In the rapidly evolving healthcare sector, especially in developing countries like India, human resource management (HRM) has emerged as a pivotal function for ensuring institutional sustainability, economic efficiency, and quality service delivery. Among the various HRM domains, the training, development, satisfaction, and retention of nursing staff occupy a central position. Nurses serve as the backbone of hospital operations, providing round-the-clock care, emotional support, and critical medical assistance. However, hospitals—particularly private multispecialty ones—often report alarmingly high turnover rates among nursing staff, which not only leads to rising operational costs but also affects patient care and organizational performance (Anwar & Shukur, 2015).

Addressing this issue demands a paradigm shift from conventional HR approaches to more holistic, culturally grounded strategies. In this context, Indian Knowledge Systems (IKS)—which encompass traditional pedagogies, values of service (Seva), mental and physical balance (Samatva), and interpersonal ethics—offer powerful yet underutilized frameworks for human development. IKS emphasizes experiential learning, contextual understanding, moral consciousness, and emotional well-being—dimensions that align remarkably well with the requirements of effective healthcare delivery and sustainable HR practices (Moustaghfir et al., 2020).

Modern training programs often emphasize technical proficiency but fall short of nurturing intrinsic motivation, ethical alignment, and emotional resilience in healthcare workers. This disconnect contributes to burnout, dissatisfaction, and ultimately, attrition. Reviving IKS-based models such as the Gurukul system (which prioritizes continuous mentorship, respect, and community-oriented learning) could help bridge this gap. When adapted into hospital HRM, such models have the potential to improve not just the functional skills of nursing staff but also their psychological engagement and workplace satisfaction (Theofilou, 2022).

Empirical studies have shown that effective training and development initiatives directly impact job satisfaction levels, which in turn influence turnover intentions (Elnaga & Imran, 2013). Job satisfaction, a multi-dimensional construct, is shaped by the quality of supervision, growth opportunities, recognition, work-life balance, and organizational culture. In healthcare, especially, job satisfaction correlates strongly with quality of care, staff retention, and institutional stability (Sharma et al., 2020). However, training programs that neglect cultural relevance or emotional well-being may fail to create lasting engagement.

By applying a Structural Equation Modeling (SEM) approach, this study investigates how training and development practices, especially those informed by IKS principles, affect job satisfaction and turnover intention among nursing staff in private multispecialty hospitals in Karnal, Haryana. The research argues that integrating traditional Indian wisdom with modern HRM practices can serve not only as a strategy for workforce development but also as a catalyst for broader economic efficiency in healthcare.

This intersection of tradition and management is not just about cultural revival—it’s about rethinking workforce models in a way that empowers employees, enhances institutional outcomes, and fosters a sustainable future for Indian healthcare.

Training and Development in Healthcare HRM

Training and development (T&D) serve as the foundation for nurturing a capable and motivated workforce, especially in knowledge- and service-intensive industries like healthcare. T&D not only improve technical competencies but also contribute to enhanced confidence, adaptability, and professional satisfaction among employees. In the context of nursing staff, continuous training ensures clinical accuracy, patient safety, and emotional preparedness (Panigrahy & Mangaraj, 2011). Elnaga and Imran (2013) emphasized that effective T&D initiatives lead to measurable improvements in job performance, while poorly structured programs often leave workers disengaged and dissatisfied.

In India, however, hospital-based T&D programs often lack cultural sensitivity and emotional depth. They focus predominantly on procedural learning, ignoring the psychological and ethical development of healthcare staff. This gap weakens the impact of such interventions on long-term job satisfaction and organizational commitment.

Job Satisfaction among Nursing Staff

Job satisfaction in healthcare is a multifaceted construct shaped by a blend of psychological, organizational, and interpersonal factors. For nurses, satisfaction arises not only from salary and benefits but also from the sense of purpose, supportive supervision, autonomy, and recognition (Sharma et al., 2020). Henderson et al. (2012) argue that a conducive learning environment and supportive workplace culture significantly influence a nurse’s perception of satisfaction.

In multispecialty hospitals, where the workload is typically high and the emotional burden intense, satisfaction can be fragile. Studies have shown that lack of appreciation, limited career progression, and poor work-life balance are leading causes of dissatisfaction among nursing staff (Keith et al., 2022). This dissatisfaction can manifest as emotional exhaustion, absenteeism, and ultimately, resignation.

Turnover Intention in Healthcare

Turnover in the nursing profession poses a serious challenge for hospital management, affecting both economic performance and continuity of care. It leads to increased hiring costs, loss of institutional knowledge, and interruptions in patient service (Anwar & Shukur, 2015). Job satisfaction has consistently been found to inversely correlate with turnover intentions. Alfes et al. (2013) demonstrated that HRM practices that prioritize employee development, recognition, and well-being lead to reduced attrition and stronger retention.

In the Indian private healthcare sector, turnover is often aggravated by insufficient T&D opportunities and a lack of emotional connection to the organization. The transactional nature of many HR policies—focused solely on compliance rather than growth—further deepens the disconnect between employees and their institutions.

Indian Knowledge Systems and HRM Integration

Indian Knowledge Systems (IKS) offer rich pedagogical, ethical, and philosophical foundations that can enhance contemporary HRM strategies. Rooted in traditions such as Gurukul, Ayurveda, and Yoga, IKS emphasizes holistic development, self-awareness (Atma Gyan), service (Seva), and harmony (Samatva)—principles that are especially relevant in emotionally demanding professions like nursing (Moustaghfir et al., 2020).

Scholars have argued that aligning training programs with culturally familiar and ethically grounded practices can improve emotional engagement and retention. Theofilou (2022) highlighted that satisfaction improves when workplace learning environments reflect local traditions and values, as they instill a deeper sense of belonging and purpose.

Incorporating IKS into hospital HRM may involve adopting dialogical learning (Samvaad), emphasizing empathy and ethics in caregiving, and creating meditative or reflective spaces for emotional balance. These practices have the potential to reduce burnout and increase job commitment among nursing professionals.

SEM in Healthcare Research

Structural Equation Modeling (SEM) has gained popularity as an analytical tool in healthcare HRM research due to its ability to measure complex, multi-variable relationships. SEM allows research to assess both direct and indirect paths, making it ideal for studying mediating factors like job satisfaction in the relationship between T&D and turnover. Studies using SEM have confirmed the causal structure of this triad in different cultural and organizational contexts (Jha et al., 2020).

For this study, SEM is used to test the hypothesized model: T&D → Job Satisfaction → Turnover Intention. The method helps validate the strength and direction of each relationship while controlling for latent variables. Additionally, it supports the empirical testing of how IKS-aligned training elements influence these constructs in an Indian healthcare setting.

The reviewed literature suggests a strong theoretical and empirical foundation for investigating the impact of training and development on job satisfaction and turnover intention. However, the integration of Indian Knowledge Systems into HRM remains an under-researched domain, particularly in the Indian healthcare sector. This study fills that gap by examining how culturally grounded training programs can transform hospital HRM practices, leading to improved retention and economic efficiency.

Research Framework

Research Objectives

1. To explore the relevance and applicability of Indian Knowledge Systems (IKS) within hospital-based human resource management (HRM) practices.

2. To examine the effect of culturally aligned training and development (T&D) practices on job satisfaction among nursing professionals.

3. To assess how job satisfaction mediates the relationship between training practices and turnover intentions in private healthcare settings.

4. To evaluate whether the integration of IKS values improves organizational stability and economic efficiency in hospital operations.

Research Questions

1. How can Indian Knowledge Systems be incorporated into modern HRM practices in healthcare institutions?

2. What is the direct impact of IKS-aligned training and development initiatives on nursing staff job satisfaction?

3. Does job satisfaction mediate the relationship between IKS-based training and staff turnover intention?

4. Can hospitals improve economic performance by reducing turnover through culturally embedded HR strategies?

Research Hypothesis

H1: Impact of IKS-based Training on Job Satisfaction

• H₀ (Null): Training based on Indian Knowledge Systems does not improve job satisfaction among nurses.

• H₁ (Alternative): Training based on Indian Knowledge Systems does improve job satisfaction among nurses.

 H2: Job Satisfaction and Turnover Intention

• H₀ (Null): Job satisfaction has no effect on nurses' decision to leave the job.

• H₁ (Alternative): Job satisfaction reduces nurses' decision to leave the job.

H3: Mediation by Job Satisfaction

• H₀ (Null): Job satisfaction does not explain the link between training and turnover.

• H₁ (Alternative): Job satisfaction explains the link between training and turnover.

H4: Overall Impact of IKS in HRM

• H₀ (Null): Using Indian Knowledge Systems in HR strategies does not help improve staff retention or reduce costs.

H₁ (Alternative): Using Indian Knowledge Systems in HR strategies helps improve staff retention and reduce costs.

Research Design

This study adopts a quantitative, explanatory research design, suitable for testing cause-effect relationships among latent constructs such as training and development, job satisfaction, and turnover intention. The rationale behind this design is to empirically evaluate the direct and indirect effects of Indian Knowledge Systems (IKS)-based HRM practices using a structured framework supported by Structural Equation Modeling (SEM). The explanatory nature allows for validating mediation paths and analyzing inter-variable dependencies within hospital settings.

Population and Sampling

The target population comprises nursing professionals working in private multispecialty hospitals in the Karnal district of Haryana, India. These hospitals represent a dynamic space where high service demand often coincides with staffing challenges, making it an appropriate environment for the study.

A non-probability convenience sampling technique was employed to select participants who were readily available and willing to respond. A total of 500 respondents were included, which is statistically adequate for SEM-based analysis (Hair et al., 2014), where a minimum sample size of 200–300 is often recommended depending on model complexity.

Data Collection Method

Data was collected using a structured questionnaire, consisting of both Likert-scale items and demographic questions. The instrument was divided into the following sections:

• Section A: Demographics (gender, designation, experience, etc.)
• Section B: Training and development practices (IKS-aligned aspects included)
• Section C: Job satisfaction indicators
• Section D: Turnover intention items

The questionnaire was distributed both online and in-person, ensuring ethical protocols like informed consent, confidentiality, and voluntary participation were strictly followed.

Instrument Validity and Reliability

The questionnaire items were adopted and modified from previously validated studies in HRM and healthcare research (Elnaga & Imran, 2013; Sharma et al., 2020). To ensure content validity, expert feedback from HR managers and nursing administrators was incorporated. A pilot test with 30 participants helped refine ambiguous items.

Reliability was assessed using Cronbach’s Alpha, ensuring internal consistency of each construct:

• Training & Development: α = 0.86
• Job Satisfaction: α = 0.84
• Turnover Intention: α = 0.81

All alpha values exceeded the 0.70 benchmark, indicating strong reliability (Nunnally, 1978).

Data Analysis Technique

Data was analyzed using SmartPLS 4, a specialized software for Partial Least Squares Structural Equation Modeling (PLS-SEM). This method was chosen due to its robustness with small to medium sample sizes, its ability to model complex relationships, and its suitability for both formative and reflective constructs.

The following statistical metrics were used:

• Reliability: Cronbach’s Alpha, Composite Reliability (CR)
• Validity: Average Variance Extracted (AVE), Discriminant Validity (HTMT ratio)
• Path Analysis: Path Coefficients (β), t-values, p-values
• Model Fit: R² (Explained Variance), Q² (Predictive Relevance)

Ethical Considerations

The study adhered strictly to ethical research guidelines. Prior approval was taken from hospital authorities. Respondents were informed of the purpose of the study, assured of confidentiality, and given the right to withdraw at any stage. No personal identifiers were collected. Data was stored securely and used solely for academic purposes.

Data Analysis and Interpretation

This section presents a detailed analysis of the data collected from 500 nursing professionals working in private multispecialty hospitals in the Karnal district. The data was processed and analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM) through SmartPLS 4 software. The purpose of the analysis was to validate the proposed conceptual model by testing the relationships between Indian Knowledge System (IKS)-based training and development, job satisfaction, and turnover intention.

Descriptive Analysis

The sample consisted of respondents across various levels of nursing designations, educational backgrounds, and experience. This section summarizes the responses of 500 nursing staff members who participated in the study. Most participants were between 25 and 40 years of age and had between 1 to 10 years of professional experience. The responses revealed that the majority of nurses had participated in training programs, but the frequency and perceived usefulness of these programs varied widely. Initial frequency distributions showed that while a significant proportion of nurses were satisfied with their current job, concerns around turnover and work-life balance were also prominent.

Measurement Model Assessment

To assess the reliability and validity of the constructs used in the questionnaire; the measurement model was first examined. This involved testing internal consistency, convergent validity, and discriminant validity of the three main constructs: Training & Development (T&D), Job Satisfaction (JS), and Turnover Intention (TI).

Gender Distribution

The sample comprised 62% female and 38% male respondents, which reflects the natural gender distribution prevalent in the nursing profession. This shows a strong female workforce, consistent with the broader demographic trends in healthcare settings across India.

Educational Qualification

Among the respondents, 58% held a B.Sc. in Nursing, followed by 22% with GNM (General Nursing and Midwifery) diplomas, 15% with M.Sc. in Nursing, and 5% with doctoral degrees. This indicates that the workforce in Karnal’s private hospitals is predominantly well-qualified, with most nurses having formal academic backgrounds relevant to their roles.

Years of Experience

A significant portion of the respondents (47%) had 1 to 5 years of experience, followed by 28% with 5–10 years, 13% with more than 10 years, and 12% with less than one year of experience. This distribution shows that the majority of the nursing staff are early- to mid-career professionals, making them more likely to respond actively to training and professional development programs.

Job Satisfaction

The overall mean score for job satisfaction was 3.8 on a 5-point Likert scale, indicating a moderate to high level of satisfaction among respondents. The majority of nurses reported satisfaction with work-life balance, recognition, autonomy, and communication in their hospital settings. However, there were some concerns related to workload stress and limited promotion opportunities.

Training and Development Satisfaction

The average score for training satisfaction was 3.6, suggesting that nurses found the training and development activities somewhat beneficial. Respondents appreciated the frequency and relevance of training, but many indicated a need for more role-specific and hands-on skill development. The qualitative comments reflected a desire for more structured career pathways linked to these development programs.

Turnover Intention

Turnover intention showed a mean score of 2.9, indicating a moderate inclination among nurses to consider leaving their current job. While many respondents valued their roles, dissatisfaction with pay, work pressure, and limited growth opportunities led some to consider seeking employment elsewhere.

Internal Consistency Reliability

The internal consistency of the constructs was tested using Cronbach’s Alpha and Composite Reliability (CR). All constructs exceeded the recommended threshold of 0.70, indicating high reliability.

Convergent Validity

Convergent validity was evaluated through Average Variance Extracted (AVE). All AVE values were greater than 0.50, confirming that the indicators converged well in representing their respective constructs.

Discriminant Validity

Discriminant validity was verified using the Heterotrait-Monotrait (HTMT) ratio, with all values below the acceptable threshold of 0.85, indicating that each construct is distinct from the others.

Structural Model Assessment

After the measurement model met the reliability and validity criteria, the structural model was examined to evaluate the strength and significance of the hypothesized relationships.

Path Coefficients and Significance

The path coefficients reveal the strength and direction of relationships between constructs. All hypotheses were tested using bootstrapping (with 5000 samples) to determine significance levels.

The results show a strong positive relationship between training and job satisfaction, and a significant negative relationship between job satisfaction and turnover intention. The indirect effect of training on turnover through job satisfaction confirms a partial mediation effect.

Coefficient of Determination (R²): R² values were calculated to determine the percentage of variance explained by the model for each dependent construct.

• 42% of the variance in job satisfaction is explained by training and development.
• 31% of the variance in turnover intention is explained by job satisfaction.

These values indicate moderate explanatory power and confirm the practical relevance of the model.

Predictive Relevance (Q²): Using the blindfolding procedure, the Q² values for both endogenous constructs were found to be above zero, suggesting good predictive accuracy of the model.

Hypothesis-Wise Summary

Interpretation

The results confirm that Indian Knowledge Systems, when integrated into HRM through value-based training, contribute to enhanced job satisfaction. This satisfaction acts as a crucial mediator, leading to reduced turnover intentions, which in turn supports operational stability and cost efficiency in healthcare institutions.

By grounding training in culturally resonant frameworks—Seva (service), Samvaad (dialogue), Samatva (balance)—nurses develop a deeper emotional and ethical connection to their roles, improving morale and institutional attachment.

The present study examined how training and development practices grounded in Indian Knowledge Systems (IKS) impact job satisfaction and turnover intention among nursing staff in private multispecialty hospitals. The results obtained through Structural Equation Modeling (SEM) affirm the hypothesis that IKS-aligned training significantly improves job satisfaction. With a strong and statistically significant path coefficient (β = 0.65, p < 0.001), the findings highlight that training programs rooted in Indian values—such as Seva (service), Guru–Shishya mentorship, and emotional balance (Samatva)—resonate deeply with nursing professionals. Unlike traditional, technically-focused training, these culturally rich interventions appeal to the emotional and ethical dimensions of healthcare work, fostering greater engagement and satisfaction.

Furthermore, the study confirmed that job satisfaction negatively and significantly influences turnover intention (β = -0.44, p < 0.001), supporting prior research that links workplace satisfaction to employee retention. In the context of nursing, where the workload is intense and emotionally demanding, satisfaction is driven not only by pay or promotions but also by emotional support, recognition, and alignment with ethical values. Training that reflects these factors contributes to a stronger commitment to the organization. More importantly, the study identified a mediating effect, with job satisfaction serving as a crucial link between training and turnover. The indirect path (β = -0.29, p < 0.001) demonstrates that while training on its own may not directly reduce turnover, it does so by enhancing job satisfaction, which in turn encourages staff to stay.

This mediated pathway emphasizes the importance of designing training programs that are not only informative but also emotionally fulfilling and culturally relevant. Hospitals that integrate traditional Indian philosophies into their HR strategies are more likely to see improvements in morale, lower attrition, and better team cohesion. Beyond these internal benefits, the study also illustrates how such HRM approaches contribute to economic efficiency. Reduced turnover means lower recruitment and retraining costs, improved service continuity, and higher patient satisfaction. IKS-based HRM models—drawing from concepts like Dharma (duty), Swasthya (holistic wellness), and Karma (responsible action)—enable organizations to cultivate a sense of purpose and belonging, which modern incentive-driven approaches often fail to achieve.

Overall, the study adds significant value to existing HRM literature by introducing a culturally grounded framework that is both theoretically sound and practically relevant. While traditional models of training and satisfaction have been well-documented, this research provides a unique cultural lens, affirming that indigenous knowledge systems are not just philosophical relics but active, transformative tools for contemporary workforce management. The findings align with global HRM theories yet deepen them by localizing strategies within India’s socio-cultural context. This cultural infusion into HR practices offers a pathway to not only retaining skilled nursing professionals but also building a more emotionally sustainable and economically resilient healthcare system.

Practical Implications

This study offers several important implications for hospital administrators, human resource managers, and policy-makers in the healthcare sector. First and foremost, the findings highlight the necessity of rethinking training and development strategies in hospitals—not merely as procedural skill-building exercises but as opportunities to foster ethical values, emotional intelligence, and cultural relevance. By embedding Indian Knowledge System (IKS) principles such as Seva (selfless service), Samvaad (dialogue), and Samatva (balance) into training programs, healthcare institutions can enhance job satisfaction among nursing staff and reduce employee turnover. These culturally aligned training models make learning more meaningful and personally engaging, leading to improved morale, stronger institutional loyalty, and fewer resignations.

Additionally, the study reveals that job satisfaction acts as a key mediator between training and turnover, emphasizing that hospital must look beyond surface-level incentives and focus on deeper psychological and emotional drivers of employee commitment. Implementing IKS-aligned HR practices can help reduce recruitment costs, minimize disruptions caused by staff shortages, and enhance continuity of patient care—all of which contribute to long-term organizational efficiency. From a policy standpoint, healthcare frameworks at the state and national level should recognize the role of traditional wisdom in modern HR management, particularly in professions that require empathy, patience, and long-term emotional investment, like nursing.

 Theoretical Implications

Theoretically, this research contributes to the growing body of literature that explores the intersection of indigenous knowledge and organizational behavior. While job satisfaction and turnover intention have been widely studied, the integration of Indian Knowledge Systems as a foundational element in HRM remains relatively underexplored. This study fills that gap by demonstrating how ancient philosophies can be operationalized in a contemporary healthcare setting, offering a new perspective on how cultural values can drive organizational outcomes. The validated SEM model—linking IKS-based training, job satisfaction, and turnover intention—provides a testable, replicable framework for future studies.

Moreover, the findings extend the understanding of job satisfaction from a purely psychological construct to a culturally embedded phenomenon. By doing so, this research encourages scholars to examine the emotional and ethical dimensions of employee well-being in different cultural contexts. It also supports the call for more localized models in human resource management theory, challenging the dominance of Western-centric frameworks and offering a more inclusive approach to studying workforce dynamics. In sum, this study opens the door for further interdisciplinary research that blends traditional knowledge with modern management science.

Limitations of the Study

Despite the valuable insights gained from this study, several limitations must be acknowledged. First, the research was geographically confined to the Karnal district in Haryana and focused exclusively on private multispecialty hospitals. This localized scope may limit the generalizability of the findings to other regions, hospital types, or broader healthcare settings. Second, the study employed a cross-sectional design, capturing data at one point in time. This restricts the ability to assess long-term effects or changes in attitudes that may occur over an extended period. Third, the reliance on self-reported data from nursing staff introduces the potential for response bias, particularly social desirability bias, where respondents may present more favorable views than they actually hold.

Additionally, the study focused solely on nurses, excluding other healthcare professionals such as doctors, administrative personnel, or support staff, whose experiences with training, job satisfaction, and turnover may differ. Furthermore, while the research incorporated elements of Indian Knowledge Systems (IKS), it did not differentiate between specific IKS frameworks or examine which components had the greatest impact. Finally, although statistical tools like SEM provided strong model validation, qualitative insights such as interviews or case studies could have enriched the understanding of cultural and emotional influences in greater depth.

This study set out to explore the impact of Indian Knowledge System (IKS)-based training and development practices on job satisfaction and turnover intention among nursing staff in private multispecialty hospitals. Through the use of Structural Equation Modeling (SEM), it was clearly demonstrated that culturally aligned training programs significantly enhance job satisfaction, which in turn plays a vital role in reducing turnover intention. The findings affirm that job satisfaction serves as a powerful mediating factor, connecting meaningful training experiences with employee retention. This relationship underscores the importance of emotional engagement, cultural relevance, and ethical grounding in shaping workforce behavior within the healthcare sector.

The integration of IKS values—such as Seva (service), Samvaad (dialogue), and Samatva (balance)—into human resource strategies offers a transformative approach to managing hospital staff. Unlike conventional, one-size-fits-all training models, IKS-infused programs resonate deeply with Indian employees, enhancing both personal fulfillment and professional commitment. Beyond improving individual outcomes, the adoption of these traditional principles contributes to broader organizational stability and cost efficiency by reducing staff turnover and promoting consistency in patient care.

In conclusion, this research not only validates the effectiveness of IKS in hospital HRM but also provides a meaningful framework for policy-makers, hospital administrators, and HR practitioners seeking to create more human-centered and culturally responsive healthcare institutions. By bridging ancient wisdom with modern management, hospitals can achieve both employee well-being and operational excellence—laying the foundation for a more sustainable and empathetic healthcare system.

Future Directions

While this study offers meaningful insights into the relationship between IKS-based training, job satisfaction, and turnover intention, it also opens several avenues for future research. First, similar studies can be conducted across different geographic locations and hospital types—including government, rural, and teaching hospitals—to examine whether the effects observed in this study hold true across varied healthcare settings. Future research may also adopt longitudinal designs to assess how the long-term integration of Indian Knowledge Systems influences staff satisfaction and retention over time. In addition, expanding the research scope to include other healthcare professionals such as doctors, technicians, and administrative staff could provide a more comprehensive understanding of how IKS-based HRM affects diverse roles within the healthcare ecosystem.

Moreover, future studies could explore which specific elements of IKS—such as mindfulness, yoga-based stress reduction, Ayurvedic principles of balance, or ethical storytelling—contribute most significantly to job satisfaction and retention. Combining quantitative methods with qualitative approaches, such as interviews or ethnographic case studies, could also yield deeper insights into the lived experiences of healthcare workers engaged in culturally grounded training. Lastly, research could evaluate the cost-effectiveness of implementing IKS-aligned HR strategies to offer concrete evidence for policy adoption and organizational investment. These future directions will be crucial in building a more inclusive, culturally embedded, and sustainable model for human resource management in healthcare.

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