Objective: The purpose of this study is to identify the influence of the job insecurity, job characteristics, and job engagement of the 1st grade paramedics who work in emergency medical institutions on their turn over intents, with a view to reduce the turnover rates and ensure job security by providing basic data.
Method: For this study, we enlisted 171 first grade paramedics from emergency medical institutions throughout the country be getting their informed consents after explaining the purpose of this study. As the tool for this study, we used a structured questionnaire, which is composed of 6 questions on general topics, 14 questions regarding the job characteristics and working years, 11 questions on their job engagements, 12 on job insecurity, 18 on job characteristics, and 4 questions on intents to turn over, totaling to 65 questions.
The data was collected from October 14, 2014 to October 28 of the same year, from 192 completed questionnaires returned in person or via emails. Of these, 21 questionnaires that were completed but lacking integrity in answers or not completed thoroughly. Finally, the remaining 171 questionnaires were used for this study.
The data collected was analyzed using SPSS/WIN 21.0, using frequency analysis, percentage, average, standard deviation, factor analysis, t-tests, and ANOVA. Also, correlational analysis and multiple regression analysis were performed.
Results:
1. Of the general characteristics of the first grade paramedics in emergency medical institutions, 53.8% (92) were male, while 75.4% (129) were from 20 to 29 years old. 87.7% (150) were married, while 55.6% (95) graduated from a two-year college, which was followed by 4-year university graduates (34.5% (56)) and master''s degree holders or higher (9.9% (17).)
2. As for the working years and arrangements of employment for the first grade paramedics who worked in emergency medical institutions, 40.9% (70) had one to three years of experience with the current institution, while 35.1% (60) had been working for less than a year. As for the level of the institution, 47.4 (81) were working for a regional emergency medical center, followed by 29.2% (50) working in a regional emergency medical institution and 23.4% (40) working in provincial emergency medical centers. As for the arrangement of employment, 56.7% (98) were working on timed contracts. 66.1% (113) worked in three shifts, 20.5% (35) working under ''other'' arrangements, and 13.5% worked overnight duties (23.) As for the organization, 67.3% (115) were assigned to Department of Emergency Medicine, while the distribution of their wages was that 49.1% (84) earned from 24 million won to 37 million won per year, 42.1% (72) making less than 24 million won per year, and 8.8% (15) making 37 million or higher per year. The number of fellow paramedics who work together were, in 74.9% (128) of the subjects, was 5 or more. When asked why they decided to work in a hospital, 46.2% (79) said it was due to their vocational aptitude. 26.3% (45) said they wanted to gain experience to become a civil servants. For the intent to resign from the current job, 53.2% (91) said ''NO,'' and, of those who said ''Yes'', 61.3% (49) pointed to job insecurity as the cause, while 47.5% (38) said low payment.
3. As for the differences in the employment arrangement and the size of the institution and the work experience, work experience (χ²= 33.571, p=.000), and the size of the institution (χ²= 22.818, p=.000) showed statistically significant differences.
4. The result of the analysis of job characteristics of the first grade paramedics who work in emergency medical institutions, the importance was 18.9%, expertise 15%, exhaustiveness 13.9%, and autonomy 12.7%, making up to 60.6% of power.
5. The average score of job insecurity for the paramedics in this study was 3.19. Of the detailed questions under this category, "There is a possibility that the future of the paramedics in my current institution can become uncertain." marked the highest, 3.54.
The job characteristics were analyzed as divided into four sub categories, where the importance was 3.73, expertise 3.51, exhaustiveness 3.20, and autonomy 3.39. The job engagement was 4.58 points, while the average of turn over intent was 3.28.
6. The job insecurity analyzed by the general characteristics, the gender (p=.001) and age (p=.000) showed statistically significant differences. The importance showed a significant difference by the age (p=.014,) while the expertise differed significantly by the education (p=.048.) Also, the autonomy at work differed significantly by the gender (p=.033) and age (p=.032.) The job engaged was affected significantly by the gender (p=.001) and age (p=.013.) The intent to turn over showed a significant difference for the gender (p=.001).
7. The differences in the job insecurity based on the working conditions of the first grade paramedics working in emergency medical institutions, the differences were significant by the annual salary (p=.008), the reason for choosing to work for the hospital (p=.007), and the current intent to turn over (p=.001). As for the importance, the employment arrangement (p=.016), the annual salary (p=.042), and the reason to choose to work for the hospital (p=.036), and whether to work on after being converted to a regular employee in case of a time worker (p=.049), and for the expertise, the employment arrangement (p=.000), the reason to choose to work for the hospital (p=.011), and whether to keep working for the hospital after being converted to a regular employee in case of a time worker (p=.049), for the exhaustiveness of the work, the employment arrangement (p=.027,) the working condition (p=.000,) the department (p=.016,) and whether to keep working for the hospital after being converted to a regular employee in case of timed workers (p=.049), and for the job autonomy, the work experience (p=.000), the employment arrangement (p=.025), and the annual salary (p=.021) accompanied statistically significant differences. As for the job engagement the number of fellow paramedics working together(p=.037), the reason to choose to work for the hospital (p=.000), intent of resignation (p=.005), if wishing for resignation, the planned working period (p=.035), the intent to work on for the hospital after being converted to a regular employee in case of currently timed workers (p=.005) for the intent to turn over, the size of the hospital (p=.000), organization (p=.000), the number of fellow paramedics working together (p=.001), the reasons to choose to work for the hospital (p=.000), the planned working period if the worker does not wish to resign (p=.005), and whether to continue to work after being converted to a regular employee (p=.000) resulted in statistically significant differences.
8. As for the correlations between the job insecurity, job characteristics, job engagement, and the intent to turn over, the higher the job insecurity was, the job autonomy became lower (r=-.180, p=.018) and so did the job engagement(r=-.162, p=.034). In this case, the intent to turn over turned out to increase(r=.397, p=000). In addition, the higher the importance was, the level of expertise also increased(r=.501, p=000), and so did job autonomy(r=.233, p=.002) and job engagement(r=.438, p=000). A higher expertize resulted in a higher level of job autonomy (r=.186, p=015) and job engagement(r=.448, p=.000). The higher the exhaustiveness, job engagement decreased (r=-.162, p=034), while the intent to turn over increased(r=.224, p=.003). When the job engagement increased, the level of intent to turn over appeared to decrease (r=-.354, p=000).
9. The variable that affected the intent to turn over most significantly was the job insecurity, which had a power of 15.7% (p=.000), followed by job engagement 8.6% (p=.000) and job characteristics (exhaustiveness) 2.0% (p=.034), These variables explained the intent to turn over with a power of 27.4%.
Conclusion: The first grade paramedic who worked in an emergency medical institution and participated in this study turned out to professional healthcare experts who had above-average importance, expertise, and job characteristics and performed their works with more-than-average job engagement with positive and proactive minds. However, their positions within the medical institutions were insecure, which affected their intent to turn over. Therefore, it is necessary to expand the scope of dedicated works for the first grade paramedics and reform the laws and the system to designate them as essential and required personnel for an emergency medical institution in order to enhance the quality of emergency medical services and provide prompt and efficient services of such kind in an emergency medical institution.

keywords: Paramedics, Job Insecurity, Job Characteristics, Job Engagement, Turnover Intention