their QWL (Brooks & Anderson, 2004; Suresh, 2013).
Besides to a high moderate level of QWL, findings also indicated that the number of nurses who had
intention to stay (65% of the sample) was approximately twice time larger than those with intention
to leave (36%) as the researcher‟s expectation and assumptions. We expect that there could be a
negative correlation between the level of QWNL and turnover intention, however further statistical
tests need to be applied to confirm it and to answer the research objectives.

3.2 Further plan for the master thesis

3.2.1 Assessment of reliability

The reliability of scales will be measured by using a reliability coefficient (Cronbach‟s α); and
a sufficient level of internal reliability should be 0.7 or higher (Nunnally, 1978). The number of
questions will be reverse-coded in term of ensuring the consistency of results; and they are questions
1,3,6,8,9,10 for ATS and questions 4, 12, 11, 15 for QNWL). According to (Nystedt, Sjoberg &
Hagglund, 1999), it is relevant to test the reliability of a new instrument when it is translated and
used in different countries. As this is the first time that these two survey questionnaires (QNWL and
ATS) are used in the Vietnamese hospital context; thus it is necessary to confirm the reliability of
these two instruments even though these survey tools have been demonstrated to be well-established
form several previous researches across nations.

3.2.2 Assessments of validity

According to Segars& Grover (1993), an instrument can be multi-dimensional even its

Cronbach‟s alpha is high. Therefore, Exploratory Factor Analysis (EFA) will used to measure the
validity of the survey instruments and there are not prior restrictions on the structure of the model for
carrying this analysis. EFA will be conducted on QNWL and ATS using SPSS version20.0 in term of
developing model that more closely fit the data as well as to discover the underlying factor structure
of a relatively large set of variables or a construct (Tabachnick & Fidell, 2001). A principle

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Componets Analysis (PCA) with a varimax rotation will be used in term of conducting EFA test, and
all of the items which are included in the scales will be utilised during this analysis.

3.2.3 Data analysis

3.2.3.1 Descriptive analysis

SPSS version 20.0 was used to undertake the descriptive analysis in order to transform the
raw data on the quality of nursing work life and turnover intention into the form which could provide
the information to describe a set of factors in a given situation. Frequencies, percentage, subscale and
total scores, means and standard deviations were mainly used to undertake the descriptive analysis.

3.2.4 Inferential analysis

Regard to the study hypotheses, a standard multiple regression and a sequential (hierarchical)
multiple regression will be used to confirm the hypotheses. The data analysis plan is presented as
follows:

Hypothesis 1:TheQWL dimensions (work life/home life, work design, work context, and
work world) are useful in predicting turnover intention

H1a: Work life/Home life dimension negatively associates with turnover intention.

H1b: Work design dimension negatively associates with turnover intention.

H1c: Work context dimension negatively associates with turnover intention.

H1d: Work world dimension negatively associates with turnover intention.

Analysis plan: to test the first hypothesis, a, b, c, d; multiple regression analyses will be
used. According to (Pallant, 2007; Tabachnick & Fidell, 2001), the effects of more than one
independent variable on one dependent variable can be explored by using multiple regression
analysis. For this study, a standard mupltiple regression analysis is used to exam how well the four
QWL dimensionsare correlative to turnover intention.

Hypothesis 2: Among the four dimensions of QWL, the work context dimensions make the
most significant contribution to explaining the turnover intention of nurses.

Analysis plan: For the hypothesis 2, the beta values – standardized regression coefficients –
will be used in order to compare the contribution of each QWL dimension to turnover intention.
According Pallant (2007), this analysis technique allows us to compare the value for each of the

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different variables as these values have been converted to the same scale (p.159). The QWL
dimension with largest beta value indicates that it makes the strongest unique contribution in
explaining turnover intention.

3.2.5 Master thesis plan

In term of estimating the work volume and tracking the process on writing master thesis, an
implementation plan is presented as follows:

Activities Duration

Exploratory Factor Analysis 2 weeks

Reliability Analysis 1 week

Inferential Analysis (hypothesis confirmation) 2 weeks

Interpreting the analysis results 2 weeks

Writing up master thesis report 4 weeks

Review 1 week

Total 12 weeks

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5. Appendix
The Survey Questionnaire
The purpose of this questionnaire is to gather factors that influence your perceptions of quality of
work life and voluntarily leaving your current job, and your background information. Please
complete all of the questions. Thank you for your valuable input to this research study and be assured
that your answer will be kept confidential.

SECTION I: QUALITY OF NURSING WORK LIFE

Adapted from Brooks (2001)

Instructions: The purpose of this section is to give you an opportunity to indicate what things you
are satisfied and dissatisfied with your quality of work life. For each statement, ask yourself how
much you disagree or agree with, using the scale given below (from 1 to 6). Number (1) indicates
that you Strongly Disagree with statement, (2) Moderately Disagree, (3) Disagree; number (4)
indicates that you agree with the contents, (5) Moderately Agree, and (6) Strongly Agree. Please
circle your answer for each statement and answer every item. There is no right or wrong answers.

Moderately Disagree

Moderately Agree
Strongly Disagree

Strongly Agree
Disagree
Agree
Statements

1 I am able to balance work with my family needs. 1 2 3 4 5 6

It is important for me to be providedemployees on-site/ near childcare
2 1 2 3 4 5 6
services.
3 I have energy after work. 1 2 3 4 5 6
4 The system of working hours are negatively affects my life. 1 2 3 4 5 6
My organization‟s policy for vacation is appropriate for me and for my
5 1 2 3 4 5 6
family.
It is important for organization to assist in providing care for elderly
6 1 2 3 4 5 6
parents of their employees.
It is important for me to be provided employees on-site ill childcare
7 1 2 3 4 5 6
survives.
8 I receive sufficient assistance from nursing assistants and service workers. 1 2 3 4 5 6
9 I have the autonomy to make client/patient care decisions. 1 2 3 4 5 6
10 I am satisfied with my job. 1 2 3 4 5 6
11 I perform many non-nursing tasks. 1 2 3 4 5 6
12 My workload is too heavy. 1 2 3 4 5 6
13 In general, society has an accurate image for nurses. 1 2 3 4 5 6
14 I am able to provide good quality client/patient care. 1 2 3 4 5 6
15 I experience many interruptions in daily work routine. 1 2 3 4 5 6
16 I receive quality assistance from nursing assistants and service workers. 1 2 3 4 5 6

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17 There are enough RNs in my work setting. 1 2 3 4 5 6
18 I receive feedback on my performance from my nurse manager/supervisor. 1 2 3 4 5 6
19 I am able to communicate well with my nurse manager/supervisor. 1 2 3 4 5 6
20 I am recognized for my accomplishments by my nurse manager/supervisor. 1 2 3 4 5 6
21 My nurse manager/supervisor provides adequate supervision. 1 2 3 4 5 6
22 I am able to participate in decisions made by my nurse manager/supervisor. 1 2 3 4 5 6
23 Nursing policy and procedures facilitate my work. 1 2 3 4 5 6
24 Upper-level management has respect for nursing. 1 2 3 4 5 6
25 Friendships/ relationships with co-workers are acceptable. 1 2 3 4 5 6
26 I communicate well with physicians in work setting. 1 2 3 4 5 6
I am able to communicate well with other co-workers (lab technician,
27 1 2 3 4 5 6
pharmacist assistant,etc.).
28 There is teamwork in my work setting. 1 2 3 4 5 6
29 I feel respected by physicians in my work setting. 1 2 3 4 5 6
30 I receive support to attend continuing education and training programs. 1 2 3 4 5 6
31 My work setting provides career advancement opportunities. 1 2 3 4 5 6
It is important to have opportunity to further my nursing education without
32 1 2 3 4 5 6
leaving the current job.
33 I feel a sense of belonging in my work place. 1 2 3 4 5 6
34 I feel safe from personal harm (physical, emotional or verbal) at work. 1 2 3 4 5 6
35 I have adequate client/patient care supplies and equipment. 1 2 3 4 5 6
36 The security department provides a secure working environment. 1 2 3 4 5 6
37 I have enough time to do my job well. 1 2 3 4 5 6
38 My salary is adequate for my job, given a current job market conditions. 1 2 3 4 5 6
39 I believe my job is secure. 1 2 3 4 5 6
40 It is important to have a designated private break area for the nursing staff. 1 2 3 4 5 6
41 My work impacts the lives of patients, families, community. 1 2 3 4 5 6
I would be able to find my same job in another organization with about
42 1 2 3 4 5 6
same salary and benefits.

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 SECTION2: TURNOVER INTENTION

Anticipated Turnover Scale (ATS)

Adapted from Hinshaw & Atwood (1984)

Instructions: The purpose of this question is to give you the chance to express your opinion of the
possibility of voluntarily leaving your present job. For each item below, circle ONE response. Please
be sure to use the full range of responses (Agree Strongly to Disagree Strongly) and answer every
item.

Moderately Disagree

Moderately Agree
Disagree Strongly

Slightly Disagree

Agree Strongly
Slightly Agree
Uncertain
Scoring
Items of the Scale
Key *

(-) 1. I plan to stay in my position.

2. I am quite sure I will leave my position in the
(+)
foreseeable future.
3. Deciding to stay or leave my position is not a
(-)
critical issue for me at this point in time.
4. I know whether or not I will be leaving this
(+)
organization within a short time.
5. If I got another job offer tomorrow, I would
(+)
give it serious consideration.
6. I have no intentions of leaving my present
(-)
position.
7. I have been in my position about as long as I
(+)
want to.
(-) 8. I am certain I will be staying here.
9. I don‟t have any specific idea how much longer
(-)
I will stay.
(-) 10. I plan to hang on to this job.
11. There are big doubts in my mind as to whether
(+)
or not I will really stay in this organization.
(+) 12. I plan to leave this position shortly.

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 SECTION3: DEMOGRAPHIC INFORMATION

Instructions: Please mark only one answer for each question unless otherwise indicated.

1. Gender: Male  Female

2. Age:
 20 - 30 years 31- 40 years 41 - 49 years 50 - 59 years Above 60 years

3. Ethnicity:
KinhThai Mong  Chinese Others………………………

4. Marital status:
 Never marriedMarried Divorced Widowed
5. Do you have children? ( if say no, do not need to answer question 6)
YesNo

6. Number of dependent children

 1 child2 children 3 children 4 children Above 4 children
7. Education:
Vocational degreeAssociates degreeBachelor Master Other:………...

8. Employment status
 Full-time Part-time Contingent  Others………………………

9. How long have you worked in nursing field?

Under 3 years 3 - 10 years11- 20 years21- 30 years Above 30 years

10. How many total years of employment have you had in your present organization?
Under 3 years 3 - 10 years11- 20 years21- 30 years Above 30 years

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