The Impact of Nurse Empowerment on Their Intent-to-Stay: A Case in Private Medical Health Care.

This case report explores the impact of work empowerment among the nursing staff in a private medical health care institution in the state of Kedah, West Malaysia.. The main purpose of the study was to apply the Kanter's theory of structural empowerment with the utilization of measuring instru...

Full description

Saved in:
Bibliographic Details
Main Author: Yu, Chye Wah
Format: Thesis
Language:eng
Published: 2006
Subjects:
Online Access:https://etd.uum.edu.my/95/1/yu_chye_wah.pdf
Tags: Add Tag
No Tags, Be the first to tag this record!
id my-uum-etd.95
record_format uketd_dc
institution Universiti Utara Malaysia
collection UUM ETD
language eng
topic HD61 Risk Management
spellingShingle HD61 Risk Management
Yu, Chye Wah
The Impact of Nurse Empowerment on Their Intent-to-Stay: A Case in Private Medical Health Care.
description This case report explores the impact of work empowerment among the nursing staff in a private medical health care institution in the state of Kedah, West Malaysia.. The main purpose of the study was to apply the Kanter's theory of structural empowerment with the utilization of measuring instrument modified by Chandler (1986) and Laschinger(1996, 1999,2001) to examine the influence of nurses' work empowerment towards their intent-to-stay in this particular organization. The whole population census of 103 nurses participated in the study using cross-sectional techniques and interview method. A excellent response rate of 100% is achieved. Survey measures administered comprise few instruments: Organizational Description Opinionnaires (ODO) which measure nurses' perceptions of their manager's power; Conditions for Work Effectiveness Questionnaires (CWEQ) aim to measure overall work empowerment, which encompass nurses' perceptions of their access to the four work empowerment structures: opportunity, information, support, and resources; Job Activities Scale(JAS) measures the formal or position power; the Organizational Relationships Scale (ORS), measures informal power and Intent-to-stay (ITS) index, measures nurses' intention to remain with the organization. Findings revealed that work empowerment will not vary regardless of the nurses' job status. Male and female ethnicity differ significantly (p<0.05) in term of work empowerment. However there are no significant differences between nurse managers and staff nurses in term of their intent-to-stay. Again, in comparison among nurses in three different job levels, i.e, nurse manager, staff nurse and auxiliary nurse also did not exist any differences in their intent-to-stay. The correlation analysis found the existences of significant positive relationship between: i) nurses' intent-to-stay and their work empowerment; ii) nurses' intent-to-stay and their perceptions of formal power within the work environment; iii) nurses' intent-to-stay and their perceptions of informal power within the work environment; iv) nurses' work empowerment and their perceived power towards their manager within the work environment. The results also substantiated that the job status/ levels and work empowerment did significantly predict 31% of the variance in nurses' intent-to-stay. However work empowerment is a better predictor than job status. The findings suggest further investigation in public health care institution for comparative purposes to elicit and explicate a lucid picture of nursing issues in empowerment and turnover. Keywords: "empowerment"; "intent-to-stay"; "turnover" & "healthcare"
format Thesis
qualification_name masters
qualification_level Master's degree
author Yu, Chye Wah
author_facet Yu, Chye Wah
author_sort Yu, Chye Wah
title The Impact of Nurse Empowerment on Their Intent-to-Stay: A Case in Private Medical Health Care.
title_short The Impact of Nurse Empowerment on Their Intent-to-Stay: A Case in Private Medical Health Care.
title_full The Impact of Nurse Empowerment on Their Intent-to-Stay: A Case in Private Medical Health Care.
title_fullStr The Impact of Nurse Empowerment on Their Intent-to-Stay: A Case in Private Medical Health Care.
title_full_unstemmed The Impact of Nurse Empowerment on Their Intent-to-Stay: A Case in Private Medical Health Care.
title_sort impact of nurse empowerment on their intent-to-stay: a case in private medical health care.
granting_institution Universiti Utara Malaysia
granting_department College of Business (COB)
publishDate 2006
url https://etd.uum.edu.my/95/1/yu_chye_wah.pdf
_version_ 1747826842507673600
spelling my-uum-etd.952013-07-24T12:05:34Z The Impact of Nurse Empowerment on Their Intent-to-Stay: A Case in Private Medical Health Care. 2006-05-12 Yu, Chye Wah College of Business (COB) Faculty of Business Management HD61 Risk Management This case report explores the impact of work empowerment among the nursing staff in a private medical health care institution in the state of Kedah, West Malaysia.. The main purpose of the study was to apply the Kanter's theory of structural empowerment with the utilization of measuring instrument modified by Chandler (1986) and Laschinger(1996, 1999,2001) to examine the influence of nurses' work empowerment towards their intent-to-stay in this particular organization. The whole population census of 103 nurses participated in the study using cross-sectional techniques and interview method. A excellent response rate of 100% is achieved. Survey measures administered comprise few instruments: Organizational Description Opinionnaires (ODO) which measure nurses' perceptions of their manager's power; Conditions for Work Effectiveness Questionnaires (CWEQ) aim to measure overall work empowerment, which encompass nurses' perceptions of their access to the four work empowerment structures: opportunity, information, support, and resources; Job Activities Scale(JAS) measures the formal or position power; the Organizational Relationships Scale (ORS), measures informal power and Intent-to-stay (ITS) index, measures nurses' intention to remain with the organization. Findings revealed that work empowerment will not vary regardless of the nurses' job status. Male and female ethnicity differ significantly (p<0.05) in term of work empowerment. However there are no significant differences between nurse managers and staff nurses in term of their intent-to-stay. Again, in comparison among nurses in three different job levels, i.e, nurse manager, staff nurse and auxiliary nurse also did not exist any differences in their intent-to-stay. The correlation analysis found the existences of significant positive relationship between: i) nurses' intent-to-stay and their work empowerment; ii) nurses' intent-to-stay and their perceptions of formal power within the work environment; iii) nurses' intent-to-stay and their perceptions of informal power within the work environment; iv) nurses' work empowerment and their perceived power towards their manager within the work environment. The results also substantiated that the job status/ levels and work empowerment did significantly predict 31% of the variance in nurses' intent-to-stay. However work empowerment is a better predictor than job status. The findings suggest further investigation in public health care institution for comparative purposes to elicit and explicate a lucid picture of nursing issues in empowerment and turnover. Keywords: "empowerment"; "intent-to-stay"; "turnover" & "healthcare" 2006-05 Thesis https://etd.uum.edu.my/95/ https://etd.uum.edu.my/95/1/yu_chye_wah.pdf application/pdf eng validuser masters masters Universiti Utara Malaysia Aiken, L., Clarke, S., Sloane, D., Sochalski, J. & Silber, J. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002:288 (16):1987-1993. Aiken, Lewis R. (1994). Psychological testing and assessment, Boston: Allyn and Bacon. American Federation of State, County and Municipal Employees, AFL-CIO website (2003). Solving the nursing shortage: listening to nurses: dissatisfaction and burnout on the job. Available: www.afscme.org/unn/sns06. htm.Accessed April 2,2005. Ang Seng Chai (1999). Performance and Empowerment: lesson in leading and motivating employee, Shah Alam: Fajar Bakti. Anonymous (2003) Sample: :cause of nurse exodus, Nursing Administration Quarterly 27(2), 164-171, April/June. Asian Strategy and Leadership Institute (1995,21 August). Proceeding of a seminar on Strategic Visioning, Empowerment and Change, Pan Pacific Hotel, K. Lumpur. Petaling Jaya: Asian Strategy and Leadership Institute. Bailey, D.M.(1991). Research for the Health Professional: a practical guide, 2nd ed. Philadelphia: F.A.Davis Company. Balik, W. L. (1996). Managerial reform and professioinal empowerment in the public service, Westport: Quorum Books. Barry, T. (2002). The impact of nurse aide empowerment strategies on nursing home resident outcome. Phd. Theses, The Pennsylvania State University, U.S. Beckhard, R. (1969). Organization development: strategies and models, Reading: Addison- Wesley, Behrend, H. (1953). Absence and Labout Turnover in a changing Economic Climate, Journal of Occupational Psychology, 27, 185-196. Bennis, W.G. (1989). Organizations of the future, in Natemeyer, W.E. and Gilberg, J.S., Classics of Organizatioinal Behavior, Danville: W.E.,Interstate, 300-12 Blanchard, K. ; Carlos, J. P. and Randolph (1999) The 3 keys to empowerment: release the power within people for astonishing results, San Francisco: Berrett-Kohler. Block, P. (1987). The Empowered Manager: Positive Political Skills at Work, San Francisco: Jossey-Bass. Brehm, A. H. and Cohen, A. R. (1962). Exploration in cognitive dissonance, New York: Academic Press. Caudron, S. (1995). Create an empowering environment, Personnel Journal, 74-9,28-36. Cavana, R. Y.; Delahaye, B. L. and Sekaran, U. (2001). Applied business research: qualitative and quantitative methods, Milton, Qld. : John Wiley. Chandler, G. (1986). The Relationship of Nursing Work Environment to Empowerment and Powerlessness [unpublished doctoral dissertation]. Salt Lake City, Utah: University of Utah. Chandler, G E., (1991). Creating an Environment to Empower Nurses, Nursing Management,22-8, 20-23. Chandler, G E., (1992). The Source and Process of Empowerment, Nursing Administration Quarterly, 16-3, 65-71. Chevan, J. & Chevan, A. (1998). A statistical profile of physical therapists, 1980 and 1990 Phys Ther. 78:301-312. Conger, J A., (1990).Leadership: the Art of Empowering Others, The Academy of Management Executive, 111-1, 17-24. Conger, J.A. and R.N. Kanungo (1988). The empowerment process: integrating theory and practice, Academy of Management Review, 13-3,471-82. Cynthia, D. and Dennis, T. J. (1991). Empowerment: building committed workforce, London: Kogan Page. Donaldson, C. (2004). Retention management key in talent-short market, Human Resources Magazine, Reed International Books Australia Pty Ltd Festinger, J. R. (1957). A theory of cognitive dissonance, Evanston, Ill: Row, Peterson. Fletcher,C.E.(2001, June). Hospital RN's job satisfactions and dissatisfactions. Journal of Nursing Administration, 31(6), 324-31. Frohman, A.L. and Johnson, L.W. (1993). The middle management challenge: moving from crisis to empowerment, New York: McGraw H11. Garfield, C. (1993). Employee empowerment, Executive Excellence, 10-3,20-22. Gilbert, G.R. (1993). Employee empowerment: flaws and practical approaches, The Public Manager, 22-3,45-9. Goddard MB, Laschinger HKS.(1997). Nurse managers' perception of power and opportunity, Canadian Journal Nursing Administration, 10(2):40-66. Griffin, A. and Shevenaugh, D., (1995). Best Practice For Customer Satisfaction in Manufacturing Firms, Sloan Management Review, Winter, 87-98. Hatcher, S. and Laschinger, HKS, (1996). Staff Nurses' Perception of Job Empowerment and Level of Burnout: A Test of Kanter's Theory of Structural Power in Organizations, Canadian Journal of Nursing Administration, May-June,74-94. Hackman, J.R. and Oldham, G.R. (1976). Motivation through the design of work: test of a theory, Organizational Behavior and Human Performance, 16,250-79. Herzberg, F. (1959). The Motivation to Work, New York: John Wiley & Sons, Inc. Herzberg, F. (1968). One more time: how do you motivate employees?, Harvard Business Review, 46-1,53-62. Heyns, G. J. (1973). An investigation into Lbbour Turnover amonh clerical Personnel, Theses M. Com thesis, University of Port Elizaberth. Hills, J.M.M. (1951). A consideration of Labour Turnover as the resultant of Quasi-stationary Process, Human Relat., 4,255-264. Hinrichs , J. R. (1980). Controlling absenteeism and turnover, Scarsdale, NY: Work in America Institute. Hogan, C. (2000). Facilitating Empowerment: a handbook for facilitators, trainers and individuals, London: Kogan Page. Honold, L. (1997). A review of the literature on employee empowerment. Empowerment in Organizations, 5(4), 202-212. Hooper, B. J. (1995). The career ladder: its effects on job satisfaction as perceived by registered nurse, Annn Arbor: UMI Hom. P. and Griffeth R. W. (1995). Employee turnover, Cincinnati: South-Western. Ingersoll, Gail L. (May, 2002). Nurses' Job Satisfaction, Organizational Commitment, and Career Intent. Journal of Nursing Administration. 32(5):250-263. Johnson, R. and Redmond, D.(1998). The art of empowerment: the profit and pain of employee involvement, London: Financial Time. June, L. H. et al. (2003). Predicting Registered Nurse Job Satisfaction and Intent to Leave, Journal of Nursing Administration, 33(5):271-283, May. Kanter, R.M. (1968). Commitment and social organization: A study of commitment mechanisms in utopian communities. American Sociological Review, 33, 499-517. Kanter, R. M. (1993). Men and Women of the Corporation, Second ed. New York: Basic Books. Kanter R.M. (1979). Power failure in management circuits, Harvard Business Review. 57(4):65-75. Kanter, R M, (1977). Men and Women of the Corporation, New York: Basic Books, Inc. Kanter, R. M. (1989). Change masters, in Natemeyer, W.E. and Gilberg, J.S., Classics of Organization Behavior, Danville: Interstate, 358-70. Keller,T and Dansereau,F(1995).Leadership and Empowerment: A Social Exchange Perspective, Human Relations,48-2,127-145 Kinlaw, D. C. (1995). The practice of empowerment: making the most of human competence, Aldershot: Gower. Kizilos,P,(1990). Crazy About Empowerment, Training,,47-56. Klakovich, M D.,(1996). Registered Nurse Empowerment Model Testing and Implications for Nurse Administrators, Journal of Nursing Administration, 26-5, 29-35. Kraut, A. (1975). Predicting Turnover of Employees from Measured Job Attitudes, Organizational Behavior and Human Performance, 13,233-243. Kutzscher, LIT; Sabiston,JA; Laschinger, HKS & Nish, M.(1997). The effects of teamwork on staff perception of empowerment and job satisfaction. Healthcare Manage Forum, lO(2): 12-17. Landes, L. (1994). The myth and misdirection of employee empowerment, Training, 31 - 3, 116-17. Laschinger, HKS. (1996). A theoretical approach to studying work empowerment in nursing: a review of studies testing Kanter's theory of structural power in organizations. Nurs Adnz Quarterly, 20-2,25-41. Laschinger HK, Almost J, Tuer-Hodes D.(2003). Workplace empowerment and magnet hospital charactcristics: making the link, Journal Nursing Administration, Jul-Aug, 33(7-8):410-22. Laschinger, HKS. et al. (2001). Impact of Structural and Psychological Empowerment on Job Strain in Nursing Work Settings: Expanding Kanter's Model, Journal of Nursing Administration, 31-5,260-272. Laschinger, HKS. et al. (2004). Predictors of Nurse Managers' Health in Canadian Restructured Health Care Settings, The Nurse Manager,July, UWO, Canada. Laschinger, HKS; Sabiston, JA. & Kutszcher, L.(1997). Empowerment and staff nurse decision involvement in nursing work environments: testing Kanter's theory of structural power in organizations. Res Nurs Health, 20,341-352. Laschinger HKS.(1996). Measuring empowerment from Kanter's (1977,1993) theoretical perspective. Journal of Shared Governance, 2-4,23-26. Laschinger HKS, Wong C. (1999). Staff nurse empowerment and collective accountability: effect on perceived productivity and self-rated work effectiveness. Nursing Economics, 17,308-316. Laschinger, W.B. (1994).Staff nurse perception of job empowerment and organizational commitment. A test of Kanter's theory of structural power in organizations. Journal of Nursing Administration, 24-4 Suppl, 39-47. Laschinger HKS, Sharnian J.(1994). Staff nurses' and nurse managers' perception of job-related empowerment and managerial self-efficacy. Journal of Nursing Administration, 24,1038-47. Lashley, C. (1995). Employee empowerment in services: a framework for analysis, International Journal of Contemporary Hospitality Management, 7(1), 27-32. Lashley, C. (1995) Towards an understanding of employee empowerment in hospitality services. International Journal of Contemporary Hospitality Management, 7(1), 27-32 Lawler, E. E.; Mohrman, S. A. and Ledford, G. E. (1992) Employee Involvement and Total Quality Management, San Francisco: Jossey-Bass. Leatherman, D. (1992). Quality leadership through empowerment: standards of leadership behaviour, Amherst: Human Resource Development Press. Lee Hock Chuan (1996). A study on the deferences in role clarity, Job satisfaction and intent-to stay between exempt staff from foreign and local manufacturing firms, Research report by MBA student, June. Lewin, K. (1951). Field Theory in Social Sciences, New York: Harper & Row. Long, J.R. (1951). Labour Turnover under Full Employment, Menograph A2, Faculty of Commerce and social science. Lynch, E.L. (2002). Considering Leaving? Consider This. Nursing Spectrum, 20(2). Mallak, L.A. and Kurstedt, H.A., Jr. (1996). Understanding and using empowerment to change organizational culture, Industrial Management, November/December, 8-10 Macy, B.A., Thompson, R.C. and Farias, G. F. (1995). Describing and assessing current high performance work practices in innovative organizations: A benchmarking study of 82 North American organizations, Academy of Management Meetings, Vancouver, Canada. Malone, T.W. (1997). Is empowerment just a fad? Control, decision making, and IT, Sloan Management Review,38-2, 23-9 Marniero, L A., (1986). Coping With Powerlessness: The Relationship of Gender and JobDependency to Empowerment- Strategy Design, Administrative Science Quarterly, 31, 633-653. Martin, L.A.C. (1994). The Patterns of Empowerment: An Examination of Conditions Affecting Employee-empowerment Efforts, University of Knoxville, Knoxville.. Menon, S.T. (1995). Employee Empowerment: Definition, Measurement and Construct Validation, McGill University, Canada. McClelland, D.C. (1975). Power: The Inner Experience, New York: Irvinton Press. McDermott, K, Laschinger, H K S, and Shamian, J(1996).Work Empowerment and Organizational Commitment, Nursing Management, 27-5,44-47. Mosley, D. C. Jr. (2002). The influence of person-job fit, person-organization fit and self-efficacy perception on work attitudes, job performance and turnover,Ann Arbor: UMI Mowdey, R. T. ; Porters, L. W. and Steers, R. M. (1982). Employee-organization linkages: the psychology of commitment,absenteesim and turnover,London: Academic Press. McNeese-Smith, D. (2001, February). Staff nurse views of their productivity and nonproductivity. Heath Care Management Review, 26(2), 7-19. Mills, D. Q.(1994). The Empowerment Imperative: six steps to a high performance organization, Massachusetts: Human Resource Development Press, Inc. Morris, S. & Willcocks, G. (1999). Successful Empowerment in a week, London: Hodder & Stoughton. Mosbley,W.H.(1982). Employee turnover, causes,consequences and control, Reading, MA: Addison-Wesley. Neilsen, E.H. (1986). Empowerment strategies: balancing authority and responsibility, in Srivastva, S., Executive Power: How Executives Influence People and Organizations, San Francisco: Jossey-Bass. Ong Soon Chuan (2002). Job satisfaction of nurses in Hospital Kota Bahru. Theses UUM. Parker, L E. and Price, R H (1994). Empowered Managers and Empowered Worlters: The Effects of Managerial Support and Managerial Perceived Control on Workers' Sense of Control Over Decision-Making, Human Relations, 47-8, 911-928. Parpart, J. L,; Rai, S.M. and Staudt, K.(2002). Rethinking empowerment: gender and development in a global/local world, London: Routledge. Pettmanm B. 0 . (1973). Some factors influencing Labour Turnover: A review of Research Literature, Indust. Relation J. 4,43-61. Plunkett, L. C. and Fournier, R. (1991). Participative management: implementing empowerment, New York: Wiley. Polit, D. F.; Beck, C. T. and Hungler, B. P. (2001). Essentials of Nursing resarch: methods, appraisal and utilization, Philadelphia: Lippincort. Price,J.L.and Mueller,C.W.(1986). Absenteeism and turnover of hospital employees, Greenwich, Conn.: JAI Press. Quinn, M. D. (1994). The empowerment imperative: six steps to a high performance organization, Massachusetts: Human Resource Development. Randolph, D. S. et al. (2005). Predicting the effect of extrinsic and intrinsic job satisfaction factors on recruitment and retention of rehabilitation professionals, Journal of Healthcare Management, 1-5,49-55. Radice, B, (1994). The Relationship Between Nurse Empowerment in the Hospital Work Environment and Job Satisfaction: A Pilot Study, Journal of the New York State Nurses Association, 25-2, 14-17. Robinson, R. D. (1997). The empowermerzt cookbook: action plans for creating, substaining or refocusing empowerment work teams, New York: McGraw Hill. Rothstein, L.R. (1995). The empowerment effort that came undone, Harvard Business Review, January-February, 20-31. Ruben. J. J. (1993). Perceived factor associated with high and low job satisfaction among teachers, Ann Arbor: UMI. Sabiston JA, Laschinger HKS(1995). Staff nurse empowerment and perceived autonomy: testing Kanter's theory of structural power in organizations.Journa1 of Nursing Administration, 25(9),42-46. Scroggins, W. A. (2003). Selection, meaningful work and employee retention: a self-concept based approach to person-job fit, Ann Arbor: UMI. Sims, H.P., Jr., (1986). Beyond quality circles: self-managing teams, Personnel, 52-1, 25-30 Smale, G. et al. (1993). Empowerment, assessment, care management and the skilled work, London: HMSO. Sagie, A. and Koslowsky , M. (2000). Participation and empowerment in organization: modeling, effectiveness and application, Thousand Oaks: Sage. Schmieding, N J,(1993). Nurse Empowerment Through Context, Structure and Process, Journal of Professional Nursing, 9-4, 239-245. Seeman, M. (1959). On the meaning of alienation, American Sociological Review, 24, 783-91. Shader, K., Broome, M. E., Broome, C. D., West, M. E., & Nash, M. (2001, April). Factors influencing satisfaction and anticipated turnover for nurses in an academic medical center. Journal of Nursing Administration, 31 (4), 210-6. Spence Lashinger, H. K., Sullivan Havens, D. (1997, June). The effect of workplace empowerment of staff nurses' occupational mental health and work effectiveness. Journal of Nursing Administration, 27(6), 42-50. Spence Lashinger, H. K. and Sullivan Havens,D.(1997,June). The effect of workplace empowerment of staff nurses' occupational mental health and work effectiveness. Journal of Nursing Administration, 27(6), 42-50. Spratley E., Johnson, A., Sochalski, J., Fritz, M. & Spencer W. (2001). The registered nurse population March 2000: findings from the National Sample Survey of Registered Nurses. Division of Nursing, Bureau of Health Professions, US. Health Resources and Services Administration, Rockville, MD. Spreitzer, G M., (1995). Psychological Empowerment in the Workplace: Dimensions, Measurement, and Validation, Academy of Management Journal, 38-5, 1442-1465. Spreitzer, G M., (1996). Social Structural Characteristics of Psychological Empowerment, Academy of Management Journal, 39-2,483-504. Staw, B. M.(1974). Attitudinal and behavioral consequences of changing a major organizational reward, Journal of Personality and Social Psychology, 29, 742-751. Staw, B. M. (1980). The consequences of turnover, Journal of Occupational Psychology, 1, 253-273. Stewart, A. M. (1994). Empowering people, London: Pitman Publishing Steward, A. (2001) Theories of power and domination: the politics of empowerment in late modernity, London: Sage. Stewart, R. (2004). The impact of long term care nurse empowerment and facility ownership on nurses' intent-to-stay.Phd. Theses, Indiana University school of Nursing,U.S. Sullivan, K.D. (1994). Empowerment and control: a new management paradigm, Educational Leadership, Seattle University, Seattle. Sullivan, K. and Howell,J.L.(1996). Wide Awake in Seattle: Success Stories of Outstanding Leaders who Learned to ShareLeadership, Seattle: Integrity Publishing,. Tannenbaum, A.S. (1968). Control in Organizations, New York: McGraw-Hill. The New Straits Times (2005). Student nurses' failure rate shocking. NST, 22 February 2005. Thomas, K W. and Velthouse, B A (1990). Cognitive Elements of Empowerment: An Interpretive Model of Intrinsic Task Motivation, Academy of Management Review, 15-4, 666-681. Thomas, K.W. and Tymon, Jr., W G (1993). Empowerment Inventory, XICOM Inc. Publishers. Toscano,P., & Ponterdolph,M.(1998,August). The personality to buffer burnout. Nursing Management, 29(8),32L, 32N, 32R. Tseo, G.K.Y. and Ramos, E.L. (1995). Employee empowerment: solution to a burgeoning crisis? Challenge, 38-5,25-7. Uma Sekaran (2003). Research Methods for Business: A Skill Building Approach,4th ed., Singapore: John Wiley & Sons,Inc Van Der Marve, R. & Sylvia Miller (1975). Consistency in Inter-organizational Labour Turnover, Occupational Psychology, 48, 137-152. Vogt, J.F. and Murrell, K.L. (1990). Empowerment in organizations: how to spark exceptional performance, San Diego: University Associates. Ward, P.J. (1993). A study of organizational variables affecting worker empowerment. Educational and Psychological Studies, University of Miami, Miami. Wicklund, R.A. & Brehm, J. W. (1976). Perspective on cognitive dissonance, Hillsdale, N.J.: Lawrence Erlbaum. Wilson, T. (1996). The empowerment manual, A1dorshot:Gower Wilson, B and Laschinger, H KS (1994). Staff Nurse Perception of Job Empowerment and Organizational Commitment: A Test of Kanter's Theory of Structural Power in Organizations, Journal of Nursing Administration, 24 -4S, 39-47. Yeuh-Yun Wu (1994). Relationship among teachers perception of empowerment, job satisfaction and organization commitment in public schools, Ann Arbor: UMI. Zanna, M.P, & Cooper, J. (1976). Dissonance and the attribution process. In N.J. Ickes, & R. F. Kidds (1976) (Eds). New direction in attribution research, Vol. 1 Hillsdale, N.Y.: Laerence Erlbaum http://juns.nursing.arizona.edu/articles/Fall%202002/ Kettle.htm http://www.academon.com/lib/paper/52703.html http://nsweb.nursingspectrum.com/cfforms/GuestLecture/ ConsideringLeaving.cfm http://publish.uwo.ca/~hkl/request.html. http://www.kedahmedical.com.my http://www.kpjsb.com.my http://www.nst.com.my http:www.thestar.com.my