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Article Excerpt
The intentions of adults with multiple sclerosis (MS) to voluntarily leave positions of employment (i.e., turnover intentions) are of interest in vocational rehabilitation because they are often the end result of deficiencies in on-the-job interventions by rehabilitation professionals and employers (Gilbride & Hagner, 2005). Calling for a career perspective in rehabilitation, Rumrill and Roessler (1998) described the need for on-going follow-up services to help employed individuals with chronic illnesses identify and reduce or remove barriers to productivity. Allaire, Li, and LaValley (2003) demonstrated that such interventions enabled individuals with rheumatic diseases to maintain their employment, thereby avoiding both an interruption in their work lives and a "sick role" self-definition. Consequently, planning to leave one's job is an early warning sign that immediate rehabilitation interventions are in order if employees with chronic illnesses are to solve job-related problems and maintain their employment (D'Zurilla & Nezu, 1999).
Employed adults with MS are particularly appropriate candidates for workplace interventions targeted at job retention. The rationale for this statement is very simple. Most adults with MS have an employment history (over 90%, LaRocca, Kalb, Schienberg, & Kendall, 1985; LaRocca, 1995; Rumrill, Roessler, & Koch, 1999), and most (approximately 60%, LaRocca, 1995; Rumrill, 1996) were working at the time of their diagnosis. However, retention of their jobs is another matter, given the fact that only 20 to 40 percent continue to work following diagnosis of their MS (Beatty, Blanco, Wilbanks, Paul, & Hames, 1995; LaRocca, 1995; Rumrill et al., 1999). Thus, the purpose of this study was to identify factors predicting "turnover intention" in light of the need to improve job retention success through on-the-job follow-up services that rehabilitation professionals could provide adults with MS.
Research indicates that turnover intention, i.e., thinking about leaving one's job, is the best and most immediate predictor of turnover (Dougherty, Bludorn, & Keon, 1985; Hui, 1988; Martin, 1979; Mobley, Homer, & Hollingsworth, 1978; Steers & Mowday, 1981). Although it is true that some jobs are not worth keeping, it is also accurate to say that much time, effort, and money is invested in ensuring that vocational placements through rehabilitation services are in the best interests of the person. Losing such a position, when it might have been avoided through timely and appropriate interventions, is therefore, a tragedy of no small proportions. Hence, empirical findings regarding factors affecting turnover intention among individuals with disabilities have considerable pertinence for the development and implementation of job retention interventions in rehabilitation.
Since the turn of the century, researchers in the fields of management, human resources, and industrial/organizational psychology have invested considerable effort in developing a model to predict voluntary turnover (Moore, 1998). Models resulting from their work have ranged from simple linear ones generated through regression analyses to more complex, dynamic ones resulting from structural equation modeling (e.g., Feeley, & Barnett, 1997; Flaherty & Pappas, 2002; Mitchell, Wise, & Fireman, 1996; Quinn, Rycraft, & Schoech, 2002). The amount of variance in turnover accounted for in these studies typically ranges from 17% to 30%, with one particular model explaining 63% of the variance in turnover intentions. Predictors of turnover in the research literature include job satisfaction, organizational commitment, supervisor relations, coworker relations, compensation and benefits, internal job mobility, organizational communication, organizational support, job match, and, finally, turnover intention. Turnover intention is central to this investigation because, as previously noted, it is the best and most immediate predictor of voluntary turnover.
It is important to point out that, although many models of employee turnover have been introduced and tested, few models include the symptoms of a disabling or chronic illness condition (Devins & Shnek, 2000; Roessler, 2004) as a precipitant of turnover intentions and, therefore, voluntary turnover. Therefore, in addition to including workplace variables encompassed in current turnover models, the model used in this study also incorporated a disability and illness factor, severity of symptoms, which was used as an independent variable predicting turnover intentions.
The rationale for the study is compelling. If rehabilitation professionals can predict turnover intentions, they can predict turnover and intervene prior to job loss in situations in which the person wishes to retain employment. Increasing the probability of job retention means that more people with disabilities will lead fulfilling lives. Indeed, maintenance of employment is directly related to quality of life (QOL) reported by people with chronic illnesses such as MS (Koch, Rumrill, Roessler, & Fitzgerald, 2001; Rumrill, Roessler, & Fitzgerald, 2004). The reasons for this connection between employment and QOL ratings are obvious in western cultures (Szymanski et al., 2003). Work fulfills survival and psychological needs of individuals. Income generated through employment helps people secure the goods and services they need to exist, and participating in work offers individuals a sense of meaning and identity.
Findings from this study also contribute to our understanding of rehabilitation interventions that enable people with disabilities to maintain their employment. These interventions may range from medical to workplace strategies. The importance of services to decrease turnover among people with disabilities is stressed in discussions of the mission of vocational rehabilitation and the role of the counselor (Hershenson, 1998; Rumrill & Roessler, 1998; Salomone, 1996). Whenever rehabilitation clients become turnover statistics, they constitute a failure of the program to use its resources effectively to achieve one of its most central goals, i.e., long-term competitive employment of people with disabilities. Loss of employment only adds to the stress that individuals experience in dealing with disability (Banks, 1995), a combined negative status that has devastating effects on adults with disabilities and their families.
Focusing on employed adults with MS, this study assumed that most of the workplace correlates of turnover intentions for the general population were pertinent for this group as well. Therefore, the job satisfaction variable from Moore's (1998) model was included in the current model, and the organizational commitment variable was replaced by one labeled "employment support." Employment support in the current model can be equated to organizational support as described by Moore. Employment support was substituted for organizational commitment because it was hypothesized that most people with disabilities would be committed to their place of work. Bromoge (1999) reported that people with disabilities were less likely to be absent from work and much less likely to voluntarily leave their place of employment. Furthermore, Moore hypothesized that the level of organizational support would predict turnover intentions in her original model, but found that it did not in the population she studied. She attributed the lack of a relationship between organizational support and turnover intentions to the fact that all of the organizations in her study (integrated-circuit chip manufacturers in the Silicon Valley) were highly supportive of their employees. It is much less likely for the cross section of employers who have hired people with MS to be uniformly supportive of their employees; therefore the employment support construct was added to the current model (Roessler, Neath, McMahon, & Neath, in press).
Representing the constructs of distress and coping ability, adaptation is the final variable of the model of turnover intention used in this investigation....
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