West Bengal University of Technology

Summer Project Report

On

RETENTION OF NURSES
AT

APOLLO HOSPITAL
BY

AISHWARYA BATTA
WBUT Regn No:

071360709201059

of MBA -11 (2007-2009)

WBUT Roll No: 071360709059

Army Institute of Management Kolkata

PROJECT REPORT RETENTION OF NURSES

AT APOLLO HOSPITAL

APOLLO HOSPITAL, HYDERABAD

BY

AISHWARYA BATTA
ROLL NO: 071360709059 REGN NO: 071360709201059

CONTENTS
Page No
CERTIFICATE ACKNOWLEDGEMENT EXECUTIVE SUMMARY CHAPTER 1. THE COMPANY Company Profile CHAPTER 2. THE PROJECT Purpose and Scope of the study Methodology 4 5 6-7 9-16

19-20 22-23

CHAPTER 3. COLLECTION AND ANALYSIS OF DATA Data Collection 26-45 Data Analysis 47-48 CHAPTER 4. FINDINGS AND RECOMMENDATIONS Conclusion 51 Constraints and limitations 53 Recommendations 55-57 REFERENCES APPENDICES BIBLIOGRAPHY

59-60 62

GUIDANCE-cum-COMPLETION CERTIFICATE

This is to certify that Ms. Aishwarya Batta, WBUT Regn No 071360709201059 of 2007-2008 ,WBUT Roll No 071360709059, has undertaken the project titled Retention of Nurses at Apollo hospital under our guidance from 02 June 2008 to 31 July 2008 at Apollo hospital, Hyderabad and has completed the said project successfully.

Organizations seal

External Guides Full Signature Designation

Internal guides full Signature

ACKNOWLEDGEMENT

I express my deep sense of gratitude to my Guide Ms. Sharanya Reddy T (HR Executive), Apollo hospitals for permitting me to work on this dissertation and for allowing me to use the resources at company. I am grateful to Dr.K K Chaudhuri (Project Guide) for their invaluable guidance and encouragement, which helped me to complete the project successfully. I am thankful to Ms. Swathi of Apollo Hospital who have helped me in successful completion of my project. Finally, I thank all the people who have directly or indirectly helped me through the course of the project.

AISHWARYA BATTA

EXECUTIVE SUMMARY

TITLE
RETENTION OF NURSES

PURPOSE
Employee retention is crucial to the long term success of the organization and therefore the ability to retain employees is a primary measure of the health of organization. Employee retention strategies are important to ensure that organizations retain the necessary human capital resources required to profitably run their businesses when skill shortages are at an all time high. Retention of nurses was chosen as the topic because the attrition among nurses was found to be high from the hospital records and exit interview forms for the year April 07- March 08.

OBJECTIVES
To determine the satisfaction levels To determine the reasons of attrition To suggest suitable strategies To determine whether the reasons stated in the exit interview forms still exist in the present workforce

LIMITATIONS
Due to time constraint and also the work schedules of the nurses the researcher is not able to study the entire population. Those who were accessible and willing to participate were covered under the survey. Feedback about the organization from those who resigned could not be taken. The study is limited to one hospital hence there is no scope for comparison of variation between organizations. Due to time constraint no industry or company wise compensation comparison could be done. The findings and suggestions are applicable for only Jubilee Hills branch of Apollo health city.

FINDINGS
There are high turnover intentions and majority of the workforce plans to leave the organization on expiry of the 2 year bond. There is no uniformity in practices that are followed by various departments which is exhibited by mixed response to few questions. The nurses are dissatisfied with the job due to the negative attributes such as Salary and increments No instant recognition Workload Lack of motivation Superior subordinate relationship

RECOMMENDATIONS
Instant recognition and motivational programmes need to be started.

APOLLO HOSPTALS
MISSION To bring healthcare of International standards within the reach of every individual. We are committed to the achievement and maintenance of excellence in education, research and healthcare for the benefit of humanity.

Dr. Prathap C. Reddy

THE JOURNEY BEGAN..

.when a patient in his late 30s lost his life because he could not afford $20000 and make it to Houston for a Coronary bypass surgery (9th November 1979).

APOLLO LOGO
9

Executive Chairman

Dr. Prathap C. Reddy

Awarded Padma Bhushan in 1991 Awarded Sir Neel Ratan Sarkar award for Medical Excellence in 1998 Introduced the concept of Private Medical Insurance. Awarded Ernst and Young Entrepreneur of the Year for Service sector.

Managing Director AHEL

Ms Preetha Reddy

10

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Apollo Hospital
Apollo Hospitals Group started as H. M. Hospital in Chennai in early 1980s, and now, is the largest healthcare group in Asia, with over 8000 beds in 41 hospitals, a string of nursing and hospital management colleges, and dual lifelines of pharmacies and diagnostic clinics providing a safety net across Asia. Apollo Hospitals is a healthcare corporation that operates 38 hospitals in South Asia. It is the largest healthcare provider in Asia and the third largest in the world. It is headquartered in Chennai, India. Apollo Hospital Delhi is the first hospital in India to be accredited by the JCI and is affiliated with Johns Hopkins international, the Mayo Clinic, and many major hospitals in the United States and Europe. Apollo Group companies

Apollo Pharmacies Apollo Health and Lifestyle Limited Apollo Health Street Incorporated Medvarsity Online Ltd Apollo Telemedicine Networking Foundation Apollo Hospitals Education & Research Foundation

12

Mission Statements:
To provide healthcare of international standard within the reach of every individual. With emphasis on warm and personalized patient care consistently exceeding the expectations of the patients. By caring compassionate and term oriented professionals with high ethical standards, honesty and integrity. We are committed to the achievement and maintenance of excellence in education, research and healthcare for the benefit of humanity.

Vision Statements:
Health care with a smile. Shaping the healthier future. Healthcare with empathy and dignity. Cost effective medical care. Medical excellencethrough quality, equity and accountability.

Goals of apollo Hospitals:

Excellence in modern healthcare comparable to international standards. The delivery of the specialty services to patients for the local catchments areas and act as an efficient tertiary referral center. Strive for continuous personal and professional development of human resources. Continuous improvement in all facets of health care delivery using updating knowledge and constant self assessment:

THE APOLLO HOSPITALS GROUP

The Apollo Group of Hospitals today is not only an acknowledged leader in the world of super-specialty based quality healthcare delivery in Asia, but is also considered as the largest integrated healthcare delivery company, complete in every sense of the term.

13

Apollo Hospitals, Jubilee Hills, Hyderabad is a 550-bed tertiary care centre. It has over 50 medical and surgical disciplines. Spread over a campus area of 35 acres, the hospital has a built-up area of 190,000 square feet. Its services are supported by sophisticated technology and experienced medical professionals. The first PET CT Scanner in India was installed at Apollo Hospitals, Hyderabad in January of 2005. Most of the consultants at the hospital have international experience either educational, work experience - related or observational. The average staff to patient ratio for the hospital is 3:1 with a 1:1 ratio prevailing in priority areas like the Intensive Care Unit and the Cardiac Care Unit. Apollo Hospitals, Hyderabad handles close to 100,000 patients a year. International patients from Tanzania, the USA, the UAE, Kenya, Oman and neighbouring Asian countries are treated by the hospital every year. Medical Milestones Apollo Hospitals, Hyderabad has several notable accomplishments to its name. The hospital has been the first in the country to pioneer and perform several revolutionary procedures, technologies and services such as:

Advanced orthopaedic surgery - Knee & hip replacement, Ilizarov Limb Lengthening, etc. Balloon and LASER angioplasty techniques

14

Keyhole spinal surgery Modern emergency care by introducing 1066 Emergency Service line Largest series of surgical and invasive cardiac procedures to treat children with complex congenital heart disease

Centres of Excellence The Centres of Excellence at the hospital are:

Cardiology & Cardiothoracic Surgery Cosmetic, Plastic, Hand & Micro Surgery Critical Care Medicine Diabetology & Endocrinology Medical & Surgical Gastroenterology Nephrology & Urology Neurology & Neurosurgery Obstetrics, Gynaecology & IVF Oncology Orthopaedics Paediatric Cardiology Ophthalmology

Awards and Innovations Save A Childs Heart (SACH) was awarded runner-up in the Corporate Governance Category in Hospital Management Asia, 2004 - the annual conference of hospitals across Asia in Bangkok,

15

Apollo to set up hospital in Mauritius

The JV will focus on medical tourism Apollo to invest 26 p.c. of the total cost
PHOTO: AFP

SPREADING WINGS: Prathap C. Reddy (right), Chairman, Apollo Group of Hospitals, with Dawood Rawat, Chairman, British American Investment Co. Ltd., Mauritius, at a press conference in Hyderabad on Thursday.

HYDERABAD: Apollo Hospitals, in association with British-American Investment Co. (Mtius) Ltd, will be setting up a 200-bed multispeciality tertiary care hospital in Mauritius. Besides healthcare needs of the people of Mauritius, Apollo Bramwell Hospital will focus on medical tourism and will be completed by January 2009. Addressing a press conference here on Thursday, Apollo Hospitals Chairman, Prathap C. Reddy, said the estimated investment for the world-class facility was $70 million with a debt-equity ratio of 1.25:1. Apollo Hospitals would invest 26 per cent of the total cost. A joint venture British American Hospitals Enterprises Ltd between a subsidiary of the British-American Investment Co. and Apollo Group was floated to execute the project. Apollo would provide technical consultancy during the implementation of the project and takeover the operations after its completion.

16

Nursing institution
Dr. Reddy said initially, 200 doctors, nurses and paramedical staff would go to Mauritius from India, while 800 would be recruited locally. He hoped that a lot of highly-qualified Mauritian doctors working elsewhere would return to their motherland and work in the new facility. The hospital would also have a nursing institution, said Dawood Rawat, Chairman, British-American Investment Co. This hospital would cater to the needs of the people in the region (East African countries, Madagascar) and also attract medical tourists across the globe, he said. Apollo, being the pioneer of telemedicine, would network all its hospitals, including those in India, Dhaka, Colombo, Muscat, Yemen, Mongolia, Nigeria, the Netherlands Antiles and Riyadh. In the next 100 days, all doctors in Apollo Hospitals would be connected through webcams for extending instant telemedicine.

17

18

19

PURPOSE OF THE STUDY

Today every organization faces the problem of high attrition rate and hence all organizations are trying to find strategies to prevent good workforce from leaving the organization. The attrition rate is high among nurses. Therefore, it is important to find out the reasons of dissatisfaction among nurses and also their turnover intentions.

OBJECTIVES
To identify the causes of attrition To study the existing retention strategy To find out the satisfaction level of employees To bring out the expectations of employees from the company To suggest suitable strategies to retain employees

SCOPE OF THE STUDY

This study will help the organization to retain its valuable workforce by highlighting the main factors which result in high nurse turnover. The study will also highlight the satisfaction level of nurses and their turnover intentions so that the organization can take suitable measures to prevent them from leaving the organization. The study will cover senior nurses from various departments of Jubilee Hills branch. The suggestions of the study will only be applicable for retention of nurses in this hospital. These suggestions could be used to retain employees in other industries with slight variation to the suggestions to address those specific problems.

20

21

METHODOLOGY
SAMPLE SIZE
The sample size for the study is 46.

SAMPLING TECHNIQUES
The sampling technique used for the study is Non- probability Convenience sampling. Sampling method was adopted as it is requires less cost, less labour and helps collect important information at a greater speed. There is no need of list of population.

PARTICIPANTS
A survey was conducted using self-administered questionnaire as the source of primary data collection. The sample size consisted of 46 senior nurses from various departments such as MICU, NEURO etc. of Apollo Health City Hyderabad.

RESEARCH DESIGN
The research design is exploratory. During research, the primary objective is to find out about the reasons of resigning, the areas that need attention and also job satisfaction levels of the nurses with the help of exit interview forms and questionnaire .

MEASURES
The structured questionnaire consisted of 28 items which were measured on a five point LIKERT scale given by RENSIS LIKERT which required only about 10 minutes time to answer. The questionnaires spanned over/covered eight variables or parameters. In order to obtain the unbiased opinions, it was assured to the participants that the information provided by them would be kept confidential as they need not mention their names, departments or designations.

22

DATA COLLECTION PROCEDURE

Permission from the superintendent of nurses was taken to conduct the survey. A group of 46 senior nurses were approached personally. Their confidence was gained by explaining the purpose of the survey and ensuring the confidentiality of the questionnaire in order to get the unbiased answers. Questionnaires were distributed to the respondents who expressed their willingness to participate in the survey. The filled in questionnaires were collected at the appointed time. It took more than a week to gather information. Subsequently the data collected was analyzed.

SOURCE OF DATA
The data was collected from primary and secondary sources

DATA COLLECTION
The data collection is of two types

PRIMARY DATA COLLECTION

Questionnaire

SECONDARY DATA COLLECTION

Exit interview forms Hospital records Websites

DATA ANALYSIS
The data collected in the form of responses to the questions of questionnaire was converted into graphical form using Microsoft excel. The data was then analyzed based on the graphs obtained for each question.

23

24

25

ATTRITION DETAILS APR 07- MAR 08

Month Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08
TOTAL

Nursing 43 28 19 15 24 18 17 18 39 33 28 43 325

Executive 1 2 8 4 5 5 3 3 1 2 1 4 39

Medical 15 10 16 8 7 9 7 5 5 6 11 12
111

Paramed 2 1 6 2 5 4 6 6 2 2 4 2
42

Support Staff 5 3 6 0 7 5 6 3 2 5 2 6
43

Admin 0 0 0 0 1 0 0 0 0 0 1 0
2

The table above shows that attrition is highest among nursing staff and therefore the project deals with the problem of retention of nurses. This is the attrition trend over the last year for all Hyderabad branches including Jubilee hills branch where the project was undertaken. The above data has been graphically represented on the next page.

26

ATTRITION DETAILS APR2007-MAR2008

50 45 40 35 30 25 20 15 10 5 0 Apr- M Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar07 ay- 07 07 07 07 07 07 07 08 08 08 07 MONTHS

NO. OF EMPLOYEES

Nursing Executive Medical Paramed Support Staff Admin

ACQUISITION DETAILS APR2007-MAR2008

45 40 35 30 25 20 15 10 5 0 Apr- M Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar07 ay- 07 07 07 07 07 07 07 08 08 08 07 MONTHS

NO. OF EMPLOYEES

Nursing Executive Medical Paramed Support Staff Admin

27

ACQUISITION DETAILS APR 07-MAR 08

Support Staff 5 4 5 2 6 2 3 1 5 4 6 4 38

Month Nursing Executive Medical Paramed 23 3 7 4 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 TOTAL 15 15 14 13 12 6 8 4 40 30 21 201 2 4 4 5 5 4 3 0 0 2 1 28 13 7 8 15 11 6 10 3 10 8 15 93 1 0 1 6 2 0 3 2 5 2 5 26

Admin 1 2 0 0 3 0 0 0 0 0 0 0 6

The table above shows the acquisition data for last year for all the branches of Hyderabad. The data mentioned has been graphically represented on the previous page for a better understanding of the gap between the attrition and acquisition which thereby highlights high attrition or low retention.

28

DETAILS OF NURSES APR 07-MAR 08

Month Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08
TOTAL

Acquisition 23 15 15 14 13 12 6 8 4 40 30 21 201

Attrition 43 28 19 15 24 18 17 18 39 33 28 43 325

For ease of reading the data pertaining to the nursing staff is shown above. The table above , clearly shows high attrition of nurses and also that there is a requirement of 124 nurses.

29

The graphical comparison of the acquisition and attrition data of nurses given in the previous table.

COMPARISON OF ACQUSITION AND ATTRITION OF NURSES

50 45 40
NO.OF EMPLOYEES

35 30 25 20 15 10 5 0 Apr-07 May- Jun-07 Jul-07 Aug07 07 Sep07 Oct07 Nov07 Dec- Jan-08 Feb07 08 Mar08

MONTHS

Acquisition

Attrition

This graph clearly shows the trend for the previous year and that the attrition rate is high.

30

EXAMINATION OF 62 EXIT INTERVIEW FORMS

Salary related issues amongst others were mentioned by 39 nurses. Numerical breakdown with reasons is given below:SNO 1 2 3 4 5 6 7 8 9 10 11 12 13 REASONS FOR DISSATIAFACTION / RESIGNATION LOW SALARY/INCREMENTS MARRIAGE/PERSONAL HIGER STUDIES NO RECOGNITION FOR GOOD JOB DONE LACK OF JOB SATISFACTION JOB ABROAD PROLEM WORKING IN SHIFTS NOT CLEARLY DEFINED REPORTING STR PROMISES NOT FUFILLED GRIEVANCES NOT ADDRESSED INCOSTENT RULES AND REGULATIONS PROBLEM WITH DESIGNATION NO DIRECTION IN WORKING 39 10 8 7 5 8 4 4 4 3 3 3 1

Table given above is graphically shown below:-

REASONS OF DISSATISFACTION/ RESIGNATION

45 40 35 30 25 20 15 10 5 0 39
NO. OF NURSES

10

7
NO RECOGNITION FOR GOOD JOB DONE

5
LACK OF JOB SATISFACTION

4
PROLEM WORKING IN SHIFTS

4
NOT CLEARLY DEFINED REPORTING STR

4
PROMISES NOT FUFILLED

3
GRIEVANCES NOT ADDRESSED

3
INCOSTENT RULES AND REGULATIONS

3
PROBLEM WITH DESIGNATION

1
NO DIRECTION IN WORKING

LOW SALARY/INCREMENTS

MARRIAGE/PERSONAL

HIGER STUDIES

JOB ABROAD

7 REASONS

10

11

12

13

31

QUESTINAIRE RESPONSES(46/90)
TURNOVER INTENTION 1. I OFTEN FEEL LIKE QUITTING MY JOB IN THIS ORGANIZATION.
I often feel like quitting my job in this organization.
20 18 16 18

NO. OF NURSES

14 12 10 8 6 4 2 0 STRONGLY DISAGREE DISAGREE NEUTRAL NURSES' OPINION AGREE STRONGLY AGREE 4 9 7 8

Majority of the employees are not very satisfied with their present job.
2. IT IS LIKELY THAT I WILL LEAVE MY ORGANIZATION WITHIN THE NEXT YEAR.

It is likely that I will leave my organization with in the next year.

18 16 14 14 16

NO. OF NURSES

14 12 10 8 6 4 2 0 STRONGLY DISAGREE DISAGREE NEUTRAL NURSES' OPINION AGREE STRONGLY AGREE 1 1

Majority of the employees plan to leave the organization in the next year. Shows low motivation levels among employees Shows high dissatisfaction among employees and low sense of belonging towards company. Shows high turnover intentions. 32

3. I AM CURRENTLY LOOKING FOR JOB PROSPECTS IN OTHER COMPANIES.

I am currently looking for job prospects in other companies.

18 16 14 12 10 8 6 4 2 0 16 12 13

NO.OF NURSES

STRONGLY DISAGREE

DISAGREE

NEUTRAL NURSES' OPINION

AGREE

STRONGLY AGREE

Majority are not really happy and satisfied in their current job, so are looking for job prospects in other companies. Very few are not looking for job whereas most of them are shows high level of dissatisfaction and turnover intentions

4. I HAVE NO INTENTION OF LEAVING MY CURRENT JOB.

I have no intention of leaving my current job.

25 21

NO.OF NURSES

20 15 10 10 5 0 STRONGLY DISAGREE DISAGREE NEUTRAL NURSES' OPINION AGREE STRONGLY AGREE 3 3 9

Majority of the nurses dont have any intention of leaving the organization due to the two year bond. Most of the nurses covered under survey have less than two experience so they dont intend on leaving till bond duration is over. Majority of nurses are working in the organization due to bond. Only those nurses who have completed two year or more in the organization are planning to leave the organization. Shows high turnover intention of employees. 33

COMMITMENT
5. I REALLY FEEL AS IF MY ORGANIZATION'S PROBLEMS ARE MY OWN.

I really feel as if my organization's problems are my own.

18 16 14 12 10 8 6 4 2 0 17 14

NO.OF NURSES

7 5 3

STRONGLY DISAGREE

DISAGREE

NEUTRAL NUSES' OPINION

AGREE

STRONGLY AGREE

Results in lesser feeling of commitment towards company. Shows employee dissatisfaction and that they are less motivated. They dont feel that they are an important part of the organization.

6. I DO NOT FEEL A STRONG SENSE OF BELONGING TO MY ORGANIZATION.

I do not feel a strong sense of belonging to my organization.

14 12 13 9 6 5

NO.OF NURSES

12 10 8 6 4 2 0

STRONGLY DISAGREE

DISAGREE

NEUTRAL

AGREE

STRONGLY AGREE

NURSES' OPINION

Majority of nurses do not feel a strong sense of belonging towards the company. Results in less commitment towards company.

34

7. IT WOULD BE VERY HARD FOR ME TO LEAVE MY ORGANIZATION RIGHT NOW EVEN IF I WANTED TO.

It would be very hard for me to leave my organization right now even if I wanted to.
18 16 14 12 10 8 6 4 2 0 16 11 9 6 4

NO.OF NURSES

STRONGLY DISAGREE

DISAGREE

NEUTRAL

AGREE

STRONGLY AGREE

NURSES' OPINION

Majority want to leave the organization but they cant due to the bond. Shows that the nurses are not satisfied with the job and are presently working with the organization due to bond .

8. IT WOULD BE TOO COSTLY FOR ME TO LEAVE MY ORGANIZATION NOW.

It would be too costly for me to leave my organization now.

25 20

NO. OF NURSES

20 15 10 5 5 0 STRONGLY DISAGREE DISAGREE NEUTRAL NURSES' OPINION AGREE STRONGLY AGREE 2 12 7

Majority feels that it would to too costly to leave the organization during the duration of the bond. Highlights the fact that compensation to be paid to the company for leaving the organization during the duration of the bond will be too expensive.

35

9. IT WOULD BE BENEFICIAL FOR ME TO CONTINUE IN THIS ORGANIZATION.

It would be beneficial for me to continue in this organization.
25 20

NO.OF NURSES

20 15 10 5 0 STRONGLY DISAGREE DISAGREE NEUTRAL NURSES' OPINIOIN AGREE STRONGLY AGREE 8 5 7

Majority of nurses feel that it will not be beneficial for them to continue in the organization.

10. EMPLOYEES' SUGGESTIONS ARE SERIOUSLY TAKEN INTO CONSIDERATION.

Employees' suggestions are seriously taken into consideration.
30 25 25

NO.OF NURSES

20 15 10 5 0 STRONGLY DISAGREE DISAGREE NEUTRAL NURSES' OPINION AGREE STRONGLY AGREE 4 7

Majority feels that employees suggestions are not seriously taken into consideration.

36

11. MY SUPERIOR PRAISES ME WHEN I PERFORM WELL.

My superior praises me when I perform well.
14 12 12 10 12

NO.OF NURSES

10 8 6 4 2 0 STRONGLY DISAGREE DISAGREE NEUTRAL NURSES' OPINION AGREE STRONGLY AGREE 5 7

Although majority agree that they are motivated but mixed response shows that there is no uniformity in the practices followed in different departments.

12. IN MY ORGANIZATION WE RECEIVE INCENTIVES FOR GOOD PERFORMANCE.

In my organization we receive incentives for good performance.
16 14 15

NO.OF NURSES

12 10 8 6 4 2 0

11

10 8

STRONGLY DISAGREE

DISAGREE

NEUTRAL NURSES' OPINION

AGREE

STRONGLY AGREE

Majority feels that they dont receive incentives for good performance.

37

PROCEDURAL JUSTICE PRACTICES

13. I AM CLEAR ABOUT THE WORKING DIRECTION.
I am clear about the working direction.
25 20 20

NO.OF NURSES

15 11 10 5 0 STRONGLY DISAGREE DISAGREE NEUTRAL NURSES' OPINION AGREE STRONGLY AGREE 3 10

Majority of nurses are clear about the working direction.

14. I AM CLEAR ABOUT MY REPORTING STRUCTURE.

I am clear about my reporting structure.

25 20 15 10 5 0 STRONGLY DISAGREE DISAGREE NEUTRAL NURSES' OPINION AGREE STRONGLY AGREE 10 7 2 7 20

NO. OF NURSES

Majority of nurses are clear about the reporting structure.

38

DISTRIBUTIVE JUSTICE PRACTICES

15. I ESTIMATE MY SALARY AS BEING FAIR INTERNALLY.
I estimate my salary as being fair internally.
30 25 27

NO.OF NURSES

20 15 10 10 5 0 STRONGLY DISAGREE DISAGREE NEUTRAL NURSES' OPINION AGREE STRONGLY AGREE 6 1 2

Majority of nurses feel that their salary is not fair internally.

16. MY SALARY IS FAIR IN COMPARISON WITH WHAT IS OFFERED FOR A SIMILAR JOB ELSEWHERE.

My salary is fair in comparison with what is offered for a similar job elsewhere.
40 35 35

NO.OF NURSES

30 25 20 15 10 5 0 STRONGLY DISAGREE DISAGREE NEUTRAL NURSES' OPINION AGREE STRONGLY AGREE 4 1 3 3

Majority of nurses feel that they are being paid less in comparison with what is offered for a similar job elsewhere. They are dissatisfied with the present salary.

39

17. MY PAY IS EQUITABLE IN RELATION TO MY PERFORMANCE.

My pay is equitable in relation to my performance.

25 22

NO. OF NURSES

20 15 10 5 0 STRONGLY DISAGREE DISAGREE NEUTRAL NURSES' OPINION AGREE STRONGLY AGREE 9 5 2 8

Majority of nurses feel that the salary being paid is not equitable in relation to their performance. EMPOWERMENT PRACTICES
18. MY SUPERIOR PAYS ATTENTION TO MY SUGGESTIONS AND TRIES TO IMPLEMENT THEM.
My superior pays attention to my suggestions and tries to implement them.
16 14 13 11 14

NO.OF NURSES

12 10 8 6 4 2 0 STRONGLY DISAGREE DISAGREE 5

NEUTRAL NURSES' OPINION

AGREE

STRONGLY AGREE

Majority of nurses feel that superior doesnt pay attention to their suggestions .

40

19. IN MY WORK UNIT EMPLOYEES HAVE A GREAT DEAL OF LIBERTY IN THE CONDUCT OF THEIR WORK.
In my work unit employees have a great deal of liberty in the conduct of their work.
16 14
NO. OF NURSES

14 11 9

12 10 8 6 4 2 0

10

STRONGLY DISAGREE

DISAGREE

NEUTRAL NURSES' OPINION

AGREE

STRONGLY AGREE

Majority agree that they have liberty in the conduct of their work.

20. MY SUPERIOR ENCOURAGES US TO PERFORM BETTER.

My superior encourages us to perform better.

14
NO. OF NURSES

12

13 11 8

12 10 8 6 4 2 0 STRONGLY DISAGREE DISAGREE 2

NEUTRAL NURSES' OPINION

AGREE

STRONGLY AGREE

Majority agree that they are motivated by their superiors to perform better.

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COMPETENCE DEVELOPMENT PRACTICES

21. EMPLOYEES HAVE THE POSSIBILITY TO ROTATE JOBS TO DEVELOP THEIR SKILLS.

Employees have the possibility to rotate jobs to develop their skills.

18 16 16

NO.OF NURSES

14 12 10 8 6 4 2 0 STRONGLY DISAGREE DISAGREE NEUTRAL NURSES' OPINION AGREE STRONGLY AGREE 4 8 9 9

Majority feels that there is no possibility of rotating jobs to develop their skills.

22. EMPLOYEES HAVE OPPORTUNITIES TO UPGRADE THEIR SKILLS.

Employees have opportunities to upgrade their skills.

18 16 14 12 10 8 6 4 2 0 16

NO.OF NURSES

10 8 6 6

STRONGLY DISAGREE

DISAGREE

NEUTRAL NURSES' OPINION

AGREE

STRONGLY AGREE

Majority feels that there is lack of opportunities.

42

WORKLIFE POLICIES 23. I AM HAPPY WITH THE FACILITIES PROVIDED AND RECREATIONAL PROGRAMMES.
I am happy with the facilities provided and recreational programmes.
25
NO.OF NURSES

20 14 7 4 1 STRONGLY DISAGREE DISAGREE NEUTRAL NURSES' OPINION AGREE STRONGLY AGREE

20 15 10 5 0

Majority are fine with the facilities and recreational programs.

24. I AM HAPPY WITH WORKING HOURS AND SHIFT TIMINGS.

I am happy with working hours and shift timings.

25 23

NO.OF NURSES

20 15 10 5 0 STRONGLY DISAGREE DISAGREE NEUTRAL NURSES' OPINION AGREE STRONGLY AGREE 4 2 10 7

Majority of nurses are fine with the current work and shift timings.

43

25. I AM ABLE TO BALANCE MY PERSONAL AND PROFESSIONAL RESPONSIBILITIES.

I am able to balance my personal and professional responsibilities.

16 14 15 12 10

NO.OF NURSES

12 10 8 6 4 2 0 STRONGLY DISAGREE DISAGREE 5 4

NEUTRAL NURSES' OPINION

AGREE

STRONGLY AGREE

Majority are able to balance personal and professional responsibilities.

STREESS/WORKLOAD 26. MY WORK ENVIRONMENT IS COMFORTABLE.

My work environment is comfortable.

20 18 16 14 12 10 8 6 4 2 0

18 14 8 6 0 STRONGLY DISAGREE DISAGREE NEUTRAL NURSES' OPINION AGREE STRONGLY AGREE

NO.OF NURSES

Majority of nurses find the work environment comfortable.

44

27. MANPOWER IS NOT EQUAL TO WORKLOAD.

Manpower is not equal to workload.

30 28

NO.OF NURSES

25 20 15 10 5 0 STRONGLY DISAGREE DISAGREE NEUTRAL NURSES' OPINION AGREE STRONGLY AGREE 3 4 6 5

Majority of nurses feel that manpower is not equal to workload. Results in stress and finally in job dissatisfaction.

28. I OFTEN FEEL THAT THERE IS TOO MUCH WORK TO DO.

I often feel that there is too much work to do.

25 21

NO.OF NURSES

20 15 10 5 0 STRONGLY DISAGREE DISAGREE NEUTRAL NURSES' OPINION AGREE STRONGLY AGREE 2 2 12 9

Majority of nurses feel that there is too much work. There is too much workload on nurses which results in stress.

45

DATA ANALYSIS

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1. The turnover intention among the nurses was found to be high. The company needs to analyze the reasons and take steps to retain nurses with 2 years or more experience. 2. Majority of nurses are not very satisfied and therefore they are looking for better job prospects. 3. Majority of them work for 2 years duration only because of the bond. They have to pay a huge amount if they wish to terminate the bond before the expiry of the bond so they work with Apollo Hospital only to gain initial job experience and the brand name which helps them gain better job prospects in other hospitals in India or abroad. 4. The survey was conducted on 46 senior nurses of various departments from which it was found that majority of nurses are females in the age group of 2124 years with 6 months to 2 years experience and few had more than 2 years experience. 5. The workforce was found to be less which resulted in workload and stress. This also results in job dissatisfaction. 6. The company has not been very successful in making the employee feel that they are valuable assets and that company really cares for it which results in less commitment towards company and less job satisfaction thereby increasing the turnover intentions of nurses. 7. Nurses strongly feel that they are being paid less than other hospitals and that there salary is not fair internally and also they are not paid for over time. They also feel that the increment of salary is not equitable in relation to their performance. Majority of them are unhappy with their salary and increment as they feel it is too low and results in dissatisfaction among them. Form the survey; it is clear that a hike in salary and increment will definitely help retain skilled nurses. 8. The growth opportunities are less which demotivates the employee and makes the routine job monotonous. The company needs to motivate nurses apart from the training programs it runs. 9. The mixed responses to certain questions shows that throughout the organization uniform practices are not followed. Certain change in the

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organizational culture is necessary which would bring about change in recognition practices and also improve superior subordinate relationship in departments where the responses were not satisfactory. Therefore, an outside consultant be appointed to examine the situation. 10. New and innovative recognition and motivation practices need to be implemented and in certain departments superior subordinate relationship needs to be given attention so that nurses are satisfied and feel less stressed. 11. Company needs to look into the matter of salary and incentive hike which has been found to be the major factor of dissatisfaction. 12. Company needs to motivate and make nurses feel as important part of organization and show that they value and recognize the efforts and good performances by them.

THE NEGATIVE ATTRIBUTES ARE: 1. 2. 3. 4. 5. SALARY AND INCREMENTS WORKLOAD RECOGNITION LACK OF MOTIVATION AND JOB SATISFACTION SUPERIOR AND SUBORDINATE RELATIONSHIP

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CONCLUSION
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In order to motivate employees, Apollo needs to look into the factors mentioned below: Certain factors that will motivate and retain the nurses are 1. Salary 2. Full appreciation of work done 3. Interesting work 4. Good working conditions 5. Promotion and growth in the organization 6. Personal loyalty to employees 1. Job security 2. Sympathetic help with personal problem These factors will help retain the workforce as they would address the problems of the organization which were highlighted during the survey. The recommendations given in the project report will help Motivate and instill competitive spirit Instant recognition Reduce stress Bring about a feeling of belonging and commitment towards company I can live for two months on a good compliment. Mark Twain As stated above by Mark Twain when you reward and recognize employees, they are happier, stay longer and are more productive. Companys access to new talent is not a solution to attrition. The company needs to retain experienced nurses as they directly interact with the customers and build long term business relations with customers. The company needs to make its employees happy so that the customers are happy in order to achieve their vision of health care with a smile, shaping the healthier future, healthcare with empathy and dignity, cost effective medical care and medical excellencethrough quality, equity and accountability. In oder to attain their misson to provide healthcare of international standard within the reach of every individual,with emphasis on warm and personalized patient care consistently exceeding the expectations of the patients,by caring compassionate and term oriented professionals with high ethical standards, honesty and integrity apollo needs to reatin its skilled nurses .

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LIMITATIONS
Due to time constraint and also the work schedules of the nurses the researcher is not able to study the entire population. Those who were accessible and willing to participate were covered under the survey. Feedback about the organization from those who resigned could not be taken. The study is limited to one hospital hence there is no scope for comparison of variation between organizations. Due to time constraint no industry or company wise compensation comparison could be done. The findings and suggestions are applicable for only Jubilee Hills branch of Apollo health city.

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RECOMMENDATIONS
1. EXPERIENCED NURSE RECRUITMENT
Recruitment of more experienced nurse staff is required as the current workforce is not sufficient to meet the current workload. The current workforce consists mainly of nurses with less than 2 years experience. Therefore, nurses with more than 2 years experience need to be hired which will reduce the stress among nurses and help retain the current workforce.

In order to retain good workforce, 2. INSTANT RECOGNITION AND REWARD In order to avoid the perception of unfairness there must be a transparent and acceptable system to measure what is good performance. (eg. Attendance, work completion on schedule, patient feedback etc.) Bearing the above in mind some recognition and reward examples are recommended below. (a) STAR NURSE OF THE MONTH The superintendent will give the nurses of all nurse station the badges for their each good performance and at the end of each month the nurse who has maximum badges per nurse station will become the star nurse of the month for that particular nurse station. At the end of the six months the nurse who becomes star nurse of the month maximum no. of times will receive a gift voucher of Rs 1000. The same practice will continue for the next 6 months and so on. The consistently 2nd best performer will get Rs 500 gift voucher for every 6 months.

(b) BEST NURSE STATION Every year the company should declare the best star nurse station on an important day such as foundation day where a memento or a revolving trophy should be awarded by the chairman or the MD of the company. The photograph of the prize winning ceremony should be put up on the respective nurse station.

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The superintendent will tally the no. of star nurses per nurse station and declare the best nurse station depending on the nurse station that has maximum no. of star nurses in that year.

(c) GOLD CARDS Each nurse at the nurse station will be given 5 gold cards at the beginning of each month. They will give them to each other for doing a good job and at the end of the month they tally the gold cards and the nurse who gets the maximum no. of cards is the winner who gets a special prize.

3. WELFARE PROGRAMMES

(a) TRADITIONAL FUN TIME A traditional day should be celebrated wherein all the nurses need to come traditionally dressed and there would be fun filled games such as musical chairs etc. and snacks . it should be arranged within the campus for about 4 hrs i.e. 2 hrs for each batch of nurses so that all the nurses have the opportunity to attend and enjoy the program being organized. (b) BIRTHDAY CELEBRATION The nurse should be welcomed with a card and few flowers at the nurse station apart from the cake cutting ceremony . (c) APPRECIATION CARD The company should give a appreciation card to a good performing employee after reviewing their performance every 2 years. Thereby making the employee feel as an important part of the organization. (d) SUGGESTION COMPETITION HR suggestion box would be provided at a particular nurse station for all the nurses to give their ideas or complaints. If the idea is implemented then the praise certificate issued by the superintendent would be put up at the nurse station of the concerned nurse and extra two marks would be added during performance appraisal.

(e) ORGANIZING PICNIC AND TOURS

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Picnic should be arranged on two Sundays so that everybody gets to enjoy this opportunity. 4. SALARY Money may not be the only factor for a professional to quit an organization. However, it surely feature as one of the reasons. The most important way in which a company acknowledges the professional is by paying him.

5. ORGANIZATION GAOLS AND PERSONAL GOALS Make organizations goals relate to their personal goals so that nurses are motivated to achieve those and are satisfied employees on attaining the goal.

6. RETENTION FROM DAY 1 Think of your employees as your internal customers commit to building relationships with them. Invest in training, objective assessments etc.

7. INNOVATIVE AND CREATIVE WELFARE AND MOTIVATIVE PROGRAMMES The company should create new innovative and creative welfare and other employee motivational programs at least after 5 years as the old programs become monotonous and should be replaced with the new ones.

Industry survey should be done to ascertain the practice of having bonds on employment as also the payment of overtime.

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Appendices

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Annexure Design (Appendix A) Strongly Disagree Disagree 1 2 Neutral 3 Agree 4 Strongly Agree 5

TURNOVER INTENTIONS (TI) 1. _______ I often feel like quitting my job in this organization. 2. _______ It is likely that I will leave my organization within the next year. 3. _______ I am currently looking for job prospects in other companies. 4. _______ I have no intention of leaving my current job (reverse). AFFECTIVE COMMITMENT (AC) 5. _______ I really feel as if my organizations problems are my own. 6. _______ I do not feel a strong sense of belonging to my organization (reverse). CONTINUANCE COMMITMENT (CC) 7._______ It would be very hard for me to leave my organization right now even if I wanted to. 8._______ It would be too costly for me to leave my organization now. 9._______ It would be beneficial for me to continue in this organization. RECOGNITION PRACTICES (RC) 10. ______ Employees suggestions are seriously taken into consideration. 11. ______ My superior praises me when I perform well. 12. ______ In my organization we receive incentives for good performance. PROCEDURAL JUSTICE PRACTICES (PJ) 13. ______ I am clear about the working direction. 14. ______ I am clear about the reporting structure. DISTRIBUTIVE JUSTICE PRACTICES (DJ) 15.______ I estimate my salary as being fair internally. 16.______ My salary is fair in comparison with what is offered for a similar job elsewhere. 17.______ My pay is equitable in relation to my performance.

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EMPOWERMENT PRACTICES (EMP) 18.______ My superior pays attention to my suggestions and tries to implement them. 19. ______ In my work unit employees have a great deal of liberty in the conduct of their work. 20. ______ My superior encourages us to perform better. COMPETENCE DEVELOPMENT PRACTICES (CD) 21. ______ Employees have the possibility to rotate jobs to develop their skills. 22. ______ Employees have opportunities to upgrade their skills. WORK LIFE POLICIES (WL) 23. ______ I am happy with the facilities provided and recreational programmes. 24. ______ I am happy with working hours and shift timings. 25. ______ I am able to balance my personal and professional responsibilities. STRESS/ WORK LOAD (S/W) 26. ______ My work environment is comfortable. 27. ______ Manpower is not equal to workload (reverse). 28. ______ I often feel that there is too much work to do (reverse).

1. Gender _______Male 2. Age _______ years

_______ Female

3. Work Period ________ years 4. Marital Status _____Single _____ Married _____ Other 5. No. of Children _____

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BIBLIOGRAPHY
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WEBSOURCES
1. Employee Retention (a). http://retention.naukrihub.com/retention.html (b). http://retention.naukrihub.com/importance-of-employee-retention.html (c). http://retention.naukrihub.com/retention-strategies.html

2. Company Profile (a).http://www.apollohospital.com (b).http://www.wekipedia.com

3. Research Methodology (a). http://www.socialresearchmethods.net/kb/sampterm.php (b). http://www.socialresearchmethods.net/kb/writeup.php

TEXT BOOK SOURCES

(a).C.R. Kothari. Research Methodology Methods & Techniques, New Age International (P) Limited, Publishers. (b).William G. Zikmund. Business Research Methods, Thomson South-Western

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