Running Head: EMPLOYEE TURNOVER

Amanda Bryant
Implications of Employee Engagement and Lowering Employee Turnover
Siena Heights University

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Abstract

This analysis examines areas of concern in relationship to employee turnover and engagement. In
order to identify areas producing high employee turnover several studies were analyzed. The
following questions are addressed: What can be done to lower employee turnover within
organizations? What can be done to increase employee engagement? What causes high turnover?
Increasing employee engagement has a positive effect on lowering employee turnover.
Historically, employees choose to leave their work places due to lack of opportunities for
professional development, inadequate compensation, boredom/ lack of challenge, and job stress
and unfair treatment. To combat these areas this analysis will address areas such as growth and
development, dealing with stress and burnout, and employee engagement. Leadership support is
of utmost importance. During this study the reader will see analytic models, and an analysis of
previous studies on employee engagement and turnover, with reference in regards to labor union
contracts. Several studies and senior leadership was consulted during the courses of this analysis.
At the conclusion of this analysis an action plan will be identified addressing areas of concern
and retention. The action plan is readily useable with steps to follow to lower turnover and
increase engagement. If implemented organizations could save tons of money on recruitment and
training costs.
Keywords: employee engagement, employee turnover, retention, lack of challenge,
leadership support, job stress and unfair treatment, professional development,
inadequate compensation, Nursing, Human Resources

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Implications of Employee Engagement and Lowering Employee Turnover

Background
ValleyCare Health System of Ohio is a unionized system of hospitals with three locations
including: Hillside Rehabilitation Hospital, Northside Medical Center and Trumbull Memorial
Hospital. ValleyCares main focus is patient experience. ValleyCares mission is to provide a
positive patient experience with a commitment to the latest medical advances, physician
recruitment, and by providing quality healthcare in our region (ValleyCare Health System of
Ohio, 2016, p. 1).
Historically, employees choose to leave their organizations due to lack of opportunities for
professional development, inadequate compensation, boredom/ lack of challenge, job stress and
unfair treatment. To combat areas of concern this analysis will address areas such as growth and
development, dealing with stress and burnout, and employee engagement. In regards to growth
and development ValleyCare must address areas such as stretching assignments, job rotation, and
developing formal mentoring programs, which will be illustrated in the action plan.
A goal of ValleyCare is to integrate collaborative decision making and quality
improvement initiatives. ValleyCare is partnered with Community Health Systems; a system of
hospitals who value positive attitudes, take pride in their employees personal appearance, their
commitment to co-workers, high levels of communication, customer waiting, privacy,
responsiveness, safgety awareness, service recovery, and having a sense of ownership. As part of
ValleyCares partnership employees must follow the Community Cares Pledge which states:

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Our commitment to our Community Cares culture is reflected by our employees,

volunteers and physicians creating a great place for employees to work, physicians to
practice medicine, and patients to receive care.
The standards of behavior will makes these values visible in our attitudes and in our
work. They are used to guide our behavior in creating and maintaining a culture and
practice of outstanding service to employees, physicians, patients, families and visitors.
Many of the standards are second nature; they are examples of courtesy and respect to
one another and the customer we serve. However, adopting them as required behaviors
provides clear expectations to every employee.
At the conclusion of the pledge employees are required to provide their signature. While,
increasing employee engagement and motivation, and lowering turnover requires leadership
support, ValleyCare is unionized which introduces a barrier in communication. Not to mention,
increased levels of communication are necessary during this process.
Proposed Action Plan
Towards the end of this analysis the reader will find an action plan addressing areas of
concern. The proposed action plan to address areas of concern within ValleyCare are illustrated
in the table below. Table 1 lists steps to follow to begin lowering turnover and increasing
engagement.
Turnover and Engagement
Steps

Result

1.

Interview Employees

Finds relevant sources

2.

Communicate with leadership and other staff

Everyone is on the same page

3.

Determine main cause of distractions

Narrows down the problem

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4.

Develop Action Plan

Name sources, necessary parties, and

problem

5.

Act on Action Plan

Solve Problems

6.

Repeat steps if necessary

Gather more information

7.

Maintenance

Lessons learned

Table 1: Lowering Employee Turnover

In reference to Table 1 and according to the Cleveland Clinic website employees want to
be recognized and have a voice. This includes having open dialogue about issues in the
workplace. Dialogue includes what Cleveland Clinic should start, stop, and continue doing,
along with patient care and communication (Cleveland Clinic, 2016). ValleyCare possesses
strong senior leaders who value open dialogue, in spite of barriers. ValleyCare currently going
through significant organizational change, with current union contract negotiations.
During this analysis the reader will better understand leaderships interaction with
employees in comparison to culture handbook by Community Health Systems. Also, ways to
lower costs, employee turnover, and grievances will be discussed. The study will not address
employee health concerns in debt.
Literature Review
This literature review targets studies on employee engagement, turnover, and retention.
Researchers have long assumed employee engagement, turnover, and retention are important
areas to explore. For instance, eminent scholars of engagement, Hansen, Byrne & Kiersch
expressed in How Interpersonal Leadership Relates to Employee Engagement, that cost

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containment knowledge is a must have. As Hansen, Byrne & Kiersch (2014, p. 3) themselves put
it when not engaged, employees cost their organizations between $292 and $355 billion
annually. Another leading argued that turnover intentions are considered the most proximal
antecedent of organizational exit (Mai, Ellis, Christian & Porter, 2016, p. 1).
Ultimately when it came to the nature of turnover, the basic assumption was that
employee engagement should increase and turnover should decrease. But a new body of research
shows that engagement, turnover, and retention are far more complex issues requiring further
exploration. According to Studer (2003, p. 179) the American Organization of Nurse Executives
estimates recruiting costs at $50,000 per RN, so savings become substantially greater when
considering just the benefit of reducing nursing turnover.
Employee Engagement
Conventional wisdom has it that, employee engagement is characterized by high emotion
and energy, focused attention, and ultimately being present (Byrne, 2016). As an illustration,
meetings have the tendency to limit engagement. However, meetings that provide open
discussion in a more positive light have the ability to increase positive outcomes for
organizations, such as employee engagement (Yoerger, Crowe & Allen, 2015, p. 3), including
respecting obligations to co-workers (Community Health Systems, p. 5). Furthermore, health
problems play a role in the measurement of engagement through measuring productivity
(Mariglia & Johns, 2016). According to Studer (2003), we cant motivate employees. They
motivate themselves. But leaders can create a culture in which people are more inspired to
motivate themselves than in average work environments. And they can avoid words and actions
that de-motivate them.

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According to Byrne et al. (2016), UWES is utilized a lot throughout research of employee
engagement. However, there are concerns with utilizing this scale alone. In Byrnes study UWES
and JES scales were utilized in order to measure engagement. In conjunction with JES it was
determined that engagement is not the same as the opposite of burnout, but the study revealed
psychological meaningfulness and engagement are highly related.
Miraglia & Johns (2016) point is that there is a relationship between psychological
meaningfulness and employee engagement explaining the idea of hiring employees who have a
psychological attachment to the position as employees want and love their positions, and are
inclined to stay longer. During the onboarding process encourage employees to be innovative.
Studer (2003, p. 182) recommends organizations hardwire employee participation in the same
way as with leaders, by also telling them they must implement one Bright Idea to receive a good
evaluation.
Employee Turnover
On the other hand, Hagedorn, Paras, Greenwich & Hagopian (2016) were curious how
collective bargaining contracts promote public health. Family, individual, and community
wellbeing were areas of concern. Contract-protected benefits and working conditions were
enumerated, before interviewing union organizers and members to learn how these promoted
health. What is more, retirement and pension plans are favorable among union members. Wage
and benefit standards, working hour limits, and workplace hazards are protected under labor
union contracts. Union contracts are often negotiated for years at a time, hence efforts to
heighten and maximize communication, comradery among employees and leadership is
encouraged, including treating one another with professional courtesy and respect at all times

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(Community Health Systems, p. 5). While labor union contracts are not often utilized contracts
have the potential to increase public health, by encouraging healthy work habits.
In Viotti and Conversos (2016) view, one area of concern in reference to turnover is
shortage of resources. Shortage of resources in healthcare, especially nursing, has presented itself
in a demeaning manner, and is associated with lack of challenge. Job performance expectations
of new nurses contribute to stress and high turnover rates, which further exacerbates the lack of
nursing resources to meet increasing demands. To remain competitive, leaders must understand
other mitigating factors such as the work environment and the effect it has on nurses. Workload
is constantly increasing. Nurses employed under these conditions experience undue stress on
families and caregivers. In the result of abnegated care, nurses become overwhelmed because
they are forced to manage negative feedback from patients when the nurse is unable to meet their
expectations. Negative behavior lowers retention.
Employee Retention
Employees choose to leave organizations for many reasons beyond the control of
management. For this reason increasing employee retention may not be practical. However, one
cost efficient way to address turnover and retention is skill discretion. One of the biggest factors
fueling high employee turnover rates is job stress. When stress is recognized it is necessary to
identify main causes. Viotti and Converso (2016, p. 4) define skill discretion as a persons
opportunity to acquire and use specific job skills in the work process. Viotti and Converso
(2016) celebrated the fact, skill discretion can be utilized as a tool to reduce stress on the job and
increase job well-being.

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According to Klotz and Bolino (2016) leadership support is also necessary during
stressful work conditions. Leadership support includes utilizing facets of social exchange theory;
which includes exchanging information over time. Klotz and Bolino (2016, p. 1) state that when
two interdependent parties exchange resources with each other over time, and they abide by the
rules of reciprocity when doing so, they tend to form strong, positive relationships. This
positive relationship is a part of what fuels employee engagement and lowering of turnover rates.
When behavior is not reciprocated and no support is warranted from leadership employees do not
feel apt to go above and beyond the call of duty. Lack of support from leadership including lack
of access to educational and professional growth opportunities increases turnover behavior.
Selander and Ruuskanen (2016, p. 2) themselves write, turnover behavior can be
recognized through turnover intentions. Turnover intentions refers to an employees intentions
to voluntarily quit their current job. According to Klotz & Bolino (2016), voluntary turnover has
gained significant attention over the years because of the negative effects it has on an
organization. In the past the focus has been on intentions to quit, the decision to quit, and actual
turnover. In healthcare a productive and engaged workforce is needed in order to service patients,
decrease costs, and create job security. Relationships among employees play a role in their level
of engagement and ultimately whether or not the employee wants to leave the organization.
Therefore, presenting a positive correlation in the lowering of turnover and increase in
engagement through serving relationships identifies an employees intentions to quit through the
utilization of social exchange. Social exchange influences the manner in which an employee
chooses to resign, including their emotional reactions.
Intentions to quit can also be identified through accessing the employees health. Here
many enthusiasts would probably approve attending work ill lowers productivity. Attending work

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ill prevents the staff from functioning at full capacity and influences productivity. Additionally,
frequent call offs, arriving to work late, and working ill requires careful evaluation. Not all ill
employees hinder an organizations productivity (Miraglia, 2016). In the study completed by
Klotz & Bolino (2016) emotional reactions were measured using a shortened version of JobRelated Affected Well-Being Scale.
Moreover, allowing employees to utilize skills gained through educational background or
experience puts the organization at an advantage. Work goals are the number one priority. Skill
discretion helps achieve goals and reduce job demands, and associated psychological costs
(Viotti & Converso, 2016, p. 3). According to Selander & Ruuskanen (2016), low job quality
plays a role in turnover intentions. When work is intrinsically rewarding turnover intentions are
low. When employees are recognized retention rates are high.
According to Yoerger, et al. (2015), leadership support is an important piece to the
puzzle, along with adequate communication among all staff within ValleyCare.. Support can
measured in meetings as well. Employees develop the desire to and a greater passion to
participate in daily activities, which has a positive effect on the organization. Desire and passion
are characteristics of engaged employees. Employees who value protection.
Union Contracts
In addition to employees valuing protection, unions protect employees from unsafe work
conditions. Employees should not be contacted while out of work, if the matter is non serious or
non-urgent. Contacting employees during other times will help employees not feel isolated or
ignored. Contact should be made in alignment with employees return to work. Disciplinary and
performance raise red flags among employees (Lynch, 2016).

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In Hagedorn et al. (2016) view, unions have been instrumental in providing safe and
healthy work environments. To add, members consistently trade wage for health benefits.
Members continuously choose strong health benefits over wage increases. However, the desire
and passion for their work environments is tied to the desire for better wage offers. Union
contracts have been known to lack specificity. Communication of contract information is
important when relaying contract information to employees. It is necessary to have things such
as bulletin boards to communicate information. In addition to effective communication, a readily
available union representative on site. Communicating information also involves properly
training employees along with proper compensation. At ValleyCare salaries, wages, and benefits
are negotiated and set in the contract. Melissa Benett, Chief Operating Officer for ValleyCare
reported that wages has been an ongoing issue with recruiting and retaining employees. The
longevity of the contractshas at times made rates noncompetitive with other facilities (M.
Bennett, personal communication, August 18, 2016).
According to Viotti & Converso (2016), inadequate training produces emotional
exhaustion, which can lead to burnout. Burnout is common for employees experiencing work
related stress. In this respect turnover is described as behavioral. Organizations are affected
negatively when employees choose to leave an organization: experienced employees are replaced
with new employees who lack cultural knowledge (resulting in a loss of productivity), and the
organization must also cover training and recruitment costs.
The essence of Miraglia & Johns (2016) argument is presenteeism is of utmost
importance. According to Byrne, Peters, & Weston (2016), transparency is necessary in order to
disclose an employees level of presenteeism. Employee must feel the need to be present in their

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work environments. On the other hand, job stress leads to mental illnesses such as depression.
Depression and other mental illnesses are difficult to disclose in the workplace.
Research Methodology
During this study and in collaboration with ValleyCares current organizational goals the
following areas will be addressed: cost containment, lowering employee turnover rates and
lowering of grievances. Four senior level representative employees at ValleyCare were consulted
on a continuous basis through group supervision and coaching. Several outside resources were
utilized to complete this study. Results from studies will be recorded over a three year period,
resulting in increased standards of performance. Outcomes can be taken into consideration over
the same three year period.

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The figure displays major areas of concern within ValleyCare Health Systems of Ohio and
their sub-problems, along with areas needing development. Figure 1 displays areas of concern.

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Identify areas
causing high
turnover rates and
low engagement
within ValleyCare
Health Systems of
Ohio

Determine whether lack

of opportunity for
professional
development is an issue

Determine whether job

stress and unfair
treatment is an issue

Determine whether
boredom/lack of
challenge or inadequate
compensation is an issue
is an issue

Analyze employee
engagement and
turnover data

analyze current
educational
opportiunities

Nature of
occupational
attitudes

skill discretion

measuring
employee
engagement

Implementation
of educational
opportunities

characteristics of
unfair treatment

benefits
administration
and union
contracts

measuring
employee
turnover

Support from leadership

Skill Discretion

Meetings

Figure 1: Areas of Concern

Action plan

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The present action plan is limited to 30/60/90 days nurses and offers answers to the
following research questions: To what degree are leaders within ValleyCare servant leaders?
What is the level of employee engagement within ValleyCare? What is the relationship between
employee turnover and employee motivation? Compare and contrast behavioral traits within
ValleyCare.
While all strategies may not be practical in increasing retention, this action plan will
address stretching assignments, job rotation, developing formal mentoring programs,
implementing coping mechanisms, work life balance, promoting exercise and physical activities,
employee recognition, and cost containment. Table 1 should be utilized to begin this process.
Turnover and Engagement
Steps

Result

1.

Interview Employees

Finds relevant sources

2.

Communicate with leadership and other staff

Everyone is on the same page

3.

Determine main cause of distractions

Narrows down the problem

4.

Develop Action Plan

Name sources, necessary parties, and

problem

5.

Act on Action Plan

Solve Problems

6.

Repeat steps if necessary

Gather more information

7.

Maintenance

Lessons learned

Table 1: Lowering Employee Turnover

During a 30 day follow-up it is necessary to interview employees asking the following questions:

How do we compare with what we said?

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What is working well?

Are there any individuals who have been helpful to you?

Have you received the training and tools you need to do your job?

What ideas for improvement do you have? (ValleyCare Health System of Ohio, 2016)

The answers to these questions can be utilized to communicate with leadership, while
determining the main cause of distraction and ultimately beginning to develop an action plan
with the goal of increasing employee engagement and lowering employee turnover. Ultimately
what is at stake here is a misplacement of adequate skillset. Here we will be able to determine
where it is best to place an employee within an organization (according to skillset and responses)
while implementing coping mechanisms. Coping mechanisms include helping employees
understand their relationship to the organization. According to Selander and Ruuskanen (2016),
work becomes meaningful when employees consider organizational goals as their own.
Determining and employees relationship to ValleyCare may be accomplished during onboarding
and through formal mentoring programs. In order to develop a formal mentoring program
ValleyCare leaders must consider what practices should be stopped, started, and continued based
off employee responses.
To combat high levels of stress and burnout employers will have to implement coping
mechanisms, work life balance initiatives, and promote exercise and physical activities. To
manage stress and burnout leadership departments within ValleyCare must become motivated to
implement coping mechanisms, work life balance initiatives, and promote exercise and physical
activities. In relationship to employee turnover, engagement, motivation and cost containment,

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areas addressed will include skill discretion and presenteeism. Over the years presenteeism has
been utilized in much of literature (Miraglia & Johns, 2016). Non-union employees expressed
concerns in this area. With union employees there is a sense of job security while serving as a
member of a union. Employees are not adept to change, and are not comfortable with current
employee contracts, so they refuse to sign up to become a member of the union.
ValleyCare will have to integrate collaborative decision making and quality
improvement. Additionally, union contracts should be viewed in relationship to onboarding,
grievances, personal questions, attendance, and use of technology. To address lack of
opportunities for professional growth and job stress and unfair treatment skill discretion must be
addressed within ValleyCare. Skill discretion refers not only to the opportunity use consolidated
skills but also to the process of learning new things and of exercising creativity (Viotti &
Converso, 2016, p. 1).
Projected Outcome
Graph 1 illustrates projected outcomes of what happens when employees are challenged
and receive needed support, over a three year period.

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Employees Who Are Supported and Challenged

6
5
4
3
2
1
0

Series 1

Series 2

Series 3

Example analytic model showing results of projected outcome.

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Conclusion
It is necessary for leaders of ValleyCare to identify behavior related to turnover intentions.
Although ValleyCare Health Systems of Ohio is a unionized system of hospitals, in collaboration
with Community Health Systems, ValleyCare continuously strives to provide a positive patient
experience to patients. In a personal communication with Melissa Bennett, Chief Operating
Officer of ValleyCare nurses are able to transition to other facilities with the Community Health
Systems network, if the opportunity presents itself. Nurses do not lose seniority. Other hospitals
do not recognize union pieces (personal communication, August 25, 2016).
Those unfamiliar with this school of thought may be interested to know that it basically
boils down to presenteeism. Performance and commitment are areas of engagement that show a
positive motivational state (Byrne, Peters & Weston, 2016). An employees level of presenteeism
represents the difference between being absent vs being fully engaged (Klotz & Bolino, 2016).
According to Hagedorn, Paras, Greenwich & Hagopian (2016), employee health is important,
and one that employees and employers care about. Retirement and pension plans offer
organizational stability. With this being said, union employees are more likely to have a
retirement or pension plan and are more likely to participate in a retirement plan sponsored by
their employer than employees who are not members of a union (Hagedorn, Paras, Greenwich,
& Hagopian, 2016).

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