Teoría de auditoria de gestión de mantenimiento

This section discusses the relationship of personal accomplishment with job resources (JDR) and intention-to-leave (InToL).

130 The present study confirms the relevance of personal accomplishment on dental nurses in their work place. Although as a component of the burnout measure MBI in this research personal accomplishment was utilised as a measure of personal resources. The results indicate that dental nurses who expressed higher levels of a sense of ownership of the surgery and lower repetition of daily work routine had significantly higher levels of personal accomplishment. Furthermore, aspects of personal accomplishment appear to be a key factor when explaining intention-to-leave, in particular dental nurses reporting high levels of energy and accomplishment had higher intentions of leaving dental nursing.

The role of personal accomplishment as a component of burnout as assessed by MBI with work engagement required further investigation, specifically its relationship with intention-to-leave. Some have suggested that personal accomplishment should instead be considered as a ‘4th factor of work engagement (Schaufeli & Bakker, 2004). However, other research investigating the association between the 3 burnout components have reported significant correlations with intention-to-leave (Maslach et al., 2001). Whilst in this research the personal accomplishment measurement score was not reversed as would have been necessary if included as reduced personal accomplishment in the sub- scale of burnout where a low score reflects higher burnout. However, the positive association found between personal accomplishment and intention-to-leave in this study was still not in the expected direction as found in the literature (Alarcon & Edwards, 2010; Leiter & Maslach, 2009; Schaufeli & Bakker, 2004). One explanation may be the feature of dental nursing which is to give support to the dentist or dental therapist in the surgery so an opportunity for personal accomplishment by the individual is limited.

The findings suggest that a motivational process occurs in dental nurses who are self- efficacious more specifically to high energy and high accomplishment can experience high intention-to-leave, particularly if a high sense of ownership of surgery, low repetition of tasks and provision of career development is experienced by the dental

131 nurse at work. Consequently this suggests that personal accomplishment appears to play an important role along with work engagement in explaining intention-to-leave among dental nurses.

6.3WORK ENGAGEMENT

In this section the research question addressed relates to the investigation of work engagement among this occupational group.

Among this group of Scottish dental nurses whilst the overall level of work engagement was favourable when compared to other occupational groups as found in the UWES manual (Schaufeli & Bakker, 2003) when considering the 3 sub-scales of dedication, absorption and vigour separately some differences were shown. The results found that the dental nurses in this study were more dedicated (p < 0.0001), and absorbed (p < 0.007) and had less vigour (p < 0.0001) when compared to other groups.

In addition, the research found work engagement significantly predicted intention-to- leave among dental nurses when entered into a simple regression model. This finding confirms the relevance of work engagement in this context of dental nursing. Dedication is the factor which most helps to understand intention-to-leave by explaining 36% of the variance and so those dental nurses who stated higher dedication to their job showed lower intention-to-leave. The other factors of vigour and absorption equally predicted an additional 6 % of the variance in intention-to-leave but in the opposite direction. Dental nurses who expressed higher vigour but lower absorption in their work showed lower intention-to-leave.

Also, it is noted that this result has implications about the 3 sub-scales of work engagement and in particular how each has a different mediating effect on intention-to- leave. Dedication was found to be a key predictor of intention-to-leave, rather than all three when explaining the relationship between work engagement and retention among

132 dental nurses. A higher sense of being involved and a feeling of significance and pride lowered a dental nurses’ intention to leave the profession. This finding that the levels of dedication and absorption are significantly higher among dental nurses when compared to other occupations, however, this is consistent with another study which found the work engagement of dentists showed higher mean scores of on dedication and absorption (Gorter et al., 2008).

The result of reduced vigour was unexpected as a previous study measuring work engagement among dental care professional which included dental nurses found vigour to have the highest mean score of the 3 sub-scales. Yet, it is not reported if these dental nurses were trainees or not. So it may be proposed that the supporting role to dentists in the surgery, together with the high repetition of procedures undertaken by the dental nurses may explain the lower levels of energy found among the trainees.

Also, previous empirical evidence has found task significance, where an employee finds work meaningful, it in turns leads to work engagement (Kahn, 1992) and more specially to vigour (Mauno et al., 2007). In addition, in a qualitative study (Shraga & Shirom, 2009), defining job significance as the amount of impact both on others and the organisation itself, found it to the job characteristic most likely to an effective predictor of experiencing vigour at work. Despite, the limited number of studies making a comparison between dentists and DCPs and other occupations it may be suggested that the sedentary quality of surgery working reduces the opportunities for vigour in some circumstances. Overall, these features of dental nursing may explain the reported findings of low vigour among this group of dental nurses; however, vigour did not predict higher intentions to leave.

A major goal of this research was to determine if the mediational role of work engagement between job resources and intention-to-leave could be replicated within the dental nursing context and if it predicted intention-to-leave the profession. The results found confirmed replication of the mediational model of work engagement. First, the

133 findings confirmed a direct relationship between aspects of the work place, in particular professional resources which included beliefs about registration, task variety and task significance and work engagement. Secondly, work engagement was a very strong indicator of intention-to-leave and therefore it mediated the effect of work place factor of professional resources on this outcome.

In addition it is observed that the overall model of work engagement when entered into the latent variable model makes no distinction between the 3 components of the engagement. The latent variable model pools the common variance associated with the latent variable and uses this to predict intention to leave. Hence the individual component and their individual variation with InToL will not be reflected as it was in the simple regressions where each of the three components of engagement was examined for their separate relationship strength with InToL.

Also it is noted that when job resources (JDR) was entered into a simple regression model its relationship with intention-to-leave was not significant (r = 0.10; p > 0.5). Therefore not ascribing to the criteria outlined by Baron & Kenny (1986) to detect a mediational relationship in their causal steps method (Step 1). However, MacKinnon (2008) argues that there are limitations to this method in establishing mediation, particularly in both a multiple mediator model and a latent variable mediation model. Following on MacKinnon states that:-

‘As the number of mediators increases, the number of possible combinations of consistent

and inconsistent mediation effects increases. As a result, the requirement of a significant total effect, c’, may be incorrect for some models’. (p. 111)

Also in considering the benefits of latent variable MacKinnon comments that:-

‘Once measurement models are specified, the usual tests for indirect effects can be based on

134 Overall, these statements provide additional support for the mediational model of work engagement proposed in this research. However, other assumptions regarding the timing priority of the measurements and any suggestions of causal relationship still apply to the mediation model. This is discussed further in the limitations of the research (6.6.3) later.