In the following, different aspects of literature about the topic have been given.

Globally, there is sufficient literature about the factors affecting the retention of nurses like environmental degradation, bad operating surroundings, loss of availability of devices, sexual harassment, lack of group support and absence of recognition.

Work environment conditions play an important role in employee flexibility, productivity, job satisfaction [15] and providing good working environment for nurses, improving effective nursing services, job satisfaction and job security [16] improve nurse satisfaction. In addition, providing clinical equipment and resources in the clinical sector can improve the work environment, provide training facilities, and enhance quality care so that employees can make the most of their potential [16] .

Occupational problems affect nursing retention rates; most nurses will experience traumatic experiences [17] . The literature indicates that newly graduated nurses quit their nursing careers because of job dissatisfaction, fatigue, and frustration, and sought alternative employment [18] .

Less professional interaction between nurses and physicians, lack of teamwork, lack of confidentiality that undermines patient dignity, and specific clinical factors for patient care that effect nurses [19] . Registered nurses who leave their jobs for two to three years show unexpected working conditions such as unreasonable conflict, harassment, and lack of clinical professional support [19] .

Reference [20] says, Employee turnover is a situation where employees exit the organization voluntarily for various reasons or are relieved by the organisation or retire, thereby affecting the organization, most times negatively in terms of costs and the capacity to deliver the minimum required services. In relation of nursing staff turnover, the effects of turnover in the organization includes lack of experience and knowledgeable staff, work overload on remaining staff, frustration and poor patient care.

Various studies have confirmed that highly paid employees can keep their jobs. Finnish nurses showed positive feedback on monetary rewards and other benefits. Some countries have improved remuneration packages to increase barriers for nurses [21] . An employee salary scale that adapts to life needs will lead to employee job satisfaction [22] .

Skilled managers need to identify problems in the unit, identify misconduct for themselves and others, identify staff needs, use critical thinking in problem solving, and encourage communication. The use of derogatory language to use unscrupulous supervisors organized by subordinates could adversely affect the perception of nurses in the medical field [23] .

A study conducted in Jordan stated that nurses working in hospitals need independence, a sense of responsibility and hope that it will be led by a co-director of a nurse. Nurses also note that more independence is affected by supportive management, education and experience. It was also found that occupational independence is directly related to a position and a certain level of experience in a nurse’s work [24] .

A study conducted in Islamabad, Pakistan showed that working conditions were more comfortable and working relations with male coworkers were friendlier in private hospital as compared to public hospitals. Private hospital nurses were more satisfied with positive feedback of their performance, professional growth, and promotion system [25] . Furthermore, a study conducted at a private hospital in Karachi showed that attractive salary, melting pot benefits, promotion plan, favorable working environment, support staff and career development opportunities were the keys to improving the level of nursing care in private hospitals [26] . Another study conducted by reference [27] on Nurses’ job satisfaction and willingness to stay in private hospitals found that majority of nurses were dissatisfied. The reasons for dissatisfaction were work, performance and the relationship between nurses and doctors.

The theoretical framework for this study was based on the “Maslow’s Hierarchy of Needs Theory”, the theory of need is the basis for explaining, analyzing, or interpreting a nurse’s needs. The theory looks at the needs and motivations of the people and emphasizes the fact that workers are driven by different things at different times in their lives (See Figure 1 ).

n = Z² 1 − a/2P (1 − P)

d²

Z² 1 − a/2 = for 95% confidence level = 1.51

n = Sample size = 150

d =Margin of error = 8%

This research aggregates the responses of survey respondents into a scale. The aggregated responses have been recorded in SPSS version 20 of the test. In SPSS, reliability tests have been conducted to determine the reliability of the problem scale. Each research scale has undergone Cronbach’s Alpha. Correlation tests have been performed to assess the relationship between the study variables in detail. In order to assess the relationship between the variable factors and the research variables, regression tests were performed on each pair of independent variables and dependent variables to perform regression analysis. The results of all the above tests have been interpreted to guide the conclusion. After obtaining the research test results in SPSS and interpreting the regression output as a model summary, ANOVA table and coefficients, the research hypothesis have been tested.

Among 150 participants, 77 (51.3%) nurses were aged < 25 years, 65 (43.3%) were aged between 25 - 35 years and only 8 (5.3%) were aged > 35 years. In this study, both the gender participated. Total participants were 150 and among them, 125 (83.3%) nurses were female and 25 (16.7%) were male. Participants with different marital status like married and unmarried were included, total participants were 150 and it was found that most of the nurses that is 126 (84.0%) were single and 24 (16.0%) were married. 1 (0.7%) became a qualified nurse during 1971-1980, 3 (2.0%) became professional nurses during the years 1991-2000, 23 (15.3%) were qualified during the years 2001-2010 and 123 (82.0%) passed their exam during 2011-2015. Regarding work experience of the participants, 117 (78%) were working in the organization from 0 - 5 years, 17 (11.3%) were working from 6 - 10 years, 7 (4.7%) were working from 11 - 15 years and 9 (6%) have work experience of more than 15 years. As far as their professional preparation is concerned, 42 (28%) were BSc Nursing degree holders and 108 (72%) had done their Diploma in Nursing.

In response to the question regarding intention to leave the organization, 13 (8.7%) replied that they intend to leave their organization, whereas, 137 (91.3%) replied that they would not leave their organization. It was asked from the participants if they have plan to leave the organization next year. In response to this question, total 150 participants responded and among them, 16 (10.7%) were interested to leave their organization during the next year. In further explaining the intention to leave the current organization, 8 (5.3%) replied that they will leave for working overseas, 7 (4.7%) replied that they want to move from public to private sector, 3 (2%) gave other reasons to leave their current organization and majority of them (88%) did not responded. Upon asking the question about the shortage of professional nurses, 132 (88.0%) replied that there is a shortage of professional nurses in their hospital, whereas, 18 (12.0%) replied that there is no shortage. Inquiring about the reason to leave the organization, 132 (88%) did not responded, long duty hours (12 to 30 hours) was the concern of 4 (2.7%) participants, however, working environment is not appropriate was shown by 8 (5.3%), 2 (1.3%) stated salary issues as their reason, and domestic problems was the cause of 4 (2.7%) respondents.

To check the reliability of the scales, Cronbach’s Alpha test has been applied. Number of items in both of the scales was 6. If the reliability is more than 7, then the scales are considered reliable, so in this study, the scales were considered reliable (See Table 1 ).

Descriptive statics were applied to check the mean values of total response of the variables (See Table 2 ).

There was a significant correlation among all the variables. Sig value was 0.000, which is ideal in strong correlation (See Table 3 ).

p < 0.01, ^***p < 0.001 N = 150^**. Correlation is significant at the 0.01 level (2-tailed).

The result showed that there is strong impact of the independent variable on dependent variable, as the significance value is 0.000 (See Table 4 ).

a. Predictors: (Constant).

a. Dependent Variable: Retention; b. Predictors: (Constant).

a. Dependent Variable: Retention

R measures the strength of linear relationship between IV and DV. R value between IV and DV is 0.437 which tells that if IV increases by 1 then DV will increase by 0.437 that is 43.7% positive variance. IV has strong positive correlation with DV in the presence of mediating variable. R square shows the magnitude of relationship between IV and DV (See Tables 5-6 ).

Hypothesis status is given below in tabular form: (See Table 7 ).

Table below shows the responses of the participants in terms of a Likert Scale options between “strongly disagree”, “disagree”, “Don’t Know” “agree” and “strongly agree” (See Table 8 ).

*S-Significant; *NS-Non-significant.

There was statistically significant association between leaving organization and salary (p-value 0.002) (See Table 9 ).

There was statistically significant association between leaving organization and Hospital share options (p-value 0.027) (See Table 10 ).

There was no statistically significant association between leaving organization and health care benefits (p-value 0.192) (See Table 11 ).

There was statistically significant association between leaving organization and late shift allowance (p-value 0.003) (See Table 12 ).

There was no statistically significant association between leaving organization and Housing subsidy (p-value 0.092) (See Table 13 ).

There was no statistically significant association between leaving organization and Annual revision of salary (p-value 0.193) (See Table 14 ).

There was statistically significant association between leaving organization and Incentives for working unsocial hours (p-value 0.300) (See Table 15 ).

There was no statistically significant association between leaving organization and retirement benefits (p-value 0.723) (See Table 16 ).

There was no statistically significant association between leaving organization and Certificate and qualification bonus (p-value 0.884) (See Table 17 ).

There was no statistically significant association between leaving organization and Meal vouchers when on duty (p-value 0.622) (See Table 18 ).

There was statistically significant association between leaving organization and child care facilities (p-value 0.200) (See Table 19 ).

There was statistically significant association between leaving organization and well ventilated rest-rooms (p-value 0.006) (See Table 20 ).

There was no statistically significant association between leaving organization and reward for outstanding performance (p-value 0.088) (See Table 21 ).

There was no statistically significant association between leaving organization and Respect from management and physicians/doctors (p-value 0.102) (See Table 22 ).

There was statistically significant association between leaving organization and Safety rules and regulations (p-value 0.044) (See Table 23 ).

There was no statistically significant association between leaving organization and Safe working environment (p-value 0.224) (See Table 24 ).

There was no statistically significant association between leaving organization and Flexible working hours, which I am allowed to choose (p-value 0.442) (See Table 25 ).

There was no statistically significant association between leaving organization and team building excursions (p-value 0.806) (See Table 26 ).

There was no statistically significant association between leaving organization and continues feedback. (P-value 1.00) (See Table 27 ).

There was no statistically significant association between leaving organization and Opportunity and reward system (p-value 1.00) (See Table 28 ).

Data analysis revealed three major themes and categories as under: (See Table 29 ).

The findings of this study revealed that 91.3% of nurses do not want to leave their job. Factors that contributed to the retention of nurses in their job were rewards of outstanding performance, respect form management and physicians/doctors, safety rules and regulations and safe working environments. Furthermore, statistically significant association was found between subject leaving organization and hospital share option that is P-Value 0.027, whereas, no statistically significant association was found between leaving the health care benefits that is P-Value 0.192. And there was no statistically significant association was found between leaving organization and reward for outstanding performance (P-Value 0.088). Likewise, no statistically significant association was present between leaving the organization and respect from managers and physicians (P-Value 0.102).

1) Selection process was well designed.

2) Sample was representative of the population.

3) Collected data was easy to analyses.

4) Data was consistent, precise and reliable.

5) The study established preliminary evidence in planning a future advance study.

6) This study found some of the substantial reasons that have resulted in nurses’ job dissatisfaction and turnover.

1) Study results may not be generalized because of non-probability sampling

2) Data collection may take more time

3) A large sample size may give a clearer depiction of scenario.

4) Large number of male participants could have had an effect on the findings, as males might have different needs from those of females.

5) Data was collected from institutions with almost similar facilities, environment and stakeholders. Variation in context and types of hospital management system might have brought different results.

6) Current study is descriptive and cross sectional this could have been conducted as analytical or qualitatively.

1) There should be created more supportive professional nursing exercises so that nurses can fully develop their potential for professional interaction. This can be done by developing a clinical ladder that can be improved within the organization.

2) Motivate working nurses by decreasing the workload and developing a reward system for nurses based on the workload.

3) By strengthening mutual leadership and management skills within the hospital, opportunities are created to attract and retain nurses.

4) Improve a positive work environment by promoting teamwork, promoting continuous learning, trust, respect and flexible arrangements.

5) Future studies should explore additional factors, related to retention of nurses like the relationships of nurses with their patients, patient’s family members that affect the satisfaction level of nurses with their jobs.

6) Additionally, studies should be conducted to investigate these issues one by one in deeper context and devise methods for developing a nurturing workplace that understands nurse’s needs.

7) Current study findings will help health systems policy makers, including those at Federal and organizational level to develop and implement effective strategies to improve the satisfaction level of nurses at health sector and to minimize the factors leading to shortage and will improvethe retention of nurses.