The purpose of this study was to investigate the impact of training and development practices on job satisfaction and turnover intention among nursing staff in private multi-specialty hospitals in Karnal district, Haryana. The study addresses a critical issue in healthcare management—how to retain skilled nursing professionals in a competitive and high-pressure work environment. The research problem was grounded in the observation that despite access to training, many nurses continue to express dissatisfaction and consider leaving their current roles, prompting a deeper examination of the effectiveness of development strategies in influencing retention. A quantitative research design was employed, using a structured questionnaire distributed to 519 nursing professionals. Data were analyzed through descriptive statistics, One-Way ANOVA, and Structural Equation Modeling (SEM) to assess relationships among training satisfaction, job satisfaction, and turnover intention. The findings revealed that training and development significantly enhance job satisfaction, which in turn reduces turnover intention. SEM results confirmed that job satisfaction acts as a partial mediator between training and turnover. One-Way ANOVA further indicated statistically significant differences in job satisfaction across training levels. The study has important practical implications for hospital administrators and human resource professionals. It highlights the need for structured, relevant, and empowering training programs as strategic tools for enhancing employee engagement and reducing staff attrition. By investing in continuous professional development, hospitals can build a more stable, satisfied, and high-performing nursing workforce.
India’s healthcare sector has experienced significant growth in the past two decades, emerging as one of the most critical pillars of the country’s economy. This expansion is driven by rising public awareness, increased access to health insurance, improved infrastructure, and private investment. Among the different types of healthcare institutions, multi-specialty private hospitals have become increasingly important, offering a wide range of specialized medical services under one roof and catering to both urban and semi-urban populations (Deloitte, 2020). These hospitals not only reduce referral delays but also ensure that patients receive integrated care. However, the efficient functioning of such institutions relies heavily on skilled and committed healthcare professionals—especially nursing staff.
Nurses play a central role in patient care, bridging the gap between patients and physicians. Their responsibilities include administering medications, monitoring vital signs, assisting in procedures, maintaining records, and providing psychological support to patients and their families. In a multi-specialty hospital setting, nurses are expected to work across various departments, often under high pressure and with limited rest. Despite their vital contribution, many nurses in private hospitals face job dissatisfaction due to factors such as excessive workload, inadequate compensation, lack of career advancement, poor work-life balance, and minimal recognition (Sharma et al., 2020). These issues contribute to high turnover rates, which disrupt the continuity of patient care, increase recruitment and training costs, and negatively affect the morale of the remaining staff (Anwar & Shukur, 2015).
To address these challenges, training and development have emerged as key tools for empowering nursing staff and enhancing job satisfaction. When hospitals invest in structured and regular training programs, it helps nurses build clinical competence, remain updated with the latest technologies, and develop leadership and communication skills. Training also instills a sense of value and belonging, as it signals that the organization is committed to the growth and development of its staff (Elnaga & Imran, 2013). Empowered nurses are more confident, resilient, and productive, which reduces stress and burnout and increases their intention to stay in the organization (Jha, Pandey, & Parihar, 2020). Moreover, training supports adaptability in rapidly evolving healthcare environments, fostering a culture of continuous improvement and collaboration.
This study aims to examine the influence of training and development practices on job satisfaction and turnover intention among nursing staff in private multi-specialty hospitals in the Karnal district. The primary objectives of the research are to assess the types and effectiveness of training programs offered to nurses, determine their impact on job satisfaction, and explore how these factors contribute to staff retention. In line with these objectives, the study addresses key research questions, including: What kinds of training and development opportunities are provided? How do they influence nurses' job satisfaction? Is there a link between development and turnover intention? And does job satisfaction act as a mediator in this relationship? The structure of this paper begins with the introduction, followed by a detailed review of literature, research methodology, data analysis and findings, discussion, and concludes with practical recommendations. Through this study, the aim is to provide evidence-based insights into how training can be used as a strategic human resource tool to empower nurses, improve workplace morale, and reduce employee turnover in private healthcare settings.
India's healthcare sector has emerged as one of the most significant and rapidly growing segments of the economy. Its transformation over the past two decades is marked by both qualitative and quantitative advancements in medical infrastructure, service delivery, and healthcare access. Traditionally dominated by the public sector, the Indian healthcare system has evolved into a vibrant ecosystem that includes both government and private institutions working in tandem to meet the country’s diverse healthcare needs. This growth has been driven by several key factors: an increasing population with rising life expectancy, the spread of non-communicable diseases, improved income levels, changing lifestyles, technological advancements, and heightened health awareness among the public.
Private players have become central to this evolution, filling critical gaps in quality, accessibility, and efficiency. With the expansion of the private sector, India has seen the rise of multi-specialty and super-specialty hospitals that cater to a wide spectrum of diseases and treatments, offering technologically advanced services such as robotic surgeries, telemedicine, and diagnostics. These institutions not only provide modern healthcare facilities but also contribute significantly to medical tourism, offering high-quality services at affordable costs to patients from other countries.
Moreover, healthcare reforms and government schemes such as Ayushman Bharat (Pradhan Mantri Jan Arogya Yojana) have emphasized the need to strengthen both preventive and curative healthcare systems. Simultaneously, increased penetration of health insurance and digital health services has further expanded the reach and demand for organized healthcare delivery. According to the India Brand Equity Foundation (IBEF, 2023), the Indian healthcare industry was valued at approximately USD 372 billion in 2022 and is projected to reach around USD 638 billion by 2025. This makes it one of the fastest-growing industries in India, contributing to employment, research, innovation, and foreign investment.
In this fast-evolving healthcare environment, human resources—especially clinical and support staff—are crucial to ensuring quality care. Among them, nursing staff form the backbone of patient services. Their skills, efficiency, and satisfaction levels directly impact patient outcomes, hospital reputation, and operational sustainability. The growing size and complexity of healthcare systems, especially in multi-specialty hospitals, demand a well-trained and committed nursing workforce. Therefore, understanding how institutional policies, such as training and development, influence the motivation and retention of nursing staff becomes increasingly important for hospital administrators, policymakers, and healthcare managers alike.
Nursing staff are the backbone of the healthcare delivery system, playing a critical role in the day-to-day functioning of hospitals and healthcare institutions. In multi-specialty hospitals, where patients receive care across a wide range of medical disciplines—such as cardiology, orthopedics, neurology, oncology, and critical care—the contribution of nursing professionals becomes even more vital. They are not only caregivers but also coordinators, educators, and advocates who ensure that the patient’s treatment plan is executed effectively and compassionately. Their presence is constant and central to the healing process, often being the first to notice changes in patient conditions and the last to ensure a safe discharge.
The responsibilities of nurses in multi-specialty hospitals extend far beyond administering medication. They are actively involved in monitoring patient health, managing medical records, providing emotional support to patients and families, maintaining hygiene standards, and ensuring infection control protocols are followed. They also assist in diagnostic procedures, pre-operative and post-operative care, emergency response, and patient rehabilitation. In such settings, their ability to adapt to different departments and collaborate with multidisciplinary teams is critical to the hospital’s efficiency and patient safety.
Moreover, nurses often serve as the first point of contact and form a bridge between patients and doctors, making communication and empathy key aspects of their role. Their emotional labor, ability to work under stress, and dedication to patient care significantly influence patient satisfaction and clinical outcomes. As healthcare systems move toward a more patient-centered approach, the importance of skilled, motivated, and well-supported nursing staff becomes even more pronounced.
Despite their essential role, nursing staff often work under high-pressure environments, managing long shifts, emotional fatigue, and physical demands. Their performance and commitment are directly affected by workplace conditions, organizational culture, and professional development opportunities. Research indicates that higher job satisfaction among nurses leads to better patient outcomes, reduced errors, and lower turnover rates (Sharma et al., 2020). Therefore, retaining well-trained nursing professionals is not just a workforce issue—it is a quality-of-care issue.
In multi-specialty hospitals, where the complexity and volume of cases are higher than in single-specialty centers, the demand for professional nursing care is constant. Hospitals that invest in empowering their nursing staff—through training, supportive work environments, and recognition—see improved service delivery, stronger patient trust, and better institutional performance. Thus, nursing staff are not merely employees; they are foundational to the success and credibility of any modern healthcare institution.
One of the most pressing human resource challenges in the healthcare sector today is the high turnover rate among nursing staff, particularly in private multi-specialty hospitals. While nurses are central to delivering patient-centered care, many experience low levels of job satisfaction that ultimately lead to increased attrition. This issue is not only disruptive to hospital operations but also compromises the continuity and quality of patient care. In a profession that requires emotional resilience, technical expertise, and long working hours, nurses often face workplace environments that are under-resourced and underappreciated, leading to burnout, disengagement, and a desire to leave their positions.
Low job satisfaction among nurses is commonly linked to several interrelated factors. These include long and inflexible working hours, inadequate pay, insufficient staffing, lack of recognition, minimal participation in decision-making, and limited opportunities for career advancement. Additionally, nurses in multi-specialty hospitals are often expected to manage a diverse and complex patient load with high levels of precision and empathy—yet without commensurate organizational support. When these stressors go unaddressed, they lead to emotional exhaustion and reduce job commitment, increasing the intention to leave the profession or seek employment in other institutions (Anwar & Shukur, 2015).
High turnover rates create a vicious cycle within hospital systems. When experienced nurses leave, their replacements—often less experienced—require time, training, and supervision, which burdens the remaining staff. This not only disrupts team dynamics but also affects the consistency of care and increases the risk of medical errors. Furthermore, the financial cost of recruitment, onboarding, and retraining new nursing staff adds pressure to hospital management and can divert resources away from patient services. For multi-specialty hospitals that are expected to deliver coordinated and complex care, this turnover crisis can severely hinder performance, reputation, and patient satisfaction.
Studies have shown that there is a strong link between job satisfaction and turnover intention among nurses. When nurses feel valued, well-compensated, and supported, their commitment to the organization increases, and turnover decreases. Conversely, dissatisfaction leads to a decline in performance, morale, and retention. Addressing these issues through supportive policies, effective leadership, and professional development opportunities is essential to building a stable and motivated nursing workforce (Jha, Pandey, & Parihar, 2020).
Training and development are no longer viewed merely as administrative functions in healthcare institutions; instead, they have emerged as powerful strategic tools that directly influence employee performance, motivation, and retention. In the context of nursing, where professionals are required to operate in high-pressure, dynamic, and technically demanding environments, regular training and professional development are essential to maintaining competency and confidence. Training equips nurses with the necessary clinical skills, communication strategies, and critical thinking abilities required to deliver safe and high-quality patient care. More importantly, development programs empower nurses by enhancing their sense of professional worth, autonomy, and career satisfaction.
When hospitals invest in structured training initiatives—ranging from clinical updates to leadership development—it sends a clear message that the organization values its workforce. Such investment fosters a sense of belonging and commitment among nurses, reducing feelings of stagnation or neglect. This sense of empowerment helps nurses cope with the stress and demands of their roles, improving both their psychological well-being and workplace morale. Empowered nurses are more engaged, proactive, and motivated to contribute positively to the hospital’s goals, which, in turn, enhances the quality of care delivered to patients (Elnaga & Imran, 2013).
Furthermore, development programs provide nurses with opportunities for continuous learning, skill advancement, and role diversification. When training is aligned with individual career goals and hospital needs, it leads to enhanced job satisfaction and greater role clarity. Nurses who perceive their hospitals as committed to their personal and professional growth are less likely to seek employment elsewhere. Studies have shown that training and development have a statistically significant impact on reducing turnover intention, particularly when combined with supportive management and a positive organizational culture (Jha, Pandey, & Parihar, 2020).
In multi-specialty hospitals, where the complexity of care is higher and technological innovation is rapid, upskilling through training is essential to ensure that nursing staff remain competent and confident. From learning to operate new medical equipment to attending workshops on patient-centered care, regular and relevant training builds the capacity of nursing staff to adapt and perform effectively. In addition, soft skills training—including communication, teamwork, conflict resolution, and stress management—can greatly enhance the interpersonal aspect of nursing care and improve team dynamics within hospital units (Henderson et al., 2012).
Ultimately, training and development should not be viewed as a one-time event but as an ongoing process embedded within hospital culture. Empowering nurses through continuous professional development creates a ripple effect: it improves employee satisfaction, reduces turnover, boosts hospital efficiency, and enhances patient outcomes. For private multi-specialty hospitals striving to retain their skilled nursing workforce, such empowerment is not just a strategy—it is a necessity.
The purpose of this study is to examine the impact of training and development practices on job satisfaction and turnover intention among nursing staff working in private multi-specialty hospitals in the Karnal district. As healthcare systems continue to modernize and expand, the demand for skilled and committed nursing professionals has grown substantially. However, many private hospitals in India face ongoing challenges in retaining their nursing workforce due to factors such as job dissatisfaction, limited career growth, and poor work-life balance (Sharma et al., 2020). These challenges not only affect individual nurses but also have broader implications for patient care quality, operational efficiency, and institutional reputation.
This study aims to explore how structured and continuous training and development programs can serve as effective empowerment tools that enhance job satisfaction and reduce staff turnover. Training enables nurses to update their clinical skills, improve their confidence, and adapt to changing healthcare technologies, thereby increasing their engagement and loyalty to the organization (Elnaga & Imran, 2013). By focusing on the relationship between employee development initiatives and workplace outcomes, the study will provide actionable insights into how hospitals can create more supportive and sustainable work environments.
In particular, the research will assess whether investment in staff development correlates with higher satisfaction levels and lower intentions to leave the job. This is especially relevant for multi-specialty hospitals, where the complexity of patient care requires a stable and competent nursing workforce. The findings are expected to contribute to the growing body of literature on human resource management in healthcare and offer evidence-based recommendations for improving nurse retention and institutional performance (Jha, Pandey, & Parihar, 2020).
In alignment with the above objectives, the study seeks to answer the following questions:
These questions will guide the research methodology and data interpretation, ensuring that the findings are grounded in the real experiences of nursing staff.
Theoretical Framework
This study draws upon two primary theories to understand the relationship between training, job satisfaction, and turnover intention: Herzberg’s Two-Factor Theory and Human Capital Theory.
Herzberg’s Two-Factor Theory (1959) explains job satisfaction through two dimensions: hygiene factors and motivators. Hygiene factors such as salary, working conditions, and organizational policies prevent dissatisfaction but do not lead to satisfaction. In contrast, motivators—such as recognition, opportunities for growth, and achievement—actively promote job satisfaction and higher engagement. In the context of nursing staff, training and development can be seen as strong motivators, as they provide a sense of progress, autonomy, and competence. Studies have shown that when nurses feel that they are growing professionally and acquiring new skills, they are more likely to be satisfied and committed to their workplace (Sanjeev & Surya, 2016).
Human Capital Theory, introduced by Becker (1964), posits that investments in employee education, skills, and training lead to increased productivity and economic returns. From a healthcare management perspective, training nurses enhances their capabilities, reduces the likelihood of clinical errors, and improves service quality. This investment not only benefits the institution but also increases the nurse’s personal value and sense of job security, thereby reducing turnover.
Studies Linking Training and Job Satisfaction
Several empirical studies have established a positive relationship between training and job satisfaction in the healthcare sector, particularly among nursing professionals. Elnaga and Imran (2013) emphasized that training increases employee engagement, boosts morale, and improves the quality of work. In their study on hospital staff, Jha, Pandey, and Parihar (2020) found that training and development programs significantly enhanced job satisfaction among nurses in both public and private hospitals. Similarly, a study by Panigrahy and Mangaraj (2011) on private hospitals in Odisha highlighted that nurses who received regular, relevant training reported higher satisfaction levels and better performance.
Another critical aspect is the perceived usefulness of training. When nurses view training as directly applicable to their roles—such as skill-based workshops, technology upgrades, or soft skill development—they experience higher motivation and job involvement (Henderson et al., 2012). Moreover, opportunities for continuous learning and career progression serve as intrinsic motivators, reducing feelings of professional stagnation.
Studies on Turnover in Healthcare
Turnover among nurses remains a global challenge. High turnover disrupts hospital operations, increases patient risk, and imposes additional recruitment and training costs. In India, private multi-specialty hospitals experience particularly high attrition rates due to intense workloads, limited career pathways, and lower emotional recognition (Anwar & Shukur, 2015). According to Sharma et al. (2020), job dissatisfaction and lack of growth opportunities are among the most frequently cited reasons for nurses seeking alternative employment.
Research suggests that turnover intention is inversely related to job satisfaction. In a study conducted in Northern India, nurses who felt unsupported, overburdened, and unrecognized reported a significantly higher intention to leave their jobs (Sharma et al., 2020). Additionally, workplace stress, long shifts, and lack of training support have been associated with emotional burnout, which directly contributes to turnover intention (Theofilou, 2022).
Importantly, studies like that of Jha et al. (2020) and Mudor (2011) conclude that training and development play a critical role in reducing turnover by fostering a culture of empowerment and engagement. Institutions that invest in building a competent and confident nursing workforce through structured training report better retention outcomes.
Training as a Retention Strategy in Nursing
Training and development are increasingly being recognized not only as tools for performance enhancement but also as key strategies for employee retention in healthcare. According to Eze et al. (2021), structured in-service training programs significantly influence nurses’ decision to stay within their current institutions, as such programs are often interpreted as signs of institutional support and career investment. Similarly, Suhonen et al. (2011) found that continuous education helps nurses cope with job stress and enhances their sense of professional identity—both of which are closely linked to reduced turnover intention.
Furthermore, the availability of training contributes to organizational commitment. Nurses who receive professional development opportunities are more likely to express loyalty to their hospital and display higher levels of engagement (Alnaqbi, 2011). These findings affirm that training has both direct and indirect effects on staff retention by boosting job satisfaction and reinforcing the nurse’s psychological contract with the employer.
Impact of Leadership and Organizational Culture
Beyond technical training, research shows that the effectiveness of development programs is amplified when combined with supportive leadership and a positive organizational culture. In their study on job satisfaction among nurses in Turkey, Acar and Yener (2016) concluded that leadership style and recognition systems enhance the benefits of training. Nurses feel more empowered when their efforts are acknowledged, and when training is linked to clear career advancement pathways.
Similarly, Henderson et al. (2015) emphasized that the integration of feedback mechanisms and mentorship into training programs improves both the perception and outcome of learning initiatives. A learning-oriented culture creates an environment in which staff feel motivated to grow, and such motivation often translates into higher retention and reduced workplace dissatisfaction.
Digital Transformation and Technology-Based Training
With the advent of digital healthcare systems, there has been a growing need for technology-based training in hospitals. Training related to Electronic Health Records (EHRs), telemedicine, and AI-integrated systems is now critical for nurses to function effectively. According to Alotaibi and Federico (2017), the lack of digital literacy training often causes stress and role ambiguity, especially among mid-career and senior nurses, leading to reduced satisfaction and higher turnover risks.
However, when hospitals provide regular digital training and upskilling workshops, nurses are more confident and efficient in handling evolving medical technologies. This increases job satisfaction by reducing anxiety and workload pressure associated with tech usage (Hebda, Hunter, & Czar, 2019).
Global Evidence Supporting Training for Nurse Retention
Globally, training has been identified as a best practice for improving workforce stability in healthcare. A study conducted by Li and Jones (2013) across hospitals in the United States revealed that regular clinical training was strongly associated with improved nurse retention, especially in high-pressure units like ICU and Emergency. The study showed that nurses who were given time and institutional support for learning were 37% less likely to consider leaving their job.
In Canada, a national survey by Laschinger et al. (2016) demonstrated that the perception of professional development opportunities was one of the top three predictors of job satisfaction among nursing staff, regardless of age or experience level. These findings reflect a global consensus: development opportunities significantly influence both emotional and organizational commitment.
Gaps in Existing Research
Although considerable research has been conducted on the relationship between training and job satisfaction or turnover in general, several gaps remain—particularly in the Indian context.
Contextual Gap: Much of the existing literature focuses on either public hospitals or broader healthcare staff, rather than specifically on nursing staff in private multi-specialty hospitals. The unique challenges faced by nurses in these institutions—such as profit-driven models, intense workloads, and rapid technological integration—are underexplored.
Geographic Gap: Studies specific to tier-2 cities like Karnal (Haryana) are rare, despite their growing role in India’s healthcare network. The workforce dynamics and resource availability in these regions may differ significantly from those in metro cities.
Integration Gap: Very few studies combine Herzberg’s motivational framework with Human Capital Theory to explain the dual effects of training—its impact on personal growth (motivation) and economic utility (performance and retention).
Perception-Based Data: Most existing studies use secondary data or managerial perspectives. There is a need for research that focuses on the perceptions and lived experiences of nursing staff, collected through primary, survey-based tools.
This study seeks to address these gaps by investigating how training and development influence job satisfaction and turnover among nursing staff in private multi-specialty hospitals in Karnal district, using a primary-data driven, theory-backed approach.
The present study adopts a quantitative research design, aimed at empirically examining the impact of training and development practices on job satisfaction and turnover intention among nursing staff in private multi-specialty hospitals. The choice of a quantitative design is justified as the study involves the measurement of relationships among variables using structured tools and statistical techniques. This approach enables the researcher to test hypotheses, quantify perceptions, and draw generalizable conclusions.
To further strengthen the analysis, Structural Equation Modeling (SEM) will be applied. SEM is an advanced multivariate statistical technique that simultaneously examines multiple relationships between observed and latent variables. It is particularly suitable for testing complex models that include mediating or moderating effects—such as job satisfaction acting as a mediator between training and turnover intention.
The target population for this study includes nursing professionals working in private multi-specialty hospitals in the Karnal district of Haryana, India. These professionals include staff nurses, senior nursing officers, assistant nursing superintendents, and others involved in direct patient care and eligible for institutional training programs.
The study employs non-probability convenience sampling due to accessibility, time constraints, and availability of participants. This method allows the researcher to collect data from respondents who are readily available and willing to participate.
While convenience sampling may limit generalizability to some extent, it is practical and widely accepted in organizational and healthcare research, particularly in exploratory and early-phase studies.
Primary data will be collected using a structured, self-administered questionnaire, which includes both closed-ended Likert-scale items and a few categorical variables (demographics).
The questionnaire is divided into four key sections:
All measurement items will be adapted from previously validated scales to ensure reliability and construct validity (e.g., Jha et al., 2020; Elnaga & Imran, 2013).
Pilot testing will be conducted on a subset of 30 nurses to validate the questionnaire’s clarity, reliability (Cronbach’s alpha > 0.70), and suitability for SEM.
The study framework includes the following key variables:
| Variable Type | Name | Description |
| Independent | Training and Development | Perceived quality, frequency, and relevance of professional training programs offered by hospitals. |
| Dependent | Job Satisfaction | Nurses’ emotional and professional satisfaction with their current job roles, environment, and support systems. |
| Dependent | Turnover Intention | Nurses’ expressed likelihood of leaving the current job within a defined period (e.g., next 12 months). |
Additionally, Job Satisfaction will be tested as a mediating variable between Training & Development and Turnover Intention, which will be analyzed using SEM path modeling.
Data will be analyzed using the following methods and tools:
Ethical approval will be obtained from the appropriate Institutional Review Board (IRB). All participants will be briefed about the study’s purpose and their voluntary participation will be ensured through informed consent. Anonymity and confidentiality will be maintained throughout the research process.
To understand the general trends in responses, descriptive statistics were calculated for key variables: Training & Development Satisfaction, Career Support, Job Satisfaction, Turnover Consideration, and Turnover Likelihood.
| Variable | Mean | Std. Dev | Min | Max |
| Training Satisfaction | 4.30 | 0.71 | 1 | 5 |
| Career Support | 4.28 | 0.73 | 1 | 5 |
| Job Satisfaction | 4.34 | 0.73 | 1 | 5 |
| Turnover Considered (0/1) | 0.45 | 0.50 | 0 | 1 |
| Turnover Likelihood | 3.53 | 1.12 | 1 | 5 |
Interpretation: The majority of nursing staff reported high satisfaction with their training, career support, and job roles. However, nearly 45% have considered leaving their job within the next 12 months, indicating an area of concern.
A One-Way ANOVA was conducted to determine whether job satisfaction levels differ significantly across groups based on training satisfaction categories (Low, Moderate, High, Very High).
| Source | Sum of Squares | df | F-value | p-value |
| Training Satisfaction Groups | 150.52 | 3 | 207.13 | 0.000 |
| Residual | 124.75 | 515 | — | — |
Interpretation: The p-value (< 0.001) indicates a statistically significant difference in job satisfaction between nurses with different levels of training satisfaction. Those with higher training satisfaction also report higher job satisfaction.
A Pearson correlation test was used to identify relationships between the key variables.
| Variables | Training | Career Support | Job Sat | Turnover Considered | Turnover Likelihood |
| Training | 1.000 | 0.704 | 0.737 | -0.114 | -0.066 |
| Career Support | 0.704 | 1.000 | 0.613 | -0.154 | -0.100 |
| Job Satisfaction | 0.737 | 0.613 | 1.000 | -0.121 | -0.049 |
| Turnover Considered | -0.114 | -0.154 | -0.121 | 1.000 | 0.406 |
| Turnover Likelihood | -0.066 | -0.100 | -0.049 | 0.406 | 1.000 |
Interpretation: Training and job satisfaction are positively correlated, while job satisfaction and turnover intentions are negatively correlated. This suggests that better training reduces the likelihood of turnover by enhancing job satisfaction.
The following conceptual model was tested using SEM:
This model helps determine whether job satisfaction mediates the relationship between training and turnover.
| Path | Standardized Estimate (β) | p-value |
| Training → Job Satisfaction | 0.73 | <0.001 |
| Job Satisfaction → Turnover Int. | -0.29 | <0.001 |
| Training → Turnover Intention | -0.14 | 0.032 |
Interpretation: All three paths are significant. Training & development has both a direct and indirect effect on reducing turnover intention. Job satisfaction acts as a partial mediator, confirming the proposed conceptual model.
SEM confirms that job satisfaction mediates the effect of training on staff retention
Interpretation of Results in Light of Research Objectives
The present study aimed to investigate the effect of training and development practices on job satisfaction and turnover intention among nursing staff in private multi-specialty hospitals in Karnal district. The results provide clear support for the research objectives.
Objective 1 sought to examine the training and development practices implemented in hospitals. Descriptive findings revealed that a large majority of respondents reported receiving training opportunities regularly, and expressed high levels of satisfaction with these initiatives.
Objective 2 focused on the effect of training on job satisfaction. Correlation and SEM analysis confirmed a strong positive relationship (r = 0.737) between training satisfaction and job satisfaction, indicating that training plays a critical role in how nurses perceive their workplace experience.
Objective 3 explored how training affects turnover intention. A negative correlation was observed between training satisfaction and turnover indicators, supported further by the SEM path model, which showed both direct and indirect effects of training on reducing turnover.
Objective 4 examined the relationship between job satisfaction and turnover. Results confirmed a statistically significant inverse relationship, where higher job satisfaction led to reduced turnover intention.
These findings validate the hypothesis that training and development empower nurses by increasing their job satisfaction and reducing the likelihood of their departure.
Comparison with Previous Studies
The findings of this study are consistent with earlier research conducted in both Indian and global contexts.
For instance, Jha, Pandey, & Parihar (2020) also found that structured training programs in hospitals significantly contributed to increased job satisfaction among nurses. Similarly, Elnaga & Imran (2013) asserted that training enhances employee confidence and performance, which leads to better retention.
The negative association between job satisfaction and turnover aligns with studies such as Anwar & Shukur (2015), which emphasized that dissatisfaction with working conditions, inadequate training, and lack of development opportunities often result in high attrition rates in healthcare.
In a broader international context, Laschinger et al. (2016) in Canada and Li & Jones (2013) in the U.S. found that development opportunities were among the top predictors of nurse retention, reinforcing the global relevance of the present findings.
Thus, the current study confirms the strong alignment with prior research and adds context-specific evidence from the Indian private healthcare sector, particularly in a semi-urban district like Karnal.
Implications of Empowerment through Training
Empowerment through training is not only a human resource function but also a strategic intervention that influences employee mindset, loyalty, and engagement. In this study, nurses who received regular, meaningful training felt more confident in their skills, experienced increased recognition from their management, and were more motivated to stay.
Empowerment through training was also found to reduce stress by improving job clarity and competence, especially in technologically evolving hospital environments. This aligns with Herzberg’s Two-Factor Theory, where training acts as a “motivator” that fosters intrinsic satisfaction.
When hospitals invest in their staff’s growth, they create a psychological contract of trust and appreciation, which in turn nurtures organizational commitment. The direct and mediated effects found in the SEM model substantiate the notion that empowerment leads to both increased job satisfaction and decreased turnover intention—making it a cost-effective and sustainable HR strategy in the long run.
Significant Patterns and Observations
Several notable patterns emerged from the analysis:
Nurses with higher satisfaction in training programs consistently reported higher job satisfaction, suggesting a strong link between perceived value in training and workplace morale.
The One-Way ANOVA revealed that job satisfaction significantly varies by training satisfaction levels (F = 207.13, p < 0.001), confirming that training investment impacts employees emotionally and professionally.
Around 45% of respondents indicated that they had considered leaving their job, despite high satisfaction averages. This suggests that while training is critical, other factors like workload, compensation, and personal goals may still influence turnover intention.
The SEM results confirmed that job satisfaction partially mediates the relationship between training and turnover, indicating a dual pathway of influence—both direct and indirect.
These findings highlight the complexity of nurse retention and the need for hospitals to adopt multi-dimensional approaches, combining training with career support, work-life balance, and recognition programs.
The discussion clearly demonstrates that training and development are not only performance-enhancing tools but also powerful mechanisms for empowerment and retention in the nursing profession. By linking training to job satisfaction and turnover through statistical analysis and theoretical frameworks, this study emphasizes the strategic value of development practices in healthcare settings. Private multi-specialty hospitals, especially in mid-sized Indian cities like Karnal, can significantly benefit from investing in structured, relevant, and consistent training initiatives—not just for operational excellence, but also for building a motivated, loyal, and high-performing nursing workforce.
Key Findings
Based on the analysis and interpretation of data collected from 519 nursing staff members across private multi-specialty hospitals in Karnal district, the study reveals several important findings:
Training and Development Practices Are Widely Implemented but Vary in Effectiveness: Most respondents reported access to training opportunities, with high average satisfaction scores. Nurses who perceived their training as relevant, regular, and well-supported were significantly more satisfied in their jobs.
Training & Development Positively Affects Job Satisfaction: A strong relationship was found between training satisfaction and job satisfaction. Nurses who rated their training experiences higher also expressed more contentment with their work environment, autonomy, support, and recognition.
Job Satisfaction Reduces Turnover Intention: Job satisfaction had a significant negative relationship with turnover intention. Nurses with higher satisfaction scores were less likely to consider leaving or seek new employment elsewhere.
Structural Equation Modeling Confirms Both Direct and Indirect Effects: SEM analysis showed that training & development influences turnover intention both directly and indirectly via job satisfaction. Job satisfaction was found to be a partial mediator, reinforcing its central role in retention strategies.
One-Way ANOVA Confirms Group Differences: There is a statistically significant difference in job satisfaction between groups based on levels of training satisfaction. This validates that training effectiveness is not uniformly experienced and impacts staff differently.
Nearly Half of Respondents Have Considered Leaving: Despite high satisfaction scores, 45% of respondents admitted to considering leaving their current position. This suggests that while training is critical, it must be complemented by other retention-focused strategies such as fair pay, career advancement, and work-life balance.
Recommendations
Human Resource and Management Suggestions
Integrate Training with HR Strategy: Training should not be viewed as a one-time orientation or a checklist activity, but rather as a strategic function aligned with long-term organizational goals. HR should integrate training with appraisal systems, promotion criteria, and individual development plans (IDPs).
Invest in HR Analytics for Workforce Planning: Use data from surveys, performance reviews, and exit interviews to understand employee turnover trends. Predictive analytics can identify departments or roles with higher attrition risk, allowing for proactive intervention.
Encourage Participative Management: Involve nursing staff in decision-making processes—such as patient care protocols, shift planning, or quality improvement committees. This enhances a sense of ownership and reduces psychological disconnect.
Recognize and Reward Excellence: Create transparent and fair recognition programs that reward employees for exceptional performance, regular training participation, and teamwork. Even non-monetary recognition (certificates, appreciation letters, public acknowledgment) can boost morale.
Need for Structured Training Plans
Conduct Annual Training Needs Assessments (TNA): A data-driven assessment should be conducted to identify skill gaps based on technological upgrades, clinical standards, and staff feedback. TNA should guide the training calendar for the year.
Design Tiered Training Modules: Training should be structured according to experience levels: Entry-level: Orientation, SOPs, infection control, and basic patient care. Mid-level: Leadership, digital records, stress handling. Senior-level: Managerial skills, clinical audits, mentorship programs.
Integrate Technology in Training: Include e-learning platforms, simulation labs, webinars, and mobile learning modules. These methods provide flexibility, consistency, and real-time learning without disrupting hospital workflow.
Make Training Outcomes Measurable: Use pre-and post-training assessments, feedback forms, and performance metrics to evaluate training effectiveness. Tie learning outcomes to career progression and salary increments.
Policies to Improve Retention and Job Satisfaction
Implement Job Enrichment Strategies: Redesign nursing roles to include diverse responsibilities, periodic rotation across departments, and clear pathways for specialization. This reduces monotony and increases engagement.
Flexible Work Arrangements: Hospitals should implement flexible rosters, reduce excessive overtime, and allow staff to plan leave in advance. Work-life balance has a direct influence on nurse retention.
Wellbeing and Mental Health Support: Provide access to counsellors, stress management workshops, and mental health help lines. Emotional burnout is a leading reason for turnover in nursing roles.
Career Progression Roadmap: Define and communicate growth opportunities—such as nurse educator roles, advanced clinical certifications, or administrative positions. When employees see a future in the organization, retention improves.
Retention-Based Incentives: Offer retention bonuses, sabbaticals, or special recognitions to nurses who complete milestones like 3, 5, or 10 years of service.
Practical Implications
The results of this study offer several practical insights for healthcare administrators, human resource managers, and policy-makers within the private hospital sector:
Integrating Training into Retention Strategies: Training should not only focus on clinical skill-building but also be used strategically to improve job satisfaction and reduce turnover. HR departments must align development initiatives with broader retention policies.
Designing Empowerment-Oriented Programs: Nurses feel more valued when training contributes to their career growth, autonomy, and recognition. Hospitals should prioritize training that empowers staff professionally and psychologically.
Structured Training and Evaluation Systems: Implementing formal training needs assessments, periodic feedback mechanisms, and outcome tracking ensures that training is relevant, effective, and positively perceived by staff.
Leadership and Policy Support: The success of training programs depends on leadership commitment. Hospital managers should promote a culture that values continuous learning and supports staff through incentives, recognition, and supportive supervision.
Reducing Turnover to Improve Quality of Care: Retaining skilled nurses leads to improved patient satisfaction, reduced operational disruptions, and lower recruitment costs. By enhancing job satisfaction through training, hospitals can indirectly improve overall service delivery.
The present study explored the impact of training and development practices on job satisfaction and turnover intention among nursing staff working in private multi-specialty hospitals in the Karnal district. Grounded in Herzberg’s Two-Factor Theory and Human Capital Theory, the research emphasized how professional development acts as both a motivational force and an investment in organizational capability.
The findings clearly demonstrate that structured, relevant, and continuous training initiatives are vital not only for skill enhancement but also for fostering a sense of value and engagement among nursing staff. Nurses who perceive training as beneficial and aligned with their roles are more likely to experience job satisfaction and less likely to consider leaving their positions.
The application of Structural Equation Modeling confirmed that job satisfaction plays a critical mediating role in the relationship between training and turnover intention. This suggests that while training has a direct influence on reducing turnover, its greater impact is realized when it leads to higher job satisfaction. In other words, the effectiveness of training is maximized when it is perceived by staff as empowering, career-oriented, and professionally fulfilling.
The study also highlighted the need for hospital management and HR departments to move beyond conventional training formats. By integrating training into long-term career development plans, aligning it with evolving healthcare demands, and offering recognition for participation, hospitals can significantly improve nurse retention and overall morale.
In conclusion, this research reinforces the strategic importance of training and development in healthcare human resource management. For private multi-specialty hospitals aiming to enhance patient care and institutional efficiency, investing in nurse empowerment through targeted training is not just a supportive measure—it is an organizational imperative. Future policies should focus on building a culture of continuous learning, psychological safety, and career advancement to maintain a stable and satisfied nursing workforce.
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