Staying Despite Strain: A Systematic Grounded Theory Study of Human-Centered HRM and Healthcare Worker Retention

Ferdy Toway Rumambi; David Paul Elia Saerang; Djurwati Soepeno; Rudy Steven Wenas

doi:10.63922/ijebir.v5i04.4575

Ferdy Toway Rumambi Program Doctor Management Science, Sam Ratulangi University, Indonesia
David Paul Elia Saerang Faculty of Economics and Business, Sam Ratulangi University, Indonesia
Djurwati Soepeno Faculty of Economics and Business, Sam Ratulangi University, Indonesia
Rudy Steven Wenas Faculty of Economics and Business, Sam Ratulangi University, Indonesia

DOI: https://doi.org/10.63922/ijebir.v5i04.4575

Keywords: healthcare worker retention, human-centered HRM, systematic grounded theory, technostrain, psychological contract breach, perceived organizational support, ; organizational justice, conditional staying

Abstract

Healthcare organizations face a retention problem that conventional turnover metrics cannot fully diagnose. Workers may stay because they remain committed, because they need income or career credentials, or because secure employment traps them in defensive compliance. This study develops a grounded theory of how healthcare workers construct decisions to stay amid clinical, emotional, administrative, digital, and employment-status pressures. The study applies systematic grounded theory in the Strauss and Corbin tradition. Data were collected through three iterative rounds of semi-structured interviews with clinical workers, support personnel, unit managers, and HR-level informants. Round 1 opened the category, round 2 deepened it through theoretical sampling, and Round 3 tested the emerging model. The analysis used open, axial, and selective coding; constant comparison across professions, employment statuses, units, and two interviewer datasets; memo writing; negative-case attention; and audit-trail procedures. The core category is Conditional Staying. Healthcare workers stay not because strain disappears, but because they reinterpret layered strain through professional calling, employment security, peer solidarity, economic necessity, career aspirations, and perceived organizational care. The resulting typology distinguishes Committed Staying, Pragmatic Staying, and Defensive Staying. The model shows how Layered Strain activates a Perceived Organizational Care Gap, which triggers Retention Reframing and produces qualitatively different forms of staying. The study shifts healthcare retention theory from a binary stay-or-leave logic toward the quality of staying. It demarcates the perceived organizational care gap from perceived organizational support, psychological contract breach, and perceived organizational obstruction. It also reframes technostrain as a strategic HRM issue rather than a merely technical information-systems problem.

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