Abstract
Background & aims
Organizational climate is recognized as a key factor in enhancing performance and retaining the workforce. Retaining operational staff in emergency medical centers is vital for improving service quality and reducing the costs associated with job turnover. This study aimed to investigate the relationship between organizational climate and Employee retention tendency of operational staff of the Accident and Emergency Medical Center of Mazandaran University of Medical Sciences.
Materials & methods
This descriptive-correlational study was conducted on 210 operational staff members of the Mazandaran Emergency Medical Center, selected through stratified sampling from 30 bases. Data were collected using a demographic and occupational characteristics checklist, an organizational climate questionnaire, and an employee retention tendency questionnaire. Data analysis was performed in SPSS version 26 using statistical tests including the independent t-test, analysis of variance, and Pearson correlation coefficient.
Results
The mean scores for organizational climate (113.12 ± 17.76) and Employee retention tendency (47.27 ± 12.55) were at a desirable level. A statistically moderate correlation was found between organizational climate and employee retention tendency (p < 0.001; r = 0.42). A significant relationship was observed between Employee retention tendency and employment status in administrative departments (p = 0.031), non-smoking (p = 0.004), and favorable economic status (p = 0.001). Furthermore, organizational climate was significantly associated with marital status (p = 0.044).
Conclusion
A favorable organizational climate plays a crucial role in enhancing the retention tendency of emergency medical operational staff. Therefore, healthcare organizations are recommended to implement strategies that improve the organizational climate and, in turn, strengthen human resource retention.
Keywords: Organizational climate, Personnel retention, Emergency medical services, Emergency medical technicians
Introduction
In the complex and high-pressure world of emergency medical services (EMS), healthcare professionals often work in environments where every second counts, and the margin for error is slim. Their decisions and actions can mean the difference between life and death, making the organizational setting in which they operate profoundly important [1]. Among the many factors shaping the experiences and outcomes of EMS personnel, “organizational climate” stands out as a critical yet often overlooked element [2].
Organizational climate is associated with a group of attributes of the work environment that perceived by individuals who work in this surroundings and power work motivation and acts as an effective source to figure and influence behavior [3]. Organizational climate reflects how employees collectively make sense of the events, policies, and routines they experience at work including the behaviors they feel are encouraged, supported, or expected [4].
Organizational climate, as one of the key factors, plays a fundamental role in shaping employees’ attitudes toward their organization. It significantly influences their sense of belonging and attachment, as well as the quality of interpersonal relationships among colleagues [5]. Furthermore, it impacts job satisfaction, task effectiveness, self-confidence, and organizational commitment [6, 7]. A positive and well-established organizational climate serves as a vital catalyst for enhancing employee motivation, creativity, and innovation. Moreover, it promotes mental well-being, facilitates both personal and professional development, and provides a foundation for sustained organizational success and long-term sustainability [8].
Employees in healthcare settings, especially those working in pre-hospital emergency services are frequently exposed to high levels of psychological pressure and stress. Due to the physical, emotional, and mental demands of their roles, these professionals often face an unfavorable organizational climate [9]. The work environment for this group involves multiple organizational dimensions that can either support their performance or hinder their ability to carry out tasks effectively [10].
Previous studies in Iran have shown that a weak or negative organizational climate is associated with an increase in clinical errors and a decrease in the quality of pre-hospital care [11, 12]. It was also found that organizational climate predicts 20% to 50% of job burnout among pre-hospital emergency staff [13]. Furthermore, an unfavorable organizational climate was able to predict 15% to 40% of job dissatisfaction among EMS personnel [14] and have strong relationship with medical errors, an increased risk of life-threatening incidents for patients [15] and turnover intention among nursing staff [16]. While a more positive and supportive organizational support has been linked to increased commitment and psychological well-being among nurses and a greater likelihood of continued collaboration with the organization [17].
considering the high intensity demands of pre-hospital emergency services, an unfavorable organizational climate significantly contributes to reduced job satisfaction and may diminishes employees’ intention to remain within the organization.
Human resources are recognized as an organization’s most valuable asset and it’s the main factor of continuity, success and achievement of organizations’ goals [18]. Managers consistently seek employees who perform well, carry out their responsibilities effectively, remain loyal to the organization, and have no intention of leaving their jobs [19].
The term “retention” can be described as an organized effort to develop and enhance a work environment that consistently motivates employees to remain, while applying policies and practices tailored to their diverse needs [20]. Employee retention refers to the process of maintaining or encouraging talented and valuable employees to continue working within the organization for an extended period, which is a key strategy for preserving an effective workforce and fulfilling operational demands [20, 21]. It also considered a critical factor influencing the success or failure of organizations [22]. For this reason, Organizations have to put numerous efforts to encourage employees to be dedicated, devoted and rooted in the organization or company. The hiring of new talented employees might be one of the most important issues for the sustainability of an organization; however, retaining the valuable employees could be a much better cost saving and more effective method for the organization [21].
In healthcare organizations worldwide, one of the most challenging tasks for healthcare managers is retaining registered personnel [23]. Medical staff retention is influenced by economic, organizational, environmental and personal factors [24]. A positive organizational climate, in which employees feel they are treated fairly and valued for their contributions to the organization, their retention tendency may increase, as this sense of justice fosters loyalty, strengthens commitment, and builds a lasting connection with the workplace [25]. This is why employees who believe they are treated fairly in light of their organizational contributions are more likely to remain with the same company over the long term [23].
Organizational climate in Iran’s pre-hospital emergency services faces several significant challenges that adversely affect staff performance and retention. High work pressure, heavy patient loads, and resource shortages are major stressors that can lower job satisfaction and increase employees’ intention to leave [26]. Furthermore, inadequate organizational policies, such as a lack of flexible work schedules and insufficient managerial support, weaken the organizational climate and diminish employee motivation [27]. Another critical challenge is the frequent exposure of emergency personnel to psychological and verbal violence, which negatively impacts their sense of safety and perceived organizational support [28].
Pre-hospital emergency personnel, due to the critical, high-pressure, and time-sensitive nature of their work, are exposed to considerable psychological and physical stress. On the other hand, retaining skilled and motivated employees one of the fundamental priorities of healthcare organizations requires fostering and strengthening a positive organizational climate, in which employees feel valued and treated fairly. Such an environment enhances their commitment, loyalty, and willingness to remain within the organization.
Pre-hospital emergency personnel face considerable psychological and physical stress due to the critical, high-pressure, and time-sensitive nature of their work. Retaining skilled and motivated employees one of the fundamental priorities of healthcare organizations requires fostering a positive organizational climate in which employees feel valued, supported, and treated fairly. Such an environment enhances commitment, loyalty, and the willingness to remain within the organization.
The primary hypothesis of this study is that a positive organizational climate is positively associated with employees’ retention tendency in pre-hospital emergency services. Organizational climate was chosen as the main independent variable because of its demonstrated impact on job satisfaction, organizational commitment, performance quality, and psychological well-being. Focusing on this variable, rather than broader workplace factors, allows for a precise assessment of how the work environment influences employees’ intention to stay. Previous studies in Iran indicate that organizational climate can predict a substantial proportion of job burnout and dissatisfaction among emergency personnel, emphasizing its importance for workforce stability.
Despite its significance, few studies have explored the relationship between organizational climate and employee retention tendency in pre-hospital emergency settings within the Iranian context. This study aims to address this gap, providing evidence to guide human resource strategies, improve service quality, and enhance the stability and effectiveness of emergency medical care systems.
Methods
Design and aim
This is a cross-sectional and descriptive-analytical study, which was conducted with the aim of determining the relationship between organizational climate and the Employee retention tendency of operational staff in the medical emergency centers covered by Mazandaran University of Medical Sciences. This study was carried out from October to December 2024.
Study setting and participants
In the current study, the research community included all operational staff in the medical emergency centers affiliated with Mazandaran University of Medical Sciences. The study was conducted across the bases covered by the Medical Emergency and Accident Center of Mazandaran University of Medical Sciences, including 37 urban bases, 62 road bases, and one air base.
Inclusion criteria included consent to participate in the study, at least one year of work experience in pre-hospital emergency services, and holding an associate degree, bachelor’s degree, or higher in nursing, anesthesiology, or medical emergency fields. Exclusion criteria included experiencing traumatic or stressful events in the past 6 months (such as the death of a close relative, divorce, or exposure to distressing situations during emergency missions in the past 6 months).
The stratified sampling method was chosen to ensure representativeness of the diverse operational staff across different types of emergency bases (urban, road, and air) and geographic regions (east, west, and center) within Mazandaran Province. Given the heterogeneity in work conditions, workload, and organizational climate across these bases, this method helps to capture a more comprehensive and generalizable picture of the relationship between organizational climate and employee retention tendency. Stratified proportional allocation and random selection within each stratum minimized selection bias and enhanced the external validity of the findings.
Sample size and power
To determine the required sample size, considering that no previous studies had examined the correlation between pre-hospital emergency organizational climate and employee employees’ job retention tendency, a pilot study was conducted on 30 medical emergency staff. The correlation coefficient obtained in this pilot study was 0.2. Finally, considering a type I error of α = 0.05 and a test power of 80%, the sample size was estimated to be 196. To account for a 5% non-response rate, the final sample size was estimated to be 216.
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A total of 210 participants, comprising both operational and incident center staff working in emergency medical centers, were selected through a stratified sampling method. Initially, the province was divided into three regions: east, west, and center. Within each region, bases were selected using proportional stratified allocation. From each selected base, a list of eligible personnel was compiled, and 7 individuals meeting the inclusion criteria were randomly chosen to participate in the study.
Instruments
Before conducting the research, permission was obtained from both creators of the localized version of these two questionnaires, and then the researchers began to conduct this study. The data collection in this study was based on the self-reporting method via three following questionnaires:
Demographic and occupational questionnaire
was used to collect information such as age, marital status, education level, smoking status, organizational position, employment type, place of service, household size, work shift, weekly working hours, economic status, income level, and underlying medical conditions.
Organizational climate questionnaire
This questionnaire was first designed in 1963 by Halpin et al. [29]. This questionnaire consists of 32 items and is designed based on a 5-point Likert scale, ranging from “very low” (score of 1) to “very high” (score of 5). The subscales of the questionnaire include group morale (items 1–4), hindrance (items 5–8), intimacy (items 9–12), consideration (items 13–16), aloofness (items 17–20), disengagement (items 21–24), influence and dynamism (items 25–28), and production emphasis (items 29–32). The total score of the questionnaire ranges from 32 to 160 [30]. A score below 40 indicates a low level of organizational climate, a score between 40 and 80 indicates a moderate level, a score between 81 and 120 indicates a desirable level and a score between 121 and 160 indicates a highly desirable level of organizational climate [31]. The validity of this questionnaire in Iran was firstly measured by Sarmad et al. and its reliability was obtained 0.96 using Cronbach’s alpha coefficient [32]. In the present study, the validity of the questionnaire was confirmed by relevant professors and experts, and its reliability was tested, with an intra-cluster correlation coefficient of 0.98 and 0.92 using Cronbach’s alpha coefficient.
Employee retention tendency questionnaire: This questionnaire was firstly designed in 2001 by L. Mak in order to determine employee motivation and retention. This questionnaire consists of 18 items and three dimensions: burnout (questions 1 to 10), loyalty (questions 11 to 14), and turnover intention (questions 15 to 18) [33]. Each item is scored on a 5-point Likert scale, ranging from completely disagree (1 point) to completely agree (5 points) [34]. The reliability of this questionnaire was calculated by the designers of the questionnaire to be 0.87, 0.94, 78 respectively for Loyalty, Burnout and Turnover intent [33]. The validity and reliability of the Persian version of this questionnaire were calculated by Joharipour et al., and its Cronbach’s alpha was found to be 0.90. 2 questions of burnout and one question of loyalty were removed from the Persian version of this questionnaire due to cultural differences. Therefore, the burnout subscale in the Persian version has 8 questions and loyalty subscale has 3 question [35]. Therefore, the range of the questionnaire score is between 15 and 75. The higher the score, the greater intention to stay [19]. The reliability of this questionnaire was calculated as 0.81 using Cronbach’s alpha coefficient during this research.
Data collection
After obtaining the approval of ethics committee and the necessary permits from the Vice Chancellor for Research and Technology at Mazandaran University of Medical Sciences, and the necessary permits, the researchers visited the pre-hospital emergency bases affiliated with Mazandaran University of Medical Sciences. A well-trained researcher provided detailed explanations about the study and its objectives and obtained a written consent from all participants. then participants were asked to complete the questionnaire carefully. Since the demographic questionnaire used in the study did not include personal identifiers such as names or national identification numbers, participants were assured that all collected data would remain confidential. As not all personnel working in the pre-hospital emergency department were present during a single shift, the researchers revisited the relevant bases to ensure the completion of the required sample size.
Statistical analysis
For data analysis, SPSS version 22 was used. Descriptive statistics, including mean, standard deviation, median, percentage, and frequency, were reported. The assumption of normality was tested using the Kolmogorov-Smirnov test, along with skewness and kurtosis indices. Upon confirmation of data normality, parametric tests were applied. Data analysis included independent t-tests, analysis of variance (ANOVA), Pearson correlation coefficient. In all statistical analyses, a significance level of less than 0.05 was considered.
In the present study, missing data were minimal. Any incomplete questionnaires were carefully reviewed, and cases with substantial missing responses were excluded from the analysis. For items with occasional missing responses, mean imputation was applied to ensure completeness of the dataset while minimizing bias.
Ethical approval and consent to participate
The study protocol was reviewed and approved by the Ethics Committee of Mazandaran University of Medical Sciences (IR.MAZUMS.REC.1403.062). All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Permission to conduct the study was obtained from the relevant authorities. Prior to data collection, the researcher introduced himself to the directorates of each pre-hospital emergency department. A trained research assistant explained the study objectives to the participants and informed them that participation was voluntary, and refusal to participate would not result in any negative consequences. Written informed consent was obtained from all participants. Confidentiality and anonymity of the participants’ data were strictly ensured, and only the research team had access to the information.
Results
After distributing about 220 questionnaires, 210 participants completed all three questionnaires and were included in the study. Of these 210 participants, 179 (85.2%) were urban residents, 153 (72.9%) were married, 169 (80.5%) held a bachelor’s degree and 200 (95.2%) were based in operational units. The mean ± SD age was 34.72 ± 9.1 and the mean (SD) work experience was 9.75 ± 7.8 years. Other demographic information’s are given in Table 1.
Table 1.
Demographic characteristics of the nurses participating in the study
| Variable | Subgroups | (%) N |
|---|---|---|
| Marital Status | Single | (27.1%) 57 |
| Married | (72.9%) 153 | |
| Educational level | Associate Degree | (13.8%) 29 |
| Bachelor’s Degree | (80.5%) 169 | |
| Higher than Bachelor’s | (5.7%) 12 | |
| Employment Type | Permanent | (51.4%) 108 |
| Contractual | (31.9%) 67 | |
| Temporary | (9.5%) 20 | |
| Corporate | (7.1%) 15 | |
| Place of Service | Headquarters | (4.8%) 10 |
| Base | (95.2%) 200 | |
| Base Type | Urban | (43.3%) 91 |
| Roadside | (56.7%) 119 | |
| Organizational Position | Manager | (10%) 21 |
| Technician | (90%) 181 | |
| Tobacco Use | YES | (5.7%) 12 |
| NO | (94.3%) 198 | |
| Economic Status | Poor | (22.4%) 47 |
| Moderate | (71.4%) 150 | |
| Good | (6.2%) 13 | |
| Work experience (year) | Below 11 | (62.35%) 131 |
| 11–20 | (25.71%) 54 | |
| 21–30 | (11.94%) 25 | |
| Age, Mean ± SD | 34.72 ± 9.10 | |
| Working hour per week, Mean ± SD | 51.38 ± 14.51 | |
The results showed that the mean ± SD score for organizational climate was 113.12 ± 17.76 indicating that the organizational climate was at desirable level. Among the different dimensions of the organizational climate questionnaire, the highest mean score was related to “team spirit” with mean ± SD score of 14.99 ± 2.35, while the lowest mean score was related to “harassment” with mean ± SD score of 8.17 ± 3.2 (Table 2).
Table 2.
Pearson correlation between organizational climate and employees’ retention tendency
| Variables | Mean (SD) | 1–5 basis Mean (SD) |
Pearson correlation | P-value | |
|---|---|---|---|---|---|
| Organizational Climate | Absence of Burnout (8–40) | 26.97 (6.67) | 3.37 (0.83) | r = 0.44 | p < 0.001 |
| Loyalty (3–15) | 9.43 (3.13) | 3.14 (1.04) | r = 0.39 | p < 0.001 | |
| Lack of Desire to Leave (4–20) | 10.88 (4.41) | 2.72 (1.10) | r = 0.47 | p < 0.001 | |
| Employees’ Job retention tendency (15–75) | 47.27 (12.55) | 3.15 (0.83) | r = 0.42 | p < 0.001 | |
| Employees’ retention tendency | Team spirit (4–20) | 14.99 (2.35) | 3.74 (0.58) | r = 0.15 | p = 0.028 |
| Harassment (4–20) | 8.17 (3.20) | 2.04 (0.80) | r=-0.23 | p < 0.001 | |
| Intimacy (4–20) | 14.85 (3.37) | 3.71 (0.84) | r = 0.52 | p < 0.001 | |
| Interest (4–20) | 14.35 (3.14) | 3.58 (0.78) | r = 0.37 | p < 0.001 | |
| Consideration (4–20) | 13.47 (3.82) | 3.36 (0.95) | r = 0.29 | p < 0.001 | |
| Distancing (4–20) | 12.51 (2.72) | 3.12 (0.96) | r = 0.15 | p < 0.001 | |
| Influence and Dynamics (4–20) | 13.44 (3.87) | 3.36 (0.96) | r = 0.29 | p < 0.001 | |
| Focus on production (4–20) | 13.37 (3.93) | 3.34 (0.98) | r = 0.19 | p = 0.005 | |
| Organizational Climate (32–160) | 61.85 (11.57) | 3.44 (0.64) | r=-0.27 | p < 0.001 | |
Note: acceptable p value is p < 0.05
Regarding the findings related to employee retention tendency, the mean score was 47.27 ± 12.55, indicating a below average level among operational staff. This classification is based on percentile ranges, where scores below the 25th percentile represent low retention tendency, scores between the 25th and 75th percentiles indicate average retention tendency, and scores above the 75th percentile reflect high retention tendency. Among the different dimensions of the job retention tendency, the highest mean score was related to “Absence of Burnout” with mean ± SD score of 3.37 ± 0.83, while the lowest mean score was related to “Lack of Desire to Leave” with mean ± SD score of 2.69 ± 0.66 (Table 2).
The results of Pearson’s correlation test showed that there is a statistically moderate relationship between organizational climate and employee retention tendency scores (r = 0.42, p < 0.001). The most significant association was observed between organizational climate and reduced desire to leave, indicating a positive influence of climate on retention (p < 0.001 and r = 0.47). “Intimacy” has the most positive relationship with employee retention tendency (r = 0.52, p < 0.001) (Table 2).
According to the results of this study, single employees had higher scores on organizational climate than married employees. Also, age, work experience, and working hours per week had an inverse relationship with organizational climate scores. No relationship was observed between other demographic variables and organizational climate scores (Table 3).
Table 3.
The relationship between demographic characteristics of participants with employees’ job retention tendency and organizational climate (n = 210)
| demographic characteristics | Organizational Climate | Employees’ retention tendency | |||
|---|---|---|---|---|---|
| Mean (SD) | Test result | Mean (SD) | Test result | ||
| Economic Status① | Poor | 110.11 ± 22.72 | *F = 1.37 | 41.85 ± 13.30 | ***F = 7.02 |
| Moderate | 113.58 ± 15.18 | 48.42 ± 11.40 | |||
| Good | 118.69 ± 24.12 | 53.53 ± 16.58 | |||
| Base Type② | Urban | 113.6 ± 15.67 |
*t = 0.34 df = 208 |
48.38 ± 11.95 |
*t = 1.13 df = 208 |
| Roadside | 112.75 ± 19.26 | 46.41 ± 12.97 | |||
| Organizational Position② | Manager | 115.04 ± 19.73 |
*t=-0.08 df = 208 |
50.04 ± 12.08 |
*t = 0.14 df = 208 |
| Technician | 112.91 ± 17.57 | 46.96 ± 12.59 | |||
| Marital status② | Single | 117.16 ± 16.97 |
**t = 2.02 df = 208 |
49.70 ± 14.87 |
*t = 1.72 df = 208 |
| Married | 111.62 ± 17.87 | 46.37 ± 11.49 | |||
| Education level① | Associate Degree | 118.96 ± 18.58 | *F = 2.07 | 51.62 ± 11.49 | *F = 2.04 |
| Bachelor’s Degree | 112.43 ± 17.69 | 46.57 ± 12.62 | |||
| Higher than Bachelor’s | 108.83 ± 16.89 | 46.67 ± 12.96 | |||
| Employment Type① | Permanent | 111.98 ± 17.61 | *F = 0.37 | 45.77 ± 12.14 | *F=-1.20 |
| Contractual | 114.25 ± 19.12 | 48.83 ± 12.90 | |||
| Temporary | 115.30 ± 15.94 | 47.65 ± 15.34 | |||
| Corporate | 114.00 ± 15.67 | 50.53 ± 8.82 | |||
| Place of Service② | Headquarters | 117.03 ± 25.27 |
*t = 0.70 df = 208 |
55.60 ± 11.97 |
**t = 2.16 df = 208 |
| Base | 112.93 ± 17.37 | 46.85 ± 12.46 | |||
| Tobacco Use② | YES | 107.5 ± 10.29 |
*t = 1.13 df = 208 |
37.08 ± 11.53 |
**t = 2.64 df = 208 |
| NO | 113.46 ± 18.07 | 47.88 ± 12.36 | |||
| Variable | Mean ± SD | Pearson Correlation Coefficient | p-value | Pearson Correlation Coefficient | p-value |
| Age | 37.42 ± 9.10 | r=-0.11 | 0.031 | r=-0.14 | 0.049 |
| Work experience (year) | 9.75 ± 7.8 | r=-0.16 | 0.017 | r=-0.13 | 0.066 |
| Working Hours per Week | 51.38 ± 14.51 | r=-0.11 | 0.096 | r=-0.14 | 0.047 |
Note: acceptable p value is p < 0.05. ① Analysis of variance (ANOVA) test and ② t-test for independent groups. *p > 0.05 **p < 0.05, ***p < 0.01
People with higher economic status, people working in the Headquarters sector, and people who did not use tobacco had a higher Job retention tendency. Also, age, work experience, and working hours per week had an inverse relationship with Employee retention tendency scores. No relationship was observed between other demographic variables and Employee retention tendency scores (Table 3).
Discussion
The present study aimed to determine the relationship between organizational climate and Employee retention tendency of operational staff at emergency and accident center of Mazandaran university of medical sciences. A statistically moderate relationship was identified between organizational climate and employee’s job retention tendency. This indicates that a favorable organizational climate is directly associated with an increased likelihood of employees remaining in the organization. Although the correlation coefficient was statistically significant (r = 0.42, p < 0.001), its magnitude was modest, suggesting that while organizational climate plays an important role, other contextual and organizational factors are also likely to influence employee retention. Thus, statistical significance should be distinguished from practical relevance.
Previous research has shown that a supportive organizational climate positively affects nurses’ retention tendency [36, 37]. Eliyahiai et al., in a structured review, reported that factors such as team spirit, strengthened nursing management, a suitable organizational climate, and organizational support are associated with increased employee retention among nurses [38]. A positive organizational climate fosters commitment and job satisfaction, thereby enhancing organizational loyalty [39].
In this study, the strongest positive correlation within organizational climate was observed for the ‘Absence of Burnout’ dimension. Leveraging a positive organizational climate as a management strategy can enhance employees’ desire to remain in their profession by promoting a healthy psychological environment, work control, engagement, and motivation, ultimately reducing burnout [40]. Greater organizational climate and perceived support in the workplace are associated with higher motivation, job satisfaction, and teamwork, and lower burnout among employees [41].
The results of this study indicated that the strongest negative association within organizational climate was observed for the ‘Lack of Desire to Leave’ subscale. Sharifian et al., in a systematic review conducted during the COVID-19 pandemic, reported that organizational factors—specifically organizational climate and motivational elements—were among the main reasons for nurses leaving their jobs. Increased pressures to fulfill responsibilities, combined with shortages of hospital equipment and human resources and lack of managerial support, created an unfavorable organizational climate, reduced motivation, and led to resignations [42]. Similarly, Al-Nuaimi et al. found that a favorable work environment and job satisfaction positively influence nurses’ retention tendency, aligning with the present study’s findings. Strengthening a positive organizational climate is therefore a key strategy for retaining healthcare personnel [43].
In the current study, the organizational climate at the emergency medical center was favorable. Among the dimensions assessed, ‘Team Spirit’ had the highest mean score, while ‘Harassment’ had the lowest. Cohesion among emergency medical personnel results from mutual respect and positive workplace relationships, fostering teamwork and effective communication [44].
Previous research also shows that psychological violence, particularly verbal harassment, is the most common form of workplace violence against emergency medical personnel, with 77.2% of respondents reporting such experiences in the past year [45]. Exposure to these stressors can negatively affect performance and job motivation, leading to outcomes such as anger, reduced self-confidence, absenteeism, and job turnover [46].
The findings of this study indicated that the mean score of employees’ retention tendency was below average. Among the subscales, ‘Absence of Burnout’ received the highest score, whereas ‘Lack of Desire to Leave’ received the lowest. In Iran, the tendency to resign is particularly prevalent among emergency medical personnel due to factors such as work pressures [47], insufficient organizational support, low job flexibility [48] ), and mandatory overtime [49]. Hart et al. emphasized that a healthy and supportive work environment enhances nurses’ retention tendency in hospitals [50]. Furthermore, Mousavi et al. reported a direct and significant relationship between the hospital’s ethical climate and nurses’ retention tendency [17].
The study findings indicate a statistically significant relationship between organizational climate and participants’ marital status, with single employees reporting higher perceived organizational climate than married employees. This finding contrasts with previous research; for instance, Devi et al. reported no significant association between marital status and perceived organizational climate [51] whereas Ameen et al. found higher perceived organizational climate among married employees [52]. One possible explanation is that expectations for promotion among older, married employees may increase competition and reduce collaboration, thereby lowering their perception of organizational climate [53]. However, this remains speculative, as the current study did not directly examine these mechanisms. Further research is needed to clarify the relationship and identify underlying factors.
Findings from previous studies indicate that employees’ retention tendency is influenced by a wide range of factors, including individual characteristics (e.g., age, smoking, economic status, physical and mental health) and workplace conditions (e.g., organizational climate, managerial support, employee–patient relationships) [38]. The role of age appears complex: while some evidence suggests an inverse relationship, possibly due to limited promotion opportunities, increased role strain, or higher burnout risk among older and more experienced staff [54], other studies, such as Owens et al., report that older and more experienced nurses are more likely to remain in their positions [55]. This tendency may reflect greater psychological balance, stability, and stronger emotional attachment to the profession that often accompany increased age [56].
Practical strategies for improving organizational climate
Based on the findings of this study, healthcare administrators and hospital managers should prioritize improving organizational climate to enhance employee retention, particularly in high-stress settings such as emergency medical centers. Practical strategies include implementing leadership development programs that emphasize transformational and supportive leadership to foster trust and open communication.
Encouraging employee participation in decision-making can increase staff empowerment, ownership, and commitment. Promoting teamwork through team-building activities and interprofessional collaboration strengthens social cohesion and reduces workplace conflicts. Additionally, hospitals should support employees’ psychological well-being by providing access to mental health resources, stress management programs, and flexible scheduling to mitigate burnout and job-related stress.
Finally, establishing clear anti-harassment policies and cultivating a safe and respectful workplace culture can further improve organizational climate, ultimately enhancing job satisfaction and reducing turnover intentions among healthcare personnel.
Strengths and limitations
Although numerous studies have investigated organizational climate, no research to date has directly examined its relationship with retention tendency among emergency medical staff in Iran, a topic that remains largely underexplored. This study addresses this important gap by focusing on a high-stress healthcare context. Moreover, it was conducted at the Mazandaran Emergency Medical Center, which oversees 100 emergency medical bases, thereby providing a large and diverse sample. This broad coverage not only strengthens the representativeness of the sample but also enhances the generalizability of the findings to other emergency medical settings in the region.
Research limitations
A major limitation of this study is the reliance on self-reported data, which may introduce cognitive bias, fear of disclosure, or concerns regarding confidentiality. In addition, the psychological state of emergency medical personnel—such as chronic fatigue and job stress from heavy workloads—could have influenced the accuracy of their responses. Stressful events, including high-risk missions occurring during questionnaire completion, may also have temporarily affected participants’ perceptions of their work environment or job retention tendency, potentially biasing the results.
Another limitation relates to the cross-sectional design, which does not allow for causal inferences between organizational climate and job retention tendency. Therefore, definitive conclusions about cause-and-effect relationships cannot be drawn.
Finally, replication of this study in diverse settings and populations is recommended to enhance the validity and generalizability of the findings.
Conclusions
The study findings showed that the organizational climate of the emergency medical center was rated at an acceptable level, while employees’ retention tendency scored below average. A moderate, statistically significant correlation was identified between organizational climate and retention tendency. In addition, retention tendency was significantly associated with factors such as non-smoking status and favorable economic conditions.
In conclusion, it is recommended that human resource policies focus on improving organizational and environmental conditions, particularly in operational departments where work demands are high and stressful. Strategies such as enhancing participation in decision-making, providing supportive programs, strengthening interpersonal relationships, and promoting organizational justice may foster a positive organizational climate and, in turn, improve employees’ retention tendency.
Acknowledgements
This study is derived from a master’s thesis in the field of Emergency Nursing at Mazandaran University of Medical Sciences and is part of a research project with the code IR.MAZUMS.REC.1403.062. I would like to express my sincere gratitude to the Vice Chancellor for Research and Technology of Mazandaran University of Medical Sciences for providing financial support for this project. Additionally, I extend my heartfelt thanks to the administrators and operational staff of the emergency medical centers affiliated with Mazandaran University of Medical Sciences for their invaluable cooperation and assistance in conducting this study.
Author contributions
Data collection: Ali Akbar Hasanpour, Mohammad Javad Ahmadzadeh-zeidiData analysis: Mohammad Ali Heidari Gorji, Vida Shafipour, Abolfazl HosseinnatajFinal approval: all author.
Funding
This study was funded by Mazandaran University of Medical Sciences.
Data availability
The datasets are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
This study was conducted from the Vice Chancellor for Research and Technology at Mazandaran University of Medical Sciences. After obtaining the approval of ethics committee and the necessary permits from the relevant authorities, the researcher introduced himself to directorates of each pre-hospital emergency department. A well-trained and experienced research assistant explained study objectives to participants and told them that their participation was voluntary and refusal to participate would not result in any negative consequences. All participants were assured of the confidentiality of all the information of the research and only the researchers have access to the data. Then informed consent was obtained from all study participants.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets are available from the corresponding author on reasonable request.