1M. Shafhuan B. Yusran, 1Hasifrafideeb. Hasbollah,1M.Firdausb. M. Nasir

DEVELOPINGACONCEPTUALFRAMEWORKFORSTAFF DEVELOPMENTINMALAYSIANURSINGHOME

1M. Shafhuan B. Yusran, 1HasifRafideeB. Hasbollah,1M.FirdausB. M. Nasir

1FacultyofEntrepreneurship and Business, UniversitiMalaysiaKelantan, Malaysia

Email:,,

Abstract-Nursing staffthathadbeenassigneddutiesfor the residents including providepersonalcare, assisting withactivities andmedications,serving meals,andcompleting resident’s laundry and housekeeping.Sometimes,toomanyresponsibilitiesbytakingcareofresidentsmayleadtoworking extrahours. Due to this,nursing staff willexperience frequentchanges in their working shifts, resulting intoextendedovertimeandworkingatdaysoffthatmayresultintoturnover.Turnovermayleadinto potentialnegativehealth outcomefornursing homeresidents innursing staffpayment(salary,wagesand otherbeneficiation)aredisproportionatecomparetotheirworking hours.Itisbecauseofnursing home nursesare the lowestpaid employees in healthcarelabour force. Understandingturnover in nursinghomes areimportantbecauseitcaninfluencetheoperationofanursinghome. Thepurposeofthis paperisto identify thecharacteristics thatcontributetothestaffturnoverby developing aconceptual framework for staff development in retaining the staffin anursing home.Fourcharacteristics thathavebeen identified which arepeople, program, processand rewards.

Keywords:StaffTurnover,StaffDevelopment, NursingHome, StaffRetaining, Malaysia

1. Introduction

Inthiseraofglobalization,every organizationiseagertomanagetheirstaffturnover methodically.Good payand benefits inan economic areverydifficult to an organization in order tomeetthebasic necessitiesofoffering asafeenvironment(Raj,2013). Staffturnoverisacause ofconcernforhealthcareorganizationsthatmayleadtoimplicationonthequality ofservicethat provide tothepatient.Highproductivity,fewer turnoverandbeprofitable were every organizationwishes(Raj,2013).According toRoslan,Hazila,Filzatunand Azahadi,(2014)staff turnover canbereferasthe processthatemployeesleavinganorganizationandneedtobe replaced.Highstaffturnovermay resultinincreasingcostinselectionandrecruitment. Furthermore,turnoverisa largeandexpensive probleminthe long-termcareenvironment (Zhang,Punnett,GoreCPH-NEW,2014)thatmayaffectingqualityofcare,patientsafety and patientsatisfaction(Sellgren,EkvallandTomson,2007).Roslanetal.(2014) addedthatitalso affectstheorganizationalproductivityaswellasthemoraleandmotivationoftheremaining staff.

Innursinghomepointofview,turnoverisathighratebetweennurses,topmanagement,and nurseassistants.Comparing tootheroccupationalgroups,nursestendtoleavetheprofessionata

muchgreater rate(Banaszak-Holl& Hines,1996;Castle,2005;Castle,Engberg,& Men,2007; Castle,2009;Heijden,Dam,Hasselhorn,2009;Hunt,CorazziniandAnderson,2014).Getting alowestpaidemployeesinhealthcareindustry arethemainproblemoftheseturnover (Nolkier, Ejaz,MenneJones,2006).Potentialforgetting negativehealthoutcomeforresidentsmay occur if nursing home got nurse turnover (Castle, Engberg and Men, 2007). As a result, increasingnumberindeficienciescaused by thecharacteristicsoftheresidentwillmakethe remainingnursing stafftoworkingextrahours(Harrington,Zimmerman,Karon,RobinsonBeutel, 2000)and makethepayment becomedisproportionate compareto theirworkinghours.

Moreover,North, Rasmussen,Hughes,Finlayson,Ashton, CampbellandTomkins,(2005) stated thatnursing professionwillbeexperiencing declinenumbersofnewnurses,andolderaverage age ofnewgraduatesandhighratesofyounger nursesleavingtheprofessionduetoan unwillingnesstoaccepttherelatively highstress,lowsalary,andlimitedopportunitiesfor advancement.Thispaper attemptstodevelopaconceptualframeworkfor staff performance developmentinnursinghome Malaysia.The dimensionof the staff developmentsuchaspeople, program, process and rewards will be explored.

MinistryofHealth(2009)statedthatMalaysiahadapproximately75,000activenursesinthe governmentandprivatehospitals.75% of themworkinginthegovernmenthospitalswhile 25% oftheminprivatehospitals.Unfortunately,thenumberisstillnot enoughandMalaysiahospitals have beenforcedtohireforeignnursestomeetthe currentdemand.Asaresult,the situationare gettingworsenwhenmany trainednursesingovernmenthospitalswillingtogototheprivate sectorduetobetteroffersandotherfactorssuchasworking environmentandworkload(Omar, Majid, JohariAnuar, 2014).

1.1 ProblemStatement

In healthcareorganizations,nursing homerespectively,turnovercanbeacauseofconcernasit willgavenegativeoutcomesonthequalityofserviceprovidedtopatient. Failureinretaining nursesinnursinghomemay leadintopotentialnegativehealthoutcomeforresident(Castle, EngbergandMen,2007).Furthermore,increasingindeficienciesmayoccurcausedby the characteristicsoftheresidentthatmaking nursing stafftoworking extrahours(Harrington, Zimmerman,Karon,RobinsonandBeutel,2000).Asa result,itcanhappenwhennursing staff payment(salary,wagesandother beneficiation)are disproportionate compare totheir working hours.Understanding turnoverinnursing homesareimportantbecauseitcaninfluencenursing homefacility operationcost,lowernursingstaffsatisfaction(Parsons,2003),andwillresulting negativeoutcome for residents (CastleEngberg,2003).

Educationheterogeneity alsocaninfluencesthenursing staffturnover(Castle,2005).Poorpain management that including sleep disorder, poor nutrition, depression and stress, anxiety, agitation, decreasedactivity,delayed recuperation,andlowerquality oflifecanaffectthe performanceofthenurses(Ferell,1995;Stein,2001;Herr,2002).Nursing staffmustbe conversantaboutpainandtheirmedicationtodispelresidentandfamily myth(Jones,Fink, Pepper,Hutt,Vojir,Scott,ClarkMellis,2004).Itisbecauseconflictwithresidentsandtheir familiesweresignificantly associatedwithemotionalanddepersonalization(Fujiwara, Tsukishima,Tsutsumi,KawakamiKishi,2003).Trainingisimportanttonursingstaffto

overcomejob-relatedstress.Itisbecausethey required75hoursofentry-leveltraininginorders to train workers properly(Noelkeret. al, 2006).

Top management staffing and profit status also oneofthemost common turnovers (Castle, 2006) becausenursing home’sownermakessomechangesintheir organization(Castle,2006; Donoghue,2010). Satisfactionswithsupervisionare importantbecauseitpositedasa main componentofoveralljobsatisfaction,jobperformanceand retentionofnursing staff(Nolkier, Ejaz,MenneandJones,2006). Lackofsupervisingandcommunicationwithco-workeror supportfromtopmanagementcancreateturnoveramong nursing staff(Fujiwaraetal,2003).In addition,nursinghomefacilitieswithhighersupervisoryworkloadshadlessjobcommitment and can increasedemotionalexhaustion among others colleague(Donoghue, 2010;Mckenzie, Teri,Salazar,Farran,BeckPaun,2011).Supportfromsupervisorisimportanttodecreasing stressamong long-termcarenursing staff (Liang,Hsieh,Lin,andChen,2013). Lackofsupport andassistancefromsupervisorwillmakenursing staffexperiencingnegativephysicaland emotionalchanges(Noelkeret.al,2006).Therefore,toovercomethisproblem,conceptual framework paperwill beproposed.

2. Literature Review

2.1 Dixon StaffDevelopment Model

Staffdevelopmentreferstoasystematically planned,inclusivesetofprofessionallearning opportunitiesthatcarriedoutovertimeforachieving thespecificdistrict-wide,campus,and departmentimprovementobjectives(Dixon,2001).Themaingoalofstaff developmentmodel processisincreasingemployee learningandengagement,andcontinuousimprovementforall staffs byimplementing acultureofprofessional learningbasedcommunitywithin the area.

Staffdevelopmentimprovesthespecialty practiceofnursingprofessionaldevelopmentforthe improvementofhealthcaresignificances(Dixon,2001).Moreover,nursing practicecanbe defined by standards,basedonstudy,andcriticaltoquality patientandorganizationaloutcomes. Dixon(2001)also statedthis modelcancommitinproviding researchandresourcesthatcan enhance the practice locally,ineachorganizationsrespectively.Thismodelalsocanincorporate staffdevelopment in attainingtheorganization’s goals that is can bringpositiveoutcomes.

Figure1:Dixon’sEquity-SensitivePerspectiveModel

Source:AdoptedfromDixon(2001)

Figure1showsthatstaffingmodelsuggestingacloserelationshipbetweenstaffdevelopment andperformanceappraisal.Performanceappraisalinstaffdevelopmentpractiseisdepending on the contextof workplace.The effectivenessofstaff developmentpracticesmustappeartostaff andorganization’simprovementthatoriginatefromdevelopmentalplan,including attentionto both process and recognizematuration in staffhimself.

Dixon(2001) statedthatanEquity-Sensitive Perspective (ESP) modelofleading,educating, and managing hadbeenofferedinstaffing model.ESPmodelis synergistic conversionsmodelthat focusing on people, process andprogram in the context ofinstitutional change. Scott(200)added thattomeetthe needsforexcellence service andprofessional,staffdevelopmentshouldalsobe a priority tostaff.Appropriatestaffdevelopmentprogramsandtrainingwilleventuallyguarantee that continuingeducation process can makethestaff remain knowledgeable.

Themainobjectiveofstaffdevelopmentisimproving thestaffandorganizationaleffectiveness. Thisprocess can affectsthe interpretationsofjobrequirements,relationshipbetweencolleagues andviewpointonthe methodsof working.Ina socialcontext,staff developmentisemphasizing teamwork,builtonafoundationofcollaboration.Furthermore,staffdevelopmentisaprocess thatdemonstrating thecommonnessofpurposeofallstaffandthecriticalnatureofindividual knowledge and skills in orderto perform the assigned duties in relation to theworkgoal.

2.1.1 People

Thismodelisdevelopedforthemanagementoforganizationthatareincreasingly hiringpeople, anddosometaskforotherpeoplewithvariousbackgrounds.Dixon(2001)statedthatpeople shouldbefocusonwaysthatmenandwomen,orvariousraces,reflectdifferencesinvalues, attitudes,behaviourstyles,waysofthinking andculturalbackground.PeopleintheEquity- Sensitive Model that been adopted from Dixon (2001) highlighted ‘people’ that work in

organizationmustfostering awarenessandacceptanceofindividualdifferences,encouragement greaterunderstanding ofthenatureanddynamicsofthedifferences.Inaddition,thismodelhas beenviewashelping participantstounderstandtheirownfeelingsandattitudesaboutvarious people,exploring howthedifferencesmightbetappedasassetsintheworkplaceand attractiveness in work relations between various people.

Dixon(2001)statedthatstaffdevelopmentmustbecognizantofthevariationinthematurityand growthofpeopleandtheorganization.Moreover,atthesametimeassomepeoplemayhave beenservedtheprofessionformanyyearswhileothermay beonly thebeginningoftheir professional careers.Dixon(2001) addedthatthefunctionalrolesof people instaffdevelopment maychangeand need retoolingforthenew responsibilities.

2.1.2 Program

InEquity-Sensitive Model,program isone of the factorswhichisreferredtoanassortmentof termssuchasinservice,continuing professional staffing andassumesvariousforms.Programin staffdevelopmentmodelshouldbeamainconcernofemployeeandorganization.Training and development activities and programs should include all peopleworking within theorganizational division in orderto achievethegoals forqualityserviceand professional and personalgrowth.

Appropriatestaffdevelopmentprogramswillultimately ensuringthatcontinuouseducation occursinorderforstafftostay behindknowledgeableinthefieldofnursinghomemanagement. Moreover,italsoprovidesbasic understandingof the culture inthe organizationaswellas providing abasicunderstanding intheory andpractice(Dixon,2001).Dixon(2001)addedthat using programtopromotestaffdevelopmentinitiativessuchasjobroaster,mentoring,andself- directed trainingcan be an advantages methodforimplementingstaffdevelopment activities.

Furthermore,implementingaprogramcanbevery beneficial by helpingtoaddressissuesof diversity,assistmiscellaneouspopulationswithintegratingmorefully intotheorganizationand by providingstaffingopportunities.Programisanoff-line helpby onepersontoanotherin making significanttransitioninknowledge,workorthinking andalsoconcludethatitisnot usuallyconsideredanofficialaccountability,butarelationshipthatbeendevelopedforpurpose of aidlessexperiencedstaff memberstolearn(Dixon,2001).Dixon(2001) alsostatedthatstaff development program as an initiative that promoting and addressing issues to pertain the diversitythatincludesponsoring training andbasedprogramsuchasworkshopwhichgiveresult to awareness, skill enhancement andcollaborationon various issues.

2.1.3 Process

Dixon(2001)statedthat,allstaffinorganizationwillparticipateinanon-going processofstaff developmenttoachieve the particularmissionofeachdifferent,supervisorswilldevelopa plan forstaffdevelopmentthatencompassthemissionsoftheorganizationandthedepartment.The

aimof ‘process’ instaffdevelopmentmodelisthe effectivenessof improvementinstaff and organizationalandwill affectstheinterpretationofjobrequirements,relationshipbetween colleagues and perspectives on themethods ofworking.

‘Process’of staffdevelopmentoccursinasocialpointof viewandemphasizesteamwork,built onanorganizationof collaboration(Dixon,2001). Staff developmentalsoinclude a processthat willdemonstratesthecommonnessofallstaff’spurposesandthekey natureofindividual knowledgeandskillinordertoperformtheassigneddutiesinrelationtotheorganization’s goals .

Equity-Sensitive Model(ESM) alsopointoutthatthe ‘process’,staff developmentison-going andattachedindaily workandmaking itnoticeableinallpersonnelfunctionofthedivision (Dixon,2001).Inaddition,allofotherstaffing functionsarerelatedto‘process’whichistruein supervisionandperformanceappraisalwhereitisnecessary toestablishandsustainsthe conditionsthatrequiredforeffectivenessofperformance management.If‘process’isproperly facilitated,performanceassessmentwillconfirmsthatemployeecanacceptthe roles,evaluates theextenttowhichperformancegoalsarebeingmet,identify problemsandbarriersinthework environment,providingpositive andbeneficialfeedback,encourageregular jobrelated conversationbetweensupervisorsandstaffmembers,andprovidetheinformationthatneeded fortheperformancereward process.

2.2 Current Model forStaffDevelopmentinNursing Home

Basedon pastliterature,programwithastrong professionaldevelopmentcomponenthavebeen showntoyieldbetterstaffretentionratesandbetterperformanceindevelopmentaltask(Mullei etal,2010).Furthermore,previousresearchandanalyticalliterature by Huntetal,(2014) constantly pointstotherelationshipofhighleveladministrativesupporttothesuccessofstaff developmentinanorganization.Inaddition,leadershipmustbe establishorganizational objectivesthatrelatedtotheimprovementofworking styles,createaclimatethatwillfostering and encouragingstaffdevelopment.

Furthermore,while supportandleadershipofprocessandpeople inorganizationalisimportant, literature also points out the limitation of that leadership. Ha et al (2014) stated that the supervisorshould havethe responsibilityforleadingstaffdevelopment intheorganization, atask thatevidently requiremoretimeandfocusbeforebeingaccepted.Kashetal(2010)statedthata carefulbalanceneedstobe establishedinwhichtheadministrative leadershipsetsthe circumstance forstaffdevelopment.

Well-formedstaffdevelopmentplansrecognizethatmanydiversetrainingareneededovera long period(Dixon,2001).Inaddition,italsorecognizethattraining mustberelatedto organizational mission that should be systematic, demonstrable, and highly regarded improvement ofstaffdevelopment.

2.3 Conceptual FrameworkforStaffDevelopment

Figure2:ConceptualFrameworkfor staffdevelopmentin Malaysianursinghome

Source:AdaptedfromDixonStaffDevelopmentModel

Figure 2indicatesthe conceptualmodelthatbeenadaptedfromDixonstaff developmentmodel. The elementsofpeople,program,andprocesshave beenexplainedinthe literature review. However,there isfourthelementthatcanbe contributedtothe conceptualframeworkwhichis rewards.

2.4 Rewards

Rewardscanbe defineasallthe financial,non-financialandpsychologicalpaymentsthat providedbyorganizationtotheemployeesbecauseoftheircontributionwithinthecompany

(Bratton &Gold, 2003).Furthermore, Malhotra,Budhwar and Prowse (2007) claimed that “work rewards”expressedthebenefits,workerreceivefromthe organization andareconsideredthe “determinantsof job commitmentand satisfaction”. MilkovichandNewman (2004)addedthat thetangiblebenefitsandprovisionsthatbeenobtainby employeewaspartofthe“employment relationship” was representasarewards.Ontheotherhand,financialincentivesare notalways assimilateby employeeandphysicalincentiveusuallynotsatisfiesthebasicpsychologicalneeds (Stone, Bryant and Wier,2010).

Rewarding areessentialasabenefitsandanultimatemotivatortorealizetheorganizational performance(AbbasZaidi, 2011;Ahmadloo,Boroujeni,Gohari,Hosseinipour, 2013).In this globalizationera,rewardinghasbeenadopted bymany differentorganizationswhetherinboth public andprivate sectors.Furthermore,Bowen(2000)andAbbasetal(2011)statedthat rewardingsystemisimportantasamotivatortobuilding upself-esteemandtodeveloppositive relationship between managers and their employees.

Generally,theemployee’sincisivepointofviewtowardstherewarding practicedependsontwo factorswhicharecomplexityandcommunication(Goharietal.,2013).Havingasignificantly communicationof the offer andtheconcentrationonthe rewardsaswellasthe consideration aboutunderstanding themethodologies,targetsand measuresthatapplied whileintroducing rewards aretherequirement foraclearrewardsystems. The firm’sgoal, theirsupplyand theway they were rewarded are crucial for employees to take note because obscurityon this will decrease the motivationvalue (Gibbons,1998).Ivana,LovorkaandNevenka(2009) statedthat rewardingsystemmustbepreciseandclearregarding awards.Moreover,criteriaofsatisfaction andawardrecipient’srecognitionshouldbeattainingby rewards(Ivanaetal,2009).Asaresult, Abbas andZaidi(2011)mention that rewardcanbegivenrelatedto theperformance,appropriate with job measurement and irrevocable.

Goodorganizationsmake a proper rewardmanagementsystemfor their employees;andgood rewardmanagementsystemwhiledecidingrewardsfortheemployeesconsiderbothfinancial andnon-financialrewardsbecauseanidealrewardsystemdoesn’tignoreanyoftheattribute becauseeveryemployeehas different causeofmotivation (Armstrong and Murlis, 1991).

2.5 Monetary andNon-Monetary Rewards

Theoppositionofmonetary andnon-monetaryrewardwasoriginated byHerzberg,Mausnerand Synderman(1957)statedthat the achievement, recognition andadvancement as an non-monetary thatmotivatetheemployeesmorethanmonetaryrewardsuchassalary,jobsecurity orworking environment.Philosophy ofmonetary rewardwasoriginatedfromtheterm“utilitarianism”that employee’sperformancecanbeenhancedby providingmonetary rewards(Zhou,Zhang,Montoro-Sanchez,2009).Furthermore,Zhouetal(2009) addedthatthetermof“romanticism” referstothenon-monetary rewardthatwillboosttheinnovationandcreativenessofthe employees.Bates(2006)indicates,formoney tomotivate,meritpay risesmustbeatleast seven percentsofbasepay foremployeestoperceivethemasmotivatingandtocatchanybody’s intention.

2.5.1 Monetary Rewards

Themostinfluentialandpowerfulincentiveinthesociety ismoney.Moneyalsoisalwaysbeing usedtoinfluenceandmotivateemployeesinanorganization(Zani,Rahim, Junos, Samanol, Ahmad,Merican,SaadAhmad,2011).Llewellyn,EdenandLay (1999)statedthatmonetary rewardswastakeninfromthe formof directfinancialsuchaspersonalincome.Thishasbeen support by MathauerandImhoff(2006),ZaidiandAbbas(2011)andHarunavamweand Kanengoni(2013)statedthat financial incentiveis a form ofmonetaryvalues or equivalents such asbasicsalary,allowancescheme, healthinsurancepremiums,housing allowance,other provisions,increasinginsalaryandbonuses.Adam(2010)hadstatedthatmonetaryrewardisa

‘tangibleawards’.

2.5.2 Non-Monetary Rewards

Non-monetary rewardcanbedefineastheonethatinvolvenodirecttransferoffinancialvalues or equivalent such as holidays, recreational activities and recognition from the superior (MathauerImhoff,2006;HarunavamweKanengoni,2013).Italsocanbedefinedasa status,congeniality ofwork,careerprogressionandhealthcarebenefitsthatofferedtothe employeesinanorganization(Llewellynetal,1999;Moore,M.S.S.W.,2010).Manolopoulos(2008)statedthatnon-monetary rewardsarethefactorssuchas“opportunitiesforcreativity, opportunitytouseinitiativesandtheperceptionofworkimportanceintheoutsideworld”.In addition,non-monetary rewardsaretheonesthatnotinvolvingcashormoney anditisallabout thejobitselfthatmotivatesemployeestowork(Roslizaetal,2011).Non-monetary rewardsare an ‘intangible awards’(Adam, 2010).

3. Conclusion

Thispaperilluminatestheconceptualframeworkfornursinghomestaffdevelopment.Dixon staffdevelopmentmodelthatconsistthe elementofpeople,programandprocesshave been adaptedintothe conceptualframework.However,rewardshadbeenidentifiedasa one of the contributingfactorsofstaffdevelopment.Itisbecauserewardsleveragethesatisfactionofstaff to retain in nursing home. This conceptual paper is the preliminary phase in developing theoretical framework ofstaffdevelopment modelin Malaysia’s nursinghome.

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