Intention to leave and associated factors among laboratory professionals working in Amhara National Regional State public hospitals, Ethiopia: institutional based cross-sectional study

Objective laboratory professionals play a vital role in the detection, diagnosis, and treatment of diseases. Therefore, it is important to get a deeper knowledge of workplace variables that either motivates laboratory staffs to remain employed or lead them to leave their current jobs. Thus, this study aimed to assess intention to leave and associated factors among laboratory professionals working in public hospitals of Amhara National Regional State, Ethiopia. A total of 220 (65.5%) with 95% CI: 60-70 laboratory professionals had the intention to leave their hospitals. Dissatisfaction with educational opportunity (AOR: 3.59, 95% CI: 1.61-7.99), pay and benefit (AOR: 3.89, 95% CI: 1.53-9.89), recognition (AOR: 2.69, 95% CI: 1.35-5.38), working environment (AOR: 2.77, 95% CI: 1.45-3.30), high workload (AOR: 1.94, 95% CI: 1.04-3.63), low affective commitment (AOR: 2.05, 95% CI: 1.10-3.82) and being unmarried (AOR:2.46, 95% CI: 1.32-4.58) were the factors significantly associated with intention to leave. The magnitude of laboratory professionals’ intention to leave was found to be high. Health care policymakers and hospital managers need to develop and institutionalize evidence-based retention strategies to reduce the intention of laboratory professionals to leave.


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In return, laboratory staff can become dissatisfied by the lack of faith in their profession and as a result, high staff turnover which affects the performance of LP's and ultimately quality of the clinical care [3,4].
Intention to leave is individuals' subjective prediction about leaving the current profession, working place or an organization in the near future, which was considered as a proxy of actual leaving [5,6]. Studies show that there are several factors that contribute to the intention to leave. Job satisfaction (such as pay and benefit, work autonomy, coworker relationship, supervision, working environment, and working condition) and organizational commitment are the most important factors which play an important role in determining employees' intention to leave their job or their organization [7].
Health professionals' intention to leave significantly affects the functioning of the health care sector worldwide, especially in developing countries, and it impedes progress towards different health-related goals [8,9]. It affects organizations to achieve its objectives since it reduces innovation, affects the quality of services and motivation of employees and it is very costly for an organization [9, 10].
Globally, employee intention to leave and instability at health facilities is high, particularly in developing countries [11,12]. In South Ethiopia 59.4% health professionals intended to leave their working places [13]. Similarly, in the Amhara region, 60.2% of nurses reported they desire to leave their current working place [14].
The relationship between intention to leave and other variable have been uncertain in most of the studies. Considerable researches focused on the nursing field shortage and turnover intention of their workplace [15]. However, staffing shortages and turnover intentions are affecting other health care professions as well and the reasons behind laboratory professional intention to leave were unknown. Therefore, this study has the potential to address workplace variables that influences laboratory profession intention to 4 leave their workplace.

Study design and setting
An institutional based cross-sectional study was conducted in Amhara National Regional State (ANRS) public hospitals from February 16 to March 14/2016. ANRS is located in Northwestern Ethiopia. The Regional state has 40 functional hospitals (5 referral, 3 general, and 32 primary hospitals) and 834 health centers with a total of l,699 laboratory professionals [16]. The study population were all laboratory professionals in ANRS public hospitals who were working for at least six months before the study period.

Sample size and sampling procedures
The sample size was determined using 52.5% proportion of health professionals' turnover intention [17], by considering population correction formula, 1.5 design effect, and 10% for non-response rate, the final sample size was 366. Study participants were selected using a stratified cluster sampling technique. Laboratory professionals were stratified based on their level of working organization (primary hospitals, general hospitals, and referral hospitals). Then the calculated sample size was proportionally allocated for each stratum. Three referral hospitals, 2 general hospitals, and 16 primary hospitals were selected from each stratum by using lottery methods. Finally, all laboratory profession from each selected hospital were included in the study.

Measurements
Data were collected using a structured self-administered questionnaire which was first prepared in English, and then translated into the local language (Amharic), and then backtranslated to English to maintain its consistency. The dependent variable, intention to leave the workplace was measured by three items following Mobley et al. definition [18].
The respondents were asked to indicate the extent of their personal agreement using a 5 five-point Likert scale (1: strongly disagree to 5: strongly agree). Respondents who scored more than 60% of the sum of all the intention to leave scale items were considered as showing the intention to leave [19].
Job satisfaction was measured with a five-point Likert scale of 72 items that included 12 subscales. (pay and benefit (5 items), supervisor support (12 items), policy and strategy (5 items), coworker relationship (5 items), training opportunity (6 items), the nature of work (10 items), responsibility (3 items), autonomy (3 items), workload (7 items), performance appraisal (3 items), recognition and reward (4 items) and work environment (7 items) were used. Laboratory professionals who scored >60% of the sum of the satisfaction scales were considered as satisfied [19]. The reliability of the tool for each subscale was checked using Cronbach's alpha reliability test with a score of greater than 0.78.
Organizational commitment (affective, normative, and continuance commitment) was assessed using the scales developed by Meyer and Allen [20]. A five-point Likert scale (1: strongly disagree to 5: strongly agree) of three items for each component were used. A score with more than 60% of the sum of the commitment scales represented a high organizational commitment.

Data processing and analysis
The completed data were entered to Epi-info Version 7 and exported to SPSS version 20 software for analysis. Both bivariable and multivariable logistic regression analysis were computed to identify factors that affect the intention to leave. In the final model variables with a P-value < 0.05 and adjusted odds ratio (AOR) with 95%CI were used to declaring the associated factors after model fitness was checked using Hosmer-Lemeshow goodness-of-a-fit test (p = 0.25).

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Socio-demographic characteristics of the respondents A total of 336 laboratory professionals have answered the questionnaire with 91.8% response rate. The median age of the study participants was 27 (IQR: 26-30) years.
Majority of the respondents were males 216 (64.3%) and more than half of the respondents were unmarried 182 (54.2%). Fifty-six percent of the respondents were bachelor degree holders in laboratory technology and 53.9% of the respondents had 1-5 years of work experience. Forty-nine percent of the respondents were working in primary hospitals, and the median monthly salary was 3145 (IQR: 2514-4725) Ethiopian birr (Table   1).

Intention to leave, organizational commitment and job satisfaction
The overall intention to leave the hospital among laboratory professionals in the study was 65.5% (95% CI: 60-70). The median intention to leave the laboratory profession was  (Table 2).

Factors associated with intention to leave
In the multivariable logistic regression analysis, eight variables were statistically significant. Accordingly, laboratory professionals who were unsatisfied with payment and benefit were 3.42 times more likely to leave the organization than those who were satisfied (AOR: 3.42, 95% CI: 1.39-8.42). These who were unsatisfied with professional opportunity were 3.59 times more likely to leave their current working organizations than This discrepancy could have resulted from differences in infrastructure in the health institutions, study area, and differences in the study participants that might affect the intention to leave.
Our finding shows that unsatisfied LPs' with payment and benefit were 3.89 more intended to leave their hospital as compared to their counterparts. This finding is consistent with other similar studies conducted in Ethiopia [19,21,22]. This could be explained by the disproportionality of task and benefit they received will pushed to search for a new job.
8 Whereas satisfied professionals want to remain within the organization because of their need to maintain benefits.
Our finding shows that LPs who were unsatisfied with educational opportunity were 3.59 times more likely to leave their organization when compared with their satisfied counterparts. This finding shares the same evidence as poor training opportunity increases intention to leave in other studies too [19,21,24]. This can be explained by less professional opportunity may increase job dissatisfaction because of the absence of a chance to grow and develop their own abilities.
Intention to leave was higher among the respondents who were unsatisfied with recognition and reward compared to their counterparts. This might be satisfied professionals believe that losing an organizational reward will be costly and would not find The finding also shows LPs who were unsatisfied with the working environment were three times more likely to leave their hospital compared to their counterparts. This finding is in agreement with a study was done in Sidama zone and Jimma zone public health facilities [27, 28] and also supported by Herzberg two factor theory of motivation which identifies recognition, work condition, the nature of the work, and responsibility that influences employee's intention to stay or leave by affecting their satisfaction [26]. The other possible explanation would be substandard working conditions or lacks important facilities in the workplace such as proper lighting, furniture, restrooms, and other health and safety provisions will facilitate the inconvenience of employees to stay for a long time.
Our study identifies laboratory professionals with high workload were more likely to leave their organization which is congruent with other studies [28,29]. This could be being overloaded will increase their pressure and will produce high fatigue which leads them to seek employment elsewhere.
Moreover, the study finding shows that LPs with low affective commitment were two times intended to leave their organization compared to these with high affective commitment.

Conclusion and recommendation
Laboratory professional's intention to leave public hospitals in ANRS were found to be high, which will be detrimental for both the organization as well as to the employee.
Dissatisfaction with a training opportunity, compensation and benefit, recognition at work, working environment, low affective commitment, and high workload were the factors that influence intention to leave. Policy makers and hospital administrators need to develop and institutionalize evidence-based retention strategies to reduce laboratory professionals' intention to leave.

Limitation of the study
Use of self-reporting measures may have some potential of reporting bias, because of the respondents' interpretation of the questions. Furthermore, this study was not triangulated with qualitative method. The other limitation was a lack of follow-up, in which the researcher could compare participants' intentions to leave or stay with their actual turnover actions.

Ethics approval and consent to participate
Ethical clearance was obtained from the ethical review committee of the Institute of public health, college of medicine and health science, the University of Gondar (Ref. No. IPH/2826/2016). Before communicating the study participants' Official letters was obtained from Amhara National Regional State Health Bureau and each selected hospital.
For each study participants, full information was given regarding the purpose and importance of the study. As well they were informed that they are free to refuse in participating or answering any of the questions without any restriction and finally written consent was obtained from each participant. Name of participants' and any personal identifiers were not included in the study and the confidentiality of the data was kept at all level of the study.

Availability of data and materials
Data will be available upon reasonable request from the corresponding author.

Funding
No funding source available.

Acknowledgments
Authors would like to thank Amhara National Regional Health Bureau and all Hospitals in the Regional State. Our appreciation also goes to data collectors for their unreserved contribution in data collection activities and study participants.

Consent for publication
Not applicable.

Competing interests
The authors declare that they have no competing interests.

Authors' contributions
Endalkachew D, Gashaw A, and Geta A conceived of the study, developed the tool, coordinated the data collection activity, and carried out the statistical analysis.
Endalkachew D and Tsegaye G participated in the statistical analysis, revision of the paper and drafted the manuscript. All authors read and approved the final manuscript.