Factors Affecting the Turnover Intention of Indonesian Radiographers during the Covid-19 Pandemic

Radiographers are one of the frontlines of covid 19 patient services, including professions affected by the covid 19 pandemic. This study was conducted to prove the effect of Work Engagement (WE), Job Satisfaction (JS), Quality of Work Life (QWL) and Job Stress (JSt) and on radiographers Turnover intention (TI) during the Covid 19 pandemic, using an online survey of Indonesian radiographers, collected 243 respondents and used the SEM-Amos analysis technique version 24 in its hypothesis test. The results of the analysis prove that Work Engagement and Job Satisfaction have a negative effect on Turnover Intention, while Quality of Work Life does not affect Turnover Intention and Job Stress has a significant


INTRODUCTION
Since it was first announced, precisely in December 2019, it was reported that the number of patients with covid 19 has increased.Covid, which initially occurred in Wuhan, Hubei province, China, is associated with bats and snakes as hosts.And in less than a month, the increase in cases is very significant and extends to all corners of China, and several countries such as Japan, the Republic of South Korea and Thailand (Susilo et al., 2020).The rapid and widespread spread of the corona virus disease almost throughout the world caused the World Health Organization WHO to designate this event as a pandemic on March 12, 2020(WHO, 2020).Corona Virus 19 has become a frightening scourge to date.The consequences of this pandemic are almost felt by all business industries.The health industry is no exception, in this case hospitals.
The covid 19 pandemic also forces hospitals to always be ready to provide the best health services, so hospitals must be strong in facing various challenges and impacts caused in order to survive in providing health services, to covid 19 sufferers and general patients.In addition to facing external problems, Covid-19 has also caused a lot of turmoil in the internal hospital, especially health service providers such as medical personnel and other health workers (Adiputra, 2020).Lifestyle changes, involvement in health service delivery, high work stress ultimately have an influence on the level of satisfaction and also have a lot of impact on changing jobs (Siska Sinaga &;Kasmiruddin, 2015).Job stress due to covid 19 also causes an increase in turnover intention in the nursing profession, so identifying and managing factors related to job stress can prevent nurses' turnover intention in these critical circumstances (Mirzaei et al., 2021).
The impact of Covid-19 turned out to be able to affect the quality of life and behavior of the community by making adjustments.The behavior of changing working hours, changing contact with family, relatives and co-workers, also causes great stress that rages between duties and responsibilities as well as the safety and security of workers and their families because it is feared to be carriers of the virus to the family (Fajar et al., 2020).
Team involvement in service providing activities is also a problem in itself, even internal conflicts often arise, especially in selfish individuals who try to avoid providing services to covid patients (Nurhidayati &;Anam, 2020).Even though companies and governments provide additional benefits to motivate service providers so that it gives its own impression in terms of job satisfaction.This condition also triggers the desire to move and stop working (Nurhidayati &;Anam, 2020).
Among the officers who serve covid patients are radiographers.Radiographer is a health worker profession in health facilities where the task and obligation is to make diagnostic imaging images to establish diagnoses using existing modalities in radiology such as x-rays, CT scans, MRI, ultrasound and others (Ministry of Health, 2020).
This study was conducted in order to test the model of the effect of Work Engagement, Quality of Work Life Job Satisfaction, and Job Stress on radiographer Turnover Intention during the Covid 19 pandemic.With the knowledge of the dominant factors that influence the desire to change radiographer jobs will help management plan the development of radiographers in the future.

THEORETICAL REVIEW Work Engagement (WE)
Engagement can be interpreted as a high level of intensity and perseverance in work efforts (Colquitt et al., 2019).Work Engagement itself can be interpreted as an engagement, satisfaction, and enthusiasm of individuals to work (Kreitner &;Kinicki, 2010).Many experts define Work Engagement, one of which is Scaufelli, et al (2006) where Work Engagement is defined as a positivity and fulfillment of work from the central mind that has been characterized.Work engagement is a motivation and is central to positive thinking related to a job.Its characteristics are passion, dedication and absorption.So if someone has the characteristics of these three traits then that person can be said to have engaged in work.
McShane and Glinow (2018) define employee attachment as individual emotions and cognitive (rational) motivations, specifically focused, intense, persistent, and purposeful efforts towards goal work.It is emotional engagement, commitment, and satisfaction with the job, as well as a high level of absorption in the work and a sense of self-efficacy in doing the work.
Employee attachment is a person's involvement with, satisfaction, and enthusiasm for doing work.Employees who have high engagement, he will have a desire for their work and perceive a deep relationship with his company, employees who do not have high engagement have actually checked and spent time but not all attention is given to their work (Stephen P. Robbins &;Judge, 2017).If a worker has an attachment then he will be motivated to give the best effort for his company (Marciano, 2010).In other words, a worker has high engagment, so he will devote everything to the maximum both physically and psychologically for his work.
From some of the definitions mentioned above, it can be summarized that Work Engagement is a suggestion or motivation to work without being forced either physically or psychologically, of course, with enthusiasm and selfsatisfaction in someone who works.The involvement in radiographer work activities in serving covid patients is based on pandemic conditions that force radiographers to deal directly with patient examinations.Where the service provided is a process of team work between professions and internal professions, such as doctors, nurses, administration and radiographers.In its implementation, the involvement of radiographers in the process of serving covid patients is often one of the factors that cause someone to want to change jobs.Enthusiasm, interest in work, pride and challenges of work and difficulty escaping from the shadow of work are indicators used in this study Scaufelli, et al (2006).

Job Satisfaction (JS)
Job Satisfaction (JS) is one of the individual mechanisms that directly affects performance and commitment in the organization (Colquitt et al., 2019).If an employee is satisfied with his work and has positive emotions at work, of course they will be able to do their job better and choose to stay at the company for a relatively longer period of time (Colquitt et al., 2019).
Furthermore, Colquitt et al, (2019) define that Job Satisfaction or job satisfaction is a pleasant emotional state, and is the result of an assessment of work activities or work experience.An employee if the level of job satisfaction is high then he will experience positive feelings and vice versa employees who have a low level of job satisfaction will experience negative feelings when thinking about their tasks or engaging in their work activities (Colquitt et al., 2019).Newstrom (2007) states that job satisfaction is an affective attitude, namely feelings of liking or not towards something.In line with this, according to Robbin and Judge (2017), job satisfaction is a positive feeling of work produced as an evaluation of its characteristics.Confirmed by Scandura (2019) that job satisfaction is as a pleasant or positive emotional condition resulting from job appraisals or employee work experience.
In this study, job satisfaction was used as one of the factors that encourage a radiographer to change jobs.By adopting research indicators from Nadiri and Tanova (2010), among others, satisfaction with salary, job conditions, fairness of treatment and payment, and satisfaction with the awards given, it is one of the factors suspected to influence employees in deciding to change jobs.

Quality of Work Life (QWL)
Quality of Work Life is a term that refers to whether or not the work environment is preferred, the QWL treatment program is another way for the organization to carry out its responsibilities to develop its working and working conditions as well as for the health and economy of the organization.In addition to improving the work system, there are several other QWL programs that can be done such as developing employee skills, minimizing work stress, and strengthening more cooperative work-management relationships (Newstrom, 2007).QWL is when an employee is able to meet his needs by working within his organization (Dessler, 2013).
Fillippo added that QWL is a good change activity that occurs at every level in the organization.This is to increase the effectiveness of the organization in a better scope by increasing its dignity and human growth (Filloppo, 2005).
From the definition above, QWL is a condition where an employee has been able to meet his job needs well and seeks to make improvements to the effectiveness of his organization.In this study, the QWL indicator was adopted as one of the indicators that allegedly can influence an employee in deciding to move to a new place.Perceptions of compensation suitability, occupational risks to health, job prospects themselves and work conditions are suspected to influence employee decisions to move jobs from Ionescu, et al (2013).

Job Stress (JSt)
Stress is a psychological response to demands that have certain consequences for the person and also burden or exceed his capacity or the person's resources.This suggests that stress depends on the nature of the person facing it.Each person will be different in terms of responding depending on their perspective and treatment of stressors and how they cope with them.Thus, each person will have different levels of stress even when faced with the same conditions and situations (Colquitt et al., 2019).Kinicki &;Fugate (2016), stress can be defined as an adaptive response, which is linked by its characteristics and or with the psychological processes of the individual as a consequence of what is done externally, it can also be situations or events that put psychological and or physical demands on a person (Kinicki &;Fugate, 2016).
Stress is a dynamic condition in each individual in facing an opportunity, or obstacle, even a demand where it is associated with something he wants and the output can be perceived as something uncertain but its existence is very important (S P Robbins et al., 2018).
Conditions of work stress such as the number of activities given to be a burden on employees, work conditions that require a full employee to never leave even often have a physical impact and cause physical reactions such as shortness of breath and so on are indicators of work stress that is suspected of affecting an employee to change jobs.Kuo, et al (2014) stated that high levels of job stress can cause employee dissatisfaction and have an inverse relationship between job stress and job satisfaction, including the next effect is on turnover intention among nurses.This is supported by his opinion Labrague, et al (2018) suggest that work stress strongly predicts the desire to change jobs (turnover intentions) in nurses.Work stress felt by workers is lower, resulting in less turnover intention in the nursing profession in critical care units (Chegini et al., 2019).Likewise, confirmed by Fong, et al (2013) stated that work pressure is positive and has a very strong effect on the tendency to stop working.In line with this, Y. Zhang at al (2021) found that work stress has a direct influence on the desire to move to a better level of job satisfaction and organizational commitment.

Turnover Intention (TI)
Turnover intention is an event that often occurs in almost all institutions and this condition is associated with unfavorable consequences for employees (Chegini et al., 2019).This turnover intention according to Mobley (1978) is a tendency or intention of employees to quit work consciously and voluntarily or the desire to move to a new workplace of their choice.
Based on the definition above, that turnover intention is a person's desire to move work (leave) consciously and voluntarily to a new place to get better or there are other considerations.

Work Engagement and Turnover Intention
Research De Simone, et al (2018) states that there is a correlation between job satisfaction, job involvement and the desire to move.This is in line with Zhang, et al (2020) who assert that work involvement is also a strong early predictor of the intention to change village doctors.Dan Chegini, et al (2019) higher quality of work life will result in fewer exit intentions in critical care unit nurses.
Hypothesis 1 It is suspected that there is an effect of Work Engagement on Job Satisfaction.Job Satisfaction and Turnover Intention Zhang, et al (2020) who affirm that job satisfaction is a strong early predictor of village doctor switching intentions and Labrague, et al (2018) found that job satisfaction strongly predicts job turnover intentions in nurses.While De Simone, et al ( 2018) also strengthen that job satisfaction can have a significant effect on turnover intention (desire to change jobs).While Liu, et al (2018) stated that job satisfaction has a strong influence on turnover intention.
Hypothesis 2 Suspected effect of Job Stress on Turnover Intention.

Quality of Work Life and Turnover Intention
Zhang, et al ( 2020) who assert that work engagement is also a strong early predictor of village doctor switching intention.Chegini, et al ( 2019) stated a higher quality of working life will result in less exit intent in critical care unit nurses.
Hypothesis 3 It is suspected that there is an effect of Quality of Work Life on Turnover Intention.

Job Stress and Turnover Intention
Fong, et al ( 2013) Work pressure is positively significantly associated with the tendency to quit work.Kim and Kim (2021) stated that Job stress is one of the main positive predictors affecting employee turnover intention.
Hypothesis 4 It is suspected that there is an effect of Job Satisfaction on Turnover Intention.
Figure 1.Theoretical Framework Model

METHODOLOGY
In determining the sample of this study, a purposive non probability sampling technique method was used.to determine heterogeneous samples (Vehovar et al., 2016 ), special criteria were made to filter respondent data so that a representative sample was obtained (Klar &;Leeper, 2019).The criteria used are the radiographer profession and have or are currently working serving covid patients.
Analysis of the pattern of relationships between variables and their direct or indirect influences, the relationship of independent variables to dependent variables is carried out by path analysis ( Valenzuela &;Bachmann (2017).AMOS applications are used to determine, assess, estimate, and create models or path diagrams that will show the hypothesis of inter-variable relationships (Byrne, 2016).Path analysis is carried out for data analysis using structural equation 1217 modeling SEM (Structural Equation Modeling) as one of the tools in statistics to test and estimate causal relationships with a combination of statistical data and qualitative causal assumptions (Hair et al., 2014).
This research questionnaire adopts from previous researchers' questionnaires with adjustments developed to be the instrument of this study.The questionnaire adopted from Ionescu, et al (2013) 10.I get paid well for the work I do.11.My job is a risk to my health and safety.12. My job offers great prospects for my career advancement.13.My job is very strict.

Job Stress (JSt)
The questionnaire adopts from Shukla and Sarivastava (2016) 14.I have a lot of work, I'm afraid I can't finish it.15.I never took time off.16.My job makes me gerogi.17.I am burdened with my work.18.I sometimes feel tightness in my chest when I think about my work.

Turnover Intention (TI)
The questionnaire adopts from E.K. Lee, dkk (2020) 19.I am seriously considering leaving my job.20.I intend to quit my current job.21.I have already started looking for another job.

RESULTS
This research was conducted in December 2020 to the radiographer profession through an online survey.The population of this study was 2,695 radiographers in Indonesia who provided covid services.Sample collection is carried out by accidental sampling.Where the sample was randomly conducted on radiographer colleagues who received a broadcast survey through social media information, whatsapp and facebook groups.The sample obtained in this study was 243 people.Respondents from this study are diverse, consisting of female and male radiographers, their ages also vary, their level of education and income also vary.At the initial stage of the survey, there is a screening of respondents by specifying the criteria for respondents who are entitled to fill.In this study, the minimum criteria for respondents were those who were still working or had worked for at least 3 months and served covid 19 patients.The survey used the Microsoft Forms Office 365 online application questionnaire.
The validity test and reliability test of the research indicators were conducted using Confirmatory Factor Analysis (CFA) Latan ( 2012).This test is carried out so that the data is valid and reliable in measuring the model so that the picture of the indicator in the measurement of Turnover Intention can be known.First order confirmatory factor analysis (1st order CFA) is a measurement model that can be directly done for all dimensions or components studied (Ika &;Dwi, 2012).According to Hair, et al (2010) by using this CFA method, not only obtained validity testing of a construct (Construct Validity), but also can be used to analyze the reliability of the construct (Construct Reliability).Then the data is analyzed using AMOS software version 24.0 to test the model (SEM / Structural Equations Modeling).The most widely used model accuracy index is Chi-Square (Joreskog & Sorbom, 1993).To assess whether a model is declared fit or not, it can be seen from the Chi-Square value above 0.05 (p-value > 0.05) because the results show no difference between the model and the data (Joreskog &;Sorbom, 1993).
Table 3. CMIN (The Initial Data Model is Not Yet Fit) Table 3 above shows the initial data before modification using SEM Amos 24.0, P value shows 0.000 which means the model is not yet fit.To achieve model fit ( P>0.05) then the MI (Modification Indices) process is carried out by eliminating high loading factors (Hair et.al., 2014).
The MI process is carried out to obtain the Standardized path of fit model by following the procedure for gradually eliminating the loading factor (Thakkar, 2020)

Table 4. Model Fit
The results of table 3 analysis above show that Chi Square (CMIN) is 85.621 and P value is 0.62, this value is greater than 0.05 indicating that the model is declared fit.Next, hypothesis testing is carried out.Using AMOS version 24.0, the results of data processing are obtained as follows (figure 3):

DISCUSSION
Research has found that work engagement negatively affects turnover intention.This is in accordance with Kim and Kim's (2021)  Satisfaction with work results, performance and benefits obtained in this study causes job satisfaction to negatively affect turnover intention this is not in line with the findings of De Simone, et al (2018) which states that job satisfaction or job satisfaction has a stronger effect on the desire to change jobs (turnover intention) and Zhang, et al (2020) which confirms that job satisfaction is a strong early predictor of the intention to change village doctors.Liu, et al (2018) job satisfaction has a significant influence on turnover intention.Labrague, et al (2018) found that job satisfaction strongly predicts turnover intentions in nurses.However, this finding is in line with the findings of Kim and Kim (2021) which states that job satisfaction is a negative predictor of turnover intention.
The quality of work life indicators used in this study adopt research indicators from Ionescu, et al (2013), namely the motivation of salary suitability with the type of work performed, the risk of work that is at risk to health and safety, the existence of good prospects for career advancement and my work is very tight, the four indicators did not affect turnover intention.This finding contradicts the results of research from Zhang, et al (2020) who affirm that work involvement is also a strong early predictor of village doctor switching intentions.Dan Chegini, et al (2019) higher quality of work life will result in fewer exit intentions in critical care unit nurses.
High workload, never taking time off, jobs that make jagged, burdened and feeling tight when thinking about work contribute to job stress having a positive effect on turnover intention.This is supported by findings from Labrague (2018) Job satisfaction strongly predicts turnover intentions in nurses.Kuo, et al (2014) Excessive levels of job stress can lead to employee dissatisfaction and an inverse relationship between job satisfaction and job stress, including subsequent effects on turnover among nurses.The results of this study showed that job satisfaction was significantly associated with job stress and the desire to move.Dan Fong, et al (2013) Work pressure is positively significant with the tendency to stop working.

CONCLUSIONS AND RECOMMENDATIONS
Radiographers as one of the frontlines in serving covid patients are needed by hospitals and the community.This paper examines a model of the factors that influence radiographers' turnover intention .The study's findings contribute to a discussion of what factors cause a radiographer to want to change jobs or stop working.So that these findings can be used as input for managers in carrying out retention and coaching of radiographers.

FURTHER STUDY
The limitation of this study is that it still does not specify to the profession of a particular class of hospital radiographers, as it is known that hospitals are complex units with multi-professions in them and with all equipment facilities owned according to class criteria so that there will be different influences of busyness between hospitals with one another.Therefore, the suggestion for future research is to focus on a particular class so that there is homogeneity of activities in its ministry.

ACKNOWLEDGMENT
, namely the initial number of indicators of 18 items, gradually eliminated by 4 items that have a high loading factor.The remaining indicators of the elimination process are 14 items, consisting of Work engagement 3 indicator items, Job Satisfaction 2 indicator items, Quality of work life 3 indicator items , Job stress 3 indicator items and Turnover intentions 3 so as to achieve the fit model shown in figure 2.

Figure 2 .
Figure 2. Standardized Path of Fit Model

Figure 3 .
Figure 3. Full Model SEM Test Results

Table 2 .
Characteristics of Respondents

Table 5 .
A Table with Numbers and Text Description Automatically Generated From table 5 above, obtained information on the CR value of Work Engagement is -2.307 meaning Work Engagement negatively affects Turnover Intention, while the CR value of Job Satisfaction is -2.363 which means Job Satisfaction negatively affects Turnover Intention, the CR value of Quality of Work Life is 0.356 which means Quality of Work Life did not affect Turnover Intention and the CR value of Job Stress was 3,118 which means that Job Stress had a positive effect on Turnover Intention.
research that work engagement is a negative predictor of turnover intention.Work engagement indicators in this study adopt research indicators from Scaufelli, et al (2006), namely work enthusiasm, enjoy, pride with work and cannot remove the shadow of work in daily life and apparently causes work engagement to have negative turnover intention.This corroborates the findings of De Simone, et al 1223 (2018) who stated that there is a correlation between job satisfaction, job engagement and the desire to move.