The role of support antecedents in nurses' intentions to quit: the case of Australia

Association between Organizational Support and Turnover Intention in Nurses: A Systematic Review and Meta-Analysis

Although recent studies suggest a negative relationship between organizational support and turnover intention among nurses, there has been no systematic review on this issue. The aim of this systematic review and meta-analysis was to synthesize and evaluate the association between organizational support and turnover intention in nurses. The review protocol was registered with PROSPERO (CRD42023447109). A total of eight studies with 5754 nurses were included. All studies were cross-sectional and were conducted after 2010. Quality was moderate in five studies and good in three studies. We found a moderate negative correlation between organizational support and turnover intention since the pooled correlation coefficient was -0.32 (95% confidence interval: -0.42 to -0.21). All studies found a negative correlation between organizational support and turnover intention ranging from -0.10 to -0.51. A leave-one-out sensitivity analysis showed that our results were stable when each study was excluded. Egger's test and funnel plot suggested the absence of publication bias in the eight studies. Subgroup analysis showed that the negative correlation between organizational support and turnover intention was stronger in studies in China and Australia than those in Europe. Organizational support has a moderate negative correlation with turnover intention in nurses. However, data regarding the impact of organizational support on turnover intention are limited. Moreover, our study had several limitations, and thus, we cannot generalize our results. Therefore, further studies should be conducted to assess the independent effect of organizational support on turnover intention in a more valid way. In any case, nursing managers should draw attention to organizational support by developing effective clinical practice guidelines for nurses so as to reduce turnover intention.

The mediating role of organizational commitment between workplace bullying and turnover intention among clinical nurses in China: a cross-sectional study

BACKGROUND

Workplace bullying experienced by clinical nurses is a critical and pervasive issue that not only detrimentally impacts nurses but also poses a significant threat to the overall quality of nursing services and patient care. This study aimed to determine the mediating role of organizational commitment in the relationship between workplace bullying and turnover intention among clinical nurses in China.

METHODS

Participants were recruited from 40 hospitals in various provinces of China from December 2, 2021 to February 25, 2023, using convenience sampling. After obtaining hospital ethical approval and participants' informed consent, clinical nurses (n = 585) from different nursing departments in different hospitals completed the questionnaire. The Socio-demographic Questionnaire, Negative Acts Qestionnaire, Chinese Workers' Organizational Commitment Scale and Turnover Intention Questionnaire were used to collect general demographic data of nurses and assess workplace bullying they experienced, their level of organizational commitment and turnover intention. Descriptive statistics, Pearson correlation analyses and structural equation model were adopted to analyze the data.

RESULTS

Pearson's correlation analysis showed that that workplace bullying was significantly negatively correlated with organizational commitment (r = - 0.512, P<0.01) and significantly positively correlated with turnover intention (r = 0.558, P<0.01), organizational commitment was significantly negatively correlated with turnover intention (r = - 0.539, P<0.01). Mediation analysis indicated organizational commitment partially mediated the association between workplace bullying and turnover intention. The total effect (β = 0.69) of workplace bullying on turnover intention consisted of its direct effect (β = 0.41) and the indirect effect mediated through organizational commitment (β = 0.280), with the mediating effect accounting for 40.58% of the total effect.

CONCLUSION

Organizational commitment mediated the associations of workplace bullying and turnover intention. Therefore, healthcare organizations and nursing managers should develop appropriate strategies to enhance nurses' organizational commitment in order to reduce their turnover intention.

Nurse practice environment, perceived organizational support, general well-being, occupational burnout and turnover intention: A moderated multi-mediation model

AIMS

To test the relationship between practice environment and turnover intention, considering the moderation of perceived organizational support (POS) and the mediation of general well-being (GWB) and occupational burnout (OB) among the nurse population.

DESIGN

A cross-sectional survey design.

METHODS

Based on a sample of 474 nurses from two hospitals between May 2020 and September 2021, a moderated multi-mediation model was tested in which GWB and OB served as two mediators between practice environments and nurses' turnover intention, and POS was regarded as a moderator between practice environments and GWB.

RESULTS

This current study supported a moderated multi-mediation model where the relationship between practice environment and turnover intention (B = 0.33, p < 0.001) was mediated by GWB (B = 0.17, p < 0.001) and OB (B = 0.18, p < 0.001), and POS moderated the effect of practice environment and GWB (B = 0.19, p < 0.001).

PUBLIC CONTRIBUTION

The findings of this study can inform the design of effective organizational support and meet nurse emotional needs programmes to reduce the turnover intention among nurses.

The Effect of Work Engagement and Perceived Organizational Support on Turnover Intention among Nurses: A Meta-Analysis Based on the Price–Mueller Model

Aim. To elaborate on the relationship between work engagement, perceived organizational support, and the turnover intention of nurses by analysing some potential moderators. Background. Nurses’ turnover intention is negatively impacted by their level of work engagement and perceptions of organizational support. However, it is challenging to reach a consistent conclusion. Methods. Data were acquired from six electronic databases. Each study was evaluated using the quality assessment tool for cross-sectional studies of the Agency for Healthcare Research and Quality (AHRQ). STATA 15.0 was used to analyse the data, and a random effects model was used. The groups that included two or more studies were added to the moderator analysis. Results. A total of 40 study articles involving 23,451 participants were included. The turnover intention of nurses was inversely associated with work engagement (coefficient: −0.42) and perceived organizational support (coefficient: −0.32). A substantial moderating role was played by cultural background, economic status, working years, and investigation time ( $P<0.05$ ). Conclusion. Work engagement and organizational support significantly reduced turnover intention among nurses. Considering the acute shortage of nurses worldwide, nurses with lower wages, fewer working years, and lower levels of work engagement should be given more attention and support from their organizations. Implications for Nursing Management. The meta-analysis suggested that managers should give their employees a more organizational support and promote their work engagement to motivate nurses’ retention intention and maintain a stable workforce with little employee turnover.

Turnover Intention and Organizational Commitment of Primary Healthcare Nurses

Turnover intention is a predictor of the decision to leave an organization, which, if carried out, affects the quality of care provided. There is an association between turnover intention and organizational commitment. The more committed nurses are to the unit in which they work, the more committed they become to the unit's organizational goals; thus, they tend to continue working for the organization. Aiming to assess the turnover intention and the organizational commitment of nurses in primary healthcare, we conducted a quantitative, observational, descriptive, and cross-sectional study. The Intention of Turnover Scale and the Organizational Commitment Scale were applied in a sample of 297 nurses. Data were analyzed based on descriptive statistics. About 92.8% of the nurses intend to stay at their current workplace and only 7.3% plan to leave soon, suggesting low turnover intention; 84.5% of the nurses are willing to make an effort beyond what is normal to help their organization succeed, and 88.7% feel really interested in the destiny of the organization, which shows high organizational commitment. Pearson's Coefficient revealed the existence of a significant negative correlation between the factors "Intention to leave" and "Committed to the organization" (r = -0.51, p < 0.01). These findings suggest that, when nurses are more committed to their work and to the organization, they display less intention to leave, keeping the teams committed and motivated towards the organizational goals Our findings may guide nurse managers and policy-makers to develop strategies that retain nurses in organizations, keeping them motivated and engaged, and focusing on higher organizational commitment due to the influence it may have on the turnover intention.

The Race to Retain Healthcare Workers: A Systematic Review on Factors that Impact Retention of Nurses and Physicians in Hospitals

The shortage of healthcare workers is a growing problem across the globe. Nurses and physicians, in particular, are vulnerable as a result of the COVID-19 pandemic. Understanding why they might leave is imperative for improving retention. This systematic review explores both the prevalence of nurses and physicians who are intent on leaving their position at hospitals in European countries and the main determinants influencing job retention among nurses and physicians of their respective position in a hospital setting in both European and non-European countries. A comprehensive search was fulfilled within 3 electronic databases on June 3rd 2021. In total 345 articles met the inclusion criteria. The determinants were categorized into 6 themes: personal characteristics, job demands, employment services, working conditions, work relationships, and organizational culture. The main determinants for job retention were job satisfaction, career development and work-life balance. European and non-European countries showed similarities and differences in determinants influencing retention. Identifying these factors supports the development of multifactorial interventions, which can aid the formulation of medical strategies and help to maximize retention.

The role of organizational support and self-efficacy on work engagement among registered nurses in Jordan: A descriptive study

AIM

The aim of the current study was to examine the relationship between work engagement and perceived organisational support and self-efficacy among registered nurses in Jordanian hospitals.

BACKGROUND

Nurses constitute the backbone of the health care system. Work engagement among nurses is critical due to its various positive outcomes: it enhances job satisfaction, job performance, organisation commitment and emotional health. According to the job demand-resource model, perceived organisational support and self-efficacy increase work engagement.

METHOD

A cross-sectional, descriptive and correlational design and multistage cluster sampling were implemented. A total of 186 registered nurses were recruited. Self-administered questionnaires were used to collect data from the participants.

RESULTS

Nurses showed an average level of work engagement. The dedication subscale showed the highest score among the three subscales representing work engagement. The results showed that perceived organisational support and self-efficacy were positively correlated with work engagement (p < .01).

CONCLUSION

Perceived organisational support and self-efficacy correlated positively with work engagement.

IMPLICATIONS FOR NURSING MANAGEMENT

An effort should be made to provide a supportive work environment by offering training programmes, sufficient job resources and positive feedback, which, in turn, improve nurses' work attitudes, self-efficacy, perception of the work environment and intention to stay in a health organisation. This study is a descriptive study and has an IRB number 766-2019.

Satisfaction With the Quality Nursing Work Environment Among Psychiatric Nurses Working in Acute Care General Hospitals

BACKGROUND

The objective of this study was to investigate the impact on patient care quality of a positive, high-quality environment that is tailored to the practice of nursing. This study enabled nurses to show their professional skills and knowledge, which may help enhance job satisfaction. To date, little research has been done to assess the relationship between the nursing work environment and the job satisfaction of psychiatric nurses employed in acute wards of general hospitals.

PURPOSE

This study was designed to explain the relationship between job satisfaction and the perceived indicators of a quality nursing work environment (QNWE) after adjusting for demographic characteristics and work characteristics.

METHODS

A cross-sectional correlational design was employed, and a stratified random sample of 185 psychiatric nurses (99% response rate) working in acute wards in Taiwan was surveyed in 2013. Nurses were asked to complete a self-administered questionnaire that included measures of perceived QNWE and job satisfaction and demographic variables.

RESULTS

A statistically significant, positive relationship was found between perceived indicators of QNWE and job satisfaction (r = .813, p < .001). In the hierarchical multiple linear regression model, for the subdimensions of QNWE, the variables "perceived indicators of professional specialization and teamwork" and "support and caring" showed a significant and positive association with job satisfaction, after adjusting for personal demographic characteristics.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Job satisfaction is related to the perception of nurses regarding their work environment. Therefore, nursing managers should improve workplace satisfaction by supporting and caring for nurses and creating better career development and teamwork opportunities for nurses through job training and planning.

A quest for quality care: Exploration of a model of leadership relationships, work engagement, and patient outcomes

Aim

To explore the effects of resonant leadership, leader exchange relationships and perceived organizational support on work engagement and patient outcomes.

Design

A cross‐sectional survey design.

Methods

Data were collected in June and July 2016 from 252 nurses and clerical staff and institutional patient safety (falls rates) and patient satisfaction (Friends and Family Test) in New Zealand. Data were analysed with structural equation modelling (SEM).

Results

The final model was an excellent fit to the data (χ² (22, N = 252) = 39.048, p = 0.014). Resonant leadership was significantly and positively associated with relationships at work, perception of unit care quality (β = 0.28, p < 0.001), reduced falls rates (β = −0.14, p < 0.05) and better patient satisfaction (β = −0.41, p < 0.001). A direct effect of resonant leadership was demonstrated on patient satisfaction (β = 0.20, p < 0.01). Perceived organization support (β = 0.40, p < 0.001) and leader–member exchange (β = 0.46, p < 0.001) were confirmed antecedents of work engagement. Work engagement was confirmed as an antecedent of nurse perception of unit care quality (β = 0.21, p < 0.001). Where social exchanges exist, work engagement mediates these. Three further mediated paths bypassed work engagement altogether.

Conclusion

Existing literature investigating the drivers and impacts of work engagement predominantly focuses on staff outcomes rather than patient outcomes. The findings identify modifiable factors to improve staff experience, patient safety, and ultimately patient satisfaction. Resonant leadership, a relational style, is a core antecedent of quality care and positively associated with staff experience and patient outcomes.

Impact

This investigation into a real‐world problem for nurse leaders also confirmed that an organizational focus on work engagement is not always required. Resonant leadership improves staff work experience, patient safety, and patient satisfaction. Nurse leaders should measure, foster, and develop resonant leadership in practice.

Caring for the carers in a public health district: A well-being initiative to support healthcare professionals

AIMS AND OBJECTIVES

To assess the impact of the proactive organisational resource allocation in terms of a 6-week well-being initiative to support public healthcare professionals' workplace engagement, well-being and job satisfaction.

BACKGROUND

Burnout of healthcare professionals can be a major cost to the Australian economy and public healthcare sector. According to the social exchange theory, when healthcare professionals perceive that their organisation proactively allocates resources to caring for its employees, then they are more likely to reciprocate and become more engaged in their work roles.

DESIGN

The study used a pre- and postsurvey of healthcare professionals who participated in the well-being initiative.

METHODS

Between February-June 2019, 172 healthcare professionals were surveyed before and after a well-being initiative. The survey included questions on workplace engagement, workplace well-being and job satisfaction. Paired t tests were used to determine whether the difference between before and after averages was significant. The TREND statement was used to ensure the quality reporting of this study.

RESULTS

The well-being initiative had a positive impact on the healthcare professionals involved in the initiative. Nursing staff benefitted the most from the well-being initiative, while the full-time staff members and highly experienced demonstrated an increase in engagement.

CONCLUSION

Well-being initiatives can be a targeted strategy to help alleviate burnout amongst healthcare professionals and build a mutually beneficial relationship between management and employees.

RELEVANCE TO CLINICAL PRACTICE

This study shows how implementing a staff well-being initiative increases workplace engagement, which benefits both the individual and the organisation.

Nurses' intention to stay: The impact of perceived organizational support, job control and job satisfaction

AIM

To propose a theoretical model of intention to stay (ITS) and examine the effects of perceived organizational support, job control and job satisfaction on ITS.

DESIGN

Cross-sectional multicentre survey.

METHODS

The survey was conducted from January 2017-July 2017 and comprised 3,240 clinical nurses from nine tertiary hospitals in eastern, central and western China, with 2,352 effective responses. Structural equation modelling was used to analyse the relationship between ITS and its correlative factors.

RESULTS

The hypothesized model was supported. Job control, perceived organizational support and job satisfaction significantly and directly affected nurses' ITS. Furthermore, job control and perceived organizational support showed indirect effects on ITS, which was mediated by job satisfaction. Perceived organizational support could positively influence job control to have a further impact on job satisfaction and ITS.

CONCLUSION

Based on a large sample of Chinese tertiary hospital nurses, this study proposed and verified a theoretical model of nurses' ITS, revealing that organization characteristics, work characteristics and affective response to work can have an impact on ITS.

IMPACT

This study was the first to examine the relationships among perceived organizational support, job control, job satisfaction and ITS, enriching the theoretical model of ITS. Nurse managers can improve nurses' ITS by enhancing their perceived organizational support, job control and job satisfaction.

Protecting healthcare through organizational support to reduce turnover intention

Purpose

Nursing profession is facing the problem of turnover across the globe. The purpose of this paper is to identify the mechanism through which organizational support helps nurses to reduce their turnover intention (TI).

Design/methodology/approach

Data from 324 nurses were collected using a questionnaire-based survey on the basis of a convenience sampling technique.

Findings

The results generated using structural equation modeling have confirmed the mediating role of organizational commitment and citizenship behavior between perceived organizational support (POS) and TI. In addition, psychological contract (PC) breach was found to weaken the positive association between POS and citizenship behavior.

Originality/value

This study adds to the previous studies by incorporating organizational citizenship behavior as a mediator between POS and TI and PC breach as a moderator between POS and citizenship behavior using social exchange and job-demand-resource theories.

Nurses’ reciprocation of perceived organizational support: the moderating role of psychological contract breach

Purpose

The nursing profession demands emotional and psychological attachment to perform well. Nurses should not only engage in their work thoroughly, but also be willing to perform beyond their normal job descriptions. Therefore, the purpose of this paper is to examine the role of perceived organizational support (POS) in enhancing nurses work engagement (WE) and extra-role behavior (i.e. OCB).

Design/methodology/approach

This study used a questionnaire-based survey to collect data from 389 nurses.

Findings

The study found that the relationships among POS, WE, and citizenship behavior may further be explained through affective commitment (AC); whereas the association between POS and AC is moderated by the psychological contract breach.

Research limitations/implications

The data for this study was collected through self-reported questionnaires at one point of time. The implications for the policy makers are also discussed.

Originality/value

This study integrates job demand resource and social exchange theories in the healthcare sector to explain the nurses’ response to POS.

Australian primary health care nurses most and least satisfying aspects of work

AIMS AND OBJECTIVES

To identify the aspects of working in Australian primary health care that nurses rate as the most and least satisfying.

BACKGROUND

The nursing workforce in Australian primary health care has grown exponentially to meet the growing demand for health care. To maintain and further growth requires the recruitment and retention of nurses to this setting. Understanding the factors that nurses' rate as the most and least satisfying about their job will inform strategies to enhance nurse retention.

DESIGN

A cross-sectional online survey.

METHOD

Nurses employed in primary health care settings across Australia were recruited (n = 1166) to participate in a survey which combined items related to the respondent, their job, type of work, clinical activities, job satisfaction and future intention, with two open-ended items about the most and least satisfying aspects of their work.

RESULTS

Patient interactions, respect, teamwork, collegiality and autonomy were identified as the most satisfying professional aspects of their role. Personal considerations such as family friendly work arrangements and a satisfactory work-life balance were also important, overriding negative components of the role. The least satisfying aspects were poor financial support and remuneration, lack of a career path, physical work environment and time constraints. National restructuring of the primary health care environment was seen as a barrier to role stability and ability to work to a full scope of practice.

CONCLUSIONS

This study has identified a range of positive and negative professional and personal aspects of the primary health care nursing role, which may impact on staff recruitment and retention. Findings from the study should be considered by employers seeking to retain and maximise the skills of their primary health care workforce.

RELEVANCE TO CLINICAL PRACTICE

Understanding the factors that nurses perceive as being the most and least satisfying aspects of the work is can open up dialogue about how to improve the working experience of nurses in primary health care.

The impact of individual and organizational resources on nurse outcomes and intent to quit

AIM

To examine the impact of an individual resource factor (psychological capital) and an organizational resource (management support) on nurses' intentions to quit.

BACKGROUND

Nursing work can be stressful and as a consequence, nurses suffer greater stress and stress-related sickness, including depression, than the general population. Stress can be mitigated in the workplace depending on the availability of resources in the workplace. Resources can come from the organization or the individual themselves.

DESIGN

The study is quantitative using a cross-sectional design.

METHODS

The study analysed data from 242 nurses working in five Australian hospitals in the one regional network during 2013.

FINDINGS

The predictors explained almost half of the variance of nurses' intent to quit. Psychological capital had the dual benefits of reducing nurses' perceptions of psychological distress and simultaneously increasing their job satisfaction.

CONCLUSION

Psychological capital is an example of the personal resources a nurse brings to work. Nurse managers can now understand the impact of a new form of protective resources that influence the levels of strain felt by nurses. If nurses present with low psychological capital, then up-skilling nurses with these personal attributes will positively impact on their health and well-being and, in turn, enhance the care of patients.

The relationships between perceived organizational support, affective commitment, psychological contract breach, organizational citizenship behaviour and work engagement

AIM

This study examines the factors that mediate and moderate the relationships of perceived organizational support with work engagement and organization citizenship behaviour. Specifically, affective commitment is posited to mediate and psychological contract breach to moderate the above relationships.

BACKGROUND

Nurses play a critical role in delivering exemplary health care. For nurses to perform at their best, they need to experience high engagement, which can be achieved by providing them necessary organizational support and proper working environment.

DESIGN

Data were collected via a self-reported survey instrument.

METHODS

A questionnaire was administered to a random sample of 750 nurses in nine large hospitals in India during 2013-2014. Four hundred and seventy-five nurses (63%) responded to the survey. Hierarchical multiple regression was used for statistical analysis of the moderated-mediation model.

RESULTS

Affective commitment was found to mediate the positive relationships between perceived organizational support and work outcomes (work engagement, organizational citizenship behaviour). The perception of unfulfilled expectations (psychological contract breach) was found to moderate the perceived organizational support-work outcome relationships adversely.

CONCLUSION

The results of this study indicate that perceived organizational support exerts its influence on work-related outcomes and highlight the importance of taking organizational context, such as perceptions of psychological contract breach, into consideration when making sense of the influence of perceived organizational support on affective commitment, work engagement and citizenship behaviours of nurses.

Perceived organisational support, organisational commitment and self-competence among nurses: a study in two Italian hospitals

AIM

This study examined the contributions of perceived organisational support (POS) and organisational commitment (i.e. affective, continuance and normative) to self-competence among nurses.

BACKGROUND

In high-POS environments, workers benefit from socio-emotional resources to improve their skills, while positive forms of commitment (e.g. affective commitment) create a fertile context for developing one's competencies.

METHODS

A cross-sectional study was conducted among the nursing staff of two Italian urban hospitals (hospital A, n = 160; hospital B, n = 192). A structured questionnaire was administered individually to the nurses. Data analysis was conducted through multi-group analysis and supplemented by a bootstrapping approach.

RESULTS

The results showed that POS was positively related to self-competence through affective commitment. In contrast, continuance and normative commitment did not mediate this relationship.

CONCLUSIONS

This study shows that supporting employees through caring about their well-being as well as fostering positive forms of organisational commitment increases nurses' self-competence.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers may increase support perceptions and commitment among their staff by rewarding their contributions and caring about their well-being, as well as concentrating on training strategies that improve work-related skills.

Job satisfaction of Malaysian registered nurses: a qualitative study

BACKGROUND

Job satisfaction is an important factor in health care settings. Strong empirical evidence supports a causal relationship between job satisfaction, patient safety and quality of care. However, there have not been any studies exploring the job satisfaction of Malaysian nurses.

AIM

The main purpose of this qualitative descriptive study was to explore the factors related to feelings of job satisfaction as well as job dissatisfaction experienced by registered nurses in Malaysia.

METHOD

A convenient sample of 46 Malaysian nurses recruited from a large hospital (number of beds = 895) participated in the study. A total of seven focus group discussions were conducted with nurses from surgical, medical and critical care wards. A semi-structured interview guide was used to facilitate the interviews, which were audio-recorded, transcribed verbatim and checked. The transcripts were used as data and were analysed using a thematic approach.

FINDING

The study identified three main themes that influenced job satisfaction: (1) nurses' personal values and beliefs; (2) work environment factors and (3) motivation factors. Concerning the nurses' personal values and beliefs, the ability to help people made the nurses felt honoured and happy, which indirectly contributed to job satisfaction. For work environment factors, team cohesion, benefit and reward, working conditions play an important role in the nurses' job satisfaction. Motivation factors, namely, professional development and clinical autonomy contributed to job satisfaction.

CONCLUSION

It is important for nurse leaders to provide more rewards, comfortable work environments and to understand issues that affect nurses' job satisfaction.

RELEVANCE TO CLINICAL PRACTICE

Our findings highlight the importance of factors that can improve nurses' job satisfaction. The study provides basic information for hospital administrators in planning effective and efficient policies to improve nursing job satisfaction in order to increase the quality of patient care and decrease nursing turnover.