Keywords

Competence, Impact, Meaning, Self-Determination, Psychological Empowerment, Turnover Intention.

Introduction

Organisations play an important role in the economic growth of countries around the world, regardless of their degree of development. As a result, any economy pursuing growth must prioritize the sustainability of any organisation. Moreover, the effectiveness of an organisation's functionality is critical to their long-term survival experience (Struwig et al., 2019). In sustaining the survival of organisations and facilitating the delivery of diverse organisational goals it is also necessary to employ and deploy employees who are empowered. In this regard, employees play a critical role in the delivery of healthcare services, especially, in the Healthcare Sector (Adepoju et al., 2017). Hence, due to the critical role they play in the organisation there is needed to empower them for reduced level of turnover intention. In contrast, disregarding employee efficiency and productivity in favor of other factors not only reduces organisational efficiency and productivity, but also increases accidents, resulting in employee dissatisfaction and consequently intention to leave (Hosseini et al., 2020). Recent study by the Nigerian Health Watch, showed that out of 10 medical doctors, 8 of them are currently seeking better work opportunities oversees due to lack of intrinsic motivation and sense of competency their jobs are supposed to offer (Isbell & Ojewale, 2018; Owoseye, 2018). Consequently, Adeniji et al. (2019) revealed that out of a total of 40,000 Nigerian Medical Doctors, 19,000 of them are based abroad, while from the remaining 21,000, 70% operate in urban areas, which host 30% of the population. In a recent report, Abang (2021); Salau et al. (2020) stated that brain drain is impacting healthcare sector as most Nigerian doctors seek better work conditions and pay abroad. As a result, the World Health Organisation (2017) lists the country among 44 percent of nations with less than one percent of doctors per 1000 population (WHO, 2017; Abdullahi, 2018). However, given its size and population, there are fewer health workers per unit population than are required to provide effective healthcare services in the country (Oladejo et al., 2015). Furthermore, in Nigeria, issues of lateness, work withdrawal, decreased performance, low organisational citizenship behaviour, and inadequacy of manpower overwhelms the healthcare sector and has led to high turnover intention (Oluwafemi, 2013; Oluwale et al., 2018).

Therefore, with the above issues playing out, it became paramount to introduce the concept of psychological empowerment in the Nigerian healthcare sector to help reduce turnover intention among Doctors and Nurses. Psychological empowerment is seen as an intrinsic task motivation that reflects a sense of self-control and improves one’s active involvement in a role, which ultimately decreases turnover intention of employees in the workplace. Thus, acting out as an essential role in solving the challenges regarding turnover intention among Doctors and Nurses in the Nigerian healthcare sector. Geographically, Al-Dmour et al. (2018); Tyagi & Shah (2018) studied psychological empowerment and employee engagement in India and Jordan. Shah et al. (2019) have investigated psychological empowerment and employee attitudinal outcomes. Meng & Sun (2019) reviewed the impact of psychological empowerment on work engagement among University faculty members in China. Considering the importance and need to enhance employees’ intention to stay, these studies have not done justice in accessing the role of psychological empowerment on turnover intention of employees in the Nigerian Healthcare Sector. Thus, it was necessary to replicate the same in Nigeria. Hence, it was deemed important to situate the effect of psychological empowerment (meaning, competence, self-determination, and impact) on the turnover intention of employees in the Nigerian Healthcare Sector.

P1 Psychological empowerment has no significant influence on employees’ turnover intention.

Literature Review

Psychological Empowerment

Psychological empowerment is a very significant form of organisational empowerment implemented in the workplace. Edalatian Shahriari et al. (2013) opined that psychological empowerment is a new method of increasing the level of motivation in the workplace and has gained an increased level of attention from organisational managers. However, Prasetio et al. (2017); Bin Jomah (2017) revealed that the concept of psychological empowerment plays a vital role in cognitive, emotional, and behavioural constructs such as satisfaction and commitment in the workplace, among others. Jaiswal & Joge (2018) emphasized that the perspective of psychological empowerment is focused on the way employees experience empowerment in the workplace. Similar to this, Jordan, Miglič et al. (2017) opined that psychological empowerment can be referred to as both a motivation and process of an employee's view of his or her effectiveness compared to other organisational members, both with the help of formal and informal procedures and techniques for encouraging effectiveness. Dahou & Hacini (2018) argued that the four dimensions of psychological empowerment are recognized as meaningfulness, choice, competence, and impact and as the individual gives higher scores to each of these elements, the more the sense of empowerment they experience.

Meaning

This can also be called Significance (Ulutaş, 2018). It can be referred to as the point to which employee values and appreciates a work task assigned to him/her, which is based on his/her values and norms (Dahou & Hacini, 2018).

Competence

This is referred to as an employee’s belief in his or her capability to fulfil a task assignment and activity with skill in the best way possible (Flaherty et al., 2017; Ulutaş, 2018).

Self-determination

This refers to an employee’s sense of freedom on how to carry out the task assigned to him or her (Mishra, 2016).

Impact

This can be referred to as the behaviour where an employee makes a change (s) in influencing administrative, strategic, or operating outcomes (Flaherty et al., 2017).

Turnover Intention

Turnover intention is a significant concept in today’s business world that is expressed. The concept can be interchanged in several forms in literature such as the intention to quit or intention to leave (Malik & Khalid, 2016). Ibrahim et al. (2013) pointed out that turnover rates vary from organisation to organisation. That is why, the question of retaining workers who have unique and inimitable abilities has been a major issue facing companies in the world's emerging, less developed and developed countries (Olawale & Olanrewaju, 2016). In Nigeria, specifically, the turnover intention is a rampant issue (Ajayi & Olatunji, 2017). Okafor & Chimereze (2020) emphasized that increased mobility of nurse employees has resulted in the shortage of skilled workforce in the developing nations as a lot of these employees believes that there are better opportunities for development outside their country of origin. Furthermore, the researchers observed that the UK and United States respectively attract many of the Nigerian nurse emigrants.

Past works from other scholars have demonstrated that intention to quit a workplace by employees is consistently associated with actual turnover (Idiegbeyan-Ose et al., 2018; Olawale & Olanrewaju, 2016).

Idiegbeyan-Ose et al. (2018) asserted that turnover intention can be defined as a situation in which an employee chooses to permanently quit or leave a specific organisation for certain reasons. Turnover intention can be defined as an employees’ behavioural attitude to pull out from an organisational work environment (Rajapaksha & Kappagoda, 2017). According to Hussain & Xian (2019), employees’ turnover intention means that an organisational member in the organisation have a plan or thought to voluntarily leave their current organisation.

Psychological Empowerment and Turnover Intention

Jaiswal & Joge (2018) focused on investigating the impact of psychological empowerment and employee retention. From their result, they were able to confirm that psychological empowerment contributes to employee retention in the workplace. From the foregoing result, it suggests that there is a possible relationship between psychological empowerment and turnover intention of employees because as psychological empowerment practices improve employees’ retention the lesser the level of turnover intention amongst employees in the workplace. Similarly, Aggarwal et al. (2018) pointed out from their study, that to have a harmonious environment in the workplace, it is important to develop an environment that fosters psychological empowerment among workers as this has a significant role on attitudinal and behavioural outcomes. Consequently, one of such significant role psychological empowerment can play is reducing the level of employees’ turnover intention. Hence, psychological empowerment can significantly affect the turnover intention of employees.

Furthermore, Ghaniyoun et al. (2018) examined the study of psychological empowerment and its associated factors among operational staff. Indications from the result of the study indicated that there is a significant correlation between psychological empowerment (self-determination) and work experience, and once this happens, it can affect an employee’s turnover intention. Thus, this study implies that since there is a significant correlation between psychological empowerment and work experience, psychological empowerment would also have a significant effect on turnover intention of employees. Mabekoje et al. (2017) established key results in his study on the predictive and incremental validity of psychological empowerment dimensions on employees' career commitment, among others. The key results established from the study revealed that psychological empowerment showed both incremental predictive effects on the employees' career commitment. Thus, their study concluded that empowering academic staff psychologically has both add-on and predictive effects on employees' career commitment of teachers beyond the contribution of competence, relatedness, and autonomy. Therefore, since there are an add-on and predictive effects of psychological empowerment on employees' career commitment as earlier established, there is a possibility that psychological empowerment will significantly affect the turnover intention of employees. This is because, the more career commitment employees have, the more it affects his or her turnover intention level.

Additionally, Arogundade et al. (2017) conducted a study on psychological empowerment as a predictor of work engagement. The results revealed that the overall dimensions of psychological empowerment jointly caused 25% of the variance in employees' engagement at work. Furthermore, the study showed that diverse dimensions of psychological empowerment contributed differently to the variance in employees' engagement. Similarly, the empirical findings from each study affirm the benefits of psychologically empowering workers to enhance positive employee behavioural such as engagement leading to the reduced turnover intention of employees. Thus, the empirical evidence seems to indicate that psychological empowerment and turnover intention of employees has a relationship in the work settings.

Nigerian Healthcare System

Nigeria, healthcare has been considered as one of the most essential systems that should be available to every citizenry in the country. Similarly, in the pyramid of healthcare system, three vital levels that make up the pyramid this include the primary level, secondary and tertiary level. Furthermore, the tertiary level which involves the Tertiary Teaching Hospitals and is considered the highest in the healthcare system of Nigeria. These hospitals under the tertiary levels serves as a referral center where referrals from the primary and secondary levels or health facilities are considered due to the level of specialized healthcare delivery or service offered to the challenged or those with complex ailments and high-risk surgical procedure through high-cost technological resources. Thus, the Nigerian healthcare sector is important to the Nigerian economy and therefore plays an extremely important role.

Reinforcement Theory

This theory by the behaviorist Skinner was propounded in 1969. The theory can also be referred to as behaviorism or operant conditioning, which has been one of the oldest theories of motivation in the world. This theory describes the individual or groups and how they act. The stance of Skinner’s theory is built on the assumption that behaviors of individuals or groups of people are driven by consequences. Furthermore, reinforcement theory argues that an individual or group of people’s behaviour can be changed by introducing positive reinforcement or negative reinforcement strategies.

Therefore, the significance of this theory relates to this study “a conceptual review of the role of psychological empowerment on employees’ turnover intention in the Nigerian Healthcare Sector”. This is because when workers receive positive reinforcement in terms of psychological empowerment from their employer, they are less likely to leave, resulting in high long-term organisational success.

Methodology

The study is a conceptual review and different concepts in line with this study were reviewed to provide an understanding of psychological empowerment and employees’ turnover intention in the Nigerian Healthcare Sector. Psychological empowerment was broken into aspects such as meaning, competence, self-determination and impact. While, employees’ turnover intention was positioned as a single variable. The study adopted B.F. Skinner’s Reinforcement theory to complement the knowledge of the key concepts reviewed in this paper. After that, the study developed a schematic model showing the role of psychological empowerment and employees’ turnover intention to a clear understanding of the concept and proposition revealed in this study (Figure 1).

Research Proposition

P₁ Psychological empowerment has a significant influence on turnover intention.

Conclusion

The study in conclusion, proposed that psychological empowerment which includes meaning, competence, self-determination, and impact has a positive effect on employees’ turnover intention. This is because each time employees are empowered psychologically; they feel positive that they can attain goals of a particular task offered to them.

Implication and Recommendations

The study shows that there is a possibility that psychological empowerment would affect the level of employee’s turnover intention (Doctor and Nurses). Thus, the Federal Government and Management of the Nigerian healthcare organisations should foster and reinforce the level of psychological empowerment (meaning, competence, self-determination, and impact) within the hospitals. Similarly, improving the level of psychological empowerment in Nigerian Healthcare organisations would ultimately reduce the level of turnover intention. Considering that when employee’s turnover intention is reduced in the Healthcare Sector in Nigeria this would help to increase in the level of organisation’s sustainable performance.

Contribution to Knowledge

This study adds to the body of knowledge by allowing the Federal Government of Nigeria and managers of Nigerian Healthcare organisations to better comprehend the idea of psychological empowerment and turnover intention of employees (Doctors and Nurses). Also, emphasizing that when the degree of psychological empowerment aspects is increased, it helps to show the potential effect of psychological empowerment on employees' turnover intention (Doctors and Nurses). These aspects of psychological empowerment include; meaning, competence, self-determination and impact.

Suggestion for Further Study

A survey concerning psychological empowerment and turnover intention in Nigerian healthcare sector, across all geographical regions in Nigeria, is needed to be carried out in order to fully comprehend the effect of psychological empowerment on turnover intention (Doctors and Nurses) in the Nigerian Healthcare Sector for generalization.

Acknowledgement

The author(s) acknowledge the consideration and sponsorship of this study by Covenant University.

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Received: 03-May-2021, Manuscript No. ASMJ-21-3695; Editor assigned: 06-May-2021, PreQC No. ASMJ-21-3695 (PQ); Reviewed: 25-May-2021, QC No. ASMJ-21-3695; Revised: 08-Feb-2022, Manuscript No. ASMJ-21-3695(R); Published: 15-Feb-2022