Should I stay or should I go? The impact of working time and wages on retention in the health workforce

BACKGROUND: Turnover in the health workforce is a concern as it is costly and detrimental to organizational performance and quality of care. Most studies have focused on the influence of individual and organizational factors on an employee’s intention to quit. Inspired by the observation that providing care is based on the duration of practices, tasks and processes (issues of time) rather than exchange values (wages), this paper focuses on the influence of working-time characteristics and wages on an employee’s intention to stay. METHODS: Using data from the WageIndicator web survey (N = 5,323), three logistic regression models were used to estimate health care employee’s intention to stay for Belgium, Germany and the Netherlands. The first model includes working-time characteristics controlling for a set of sociodemographic variables, job categories, promotion and organization-related characteristics. The second model tests the impact of wage-related characteristics. The third model includes both working-time- and wage-related aspects. RESULTS: Model 1 reveals that working-time-related factors significantly affect intention to stay across all countries. In particular, working part-time hours, overtime and a long commuting time decrease the intention to stay with the same employer. The analysis also shows that job dissatisfaction is a strong predictor for the intention to leave, next to being a woman, being moderately or well educated, and being promoted in the current organization. In Model 2, wage-related characteristics demonstrate that employees with a low wage or low wage satisfaction are less likely to express an intention to stay. The effect of wage satisfaction is not surprising; it confirms that besides a high wage, wage satisfaction is essential. When considering all factors in Model 3, all effects remain significant, indicating that attention to working and commuting times can complement attention to wages and wage satisfaction to increase employees’ intention to stay. These findings hold for all three countries, for a variety of health occupations. CONCLUSIONS: When following a policy of wage increases, attention to the issues of working time—including overtime hours, working part-time, and commuting time—and wage satisfaction are suitable strategies in managing health workforce retention.